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Home My WebLink About17-124I~ _ � r CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 2240-1 82 6 (319) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) . IDENTIFICATION NO. / % /-� (Office Use Onl ) 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 MSA Mt DCUW1N 2. Address (REQUIRED) 2c5 Pf l'�cIcctij N'Cl <<P F-alq 3. Contact Information (REQUIRED) Email: -Q 6 w,. Vt (�) C,Aaa 1 '(�'tCell Phone: a I q) 2 0c1- 1630 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 6 5 / I �,, % a C`, Z b. Taxicab Business Name (REQUIRED) 'rowcty% I �iX i Cci) 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? -A� C Type of offense IC- W, W here Ci _ 2C-, I� �c w�c�+-i C c•��c,�S� .tib c� -^[� What happened to the charge? (Circle one) Convicte Dismissed Deferred Suspended Plead Guilty:<fOtheL. � s Have you been arrested / charged with any traffic offenses in the last five years? car_ ro Type of offense W here- hencst V CC.c•� -Tl ^ V ) C -A 0 rI I—jZ(� What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other P`4�a 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? PJ 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) P e 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 i �f i AF1� -7R issued on b9 / i S//9 expiring on c- % I R / 20 zz 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 L, Date A / DQ % I - - 1f+!#if iffYfflfllflllflllf f 11ff1ffiHifflfYff}1!!!fllfYf 1f1111f1HHYYYflryfl111f11f!!1f fiffiflfYffllfYYYfflllfff1H11111f1111f11f11f1rffiYT111f STATE OF IOWA ) COUNTY OF JOHNSON ) bscribed and sworn to before me by jQkSSgn n,tihM�c�. on this + day of �P'� 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. Signature of City Clerk or ignee —� paw fflllrf r«frlr:rflrY+r11r11f+aoY.lrf:f::frrrrrf»rrf rrr:YYffrlrrf llflf::lf lrfrrrrfrre.f+1111fY1111ff111frrr:frrlrra!!1!!11!!1:ff«rrrr:raY!llrlf Office Use Only Co n V) ^� Approved application - + -s r DCI report I State certified driving record Website update = o orn �yC N I� Jj Clerk/rA%IDRNaADGEAPPL92014amende DOC 07/2016 State of Iowa Division of Criminal Investigation 215 E. 7' Street Des Moines, Iowa 50319 Phone: 515/725-6066 Fax: 515/725-6080 Iowa Criminal History Record Check Walk -In Renuest Yourname: jH 4 N h Address: 1c 1 S M4 A%jr Rp4 lOC Ci /State/Zi : CA 9 2'S 0 Phone #: 7jq-2-o*j—jj670 Reauestine an Iowa criminal history record check on: Fill in all shaded areas. Last Name Apellido (mandatory) First Name Primer Nombre (mandatory) Middle Name S,Spndo Nowfve (recommended) MM ED 9A SSAN HOHANEO ELPrN tN Date of Birth Fecha Aracimiento(mandatory) Mender Genoa (owndatory) Social Security Number (recommended) 0 1/119 /19,712 ['Male ❑ Female 0 01- L15'- S6 9 U Waiver Signature Firma (If the request is on yourself, please sign. If the request is on someone else, write N/A.) Ex�_.. l' L Results DO USE ONLY As of L-30-17 a name and date of birth check revealed: ❑ No record found 41 "cord attached DCI # DCI initials Receipt Number of requests 1 x $15.00 per last name = Total amount $ 1 S G O Method of payment: cash money order check # y ay(omasterCard or Visa (last 4 digits) Cardholder's name DCI initials Credit Card # DCI -83 (09/09/ 10; Revised 10/ 1/ 10; form reviewed 08/11/14) Exp. Date IOWA CRIMINAL HISTORY MISDEMEANOR CONVICTIONS ONLY DCI:01041223 NAME: AHMED,HASSAN MOHAMED AHMED,HASSAN MOHAMED ELAMIN DOB SEX RAC HGT WGT EYE 19780118 M W 510 270 BRO DCI 01041223 PAGE 1 OF 1 DATE PRINTED - 2017/08/30 HAIR SKN POB BLK MED YY ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** O1 ARRESTED/TAKEN INTO CUSTODY 20160126 AGENCY: IA0520200 IOWA CITY PD CHARGE NO- 01 IA STATUTE IA708.2A(2)(B) DOMESTIC ABUSE ASSAULT CAUSE BODILY INJURY/MENTL ILLNSS TRK#: IA00MC201 COURT DISPOSITION AGENCY: IA052015J JOHNSON CO DIST COURT COUNT NO- 01 IA STATUTE: IA708.2A(2)(a) DOMESTIC ABUSE ASSAULT- IST OFFENSE Resident Household Member COURT CASE ID: 06521 SRCRI10831 CHARGE CLASS: MISDEMEANOR CONVICTION TRK#: 1A00MC201 RESTITUTION BATTERER-S EDUCATION PROGRAM SENTENCE DISP EFF DAT JAIL 2D 20161031 FINE $65.0 20161031 COMMUNITY SERVICE MAY PERFORM COMM SERVICE IN 20161031 LIEU OF PAYMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION c_c_____1 Iowa Department of Transportation Once of Drilnes Services (Toil Free) 500532-11121 PO BoxVZM, Das Mcines, IA 503198-+3204 515.244-8124 FAX: 515.7394537 Certified Abstract of Driving Record Inquiry Date: 9/1/2017 DL/ID #: 799AK5578 (IA) Customer #: 6213514 Name: Ahmed, Hassan Class: D ID Status: None Mohamed Elamin Address: 1241 MOSES Audit #: 7995578 DL Status: VAL BLOOM LN Issue Date: 04/18/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 01/18/2022. CDL Cert Status: None 522451590 Endorsements: Chauffeur 2 CDL Med Status: None Mailing Address: 1241 MOSES Restrictions: NONE Restriction None BLOOM LN Supplement: Date of Birth: 01/18/1978 Mailing IOWA CITY, IA Sex: M City/State: 522451590 History Information Convictions Citation Date Conviction Date ACD I Explanation iCounty JUR 108/22/2016 109/26/2016 S93 Seed Johnson IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Dake I Case Number JUR 08/22/2016 937065 IA Name: Ahmed, Hassan Mohamed Elamin DL/ID: 799AK5578 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: dFglliif p`�',r+yi 9/1/2017 IOWA �� D. 0. T� 3 Office of Driver Services Iowa Department of Transporation Name: Ahmed, Hassan Mohamed Elamin DL/ID: 799AKS578