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Home My WebLink About16-214CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. (Office Use Onl 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 r'lYZ'ai 1Middle 11WIC, Lash 2. Address (REQUIRED) q d 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date b. Taxicab Business Name 5. Prior experience in (All passengers: 0 M U e C—OM Cell Phone: _''906 221 u(�Z( sent via email) 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 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? Alt) Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty 7. Have you been arrested / charged with any traffic offenses in the last five years? A161 Type of offense Where Other When What happened to the charge? (Circle one) N Convicted Dismissed Deferred Suspended Plead Guilty_ Ot* 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five:yearS? i ,N Type of offense Where What" - 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 e y �err��Ify that I ave iss d to me by the Iowa Depa ant of Transporta .on a valid Driver's license number 7f�tyJ(� issued on expiring on 0I �of wZf 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 ✓ / w %'(AT 1 lYZ� (/� Date +r++++xxxxrx+xxxrrrr+rr+++++++xxrxrr++r+++++++xxxrr+++++r+++x++sxxr+xr+rr++r++++++xxxxxxrrx+rr+r+r++++xxxxxxxxxxrrxxrxrrrr++++xx++xrx+++r+r++rr+ STATE OF IOWA COUNTY OF JOHNSON e a� bscribed and sworn Q before me by � �r a+1 �� ) on this o'� day of 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). 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. /F7�u (-/ - -eo t Signa re of City Clerk or designee 1?/� Y -//o Date rxrxrrrrr»+xx+xxxxxxxxrrrr+a++++xx*+*++r++++a+xxxxxrrr+rrx+r+x+xx++xx+rrr+++rrr+++xxx+x+xx+rrrrrrrrr+rr+++++x++x+xxx++x+rr++++++x+x+x++xxx+xxxx Office Use Only Approved application DCI report State certified driving record Website update CIe,WrA%IDRN9ADGEAPP02014sm nde .DDC 07/2016 a cn ._ rn c - . - LY3 CIe,WrA%IDRN9ADGEAPP02014sm nde .DDC 07/2016 v 'F M./. I, Lv 1v Iv. J/'.... v,. v, v,,,,,,.,— •... vv. I.—.... Frcm:ully of lowe =Icy Ciork Urrte6 319 3666497 1109/16/2010 10.58 467e; P.002/002 Criminal STATEOF IOWA istory Record Check Request To: Iowa Division of Criminal Investigation support operations Bureau, l't Floor 215 r. 7" street Des Moines, Iowa 50319 (515) 725-6066 (515) 725-6080 rax I and reouestintr an Tows Criminal Rictmv RecnrA Check DCT Account Number: _ j OD 7 .ter (irappilesblc) From: City of Iowa Ciry City Clerlt's office 410 S. Washington Street Iowa City, IA 52240 Phone: 319-356-5041 Fat;: 319-356-5497 Last Name (mandatory) First Name (mandatory) Middle Name (recommended) /4 t t = i4bda &A Date of Birth (mandatory) Gender (ma» daiory) Social SecurityNumber (recommended) 0-1 a I) !q 6 a e ale ❑Female i9 70 C 9 3 d g 2 hraiver Injoarnafion: Without a signed waiver from Ilia subject of the request, a complete criminal history record may not be releasable, per Code of rows, Chapter 692.2, For complete criminal history record information, as allowed bylaw, always ob(ain a waiver si nature from the subject of the request. IhatVer Release; l hereby give pmoission far the above requesting official to conduel An Imva criminal history neord clued: with the Division of Criminal Invosliganian(DCl). Any criminal history data conccnilingme that is maintained by the DCl may he released as allowed by Walver Signafnre: ✓�I_ J _/,/:'�/ u Iom'A Criminal History Record Check Results MCI use Duly) As of Aaw'L a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCT u; :. 0 Iowa Criminal History Record attached, DCT # '<< u ��l j,. DCI initials DCI -77 (08/25/10) Received Time Seo. 16. 2016 1:41PM No. 4111 CJHUVtWA00T SMARTER 1 51MPLER I CUSTOMER DRIVEN WWW'IOWadOt.gOV Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-11211 Fax: 515239-1837 WWW.IOWadot_gov Certified Abstract of Driving Record Inquiry Date: 9/24/2016 DL/ID #: 123AM6126 (IA) CDL Permit Class: None Customer #: 6534984 Class: D CDL Permit Issue Date: None Name: All Hamed, Abdelrahman Abdalla Audit #: 1236126 CDL Permit Expiration None Date: Address: 808 WESTWINDS DR APT 2 Issue Date: 08/17/2016 COL Permit None Endorsements: Expiration Date: 01/01/2021 CDL Permit Restrictions: None City/State: IOWA CITY, IA 522464027 Endorsements: 2 ID Status: None Mailing Address: 808 WESTWINDS DR APT 2 Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Mailing IOWA CITY, IA 522464027 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 1/1/1960 CDL Cert Status: None Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Ali Hamed, Abdelrahman Abdalla DL/ID: 123AM6126 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 9/24/2016 D. 0. T. f 0R1R �� Office of Driver Services Iowa Department of Transportation Name: Ali Harrod, Abdelrahman Abdalla DL/ID: 123AM6126