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Home My WebLink About20-032ao-�� l IDENTIFICATION NO. 2 '� (Office Use Only) fir""Ill ��ri APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) CITY OF IOWA CITY 410 East Washington Street Failure to complete the "required" inform wlllresultln dental ofthe application 10tra City. lots 52240-1826 (319) 356-5040 Last (319) 356-5497 rA:( /First Middle 1. Name (REQUIRED) G— 0k1z--'N VG "Z- 'f'C"kt zt 2. Address (REQUIRED) t `off `'Zt Srt Q..)J r< P 1 —C -C h'q.} V*k l.\ O 3. Contact information (REQUIRED) Email: I jiCFr� Cali Phone: '775 H5 ! 3 9 q (Al wntteM communication sent via email) 4a. Driver's License expiration date (REQUIRED) '�(3' L z— z c) z. Ca b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When c� !.5 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other__" 7. Have you been arrested f charged with any traffic offenses in the last five years? 7T .i What happened to the charge? (Circle one) W When 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? ILQ® Type of offense Where W= g. Have you ever applied to be an Iowa City. taaxi driver using a different name? If yes. please provide the name(s) 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 Drivers license number I o A f t lSt 'T, issued on 7-Z3- Z xpidng on 8 Z2- ZOZ- i understand that if I falsely answer any questions in this application, that this application may be denied, I agree that In making this apprication, 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�U Date %- Z.''5' Z'02. 0 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this day of Notary Public in and for the State of Iowa C7 re.nm.+�.+w+«newt,.«n�.aw..M,.wHe+w»aw.x4.F4.4,uwwe.».arra.wrnr�.+,Mu+.w...Aq.....wµaA+waa.,,q.,M,.wwn.se+n.w..o..wa+wuMimn.ranrx. c� I have reviewed this application, DCI report, and the State certified driving record of this applicant and hive determined that there is no information which would indicate that the Issuance would be detrimental to the safety, hegith br wlal�are of reel dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license 7,^// - ?W S' ure 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. Office Use Only Approved application DCI report State certified driving record Website update Date Cbr2rraXiDrnvsnocsAPPLe2018mended.DOC D4/2018 �4IOWA DOT www.iowadot.gov SMARTER I SIMPLER I CUSTOMER DRIVEN g� Drw« a Identneanon SmIc" PO Box 92041 Des Moron . IA 50306-9204 phone 5151.41-91241 Fax 515299-1837 Certified Abstract of Driving Record Inquiry Date: 7/17/2020 DL/ID #: 430AF1193(IA) Customer #: 5593781 Name: Gonzalez Cox, Class: C ID Status: EXP Alfredo Address: 1402 21ST AVENUE Audit #: 4261199 DL Status: VAL PL Issue Date: 10/18/2019 CDL Status: None City/State: CORALVILLE, IA Expiration Date: 06/24/2020 CDL Cert Status: None 522411444 Endorsements: NONE CDL Med Status: None Mailing Address: PO BOX 3389 Restrictions: NONE Restriction None Supplement: Date of Birth: 06/24/1961 Mailing IOWA CITY, IA Sex: M City/State: 522443389 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 10512312016 922294 IA Name: Gonzalez Cox, Alfredo DL/ID: 410AF1193 Pursuant to Iowa Code 4321.10, 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: Gonzalez Cox, Alfredo DL/ID: 410AFI193 7/17/2020 Aim Driver & Identification Services Iowa Department of Transporation O O r c N v 0714uL 20: 2020.12:07Ph}Cob DCI IOWA � yg� No 7558 P. 1/2��opp STATE OF IOWA Criminal'Eiistory Record Check Request Form z, M&A or FM comnated forms tn; Iowa Divi*ian of Criminal Investigation Support Operatiom Bureau, V Floor 215 F, 7rb stmt Det Molaoe, low% 50319 (515) 735.6066 (515) 725-6080 Fax DCl Account Number: 9%7-F ' Cdappliwbk) Send rrsultz tw Nam* YdlOICdb of lows cilr Address _ P.O. Hoc 428 Iowa City, laws 522M Phone CM3304777 Fax 320.359-4142 DCI -77 (updated 06.262018) Page 1012 Received Time Jul. 16. 2020 4:43PM No, 7355 Jul. 20, 2020 12:08PM DC[ IOWA No. 7558 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 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: httn:llwww.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).