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HomeMy WebLinkAbout21-022I r _I SAN lMtlerrar®1l IDENTIFICATION NO. ' © 2-2- (Office 2(Office Use Only) APPLICATION FOR TAXICAB I MOTORIZED PEDICAS 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" Information w111 result in dental of the aoplicatiot� lona City. lona 52240.1826 (3191356-5040 Last First Middle (319) 356-5497 FAX , 1. Name (REQUIRED) ii' Itiwez- 4J+I'V 2. Address (REQUIRED) /6 114 S Q K J u -s 3. Contact Information (REQUIRED) Emall: At ct C bi ri-G" !/ 4'1� Cell Phone: s /4 4a. Driver's License expiration date (REQUIRED) }-i ::0 _ b. Taxicab Business Name (REQUIRED) — C, j 5. Prior experience In transportation of passengers: r~*s -v (i .1 CD ca 8. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State oreisewhere? Twe of offense Where When —_fZi�91 Tuwc� Gf`Y 9�.Iy-,�Dle� 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 last five years? Type of offense ��--- Where . When 07/22 ).o [7 aso a Sa D u1 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? Type of offense Where Whe SeA,, .1 -it- 9' y 420 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) 0412018 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER I) REPORT AND STATE CERTIFIED DEPARTMENT OF CRIMINAL INVESTIGATION (DC 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�hay�ssued to me by ills Iowa [)apartmentx Irin of Transportation a valid Driversunderstand that It I Issued onQ p 9 falsely answer a questions in this application, that this application may be denied. i agree that n making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, In their discretion, to examine any and to all records end times with all ofthe to this provisionstication, and I further agree of Title 6, Chapter 2,20 a pity if (Needs to be signed in frocab Zt of r is granted, Notary Public) at all Date ® � 3 . ! Signature of Appllcent STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by an`ttile:_ " day of have rltapplication, DOI and the State Issuance rdapplicant have tere is nreviewed information wuld Indite that the wouldbe detrimental to the safety, health or welfare of real - dente of the City of Iowa City (Title 6, Chapter 2, City Code). Expiration date of Driver's license 1' /y/Z s stu n a or designee 'Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CRY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Office Use Only Approved application DCI report State cer0fled driving record Websfte update Date 0j0WfAXIDRNWQEAPPU2010Mndeddx70 0412018 to30. 2611 4 :D4PM� ONIOWA ffAX)31933E2 ; 0120 P•r 1,` d002 STATE OF IOWA Criminal History Record Check Request Form �s DC1 Account Number. 9%7•F curve«el.) Mdl or Fax 2=RkgW foams te: Saud results 1,Q,; Iowa Dlvrsios et CrSmival iavostigatioa Name _Yal10w,Cab at]*we_.City Sepport Operat5oor But tau, 1e floor fie 21! L. 7o Street A4dresa P.O. Boz 428 a Der Molaaa, Iowa 68319. � (SIS) 725-6066 Iowa City, Iowa $22" - I ... (51S) 725-6080 Fax Phoaa f319)338-9777 .a -n M -- Fax 319-359.4142 I am reafemnt an Iowa Criminal Hi ntr R A r`.h, it nn• — / / l S r l IJMeIe1,7 Female l ( r� v / J' -e efjrclaiBrep;ttl�°iaiga i rd may s ?� UtrfiC!rrl .wad ey ua, . rM(yp"-C4..d•rdlia� T Jr t�� M�`IPYl.itl..y[Y .I '...x.. aaao Wa 1 J,t VlY L.YGba\ 1 Y f]W Use only) �3n -'Iowa criminal'; �, As of 3 0 � �,1 a eee=b of th j fddPY v=eM dld8te if /trtb =vealed < ' v, y s '•. .' s' n 31 m No Iowa Critninal History Reoo4" A with rim, z1 � z U v.��� emom r to p rr„ luwa Criminal History Record attached, DCI ro# q �o�o y51 DCI initials�(x DCI -77 (updated 06-2(3.2018) Paget oft Fere:ved T re Mar.^i. 2021, 1?:140P Nt.58'C i Mar, 30. 