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Home My WebLink About17-046.�r 1 CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 3S6-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. I I- oe/L (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 2. Address (REQUIRED) I 20 //JJ� 3. Contact Information (REQUIRED) Email: O' A.?�t1t�A lUi (All written communis 4a. Driver's License expiration date (REQUIRED) o q/-q'ao b. Taxicab Business Name (REQUIRED) �EMAJOVI T& s 5. Prior experience in transportation of passengers: 11)qj1/rA sent via email) Last Cell Phone:31q L76 g106 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State orelsevfhere? 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? 1 { ( > Type of offense 1 Where When km U - -e LI bej, -j Im rfLi e gIz9a 1 R i e1>10 l, h rev, T A I I Oq Na a► 6 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) 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 o241g 14 Qy� �, issued on 3 12 11 expiring on 9 122- 1 t q . 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 _ _ _ Date G STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by AVI" on this L— 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 ojlewGLCity (Title 5, Chapter 2, City Code). 2221 / r Signature o Police C ief designee Dat AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO M07FITHAN ONE YEAR FROM THE DATE LISTED BELOW. S gnature of City Clerk or designee Date Office Use Only Approved application DCI report State certified driving record Website update aerkrrnxiDRivenoceAPPr9201aa dMDoc 07/2016 ARTS Page 1 of 2 1 d ClJ10WADOT, SMARTER 1 SIMPLER I CUSTOMER DRIVEN WWW'IOW7dOt.gOV Inquiry 3/17/2017 Date: Customer 5409180 Name: Ahmed, All Omer All Address: 1520 MCKINLEY PL City/State: IOWA CITY, IA 522464132 Mailing PO BOX 2532 Address: Mailing IOWA CITY, IA City/State: 522442532 Date of 9/22/1968 Birth: �11/OS/2012 Sex: M Convictions Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-1121IFax: 515-239-1837 www-lowadol.gov Certified Abstract of Driving Record DL/ID #: 248AD4337 (IA) CDL Permit Class: A Class: D Audit #: 1649424 Issue Date: 03/02/2017 Expiration 09/22/2018 Date: Endorsements: 3 Restrictions: Commercial Learner Permit, CDL Intrastate Only Restriction None Supplement: History Information CDL Permit Issue 03/02/2017 Date: CDL Permit 05/16/2017 Expiration Date: Explanation CDL Permit NONE Endorsements: �11/OS/2012 CDL Permit CDL Intrastate Only Restrictions: IA ID Status: None DL Status: VAL CDL Status: VAL CDL Permit LIC Status: CDL Cert Status: Excepted Intrastate CDL Med Status: None Citation Date Conviction Date ACD Explanation County JUR 09/01/2012 �11/OS/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA 07/10/2016 11/29/2016 M14 Fail to Obey Traffic Sign/Signal Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number JUR 12/12/2015 1895326 SIA Name: Ahmed, All Omer Ali DL/ID: 248AD4337 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: http://172.29.254.55/drivers/reports/customerhistorylcertiffeddrivingrecord.aspx 3/17/2017 ARTS ""•:��/"4 3/17/2017 IOWA :C4 f 9%....� r Office of Driver Services 111 Iowa Department of Transportation Name: Ahmed, Ali Omer All DL/ID: 248AD4337 Page 2 of 2 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 3/17/2017 ,Feb. 15. 2017, 9:35A. ,.,Div of Criminal Investigation 02/14'2017 16: No.3786J83P. 1002/002 i real cuv, ,STATE OF IOWA I,I A JI l^a ' RequestI s. �ylgb�prlayQ✓ �.G-. '1'o: Iowa mvislon of Criminal Investigation Support Operations Ilurcau, 1" Floor 215 D.1" Street DcsMohtes,Towa 50319 (515) 725.6066 (515) 725.6000 Fax T am rpnimMina an rnwa Criminal Nietnry R nrnrA Ohnnb nn. DCI Accounl'\umber: C10D-Z- (ifapplicoble) From: City of lawn Clty City Clerk's Office _4101;. Washington Street Iowa City, IA 52240 Phone: 319-356.5041 Fax: 319-56-5497 Last IYaME (mandatory) First Da/me 6nmdatorY) Middle Name (rcwmmended) Aja -ed" (� Ome ra. U, Date Of Birth (mandelory) Gender (mandatory) Social Seettritiv Number (recommended) �fmale ®Female I-7 6— a I I WWVeP INfDYhiC!%lt: 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 complete criminal history record information, as allowed bylaw, always obtain a waivers' nature from the sub act of the request, Waiver Release:[ hereby give permission for Ilse abovo rcgeesllog official to conded mr Iowa erimiaal history record check with she Otvision o[Crlminal Investtgadm, (nCn. Any criminal hislory data eonceming me Thal is matmaincd by the DCI maybe released as allowed bylaw. GYRE veY 3igYtOlra'e; FM Iowa Criminal History Record Check Results tucl nsa only) As of Z--15 `) -7 a search of the provided name and date of birth revealed: No Iowa Criminal History Record fo-und with DO c Iowa Criminal History Record attached, DCl # =: ib— DCI initials DCI -77 (08/25/10) Received Time Feb, 14. 2017 2:17PM No 3705