HomeMy WebLinkAboutAgreement_General_10/12/2017_Florida Dept of Highway SafetyDocuSign Envelope ID: DDF5CEOA-899A-41FE-A879-AC8FDDF639F1
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FLORIDA MEMORANDUM OF UNDERSTANDING
FOR LAW ENFORCEMENT AGENCY ACCESS TO
DRIVER AND VEHICLE INFORMATION DATABASE SYSTEM (DAVID)
Contract Number HSMV- HsMv-0257-18
rThis Me orandum of Understanding WOU) is made and entered into by and between
egyc:, i H.C'WA , hereinafter referred to as the Requesting Party, and the Florida
Dement of Highway Safety and Motor Vehicles, hereinafter referred to as the Providing Agency,
collectively referred to as the Parties.
Puraose
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.S.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 taw 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 DAVID information for the purposes of carrying out its statutorily mandated law enforcement
and prosecutorial functions.
This MOU is entered into for the purpose 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 by Requesting Party shall only be for a lawful purpose.
IL 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. Driver License Information — Driver license and identification card data collected and maintained by
the Providing Agency. This information includes 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
law enforcement agencies through the DAVID system for purposes of contacting those listed in the event
of an emergency, as noted in Section 119.0712 (2)(c), Florida Statutes.
D. Driver Privacy Protection Act (DPPA) — The Federal Act (see, 18 United States Code § 2721, at seq.) that
prohibits release and use of personal information except as otherwise specifically permitted within the Act.
E Law Enforcement Agency — Any state, county or city law enforcement agency, and state attorney offices
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DAVIO (LFA) Da+a Exchange MCU (Rev, 11 -20161
operating under the laws and authority of the state of Florida
F. Insurance Record — Insurance information, such as Insurance Company name, policy type, policy
status, insurance creation and expiration date provided to the Requesting Party, pursuant to Section
324.242(2), Florida Statutes.
G. Parties-The Providing Agency and the Requesting Party,
H. Personal Information — As described in Chapter 119, Florida Statutes, and information found in the
motor vehicle record which includes, but is not limited to,the subject's driver Ideriffication number, name,
address, telephone number, social security number, medical or disability information, and emergency
contact information.
I. Point-of-Contact (POC) - A person(s) appointed by the Requesting Party as the administrator of the
DAVID program in their agency.
J. Providing Agency-The Florida Department of Highway Safety and Motor Vehicles. The Providing Agency
Is responsible for granting access to DAVID information to the Requesting Party.
K. Quarterly Quality Control Review Report — Report completed each quarter by the POC to monitor
compliance with this agreement. The following must be included in the Quarterly Quality Control
Review Report:
1. A comparison of the DAVID users by agency report with the agency user list;
2. A listing of any new or inactivated users since the last quarterly quality control review,and
3. Documentation verifying that usage has been internally monitored to ensure proper,authorized use
and dissemination.
L. Requesting Party - Any law enforcement agency that is expressly authorized by Section
119.0712(2), Florida Statutes, and DPPA to receive personal information contained in a motor vehicle
record maintained by the Providing Agency.
M. Vehicle Information — Title and registration data collected and maintained by the Providing Agency
for vehicles.
Ill. Le-gal Authorlty
The Providing Agency maintains computer databases containing information pertaining to driver's
licenses and vehicles pursuant to Chapters 317, 319, 320, 322, 328, and Section 324.242(2) Florida
Statutes. The driver license and motor vehicle data contained in the Providing Agency's databases is
defined as public record pursuant to Chapter 119, Florida Statutes, and as such, is subject to public
disclosure unless otherwise exempted bylaw.
As the custodian of the state's driver and vehicle records, the Providing Agency Is required to
provide access to records permitted to be disclosed by law, and may do so by remote electronic means,
pursuant to Sections 119.0712(2), 320.05, 321.23, 322.20, and 324.242(2), Florida Statutes, and applicable
rules.
Under this MOU, the Requesting Party will be provided, via remote electronic means, information
pertaining to driver licenses and vehicles, including personal information authorized to 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 said
Information shall do so in compliance with Section 119.0712(2), Florida Statutes and DPPA. In addition, the
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DAVID(LEA)Data EKd=Ve MOU(Rev.it-Mle)
Requesting Party agrees that insurance policy information shall be utilized pursuant to Section 324.242(2),
Florida Statutes.
