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Home My WebLink About14-141 Authorization Number /L/-f t/ l 1 1 (Office Use Only) imioniqr 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 I + Last 0S �N 1. Name MOStJ0 vW-vvveCk 2. Mailing Address 3 11 UQnvA d-r SW # 3 Cc ►c,s t 5-2q 0q 3. Telephone: Home 2 C1 - l�t -1 —-11 -I c\ Other: 4. Prior experience in transportation of passengers: yC'S 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? yc?S Type of offense spm a;{ a�c�t�- Where When \t Ci /2cl i-i `1 V.v.{v--1 S1v� 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? I v 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) IV� 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) cier c/taxidrivbadg 03/2014 1r - I ereby certi that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number U�,, LA OWE-6-v-1 . 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 *jr .— Date 01 r t (+ /ZOI Li 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 ko Sri 11 !V, , dS tea,� . On this /1 day of WENDY S.MAYjR Notary Public in an r the State of low<' comrmssron Number 329428 • AI Commission 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 residents of the City of Iowa City (Title 5, Chapter 2, City Code). 7_,___,v Signre of Po fe •' i : designee Date 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. 27-- l( Signarre of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 1/2" (width)and 5'/2" (height) and prominently displayed to all passengers. *************************************************************.**************************.******************************************************* Office Use Only Approved application DCI report State certified driving record Website update clerWta idrivbadgeapp2014.doc 03/2014 'Tun. 2014 3:45PM Div of Criminal Investigation NNv.o, 3232 P4 P. Vvu. Lf. Lug/ L. JVIuI (. i \, •'1 Vin vl „ vi ,vnu •• 1 ‘y • r\L()It RI'FYO/ y, STATE ®L !L® L1\ D >r�VY �i, • ;'`' `V �, Criminal llll M®my Record (Check . ; '`' r. ' DCI Account Number: Q 00 02 -F (it applicable) To: Iowa Division of Criminal Investigation From: City of Iowa City • • Support Operations Bureau, 1"Floor City Cleric's Office 215 F.7th Street 410 E.Washington'Street Des Moines,Iowa 50319 ' (515)125-6066 Iowa City, IA 52240 (515)7256080 Fax Phone: 319-356-5041 Fax: 319-356-5497 I ant requesting an Iowa Criminal History Record Check on: . Last Name Onandalary) $(first Name(mandatory) Middle Name(recommended) 0SMPlan1 MOS )p I/1vWawr.eCI • •Date of Birth(mandatory) Gender(mandatory) Social Security Number(recornmendid) O1 -- (I -— ( CM Mae ®Female 2I2 ^ 6,5 — (0' i1 Waivevinformaa'ion:'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 waiver signature from.the subject of the request. • • Waiver Release:I hereby give permission for the above requesting official to conduct an Iowa criminal history record check with the Division of Mutual Investigation(DCO. Any criminal history data concerning me that is maintained by the DCI may be pleased as allowed bylaw, . • Waiver Signature; 1 I,r. LASv�y-kyr-d` 'v`O-U�..L Iowa Criminal Histor . Record Check Results (DCluse only) . . . As of 6-33—/y , a searoh of the provided name and date of birth revealed: No Iowa Criminal History Record found with DCI t ; " 1, : — 0. ri 0 Iowa Criminal History. Record attached, DCI# DCI initials v • " Received •T me'7Jon. '27'0:2014 2: 29PM No. 3692 W,i0W+�CIat. ov ..SMARTER I SIMPLER I CUSTOMER VU1N RIVEN g -- Office of Driver Services PO Box 9204 i Des Moines,IA 50306-9204 Phone:515-244-9124 1800-532-1121 [Fax:515-239-1837 www-iawadotgov Certified Abstract of Driving Record Inquiry Date: 6/27/2014 DL/ID#: 307AE8467 (IA) Customer#: 5473969 Name: Osman, Mosab Mohamed Class: D ID Status: None Address: 211. LYNN AVE UNIT 210 Audit#: 5247092 DL Status: VAL Issue Date: 05/24/2011 CDL Status: None City/State: AMES, IA 500147102 Expiration Date: 07/11/2016 CDL Cert Status: None Endorsements: 2L COL Med Status: None Mailing Address: 211 LYNN AVE UNIT 210 Restrictions: NONE Restriction None Date of Birth: 7/11/1981 Supplement: Mailing City/State: AMES, IA 500147102 Sex: M History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 09/13/2009 09/29/2009 592 Speed ,,. +LinnIA ,,. 4 09/14/2011 [10/25/2011 N50 :Improper Turn Story IA 06/12/2013 06/28/2013 592 .Speed ___ 'Story IA 09/22/2013 10/15/2013 :Miscellaneous - _-- ;Benton IA , 05/23/2014 06/08/2014 '592 Speed (10 mph&under In 35-55 mph zone) Tama :IA Name: Osman, Mosab Mohamed DL/ID: 307AE8467 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: 'iteic& ,Ili $t......•..4\ 6/27/2014 ' IOWA 'a4 a D. O. T.le '1,14, /�,`� Office of Driver Services r pf OAIVEB s= Iowa Department of Transportation Name:Osman, Mosab Mohamed DL/ID: 307AE8467