HomeMy WebLinkAboutMOU DAVID Sys_FDHSMV_City_Contract No. 0020-20_7-25-19 DocuSign Envelope ID:8D71A389-A662-4677-9FDA-E19F44DADBE9
FLORIDA MEMORANDUM OF UNDERSTANDING
FOR GOVERNMENTAL ENTITY ACCESS TO
wt.,MX!WC.R��, DRIVER AND VEHICLE INFORMATION DATABASE SYSTEM (DAVID)
Contract Number HSMV- 0020-20
This Memorandum of Understanding (MOU) is made and entered into by and between
City Of Cape Canaveral
hereinafter referred
to as the Requesting Party, and the Florida Department of Highway Safety and Motor Vehicles, hereinafter
referred to as the Providing Agency, collectively referred to as the Parties.
I. purpose
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 government entity operating under the laws and authority of the state of
Florida and/or operating under Federal laws. As a government entity, 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 duties and 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.
II. 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, et seq.)
that prohibits release and use of personal information except as otherwise specifically permitted within the
Act.
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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.
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 identification 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 Government entity that is expressly authorized by 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.
III. Legal Authority
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 by law.
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
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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
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:
1. 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.
Safequardinq Information,subsection C.
3. Ensure that its employees and agents comply with Section V. Safequardinq 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 law enforcement, other 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 Party'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
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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 II.
Definitions. K, and utilizing the form attached as Attachment II.
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. Timely submit the Attestation and Certification statements as required in Section VI. Compliance and
Control Measures, subsections B and C.
13. For Federal Agencies Only: The Requesting Party agrees to promptly consider and adjudicate any
and all claims that may arise out of this MOU resulting from the actions of the Requesting Party,
duly authorized representatives, or contractors of the Requesting Party, and to pay for any
damage or injury as may be required by Federal law. Such adjudication will be pursued under
the Federal Tort Claims Act, 28 U.S.C. § 2671, et seq., the Federal Employees Compensation
Act, 5 U.S.C. § 8101, et seq., or such other Federal legal authority as may be pertinent.
V. Safeauardinp 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 Parties mutually agree 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,
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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's security policies shall be made available to Requesting Party.
E. When printed information from DAVID is no longer needed, it shall be destroyed by cross-cut
shredding or incineration.
F. The Requesting Party shall maintain a list of all persons authorized within the agency to access
DAVID information, which must be provided to the providing agency upon request.
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 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.
I. By signing this MOU, the Parties, through their signatories, affirm and agree to maintain the
confidentiality of the information exchanged through this Agreement.
VI. Compliance and Control Measures
A. Quarterly Quality Control Review Report — Must be completed, utilizing Attachment II, Quarterly
Quality Control Review Report, within 10 days after the end of each quarter and maintained for two
years.
B. 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 from their Agency's Internal
Auditor, Inspector General, Risk Management IT Security Professional, or a currently licensed
Certified Public Accountant, on or before the third and sixth anniversary of the agreement or within
180 days from receipt of an Attestation review request from the Providing Agency. The Attestation
Statement shall indicate that the internal controls over personal data have been evaluated 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 review have been corrected and measures enacted to prevent recurrence. The Providing
Agency may extend the time for submission of the Attestation Statement upon written request by the
Requesting Party for good cause shown by the Requesting Party.
The Attestation Statement must have an original signature of the Agency Head or person designated
by Letter of Delegation to execute contracts/agreements on their behalf, and may be sent via U.S.
Mail, facsimile transmission, or e-mailed 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
Fax: (850)617-5168
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E-mail:DataListingUnit onflhsmv.gov
C. 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 access, distribution, use, modification, or
disclosure, and is in full compliance with the requirements of this MOU. The Requesting Party shall
submit this statement annually, within 45 days after the anniversary date of this MOU. (NOTE:
During any year in which an Attestation Statement is provided, submission of the Internal Control
Attestation will satisfy the requirement to submit an Annual Certification Statement.) Failure to timely
submit a certification statement may result in an immediate review request and, based upon the findings
of the review, suspension or termination of Requesting Party's access to DAVID information as indicated in
subsection B.,above.
In addition, prior to expiration of this MOU, if the Requesting Party intends to enter into a new
MOU, a certification statement attesting that appropriate controls remained in place during the final
year of the MOU and are currently in place shall be required to be submitted to the Providing Agency
prior to issuance of a new MOU.