2021 4:10PM DCI IOWA No. 0220 P. 2/3 ADDITIONAL IDENTIFIERS PHOTO AVAILABLE. Y CCH RECORD •`• Ol ARRESTED/TAKEN INTO CUSTODY 20120929 AGENCY. IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / 13T OFF TRK#. 1A00Fe VOl COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(2)(A) OPERATTHO NRTLE UNDER THE INFLUENCE IST OFFENaE COURT CASE 1D: 06521 OWCRO99555 TRK#! IAOOFBV01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP $FF DAT DEFERRED JUDGEMENT 5625 CIVIL PENALTY 20130311 PROBATION iY 20130311 UNSUPERVISED PROBr INFORMAL PROB REVIEW 10/01/13 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.lowsoexaffender.com/ . However, even though some information in 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 confidentia: 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 IOWA CRIMINAL HISTORY DCI 00966451 COURT DISPOSITION PENDING PAGE 1 OF 2 STATUS UNKNOWN DATE PRINTED - 2021/03/30 DCI:00966451 NAME: RODRI9UE'6,AGU9TIN JR DOB SEX RAC HGT NGT EYE HAIR SKN POB 19570604 M W 507 The PRO sRO MED TX ADDITIONAL IDENTIFIERS PHOTO AVAILABLE. Y CCH RECORD •`• Ol ARRESTED/TAKEN INTO CUSTODY 20120929 AGENCY. IA0520400 IOWA CITY UNIV SEC PD CHARGE NO- 01 IA STATUTE IA321J.2(A) OPER VEH WH INT (OWI) / 13T OFF TRK#. 1A00Fe VOl COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(2)(A) OPERATTHO NRTLE UNDER THE INFLUENCE IST OFFENaE COURT CASE 1D: 06521 OWCRO99555 TRK#! IAOOFBV01 DRUNK DRIVING SCHOOL SUBSTANCE ABUSE EVALUATION SENTENCE DISP $FF DAT DEFERRED JUDGEMENT 5625 CIVIL PENALTY 20130311 PROBATION iY 20130311 UNSUPERVISED PROBr INFORMAL PROB REVIEW 10/01/13 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.lowsoexaffender.com/ . However, even though some information in 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 confidentia: 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 Mar, 30. 2021 4:11 PM DCI IOWA No.0220 P. 3/3 BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION 11 Cwww iowadot ov SMARTER I SIMPLER I CUSTOMER DRIVEN g Omer & MnNrleatlon sellas PO Box 92D11 Des Moines, IA 503069201 Phone- 515-244-91241 Fax 515-239-1837 Certified Abstract of Driving Record Inquiry Date: 3/31/2021 DL/ID #: 775YY2790(IA) Name: Rodriguez, Agustin Class: C v CDL Cert StatusNone; JR JUR Address: 1014 SANDUSKY DR Audit #: 5064791 Supplement: — IA Issue Date: 10/23/2020 City/State: IOWA CIN, IA Expiration Date: 06/04/2024 C:) T7 S 522407038 x w Fail to Post IA IA Endorsements: NONE Mailing Address: 1014 SANDUSKY DR Restrictions: NONE Date of Birth: 06/04/1957 Mailing IOWA CITY, IA Sex: M City/State: 522407038 History Information Convictions Customer #: 2362001 Conviction Date ID Status: None Explanation lCounty OL Status: VAL 09/29/2012 CDL Status: None A20 v CDL Cert StatusNone; IA JUR CDL Med Statin 9Nonat� " e Restriction, r.,,„None OWI Test Failure Supplement: — IA C-, On 12/04/2012 f OWI Test Failure 'gym -v IA C:) T7 S 04/03/2018 x w Fail to Post IA IA Citation Date Conviction Date ACD Explanation lCounty JUR 09/29/2012 03/11/2013 A20 Deferred Judgment Johnson OWI IA Operating While Intoxicated Test Refusal/Test Failure Violations Occurance ACD Explanation JUR lCounty 109/29/2012 IA98 OWI Test Failure IA Johnson Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Revoked 12/04/2012 06101/2013 A98 OWI Test Failure IA IA Dis ualified 12/04/2012 12/03/2013 A98 OWI Test Failure IA IA Suspended 04/03/2018 04/06/2018 Fail to Post IA IA Security for an Accident -Owner Onl Name: Rodriguez, Agustin JR DL/ID: 775YY2790 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: Rodriguez, Agustin )R DL/ID: 775YY2790 3/31/2021 A2Z2, Driver & Identification Services Iowa Department of Transporation _ o N � Sa. r - M s Co