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Home My WebLink About16-047i r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa S2 240-1 82 6 (3 19) 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED IDENTIFICATION NO. ) �` oq j (Office Use Only) APPLICATION FOR TAXICAB i 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 3. Contact Information (REQUIRED) Email: t-2clxx StxVinc�7 thy! c�i�c- gellPhone:HiQ (All written'commfunication sent via email) 4a Chauffeur's License expiration date (REQUIRED) 1 2/ L'' /3�, , v b. Taxicab Business Name (REQUIRED) 'k � �i ter 5. Prior experience in transportation of passengers. -P M u -10n 9( 6 Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? gn Type of offense Where When What happened to the charge? (Circle one) _ Convicted Dismissed Deferred Suspended Plead Guilty rpOther 7. Have you been arrested / charged with any traffic offenses in the last five years? U 0 -' Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Othery IY 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? tz 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) 1\1 v 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) 02.12015 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 2 (, S issued on &2 �z expiring on 2 2 I understand that if I falsely ans er any questions in this application, that this appl cal N. ma 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 �flr�io. ��,lr, 0,,., Date UJ ) STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and sworn to before me by t99QQL S 5 lJ pl i i mv� on this day of WEN S "S. "VSR 1 n and ld3lL.-�=�,W�..�. T2Yr26 Notary Public in fdF the State of Iowa 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 il7oJ Signat e o olice Chief or designee Date 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. Signdture of City Clerk or designee Office Use Only 3 /71aZ,5-2/,� —� Date Approved application DCI report " State certified driving record Website update ClerklrAXIDRIveADGFAPPL92014amended.D00 03/2015 Mar. 1, 21116 11:19AM Dlv e' S;rIir nal loue�i garlon il0.0110 r. I F - .. .0..— —.1 cla. .. 02/29/2ole loam 0421 v.00R/002 NATE Off'IOWA Cirimiilai History .Recop7d Cheek Request I+`orin To: Iowa Divlslon of Criminal Invesiigadon Support operations Bureau, V Floor 215 9,'7'1' street Deg Moines, Yowa 50319 (515)725-6066 (515)725.6080 Fax I am re0uestine an Iowa Liminal Histe v Record Clxok on: DCI Account Number; 400Q (if applicaDk) Prom: City of Yowa CIfj C€ty Clerk's Office 410 D, Wash€ngton Street Iowa, lA 52240 Phone: 319-356-5041 Fax: 319-356-5497 Last Name onandanoro — First Name (mandatory) T^ Middle Name pcmmmendea SoArt >,,an Pate of Sirtll (mandatory) Gender (uil nduory) Social Security Number (rc000,menacd) Iz 23 19772 ®Male L�Felaale 7 5 -77 1 Waiver Information-' Withoul a Signed waiver from (tic Subject of the request, a Complete criminal history record may mol be roleasable, per Cede of lova, Cllap(e)' 692,2. For cmmpleta criminal history record lnformat1011, a3 allowed by I81Y, always Obtain a waiYer signature from the sub ect of the re 485'. Waliver Release, t hereby give permission for the ahovc,,questing official Ic conduct un lmsa criminal hisloo record cheek with the Division of Criminal lovenigatioll ()CI). Any criminal hiu.ry deli cauwnling nit Ihnl 15 ntainlained by Ilse DCl may be «leased ss allon'ed by law. Ivaiver si'gnairmie: `4.;_ �g1 t • c . Iowa Criminal History Record Cheek Results ; Elli" Only) r1 r, As of ��a search of the pfovided name and date of birth revealed -b U y,` �j -F No Iowa Criminal History Record found wilh ACI - 1 `r N t d lolva Criminal latistoiy Record attached, 1701 UC1 inuials _ DCI -77 (08125110) Received Time Feb -29. 2016 9:40AM No b453 ,f Iowa Department of Transportation ![ A,xpitUreef , R.ro%es laalP ee'iWo512-11r'l 1'D 1*c, 9:'i 005 fult,t.Lr� %A, Ci30,. 1 515 244 q124 Certified Abstract of Driving Record Inquiry Date: 2/26/2016 DL/ID #: 824AK2657 (IA) Customer #: 6246355 Name: Soliman, Reda Class: B ID Status: None Medical Examiner Jurisdiction Soliman Saleh Medical Examiner Phone 319) 356-3335 Medical Examiner Type Address: 2652 ROBERTS RD Audit #: 9753742 DL Status: VAL 12/15/2017 APT 2D 02/03/2016 Issue Date: 02/03/2016 CDL Status: VAL City/State: IOWA CITY, IA Expiration Date: 12/23/2020 CDL Cert Status: Non -Excepted 522462740 Interstate Endorsements: PS CDL Med Status: Certified Mailing Address: 2652 ROBERTS RD Restrictions: Corrective. Lenses, Restriction None APT 2D Automatic Supplement: Transmission, No Manual Transmission Equipped CMV, No Class A Passenger Vehicle Date of Birth: 12/23/1972 Mailing IOWA CITY, ]A Sex: M City State: 522462740 CDL Medical Examiner's Certificate Certificate Specifics Explanations Medical Examiner First Name Tracie Medical Examiner Last Name Neustel-Abbott Medical Examiner Suffix ARNP Medical Examiner License Number A091593 Medical Examiner National Registry Number 6826553121 Medical Examiner Jurisdiction lA Medical Examiner Phone 319) 356-3335 Medical Examiner Type Advanced Practice Nurse Medical Certificate Restriction 1 Wearing corrective lenses Medical Certificate Issued Date 12/15/2015 Medical Certificate Expiration Date 12/15/2017 Date Added to CDLIS Driving Record 02/03/2016 History Information CLEAR DRIVING RECORD Name: Soliman, Reda Soliman Saleh DL/ID: 824AK2657 Pursuant to Iowa Code §321.10, I, Melissa Spiegel, 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: v WIC11 Irt' 2/26/2016 IOWA". AA t+ Office of Driver Services Iowa Department of Transporation Name: Soliman, Reda Soliman Saleh DL/ID: 824AK2657