HomeMy WebLinkAboutAgreement_General_11/24/2008
MEMORANDUM OF UNDERSTANDING
DRIVERS LICENSE OR MOTOR VEHICLE RECORD DATA EXCHANGE
C®ntract Number ml(-OG(,n-~q
This Memorandum of Understanding
Village of Tequesta
(MOU)
is made and entered into by and between
hereinafter referred to as the Requesting Party
and the Department of Highway Safety and Motor Vehicles hereinafter referred to as the Providing Agency.
Purpose of the Data Exchange
The purpose of this MOU is to establish conditions under which the Providing Agency agrees to provide electronic
access to information relating to driver license, motor vehicle or traffic crash data to the Requesting Party. The
Requesting Party is performing as (please mark all that apply):
^ A Network Provider for driver license information for Third Parties. Attachment 1 applies.
^ A Network Provider for motor vehicle information for Third Parties. Attachment 9 applies.
^ A Government Entity to obtain driver license information through an existing Network Provider portal.
Attachments 2 and 7 apply.
^ ~ GGVernment €ntity tG obtain motor vehicle information through existing Network Provider portal.
Attachments 7 and 10 apply.
^ A Requesting Party of motor vehicle information accessed through the Division of Motor Vehicles public
records section. Attachments 7 and 8 apply.
^ A Requesting Party of driver license information accessed through the Division of Driver Licenses Bureau
of Records. Attachments 3 and 7 apply.
^ A Requesting Party of periodic driver license information for insurance underwriting accessed through the
Division of Driver Licenses Bureau of Records. Attachments 4 and 7 apply.
^ A Requesting Party of traffic crash information accessed through the Division of Administrative Services.
Attachment 7 applies.
^ A network provider of driver license information for authorized Government Entities. Attachment 5
applies.
^ A Network Provider of driver license information status check. Attachment 6 applies.
A governmental entity accessing data through one of the Driver License and Vehicle Information Database
systems. Attachment 7 applies.
without access to driver license photographs and signatures.
with access to driver license photographs and signatures, as authorized by section 322.142(4),
Florida Statutes.
^ Other Requesting Party. Attachment 7 applies.
Data Exchange MOU (05/2008) Page 1 of 7
Y
Definitions
A. "Driver's Privacy Protection Act" (DPPA) - 18 United States Code section 2721 et seq.
B. "Providing Agency" -The Department of Highway Safety and Motor Vehicles. The agency responsible for
granting access to driver license, motor vehicle, or traffic crash data to the Requesting Party.
C. "Requesting Party" -Any entity type that is expressly authorized by section 119.0712(2), Florida Statutes
and DPPA to receive personal information and highly restricted personal information that requests
information contained in a driver license, motor vehicle, or traffic crash record.
D. "Parties" -The Providing Agency and the Requesting Party.
E. "Third Party" -Any individual, association, organization, or corporate entity who receives driver license,
motor vehicle, or traffic crash information or data maintained and released by the Providing Agency or
Requesting Party.
F. "Government Entity" -Any federal, state, county, or city government, including any court or law enforcement
agency.
G. "Network Provider" - A Requesting Party whose access is provided by remote electronic means through the
System to request specific types of data at a minimum of 5,000 transactions per month. A six (6) month
startup period will be allowed for new Network Providers, during which time, less than 5,000 transactions per
month will be accepted.
H. "Personal Information" -Information found in the motor vehicle or driver record which includes, but is not
limited to, the subject's driver identification number, name, address, telephone number, and medical or
disability information. Personal information does not include information related to vehicular crashes, driving
violations, and driver's status.
I. "Vendor Number" - A four digit number assigned by the Providing Agency identifies the type and duration of
the Driver License record. The vendor number is assigned to both commercial vendors and Government
Entities by the Providing Agency, Division of Driver License, Bureau of Records. Misuse of a vendor number
to obtain driver license record information is strictly prohibited and shall be grounds for termination in
accordance with Section X.
J. "Driver license information" -driver license and identification card data collected and maintained by the
Providing Agency.
K. "Motor vehicle information" -title and registration data collected and maintained by the Providing Agency for
vehicles, vessels, and mobile homes.
L. "Traffic crash information" -traffic crash data and traffic crash reports collected and maintained by the
Providing Agency.
