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Home My WebLink About18-039. ° . IDENTIFICATION NO. 10j - b 3 (Office Use Only) 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 Streel Iowa City, Iowa 52240-1826 Failure to complete the "required" information will result in denial of the application (3 19) 356-5040 (319) 3S6-5497 FAX First M" dle La 1. Name(REQUIRED) �Sg�� 4 1+ti1an j �t��st 2. Address (REQUIRED) -2S s a:-9 SS L( J2 (.1 / /J r 4 r ;Lr,(A E Z-1- 6 3. Contact Information (REQUIRED) Email: t=�r.�+tica/C.0 Q ic1W- GM Cell Phone: -Z-2- S 13 } p (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) _� 4- / Z - 2 .2 S b. Taxicab Business Name (REQUIRED) r%•trl� Xi �g 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? Xl<S no Type of offense reoLrk-c,Ii-f c Sign Where J -gyms, When P - - IT -2,�i What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended lead Guil Othe , Have you been arrested / charged with any traffic offenses in the last five years? o Type of offense Where } ' n -'o What happened to the charge? (Circle one) �O Q x tv Convicted Dismissed Deferred Suspended Plead Guilty' OtheP 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years N 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) /\1 C7 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 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 6q Q 1 6 a C; issued on,! 14_I X expiring one tr IZ-2-,"LS. 1 understand that 9 1 falsely answer any questions in this application, that this application may be denied. I agree that in making this application, 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, 9 authorization to be a taxicab driver is granted, to comply at all times with all of the provisions of Title 5, Chap r 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Date "fit a S - IK V f11fHY14f4H#HfflllfYffffllfllfllHftW#HH#4H1fH11HH1fHH#Yf11fl11fHlHfHIHIHHfffflHH111HHHflHHH1HHHHHW W14f1111f!!1f!! STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by A Soa d! 5 . Pzx�a � J t on this day of A /\ r. I -ZdDiP1 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 Drivers lice se Signature olice Chief or designee OY-/z -ZC, r -P 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. SSI ature of City Clpr'k or designee 5-1Y Date Yf fHH#HRHlffffllfflflffHf 1H#f#fHllff flHflf f ffff+HlfY4H#HH+W HRH#H#f 1fH1ff f IHff#+4H41HfH#H1fl1111H1ff H#Hf#HfifHH+f4#11f GeriJrAXIDRMLADGEAPPL92014ameMaO.DOC 07/2016 Office Use Only 'Q1 6 Approved application D- i 70 r DCI report State certified driving record �� <r— cit Website update ZZE: N O W GeriJrAXIDRMLADGEAPPL92014ameMaO.DOC 07/2016 a AC Iowa Department of Transportation Office of Umrer Services (Tal Free) UDO-532-Wl PO 80x 92D4, Des Manes, IA 50306-9204 515-2449124 FAX: 515-239,1837 Convictions Citation Date Certified Abstract of Driving Record ACD Inquiry Date: 4/5/2018 DL/ID #: 669AI7600(IA) Customer #: 6063944 Name: Makawi, Asaad Class: D ID Status: None Fail to Obey Traffic Sion/Signal Sullman IA 02/27/2016 03/23/2016 592 Address: 2355 JESSUP CIR Audit #: 2633626 DL Status: VAL Issue Date: 03/14/2018 CDL Status: None City/State: IOWA CIN, IA Expiration Date: 04/12/2025 CDL Cert Status: None 522461715 Endorsements: Chauffeur 3 CDL Med Status: None Mailing Address: 2355 JESSUP CIR Restrictions: NONE Restriction None Supplement: Date of Birth: 04/12/1963 Mailing IOWA CITY, IA Sex: M City/State: 522461715 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 10/27/2013 03/12/2014 M14 Fail to Obey Traffic Sion/Signal Johnson IA 12/21/2013 01/21/2014 M14 Fail to Obey Traffic Sion/Signal Johnson IA 02/27/2016 03/23/2016 592 Seed Johnson IA Name: Makawi, Asaad Suliman DL/ID: 669AJ7600 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: 4/5/2018 IOWAN aMm% ate¢ Office of Driver Services -- Iowa Department of Transporation eMar; 16;, 2018e_1:19PM Div of�Crim�nml�Ivaegtigation U3/,3/2B,B ,3Nz 6119N63Y P�/o2/opp ,kd Check .::ice �r,:-STATE OF IOWA 'A ��IOW y iHistory ,a t ,�� Request To: Town Division of Criminal Investigation Support OperatiansYlurtau, 1" Floor 215 E. 7`4 Street Des )Moines, Tows 50319 (515) 725-6066 (515) 725.6080 Fax atn H19<�-l4U/ DO Account Number: 1-f o o (ifapplicable) .From; Cif of Iowa cit City Clerk's Office 410 E, Washington Street lows City, IA 52240 Phone: 319-356.5041 Fax: 319456-5497 o — 12 ' 9 6 I Quale ❑Female 15 17 1K 4S WRiverinjorntalton: Without a signed waiver fro m the subject of the request, a complete criminal history record may not be releasable, per Code of Tows, Chapter 692.2. For comolete criminal history record information, as allowed by low, always )blain a waiver signature from the subiect of uha renusca_ fyniver Release: I hereby givc permisalon for etc abaverequesling official to snnduae an lows criminal hislory record check Will, the Dlvision of Criminal lnres(lgalion(DC)). Mycdminatlsissorydaloconumungmeshatlsmaintalnedb Iho I4ssa r<Icased as alloned bylaw, �.. Waiver Siff nature; As of �l� 6 /� , a search of the provided name and date of birth revealed: No Iowa Criminal history Record found with DCI ❑ Iowa Criminal history Record attached, DCI DCI initials DCI -77 (08/25/10) Received Time Mar. 13, 2018 2:42PM No -5537 (DCI use only) I. V ,l I l.s