This MOU is governed by the laws of the state of Florida and jurisdiction of any dispute arising from
this MOU shall be in Leon County,Florida.
IV. Statement of Work
A. The Providing Agency agrees to:
1. Allow the Requesting Party to electronically access DAVID as authorized under this agreement.
2. Provide electronic access pursuant to established roles and times, which shall be uninterrupted
except for periods of scheduled maintenance or due to a disruption beyond the Providing Agency's
control, or In the event of breach of this 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.
3. Provide an agency contact person for assistance with the Implementation and administration of this
MOU.
B. The Requesting Party agrees to:
I 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 further described 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 other purpose, Including developing
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. Safeguarding
Information.subsection C.
3. Ensure that its employees and agents comply with Section V.Safeguarding Information.
4. Refrain from assigning, sub-contracting, or otherwise transferring its rights, duties, or obligations
under this MOU,without the prior written consent of the Providing Agency.
5. Not share, provide, or release any DAVID information to any other law enforcement, governmental
agency,person,or entity not a party or otherwise subject to the terms and conditions of this MOU.
6. Protect and maintain the confidentiality and security of the data received from the Providing Agency
In accordance with this MOU and applicable 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 Parly's negligent, improper, or unauthorized access, use, or
dissemination of information provided by the Providing Agency,to the extent allowed by law.
8. Immediately inactivate user access/permissions following termination or the determination of
negligent, improper, or unauthorized use or dissemination of information. Update user
access/permissions upon reassignment of users within five(5)business work days.
9. Complete and maintain Quarterly Quality Control Review Reports as defined in Section 11 —
Definitions—J,and utilizing the form attached as Attachment 11.
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DAVID(LEA)Data Exchange MOU(Rev.11-2016)
10. Update any changes to the name of the Requesting Party, its Agency head, Its POC, address,
telephone number and/or e-mail address in the DAVID system within ten calendar days of
occurrence. The Requesting Party is hereby put on notice that failure to timely update this
information may adversely affect the time frames for receipt of information from the Providing
Agency.
11. Immediately comply with any restriction, limitation, or condition enacted by the Florida Legislature
following the date of signature of this MOU, affecting any of the provisions herein stated. The
Requesting Party understands and agrees that it is obligated to comply with the applicable
provisions of law regarding the subject matter of this Agreement at all times that it is receiving,
accessing,or utilizing DAVID information.
12. Cooperate with the Providing Agency in Field Audits conducted pursuant to Section Vt.B.,below.
13. Timely submit the reports and statements required in Section Vt. Compliance and-Control
Measures,below.
V. Safeguardilla Information
The Parties shall access, disseminate, use and maintain all information received under this
Agreement in a manner that ensures its confidentiality and proper utilization 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 willfully and knowingly discloses any Information in violation of DPPA may be
subject to criminal sanctions and civil liability.
The Parries mutuallyagree to the following:
A. Information exchanged will not be used for any purposes not specifically authorized by this MOU.
Unauthorized use includes, but is not limited to, queries not related to a legitimate business purpose,
personal use,or the dissemination,sharing,copying,or passing of this information to unauthorized persons,
B. The Requesting Party shall not indemnify and shall not be liable to the Providing Agency for any driver
license or motor vehicle information lost damaged, or destroyed as a result of the electronic exchange of
data pursuant to this MOU,except as otherwise provided In Section 768.28,Florida Statutes.
C. Any and all DAVID-related information provided to the Requesting Party as a result of this MOU, particularly
data from the DAVID system, will be stored in a place physically secure from access by unauthorized
persons.
D. The Requesting Party shall comply with Rule 74-2, Florida Administrative Code, and with Providing
Agency's security policies, and employ adequate security measures to protect Providing Agency's
information, applications, data, resources, and services. The applicable Providing Agency security policies
shall be made available to Requesting Party.
E. When printed information from DAVID has met record retention, it shall be destroyed by cross-cut shredding
or incineration in accordance with Florida law.
F. The Requesting Party shall maintain a list of all persons authorized within the agency to access DAVID
information.The list will not be provided to the Providing Agency, but shall be subject to viewing during any
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DAVID(LEA)Data Odwp MOU(ReV.11-2016)
field audit conducted by the Providing Agency or in the event of a violation under Section VI.,D,of this MOU
for the purposes of ascertaining whether the person or persons involved have been removed from the list or
have otherwise had their DAVID access modified or limited.
