MEMORANDUM OF UNDERSTANDING FOR GOVERNMENTAL ENTITY ACCESS TO DRIVER AND VEHICLE INFORMATION DATABASE SYSTEM (DAVID)AUK*
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MEMORANDUM OF UNDERSTANDING
FOR GOVERNMENTAL ENTITY ACCESS TO
DRIVER AND VEHICLE INFORMATION DATABASE SYSTEM (DAVID)
Contract Number HSMV.
This Memorandum of Understanding (MOU) is made and entered into by and between
City of Clearwater Parking System , 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.
L 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 intonation, 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.
11. 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.
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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DAVID (Government Entity) Data Exchange MOD (Rev, 11-2016)
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 101 ited to the subject's driver identification number, name,
address, telephone number, social security number, medical or disability information, and emergency
contact information.
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.
111. 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, 32123, 32220, 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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DAVID (Govemment Entity) Data Exchange MOU (Rev. 11-2016)
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. 5taterpent of Wo
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 rotes and times, which shall be uninterrupted
except fo r p e no d s 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
m aintenance will norm ally occur Sunday mornings between the hours of 6:00 A.M. and 10:00 AM.
3 Provide an agency contact person for assistance with the implementation and administration of this
MOU.
B. The Requesting Party agrees to:
1. Uti 1 ze 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 em ergenc y contact in the event of a serious injur y, death, or other
incapacitation. ECI shall not be released or utilized for an y other purpose, including
developing leads or for criminal investigative purposes,
2, Retain information obtained from the Providing Agency only if necessary for law enforcem ent
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.
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, tattler 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 Partys 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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DAVID (Government Entity) Data Exchange. MOU (Rev. 11-2016)
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 andior 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 8 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. Safeauardlng Information
The Parties shall access, disseminate, use and maintain all information received under this Agreernent
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 resuit of this MOU,
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DAVID (Government Entity) Data Exchange MOU (Rev. 11- 016)
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 71A-1.005, 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, affin-n and agree to maintain the
confidentiality of the information exchanged through this Agreement.
Vt. Complianceand 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-maileci 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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DAVID (Government Entity) Oata Exchange MOU (Rev. 11-2016)
E-mail: DatalistinqUnitafihsrn v.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 bmely
submit a certification statement may result in an immediate review request and, based upon the findings
of the review, suspension or term ination 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 Term
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 ail 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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DAVID (Government Entity) Oata Exchange MOU (Rev. 11-2016)
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. Notice%
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: DataListinqUnitMlismv.qov
For the Requesting Party:
Agency Point-of-Contact listed on the signature page.
XI. Additional Database Access/Subsequent MOU's
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 infonrtation 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 M0U'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 MOIJ'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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DAVID (Gavernn,ent Entity) Data Exchange MOU (Rev. 11-2016)
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;
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, OGCFiling Ihsrmv.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
Page
DAVID (Goverment Entity) Data Exchange M{7IJ {Rev. 11 -2016)
IN WITNESS HEREOF, the Parties hereto, have executed this Agreement by their duly authorized officials on
the date(s) indicated below.
BY:
REQUESTING PARTY:
CITY OF CLEARWATER, FLORIDA,
A municipal corporation and
political subdivision of the State of Florida
City of Clearwater Parking System
Agency Name
100 S. Myrtle Ave, Suite 220
Address
Clearwater, Florida 33756
Signature of Authorized Official
Hunter Hughes
Printed/Typed Name
Parking Manager
Title
Date
Hunter.Hughesmyclearwater.com
Official Agency Email
727-562-4774
Phone Number
Agency Point-of-Contact:
Sue Tel lier
Printed/Typed Name
Sue.Telliermyclearwater.com
Official Agenc all
amilo A. Soto
Assistant City Attorney
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DAVID (Government Entity) Data Exchange MOU (Rev. 11-2016)
PROVIDINGAGENCY:
Florida Department of Highway Safety and Motor
Vehicles
2900 Apalachee Parkway
Tallahassee, Florida 32399
BY:
Signature of Authorized Official
Lisa M, Bassett
Printed/Typed Name
Chief, Bureau of Purchasing and Contracts
Title
Date
Attest:
Rosemarie Call
City Clerk
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
En FLORIDPA
Florida Department of Highway Safety and Motor Vehicles
n----------
HIGHWAY SAFETY AND MOTOR MAICLES Contract/Agreement Review
DHSMV Contract No.: Hsmv-0184-18 Division: Motorist Services Date: 10/20/2017
Contractor Name: City of Clearwater Parking System
Contract Summary: Previous MOU HSMV 0140-15 Please terminate HSMV 0140-15
Total Cost/Revenue: 0.0 or No Cost ❑x Term: six years
Contract Manager: Patrick Lineberry Phone: 850-617-2805
® New Agreement
❑ New Contract(Procurement)
Procurement Method: ❑ITB ❑RFP ❑ITN ❑RFQ ❑Single Source ❑Informal Quote
❑Exempt per , Florida Statutes ❑x Not Required
❑ Renewal ❑ Amendment
❑ Settlement Agreement ❑ New/Revised Template
Approvals Comments
Division Director(s)
oo.„Sig...d by:
SignaturEOA2EF6A4TA8E4B6
a�tvf tadrt.�. Date?0/20/20)_7
_..
