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Home My WebLink About19-0684- r Ir CITY F IOWA CITY 410 East Washington Slrcct Iowa City, Iowa 52240-1826 (319)356-5040 (319)356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) _ IDENTIFICATION NO. 1 q " D (0 A (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 Last 3. Contact Information (REQUIRED) Email: M 4a. Drivers License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED), First written communication 2—Cl f 20 ZZ Middle 0-6II Phone: 3� [ 'QW 2&lx email) 5. Prior experience in transportation of passengers: 'i 7)(Ae PLV� �r- 6. oJ� S-er yl GB..) 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Tyne of offense Where When PKI Iowa What happened to the charge? (Circle one) Convicted Dismissed eferre Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses to the last five years? Where When ('/4 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? LL 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) PAGE FOR NO] ARY) 04/2018 P Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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 at I have issued to me by the Iowa epa ment of Transportation a jvalid Driver's license number it I y issued on Z- expiring on W Z I understand that if I falsely answer any questions in this application, that this a lira on may be denied. I gree 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 provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant(/ Date 2q HH##ifHHfrtHHH##!#HHHHHHlHHIi!#H####H#HH#H##H#HH#1t##*###H##HH!!!H#!H!!H#HHlHlHH!##N!llHHH1HllHHHHHH# STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by 4y-, Ps` LO � VG WA k, 5 on this %'I day of ASHLEY A JAY-PLATZ Comm scion No. 78503( July 14, 2020 #tHetlf#1eHHlR/e11*k#tttYiRfH*ieRH##HHHH!/rtR1(4/(4!/e#klH1(H#H##}lRt3leMeHittRRRiff!!#f##H HH/eH I have reviewed this application, DCI report, and the State certified driving record of this applicant ve rlj r that there is no information which would indicate that the issuance would be detrimental to the safety ea resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). AUG 2 91019 Expiration date of Driv W I 1 0e - City Clerk Iowa City, Iowa ' 7 OF- Z 9- Z,0/4 Signa of Police Chief or designee Date -7r- AFTER 7r 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. Approved application DCI report State certified driving record Website update Cier AXIDRIVBADGF PPL92018amended DOC Office Use Only 9- 0q-1 g Date 0412018 J10WA00T www.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN Inquiry 8/29/2019 Date: Customer 4685633 Name: Willis, Andrea Lolita Address: 924 23rd Ave Apt B Dmnr S ldsntifieation torvices PO Box 9203 1 Des Movies. IA 50306-9204 Phone 51'5244-91241 Fax 515-2331837 Certified Abstract of Driving Record DL/ID #: 181AD9000 (IA) CDL Permit Class: A Class: Audit #: Issue Date: Expiration Date: B 3991016 07/12/2019 08/29/2023 City/State: Coralvllle, IA 522413107 Endorsements: Passenger, School Bus Mailing 924 23rd Ave Apt B Restrictions: Commercial Learner Address: Permit, CDL Intrastate Only, No Class A Passenger Vehicle IOWA CRY 1pa Restriction None Mailing Coralville, IA 522413107 Supplement: City/State: County 11/24/2014 Date of 8/29/1980 Speed Birth: IA Johnson Sex: F M14 Fail to Obey Traffic Sign/Signal History Information rnnvir inn. CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: 07/12/2019 07/12/2020 Passenger, School Bus CDL Intrastate Only, No Class A Passenger Vehicle, No Passengers in CMV Bus None VAL CDL Status: VAL CDL Permit LIC Status: CDL Cert Status: Non -Excepted Intrastate CDL Med Str:I E D AUG 2 9 2019 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: City uierK IOWA CRY 1pa Citation Date Conviction Date ACD Explanation yl1R County 11/24/2014 01/04/2015 S93 Speed IA Johnson 02/06/2015 06/04/2015 M14 Fail to Obey Traffic Sign/Signal IA Johnson 10/02/2017 12/15/2017 S92 Speed IA Johnson 12/01/2017 01/16/2018 S92 Speed IA Johnson 03/07/2018 04/25/2018 S92 Speed (10 mph & under in 35-55 mph zone) IA Linn 04/11/2019 05/20/2019 M14 Fail to Obey Traffic Sign/Signal IA Johnson 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: Name: Willis, Andrea Lolita DL/ID: 181AD9000 (IA) 8/29/2019 A 2� A7� Driver & Identification Services Iowa Department of Transportation 081A; Aua.20.2019 1:39PM DCI IOWA IOWA CRIMINAL HISTORY DCI 01013136 NON CONVICTION PAGE 1 OF 2 DATE PRINTED - 2019/08/20 DCI:01013136 NAMS: WILLIS,ANDREA LOLITA DOB SEX RAC HOT WGT EYE HAIR SKN POB 19800829 F B 502 160 BRO BLK LBR IL ADDITIONAL IDENTIFIERS TAT CHEST PHOTO AVAILABLE: Y TAT R THGH CCH RECORD **" 01 ARRESTED/TAKEN INTO CUSTODY 20141003 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- Ol 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 01,000 -- Forgery COURT CASE ID: 06521 FECRIO6625 CHARGE CLASSr NON CONVICTION. TRK#: 1AOOJXL01 RESTITUTION SENTENCE DEFERRED JUDGEMENT VICTIM RESTITUTION PAID PROBATION lY DISCHARGED FROM > DEFERRED JUDGEMENT 02 ARRESTED/TAKEN INTO CUSTODY 20150810 AGENCY: IA0570000 LINN CO SO CHARGE NO- 01 IA STATUTE IA715A.5 TAMPERING WITH RECORDS - 1967 TRK#r 5A00R3N01 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- OS IA STATUTE: IA715A.5 TAMPERING WITH RECORDS . COURT CASE ID: 06571 AGCRI13832 CHARGE CLASS: NON CONVICTION TRK#: 5AOOR3NO1 SENTENCE DEFERRED JUDGEMENT lY PROBATION 1Y DISCHARGED FROM DEFERRED JUDGEMENT DISP EFF DAT 20151005 20151005 20160817 DISP EFF DAT 20160225 20160225 20170221 No. 5511 P. 3 FILE® AUG 2 9 2019 City Clerk Iowa City, Iowa A Aug.20.2019 1:39PM DCI IOWA DCI 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 is a public record but can only be released to non -law enforcement agencies by the ACT. No. 5511 V. 4 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.iowagexoffender.com/ . However, even though some information is available on this site, the actual records for juveniles 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). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVfi IDENTIFICATION THI5 RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRININAt INVESTIGATION F!1 Aus 2 9 City Clerk Iowa City, Iowa