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Home My WebLink About17-109 IDENTIFICATION NO. rI I V 1 r 1 (Office Use 0 y) saariA 41144041 ARE. APPLICATION FOR TAXICAB 1 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 Last 1. Name (REQUIRED) tvi hrr oko Act.(rt 2. Address (REQUIRED) t S 4 Abet, 4r, z Ape- f 2 Q,444.0, c,;1'1 A y 2.9-4.6 3. Contact Information(REQUIRED) Email: N,teh_6Teti Itetw Cell Phone: 3I4- -tar,- rt!z11 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 6 / - cf f 2.o1-O b.Taxicab Business Name(REQUIRED) -SmWG.v‘ •e-oei 16 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? No 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? an Type of offense Where Then -spe 'a dill C.)."‹. r. ---i What happened to the charge?(Circle one) ...� ..� Convicted Dismissed Deferred Suspended Plead Guilty SCAer 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five yeart? p ) 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) 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 14-A L 51-o'3 issued on € 'i. /ZvI6 expiring ono./24./2.0?? . 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 Date O 'f ************************************************************************************************************************************************ STATE OF IOWA COUNTY OF JOHNSON ) \ ubscribed and sworn to before me byfcC\b N r-a`M� d g�� on this I$�� day of v)�,sV• ac=t • k�, Nott'Public iq and for the State of Iowa l3\ 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). Expirati•n date . I fiver's Ii-ense 2721/7&v � / / Sign. re o Poli.liM• _fir designee Nate 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. J17 Signature Signature of City Clerk (4 esignee Date a *t2 C an -4 c7 ************************************************************************************************************tp ** ***** ************ Office Use Only :< 3 rTt Approved application } tJ DCI report State certified driving record Website update Clerk/TAXIDRIVBADGEAPPL92014amended.DOC 07/2016 Customer History Page 1 of 1 Customer History Certified Driving Record 0110WADOT CjCourt Certified Driving Record SMARTER I SIMPLER I CUSTOMER DRIVEN Customer and DL/ID PO Bo) Information Phone:515-244-9124 History Events Only dInternal Complete Driver Certified Abstract of Driving Record History 0Non-Certified Driving Record Inquiry 8/10/2017 DL/ID #: 874AL5703 (IA) CDL Peru Date: Class: Customer 6311770 Class: D CDL Pen #: Issue Da Name: Abdalla, Mohamed Audit#: 1330450 CDL Peru Expiratic Address: 1545 ABER AVE APT 12 Issue Date: 09/28/2016 CDL Pen ; Endorsee Expiration 02/24/2020 CDL Peru Date: Restricti City/State: IOWA CITY, IA Endorsements: Chauffeur 3 ID Statu 522464708 Mailing 1545 ABER AVE APT 12 Restrictions: NONE DL Statu Address: Restriction None CDL Stat Mailing IOWA CITY, IA Supplement: CDL Peru City/State: 522464708 Status: Date of 2/24/1976 CDL Cerl Birth: Sex: M CDL Med History Information CLEAR DRIVING RECORD Name: Abdalla, Mohamed DL/ID: 874AL5703 (IA) Pursuant to Iowa Code §321.10, I, Melissa Spiegel, Dirz,,,.! of Nice Mr ver Transportation, do hereby certify that I am the custodian of th i=i.ords Id by. �e''pOffic true and accurate copy of an official record currently in the cu d<offi i offi d tl Director of the Iowa Department of Transportation to so certify.- C7 In witness whereof, I have caused my signature and the seal ca..t emen e SE Iowa this date: t.)1 -EHICIf p,111 4 ,//�,b, 8/10/2017 iA 10 : irk1/7„64664(.I0e, I /,,4,4� .'•••••''•� `� Office of Driver Services h`‘‘\,„,VE�!,_= Iowa Department of Transp Name: Abdalla, Mohamed DL/ID: 874AL5703 (IA) IPhttp://172.29.254.55//drivers/reports/customerhistory/default.aspx?uid=B01 E927C2C 1733... 8/10/2017 Aug. 8. 2011 9: 34AM Div of Criminal Investigation No. /411 F. Fru„..uaty u• ruWm u.ity Gl&rrc Wnoa C?14i :gp66a67 08/02/2017 13:07 #160 P.0o2/002 xi 4 A t. �Jy Fi . /t it r?,,VSTATE OF IOWA ,\(y;J1: y ` ryry ` , .. ., r,; Creihrhpnni History Record Check "'WVo a II`4 -`\'• i�=:ti j ii eq attest Form /..01.,....*.;.-.1 r'`,.. 4` DC)Account Number: l ° b 1— (if apphc i,lc)--:.. To: lOvect Diviniou of Criminol Ynvcstigation From: City of Iowa City Support Operations Bureau,1' Floor City Cleric's Office ----215 E.lth Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, IA 52240 (5155-715-Baur hax -- — Phone: 319-356-5041_ Fax! 319-3565497 1 am requesting an Iowa Criminal IYistoiy Record Check on: _ Last Name (mmndntor ) First Name`nandutory) Middle Name(recommended) — ibdaf cck tvr011.001-ed ` 1 yr.A. V Date of Birth onandatoq.) Gender(mandatory) Social Security Number (recommended) o9- / `Z Zil 1 9 6 to ale DFeniale S 51- Gra- 5c.,O Waiver Information: Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of lowe,Chapter 692.2.For complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request. d+!aiv_emi(elease:Yhereby_give pennission.fur-the above.regaesting oflicial.to conduct an Iowa-criminal history record•cheok•wirh the Division•of Criminal--- Investigation(Den), Any criminal hisioiy data concerning me that is maintained by the PCI may be released as allowed by law. Waiver Signature: �, Iowa Crimir>ial is><oxy Record Chet;ii ]CTesuIts (DCIVirally) _ _, As of - U- I 1 a search of the provided name and date of birth revealed: 41012 .3a1 "In NNo Iowa Criminal History Record found with DC1 '44 . :_-o MI • 0 Iowa Criminal History Record attached, DCI# � " cit cr DCI initials CA..v.) DCI-77 (08/251)0) Received Time Aug. 2. 2017 12:41PM No. 3996