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Home My WebLink About15-180CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. 16 — t (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 Last SV 1 , \n � v 3, Contact Information (REQUIRED) Email: klamadc K3z(0661; me(J r_CeIIPhone: 1315-32�-b6y�( (All written communication sent via email)' 4a. Chauffeur's License expiration date (REQUIRED) 6 /1 jL Z 7O 2 3 b, Taxicab Business Name (REQUIRED) Ayy1 t' CZ T ; ta✓0� Tt (' r �e {� )C lel Cg 5. Prior experience in transportation of passengers �g r c e- 6. 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? A10 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? !V 0 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? ft/0 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 ST DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLIC You must apply for an individual Department of Criminal Investigation Report (form avatlabl}r uygn remt) Ii 6 " J (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARa")T . r 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 valid Chauffeur's license number /A�)(] aF 64S issued ono8li31 r<expiring on Z3. I understand that if I Pals- answer any questions in this application, that this app icah n 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 shb /,Z,? is STATE OF IOWA ) COUNTY OF JOHNSON ) �tn� � Subscribed and sworn to before me by V A_k J0 A.ELkciillc on this <9 5 day of )LOIS YVENDY 5. MAYE:R _ Notary Public in and ibf the State of Iowa 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 or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). / 7 Expiration date of Chauffeur's license � :/ /? ?l Signature of Polio Chi f or designee Date 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 of C4CIerk or designee Date } cn Office Use Only '52t Approved application v DCI report State certified driving record ' Website update. c,a CIerP/ IDRIVB GE4PPL92014amended.DOC 03/2015 Adg.19 2015 10:03AM Div o= Criminal ]nvestiu tion No 3416 P. 21/6 From _Clcy 01 lows City Clork Giflcc al. 3866--+ 08/15/2015 13:06 tr212 P.002/002 STATE, OF IQ' VYA Criminal History Ree1}red Rergce(.st Form Iowa Divi5ian nl Criminal Inecstigalion Support Operations Ihlreau, I" Noor 215 F. 7" Street Des li4nine8, Iowa 50319 {5I 5)725.6065 (515) 92.5-wo rax DO Account N inibti: _1400a -T T1 -am: Ci[y of Iowa C'it city clerlf` eyrr�e 410 L. ��'asltinglon,5'treet lu�ca Cilya IA 32240 Pboue: 1119-356.5041 Pox,: 319-355-5497 4PIOWADOT 'F. SMARTER SI1APUil. 1 �u' rG e1 FTIVEN )�uV i11.lQ�1Jt t[ CiGef�QR{ Office of Dtiv r Services PO Bo;< 3204 I Des ?:twines IA 503. 3-9204 Phor e 536-244 91241 80f 12 #12t ; Fax 5s www .iowad rt{iY Certified Abstract of Driving Record Inquiry Date: 8/26/2015 DL/ID #: 450AF6378(IA) Customer #: 5729103 Name: Sharif, Mohamed Ali Class: D ID Status: None Address: 2413 SHADY GLEN CT Audit #: 9336298 DL Status: VAL 12/07/2013 01/22/2014 Issue Date: 08/13/2015 CDL Status: None City/State: IOWA CITY, IA Expiration 08/17/2023 CDL Cert None 522464115 Date: r Status: Name: Sharif, Mohamed Ali DL/ID: 450AF6378 Endorsements: 2 CDL Med None Status: Mailing Address: 2413 SHADY GLEN CT Restrictions: NONE Restriction None Date of Birth: 8/17/1978 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522464115 History Information convictions Name: Sharif, Mohamed Ali DL/ID: 450AF6378 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: p�`i CenAct€on Duto ACD Explari `tWn County 3U%1 11/20/2010 02/15/2011 M14 Fail to Obey Traffic Sign/Signal Johnson .IA 05/11/2012 06/14/2012 M70 Improper Passing Johnson IA 12/07/2013 01/22/2014 .592 .Speed Johnson IA Name: Sharif, Mohamed Ali DL/ID: 450AF6378 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: p�`i o@yENICIf y 8/26/2015 IOWA II ,'Offic of Driver eof l Iowa Transportation, IoweDepa Department r Name: Sharif, Mohamed Ali DL/ID: 450AF6378 c''