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Home My WebLink About15-250CITY 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. /5'0�5� (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 , I . Middle i Last 3. Contact Information (REQUIRED) Email: 4a. Chauffeur's License expiration date (R b. Taxicab Business Name (REQUIRED) clstw C. I-rr c ,A i � Yvtcs IEe�PhQne: 3 j� (All written communication sent "a email) � 5. Prior experience in transportation of passengers: r r-, '--/n C 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? ti( 5 Tvpe of offense Where When l)oMt-�3 Nes Mo,'n s D -0D9 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other . / 5 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When J—U-/4 What happened to the charge? (Circle one) _ Convicted Dismissed Deferred Suspended Plead Guilty EOther�n 7-) n 8 Has your driver's license or chauffeur's license been suspended or revoked in the last five yep sr� _E Type of offense Where Oh' n rr- - L, 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prdvide th4*Pame(s) 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) 0212015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department f Transportation a valid Chauffeur's license number Z i 1?3i2 r,bt �_ issued on a�ai �xpiring on c _e•cfi _2e 1 �I understand that if I falsely answer any questions in�is application, that this application may be denied, 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 Furth 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 22 Qf the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date /Q _ o (-A S STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by M �� J ; n �� • S a l t v� e� on this day of C�tA,L,,,- ot"i . Nbtary R}iblic in and for the State-bf Iowa **hk**k*#*#********k*****##******kk**k###**#**frk£##*#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). license ah z or designeeDatd 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. Signatu eof City Clerk or designee le/rte//-x Dat Office Use Only Approved application co .. fs DCI report r) - State certified driving record Website update N) r"a r3l CIziWT MRIVEADGEAPPL92014amended.DOC 03/2015 Oct, 9. 20159:45NM D l v c Criminal Investi€ation No. 8200 P. 1!1 Pr_ .,—, — ..a .— --y cion. — — ,J..... -- 10/07/2018 14:.-, J29:a x.--2/002 STATE OTIOWA € Cr tininal History Record Chf,,ck 0�=�°' Request Form DC1AccoimtNwnbel; (lf applicaLlc) '� To: Iowa Divisiatt of Criminal lnveselgstion From: Cic)�uYlnwa Cicy _ support Operations Bureau, 1't F1G o1 Cip4 c='lerk's C1iGce — — "- 115 E. "7"' Sivect 310 E. W shingtorl 5trege Des Moines, Iowa 50319 (515) 7241-6066 lown Cit • IA 52250 15j�ye_6•(tNYt`E�aa :�]A S2, 40 --- Criminal Hate Of )ail-tla (,nanJator)') (:!) % - 5 c-}- Phone; 319-356.5041 ra x: 319-356-5497 Record Check on ase lyame Onanaatop•) __ i v1 RICA" (mandatory) ®Male ❑Female die Name 1\—A C t,\r--� C` W'�— C. N W(Iivv'Iqf0J'Y?ftfi0IV Without a signed waivel' from eke subject of the regucsl, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For complete criminal history record luforillaliou, as allowed by law, always Obtain a a•aiversignature from the subleet of the r2mwn t Waiver Release: t ncrcby 0'ePcimi350n for the Above rcquEsfl,E ofr"c=al m nAvcr an lova crimbial hisiary rcooid check wiAr the Division of CrLvi,l brcespgstim, (DC). Nry uiminel hinop� date conccming me that is mxintaj'IM by the C7 may 6c released as allowed by law, YYaiverSign(Ils{re:__ ( Q. 101ra Criminal IIistor r Record Check Results —F70ci t'« muy) As of a search of the provided name and date of bir(h revealed:-,: t ' Z. cn No IOxva Criminal History Record found with Del lova Criminal History Record attached, Del t, - Q 41:7 Del initials 'UAL, DCI -77 (08/25/10) — �✓ — �— — -- — RBCEiveo Time Oct. 7. 2015 2:38PM No. 9697 Ae Q i�do.ou s�ttaRT�� I =Err=�i.�:F I c�srro��€� _� RItiEv Office of Driver Services PO Bo' 4204 Des Moines. iA 50:108-9204 Ph-,ne:515-2:W-9124 { 80Rr632. 021 I Fnxt 515-235-1837 www. inwadovgov Certified Abstract of Driving Record Inquiry Date: 10/7/2015 DL/ID #: 137BB0959 (IA) Customer #: 4102089 Class: D Name: Salih, Nagmeldin Mohamed Audit #: 6175614 Address: 2548 INDIGO DR Issue Date; 08/01/2012 Expiration Date: 08/04/2017 City/State: IOWA CITY, IA 522406808 Endorsements: 3 Mailing 2548 INDIGO DR Restrictions: NONE Address: 07/26/2011 Restriction None Mailing IOWA CITY, IA 522406808 Supplement: City/State: None DL Status: Date of Birth: 8/4/1967 None Sex: M History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: Explanation CDL Permit None Endorsements: 07/26/2011 CDL Permit None Restrictions: IN ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation County IUR 11/28/2010 07/26/2011 S92 Speed IN 07/18/2014 07/25/2014 S93 Speed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number IUR 07/18/2014 808533 IA Name: Salih, Nagmeldin Mohamed OL/ID: 137660959 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: Salih, Nagmeldin Mohamed DL/ID: 137880959 10/7/2015 Office of Driver Services Iowa Department of Transportation