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Home My WebLink About14-022 Authorization Number l —aa I i (Office Use Only) :VIII imenomilazir APPLICATION FOR TAXI DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday–Friday.) Iowa City. Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First Middle L st t—Name Cil mt 2. Mailing Address 1 lO cd\ . row c C.k SQ S IV 0 3. Telephone: Home 311 (3` L a--4\1 Other: 4. Prior experience in transportation of passengers: "'I A 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? No Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 1\10 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When \\I ,r\s-,)c (‘ tars, 1-711–q)01 r'O 1 O ab) 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N o Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) \\Io DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report(form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 03/2013 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number SYi a c_A 5h . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will be denied. I agree that in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in their discretion, to examine any and all records and documents relating to this application, and I further agree that, if a license is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant -" Date 1/ 7'/ STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by �� C , � �,� Gc , 5��s. On this day of I'stotan,Lublic in and for the Sta e of Iowa --7 431 I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City(Title 5, Chapter 2, City Code). /AV/7 S' nature of Police Chief or designee Date YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Si�121 f n— �� /' /fG ure of City C erk or designee f Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1" (width) and 5 1/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update derk/taxidrivbadgeapp2010 doc 03/2013 'Y Jan. 29; 2014 1 : 19PM tDiv of Criminal iInvestiegation. NNoo. .. 8022 P.• e1/2 Fm,,,er 1 L, STATE OM IOWA t�01 `4� re' `•tey Li �'' Crilmiraal 1iistoiry Record Check '�� C;;;;"�'._?, � Request Porm F'\': ;s/ ]JCIAccountNumber: ,,''ryi7`e- (Iteycable) To; Iowa Division of Criminal Investigation From; City of Iowa City Support Operations Bureau,lie Floor City Clerk's Office 215D,7"'Street 410 E.Washington Street Des Moines,Towa 50319 (515)725.6066 Iowa City, JA 52240 . (515)725-6080 Fax Phone: 319-3565041 • Pax: 319-356-5497 Tam requesting an Iowa Criminal Histoiy Record Check on: Last Name(mandetety) klrst Name(monde!ono Middle Name(rc ammelded) GCA\(- 1 9.,oy1 C.rrse r Date of Birth(mandalory) Gender(madder)) Social Security Number(recommended) % i 1 a I 1 SI I; )Male - riFemale 'ilk B.g q 4 yi- _ Waiver%nfortnadon:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter'692,2.For complete criminal history record information,as allowed bylaw,altyays obtain a waiver signature from the subject of the request. Waiver.Release:X hereby give permission for rhe above roquestingomdal to conduct an Iowa crlatlnal histotyrecord chcckwhh the Division of Criminal Investgallon(DCI). My criminal history data meaning mo that fs main al' d by thebalmay be released as ollowed by law. • Waiver Signature: ......_ __,/ /f _ : 1 a 0.1,e,4 Ioy j Criminal.History Record Check Resultspccl" ,,,y) As of 1.-2,61- y—I , a search of the provided name and date of birth revealed; h cn =r "---1-.c., (n i N.) Om -Y-I0 c"' ;e• a No Iowa Criminal History Record found with DCI >.71 a `"-n _ a' iYs N D CI Iowa Criminal HistoryRecord attached,DCI it '' DCI initialsl hceived Time7Jan: 21. ))2014 2: 17PM No. 1230 Iowa Department of Transportation t Office of driver Services (Toll Free)800-532-1121 PO Box 9204,Des Moines,IA 50305-9204 515-244-9124 FAX_515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/24/2014 DL/ID#: 382AE5856 (IA) Customer#: 5197916 Name: Clement Gonzales, Raul Class: D ID Status: None Cesar Address: 1101 PRAIRIE DU CHIEN Audit#: 7727057 DL Status: VAL RD Issue Date: 01/24/2014 CDL Status: None City/State: IOWA CITY, IA Expiration 08/12/2014 CDL Cert None 522455929 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 1101 PRAIRIE DU CHIEN Restrictions: Corrective Lenses Restriction None RD Date of Birth: 8/12/1986 Supplement: Mailing City/State: IOWA CIN, IA Sex: M 522455929 History Information Convictions Citation Date Conviction Date ACD Explanation County OUR 11/18/2010 12/10/2010 S92 Speed (10 mph&under in 35-55 mph zone) Louisa IA 05/30/2012 08/03/2012 515 Speed IL 08/22/2012 10/07/2012 S92 Speed (10 mph&under in 35-55 mph zone) Louisa IA — 03/16/2013 04/23/2013 B64 No Insurance Card Louisa IA 03/16/2013 04/23/2013 Improper Registration Louisa IA Name: Clement Gonzales, Raul Cesar DL/ID: 382AE5856 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of an official record currently In the custody of said office, and that I have been authorized by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: 0,1Reff,,4,$ 4' , 1/24/2014 d•*: :1 t r., ciran c.:D. O. T. :• % ,,IIID' vit ilia s Office of Driver\ Iowa Department erviof es Transportation Name: Clement Gonzales, Raul Cesar DL/ID: 382AE5856