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Home My WebLink About16-063CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1926 (3 19) 356-5040 (319) 3S6-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 1L2— 3 (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 Middle 2 Address (REQUIRED) 31$ 1 inkb,wc 1-vf 4k -q lowq �1 \ Pt 5-22-,4 3. Contact Information (REQUIRED) Email: —c"-�qMA i b Cell Phone: 7n3 -tae �{c p (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) (012 3 20 k-+ b. Taxicab Business Name (REQUIRED) Cirl Coq) 5. Prior experience in transportation of passengers: C�=N. CA 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? hly Type of offense What happened to the charge? (Circle one) Where Convicted Dismissed Deferred Suspended Plead Guilty Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where When Other f&C� 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 five years? /J0 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 khe`rrame(s) ` ) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE C6RTIF[W = �~ DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual Department of Criminal Investigation Report (form available upotf-request). r.y (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 546 AN y370 issued on oS/31/2.13 expiring on to/23 /20IT . 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 31 22-12-C) (� STATE OF IOWA ) COUNTYOFJOHNSON ) Subscribed and sworn to before me by ga on this Z% day of t -kr K, to -7 .i vv 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). license 101w X1 1 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. Signahwe of City Clerk or designee Approved application DCI report State certified driving record Website update 3 Z � Date Office Use Only -er Cle,k/rAXIDRNBABGFAPPL92014amended.DOC 03/2015 Miar.21, 2016 9�34AM Div o'i Criminal lnvtstigation No.9911 P. 1/3 From;CltY of Iowa Clty Clerk C>moe 919 36664637 03/16/2016 13:01 V43B P.00Z/002 STATE OF IOWA. �; i Criminal Histot�y Recons Check :� Request Form To: loeia DiviSiolt of Criminal Investigation 5aPPort Operations Bureau, I" Floor - 215 E. 7" Strect Des Moines, Iowa 56319 (515) 725,6066 . (515) 725.6000 Fax C� an AL(n )4lq L1 ate of ISI/ 23 / (143 Check B 0HP LD 1�j TXIAccomilNumber:, _4-002—, (Irepplicebl") From: Cityoffowac1ty -city cterh°a- 410 E. Washi4f, Street ZOwa City, CA 52240 Phone: 319.396-5041 Yox: 319-356-5497 �— tc 131c ❑Female A 2 2'-1- "79 - I199 Plitiver Mfornfation, Without a signedwaiver from the subject of the request, a complete crlrninal hislory record may not be releasable, per Code of fotva, Chapter 692.2. For complete criminal history record loformatitot, as attowed by late, ahvays obtaina waiver sianalore from the subtect of the reoaest. WR6Vet' tiefed$e: I he¢hy give pennlseion for Ilia above rcqucsling of idef In conduct w Imva criminal historyrecord cluck %villi the Division ofCrilltinal I1)v0ug41i0n(DCi, Ally triminal(jistory"awnccrning me that iS olainlaincd by the DCI maybe Uleescd as allowed by lam, n^ ' Waiver signature; Iowa Criminal History Record Cheeks Results t ns a III As of 3 �a( (e; _ a search of the provided name and date of birth revealed :, )1-,, No Iowa Criminal. l3istors> Record found with LACI '0 C> ❑ Iowa C41ninal History lteoord attached, I)CI # { iM DO initials_ T PorFivoA Tim, Mar 15 901E 1) 4AFM Nn 0114 IOWADOT Www4owedotgov 4.r. Office of Driver Services Fu Box Q204 t Des Moines- to 606-9244 Phone: 515-244-Pi24 i 800-532-4121 I Fax. 515-239-1837 www.Jawadot g[t*l Certified Abstract of Driving Record Inquiry Date: 3/15/2016 DL/ID #: 596AH4569 (IA) Customer #: 5955498 Class: D Name: Algaali, Bahaeldin Akasha Audit #: 6994884 Address: 318 FINKBINE LN APT 9 Issue Date: 05/31/2013 CDL Status: None Expiration Date: 10/23/2017 City/State: IOWA CITY, IA 522461706 Endorsements: 3 Mailing 318 FINKBINE LN APT 9 Restrictions: NONE Address: Restriction None Mailing IOWA CITY, IA 522461706 Supplement: City/State: Date of Birth: 10/23/1973 Sex: M History Information CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: ce of Driver eof Services CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None COL Permit Status: ELG COL Cert Status: None COL Med Status: None Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. )accident Date Case Number' 3UR 01/22/2014 _.. _.. .....,781326._. _. _.. IA. _ Name: Algaali, Bahaeldin Akasha DL/ID: 596AH4569 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: 10�: """••`.��1w�4� 3/15/2016 IOWA T %Offo ce of Driver eof Services Iowa Department Name: Algaali, Bahaeldin Akasha DL/ID: 596AH4569 - -• ~