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Home My WebLink About16-202CITY OF IOWA CITY 410 East Wash!nglon Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (3 19) 3S6-5497 FAX 1. Name (REQUIRED) 2. Address IDENTIFICATION NO. Ili - D -013 - (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 0 KI)' 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQUIRED) . t 5. C)k 6A P.1 6k �p 6. —2 — email) Phone: 4pi --I try—, 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 Dismis. 7. Have you been arrested / charged with Type of offense What happened to the chargg? (Circle one) Deferred Suspended Plead Guilty offenses in tie last five years? Other When y nvicted Dismi sed Defer ed �Susp¢nded Plead Guilty Y Other 8. Has our drivers lice a or chauffeur's lice a been sus n d or reloked in the last five ears? N Type of offense W er When = ca N IM :> —1 t 9. Have you ver applied to be an Iowa City taxi driver using a different name? If yes, please proyt�tthe> Qme(�'i1 t DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW must apply for an individual Department of Criminal Investigation Report (form available upon request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) ID 07/2016 ON FOR TAXICAB VEHICLE DRIVER q -2-Z- 6 )0-2--Z01(0 I hereby certify that I have issued to me by the Iowa De rtment of Transportation a valid Driver's license number issued on Airing on — — I understand that if I falsely answer any questions in this application, that this ap lic`a m y be denied. I agree that in making this application, 1 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 ofrra Notary Public) Signature of Applicant_ – Date 2– fllf!!+#+#a#ararrrr+rrrrrrrr++rrr+rm++++++s,+a++aa+rfr+rrrrrrrrr+rrrr+a++aa++++aa++ae+++++++rr+rr++rrrrrrrrrr:rrrrrrrrrr++++a+++a+++aaarr++++ar STATE STATE OF IOWA ) COUNTY OF JOHNSON ) Subscrib d and sworq to before me by t)JA Ok ; � ':N j r0cy � IXA 0 Cp on this day of ,l A WENDY S. MAYER N ry Public in an or the State/ off lo My Co"""Is4°" R*444Rf*RRRR1eRR 4* 4i*4* illle**4******RR**R**R1tR+t1#44#4444***#**RRRRRR*RRRRRR*R4#4*444*4*4**4****M*RR*RR**1t*tR***RRR*RRRRR1tfe*RR 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 �C.oue).). Expiration date of Driver's license L l Signature of Police Chief or designee /4//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. Sign re of City Clerk or designee n//(, Date N J Cly Office Use Only Approved application 1� b DCI report _? State certified driving record - o Website update o Clerk TAXIDRIVSADGEAPPL92014ame dtl DOC 07/2016 CIJ10WADOT www.iowadogov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 www.lowadot.gov Certified Abstract of Driving Record Inquiry Date: 9/8/2016 DL/ID Jr; 532AGS413 (IA) CDL Permit Class: None Customer is 5846338 Class: D CDL Permit Issue Date: None Name: Sidahmed, Shaklr Mohamed Audit #: 1276868 CDL Permit Expiration None Date: Address: 2509 BARTELT RD APT ID Issue Date: 09/02/2016 CDL Permit None Endorsements: Expiration Dote: 04/20/2021 CDL Permit Restrictions: None City/State: IOWA CITY, IA 522462715 Endorsements: 3 ID Status: None Mailing Address: 2509 BARTELT RD APT ID Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Mailing IOWA CITY, IA 522462715 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 4/20/1957 CDL Cert Status: None Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Sidahmed, Shakir Mohamed DL/ID: 532AG5413 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: Or44 •IOWA 9/8/2016 • cc D. 0. T.�ia�•tJUf �f....... . Office of Driver Services ttgf� oma` Iowa Department of Transportation Name: Sidahmed, Shaklr Mohamed DL/ID: 532AGS413 Aug.31. 2016 10:39AM Div of Criminal Investigation os/26/20,9,p;gIVO.ly�a6ae _ z,00z Ff_.. ._ _. ._v.. _ Gl er..— ....... ..... ------ . STATE E ®1t 1IDVt J!A 'i Criminal] History Recopol Check Requegt Form �Sf To: Iowa Division of Criminal Investigation Support Operations Bureau, V Floor 215 E. 71" Street Des Moines, Iowa 50319 (515)725-6066 (515)725-6080 Fax T _ ...,:.. . T--.. r.-0 nl T]414 ,,, 17 arnrA rv,&• tr on - IDCT AccountNumber: 1V C2Q5-C (ifopplicobit) From: City of Iowa Cid City Cleric's Ofliee 410 E. Washington Street Iowa City, IA 52240 phone: 319-356.5041 Fax: 319-356-3497 Imtst NRMC (nl8ndettlory) F1rSt Mine (mandatary) Middle Name, (recommended) NN-�kr I Y`c kCk VkeJ Date of Birth (mandatory) Gender (mandatory) 5oeial SeCUrj NUmber (recommuldtd) pQ —7 Prp ri t 2P� I l I dMille ®remale 1 Wnivel•Information, Wi(hout 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. Tor complete criminal history record information, as allowed by lair, always obtain a waiver signature from the subject of the r nest, Waiver Release; I hereby give pennission for the aboe u ting official to oasdnel nn Iowa criminal hislory record eherk wilh the Division of Criminal Investigation (DO). Any cdminel histary dole eonccmio a ' maintainadb the DCllnaybeseleased Asollotvcdbylow. Waiver Signature: Iowa Criminal Ilistory Ruq d Dktecir � (DCnneonly) As of a search of the provided name and date of birth revealed[ �r / Ata larva Criminal history Record found with DCT -f- .. vt • ,., r , u CI Iowa Criminal history Record attached, DCI # { 7% N DCT initials Ge DCI -77 (08/25/10) Received Time Aug, 25. 2016 10:04AM No. 2519 M