HomeMy WebLinkAbout17-016CITY OF IOWA CITY
410 East Washington Street
Iowa City, Iowa 52240-1826
(3 19) 356-5040
(319) 356-5497 FAX
IDENTIFICATION NO. / -1 -N L 1 -
(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
First Middle q^ JJ Last
1. Name (REQUIRED) G)Mccl Ac- �e e'1
2. Address (REQUIRED) 2(�,-)FJ Raje/f@A ;&2A 522-1{b
3. Contact Information (REQUIRED) Email: Cell Phone: (-31q 393 613(
(All written communication sent via email)
4a. Driver's License expiration date (REQi
b. Taxicab Business Name (REQUIRED)
5. Prior experience in transportation of passengers: _T t4-5--4 -10 y 41 j'Vi " E In
4,-2G( ( ' r-21 12nl'L rIL f—a j
6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere?�
Type of offense
What happened to the charge? (Circle one)
Where
When
Convicted Dismissed Deferred Suspended Plead Guilltty Other
Have you been arrested / charged with any traffic offenses in the last five years?
Type of offense Where When ^�
or;yin . wyo" LL(- '1 34 Ol.-rh C i `� ( 2
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? NO
Type of offense
Where
When
r, ,
E2
9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the names)
Z:>
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
G CAS Q L 1> 4A R issued on 12lQo4(6expiring on I understand that if I
falsely arlswer any questions in this application, that this application may be denied.agree a that i 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 Applican T Date I '
STATE OF IOWA )
COUNTY OF JOHNSON )
Subscribed and sworn to before me by on this �ti _ 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).
license
Z/
designee 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.
\SLignaturt, of City Clerl or designee
\2A n
Date
CIaMlrA%IDRNBADGEAPPL92014aa dad.DDC 07/2016
�a
Office Use Only
Approved application
J
DCI report
Na
State certified driving record
Website update
CIaMlrA%IDRNBADGEAPPL92014aa dad.DDC 07/2016
CillilIOWA DOT
SMARTER I SIMPLER I CUSTOMER DRIVEN VVWW'IOWBdOt 90V
Inquiry Date: 1/27/2017
Customer #: 6416805
Name: Idris, Omar Adam Abdalla
Office of Driver Services
PO Box 9204 1 Des Moines, IA 50306-92D4
Phone: 515-244-9124 1 8OD-532-1121 I Fax: 515-239-1837
www. iowadot gov
Certified Abstract of Driving Record
DL/ID #: 947AL1383(IA)
Class: D
Audit #: 1502121
Address: 2608 BARTELT RD APT 1B Issue Date: 12/20/2016
Expiration Date: 08/16/2023
City/State: IOWA CITY, IA 522462730 Endorsements: 3
Mailing 2608 BARTELT RD APT 1B Restrictions: NONE
Address: Restriction None
Mailing IOWA CITY, IA 522462730 Supplement
City/State:
Date of Birth: 8/16/1978
Sex: M
History Information
Convictions
CDL Permit Class: None
CDL Permit Issue None
Date:
CDL Permit
None
Expiration Date:
CDL Permit
None
Endorsements:
1/27/2017
CDL Permit
None
Restrictions:
ID Status:
None
DL Status:
VAL
CDL Status:
None
CDL Permit Status:
ELG
CDL Cert Status: None
CDL Med Status: None
Citation Date Conviction Date ACD Explanation County )UR
11/10/2016 ,11/28/2016 N63 .Driving Wrong Way on One Way Street Johnson IA
Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation.
Accident Date Case Number JUR
11/28/2016 954714 IA
Name: Idris, Omar Adam Abdalla DL/ID: 947AL1383
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:
Name: Idris, Omar Adam Abdalla DL/ID: 947AL1383
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0
1/27/2017
C�n u .
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Office of Driver Services
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Iowa Department of Transportation
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Name: Idris, Omar Adam Abdalla DL/ID: 947AL1383
F,Jan.JU_ 2UI/,I,IU;h/AM CIorUly of Criminal 1nvestigatlon 01/27/2019 M:. No. '2413gptP...l/1,/002
— Jan. 23. 2017 1:I8PM Div of Criminal Inuesligalion No. 1961 P, 2/3
Prom:0l.y Of 1e~6 OnY 016ik Orlleo 310 66,1119CA07
01/20/2017 18:21 +e1f07 P,002/002
STATE OF IOWA 3.
Crime nal Ifistary )Reeoyd Cbeek
Regnest Fort"
're: Iowa\ Division of Criminal le vtstigallon
Supporl Operations Bureau, P Floor
215 L. I" Street
Des Maines, lows 90319
(515) 725.6066
(615)725-6080 FAX TO V
1 Ain renneeeiuo on Inure Cri...:.0 Mo..... R.wn
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(Ihpylinel,)
From; —6ty of Iowa Civ
gtyClcrk'rOffice
410 E, Wosldneton Strut
Iowa Cit9, 14_52240
FON phone, 319-356-SO41 -_
319.3S6.5497
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Nraiverrinjorrr1017011i Without a signed walver from Ihoaubject of (he request, a complete criminal history record may not
be releasable, per Colic of fowa, Chapter 691.7. For tom tete criminal hltlory record hlforma(lon, ar allowed by law, always
obtain a waiver al ns lure from tha sob ect or the 1'e nest,
P)fa[ver Airlease.. t nerelyawe permlulen ler we ahnrc re9umtalaarriei,l to cendaG rn Iowa clime"! 1110ty rcoerd cask onb do Dlvirion o[CGminsl
Inrullplien (DCI), Any Glmtnd lllJtory dm connmin; nm teolir malnnlaed 6y lneDgmqac relayed at allowM ay len•.
WrrNn.SignnlNre: �v� �21g�,,,,t_��
�«� uea ea a�w ne (DCI ,Ge only2
As of _ �' 7V'"� 1 , a starch of the provided pante and date of bldh revealed:
'73
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W, No Iowa Criminal Hisiory Record found Willi DC1 ! [ 1'v
❑ loW11Chillioal hlistory Record attaehod, DO p_ v
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DCI 65itiols
PCl•77 (U6/2511 U)
Received Time. ,Ian. 70. 7017 1.44PM Mn 1070
Received Time Jan. 27. 2017 2:06PM No.2359