HomeMy WebLinkAboutAgreement_General_9/14/2023_Florida Department of Motor Vehicles i = i M o f i
DocuS;ign Envelope la: AESCID&5-]FB2-4E23-8F2C-IEC15533C4405
r L W *a 11W1 ■ Florida Department of Highway Safety and Motor Vehicles
RAMk1HI0KMW5,k-EY AHUNMRVEHICLEa
Contract f Agreement Rovie"
FrSMV-0221-24 MOtOri5t Services [late_ 9/26/2023
C7HSMV Contract No-; Division,
Contractor Namezz Tequesta, Rol i ce Department
Contract Summary: replacing DAVID LEA MpU HSMV-0257-18. upon completion terminate HSMV-0257-18.
HSMV Functional pOC:Adlthony Anderson
Total Cost! Revenue. NA or No Cost[M Term: Si x (5) years
Contract Manager. Bradley Perry Phone: 850-617-2805
® New Contract (Procurement): ❑117113 ❑RFP ❑ITN ❑RFQ ❑Single Source ❑Informal Quote
❑Exam pt per , Florida Statuttes N Not Required
❑ Renewal ❑ Amendment ❑ Extension
❑ Settlement Agreement ❑ New J Revlsed Template
Ad provals Comments
Contract Administrator
ErFaa310natl by:
i nature; Daite:9/29/2023
Division 0iEzcjkarAadfGr Designee
6ocus4gr dq:
Sig natu re: �Pr Or rwro. C1atP.=9.' 9/ D3
ETEA17mrq"F1
Signature: Date-
Budget
Signature: Date:
® If cracked,budgetary reviewiepproval is not required Em Funds are not
expended under this Cgntrt� reenrarrt.
ACCUunting
Signature: Date:
IJ If shacked,ap=unlinQ raviiewlapproval is root required as Funds are not
received or obligaled under this Cordracb reement.
Information Services
Signature: Date_
[A If checked,]$A revlew/approval is not required as this doCLsnenl does
no Impga Informaflon s
QAS Chief Administrative Officer
Signature: Date:
I2 If checked,DAS Chief Administrative CKficer reviewlapprovel is not
required as the document is a previously-approyed boderplele.
Legal
Signature: Date:
CR If dtrecked,legal revlewfappcoval Is not required as the docurnenl Is a
previouW-apomed boilerplate.
Chief of Purchasing &Contracts
CWc Iignrtl
Signature' I Datea/29/2023
Director o t r 1i`ii`&gmtive Servioes
by.
Signature; 6,LiLL. Lill Data:10/11/2023
❑ If checked, is nN required as the d0oument is a
prwjousty-approv6d boflar late.
Deputy Executive Director
Signature: date=
If chackad,reutewlapprowal by Deputy Executive Directoris not required
as the dommerrt is either an approved template or does not fall under the
Deputy DepuLy Executive Dir&clor's areas of e4sponsibility.
Child of Staff! Executive Director
CW I$' ..
Signature;1 JuKmAr I f Date.1011112423
❑ If checked, @rp t r .Oy Chief of SlafflExncubve Director is not
required sa the document is either an approved template or does rrpt
require review the Chief of StafflExecutive Director.
H MV 06020("2019)
DocuSlgn Envelope ID:AE8CI065-4FB2-4E23-8F2C-EC15553C4405
Dave Kerner
Executive diractor
F L 11=1' S M V
FLORIDA HIGHWAY SAFETY AHb640TORVEHICLES 290UApalacheeParkway
Tallaham@, 32399-0500
www,flhsmv.gov
January 17, 2023
TO: Kevin Bailey, Directo
Division of Administrative SVrMimm
THROUGH: Robert R. Kynoch, Director
Division of Motorist Services
FROM: Stephanie D. Duhart, Chief A i rative Officer
Program Planning Administr, ion, Division of Motorist Services
SUBJECT: Delegation of Authority for Motorist Service Agreements
Effective February 14, 2022, Division of Motorist Services Director Robert Kynoch has requested that all
Me,morardunis of Understanding (MOUs)related to Driver and Vehicle Information Database (D.A.V.I.D — law
enforcement agencies or government entities)be signed via DocuSign by Bradley Perm,,Bureau+Chief of Records.
In addition to D.AN I.D., Cbief Perry will also sign all Facial Recognition MOUS, Bradley will be the last, and
final approver regarding bath Facial Recognition and. D.A.V.I.D. MOUs (LEAS and government entities), All
oduer MOUs and/or agreements relate to Data Exchange, whether amendments,templates, contracts or updates,
will be signed by Director Kynoch.
Please feel free to contact me if you have questions. I can be reached at (850) 617-25 6 or
tit�l�li.ao7icL14alrf�rrt�c�t�h�:r���.P,t�e ,
CC; Richie Frederick,Deptay Division Dim tor,Division of Motorist Services
11radIcy Perry,Chief,bureau of Records, Division of Motorist Services
Mark Hernandez,Chief,Purchasing and Convacts, Division of Administrative Services
Flizabcth Miles,ICommot Adininistrator and Tern Supervisor, Division of Administrative Services
SDD,'nd
C, File
Service * integrity • Courtesy • Professionalism • Innovotion . Excellence
An Equal Opportunity Employer
DocuSign Envelope ID:AESCIDBS-0F82-4E238F -EC1555K4405
DAVID
Memorandum of Understanding (MOU)—Item check list
Agency Name.•kequesta Police Department
Documentation of current licensure or certification from resident state of corporation
Reviewed copy of requestor's business license.
❑ In state corporation status obtained from www.sunbiz.org.
Or
Out of State Corporation licensure or certification submitted by requester (attached).
Reviewed requester's website comparing DPPA exemption tlairred to the business needs or
services provided to third parties..
If vendor is acting on behalf of a government agency, a letter of authority i5 attached.
This is a Government agency.
This is a Law Enforcement Agency.
Memorandum of Understanding
Current forms have been provided.
F] Requester has provided appropriate signatures.
Letter of delegation is required if signed by other than authorized official.
0 SW�W_
/
Reviewed by: LDate: 9/26/2023
Deepa vasudevan
Bureau of Records
DocuSign Envelope ID:AE8CI065-4FB2-4E23-8F2C-Ec15553C4405
FLU
Contract Number H MV- 0221-24
MEMORANDUM OF UNDERSTANDING
FOR LAW ENFORCEMENT AGENCY ACCESS TO
DRIVER AND VEHICLE INFORMATION DATABASE SYSTEM (DAVID)
This Memorandum of Understanding (MOU) is made and entered into by and between
Tcquesta Polioe Depaikment
hereinafter referred to as the Requesting Party, and the Florida [)apartment of Highway Safety and Motor
Vehicles, hereinafter referred to as the Providing Agency, collectively referred to as the Parties-
I, Purpos
The Providing Agency is a government entity whose primary duties include issuance of motor vehicle
and driver licenses, registration and titling of motor vehicles, and enforcement of all laws governing traffic,
travel, and public safety upon Florida's public highways..
