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Home My WebLink About16-194CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 22 40-1 82 6 (3 19) 356-5040 (319) 3S6 -S497 FAX 1. Name (REQUIRED) - 2. Address (REQUIRED) IDENTIFICATION NO. C (Office UseOnly) 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 3. Contact Information (REQUIRED) Email: (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) _ V 5. Prior experience in transportation of passengers: r6Y oye- } s ye s I ( a Zo'2-3 Last / <:�IAfA/VI t Cell Phone:.31q-321-0tgLi 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? A� Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other go 7. Have you been arrested / charged with any traffic offenses in the last five years? �,j e S Type of offense Where When jsCa�L�y��14�t5inr �0NM9ON uCA IN 1I-z- � 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? N Type of offense Where W herE c. .-i J 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please plrppe the nam n .-r" DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERT4"ED 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 h ve issued to me by the Iowa Department of Transportation a valid Driver's license number L)�p 11sr Z A issued on p� t 1?a [expiring on �1' 1 ZR 3. I understand that if I fa s ly ans er any questions in this application, that this appl titi n may be denied. I a ree 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 62 STATE OF IOWA ) COUNTY OF JOHNSON ) n Subscribed and sworn to before me by }U jAa&,�/ a ��f r on this �� day of I _ �'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 Q#y of Iowa City (Title 5, Chapter 2, City Code). ;r's license Q I I I Z3 or designee 'Dath 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. asp/ Sig Lure of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update 1-7 //,/ Date GaurixiDRNSADcrnaPOzoi�DDC 0712016 N 0 Cd a n rn �nJ �r n M =?? $7 cn GaurixiDRNSADcrnaPOzoi�DDC 0712016 UWA DoT SMARTER 1 SIMPLER 1 CUSTOMER DRIVEN vvww,lOWadOt.gOV Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fat: 515-239-1837 vfx JaNadot.gov Certified Abstract of Driving Record Inquiry Date: 8/16/2016 DL/ID #: 450AF6378 (IA) CDL Permit Class: None Customer #: 5729103 Class: D CDL Permit Issue Data; None Name: Sharif, Mohamed All Audit #: 9336298 CDL Permit Expiration None Date: Address: 2413 SHADY GLEN Cr Issue Date: 08/13/2015 CDL Permit None Endorsements: Expiration Date: 08/17/2023 CDL Permit Restrictions: None City/State: IOWA CITY, IA 522464115 Endorsements: 2 ID Status: None Mailing Address: 2413 SHADY GLEN CI Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Mailing IOWA CITY, IA 522464115 Supplement: CDL Permit Status: ELG City/State: Data of Birth: 8/17/1978 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions :nation Data Conviction Date ACD Explanation County ]UR 15/11/2012 08/14/2012 M70 Improper Passing Johnson IA .2/07/2013 01/22/2014 S92 Speed Johnson IA Name: Sharif, Mohamed Ali DL/ID: 450AF6378 Pursuant to Iowa Code 4321.10, 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: IOWA ,oy /4 ). 0. T.;v 8/16/2016 /J ��5' Office of Driver Services pM...... at Iowa Department of Transportation Name: Sharif, Mohamed All DL/ID: 450AF6378 Aug,17. 2016 2:48PM Div of Criminal Investigation No,0839 P. 1/5 Flun�,u��y u� �JMr -.y ClerR Vu1V1 Jib aootluv/ 09/16/201C 12;01 1462y W.UU21002 ,,..aSTATE OF AOWA �I 'y elow s Criminal i ' r tl"�J „ lF till} ) Request To: Iowa Division of criminal Investigation Support Operations Bureau, 1[l Floor 215 P, 7'a Street Des Molnes, Iowa 50319 (515) 723-6066 (51.5) 725-6080 Fax I enl re0116dilla 211 IOWA rrilllillcl t-ticemv RnnnrA "haul. nn DCI Account Number: gOC>Z'tr (ifepplieable) From: it of Iowa C?Cy City Clark's Office - 410 L. Washingtnn street Iowa City, IA 52240 Phone: 319-356.5041 Fax: 319-356-5497 Last Name (maodatoey) First (/endalaoo9 Middle Nalne (rcwmmcnded) /(mandatory) �JNlimem / �1t Date of Birth Gender (nlandolory) Social Securq Number (rccommn caca O O' i7 l �� Q U %Male ❑Female ( qj ��j /J�� Waiver Inforntatioar Withouta signed waiver from thosubject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For co_ mnlet0 criminal history record information, ay aliolived by law, always obtain a waiver signature from the subject of the request. 1'i/AIV el• Release: I hcreby give permission for lbe above rcgpcsting offieitl to conduct as Iowa criminal history, rtaord cheek will, the Division Of Criminnl Investigation (DCO, Any criminal history dela contenliog me [list is mainly ned by IIIc DCI may be released as allowed by larva Waiver Signature: Iowa Criminal History Record Check Results As of a search of the provided Dame aad date of birth revealed: No Iowa Criminal history Record found with DCI ❑ Iowa Criminal history Record attached, DCI ,E . . DCI initials - DO -77 (08/25110) Received Time Aug. 15. 2016 11:52AM No. 1684 NCI use only) C