III. Legal Authority
WHEREAS, the Providing Agency maintains computer databases containing information pertaining to driver licenses
pursuant to Chapter 322, Florida Statutes; and
WHEREAS, the Providing Agency maintains computer databases containing information pertaining to motor vehicles
pursuant to Chapters 319 and 320, Florida Statutes; and
WHEREAS, the Providing Agency maintains computer databases containing information pertaining to traffic crashes
pursuant to Chapter 316 and 321, Florida Statutes; and
WHEREAS, the driver license, motor vehicle, and traffic crash data contained in the Providing Agency databases is
defined as public record pursuant to Chapter 119, Florida Statutes; and
Data Exchange MOU (05/2008)
Page 2 of 7
WHEREAS, the Providing Agency as custodian of the foregoing records may provide access by remote electronic
means and charge a fee for the direct and indirect costs of providing such access, pursuant to sections 119.0712(2),
320:05, 321.23, and 322.20, Florida Statutes, and other applicable rules and policies; and
WHEREAS, the Requesting Party may obtain via remote electronic means blocked personal information exempt
from public disclosure as provided pursuant to section 119.0712(2), Florida Statutes, with exception of social security
number, the Requesting Party shall maintain the confidential and exempt status of such data. Anyone accessing
records obtained per this agreement must ensure that the end users of the records are complying with section
119.0712(2), Florida Statutes and DPPA.
NOW THEREFORE, the Parties, in consideration of the promised and mutual covenants hereinafter contained, do
hereby enter into this MOU.
IV. Statement of Work
A. The Providing Agency agrees to:
1. Provide the Requesting Party with the technical specifications required to access driver license, motor
vehicle or traffic crash information in accordance with the access method being requested.
2. Allow the Requesting Party/Network Provider to electronically access driver license and/or motor vehicle
and/or traffic crash information through a telecommunications link to be established between the
Requesting Party/Network Provider's computer and the Providing Agency.
3. Accept the Requesting Party/Network Provider's electronic requests and respond with appropriate data.
At a minimum, 90% of the responses to electronic requests from Network Providers will occur within 15
seconds of receiving the transaction.
4. Collect all fees, pursuant to applicable Florida Statutes, rules and policies for providing the electronically
requested data. The fee shall include all direct and indirect costs of providing remote electronic access,
according to section 119.07(2)(c), Florida Statutes.
5. Collect all fees due for electronic requests through the Automated Clearing House account of the
banking institution which has been designated by the treasurer of the State of Florida for such purposes.
6. Discontinue access of the Requesting Party for non-payment of required fees. The Providing Agency
shall not be responsible for the failure, refusal, or inability of the Requesting Party/Network Provider to
make the required payments, or interest on late payments for periods of delay attributable to the action
or inaction of Network Providers.
7. Not indemnify or be liable to the Requesting Party/Network Provider for any driver license, motor vehicle,
or traffic crash information, programs, job streams, or similar items delayed, lost, damaged, or destroyed
as a result of the electronic exchange of data pursuant to this MOU, except as provided in section
768.28, Florida Statutes.
8. Provide the Requesting Party with a schedule of fees appropriate for the information being provided by
the Providing Agency.
9. Notify the Requesting Party/Network Provider thirty (30) days prior to changing any fee schedules when
it is reasonable and necessary to do so, as determined by the Providing Agency. The Requesting
Party/Network Provider may continue with this MOU as modified or it may terminate the MOU in
accordance with Section X., subject to the payment of all fees incurred prior to termination.
10. Perform all obligations to provide access under this MOU contingent upon an annual appropriation by the
Legislature.
Data Exchange MOU (05/2008) Page 3 of 7
11. Provide electronic access for Network Providers to driver license and/or motor vehicle information 24
hours a day, 7 days per week other than scheduled maintenance or other uncontrollable disruptions.
Scheduled maintenance normally occurs Sunday mornings between the hours of 6:OOAM to 10:OOAM.
B. The Requesting Party agrees to:
1. For a Network Provider, submit no less than 5000 transactions per month. (This does not apply to
Government Entities.]
2. For a Government Entity, driver license, motor vehicle, or traffic crash information may only be used for
the express purposes originally agreed to by the Government Entity and Providing Agency. Information
obtained from the Providing Agency by a Government Entity shall not be retained by the Government
Entity or resold to any Third Party.
3. Be responsible for interfacing with any and all Third Party end users. The Providing Agency will not
interact directly with any Third Party end users. Requesting Party shall not give Third Party end users
the name, E-mail address, and /or telephone number of any Providing Agency employee without the
express written consent of the Providing Agency. (This does not apply to Government Entities.]