In carrying out its statutorily mandated duties and responsibilities, the Providing Agency collects and
maintains personal information that identifies individuals- This information is stored in the Department's Driver
and Vehicle Information Database system, commonly referred to as "DAVID." Based upon the nature of this
information, the Providing Agency is subject to the disclosure prohibitions contained in 18 U. -C. 2721,
the Driver's Privacy Protection Act (hereinafter "DPPA"), Section 119.0712(2). Florida Statutes, and other
statutory provisions.
The Requesting Party is a law enforcement agency operating under the laws and authority of the state of
Florida. As a law enforcement agency, the Requesting Party may receive personal information from DAVID under
the government agency exception provided in DPPA as indicated in Attachment I. The Requesting Party
utilizes OAV'IID information for the purposes of c-arrying out its statutorily mandated law enforcement and
prosecutorial functions.
This MOU is entered into for the purposa of establishing the conditions and limitations under which
the Providing Agency agrees to provide electronic access to DAVID information to the Requesting Party. Use of
the data I)y Requesting Party shall only be for a lawful purpose.
It. Definitions
For the purposes of this Agreement, the below-listed terms shall have the following meanings:
A. DAVID - The Providing Agency's Driver and Vehicle Information Database system that accesses and
transmits driver and vehicle information.
B. Graver License Information - Driver license and identification card data collected and maintained by the
Providing Agency.This information incl,ides personal information as defined below,
C- Emergency Contact Information (ECI) - Information contained in a motor vehicle record listing
individuals to be contacted in the event of an emergency, Emergency contact information may be
released to lava enforcement agencies through the DAVID system for purposes of contacting those
listed in the event of an emergency. as noted in Section 1 19.0712 (2)(d), Florida Statutes.
D. Driver Privacy Protection Act (DPPA) - The Federal Act (see, 18 United States Code § 2721, et seq-)
that prohibits release and use of personal information except as otherwise specifically permitted within the
Act,
E- Government Entity - Any non-law enforcement agency of the state, city or county government and
all Federal agencies,which may include Federal law enforcement agencies.
P- Insurance Record — Insurance information, such as Insurance Company name, policy type, policy status,
insurance cfeation and expiration date provided to the Requesting Party, pursuant to Section
34.24 (2),Florid$tatutes.
DAV'ID(LEA) MOU N T I S (New 111 019�
DocuSign Envelope ID:AEBCIDBS-0F82-4E238F -EC1555K 405
D, Parties.,The Providing Agency and the Requesting Party,
11. POMOr)al Into"natlon As described In Chapter 119, Florida SWutes, Information Found in the
mn(or ve9h9cle record, which includes, bug is not limited to, they subject's driver identification number, name,
address. telephone number. soclal security number, medical or disability inrormatlpn, and am�?rgency
contact in Formation,
I- Point-OF•Contect (POC) - A parson(s) �ippoinled by the Roquosflng Party as the administrator of the
DAV 10 program in their agency.
J, Providing Agency-The Florida Dupartment of Highway Safety and dolor Vehicles. The Providing Agency
Is responsive for granting access to DAVID information to the Requesting Party,
K, Querlerly QuaMy Control Review Report — Report snnp1olrxl Path gLAArtOr by We Ropuw"tmg Pelrty'a
POO to monitor cornplianco with tho MOU_ The following niu5l bo included in they Quartorly Qunlily
Control Review Report:
1, A comparison of the DAVID users k}y agency report with the agency user list.
2. A listing of any nova or inactivated users since the lasl quartorly quaiityconlrvl revlOw, and
3. Docurnwatlon verifying that usage has boon Internally monitored to ensure proper,aulhvrized use
and dissemination,
L. Requesting Party - Any law enforcement arse ricy that Is expressly authorized by Section 119,0712(2).
Florida Statuloa, and DPPA to receive personal Information contained In a motor vohlcie record
nialntalned by they ProvidIng Agency.
M_ Vehicle Information -- Tiller end registra lion data collected and mslntaini�d by the Providing !Agency
for vehicles,
Iii, Leall Authority
1'he Providing Agency maintains computer databases containing Information purtaining to +drivenr's licenses
and vi.r11k1el s pr,rsuanI to Gharptors 317, 319, 320, :322, 32 8, Land Section 324.242(2), Florida Statutes. The driver
license and motor vaNcie data contained In the Providing Agency's databases is defined as public reoord
ptirsuaiit to Chapter 119, Florldal Statutes, and as such, fs subjeci to public disclosure unless otherwlse axe m fated
by lain+.
As the custodian of the state's driver and vehicle records, the Providing Agency is required to provides
access to records permitted to be discloserd by law+ and may do so by remote elecironle aeons pursuant to
Sections 119.0712(2). 320,05. 321.23, 322.20, and 24,242(2), Florida Statutes, and applicable rules.
Under this MOU, the Requesting Party will be provided, via n!tmotea electronic means. Information
pertaining to driver Ilcegnses and venleles, including personal information authorized 10 be released pursuant to
Section 119,0712(2). Florida Statutes and DPPA. By executing this MOU, the Requesting Party agrees to
maintain the confidential and exempt status of any and all Information provided by the Providing Agency
pursuant to this agreement and to ensure that any person or entity accessing or utilizing sold information shall
do so in compliance with StWion 119,0712(�), Florida Statutes and DPPA,. In addition. the Requesting Party
agrees that insurance policy Information shall be utilized pursuant to Section 324.242(2), Florida Slatules,
Furthermore, the dace ased date of an Inrdfvidual Stall only be prodded to a Requestlnq Party that rneects the
quafiflcatlons of 15 CFR §1110.102. Disclosure of the deceased date of an individual, which is not in compliance
with 15 CFR §1110.102. is punishable under 15 CFR §1110.200. Additionally, because the Social Security
Administralion does riot guarantee the accuracy of t" Death Master File (DMF), the Requeellrig Party is reminded
that adverse tactlon .should not Na t8kerr against any individual without further investigation to verify the death
Information listed,
This IOU is governed by the laws of the state of Floricla and jurisdiclron of end{ disputo arising from
this Pk OU shall be in Leon County, Florida,
DAVID (1eFA)MOLJ NTIS (New 1112011))
Page 2 of 9
DocuSign Envelope ID:AEBCID95 OF82-4E238F -EC1555K 405
IV, Statement of Vork
A, TheProvideng Age ncyagreesto:
1, Allow tho Requesting Party to electronically access DAVID as authorized under this agreement_
2. Provide electronic access pursuant to established roles and tlmes, which shall be
uninterrupted except for periods of scheduled maintenance or due to a disruption beyond tho
Providing Agency's control, or In the event of breach of thl.s MOU by the Requesting Party.
Scheduled maintenance will normally occur Sunday mornings between the hours of 6:00 A-M.
and 10-00 A.M. EST.
