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Home My WebLink About20-056►r 3 r®rill N L -!S CITY OF IOWA CITY 410 East Washington Street lona City. Iowa 52240-1826 13 19) 356-5040 (319) 356-5497 FAX 1. Name(REQUIRED) 2. Address (REQUIRED) _ IDENTIFICATION NO. Zn — 6 STO (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Pp116e 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: First Middle ,1, n^ yj_ Cell Phone: sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: IV 9tpa-5 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? %-e—S Type of offense TAe.Tf 3 _ P Lk!C!j)gtX Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other= 7. Have you been arrested / charged with any traffic offenses in the ast five years? No Type of offense Where When 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? &O 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) YAUh 1 -UK KhfAUIKtU 04/2018 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 eof Transportation sportatioIt n a valid Drivl understand that If I O� n88 number Issued on—9 — r -- false y answer any questions In this application, that this applicatlon may be dented. 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 i a I documents relating to this application, and I further agree that, If authortzatlon to be a taxicab driver Is granted, to comply a times with all of the provls nee f Title %Ch pier 2 f the City Code. (Needs to be sign of a Notary Public) Signature of Appllcaq - " ; a, Date H}HHHtHtttttMHM4ttMttttM*HRYHHttHtHtttthHt *t M'HitHH}*«H�HitHHHttttkHHttttHtttH}H.tttMtHH* Mttt«*ttHtMH'tHRHtt STATE OF IOWA ) J Q dVQ COUNTY OF JOHNSON ) d Subscribed and sworn to before m y l \ on this day of Note ry Public In and for the State of Iowa _ 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 Driver's license Cr— b ` Signre o Police Chlef or designee Date atu 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. signature of City Clerk 91designee Date }}}}}}}tA#f;fAHtY}MMHf#H#*#M41#**t#M#*#4}#kH*#*1t*M44HM}t**}}M*kF}MtYt}Hk}}}}}}}*}M}k*Ha*k}iM}}k1H}k}kk#kik}M*}Hk}k#kH}M}A Office Use Only Approved application DCI report State certified driving record Webslte update aawrAXJDRNG"EQPuWi80MV 6&Doc 04/2019 1 cry 9 7010.�4-10Ph1� DCI IOWA No. 6374 P.r Iv1=2 STATE OF IOWA m Criminal History Record Check Request Form Nom' Malljr Pax caoonleted forms to: Iowa Di.ielon of Criodasl lave fthel■n Support (lperadow Hnrea% 10 !Icor 215 K 7° Street Des Mailer, faw■ 50319 (515) 725.6061 (515) 725-080 Fax DCI Account Number: 9967-F Send results to: N■sacYd16w0Cab Nlawa C14 Addrexe P.O. Box 428 Iowa City, lows 522" _ PYoaa (319)338-9777 _ Fax 319359.1142 Iowa Criminal History Record Check Results ? As of I- /" I -.)�p , a smrL of the provi&A nxrL "- date of birth rryealed: No Iowa Criminal History Record f6•,u1d µith DCI Iowa Criminal I istory Record attached, L VVVV DC1 initials. -1.k- Da-77 DCI -77 (updated 06.26-2018) Received - me Dtc 3. 1070 4:43PM No. 5560 criminal, lnwa criminal `; ': Ms ory ,r w"-,,, ..... a ( 4n�ngN 4... (DCI use on.')) l cam. 04-2q0 -2q0 :rr't q:Qliltv1111 �';NVI:: pop 1 oft Dec. 9.2020 WIN DCI IOWA No.6379 P. 2/3 IOWA CRIMINAL HISTORY DCI 00726914 FELONY CONVICTION PACE 1 OF 2 DATE PRINTED - 2020/12/D9 DCI:00726914 NAME: VAILLANQOURT,RONALD PAUL VAILLANCOURT,RONALD PAUL JR DOB SEX RAC MGT WGT EYE HAIR SKN POB 19750616 M W 601 220 BRO BRO LBR MA ADDITIONAL IDENTIFIERS PHOTO AVAILABLE- Y TAT L ARM TAT R ARM TAT UL ARM CCH RECORD 6-- 01 ARRESTED/TAKEN INTO CUSTODY 20111120 AGENCY: IA0570100 CEDAR RAPIDS PD CHARGE NO- 01 IA STATUTE IA713.6A(I) BURGLARY 3RD DSORSS TRK#: 5AOOIMXDI CHARGE NO- 02 IA STATUTE IA714.2(3) THEFT 3RD DEGREE - 1978 TR"; SAOOIKX02 COURT DISPOSITION AGENCY: IA057015J LINN CO DIS^_ COURT COUNT NO- 02 IA STATUTE- IA713 6A)1) BURGLARY 3RD DEGREE COURT CASE ID• 06571 FECRIO1314 CHARGE CLASS- FELONY CONVICTION TRK#: SAOOIMX02 SENTENCE DISP BPP DAT SUSPENDED FINE $750 2DI30419 C-)-� SUSPENDED PRISON 5D 20130419 —iC'D CD r PROBATION 2Y 20130419 {m ITT PRISON 5Y 20130419 C;_„% COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 03 IA STATUTE. IA714.2(2) THEFT 2ND DECREE - 1970 COURT CASE ID: 06571 FECRIO2314 CHARGE CLASS: FELONY CONVICTION TRK#: 5ACOIMX03 SENTENCE DISP EFF DAT SUSPENDED PRISON 5Y 20130419 PROBATION 2Y 20130419 PRISON 5Y 20130419 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 DCT. Dec. 9. H20 4:1IPM DCI IOWA No. 6379 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 thin response. A signed release authorisation 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://wsw.iowasa=ffender.com/ . However, even though mom 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(1B). IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION TNIs RECORD IS BASED ON INFORMATION FURNISHED. ME CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION a` . A A inat o�OWB ` resutts; a : histoN a" h3a°�ninatio'` 5� P. 3/3 ti 0 CG i" C4`1 DOT SMARTER I SIMPLER 1 CUSTOMER DRIVEN www•IowadoG gov DOW 61Welrlsatlan 5arAm PO Box 9mM I Das Maines. IA 50:30&WU PtWW 515244-91241 Fax 515-23&1&47 Certified Abstract of Driving Record Inquiry Date: 12/3/2020 DL/ID 7F: 206AD8041 (IA) Customer ft: 5355236 Name: Vaillancourt, Ronald Class: C ID status: EXP Paul JR Address: 2551 Holiday Rd Apt Audit W: 5154425 DL Status: VAL J4 Issue Date: 12/03/2020 CDL Status: None City/State: Coralvllle, IA Expiration Date: 06/16/2028 CDL Cert Status: None 522412791 Endorsements: NONE CDL Med Status: None Mailing Address: 2551 Holiday Rd Apt Restrictions: NONE Restriction None 34 Supplement: Date of Birth: 06/16/1975 Malling Coralvllle, IA sex: M ' - �-'I CD ..b - City/State: 522412791 History Information —I c7 0 r— CLEAR DRIVING RECORD oz W Name: Vaillancourt, Ronald Paul )R DL/ID: 206AD8041 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: Vaillancourt, Ronald Paul JR DL/ID: 206AD8041 12/3/2020 C� Driver & Identification Services Iowa Department of Transporatlon d0,(Y70<- _