D. 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 a result of
unauthorized access, distribution, use, modification, or disclosure, by any means, within 30 days of such
determination. The statement must be provided on the Requesting Agency's letterhead and include
each of the following: a brief summary of the incident; the outcome of the review; the date of the
occurrence(s); the number of records compromised; the name or names of personnel responsible;
whether disciplinary action or termination was rendered; and whether or not the owners of the
compromised records were notified. The statement shall also indicate the steps taken, 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 at the address indicated in VI.B., above. (NOTE: If an incident
involving breach of personal information did occur 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 not statutorily required".)
In addition, the Requesting Party shall comply with the applicable provisions of Section 501.171, Florida
Statutes, regarding data security and security breaches, and shall strictly comply with the provisions
regarding notice provided therein.
VII. Agreement Terra
This MOU shall take effect upon the date of last signature by the Parties 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 same subject matter.
VIII. Amendments
This MOU incorporates all negotiations, interpretations, and understandings between the Parties
regarding the same subject matter, and serves as the full and final expression of their agreement. This
MOU may be amended by written agreement executed by and between 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 shall prevail. All
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provisions not in conflict with the amendment(s) shall remain in effect and are to be performed as
specified in this MOU.
IX. Termination
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 the other party. Written notice of termination
shall be provided to the breaching party; however, prior-written notice is not required and notice
may be provided upon cessation of work under the agreement by the non-breaching party.
B. In addition, this MOU 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
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 obligations of either party under the MOU will remain 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. Mail, facsimile transmission,
or e-mail to the following individuals:
For the Providing Agency:
Chief, Bureau of Records
2900 Apalachee Parkway
Tallahassee, Florida 32399
Fax: (850)617-5168
E-mail:DataListingUnit a(�.flhsmv.gov
For the Requesting Party:
Agency Point-of-Contact listed on the signature page.
XI. .• •- '••. •• . •. . _ - . •• •I u •
The Parties understand and acknowledge that this MOU entitles the Requesting Party to specific information
included within the scope of this agreement. Should the Requesting Party wish to obtain access to other
personal information not provided hereunder, the Requesting Party will be required to execute a subsequent
MOU with the Providing Agency specific to the additional information requested. All MOU's granting access to
personal information will contain the same clauses as are contained herein regarding audits, report
submission, and the submission of Certification and Attestation statements.
The Providing Agency is mindful of the costs that would be incurred if the Requesting Party was required to
undergo multiple audits and to submit separate certifications, attestations, and reports for each executed
MOU. Accordingly, should the Requesting Party execute any subsequent MOU with the Providing Agency for
access to personal information while the instant MOU remains in effect, the Requesting Party may submit a
written request, subject to Providing Agency approval, to submit one of each of the following covering all executed
MOU's. Quarterly Quality Control 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 or to subsequently rescind an
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approved request based upon the Requesting Party's compliance with this MOU and/or any negative audit
findings.
XII. Application of Public Records Law
The Requesting Party agrees to 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 records, provide the Department with a copy
of the requested 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 Statutes, or as otherwise provided
by law.
3. Ensure that public records that are exempt or confidential and exempt from public records 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 contract, transfer, at no cost, to the Department all public records in possession
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 shall meet all applicable
requirements for retaining public records. All records stored electronically must be provided to the
Department, upon request from the Department's custodian of public records, in a format that is
compatible with the information technology systems of the Department.
IF THE CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO
THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT
(850) 617-3101, OGCFiIinq(cflhsmv.gov, PUBLIC RECORDS
COORDINATOR, OFFICE OF GENERAL COUNSEL, 2900 APALACHEE
PARKWAY, ROOM A432, MS 02, TALLAHASSEE, FL 32399
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
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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:
Florida Department of Highway Safety and Motor
City Of Cape Canaveral Vehicles
Agency Name 2900 Apalachee Parkway
100 Polk Ave Tallahassee,Florida 32399 Street
Address
Suite
Cape Canaveral FL 32920
City State Zip Code
BY: BY:
DocuSigned by:
Signature of Authorized Official Sigtetn€fsaf3A tthorized Official
David Greene Stephanie Sanford
Printed/Typed Name Printed/Typed Name
City Manager _ Chief
Title Title
c�/6 l/ ? 7/25/2019
Da ( / Date
d.greene@cityofcapecanaverai.org
Official Agency Email Address Phone
321-868-1220
Number
Agency Point-of-Contact:
David Dickey
Printed/Typed Name
d.dickey@cityofcapecanaveral.org
Official Agency Email Address
321-868-1220/321 -868-1247
Phone Number Fax Number
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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)
1,4 ,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 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: To obtain owner information of
