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Home My WebLink About15-224��rdlll� CITY 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. (Office UseOnly) 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 Last 3. Contact Information (REQUIRED) Email: ,go d- V,2sSAme {t cqP � 6� 4a. Chauffeur's License expiration date (REQ b. Taxicab Business Name (REQUIRED) _ �� QZ.r( 0.Yt q� L -'v C 0.1,c� 5. Prior experience in transportation of passengers: 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State pr. elsevre? c: Type of offense Where �n What happened to the charge? (Circle one)i°' t Convicted Dismissed Deferred Suspended Plead Guilty `,''Other c n wa 7. Have you been arrested / charged with any traffic offenses in the last five years? 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? Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(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) 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 ---I a q a � Q q 1 � issued on 9tltxpiring on E1To I f. I understand that if I falsely answer any q estions in thi6 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 stall 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 1( 0 �S STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by1V1�x�s� , kM l ) on this / day of Public in and Number 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 Cyity,Qf Iowa CiV (Title 5, Chapter 2, City Code). license k fV 0 or designee ate 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 f City Clerk or designee Approved application DCI report State certified driving record Website update DDaa S f�J C5 Office Use Onlyq n—C 74 C`) fir' —.r $ c y. c -n Clerkrr xIDRIVBADGE PPL92014amendedDOC 03/2015 qg'vWiUVUAD0T VVVIAV, iQviidot gov -t,AARTEM1'; `""+1 L C tU TP,."r`v UR•1r:'ti Offire of Driver Services WG DoS_041 Cies k3oines,!A 5130Pr2,4 W I14nc: -1P- 244-9124 I eZC 532:1'21 i F.3'C: d3 -'3e;-t437 vawwiowadol.aov Certified Abstract of Driving Record Inquiry Date: 9/16/2015 DL/ID #: 739AJ9915(IA) CDL Permit Class: None Customer #: 6149393 Class: D CDL Permit Issue None Iowa Department of Transportation Date: Name: Khalil, Mohamed A Audit #: 8685599 CDL Permit None Expiration Date: Address: 1017 20TH AVE Issue Date: 12/11/2014 CDL Permit None Endorsements: Expiration Date: 06/25/2018 CDL Permit None Restrictions: City/State: CORALVILLE, IA 522411342 Endorsements: 2 ID Status: None Mailing 1017 20TH AVE Restrictions: NONE DL Status: VAL Address: Restriction None LDL Status: None Mailing CORALVILLE, IA 522411342 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 6/25/1966 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions CiTatkin Da ..... Conviction Date D Explanation County ..... . ,]teR 103/11/2015 Ye 04/13/2015 S92Speed - Johnson 'IA Name: Khalil, Mohamed A DL/ID: 739AJ9915 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: b•""'•: ��'/�,�y 9/16/2015 D. 0. Q,`; ....... Office of Driver Services Office Iowa Department of Transportation Name: Khalil, Mohamed A DL/ID: 739AJ9915 G.Aug, 4, 2015 3:25PM,isjV of Crlmina'_investi-at ion De031206 �No,4593,gsP 2/2UO2 STATE OF 10\7VA " Criminal Histary Record � heck v ReE]aest Form To: I(wu I)IvislOn of Criminal Investigation 4uppurl Oil aIimis Burt a It, I" %your 215 Y. 7"' gtrcel Des hi Iowa 3(13 19 (515)725.6066 (515)12$.6080 Fax 1 a)n roquestinp an of Birth 061-5(�q C6 M6rNk\-n Del' Accntuu Number: __- I-! num _)� _ --(il'epplioahlt) City C.'Ierlt's (if4ce. 4I0 L. R'ashin tun u'lrcet Iotsa City, IA 52246 Thune: 3)9-356-5041 riix; 319-356-5497 —^— OFemalc A Yn �Z-Sq 450 warmer Lirforiria/(Ott: Without a signed waiver from the subject of the request, a complete criminal history record may not be. releasable, per Code of lova, Chapter 692.2, ror comniele criminal history record inlormation, as allowed by law, aheays obtahl a waiver siBna ture fr.. rh. <I IIli M,it11,e Waiver Release:Ihtmhp glee permission rorthe aboreregriearing offeio)to eondut(a, Iowa ni 'isl hincry record check with the Division or trio InvcFliga(ior(OCI). An aiming sinal Ally 11lialory dela Coneeming me tllal is maimainad by the DCI ma be rt a e s Q 9 allowed bylaw, IG,Pva Criminal History Ree-ol-d Cheek Results---— —li--- II)Cl list Duly) As of_4 � a search of the provided name and date of'birih revealed: Lit NO, Iowa 0-1117in<al History Record found with. DC! lots'a Criminal 1-listury Record atlached, DCI i! ............ a). so �_. -- )XI IIlll18kz C5 � =� -___• _ 1)C9-77 (08/25/10) ,.. _— _.... _t...... p� .. _ _. _ ... Received Time Aug 3. 2015 11:11AM No -4449