The URL can be used to link to this page

Home My WebLink About16-018� r i CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) IDENTIFICATION NO. II � G I � (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 v^� 3. Contact Information (REQUIRED) Email: ((Uzynav 06 V\ k G:i Phone: 30 (01( 73 i l (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) o S (('T f 2- 1 -7 b. Taxicab Business Name (REQUIRED) CCc, 10 5. Prior experience in transportation of passengers: Jrti )o SS 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? W o Type of offense Where When 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? vJ O Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Qther I- 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? — V,/ O Type of offense Where When m 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please proyide'the%me(s),,,.1 '-- DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED l DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW CD You must apply for an individual Department of Criminal Investigation Report (form available upb request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 02/2015 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that 1 have is_gued to me by the Iowa Department of Transportation a valid Chauffeur's license number 14t t-_ _n Ys issued on i 12A 2- expiring on A 117 42,17 . 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 Date 1I 21�1 I I I, STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by IM ',�So P on this day of Notary Public in an r the Sta a of Iowa r,..nmi�eiM1 Capev� **#*****k*****#***kk*h##*#k******************kkk******##k***k***k*************k*#*##****k*k***#******k**k*******k*******#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 Chauff is license Signature of Police Chief 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. ign re of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update /A,1L/ Date eien✓rn IDRNBADceAPPr92m4amende Doc 03/2015 m ca u eien✓rn IDRNBADceAPPr92m4amende Doc 03/2015 q01UVUA00TSPOARTER i `f 4PI=F I CULT()`, EF DRIVP! VtflldLV.14V1f�Cl{}t.0 tiV Office of Driver services PO Do,9204 Des Moines IA 5030c-92�}.4 Phore-,15-244-9124 1 00-532-1121 I Fav: 515-239-1A37 v.-Arw ov/300Egov Certified Abstract of Driving Record Inquiry Date: 1/29/2016 DL/ID #: 144AC2108 (IA) CDL Permit Class: None Customer #: 5262644 Class: D CDL Permit Issue None 10/22/2014 11/07/2014 S92 Speed (10 mph ✓9 under in 35-55 mph zone) Date: IA Name: Saeed, Khalid Azhari Audit 9: 6182099 CDL Permit None Mohamed Expiration Date: Address: 36 ANISTON ST Issue Date: 08/03/2012 CDL Permit None Endorsements: Expiration Date: 08/17/2017 CDL Permit None Restrictions: City/State: IOWA CIN, IA 522402216 Endorsements: 3 ID Status: None Mailing 36 ANISTON ST Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522402216 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 8/17/1983 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/26/2011 09/19/2011 S93 Speed Johnson IA 10/22/2014 11/07/2014 S92 Speed (10 mph ✓9 under in 35-55 mph zone) Linn IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 01/17/2015 840606 IA Name: Saeed, Khalid Azhari Mohamed DL/ID: 144AC2108 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: .......... !irI4 1/29/2016 IOWA D. 0. T.; ' / ®f111E6 . � Office of Driver Services Iowa Department of Transportation Name: Saeed, Khalid Azhari Mohamed DL/ID: 144AC2108 FJan, 26. 2016° 9 51A1 C o — 01/22/mole 13: DivCriminzl Investigation Nd &3a 6f179 1!32 O02 STATE OF IOWA lowsCriminal HistoryI Record Check Request Form 1144; To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 I;. 71h Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6000 Fax DO Account Number; '-I-C O .2 - F— (Ifapplicablc) From: Clty of Iowa LLEY — City Clerk's Office 410 C. Washington °free[ Iowa City, IA 52240 Phone: 319-356-5041 Fax: 319.356-5497 A z�nG mo kill i, Di( o f Iq 3 I_ 1%male 122,3- 9C,- 51 rraf Pei' DIJOPMal101V Without a signed walver from the subject of the request, a complete criminal hislory record may not be releasable, per Code of Iowa, Chapter 6912. For complete criminal history record Information, as allowed by law, always Waiver neiea$e: I hereby give permission for the above requesling official To conduce en Iowa erielinel history «cord check nigh The ()IV15i0a of Criminal Invaligalia, (DCI). Any criminnl hisTory data concerningme ills. is maintained by the VCl may be reteesed as allowed bylaw. Waiver Sienatare: Iowa Criminal History Record Check Results r' cr, As of q a search of the provided name and date of birth revised': No Iowa Criminal History Record found with DCI o y y. r - El Iowa Criminal History Record alttached, DCI # DCI initials J xt DCI -77 (08/25/10) Received Time Jan. 22. 2016 12:36PM No. 5e 68 L_ N N V —1 (orIse only) .�r11 c cr) I D