The URL can be used to link to this page

Home My WebLink About15-068` r 1 Aiiii CITY OF IOWA CITY 410 Last Washington Street Iowa Cit, Iowa 52240-1826 (319) 356-5040 (3 19) 3 6-5497 FAX 1. Name (REQUIRED) Authnri7ati0n Numbi Is -P&S wince Use Only) APPLICATION FOR TAXI / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) Failure to complete the "required" information will result in denial of the application 2_ Mailing Address (REQUIRED) 11 -Pi( - 3. (. 3. Contact Information (RECIUIRED) Email: ,L�S__ 4. Prior experience in transportation of passengers: Last 6 Cell Ph6ne. 3 1 °7-L-171-78YS' 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 een convicted of operating a motor vehicle while under the influence of alcohol or dri n4e lastfjve years? t Type of Offense Where men C, f 1 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Icr✓1 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 names) N (� 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) 09/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license numbei . 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 Date 1 L 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 _Kr.kk L -- `��nit,lL�— On this day of 4�-- a',;' s_ , w6NDY S, MAYER Notary Publicqh and for the State ofjowa 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). Signat re of Pptce Chief or;desigry e C�t-f• %5 � �f�%� 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 Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'MY' (width) and 51/2" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update Cad AXIDRIVDADrE PPr92014amend_d.DOC 0912014 DOT www. iowa d ot. g ov SMA;ITER i SlhkPi_R I CUSIOM'IER DRIVEA Inquiry Date: 10/9/2014 Name: Slama, Kamel Gassmelseed Address: 1454 ABER AVE City/State: IOWA CITY, IA 522464700 Mailing Address: 1454 ABER AVE Mailing City/State: IOWA CM, IA 522464700 Convictions Office of Driver Services Pin Box9204 i [)as Moines. IA 50306 U104 Ph ,ne- 515-2414124 [ 501I-532-1 1111 Fav1 515-239-1837 ,vvi a.lo'r:adot.gov Certified Abstract of Driving Record DL/ID #: 131AC5876 (IA) Customer #: 5239074 Class: D ID Status: EXP Audit #: 6916748 DL Status: VAL Issue Date: 05/03/2013 COL Status: None Expiration Date: 08/02/2017 CDL Cert Status: None Endorsements: 3 LDL Med Status: None :Restrictions: NONE Restriction None Date of Birth: 8/2/1966 Supplement: Sex: M History Information Citation Date Conviction Gate ACD explanation County ?OR 07/05/2011 08/22/2011 S92 Speed Iohnson 1A 09/11/2012 10/21/2012 S92 Speed Keokuk IA 08/06/2013 08/23/2013 S92 Speed (10 mph & underin 35-55 mph zone) Keokuk IA 04/25/2014 05/27/2014 S92 Speed (10 mph & under In 35-55 mph zone) Washington IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 12/15/2013 773612 IA Name: Slama, Kamel Gassmelseed DL/ID: 131ACS876 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 efficial record currently In the custody of said office, and that I have been authorized by the Director of the Iowa Department of Tmnsportatlon to so certify. JIn witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa this date: f 'oO&yENIClfg76/6�yr IC/912014 IOWA'' * go. W:D.O.T. 'i41 m yrl NI�IZITtBrvices eDepartment of Driver eofTransportation Iowa Name: Slama, Kamel Gassmelseed DL/ID: 131AC5876 Oct. 15. 2014 10 25A1111 V6 0. LV 14 z IeIV ��aF1' U4Lp d 9� ,,Lralva`�� Div of Criminal Investi;atioo LILY blerK - U I I Y 01 lama L,IIY STATE OF A(DWA Cirfil>ffu>inol Matorry Recoyd (Check )< equeA F®irpn To; Iowa DivIslon of Criminal Nvastigetloh Support Operallona Bureaq, 10 Flo or 215 R: 7" VFW AesRioines,Iowa 603I.9 (glS) 725-6066 (515)725.6000 Fax No -2028 P. 2/3 Ivo, )m H. tit —37 � DCI AocowztNwnber 'bp�k-t— .r (leuppu`�ti1�) From: City of Iowa City City MAE'S Office 410 E. Washington street Iowa ON, IA 52240 11hohe; 319-356-5041 i ax; 319,356-5499 Record Check As of t 6A 1( 1 � �A , a search of the provided name and date of birth revealed: `P No Iowa Criminal History Record fotrtad with DCT W Iowa Criminal History Accord attached, DCI # DCTinitlals Ar—.. Received TlmerOct. 8. 0014 2:17PM No. (IMvp Oils) c'