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Home My WebLink About12-066(319) 356-5497 FAX 1. Name First D �M h Middle Last �D Z17 ^1/ H 2. Mailing Address S 1 °J S V p n wt -aL`a [ 3. Telephone: Home � )1� 21 7L Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 1/1 t1 f7'f Type of OffenseWhere When 7. Have you been convicted of any traffic offenses in the last five years? Q S Tvoe of offen a Where When S'Pee d �Loau u 8. Has your driver's license or chauffeurs 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) 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) cle"M idrivbadg 09/2010 Authorization Number yd" (�6 l 1 (Office Use Only) �S, fflK CITY OF IOWA CITY APPLICATION FOR TAXI DRIVER (Police Department review must be made 410 East Washington Street between 8 a.m. to 3 p.m., Monday— Friday.) Iowa City, Iowa 52240-1826 (319) 356-SO40 (319) 356-5497 FAX 1. Name First D �M h Middle Last �D Z17 ^1/ H 2. Mailing Address S 1 °J S V p n wt -aL`a [ 3. Telephone: Home � )1� 21 7L Other: 4. Prior experience in transportation of passengers: 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? 1/1 t1 f7'f Type of OffenseWhere When 7. Have you been convicted of any traffic offenses in the last five years? Q S Tvoe of offen a Where When S'Pee d �Loau u 8. Has your driver's license or chauffeurs 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) 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) The re- port will be mailed to the individual making the request and needs to be reviewed by the Police Chief with this appli- cation. (OVER FOR REQUIRED SIGNATURE AND NOTARY) cle"M idrivbadg 09/2010 I hgreby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeurs license number hr 2) I 27j 34 I understand that if I falsely answer any questions in this application, that this application may be denied. I un rstand that if I falsely answer any of the questions in this application, that this application will 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 a license 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 N / / $� % �O Date�� STATE OF IOWA ) COUNTY OF JOHNSON ) gibed and swom to before me by ll / t i MLI. f� �l 1�Q O On this 2 cj T "� day of 1� L� :u<r otary Public in and for the State of Iowa : Commission Nu . ��r 221919 •1 MyC ,n-' #AYY#Ht#Y#H*#**#Yf»#t#Yflt»Ilft##Ii1f!#t##*1 iY1##Yf1f**h**#flfH[lflffifYYfHt##Y##f*R#RBBB!»11Hf11ff1ffYY*H1iHf****t I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). -4� &X44-'4 SignatOre bf Police C or designee -D i/1,��-ori X4"' 96f,L Sign6ture of City Clerk or designee -91 9/a ' Date Date After Police Chief and City Clerk have approved authorized taxi driver names will be placed on the city website at icgov.org. Taxi cab businesses are required to provide Driver Identification cards. Office Use Only Approved application DCI report State certified driving record Website update der midriv adgeapp2 10. 0912010 Inquiry Date: Name: Address: City/State: Iowa Department of Transportation Office of Dmrer Services (Toll Free) 81HI-532-1121 PO Banc 9204, Des Moines, IA 5030&9204 515-2449124 FAX: 515-2391637 2/29/2012 Diallo, Oumar 2512 ASTER AVE IOWA CITY, IA 522406733 Mailing Address: 2512 ASTER AVE Mailing City/State: IOWA CITY, IA 522406733 Convictions Certified Abstract of Driving Record DL/ID #: 434ZZ5639 (IA) Customer #: 2959537 Class: D ID Status: None Audit #: 5455187 DL Status: VAL Issue Date: 08/19/2011 CDL Status: None Expiration 09/17/2012 CDL Cert None Date: Status: Endorsements: 3 CDL Med None Status: Restrictions: NONE Restriction None Date of Birth: 9/6/1970 Supplement: Sex: M History Information Citation Date Conviction Date ACD Explanation County OUR 10/21/2009 110/2_7/2009 S92 Speed 52 IA 07/30/2011 ".08/03/2011 mmM14 V� Fail to Obey Traffic Sign/Signal 152^TY IA T Name: Dlallo, Oumar DL/ID: 434ZZ5639 Pursuant to Iowa Code §321.10, I, Kim Snook, 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: •""'•: �i'V 2/29/2012 D. O. T. f '••••"gv<`= Office Driver Services DRIYE� a of Iowa Department of Transportation Name: Dlallo, Oumar DL/ID: 434ZZ5639 FPb: 27: 2012 9; 59AM 0 ,Div of Criminal Investigation NNo.5453 fP. �l/1 .., .......1 ... 1 •. .v.l t a l l OV IOWA \ ��Imingd.JfflstwryRecoird Check V/nlH? DCIAccountNumbor: ooq— ' � QPoppllub e)—J TO- io1Y9X1tyt'efo4orCrfmMa1rnvextfgArroh VYoln: CITY OW towA elw 94pportOpe(4lfon3)lur6nu,I°rtJIoor Cz7:Y CLS$>L's Omer, WB.7"Street Gin >a_ TaAsxi'P- 09 OTRBRT bouxpineslrova �U319 (m)71g-dm XM- CITY TOGTA 5294A Md) 19- 600e 17gYC pitgngr X319--3i6-5n41 _.�. I Am requestfn& an Iowa Cr1knWI Fltege record Check on; �a9t abYlC mnndn(e BrAxet Ae mendA(o MOO Name, OCcommeg ea) DAt-oOfDiYt%(nenderonl Qe tTer mandate) SbetHlSeetYl7f 15711thher reeommondee 0 -6- WpdyBf.rVO)- J7&yf. WAWA YWYorfrom,thesuhieotof tfln refine t,,ato}nrraf9 orI)ulnalh(story recordplay)lot DO YdWnbfc� per Coda Wo•{yp, Chaptee0.3,2, Vat cofip►0(d'crlmfualhisloryl'enol'al Mforhtn![on, asallavred WAV;, p(prays Wrte'ver�e%�ty�a; l Acrcbygfvo penhfssrOR LDCIho gboYeregrtesUngosifc%f fo mrlducLan fosvacdminil his[ory[oeotq oheak WNh IAePhislod oCCrimfnol llriosdgafon rpop. Mymfrofno1L111orydnraegnymfngmalbn[IsmalnmfnedriyrrioDbfmayboro(cAvodAs nl(owedbylnw. r , , n /. :+•.v 11 w W AAAA" Aui.y O�"X T �WUw µ•v V%1^ANW"A 4,3 (p(.') Ufa only) As ofd a search of thaprov#ed name nrld data o bil t6.revealed: ;�; L NoIoWHGS1mT11aIS stoYyltecordfoUndwithl)CT cn Iv0-1 ;. Iowa drafnalWator, Retudatfacheci,DOU =- bCi3tlltlHls LJJJ .:.'-' cr Received TimeSFeb.22, 2012 3:05PM No. 5041