G. Access to DAVID-related information, particularly data from the DAVID System, will be protected in such a
way that unauthorized persons cannot view,retrieve,or print the Information.
H. Under this MOU agreement access to DAVID system shall be provided to users who are direct employees of
the Requesting Party and shall not be provided to any non-employee or contractors of the Requesting Party.
1. By signing this MOU,the Parties,through their signatories,affirm and agree to maintain the confidentiality of
the information exchanged through this Agreement
VI. CoLLnollance and Control Measures
A. Quarterly Quality Control Review Report—Must be completed, utilizing Attachment 11, Quarterly Quality
Control Review Report,within 10 days after the end of each quarter and maintained for two years.
B. Field Audits — Field audits shall be conducted by the Providing Agency in order to ensure that MOU
requirements concerning internal controls are being met Field audits shall be conducted on-site by
Providing Agency employees, who shall be designated as "Field Liaisons"for the purposes of this MOU.
Field Liaisons shall be geographically located throughout the state. The Requesting Party shall cooperate
with the Field Liaisons in conducting field audits by granting access to systems and records related to this
MOU and assigning appropriate personnel to respond to information requests.
Audits shall be conducted a minimum of once, every two years. Field Liaisons shall contact the POC 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 the audit
report conclude that deficiencies or issues exist in regard to the Requesting Party's internal controls, or
access to or use of DAVID Information, Providing Agency reserves the right to take, based upon the
nature of the deficienclesfissues found, any or all of the following actions: audit more frequently than
once, every two years, andlor suspend or terminate Requesting Partys access to DAVID information
until such time as Requesting Party submits proof satisfactory to the Providing Agency that the
deficlencles/issues have been corrected.
C. Internal Control Attestation — This MOU Is contingent upon the Requesting Party having appropriate
internal controls in place at all times that data is being provided/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., above. The Attestation 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 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 the Attestation
upon written request by the Requesting Party. The Attestation must have an original signature of the Chief,
Sheriff, or State Attorney,or person designated by Letter of Delegation to execute contracts/agreements on
their behalf,may be sent via U.S.Mail,facsimile transmission,or e-malled to the Providing Agency's Bureau
of Records at the following address:
Department of Highway Safety and Motor Vehicles
Bureau of Records
2900 Apalachee Parkway,MS 89
Tallahassee,Florida 32399-0500
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DAVID(LEA)Data Exchange MOU(Rev.11-2016)
.
Fax (8K50)617'5168
E-mail:
D. Annual Certification Statement ' The Requesting Party shall submit to the Providing Agency an
annual statement indicating that the Requesting Party has evaluated and certifies that It has adequate
controls in place to protect the personal data from unauthorized acoeuo, distrib/tion, use, modifioadon, or
disclosure, and is in full compliance with the requirements of this YWDU. The Requesting Party aheU
submit this statement annually, within 45 days after the anniversary date of this K4OU. (NOTE: During
any year in which a Field Audit is conducted, submission of the Internal Control Attestation may satisfy the
requirement to submit an Annual Certification Statement.) Failure to timely submit the certification
statement may result inmnimmediate field audit and, based upon the findings of the audit, suspension
or termination of Requesting Party's access to DAVID information as indicated in subsection B.,above.
In addition, prior to expiration of this N1OU, if the Requesting Party intends to enter into a new K8(]U,
n certification statement attesting that appropriate controls remained in p|mm* during the fine) year ofthe
K4OU and are currently in place shall be required to be submitted to the Providing Agency prior to
issuance mfa new PNOU.
E. Misuse of Personal Information —The Requesting Party must notify the Providing Agency in writing of
any incident where determination is made that personal information has been compromised as e
result of unauthorized aooeoo, distribuUon, use, modifivation, or disclosure, by any means, within 30
days of such determination. The statement must be provided on the Requesting Porty'e letterhead and
include each o{the following: a brief summary of the incident; the outcome of the review; the date ofthe
ocuurnenoe(m); the number of /eoundo compromised; the name or names of personnel responsible;
whether disciplinary action or termination was rendered; and whether or not the mwm*re of the
compromised records were notified. The statement mho|| also indicate the steps takan, or to be taKen,
by the Requesting Agency to ensure that misuse of DAVID data does not continue.This statement shall
be mailed to the Bureau Chief of Records otthe address indicated in Section V|. C.. above. (NOTE:
/f on incident involving bnomoh of personal information did occur and Requesting Party did not notify
the owner(s) of the compromised n»cnnds. the Requesting Party muet indicate why notice was not
provided,for example"Notice not statutorily requ{nyd.^)
In addition, the Requesting Party ohoU comply with the applicable provisions of Section 501.171.
