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Home My WebLink About15-241CITY OF IOWA CITY 410 Cast Washington Street Iowa City, Iowa 52240-1826 (3 19) 3S6-5040 (319) 356-S497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 1 �S � c7 q 1 (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 2. Address (REQUIRED) [ (� 44 A 1 � 2 7 � � / ' 3. Contact Information (REQUIRED) Email: , n (]� � _ , iTvr yam` Cell Phone '� - �'t� - 5 1 Q '( All written co 1Lr tion sent via email) 42. Chauffeur's License expiration date (REQUIRED) - [ ? ( (r,' 1 2 o I � b. Taxicab Business Name (REQUIRED)_,,} 5. Prior experience in transportation of passengers: A , _ °1V\ nw y 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? A-))4— Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Have you been arrested i charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where Other 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 fivee �-- y afS.. ,'&, Type of offense Where -� o 7 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provid-e',the I-Me(s) A 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 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by P the Iowa [Department of Transportation a valid Chauffeur's license number issued on '1 I'" expiring on !21151 A1C I understand that if I falsely an wer any questions in this application, that this app ication 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) a Signature of Applicant ( t° } DateJ_41�� 0� Y STATE OF IOWA ) COUNTYOFJOHNSON ) upscribed and sworn to before me by �� R A- �n 1k� , on this a day of � 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 Cha eur's license 1� d l S o L S Signature of olice Chief or esignee I Vale 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. 6I91` e of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date t«i? Clerk/rA%IDRIVDADGEAPPL92014amendedDOC 0312015 T2 Clerk/rA%IDRIVDADGEAPPL92014amendedDOC 0312015 ��, owadotgov ;� r � �,�,a��r 9 c�3tc,._, �ei�� Inquiry 9/30/2015 Date: 12/15/2015 Customer 3602586 Date: Name: Ali, Mohamed Awadalla Endorsements: Mohamed Address: 1216 5 G AVE APT 7 Office of Driver Services PO Boy 9204. Des Moines, I.A 50.306-9264 Phone: 5155-244-91241 SGC -E32-11211 Fuc 595-235-1837 'W V`''J.4JiY3dC}t:9tJ'J Certified Abstract of Driving Record DL/ID #: 102BB0710 (IA) CDL Permit Class: None Class: D Audit #: 8411832 Issue Date: 09/03/2014 History Information Convictions CDL Permit Issue None Date: CDL Permit None Expiration 12/15/2015 CDL Permit None Date: City/State: NEVADA, IA 502012727 Endorsements: 3 Mailing 1216 S G AVE APT 7 Restrictions: Corrective Lenses Address: None Restriction None Mailing NEVADA, IA 502012727 Supplement: None City/State: Date of 12/15/1968 Birth: Sex: M History Information Convictions CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation County )UR 02/18/2012 03/20/2012 B64 No Insurance Card Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 7UR ]1/21/2012 669245 IA.. Name: Ali, Mohamed Awadalla Mohamed DL/ID: 102BB0710 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: .......... s �~r �nuu oi4, 9/30/2015 State of Iowa Division of Criminal Investigation 215 E. 7' Street Des Moines, Iowa 50319 Phone: 5151725_6066 Fax: 5151725-6080 Iowa Criminal History Record Cheek Walk-in Request Your name' 1✓ Address: 0-7 Ci /State/Zi Phone#: lq-Si Requesting an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apellido (mandatory) First Name Pr! er�Nmnbrre (mandatory) Middle Name T gsmdo Nombre (recommended) �� lavi ah? - cis �WAZfL((a Date Birth Fecha Nacimiento (mnndmory) eroof Gender Gen(mandatory) Social Security Nu her (recommended) / !c2 I / -//9b,'-7 Male ❑ Female &-- 41 G Waiver Signature bF nor Qf Hie z q/ueest is on yourself, please sign 1fOte request is on someone else; write NIA.) 1 _ °"Ust°TL}. Results tt ii As of IClal15 a name and date of birth check revealed: ,�zrNo record found o >: r• a ', M ❑ Record attached DCI # -� n DCI initials r� �1- U)nl ,y. Receipt Cn -0 7 Number of requests x $15.00 per last name= Total amount $ Method of payment: cash money order check # MasterCard or Visa _ (Last 4 digits) Cardholder's name initials DCI -------------------------------------------------------------------------------------------------------------------------------------------- Credit Card # Exp. Date DCI -83 (09/09/ 10; Revised 10/ 1 / 10; form reviewed 08/11/ 14)