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Home My WebLink About18-095CITY OF IOWA CITY 410 East Washington Strcel Iowa City, Iowa 52240-1826 (3 19) 3S6-5040 (319) 3S6-5497 FAX Last 1. Name (REQUIRED) 2. Address (REQUIRED) IDENTIFICATION NO. (Office Use Only) APPLICATION FOR TAXICAB I 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) (AII written corn 4a. Driver's License expiration date (REQUIRED) sent via email) b. Taxicab Business Name (REQUIRED) � al) �Ln_y�c�g � C�3Q 1 5. Prior experience in transportation of passengers: cc eLA : Vs Ov ^ 00 ane 6. Have you ever been arrested / charged with any misdemeanors and/or felonies in this She or elW"ere? _ CO) Type of offense Where What happened to the charge? (Circle one) Convi,c,t�J Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested / charged with any traffic offenses in the last five years? Type of offense Where When SPPect Sow cAl, 63, AL2 2ot� we`rJ 1Ft�.Fr oe— ¢ v r What happened to the char e? (Circle one) Con2auffeur's Dismissed Deferred Suspen d Plead Guilty Other 8. Has your driver's license license been suspended or revoked in the last five years? XP% Type of offense Where When �,\\ To Secur,t NgVIrmett Vi014Fo✓ SV ✓ �� k 1 9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s) �/O (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 04/2018 A 10 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 valid Drivers license number ta-a 0 : +2-4T6 issued on AQ -U _ A xpiring on o):at- Jai . I understand that f I falsely answer any questions in this application, that this application may 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 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 ofg Notary Public) Signature of Applicant Date_ _ 3 a g -n C-)-< -��m Gr -o STATE OF IOWA ) y COUNTY OF JOHNSON ) Subscribed and sworn to before me by V"nx1t6 Mpk)aryaA1e&0 on this day of A, b us :V ZvLb . WENDYS.MAYER Iowa 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). Expi7M;F-'�77 1, 0, 1� 2 -7"r- Signator 7"r Signator f 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. l re of City Clerk of Approved application DCI report State certified driving record Website update GeA/ IMIV DGEAPPL92018a.ndWDOC Office Use Only Date 04/2018 ARTS C210WA00T SMARTER 151MPEER f CUSTOMER DRIVEN Page 1 of 2 wwmiowadot6ov Driver& Identification Services PO Bax 92041 Des Moines, IA 5D3C6-92D4 PWW:515.244-91241 Fmc 515.2'39.1831 Certified Abstract of Driving Record Inquiry 8/31/2018 DL/ID #: 669A72746 (IA) Date: None Endorsements: 03/22/2017 Customer 6063417 Class: D ID Status: None DL Status: VAL Name: Mohamed, Mahmoud Audit #: 3134749 Address: 2464 Rushmore Dr Issue Date: 08/24/2018 Expiration 01/01/2026 Date: City/State: Iowa City, IA 522464131 Endorsements: Chauffeur 3 Mailing 2464 Rushmore or Restrictions: SR Required Address: Restriction None Mailing Iowa City, IA 522464131 Supplement: City/State: Date of 1/1/1977 Birth: Sex: M History Information Convictions CDL Permit Class: None CDL Permit Issue None Date: CDL Permit None Expiration Date: Explanation CDL Permit None Endorsements: 03/22/2017 CDL Permit None Restrictions: lJohnson ID Status: None DL Status: VAL CDL Status: None CDL Permit ELG Status: (Improper Turn CDL Cert Status: None CDL Med Status: None Citation Date Conviction Date ACD Explanation JUR County 01/23/2017 03/22/2017 S92 ISpeed IIA lJohnson 01/06/2019 02/06/2018 IN63 Driving Wrong Way on One Way Street IIA Johnson 01/11/2018 03/20/2018 IN50 (Improper Turn IIA Johnson Sanctions Type Effective End ACD Explanation JUR Occurrence JUR Suspended 02/11/2014 07/08/2014 1 1 Fail to Post Security for an Accident -Owner Only IIA IA Suspended 04/24/2018 07/22/2018 1WO1 I Habitual Violator IIA IIA Suspended 108/20/2016 08/23/2018 IB63 IFall to Refile SR22 IIA SIA Name: Mohamed, Mahmoud DL/ID: 669AJ2746 (IA) Pursuant to Iowa Code §321.10, I, Darcy Doty, Driver & Identification Services, Iowa Department of Transportation, do hereby certify that I am the custodian of the records held by Driver & Identification 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: http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 8/31/2018 ARTS Page 2 of 2 Name: Mohamed, Mahmoud DL/ID: 669AJ2746 (IA) http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 8/31/2018 A8/31/2018��^,,�..''' """ w��20ccs A Ol/0. Driver & Identification Services Iowa Department of Transportation http://172.29.254.55/drivers/reports/customerhistory/certifieddrivingrecord.aspx 8/31/2018 Aug.lh. 2U16 11:33AM Div of Criminal Investigation No.9M V. 1/h Fr �,,y Clerk vrrioo aiv U065467 09/09/201a 16!29 4632 P,002/002 i P+nil STATE I,I IOWA \l 1 050A 1 1i •a1.li ;:1 1Request For TO! Iowa Dlvislon of Criminal Investigation Support Operations Bureau, I" Floor 215 E. 71h Street Des Moines, lows 50319 (515) 725-6066 (515)725.6060 Fax I em reotlectmrr an Tnwa f:r,m,nal MkMry rinnnrel M,o..L--1 DCl Account Number Da I� (if applicable) From: Clt of Iowa Ctl City Clerk's Office 410 B. Washington Street Iowa City, IA 52240 Phone; 319-356.5041 Fox: 319-356-5497 Lost Dame (mandator,) First Dame (m.ndalory) Mildlle Name (reeoatmended) ti%a�G\� e v�nt.�M� A Bate Of Birth (mandatory) CrettdeY (mandnory S/�OC�1IAL SeeBYi hlnmber (recommended) E&Male ❑Female 'l 9(- o9,1- G � 3 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 com lete criminal history record information, as allowed by law, always obtain a waiver signature from the subject of the request, Waiver Release; I hcrcbygh1c permission for The above requesting ostcisl to eondua an Iowa criminal historyrecord ehcck with the nivislon oCCriminal Investigation(M). Any criminal hislorydala concerting me that Is that is maintained (he Del maybe released as allowed bylaw. Waiver Signahue: k (DCl use only) As of 1' ^ P a search of the provided name and date of bird! revealed: *--Nb Iowa Criminal history ]record found with Del l Iowa Criminal History Record attached, DCI # t Del initials�,_l=� iV LL;1-/7 (U8/25/10)