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Home My WebLink About14-1761 r i ��,% CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name 2. Mailing Authorization Number e q— / 7 L2 (Office Use Only) i M e✓,c�� c kr APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday.) 3. Telephone: Home Other: 4. Prior experience in transportation of passengers: 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) derena.idrveedg 0312014 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When /Uci 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs years? P j Type of Offense Where When in the last five 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When t Sf UIG�Al. ° �)ob9nSo �ea }d ��LI�Z"(� ryq 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Tyoe of offense Where When ✓ _I0 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) derena.idrveedg 0312014 I hpmber hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license nu 1(0 '7Z IZ� . I understand that if I falsely answer any questions in this application, that this application may be vied. 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 � I-; )L1 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. Wxx:tWWr„WWWW*********WW**xzxW-xxWxtxW*W.M*****x*k*****z****Wxxxxxx#xWY'k*Wv************W**x*xxxxxxxxx*WWWW*********W*******txxxx x.W*Wh**** STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by Lk) C�L, 1 {lg . co p r , r On this :7- t si day of va'�.�„ I WENDY S. 1JPYER My Commissiuq Expires for the State 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). Signaturef of PolU C & f or d signee 21.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. Sign ture of City Clerk or designee ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2" (width) and 5 %" (height) and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update Cera ,d&bzd,.pp2014 me 0312014 0 4 iUUVA00T w.:. W vmvicii.gov Office of Driver Services FO Bo): 9204 ; Das Moines, 14 50306-9204 Phone_ 515-244-9124 1 80[1-532-1121 f Fait_ 51.5.2331837 'A w 1a'V3dcit.gov Certified Abstract of Driving Record Inquiry Date: 8/21/2014 DL/ID #: 960ZZ4343 (IA) Customer #; 3342803 Name: Elgaali, Wail Class: D ID Status: None Mohammed Address: 2442 ASTER AVE Audit #: 8347972 DL Status: VAL Issue Date: 08/12/2014 CDL Status: None City/State: IOWA CITY, IA Expiration 02/13/2022 CDL Cert None 522406731 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 2442 ASTER AVE Restrictions: NONE Restriction None Date of Birth: 2/13/1986 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522406731 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 09/07/2011 ,11/29/2011 F04 Seat Belt Violation Johnson IA Name: Elgaali, Wail Mohammed DL/ID: 96OZZ4343 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: 1"••"•�y'/4�� 8/21/2014 IOWA D. 0. T.ej�' 7p ➢➢IYER S Office of Driver Services Iowa Department of Transportation Name: Elgaali, Wail Mohammed DL/ID: 960ZZ4343 .f °I uo.'11 2014 2:23NO CDI;v of CrlffiiitI Investlgatico r t11aW9� �4t1%fF,:CNNr`4 STAT -9 OIF I®VJA. CrlmiaO Historry Recoyd Check Reque$11 ]H t irm To: TowaDivision ofCriminal Iuvestigaflan Support Operations Surean, VFloor 21.5 F. 71a street Des Moines, Towa 50319 (515) 725-6066 (515) 725-6090 Fox Tam renne.efina an Tnwa Criminal TTistnty Record Check on: 0?-. 0'0 pI- "12 DCT Account Number: a-' (irappucable) Prom: City of Tocva City City Clerk's Office 410 E. Washington Street Iowa ON. TA 52240 Phane: 319356-5041 Fsx: 319356-5497 LastNa,ne. (111andetory) Drat Name (mandatory) Middle Name (rcwn,n,cndcd) c: l Ma��nMYv, 0 - Date of Birth (mandatory) (mandatory) SOoial Sf Cil lty rjunrbet' (rtcommcndcd) d 2 l 3 I �1Y][ale �Fomale 9 o q5 Z 1 I W(JJV6r JnfO?PnaJJOtt: Without A signed Waiver from the subject of She request, a colnplefe criminal history record maynOt ba releasabfe, per Code of Iowa, Chapter 692.2. For complete criminal history record iuformatfo 1, ns allowed by lav', ahvnys Wain a waiver signature from the subject of the reclucst W(tivef .iieleaSe: 1 hereby give paa,lssion for the ahove rcguuting official to conduct m Iowa criminal I,latory rcwrd cluck Nath Iho Dlvislon ofCtlminel invesdgmion (1)Co) Any criminal hlsrary dela conceniing me Thal is mainlainod by the DCI maybe released se eiloW<d by law, D�rt['verSignnfure: J ��vJ Iowa C imingl ffistpry ][record Check ]results As of ' ;�— a search of the provided name and date o£bu2h revealed; No lows Cyimfnal History }Zecord Pound wltli DCT Iowa Criminal History Record attached, ACT # DCIinidaIs„S� Received 1ime7Aue.15.'C2014 1t`iSNV No. 7221 (ndj lyse only) c: l rJ