The URL can be used to link to this page

Home My WebLink About17-115 - r IDENTIFICATION NO. / —7—/I 5 / I - 1 (Office Use Only) —Z146' sza 7► �::Illi� � APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made between 8 a.m.to 3 p.m., Monday-Friday) 410 East Washington Street Iowa City, Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application (319) 356-5040 (319) 356-5497 FAX First ( Middle Las 1. Name(REQUIRED) (VA a 1,,W\n U c'\ 1)10 6111/1P 2. Address (REQUIRED) 3at. Nk L e I Iv xi 3. Contact Information (REQUIRED) Email: Lo c-q 321 0 ' ,�\-covn Cell Phone: 3\c -333 -1o1-2 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) -- ( — 26 j 8 b. Taxicab Business Name(REQUIRED) v 21/3 12d / 3 fo w Yl V ' X ra U 5. Prior experience in transportation of passengers: !v >(t1-&, 7 7Pfr:U s ‘c•,*V( 1- 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? •_ Type of offense Where When cam---I 3 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? )/-19 Ye S of_offen Where When A A lou t O �+nso� W -Vit~( 2 3 -7'11 1.4 n I)/ )01/404(27 What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guil Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the five years? ,�t7 •)(;0s Type of offense Where ghen = VvA kv 2 Sec.utAy fur a.A Lc i 1/9 w ,)okv, So h wg-1. Vrt 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please probe cine( 0 CDv DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CrRTIFIPIA 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 J . 4 APIPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 I hereby ctertify thatl‘ have issued to me by the Iowa Department of Transportation a valid Driver's license number Ma vk&it issued on 6 2.13-. /3 expiring on U i- e(- f R . I understand that if falsely answer any questions in this application, that this application may be denied. I agree that in making this application, 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 — =r— Date 0- 2 5.- Z 0 ( 1' STATE OF IOWA ) COUNTY OF JOHNSON ) n Subscribed and sworn to before me by 1 l ,' �r,� KAkc� -Q` on this 25" day of '3 orNotary Public 11 and for the Stat of Iowa Atm,5.IUAYER • rm�a con Number 729428 ************ i** *r *yk *r **********************k************************************************* **********A AA A AA k**** I have reviewed this ap((((((plication, 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). Expirati• •.to o Dri, :is license J ( I I U A 772ri7 Signature of Police Cwief or designee Dat 9 9 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. cei0 - J� i7� Sig at ature of City Clerk esignee ' Dal112 = •aWr Cy"4 r to cn Office Use Only ic c) JP' CTI Approved A7\ Approved application DCI report State certified driving record Website update Cl erkfTAXIDRNBADGEAPPL92014amended.DOC 07/2016 C3IowADoT SMARTER I SIMPLER I CUSTOMER DRIVEN W1NW'IOVVBdOt.g0V Office of Driver Services PO Box 92041 Des Moines,LA 50306-9204 Phone:515-244-9124 1800-532-11211 Fax:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 8/19/2017 DL/ID#: 669AJ2746(IA) CDL Permit Class: None Customer#: 6063417 Class: D CDL Permit Issue None Date: Name: Mohamed,Mahmoud Audit#: 6692746 CDL Permit None Expiration Date: Address: 342 FINKBINE LN APT 7 Issue Date: 02/13/2013 CDL Permit None Endorsements: Expiration 01/01/2018 CDL Permit None Date: Restrictions: City/State: IOWA CITY,IA 522461714 Endorsements: Chauffeur 3 ID Status: None Mailing 342 FINKBINE LN APT 7 Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA 522461714 Supplement: CDL Permit Status: ELG City/State: Date of Birth: 1/1/1977 CDL Cert Status: None Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation JUR County 07/04/2013 07/29/2013 593 Speed MD 01/23/2017 03/22/2017 592 'Speed IA Johnson Sanctions Type Effective End ACD Explanation JUR Occurrence JUR Suspended 02/11/2014 .07/08/2014 Fail to Post Security for an Accident-Owner Only IA IA Name: Mohamed,Mahmoud DL/ID: 669A02746(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, aSnkeny,Iowa thiidate:r-'' - ' c7-t no iilr.. _ 1s� ***...•. ., 4i, 8/19/2017 �'ftin ' IOWA : s co ..D. O. T. � �f� � * c k • , III' alb N, Office of Driver Services "� ON HIY� Iowa Department of Transportation Name: Mohamed, Mahmoud DL/ID: 669A32746(IA) Aug. 23, 2017 10: 25AM . Div of Criminal Investigation No, 8884 P. 10/12 Frarn:Cl ty Or Iowa City Clerk Offloo 318 3666407 Oa/l7/2017 •t :34 4106 P.009/003 STATE OF NAVAr".., '.`_,.7...i.3) „,:oi.,.� /�,�a,\7I/�• . ,j,.- N '`, Cri ;inal History Record Check � •.o Vl ` > ' c,M`kin . ,--„,',:q.,,-,2 lactest Form fi • ,�• ,, . • DCI Account Number:___ QC, .[, (if npplicrblc) 'Fo: Iowa DiVis(tsn of Criminal Investigation From: City of Iowa City _ _ 1 Support Operations Bureau, 1”Floor City Clerk's Office 215 E. 71^Street 410 E. Washington Street Dies Moines,Iowan 50319 --' -• 45-14)--7-15-604,6 iuvra Cay, 1A 52.24( (515) 725-6080 Fax `�-^�-- Plsone; 319-356-5041 Fax: 319-356-5497 I am requesting an Iowa criminal History Record Check on: Last Name (mandator') First Flame(mandatory) _ Middle Name(recommended) ~ MC)\\NCKN� r ,LX`M ki At Date of Birth (mandatory) Gender(ntandatoty) Social Security Number(recommended) C)` ^ 0 `r \R9-.1s caMa1e ❑Female 1-kc` - 21- v \ cA Waiver information: Without a signed waiver from(he 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 by law,always obtain a waiver signature from the subject of the request. — —''Wtninre,'R hrlSe:I hereby gic'permission for the above requesting official to conduct an towaer(minsl hiscoty record check with die Division o(Crimiltal investigation(DCI). Any criminal history data concerning me that is mandoined by the DCT may be released as allowed by law. N ,-A Waiver Signature: - *= CI dioludi Iowa Criminal History Record Check Results ,-,....c)Cltsonl)) r` - As of 3 , 23 -n , a search of theprovided name and date of birthrevealed; = c, r �eared: ) t�A co Ili No Iowa Criminal History Record found with DCI en 0 Iowa Criminal History Record attached, DCI# - DCI initials dY-1"1 DCI-7? (06/25/10) RcrnivPd TirP Ails, 17 9n17 4 f17PM NA. 51(11