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Home My WebLink About15-044 Authorization Number /5 0/11/ _ r 1 (Office Use Only) I era sast raw 44141 itt 'ft AWN 111111:11r ��— APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday—Friday.) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name(REQUIRED) al}{mac L.tD(Al) Ac* EO fL-C-11 2. Mailing Address(REQUIRED) '2.5 2 P-ck l Pc t&wet c i A St294. 3. Contact Information (REQUIRED) Email: 6000,7,6i, 1a.ccwSCell Phone: 7.1k3 —2oc,--9 4. Prior experience in transportation of passengers: &Yfc l!/eeur La%{ - t �D 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where 1/11fieh ' '`;~' _rw. 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? N'd> Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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 tame(s) itk) C.:l j l DEPARTMENT OF CRIMINAL INVESTIGATION(DCI)REPORT AND STATE C-ERTIFIED -- DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CI-IMF-REVIEW You must apply for an individual Department of Criminal Investigation Report(form available.upori-request=), (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number $'9 C. f} 14 4s q . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will be denied. 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 and documents relating to this application, and I further agree that, if a license 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) //��jj Signature of Applicant i3(�J(26-!✓_(1Date 2- 3 - n15 YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by c Vka 4 i cQ . \ I . On this ,' t 0 day of curd 7-0t 6- S tea_, wENDV s ammo Notary Public in nd for the State owa ICommission Number 720428 My Convission Expires r I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City(Title 5, Chapter 2,City Code). u. 7/5 Signature of P• 4 - or designee Date YOU ARE IT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. )) lOte-or -e• '-/C /12) Signature of City Clerk or designee D2(te Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2"(width)and 51/2" (height)and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update Clerk(TAXIDRIVBADGEAPPL92014amended.DOC 09/2014 Page 1 of 2 4, „ , ,. ,,, ,,,,,.... ,., ,,,„ - - - „Afvvvv, .g., SMARTER I SIMPLER I'CUSTOMER DRIVE .. iovv! Office of Driver Services PO Box 9204. i Des Moines,IA 50341-9204 Phone 515-244-9124 i 800-532-1121 i Fat:5=15-239-1837 wvmiowadot.gov Certified Abstract of Driving Record Inquiry Date: 1/28/2015 DL/ID#: 596AH4569 (IA) Customer#: 5955498 Name: Algaali, Bahaeldin Class: D ID Status: None Akasha Address: 2525 BARTELT RD APT Audit#: 6994884 DL Status: VAL 1A Issue Date: 05/31/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 10/23/2017 CDL Cert None 522462718 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2525 BARTELT RD APT Restrictions: NONE Restriction None 1ADate of Birth: 10/23/1973 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522462718 History Information Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/22/2014 781326 =IA Name:Algaali,Bahaeldin Akasha DL/ID: 596AH4569 Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by the Office of Driver 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: --- to lItilICLfNAa y fw:.•••.....r.o. 1/28/2015 I i .- I : IOWA *I 4P las,. I, % D. O.T..iti , v. . rhil®p•••••' $_' Office of Driver ServicesCO i%I`ypm —s' Iowa Department of Transportation Name:Algaali,Bahaeldin Akasha DL/ID: 596AH4569 1/28/2015 J..n. 29. 2015. 1 : 12PM. Div of Criminal Investigation No. 9176 P. 1/1 �an. zo. Zvi I1 :79iuv umt,lerH — t,ily of lows �l [y No. Dm 1'. L ,,,,d Z STATE OF IOWA ,- �"i,�,,,, 1"�' L~ Criminal History Receird Cheek ' � !area :• :� ',•:� ;, .;', :F ; :\ '''.•- Request Fenn f%1'r, ,41 I \ • DCI Account Number: 4 r,0 -F (if epplloeble) To: Iowa Division of Criminal Investigation awe: City of Iowa City Support Operations Dureau,.1 Foot City Cleric's Office 21d E.71b Street 410 l,Washington Street Des Moines,Iowa S0319 (915)725.6Q66 Iowa City, IA 52240 (513)115-6000 Ven - Phone: 319-3564041 • Fax: 3193563497 I am re'nest![ : an Iowa Criminal Histol Record Cheek on: Last Nnftio(mandatory) First Name(ntanda(ory) MYddIeame(recommendee) vaLess t...l (311(-Mel-D/A/ AK/451-1A 41,-41.460 Date of Birth mendeco gender(mandatory) Social Secuiri Number recommended Ic'/ 2.31113-3 Zlmaio ❑Feanale '. Li—77-- 148? Waiver Information)ormation:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 692,2.ror complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of theueat. _ , WatverRel ase:Ihereby give permission Portheabove reque lingofficialtoconductsn1oracriminalhistoryrecardcheckwllhtheDIvisfoaotCriminel Investigation(pCl).Any criminal HOW data concerning me(half maintained by tlto OCImay be released as allowed by law. ,f Waiver Signature:_. ei. / '^ —_% °t d C:564--1 Ilowa Criminaj)131i tory Record Check Results 74i.cil.only) As of I"�I-15_, a search of the provided name and date of birth revealed a 7' No Iouva Criminal Tlistoxy Record found with DCI e ___3 0 Tows Criminal HistoryRecord attached,DCI# DCI initials I,) Received Time:,4128;,—„2015-11 :53AM—No, 9089