4. Maintain a help desk for its Third Party end users. Personnel assigned to this help desk shall be fully
trained on all aspects of the electronic access and shall be prepared to answer all Third Party end user
questions. In cases where the Requesting Party/Network Provider help desk personnel are unable to
answer a question from a Third Party end user and that question must be answered by Providing Agency
personnel; the Requesting Party shall obtain the answer from the Providing Agency and then relay the
answer to the Third Party end user. jThis does not apply to Government Entities.]
5. Insure that its employees and agents comply with Section V. Safeguarding Information procedures of this
MOU.
6. Not assign, sub-contract, nor otherwise transfer its rights, duties, or obligations under this MOU without
the express written consent and approval of the Providing Agency.
7. Use the information received from the Providing Agency only for the purposes authorized by this
agreement.
8. Protect and maintain the confidentiality and security of driver license, motor vehicle, and traffic crash
information received from the Providing Agency in accordance with this MOU and applicable state and
federal law.
9. Defend, hold harmless and indemnify the Providing Agency and its employees or agents from any and all
claims, actions, damages, or losses which may be brought or alleged against its employees or agents for
the Requesting Party's negligent, improper, or unauthorized use or dissemination of information provided
by the Providing Agency.
10. Update user access permissions upon termination or reassignment of users within 5 working days and
immediately update user access permissions upon discovery of negligent, improper, or unauthorized use
or dissemination of information. Conduct quarterly quality control reviews to ensure all current users are
appropriately authorized.
11. For all records containing personal information released to a Third Party, maintain for a period of 5 years,
records identifying each person or entity that receives the personal information and the permitted
purpose for which it will be used. The Requesting Party shall make these records available for
inspection upon request by the Providing Agency. (This does not apply to Government Entities.]
12. Pay all costs associated with electronic access of the Providing Agency's driver license and/or motor
vehicle and/or traffic crash information; such costs shall include all one time, recurring, and usage
charges for all hardware, software, and services required to connect to and use the electronic access.
Payment must be in advance of receiving any information or use electronic means as follows:
Data Exchange MOU (05/2008) Page 4 of 7
® Complete and sign the appropriate document(s) to allow the Providing Agency's designated banking
institution to debit the Requesting Party's designated account.
• Maintain an account with a banking institution as required by the Providing Agency.
^ Pay all fees due the Providing Agency by way of the Automated Clearing House account of the
Providing Agency's designated banking institution. Collection of transaction fees from eligible and
authorized Third Party end users is the responsibility of the Requesting Party.
V. Safeguarding Information
The Parties shall access, use and maintain the confidentiality of all information received under this agreement in
accordance with Chapter 119, Florida Statutes, and DPPA. Information obtained under this agreement shall only be
disclosed to persons to whom disclosure is authorized under Florida law and federal law. Any person who willfully
and knowingly violates any of the provisions of this section is guilty of a misdemeanor of the first degree punishable
as provided in sections 119.10 and 775.083, Florida Statutes. In addition, any person who knowingly discloses any
information in violation of DPPA may be subject to criminal sanctions and civil liability.
The Parties mutually agree to the following:
A. Information exchanged will not be used for any purposes not specifically authorized by this agreement.
Unauthorized use includes, but is not limited to, queries not related to a legitimate business purpose;
personal use, and the dissemination, sharing, copying or passing of this information to unauthorized persons
B. Information exchanged by electronic means will be stored in a place physically secure from access by
unauthorized persons.
C. Access to the information exchanged will be protected in such a way that unauthorized persons cannot
review or retrieve the information.
D. All personnel with access to the information exchanged under the terms of this agreement will be instructed
of, and acknowledge in writing, the confidential nature of the information. Signed acknowledgements must
be retained and updated annually by the Requesting Party.
E. All personnel with access to the information will be instructed of, and acknowledge in writing, the criminal
sanctions specified in state law for unauthorized use of the data. Signed acknowledgements must be
retained and updated annually by the Requesting Party.
F. All access to the information must be monitored on an on-going basis by the Requesting Party. In addition,
the Requesting Party must complete an annual audit of at least 5% of all data accessed to ensure proper
and authorized use and dissemination.
G. By signing the MOU, the representatives of the Providing Agency and Requesting Party, on behalf of the
respective Parties attest that their respective agency procedures will ensure the confidentiality of the
information exchanged will be maintained.
VI. Compliance and Control Measures
A. Internal Control Attestation -This MOU is contingent upon the Requesting Party having appropriate
internal controls of personal data sold or used by the Requesting Party to protect the personal data from
unauthorized access, distribution, use, modification, or, disclosure. Upon request from the Providing
Agency, the Requesting Party must submit an attestation from a licensed Certified Public Accountant
performed in accordance with American Institute of Certified Public Accountants (AICPA) "Statements on
Standards for Attestation Engagement", or alternatively by a currently licensed and independent Certified
Information Systems Auditor (CISA) in accordance with Information Systems Audit and Control Association
(ISACA) "IS Standards, Guidelines, and Procedures for Auditing and Control Professionals". In the event the
Requesting Party is a governmental entity, the attestation may be provided by an internal auditor or inspector
Data Exchange MOU (05/2008) Page 5 of 7
general. The attestation must indicate that the internal controls of personal data have been evaluated and
are adequate to protect the personal data from unauthorized access, distribution, use, modification, or
disclosure. The attestation must be received by the Providing Agency within 90 days of the written request.
See Section XI for complete mailing address
B. Misuse of Personal Information -The Requesting Party must immediately notify the Providing Agency and
the individual whose personal information has been compromised of any unauthorized access, distribution,
use, modification, or disclosure. The statement to the Providing Agency must provide the date and the
number of records affected by any unauthorized access., distribution, use, modification, or disclosure of
personal information. Further, as provided in section 817.5681, Florida Statutes, the document must provide
a statement advising if individuals whose personal information has been compromised have been notified
and, if not, when they will be notified. The statement must include the corrective actions and the date these
actions are completed by the Requesting Party. See Section XI for complete mailing address.
C. The Providing Agency shall receive an annual affirmation from the Requesting Party indicating compliance
with the requirements of this agreement no later than 30 days after the anniversary date of this agreement.
VII. Reimbursement Of Costs
Providing Agency will debit the account of the Requesting Party currently on file. The amount debited will be in
accordance with sections 320.05 and 322.20 Florida Statutes and with this MOU. Specific fee calculations are
incorporated by an attachment to this MOU. (This does not apply to Government Entities.]
VIII. Period of Performance
This MOU shall be effective upon the last signature of the Parties to this agreement and will remain in effect for three
years from the date of execution, as provided in Section X. Once executed, this MOU supersedes all previous
agreements for these conditions of services defined in Section I.
IX. Amendments
A. This MOU incorporates all prior negotiations, interpretations, and understandings between the Parties, and is
the full expression of their agreement.
B. This MOU may be subsequently amended by written agreement between the Parties. Any change,
alteration, deletion, or addition to the terms set forth in this MOU and its numbered addendums must be by
written agreement executed by both Parties.
C. All provisions not in conflict with the amendment(s) shall remain in effect and are to be performed as
specified in this MOU.
X. Termination
A. This agreement may be terminated for cause by either party upon finding that the terms and conditions
contained herein are not being followed. No written notice or notifying period will be required.
B. This agreement is subject to unilateral cancellation by the Providing Agency without notice for failure of the
Requesting Party to comply with any of the requirements of the MOU and applicable Florida Statutes,
including section 119.0712(2), Florida Statutes.
C. The Contract may be terminated upon thirty (30) days notice in writing to the Contract Manager without
penalty to either party. All obligations of either party under the contract will remain in force during the thirty
(30) day notice period.
Data Exchange MOU (05/2008) Page 6 of 7
X6. ~wencb Contacts
Any and all inquiries or written communications pertaining to this MOU shall be sent to the Contract Administrator.
Gregory Bickford -Contract Administrator
Department of Highway Safety and Motor Vehicles
2900 Apalachee Parkway
Neil Kirkman Building, Room 8-418, MS 31
Tallahassee, Florida 32399-0524
(850) 617-3203 -Phone
(850) 617-5115 -Fax
The Contract Managers responsible for management and monitoring of the performance of the terms and conditions of
this MOU are as follows:
Driver License and Insurance Records
Dana Reiding -Contract Manager
Chief of Driver License Records - DDL
Department of Highway Safety & Motor VehiGes
Kirkman Building, Room A234, MS 89
2900 Apalachee Parkway
Tallahassee, Florida 32399-0575
Motor Vehicle and Vessel Records
Boyd Walden -Contract Manager
Chief of Titles and Registrations - DMV
Departmen4 of Highway Safety & Motor Vehicles
Kirkman Building, Room A3's8, MS 68
2900 Apalachee Parkway
Tallahassee, Florida 32399-0530
Network Providers
Dana Reiding -Contract Manager
Boyd Walden -Contract Manager
Crash Records
Jim Hage -Contract Manager
Crash Records Manager
Department of Highway Safety & Motor Vehicles
Kirkman Building, Room 6431, MS 20
2900 Apalachee Parkway
Tallahassee, Florida 32399-0500
IN WITNESS HERETO, the PARTIES have executed this Agreement by their duly authorized officials.
