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Home My WebLink About14-226 Authorization Number / -02cg-(' r (Office Use Only) III gar APPLICATION FOR TAXI/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 n First Middle Last 1. Name (REQUIRED) f1+1/\�},•.��c.1 �1nwe,� N\�11�ti o Y c� `M\zrs;•^-) 2. Mailing Address (REQUIRED) •eT--\ - 11 3. Contact Information (REQUIRED) Email: keN\\t\t,%: .1 e%.,- ..A Cell Phone: \`'1 1.-06w 4. Prior experience in transportation of passengers: 1-f- '«Ys - V c)hk\fej. yJ; l ,1-vyeJ Yc 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? (VD Type of offense Where When 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Al Q Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When -26-Zak o 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) DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE c RTIFD 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). r (OVER FOR REQUIRED SIGNATURE AND NOTARY) rn 09/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 7A 1a C--) . I understand that if I falsely answer any questions in this application, that this application may De denied. I understand that if I falsely answer any of the questions in this application, that this application will 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 a license 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 it Date IC `9 YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by 1(\ 19,4 nu A-. , E) . On this Cr ti-k. day of C)r c,lak r 1 1-)c 5 i kl aAr WENDY 5 MAYER L�C� 5 e�� 'ommissio�,hl�..dlEr 71Gd�A Notary Public in for the State o Iowa My Commis i•n Expires I have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter- mined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code). 6/9 a. - - °. ice Chief or designee Date • •U ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org. �AAJ �Jf/t� /e / // .7Z-. Signaturaof City Clerk or designee l bate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1" (width) and 5 1/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update CIerk/TAXIDRIVBADGEAPPL92014amended DOC 09/2014 : "- 10 OT as WWW,lowadotgov SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 I Des Moines,iA 50306-9204 Phone:515-244-91241800-532-1121 1 Fax:515-239-1837 www_iowadot.gov Certified Abstract of Driving Record Inquiry Date: 10/1/2014 DL/ID#: 457AF5304 (IA) Customer#: 5735973 Name: El Hossiny, Mahmoud Class: D ID Status: None Ahmed Mahmoud Address: 423 HIGHWAY 1 W APT 17 Audit#: 6856868 DL Status: VAL Issue Date: 04/11/2013 CDL Status: None City/State: IOWA CITY, IA 522464209 Expiration Date: 02/12/2016 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 423 HIGHWAY 1 W APT 17 Restrictions: Corrective Lenses Restriction None Date of Birth: 2/12/1987 Supplement: Mailing City/State: IOWA CITY, IA 522464209 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 09/26/2010 10/18/2010 S92 Speed Iowa IA 06/01/2011 06/13/2011 592 Speed (10 mph&under in 35-55 mph zone) Tama IA 10/27/2011 01/20/2012 S92 Speed Johnson IA Name: El Hossiny, Mahmoud Ahmed Mahmoud DL/ID:457AF5304 Pursuant to Iowa Code §321.10, I, Kim Snook, 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: x�O%�EYICIf.4 I$ 10/1/2014 14i IOWA�'%"' syA.:D. O. T. % hy�1/DRIYf�S w Office of Driver Services (-) ni 'u- Iowa Department of Transportation —i —I -iCnFri Name: El Hossiny, Mahmoud Ahmed Mahmoud DL/ID: 457AF5304 - ■■ Oct. 6. 2014 12: 54PM Div of Criminal Investigation No. 2055 P. 1/4 +�. r. purr c � r II vii, vruin Vit, VI Luau �y 1c V. JL l7 1. L/ L 0 4V:1N STATE ATE OIL1 IOWA , 47,i a (4w) (Crrtlmititmli IHh torry' Rod Cheek F Arlo4 7 I k equ st Form ! •_....i ..'`? 'C',Ni ire'' -- 1/4 DCI Account Number: (t0 V'`),_ - v-- of (if sppiicabla) To; Iowa Division of Criminal r ivestigat(on From; _City of Iowa City Support Operations Bureau, 1"Floor City Cleric's Office 2151;, 71d Street 410 .Washington Street Des Moines,Iowa 50319 (515)725.6066 Iowa City, IA 52240 (5x5)725-6080 Fax "` Phone; 319-356.5041 Fax: 319-356-5497 I am requesting an Iowa Criminal History Record Check on: Last Name Mandatory) First Name(mandatory) Middle Name recommended) • thossIJ\' L iYlf A D (0611MMAD Date of Birth =awry) .Gender mendelory Social Securl Number(recommended) 02/ \V -1 Wale °FemaleU I ( d ,Yr) • - Waiver information; - Waiverinformation.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 si!nature froln the sub'ect of the re,nest, Wa1Ver Release:thereby&rye permission for the above requesting official to conduct en Iowa criminal history record check with the Division of Criminal Inyestigation(DM). Anycriminal hf story data concerning me that is maintained by the DC1 may be refeased Be allowed by taws Waiver Signature; / ,C%C� - 16 - Iowa Criminal History Record Check Results c ..:It;sa > ' % As of lQ r!D —/V , a search of the provided name and date of birth revealed; _,c-, Lo.;.. F .. ,. .... o ::' . 0 . No Iowa Criminal History Record found with DCT . . , • El Iowa Criminal History Record attached,DCI# _ DCI initials 4 4 . j Received Tirne�i0ct, 1.,0)014 2:30PM No. 1111 .