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Home My WebLink About12-166r1 Authorization Number !a - 144 r _ 1 (Office Use Only) ++. cap 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) 356-5040 (319) 356-5497 FAX First n Middle nAst 1. Name llf�z2h A� o V r,Ij, ya j�o l a wreLn AL 2. Mailing Address 2-53S _f/ Ill 3. Telephone: Home Other. Si i —17 q - gY (ek 4. Prior experience in transportation of passengers: ✓p ((!1 Cw G I - n w (''Y�^ c 3, (a � _ Z O C. " (I 11 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?A/C Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When 5--e e A C 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? N.r Tvoe 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) derMa idriwadg 06/2012 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number SGL IZB0-710 . I understand that if I falsely answer any questions in this application, that this application may be denied. I understand 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 IXC L'--64 ti Date Z //4 ( 2A (2— STATE 2 STATE OF IOWA ) COUNTYOFJOHNSON 1 Subscribed and sworn to before me by� �^ 4 h a J w� ��\\�_� �� On this t b day of tagLPu lic in and for the State f Iowa -7 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). Si&atilni Police Chief or designee Sig ture of City Clerk or designee Date Date NOT VALID UNTIL Police Chief and City Clerk have approved and authorized taxi driver names 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 derk/Iazidn ba4geapp2010. 06/2012 .l. Iowa Department Office of Driver Services PO Box 9204, Des Moines, IA 50305-9204 of Transportation (Toll Free) 800-532-1121 515-244-9124 FAX: 515-239-1337 Certified Abstract of Driving Record Inquiry Date: 8/9/2012 ACD Explanation DL/ID #: 102BB0710 (IA) Name: All, Mohamed Awadalla Class: D IA Mohamed 03/20/2012 B64 No Insurance Card 52 Address: 2535 BARTELT RD APT 1D Audit #: 4881946 Issue Date: 12/14/2010 City/State: IOWA CITY, IA 522462722 Expiration 12/15/2015 Date: Endorsements: 3 Mailing Address: 2535 BARTELT RD APT 1D Restrictions: Corrective Lenses Date of Birth: 12/15/1968 Mailing City/State: IOWA CITY, IA 522462722 Sex: M History Information Convictions Customer #: 3602586 ID Status: None DL Status: VAL CDL Status: None CDL Cert Status: None CDL Med Status: None Restriction None Supplement: Citation Date Conviction Date ACD Explanation County 3UR 08/06/2009 09/02/2009 Speed (10 mph & under in 35-55 mph zone) 77 IA 02/18/2012 03/20/2012 B64 No Insurance Card 52 IA Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date Case Number 7UR 01/21/2012 669245 IA Name: Ali, Mohamed Awadalla Mohamed DL/ID: 102BB0710 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�4 8/9/2012 �_> ...... S� Office of Driver Services Iowa Department of Transportation Name: All, Mohamed Awadalla Mohamed DL/ID: 102BB0710 Aug.15. 2012 2:21PM Div of Criminal Investigation No.9065 P. 3/6 AU g. Y. [ul[ [:4jrlvl l,lty t,lere - t,lty of toga t,lty 140:[t1Y5 P. L i,, • bri miSTAT-H OP IOWA nalMstory Record Check RequestForm To; Yowab(Olo,6rcriminalrnVadreAtfoh suppoyt oporattons Raronu, X°tWooe 215E.7'4 Sfrect beaMetnas,Xawa Sos19 (515) 725.6066 (51� 725-bu9n b'a� Name Ml AccounENuinber; L('00�—� grappliaAwo— PM1n,' GTTY OF TnTaa DJU .� CITY CLm's OlyfxCS 410 'K. TYA SMj STREET TOWA CTTT Tr�ra 2z/p Phone: R19•—a56--SOk1 _—`_, TYaxe RTq—a�_S[{47 — e k4C�j l2 f tSl/ j69 I Male �pemaTo `FS I —2,9 -3� 97 wa/Ve,(,7 folrri at10n; without n srgned 1wa1} e� ]Yom Iltasubjcce o1 tho regaes6> q eornpioto chJlntaal hfsfmy record lllgy trot bol'oiopsgbTc� per We ofYo�yp, Ciapter692.1 h'aY corn a e'crJminAl ldstoXy record infoamntton, n�gllo�aod 5ylow, gtWgy3 V,-.--...-._. _...1... .......- � . -_.. Waiyerlteferry'e; rhefGbyblVe pOtta(vs(en 2rlho nbova ragYelllrt(f0ai0iAl la condUO(ejt iowe odm(nal Itlslorytword cherkwilh NeDlislnn OPCominel YnveatigelTon(Dcp, any orlhltnallflaloryde�noottwmrn molMtlamatn+ Ined6ylheAOimey6oYolcpodavallow<dby/siY. .r A , Iowa Criminal ffistorlyReeard CheckReaultg As of at search of dieprovided name and dato ofblrth.aevoala, lel'oYowaLiiininelFriatoxyiZecordFoVndvvithDCT rowa Cximinalilistory'ReCo>'datiached, DCY M1 Received T.ime Aug. 9. 2012 2:43PM No._1136 -in�'�a�'. u c :` en —�7:a r,:+ts:rocn:. r^Nw y� c.