Florida Statutes, regarding data security and security bv000has, and whoU strictly comply with the
provisions regarding notice provided therein.
VU. AcireementTerm
This YNOU shall take effect upon the date of last signature by the Parties and shall remain in effect
for six (G) years from this date unless sooner terminated or cancelled in onnomdanun with Section |X.
Termination. Once executed, this yNCJU supersedes all previous agreements between the parties regarding
the same subject matter.
Vill' Amendments
This K4OU incorporates all negotiotiono, interp/etationn, and understandings between the Parties
regarding the same subject maUar, and serves as the h/U and final expression of their agreement. This
yWOU may be amended by written agreement executed by and between both Parties. Any change,
a|haration, doletimn, or addition to the benno set forth in this KADU, including to any of its ottochmmnto, must
be by written agreement executed by the Parties in the same manner as this yWOU was initially executed.
If there are any conflicts in the amendments to this MOU. the last-executed amendment shall prevail. All
provisions not in conflict with theamendmont(a)shall remain /n effect and are to be performed as specified in
Page Gcf0
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this MOU.
IX. Termination
A. This K4OU may be unUmb»noUy terminated for cause by either part/ upon finding that the terms and
conditions contained herein have been breached by the other party. Written notice of termination shall be
provided to the breaching party; hovmmxar, prior-written notice is not required and notice may beprovided
upon cessation of work under the agreement by the non-breaching party.
B. In addition, this yWOU is subject to unilateral termination by the Providing Agency without notice to
the Requesting Party for failure of the Requesting Party to comply with any of the requirements of this
NYOU, or with any applicable state or federal laws, rules, or rmgu|oUoma. including Section
119.0712(2). Florida Statutes.
C. This WYOU may also be omnuaUmd by either party, without penalty, upon 30 days' advanced written notice
to the other party. All obligations of either party under the KAOU will remain in full force and effect during
the thirty(3O)day notice period.
X. Notices
Any notices required to be provided under this K8OU maybe sent via U.G. K4oU, facsimile
transmission, or e-mail bm the following individuals:
For the Providing Agency:
Chiof, Bureau ofRecords
280UApo|aoheeParkway
Tallahassee,Florida 3230B
Fax:(85U)S17-5168
E-mail:
For the Requesting Party:
Agency Point-of-Contoot listed on the signature page.
X|. Additional Databa§e Access/Subsequent MOU's
The Parties understand and acknowledge that this K8OU entitles the Requesting Party to specific
information included within the scope of this agreement. Should the Requesting Party wish to obtain aouena to
other personal information not provided hereunder. the Requesting Party will be required to execute o
subsequent YWOU with the Providing Agency specific bm the additional information requested. All yWOU'ogranting
access tnpersonal information will contain the same clauses mo are contained herein regarding audiba, report
submission,and the submission ofCertifioation and Attestation statements.
The Providing Agency in mindful of the coots that would be incurred if the Requesting Party was required
to undergo multiple audits and to submit separate oertiOcationy, afteatoUona, and reports for each executed
YWOU. Aouomding|y, should the Requesting Party execute any subsequent K0OU with the Providing Agency for
access to personal information while the instantKAOU nornminm in effect, the Requesting Party may submit o
written roqueet, subject to Providing Agency opprovo|, to submit one of each of the following covering all
emauu0ud yNOU'o: Quarterly Quality Cunhn| Review Report; Certification; and Attestation; and/or to have
conducted one comprehensive audit addressing internal controls for all executed MOU's. The Providing Agency
shall have the sole discretion to approve or deny such request in whole or in part ortn subsequently rescind an
approved request based upon the Requesting Party'o compliance with this K8OU and/or any negative audit
findings.
Page TufQ
. .
X111. Application of Public Records Law
The Requesting Party agrees 0o comply with the following requirements of Florida's public records laws:
1' Keep and maintain public records required by the Department to perform the service.
2. Upon request from the Department's custodian of public reunndy. provide the Department with a
copy of the vaqunohod records or allow the records to be inspected or copied within a reasonable
time at a cost that does not exceed the cost provided in Chapter 119. Florida 8tatuboo, or as
otherwise provided bylaw.
