HomeMy WebLinkAbout14-179410E - ast Washington Street
Iowa ity, Iowa 52240-1826
(319) 356-SO40
(319) 356-5497 FAX
1. Name
2. Mailing
Authorization Nurnber / —
.. .. _ (Office Use Only)
APPLICATION FOR TAXUMOTORIZED PEDICAB VEHICLE DRIVER
(Police Department review must be made
between 8 a.m. to 3 p.m., Monday — Friday.)
3. telephone: Home.= yet _ � _�_" Other:
4. Prior experience in transportation of passengers:
When
6. Have you b en convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? 10
7. Have you been convicted of any traffic offenses in the Vast five years?
MM
i
B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?
Type of offense
When
9. Have you ever applied to be an loWa 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)
d6WtwWnVbWu 03/2014
Ihereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number
. I understand that if I falsely answer any questions in this application, that this
appli tion ma be d nied. 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 /theovisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public)
Signature of Applicant 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.
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to b 9 v4 Aefore me by r"
l ` On this `""' da of
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).
g��p`f ofid� , d"a ig e
Si na ulre � es n e
/ .4 _ A
Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERKS OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
Signature of City Clerk or designee
.........._..�.......=a). ." F
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/a" (width) and 5'/z"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update . ......... _.............................
clerklbxiddvbadgeapp2014.doc 03/2014
r
DOT vmrol, iowadotgov
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Of c's of DFive¢Seuwiia eA
pO Box 9204 ! Des Ildfsaiilnes, A 5fJ.XX5✓g2..fld
P hane.: 515-244-9 UN I11 XD 5:32:-1'121 1 Fwc: 615 -239 -ft Y
9WtlNw l6XM1Adada1 .ijuov
Ceir lfrlil d Abstract of Diriviing R erffln^d
Irnqu by 10at=
8/19/2014
DN./1D 4e
54SAG0871 (IA)
Custaarser .
5868786
Name::
Salah, Omer Mal
Cie=
D
ED statues:
None
Address
2630 WHISPERING
Audit #fie
59357.55
De., st'atum
VAL
PRAIRIE AVE
Innsus Datia'a
04/20/2012
CDIL statu m
None
ClIty/stat'a'a
IOWA CITY, IA
IY1alpilratloun
10/15/2016
ODII.^ Deir't
None
522406612
IDatz:
stat usa
Endoirseumreun'tm
3
CIDI.IWNed
None
Statu m
MalllhW .Add
2630 WHISPERING
Restrictionim
NONE
R.estrla:don
None
PRAIRIE AVE
Pate of Bertha
10/15/1967
Supplea mnb
NNauuNng City/ tau
IOWA CITY, IA
sem:
M
522406812
ClUtkun LNita,
CePll"vIIrflioin IDate
ASM
1a.1piaunatlioun ....,
,Col .....,
oo sw^u 11.9
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11I1111e
03/03/2033
03/25/2013
S92
Speed
Johnson
1A
O711119/201.3
0812.3/2e113
S92
:Ypeed
Danhua,numrn
IIA
Acc6delmts •- Accident invollvelmueurit iiundiicated does NOT uneain the HinduwiduuM was at fault or gliveln a citaidon..
Accident 111 ate R asm 11911�dvmineee' ,1I1R
O9/201201.1. 640800 IA
Pursuant to Iowa Code §321..1.0, 1, Nim Snook, Director of Office of Driver Services, 'Iowa Department of 'Transportation, do
hereby certify that I am the custodian or the records held by the Ofte of Driver Services, that this is a true and accurate oer" of
an official record currently In the custody of said o0'ice, and that I have been authalzed 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:
m ,..""
8/1.9/'201.4
a "in���rw."� .
I
J1, 31. 2014 4IL, 0i/ of CriminalsInvestigation
Jv �: �w GV IT 11•Tuun —
STATX OJV IOWA
a
Criminal IIi FRI+ ReC00 Check
i Request qu r ni i i
ft Iowa Division. of Criminal MottigatiOn
Support O ....f Al'iFloor
2f9 X Yh Street
Deamolm,lownd.
#6
rau Fax
NNo.6161 p.P. _.I/1
bCI AccovuiNum'ber, „�;_
�a�egaRRr.�CeD
Nam;: Ct.. Off1011r IfG-6q—dowm Rio
ow w. TA 0240
Phone, 319.3s6'4041
N.+°at:
Mows Criminal ffistor, ' ecoid. Check Resulti (DCl use only
.As of a, eoaiodu of provzde:d...wun.e anal doto ofhh't%..vevealed:
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No Iowa Orbaxinal Mitory Record found wl" DC1
...
Iowa Crizninal.:kftwtory.Record attached, DCI ,
iDCHndtf.als
ece ved Time_M.30._2014_11,40AM—No.