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Home My WebLink About16-177�r"III CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319)3S6-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 16 M (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 Last 2. Address (REQUIRED) G%CIl'f1Fi1 7- tl 3. Contact Information (REQUIRED) Email: GL-Qtfzc(c. 9)YQVlcc� C(7,. -v Cell Phone:(All written written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 6 ( t 11 '1 -- N —0 ( l b. Taxicab Business Name (REQUIRED) �c Bk-,) qy\ \ ck) t r_, � J 5. Prior experience in transportation of passengers: X e:::S 2 Y tv N U 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State'oi elsewhere? =_ Type of offense W hereWWhQIn �— C A 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? Type of offense Where When nc�vin wir 1VL�/4C r y \I 2�t3 SPQR � ,�, to wa C,ff-) 2 /? 2 21 o / What happened to the charge? (Circle one) / C i t Convicted Dismissed Deferred Suspended Plead Guilty to/el/ 20( 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 name(s) 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) 07/2016 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number ell) .f- 0 IN :�4 0 \ issued on le i ✓c? expiring on 61 , ) i - ( �. 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 361F4 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). Ex pir ion 4f Driver's license Sig t e 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. S'ignalw,e of City Clerk or designee 4/30 //"/ ate NNNfI+fNf f1f f f!f flfflfTNlHallf f lfff!!!Nf-f111lfiTfff 11+1!!1!!lflNfMNlf+1t'N'fM11fNNMllfffffllNlHltYrkNNINNlM1NNIlf111NfTT Office Use Only Approved application DCI report State certified driving record Website update aen✓ IDRNWDGEn gmi�.Doc 0712016 N O c� 71 +Nr++++NN++Nr+Nrr+NNlNNN+++Na++a++rN++rrNNNN+NN+rNrr+rr+N+rNNNrNNN+N+++Nrrr+NrfifNfllfONN+�,Ir+++N11rr N1r tl) STATE OF IOWA ) COUNTY OF JOHNSON ) a _„ Subscribed and sworn to before me by zoRl(iapc 7 e-511 n k :SeeA,ao l on this`dSc� -. day of j vac S Notary Public in and foklhe State of to F41• M1 II f1m+:FR1t+I,+f++flm+f+fN++r+N+N+N++f+N+++'YMf k+1+*+1t+feft1t1t1�1++M1fl+NrffifYlelfNN1N#+1,lN++f+N+i,F#flNfff4fftlf++++l+++itk+'+++i+'k1Y#tYfr411t 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). Ex pir ion 4f Driver's license Sig t e 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. S'ignalw,e of City Clerk or designee 4/30 //"/ ate NNNfI+fNf f1f f f!f flfflfTNlHallf f lfff!!!Nf-f111lfiTfff 11+1!!1!!lflNfMNlf+1t'N'fM11fNNMllfffffllNlHltYrkNNINNlM1NNIlf111NfTT Office Use Only Approved application DCI report State certified driving record Website update aen✓ IDRNWDGEn gmi�.Doc 0712016 4" Iowa Department of Transportation pp (Mca d Direr Services (rdl FMW 800532.1121 PO Bmr 9204,DWMdnw, A50386 9204 515244-9124 4" FAX 515239-1837 Certified Abstract of Driving Record Inquiry Date: 8/18/2016 DL/ID #: Name: Seedahmed, Class: 7286386 Zoelfigar Khalil VAL Address: 2656 ROBERTS RD Audit #: 01/22/2018 APT 1C None 2 CDL Med Status: Issue Date: City/State: IOWA CITY, IA Expiration Date: Seed 522462742 IA 1/22/1968 Endorsements: Mailing Address: 2656 ROBERTS RD Restrictions: APT 1C Date of Birth: Mailing IOWA CITY, IA Sex: City/State: 522462742 Convictions 684AI7191 (IA) Customer #: 6082387 D ID Status: None 7286386 DL Status: VAL 08/28/2013 CDL Status: None 01/22/2018 CDL Cert Status: None 2 CDL Med Status: None NONE Restriction None Seed Supplement: IA 1/22/1968 M History Information Citation Date Conviction Date ACD Explanation County JUR 11/03/2013 11/14/2013 N63 Driving Wrong Way on One Way Street Johnson IA 02/2212014 03/26/2014 S92 Seed Johnson IA 10/2112014 12101/2014 S92 Seed Johnson IA Name: Seedahmed, Zoelfigar Khalil DL/ID: 684A17191 Pursuant to Iowa Code §321.10, 1, 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: 8/18/2016 iowA Q. 0. T� to+'' Office of Driver Services Iowa Department of Transporation Rug.LY. Lulb L:Lbrm ulv oT Griminal Investigation No.1764 P. 3/8 Fr..... �. ...N.. ...a Cler.. .-... ....� --- ..---..---- 08/23/2096 11:i— rr 636 �003 Cuivalilrna➢ Msttorry Recp�d Check 0 Req uegt Formm To: Iowa Division of Criminal Tilvegtigattolt support Operations Bureau, I" Floor 215 Ti, 7'a Street Des Moines, Iowa 50319 (515)723.6066 (515) 725.6090 Vag Check DCI Account Number: „ I/oo Z F utepplieablc) Frum: City of IowaCity City Clerk's Office ��- 00 G. Washington Street Ioa'a City, TA 52240 Phone: 319-356.5041 Fax: 319-356-5497 — L 5—(�edg4 mP-. � I zin �qqr I IO ha L[ L I C) (I M 1%B B I Male ❑Female I Zili, i— WaiverTnlormrstioir: Without et signed waiver from thesubject ofthe request, a complete criminal history record may not he releasable, per Code of Towe, Chapter 692.2. For co plate criminal history record information, as allowed by law, always obtain a walver9tPnah,re Firm it,. m,Fe..e .. r eh.. ......__. Waiver Release: thereby stet pcnnission for We above anucsting official to conduct an Iowa criminsl history record eheclnvilh the Digsston orcriminal lovestigalsoll tDCI). Any elimtaal littlory data coaeeming me shat b maintained by Ilse DO may be released as ollowed by lase. Waiver SEPlzat"ree fE&LI?�, � .... n I 1 gown_ Crimilaal Ii[istory Record CheckResults (D lend only) As ofa search of the provided name and date of birth revealed:;. Iv V? No Iowa Crinunal Hislar Record fowld with DCI �• �� Y I• li t ® Iowa Criminal History Record attached, DCI # _ C) DClinitials DCI -77 (08/25/10) Received Time Aug.23. 2016 10:57AM No.2387