3, Provide an agency contact person for e:;sistance with the Implementation end administration of
this MOU.
B. The Requesting Party agrees to:
t. Utilize information obtained pursuant to this MOU, including Emergency Contact Information
(ECI), only as authorized by law and for the purposes prescribed by law and as furlherdescribed
in this MOU. In the case of ECI, such Information shall only be used for the purposes of
notifying a person"s registered emergency contact in the event of a serious injury, death, or
other incapacitation. ECI shall not be released or utilized for any [ether purpose. Including
doveloping leads or for criminal investigative purposes,
2. Retain information obtained from the Providing Agency only if necessary for law enforcement
purposes. If retained, information shall be safeguarded in compliance with Section V.
SafeauardIng Informallon.subsectionQ_
3, Ensure that its employees and agents comply wilh Section V. Pfegu Hrdirrg Iriforma11J.9-y.
4, Refrain from assigning, sub-contracting, or cthorwiso transferring its rights, duties, or
obligations under this MOU,without the ipricif written consent of the Providing Agency.
5_ Not share, provide, or reloase any DAVID Information to any other law enforcement,
governmental agency.Pierson,or entity not a party or otherwise subJect to the terms and conditions
of this MOU_
6. Protect and maintain the confidentiality and securltyr of the data receivad from the Pfovlding
Agency in accordance with this MOU and appl1cable state and federal law,
7. 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 access,
use, or dI5sern 1netion of infarrnatlon provided by the Providing Agency,tO ttio oxtont aIlowud bylaw.
S. Immediately inactivate user acc#sslparmissions following termination or the determination of
negligent. improper. or unauthorized usia or dissemination of information and to update user
accessipermisslon8 upon reassignment of users within five(5)business work days,
g. Complete and maintain quarterly Quatity Control Review RepMs as defined in Section II.
IOefinitions, K,and utilizing the form atlechud as Attachment I I_
10, 'Update any changes to the name of tho Roquosting Party. Its Agency hoad, Its POC, address,
telephone nurrrber anWar e-mail address in the DAVID system YAthin ten calendar days of
occurronccr_ Tho Requesting Party is hereby put on notice that failure to timely update this
information may adverseIV ;effect th$ time frames for receipt of Information frornthe Providing
Agency,
DAVID(LEA) MOU NTIS(New 1 V2019)
Page 3 of 9
DocuSign Envelope ID:AEBCID95 OF82-4E238F -EC1555K4405
11, Irnmediatoly comply with any restriction. linnilgtion, or oondillon uriacted by the Florida
Legislature following the date of signature c4 this MOU, affecting any of the proviaicxrs herein
stated. The Requesting Party understands and agrees 1hat it is obllgateel to comply with the
applicable provisions of law regarding the subject Madtor of lhls Agreement at all times that It
is receiving, aocsssing.or utilizing DAVID Informalion.
12. Cooperate with the Providing Agency In Field Audits conducted pursuant to Sectiori VI..GornpliarLr�
and Control I1r asures, subsection B., below.
13. Timely submit the reports and statements required in Section VI. Compliance and Control
Measury!�.buIow.
14. Access and utilize the deceased date of eau individual. or ether information from the NTiS Limited
AC:cass Death IvAslef File, as defined in 15 CFR §1110.2, in conrormity with 1:110 following
rvq uiremen ts:
a) Pursuant to 15 CPR §1110 102, the Requesting Party cerldles that Its access to DMF
Information is appropriate because the Requesling Party: (1) has a logitlmsto fraud
prevention Interest, or a legitimate business,purpo,4e pursuant to a Iran+, governmental rule„
regulallon, or flduciar+y duty; (ii) has systems, facllftlas, and procedures in place to
safegugrd such information, and experle nce In rnainlaining tho confidentiality. security,
acid approprialu use of such information, pursuant to mquireinents reasonably similar to
Ihn requirements of saellorl 6103(p)(4) of the interna? Reverwe Cade of 1986, and (Ili)
agrees to siAisfy such similar requirements.
b) Purs,uant to 15 C F R §1110.102, the Requesting Party cartifles that it w1lI riot; (i) disclose
DMF Information to any person other than a person wbo meets Me requirements of
Section IV, Statement Qf Wart, subsection B. paragraph 14 (a), above; (ii) disclose DMF
Information to eny person who uses the Information for any purpose other then a legitimate
fraud proventlon Inle rest or a leg I(rns(e business pUrpcase pursuant to a law„governmental
rule, regulation, or fiduciary duty; (W) disclose DMF Informations to any person who further
discloses the information to any per-+on other than n person who rneel:s tha requirements
of subsection IV. B. 14 (a),above; or (iv) use UIVIF Information for any purpose other than
a legitimate fraud prevention interest or a legltirnate business purpose pursuant to a law,
govern mentai rule, regulslion or flduolary duty.
V. Safeq�jarding lrlfarrnat,ion
The Parties shall acc+gss, disseminate, use and maintain all information received kinder this MOO in €r
manner that censures itsconfidentiality and proper utilization in accordance with Chapter 119, Florida Statutes,
and DPPA. Information obtained under this MOU shall only be disclosed to persons to whom disclosure 1,9
authorized under Florida law and federal law.
Any person who willfully and knowingly violates any of the provisions of this seclion is guilty of a
misdemeanor of the first degree punishable as provided In Sections 119.10 and 775,083, Ploridar Statutes, In
addition, any person who wllifuIly taiId knowingiy discloses any Information in violation of OPPA rTaay be sublecl
to criminal saanctions and civil liability_ Furhermore, failure to corrtply with 15 C F R §I I10.1D2 pertaining to the
deceased date of an individual may result In penelltles of S1,000 for each disclosure or use, trp to a n1aximum of
$2 50,000 in ptrnaIlies per calendar year, pursuant to 15 CFR §1110.200.
Tlie PArlies rn utua11y degree to the followlrag;
A, Information exchanged will not be used for ,any purposes not specifically authorized by this MOO.
Unauthorized use inc:lueles, but Is not lirnited to, queries not related to a legidniato husinees purpose.
perrsdrial use,or the dissernination,sharing,copying,or passl17g of this information tounautharized persons.
3. The Requesting Party shall not indemnify and shall not be liable to the Providing Agency for any driver
DAME] (LEA}MOU NTIS (New 111201.0)
Page 4 of 9
DocuSign Envelope ID:AESCIDBS-0F82-4E238F -EC1555K4405
license or motor vehicle information last, damalgod, or destroyed as a result of the electronic exchange
of data pursuant to this MOU, except a$otherwise provided in Soeion 768_28,Florida Slatutes,
C, Any and all DAVID-related Information provided to the Requesling Party as a result of this MOIJ,particularly
data from Cher DAVID system, will ba stored In a place phySiceIly secure from access by unauthorizeel
persons,
D, The Requesting Party shall Comply with Rule 60GG-2, Florida Administrative Code, and with Providlng
AgancVs security policies. and employ adequate security meBsures to protect Providing Agency's
information, applications, data, resources, and seNces, The applicable Providing ngenCy's severity
policies ehali be made available tO ROCiLiostinrg Party. Additionally, with respect to the daceased date of an
Individual. the Requesting Party shall have systanis, facilities, and prooedures irx place to safeguard such
informatlon, and +experfeance In rnaintalning the confldentiallty, security, and appropriate use of such
Iraformatlon, pursuant to requirements reasonnhly ;~imilar to then requirements of section 6103(p)(4) of the
Intornal Revenue Code of 1986 and agrees to satisfy suoh elmilar re quiroments.
