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Home My WebLink About18-023 IDENTIFICATION NO. t cc ZA 1 r 1 (Office Use Only) ::IIIOW ilika qs •ft alle Oa OW APPLICATION FOR TAXICAB/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (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 (319) 356-5040 (319) 356-5497 FAX FirstMiddle 11 Last (('' 1. Name(REQUIRED) =�c1. o. S\AXitMwv, (Cra 2. Address (REQUIRED) C\ \ 2Z AV z C_59--ca\LV&Q APS -kick 3. Contact Information (REQUIRED) Email: SckCizac„xi e,G .iL _Coy" Cell Phone: \cVrj t` . 7m (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 03/p ( /2c.) I'S) b.Taxicab Business Name (REQUIRED)0003 a n j q xl cab. 5. Prior experience in transportation of passengers: I /'t iJ ' .4 0 ? -lox E?2eierI P , 6. Have you ever been arrested/charged with any misdemeanors and/or felonies in this State or elsewhere? /1/0 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? 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? 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) (I/O DEPARTMENT OF CRINIQ►i,INVESTIGATION (DCI) REPORT AND STATE CERTIFIED DRIVING RECORD MUST br NY THIS APPLICATION FOR POLICE CHIEF REVIEW You must apply for an individual DepartAirit of riminal Investigation Report(form available upon request). (SECOND P/kiGFOr'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 E( a fes\ issued on 1 / c)/ l' expiring on If L29/2,4,25. 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 n DE STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by _; G ', G. A. F L0_v -1 t1 on this 2 7 day of f e,Ror�t o-fy 2°3rg oMI ..isesevNetAfbe, 729+9a WENDY S MAYER Notary Public in 9nd for the State Iowa CommissIon,Expires ow ki 3 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 • Dr;;--- -nse 11 -0( _ �L �t O /g Sign.' e 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 ature of City Clerk or designee Date Office Use Only Approved application DCI report State certified driving record ��- Website update CD C) -ry 'en R. 0 4, raw, (7) 1,77 Pr Clerk/TAXI DR IVBADG EAP PL920 1 4 amended.DOCC:7 07/2016 earn', Virginia Department of Motor Vehicles P.Q. Box 27412 Richmond - ifa. 23269-0001 Nom TRANSCRIPT OF DRIVER HISTORY RECORD AS OF 02/02/2018 EMPLOYMENT / SCHOOL / MILITARY PAGE REQUESTED FOR: ELAREIFI, SAFIA, SULIMAN GAD ALLA 961 22ND AVE APT 14 CORALVILLE, IA 52241-1560 REQUESTED BY: ELAREIFI, SAFIA, SULIMAN GAD ALLA 961 22ND AVE APT 14 CORALVILLE, IA 52241-1560 INFORMATION PROVIDED BY REQUESTOR: T61443637 ELAREIFI, SAFIA, SULIMAN GAD ALL 11241973 F ELAREIFI, SAFIA SULIMAN GAD ALLA BIRTH DATE: 11/24/1973 961 22ND AVE APT 14 CORALVILLE, IA 52241-1560 RESIDENT JURISDICTION: IOWA ADDR CHG DATE: 02/02/2018 CUSTOMER NUMBER: CANNOT DISPLAY UNDER FEDERAL AND/OR STATE LAW DRIVER LICF,NSr; STATUS: N)T LICENSED DRIVER POINT BALANCE: +3 COMMERCIAL DRIVER STATUS: NOT LICENSED PREVIOUS DATE ISSUED: 06/14/2017 EXPIRES: 11/24/2024 LICENSE LICENSE TYPE: DRIVERS LICENSE ISSUE TYPE: RENEWAL CLASS: D OPERATOR DL ENDORSEMENTS: NONE RESTRICTIONS: YES SURRENDERED: 01/31/2018 SURRENDERED RSN: STATE TO STATE PREVIOUS DATE ISSUED: 05/04/2016 EXPIRES: 11/24/2016 RSN: DESCRIPTION LICENSE LICENSE TYPE: DRIVERS LICENSE ISSUE TYPE: DUPLICATE CLASS: NONE ENDORSEMENTS: NONE RESTRICTIONS: NO PREVIOUS DATE ISSUED: 10/21/2010 EXPIRES: 11/24/2016 RSN: DESCRIPTION LICENSE LICENSE TYPE: DRIVERS LICENSE ISSUE TYPE: REISSUE CLASS: NONE ENDORSEMENTS: NONE RESTRICTIONS: NO cu 877 0 _AD rift O jC 0171 ICS• I 7. LV I 0 0: )9„191 uIv or iminaI Investigation No. 4120 P. 1/1 Pror-n!Clty of Iowa Clty Clerk Office. 