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Home My WebLink About17-149� r t CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 Q 19) 356-5040 (319)356-5497 FAX 1. Name (REQUIRED) . IDENTIFICATION NO f "7 Ll (Office Use O ly) 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 First 2. Address (REQUIRED) ;�\ C, 1-� `7 �1\ RM \1 k ,r .) �- 3. Contact Information (REQUIRED) Email: Vf\0ALSCl f qa �'- — C �. CelI Phone: f�Z 19J 3d (AII written communication sent via email) 4a. Driver's License expiration date (REQUIRED) c; /�q c' b. Taxicab Business Name (REQUIRED) r aio 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 Where When What happened to the charge? (Circle one) Convicted Dismissed eferred, Suspended Plead Guilty Other Have you been arrested / charged with any traffic offenses in the last five years? /`-' 0 Type of offense What happened to the charge? (Circle one) Where 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? 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) n,/ 6 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 Depart ent of Transportation a alid Drivers license number CJ i32 is A 0o issued on expiring on I understand that if I P 9 falsely answer any questions in this application, that this ap licati n ay be denied. I gree'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 117 L7 YT STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed land sworn (o before me by �1` �11 �lAprYt99�) on this ��h day of CHRISTINE OLNEY I Notary Public in 46d for the State of Iowa = 1 I • + M Comm Expires 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 'rl? e ` �2— Signature of Porft Chief or designee & h117 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. Sighature of City Cler or designee Office Use Only Approved application DCI report State certified driving record Website update i/- 7-/ 7 Date Cle,k/ IDRIVBADGEAPPL92014amended.DOC 07/2016 ff 16,Oct.27. 2017310:47AMCBbDiv of Criminal InvestigationNo. 4787 P. 1/2 (FA%)31933s2'. _ .._ _iDg2 r�I112194';'�`a CriminalSTATIE OF IOWA HistoryRecord Request Form To: lows Dlvlelon or Criminal Invostlgatlon Support Operatlons Bureau, l" Floor 215 E, 7'a Street Des Molitcs, Iowa 50319 (515)725.6066 (515)'725.6080 Fax :lt DCI AoaountNumber; ' 9967-F (Ifoppllaable) Froms 'Yellow Cab of Iowa City _ P.O. Box 428 Iowa City, U. 62244 (319)336.9777 Phonon Far: (319)339-7302 1c-�n,la1� Date of Birth rnudalory) GBndor mandate 'Social'6leourl Number recommended q/a�It Q(Mtale ❑Tlemale �ot�-9�j�e — ��b 6 Walver rlfforinfaflon. Without a elgtted waiver from the subleot orthe request, a camplete orlminnl history record tttay not he rdeosable, per Coda of Iowa, Chapter 6912, For gpmnlote orlminal hlstory-record Information, es allowed by!AiY, Alwaya Wal ver Release: I hereby glue psmllatlod tbf the above In V01110alton(DC)), Any Criminathhtory dale eoneemin2meI valvar ✓" 111112 o(09lal to Conduct on Iowa orlmlnat hlrlary record obook wllh The Dlvlslon of Crlminel mslmalnrd by the DC( My be ralamed as allowed by low, (Dct we only) As of �� :Z'7 i I , a search of the provided name and date of birth reveslodl DCI -77 (08/25/10) Received Time Oct. 15. 2017 12:47PM No, 8999 ❑ No Iowa Criminal History Record found with DCI •' ' . C3 _ Iowa Criminal History Record attached DCI # U) -i; •� _ Crl 11Y.I U) M DCI inidale_,-,-L� DCI -77 (08/25/10) Received Time Oct. 15. 2017 12:47PM No, 8999 ?' Oct.27. 2017 10:48AM Div of Criminal Investigation IOWA CRIMINAL HISTORY DCT 00909990 NON CONVICTION PAGE 1 OF I DATE PRINTED - 2017/10/27 DCI:00989990 NAME: MOHAMEDALI,MODA5IR KHIL DOS SEX RAC MGT WGT EYE HAIR SKN POB 19530920 M B 506 199 BRO SLK DRK YY No.4787 P. 2/2 1 ADDITIONAL IDENTIFIERS PHOTO AVAILABLE: Y CCH RECORD *** 01 ARRESTED/TAKEN INTO CUSTODY 20130917 AGENCY: IA0520100 CORALVILLE PO CHARGE NO- 02 IA STATUTE IA700.2(6) ASSAULT TRK#: IAOOHL702 COURT DISPOSITION AGENCY: TA052015J JOHNSON CO DIST COURT COUNT NO- 02 IA STATUTE: IA700.2(6) ASSAULT COURT CASE ID: 06521 AGCRIO3031 CHARGE CLASS: NON CONVICTION TRK#: IA00ML702 SENTENCE DISP EFF DAT FINE $100 20140310 DEFERRED JUDGEMENT $100 CIVIL PENALTY 20141118 PROBATION lY 20141118 DISCHARGED FROM 20141119 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT, THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY. DIVISION OF CRIMINAL INVESTIGATION CC--., ffff- Iowa Department of Transportation pp Otlia: of D"m Services ( Toll Free) BDG 532-1121 PO Box 9204, Des Manes, tA 503D&9204 515-244-9124 0 FAX. 5152391837 Certified Abstract of Driving Record Inquiry Date: 10/27/2017 DL/ID #: 082AA0058(IA) Customer #: 1142265 Name: Mohamedali, Class: D ID Status: None Modasir Khlilil Address: 638 WESTGATE ST Audit #: 8489835 DL Status: VAL APT 46 Issue Date: 09/30/2014 CDL Status: None City/State: IOWA CITY, IA Expiration Date: 09/28/2022 CDL Cert Status: None 522464636 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 638 WESTGATE ST Restrictions: NONE Restriction None APT 46 Supplement: Date of Birth: 09/28/1963 Mailing IOWA CITY, IA Sex: M City/State: 522464636 History Information CLEAR DRIVING RECORD Name: Mohamedali, Modasir Khlilll DL/ID: 082AA0058 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: =— d511C1f 1, 10/27/2017 t 'IOWA ' D. 0. T. 4h"1h.P+ Office of Driver Services Iowa Department of Transporation Name: Mohamedali, Modasir Khlilil DL/ID: 082AA0058