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Home My WebLink About19-0701 � 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 IDENTIFICATION NO. III -0-70 (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 First Middle (319) 3S6-5497 FAX -� 1. Name (REQUIRED) � V 2. Address (REQUIRED) /-/y %4�1 5 ,4 3. Contact Information (REQUIRED) Email Cell Phone: 3 12 - 3 5 z O 3 � (AII written communication sent via email) 4a. Driver's License expiration date (REQUIRED) -�?--1S 2-0 Z3 b. Taxicab Business Name (REQUIRED) CeA i 5. Prior experience in transportation of passengers: ,yq C�o �Y e -a --e -S 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When ktx,)LI stir 1 c_4, /9 8;3 -k4 woi � l 9 a s i^ �T t ti✓ � A ?a el 9 E5 0 What happened to the charge? (Circle one) _ M -V Convicted Dismissed Deferred Suspended lead G "er 7. Have you been arrested/ charged with any traffic offenses in the last five years? 9 Type of offense Where When c.✓ oche -y �Z a i Cs . ., a <- —.i ,/10 2 0 / 7 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended �PleadGuilty� Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 14 /l s-, 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) AND NOTARY) 04/2018 171 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 that I have issued to me by the Iowa Department of Transportation a valid Driver's license number f, V3 n !k 7-z� -1 3 issued on 0 -7 -1 4-/7 expiring on O 8--/s -Z 3 1 understand that if I falsely answer any questions in this application, that this application may 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 furtheragree that, H authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title 5, Chapter 2, of ei Code. (Needs to be signed in front of a Notary Public) Signature of Applicant r r' Date a 20/9 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this 2 ?i R CS day of ASHLEY A JAYTATZ o Commission No. 785030 N tary Public in arfd fbr1tW Stat /^ �ovr► July 14, 20211 i-- _i -u .,._� C—, C N I have reviewed this application, DCI report, and the State certified driving record of this appil and have determined that there is no information which would indicate that the issuance would be detrimental to the sa eeM or wblfdre of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). r 0 license OG-frZz)z3 Chief or designee 9-z37q 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. of City Clerk of designee Approved application DCI report State certified driving record Website update Clerk/TA IDRNBADGE WL9201eemended DOC Office Use Only Date 0412018 • - 'Se�,�,20. 2019 4:,24PM� DCI IOWA fA)03193381No. 0426 P., 1/2,1002 STATE OF IOWA Toa Iowa Division ofCriminal lnveedgatwu Support Operations Bureau, 10 Flour 215 F. 7re Street nor Momma, Iowa 50319 (516) 725.6066 (515) 7256080 Fax Request Form DCI Account Number:—9967-F (if awfleable) From Yellow Cab of Lora City P.O. Box 428 Iowa City, IA. 52244 (319) 338-9777 pbonm Fav (319) 339-7301 jgw-a 1 -,MMA -1 &wTox9 Keegl'Q S jk0CK.'di@ffi111131 (DCI wr mty) tl r] h '� \ As of `l 011 a search of the provided aa= and date o�bikyh ttlVe9lt }?�; No Iowa Criminal History Record fotuid with ACI; '•, oJ�fN � :• �,s ATE OF IOWA/DPS SEP 12 2019 0 Iowa Criminal history Record extaehed, DCI # rl' �� ii se�ttnrt . "` rrurnnenmitt"0��` b V OF CRIMINAL INVES DCr initials DCI -77 (08/2S110) Received Time Sep, 12. 2019 10:2BAM No. 8881 a.. vuvvn v . Last Name l Fik*tXH=Q_ dmrh MiddleNarhe moogg Dau trPBlrth node Gender mu deerA SoelalSe Numb &===mdtQ 1 — I 'q S 2 ale ❑Bemaie S� �— `7 4- 1 6 1Watvsr 100rMatt0n: Without a dp6d waiver from the object of the request, a 66p4plete orlmmal history record may tot be releasabit, per Code of lows, Chapter 6911. Pier S'AmpiOtp criminal history record lutormatlon, ae allowed bylaw, always obtain a waiver si ature floie the sUbjact or the request. jWafivo•ReleGwe;lhaeby Ztvc peradssion for tho abovextuetme offici�lW wimlualhtemryn Cho* the Dlvialoa ofCrlmlael SnvertlradOa M(71. Myarlminalhlaory den 0000ar4ln�moihntnel - Da ruy be of suowed by kw. fI'nlver Signafurg jgw-a 1 -,MMA -1 &wTox9 Keegl'Q S jk0CK.'di@ffi111131 (DCI wr mty) tl r] h '� \ As of `l 011 a search of the provided aa= and date o�bikyh ttlVe9lt }?�; No Iowa Criminal History Record fotuid with ACI; '•, oJ�fN � :• �,s ATE OF IOWA/DPS SEP 12 2019 0 Iowa Criminal history Record extaehed, DCI # rl' �� ii se�ttnrt . "` rrurnnenmitt"0��` b V OF CRIMINAL INVES DCr initials DCI -77 (08/2S110) Received Time Sep, 12. 2019 10:2BAM No. 8881 — Seo. 20. 2019 4:25PM DCI IOWA No. 0426 P. 2/2 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 eonfi entiai juven le -reed rreppficatiommust beftfedyrursaant to tows Cede section 232.147(18). Additionally, criminal history data concerning convictions for cortain juvenfle sex offenses can be found on the Iowa Sex Offender Registry: http://Www.iowasexoffender.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). c C� =i n -C -<r- rn o� ZrI O 410WADOT SMARTER I SIMPLER 1 CUSTOMER DR IYEN www.iowadot.gov Drwir & IdwnElestion Sa4vkss PO Box 92041 Des Moines. IA 60305.9204 Phctle 51`r2-1-3-9124 1 Fax 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 9/16/2019 DL/ID #: Name: Rivas Valle, Jorge Class: Aldo Address: 4494 TAFT AVE SE Audit #: LOT 19C Mailing City/State: Convictions Date of Birth: IOWA CITY, IA Sex: 522408166 638AH7593 (IA) D 1978892 07/19/2017 08/15/2023 Chauffeur3l Corrective Lenses 08/15/1952 M History Information Customer #: Issue Date: City/State: IOWA CITY, IA Expiration Date: 522408166 JUR DL Status: Endorsements: Mailing Address: 4494 TAFT AVE SE Restrictions: LOT 19C IA Mailing City/State: Convictions Date of Birth: IOWA CITY, IA Sex: 522408166 638AH7593 (IA) D 1978892 07/19/2017 08/15/2023 Chauffeur3l Corrective Lenses 08/15/1952 M History Information Customer #: 6027518 ACD ID Status: None JUR DL Status: VAL M14 CDL Status: None IA CDL Cert Status: None CDL Med Status: None Restriction N Nonce Supplement: O �n N c-) ro r- -1 C -W 'fir v M m = �� r.'.3D -r- C=) 0 Citation Date Conviction Date ACD Ex lanation lCountv JUR 06/10/2017 08/29/2017 M14 Fail to Obey Traffic SI n SI nal Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 105 /03/2017 983067 IIA Name: Rivas Valle, Jorge Aldo DL/ID: 638AH7593 Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of 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: Rivas Valle, Jorge Aldo DL/ID: 638AH7593 9/16/2019 A21-24 Driver & Identification Services Iowa Department of Transporation N O 0 �.O Dy M '—In W r- rn D � 0