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Home My WebLink About14-182 Authorization Number 14— , � r . (Office Use Only) riU1:11140,Apiha..41 mk. Ate an iitiar 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 City, Iowa 52240-1826 ( ) 356-5 4U (319X First ` Middle Last 1. Name i�eVl 1"l O C: ryloq n'1 E 2. Mailing Address 1-2 9 f_ ?4/0 v a./ ///r//fes; ,T4, j 2 2. (; 3. Telephone: Home 3 Other: j t ct 2 (c, -- -? 4. Prior experience in transportation of passengers: YCG5 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Ift/t7 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? h/ Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? ,(1°S Type of offense Where When Fec 0 I'— 0 q— 2c.:( 3 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Yed Type of offense Where When C22/(//2,0 0 2/8 2& jr-74, o7-QtiVzPiq 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). (OVER FOR REQUIRED SIGNATURE AND NOTARY) clerk/taxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number / . 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) 2-7 / / Signature of Applicant 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. STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by I1r'Vyly, l kit IV\off,a ttt e�0 . On this a l - day of .PRS WENDY S MAYFR Notary Public in and tr he State of Iowai' Commission Number 7294281 My Commissi.n Expires ow* — ********** *************,*********************,***********************,*******,*********************************** 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). e/ \Signature q olice ief or desi nee may 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. i-e-402 ' -kZ4/1_/ f,2_5 /// Signature City Clerk or designee / ate Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 51/2" (height) and prominently displayed to all passengers. ************************************************************************************************************************************************ Office Use Only Approved application DCI report State certified driving record Website update cierk'tax'drivbadgeapp20 4 doc 03/2014 � I e � AT y ,�� f 5 d I fit: D T LL j . . a WWW. owadatgciv SMARTER ! SIMPLER I CUSTOMER DRIVEN......- - -- Office of Driver Services PO Box 9204 g Des Moines,IA 50306-9204 Phone 515-244-9124 I 800.532-1121 I Fax:515-239-1837 ww.v iow'adOt aov Certified Abstract of Driving Record Inquiry Date: 8/14/2014 DL/ID #: 669A32746 (IA) Customer#: 6063417 Name: Mohamed, Mahmoud Class: D ID Status: None Address: 5659 KIRKWOOD BLVD Audit#: 6692746 DL Status: VAL SW APT 9 Issue Date: 02/13/2013 CDL Status: None City/State: CEDAR RAPIDS, IA Expiration 01/01/2018 CDL Cert Status: None 524045293 Date: Endorsements: 3 CDL Med Status: None Mailing Address: 5659 KIRKWOOD BLVD Restrictions: NONE Restriction NoneI SW APT 9 Date of Birth: 1/1/1977 Supplement: i.. Mailing City/State: CEDAR RAPIDS, IA Sex: M 524045293 History Information Convictions Citation Date Conviction Date RCD Explanation County JUR 07/04/2013 07/29/2013 593 Speed MD Sanctions Type Effective End ACD Explanation Occurrence JUR JUR Suspended 02/11/2014 07/08/2014 Fail to Post Security for an Accident-Owner Only IA IA Name: Mohamed, Mahmoud DL/ID: 669A12746 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 recordil 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: /o`O3.... IFp�`,\ 8/14/2014 k: IOWA• M 4e PRIVETS` Iowa Department of Driver rtme tServices Transportation Name: Mohamed, Mahmoud DL/ID: 669AJ2746 pAug. 21. 2014 11 .27AM CDiv of Criminal Investigation Oa: 7977 p,P. - 1/1 • • ( ^gN: STATE OF IOWA � ] :, .::"1>-,.: ' : n Crtinx �� story i;eeo � � aecs •CV ' • ..'" •• our � " "j Request Form : • ..cw, rl�i. m DCI Account Number: 1-1 MO-F (iCappliiceblt) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations Bureau,1"Floor City Clerk's Office • 215E.7th Street 410 E.Washington Street . Des Mollies,Iowa 50319 (515)725-6066 Iowa City, rA 52240 (515)725-6080 Fax •• Phone: 319-356-5041 . Fax: 319-356-5497 I am requesting an.Iowa Criminal llistoly Record Check on, • Last Name (mandatory) First Name(mandatory) Middle Name(recommended) M 0 k 071/2 e CA in q I\1 fYI 0 0 A . Date co of Birth((mandatory) Gender(mandatory) Social Security Number(recommended) / 0 / — o `` t "1� Male , ❑Female `l 1ryI / 6.1 13 Waives'Infon naflon:'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 waiversignature from the subject of the request. Waiver Release:I hereby Ova permission fbr(ha above acme-sang official to conduct an Iowa csiminai historyrecord chcckwilhthebivision of Criminal hrvosiI stlonHCl). Any criminalbislosydetaconcemingmethatlemahuainedbythobamayberelatedasallowedbylaw. Waiver Signature: . L Svee&-a.y ts•k� Iowa Criminal History ecord Check Results (J (DCI natality) ' As of Zs '?-4'(q , a search of the provided name and date of birth revealed: - 11* No Iowa Criminal History Record found with DCI ..., 1. , ) 0 Iowa Criminal History Record attached,DCI# DCI initials C. IT ' • T\r1T 7-I/Aa PI II 0. Received Time 'Aug. 14. • 2014 3: 19PM No. 7130