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Home My WebLink About17-119or or I r t i CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 13 19) 356-5497 FAX 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. X1 ) � `1 (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 Middle Last A U 3. Contact Information (REQUIRED) Email: pch;/4 2a2bti Cell Phone: 31q-5 All written communication sent via email) 4a. Driver's License expiration date (REQUIREEDD) (II — 0 1 , 2 0 2 � b. Taxicab Business Name (REQUIRED) , w�LN 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? N10 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? Type of offense What happened to the charge? (Circle one) Where ti When 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? n,/D Type of offense Where When z. 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please n e { name DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STAT VRE.ZIEDM DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICF_VIE 1t - You must apply for an individual Department of Criminal Investigation Report (form availablet6�bn request). (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 07/2016 ri 1" APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby certl that I have 'ssued to me by the Iowa Dep rtment of Transportationa valid Driver's license number �<2AlI t Issued on ls_expiring on /'1070 . I understand that if I falseI4 a swe any questiorils ih 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) '^ r Signature of Applicant Q S h rW r Date G fflff,.#.....,ff.f,....f..ffffff!„f,,,,,.iflfflflff,ff1,llff,l,,,,,,,f„»}f„f1fl11ffflf,lf,,,f,f,##,1f,,,,,f#,###f1f1f...flff..fffffl,ffff!„ STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by-�o4�- . E r on this 3 day of A -,y 1L5 f'— Z -OI I AM I .�,,,„,. ,..,� Notary Public in a6difor the State of to , c I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no nformat' hich would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the Cit Iowa 5, Chapter 2, City Code) Expiration ate Iver's nse or aiv 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. 8 f ?DC7 /17 Signature of City Clerk or dysignee Date }f1H11ff}1f f fflf f!!ff!!!H}f1f##Y#f11ff111ffflf1ff11f 11ff11flTfflf HHH1fffHfffff lflf ffillfHHltflfHlfflff}}ffa{1i,11ff ffflfflflfllf 1f f!f f! Office Use Only Wit? c :s> -.4G .� �-� o r- Approved application DCI report �M = State certified driving record Q Website update w GenJrA IDRIV94DGEAPPL9Ml4a.ntl .DOC 07/2016 I i I ►DOT www iowadot. ov SMARTER I SIMPLER I CUSTOMER DRIVEN 9 Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone '515-244-912418DG-532-11211 Fax: 515-239-1837 www.iowadol.gev Certified Abstract of Driving Record Inquiry Date: 8/30/2017 DL/ID a': 742A33541 (IA) Customer #: 6124543 Class: D Name: All, Rashid Abdlrhman Audit A: 8787379 Date of Birth: 1/1/1975 Elzber Sex: M Address: 2606 BARTELT RD APT 2A Issue Date: 01/23/2015 Expiration Date: 01/01/2020 City/State: IOWA CITY, IA 522462729 Endorsements: Chauffeur 3 Mailing 2606 BARTELT RD APT 2A Restrictions: Corrective Lenses Address: CDL Permit Restriction None Mailing IOWA CITY, IA 522462729 Supplement: City/State: Restrictions: Date of Birth: 1/1/1975 None Sex: M CDL Status: History Information Convictions LDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: CDL Permit None Endorsements: CDL Permit None Restrictions: ID Status: None DL Status: VAL CDL Status: None CDL Permit Status: ELG CDL Cert Status: None CDL Mad Status: None ;nation Date Conviction Date ACD Explanation lUR County 33/11/2017 03/27/2017 Improper Registration IA Johnson Name: All, Rashid Abdlrhman Elzber DL/ID: 742AJ3541 (IA) Pursuant to Iowa Code §321.10, 1, 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 1 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: `�VEtlICIf ®`o, fay:* IOWA'=95 8/30/2017 Office of Driver Services Iowa Department of Transportation G �-� r Name: All, Rashid Abdlrhman Elzber DL/ID: 742AJ3541 ([A) Vii:'— C:) m M '' W tD ,.Aug. 29. 201/ 3:26PM_,�,Div of Criminal Investigation earza�rxe,r,,:,o.5841zOP:•2/2,00z STATE OF IOWA C'rlelv1nd History Reetlyd Chiecld. V Requeo Arm Y !ti`vJ DO Account )\umber• _qt1ra —. (itspplicable) To; Iowa Division of Criminal Investigation From: Cit ofIov:e City Support Operakuns Bureau, la' Floor -"�--•- _.---- t)rs A7uines, Iowa 50319 - 215 F. 7", Street City Clerk's Office 410 It. Washington !Street 66 IOWB (515) 725.6080 Fax r LJL 4 �I Date of - aI Phone: 319-356-5041 Fax: 319.3565497 -- R SHiD G I lZmale ❑Female 35`1' -qy -- l X65 Waiver Xnformatiafu Without a signed waiver from the subject oftbe request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For co a criminal Aletory record information, as allowed by lew, always obtain a waiver sianature from the anhted nr sun .-.,.... n ur ver /tete[/s'e; l hereby give pcsmission Cor Ne above regocsligg official to conduct an Iowa criminal history record check wid! the Division oCCriatiI lovesllgalion (DO). My criminal history data concemingme that is maintained by slit DCl maybe released as allowed bylaw. Waiver Signature: 14"A Ari " u v uaaalaaa ir.lJ[VfCl: fu%_neCKMSIIMS �P'--t - 0-4 C:) 6l use only) As of a search of the provided name and date of birth revs No Iowa Criminal History Record found with DCI` w .o 0 Iowa Criminal History Record attached, DCI DCI initials_` DCI -77 (08/25/10) Received Time Aug.25. 2017 3:04PM No.5585