3. Ensure that public naoondo that are exempt or confidential and exempt from public n*oondo
disclosure requirements are not disclosed except as authorized by law for the duration of the
contract term and following completion of the contract if the contractor does not transfer the records
to the public agency.
4. Upon completion of the coninanL, transfer, at no cost, to the Department all public records in
puoamauion of the Requesting Party or keep and maintain public records required by the public
agency to perform the service. If the Requesting Party transfers all public records to the Department
upon completion of the contract,the Requesting Party shall destroy any duplicate public records that
are exempt or confidential and exempt from public records disclosure requirements. If the
Requesting Party keeps and maintains public records upon completion of the contract,the contractor
nhoU meet all applicable requirements for retaining public vaoomdm. All records siunod electronically
must be provided to the Deportment, upon request from the Department's custodian of public
records, in a format that is compatible with the information technology systems of the Department.
0� ��� ��|����������� ��� ������8���� ��������U��� ���
.. ...~� CONTRACTOR~ ~~~~ HAS ~~~~~�~�..~~.~.~ ..~~.�~~.~~~..~~~ THE
APPLICATION d�� ��������� ��� FLORIDA �� �� ���
~ ~ . ~~,~. ...~.~~ -.. CHAPTER~ ~�~- ' '~, . ~~-_-..~_' ' STATUTES,'' .~ . ~�_', . ~~ THE
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO
THUS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS
��~� ����� {��������� PUBLIC~~~ v`~^~�x � ~ ^ '~ ^~ `' ^ ~^~~~~~=~ R~~~~~°RD==
COORDINATOR, |������ ��� ������� ������U ���� ����
~~.~.~.~~.... .~ ~~.~, OFFICE.~~~~ ~~~ ~~~-..~-....� _~--~~..,~.-._, ���~ ~. ..�.�.~..~_~�
���� U��� �� ��U �� �K
PARKWAY, .~__.�..~ ' .._�' ~'� ~~~` .. .~~~. ~~ ~~~_~~�� . ~~ ~23~~
REMAINDER OFTHIS PAGE INTENTIONALLY LEFT BLANK
Page OofB
IN WITNESS HEREOF,the Parties hereto, have executed this Agreement by their duly authorized officials on the
date(s)indicated below.
REQUESTING PARTY- PROVIDING AGENCY:
U ` 1^ Q D� I Florida Departmentof Highway Safety and Motor
�c t L)6fz+ Vehicles
Agency me 2900 Apalachee Parkway
3y S 1 P.3 U,S+C, Zr Tallahassee, Florida 32399
Street Address
Suite
e$v.,S-fr, 3 u t�
City State Zip Code
BY: BY:
' r
Signatu a of Phtfionz9d t ial Signature of Authorized Official
��► (b�LniY�c n Lisa M.Bassett
Printed ed Name Printed/Typed Name
YY W4 r Chief. Bureau of Purchasing and Contracts
Title Title
1p -Ia—�r1
Date Date
Pb(enra.A -�thKeffz, .yr3
Official Agency Email Ad Tess
S�o i oytoS
Phone Number
Agency Point-of-Contact:
17-)►2 �- 31 M YY1C Crj�l((.J
Printed/Typed Name
-1 ("Cs ('e-L,J 4
Official Agency Email Address T
5LP I - r)t.,k 105:51 )-
V;�'v Phone Number
Fax Number
Page 9 of 9
DAVID(LEA)Date Exchange MOU(Rev.11-2016)
DocuSign Envelope ID: DDF5CEOA-899A-41FE-A879-AC8FDDF639F1
IN VWTNESS HEREOF, the Parties hereto, have executed this Agreement by their duly authorized otiicfais on the
dates) Indicated below.
REQUESTING PARTY:
me .�
jq S 1 ey es+>� Zr
Street Addrees
Printed/T*d Name
Yl` riga r
Title
10 -1a. -VN
Ft(enna.nfab �6kertz' .0(3
Oft>Qial Agency Email Ad ss
5�o i --)ion- 04 LOS' -
Phone Number
Agency Palms
la-� e F -3► m
Printedrryped Name
-I(Y\c�rtw 4
OffclW Agency Email Address
5t1p 1- r)`.? , 05 :�I r2-
►i'r Phone Number
Fax Number
PROVIDING AGENCY:
Florida Departmentof HighwaySafetyand Motor
Vehicles
2900 Apalac hee Parkway
Tak hassee, Florida 32399
. -iI4�� ��•�•tiy r��� r •...
