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Home My WebLink About16-238CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa S2240-1826 (319) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ IDENTIFICATION NO. % (g - 7Z-25 n (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 Last c_ I, 2. Address (REQUIRED) 'jSr+4"X- IQtJo,, •T�y 3. Contact Information (REQUIRED) EmaiC n ,�4 Cell Phone: Zt clI (All written commu a ioi n sent via email) 4a. Driver's License expiration date (REQI b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of pa 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? A3cT Type of offense Where When What happened to the charge? (Circle one) Convictedsmissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? U10 Type of offense What happened to the charge? (Circle one) Where When 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 , 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide tt>ename(s) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTPFIED 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 r 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 3 7 R g anyQ )� issued on Z __ 1_1 2'J expiring on o $ _ cU -) I understand that if I falsely answer questions in this application, that this application may be denied. Il 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 furtr agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title 5, Chapteof the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date 16 iP - % 6 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ( kg) vv,cAcb t ti l'1 on this 20 day of (7c�7)lenf 2or`7 _ 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, Coity Code). Expiration date of Driver's license 9 (L2� Signature of Police Chief o esignee 1612-4 C ,("� —� 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. ^� Sig ature of City Clerk or designee P Office Use Only ;F5 po Approved application DCI report State certified driving record Website update CIeM/rAXIORNMGPAPPL92019amended.DOC 07/2016 Qct.19. 2016 2:36PM Div of Criminal Investigation No, 5141 P. 1/2 From:Clry of Iowa Cr:y Clerk Ofllca 210 0666407 10/17/2016 11:0.2 0712, STATE OF 1,017VA tCrhnffiai Historpl Record Chock �\ Request Fos fn To: 1ov.,a Division of Criminal Invesllgation support Operations Bureau, la' Floor 215 E. I", street Des motiles, Iowa 50319 (515) 725-6066 (515) 725-6080 Fax all Iowa 9- ejL- - 116' DO Account Number; qco�;L — �ifapplicable) Frum: City of Iowa CI'h• City Cleric's Office 4101;, 'Waa�n $[reef Iowa Cl!L, ISA— phone: 319-356-5041 Fax: 319-356-5497 5t5 me9j in Itler (manderory) ale Opetnale /\'10'}--t0-r—ej :i $2 -35-OkcJiS- rMaffdr" Without a signed waiver from the subject of the request, a complete criminal history record may not per Code orlowo, Chapter 692.2. For eom l w signature from the suh_fect of the reauesi. etc criminal history record rnformallon, as allowed by law, always Hlft"'eP /lelease; l huaby give ycnnission for the above rcqui luvestigslian Mcb. Any criminal historydata concerning Ibe [hat is Waiver life conduct m loe'a erhninsl history record Brock vvilh the Division orcriminai by the DQ may be released ss allmved by[,,,. Iowa Crimilxai R€storey Ytecord Checlr Results As of �Q fro a search of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCII Il Iowa Criminal History Record attached, DC1 DO initials DCI -77 (06/25/)0) Rpfp lvP9 Tim Orl. ll 9016 10-44AM No. 6910 i' i. www.iowadot.gov SMARTER 1SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 92041 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-11112111 Fax: 515-239-1837 www_bwadol.gov History Information Convictions Citation Date Conviction Date ACD Explanation County JUR / jspeed Johnson IIA 07/18/2014j2014 - - 107 25/2014 _ -- -- _ - ---1593 - -- ---- Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date _ _ Case _3 Number JUR D7/18/2014 80853TA Name: Salih, Nagmeldin Mohamed DL/ID: 137BB0959 N Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department o%ansportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this Is true apd, accurate copy of an official record currently in the custody of said office, and that I have been authorized by the Director of fhe At a Depa rtd'ient of Transportation to so certify. _ O In witness whereof, I have caused my signature and the seal of the Department to be set upon this-dGFu}nent, at Ankeny Iowa this date: _ PQ dE..... . Certified Abstract of Driving Record Inquiry 10/19/2016 DL/ID #: 137BB0959 (IA) CDL Permit Class: None Date: Customer 4102089 Class: D CDL Permit Issue None #: Date: Name: Salih, Nagmeldin Audit #: 6175614 CDL Permit None Mohamed Expiration Date: Address: 2548 INDIGO DR Issue Date: 08/01/2012 CDL Permit None Endorsements: Expiration 08/04/2017 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: 3 ID Status: None 522406808 Mailing 2548 INDIGO DR Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522406808 Status: Date of 8/4/1967 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation County JUR / jspeed Johnson IIA 07/18/2014j2014 - - 107 25/2014 _ -- -- _ - ---1593 - -- ---- Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date _ _ Case _3 Number JUR D7/18/2014 80853TA Name: Salih, Nagmeldin Mohamed DL/ID: 137BB0959 N Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Director of Office of Driver Services, Iowa Department o%ansportation, do hereby certify that I am the custodian of the records held by the Office of Driver Services, that this Is true apd, accurate copy of an official record currently in the custody of said office, and that I have been authorized by the Director of fhe At a Depa rtd'ient of Transportation to so certify. _ O In witness whereof, I have caused my signature and the seal of the Department to be set upon this-dGFu}nent, at Ankeny Iowa this date: _ PQ dE..... . Name: Salih, Nagmeldin Mohamed DL/ID: 137880959 10/19/2016 Office of Driver Services Iowa Department of Transportation r�> ra L c CD y1` �L Q C