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Home My WebLink About15-201IDENTIFICATION NO. is —2-01 i (Office Use Only) Y�-OMNI APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m, to 3 p.m., Monday - Friday) 410 East Washington Street Iowa City. Iowa 52240-1826 Failure Or" )p ete the "re uired" in v 1 will result in denial of the application (3 19) 356-5040 (319) 356-5497 FAX C \\ First v \ Las 1. Name (REQUIRED) ( a A v�1u yr 2. Address (REQUIRED) j Z S �) A �� ev S'[' /3 wG �� ZZc+ri 3. Contact Information (REQUIRED) Email: b I co(y3a (9 61 vr14i1 Cell Phone: --34 2-3 (All written communication sent via email) _ 4a. Chauffeur's License expiration date (REQUIRED) _� 6 Q Zd 2- o b. Taxicab Business Name(REQUIRED) ( > YYlI�t�C'�irv, 5. Prior experience in transportation of passengers:1°(�t S"' ` ro — 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this StaterAor else rvre? eS .v i e N M b'on r- fZI211L � � r l J 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? La p� �t tkk LwQo&;� Type of offense SIkKere - 6d Z0' �— v Qad "� P3okn+en C. �-9 When 52.I.zoi�l -pttad St.* $t(i J nlvyet Z 3l 1 1 T- 4-2-11 4qd drd ptead 5 IIda• T.1,a What happened to the charge? (Circle one) i C.ty -1 o x T 11.16.2011 ( d <.ad"W 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 _ r NU_Y1,�t-_J_C�wINYA� Sd\J,0, t I //_ -2 r --L 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) I r „ 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 )57 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 2j 1611 5 /� that — I have issued to me py the Iowa Departm(Int of Transportation a valid Chauffeur's license number 3J q z- j 6 issued on expiring on G0612,o2Z . I understand that if I falsely answer any questions In V 11 dpNucauon, 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 Date D f 2U I S STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed andel sworn to before me by \��k \ O� \Smrnp on this atm day of s� I� cin and forthe Stateaf Iowa 17 ********k*k*******#*k****£******k****k*****k*kkh********kk#*k***k****kk*#k#*#*k******#k##********}##*#*********kk****k******#k**#******k**#***** 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 OIQ 11n IZ Signature of olic Ch' f or designee bSZc)tf5_ Date 0 AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN I,p CI� F011 MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. - cz Signature of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update to -C tv Dif to cn va QerM/rAXIDRIV9ADGEAPPL92014amended.DOD 03/2015 Iowa Department of Transportation CAW00ce of Dry 3tryi-m (Toll F rn) WO -552-1121 PO 9M 4204, Des 14010tm,1+t Fw31M 9204 515-244-$124 F,A 515 239k 1837 Inquiry Date: Name: Address: City/State: Mailing Address: Mailing City/State: Convictions Certified Abstract of Driving Record 8/19/2015 DL/ID #: Mohammed, Class: Barakat Fageery ]UR 1287 SWISHER ST Audit #: VAL Issue Date: IOWA CITY, IA Expiration Date: 522451592 07/25/2012 S92 Endorsements: PO BOX 342 Restrictions: 05/24/2014 Date of Birth: IOWA CITY, IA Sex: 522440342 Restriction 435AF8256 (IA) D 8831490 02/10/2015 06/10/2023 3 NONE 6/10/1971 M History Information Customer #: 5626613 ACO ID Status: None ]UR 12/31/2011 DL Status: VAL S eed Johnson CDL Status: None 07/25/2012 S92 CDL Cert Status: None IA 05/24/2014 CDL Med Status: None 5 eed Johnson Restriction None 07/09/2014 IF04 Supplement: Johnson cs ^_i cr Citation Date Conviction Date ACO Ex lanation A x'" Coon ]UR 12/31/2011 05/01 2012 S92 S eed Johnson IA 07/10/2012 07/25/2012 S92 Speed (10 mph & under in 35-55 mph zone Johnson IA 05/24/2014 06/13/2014 592 5 eed Johnson IA 06/03/2014 07/09/2014 IF04 Seat Belt Violation Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Sanctions Type Effective End ACD Explanation Occurrence IUR ]UR Suspended 01/06/2015 02/05/2015 051 Non -Payment of IA fA Child Support Name: Mohammed, Barakat Fageery 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. 