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Home My WebLink About17-127� r 1 CITY OF IOWA CITY 410 East Washington Slreel Iowa City, Iowa 52240-1826 (319)356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. (Office Use On)— APPLICATION 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 Last,, 3. Contact Information (REQUIRED) Email: nt�)v, e rj;,,S4I:I. Q � r VC1, I - C,,, Cell Phone: 3 15 „ �S'�l o 4� (AlTwritten communication sent via email) 4a. Driver's License expiration date (REQUIRED) $ to t� / 2 ) c� b. Taxicab Business Name (REQUIRED) : ,n �a � — �g '� G �� —� 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? illi c> i10 Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When S� C'c-j � e, L S U n (5 71? &4-� What happened to the charge? (Circle one) Convicted Dismissed Deferred SuspendedPleadGuilty' Othe6 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five AS* b*10 Type of offense Where j �n 0 —t n rn ..fit ..D 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please piOvide the C� o 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 a artment of Transportation a valid Driver's license number i 5 7 1� f m a\ -5 % issued on C expiring on 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 fvver agree that, if authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title 5, Cha a 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant \y � Date9 1 S– //�, xxxxxxxxxxx+xxxxxxxxxxxxxxxxxxxxxxx+x++++++++++xxx+xxxxxxxxxxxxxx+x+++xx+xxx+xxxxxxxxxxxxxx+++++x++++xx+xxxxxxxxx+++++++xx+xxxxxxxxx.x++++++x+++ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by A)N Aea L CQ LA j �, � on this `J day of �D _i , .\,..n - c .1 A . PublicOff and for the State 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). 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. FF pp DCI report State certified driving record Website update Ger$UTA IDRIVBADGEAPPL92014am ndw.DOC 07/2016 9 X, IJ 7 Signature of City CI or designee —� Date o y> � Office Use Only�� -p i � l ,;x w A roved a lication �" + FF pp DCI report State certified driving record Website update Ger$UTA IDRIVBADGEAPPL92014am ndw.DOC 07/2016 C,J10WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN www•Iowado�gov Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-91241800-532-11211 Fax 515-239-1837 www.lowadotgov Inquiry 8/29/2017 Date: None Customer 4102089 CDL Permit Issue None Name: Sallh, Nagmeldin Date: Mohamed Address: 2548 INDIGO DR City/State: IOWA CITY, IA 522406808 Mailing 2548 INDIGO DR Address: Mailing IOWA CITY, IA City/State: 522406808 Date of 8/4/1967 Birth: Sex: M Convictions Certified Abstract of Driving Record DL/ID #: 137BB0959 (IA) CDL Permit Class: None Class: D CDL Permit Issue None Date: Audit #: 2044829 CDL Permit None Expiration Date: Issue Date: 08/09/2017 CDL Permit None Endorsements: Expiration 08/04/2024 CDL Permit None Date: Restrictions: Endorsements: Chauffeur ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG Status: CDL Cert Status: None CDL Med Status: None History Information G9 ;nation Date Conviction Date ACD Explanation )UR 13unty 17/18/2014 07/25/2014 S93 Speed IA MnsonT Accidents - Accident involvement indicated does NOT mean the individual was at fault ntglveq;q cit ion. Accident Date )UR Case Number -- ____._—__ 07/18/2014 IA- _-��-1808533 �� W CD r1a Name: Salih, Nagmeldin Mohamed DL/ID: 137BB0959 (IA) 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: _' pFNICIf p''o, 8/29/2017 Office of Driver Services Iowa Department of Transportation Name: Salah, Nagmeldln Mohamed DL/ID: 137BB0959 (IA) E5 ';:S2 D --4 c'> -C -=tc� M rn C) Y RrSep.�Sy 2011j:16AM Div of Criminal Investigation No. 9969 P. 1 FAX STATE 01-410WA Cyirv4Et21 History Record Check #0aw" Request Form DCl Account Number: _� (irapplidable) To: Iowa Division of Criminal investigation From: City of Larva Support Operations Bureau, I" Floor City ClmlPs office 215 E. 7"' Street 4101;. WashLngon street [)es Moines, [own 50319 —^-- (515)72S-6066 Io.va Cit 1A 52240 .-. •ax --�-- ].'hone; 319-356-5041 Fax: 319-3564497 I am reouestina an Iowa Criminal Y4ietnry R ecnrd Chisel n„ - Last Name (inandatnry) First Name (mandatory) Middle Name (recommeadcd Date of Birth (mandalosyGender mandato • Social SecuritvNumbs[ (rcmmmended) 8 G ®Male ❑Penlale (-� SWaiv2 _ S5 _ : ( 0 75- Waiver er Xnformatloa: without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of row•a, Chapter 692,2. For complete criminal history record information, as allowed by law, always obtain a waiver si nature from the subject of the request. Wlri/river Release: I hereby rive ncnniwlon earthe sn�y.r>n,,.,�;,,�fictal conduu-ui lo,m criminetListerymoordshcckmith9hciaivision-orGimival--" Innstigation (DCC). Aoy aimioal hislopr data eoneeming me drat is maintained by Dal may be released as allowed by Inv. r. Waiver Signature: _ Iowa Criminal Hi.storyRecord Check Results 'EMM use anly) As of (S k M a search of the provided name and date of birth revealed�> --0 •t - ( at No Iowa Criminal history Record found with DCI -� •, -10 � - to ❑ Iowa Criminal Histody Record attached, DO # o v DCI initisls� SJGA-/r kU5//3fLU) Received Time Aug.29, 2017 10:31AM No.5772