E. When printed information [torn DAVID has met Fecord retention, It shall be destroyed by Bross-cutshrWdIng
or Incineralion.in a=rdance with Florida law.
F. The Requesting Party shall maintain a list of all persons aulhorized within the agency to access DAVID
inforrmatiOn, The tilt wlli not be provided to f►e Providing Agency but smell be subJect to vlowing during any
field audit conducted t>y the Providing Agency or Ire the event of a violation under Section Vi, Cornpl!an4
aril Control ea cur , subsection D, of WeMC1t1 for the purposes of ascemalning whether the per�en or
persons Involvod have been removed from tho list or have othe lso had thoIr DAVID access modified or
llrrtited.
G. Access to DAVID-related Information. paarticularly data from the DAVID Syslem, wIII be protected in such
a way that unauthorizelhd persons cannot view, retrieve,or print the inf arm a0an.
He Under this MOU agreement, acoass to DAVID system shall he provided to users whoa are dIrect employees
of the Requesling Party and shall not be provlded to any rion-empkay6,e or contractors of the Requesting
Marty,
t, By signing this MOU, the Parfios, through their signatories. affirm and agree to maintain they confideniiallty
of the information exchanged through 1hIs agreement.
Vt. Corrielience anal Control Measurelt
A. Quarterly Quality Control Reylew Report — gust be corrlpWed pursuant to Section. IV, 13(g), utilizing
Attachment 11, Quarterly Okiality Control Re?vi+ew Deport, within 10 days alter the end of mach quarter rind
maintained for two years. The following roust be Included in ihi�Quarterly Quality Control Rervlew Report:
1, A com parl son of tho DA ID users by agency report with Iha agency user list;
2. A IlstIng of any new or inactivated users since the last quarterly quality control revIew, and
3. Documentation verifying that usages has been internally rnorAored to ensure proper,
authorized use and dlssernlna#ion utilizing the auditing fractures available In DAVID.
13, Fleald Audits -- Field audits shall be conducted by the PmAding Agericy in order to ensure that
MOU requkernents concerning Internal controls area being met. Field audits shall be conducted on-site
by Providing Agency employees, who shall be designated sa 'Field Liaisons" for the purposes of this
MOU. Field I Iaisons shall be geographically located throughout ft state. The Requesting Party shall
cocpe rate with the Field Liaisons in conducting field audlta by granting access to systems and records
related to this MOU and aselgning appropriate personnel to respond to information reg4aests.
Audits shall be conducted a minimum of once, every two years_ Field Liaisons shall contact the PQC
in order to schedule the audit. At the completion of the audit, the Field Liaison will complete ;a report
and provide a copy to the Requesting Party within ninety (90) days of the audit date. Should than
audit report conclude that deficiencies or issues oxiit in regard to the Requesting Party's internal
DAVID (LEA)MOU NTiS (Now 1112019�
Page 5 of 9
DocuSign Envelope ID:AESCIDBS-0F82-4E238F -EC1555K 405
controls, or access to Dr use of DAVID inforrnation, Providing Agency reserves 910 right to tako.
based upon the nalure of the defi6ende8 issues found. any or all of the following actions. audit more
frequently than once, every two years; andior suspend or terminate Requesting Patty's access to
DAVID information until such time a$ Requesting Party submils proof SAtlsfactory to the Providing
Agarrcy that the deficienclesJissues have been corrected,
C. Internal Cvnttol Attestation This MOU is contingent upon the Requesting Party having appropriate
Internal controls in place at all times that data is being providedireceived pursuant to this MOU to onsurs
thntthe date is protected frorn unatilmorized access, distribution, use, modification. or disclosure. The
Requesting Party nnust submit art Atteslation statement no later Than 45 days after receipt of then audit
report referenced in Section VI.. Corripliance and Control Meatiures, subsection B., abovo, The
Attestation shall indicalte that the internal controls over personal data have been reviewed and evaluated
in light of the audit findings and are adequate to protect the personal data from unauthorized access,
distrlbulion. use. rnadiFiication, or disclosure. The Atte elation shall also certify that any And all
doficluncioslissuos found during thre audit have boon corrected and measuros onacled to provont
recurrence. The Providing Agrincy may extend the time for sutrrnisslori of the Atteslatlon upon wrltien
request by the Requesting Party, The Attesiaililoil must have an original signature of the Chief, Sherlff, or
State Attorney, or person designated by better of Delegation to execule contracWagreernerits on their
bohaif, and may be sent via U.S. Mail,fac Sim ilo Iran smIssion,oro-mailod to the Providing Agoncy's 13uroau
of Records at the Ito Ilowing address;
Deapa rim ent of Highway Safety and Motor Vehicles
Chief, bureau of Records
2900 Apalachee Parkway. M599
Tallahassee, Florida 3 399-050D
Fax: (860)617-6168
E-mail: Dst LIs n UnIt . fIhsrnv, ov
D. Annual Cer#Ifi cat]on Statement-The Requesting Booty shall stjbmit to the Providing Agency an annual
statement Indicating that tha Requesting Party has evaluated and certifies That It has adequate controls
In place to protect the personal dala from unauthorized €ccess, distribution, use, modification, or
disclosure, and Is in full campllance wilh the regiuirements of this MOU. 'The Requesting Party shall
submit this stntomenl annually, Wthin 45 cinys after the enniversinry state of tl,ls MOU. (NOTE- Curing
any year in which a Field Audit Is conducted, submissim of the Internal Control Atteestatlon may satisfy the
requirement la submit an Annual Certtflcallon Stalernerit,) Fallure to timely submit the ce3rtlflcatlon
staiomonl may result in an irrtmadiate field audit and, based upon the findings of the nudil, susipurislon
or termination of Reiquesting Patty's access to DAVID information as indicated in Section VI. C omaliarrce
and Control MeeQurea, subsecllon B., above.