UAW.Bassett
Bassett
PrintedlTyped Name
Chief. Bureau of Pu MMOO and COntMdb
Title
11/7/2017
t1: It:
Page 9 of 9
DAVID M Dou 8dow MOO Tm. li- 014)
ATTACHMENT I
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,18 United States Code sections 2721("DPPA')makes personal information contained
in motor vehicle or driver license records confidential and exempt from disclosure.Personal information in a motor vehicle
or driver license record includes,but is not limited to,an individual's social 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 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 exemption number(s)
c n e+ ,as Iisted 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 statutes may subject me to criminal sanctions and civil liability.
Complete the following for each DPPA exemption being claimed. (attached additional page,if necessary):
DPPA Description of How Requesting Party Description of how Data will be used:
Exemption Qualifies for Exemption:
Claimed: to 9 UeS+CA P��i Gi✓�Q( tr+Can'C low ¢r�l orctw��hac' p�r�oSeS
16 A Law G��c��Yr+tnT
a�e.r,c�.
Obtaining personal information under false pretenses is a state and federal crime.Under penalties of perjury,I declare
that I 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 and correct.
Q�PL�bz-el� Acnw-. cwr op Pou*
Si ature of Authorized Official Title
I►h I A--Greg TeQue-STa Fbtme,hepAxrmw t
Printed Name Name of Agency/Entity
to--)S- 201T
Date
Page 1 of 2
(02/2017)
.
PUBLIC RECORDS. In accordance with Sec. I19.0701, Florida Statutes,
CONTRACTOR must keep and maintain this Agreement and any other
records associated therewith and that are associated with the
performance of the work described in the Proposal orBid. Upon request
from the Village's custodian of public records, CONTRACTOR must provide
the Village with copies ofrequested records, or allow such records to be
inspected or copied, within a reasonable time in accordance with access
and cost requirements of Chapter 119, Florida Statutes. A CONTRACTOR
who fails to provide the public records to the Village, or fails to make them
available for inspection or copying, within a reasonable time may be
subject to attorne«'sfees and costs pursuant to Sec. 119.0701, Florida
Statutes, and other penalties under Sec. 119.1[\ Florida Statutes. Further,
CONTRACTOR shall ensure that any exempt or confidential records
associated with this Agreement or associated with the performance of the
work described in the Proposal or Bid are not disclosed except as
authorized by |avv for the duration of the Agreement term, and following
completion of the Agreement if the CONTRACTOR does not transfer the
records to the Village. Finally, upon completion of the Agreement,
CONTRACTOR shall transfer, atno cost to the Village, all public records in
possession of the CONTRACTOR, or keep and maintain public records
required by the Village. If the CONTRACTOR transfers all public records tp
the Village upon completion of the Agreement, the CONTRACTOR shall
destroy any duplicate public records that are exempt or confidential and
exempt from public records disclosure requirements. |f the CONTRACTOR
keeps and maintains public records upon completion of the Agreement,
the CONTRACTOR shall meet all applicable requirements for retaining
public records. Records that are stored electronically must be provided 10
the VILLAGE, upon request from the Village's custodian of public records,
in o format that is compatible with the Village's information technology
systems.
IF CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119 FLORIDA STATUTES TO
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THUS AGREEMENT, PLEASE CONTACT THE
VILLAGE CLERK RECORDS CUSTODIAN FOR THE VILLAGE, AT
(561) 768~0685, OR AT OR AT 345
TEQUESTA DRIVE' TEQUESTA, FLORIDA 33469.
Pursuant to section 119.0712(2),F.S.,personal information in motor vehicle and driver license records can be released for the following
purposes,as outlined in 18 United States Code,section 2721.
Personal information referred to in subsection(a)shall be disclosed 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 ofmotor vehicles and
dealers by motor vehicle manufacturers,and removal of non-ownerrecords from the original owner records of motor vehicle
manufacturers to carry out the purposes of titles I and IV of the Anti Car Theft Act of 1992,the Automobile Information Disclosure Act
(15 U.S.C.1231 et seq.),the Clean Air Act(42 U.S.C.7401 et seq.),and chapters 301,305,and 321-331 of title 49,and,subject to
subsection.
1.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.
