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Home My WebLink About18-014f r — CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 5 22 40-1 826 (3 19) 356-5040 (319) 356-5497 FAX 1. Name (REQUIRED) _ 2. Address (REQUIRED) IDENTIFICATION NO. 1 8 — O 1 `'1 (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 First Middle Last 3. Contact Information (REQUIRED) Cell Phone: 3 19 93 6 9 H 5L_7- 4a. Driver's License expiration date (REQt 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 elsev re? M n Type of offense Where * hen rn y*be -� W What happened to the charge? (Circle one) N Convicted Dismissed Deferred Suspended Plead Guilty Other tv Have you been arrested / charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where 0 - Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? NV 6 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) �, O 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 r APPLICATION FOR TAXICAB VEHICLE DRIVER • Page 2 I hereby certify that I have issued to me by the Iowa Department of Transportation a v lid Driver's license number 9N �}f��")-� issued on expiring on �. I understand that if I falsely answet any questions in this application, that this applicay 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 Applicaint1�1'-� ` Date 0 I (� N P m co STATE OF IOWA ) _<r,r "0, - =1C C3 COUNTY OF JOHNSON ) Subscribed and sworn to before me by -Ata,Don ,.� �\.- Q II on this �� day of com'WNDY S MMYER Nota Public in d for the State sawn Number 7 Notary Iowa W pros 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 s . rise O(9 " Z -r uL l nature 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. c J ;( `Sig ature of City Clerl I r designee Date Date Hf!###NN#NN#N*f'Yf;;f;f;fN#f 1;fef'Y 1;fflfNN#N#N#N#Nffffff!!llflfNlflNf!##Y#N!#f#N#NffNlMf!!1N#Ni##Ni#H;ft###-#ff;flflN#N## Office Use Only Approved application DCI report State certified driving record Website update Cle ✓ A IDRNBAoceAAPPLs2o1a .dw.Doc 0712016 C14WWADOT www,iowadot,gov SMARTER I SIPAPLER I CUSTOMER DRIVEN Inquiry 2/2/2018 Date: Customer 1248379 Name: Ba, Abdoul Karim Address: 2547 WHISPERING PRAIRIE AVE City/State: IOWA CITY, IA Convictions Page 1 of 2 Office of Driver Services PO Box 9204 I Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 wwmlowadot.gov Certified Abstract of Driving Record DL/ID #: 846AA3200 (IA) CDL Permit Class: None Class: D Audit #: 1482437 Issue Date: 12/09/2016 Expiration 06/25/2021 Date: Endorsements: Chauffeur 3 CDL Permit Issue None Date: CDL Permit 522406804 Mailing 2547 WHISPERING Address: PRAIRIE AVE Mailing IOWA CITY, IA City/State: 522406804 Date of 6/25/1971 Birth: None Sex: M Convictions Page 1 of 2 Office of Driver Services PO Box 9204 I Des Moines, IA 50306-9204 Phone: 515-244-9124 1800-532-1121 1 Fax: 515-239-1837 wwmlowadot.gov Certified Abstract of Driving Record DL/ID #: 846AA3200 (IA) CDL Permit Class: None Class: D Audit #: 1482437 Issue Date: 12/09/2016 Expiration 06/25/2021 Date: Endorsements: Chauffeur 3 CDL Permit Issue None Date: CDL Permit None Expiration Date: Restriction None CDL Permit None Endorsements: CDL Permit CDL Permit None Restrictions: Iowa Department of Transportation ID Status: None Restrictions: NONE DL Status: VAL Restriction None CDL Status: None Supplement: CDL Permit ELG of Driver Services Status: Iowa Department of Transportation CDL Cert Status: None History Information CDL Med Status: None Citation Date Conviction Date ACD Explanation IUR County 11/06/2013 12/05/2013 S92 Speed IA Henry Name: Ba, Abdoul Karim DL/ID: 846AA3200 (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: •: pis �q 2/2/2018 IOWA ''; Oe;g oQ fQBIYE� Office So_ ' of Driver Services Iowa Department of Transportation 1/1 Nf)1e Name: Ba, Abdoul Karim DL/ID: 846AA3200 (IA) 2/2/2018 Feb. 1. 2018 11:33AM Div of Criminal Investigation No,2386 P. 1/1 F. rn!cslty o1 to We Clly Clerk Uellaw 016 3666487 01/31/2elb 10:da =MING V.e02/002 ,eonr Ytk� OF ,i 1 0 r l�` 1 t a t , town , 1 Re que st Form' To: Iowa Division of Criminal Investige(ion Support Operations Bureau, Is' Floor 215 E. 7" Street Des Moines, Iowa 50319 (515) 725.6066 (515) 725-6000 pax I am requesting an Iowa Criminal History Record Cheek nn, DCIAccountNumber: Llooz-i=' (ifepplicabie) From: City of Iowa City City Clerk's Office 410 R, Washington Sheet Iowa City, IA 52240 Phone: 319-356-5041 Fax: 319.356-5497 Last Name (mandatory) First Name (mandetc ) Middle Name utconnnended) ` IDCIus only) n ify ,' 4 Y -I'm Date of Birth (mandatory) Gender (mandatory) Social 5ecuri Number (recommended) UdMale ❑Female Waiver Information: 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 complete criminal history record information, as allowed by law, always obtain a waiver signature from the sub ect of the request Waiver BeieaSe; 1Inaby give permission for tho above rr4ucriins official to conduct an Iowa criminol history rcusd check with the Division of Criminal Investigation (DCO. Any Criminal history dela coneemingm alfM"Italned by the DCI may be relencd as allowed by low, Waiver Signature: Iowa Criminal History Record Check Results ` IDCIus only) n ify ,' c;lr i As of er �� a search of provided name and date of birth revealecj;, ; U, 'l is ':• 11 tri o Iowa Criminal History Record found with DCI c i '• U Iowa Criminal History Record attached, DCT # w DCT initialsjcf-,�- L)U1-II (US/2w1u) Received Time Jan. 31. 2010 9:18AM No. 3598