HomeMy WebLinkAbout16-055I
CITY OF IOWA CITY
410 East Washington Street
Iowa City. Iowa 52240-1826
(3 19) 356-5040
{319)356-5497 FAX
1. Name (REQUIRED) -
2, Address (REQUIRED)
IDENTIFICATION NO. i If y — 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
z3 S S
3. Contact Information (REQUIRED) Email:
i
o-Z9M Cell Phone: 20Z LfISI��p
all written communication sent via email)
4a. Chauffeur's License expiration date (REQUIRED) L1- ) "Lo I <z
b. Taxicab Business Name (REQUIRED) _ �� c7in�e1 y\ 1 �y �(i ect b
5. Prior experience in transportation of passengers: :TO VL "P 717s .X 1, C
6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? VV 0
Type of offense
What happened to the charge? (Circle one)
Where
When
Convicted Dismissed Deferred Suspended Plead Guilty Other
7. Have you been arrested / charged with any traffic offenses in the last five years? aoyf 7
Type of offense
r"
When
_ +_Zj,-2cI3
3
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? tom!' ()
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 nam
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIF1rzD
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW
You must apply for an individual Department of Criminal Investigation Report (form available uper+request).
(SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY)
02/2C15
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
�. � � CTI } to D issued on � 3_z6 XS expiring on o 4- i z. -2u1 Sc. 1 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 JI-vr Date -1_>--1S_ 16
xxxxxxxxxxxxxxxxxxxxxx.+axxxxxxxxxxxxxax:vxxxxxxxxxxxxxaxxxxxxxxxxxxexx.sa:vxxxxxxxxx>x+xxxxxxxexxxwxx;.xxsxezxxx+<xxxxxxxxxxzxr:e:w+xxxxxxxxxxxxxxxx
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by 3 qQ t0_,i Mo i on this I day of
Public in
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�," Iowa City (Title 5, Chapter 2, City Code).
eur's license q1 I LI ( y
or designee D t
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.
Signatt?re of City Clerk or designee
Daj4„
.�xxxx>„xxxxxxxxxxxx.x�.xxxxxxxxxxx..��x.,xx.xxxxxxx�x..xxxxxxxxxx*.xxxxxxxxxxxxxxxxxxxx,..xxxxxxxxxxxx�.xxxxxxxx.xxxx.xxx ��:.xxxxx.xxxxx.,x..x
Office Use Only
Approved application _
DCI report
State certified driving record
Website update "
Clerk/TAXIORIVBAOGE PPL52014amendedDOC 0312015
rtD.to• [ulo }:7Lr[vi uiv 07 t,rimioai Investigation IVo.8602 r. 1
Flo rn�a,y or ,vwo ucy Cl era V"'00 mna ybtlb Gu'/ 0p1253f2016 15:29 "19 F.002/002
STATE,
AOF IOWA
,
Check
Criminal
History Record
Request '
orin
lova l)ivlaioa of Criminal Investigation
Support Operations Bureau, I" Floor
215 C, 71a street
Des Moines, town $0319
(515)725-6066
(515)725.6000 Fax
HCt' 1\C� W I
to of Birth
04- 12, Ici� (Z'3
1 Y
DCI Account Numbor;.
(if'rppIfo'blc)
From: City of Iowa Clty _
City CIcrIPs Office
410 C. Washin tun strcct
Iowa Cit , lA 52240
Phone: 319-356-5041
Fax: 319-356-5497
.eeord Check on;
ir
2FsIt Name (n,anaem y)
:ender tmandalay)
Mmale ❑Female
� Lj, MN
7'2 q 6345
nfRiver (njormarfon: Without a signed waiver from the subject of the request,,A complete criminal h
islory record may not
he releasable, per, Code of 1ox-a, Chapter 692.2. For conl9lete criminal history record information, as allowed by law, always
oUtaln a walversf nature from the sub act of the request,
Waiver Release; l hereby give permissien for rhe obavc regncsting official 10 inry rta
conduct m town criminal hisloerd check with the Oivisioa of Criminal
)Mcsligatioa (DCI). Any cdmivat hislory data eeneenling mo Thal is mainlacd by�be I be released as 9110sry 1 o law,
WalverSfenarure:
Iowa Criminal H'ittnt-v Record Clleeiz Results
f ; 00 use only)
As of t `i
a search of the provided name and date of billh revelled: -0 12'
No Iowa Criminal History Record fowtd with DCI
�.
❑ Iowa Criminal History Reecoid attached, DCI #
--�
DCl initials —
DCI -77 (08/25/10) '—
Received Time Feb. 25. 2016 2:17PM No. 824
Iowa Department of Transportation
0 N i''-c;rl
F F '0 ] _,!
Convictions
Citation Date
Certified Abstract of Driving Record
ACD
Inquiry Date:
3/15/2016
DL/ID #:
669A17600 (IA)
Customer #:
6063944
Name:
Makawi, Asaad
Class:
D
ID Status:
None
Sign/Signal
Suliman
Address:
2355JFSSUP CIP
Audit #:
6807976
DL Status:
VAL
Fail to Obey Traffic
Johnson
Issue Date:
03/26/12013
CDL Status:
None
City/State:
IOWA CIT'(, IA
Expiration Date:
04/12/12018
CUL Cert Status:
None
522461715
Endorsements:
3
CDL Med Status:
None
Mailing Address:
2355 JFSSUP CIR
Restrictions:
NONE
Restriction
None
Supplement:
Date of Birth:
4/1?/1963
Mailing
IOWA CI[Y, IA
Sex:
Prl
City/State:
522461715
History Information
Convictions
Citation Date
Conviction Date
ACD
Explanation
County
JUR
10/27/2013
03/12/2014
_
M14
_
Fail to Obey Traffic
Johnson
1A
_
__
Sign/Signal
12/21/2013
01/21/2014
M14
Fail to Obey Traffic
Johnson
IA
Sign/Sigral
Name: Makawi, Asaad Suliman DL/ID: 669AJ7600
Pursuant to Iowa Code d321 .10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Ti anspormhon, do
hereby certify that I am the custodian or the records held by the Office of Driver 5erv1Ce5, that this Is a true and accurate copy of
an official record currently in the custody of said Office, and chat 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: u
L:P
nll-1
s,
MJ y�4y1Ctifyytht 3/1b/2016
IOWA err --
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Office of Driver Services
Iawa Department or Transporation