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Home My WebLink About17-123i I r i CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) 3. Contact Information (R IDENTIFICATION NO. (Office Use 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 4a. Driver's License expiration date (REQUIRED) q - Zd - 2A zi b. Taxicab Business Name (REQUIRED) t` 5. Prior experience in transportation of passengers: AV -\,V -7n`eM itom, a Vay\ 60 A �p o-� rec dv► A 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 Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? 6 Type of offense Where When What happened to the charge? (Circle one) o Convicted Dismissed Deferred Suspended Plead Guilo--c-ptttn 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five' eyaj? Type of offense Where en v 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide 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 I A( APPLICATION FOR TAXICAB VEHICLE DRIVER ' Page 2 I harabv cert; t�h_a.:t, I have issued to me by the low De� rtmen CCof Transpo I n a valid Driver's license number `-' � issued ori 10xpiring on 0 1 1 understand that if I falsely answer any questio s in his application, that this application may be denied. I agree hat 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 Titl , Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant V Date L STATE OF IOWA ) COUNTY OF JOHNSON 1 Subscribed and sworn to before me by S ,\r\ r,Q A on this l St day of ��*F >zw.6 �r do I•i . � n in and for the Stale of Iowa ffffMYffffff=ffffil/f1tMMflfffk4l#kff#ffYfflif«Rfiilf Mftlfff/fEley;!!l,}}};yyfl,fffflfyffflil,fyf,lfffyy'Iff 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 (/Ad z ( 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. &-C=igna ure of City Clerk or d ignee Office Use Only Approved application DCI report State certified driving record Website update rn —n -o 1 r E.,1 a • • � 0 Qe*/TAXIDRNRADGEAPPL92014e�W DOC 07/2016 —� 3> 2017 10:3ItY Cl�ki� of Criminal 07,26/2017 141-1 4Rr nal Investigation 0 6999Pl02 one Baal ., Ya STATE OF IOWA n s.' Criminal History Record Check � Re tIies t Form y DCI Accouot Number: T�p�-„ ` (ilepplicable) � -� To: Iowa Division of Criminal Investigation Front: City of Iowa City _ Support Operations Bureau, l'' Floor City Clerk's Office 215 E. 7" Street d10 E. Washington Street Des Moines, Parva $0319 (Sl q) 114-6066 Cn <!'yv t a 411 (SIS) 725-6080 Fax Phone: 319-356-5041 Fat: 319.3565497 - I am reauestine an Iowa Criminal Histol, Record Check on: Last Name (mandatory) Fil'St Name (mandalory) Middle Name (recommended) 5 (cLa hid S1k aK'l°r mol aroje d Date of Birth (maeda (Gender (mandatory) Social SjeSLI (recommended) j �'� 1 r6 tqNtale ❑Female (�Nulmber J� I I `� O 7� Waiver Information: Without a signed waiver from toe subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2, For comnlete criminal history record Information, as allowed by law, always obtain a waiver signature from tine subject of the request, -Waiver Beleaserl-bereby-94epennitsion-for the above requesting'officlSPlo canducr si'lowa criminal history record cheek with the Division or Criminal Investigation (DCO. Any e,imina) binary data caaerning me th it maintained by the DCI maybe released as allowed by law. Waiver Signature: Q Iowa Criminal History .Record Check Results As of _ S r3' 1 a search of the provided name and dote of birth revealed: .X No Iowa Criminal history Record found with DCI ❑ Iowa Criminal history Record attached, DCI #1. DCI initi4� DCI -77 (08/25/10) Received Time Jul, 28, 2017 2:19PM No. 3719 ca ARTS Page 1 of 2 C,J10WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN vvww.iowadot.gov Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 www.madot.gov History Information CLEAR DRIVING RECORD Name: Sidahmed, Shakir Mohamed DL/ID: 532AG5413 (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: -"""•:;�/ h�� 10VV 7/28/2017 Certified Abstract of Driving Record cc �O.Ge� •JU�� f•( Inquiry 7/28/2017 DL/ID #: 532AG5413 (IA) CDL Permit Class: None Date: Iowa Department of Transportation Customer 5846338 Class: D CDL Permit Issue None #: Date: Name: Sidahmed, Shakir Audit #: 1276868 CDL Permit None Mohamed Expiration Date: Address: 2509 BARTELT RD APT Issue Date: 09/02/2016 CDL Permit None 1D Endorsements: Expiration 04/20/2021 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: Chauffeur 3 ID Status: None 522462715 Mailing 2509 BARTELT RD APT Restrictions: NONE DL Status: VAL Address: 1D Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522462715 Status: Date of 4/20/1957 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Sidahmed, Shakir Mohamed DL/ID: 532AG5413 (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: -"""•:;�/ h�� 10VV 7/28/2017 ; D. O.T.T..:a�% cc �O.Ge� •JU�� f•( Office Driver Services f RRIVEN $ of "a�.�� Iowa Department of Transportation Name: Sidahmed, Shakir Mohamed DL/ID: 532AGS413 (IA) http://172.29.254.55/drivers/reports/eustomerhistorylcertifieddrivingrecord.aspx 1 a 7/28/2017