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HomeMy WebLinkAbout20-003I r CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 IDENTIFICATION NO. Zo' 00 3 (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 13191 356-5497 FAX _/ Cilyolo1..�.7 IVB o Q _ -1ei LA _ 11 1. Name(REQUIRED) ,r / / :J Ot',n $01�W�7M�/ M��. r �� t!Q\M \rl n< M1 Ll��d(' I5✓� E 2. Address (REQUIRED) a l' See t O+ > 9�. W $ox l /3SSAJ1.1' Ir(if..'( '(0 1/Fl.td] TO I.rF1,G1 iFn,aUS ',A "Sur-� 3. Contact Information(REQUIRED)Email: merene�5 mc'bW,ar,1,b.net Cell Phone: )31-;LjQ-g5bb (All written communication sent via email) ow - I d(fwtye IOWA C,1/ 4a. Drivers License expiration date (REQUIRED) 112/64/20,Z3 Zoos ow - 2 °R 0%sq' 16VA 64 b. Taxicab Business Name (REQUIRED) i/g g -ow CAB of kowA C,T y 5. Prior experience in transportation of passengers: 1r�) 14p s \,v 1`4 F L_Ats ri XPA4e6 W,111 yr-L.Ww Gkt3. No Ar'I— FAt1 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or "kAyher i --rte Type of offense pA1'1VK%d5 Where LA _ 11 p INT, M�nk�btl 4 WeAC'OrJ ,r / / :J Ot',n $01�W�7M�/ M��. r �� t!Q\M \rl n< M1 Ll��d(' I5✓� E Id air 6k, �A�9 0tl �m /3SSAJ1.1' Ir(if..'( '(0 1/Fl.td] TO I.rF1,G1 iFn,aUS ',A "Sur-� � � F rV ow - I d(fwtye IOWA C,1/ sK.11 Zoos ow - 2 °R 0%sq' 16VA 64 JvLI °". 2cepq What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended lead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type oft offense Where When _ST�� 'a L?nrte,Lv,LLE MfY 6r 2o19 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended lead Guilty Other 8. Has your drivers license or chauffeurs license been suspended or revoked in the last five years? No 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) No (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) aveg 7 -v,C 04/2018 -zlq Not ""901 Rv 3„tr51W lbN Wl?lJ vMV/1W 0y ICA INgw o°Y NA p -a 9 r 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 y2gYvG23© issued on cl dots? expiring onZOZ3 I understand that if I falsely answer any questions in this application, that this appli tion may be denied. I aigre6that in making this application, 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 Applicantr�AIA d Bat /^"^ i �,>.��or���� — �a�•a° Joao 33343444!!!!1#i4#******4**4444111!!!!44#**lifi*RRt3R1f44##:F4#***##iiiiiflt4#liik###*#**#4#4111##i4i#i*i##**4#f**f####i444#*#{;; !3!!4111#4ii#ii** STATE OF IOWA COUNTY OF JOHNSON Subscribed and swom to before me by oko--fhnoon this �day of Jo v 2620 ASHLEY A JAY-PLATZ o o CommssonNo.785030 Notary Public' a theS a Iowa 10VO July 14, 2020 v n t I have reviewed this application, DCI report, and the State certified driving record of this applicant a e d*rminea hat there is no information which would indicate that the issuance would be detrimental to the safety, he ware oi- dents of the City of Iowa City (Title 5, Chapter 2, City Cade). t r N Expiration date of nse /Z " C''/- r� Signature of Police Chief or designee 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. or Office Use Only I - Approved application DCI report