In addition, prior to expiration of this MOO, if the RerquastIng Party intands 40 enter into a new MOU..
a cerlif catlon statement attesting that appropriate controls rorrialned in place during the final year of the
MOU and are currently in place shall be required to be sribrrrltted to Ilse Providing Agency prior to
Issuance of a new MOU.
k. MIsuto of Personal InformatIon — The Requesting Party roust notify the Providing Agency in writing of
any incident where delerminotion is made that personal Information has been compromised as a result
of unauthorized access, distribution, use, modification, or disclosure, by any means, +within 30 days
of such delorr motion. `fhe stalemerit must be provided on the Requesting Patty's letterhead and Include
each of the following; a brief summary of the incident; the outcome of ibe revle : the date of the
oceurrence(s), the nuinUor of rocords oompromised, the name or names of personnel responsible;
whether disciplinary action or lerrrnination +vas rendered; and whether or not llhe owners of the
ccrn prom ised records were notified. The statement shall also ind lea te the steps taken, or to be taken,
by the Requesting Agency to ensure that misuse of DAVID data does not continue. This statement shall
bo mailod to tho i3urcau Chief of Records at the address Indicdtod in Section VI_ Compliance and
Control Measures, subsection C.. above, (NOTE; If an Incident involving brea0h of persurial
information did oocur and Requesting Party did not notify the owner(s) of the compromised records,
the Requesting Party must indicate why notice was not provided, for example "Notice riot stalutorlly
required.")
DAVIT] (LEA)M(XJ NTI S(Mew 1112019g
Page 6 of 9
DocuSign Envelope ID:AEBCID95-OF82-4E23_8F -EC1555K4405
In addition, the Requesting Party shall comply with the applI cab lo provisions of Section 501.171. Florida
Statutes, regarding data soC�jnly and security breaches, and shall strictly comply with the provisions
regarding notice provided therein,
Vil. Agreement Terrn
This MOU shall take effect upon the date of last signature by the Partia's and shall remain In effect for six (6)
years from this date unless sooner terminated or cancelled in accordance with Section IX. Termination. Once
executed. this MOU supersedes all previous agreements between the parties regarding the sarne subject rnsubject atter.
hill. Am-gn mein s
This MOU Incorporates all negotiations, interpretations, and understandings between the Parties regarding
the same subject matter and serves as the full .and final expresalon of their agreement- This MQU may be
amended by written agreement executed by and Wwefiri both Parties, Any change, alteration, deletion, or
addition to the terms set forth In this MOU. Including to any of its attachments, must be by written agreement
executed by the Parties in the same manner as this MOU was initially executed. If there are any conflicts In
the amendments to this MOU, the last-executed amendment Bharl prevail. All provisions not in conflict with
the arnendment(s)shall remain In effect and are to be performed as specified in this MOU,
IX. Term Inatlon
A. This MOU may be unilaterally terminated for cause by either party upon finding that the terms and
conditions contained herein have been breached by tho other party. Written notice of torrnination shall be
provided to tha txeaching party; however, prior-wrilton notice is not required, and notice may be provided
upon cessation of work under the agreement by the non-breaching parky-
R In addition, this MOU Is subject to unilateral termination by the Providing A oncy without notice to
the Requestin(J Party for failure of the Requesting Party to comply with any of the requirements of this
MOU, or with any applicable state or federal laws, rules, or regulations. Including Section 119,0712(2),
Florida Statutes,
C. This MOU may also be cancelled by either party, without penalty, upon 30 days' advanced written notice
to the other party. All abligation9 of either party under the MDU win rernnin in full force and effect during
the thirty(30)day notice period,
X. Notices
Any notices required to be provided under this MOU may be sent via U,S, Mall, facsimile transmission, or
e-mail to the following individuals:
For the Providing Agency;
Chief, Bureau of Records
900 Apalachee Parkway
Tallahassee,Florida 32399
Fax: (860)617-5166
E-mail: DstaListingUnit a,.flhsmv.gov
For the Requesting Party,
Agency Point-of-Contact Ilsted on the signature page,
Xl. Additigagi Database AcconLaybsoguont MOU's
The Parties understand and acknowledge that this MOU entitles the Requesting Party to speclfic information
inClWed within the scope of this agreement. Should the Requesting Party wish to obtain access to other personal
information not provided Hereunder, the Req lesklr,g Party will be raquired to oxecute a subsequent MOU with the
DA IO (LEA) MOU INTIS (New 1112019)
Page 7 of 9
DocuSign Envelope ID:AESCID95 OF82-4E238F -EC1555K4405
ProAdIng Agency speciftc to the additional inf€oration requosted. All MOU's granting access to personal information
will contain the serne clauses as are conwinod herein regarding audits. repar( submi8sinn, and I h a submission of
C artif(cation and Atte`matlon statements..
The Providing Agency is Mindful of the costs that would be Incurred If the Requesting Party wta-z" t6quir d to
undergo multiple audlis and to submit separate cerlifrcaticns, attestations. and reports for each executed MQt1-
Accordingly, shoutd the Requesting Party execute any subsequenl MOU with the Providing Agency for access to
personal Informatlorw white the Instant MOU Mmalns In 8ffect. the Requesting Party may submit a written request.
sub)eet to Provlding Agency approval. to submit one of each of the; following covering all axectiled MOU's.,
Quarterly Ouallty Control Revlaw Report; Certification; and Attestation: and/or to have conducted one
comprehensive audit addressing intoriwti controls for all exacuted MOU's. They Providing Agency shall haute the sole
discretlon to approve or deny such request in whale or In part or to su6sequendy ros Ind an approved request
based upon the Requesting Party's compliance with this MOU and/or any negative audit findings,
}Cll. Apallcation of Public Records Law
The parties to this Agreemrrent recognize end ackn owl adge that any govern niontaI agcricy having custody of
records rnade or receNed In connection with the transaction of official business remains msponsible for responding
to public records requests for those records in accordenco with state law (Including Chapter 1191, Florida SWtutvs).
and that public records that are exempt or confidential from public records discicsuro requirements will not be
disclosed except as authorized by law.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION
OF CHAPTER 119, FLA. STAT., TO THE CONTRACTOR'S DUTY TO PROVIDE
PUBLIC RECORDS RELATED TO THIS CONTRACT, CONTACT THE
CUSTODIAN OF PUBLIC RECORDS AT (050) 17- 101,
OGCFILII+J(C(a FLH MV.GOV, OFFICE OF GENERAL COUNSEL., 2900
APALACHEE PARKWAY, STE. A4 2, TALLAHASSEE, FL 323 9- 504,
X11L Cortificatinn tnfortnalion
Phirstiarrrl to Sncluori IV- 5t€rtC►meril of Work, subsectlon A paragraph 14(s), above, the Requesting 'Party
cartiflos that floss to DMF information is approprlate based on iho fallowing spocific lowposo (pleaso doscribe the
1e99tirnate purpose).
The Tequesta Police pepartment, being a local governmental law enforcement agency, has a fraud
-Prevention int .rest The Toque;sta Pa ice 1?epartrti�en will not_disclosc [)MF inforination to any. arson
5 1 4
for any+xtlier-thax) it legitimate fraud prcventi on inLe're'St or other law enforcement purposes— .
