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Home My WebLink About16-120IDENTIFICATION NO. l l 1 (Office Use Only) APPLICATION FOR TAXICAB I MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m, to 3 p.m., Monday — Friday) 410 East Washington Street Iowa City. Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First Middle st 1. Name (REQUIRED) t/ IluW7e AA Icy C/ 2. Address (REQUIRED) c-'-E6—L/-) y5 22LrK 3. Contact Information (REQUIRED) Email: Cell Phone: ?1�1-4on•-�12�� (All written communication sent via email) 4a. Chauffeur's License expiration date (REQUIRED) Z/ °2 % / %j`Z0 b. Taxicab Business Name (REQUIRED) (/I b 5 Prior experience in transportation of passengers (rya{ (oU,,rrL,/ 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? 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? /,\/a 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 n NO 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 uppri 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 7 4 A 5 issued on ei expiring on 2/ . 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 s Date WZ01b/ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this Z day of -7" w e T r,1 1 a. 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 02 L2C)2D __J �I 0(,;;�2�I � Signature of P lice 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. 1%ac: Sign ure of City Clerk or designee Yate h****W**WA*tttt****kAWttW**WWW£*WWWWWWWWWW**W*+*******+++***+££+*+*+*+********+***££££*k+***£**£+*#*####k#k}}*}*#+*#k+*#}}#*x**x*xx*xxxhxhh***** Office Use Only Approved application DCI report State certified driving record Website update Cler TAxIDRIVBADGEAPPL92014amenCed.DOG 03/2015 11 un. o, P)10 �'�20P,ivl_ uiv o criminal !ovestlgatlon No. P. 4/4 F rc:... 'l&,k .. �..--. _-_---, 06/02/20'10 tO:a� �53a .-,vvc/002 S'1'ATEI' € F IOWA j�'> ill�el�af History Re-cf)rd Fite.( Request Form f wvh Division of C'rlminal loveslil!ation Support Operations Bureau, V Rioor 2.14 C. 7"' Street Cies M1loiucs, Iowa 503]9 (515) 725-6066 (575) 725-608(1 l -,ax �-l6JCA of o",/2�-/ /q76 ItiaYn-eA )DCl Aecounl Number: t -(2M (iraPPlicalsk) Froin: (lty of lows cil� 310 L. 0Lh- o Strrel Iowa City, L, 52240 Phone: _319-356-504J. 4_ - Par:: 319-356-5499 Eal ale ❑T''entale lz P3 1- 66 - -!2- Waiver-LafOrntnfioft: Wlthou I a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2, For cow criminal history record (uformation, as allow•ud by law, always obtain a waiver si nature frau the sub,eet of the re uest, Mrlver Re%20-e: 1 hereby give ptrnlission for the abov Iuvesliption(CCI), My crimioel llislorydala concerniogme lhzQis mai1gilBined bylLenCln all Iowa criminal hisloryrecord tl;ccr in, u,t 9n ofCriininal y be released as allowed bylaw, Plvisi tVnrver Signdrure;__� _ 10WR Crimiwil eeoa t Check llesults e0 uct Only) As oi'_ �' a search of [ht provided name and date of bi1-ib revealed: rhe No Iowa Uiminal 14islory Record lilwld u'ilh UCl lows Criminal His(ory X(',cord attached, DC) It - DCi initjal$ �Vv t, Y',•I n� Received Time Jun. 2, 2016 10;27AM No -6646 C4iUWA00T uvVVVV,i0waaot.gov SMARTER I SIMPLER f CUSTOMER DRIVEN w - __ ... . Inquiry Date: 6/23/2016 Customer #: 6311770 Name: Abdalla, Mohamed Address: 106 1ST AVE Office of Driver Services PO Box 9204 i Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 www.towaclot.gov Certified Abstract of Driving Record DL/ID #: 874AL5703 (IA) Class: D Audit #: 9072752 Issue Date: 05/09/2015 Expiration Date: 02/24/2020 City/State: CORALVILLE, IA 522412602 Endorsements: 3 Mailing 1061ST AVE Restrictions: NONE Address: Restriction None Mailing CORALVILLE, IA 522412602 Supplement: City/State: None DL Status: Date of Birth: 2/24/1976 None Sex: M History Information CLEAR DRIVING RECORD Name: Abdalla, Mohamed DL/ID: 874AL5703 CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: Transportation E.s ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that I ar 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 c 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 he set upon this document, at Ankeny, Iowa this date: 6/23/2016 O,`O�'-......;.f/�y 11¢ IOWAa''�rds.il� Services pwiceDepartment Driver Transportation E.s Name: Abdalla, Mohamed DL/ID: 874AL5703 _ 1