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Home My WebLink About18-016r IDENTIFICATION NO. /FLTj LP 1 1 (Office Use Only) CITY OF IOWA CITY APPLICATION FOR TAXICAB I 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 (3 19) 356-5040 (319)356-5497 FAX First Middle Last 1. Name (REQUIRED) r� c.2Ctr AL ALAS 2. Address (REQUIRED) tk Ayc st/J -#,j Ceda r Rq re JA ! 2q &.4 T `9 3. Contact Information (REQUIRED) Email: II rt � rc e) -i[ -Cell Phone: (All written commt»tiion sent via email) 4a. Driver's License expiration date (REQUIRED) ®2— 22 — '2 of 9 b. Taxicab Business Name (REQUIRED) cLa�r ga n j p(y 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? KA5 Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years?._ 211% Type of offense Where When 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 the last five years? A/d Type of offense Where When ti 0 -- m rJ T1 --1 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please prdYitL e'Yhe rrjame(&t� IR%d —r <—) rn -�r— DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE .C@RTINit D 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 Department of Transportation a valid Driver's license number issued on6J'23-La expiring on I understand that if I falsely answer any questions in this application, that this application 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 Date�- 11fY1f11N1Nf}#iff+#ff#ffY#H1fHflfYf 11111111 1111 f fii#11f1fYffYff if 1f f YNYfff YYYf##f#Ytf11f11fHf1f 111144!!##11111f1flHfYiff Y#Y!##f{yf#lfffff STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by kjn6Z{L( .Wwjon this —� day of ZUI Si . 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 _ 6l L3/2•�2-Y ,off Signature of Police Chief or designee 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. Sig lure of City CIQJ or designee Approved application DCI report State certified driving record Website update 0 Office Use Only n m --n D__q w c>-< C, r =-1Ci <rm M G::0 Q Ir _ t GeA MIDRNBADGF W 92o14am de DOC 07/2016 Date 0 Office Use Only n m --n D__q w c>-< C, r =-1Ci <rm M G::0 Q Ir _ t GeA MIDRNBADGF W 92o14am de DOC 07/2016 4PIOWADOT vvvvw,iowadogov SMARTER I SIMPLER 1 CUSTOMER DRIVEN Office of Driver Services PO Box 9204 1 Des Moines, IA 50306-9204 Phone :515-244-91241800-532-11211 Fax: 515-239-1837 wwwxiwadot gov History Information CLEAR DRIVING RECORD Name: ELbadawi, Nazar Mahgoub ELga DL/ID: 204AN2005 (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: IOWA ).0.T Name: ELbadawi, Nazar Mahgoub ELga DL/ID: 204AN2005 (IA) 2/6/2018 0 Certified Abstract of Driving Record Inquiry 2/6/2018 DL/ID #: 204AN2005 (IA) CDL Permit Class: None Date: Iowa Department of Transportation --4 C0 :<r- m Customer 6666675 Class: D CDL Permit Issue None #: v Date: Name: ELbadawi, Nazar Audit t#: 2485848 CDL Permit None Mahgoub ELga Expiration Date: Address: 50 66TH AVE SW APT 5 Issue Date: 01/23/2018 CDL Permit None Endorsements: Expiration 06/03/2024 CDL Permit None Date: Restrictions: City/State: CEDAR RAPIDS, IA Endorsements: Chauffeur3 ID Status: None 524045349 Mailing 50 66TH AVE SW APT 5 Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing CEDAR RAPIDS, IA Supplement: CDL Permit ELG City/State: 524045349 Status: Date of 6/3/1970 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information CLEAR DRIVING RECORD Name: ELbadawi, Nazar Mahgoub ELga DL/ID: 204AN2005 (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: IOWA ).0.T Name: ELbadawi, Nazar Mahgoub ELga DL/ID: 204AN2005 (IA) 2/6/2018 0 rn 7'1 Office of Driver Services Iowa Department of Transportation --4 C0 :<r- m -a M a v t dan.LY, zvio j:4irM Uiv of Criminal Investigation No.2019 P. 1 From:Cley 01 IOW9 CITY Clerk dfrlam 310 3666467 01/26/2016 13;20 .361 V.002/002 To; Iowa Division of Criminal Investigation Support Operations Bureau, f`I Floor 215 E. 7" Street Des Moines, Iowa $0319 (515) 725-6066 (515)725.6000 Fax 1 ant requesting an Iowa Criminal Ms(oiy Record Check on: DCI Account Lumbar; (ifapplleaDle) From: City llffowa Cit City Clerk's ofnee 410 E. Washington Street Iowa City, IA 52240 Phone: 319-356.5041 Fax: 319.356-5497 Lest Name (mandatory) First Name (mandatory) Middle Name (reeoauaeoded) Ms�Ylrt G 7 i)ate Of Birth (mardaloq') Gender (mmdalory SOcial Securi Number (recommended) [Female �,,- ._ I e _ 4' ( `"19 WQfverinjnrdentfOn: 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 co_ mnleta criminal history record information, as allowed by law, always obtain a waiver signature from the sublect of th. Waiver Release: l iwreby give permission for the above requesting official to conduct an Iowa wiminal idstory record chock with ale Dlvision of Criminal 1nvo5t19all0n(DL7). Any aiminal lllswry dale eomentlng me that is mainlaincd bythe DCl may berelcascd as allowed bylaw. Waiver Signnture: Iowa Criminal History Record Check Results As of �- a �-1 I , a search of the provided name and date of birth revealed; tel! No Iowa Criminal History Record found with DCI r i Iowa Criminal History Record attached, DCI DCI initialsiCL-0 ACI -77 (08/25/10) Received Time Jan, 26. 2016 11:50AM No. 3399 � (DGlalge only)..es 7 Vi ' i 1...✓ it F) W L a -