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Home My WebLink About15-041�thorization Numbe CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX First 1. Name (Office Use Only) APPLICATION FORTAXI/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) T1 51 c 2. Mailing Address c /7 -I-. )2-1) 2G- 1 �1 3. Telephone: Home I a -) =/ � co Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? /,LL2 Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? A A/ Type of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? ,n Aro Tvoe 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) 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) deMa)ddrfvbadg 03/2014 -1 -hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number GAS%,-2�r �Gf� '70l 'z 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 t4CtyCodeeeds to be signed in front of a Notary Public) Signature of Applicant C��,�� i DateG% 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. **********************#****#kk******£*******£**k**k***k***k#*k****k***t**********************£*x****k*****************#***********£*******k***** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ,,,, a<e)ajA 0 1 1_,lr1Acu-r�On this 1 L_ c day of A s � % '4 i 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). 9_- /_/- /K Signatu a of Police ie o designee Date 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. Signature of City Clerk or designee y -/-,/- /,-- Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'h" (width) and 5 %11 (height) and prominently displayed to all passengers, Office Use Only Approved application DCI report State certified driving record Website update derMarid*badgeapp2014.doc 03/2014 To; IowaNvlslandCrhntuA1NVostlgatfon Support OperatloneDuroau, l VOOP 215 TH 7/h StroDf Des Mobtos, Iowa 50319 (019) M4066 (SIS) 929-60eo gaY From: —CRY bfTown CRY CUy Clerlt's offloo 410 R. WnAfugfon Strsof Iowa CJLy, IA 52240 p tlolle: 3Y9.9S6 So4I 9Xi 31939d -M97 Iowa�riMina aistaxy Rarord Check Results As of a.search of 1heproVitlednsn1e and dAto of bi1T11tevea[ed: No Town, CI\lmnial Msroiy Record found with DCi El IowaCriminni ffistoqRecoid attached, DC1b Dol inifials Received Time �Auq, 1.3014 6:ffl No, 6525 ZcLcl yro I1 Avzl of 14 4: nrr oo. fij it 35 PM 12. 2014 2:35PM 014 o iv Investigation Div of Criminal Investigation Criminal Ni No, 7163 PP. 1/1 v, o w/vl P ® /,..p, ul AV11 11 ♦111111 YI\� V♦41 (\ ul ♦� JI ♦V,Ib VI\f II V♦/V'�I' ®® y� r S7CA'J H (OF YOVVA �eco�m� RequeA ]��0)(Ma! DCI AccountNumber;_�Inn IIryV)lon lo) To; IowaNvlslandCrhntuA1NVostlgatfon Support OperatloneDuroau, l VOOP 215 TH 7/h StroDf Des Mobtos, Iowa 50319 (019) M4066 (SIS) 929-60eo gaY From: —CRY bfTown CRY CUy Clerlt's offloo 410 R. WnAfugfon Strsof Iowa CJLy, IA 52240 p tlolle: 3Y9.9S6 So4I 9Xi 31939d -M97 Iowa�riMina aistaxy Rarord Check Results As of a.search of 1heproVitlednsn1e and dAto of bi1T11tevea[ed: No Town, CI\lmnial Msroiy Record found with DCi El IowaCriminni ffistoqRecoid attached, DC1b Dol inifials Received Time �Auq, 1.3014 6:ffl No, 6525 ZcLcl yro I1 Avzl of 14 4: nrr oo. fij it Office of Driver Services ,PQ Box 9204,( Des Modes, IA 50306-9204 Phone; 515-244-91241800 -32-1121 1. Fax: 516-.235-1837 wv4wJcwadot.gov Certified Abstract of Driving Record Inquiry Date: 8/6/2014 Name: Mohamed, CDL Med Gamerelanbia Ismail Address: 2608 BARTELT RD APT Restriction 2D City/State: IOWA CITY, IA 522462730 DL/ID #: 684A]7013 (IA) Class; D Audit #: 7189403 Issue Date: 07/31/2013 Expiration 01/01/2018 Date: Endorsements: 3 Mailing Address: 2608 BARTELT RD APT Restrictions: NONE 2D Date of Birth: 1/1/1957 Mailing City/State: IOWA CITY, IA Sex: M 522462730 History Information Convictions Customer #: 6082673 ID Status: None DL Status: VAL CDL Status: None CDL Cert None Status: CDL Med None Status: Office of Driver Services Restriction None Supplement: Iowa Department of Transportation Citation Date Conviction Date ACD Explanation County ]UR 03/01/2014 ;03/24/2014 N01 .Fail to Yield Right of Way']chosen IIA Name: Mohamed, Gamerelanbia Ismail DL/ID: 684A]7013 Pursuant to Iowa Code §321.10, 1, 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 1 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: Mohamed, Gamerelanbla Ismail DL/ID: 684A]7013 8/6/2014 IOWA ).O.T.'�% ..... Office of Driver Services � Iowa Department of Transportation Name: Mohamed, Gamerelanbla Ismail DL/ID: 684A]7013