Requesting Party: Providing Agency:
Village of Tequesta Florida Department of Highway Safety
345 Tequesta Drive and Motor Vehicles
Tequesta, Florida 33469 2900 Apalachee Parkway
Talla ssee rida 32399
By: By:
Michael Couzzo
Pnntetl/TypeE Name
Village Manager
itle
~' /3 bG
Date
' Stacv Arias
PrintetlRypetl Name
Chief of Purchasing & Contracts
Title ~
~/ ',/~
i~ ~ ~U
Date ~
Data Exchange MOU (05/2008) Page 7 of 7
A-TT~~ 6.9 f~i E IVT 7
Requesting Party ®ata Access Specificati®ns
Contract Number ~-4Slmy-nlo(.n-Qq
Access Method or Condition. The Requesting Party shall attest to their respective statutory eligibility by
completing the DPPA Form (HSMV 96015).
Access Specifications. Please list each separate organizational unit requiring access within your Department.
Organizational Unit
(Division, Bureau,
Program, Office)
Description of specific data
needed Description of specific use of data, to
include statutory or administrative rule
requirements.
Number of
members
requiring
access
Road Patrol DAVID Investigation/Identification 20
Communication g
III. Requesting Party Information. Requesting Party contact information is as follows (all information required):
Managerial and Technical Point of Contact's Name: Jennifer Gazo
Phone number: 561-744-4014
Email address is: JGazo@Tequesta.orq
Requesting Party:
Village of Tequesta
345 Tequesta Drive
Tequesta, Florida 33469
Providing Agency:
Florida Department of Highway Safety
and Motor Vehicles
2900 Apalachee Parkway
Tallahassee, Florida 32399
Under penalties of perjury, I declare that
I have read the foregoing and that the
facts stated in it are true.
sy:
Michael Couzzo
Printed/Typed Name
Village ana r
ru
Dale
sy:
Stacy Arias
Printed/ Typed Name
Chief of Purch sin & C ntracts
T le
Date
Data Exchange MOU -Attachment 07 (05/2008) Page 1 of 1
FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
Request For Exempt Personal Information In A Motor Vehicle/Driver License Record
Section 119.0712(2), Florida Statutes, and the Driver's Privacy Protection Act, 18 United States Code sections 27212725 ("DPPA") make personal
information contained in motor vehicle or driver license records confidential and exempt from disclosure. Personal information in a motor vehicle
record includes, but is not limited to, an individual's social security number, driver license or identification number, name, address, telephone
number, medical or disability information, and emergency contact information. Personal information does not include information related to
vehicular crash data (such as occurrence of a crash, speed, vehicle identity, alcohol use, location and cause of crash), driving violations, and driver
status. Personal information from these records may only be released to individuals or organizations that qualify under one of the exceptions
provided in section 119.0712(2), F. S., and DPPA, which are listed on the back of this form. A request for information may be made in letter form
(on company/agency letterhead, it appropriate) stating the nature of the request, the exception under which the request is made, the use of the
information, and a statement that the information will not be used or redisclosed except as provided in s. 119.0712(2)(b), F.S., and DPPA, or by
completing the information below.
Please complete either Part 1 or Part II:
Part 1:
I am an individual requesting personal information contained in the motor vehicle, vessel, crash or driver license record of the following
individual(s) (attach additional pages if necessary), under exception number as listed on the reverse side of this form:
Name:
Vehicle/Vessel Title Number: Vehicle License Plate Number:
Florida Driver License/identification Card Number:
Florida Traffic Crash Report Number:
Section 316.066(5)(a), F.S. limits who may obtain a crash report within 60 days offer the report is filed. I declare that I om qualified to obtain this
information under Crash Report exception number . as listed on the reverse side of this form. Proof of identification is required.
Part IL
I am a representative of an organization requesting personal information for one or more records as described below. I declare that my
organization is qualified to obtain personal information under exception number 2 , as listed on the reverse side of this form.
I understand that I may not use or redisclose this personal information except as provided in s. 119.0712(2), F.S., and DPPA and that any use or
redisclosure in violation of these statutes may subject me to criminal sanctions and civil liability.
The information will be used as follows (attached additional page, if necessary):
Law Enforcement purposes only
Tequesta Police Department Jennifer Gazo
Company or Agency Name (if applicable)
Printed Name of Requestor or Authorized Agent
Obtaining personal information under false pretenses is a state and federal crime. Under penalties of perjury, I declare that 1 have read the
foregoing Request For Exempt Personal Information In A Motor Vehicle/Driver License Record and that the facts stated in it are true.
~ ~'~ ~ -~
~..~~,.af .x rL~e3
Signat re of Requ stpr or A~ h ized Agent
September 8, 2008
Date
HSMV 96015 (05/08)
DRIVER'S PRIVACY PROTECTION ACT EXCEPTIONS
1. For use in connection with matters of motor vehicle or driver safety theft, motor vehicle emissions, motor vehicle product alterations,
recalls, or advisories, performance monitoring of motor vehicles and dealers by motor vehicle manufacturers, and removal of nonowner
records from the original owner records of motor vehicle manufacturers, to carry out the purposes of the Anti Car Theft Act of 1992, the
Automobile Information Disclosure Act, the Clean Air Act, and chapters 301, 305, and 321331 of title 49 U.S.C.
2. For use by any government agency, including any court or law enforcement agency, in carrying out its functions, or any private person or
entity acting on behalf of a federal, state, or local agency in carrying out its functions.
3. For use in connection with matters of motor vehicle or driver safety and theft; motor vehicle emissions; motor vehicle product alterations,
recalls, or advisories; performance monitoring of motor vehicles, motor vehicle parts, and dealers; motor vehicle market research activities,
including survey research; and removal of nonowner records from the original owner records of motor vehicle manufacturers.
4. For use in the normal course of business by a legitimate business or its agents, employees, or contractors, but only:
a. To verify the accuracy of personal information submitted by the individual to the business or its agents, employees, or
contractors; and
b. If such information as so submitted is not correct or is no longer correct, to obtain the correct information, but only for the
purposes of preventing fraud by, pursuing legal remedies against, or recovering on a debt or security interest against, the
individual.
5. For use in connection with any civil, criminal, administrative, or arbitral proceeding in any court or agency or before any selfregulatory
body for:
a. Service of process by any certified process server, special process server, or other person authorized to serve process in this state.
b. Investigation in anticipation of litigation by an attorney licensed to practice law in this state or the agent of the attorney; however,
the information may not be used for mass commercial solicitation of clients for litigation against motor vehicle dealers.
c. Investigation by any person in connection with any filed proceeding; however, the information may not be used for mass
commercial solicitation of clients for litigation against motor vehicle dealers.
d. Execution or enfarcerrient of judgments and orders.
e. Compliance with an order of any court.
6. For use in research activities and for use in producing statistical reports, so long as the personal information is not published, redisclosed,
or used to contact individuals.
7. For use by any insurer or insurance support organization, or by a selfinsured entity, or its agents, employees, or contractors, in connection
with claims investigation activities, antifraud activities, rating, or underwriting.
8. For use in providing notice to the owners of towed or impounded vehicles.
9. For use by any licensed private investigative agency or licensed security service for any purpose permitted under this paragraph. Personal
information obtained based on an exempt driver's record may not be provided to a client who cannot demonstrate a need based on a police
report, court order, or a business or personal relationship with the subject of the investigation.
10. For use by an employer or its agent or insurer to obtain or verify information relating to a holder of a commercial driver's license that is
required under 49 U.S.C. ss. 31301 et seq.
11. For use in connection with the operation of private toll transportation facilities.
12. For any use if the requesting person demonstrates that he or she has obtained the written consent of the person who is the subject of the
motor vehicle record.
13. For any other use specifically authorized by state law, if such use is related to the operation of a motor vehicle or public safety.
14. For any other use if the person to whom the information pertains has given express consent on a form prescribed by the department. Such
consent shall remain in effect until it is revoked by the person on a form prescribed by the department.
CRASH REPORT EXCEPTIONS
1. I am a party involved in the crash.
2. I am a legal representative to a party involved in the crash or an immediate relative.
3. I am a licensed insurance agent to a party involved in the crash, their insurer or insurers to which they applied for insurance coverage.
4. I am a person under contract to provide claims or underwriting information to a qualifying insurance company.
5. I am a prosecuting attorney.
6. I represent a radio or television station licensed by the FCC or newspaper qualified to publish legal notices or a free newspaper of general
circulation, which qualifies under statute.
7. I represent a local, state, or federal agency that is authorized by law to have access to these reports.
8. I represent a Victim Service Program, as defined in Section 316.003(85), Florida Statutes.
HSMV 96015 (05/08)
Public Official's Request to Suppress Records Information
This form is used to request suppression of personal information in the driver/identification, vehicle, and vessel records that you identify below. Please note
that this form and the corresponding privacy protection apply only to law enforcement officers, certain other public officials (active or former), and their
spouses and children, who are eligible for such protection under Section 119.07(6)(1), Florida Statutes. See reverse side for further information.
Please PRINT the applicable driver/identification, vehicle, and vessel records identification information requested below. The information required to
complete this form is located on the Florida driver license or identification card of the requester, and the current Florida vehicle registration certificate for the
motor vehicle(s), trailer(s), and vessel(s) in question. Do not include vehicles or vessels registered in the name of a leasing company or other organization.
In all cases, the date of birth must match the date of birth on the Florida driver license or identification card and the Florida vehicle registration certificate.
Complete additional forms if needed for other family members.
NOTE: The form(s) must be returned with a letter or other documentation on employer letterhead indicating eligibility to:
Department of Highway Safety and Motor Vehicles, Driver Privacy Protection Act Unit, 2900 Apalachee Parkway, Room B238, MS 90,
Tallahassee, Florida 32399.
Public Official/Law Enforcement Officer Submitting Request
FIRST NAME MIDDLE NAME LAST NAME
STREET ADDRESS CITY
L.~~ m ~ ^ STATE & ZIP CODE
m m m
Florida Driver License/Identification Card Number Date of Birth
Family Member(s) Driver License or Identification Card Information (spouse/child)
1. ~m~^ mmm
Florida Driver License/Identification Card Number(~~~
2• mL I 4 4~ Date of Birth
mmm
Florida Driver License/Identification Card Number((
3. ~ml l l ~^ Date of Birth
mmm
Florida Driver License/Identification Card Number Date of Birth
Motor Vehicles and Trailers {owned by any person identified above):
1. m w m
Florida License Plate (Tag) Number
2. Florida License Plate (Tag) Number
Florida Title Number
n mmm
Florida Title Number Date of Birth
Date of Birth
3. - ~~ m ~ m
Florida License Plate (Tag) Number Florida Title Number Date of Birth
,`.~ _ --
Vessels (owned by any person identified above):
1. ~~ mmm
Florida Number
Florida Title Number
Date of Birth
~. * ~ ~ m m
Flonda Number Florida Title Number Date oFB~rth
* Number shown in the box labeled "Florida Number" may be a Florida vessel registration number, official number of a federally
documented vessel, or registration number from another state.
HSMV 96020 (Rev. 02/05)
Public Official Eligibilityto Exempt Personal Information from Pubic Disclosure
Eligible public officials can request that the Department of Highway Safety and Motor Vehicles exempt from public review (disclosure) the
personal information contained in their driver, vehicle, and vessel records. Personal information includes the name, home address, social
security number, telephone number, driver/identification card number, medical or disability information and photograph or digital image of a
public official. The request must be made in writing as required in Section 119.07(6)(1), Florida Statutes, by completing the Public Official
Request to Suppress Records Information Form, HSMV 96020, revised 02/05. The form must be returned to the Department of Highway
Safety and Motor Vehicles with a letter or other documentation on employer letterhead indicating the eligibility. The following public
officials, their spouses, the children, and other family members living at the same address are eligible for privacy protection under Section
119.07(6)(1), Florida Statutes:
® Active or former law enforcement officers;
• Correctional and correctional probation officers;
• Personnel of the Department of Children and Family Services who investigate cases of abuse, neglect, exploitation, fraud, theft, or other
criminal activities;
• Personnel of the Depamnent of Health whose duties are to support the investigation of child abuse or neglect;
• Personnel of the Department of Revenue or local governments whose responsibilities include revenue collection and enforcement or
child support enforcement;
• Certified firefighters;
• Current or former justices of the Supreme Court, district court of appeal judges, circuit court judges, and county court judges;
• Current or former state attorneys, assistant state attorneys, statewide prosecutors, and assistant statewide prosecutors;
• Current or former human resource, labor relations, or employee relations directors, assistant directors, managers, or assistant managers of
any local government agency or water management district whose duties include hiring and firing employees, labor contract negotiation,
administration, or other personnel-related duties;
• Current or former United States attorneys and assistant United States attorneys;
• Current or former judges of United States Courts of Appeal, United States district judges, United States magistrate judges and
• Current or former code enforcement officers.
The department records affected by this action include Florida driver license records, Florida identification card records, motor vehicle
registration and title records, vehicle registration and title records, and vessel registration and title records, including federally documented
vessels. The Department of Highway Safety and Motor Vehicles is not allowed to release the suppressed personal information of public
officials.
