The URL can be used to link to this page

Home My WebLink About16-183� r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (319)356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO./ Lp— IS 3 (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 W Last 2. Address (REQUIRED) �-46'k wlh;5,Pw�AA Meaa,/ow OR jcwA c;i-( �A-5))4.0 3. Contact Information (REQUIRED) Email: MoI1aMadhA Sian Is ®6"4- Cell Phone: Z\A- 'A (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) M a0 b. Taxicab Business Name (REQUIRED) AMe i C'ai 0 5. Prior experience in transportation of passengers: !/40f L -/Z& S t ) r i CA Ira —16 1"VA t":�4 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? '/C%< Type of offense _ Where When FAL i, obi IfaffL s,,,_ S)r�n,,[ jchn<on joy LJl a4- 4 gezel 6-1t-�ol� 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? /j 0 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 herebyy certify that 1 have issued to me by the Iowa Department of Transportation a valid Driver's license number a 6l (�� U (! I issued on /� -/4- 0S expiring on dd - /6— }} 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 eq -1- Id 1fYY##HHi#YY#H#H#H#HY#HflHn11H1f f 11fHff Y#fYf#1f #1lH1fY#11#if#YYf####Hf#H#H#Hf fHff 111!!!!!1!l11f 11111f1fYYf+YY'FYYH##Hiii#fHff STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn ttp before me by i✓� \Aa#kcxAQ L1r . NaSSaur, on this day of c -_ , � P., . L . r-- 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 Driver's license Signature of Police Chief or designee ill /6 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 use of City Clerk or designee Date H.fYYffH.fH,f f f HHfYf.lffYYHHfYf ffY,HYHY,H,H,fHH,HHH„H.,H.HHf1HffHHf,H.ff f f fllfltf#ffHfi#1f flllfrli###MfYfffffYlY'Ff#YYf Office Use Only Approved application DCI report State certified driving record Website update aWTMIMNMaooenavL92014a�dee.DOC 07/2016 FrAug, 29, 2016, 2:27PMC1erDiv of Criminal- Investigation08/23/2016; ,a No, 1764�g,P. 7/8 OO2 STATE OF IOWA tdlVa� yi I IiHistoryRecord Check Request Forms v Y ,f11 'SF F^il To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. T" Sheet Des Moines, Iowa 5D319 (515) 72.5-6066 (515)725-6080 Fax I am remuestincr an inwa Oxhri;r,nl 4iictnn Ito ,l r•t,P�l, .,.,• DCI Account Number: Vt'i fDp'Z% (ifappliewe) From: City of Iowa City _ City Cleric's Office v 410 E. Washington street Iowa Ci , IA 52240 Phone: 319-356.5041 Fax: 319-356-5497 Last Name mandaton) ,First Name (mandatory) Middle Name (reconm,cnded) V)'laha%-77ad /1wAD Date of Birith/(mmldalot•) Gender (n,andaloo•) Social SecurityNumber mcmnmeadcd) O I - - i �1 T� G /p (�Iaie El emale -� � gPC1- -+,619 g Witiver Information., Without a signed waiver from the subject of the request, a complete criminal history record may nol be reloosable, per Code oflowa, Chapter 692.2. Far comnletC criminal history record iaformalion, as allowed bylaw, always obtain a waiver signature from the sub eel of the request. Waiver Release: 1 hereby Live p emission for Ilia above requesting official to conduct =Iowa criminal hinoryrecord eh,ck wllb dm Division of Criminal hn•estigaiian (DCl). Any criminal history data concerning me tllal is rnaialained by dm DC1 may be Maned as allowed by law, WaiverSignettlre: `L�:� : Iowa Criminal History Record Check Results (OCl use only) As of EL search of the provided mule and date of bitlh revealed: 76 No Iowa Criminal history Record found with DCI Iowa Criminal History Record attached, DCI # DCT initials-- i DCI -77 (08/25/10) Received Time Aug. 23. 2016 2:07PM No, 2424 CAwa '!i'.Mr 1 _ PO &W 2W4, Des M00iii tA W305-OW4 nt of Transportation (Toll Foe) 8IX1-532-1121 5515-244-9124 FW 515.239-1831 Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 8/23/2016 DL/ID #: 26IDD7091 (IA) Customer #: 4640700 Name: Hassan, Mohamad Class: D ID Status: None Seed Awad IL Address: 2769 WHISPERING Audit #: 9493971 DL Status: VAL MEADOW DR Issue Date: 10/14/2015 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 01/16/2017 CDL Cert Status: None 522406847 Endorsements: 3 CDL Med Status: None Mailing Address: 2769 WHISPERING Restrictions: NONE Restriction None MEADOW DR Supplement: Date of Birth: 1/16/1986 Mailing IOWA CITY, IA Sex: M City/State: 522406847 History Information Convictions Citation Date Conviction Date ACD Explanation County UR 04/21/2012 07/13/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA 06/11/2013 07/10/2013 S93 Seed IL Name: Hassan, Mohamad Awad DL/ID: 261DD7091 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: 8/23/2016 F�If}'WA�' D. 0. T., Office of Driver Services Iowa Department of Transporation