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Home My WebLink About15-174VIII h a ®4 CITY 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) 3. Contact Information (RE IDENTIFICATION NO. (Office Use Only) APPLICATION FOR TAXICAB / 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 First Middle 4a. Chauffeur's License expiration date (REQUIRED) 6 I ( —0 Z b. Taxicab Business Name (REQUIRED). A n (y^ ,-.-y� TQ x ; cc 5. Prior experience in transportation of passengers' ear r.>t 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this Statenor else re? _. e,5 Type of offense Where When I LS UO'WI'-+—'c II!�bt.$H 1� SS�a,a -1 AJLj WCt C. 1 /'2-3' Z a0�Alfird {6-i: r.ab-..ID%F4 f'T4l�Ory T CN 2.V2IRUtY C /flP.l 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? UpS Scat 13ep �,„ .�p� Type of offense Lw ew ff V4kere When _ vlPad S �A:r'a 7ohn<� G S•x.tzoi<I plead P It 4n ,.3 (• �z•st•m,l �^.�:h.a to the charge? (Circle one) I_..,, Cit. Convicted Dismissed Deferred T. 9.2o,l Plead lh2b•2ed Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? 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) I 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) 02/2015 J APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 2.J X0116 - a that I have issued to me �y the Iowa Department of Transportation a valid Chauffeur's license number �- C; Z.5 6 issued on :�_ expiring on G f 0 Zo23 . I understand that if I falsely answer drry questions in uD� op cation, 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 ApplicantDate STATE OF IOWA ) COUNTY OF JOHNSON t Subscribed and sworn to before me by Y r 4,kgN7 l'. �ohg more & on this ��day of ° Q S A ;-ko 1S c in and for the State of Iowa '1 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). Expiration date of Chauffeur's license o�q I Q IZGXS .1i L - Signature of Policd Ch' f or designee Date 0 AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN 109M CI-jj! FOR 44 MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. * -; U'7 ?/_ y // //� rte. O MSignature of City Clerk or designee D to � � / cn tia Office Use Only Approved application DCI report State certified driving record Website update cierklrAXIDRNBADGEAPPL92014 mendal Doc 0312015 Iowa department of Transportation !' OfHce of Uw*w Semces�i ;`fall f rr,y1 IjV 1421 F So.. 3204, ;.jl- F 9��+:+:0+:,, ;A WS 8264 51` 1,4 rr.2-i 1 -AX ralr- 2+a 1fi7 Certified Abstract of Driving Record Inquiry Date: Name: Address: City/State: Mailing Address: Mailing City/State: Convictions 8/19/2015 DL/ID #: Mohammed, Class: Barakat Fageery JUR t1� 1287 SWISHER ST Audit #: S92 Issue Date: IOWA CITY, IA Expiration Date 522451592 07/25/2012 S92 Endorsements: PO BOX 342 Restrictions Date of Birth: IOWA CITY, IA Sex: 522440342 435AF8256 (IA) D 8831490 02/10/2015 06/10/2023 3 NONE 6/10,/1971 M History Information Customer #: ID Status: DL Status: CDL Status: CDL Cert Status: CDL Med Status: Restriction Supplement: 5626613 None VAL None None None None 0 C C1 iV o Citation Date Conviction Date ACD Explanation County JUR t1� 12/31/2011 05/01/2012 S92 Speed Johnson IA 07/7.0/2012 07/25/2012 S92 Speed (10 mph & under in 35-55 mph zone Johnson IA 05/24/2014 06/13/2014 S92 Speed Johnson IA 06/03/2014 07/09/2014 IF04 Seat Belt Violation IJohnson IIA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 10/06/2013 763347 IA Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 01/06/2015 02/05/2015 D51 Non -Payment of IA IA cnild su ort Name: Mohammed, Barakat Fayeery DL/ID: 435AF8256 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: '; 0' T 8/19/2015 Office of Driver Services Iowa Department of Transporation Name: Mohammed, Barakat Fageery DL/ID: 435AF8256 ^, _ O ..e. O U1 u? Aug. 14, 2015 4:45PM Div of Criminal Investigation No. 3168 P. 6;7 Fr., �.�,�-i,y U, �Uwn ia,y CI BYrc venae a,a sbesp ay/ OE/Y3/2UY6 13:66 R2Og p,002/002 6 1iln nae T-Jjg0q ReCOI'>. (.[tock I e( Flcsf Fo riib DCI Account dumber: To: lows Division of Criminal 11l'VIG9110on IifappGiablcj 5upporfOperationsflureau,il'Maar Frun7: Cif ofluwaCit' 215 E. T" $tree! City Clcrlt's plfice Des D4o1neS, lova 50319 410 E. Waslling(on 5Qeet (515) 725"6066 -- (515)'72;-6080 1+ax]gwLd- t IA 52240 Phone: _ 3i9-3sG-4041: =; a 319-356-5497'~ Fax: n r ues(i1 an ]o,'a L'rilninal i]istay Record Cbeci on: r n `o 131 Raan7e Gnandetory) Tir3f NgMe (anaodalc -'�t IIdajEalll{ recEnnnd) _ aoctat security Number (acoommenava) 61161 a ,1�--' dFmale f�[� ry Jl enever ble, peraflon: Without a signed waiver from the subject of Ude request, a complete criminal history record me- nal be releasable, per Code of Iowa, Chapter 692.2. ror co— th esu criminal history record mpleteaeion� ed b1. law, rd Mva),a obtain a waiver si nrmrc from the sub ect of the request, Waiver fl eleose.1 4'tla "— — Invenigedon(DCi). Any crimi,bi Ili$, crmission for^),In3me ma9iscmainlai doffl y1�)ewiduca mlowe criminal Lismry record ehcCM ,villa Nc Division of C'linlival ry dole e6nee ) DCI may ac 111tUal as allowed by AV ff/ai ner Signafnre; _ f IMIlla UriIhi is�or $seat d �heclt Ede§aFts –` — As nf__ � � a search of the provided name and date of birth revealed: Nn lutia Criminal )lis(nry Record found with DC] mac, ]nwa Crilnunal Hishu-)r Record at(aehed, DO tl S DCI initials c: Received Time Aug. 13. 2015 1:46PM No.5499 0110 nae amyl I., Aug. 14, 2015 4:45PM Div of Crlr6nal Investigation No. 3168 P. 1/1 IOWA CRIMINAL HISTORY DCX 00954934 i - MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2015/08/14 DCI:00954934 NAME: MOHAMMED,BARAKAT FAGEERY AHMED DOB SEX RAC HGT WGT EYE HAIR SKN POP 19710610 M B 509 150 BRO BILK DRK YY ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD **+ 01 ARRESTED 20120423 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA706.2A(2)(A) DOMESTIC ABUSE ASSAULT o_ TRKt: 1A00E5U01 COURT DISPOSITION_',c AGENCY- IA052015J JOHNSON CO DIST COURT f'3 •'-: fV COUNT NO- 01 IA STATUTES IA700.2A(2)(A) rn y DOM98TIC ABUSE ASSAULT 'A COURT CASE ID; 06521 SMSM089571 +- G+5 CHARGE CLASS: MISDEMEANOR CONVICTION $" Gl TRK{; 1A00E5U01 SENTENCE DISP EFF AAT DEFERRED JUDGEMENT $65 CIVIL PENALTY 20120730 PROBATION lY 20120730 COMMUNITY SERVICE 30H 20120730 FINE $500 20121210 REVOKED 20121210 AN ARREST WSTHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINEP 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 OP FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS / 1(� BASED ON INFORMATION FURNISHED, WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTICATION