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Home My WebLink About20-035CITY OF IOWA CITY IDENTIFICATION NO. 20-036 (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) 410 East Washington Street Failure to complete the "required" information will result in denial of the application Iowa City. Iowa 52240-1826 / (3 19) 356-5040 Last First Middle (3 19) 356-5497 FAX t, ) f� 1. Name(REQUIRED) 'Lcb- S O/o� 2. Address (REQUIRED) 3. Contact Information(REQUIRED)Email: CellPhone: (All written communication sent via email) 4a. Drivers License expiration date (REQUIRED) b. Taxicab Business Name (REQUIRED) Nil dew L� h 5. Prior experience in transportation of passengers: �� rr— �• �e�►�,� 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? At Q Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty .. /^Other Have you been arrested / charged with any traffic offenses in the last five years? At tom) Type of offense Where When What happened to the charge? (Circle one) Convicted Dismissed Deferred Suspended Plead Guilty Other Ate 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) At O 04/2018 Page 2 APPLICATION FOR TAXICAB VEHICLE DRIVER 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). certify that I have issued to me by the Iowa De artment of Transportation a valid Driver's license number consent to allow agents or I documents relating to this at times with all of the provislor Signature of ApplicantT_ i#+t4tRhf#iRM1YRif f RRf f{kM4tRM STATE OF IOWA ) COUNTYOFJOHNSON ) Issued on -2020 expiring on l0.9- ao2o I understand that If I ?n that this application may be denied. I agree that In making this application, I b City of Iowa City, Iowa, in their discretion, to examine any and all records and further agree that, If authorization to be a taxicab driver Is granted, to comply at all Ipter 2, of the City Code. (Needs to be signed in front of a Notary Public) Date 'is A o Subscribed and sworn to before me by on this day of Notary Public in and for the State.of Iowa «+M4..***6,.�...,f„ff*a***A....,,kR,.RRA**+ +,>...RR......R..R......R.R.Rk .,.4..*d**A!4,"A**** .*A*RR,....RR....RRRR.*****.Rf.++.... 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 off lic e8 Slgnatu� • olice 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 TE LISTED BELOW. Signatuire of City Clerk or Psignee Date 1RRidRfRf44kRtiktRlfRR4klfitRiiHkkf4{lkkkfik{fiFkRkR RRRf/MAltkkiR#RhtittkRk[itRt4YfYfYtYHHlRf1iHMRlktRlRttfl,kRMhR#,YkRk,IR}R;yyt;Fkiyl4ytkRR} Approved application Office Use Only DCI report State certified driving record Website update ClarkfrAXIDRNBADGEAPPL92018amended.DOC 04/2018 091Sep. 14. 20201; 4:20PMeab DCI IOWA TAMBMNo.4989 P. 1/2JO02 'STATE OF IOWA Criu tal History Record Check Request Form DC1 Account Number: 9967-F N�br$ex_ca®olew farms tc Crtapptia6l� Iowa DIYWon of Crlmiaal joveg4eeam Name YeO�cv Shr6 of Tara Rb 9ARort 0PUatioal Darerv, lKnoor 215 E. 70Street Addrea� F.Ot80Xd28 Dea.Mojn0%Iowa 50319 (515) 775-6066 Iowa C1q, Iowa 52244 (51SJ12$-6090 Pa phone _ �MW7 ' P� 539$994142 '— orva Criminal gisto RecorCheck Results (m�a�� A s of q c5 C7 a seerah of the > Pzovided uama and dat�tAbpyealad; c a No Iowa G4i�� Histozy Record found with „" S{DIt of rnhF �. �O z 4 Iowa Qftfiial HistoryRecord attached, DGi # his ory rfm in, (' C111o ACUiui ig t----=sults;'` CIO > lisle ,'�_• `` o ... , •�14/pl/gggq pIIW11tUP��O��_ DCI -77 (np"�3ekf106 2f 2016) Paga I of Received Time Sep. 11. 2020 1:07PM No. 4665 Sep -14-2020 4:20PM DCI IOWA No.4989 P. 2/2 Q1:�03/,IWiA16 This response can only include public criminal history data. Under Iowa law, most juvenile records are confidential. Confidential Juvenile court records, if any, cannot be included in this response. A signed release authorization is not sufficient to obtain this information from the Division of Criminal Investigation. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 23Z 147(18). Additionally, criminal history data concerning convictions for certain Juvenile sex offenses can be found on the Iowa Sex Offender Registry. htta://Www.lowasexoffender.com/. However, even though some information Is available on this site, the actual records for juveniles may still be confidential and any confidential juvenile records cannot be provided with this record. In order to request the release of confidential juvenile records, if any, an application must be filed pursuant to Iowa Code section 232.147(18). J10WAD0TA90 SMARTER 1 SIMPLER I CUSTOMER DRIVEN uwvw•iowadoi~gov D1Met S IOMMrfeftili t SeMON PO Box 92041 Des Manes, IA 50306WN Phone 515-244-91261 Fax 515-2991837 CLEAR DRIVING RECORD Name: Woldeselassie, Solomon Berhanu DL/ID: 303AP9303 Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of 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: 4epPM1ycr+T ur I�TSAyG 9/11/2020 Ae5t..'-24: (Y— A5=t0—— Driver & Identification Services Cr4t DDG' Iowa Department of Transporation Name: Woldeselassie, Solomon Berhanu DL/ID: 303AP9303 Certified Abstract of Driving Record Inquiry Date: 9/11/2020 DL/ID #: 303AP9303(IA) Customer #: 6795543 Name: Woldeselassie, Class: C ID Status: EXP Solomon Berhanu Address: 2542 Sylvan Glen Ct Audit #: 4945257 DL Status: VAL Issue Date: 09/09/2020 CDL Status: None City/State: Iowa City, IA Expiration Date: 11/28/2020 CDL Cert Status: None 522464116 Endorsements: NONE CDL Med Status: None Mailing Address: 2542 Sylvan Glen Ct Restrictions: NONE Restriction None Supplement: Date of Birth: 03/12/1989 Mailing Iowa City, IA Sex: M City/State: 522464116 History Information CLEAR DRIVING RECORD Name: Woldeselassie, Solomon Berhanu DL/ID: 303AP9303 Pursuant to Iowa Code §321.10, I, Darcy Doty, Director of 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: 4epPM1ycr+T ur I�TSAyG 9/11/2020 Ae5t..'-24: (Y— A5=t0—— Driver & Identification Services Cr4t DDG' Iowa Department of Transporation Name: Woldeselassie, Solomon Berhanu DL/ID: 303AP9303