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Home My WebLink About14-173 Authorization Number —/ 7.27 x r 1 (Office Use assimegar 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 1:73.11,15._---67--5-0-21-0D(A.)ed 0/2-0 (319) 356-5497 FAX First `� Mid le ,'Last ' 1. Name I,(fC� l ee�P �ok1C) tt�eha u. 2. Mailing Address )/1, /✓ (HCl( 51- 3. Telephone: Home 312,em 3 , a6 r 4- Other: 4. Prior experience in transportation of passengers: 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 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 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When CA)eecANc-- �,�u city Gf /�7/2UI 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When 717 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) clerWtaxidrivbadg 03/2014 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number 2-RPR . 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 Date08 /2O12-0 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 t".r•, I ,q-' W j-}ct qua.c9. On this 02c-Lk. day of Notary Public in ani1.1 for the State of I : ComWENDY S.MAYER mission Numb er 7994Z ** *tj"' *** Ql y ********************************************************************************************************** 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). AV, GF—c0-/V Signatur- of Poli" 1Tief o designee 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. Signature • City Clerk r designee Date • Taxi cab businesses are •quired 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 clerk/taxidrivbadoe2pp2014.doc 03/2014 ic.--4 ,..: :v. - -, DOT 4 • vimmiovvadOt.gay SMARTER I SIMPLER I CUSTOMER DRIVEN Office of Driver Services PO Box 9204 1 Des Maines,IA 5O306-9204 Phone:515-244-91241 800-532-1121 I Fax:515-'239-1837 www.iowadbt:gav Certified Abstract of Driving Record DL/ID #: 497AG2888 (IA) Customer#: 5795271 Inquiry Date: 8/13/2014ID Status: None Name: Hamad, Waleed Mohd Hamid Class: D DL Status: VAL Address: 1115 N COURT ST Audit#: 8295178 CDL Status: VAL Issue Date: 07/26/2014 CDL Cert Status: Excepted Intrastate City/State: OTTUMWA,]A 525011907 Expiration Date: 10/29/2016 CDL Med Status: None Endorsrsemmennts:: 3 Mailing Address: 1115 N COURT ST Restrictions: CommerciPermit, Corrl Instruction Restriction CDL Instruction mit rect ve Lenses, Supplement: Expires 1/26/2015 CDL Intrastate Only Date of Birth: 10/29/1979 Mailing City/State: OTTUMWA, IA 525011907 Sex: M History Information Convictions County JUR Citation Date Conviction Date ACD Explanation . .. .-.._.-_ .. ... _..._ i , Johnson IA 1 --- E55 3Driving Without Headlamps or With Park Lamps 01/27/2012 03/30/2012 � -�� -- --- I]ohnson IIA_... 03/19/2013 05/31/2013 ,592 Speed (10 mph &under in 35-55 mph zone Name: Hamad, Waleed Mohd Hamid DL/ID:497AG2888 that am t e Pursuant to Iowa Code §321.10,I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transpoffis alrtato n c do hereby y in the certify todI of s/he custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of 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: ..,..yi , o.S•**1Clf:NS1% 8/13/2014 • IOWA Ye'', 1* Cr? ,. \D. 0.T..: t �'Ooite%'••••••'g�1? Office of Driver Services �'�` �., Iowa Department of Transportation Name: Hamad, Waleed Mohd Hamid DL/ID:497AG2888 Aug. 18. 2014 12: 56PM Div of Criminal Investvingation/ NNo.J7642 PP . X1/2 • /F e1`ia,:'\ STATE G OFIOWA ' .(;art-. .. �` iii vinri? Crrnrnnirmal History Record Check • a T11' /1 .� Request Form.' / t Yt"teF'I gna.,,,:,;., • .::4Lfu VA1'.p ' I 'Ti'T R DCI Account Number: oOO—P (If applicable) ' To; Iowa Division of Criminal investigation From: City of Iowa City Support Operations Doreen,l"Floor ' ' City Clerk's Office • 215 B.11h street 410 F.Washington Street Des Moines,Iowa 60319 (515)725-6066 Iowa City, IA 52240 • (S15)729-6080 Fax , Phone; 319-356-5041 • Fan. 319-356-5497 • I ain requesting an Iowa Criminal History Record Check on: • Last Name (mandatory) _First Name p„endalotyj Middle Name(reeontmcndee) , a aMaa Waked, eed, r( Date of Birth (mandattoory) Gender(mandatory) Social SecuritynNumber(recommended) 10 /1 1 OMale OFemale 333i 08,i 9 aa0 1 Waiver Information: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 o waiver signature from the subject of the request. ' • Waiver Release:I hereby sive permission fertile above requesling official le conduct an Iowa crlmtnsl h(uory record chock with thablvision of criminal .. Investigation(OCI). Any ciliated history Jan concerning mother is maintained by iho Delmer be refused et allowed by law, Waiver Signature: ` C� • Iowa Criminal History Record Check Its �` (Der use.only) As of Q-` 1%/I LJ , a search of the provided name and date of birth revealed: • ' • , , j2t. No Iowa Criminal History Record found with ACI 0 Iowa Criminal History Record attached,DCI# .. !" DCI initials DCI-77(08/25/101 • Received I ime Aue. 19. 9014 9: 55AM No. 7904