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HomeMy WebLinkAbout17-104 4r . IDENTIFICATION NO. / 1 — 1 (Office Use Only) datirmosi Ea; ::III CITY OF IOWA CITY APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER (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 Fir Middle Last 1. Name(REQUIRED) G4. ow I/Qm,d,q (a' Naureflee 2. Address (REQUIRED) Z VILA '64rt e I t R d 1444, C, t-y , I ,,, cz _ 5 `72`1 3. Contact Information (REQUIRED) Email: 9.8,144f >G/ 0116/ YebsCell Phone: `3 t 6 9-1 5-in (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) r,1/0 // 20? I b. Taxicab Business Name (REQUIRED) �', 6 Jo«moo 5. Prior experience in transportation of passengers: 2 �j��.,,L5- 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere?/t/ Type of offense Where When /i/o What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other A/o 4/74 ,/ 7. Have you been arrested/charged with any traffic offenses in the last five years? Type of offense Where When '7 y c,(,-c �)/2 oLTSdyt IIf 2/ '?e/ ( c What happened to the charge?(Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in t the years? ii .-' Type of offense Where When N c m 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please pri0 th Lamer" e./7 =< m DEPARTMENT OF CRIMINAL INVESTIGATION (DCI)REPORT AND STATTIP D Q E 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 3 R • 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 _ issued onF expiring on p I pi/2n 71 . I understand that if I falsely answer any questions in this application, that this a p i ation 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 fr ,�"' Date /l.> i 1-7 STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by �jq rs r .}-+• Pr- )oufi e1ck4;...on this >� t 1 day of AusTst z0/7. • WENDY S.MAYER *144 Comimssion Number 729428 Notary Public in and o the State of Iowa My Cqr> ssy Expires ow *******,r******r*,r****,r***** ******************,rk**:***********************,raw************r ** ,r*******,*****************,r*,r******* *****,r 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). Expir- on dat= o• 1 - s license t 1 Z I Signature of POW or designee Da 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. Si nature of City Cle k esignee Date N d Office Use Only G, warm n-6 Approved application M rn DCI report State certified driving record Website update �" o 0 Clerk/TAXIDRIVBADGEAPPL92014amended.DOC 07/2016 ARTS Page 1 of 2 010WADOT SMARTER I SIMPLER I CUSTOMER DRIVEN WINW'iOVVadOt.go Office of Driver Services PO Box 9204 I Des Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837 www.iowadot.gov Certified Abstract of Driving Record Inquiry Date: 8/10/2017 DL/ID#: 834AK5407(IA) CDL Permit Class: None Customer#: 6260655 Class: D CDL Permit Issue None Date: Name: Noureldein,Gaffar Hamid Audit#: 8819945 CDL Permit None Ali Expiration Date: Address: 2534 BARTELT RD APT 1C Issue Date: 02/05/2015 CDL Permit None Endorsements: Expiration Date: 01/01/2021 CDL Permit None Restrictions: City/State: IOWA CITY,IA 522462721 Endorsements: Chauffeur 3 ID Status: None Mailing 2534 BARTELT RD APT 1C Restrictions: Commercial Learner Permit, DL Status: VAL Address: CDL Intrastate Only Restriction CDL Instruction Permit CDL Status: None Mailing IOWA CITY,IA 522462721 Supplement: Expires 8/5/2015 CDL Permit Status: ELG City/State: Date of Birth: 1/1/1959 CDL Cert Status: Excepted Intrastate Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation JUR County 02/08/2015 02/10/2015 M14 Fail to Obey Traffic Sign/Signal IA Johnson Accidents-Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date JUR Case Number 11/22/2014 IA 829671 Name: Noureldein,Gaffar Hamid Ali DL/ID:834AK5407(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: ti,Z),�*.....,0/`��I+I 8/10/2017 CD G g` IOWA '•*°I ...r ..�• Is D. O.T..P.,71 t?-4 17-10 hr1, ht‘t‘'foiniiti, ' Office of Driver rrtmrof SeriTransportation O Name: Noureldein,Gaffar Hamid Ali DL/ID:834AK5407(IA) http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 8/10/2017 ,Aug. U; ZU1I\ 9:J4AMc,.,UIv of Grlmlnal Invest Igat ion c 8/03/2017 ,2.ta No. 1411 ,5 r'r uoaioo� thl ki\ ``c:•:‘`): 4-. TAT f, OF F 1y W „Lo , v, /` r� v, Criminal History .= r .fp.,- r , ':yr r 'g. qtr. r Request For � ,,,S . loom DCI Account Number: 400 .,-1: (if aprlivoble) To: Iowa Division of Criminal Investigation From: City of Iowa City Support(Operations Bureau, 1"Floor City Cleric's Office �215 E,E, 7i4 Street 410 E.Washington Street Des Moines,Iowa 50319 — _ (51 S)715-6066 Iowa C,tp_, IA 52240 (515)725-6000 Fax '_— ` Phone: M9-356-5041 Fax: 319-3S6-5497 ---- I am re uestin, an Iowa Criminal IYistoiy Record Check on: Last Name (maedatoq') F LFirst Name(mandatory) Middle Mate(recommended) No U lit. e.id e.c-t-,1 &/3-_IN f f i wt I'd 4 Li Date of Birtlt (mandatory) ti Gender(mandatory) Social Security Number (raommended} D i e 1 _ \C\V:\ Male ❑Female 1-L-14— 1 e -.3M Waiver Xnfoiiiuttiorir Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code oflowa, Chapter 692.2.FEor complete criminal history record Information,as allowed by law,always obtain a waiver sl_natu,•e from the subject of there uest. --. Waiver Release;1 hcrGLy-yirc-0umi3ni0l7.ILr g•abvrc-7a7tac>p.rts,vtfviarwtivaauLi,7.,tuna curuluai•wiLolyrl wiJ uneoc-wimine Division-orCrirninat • hwestigation(DCI). Any criminal history data concerning me that is maintained by the PCI may be released as allowed by law, Waiver Signature:, _i_' If ,'1 - 'Z. 1 I c--- -- - � , , Iowa Criminal Histor ecord Check Results -Q � tract use only) As of 8 `8 y ' - , a search of the provided name and dale of birth revealed: J N EX No Iowa Criminal History Record found with DCI ..r • 9, . o 4 — r El Towa Criminal History Record attached, DCI # ina DCI ilaitials Clii 3 ve - I7C (08/25/1 0) — w_�� --_ —-- .fir–.��© Received Time Aug. 3, 2017 11: 36AM No, 4073