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HomeMy WebLinkAbout21-010►r CITY OF IOWA CITY 410 East Washington Street IOn'a City, IGra 52240-1826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) _ IDENTIFICATION NO. Z t- D 1 C (Office Use Only) MAR 01 2021 APPLICATION -FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (P0116466 ei'Hndil review must be made between 8 a.m. to 3 p.m., Monday - Friday) Failure to complete the "required" information wilt result in denial of tri- appiicadafr Last c2l e.'iv1 y!" First /nCti Middle d7 i C 4 3. Contact Information (REQUIRED) Email: © qm ,. / , Ceppi Cell Phone: (A8 written communication sent via email) 4a. Driver's License expirationdate (REQUIRED)_ b. Taxicab Business Name (REQUIRED) --1 I.! 5. Prior experience in transportation of passengers: /' -L 3 - Z C, Z. 2— Where , u V0 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? I e S Tvoe of offense Where When 0 wT Polk Kotent\, I l- lo - M 3 _inwT Cor lu'lle _n? -e1- 2&00 ��14�o1/e SubSta.t�e boa utnc� Wh)Ie hel/ol<ed Co vif2 t,b Ie fyeteJ XoL c S Cr �i ffnl%C Sa%Sk r� ot,, What happened to the charge? (Circle one) Convicted Dismissed Deferred ct ty �/J - ? � .2 000 IU 112 l -a0 - 1 600 <-, l.:? -.z6 -.2txxO Ct lx -z3_ 2oa) Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses In the last five years? N O Type of offense Wee 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? ; Type of offense Where When g. Have you everopplied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) /V (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER DEPARTMENT OF CRIMINAL INVESTIGATION (Dcq REPORT AND srwrE 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). er's license number I hqreby certify that I have issued to me blssuedIowa onr�/-/ P-ZolL xpiring onof oc�l-Z3 rtation a vat` �'Ldvi understand that if I �51>�3 -2z c—� .3 '7 falsely answer any questions in this application, that this application may be denied. I agree that in making this application. I consent tot allow agents or employees of andthe City of Iowa I further agree that if authorization o. In their f be discretion, to driver Is granted, to records comply at ll documents relating to this app times with all of the provisions Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public � Date Z 1Z 5- 2 Z Signature of Applicant STATE OF IOWA ) COUNTY OF JOHNSON ) on this day of Subscribed and swom to before me by and for 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 di -Z3, z- L- 0 63-0 )'? Signature fPoiiceChiefordeslgnee ate AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE LDE LISTED BELOW. pt ce «,.e r «,creel aa.�oo D to Office Use Only Approved application DCI report State certified driving record Website update CWWrA%IDRNBADDFAPPLgMIS..ended.DOC 04/2018 j�? .0t, ;Z.06b 10 ,aY-a0 10 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). er's license er I h reby certify that I have issued to me b thedlon0/-//aZ !�t xpirng nof o�� L� rtation av ��alid fvl understand thatlf 1 3 '7 falsely answer any questions in this application, that this application may denied. I agree that in making this application, 1 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 f-TiHe , Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) �(icy_/—�� Date 2`z 5 — Zr''L Signature of Applicant � 1ft44R444f*R**M#f!.`44fH1f4!!t!*R414�1f.YR*M4txxt*x}fttl44f4R44#tuft**4*444t44ttkxk4Y/h*f#itt*f**4t44f4t4*#R#*4kxxt!*R4t*fi*txIF44#Rfi*144*4lkR* STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by on this day of i*k#k*k*MtYY**Ht**it***k*#+tM4xxxfxxm'r+^---- te certified there is no Information this pwhich wouDCI ld indicate that the isort, and the suance a wouldbe detrimental driving record tothis thapplicant safety, health or welfare ofresi-that dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license 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. Signature of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date M,WA)aowveaocaAPPrswrea=nded.00c 0412018 07,IFeb_2b,202.1-••9:.20A40b DCI IOWA (FMl9M8;No.5940 R. 1)o2)oo2 STATE OF IOWA Criminal History Record Cbecl� Request Form lI I ' DCI Account Number. 