The URL can be used to link to this page

Home My WebLink About16-222CITY OF IOWA CITY IDENTIFICATION NO. l Lo- 2Z2 -Z, (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) 410 East Washington Street Iowa City. Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (319) 356-5497 FAX First Middle Last 1. Name (REQUIRED) Am i1 lc�W n.cci A iaan tr 1 k t +v� 2. Address (REQUIRED) 2`f2o �P(� f2d l#JC . " tK < p� i� 5 2 7 Iff, 3. Contact Information (REQUIRED) Email: 4mri..d(bk6170 Cell Phone: S15771o666 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED)II O c�/05/901 b. Taxicab Business Name (REQUIRED) C4 5. Prior experience in transportation of passengers: /2a (l 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? !XO 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? S Type of offense Where When S Py -,r d )KIK la.,,.V-1 aS/l8/ )-ole/ S Pe Y\ se;" 41 J4/ 14 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? Type of offense Where When 0 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please providtIve name(s) A, U 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 availableiupon 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 Go ,'Zil"yoy'11 issued on t:t5/61/ iS expiring onOVOS-f )elt . 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 f5 Date2d)l6 41HH1flHlNNH1H11fHflfHlfHl�f ff }fH}f}f,}}I}N}}H}}H'k}}}}Y}HHHHHl4}li4lf4ll41flNHff11111f HNlf4f f 11HlfHflf f}f f 1fH11HlHHf STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn11 to -- before me by AcM.ti r .1 . %�. ��rQ I& laon this _ � day of 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 dateofDriver's license y` ✓( Signature of Police Chief or designee 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. 2 ?�� R . SignalVre of City Clerk or designee Approved application DCI report State certified driving record Website update ate 0 Office Use Only perk/rAXIDRN94DCEAPPL92014amendea.DDC 07/2016 rr5eR-_13, 2016„4;22PMelarDiv of Criminal Investigation os,O7�Oi6,s:flo.2863,O6P. 2/32„oa _• _ STATE E O F IOWA Crrilinni nal History Reco d Check 1(97” Request Form To: lows Division of Criminal Investigation Support Operations Bureau, 0 Floor 215 F. 71h Street l3es Moinw, Iowa 50319 (515) 725-6066 (515)725.6060 Fax I asn reollestina an lmva Criminal t-ricenry 4.n...4 rh-1, DC) AecomltNumber:_ Y 0h7 - f= (ileppliublc) From: City or Iowa City City Clerlr a Office 410 F. Washington Street XONVACRY, lA 52240 Phone: 31"56.5041 Fax: 315-356.5497 Last Name (mandato ) First Name (menomo •) Middle Name (reaoswneadeA %ra Date of Birth mane Gender maMaloq•) Social Security Number (racen„n<neea) 4 Y/Q 5/ y 6'9 VTale ®Female -y 3 Z � � Waiver Iaformaflon. Without 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. For ore tete criminal history record information, as allowed bylaw, always obtain a waiver signature from the subject of the request, Waiver Release: l hereby give pasninlod for Ale above ¢questing official to cwsdud as Iowa crinsinal history record check with are Division orcriminal Inverliption (DCI). Any crimioal history vasa concurring me)WI is maintelned by 1116DC1 maybe rcleascd as allowed by lees, WitriverSignnrure; =14a" -.. Ariz! a �a..a�uauaaa xaa 'gut ' Col ll Y IIeCIL ddCSllfiS (DCf�%w,y9 As of 1� a search of the provided name and date of bath revealed: FrNo Iowa Criminal History Recon found with DCI ❑ Iowa Criminal History Record attached, DCI # 't�_� . DCl initials_. N _ W DCI -77 (06/25110) Received Time Sep. 7. 2016 11'43AM No -3454 C410WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN wvvw.iowadotgov Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241OOD-532-11211 Fax: 515-239-1837 www.iowadot gov Certified Abstract of Driving Record Inquiry Date: 9/30/2016 DL/ID #: 673A10477(IA) CDL Permit Class: None IOWA s D. 0. - T.- Customer #: 6068081 Class: D CDL Permit Issue None Iowa Department of TransportationZ!::^� 7 i p Cj Date: Name: Ibrahim, Amin Mohamed Audit #: 9066622 CDL Permit None Adam Expiration Date: Address: 2420 BARTELT RD APT 2C Issue Date: 05/07/2015 CDL Permit None Endorsements: Expiration Date: 04/05/2018 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522462707 Endorsements: 3 ID Status: None Mailing 2420 BARTELT RD APT 2C Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522462707 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 4/5/1968 CDL Cert Status: None - Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 06/18/2014 107/07/2014 592 Speed (10 mph & under in 35-55 mph zone) Polk IA 09/20/2015 '09/24/2015 S92 Speed Johnson IA 12/19/2015 .01/08/2016 '.M14 Fail to Obey Traffic Sign/Signal Johnson 'IA Name: Ibrahim, Amin Mohamed Adam DL/ID: 673AJ0477 Pursuant to Iowa Code §321.10, 1, Melissa Spiegel, Director of Office of Driver Services, Iowa Department of Transportation, do hereby certify that 1 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: y�wy ti d '1 �tEtllIXf , r ....... B/`lit 9/30/2016 y IOWA s D. 0. - T.- .. o . � Office of Driver Services "'films ^a.H x Iowa Department of TransportationZ!::^� 7 i p Cj Name: Ibrahim, Amin Mohamed Adam DL/ID: 673AI0477