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Home My WebLink About15-142�, orlll� 4 It riWl®r®�� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-SO40 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. K - In' - (Office Use Only) APPLICATION FOR TAXICAB I 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 A s �e- r fl ue law.. C 'AY i Last 3. Contact Information (REQUIRED) EmaiJ:Omef_z19�41:k�mskr «,v Cell Phone: (All written communication sent via email) 4a Chauffeur's License expiration date (REQUIRED) �� -u I b. Taxicab Business Name (REQUIRED) _ ye 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? IV r, Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? AJ o Type of offense Where When What happened to the charge? (Circle one) 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? it✓ 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) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby ce ti�Y that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number I (,co ��tv 34rn issued on :711tj IS expiring on 6 G 20' , . I understand that if I falsely answer any questions in this application, that this ap lica ion 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-30'Lo 20th STATE OF IOWA ) COUNTY OF JOHNSON ) � r— Sub ribed and sworn to before me by C)n 2r- on this day of 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 orwelfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Chauffeur's license � ( 4-±' V Signature o j�6 Chief or designee Aa t5 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. Signat re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update % ,�O 11,5 ate Cl=,kfT MIDRIV gDGE PPLM014amaodad. Doc 0312015 Ju1,17. 2015 10:05AM D l v of Criminal Investigation No.330(1 P. 1/1 Fr9m:C1ty or Iowa Cny C16rK aeflao 319 3resa97 o7/16/2016 10:28 n162 r.uua1002 -STATE'OF 10M)A nr� Criminal of i ter[ jr Reco.rd Check J r4 Request Form y Tu: Iowa Division ufcriminal Investigation Support Cfperatious Bureau, 1"Fleur 215 L. '/" street. Des Moine:, Iowa 50319 (S) 5) 725-6066 (515)925-6080 Fax 1 am reounmino, an lmyn (Vminal 1-(ictnry Rr+nnrd 06erk m+• 1)(a Accoun1Number: 4/00, Fl um (:iLof Iowa City City — City Clerk's Office 410 F. Washlrttua 9lrcet __ Iowa City, IA 52240 Phone: 319-356-5041 Fax; 319-396-5499 Last Name (manaatmy) First Name (?nndalory) Middle Naiue (rccomf)endcd) 00 mer M�,h�rnr�� _Date of birth (mandatory) Gentler (mandatory) SocialSecurity N1lmber (recoiiruded) O 0 -Male ❑Female Waiver,Tntfornintion: Without a signed waiver from thesubject of the request, a complete criminal history record may riot be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record information, as allowed by law, alt oys obtain a waiver signature from the subject of be request. _ l' Qiver1?016!S'e: I Immby give pcnnission tot the above requesting eMdul to conduct an toxo criminal history record ohtcl, with the Div;sion o(Crimiaal InvwtiaxGon (nCO, Any asallo+vcd bylaw,II lvniverSign rtlure:_ � Iowa Criminal ffistoi•+y Record Check Results As of _-- l �l�-�i > a search of the provided name and date of birth revuded; No lowa Criminal hliglory Record found withDCI ® Iowa Criminal 19islory Record attached, DCI !J _ DO ini(ials---&N. _,.. ))C1-77 (08/25110) - Ao r lvoA Tima .1111 1F 9015 10: 19AM Na. 9 17 7 C410WADOT c,MAi RT",A. f SIM PIA 10 10M'.- t ,?M`E€4 +UVS{ s11C)4i++c3 i fi>. i �t Inquiry Date: Name: Address: City/State: Mailing Address: 7/15/2015 Elgaali, Omer Mohamed 2442 ASTER AVE IOWA CITY, IA 522406731 2442 ASTER AVE Mailing City/State: IOWA CITY, IA 522406731 Office of Driver Services PO Box 9-104 1 Des Rio€n:es, 'iAS03DS-9202 Phor:a: 6855-244-912418130 532-11121 1 Fav 515-23.3-1037 www.iowadaf.gov Certified Abstract of Driving Record DL/ID #: 960zz4340 (IA) Class: C Audit #: 7111567 Issue Date: 07/09/2013 Expiration Date: 06/06/2016 Endorsements: NONE Restrictions: NONE Date of Birth: 6/6/1988 Sex: M History Information CLEAR DRIVING RECORD Name: Elgaali, Omer Mohamed DL/ID: 960zz4340 Customer #: 3932089 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: 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 offldal 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: •""'•:r`/�y 7/15/2015 IOWA :" , ), 0. E r'••••••`$c�=- Office of Driver Services Iowa Department of Transportation Name: Elgaali, Omer Mohamed DL/ID: 960zz4340