2018/04/11 Council Agenda Packet

7. All information received from the Department's files must be destroyed once its legitimate use has ended.The method of destruction for the Department's records will be conducive to the type of record requested and in a manner that cannot be reproduced or identified in any physical or electronic form. 8. Requester shall not disclose its'Department assigned requester code,either orally or in writing,to anyone who isnot in the direct employ of the Requester and has not signed the Information Security Statement(INF 1128)other than a Department approved Service Provider (Vendor or Agent). • 9. Requester shall not sell,retain,distribute, provide or transfer any record information or portion of the record information acquired under this Agreement except as authorized by the Department. D. RESIDENCE ADDRESS ACCESS AUTHORITY 1. Requester shall protect the confidentiality of any residence address received from Department records pursuant to CVC §1808.47. Requester's employees shall not obtain or use any confidential or restricted records for any purpose other than the reason set forth and authorized by the Department. 2. Requester may release residence or mailing address information to an individual, other than an employee, who is acting on behalf of . the Requester provided an agreement acknowledging the confidentiality of residence address information pursuant to CVC§1808.47 is signed by the individual with whom the Requester has contracted services. E. AUDIT 1. Requester's documentation supporting the reason for inquiry, including but not limited to,transaction details, and computer software/ programs maintained for the purposes defined in this Agreement,shall be subject to inspection,review,or audit by the Department or its designee for a period of two years from the date of the request. 2. Requester 4grees to accommodate Department's request for an inspection,review or audit immediately upon request from the department or the department's representative and to allow on-site audits during regular business hours. F SIGNATURE REQUIREMENTS • I hereby acknowledge that I am an authorized representative of the agency named in Part I,Section B and have been designated as the person responsible for compliance with the,statutes and regulations pertaining to access and use of Department record information. I have read and agree to the provisions contained herein and shall be responsible for the orientation,training,and supervision of persons authorized to access Department record information. I understand that false or misleading answers are cause for denial of an Agreement and/or termination of any access agreement granted. I understand that if this application for requester account is approved,I will be required to conform to the statements presented within.This Agreement specifies the terms and conditions of our relationship.Any deviations will be considered by DMV as misuse and may result in both revocation of the account and refusal of subsequent applications.I understand that according to provisions of the California Vehicle Code Section 1808.45,the willful,unauthorized disclosure of information from any department record for a purpose other than the one stated in the request,or the use of any false report to obtain information from any department record,or the sale or other distribution of the information to a person or organization not disclosed in the request is a misdemeanor,punishable by a fine not exceeding$5,000 or by imprisonment in the county jail not exceeding one year,or both fine and imprisonment. I understand that according to provisions of the California Vehicle Code Section 1808.46,any person holding a requester code who directly or indirectly obtains information from the Department of Motor Vehicles using false representations or distributes restricted or confidential information to any person or uses the information for a reason not authorized or specified in this application is liable to the Department of Motor Vehicles for civil penalties up to$100,000 and shall have their requester code privileges suspended for a period up to five(5)years or revoked. I certify(or declare)under penalty of perjury under the laws of the State of California that the foregoing is true and correct. PRINT NAME AND TmF OF GOVERNMENT OFFICIAL OR AUTHORIZED REPRESENTATIVE DAYTIME TELEPHONE NUMBER ' • MettC • a5Si e Pra,)oI ib, Fif?rt'G7/ 5-noh o.SA W }' ( 425 )257-8493 SIGNATURE OF GOVERNMENT OFFICIAL OR AUTHORIZED REPRESENTATIVE CITY COUNTY STATE DATE X APPROVED BY DEPARTMENT OF MOTOR VEHICLES REPRESENTATIVE: .. • PRINT NAME AND TITLE DATE SIGNATURE' X WHERETO MAiL YOUR APPLICATION AND SUPPORTING DOCUMENTS ALL AGENCIES(Except ParkingfToll Agencies) PARKING AND TOLL AGENCIES ONLY, mail to: mail to: Department of Motor Vehicles Department of Motor Vehicles Account Processing Unit—MS H221 Justice&Government Liaison Branch PO Box 944231 Attn:Parking Coordinator—MS H171 Sacramento,CA 94244-2310 PO Box 932345 (916)657-5564 Sacramento,CA 94232-3450 • (916)657-7732 4 of6 47 INF 1130(REV.10/2013)WWW