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Home My WebLink About14-215 1 • - Authorization Number ,;41--(9-15- 9 - j (Office Use Only) �r 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 ci_ti._Iowa 52240-1826 Failure to complete the "required"information will result in denial of the application --(---.:1419).356-504-6---) (319) 356-5497 FAX 1. Name REQUIRED /, �� d 2. Mailing Address(REQUIRED) of p(,de I f 42 c1 b 3. Contact Information (REQUIRED) Email: 5 'kr9 10& f Cell Phone: '4, 2 —2c3 ?-7 f f p 4. Prior experience in transportation of passengers p tI <eci VA 1f/t ,,'(, }'d-�.L 4 C Acle tlitipyd 6.S D ca as V p 1,d 6,� v&t dot r pS I to eel d v i we` •+e I,t I k --RAJL LAS V-1-0 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? IV Type of offense Where When t...1- / PC 6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? Type of Offense Where When l'‘ 7. Have you been convicted of any traffic offenses in the last five years? Type of offense 1 Where When 1%4 ,f1S 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense - Where When pc 9. Have you ever applied to be an Iowa City taxi river usin di Brent name? If yes, please provide the name(s) li DEPARTMENT OF CRIMINAL INVESTIGA ION (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). (OVER FOR REQUIRED SIGNA"PURE AND NOTARY) SEP 2 4 2014 City Clerk Iowa City, Iowa 09/2014 P I hery certify the I haveissued to me by the Iowa Department of Transportation a valid Chauffeur's license number L . I understand that if I falsely answer any questions in this application, that this application may y be de d. u1 erstand 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 Date " 23 -20 4 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 ) scribed and §worn to before me by S hct-k; lr I t-civv\P nI . On this day of �L�r� lt�ci(Le� KFl I IF K TIITTI F Rotary Public in and for the State of Iowa i> I y Commission Number 221819 My Corn issi. 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 r=- •=nts o he City of Iowa City(Title 6, Chapt::r 2, City Code). fjly /qSignat.r�• of '1741r lief or designee / a e 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. 7e. .9/4 / / / Sign of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8'/2"(width) and 5'/2" (height)and prominently displayed to all passengers. ********************************************************************+*************************************************************************** Office Use Only Approved application DCI report State certified driving record Website update Clerk/TAXIDRNBADGEAPPL92014amended.DOC 09/2014 Sep. 10. 2014 6 : 32PM Div of Criminal InvestigationNo. 9366 P. 8/8 1 ,4-,F• .. 1-1/ 17 t . vc1I1I vtsy vicin vt.►y ui IVYt0. , IL / iIU. ) II)P . L `nri4 STATE O1 IOWA Criminal HisloAy I�ecord Check e � ? � ` �- r- o ' )1,00194,:': S„4 Request Form s •-•%.7-.20--' . .i ti DCX Account Number: Lt`(„)UP), (if applicable) 'ro: Iowa Division of Criminal Xnvestigatlon From: City of Iowa City Support Operations Bureau,1”neer City Cleric's Office 215 E.7th Street 410 E.'Washington Street Des Moines,Iowa 50319 • (515)725-6066 Iowa City, IA 52240 (515)725-6080 Fax Phone: 319.3565041 n\ ; Fat; 319-356-5497 I am requesting an Iowa Criminal History Record Check on: Last Name (mandatory) L First Name(mandatory) Middle Name(recommended) (1\_-) Caal-WY\AM c Oa k,\< kr vt_ b Vt cilitke__ d Date of Birth(mandatory) Calder(mandatory) Social Security Number recommended) Lt I 2-CD / ` 1 1 aIe •❑ female 6—1 ---9 "C" —0 2/ '7 Waive wormatiol9i:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,per Code of Iowa,Chapter 6912. 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 tom the above requesting oMclal to conduct an Iowa criminal history record check with the Division del-WWI Investigation(DCI). Any criminal history data coni Sign . ►o• nt is maintained by the DCf may Do released as allowed 6y law, • Waiver S! n 1 - ?Iowa Criminal J1[istoi v1tecord Check Resurt$ (DClttse o.1.- Ag of `[O-[LI , a search of the provided name and date of biYth revealed; . t XNo Iowa Criminal History Record found with DCI _ - V- 1L N.) U Iowa Criminal History Record attached,DCX# SEP 2 41014 City Clerk DCI initials y-' _ Iowa City, Iowa •Receive 1.�erStep. 3. 712014 1 : 01PMio. 8529 . wawSMARTER ! SIMPLER I CUSTOMER'DRIVEN i0rad0 ,g0 Office of Driver Services PO Box 9204 I Des Moines,€A 50306-9204 Phone:515-244-9124 l 800-532::-1121 Past:515-239-1837 wwwir.iowadoi.gov Certified Abstract of Driving Record Inquiry Date: 9/24/2014 DL/ID#: 532AG5413 (IA) Customer#: 5846338 Name: Sidahmed, Shakir Mohamed Class: D ID Status: None Address: 2509 BARTELT RD APT 10 Audit#: 5450123 DL Status: VAL Issue Date: 08/17/2011 CDL Status: None City/State: IOWA CITY,IA 522462715 Expiration Date: 04/20/2016 CDL Cert Status: None Endorsements: 3 CDL Med Status: None Mailing Address: 2509 BARTELT RD APT 10 Restrictions: NONE Restriction None Date of Birth: 4/20/1957 Supplement: Mailing City/State: IOWA CITY,IA 522462715 Sex: M History Information CLEAR DRIVING RECORD Name: Sidahmed, Shakir Mohamed DL/ID: 532AG5413 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: , `®�`.•.'.'...,/'/��4 9/24/2014 ,14:* IOWA 'S 1r ?t.D. O. T4::4‘1111, . •'• Office of Driver Services Iowa Department of Transportation Name: Sidahmed, Shakir Mohamed DL/ID: 532AG5413 t: lasoED SEP 2. 4 2014 Ciel C\er Iowa City, Iowa