9967-F (If Wilab)a) Mail or Fax cam -plated f mos to: Iowa Division of Criminal Investigation 215 E. " street Des Moioes,Iow& 50319 (515) 728.6066 (515) 725.6080 Fax I am remsting an rows Qiminal MangRecord Check on: Send result§ to: Name Yell Address P.O. Box Phone Fax 6 �; : ,�: • � •-.� `_�.r�K C= "iia:.. '�� � itt'a' :tl"�'�'.�,�w:,�„N�3>, a 1tmd:' .;�-• "fly' i�;�: M'•:a'„•' _to Mt & MF ...§male ©�- 23 -- r q � Z_ Gryea�m9�.neea ❑Male %' Z • f% • �/ 73 ... ...y aTriTstgFSt�Fcvrdmry ' �km`:icarn. 1' Ell Y '.. N�f'h"�`ish�i �i.f<,re'`!ti�'+'•6�e'z`21y•k•v, r+-.+� .-,i,... '�Ka rel - l�.r �'. ;�l. sia_,��•- r.. s :f. $#t'.-�' ..S t va �$L'aa�!%1�a�f0:�2RPnII40Y•mt�fll erlii Sa:- - ,... � N.. �- r M) 'y4 e� i Wt"1w'+G'fy1 f'Y•,�a G ]:4•'uf��i y /L'•�. .. ' k�e'6 d� - '�fti.it;�3$tvliloe aL:• " a b�lYe ie�tsily`r�ecL•'iodlLlte�miiidde . 'cc.ts,.'�F�,•..31y�.rr�,�,.,F•r,x„y�at.t .••. (Dc[ ue only) As of :�2.Z L, jj a search of the provided i; 1ATE OF: 101NA OPS s),� �' No Iowa CrimW4 History Record found >K jt l �r FEB 2 S 2021 V(--40wa'Crim1na1 History Record attached, DCT �f '' , • Q DC7 ' DIV OF CPIMINAI. INVEST �y' nn I)CI Wti41sDz? . DCI -77 (updaW06.46.2018) •• ' 'Page 1 oft Received Time Feb. 25. 2021 1:31PM No. 5825 Feb.26.2021 9:22AM DCI IOWA No. 5940 P. 2 IOWA CRIMINAL HISTORY DL.1 00470566 FELONY CONVICTION PAGE 1 OF 4 TRK#: 047050001 DATE PRINTED - POSSESS CONTROLLED SUBSTANCE MARIJUANA 2021/02/26 DCI:00470566 NAME: COLEVAN,TINA MARK COLEF.AN,TINA MICHELLE DOB SEX RAC HGT WGT EYE RAIR SKN POB 19720123 F W 505 305 BRO BRO FAR IA 19720723 ADDITIONAL IDENTIFIERS CF 1 (.AT P PHOTO AVAILABLE: Y TAT L ARM TAT L RHO TAT R CALF TAT R LEG CCH RECORD **• 01 ARRRBTED/TAKEN INTO CUSTODY 19931110 AGENCY: IA0770300 DES K.OINES PD CHARGE NO- 01 IA STATUTE IA321J-2 OWI IMT OFFENSE TRK#: 009350001 COURT DISPOSITION AGENCY: IA077015J POLK CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(B) OPER VEH WX IAT (OMI) / 2ND OFFENSE CHARGE CLASS: N.ISDWIEANOR CONVICTION TRK#: 009350001 SUBSTASCE ABUSE EVALUATION SENTENCE DISP SPA DAT JAIL 7D 19940203 FINE $406 19940203 SUSPENDED PRISON 2Y 19940203 PROBATION 2Y 19940203 02 ARRESTED/TAKEN INTO CUSTODY 20000702 AGENCY: IA0520100 CORALVILLE PO CHARGE NO- 01 IA STATUTE IA321J-2 ONI 2ND OFFENSE TRK#: 047050001 CHARGE NO- 02 IA STATUTE IA124-401-5 POSSESS CONTROLLED SUBSTANCE MARIJUANA TRK#: 047858602 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(C) OPER VER Wil It1T (OWI) / 3RD OFFCVSE COURT CASE ID: 06521 OVCRO55775 CHARGE CLASS: FELONY CONVICTIO14 TRK#: 047850001 LICENSE REVOKED SENTENCE DISP EFF DAT Feb.26.2021 9:22AM DCI IOA'A DCI 00470566 PAGE 2 OF 4 FINE $2500 20010413 SUSPENDED PRISON SY 20010413 PROBATION 2Y 20010413 PRISON BY 20010413 COURT DISPOSITION AGENCY: IA052015J JDHNS027 CO DIST COURT COUNT NO- 02 IA STATUTE: ZA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 OWCRO55775 CHARGE CLASS: MISDM4F.ANOR CONVICTION TRK#: 047858802 LICENSE REVOKED SENTENCE DISP EFF DAT JAIL 48H 20010413 FINE $250 20010413 03 ARRESTED/TAKEN INTO CUSTODY 20001025 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- Ol IA STATUTE IA124-401 POSSESSION CONTROLLED SUBSTANCE TRKN: 100063901 COURT DISPOSITION AGENCY: IAOS20153 JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE CHARGE CLASS: MISDEMEANOR CONVICTION TRM 100063901 LICENSE REVOKED SENTENCE DISP EFF DAT JAIL 2D 20010118 FINE $250 20010118 04 ARRESTED/TAKEN INTO CUSTODY 20001120 AGENCY: IA0520100 CORALVILLE PD CHARGE NO- 01 IA STATUTE 3A321J-17 DRIVING WHILE REVOKED TRM 100084201 COURT DISPOSITION AGENCY; IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.21 DRIVING WHILE LICENSE DENIED OR REVOKED CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100084201 SENTENCE FINE $1000 05 ARRESTED/TAKEN INTO COSTODY 20001226 No. 5940 P. 31 Feb. 26. 