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Home My WebLink About15-155� r �IIIA7tp�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319(356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. 15 — % 55' (Office Use Only) APPLICATION FOR TAXICAB 1 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 Middle Last 2. Address (REQUIRED) S \\Q le -1 u.9��n�-s, �k Ca-tc.\vii\1 r- � t 2- �. A 1\ 3. Contact Information (REQUIRED) Email: c ` ' \ . o rCell Phone: (AII written co unication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) AP 9-2. /,-O/ b. Taxicab Business Name (REQUIRED) _ A M - 5. Prior experience in transportation of passengers: \,T:> \Z C -\L - A -\,= 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When r) . l 1(U What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspendedlead Guil Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _ T o 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) r�I O c c� DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE �IF� DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CIttFFF.REW �+ You must apply for an individual Department of Criminal Investigation Report (form availliapon repu (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY~ �4 O 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a vaIiV Chauffeur's license number q 61 R 4 l (!4 O issued onojjLjAd&xpinng on understand that if I falsely answer any questions in this application, that this application may 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 authorization to be a taxicab driver 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 OX/ 1�ot5 STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by �j)af,�,yA C';c, o'.) on this 1 day of 3uor�C 1oi l Lt�d� le 5 L Ck&. ��JJ wENDY S. MnYEll __ Notary Public In aQ for the State of ITLa My Cgnmission EWplros 9W �I I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health crwelfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Chauffeur's license to 1.22 Li -' 0 IE Date Signator" AUh e of Pollcj Chief or designee AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Signature-oSignature-oT City Clerk or designee Dat ***#X**************##**X#**##**#*##******##X********#*#*#***#**##*#**#****#****£****####****£*************£****************#****£#*****XXk** _o Office Use Only xs p fiber C Approved application a?� DCI report x. State certified driving record Website update M X- C IerWTA%ID RIVBADGEAPP L92014amended. DOG 0312015 Ci DOT SMARTER 1 SIMPLER I (USTOMER DRIVE; vtr�nr ,Iouu dcat.��v Office of Driver Services Pd Bdx 9204 I Des Maines_ tA. 54306-9204 Phone- 515-244-94241 841532-1121 j Fax: 515-233)-7837 www.[o.vadotgov Certified Abstract of Driving Record Inquiry Date: 7/28/2015 DL/ID #: 961AA1640 (IA) Customer #: 1336592 Name: Gangol, Ibrahim Class: D ID Status: None Abdelrahim Address: 817 10TH AVENUE PL Audit #: 4679877 DL Status: VAL Issue Date: 09/16/2010 CDL Status: None City/State: CORALVILLE, IA Expiration 10/22/2015 CDL Cert None 522411778 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: 817 LOTH AVENUE PL Restrictions: NONE Restriction None Date of Birth: 10/22/1980 Supplement: Mailing City/State: CORALVILLE, IA Sex: M 522411778 History Information Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident De=te Case [lumber JUR 08/25/2011 :646137 IA Name: Gangol, Ibrahim Abdelrahim DL/ID: 961AA1640 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. •%"""•:!�4r1 7/28/2015 IOWA Z' I.O. T 1'...� q� Office of Driver Services Iowa Department of Transportation Name: Gangol, Ibrahim Abdelrahim DL/ID: 961AA1640 lam 4 . 201 4 0 P M Div at (aminal iovestlgatloo No. 1621 N. 1/2 13:'cv d17u r.�,2/002 S f AT OF l0`J`dA a'oLf, a: `l-it-ainal Hi,itory Record Check ' Request Forel u�. I)OlActlwnlNumher: +-ioa�� _. a= .—. (if BPF licable) To: lolva nla'151Un or('rinlina) hlvesligation From;Cifyofluv:aCi4e Support Operations Bureou, I" rlom City 215 r, 7 3Creet 4Y0 E. V✓aa hingtnn heel Ides Moinos, Iowa 50319 ---- ----- —_ _ (515) 729-6066 luua CII , lA 52240 (51s) 725-6090 Fax C�—`---------_.,_ Phone: 91,9.356-5041 Pal: 319-356-5497 — -" M. e A�1�\pati w Date of birth (�andam) (s¢dde��i (noandatog•) Social Sec4ril y 1''umber (reconinuded lJMaIe LIFemalo Waiver' rllforntafiofl: 1Vithoal a signed �yaiver from the subject of the req vest, a complete crimlaal history record may not be releasable, per Code of lova, Chapter 692.2. Por co- mplele Criminal hlstory, record Information, a9 allowed by Inky, aIWB)'S obtains q(y�lure from the subleet or (hp. renrr,,e Waiver Releflse', I Wd by give PUP icsion tar the above reptsliIle official la conduce a, luaa criminal hlsloty record check rvidl rbc Oivisioli of Criminal Inrcdigalion (UCI). Mycriminal utslDp'Jata cmu'eminy rn011101 is mawlainid by We UCl maybe ItItaud w allowed by law. I3'uiver.S'igltnrrrre: la"'a criminal Histol y ]record Check Results (ncl pae only) As of -- �� S —,a ,search of the provided came and date of birth revealed: No loaaa (;rllllllial )115101-Y R¢COl'd foLlnd with DC:I I c ? Iowa Criminal 1]islory Record attached; UC'I # i ucf iniliats__ L C3 Received Time MAI 2015 1:21PM No -3766 0 JuI 24, R I5 4:`UNIVI 0 1 v of Criminal Investigation Vo.Ib21 Y2 IOWA CRIMINAL HISTORY DCI 00636420 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED- DCI:00636420 2015/07/24 NAME: GANGOL,TBRAHIM ABDELRAHIM DOB SEX RAC HGT WGT EYE HAIR SKN POB 19800101 M W 511 160 ERO SLK MBR SU ADDITIONAL IDENTIFIERS CCH RECORD *** 01 ARRESTED 20DID216 AGENCYr lAOS20200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA123-47(4) PROVIDING ALCOHOL TO MINOR TRK##+ 100160101 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE. IA123.47(2)-A POSSESSION OF ALCOHOL UNDER AGE - 1ST OFFENSE COURT CASE ID: 06521 SMSM040324 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 100160101 SENTENCE DISP EFF DAT FINE $50 20011003 AN ARREST WITHOUT OTSPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE 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 CP