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Home My WebLink About14-157 Ilk • Authorization Number 1 q—15 Z - 1 (Office Use Only) 4th,li.g I I I 4;47 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 (319) 356-5040 (319) 356-5497 FAX First Middle },Last 1. Name �V,Vry-) \ ( A - \�'Nl 2. Mailing Address v36'Q 6 U��1 d"�P�� . D AN-6A J ) ' ; C.;4-41, )A , �j 2 2 4./ 3. Telephone: Home ‘) -- . 'b - 2 1 Other: 4. Prior experience in transportation of passengers: -r:i 9(i ofS 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? GI Type of Offense Where When 7. Have you been convicted of any traffic offenses in the last five years? 74M /e_5 Type of offense C7 4-o °be,y - C';C Where \o,,,� a C When 19_ s, S��/S�Sh y 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 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 • I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number i SCS A 0. ,� . 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 th provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front of a Notary Public) Signature of Applicant Atvvl yv ., s— 4 6, Date — l— ?v (..t 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 Pirim et. t (> . A1, . On this L9-t. day of A y . �o 5 a�� WENDY S.MAYER NoTary Public i nd for the State lowa 2p�' i Commission Number i/34ie c� My Commission Expires A '1 ?xwt_e 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). • Sign ur of li hi '7DaSi ignee te 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 Si�e of City lerk or de ignee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 51/2" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update derk/taxidrivbadgeapp2014.doc 03/2014 • irIowa Department of Transportation el Office of Oliver Services obit Free)800-532.1121' PO Box 9294,Oes Moines,IA 50305-9204 515-244-9124 sillsFAX.515.239.1537 Certified Abstract of Driving Record Inquiry Date: 7/29/2014 DL/ID it: 549AG7733 (IA) Customer#: 5876361 Name: Alin:,Ammar Class: D ID Status: None Osman Ali Address: 2608 BARTELT RD Audit#: 7903151 DL Status: VAL APT 2A Issue Date: 03/20/2014 CDL Status: None City/State: IOWA CITY,IA Expiration Date: 04/20/2016 CDL Cert Status: None 522462730 Endorsements: 3 CDL Med Status: None Mailing Address: 2608 BARTELT RD Restrictions: NONE Restriction None APT 2A Supplement: Date of Birth: 4/20/1985 Mailing IOWA CITY,IA Sex: M City/State: 522462730 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 08/31/2013 12/13/2013 M14 Fail to Obey Traffic Johnson IA Sign/Signal Name:Alim,Ammar Osman All DL/ID: 549AG7733 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: 4i1 7/29/2014 r1 .• •' s• D. O. Ti ceitiel_ _ �ha Office of Driver Services 'h Iowa Department of Transporation . '7Jul.,31. ,2014 12:46PM CDiv of Criminal Investigation 0o. 6086 pP. 1/1 • % , STATE OF IOWA !t�,tt. (;4, i n• Criminal History Record Check ; IX'. Iii (!trig 1014 • 1 ri �z Revert Form n , ...,�. gnu q DCT Account Number: 1/00.3.-1"--- (if /n0,a.4C(if applicable) To: Iowa Division of Criminal Investigation From: City of Iowa City Support Operations thweau,la Floor City Cleric's Office 215 E.7'h Street 410 E,Washington Street Des Moines,Iowa 50319 , (615)725.6066 Iowa City, IA. 62240 (516)125-6090 Fax . Phone: 319-366s041 . . Fon: 319456.5497 I am requesting an Iowa Criminal History Record Check on; Last Name (mandatory) )First Name(mnnaetory) Middle Name(rcwmmendcd) Date of Birth(mrndalory) Gender(mandatory) Social Security Number(recoinnicitdcd) o l}— pl a '' Mg $ 12Male ®Female 7 •?4— o ?-, g i g6 Waiver Information:Without a signed waiver from the subject of the request,a complete criminal history record may not be releasable,por Code of Iowa,Chapter 692.2.For complete criminal history record information,as allowed by law,always obtain a waiver signature from the subject of the request, Waiver lte!ease:I hereby give permission for(he above regnating official to condua an Iowa criminal his tiny record check with the Division of Criminal. . Investigation(DCI). Any criminal history data concerning methat ismain rained bylltwDCImaybereleescdesal(owcdbylaw. Waiver Signature: Amb,e,r^ H 1-,^^ u.Stat. - v` • Iowa Criminal IYistory Reeve Check Results, (uClstse only) As of 1-3 f"/y , a search of the provided name and date of birth revealed: • • ril No Iowa Criminal History Record found with DCI ,r, ,u 0 Iowa Criminal History Record attached,DCI# • DCI initials NM Received Time&Jul. 29. 02014 1 : 24PM No. 5849