319 3686497 02/16/2018 16:66 40,393 P.002/002 • �,'!-__ STATE OF IOWA .•,v°-; . .y o;y�w '� . Criminal History Record Check � �;.;R i.� ::lv Form X41 . DCI Account Number: 4GDZ.-1:-- (if applicable) To: Iowa Division of Criminal Investigation From: City of Iowa City Supportt Operations Bureau, 1”Floor• City Clerk's Office 215 E.7 Street 4X0 E. Washington Street Des Moines,Iowa 50319 (515)725-6066 (515)725-6010 Fax Iowa City, IA 52240 Phone; 319-356-5041 Fax; 319-356-5497 I am requesting au Iowa Criminal History Record Check on; Last Name (mandatory) First Name(mandatory) Middle Name(recommended) Date of Birth (mandatory) Gender (mandatory) Social Securi Number(recommended) • 11-- 2 --- \e"\"19 ' ❑Male 2 7 C� 5 I `� Female t'Titr,,,-frlftiraurrlv,r, witnout a signea waiver iron the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 6922.For complete criminal history record information,as allowed by law,always ( obtain a waiver signature from the subject of the request. Waiver Release;I hereby give permission for the above requesting official to conduct an Iowa criminal luslory record check with the Division of Criminal Investigation(DCI). Any criminal history dela concerning me that is maintained by the DCL may be(cleared as allowed by law. Waiver Signature: ----- 7:-c- ' l 1, Iowa Criminal History Record Check Resultsr~ w (DCluse only) iz„)—lel—�� 4� As of ,a search of the provided name and date of birth revealed; ri 0No Iowa Criminal History Record found with DCI `' A-11 '' 0 Iowa . ,- ';,�, Criminal History Record attached,DCI# o i o :rte ` v DCI initials C DCI-77 (08/25/10) " RernivPtl Tirna Feb. 15 )(11R 4'2APM Nn 41A) Page 1 of 2 SMARTER I SIMPLER I CUSTOMER DRIVEN WWW,lowadat.gov Office of Driver Services PO Box 9204(Des Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 I Fax:515-239-1837 www.iowadot-gov Certified Abstract of Driving Record Inquiry 2/22/2018 DL/ID#: 250AP6210 (IA) CDL Permit Class: None Date: Customer 6690430 Class: C CDL Permit Issue None #: Date: Name: Elareifi,Safia Sulliman Audit#: 2506210 CDL Permit None Gad Alla Expiration Date: Address: 961 22ND AVE APT 14 Issue Date: 01/30/2018 CDL Permit None Endorsements: Expiration 11/24/2025 CDL Permit None Date: Restrictions: City/State: CORALVILLE, IA Endorsements: NONE ID Status: None 522411560 Mailing 961 22ND AVE APT 14 Restrictions: Corrective Lenses DL Status: VAL Address: Restriction None CDL Status: None Mailing CORALVILLE, IA Supplement: CDL Permit ELG City/State: 522411560 Status: Date of 11/24/1973 CDL Cert Status: None Birth: Sex: F CDL Med Status: None History Information CLEAR DRIVING RECORD Name: Elareifi, Safia Sulliman Gad Alla DL/ID: 250AP6210 (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: .4ttllCLf... •• IOWA '0 2/22/2018 I/714664w j • p +\4e 9B YE*$ 4" Office of Driver Services + () [+� Iowa Department of Transportat7vam Fp" rn m ra:11) Name: Elareifi, Safia Sulliman Gad Alla DL/ID: 250AP6210 (IA) 2/22/2018