Ploase indicate whether the Requesting Party desires to ro-discloso tho docoasod date of any individual to
any other person or entity, Yes L No
If thin Rio questing Party desires lio re-disclose the dr~ceased date of any individual to any other person or eri*,
the Requesting Party,agrees that it will not re-dlrcl"e the data recohved from the Providing Agency, but rather,will
Ccntd�:l NTIS at I1 lips://+clasaic.aUs.gvvlproductsfsae-dmflg to became a Certified Verson, as defined by t5 CFR
1110.2. A Requesting Party who Is a Certified Pwson may only disclose the deceased date of anti W Ivldual
pursuant to the RequesVng Party's obligstlons under 15 CFR§1110.102_
REMAINDER OF PAGS INTENTIONALLY LEFT BLANK
DAMD (LEA) MOLL NTIS (New 1 V2019)
Page 8 of 9
DocuSign Envelope ID:AEBCIDBS-0F82-4E238F -EC1555K 405
IIV WITNESS HEREOF, the Parties hereto, have executed this Agreement by their d u I y a uthorized officials on the date(s)
indicatc-d below,
REQUESTING PARTY PROVIDING AGENCY:
Tequesta Police Department Florida Department of Highway Safety and Motor
Agency Marne Vehicles
357 Tequesta Drive 2900 Apalachee P8rkway
Street Address Tallahassee, Florida 32399
Suite
Tequesta FL 33469
City State Zip Code
BY: BY,
ooeu4Hlntd by'
v6LC,uEs2t - -
Signature of Authorized ffa 3iggnaturo of Authorized Official
MoHy Young mart Hernandez
Printedrryped Name PrintedlTyped Name
Mayor Bureau Chief, Purchasing & Contracts
Title Title
p".�b 10/12/2023
Date Date
myoung tequesta.org
Official Agency Email Address
51-78-04f
Phone Number
Agency Poinl of Contact:
Jillian Leigh
PrinledlTyped Name
j1eigh(41'terlue9ta.org
Official Agency Email Address
561-7 8-0505 J Phone Number
J Fax Number
DAVID (LEA) MOU NTIS (New 1112019)
Page 9 of 9
DocuSign Envelope ID:AEBCIDBS-0FB2-4E238F -EC1555K 405
ATTACHMENT (
FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
Request For Access to Driver And Vehicle Information Database System (DAVID)
The Driver's (Privacy Protection Act, 1B United States Code sections 2721 J"DPPA") makes personal information
contained in rnotor vehicle or driver license records confidential and exempt frUrn diSGIQSure. Personal informaliori
in a motor vehicle or driver license record includes, but is not limited to, an individual's sacral security number,
driver license or identification number, name, address, and medical or disability information Personal information
does not include information related to driving violations and driver status. Personal information from these records
may only be released to individuals or organizations that qualify under one of the exemptions provided in DPPA,
which are listed on the back of this form.
I am an authorized 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 exemption
number(s)
One 1 , as listed on page 2 of this form.
I understand that I shall not use or redisclose this personal information except as provided in DPPA and that
any use or redisclosure in violation of these laws or statutes may subject me to criminal sanctions and civil
liability.
Complete the following for each DPPA exemption being claimed (attach additional page, if necessary);
OPPA Description of how R gLlosting Party Description of haw data will be used:
Exemplion qualifies for exemption;
Claimed: Law enforcement purposes
For use by any governrnent agency, p 1'
1 including any court or law enforcernent
agency, in carrying out its functions,or
any private person or entity acting on
hehalf of a Rderal, State,or local
agency in carrying out its functions.
Obtaining personal information under false pretenses;is a state and federal crime_ Under i ejwil"iriL, of perjury.
declare that I have read the foregoing Request For Access to Driver And Vehicle Information Database System
,and that I am entitled to receive Exempl Personal Information in A Motor VehricWDriver License Record and
that the facts stated in it are true a correct,
Mayor
ignatOe of AdWorize {}fficial Title
Molly Young Tequesta Police Department
Printed Dame Name of AgencyiEntity
- AD D --
Date
Page 1 of 2
DocuSign Envelope ID:AEBCID95 OF82-4E238F -EC1555K4405
ArrAcr'aMSNT f
Pursuant to Section 119.0712(2), F. S„ personal infQrniation in motor vehicle and driver license records osier bt-
releasead for the following purposes, as outlined in 18 Unitead Slates Code, section 2721:
Persocal information reCferroid to in subsection (a) shall be disclosed for use In conneclion with mailers of w alor
ve Nele or driver safety and theft, motor vehicle emissions. motor vehicle product alterations, recalls, or advisories,
pe►rfo(mancee mar coring of motor vehicle ie and dealers by rnotor vehicles manufacturers, and removal of non-owner
records from the original owner records of motor vehicle manufacturers to carry oul the purposes of Titles I and IV
of the And tsar Theft Act of 1992, the Automobile Information Disclosure Act(15 U.S.O. 1231 el sep.), the Cloon Air
Act(42 U.S.C. 7401 el sect-), rental chapters 301, 305, and 321-331 of Title49,CFI,and,subject to subsection (H)(2),
may bed d1 sclosod ns follows,.
1. For use by any government agency. inClUding any court or law en(orceme nt agency, in carrying out its
fLincltons, or any privatee person or entity acting on behalf of a Federal, State, im local agency in carrying
out its iuncNons-
2- For use In connection with mattes of molar vehicle or driver safety and theft; motor vehicle emissions;
motor vehicle product alterations, recalls, of advisories; paFformaree;ea monitoring of motor vehicles, motor
vehicle parts and dealers: motor vehicle markm research activities. Including Survey research: and removal
of non-owner records from the original owner records of motor vehicle manufacturers.
3. For use in the normal scourge of buslness by a iegitimate business or its agents, employees, or contractors,
but only-,
a) to verify the accuracy or porsonW information*vbmllted 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 longue correct, to obtain the correct
Informadan, but only for the purpases of preventing NO by pursuing legal remedies against, or
recovering on a debt or secLrr ly Inlerest against, the IrtdivldAl.
4. M'or use In connection with any civil, criminal, adrminlstrattve, of aarbitral proonding in any Federal, Stele,
or IoCal court or agerloy or before any se d-regeutat+ory body, inctudi„V the ese mice of process, investigation
In anticipation of litigation, and the execution or enforcement of judgments and orders, or pursuant to an
order of a Federal, Stale, or local court.
5. For Ilse in ra8earch activities, jand for use In produClnq sletlstir;al reports. so long o the personal
Information is not published, rodlsclosud, or tiled to contact individuals.
b. For use by any insurer or insurance support organization, or by a self-insured entity, or its agentis,
e oyees, oar Contractors, In Conneotion with claims Invesligatlon actlymes, anlifrrlud activllias. rating or
un rwrifing.
7. For use in providing noticea to the ownears of towed or impounded vehicles.
S. For use by any IICensed:private InvestIgalive agency or Ilconc e d oecurity service for any purpose permitted
in accordance with 18 USC 2771 (b).