8/19/2015 IOWA`3 0. D. T Office of Driver Services Iowa Department of Transporation Name: Mohammed, 6arakat Fageery DL/ID: 435AF8256 n� d Cil U"J Aug.14. 2015 4;45PM Div of Criminal Igvesfigation N'c3 16 8 P, 6/7 Flu. u, —i+y -n i11wn in,y Clern . ....... 09/13/2016 13-5e OROS N,602/002 STA Th OF IOWA 6"1-ilrl�l-fat �-�iskory I�ec:ol`d �.'€Jee[� � L�, � r �, }Jq Social Sectlrih' Naln6er h~` LO�Mln lI alVeble,eCodefIowaa signed waiver frons the suhject of f , reques ,a lete criminal history record may nos be releasable, per Code al Iowa, Chapter fi92.2. %'m• co_mnlele�riminal history record informaeion Yed h), lam- w a ay obtain a waiversi nclurc from ILcsub act of th0 re nest. Waiver Release, ldc,eb `� ---- Invetlieatio0' yg10 n Pcnn+ssien for lbe above rtque5ling official to conduce m I ( �i) An)' niminbl hiSlory dale cUucenliug nit ll Is Yni+ 01°B criminal Li5lary ,CcolA ehttA w nniued by�A U\CI may be rneasvl ys allorvcd by Inw. �� N° fh°inion of Crinlival r�/aII+L✓Y SIF/nnlllrn/. �` Iowa E raninal Histor Record Check Resuits AS Gl nx ongl -��& search of the Prov+ided name and dale o(IiCl f birlh revealed: > b Iowa Criminal 14i8lmy Record libund wil)i DO s lnwd C;'riminal Ijis(orq Record attached, liC'f � � � �.1r DCa inilial5 vc1-77(08/25i10) Received Time Aug. 13. 2015 1'46PY No. 5499 M1 Acoounl Nnnlber: Iowa 11il'i:fon of'Crini ilial In l'es ljga tiu 11 orappl;cabtc) S'apfl011 Opera(kins B uresu, t"I+ioGr I'1 on1: Cil Ilf IawSCif 215 E. 7" Street Dec Mo{nes, Cify C'Ic�kse Iowa 50319 41011. Washing(oo Street {515) 725.6066 --- (515)''125-6080 l+ax - louaCtly,lA 52240 1`11011)6!_ 319.356-5041 C3+,^..r .nom. ------- 319-3— 56-5497 Fax: nre ueslhl - t1_ kin Iowa Criminal (lislay Record Check on: aft Na)— a (,nsn1,cry) tem C:) ~` - ;g a s" Q .. Tirs(lYame (Inandelary) --�---_--�. _ ..-.. —J--+'+a--__---—` IVettl�:le bum,f�A) dIEUl Social Sectlrih' Naln6er h~` LO�Mln lI alVeble,eCodefIowaa signed waiver frons the suhject of f , reques ,a lete criminal history record may nos be releasable, per Code al Iowa, Chapter fi92.2. %'m• co_mnlele�riminal history record informaeion Yed h), lam- w a ay obtain a waiversi nclurc from ILcsub act of th0 re nest. Waiver Release, ldc,eb `� ---- Invetlieatio0' yg10 n Pcnn+ssien for lbe above rtque5ling official to conduce m I ( �i) An)' niminbl hiSlory dale cUucenliug nit ll Is Yni+ 01°B criminal Li5lary ,CcolA ehttA w nniued by�A U\CI may be rneasvl ys allorvcd by Inw. �� N° fh°inion of Crinlival r�/aII+L✓Y SIF/nnlllrn/. �` Iowa E raninal Histor Record Check Resuits AS Gl nx ongl -��& search of the Prov+ided name and dale o(IiCl f birlh revealed: > b Iowa Criminal 14i8lmy Record libund wil)i DO s lnwd C;'riminal Ijis(orq Record attached, liC'f � � � �.1r DCa inilial5 vc1-77(08/25i10) Received Time Aug. 13. 2015 1'46PY No. 5499 Aug14, 2015 4:45DM Div of C r l m I n Iovestigat'uo o 310 P. 7/7 IOWA CRIMINAL HISTORY DCI 00954934 MISDEMEANOR CONVICTIONS ONLY PAGE 1 OF 1 DATE PRINTED - 2015/08/14 DCI :00954934 NAME: MOHAMMED,BARAKAT FAGEERY AHMED DOB SEK RAC HGT WGT EYE HAIR SKN POB 19710610 M B 509 150 SRO BLK 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 TRK#: 1A00E5U01 COURT DISPOSITION C= n AGENCY: TA052615J JOHNSON CO DIST COURT C"5: IV �. COUNT NO- 01 IA STATUTE- IA708.2A(2)(A) DOMESTIC ABUSE ASSAULT COURT CASE ID: 06521 SMSM089571 CHARGE CLASS: MISDEMEANOR CONVICTION -- TRK#: 1A00E5U01 tin SENTENCE DIS? EFF AAT DEFERRED JUDGEMENT $65 CIVIL PENALTY 20120730 PROBATION lY 20120730 COMMUNITY SERVICE 309 20120730 FINE $500 20/21210 REVOKED 20121210 AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED 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 OF 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. /1�J' DIVISION OF CRIMINAL INVESTIGATION