HomeMy WebLinkAbout15-080`!`
r Authorization Number h�
1 (Office Use Only}
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APPLICATION D 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
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F1r'rs Middl ( ast
l
1. Name (REQUIRED) 1 6d ako e -a
2. Mailing Address (REQUIRED) _��r�6 6 KIM In _1 4/11
3. Contact Information (REQUIRED) Email: 1 GI& W h" ('- Cell Phone('�JR J&i 1/ -fns 7
4. Prior experience in transportation of passengers: C;?" yj& rs Vti C; '"^ a i U - c u vh
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? A16
Type of offense Where
nc
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol ordru s in the last five
years?�Q
LED
Type of Offense Where hen
Ann _ n nnv
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 name(s)
AM)
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CSLtTIFIEp e
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHt6FAEyjgW ----
You must apply for an individual Department of Criminal Investigation Report (form availabib uporlEeque
e ,
(OVER FOR REQUIRED SIGNATURE AND NOTARY) ,
- rr3
09/2014
I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
2�A �� ��� . 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)
Signature of Applicant Date015
YOU ARE NO ALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FrT;biE
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. Li
APR - 8 2015
STATE OF IOWA ) Iovia City, Iowa
COUNTY OF JOHNSON 1
Subscribed and sworn to before me by A i A. t{A On this a r day 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).
Signature o oli a ief or 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
/ 3 /
D2fte
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/z" (width) and 5'h"
(height) and prominently displayed to all passengers.
Office Use Only
Approved application
DCI report
State certified driving record
Website update
CIer1UTMIDRIVBADGEAPPL92014ameoded.DDC 09/2014
="DDT
SMARTER 1 tt,,PLrF I OJSTt7ME
Office tit D€ivef Services
P6 Ex 3204 1 Des Nfoines, IA 50306-9203
Phone: 875-244 9124I'800 532-fl2t I Fax: 515-239-1837
'Nw,w icrwldoi. goo,
Certified Abstract of Driving Record
Inquiry Date:
1/23/2015
Di #:
248AD4337 (IA)
Customer #:
5409180
Name:
Ahmed, Ali Omer Ali
Class:
D
ID Status:
None
Address:
2401 BARTELT RD APT
Audit #:
7392384
DL Status:
VAL
1A
Issue Date:
10/01/2013
CDL Status:
None
City/State:
IOWA CITY, IA
Expiration
09/22/2018
CDL Cert
None
522462701
Date:
Status:
Endarsements:
3
CDL Med
None
Status:
Mailing Address:
PO BOX 2532
Restrictions:
NONE
Restriction
r1,,��--
Nonp„�„�
Date of Birth:
9/22/1966
Supplement:
FiST__
Mailing City/State: IOWA CITY, IA
Sex:
M
522442532
APR - 8 2015
City Clerk
History Information
IOUIa City, IOWA
Convictions
Citation Date Conviction Date 1CD Explanation County JUR
09/01/2012 11/08/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA
Name: Ahmed, All Omer Ali DL/ID: 248AD4337
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:
oQ�E81CLf p���It,
I, 1/23/2015
IOWA
Offic
Iowa of Driver
rtme Sof Services
aTransportation
Name: Ahmed, Ali Omer All DL/ID: 24BAD4337
V Jan; 20, 20154,06PM( I1 Div of Criminal investigationNO. 8380 P. 1
V N i- I l i CV I i Y G V i t v r l Y c I C I n b I l Y V I 1 U x a U I l r IVU . 7 7 J O F. //2
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ONE
To; -Town Tlivisfon of Criminal Yuvestigation
supportOperatlonsHureau, L"Floor
21511. I" street
Des Moines, Lawn 50319
(+15) 725.6066
(615)725-6090 Fax
941
I am ten uestina an Iowa Criminal History Rceord Check on:
)7CIAccountNunther: -t0 0 C
(ffepplfo lo)
Vrom: CilyofyowaCity r1,�
City Cleric's Office
410 V, Washington street
Iowa City, TA 52240 10N1a City, Iowa
Phone; 319-3565041
]fax: 319.356.5499
LW Name (mandato
�IY9t Mandatory)
Middle Name (recommended)
AV I M' ej
'8i110
I A I111��Lc
0,9Y1Prql
late of Birth (mandatory
Gender (menda:ory)
(Social ,g'ettiri Nup11f0C r000blmaided
Male ®Female
Waiver ,rf(/ormalioit: Without a slignm watVar fi'om the, subject of the reqq&sf, a complete criminal history record may no,
be releasable, per Code of Iowa, Chapter692,2, For 1 om lets criminal history record information, as allowed bylaw, always
ohiAln a imlver signature from tbesub tet of the re nest.
Waiver 12eleam; Iheraby givo pamtissioa forthe abovo F;gV%ting of eialto conduct enIowa cdmhlal hlatoty record check with lheDivision ofcYrtihal
hivesdgedon ())CI), Any crintinf hlsroq data concaming me that Is mealtAince! by the DCI may to reicacd as allowed by Im V,
walyeY
Actwa "riminal History Record Check Results
As of a (i 75� a search of the provided name and date of birth zevealed;
No Iowa Critalinol Histofy Record found with DC1
El Iowa Criminal HistoxyRecord attached, DCT #
DCT initials
Received Time—Jan. 15.-2415— 4 24PNrNo.8937