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Home My WebLink About21-009I P t CITY OF IOWA CITY 410 East Washington Street loiva City, lawa 52240-1816 (3 19) 356-5040 1319)356-5497 FAX 1. Name (REQUIRED) j IDENTIFICATION NO. 2-1 -OD9 (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 Last First ftp: i Ess<t Middle 2. Address (REQUIRED) f-t)i C-7��X.:rf �t� tT�Li� j �!/ e5 3. Contact Information (REQUIRED) Email: liG )� yn % Phone: (AI written commun cation sen viae ai 'l 4a. Driver's License expiration date (REQUIRED)��/ b. Taxicab Business Name (REQUIRED) &i i/a i- 5. Prior experience in transportation of passengers: 6. Have you ever been arrested/ charged with any misdemeanors and/or felonies in this State or elsewhere? d)l'f, Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 7. Have you been arrested/ charged with any traffic offenses in the last five years? Type of offense What happened to the charge? (Circle one) Where When Convicted Dismissed Deferred Suspended Plead Guilty Other 8. Has your driver's license or chauffeurs license been suspended or revoked in the last five years? t/'1 . 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) V (SECOND PAGE FOR REQUIRED SIGNATURE AND NOTARY) 0412018 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). I h1reby certify that I have Issued to me by the Iowa D partment of Transportation a valid Drivels license number A6 1 p rr _ D , _ Issued on fiiring on x/0//2022. I understand that If I falsely answer any questions In 1hls application, that this app ratio 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 nted, to documents timesriver Is a with all oftthe provisions ing to this application, Title 5, Chapter t 2, oer ff the City Code. (Neeree that, If ds toion obe signebe a ld Incab dfront ofa Notary Public) Signature of Appllcacomply et all Dated n � 0 2 � nt 4f4^� C— - 1f111ffttHlHffiHHtif ttltt♦ f„A. ". , f{f1ffA11A1Hl11f1ffffH f11fllffNYHH1H11ff1fflflfAAlf HitlhfffYHHiflfff„ftR1HHf1fHH11f rC6 1 [1111[11 STATE OF IOWA ) COUNTY OF JOHNSON ) Subscribed and sworn to before me by on this day of Notary Public in and for the State of Iowa fAf }Yl1fAHlriflHlHHflff 1HIHHMAHf�H 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 Driver's license 0l' 0 1- Z.-2- (212 Sign yfgof-P ce Chief or designee 6 :->• )1'Z) 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. Office Use Only Approved application DCI report State certified driving record Webske update Dasa C1.,WTAX1DRIV9ADGWPL92U18..Med DOC 0412018 Jan. 25.2021p• 8:30AMpp DCI IOWA F fA"o=2No.1499 P. 1*21 p STATE OF IOWA PT, A* Criminal History, Record Chel Request Fonu Iowa Dfvisfoa of Via)1.,w ntloa 1E. t op8tmdow vmvau, IR Poor Des Moines, Iowa 50319 (515) 725•b06( (515) 715-6080 Fax DQA.wnntN=bee: 9967-F �c�lfabid Name Ya➢&C*b of Ad&m P.O. ba 4M lona Cup, Iona aw-- FEB 1 :i 2021 ?bow (319) 3369777 Fax 33f, MI42 ^a torvRecord CiI tr �res.0 ' An of ,As,, 2 5 2021 ""T'��-----,� a Seai411 of the DCT -77 name and We of0i a a f'imW HWt rY R ecor0 foxmd with DCI • � tid t�{if�d h 02 �I% IQws tnel gk�oly Reoand ataohC4 DCI i�' DCiinitlale� *� aero ••, { Received Time Jan. 19. 2021 11:58AM No. 0771 r L w � 1 i F fA"o=2No.1499 P. 1*21 p STATE OF IOWA PT, A* Criminal History, Record Chel Request Fonu Iowa Dfvisfoa of Via)1.,w ntloa 1E. t op8tmdow vmvau, IR Poor Des Moines, Iowa 50319 (515) 725•b06( (515) 715-6080 Fax DQA.wnntN=bee: 9967-F �c�lfabid Name Ya➢&C*b of Ad&m P.O. ba 4M lona Cup, Iona aw-- FEB 1 :i 2021 ?bow (319) 3369777 Fax 33f, MI42 ^a torvRecord CiI tr �res.0 ' An of ,As,, 2 5 2021 ""T'��-----,� a Seai411 of the DCT -77 name and We of0i a a f'imW HWt rY R ecor0 foxmd with DCI • � tid t�{if�d h 02 �I% IQws tnel gk�oly Reoand ataohC4 DCI i�' DCiinitlale� *� aero ••, { Received Time Jan. 19. 2021 11:58AM No. 0771 r L Jan. 25. 2021 8:3DAM DCI IOWA No. 1499 P. 2 DISCLAIMER 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 232.147(18). Additionally, criminal history data concerning convictions for certain juvenile sex offenses can be found on the Iowa Sex Offender Registry: http://www.iowasexoff*nder.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). FEB 11 1011 City Clerk Iowa City, Iowa 44'OWA DOT wwwiowado ov ~'J SMARTER I SIMPLER I CUSTOMER DRIVEN 9 DMu a lantrleanen "NW*S PO Box 92041 DBS Worm IA 5030&9261 Phone 515-244-91241 Fax 5t5-239-1837 Certified Abstract of Driving Record Inquiry Date: 1/28/2021 DL/ID #: 861AK0680 (IA) Customer #: 6280989 Name: Al Haj, Eissa Yagoob Class: C ID Status: None Adam Address: 36 East St Lot 74 Audit #: 4713057 DL Status: VAL Issue Date: 06/04/2020 CDL Status: None City/State: Tiffin, IA 523401207 Expiration Date: 01/01/2022 CDL Cert Status: None Endorsements: NONE CDL Med Status: None Mailing Address: 36 East St Lot 74 Restrictions: NONE Restriction None Supplement: Date of Birth: 01/01/1989 Mailing Tiffin, IA 523401207 Sex: M FEB 1 1021 City/State: City Clerk History Information Iowa City, Iowa Accidents - Accident involvement indicated does NOT mean the individual was at fault or given a citation. Name: Al Haj, Eissa Yaqoob Adam DL/ID: 861AK0680 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: Name: Al Haj, Eissa Yaqoob Adam DL/ID: 861AK0680 1/28/2021 C� Driver & Identification Services Iowa Department of Transporation FE8i; M,