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Home My WebLink About18-070It CITY OF IOWA CITY 410 East Washington Street Iowa City. Iowa 52240-1826 (3 19) 356-5040 (319) 3S6-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. `o O/ (Office Use Only) APPLICATION FOR TAXICAB / MOTORIZED PEDICAB VEHICLE DRIVER (Police Department review must be made between 8 a.m. to 3 p.m., Monday - Friday) Failure to complete the "required" information will result in denial of the application 3. Contact Information (REQUIRED) Email: First Middle amdYAA d I�j ld Inn�MA Cell Phone: ?*5A3,251 written communication sent via email 4a. Driver's License expiration date (REQUIRED) a j b. Taxicab Business Name (REQUIRED) 5. Prior experience intransportation ofpassengers2uNC JWlilxI Dtiler' In 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this State or elsewhere? /Wirs Type ofoffense Where When r Mil fe,�ield Pt4hxo)rW¢U T -A ch j,.A F�aA;,II r�� -tr___ �": r': ��^a—��%hS�►'� " �/SLS "l�rl�Qf 1UTn T� bil,f n 44444; j;" What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspendedlead Guil Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? A[1.9 '45 -'77r— Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferr 1et}5r1�r>tiAH Plead Guilty Other 8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years? _A//,) Type ofoffense �dYh2fe�d 9Z l(1f BIZ When 9. Have you ever applied to be an Iowa City taxi driver using a different name? If yes, please provide the name(s) (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 APPLICATION FOR TAXICAB VEHICLE DRIVER Page 2 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). I hereby certify that I have issued to me by the Iowa Department of Transportation a va4d Driver's license number EF q au) 13 issued on ?expiring on I understand that if I falsely aiib er any questions in this application, that this application may be denied. agree WaT 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 authorization to be a taxicab driver 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— Date STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by (-=uuaPrftn. S1ft Z aAACNI SLQon this -7-5 day of Jt_L Zv1� I have reviewed this application, DCI report, and the State certified driving record of this applicant and have determined that there is no information which would indicate that the issuance would be detrimental to the safety, health or welfare of resi- dents of the City of Iowa City (Title 5, Chapter 2, City Code). Expiration date of D " et cense Signal Police Chief or designee Date AFTER APPROVAL BY THE CITY CLERK YOU ARE AUTHORIZED TO DRIVE A TAXICAB IN IOWA CITY FOR NO MORE THAN ONE YEAR FROM THE DATE LISTED BELOW. Sign lure of City Clerk oGd signee1 t �— 2 Date / Approved application n 1 1 DCI report State certified driving record Website update Cl&kn IDRNRAMEAPPUM188 a DOC 04/2018 A I S Page 1 of 2 C4J10WAD0T wwwJowado>, oV SMARTER I SIMPLER I CUSTOMER DRIVEN DVWW s Id4M10ealiofl SUVIC" PO ON 92041 Des MOMM IA 5WW92D4 Phone: 315244-91241 FaX 313-239.1837 Inquiry Date: Customer Name: 7/19/2018 6082673 Certified Abstract of Driving Record DL/ID #: 61 (IA) CDL Permit Class: None Class: D Mohamed, Gamerelanbia Audit #: 2324927 Ismail Address: 2608 BARTELT RD APT Issue Date: 11/18/2017 JUR 2D 03/01/2014 03/24/2014 N01 Fail to Yield Right of Way Expiration 01/01/2024 09/20/2015 10/22/2015 Date: Fail to Obey Traffic Sign/Signal City/State: IOWA CITY, IA Endorsements: Chauffeur 3 N50 522462730 IA Johnson Mailing 2608 BARTELT RD APT Restrictions: NONE Address: 2D Restriction None Mailing IOWA CITY, IA Supplement: City/State: 522462730 Date of 1/1/1957 Birth: Sex: M History Information Convictions CDL Permit Issue Date: CDL Permit Expiration Date: CDL Permit Endorsements: CDL Permit Restrictions: ID Status: DL Status: CDL Status: CDL Permit Status: CDL Cert Status: CDL Med Status: None None None None None VAL None ELG None None Citation Date Conviction Date ACD Explanation JUR County 03/01/2014 03/24/2014 N01 Fail to Yield Right of Way IA Johnson 09/20/2015 10/22/2015 M14 Fail to Obey Traffic Sign/Signal IA Johnson 02/18/2017 ,03/09/2017 N50 Improper Turn IA Johnson Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Accident Date JUR Case Number 02/18/2017 IA 970148 02/02/2018 IA 1031474 Name: Mohamed, Gamerelanbia Ismail DL/ID: 684AJ7013 (IA) 11) bfiQI Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver &'Id� attdn/9€Alcces, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & Identirictoq that this is a true and accurate copy of an official record currently in the custody of said office, and (@EsIe �iyyllh d by the Director of the Iowa Department of Transportation to so certify. In witness whereof, I have caused my signature and the seal pfjh12epe to be set upon this document, at Ankeny, Iowa this date: 66 http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 7/19/2018 ARTS Page 2 of 2 Name: Mohamed, Gamerelanbla Ismail DL/ID: 684A37013 (IA) 7/19/2018 d9�eoL da Driver & Identification Services Iowa Department of Transportation ®-3-A14 http://172.29.254.55/drivers/reports/customerhistorylcertifieddrivingrecord.aspx 7/19/2018 Jul..23, 2018 11:58AM Div of Criminal Investigation No -7375 P. 1/3 From:Crty of Iowa City Ciork 4=iffioa 310 3606497 07/19/2016 12:07 0900 P.002/002 STATE OF IOWA Criminal History Record Check Request ]Form To: Iowa Division of Criminal lnvrsligatlon Support Operations Bureau, In Floor 215 E, 7`h Street Des Moines, Iowa 50319 (515) 725-6066 (515) 725-6080 Fax Iamn F Last On: DCI Account Number: cx�a— (if npplicablc) Lrom: Cit oflowa Cit City Clcrka Office 410 E. Washington Street Iowa City IA 52240 Phone: 3M356-5041 Fax: 319-356.5497 r�-5-7 I OMAN ❑Female Waiverlfrjornmfion, 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 informatloo, as allowed by low, always obtain a waiver sign lure from the subject of the renurct_ Waiver Release: I hereby give permission for she above Invntigation(DCI). My Criminal hinory dale concerning MC! iYaiverSi,¢nafure(_ - c1 , . > conduu m Iowa Criminal history record cheek with rho Dlvlsloa of Criminal the DCl my be relmed wallowed bylaw. Iowa Criminal History Record Check Results (DCI use only) As of —l -d 3 4 , a search of the provided name and date of birth revg44: V"o Iowa Criminal History Record found with DCT ❑ Iowa Criminal history Record attached, ))CI # DCI initials �C� DCI -77 (08/25/10)