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Home My WebLink About17-144CITY OF IOWA CITY 410 Last Washington Street Iowa City, Iowa 52240-1826 Q 19) 356-5040 (319)356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 1 % J l y (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 Last 2. Address (REQUIRED) 1302 kweA 'St — -Tnwcs �t 1 A S22/1b 3. Contact Information (REQUIRED) Email: VEc. S u.) �ryia, GiN "oo4 r.-. -ell Phone: (ZIg) Z 3 3- 611.1 3 (All written communication`se71t via email) 4a. Driver's License expiration date (REQi b. Taxicab Business Name (REQUIRED) 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? 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? IV e Type of offense Where When What happened to the charge? (Circle one) N Convicted Dismissed Deferred Suspended Plead Guilty. OtheG 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five yearO cR _ Type of offense Where _Whfin — T,�^. i'T7 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide thwaame(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 Oage 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Driver's license number L (j ci issued on l:;_/II-2A expiring on I 2 I understand that if I falsely answer any questions in this application, that this app icatl ' for may be denied. I a ree 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 Re �, SL , t V Date 2-1r, 1 7- .«..,,...f.ff.f....................ff..f..f,,,,....«,,,.,.ff«f.ff,..,...,.,.,..ff...f..,f.f,...«..f.f.«««........,:««.«..«,.......«, STATE OF IOWA ) COUNTY OF JOHNSON ) Sub cribed and swornbefore me by S �61)-on this ��}� day of (� Notary Public in and fore o owa cOmmipion Nuwo w t3M2 • • k%commission 'm «f#14fi'1-tflf«R1« «f « ff1 ffffff}ffyfyy 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 T Signature of P61ic&Chief or designee a 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. v _ v 0/ . O Signature of City Clerk eesignee Date- Office a e - Office Use Only Approved application DCI report State certified driving record Website update ClerknT [DRIVBADGEAPPL92014am do .DOC 07/2016 Oct. 9. 2017 8:55AM Div of Criminal Investigation No.3077 P. 2/2 Fluu�.��q Y �Ywr ..y Gl or.. ��nur air aaeewar/ 10/06/2017 16f Oo 024b r.u.2/603 (',11 Cyie inial ffistoly Record Check Request Fenn. �t}seS� To: Iowa Divisioo of crieninat Atve.figatiao Support Operations nuresu, I,' Floor 215 E. 70' Street Das Moines, lows 50319 (515) 725-6066 (515)725-6080 Fa> om requesting en Iowa ,E;o I;" CA.,., IF-eda DCI Account Number: From: C of Iowa CiiV City Cleric's offieo 410 E. Washington Street Iowa City, IA 52240 Phone: 319-356-5041 Fail: 319-356.5497 12 2�� 19 2 I ®Male ❑Female Waiver lnjOrnaahonr Without a signed waiver from the subject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2. For tomntete criminal history record information, as allowed by law, always obtain a waiver si¢natmre from the suhierr of ch. ..�,,. r Waiver ft e(etfSe: J hereby give ytrmiWon for lilt Above requesting official to tanducl an Itoa gimidat historyrecord theck wish the Division of Ceinrinal bwestigation (M). Any «iminal hislory dale conceming me than is mainlaintd by the DCI maybe rcltated M allowed bylaw. Waiver signature: Kf j 0. ::�; 6 IQuta Crimil?al History Record Cheek Rejults As of �� ' (� a search .. t —' lue ol,f yh-1 of the provided name and date of bug, revealed:�-- No Iowa Criminal History Record found with DCI ,—� w .3 . 'o m 0 c ® Iowa Criminal History Record attached, DCI ,# L(.r L DCI initials DCI -77 (08/25/10) --� Received Time Oct, 6, 2017 2i38PM No -8043 Iowa Department of Transportation I Office a Driver Services (Toll free) 8D0 532.1121 PO Bol 9264, Des Mane:,, in 5030F�9204 515-244-9124 FAX 515.239.1837 Certified Abstract of Driving Record Inquiry Date: Name: Address: City/State: 10/6/2017 Soliman, Reda Soliman Saleh 1302 YEWELL ST IOWA CITY, IA 522402727 Mailing Address: 1302 YEWELL ST Mailing IOWA CITY, IA City/State: 522402727 DL/ID #: 824AK2657(IA) Customer #: Class: A ID Status: Audit #: 1958992 DL Status: Issue Date: 07/12/2017 CDL Status: Expiration Date: 12/23/2020 CDL Cert Status: Endorsements: Tank, Passenger, CDL Med Status: School Bus Medical Examiner Jurisdiction Restrictions: Corrective Lenses, Restriction Medical Examiner Phone Automatic Supplement: O Transmission, No Advanced Practice Nurse Manual Medical Certificate Restriction 1 Wearing corrective lenses Transmission Medical Certificate Issued Date Equipped CMV, No 1 7 C� "✓ Class A Passenger 07/31/2019 Vehide Date Added to CDLIS Driving Record Date of Birth: 12/23/1972 Sex: M CDL Medical Examiner's Certificate 6246355 None VAL VAL Non -Excepted Interstate Certified None CertificateSpecifics Explanations Medical Examiner First Name Lucinda Medical Examiner last Name ZOEILER Medical Examiner License Number 209000501 Medical Examiner National Registry Number 2276525699 Medical Examiner Jurisdiction IL o_ Medical Examiner Phone 825 561-1280 .: O Medical Examiner Type Advanced Practice Nurse Medical Certificate Restriction 1 Wearing corrective lenses -<Pq Medical Certificate Issued Date 07/31/2017 1 7 C� "✓ _ Medical Certificate Expiration Date 07/31/2019 U1 Date Added to CDLIS Driving Record 09/08/2017 History Information CLEAR DRIVING RECORD Name: Soliman, Reda Soliman Saleh DL/ID: 824AK2657 Pursuant to Iowa Code 4321.10, 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: low 10/6/2017 10 Office of Driver Services �r•rs�' Iowa Department of Transporation Name: Soliman, Reda Soliman Saleh DL/ID: 824AK2657 N ra! =ci 0 c4 3 CD Q CM ,A