ATTEST:
Lori McWilliams, CMC
Village Clerk
[VILLAGE ~L~IL] SEAL ~`•~:v
:INCORPORATED ;
VILLAGE OF TEQUESTA
--~-~~`
Michael Couzzo
Village Manager
APPROVED AS TO FORM AND LEGAL
SUFFICIENCY
Trela White, Esq. ,
Village Attorney
ANNUAL AFFIRMATION STATEMENT
In accordance with Section VI., Part A, of the Memorandum of
Understanding between Department of Highway Safety and Motor Vehicles
and ~,~ ~+ ; .'~ ~ ,~ . , ~= -k, ~~~~: ~--~~ ~ Re uestin A enc hereb
~' ~~" ~ ° ( q 9 9 Y) Y
Affirms that the requesting agef~cy has evaluated and have adequate controls in
place to protect the personal data from unauthorized assess, distribution, use
and modification or disclosure and is in full compliance as required in the
contractual agreement k-~S n ~V'"(~~e(oU_(contract number).
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Signature
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Printed Name
~~,.
Title
_. ~, _~ a
Date
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NAME OF AGENCY
DR/Ib
Gazo, Jennifer
From: Whittaker, Warren [WarrenWhittaker@flhsmv.gov]
Sent: Tuesday, November 03, 2009 11:08 AM
To: mvandeutekom@capecoral.ngt; tvaughn@co.okaloosa.fl.us; fettig.brian@spcollege.edu;
cmckay@sambaholdings.com; HugoJr@unisoftonline.com; Jimt@add.123.com;
gloria_korenman@doh.state.fl.us; mwatson@Icpa.org; wmcduffi@pbcgov.org;
nwalker@ccpao.com; Dianne.Johns@Brevardpropertyappraiser.com;
Heather.slager@myflorida.com; vtalbot@melbourneflorida.org; sissylong@polk-county.net;
Capella_Jefferies@doh.state.fl.us; Cherri.Krall@myfloridaCFO.com; Kim.Bishop@usis.com;
Tim.willis@usis.com; cedarkeypd@yahoo.com; john.earst@famu.edu;
ggaskill@nassaucountysheriff.com; mwest@levyso.com; pkeys@marcoislandpolice.us;
jcruz@homesteadpolice.com; jbeane@ci.gulfport.fl.us; econnell@sheriffleefl.org;
jennifer.wiwi@myfwc.com; mpdchief@eambargmail.com; close]@cityofnewportrichey.org;
whaleykl@flcjn.net; russellmorris@mysebring.com; donnar@jupiter.fl.us; mwelsh@ufl.edu;
allen.davis@miami-police.org; tholland@belleviewfl.org; susannecrews@village-npb.org;
kmatson86@yahoo.com; Gazo, Jennifer; gdedenbach@coab.us; spaquet@tspd.us;
Geri.Paquette@acxiom.com; frank)@softechinternational.com; Resells-plotnik@iso.com;
EDARMODY@TML.COM; jkarchefski@vbpd.org; ecostello@wmpd.org; Wendy@mdpd.com;
tbroxton@winterspringsfl.org; cruseba@flcjn.net; sdpd@southdaytona.org;
gburkett@police.zephyrhills.fl.us; pokornyt@leepal.org; stephen@scpafl.org;
tcassano@sao10.com; bill.navas@myfloridalegal.com; hlawrenz@thegeogroupine.com;
scharbonneau@co.pinellas.fl.us; melissa.mack@mymanatee.org;
Robert.Radford@Leegov.com; LPDWebinfo@lakelandgov.net
Subject: Yearly affirmation
Attachments: ANNUAL AFFIRMATION STATEMENT.doc
This is a courtesy reminder, if the anniversary date of the Memorandum of Understanding (MOU) between the
Department of Highway Safety/Motor vehicles and your agency is the month of November, as noted in Section
VI a memo stating your agency's compliance with the requirements of the agreement is required no later that 30
days after the anniversary date of the agreement. I have attached an example of an affirmation as what it could
look like. Please mail the affirmation statement to:
Department of Highway Safety/Motor Vehicles
2900 Apalachee Parkway
Attn. Warren Whittaker MS 89
Tallahassee, FL 32399
Sincerely,
Warren Whittaker
Senior Highway Safety Specialist
2900 Apalachee Parkway
Mailstop 89
Tallahassee, FL 32399-0575
Phone# 850-617-2661
The Department of Highway Safety and Motor Vehicles is committed to Service, Integrity, Courtesy, Professionalism,
Innovation and Excellence in all we do. Please let us know how we are doing via our online customer service survey at
www.flhsmv.aov.
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