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Home My WebLink About16-2691 r i CITY OF IOWA CITY 410 East Washington Streel Iowa City. Iowa 52 240-1 82 6 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. I(0 — 2VJ (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between S a.m. to 3 p.m., Monday — Friday) Failure to complete the "required" information will result in denial of the application First 3. Contact Information (REQUIRED) Email: 4a. Driver's License expiration date (REQI b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: Middle (All Phone: <�I`I q 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? t-� Q Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other "(\J O 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Ot" No 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five',years. li c Type of offense Where Wherf-i — — 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the r\( O i� 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 here card th t I have ssued to me by the Iowa D art ent of Transportation'Ia valid Driver's license number �f 3 ssued on , ` expiring on ✓� �J ( �,,Zol I. I understand that if I fads ley 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 Win= --_> Date 1A —Gj— k STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by js.ua ro , 4. on this day of WENDY S. MAYER ,,,_„_, 7, 9nl Notary Public in a for the 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 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. Sign ure of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update �Ote =i (.) a' tc) co C3erkr[AXIDRNflADGEAPPL92014amended.DOC 07/2016 ��1 DOT SMARTER I SIMPLER I CUSTOMER DRIVEN vvww.lowadot.gov Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone_ 515-244-9124 1 8DD-532-1121 I Fax: 515-239-1837 www.iowadGI.gov Certified Abstract of Driving Record Inquiry Date: 11/28/2016 DL/ID #: 893AL6739 (IA) CDL Permit Class: None Customer #: 6337618 Class: D CDL Permit Issue None Date: Name: Bah, Mamadou Audit #: 1427035 CDL Permit None Expiration Date: Address: 2010 BROADWAY ST APT H Issue Date: 11/09/2016 CDL Permit None Endorsements: Expiration Date: 11/16/2021 CDL Permit None Restrictions: City/State: IOWA CITY, IA 522407071 Endorsements: 3 ID Status: None Mailing 2010 BROADWAY ST APT H Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522407071 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 11/16/1988 CDL Cert Status: None Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Bah, Mamadou DL/ID: 893AL6739 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: - '•7.��;'A� 11/28/2016 IOWA °'y -v opz of% �rec` r DDIVE6 $ Office of Driver Services Iowa Department of Transportation Name: Bah, Mamadou DL/ID: 893AL6739 11,l)ec. h. 2016111:D/AM Cab Div of Criminal Investigation i (FAX)3193382:N0. 8647 P•, .402/002 o$arnpr.:.STATE OF IOWA 1iiQE2A.'ti°I,SCriminal History1 Ird Check RequestFor yh,.vntV••• To: Iowa Division o(Crlminal lnvastlgatlon Support opera[lolls Bureau, 1r' Floor 215 E. 7'a Street Das MOlnes, /owe 50329 (315)725.6066 '—(S I6)' 775.6080 1~'a x Last Date Of Birth (mandato M 01ale I F= Yr a rverdtVormaffoh; without a aIinad weIYBr from the subjatl nrtho bo raleglablo, Dor Code of Iowa, Chapter 692,2, For com Plate criminal h) obtain a w@Iver sl&nature from the aeho..e ar.h........-.. I Account Number; 9967-F (Irapollonbla) -rc= Yellow Cab of Iowa CitV P,O. Box 428 Iowa city, IA. 62244 (319) 338-9777 cone; Fax; _T1-9) 33-9-730-2 I- Z -t -S - WI) -1 o URI, a complete griminal history record may not -reaoro Information, sa allowed by law, always lira lBaIj ji (OCIaSE: I hereby give parmlsrlon rorthe above requesting amohl la eonducl an fotiJA Oriminel hlalary teeard eheok wllh the Division o(Criminal lnvas116alian (DCI). My erlmfnal hlslo y data eanoamldg me that Is malnfalned by the DCI maybe'released as allowad bylaw, Waiver Mgnarure, (DCI via only) As of l -� lS 11 a search of the provided name and d Its of birth revealed:' 12"�NO Iowa Criminal History Record found with DCI Iowa Criminal History Record attached, DCI # 1 DCI initlals I z I I • DC1.77 (08/25/10) i i Received Time Nov.29, 2016 1;29PM NO -9006