9. For use by are employer or Its agent or insurer to obtain or verify inf0errrAirsr, eslatiricg to a hoddui of a
commercial driver's IlConse that is required under chapter 313 of Title 49, CFR.
10. For use In connection with the operation of private tall transpe;arte3llon facilities.
11. For any other use in response to requests for individual nrintor vehicle records if the Mate has ohlainod the
express consent of the person to whorn such personal information pertains.
12. For bulk distribulion for sLwvays, marketing or solierltations if the State has obtained the express consent of
We person to whom such personal inft> oration pertains.
13. For us by any requestebr,If tho requoster demonstrateas it has obtained the=written ronsent of the individuaI
to whoa the information pertains.
14. For any other use specifi6ally authorized under tho iew of the Slets that Molds the record, If such use is
related to ills oiu.ration of a rmolor vehicle or public safety-
Page 2 of 2
DtcuSign Envelope ID:AEBCIDBS-0F82-4E238F -EC1555K4405
C
Andr,aU. . Depariment of Commerce
FialIPlaI FllFfll[iF IhFlfl1i11915lf11[C � 1 VA 22312
IMPORTANT NOTICE
On. November 1, 2011, the Social Security Administration (SSA) implemented an important change in
the Death Master File (DMF) data. NTIS, a cost-recovery government agency, disseminates the Limited
Access DMF can behalf of SSA. The Lirnited Access Death Master File contains data on deceda tits who
died less than 3 years ago.
Please see the Q and A below, provided by SSA (and edited by NTIS to change the tense once the change
had been implemented) for an explanation of the change.
Should you have any questions, please email jhoiinsell,@ntis.gov who will forward any questions not
answered below to the Social Security Administration for reply.
IMPORTANT NOTICE:
Change in Public Death Masten File Records
NTIS receives Death .Master File (DMF) data from the Social Security Administration (SSA). SSA receives
death reports from various sources, including family members, funeral hordes, hospitals, and financial
institutions.
Q» What change has SSA made to the Public DMF?
A: Effective November 1, 2011, the DMF data that NTIS receives from SSA no longer contains protected
state death records. Section 205(r) of the [Social Security] Act prohibits SSA from disclosing the state death
records SSA receives through its contracts with the states, except in limited circumstances. (Section 205r
link - 1ittp://www.ssa.govlOP_Iloine/ssact/titicO2/0205.htin)
Qm. How did this change affect the size of the Public DMF?
A: The historical Public DMF contained 89 mullion records. SSA removed approximately 4.2 million
records from this file and adds about 1 million fewer records annually.
REMINDER:
DMF users should arrays investigate and verify the death
listed before taking any adverse action against any
individual."
National Technical Information Service Email. DMFCERT NTIS.GOV
5301 Shawnee Rd Fax: 703.605.6900
Alexandria,VA 22312-2312 Form Number,N TIS FM161
DtcuSign Envelope ID:AEBCID95 OF82-4E238F -EC15553G4405
Da"Kerner
. Exe4U'LlwP QrL*G9pr
FLI: s111
FORMA WtGHWAY SAFm AND P40TOR VEHICLES
29r14 Apatachee F'aFkwsr
Ta Irahas*et F k7rida 3739M5W
wxw.rlh%rwy.gw
ANNUAL CERTIFICATION STATEMENT
In accordance with Section VI., Part D, of the Memorandum of Understanding between Department of
Highway Safety and Motor Vehicles (Providing Agency) and
(requesting Party) hereby Affirms that the Requesting Party has evaluated and have adequate controls in place
to protect the personal data from unauthorized access, distribution, use and modification or disclosure and is in
full compliance as required in the contractual agreement (contract number).
Signature
Printed Name
Title
Bate
NAME OF AGENCY
------------------------------------------------------------------------------------------
• S°ervice + Integrity - Courtesy - Piciessionalisrn • Innovation • Excellence
An Equal Oppoitunity Employer
DocuSign Envelope ID:AEBCID95 OF82-4E238F -EC15553G4405
Dave Kerner
Executive Dire€w
FL SMV
FLORIDA HIGHWAY SAFETY AND hADTOR VEHICLES ZX0Apa[a€hee Parkway
TaMhamee,Florida 32395-0U0
wow flh5rnv.pv
ATTESTATION STATEMENT
"oiaract Number
In accordance with Section VI.,Part C, of the Memorandum of Understanding between Department of Highway
Safety and Motor Vebid es and (Requesting Agency), this MOU is
contingent upon the Requesting Party having appropriate internal controls in place at all times that data is being
provide received pursuant to this MOU to ensure that the data is protected from unauthorized access,
distribution,use, modification, or disclosure_ The Requesting Party must submit an Attestation Statement no later
than 45 days after receipt of the audit report referenced in subsection B. The Attestation Statement shall indicate
that the internal controls over personal data have been reviewed and evaluated in light of the audit findings and
are adequate to protect the personal data from unauthorized access, distribution, use, modification, or disclosure.
The Attestation Statement shall also certify that any and all deficiencies/issues found during the audit have been
corrected and measures enacted to prevent recurrence. The Providing Agency may extend the time for
submission of thi Attestation 'Statement upon written request by the Requesting Party for good cause shown by
the Requesting Party-
{RNuesting Agency}hereby attests that the Requesting Party
has evaluated and have adequate controls in place to protect the personal data from unauthorized access,
distribution,use, modification or disclosure, and is in full compliance with requirements of this contractual
agreement.
Signature of Authorized Official Signature~ of Auditor
Printed Name Printed Name
Title Title
Bate Date
NAME OF AGFNCY
------------------------------------------------------------------------------------------
• Service • Integrity • Courtesy • Professionalism • Innovation • Excellence
An Equal Oppextunity Employer
LEA Rev. 01123
DocuSign Envelope ID:AE8CI065-4FB2-4E23-8F2C-EC15553C4405
ATTACHMENT II
1, VLFJ 191
QUARTERLY QUALITY CONTROL REVIEW REPORT
Point of Contacts (POC) must do the following to satisfy the MOU Quarterly Quality Control Review:
Compare the DAVID Users by Agency report with the agency user list.
o Reconcile any differences to ensuro Mato and agency records are consistent.
Keep a record of any new or inactivated users since the lest Quarterly Quality Control Review.
o Update any usersluser information as needed, document the reason for the change in
access, and the date the change is made.
Monitor usage to ensure proper, authorized use and dissemination.
* Randomly select a sample of users and run an audit report for a period during the quarter.
Look for any misuse, Including, but not limited to reason codes, running siblings, spouses,
ex-spouses, celebrities, and political figures. Look at the times of day the data was
accessed, repeated runs of same record, and unexplained access to the Emergency
Contact Information.
* Please note: DHSMV highly recommends the agency audit users as frequently as
possible to ensure misuse is not occurring.
