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Home My WebLink About14-236I�;*1 CITY OF IOWA CITY 410 East Washington Street Iowa City, lona 52240-1826 ( 19) 35- 04 (3T7r3S6-5497 FAX 1. Name (REQUIRED) Authorization Number (Office 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 "regu,'red" information will result in denial of the application Middle Last 2. Mailing Address (REQUIRED) 3!� CDy J2-§�e-� sjS 5 3. Contact Information (REQUIRED) Email: `MbL�L�S\Y °� YyNg,JU C or� Cell Phone: [31g 4. Prior experience in transportation of passengers: "k D-�-t 10 .,� -6� 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? N O Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? _T1e7 Tvpe of offense Where When 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N Type of offense Where When F:s 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provWerihe game(sr— )\.N a rn rr DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE GERTIFI- b DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REIIEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). (OVER FOR REQUIRED SIGNATURE AND NOTARY) 09/2014 I hereb certifhat I ave issued to me by the Iowa Department of Transportation a valid Chauffeu Off- ��y tooS7jhr's license number . 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�ol 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 1 rcri e� and sworn to before me by l N to / I �o f'7a/1�2d�� On this ��_ day of �r / / Ie.'�'p� e KELLIE K. TUTTLE �� /C �, commission rmmber22151 otary Public in and for the State of Iowa 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, Chatater 2, Citv Code). Signatu 6f4 -Chief or designee y 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. 9�!� Signa`Eure of City Clerk or designee Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/d' (width) and 51/x" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update C1erkrrAXIDRIVBADGEAPPL9201 aamended DOC 0912014 4�4liultivADOT - www.iowadot.gov SMARTER I SN?LER I CUSTOMER DRIVE, Inquiry Date: 10/9/2014 Name: Mohamedall, Modasir Khlllil Address: 390 WESTGATE ST APT 5 Clty/State: IOWA CITY, IA 522463126 Mailing Address: 390 WESTGATE ST APT 5 Mailing City/State: IOWA CITY, IA 522463126 Office of Driver Services PO Box 9204 ; Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax_ 515-239-1937 mmi low2dot.gov Certified Abstract of Driving Record DL/ID #: 082AA0058 (IA) Class: D Audit #: 8489835 Issue Date; 09/30/2014 Expiration Date: 09/28/2022 Endorsements: 3 Restrictions: _ NONE Date of Birth: 9/28/1963 Sex: M History Information CLEAR DRIVING RECORD Name: Mohamedali, Modasir Khlllil DL/ID: 082AA0058 Customer #: 1142265 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: c�' Pursuant to Iowa Code §321.10, I, Klm Snook, Director of Office of Driver Services, Iowa Department of Transportatlon, 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: ,o ff:'-""-"Irz�y 10/9/2014 o ; IOWA *rr, s .:: W' 0. T... -A:' c�' Offices fDer ServiTransportation ORIVERsJ`r owa Department c> i Name: Mohamedali, Modasir Khlilll DL/ID: 082AA0058 ry i\i Oc-:20. 2014 11:44AM Div of Criminal Investlgaticn No 2211 P. 5/6 L i7 vi I VIUIn Ur L U I W UI ly' N'U.)]U0 F, L STATE OF IOWA Cirnm unl Hido>ry Recegd (Check Request Form To: Iowa Division of Criminal Tuvestlgatlon Support Operations Bureau, Pf Moor 215 E. lea Street Des Moines, Iowa 50319 (515)725.6066 (515) 725-6050 Fax I aln reauesthfe an Iowa Criminal Histofp Record Check on; r DCIAcoountNiunber: p} �iPaF�plicaEte) From: City of Iowa elt}i h ? �? City Clerk's Offti _ 410 E. Wash In gtori Gtr' W ' s.. Iowa City, 1A 52240 Phone; 319-356-5041 Fax; 319-3565497 Last IOTRma (il,andotory) .Mist Name (mandatory) Middle, Name (YeeonrmendeJ? NtaVlawl�dac, MociaS6f- Date of Birth (mvdatory) Gender (Pnankory) Soci al Security Number recommended) Waiver Inforrt adoftt Without a signed waiver from the subject of the request, a complete ovirnlnal history record may not be releasable, per Cndo of Town, Chapter 692.2, For tom tete criminal Mstory record Information, ns allowed bylaw, always obtain awaivevSignature from the sub'ectofthe re aost, Waiver.Release;lhcm6yglvepermissionforthcaboverellonch omoleitomnduclanJo++aCriminal historyrecordchcekniihtb;PkisionofCr;minel 111mligaliml(I)Cn, Any aimlnal history dela concernlu el [la Irl dalaed by the DGl maybe released as allowed by law, Cf WaiverSigftalfure: Iowa Criminal History Record Cheek; Results (I)Ctusa Only) As of 1 —d -O 1 a Seacch of the provided name and date of birth revealed: ® No Iowa Criminal history Record found with DCT Iowa Criminal History Record atfached, DCI # a$q DCT initials Received Tirne76cl. if. '1�014 2:43PM No, 1978 Oc'..20. 2014 11:44AM )iv of Crinina Investigation IOWA CRIMINAL HISTORY DCI 00989990 MISDEMEANOR CONVICTION'S ONLY PAGE 1 OF I DATE PRINTED - 2014/10/20 DCI:00989990 NAME: MOHAMEDALI,MODASiR KHIL DOB SEX RAC HGT WO'I' EYE HAIR SKN POB 19630928 M B 506 199 PRO BLK DRK YY ADDITIONAL TDRNTIFIERS PHOTO AVAILAkLR: Y CCH RECORD *** No. 2211 P. 6/6 Ol ARRESTED 20130917 AGENCY: IA0520100 CORATVILLE PD - CHARGE NO- 01 IA STATUTE IA708.2(6) 4,,:'G-^ O ASSAULT TRK#: IAOOHL701�' ^^i CD 11 COURT DISPOOXTION _'r- AGENCY: rAGENCY; IA052015J JOHNSON CO DIST COURT - -- COUNT NO- 02 IA STATUTE IA706.2(6) ASSAULT COURT CASE ID; 06521 AGCR203031 CHARGE CLASS! MISDEMEANOR CONVICTION TRK#: lAODHL702 SENTENCE DISP EFF DAT FINE $100 20140310 AN ARREST WITHOUT DISPOSITION IS NOT All INDICATION OF GUILT. THI$ RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OH' IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW , ENFORCEMENT AGENCIES BY THE DCI. IN THE AB$RNCR OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OR YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION lic-