Claimed: City of Cape Canaveral Code abandoned, inoperable and illegally
1 Enforcement is tasked with parking parked vehicles.
enforcement.
4 City Code allows Enforcement
penalties of various parking
violations.
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.
City Manager
Signature of Authorized Official Title
David Greene City Of Cape Canaveral
Printed Name Name of Agency/Entity
Date
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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 of motor vehicles and
dealers by motor vehicle manufacturers,and removal of non-owner records from the original owner records of motor vehicle
manufacturers to carry out the purposes of titles 1 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 of non-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 contractors,but only-
(a)to verify the accuracy of personal information submitted by the individual to the business or its agents,employees,or contractors;and
(b)if such information as so submitted is not correct or is no longer correct,to obtain the correct information,but only for the purposes of
preventing fraud by,pursuing legal remedies against,or recon ering 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 a Federal,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 toned 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.
1 1.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.
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Docu
6 SECURED
Certificate Of Completion
Envelope Id:8D71A389A6624B779FDAE19F44DADBE9 Status:Completed
Subject:City of Cape Canaveral Review Sheet for PREVIOUS Data Exchange MOU
Source Envelope:
Document Pages: 13 Signatures:8 Envelope Originator:
Certificate Pages:6 Initials:0 Patrick Lineberry
AutoNav:Enabled 2900 Apalachee Parkway
Envelopeld Stamping:Enabled Tallahassee,FL 32399
Time Zone:(UTC-05:00)Eastern Time(US&Canada) patricklineberry@flhsmv.gov
IP Address:204.90.30.1
Record Tracking
Status:Original Holder:Patrick Lineberry Location: DocuSign
7/5/2019 2:26:02 PM patricklineberry@flhsmv.gov
Signer Events Signature Timestamp
Deepa Vasudevan —DOCuSigned by: Sent:7/5/2019 3:25:22 PM
deepavasudevan@flhsmv.gov `�"` 144"0le'"" Viewed:7/8/2019 7:58:59 AM
"-465F5F7353394D2.
Operations Manager Signed:7/8/2019 8:03:23 AM
HSMV-MS
Signature Adoption: Pre-selected Style
Security Level:Email,Account Authentication
(None) Using IP Address:204.90.30.1
Electronic Record and Signature Disclosure:
Accepted: 10/12/2015 12:46:33 PM
ID:48563923-17a2-4a54-aa27-1d66df88405d
Jaime Briggs cDocuSlpned by: Sent:7/8/2019 8:03:26 AM
JaimeBriggs@flhsmv.gov jaamt. 1W Viewed:7/8/2019 8:33:24 AM
�164518DF3A734B8
Contract Administrator Signed:7/8/2019 8:33:42 AM
HSMV-DAS
Security Level:Email,Account Authentication
Signature Adoption:Pre-selected Style
(None) Using IP Address:204.90.30.1
Electronic Record and Signature Disclosure:
Accepted: 10/21/2018 9:23:53 AM
ID:dceba8fd-c949-48bc-ac36-edd0e38fdb4d
Robert Kynoch r—DocuSigned by: Sent:7/8/2019 8:33:45 AM
robertkynoch@flhsmv.gov rOdot- Viewed:7/15/2019 9:54:38 AM
`—OA2EF6A47A8E486.
