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C�•� WASHINGTON STATE DEPARTMENT OF Driver and Plate Search (DAPS) and <br /> LICENSING Driver Information and Adjudication System (DIAS) <br /> Agency Access Request <br /> Agencies use this form to request access to the DAPS or DIAS systems.A person with authority to commit its <br /> organization to contractual obligations must sign this form. <br /> Email the completed application and documentation that identifies the designated contract administrator as an employee <br /> of your agency (examples:employee ID, credentials, badge, etc.)to: DataServices@dol.wa.gov <br /> Online system access (select all that apply): <br /> ©DAPS—online driver and vehicle records search for use in investigations <br /> ©DIAS— online system to view and electronically update driver records used by courts, prosecuting attorneys, and <br /> government agencies. <br /> Agency name <br /> City of Everett Police Department <br /> ORI or NCIC number EIN,TIN,or UBI <br /> WA0310300 <br /> Office name and location <br /> City of Everett; Everett, Washington <br /> Physical address(Street,Apartment or suite number,City,State,ZIP code) <br /> 3002 Wetmore, Everett, WA, 98201 <br /> Mailing address(Address or PO Box,City State,ZIP code) <br /> 3002 Wetmore, Everett, WA, 98201 <br /> Account administrator name(person authorized to agree to the click-through contract) Title <br /> Sandra Albertson Records Unit Manager <br /> Email (Area code)Telephone number <br /> salbertson@everettwa.gov 425-257-7454 <br /> Provide a detailed explanation of why you need driver or vehicle record information. Insufficient detail or specifics may <br /> cause your application to be rejected. <br /> Driver and Vehicle information is used by Everett Police Officers to assist with investigation of criminal cases,obtain information <br /> about stolen vehicles,and locate individuals that are missing or wanted by the police agency. <br /> Will you disclose the information to third parties? ❑Yes ❑✓ No <br /> If"Yes,"to whom and why? Be specific. <br /> No,the information is for official police use only. <br /> Do you have the authority to delegate the account administrator named above to agre <br /> contract terms and conditions? ç2. L r' <br /> I certify under penalty of perjury under the laws of the state of Wa • -. . :t the for <br /> qp-d-I / <br /> e xDate and placeigned Sign ere) -""� <br /> Mayor <br /> Title ., . <br /> For office use only <br /> Date received ❑DIAS ❑DAPS Action taken: ❑Approved ❑Denied <br /> DSHS child support enforcement? ❑Yes ❑No x <br /> 911 dispatchers? ❑Yes ❑No <br /> Signature of approver <br /> DSC-425-009(R/9/18)WA A EST: <br /> AP'ROVED I • Ft RM <br /> a Al City Clerk <br /> r-MES D.ILES City Attorney <br />