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Home My WebLink About18-084� r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 5 2240-1 826 (319) 356-5040 (319) 356-5497 FAX Last 1. Name (REQUIRED) IDENTIFICATION NO. JS-Df6)q (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday – Friday) Failure to complete the "required" information will result in denial of the application 2. Address (REQUIRED) i 30 3. Contact Information (REQUIRED) 4a. Drivel's License expiration date (REQUI b. Taxicab Business Name (REQUIRED) _ 5. Prior experience in transportation of pas First Middle rV Cell Phone: 3 cg - '-(31- y409 (All written � ��lOI.+J � aS Q•� �l-owi� RT 'L4 r_PS 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where I— W hen Q W r� ^ �n C � 1 Y n � cNa r ire m a M What happened to the charge? (Circle one) o 7r, co Convicted Dismissed Deferred Suspended Plead Guilty Othej_n 7. Have you been arrested / charged with any traffic offenses in the last five years? z S' Tyne of offense Where When �1 Z 2a1� Zv GG Zot$ W at h`appentg to tV' chVrg�. (6rcfane T`) j� vl'E ed ismissed Deferred Suspended Plead Guilty Other 8. Has your drivel's license or chauffeur's license been suspended or revoked in the last five years? N d Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using different name? If yes, please provide the name(s) A) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I hereby certify that I have issued to me by the Iowagepaar/�,o�ent of Transportati n a slid Drivers license number K( ti YW a issued on g/A expiring on 2 Za 1 understand that if I fbIsely swer any questions in this application, that this i prlica on may be denied. 1 gre 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 authorization to be a taxicab driver is granted, to comply at all times with all of the provis' s of 'tle 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date Z� N O t9 O a ...__.........-. --- ------- -- ---- ------------------._ --------------._..... STATE OF IOWA ) w ' COUNTY OF JOHNSON r a t n Subscribed and sworn to before me b . a l J . L\ y A.�44 L.. �]Itis c»Z.Z day of A,&e"c3t ZaL% . t. cn I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Dir s,,I4ense a- Z 1 " ZOz 3 CrIVA or 3-/e, Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Office Use Only Approved application DCI report State certified driving record Website update Date Gary✓rvaMNUADG APPUe 18a�aa.DOC 04/2018 ARTS Page 1 of 2 C210WADOT w,,,,,A, iowado>~ ov SMARTER 1 SIMPLER 1 CUSTOMER DRIVEN g Inquiry 8/21/2018 Date: Customer 4685633 Name: Willis, Andrea Lolita Address: 1307 BURNS AVE City/State: IOWA CITY, IA 522405868 Mailing 1307 BURNS AVE Address: Mailing IOWA CITY, IA City/State: 522405868 Date of 8/29/1980 Birth: :01/04/2015 Sex: F Convictions 01,1141r & WsntIDa~ "Men PO Box 5284 I Des Moines, IA 50W"2154 Phone: 515.244-9124 1 Fax. 515239.1897 Certified Abstract of Driving Record DL/ID #: 181AD9000 (IA) CDL Permit Class: None Class: B Audit #: 3118511 Issue Date: 08/21/2018 Expiration 08/29/2023 Date: Endorsements: Passenger, School Bus Restrictions: Restriction Supplement: CDL Permit Issue None Date: CDL Permit None Expiration Date: Explanation CDL Permit None Endorsements: :01/04/2015 CDL Permit None Restrictions: 'Johnson ID Status: None CDL Intrastate Only, No DL Status: VA o Class A Passenger Vehicle 00 None CDL Status: C-VALc- History Information CDL Permit 7—LLG ems" Status: --GG 1 CDL Cert Statusi— Qcepted Intr t t arc 3 CDL Med Status:'e co J+ W Citation Date Conviction Date ACD Explanation JUR County 11/24/2014 :01/04/2015 S93 'Speed 3A 'Johnson 02/06/2015 06/04/2015 �M14 Fall to Obey Traffic Sign/Signal IA Johnson 10/02/2017 12/15/2017 �S92 Speed IA Johnson 12/01/2017 '.01/16/2018 'IS92 'Speed IA Johnson 03/07/2018 1104/25/2018 ;S92 !Speed (10 mph & under in 35-55 mph zone) IA ,Linn Name: Willis, Andrea Lolita DL/ID: 181AD9000 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & Identification 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: MENi O! )AI ? O. http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 8/21/2018 ARTS 8/21/2018 d9 - s0 Driver & Identification Services Iowa Department of Transportation Name: Willis, Andrea Lolita DL/ID: 181AD9000 (IA) O '5n D —1 C7 RC1 :<r— m o� v t' � C G'1 N W Page 2 of 2 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 8/21/2018 Aug.20. 