State certified driving record Website update q- afi� Date am AXIDRIVBADGEAPPL92018 .de .Doc 04/2018 STATE OF IOWA Criminal History Record Check Request Form ACI Account Number: 9967•F (itaP2liublc) Mall or Fac completed forms to: Send results to: Support Operatlons bureau, is 215 E. 714 Street Des Moines, Iowa 50319 (515)725-6066 (515)'125-6050 Yax 0 12-0q. jjgsj Address P.O. Box 428 Iowa City, Iowa 52244 Phone (319)338-9777 pax 319-3594142 — s - U 1�) G C t% e r �irallYhkIAE1'.,: As of i 3 'x 210t° a search of the provided ti'date of birth revealed: v C) m m X n LJ. O NO Iowa Criminal History Record found Wt}h OW:;r s T i i.,tia J z y o Iowa Criminal History Record attachod, DCId Z m �7 ' DCl initials (���� rrrrgrrgrumuc :nog' DCI -77 (updated 06-2,6-2018) c Received Time Dec, 26, 2019 3:58PM No. 3338 Page I of 2 IOWA CRIMINAL HISTORY FELONY CONVICTION DCI 00776527 PAGE 1 OF 4 DATE PRINTED - 2020/01/03 DCI:00776527 NAME: CONNOLLY,ROBERT RAYMOND CONNOLLY,ROBERT RAYMOND JR DDP SEX RAC HOT WGT EYE HAIR SKN POS 19591204 M W 509 172 BLU SRO NJ ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y TAT CHEST TAT UL ARM TAT UR ARM CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20060518 AGENCY: IADS20000 JOHNSON CO SO CHARGE NO- 01 IA STATUTE IA708-6 INTIMIDATION W/DANGEROUS WEAPON TRW 101868501 COURT DISPOSITION AGENCY: IA052D15J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.6-2 INTIMIDATION WITH A DANGEROUS WEAPON COURT CASE ID: 06521 PECR076D27 CHARGE CLASS: FELONY CONVICTION TRK#: 101868501 SENTENCE DISP EFF DAT DEFERRED JUDGEMENT $750 CIVIL PENALTY 20070914 PROBATION 2Y 20070914 SUPERVISED PROBATION TO DCS FINE $750 20090213 SUSPENDED PRISON 5Y 20090213 PRISON 5Y 20090213 PROBATION UPON 3Y 20090213 REVOCATION OF DEFERRED JUDGMENT REVOKED 20090213 IMPOSED 5Y 20110628 02 ARRESTED/TAKEN INTO CUSTODY 20080911 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VER WH INT (OWI) / 1ST OFF TRK#: 1AO053NO1 COURT DISP09ITION AGENCY: IA05201SJ JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / IST OFF COURT CASE ID: 06521 OWCROO4680 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#+ IAD053NOI DCI 00776527 FACE 2 OF 4 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION ' RESTITUTION SENTENCE DISP EFF DAT SUSPENDED JAIL 173D 20090205 JAIL 180D 20090205 FINE $1250 20090205 PROBATION 2Y 20090205 IMPOSED 173D 20091201 REVOKED 20091201 O c ^� c 03 ARRESTED/TAKEN INTO CUSTODY 20090909 D n 2 AGENCY: IA0520200 IOWA CITY PDC-)� CHARGE NO- 01 IA STATUTE IA716.3 r CRIMINAL MISCHIEF IST DEGREE - 1978 T<f M b, rn TRK#: IA0070MOl � CHARGE NO- 02 IA STATUTE IA708.4(2) y WILLFUL INJURY - CAUSING BODILY INJURY ZT, no TRK#: lAO07CM02 CHARGE NO- 04 IA STATUTE IA321J.2(B) OPER VEH WH XNT (OWI) / 2ND OFF TRK#: 1A007OM04 COURT DISPOSITION AGENCY: IA05201SJ JOHNSON CO D15T COURT COUNT NO- 01 IA STATUTE; IA716,4 CRIMINAL MISCHIEF 2ND DEGREE - 1978 COURT CASE ID: 06521 PECROG8338 CHARGE CLASS: FELONY CONVICTION TRK#; lAO070MOI RESTITUTION SENTENCE DISP EFF DAT FINE $750 20110628 SUSPENDED FINE $750 20110628 PRISON SY 20110628 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA708.2(1) ASSAULT INTENT TO INFLICT SERIOUS INJURY -1978 COURT CASE ID: 06521 PECRO88338 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#' 1A0070M02 RESTITUTION SENTENCE DISP EFF DAT FINE $625 20110628 SUSPENDED FINE $625 20110628 PRISON 2Y 20110628 COURT DISPO91TION 1 _ _- __.