The URL can be used to link to this page

Home My WebLink About17-017IDENTIFICATION NO. / —? — 0 -1 J ! r 1 (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (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)356-5040 (319)356-5497 FAX Last 1 1. Name (REQUIRED) First Middle of lar A tom,? Aj4 :Ec4e1C 2. Address (REQUIRED) 26w 4e (%a ->A :* 2A -tA 522y¢6 3. Contact Information (REQUIRED) Email: Cell Phone:E3 &el 3� (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) - b. Taxicab Business Name (REQUIRED) �7-0 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?AID I— Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? /Type of offers e Where When 1 1/%1✓//�'i w1' YUI+/� t.J(+.w� j'71rG✓T ) �lnrh C 1 �� , I I��I � N1K'1 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 9. Have you 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) 0712016 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 A L \ 3'� issued on a /2n/(& xpiring on c, �> . I understand that if I falsely answer any questions in this application, that this application may be denied. 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 Applican Date **4}#1'!144##'k11*!!1:}f!!!1l14444414####Yi###*ff*}!*!***f*#1fl1441!!!fllYff444Yf44Y#*#*##**!lflfll!!H!llNfiY#yy:***!!lillflHHfflflf4:f!!ll11fi4Y 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 /DZ// designee Dates 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. i nat r of City Clerk or designee Office Use Only Approved application DCI report State certified driving record Website update Date Cle,mrnxiDRIVWGEAPPL920im�.DOC 07/2016 ''•, 10 WA DOT SMARTER I SIMPLER I CUSTOMER DRIVEN VVWW'IOWBCjOt 90V Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1 8DO-532-1121 i Fax: 515-239-1637 wwwJowadot.gov Certified Abstract of Driving Record Inquiry Date: 1/27/2017 DL/ID #: 947AL1383(IA) Customer #: 6416805 Class: D Name: Idris, Omar Adam Abdalla Audit #: 1502121 Address: 2608 BARTELT RD APT 1B Issue Date: 12/20/2016 CDL Status: None 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: j ' yJtea°� 4 CDL Permit None Endorsements: Iowa Department of Transportation 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 JUR 11/10/2016 ;11/28/2016.N63 ',Driving Wrong Way on One Way Street Johnson IIA 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 ......... �`,,i4 1/27/2017 IOWA` sS D. 0. T j ' yJtea°� 4 ........,r Office of Driver Services `ram ,rc Iowa Department of Transportation Name: Idris, Omar Adam Abdalla DL/ID: 947AL1383 Jan, 3U: 201/, 1U:)/AMcf&rU i v of Criminal Investigation 01/27/2017 s,:No. 14/3sac Y, 1/1„002 Jan. 23. 2017 1:18PM Div of Criminal Invesligation No. 1961 P, 2/3 RrOM:Clcy of ler& Clly fT&ik Orllo& 312 3666,107 01/20/ZO17 16:21 ,1727 P,0021002 0 STATY OF IOWA Criminal History Record Chieck Request Fort” 'ro: Iowa Division ofCraminal Investigaiion Supporl Operations Dureau,ll' Floor 215 r. 7" Street Des Moines, lows $0319 (515) 429.6066 (515) 725-6o6o fay TO V T IS F I asn r00l1etlina an Inure Criminal Aterwru R•.,,..L Ok..t-.... CCI Account Ahhttber, _Lleats'Z -%ter_ (tfap(1id61e1 Front: Clt of fowa Citi. City Clerk'* Office _"»» 410 P. Wuh,nuton Street_ 1=2j, ytA 522<0 FOR phatm 319-3563041 WN,3j9.3S6-5497 3 FORP': ]sett Nslne mrndemr Fust Nsmts (mandam Middle Natrle otconsawdoa L D rCI S M 6L ,ADA M Date of Birth nenlcle) Conder mrndam Social Securl Nwnba (reesmmeod.q p 49 / I " � 11-78 ❑ Mmale acini ^� i� �y Cf 0ratvar,lnjormc1lon.; Without— I slgned waives' from Ilsosubjeet of the request, a eomple(e criminal history record may nol be releasable, per Code of Iawk, Chapter 69b.3, For tom Iiia criminal history record btformo(loh, swallowed by law, slayays Obtain a walyerfilghature from th6 ao0 ett of the re oesl, Witiver Rdlenret 1 htttValve atlmisslen for the alert rtgtle111njoReirl to tande6 6t low. almklsl 1110ery rccold check lrllb int Olvieieh of efW1111l Inresllguien incl), Any 0104e111111ofy deluenctndng me that is mdnulaed by the net may be fettered at dlolrM by law. Wolver Signalare: av n2a,,,V+atteaalta\ lGlJ WlY aa.ccVfP l.I1GCK l(CFRI (OCI ,us only) As of �• �' "I 1 , a search of the provided name and date of bitlh rent clad: �y U J' (�h No Iowa Crinvnal 1- istoiy Record found wi01 DCI !; JI �- ❑ Iowa Cfinlival History Record atiocibod, DC1 N_ DCl initiols VU -77 (06/25/10) Received Timt Jhn.70. 7n17 7•N6PM Nn 107o Received Time Jan. 27. 2017 2:06PM No. 2359