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Home My WebLink About15-199moi• M�®�®1l CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO IS -09 (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 Middle 2. Address (REQUIRED) :7 (1 1 A y ka f V_C. (q o �f c,J!, 3. Contact Information (REQUIRED) Email: ch .�y. j r r go�It rfi� C{ ;w.a 4 j ,rte Cell Phone: 3 (AII written communicatiovia email) 4a. Chauffeur's License expiration date (REQUI b. Taxicab Business Name (REQUIRED 5. Prior experience in transportation of passe ,.v2 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? ti (-I Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guil / Other Have you been arrested /charged with any traffic offenaaa in thelast fiPars? 1 t 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? Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pro LtlCjhe We(s3 rO DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATEZ4RTIFIV�,D DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHt-E)AREkS�fEW You must apply for an individual Department of Criminal Investigation Report (form available upon request). Ro (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify tat I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 5 1 � h (01c) l.4- issued on 'J.9-;, , I 4expiring on of t_ +�_ I 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 <—_.,..,,_...._ ,i. --� Date -os STATE OF IOWA ) COUNTY OF JOHNSON ) and sworn to before me by nN a,Z - Ll Ci C : ;0.L on this _ day of S.MAYER Public in 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). Expirationtoo hauffeq�license � 1Z 1/ or designee g/71/r . bate 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. ///Q �J 9or �igna@ure of City Clerk or designee `?/3 // 5 Date fly Office Use Only `^ Approved application Ll Cj $� DCI report Gr— State certified driving record Website update 0 fs ClerkRAXIDRVBADGEAPPL92014amended.DOC 03/2015 C4,1UVVA00T wpm iloadot,v 4hr",PARTER 9 5!'.Fi ?-;, 1 GuSTCtr,T..9 ;iRIli f' Office of Driver Ser Vices PO 6014'3-04 ; Des Mo nes.. IA 5030.6 9204 Phone: 615 244-9124 1..0}532-112111Fax: 5.15-239-1837 www _Iawado..aa'r History Information Convictions Citation hate Conviction Date Act) Explanation County IUR 09/17/2011 10/10/2011 S92 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. :%cckl mi Gare Case Number JUR 10/31/2010 _....... 599546 In 01/31/2015 --- - -- 842701 - IA Name: Elawad, Moiz Sayed DL/ID: 315AE6704 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: Certified Abstract of Driving Record Inquiry 9/3/2015 DL/ID #: 315AE6704 (IA) COL Permit Class: None Date: Customer 5460751 Class: D CDL Permit Issue None #: Date: Name: Elawad, Moiz Sayed Audit #: 9187339 CDL Permit None Expiration Date: Address: 701 ARCH ROCK RD Issue Date: 06/20/2015 CDL Permit None Endorsements: Expiration 01/02/2019 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: 3 ID Status: None 522452700 Mailing 701 ARCH ROCK RD Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522452700 Status: Date of 1/2/1969 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Convictions Citation hate Conviction Date Act) Explanation County IUR 09/17/2011 10/10/2011 S92 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. :%cckl mi Gare Case Number JUR 10/31/2010 _....... 599546 In 01/31/2015 --- - -- 842701 - IA Name: Elawad, Moiz Sayed DL/ID: 315AE6704 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: �eP. z. Lull 1v,tIn1V1 UIv 0 l,riminaI InvestigaIior neo. IU81 P. 1/15 Fro M:Clly al IOWm Clty Ctbrlc D11IC& ale 3e55asa7 08/31/2015 16.4u -261 r.v�a/002 AM d_'J"rnifflhl T-distory Record Clw(,,k P2eglfcs€ Fol -111 Te: In1va DiV1 un 61'C., riminal Invesllga(ion Soppurf Opermiuns 13urca u, I" Floor 215 li. 7"' tit rec l Ues Moines, lota'a S(1319 (513)726.6066 (515) 725-60bo rax 6 vJ C4 e 01.2. 1)(;l ACCprint lslurobE'r; .r `1tCaC7d - r tifayplicablc) From: City C:lerL's [)!lice 41 U k. Washinptun 3Dtet ` — luwa Cite, tA_52240 --- ---,--•'----- Phone: s19-336-5041 Fax:319-356•Sd97"'___�_— --- 2Male ❑Female Sa-11�ej vI-76'.647 Waivei fitforrrrnffonr Willioul a signed m alver from the subject orthe request, a complete criminal h!slory record map not be releasable, per Code of lows, Chapter 692,2, For camMe(e criminal history record InformaUon, as allowed by law, elWays ubtaial a waiver sf nflure from the sub'ecl of the reauesl. M/nfver Releas,e: I hereby give permission for rhe a6 4 Inaestigalion (DC)) ary ujminel histo dale a ova requesting official to conduct an larva crnninal IM16fy .Mid elrock ,rill, 0e pirisi u ry Wlecnring nlc that is "mintallrod by IIIc DCI may be relcascd as allowed by lacy, on f Criminal Ti'nrverSignnture��- • "'" "" Iowa Criminal 14istar. ' Rec(JrdWCheck Results — _ se81'Ch of Me, provided name and date of birth re B led: i No lolva "'ll sinal History Record found with DCI u; 7 —moi= li ❑ Iowa Cri111inal History Record attached, l)(_'.J # z '' . llC9 ulilyds• �_- 00 -77 (0/251H)) - --J ----- -------- - - Received Time Au e, 31. 2015 4:32PN Rio 6939