__.. AGENCY; IA052015J COUNT NO- 04 JOFDJSON CO DIST COURT IA STATUTE: TA323J.2(0) DCI 00776527 PAGE 3 OF 4 OPER VER WR INT (OWT) / 2ND OFF COURT CASE ID; 06521 FECRO88330 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA007OX04 LICENSE REVOKED RESTITUTION SENTENCE DISP EFF DAT JAIL 6M 20110628 FINE $1875 20110628 04 RECEIVED 201.10620 � AGENCY: IA052015M OAKDALE IMCC c CHARGE NO- 01 IA STATUTE IA690.4 CUSTODY IOWA DEPT OF CORRECTIONS D TRK#: CB0OC4G01 INMATE #: 6793503 C-) CUSTODY AGENCY: IA0770150 ADULT PAROLE SVC r 'gym A 20120425 a m PAROLED tD CUSTODY AGENCY: IA077015G ADULT PAROLE SVC 3> B 20130407 IV DISCHARGED 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 DCI. 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.iowasexoffender.00 / . 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 POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. 001 %1110 bye01 )4 I310 X1110 Zh:6 yn 6-Nnf010, C3-1�. E C,J10WADOT wwwiowadot. ov SMARTER I SIMPLER I CUSIOMER HNI:R 9 Draw a kwatoc uon servrtes PO Bow 0.101 Dos Mtcnw-s a %MG 92N v me 5IS7" ' 17S 1 Fax 51S7J9 IA37 Certified Abstract of Driving Record Inquiry Date: 1/8/2020 DL/ID 4: 429VV6230 IIA) Name: Connolly, Robert Class: D o Rinsn"ld IR Restriction WC -Von%, Supplement: D'-- ]D. IA Address: 21 Second St Apt 2 Audit #: 3349226 �m ' IA Issue Date: 11/01/2018 City/State: Hills, IA 52235 Expiration Date: 12/04/2023 t' Endorsements: Chauffeur 3 Mailing Address: PO BOX 7 Restrictions: Corrective Lenses Date of Birth: 12114/1959 Mailing City/State: HILLS IA 52230007 Sex: M History Information Convictions Customer #: 2681075 ID Status: None DL Status: VAL Conviction Date CDL Status: None Explanation CDL Cert Status: NoneN ]UR CDL Med Status NoneN 02/05/2009 o Operating While Intoxicated Restriction WC -Von%, Supplement: D'-- ]D. IA Ci -< �.. -ice k r �m ' IA a m C) 0 _ � Speed Johnson IA t' N Citation Date Conviction Date ACD Explanation County ]UR 09/11/2008 02/05/2009 A20 Operating While Intoxicated Johnson IA 09/09/2009 06/28/2011 A20 Operating While Intoxicated Johnson IA 05/08/2018 06/11/2018 592 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Operating While Intoxicated Test Refusal/Test Failure Violations Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 09/22/2008 03/20/2009 A98 DWI Test Failure IA IA Disqualifled 10/11/2008 10/10/2009 A98 DWI Test Failure IA IA Revoked 12/09/2009 12/03/2010 A98 DWI Test Failure IA IA Name: Connolly, Robert Raymond JR DL/ID: 429W6230 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: Connolly, Robert Raymond JR DL/ID: 429W6230 1/8/2020 Driver & Identification Services Iowa Department of Transporation G _r7 3. CJ DD --Z t k4 Z— N