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Home My WebLink About14-201 Authorization Number /Hi - (Office Use Only) Zoll. '` ''WI®IClirir APPLICATION FOR TAXI/MOTORIZED PEDICAB VEHICLE DRIVER CITY OF IOWA CITY (Police Department review must be made 410 East Washington Street between 8 a.m.to 3 p.m., Monday—Friday.) Iowa Cit . Iowa 52240-1826 319) 356-504 (319) 356-5497 FAX First Middle Last ii 1. Name t;� sol oi� (CI iC 1,1G��1 2. Mailing Address P U' A30 K 5 5 7 Z CcV-dt(it ( (e I 0- 5 2 Z 4-1 �rn4;fI ',, 3. Telephone: lite 1 5 14z t( Jit vl sdvt. `tether: '3 ( — T s g - 6 167.. q ci I I Sze 4. Prior experience in transportation of passengers: /evs s Ur( (Li (_._y 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When 6. Have you bee onvicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five years? L.) Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? N/ Type of offense Where When s wed l o /-2_ it To I e:('& W at-( 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? /v 0 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) eAJ 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) cler ataxidrivbadg 03/2014 4mil Iii 1 I hereby certiN that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 3 a 67 _3c-; R . I understand that if I falsely answer any questions in this application, that this application may be 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 ( �_" Date a 9 /O /LoI Cf, 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 Ur,p yt,v_o S . ?1-., r., ) ,cQ . On this i day of rt, WENDY S hpr 77 otary Publi in and for the St of Iowa _ { Commission N 1mhP!779d�R My 0 mjspion Expires IOW !ll..�� ************************************************************************************************************************************************ 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). Air / c •-•,5--- Signatur olio- of or esignee Date/ / / 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. 1 'fl -'-'-- k *--‘--1:� i� Signatur f City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (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 clerldtaxidrivbadgeapp2014.doc 03/2014 Sep. 4. 2014 4: 57PM Div of Criminal Investigation No. 9412 P. � 1/4 Iv mr, Aug. 11. (1114 9: 001410 City 61erl( — t,Ity CI Lawd MIty Nv. / IJ% • , Y ,.Fa• STATE OF110WA � ",',% Criter�al History Record Check ••::?,•f:.6. ..:\ 410w • r .e. 0 , s Request Forma 2 : - DCXAccountNumber: t-)txvas-F • (if applicable) To; Town Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,1"Moor CityCIenIt's Office • 215 E.71h Street 410 B.'Washington Street • Das Moines,Iowa 50319• (515)725-6066 Iowa city, TA 52340 (515)725.6080 Fax Phone: 319-356-5041 • RAM 319-356-6497 ' • I Mn requesting an Iowa Criminal History Record Ch'eck'on: ' ' . . • Last Name (mandatory) . First Name(mandatory) . Middle Name(recommended) ��l,,alid r•.. : • 6scAYnG Saetc( Date of Birth(mandatory)" / e•! Cella (mandatary)( andatary) Social Security Number(recommended) 0 / 3I l• ! R 6Male ❑Female 2,2-:6 — `157- - 35i waiver Information: Without a signed waiver from the subject of the request,a complete criminal history record may hot be releasable,per Code of Town,Chapter(92,3.Por complete criminal history record Information,as allowed by law, always obtain a waiver si:nature from the sub ea of the re rnest. Waiver Release:t hereby give permission for the above requesting nidal to conduct an Iowa criminal hfslory record check with ihoDivfsion of Ctiminal Investigation(DCI). Any criminal history dale conuntingme chat' aintained by dm DCC maybe released as Allowed by law, Waiver Slgnalu • !j3 Criminal flistory Record Check Results (DClnt?only) As of 9/1-///if , a search of the provided name and date of birth revealed; No Iowa Ctiminal History Record found with DCI 0 Iowa Criminal History Record attacchhedd,DCI# I • -•• DCI initials ►i! n • I `1---le.'_-"Ill o.cnnff M 01dl� vvwvviovvadcitgov. SMARTER E SIMPLER I CUSTOMER DRIVEN _v. . Office of Oliver Services PO Box 92041 Des Moines,IA 50306-9204 Phone:515-244-9124 180a-532-1121 I Fate 515-239-1837 ww.v.iawadoLgav Certified Abstract of Driving Record Inquiry Date: 8/27/2014 DL/ID #: 553AG3581 (IA) Customer Cr; 5882445 Name: Khalid,Osama Saeid Class: D ID Status: None Address: 1542 DICKENSON LN Audit#: 6123240 DL Status: VAL Issue Date: 07/13/2012 CDL Status: None City/State: IOWA CITY, IA Expiration 01/31/2016 CDL Cert None 522409111 Date: Status: Endorsements: 2 CDL Med None Status: Mailing Address: 1542 DICKENSON LN Restrictions: NONE Restriction None Date of Birth: 1/31/1966 Supplement: Mailing City/State: IOWA CITY,IA Sex: M 522409111 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 09/29/2012 110/02/2012 {S92 +Speed __-- � lohnson A 12/02/2012 12/13/2012 lNDl Fall to Yield Right of Way Johnson ;IA Name: Khalid, Osama Saeid DL/ID: 553AG3581 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$ 8/27/2014 M�.' IOWF1 .,?rri I I at �'° Of DRNIowa t4% Jr. ice of Driver rtmr Servit of ces ansportatlon Name: Khalid, Osama Saeld DL/ID: 553AG3581