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Home My WebLink About16-2201 l 1 IDENTIFICATION NO. I0 -1�4cO (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday — Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (319) 3S6-5040 (319) 356-5497 FAX 1. Name (REQUIRED) 77��edb,L First Middle Last rnctA kN6Y M� Ati4g r-m2� 2. Address(REQUIRED) 21. 14 9 W!(IEfd9 V%—FAOew nw it TA 52Q 3. Contact Information (REQUIRED) Email: }G o4ryo $S 0Ydt ve • c -m Cell Phone: 3!3 —610 -5-4S'A (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) o I Al O 2 0 b. Taxicab Business Name (REQUIRED) 3o t ✓O V\ 5. Prior experience in transportation of passengers: 6. 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 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 12%CIO\1 5 2(-,Ot\ -YOLAXAC— h 12 e l lk What happened to the charge? (Circle one) C-1 I a01 --j eJ(fIC-o' �p/1 Convicted Dismissed Deferred Suspended ead Guilty her ti 8. Has your driver's license or chauffeur's license been suspended or revoked in the last fiveyears? o Type of offense Where Wheri w 9. Have yoy 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 issued on (off/L /4.�llsexpiring on OVoI� 20 2p 1 understand that if I falsely ans r 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 A Date_!) / 3 d r' 4 I STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by�} on this day of !7 otary Public rTjnd for the State 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 City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of Driver's license Date ay Signature of Police Chief or designee 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. Sigrblure of City Clerk or designee 9/:?e17/�i� D to C7 Office Use Only crnn 0 w - o Approved application DCI report State certified driving record Website update CleWTAXIDRIVMDGEAPPL92014aMWdW.DOC 07/2016 _r -.._-.v- _. Zlerlf _...__ _._ ____ ._. - 00/2G/2016 1o:4G - - .JG3 - -/002 STATE OF 10WA Crfilri la i History Reeo. ti Check Request Foran To: toyer I)!vision of Criminal Investigation Support Qperatlons Bureau, P Floor 1,IS L. 7" Street 1)es Mollies, Lowe 50319 (515) 725-6066 ,(515) 725.6090 Fal; 01101/��y6 LAEL)-Al nA a L') f)CI Account Al'uniber; _>I.oz_z :�r_ (ifapplicablc) From: City erlowa City Clty Clcrlc's Orfiec -- 410 L. WashlnRlon Strce( tewe Cily,� 1A 5224o Phone; 319-356-5041 Fal:319-356,5497 Mckovy\e4– 1SMale ❑Female I— zko' 1VRiverrrifornia IOn. Wilhout a signed waiver from the subject of the request, a complete crimhlal history record may not be release ble, per Code of Iowa, Chapter 692.2. For comoiete criminal history Mee C Information,ink Wallowed re law, always obtain a waiver signature from the sublect of More0000a WRiVer l,eiLa$e: I Wcby give permission for Ile above requesting ofrtcial to conduce �e lower criminal aistoryrorord �heca,vitB Che Divirion of Crimisal l"Miligntion(DC0. Any efimival hislory data Concerning me shat is maintained bylhe DCl may be reiwsedw Allowed by lav, Waiver• Sisnattire; .. (DCi we only) As of a search of the provided name and date of birth revealed - No )owe Criminal HistoryRecord found with DCT ` ' ff 0 c5 Lh, ® Iowa CrilMnal History Record attached, DCI # s DCl initials DCI -77 (08/25/)0) Received Time Sep, 26. 2016 10:32AM No. 4746 NUWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www.iowadot.gov Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-92D4 Phone: 515-244-91241800-532-11211 Fax: 515-239-1837 WW W.IpwadOLgoy Certified Abstract of Driving Record Inquiry Date: 9/29/2016 DL/ID #: 214CC9840 (IA) Customer #: 4313828 Class: D Name: Abdelrazig, Abdel Rahman Audit #: 8537734 Endorsements: Mohamed CDL Permit None Address: 2442 WHISPERING MEADOW Issue Date: 10/16/2014 OL Status: DR COL Status: None COL Permit Status: ELG Expiration Date: 01/01/2020 City/State: IOWA CITY, IA 522406805 Endorsements: 3 Mailing 2442 WHISPERING MEADOW Restrictions: NONE Address: DR Restriction None Mailing IOWA CITY, IA 522406805 Supplement: City/State: Date of Birth: 1/1/1956 Sex: M History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: JUR CDL Permit Expiration None Date: CDL Permit None Endorsements: _ 111/25/2014 CDL Permit None Restrictions: _ _lIA IIA ID Status: None OL Status: VAL COL Status: None COL Permit Status: ELG CDL Cert Status: None CDL Med Status: None Page 1 of 1 nation Date Conviction Date ACD Explanation County JUR .2/23/2_011 01/03/2_012 1592 1855323 IIA _ _ .1/12/2014 _ 111/25/2014 ---Speed f 592 _ _ _ _ _ _ _ _ Speed (10 mph & under In 35-55 mph zone) _ __IJohnson_ _ _ _ 'Washington _ _lIA IIA )9/19/2015 09/28/2015 IMOS Fail to Obey Officer Johnson !IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. lccident Date Case Number JUR 10/14/2011 _ (553163 ---`-� - !IA ��IIOF As {1702582 _ _ _ IIA )4/20/2015 1855323 IIA 13/20/2016 1912831 IIA Name: Abdelrazlg, Abdel Rahman Mohamed DL/ID: 214CC9040 Pursuant to Iowa Code §321.10, I, Melissa Splegel, 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 1 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: p�� -��peVtBlCI 9/299//2016 a'IOWA;a ��IIOF As (c Office of Driver Services 45E Iowa Department of Transportation Name: Abdelrazig, Abdel Rahman Mohamed DL/ID: 214CC9840 9/29/2016