�► Complete the below r"rt and ensure all actions are documented-
Quarter: ---- Year:
Total active users in DAVID
Total active users in agency records;
Users inactivated during quarter: �—
Users audited during quarter:
Total eases of misuse found:
Total cases of misuse reported to DHSMII,
POQ Signature Date
POC Name Printed
DocuSign
Certificate Of Compielkm
Envelope Id:AE8ClDS5OFB24E238F2+CEC15553 4405Status;Completed
Subject; DAVID LEA MU Renewal-Tequesta Police Department
Source Envelope:
Document Pages; 18 Signatures; 7 Envelope Originrator-
CeWicale Pages:3 Initials:0 Anthony Anderson
AutoNav:Enabled 2900 Apalachee Parkway
Envelopeld Stamping:Enabled Tallahassee, FL 32399
Time Zone;{UTC-05-.00)Eastern Time{US&Canada) anthonyanderson flhsmv-gov
IP Address: 164.51.75.1
Reciord Tracking
Status:Original Holder.Anthony Anderson Location: DocuSign
912612423 11:04,44 AM anthonyanderson flhsmv.gov
Signer Events Signature Timestarnp
r
67eepa Vasudevan aw�pw"b Sent;9l26211323 11;13:01 AM
deepavasudevan@flhsmv.gov � ly""'f`V.41 Viewed:9 6�2023 11:16;10 AM
Operations Manager {A6i0F@h937BiC� Signed.912612023 11:18:20 AM
HSMV-MS
Security Level:Email,Account Authentication Signature Adoption:Pre-selected Style
(None) Using IP Address: 164.51.75.1
Electronic Record and Signature Disclosure:
Not Offered vie DocuSi9rr
Bradley Perry DftAb""°r Sent;W261 023 11:18:22 AM
Wdleyperry@ilhsmv.gov k Viewed:912912023 11-31:24 AM
Chief of Rawd5 ETEAME4 DWi.. Signed.9J29CO23 11:33:26 AM
HSMV-MS
Security Level:E mail,A,caaunt Authentication Signature Adoplion:Pre-selecled Style
(None) Using IP Addreso; 164.51.75.1
Electronic Record and Signature Disclosure.
Not Offered via DocuSign
Elizabeth Miles Sent:9J29 623 11:33:29 AM
f ,ti o i
ElizabethMilesflhsmv.grnr Viewed:9�29l2023 2:22:18 FM
Contract Administrator ° Signed:912912023 2:24:24 PM
HSMV-DAS
Security Level:Email,Account Authentication Signature Adoption:Uploaded Signature Image
(None) Using IP Address: 164.51.75-1
Electronic Record and Signature Disclosure:
Not Offered via DocvSlgn
hp"6Y_
Mark Hernandez � Sant;9)2912023 2,24:26 PM
MarlsHlernandez flhsmv.gov (a& at. "I Viewed;9129f2023 2;46;07 PM
Bureau Chief,Purchasing&Contracts Fes, ,.. Signed;9/2912023 2;46:35 PM
HSMV-DAS
Security Level;Email,Account Authentication Signature Adoption.Pre-selecled Style
(None) Using IP Address; 164.51.75.1
Electronic Record and 5ignaturc Disclosure:
Not Offered via DociSigr
Signer Events Signature Timestamp
Kevin Bailey h�r- 9.Sent- 29f221}23 2-46:38 PM
KevinBailey flhsmv.gov Fx wua Resent:10AY2023 7:57:26 AM
Dire,cto Division of Adminislralive Services 9GWCMEAZ�W Viewed: 101t1f2023 10,33,32 AM
HSMV-DAS Signed: 1011112023 10-33:38 AM
Security Level:Email,Account Authentication 51gr►�tura Adoption_Pre-selected Style
(None) Using IP Address- 164.51,75-1
Electronic Record and Signature Disclosure:
Not Offered via Donu$ign
Jennifer Langston "°`"s9""er. Sent; 1W11t2O23 10.3141 AM
JenngerLangslm@.Ilhsmv.gov EE '` Viewed: 10111f2423 12;2OA2 PM
Chief of Staff D01QWZ7]MC44�c Signed; 10111=3 1220.44 PM
HSMV-COED
Security Level:Email.Account Authentication Signature Adoption:Pre-selected Style
(None) Using IP Address: 164.51.75.1
Electronic Record and Signature Disclosure:
Not Offered via Docu Sign
Jennie Carpenter Completed Sent: 10f1112023 12:20:47 PM
jenniecarpenter a flhsmv.gov Viewed: 1Oil 2r2023 9:24;5D AM
Contracts Specialist Signed: 1411212023 9:28r09 AM
HSMV-DAS Using IP Address: 164-51.75A
Security Level:Email,Acmunt Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered vla DowSlgrr
Mirk Hernandez Sent, 1 Oil 2d2023 9,2515 AM
MarkHernandez flhsrnv,gnv kA& hma"" Viewed: 1OV12QO2315:20:29 AM
Bureau Chief,Purchasing 8,Corrtrac ' Signed 10112wt'2023 10:26,12 AM
HSMV-DAS
Semnty Level;Email,Acnnunt Aulhentlnatlorn Signature Adopliom fire-selected Style
(None) Using IP Address; 164 51.75A
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Iverson Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Elizabeth Miles Sent: 10,12-2023 1'D.26.16 AM
ElizabothMiles@flhsfrkv.gov
ED
Contract Administrator
HSMV-DA4S
Security Level:Email,Account Aulhenticaticr
(None)
Electronic Record and Signature Cisclosure:
Not Offered vls DocuSigr►
Carbon Copy Events Status Timestarnp
Rita Ventry COPIED Sent: 10d1212023 10:26:16AM
ritaventry@llhsmv.ga v
Contract Analyst
HSMV-DA5
Security Level:Email,Aceouni Authenticatior
(None)
Electronic Rawd and Signatun� disclosure:
Not Offered via DocLjSign
Data Listing Unit Sent, 1 WI212023 10r26.16 AM
DataLlstingUnit fih$rnv_gov
ED
cvrity Level:Email,Acoount Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via Docu igrn
Jennie Carpenter E Sent; 1011212023 10.26:16 AM
jenniecarpertter@Ohmw.gov
Contracts Specialist
H MV-DAS
ewrity Level;Email,Acoount Aulheoti tiorr
(None)
Electronic Record and Signature Disclosure:
Not Offered via Docu.Sign
Gustavo Medina COPIED Sent; 1011212023 10.26:16 AM
gmedina tequ esta.org Viewed: 1(YI2f2M 11:05,16 AM
Security Level:Email,Acoaunt Authenticatior
(None)
Electronic Record and Signature Disclosure:
Not Offered via Docu Sig r
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed+Encrypted 512612023 11:13:01 AM
Certified Delivered Security Checked 10112121023 10:20:28 AM
Signing Complete Security Checked 1011212023 10:26:12 AM
Completed Security Checked 1 Oil 212023 10:26:16 AM
Payment !Events Status Tirnestarnps