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HomeMy WebLinkAbout14-192� r � S III A CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 22 40-1 82 6 (319) 356-5040 (319) 356-5497 FAX . First 1. Name Authorization Number f,4—i9,:1- (Office Use Only) ` : -yP!-^I C a 0 APPLICATION FOR TAXItMOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday.) Last 2. Mailing Address % (2 6 PL? 1-r9 14 lea- I 00 /4 C a4 j✓( Z G 3. Telephone: Home '�(�j S'/1 �ri � Other:�� 7 f j/r72 4 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?fir Type of Offense Where 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When When B. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 4� f 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) 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) derkt xldnebadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chaur'ieur's license number o 1% b . I understand that if I falsely answer any questions in this application, that this applica ion 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 rrSS_2r<— 144 - 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 ) ;rLAbscribed and sworn to before me by M0 r a_rvnelt— On this 2_ ' ` 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). Signatur o C ief or designee 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. Signa of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/z" (width) and 51/:" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update c:erkltexlcdvbedgeepF2t4.occ 03/2014 I Inquiry Date: Name: Address: City/state: Iowa Department of Transportation C"Ce nt brivtx Seroxim tv�.'J+bV Ml r.., l ::�� 1, rxs .rsc„+f ,+w ��.::G:'r :li•1� Fu 5115- fir �ruf Certified Abstract of Driving Record 8/28/2014 Elamin, Mohamed Bakri Mohamed 920 BENTON DR IOWA CITY, IA 522465216 Mailing Address: 920 BENTON DR Mailing City/State: Convictions IOWA CITY, IA 522465216 DL/ID #: 465AF7080(IA) Class: D Audit #: 7953132 Issue Date: 04/04/2014 Expiration Date: 09/13/2017 Endorsements: 3 Restrictions: NONE Date of Birth! 9/13/1962 Sex: M History Information Customer #: 5751120 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Driving Wrong Way on One Way Street Citation Date Conviction Date ACD Explanation ]UR 11/16/2009 03/15/2010 N31 —County Fail to Yield Right of Way MD 11/20/2010 12/06/2010 N63 Driving Wrong Way on One Way Street Johnson IA 04103/2012 06/08/2012 S92 Speed Johnson IA 08/31/2013 04/30/2014 S92 5 eed Johnson IA 11/20/2013 04/30/2014 S92 Speed Johnson IA Name: Elamin, Mohamed Bakri Mohamed DL/ID: 465AF7080 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: hg,. 27. 2014 4:46PV,Div of Criminal Investigation 0% M ,,,,rrr�rweSTAT9 09 I A r� torso . /J TUrrifflin2l Request l t. I , 1 To; Iowa Division of Criminal lnvegtigatlon Support Operations Bureau, 1`r Floor 215 E. 7`" Street De-3Moiues,Iowa 50319 (515) 725-6066 (51 5) 725.6080 Far Tam reouestinLr an Towa Crimina(Histolvkecord Clheckon: NNoB697 X11 1/1 DCI AccountNumbec: '`it7Dr% (ifappff, ble) From; City of Iowa City, City ClerWS Offico 410 E. Washington Street Iow© City, IA 52240 Phone: 319-356-5041 V21; 3193563497 bast Na�nandatorig First Name (mandatory) Middle, Name (recommended) Cla�i� HoLe,v� Oct �<vr Date of Bir(h(mandatory) Gend�er�(mandam) Social Security Number recommended Cj _ �.3 l `2— UlViale ❑Female 2 l Jr r 1 rJ ZS j'irafmc kformadom Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Towa, Chapter 6922, For com lets criminal history record Information, as allowed by law, always obtainawaiver signature from the sub'ectofthere uest. Wailer Rele(fNe: I hereby give permimon for the nbove rcgoca ling oniaiel to cpvdact an Iowa criminal hisrmy record chmkwith rhe Divis ion oPCriminel rnvMigalion(DCl). Any criminalhislorybalaconeendagmeloothmainlzinedby[lit DClmay bereleasedasa]Imredbylaw_ (( . WaIver Slgnaeurz'f rIowa Criminal History Record Check Results As of d ' a Seareh of the- provided name and date o£billh revealed: 60— No Iowa Cziminal History Pecord found with DCI LJ Towa, Ctiminal Historykeoord attached, DCI DCI initials Receives �ime��ug�'��,Tt'2014 2 49?M No,?812 7