Director of Motorist Services Signed:7/15/2019 9:54:47 AM
HSMV-MS
Signature Adoption:Pre-selected Style
Security Level:Email,Account Authentication
(None) Using IP Address:204.90.30.1
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Lisa M.Bassett r—DOcuS'9ned by: Sent:7/15/2019 9:54:51 AM
lisabassett@flhsmv.gov Viewed:7/15/2019 11:53:22 AM
7E2E9E098052459
DAS Chief Administrative Officer Signed:7/15/2019 11:53:55 AM
HSMV-DAS
Signature Adoption: Uploaded Signature Image
Security Level:Email,Account Authentication
(None) Using IP Address:204.90.30.1
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Signer Events Signature Timestamp
Stephanie Sanford D°c°Signed by. Sent: 7/15/2019 11:54:00 AM
StephanieSanford@flhsmv.gov 5terh"""`` Viewed:7/15/2019 4:46:34 PM
`-4DD72A6A03E94F1
Acting Bureau Chief/Procurement Administrator Signed:7/15/2019 4:47:13 PM
HSMV-DAS
Security Level:Email,Account Authentication Signature Adoption: Pre-selected Style
(None) Using IP Address: 174.228.147.146
Signed using mobile
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Kevin Bailey f—DocuSi9nedby: Sent:7/15/2019 4:47:19 PM
KevinBailey@flhsmv.gov ALM- "l0a Viewed:7/22/2019 11:19:32 AM
�Oc46,cODEA24460..
Director, Division of Administrative Services Signed:7/22/2019 11:19:38 AM
HSMV-DAS
Security Level:Email,Account Authentication Signature Adoption: Pre-selected Style
(None) Using IP Address:204.90.30.1
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jennifer Langston t—Doc"Signed by. Sent:7/22/2019 11:19:41 AM
JenniferLangston@flhsmv.gov JuAlitirtx tzuA stetA' Viewed:7/22/2019 1:19:15 PM
Acting Chief of Staff —DD82CD2535(441c Signed:7/22/2019 1:19:22 PM
HSMV-OED
Security Level:Email,Account Authentication Signature Adoption: Pre selected Style
(None) Using IP Address:204.90.30.1
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jennie Carpenter Completed Sent:7/22/2019 1:19:25 PM
jenniecarpenter@flhsmv.gov Viewed:7/23/2019 12:58:26 PM
Contracts Specialist Signed:7/23/2019 1:01:23 PM
HSMV-DAS Using IP Address:204.90.30.1
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Stephanie Sanford r--Doc°Signed by. Sent:7/23/2019 1:01:27 PM
StephanieSanford@flhsmv.gov 9t ""` 8" Viewed:7/25/2019 10:36:59 AM
`-4DD72A6A03E94F,..
Acting Bureau Chief/Procurement Administrator Signed:7/25/2019 10:37:19 AM
HSMV-DAS
Security Level:Email,Account Authentication Signature Adoption:Pre selected Style
(None) Using IP Address:204.90.30.1
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person 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
Carbon Copy Events Status Timestamp
Data Listing Unit COPIED Sent:7/25/2019 10:37:24 AM
DataListingUnit@flhsmv.gov Viewed:7/25/2019 10:38:02 AM
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Jennie Carpenter COPIED Sent:7/25/2019 10:37:24 AM
jenniecarpenter@flhsmv.gov Viewed:7/26/2019 11:35:35 AM
Contracts Specialist
HSMV-DAS
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
David Dickey COPIED Sent:7/25/2019 10:37:24 AM
d.dickey@cityofcapecanaveral.org Viewed: 10/31/2019 11:55:29 AM
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Glenda Josey COPIED Sent:7/25/2019 10:37:26 AM
GlendaJosey@flhsmv.gov
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Nikeva Mikler COPIED Sent:7/25/2019 10:37:26 AM
NikevaMikler@flhsmv.gov
Security Level:Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 7/25/2019 10:37:26 AM
Certified Delivered Security Checked 7/25/2019 10:37:26 AM
Signing Complete Security Checked 7/25/2019 10:37:26 AM
Completed Security Checked 7/25/2019 10:37:26 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
Electronic Record and Signature Disclosure created on:9/22/2015 2:45:05 PM
Parties agreed to: Deepa Vasudevan,Jaime Briggs
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, FL Dept HSMV (we, us or Company) may be required by law to provide to
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If you decide to receive notices and disclosures from us electronically, you may at any time
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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
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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
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described below. Please also see the paragraph immediately above that describes the
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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
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To request paper copies from FL Dept HSMV
To request delivery from us of paper copies of the notices and disclosures previously provided
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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;
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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..