2.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 ofnon-owner records from the original owner records of motor vehicle
manufacturers.
3.For use in the normal course of business by a legitimate business or its agents,employees,or contactors,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 corrects 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.
4.For use in connection with any civil,criminal,administrative,or arbitral proceeding in any Federal,State,or local court or agency or
before any self-regulatory body,including the service of process,investigation in anticipation of litigation,and the execution or
enforcement of judgments and orders,or pursuant to an order of aFederal,State,or local court.
5.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.
6.For use by any insurer or insurance support organization,or by a self-insured entity,or its agents,employees,or contractors,in
connection with claims investigation activities,antifraud activities,rating or underwriting.
7.For use in providing notice to the owners of towed or impounded vehicles.
8.For use by any licensed private investigative agency or licensed security service for any purpose permitted under this subsection.
9.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 chapter 313 of title 49.
10.For use in connection with the operation of private toll transportation facilities.
11.For any other use in response to requests for individual motor vehicle records if the State has obtained the express consent of the
person to whom such personal information pertains.
12.For bulk distribution for surveys,marketing or solicitations if the State has obtained the express consent of the person to whom such
personal information pertains.
13.For use by any requester,if the requester demonstrates it has obtained the written consent of the individual to whom the information
pertains
14.For any other use specifically authorized under the law of the State that holds the record,if such use is related to the operation of a
motor vehicle or public safety.
Page 2 of 2
(02/2017)
Cwditafa Of Compkdon
Envelope Id: DDF5CEOA899A41FEA879AC8FDDF639F1
Subject: Please DocuSign these documents: Tequesta Police Department LEA DAVID MOU Renewal
Source Envelope:
Document Pages: 13 Signatures: 6
Certificate Pages: 6 Initials: 0
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC -05:00) Eastern Time (US & Canada)
PA r a Tracking
Status: Original
11/2/2017
Bennett White
Bennettwhite@flhsmv.gov
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 11/3/2017
ID:be50d941-5723-447d-a7ft)-69a9O28158f1
Robert Kynoch
RobertKynoch@flhsmv.gov
Director of Motorist Services
FL Dept HSMV
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Lisa Bassett
LisaBassett@flhsmv.gov
Chief of Purchasing and Contracts
FL Dept HSMV
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Kelley Scott
KelleyScott@flhsmv.gov
Director of Administrative Services
Florida Department of Highway Safety and Motor
Vehicles
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Holder: Kayla White
kaylawhite@flhsmv.gov
ED—Slg-d
by:
.....sA`w/o.
494622BOE36MA._
Using IP Address: 207.156.9.1
EKoowftmd by:
6
OA2EF6A47ABEIBs...
Using IP Address: 207.156.9.1
CBowsgnW by:
7E2E9FOB90B2�59...
Using IP Address: 207.156.9.1
C oausq—d by:
BSB .
Using IP Address: 207.156.9.1
Status: Completed
Envelope Originator.
Kayla White
PO Box 6669
Portland, OR 97228
kaylawhite@flhsmv.gov
IP Address: 207.156.9.1
Location: DocuSign
rmusbmp
Sent: 11/2/2017
Viewed: 11/3/2017
Signed: 11/3/2017
Sent: 11/3/2017
Viewed: 11/6/2017
Signed: 11/6/2017
Sent: 11/6/2017
Viewed: 11/6/2017
Signed: 11/6/2017
Sent: 11/6/2017
Viewed: 11!7/2017
Signed: 1117/2017
Docu. ;
0secuaaD
Signer Em
Jamie DeLoach
Signatture
D -319n d
[
JamieDeLoach@flhsmv.gov
COPIED
Chief of Staff NIB
9049087AW4e°_..
