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Home My WebLink About15-1651111E CITY OF IOWA CITY 410 East Washington Street C _Iowa. it, �otya 52240-1826 \. (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) . IDENTIFICATION NO. r:5-- ✓ i (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 First 2. Address (REQUIRED) `Z jaF wH;52ERXVIVB' RQpW f)p ,,u/stc ; Ty 11) S99141) 3, Contact Information (REQUIRED) Email: Cell Phone: 3 (9— .3�T 5,9 (All writte6 communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) ) 1 /SOX b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere?_ 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? Lo 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? A20 Type of offense Where When ti 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please proviei e(s) Wcz DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STaIf Fly'aD DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE qi Ri You must apply for an individual Department of Criminal Investigation Report (form available ui regire t). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 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 �r qR r{(J issued on p / 0/ expiring on O o O. 1 understand that if 1 falsely answer any questions in this application, that this app ication may be denied. I gre 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 ofApplicant ��[, tl? Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by 14hAA N . tI� �'� r' '< in on this V1 day of of Iowa '1U 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)).. Expirati n date of Cha feur's license A`Z 17 �5 Signature o Police Chief o esignee Date AFTERAPPROVAL 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. AignatuyAreerkesig /' 5 Date ClerrfA IDRIVBADGE PPL92014amended.Doo 03/2015 N O I ##*#**#****Uy x J Office Use Only Approved report DCI repo State certified driving record Website update n> ClerrfA IDRIVBADGE PPL92014amended.Doo 03/2015 4�0 10WA00T "MART"? ggip �t -� r w ��{yry 11 �, vvWxVio adot.gov di§sM li-F(i.,ISO.t..tI Ito �TOi+a�n 4.RRIE.r Inquiry Date: 8/11/2015 Name: Abdelrazig, Abdel Rahman CDL Cert Status: Mohamed Address: 2442 WHISPERING Restriction MEADOW DR City/State: IOWA CITY, IA 522406805 Mailing Address: 2442 WHISPERING S92 MEADOW DR Mailing City/State: IOWA CITY, IA 522406805 Convictions Office of Drives Services PO Box 9204 I Des Morriss, IA 50306-sP204 Phone. 515-244-3124 1. 80[-532-1721 i far._ 575-.239-1837 www.IowaQol..gov Certified Abstract of Driving Record DL/ID #: 214CC9840 (IA) Class: D Audit #: 8537734 Issue Date: 10/16/2014 Expiration Date: 01/01/2020 Endorsements: 3 Restrictions: NONE Date of Birth: 1/1/1956 Sex: M History Information Customer #: 4313828 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: IA Citation Date Conviction Date ACD rs*planation Count,,, JU-R 12/23/2011 .01/03/2012 592 :Speed -3ohnson IA 11/12/2014 '11/25/2014 S92 Speed (10 mph & under in 35-55 mph zone) '.Washington IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident nate Case Number di.IR 10/14/2011 653163 IA 09/08/2012_... .702582 _.. IA ... 04/20/2015 .855323 _... _.. IA. Name: Abdelrazig, Abdel Rahman Mohamed DL/ID: 214CC9840 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: Name: Abdelrazig, Abdel Rahman Mohamed DL/ID: 214CC9840 8/11/2015 IOWA.' D. 0. T.;"r 9f $ Office of Driver Services 8A Iowa Department of Transportation Name: Abdelrazig, Abdel Rahman Mohamed DL/ID: 214CC9840 Aug. 10, 2015 12: 35 FM Div of Criminal Investigation No. 2626 P 1/1 c._...._.-, ,.. _.., Ctcr.. v.— .. 00/07/2016 1d:.,._, Nle.—Zv 002 STATE OF IOWA *EO"�v I'l- itlinal History P�eetl:rd Check �, 'Requesi Form 1'u: Icv a Division of Criminal Investigation Support Operations Bureau, i" rinur 215 L. 7" Street lies Moines, Iowa 50319 (515)725.6066 (515)'725-6080 Fay: TS vtl I•eell(ffi1iAe ] 7pwa Criminal Nicini, Rnrnrrl DCI Account Naroher: laity Clerk's Office 410 L—Washington SLlroel---"-_• --- ---- Foca CiIZ lA $ Fo2240 Pbobc: 319-356-5041 Fax: 319-356.5497 — - Last )vain¢ (mal;dalory First Name (mandalory) hflddle lvame 0loninlcnded) Date ski �lk'tb (man leryj Gender(mandatory) _ Social Securiq umber (t,mminw,d) 01 1G 151 6 fnMale ❑Female )-4 Waiver I1for7ttat'iorl: Without a signed waiver frons the subject of the request, a complelc criminal hislory record may not be releasable, per Code of lows, Chapter 692.2, For complete criminal history record information, as allon•ed by 1mv, always obtain a waiver signature from lbe subject of the re west. Waiver Release: I hereby give permission for the Above requesting official la conduct an Iowa criminal history rcco,d ebcck a n) the Division or Criminal tnvesligatiom (1)C1). Any criminal hissap delA cnncemimg me Ihal is maiweiued Dy u,n DCt may be released as allowed by law. WaiverSipiature; � 10wa Criminal History Record Check Results As a search of the prat,ided dame and date of bink revesleq:- Nu Jbwa Criminal Hislovy Record found with DCI rr�" UI" .—{ .. )owa Cllllllllal 1-hstcl)' Record al(ache.d, 1)C-) DCI -77 Received' Tine Aug. 7. 2015 2:25PM No.4908 (L)CI use only)