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Screen Resolution: 800 x 600 minimum
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** These minimum requirements are subject to change. If these requirements change, we will
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providing you with the revised hardware and software requirements, at which time you will
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To confirm to us that you can access this information electronically, which will be similar to
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please let us know by clicking the 'I agree'button below.
By checking the 'I Agree'box, I confirm that:
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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.
DocuSi n Envelope ID:8D71A389-A662-4B77-9FDA-E19F44DADBE9
J l V Florida Department of Highway Safety and Motor Vehicles
FLORIDA HIGHWAY SAFETY AND MOTOR VEHICLES
Contract/Agreement Review
DHSMV Contract No.: HSMV-0020-20 Division: Motori st Services Date: 7/8/2019
Contractor Name: city of Cape Canaveral
Contract Summary: New MOU
Total Cost/Revenue: 0.0 or No Cost❑ Term: six years
Contract Manager: Patrick Lineberry Phone: 850-617-2805
® New Contract(Procurement): ❑ITB ERFP ❑ITN ❑RFQ ❑Single Source ❑Informal Quote
❑Exempt per , Florida Statutes ❑X Not Required
❑ Renewal ❑ Amendment ❑ Extension
❑ Settlement Agreement ❑ New I Revised Template
Approvals Comments
Contract Administrator
c—DocuSigned by:
Signature: ,3tuttAt. S Date:7/8/2019
Division DirectorFandlor Designee
/—DocuSigned by:
Signature: Peitvl Ine(,tt, Date:7/15/2019
'-0A2EF6A47A8E486
Signature: Date:
Budget
Signature: Date:
1 If checked,budgetary review/approval is not required as funds are not
expended under this Contract/Agreement.
Accounting
Signature: Date:
j If checked,accounting review/approval is not required as funds are not
received or obligated under this Contract/Agreement.
Information Services
Signature: Date:
®If checked,ISA review/approval is not required as this document does
not impact information systems.
DAS Chief Administrative Officer
p---DocuSigned by:
Signature war---- Date:7/15/2019
❑If checked, I L�.r• '!;;.,o49inistrative Officer review/approval is not
required as the document is a previously-approved boilerplate.
Legal
Signature: Date:
5 If checked,legal review/approval is not required as the document is a
previously-approved boilerplate.
Chief of Purchasing& Contracts
,--DocuSigned
Signature:, 94,./...,t4-& 5,..4044‘ Date:7/15/2019
Director o`Aii4ii1ii9gt ative Services
DocuSigned by:
Signature: .. Date:7/22/2019
❑If checked, N ly p val is not required as the document is a
previously-approved boilerplate.
Deputy Executive Director
Signature: Currently Vacant Date:
If checked,review/approval by Deputy Executive Director is not required
as the document is either an approved template or does not fall under the
Deputy Executive Director's areas of responsibility.
Chief of Staff/ Executive Director
r—DocuSigned by:
Signature:, .oaf" Laalsfel&, Date:7/22/2019
❑ If checked,ve.vienieMemallby Chief of Staff/Executive Director is not
required as the document is either an approved template or does not
require review by the Chief of Staff/Executive Director.
HSMV 95020(03/2019)
DocuSign Envelope ID:8D71A389-A662-4B77-9FDA-E19F44DADBE9
Memorandum of Understanding(MOU) —Item check list
Agency Name: City of cape Canaveral
Documentation of current licensure or certification from resident state of corporation
[ I Reviewed copy of requestor's business license.
Ti In state corporation status obtained from www.sunbiz.org.
Or
Ti Out of State Corporation licensure or certification submitted by requestor (attached).
n Reviewed requestor's website at comparing DPPA exemption claimed to the business needs or
services provided to third parties.
Ti If vendor is acting on behalf of a government agency, a letter of authority is attached.
[5 This is a government/law enforcement agency.
Memorandum of Understanding
® Current forms have been provided.
® Requestor has provided appropriate signatures.
Ti Letter of delegation is required if signed by other than authorized official.
Form 90615 (DPPA)
® Current version of form has been provided.
Debit Authorization Form
Ti Account/Routing number is provided.
Ti An appropriate signature is provided.
[ I Copy of form provided to Revenue.
Ti N/A
DocuSigned by:
Reviewed by: a 14.444444,~t, Date:7/8/2019
Deepa vasudevagureau of Records