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Home My WebLink About16-125CITY OF IOWA CITY 110 East Washington Street Iowa City. Iowa 52240-1826 1319) 356-5090 (319) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. ) W — o (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: �lAllr�n�M�D 7s _ . ..,m _ r (All written communicationsentt Via email) 4a. Chauffeur's License expiration date b. Taxicab Business Name (REQUIREI 5. Prior experience in transportation of r, Phone: 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 Mme_ Have you been arrested / charged with any traffic offenses in the last five years? jwm yes Type of offense Where When 0/?/ r-- 2 (2n(� 1 ,`), T wil PT Sc of �4y What happened to the charge? (Circle one) Convicted ead Guilty Dismissed Deferred Suspended PlOther 6_ Has your driver's license or chauffeur's license been suspended or revoked in the last five years? hit Q 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 names) 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) 02/2015 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 aS,g. 1 1) dZ7 issued on O O expiring onC I understand that if I falsely aifswef any questions in this application, that this application may be denied. II grey ' e 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 Ux Date -77/7 / rid STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by �-\J\ v e�} T �Ar�lk, #U on this � day of 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 26 r� ---IaI Signature of Chief or designee t�7�7t In 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. Signature of City Clerk or designee 07116 Date' Office Use Only Approved application DCI report State certified driving record - Website update Cl.,k A IDRIVB DGGPPL92014..a,ded.Doc 03/2015 �un.20. 2016 1:541M )iv o? Criminai Investi;ation No. 6687 -.- ---- Oe/76/2016 13:0., w646 STATE OF IOWA Crimfnal History Reeo.rd Check Request Form To: Iowa Divislon of criminal Lavestigation Support operations Bureau, 1" Floor 215 E. 7't' Street Des Ivloiues, Iowa 50319 (515) 725-6066 (515) 725.6080 Fax I am reouestine an Iowa Criminal Flistory Record Check o n- DCI Account 7\tumber �Q !— (ifrpylienUie) Ft•orru C1ty oFlowa City City Clerk's Office 410 r. Washington Street Iowa City, IA 52240 Phone: 319-356-5041 Fax: 319.356.5497 Last Name (i» andatory) First Name (111211da101y) Middle Name (n wmmended) xb _ Date of Birth (maiMairry) Jn6� Ctender (mandatory) m Social Securiq Number (recon,mo lyd �f ale 0Female Waiver Informati0n,, Without 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 comnlere criminal history record hlfermation, as allowed by law, always obtain a walver st nature from the sub ect of the request. Waiver Release: 1 hereby give permission for We stove requcsling official to conduct en Iowa criminal hismry record elmck with the Division of Criminal Investigation (DCI). Any criminal hismry data coucuniug ole 111a(is maims' the DO m35, be released ac allowed by law, Waiver Signature: _ CA xVWil k,11711111111at 111SLU Cy MCUM LnCCK Kesuns (DCI use only) As of �4`�� So a search of the provided name and date of birth re ealedd` (per No Iowa Criminal History Record found with DCT L� i,] El lova Criminal history Record attached, DCl !/ o DCI ilhitials DCI -77 (08/25/10) Received Time Jun, 16. 2016 1:31PM No -7704 C401 iJiUWADOT SIMPLER SMARTER I I CUSTOMER DRIVEN Office of Driver Services PO Box 92041 Des Moines, IA 60306-9204 Phone: 515-244-9124 1800-532-11211 Fax: 515-239-1837 ww orwadotgov Inquiry 7/7/2016 Date: Customer 4350508 Name: Ibrahim, Mohamed Elsadig Address: 2504 BARTELT RD APT 2B City/State: IOWA CITY, IA 522462714 Mailing 2504 BARTELT RD APT Address: 213 Mailing IOWA CITY, IA City/State: 522462714 Date of 9/2/1979 Birth: Non -Excepted Intrastate Sex: M Convictions Certified Abstract of Driving Record DL/ID #: 257DD6818 (IA) CDL Permit Class: A Class: D Audit #: 1059202 Issue Date: 06/07/2016 Expiration 09/02/2019 Date: Endorsements: 3 Restrictions: Commercial Learner Permit, CDL Intrastate Only Restriction None Supplement: History Information CDL Permit Issue 06/07/2016 Date: CDL Permit 12/03/2016 Expiration Date: CDL Permit NONE Endorsements: CDL Permit CDL Intrastate Only Restrictions: ID Status: EXP DL Status: VAL CDL Status: VAL CDL Permit LIC Status: JUR CDL Cert Status: Non -Excepted Intrastate CDL Med Status: None Citation Date Conviction Date ACD Explanation County JUR 05/18/2012 08/28/2012 S92 Speed Johnson ,IA 09/29/2012 11/06/2012 S92 Speed Johnson IA 11/27/2013 .12/04/2013 M70 Improper Passing Johnson IA 10/10/2015 .11/12/2015 Defective Lights Johnson IA Name: Ibrahim, Mohamed Elsadig DL/ID: 257DD6818 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: "h 'y�—��E141Clf p2� I' ski 10 7/7/2016 y4, 7/7/2016 Office of Driver Services Iowa Department of Transportation Name: Ibrahim, Mohamed Elsadig DL/ID: 257DD6818