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Home My WebLink About18-030t , CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (319)356-5040 (319)356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. I I — t3 3N (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 Last 2. Address (REQUIRED) 26 Am .5�dm r.4- 3. 3. Contact Information (REQUIRED) Email: Cell Phone/3R NOO' 2-'3 03 (AII Written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 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 elsewhere? /V ELS Where L; nie/ When What happened to the charge? (Circle one) Convicted Dismissedeferred' Suspended Plead Guilty Other Have you been arrested / charged with any traffic o enses 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? 1yo Type of offense Where When 9. Have you ever applied to be an Iowa City taxi driver using a different namNARIA(3 11ase provide the name(s) y�.(p c ty Clerk II aa Cityy Iowa DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) AiW611T ASID 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 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 3/z5/1 S I hereby cej that I have issued to me by the Iowa D partment of Transportati n valid Driver's license number 7R 2 `� Y 19NZ issued on / expiring on 2olR . 1 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 provisiogstpf Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date 3 16 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by ia�� a� ;n m c T on this �day of \ao�zS'� Iowa 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). G l Expiration date of Drivi se� 1 97 v3 -a7 -/S S5PAdre 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. 3-7-� Signafure of City Clerk or signee Date Office Use Only Approved application DCI report State certified driving record Website update MAR 0 7 2018 City Clerk Iowa City, Iowa aen✓rnwDRNgMDceaPrL92014ammd a.DOC 07/2016 0 `10WADOT : - � ; SMART 1 0 E ' www.iowadot.gov ER SIMRLEft I STOM ft DRIVEN Office of Driver Services PO Box 9204.1 Des Moines, LA 50306-9204 Phone: 515-244-9124) 800;532-11211 Fax: 515-239-1837 www.Wiadol.gov History Information Convictions Citation Date Conviction Date Certified Abstract of Driving Record Explanation Inquiry 2/24/2017 DL/ID #: 782yy1942(IA) CDL Permit Class: None Date: IA 05/19/2014 07/21/2014 M14 Fail to Obey Traffic Sign/Signal Customer 3963874 Class: D CDL Permit Issue None #: Date: Name: Osman, Allaeldin Audit #: 9111703 CDL Permit None Mohamed Yousif Expiration Date: Address: 26 ANISTON ST Issue Date: 05/26/2015 CDL Permit None Endorsements: Expiration 04/18/2018 CDL Permit None Date: Restrictions: City/State: IOWA CITY, IA Endorsements: 3 ID Status: EXP 522402216 Mailing 26 ANISTON ST Restrictions: NONE DL Status: VAL Address: Restriction None CDL Status: None Mailing IOWA CITY, IA Supplement: CDL Permit ELG City/State: 522402216 Status: Date of 4/18/1964 CDL Cert Status: None Birth: Sex: M CDL Med Status: None History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 03/26/2012 04/20/2012S92 Speed Jefferson IA 05/19/2014 07/21/2014 M14 Fail to Obey Traffic Sign/Signal 7ohnson IA Name: Osman, Allaeldin Mohamed Yousif DL/ID: 782yy1942 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: 10WA ¢4 2/24/2017 10. T. „OBIIRt�__ Office of Driver Services Fe b. 14. 2018 8:29AM Div of Criminal Investigation No. 3119 F. 1 016e. vuioe nne unee.y/ 02/13/2018 13:26 M390 P.002/002 STATE OF IOWA PCriminal History Ree dor, y Request t Fori To: Iowa Division of Criminal Investigation Support Operations Bureau, In Floor 215 E. 7'4 Street Des Moines, Iowa 50319 (515) 725.6066 (515) 725.6080 Fax I am requestiu an Iowa Criminal DCI Account Number: _Lf 0 01— -- (rapplie" nble) ~ From: City of lows City City Clerk's Office 4L0 E. Weshln on Street Iowa Ci 7, l:A 52240 Phone: 319.356-5041 Pax: 319-356-5497 �Jn"ial� NI af-. ICn1 T1 ITA4)YAMmeA You S) Date of Birth (mmdaiory) Gender (mandatory) Social Securi Number (recommeneee) e N�/S /I q EMMale ❑Female ,:2.26 - `i� - 3 5 - WaiverYnjormnlion: Without a signed waiver from the subject of the request, a complete criminal history record may not be releasoblq per Code of Iowa, Chapter 692.2, For complete criminal history record information, as allowed bylaw, always obtain a waiver slonsture tram the enht.ef ..fn.e........ Waiver Aefease: i kn by give perosiralon for the above jequesling ogchl to conduci an low& alminal hlslory iccerd 111"k With 1h, Divleion of Climinal Invesilgation(DCl) Any edminal history data conceming Tf tel la maintained by the DCO may be released as allowed by lay. Waiver SiffisatureSY::= Iowa Criminal History Record Check Results As of a search of the provided name and date of birth ruled: ® No Iowa Criminal History Rernrel remnd with DCI Iowa Criminal History Record att ched, DCT #I 5S 0 DCI initials_ DCI -77 (06/25/10) Received Time Feb.13. 2018 1:OOPM No, 4013 -(DCI use only) 6:> a: Feb, 14. 2018 8:29AM Div of Criminal Investigation No.3119 P. 2 zcxA cArruunn naoavna DCT 00915578 NON CONVICTION PAGE 1 OF 1 DATE PRINTED - 2018/02/14 DCI:00715578 NAME: OSMAN,ALLAELDIN MOHAMED DOB SEX RAC HGT WGT EYE HAIR SKU POB 19640418 M B SOB 200 BRO BLK YY ADDITIONAL IDENTIFIERS SC R FGR CCH RECORD +++ 01 ARRESTED/TAKEN INTO CUSTODY 20040112 AGENCY: IA0570000 LINN CO SO CHARGE NO- 02 IA STATUTE IA321J-2-2A OWI 19T OFFENSE TRK#: 502380801 COURT DISPOSITION AGENCY: IA057015J LINN CO DIST COURT COUNT NO- 01 IA STATUTE: IA321J.2(A) OPER VEH WH INT (OWI) / IST OFFENSE COURT CASE ID: 06571 ONCROS4231 CHARGE CLASS: NON CONVICTION TRK#: 502380801 DRUNK DRIVING SCHOOL SENTENCE DISP EPF DAT DEFERRED JUDGEMENT SY 20040415 PROBATION 1Y 20040415 DISCHARGED FROM 20041104 DEFERRED JUDGEMENT AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY BE RELEASED TO NON -LAW ENFORCEMENT AGENCIES BY THE DCI. , IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD IS BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD COVERS THE SUBJECT OF YOUR INQUIRY, DIVISION OF CRIMINAL INVESTIGATION