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Home My WebLink About18-049sr �III� CITY OF IOWA CITY 410 East Washington Street Iowa City, Iowa 52240-1826 (3 19) 356-5040 (3 19) 356-5497 FAX 1. Name (REQUIRED) IDENTIFICATION NO. 16 0 49 (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 Ay mon Middle W)C^hvY1i)i�j1d Last SSG 2. Address (REQUIRED) ) 9 O 'k vrQ own C i I—L, 14,59Z41 3. Contact Information (REQUIRED) Email:rlcjtarnu— Cell Phone.• 1S)3335 03 (All written communication sent via email) 4a. Driver's License expiration date (REQUIRED) 9- / b. Taxicab Business Name (REQUIRED) 5. Prior experience in transportation of passengers: `/ aCi; rgAQ. r6 r � o (INN �-o c 1 - - 3} 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? A/a Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? '>tNdp i Type t [of offense Where When ,irn+T1C .slf)J) llk�i✓�l r)c Q(,%J3 Nylir) 1,2// &- �13, SO 1'xcl f PZ -5" 11 What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead GuilOther 8. Has your drivers license or chauffeur's license been suspended or revoked in the last five years? /V, 3 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) 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 here b certify tly3( I have issued to me by the Iowa Department of Transportation a valid Driver's license number n 2 `Z% issued on aG-22- k? expiring on 0`3 .-r$ - / & . 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, (, hapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant DaOe if '�6 11H11#11Mf1ff1f11flfim}}mf#1:11fiMHlMllllffH111ff1f 111141#R##YY##flllmHf 1!1111l1N11fftllH#YHY#f#fY#k11flllff!!f 1111#H1f#fffHm STATE OF IOWA ) COUNTY OF JOHNSON ) S\^ r bscribed and sworn to before me by ��w. �.v. 'lV\ . � on this � �'" day of P,Qr; `S} ao(p in and for the State 1.Yf.1.«111111..1.1 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). �— ---� 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. Signature of City Clerk or signee Z4 -3c- iW Date #feY#1111#llfm##1#1f#fa}«}}+11!111:111#1##f+}+!Y!!!»rlmfmffll#m#ea##+flf!lflllfff#m1mYf}!e}11!111«m!}lflm«1m!!mlflf:1111 Office Use Only Approved application o DCI report o ae State certified driving record $c') 2'=t a -0 Website update r- M Owk(TAXIDRN64DGEAPPL92014emertleC DOC D 07/2016 co Mar.30. 2018 10:19AM Div of Criminal Investigation Prom;Clry Of IOW6 Chy 016ek Cfflaa 319 OGOS467 No, 7498 P. 5/7 03/28/2018 12:4e Nd62 P.002/002 STATE OF )IOWA Crime nal History Recolrd Check 11 Request Foam '`' s / O DQ Account Number: %y 0 (�- (ifappliwbre) To: Iowa Division of Criminal Investigation Support Operations Bureau, I" Floor 215 E. Th Street Des Molnes, Iowa 50319 (515)925-6066 (515) 925-6090 Gay: I ani reauestine an Iowa Criminal H istory Record Check nn - From; City allows C City Cleel(Is (Office 410 E. Washington Street Iowa Cityj IA 52240 Phone: 319-356.5041 Fax: 319-356-5497 Last N21111e (mandatory) First Name (mandatory) Middle Nah7e peconmmnded) bate of Birth (mandalcly)) Gender (mandatory) Social Security Number (recommended LD C1, r r (;� c % -I 6 MMale (Female 4 e 6 --5-4 _. -? -� 6 � Waiver Information; WI(boo t a signed waiver from ihesubject of the request, a complete criminal history record may not be releasable, per Code of Iowa, Chapter 692.2, For cotnnle(e criminal history record Information, as allowed by law, always Wain a waiver signature from the subject of the request. lVaiver Release: l hcrcby give permission for the above requesting official td conduet m loge uiminal hisloryrewrd check with the Division ofCriminal investigation(DCI). Any criminal history date wnwnling me that is mart aincd by the lyCJ may be released as allowed by law. Waiver Signature: Io`tlira Criminal History Record Check Results ' ; (DClusconly) As of r 3 I a search of the provided name and date of birth revealed: t.: Jak No lowa Criminal History Record found with DCI 13 Iowa Criminal history Record attached, DC18 DCI initials: DCI -77 (09125110) Received Time Mar.26. 2016 12:09PM No -6328 Iowa Department of Transportation Office of Driver Services (TO11 Frets) NO.532.1121 PO Sex 9284, Des Motnes, IA 50306.9204 515.244-9124 FN)C 515-239.1837 Certified Abstract of Driving Record Inquiry Date: 4/5/2018 DL/ID #: Name: Sharif, Ayman Class: 7062538 Mahmoud Mohamed VAL Address: 1901 GRYN DR Audit #: 09/18/2018 CDL Cert Status: Issue Date: City/State: IOWA CITY, IA Expiration Date: Bus 522464408 S92 NONE Restriction Endorsements: Mailing Address: 1901 GRYN DR Restrictions: 09/18/1967 Johnson Date of Birth: Mailing IOWA CITY, IA Sex: City/State: 522464408 Convictions 679AJO237 (IA) Customer #: 6073198 B ID Status: None 7062538 DL Status: VAL 06/22/2013 CDL Status: VAL 09/18/2018 CDL Cert Status: Excepted Intrastate Passenger, School CDL Med Status: None Bus 04/14/2015 S92 NONE Restriction None 12/18/2015 Supplement: M14 09/18/1967 Johnson IA M History Information Citation Date Conviction Date ACD Explanation County JDR 09/01/2013 09/27/2013 S92 Seed Johnson IA 03/08/2014 04/08/2014 S92 Speed (10 mph & under in 35-55 mph zone Johnson IA 01/25/2015 04/14/2015 S92 Speed Johnson IA 12/18/2015 03/08/2016 M14 Fail to Obey Traffic Sign/Signal Johnson IA Name: Sharif, Ayman Mahmoud Mohamed DL/ID: 679AI0237 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: 4/5/2016 I®KYlY •. *�. Office of Driver Services Iowa Department of Transporation Name: Sharif, Ayman Mahmoud Mohamed DL/ID: 679A30237