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Home My WebLink About14-013 If Authorization Number / q - j. I ' 1 (Office Use Only) � P .®4,. APPLICATION FOR TAXI 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 ___/441,reT 1. --Nam Oi'n er 2. Mailing Address I .r i:sk. A - - _ t,� J jr- -- A - L r 3. Telephone: Home I q 4--12-16 ‘ Other: 4. Prior experience in transportation of passengers: -ect j/c-- 5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere? Type of offense Where When --C3-re1261 �( . (,‘ (44- 1p/2z / C) 1Fa;( c, Q Ia-e l ;: S i�J h /5;3 n ah r1�x Gl �- 5 O q l i i /.� i 2 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 N0 7. Have you been convicted of any traffic offenses in the last five years? Type of offense Where When ASC 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? Type of offense Where When � � l i\- (-- 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) ,&J Cl 1 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) clerkttaxidrivbadg 03/2013 * 1 I hereby certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number `) 7 . I understand that if I falsely answer any questions in this application, that this app ication 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) 6--G1 Signature of Applicant Date I i 2 I I q STATE OF IOWA COUNTY OF JOHNSON ) Subscribed and sworn to before me by R 1 ' 0 P-) yi,t . On this-) ' day of . 1 Notary Public in auld for the State of I•Q a � + t .►�, WENur �.MAYER ,�• z Commission Number 729428 • =t • My Commisston Expires ****** 7^' * ******* ***3**k****************************************************************************************************** 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). 1/-2///7 S'gnature of Police Chief or 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. � /C ori • ��I�� )— 1 — ) Sig atu -of City Clerk or designee Date Taxi cab businesses are required to provide Driver Identification cards. Cards must be 81/2" (width) and 5'/z" (height)and prominently displayed to all passengers. Office Use Only Approved application DCI report State certified driving record Website update clerk'taxidrivbadgeapp2010 doc 03/2013 •A Iowa Department of Transportation i+ Office of Driver Services (Toil Free)800-532-1121 PO Box 9204,Des Moines,IA 50306-9204 515-244-9124 FAX:515-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/21/2014 DL/ID #: 248AD4337 (IA) Customer#: 5409180 Name: Ahmed, Ali Omer All Class: D ID Status: None Address: 2401 BARTELT RD APT Audit#: 7392384 DL Status: VAL 1A Issue Date: 10/01/2013 CDL Status: None City/State: IOWA CITY, IA Expiration 09/22/2018 CDL Cert None 522462701 Date: Status: Endorsements: 3 CDL Med None Status: Mailing Address: PO BOX 2532 Restrictions: NONE Restriction None Date of Birth: 9/22/1968 Supplement: Mailing City/State: IOWA CITY, IA Sex: M 522442532 History Information Convictions Citation Date Conviction Date ACD Explanation County JUR 10/22/2009 12/15/2009 592 Speed Johnson IA 09/01/2012 11/08/2012 M14 Fail to Obey Traffic Sign/Signal Johnson IA Name: Ahmed,Ali Omer Ali DL/ID: 248AD4337 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: 'oo®�E..... . , 1/21/2014 : IOWA ':y% ' D. O. T.•IV I'I • 1j040f,R� $\ Office of Driver Department ofTransportation Iowa Name:Ahmed,All Omer Ali DL/ID: 248AD4337 man. l7.r• 2014411 : 56AN1� Dui vi ofv CrIimina ll l r Investigation y No. 0920 P. 1 I c V l I I V I I , ) I u r. V I r U. `t L U V I . El •,z,to a• STATE OF IOWA .tiz�v< h 1510e.-1 v `?`1 (Criminal History Record Check �; , �`;._ ��a'�),I % Request 'ormt DCI Account Number; ycoa—F= (If applicable) . Tot Iowa Division of Criminal Investigation From; City ofIowe City Support Operations Bureau,l'"Floor City Clerk's Office 215E,7th Street 410 E.Washington Street Des Moines,Iowa 50319 (515)725-6066 Iowa City, IA 52240 (515)725-6080 Fax Phone; 319-3565041 Fax 319-356.5497 • I niu requesting an Iowa Criminal History_Record Check on: Last Name(mandatory) ]First Name(mandatory) Middle Name @commended) Athri ed\ ALL 0m•er / Date of Birth(mandatory) Gender(mandatory) Social Security Number(recommended) CAI 1 E ` 6. d ' Male ®Female 513A-- 3 b\ 6 1 Waiver h'(foi'nwtioit:Without a signed waiver from iho 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'tomato subject of the request, Waiver Release:t hereby give pcnnlssion fortho above rcqucslfng official to conduct an Iowa criminal h[slaty record chedc with the Dlvltlon or Criminal Investigation(Dc . Any criminal history dam concerning me that Isma(mdned by the CI may be referred au oflowweed by law. Waiver Signattue:_ (1(.�-May1,1� /tterq r . Iowa Criminal History Record Check ReguitO, MCI meonly) As of 1 \ n\\14 , a search of the provided name and date of bitch revealed: .e_ r co C' ,} r rr1 C) a _--i 02r----No Iowa Criminal History Record found with DCI «i --- 1 v or m a' •-v Iv)"n 0 Iowa Criminal History Record attached,DCI# o.7,-: C ati x> N.) > DCI initials Received Time/Jan. 14• ))2014 1 : 15PM No, 0609