Florida Department of Highway Safety and Motor
Vehicles
Using IP Address: 207.156.9.1
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
COPIED
Not Offered via DocuSign
Becky Parramore Completed
BedcyParramore@flhsmv.gov
Leasing Consultant
Florida Department of Highway Safety and Motor Using IP Address: 207.156.9.1
Vehicles
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Lisa M. Bassett Daou819.W by:
LisaBassett@flhsmv.gov .,
Chief of Purchasing and ContractseFoeeoez,se
FL Dept HSMV
Security Level: Email, Account Authentication Using IP Address: 207.156.9.1
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Fliwam Sigh Ever -b S%Pm* e
Agent DeNway Evenfs Sb&M
Carbon Copy Events
Data Listing Unit
DataListingUnit@flhsmv.gov
COPIED
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Abigail Brennan
abrennan@tequesta.org
COPIED
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jim McGrew COPIED
jmcgrew@tequesta.org
Security Level: Email, Account Authentication
(None)
Electronic Recons and Signature Disclosure:
Not Offered via DocuSign
ThWWtWW
Sent: 11 /7/2017
Viewed: 11(7/2017
Signed: 11 /7/2017
Sent: W712017
Viewed: 11/7/2017
Signed: 11/7/2017
Sent: 1117/2017
Viewed: 11/7/2017
Signed: 11/7/2017
Sent: 11/7/2017
Sent: 11f7/2017
Viewed: 11/6/2017
Sent: 11!7/2017
Viewed: 11/7/2017
Envelope Sent
Hashed/Encrypted
Certified Delivered
Security Checked
Signing Complete
Security Checked
Completed
osloor
Security Checked
Electronic Record and Signature Disclosure created on: 9/22/2015
Parties agreed to: Bennett White
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, FL Dept HSMV (we, us or Company) may be required by law to provide to
you certain written notices or disclosures. Described below are the terms and conditions for
providing to you such notices and disclosures electronically through your DocuSign, Inc.
(DocuSign) Express user account. Please read the information below carefully and thoroughly,
and if you can access this information electronically to your satisfaction and agree to these terms
and conditions, please confirm your agreement by clicking the 'I agree' button at the bottom of
this document.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. For such copies, as long as you are an authorized user of the
DocuSign system you will have the ability to download and print any documents we send to you
through your DocuSign user account for a limited period of time (usually 30 days) after such
documents are first sent to you. After such time, if you wish for us to send you paper copies of
any such documents from our office to you, you will be charged a $0.00 per -page fee. You may
request delivery of such paper copies from us by following the procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign 'Withdraw Consent' form on the signing page of your
DocuSign account. This will indicate to us that you have withdrawn your consent to receive
required notices and disclosures electronically from us and you will no longer be able to use your
DocuSign Express user account to receive required notices and consents electronically from us
or to sign electronically documents from us.
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through your DocuSign user account all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
made available to you during the course of our relationship with you. To reduce the chance of
you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
How to contact FL Dept HSMV:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: lindaperry@flhsmv.gov
To advise FL Dept HSMV of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at lindaperry@flhsmv.gov and in the
body of such request you must state: your previous e-mail address, your new e-mail address. We
do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in DocuSign.
To request paper copies from FL Dept HSMV
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to lindaperry@flhsmv.gov and in the
body of such request you must state your e-mail address, full name, US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with FL Dept HSMV
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign account, and on the subsequent
page, select the check -box indicating you wish to withdraw your consent, or you may;
ii. send us an e-mail to lindaperry@flhsmv.gov and in the body of such request you must
state your e-mail, full name, IS Postal Address, telephone number, and account number.
We do not need any other information from you to withdraw consent.. The consequences
of your withdrawing consent for online documents will be that transactions may take a
longer time to process..
Required hardware and software
Operating Systems:
Windows2000? or WindowsXP?
Browsers (for SENDERS):
Internet Explorer 6.0? or above
Browsers (for SIGNERS):
Internet Explorer 6.0?, Mozilla FireFox 1.0,
NetSca 7.2 (or above)
Email:
Access to a valid email account
Screen Resolution:
800 x 600 minimum
Enabled Security Settings:
-Allow per session cookies
-Users accessing the internet behind a Proxy
Server must enable HTTP 1.1 settings via
proxy connection
** These minimum requirements are subject to change. If these requirements change, we will
provide you with an email message at the email address we have on file for you at that time
providing you with the revised hardware and software requirements, at which time you will
have the right to withdraw your consent.
Acknowledging your access and consent to receive materials electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you
were able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to
e-mail this disclosure and consent to an address where you will be able to print on paper or
save it for your future reference and access. Further, if you consent to receiving notices and
disclosures exclusively in electronic format on the terms and conditions described above,
please let us know by clicking the 7 agree' button below.
By checking the 'I Agree' box, I confirm that:
• I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF
ELECTRONIC RECORD AND SIGNATURE DISCLOSURES document; and
• I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, for future reference and access; and
• Until or unless I notify FL Dept HSMV as described above, I consent to receive from
exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to me by FL Dept HSMV during the course of my relationship with you.