2021 9:22AM DC( IOWA No. 5940 P. 4 AGENCY: TA0520200 CHARGE NO- 01 DRIVE UNDER REVOKE TRK#: 100117001 COURT DISPOSITION AGENCY: IA0520ISJ COUNT NO- 01 IOWA CITY PD IA STATUTE YA32117-21 JOHNSON CO DIST COURT IA STATUTE: IA321J.21 DRIVING WHILE LICENSE DENIED OR REVOKED COURT CASE IDI Obb2l CHARGE CLASS: MISDEMEANOR CONVICTION TRK#. 100117801 SENTENCE FINE $1000 06 ARRESTED/TAKEN INTO CUSTODY 20011223 AGENCY: ZA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA124-401-5 POSSESS CONTROLLED SUBSTANCE SCHEDULE I TRK#: 100431901 COURT DISPOSITION AGEIICY: IA052015J JOHNSON 00 DIST COURT COUNT NO- 01 IA STATUTE: IA124.401(5) POSSESSION OF A CONTROLLED SUBSTANCE COURT CASE ID: 06521 ACCR060849 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100431901 LICENSE REVOKED SUBSTANCE ABUSE EVALUATION SENTENCE SUSPENDED JAIL 171) JAIL 206 FINE $500 PROBATION lY DCI 00470566 PAGE 3 OF 4 MARIJUANA 2ND OFFENSE 07 ARRESTED/TAKEN INTO CUSTODY 20061201 AGENCY: XA0526200 IYKA CITY PD CHARGE NO- 01 IA STATUTE IA123.91(2) PUBLIC INTOXICATION TRK#: IA0000701 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT IIS- 01 IA STATUTE: IA123.46 CONSUMPTION / INTOXICATION - 1978 COURT CASE ID: 06521 AGCR077984 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: IA0000701 _ SENTENCE TINE SERVED 1D JAIL 11) DISP EFF DAT 20020524 20020524 20020524 20020524 DISP EFF DAT 20010221 20070221 Feb.26.2021 9:20AM DCI IOWA ACI 00470566 PAGE 4 OF 4 08 ARRESTED/TAKEN INTO CUSTODY 20101028 AGENCY: IA0520200 IOWA CITY PD CHARGE Ido- 02 IA STATUTE IA321J.2(B) OPER VER WH INT (OWI) / 2ND OFFENSE TRK$: IA00AP702 COURT DISPOSITION AGENCY: IA0520153 JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA321J.2(13) No. 5940 P. 5 OPER VF.H NH TNT (ONI) 12ND OFF COURT CASE ID: 06521 OWCRO92370 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#; IAOOAT1702 DRUNK DRIVING SCHOOL SUESTANCE ABUSE EVALUATION SENTENCE DISP EFF DAT SUSPENDED JAIL 53D 20110112 JAIL 60D 20110112 FINE $1075 20110112 PROBATION 2Y 20110112 SUPERVISED PROBATION 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 thin redponse. A signed release authorization is not sufficient to obtain this information fro;o 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(16). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www.iovmsexoffender.com/ . However, even though some information is available on this cite, the actual recorda for juveniles may still be Confidential and any confidential juvenile records cannot be provided with this record. in order to request the --sleaze of confidential juvenile records, if any, on 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. DIVISION OF CRIMIRAL INVESTIGATION C,10WADDT SMARTER I SIMPLER I CUSTOMER DRIVEN WWW'lOWBdOt.gOV DrIvar B ldil aftation services PO Box M I Das Moines. IA 50305-9201 P WW 515-244-91241 Fax 515-299-1837 Certified Abstract of Driving Record Inquiry Date: 2/26/2021 DL/ID #: 803ZZ5037(IA) Customer #: 5037454 Name: Coleman, Tina Class: C ID Status: EXP Michelle Address: 1030 E COURT ST Audit #: 7691110 DL Status: VAL APT 16 Issue Date: 01/11/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 01/23/2022 CDL Cert Status: None 522403231 Endorsements: NONE CDL Med Status: None Mailing Address: 1030 E COURT ST Restrictions: NONE Restriction None APT 16 Supplement: Date of Birth: 01/23/1972 Mailing IOWA CITY, IA Sex: F City/State: 522403231 History Information Convictions Citation Date Convlc ion Date ACD Explanation lCounty JUR 10/23/2010 01/12/2011 A20 Operating While Intoxicated Johnson IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Explanation JUR lCountv 110/23/2010 Al2 OWI Test Refusal IA Johnson Sanctions Type Effective End ACD Explanation Occurrence 7UR JUR Revoked 111/03/2010 111/02/2012 Al2 I OWI Test Refusal I IA IA Name: Coleman, Tina Michelle DL/ID: 803ZZ5037 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: Coleman, Tina Michelle DL/ID: 803ZZ5037 2/26/2021 Driver & Identification Services Iowa Department of Transporation