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Home My WebLink About16-143� r j1 ®4 � rr""III�It� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. 110/ Lr (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 First IN Last 3. Contact Information (REQUIRED) Email: Cell Phone: (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUI RFD) J0- 5. Prior experience in transportation of passengers: _ rjtnrS 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? ,A/O Type of offense Where When Si IA /171&/').415 lA15ilz�zclt� 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? L— Type of offense What happened to the charge? (Circle one) Where 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? _4zo -Tvoe of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please providO,the name(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF -REVIEW s.7 You must apply for an individual Department of Criminal Investigation Report (form available -upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0712016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Departent of Transportation a valid Driver's license number 5o'4A( '5 (e9 issued on 29 7G /(,expiring on Q!2c 14 . 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 0 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by hLtA_Acty aL'�CO �t �4j �ic.1n on this 3 day of A&LeetL4I 7-01l c 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, Chapter2, `/2, City Code). Expiration date of Driver's license e 4 '�! 12—,. u �P Signature of Police 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. Signa e of City Clerk or designee '?^ y /i6 -�mate x####w}}##xxxxxxxx*ww**,r*****##xxx}wxwwwww+wwx*xxx}}w*w:*x:rx*xx#xxwwewwwwx#*:#xx#xx:xwwwww##xxx}xxx+wwwxx#xxx}wwwwxwww*srx*++}}#xw}}#xx***wwwwww Office Use Only Approved application DCI report State certified driving record Website update Cl. k AWRlVB DGE PPL92014amendeaDOC 07/2016 Hug. •3, 2U16 12:h4PM 0 1 v of Crim,naI Investigat,on V)-9655 P. 3/26 F n_.._--.. ...♦ Clete. _....-.� -.-e ------- 9&/01/2018 09:'iee -Ea& llvv2/002 - STATE OF 101VA 'b CiPiMi nal History Record Check l j RequestForm F� DCIACcOU111. ttnnber: ---- (if oppliwblc) Tut Iowa Division of Criminal Inveailgatlon Support Operations Bureau, V Floor 215 F, 71h Street Des Moines, Iowa 50319 (51.5) 725-6066 (515) 7256000 Fax I alit rendes tine an Iowa Criminal Moory Record Check nn• Front: City of iow'a City City Clerk's Office 410 f, Washington Street Iowa City, IA 52280 Phone: 319-356.5041 Fas: 3I9-356-5497 Last Name (otanoamry) First Name (mandatory) middle Name (rccommcndcd) (D�Mncu M06 4111A I6wa� Date of )Mrth(n1,gndalo(y) Gender/(mandalol Social Security Number (rewn,mcnded ��-I'Nlale ❑Female p Waley Inf0JMT i0n: Without a signed waiver from (he soblect of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For commI)lete criminal history record iuformstimt, as allowed bylaw, always obtain a waiver siipnature from the subject of the request. Waiver Release; l hcmby give pmnissian for the above reclimiing effrcial to conduct an Iona criminal history record chccA wilh the NVI5lon of Coninol Inver pwaion (oCl). Any criminal history data emtccming me rho, is maimained by the DCI may hueleased os allowed by lain. Waiver Signature; (BCI use 6111y) As of `3 ��_ a search of the provided name and date of birth revealed. No Iowa Criminal History Record found with Del ` ❑ Iowa Criminal History Record attached, DCl # c Del initials llCT-?7 (04/25/10) —t- . Received Time Aug. 1, 2016 9:06AM No, 9390 r 9r qd 10WA D 0 SMARTER I SIMPLER I CUSTOMER DRIVEN VVWW.IOVVBC�flt 90V Office of Driver Services PO Box 92041 Des Moines, PA 50306-9204 Phone: 515-244-9124180D-.532-11211 Fax -515-239-1837 w .iowadol.gov Certified Abstract of Driving Record Inquiry Date: 7/29/2016 DL/ID #: 569AG6549 (IA) Customer #: 5909707 Class: D Name: Osman, Mohamed Ibrahim Audit #: 1186916 Address: 2425 BARTELT RD APT 2C Issue Date: 07/29/2016 8/21/1966 None Expiration Date: 08/21/2021 City/State: IOWA CITY, IA 522462709 Endorsements: 3 Mailing 2425 BARTELT RD APT 2C Restrictions: NONE Address: CDL Permit None Endorsements: c Restriction None Mailing IOWA CITY, IA 522462709 Supplement: City/State: None DL Status: Date of Birth: 8/21/1966 None Sex: M History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: c CDL Permit None Restrictions: epartment Departme D ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation County SUR 02/16/2015 03/22/2015 1592 !Speed II)ohnson lA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 7UR _ __. ...__... - '798599 Ip Name: Osman, Mohamed Ibrahim DL/ID: 569AG6549 Pursuant to Iowa Code 4321.10, 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, loika this date rte" Bjb� oOe`itHlClf oil � 7/29/2016 *; IOWA * D. 0. T.; c A�i him''•.. ��s �4yBf 1cs l61V[B'�'�` of Driver owia 1Transportation epartment Departme D Name: Osman, Mohamed Ibrahim DL/ID: 569AG6549