2018 1:48PM Div of Criminal Investigation 68/14/2018 1239 Yellow Cab am No. 9865 P. 5/8 (TA)Q319M82708 P.0021002 c i STATE OF IOWA Cf�minal History Record Check Request Form To: Iowa Division or Criminal Investigation Support Operations Baregu, la' Floor 215 E. P Street Des Moises, Iowa 50319 (515)725-6666 (515) 725-6080 Fax ate DCl Account Number: 9967-F �(Vepplleeble) Pram; Yellow Cab of Iowa City P.O. Box 428 ' YoWa City, IA. 52244 (319) 338-9777 Phone; Pax: (319) 339-7302 Ld 4�c• YD ❑Male emale Waiver Information. Without a signed waiver from the subject of the regttest, a compl¢te grb hull hiory record rpsy not be releasable, obtain a waiver si natu oer Coe f ham thahouhl 692.2. For _� ate criminal history record info rtngtlQjli all?7ed b)M, always Waiver C1eaS8; (ntnby give permission tbtth4bovc requesting Meld to oonduet on Iowa tAdLiAal history record ��,^,��L�� the Vivbl minsl Invt9ti6Rtion (DC?), Ally alminal historyft ta dan Idg me that is rpeinninod DV the DCI may be rohesed ►stiallewod by law: � f, -t Waiver Signature; ® .&; cn As of - Zo - 19 a search of the provided name and date of birch ❑ No Iowa Criminal Histo}tty Record found with DCI Iowa Criminal History Record at ched,•DCI #3b DC1 ttiitials DCI.77 (08/25/10) 0 (pCI nfe only) i/1 o X z s Aug. 20, 2018 1:49PM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCI 01013136 NON CONVICTION PAGE 1 OF 2 DATE PRINTED - DCI :01013136 2018/08/20 NAME: WILLIS,ANDREA LOLITA DOS SEX RAC HGT WGT EYE HAIR SYN POB 19800829 F B 502 160 BRO BLK LBS. IL ADDITIONAL IDENTIFIERS TAT CHEST TAT R ARM TAT R THGH PHOTO AVAILABLE: Y CCH RECORD *•• 01 ARRESTED/TAXEN INTO CUSTODY 20141003 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA715A.8(3)-A IDENTITY THEFT TRK#; 1A00JXL01 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO -01 IA STATUTE: IA715A.8(3) IDENTITY THEFT UNDER $1,000 -- Forgery COURT CASE ID: 06521 FECRIO6625 CHARGE CLASS: NON CONVICTION TRK#! IA00JXL01 RESTITUTION SENTENCE DEFERRED JUDGEMENT VICTIM RESTITUTION PAID PROBATION lY DISCHARGED FROM DEFERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 20150810 AGENCY: IA0570000 LINN CO 80 CHARGE NO- 01 IA STATUTE IA715A.5 TAMPERING WITH RECORDS - 1987 TRK#; 5A00R3N01 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA715A.5 TAMPERING WITH RECORDS COURT CASE ID: 06571 AGCR113832 CHARGE CLASS: NON CONVICTION TRK#: 5A00R3N0l SENTENCE DEFERRED JUDGEMENT lY PROBATION lY DISCHARGED FROM DEFERRED JUDGEMENT No. 9865 P. 6/8 DISP EFF DAT N 20151005 20151005 CD 20160817 wCOr a i> Ln C-3 DISP EFF AAT 20160225 20160225 20170221 Aug.20. 2018 1:49PM Div of Criminal Investigation No.9865 P. 7/8 DCT 01013136 PAGE 2 OF 2 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION I3 A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INPORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION O n �n -<r- 01 o7O v N CJ m cn r n 1 M 0 Aug -20. 2018 1:49PM Div of Criminal Investigation No -9865 P. 8/8 DISCLAIMER This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential juvenile court records, if any, cannot be included in this response. A signed release authorization Is not sufficient to obtain this information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www.lowasexoffender.com/. However, even though some information Is available on this site, the actual records forjuveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential Juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). N O L7 CO C � [7 c� m rn