Signature: Date:
Budget
Signature: Date:
;]If checked,budgetary review/approval is not required as funds are
not expended under this Contract/Agreement.
Accounting
Signature: Date:
[3t If checked,accounting review/approval is not required as funds are
not received or obligated under this Contract/Agreement
Information Services
Signature: Date:
[2f If checked,ISA review/approval is not required as this
Contract/Agreement does not impact informations stems.
Legal
Signature: Date:
[2f If checked,legal review/approval is not required as the document is
a previously-approved boilerplate
Purchasing & Contracts
D—Sig—d 6y:
Signature � m Date.10/20/2017
1
Administrative Services
❑ S'qn,db
Signatur,: S(Aff Date: 10/24/2017
Deputy Executive Director
Signature: Date:
IN If checked,review/approval by Deputy Executive Director is not
required as the Contract/Agreement.
Chief of Staff/ Executive Director
�Dm.Signteld by
Signature: JA+ t!�t� m&I Date:10/25/2017
99149OB7AA52486...
HSMV 95020 (05/2015)
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
Memorandum of Understanding(MOU)—Item check list
Agency Name: City of Clearwater Parking System
Documentation of current licensure or certification from resident state of corporation
❑ Reviewed copy of requestor's business license.
❑ In state corporation status obtained from www.sunbiz.org.
Or
❑ Out of State Corporation licensure or certification submitted by requestor (attached).
❑ Reviewed requestor's website at comparing DPPA exemption claimed to the business needs or
services provided to third parties.
❑ If vendor is acting on behalf of a government agency, a letter of authority is attached.
❑x This is a government/law enforcement agency.
Memorandum of Understanding
® Current forms have been provided.
® Requestor has provided appropriate signatures.
x❑ 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
❑ Account/Routing number is provided.
❑ An appropriate signature is provided.
❑ Copy of form provided to Revenue.
x❑ N/A
0V22B"E'TfVhite
Docuftned by:Reviewed b ��' WZ. Date: 10/20/2017
Bureau of Records
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
� "
MEMORANDUM OF UNDERSTANDING
FOR GOVERNMENTAL ENTITY ACCESS T
DRIVER AND VEHICLE INFORMATIONT I
Contract Number _ HSMV-0184-18
This Memorandum of Understanding (MOO) is made and entered into by and between
Citi of Dlea at Parkin_F1 y stem
hereinafter referred
-.._. e.
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.
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 statutorfily 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," used 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 laves 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 statutorlly
mandated duties and functions.
This MOD is entered into for the purpose of establishing the conditions and limitations udder which
the Pro0di g 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, 22aciu=
For the purposes of this Agreement, the eiow-listed terms shall have the following meanings:
A. DAVID - The 'Providing Agencys Driver and Vehicle Information Database system that accesses
and transmits driver and vehicle information.
B. Driver License Information -- Drives license and identification card data collected and maintained by the
Providing Agency. This information includes personal information as defined below.
C. Emergency Contact Information (PCI) -- 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, 'IS United States Code § 2721 , et seq.)
that prohibits release and use of personal in ormati n except as otherwise specifically permitted within the
Act,
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DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
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. Leaal 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
Page 2 of 9
DAVID(Government Entity)Data Exchange MOU(Rev. 11-2016)
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
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.
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 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 Partys 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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DAVID(Government Entity)Data Exchange MOU(Rev. 11-2016)
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
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. Safeauardina 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,
Page 4of9
DAVID(Government Entity)Data Exchange MOU(Rev. 11-2016)
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
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. Comoliance 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
Page 5of9
DAVID(Government Entity)Data Exchange MOU(Rev. 11-2016)
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
E-mail: DataListingUnitaflhsmv.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 Partys 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. Aareement Term
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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DAVID(Government Entity)Data Exchange MOU(Rev. 11-2016)
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
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, orwith 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(c_flhsmv.gov
For the Requesting Party:
Agency Point-of-Contact listed on the signature page.
XI. Additional Database Access/Subseauent MOD's
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
Page 7of9
DAVID(Government Entity)Data Exchange MOU(Rev. 11-2016)
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
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, ili I PUBLIC RECORDS
COORDINATOR, OFFICE OF GENERAL COUNSEL, 2900 APALACHEE
PARKWAY, ROOM A432, MS 02, TALLAHASSEE, FL 32399
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
Page 8of9
DAVID(Government Entity)Data Exchange MOU(Rev. 11-2016)
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
IN WITME-W HEREOF, the, Parties hereto, have executed thisthei
Agreemeni bv r du)y authOlized Off icials on
J'he date(s��iridicated be!", . . i
REQUESTING PARTY: PROVDINGAGENCY�
01"Y 0 F CL EAR414 R F LrDo-?�DA FOnda D"e'na-'men"C"Hign"Va"y' �ety-arld, W—Or
A rnjnici'Liai corporaion an.-j vehic�e-s
poiffical sued "Sloeo'Ohe tPte. ,-,f F.1,Dr1da 290"0' Atalacriee
TaHahassee, Fionda 3'23499
Age,,-,,,cy Narne
100 & M rfle Ave Suite #;x0
A dress
Oearw tey. Horida 33756
..............
k y Do S d by,
c'u,,we
SiLI A ed a It6v
Hun, r
_Lgg
L_J�uqhyes Lisa P0. Bassett
Pri-)tedqypied Name Prmted,'Typed Name
n
PaIrkIq M,ana,-,,er Chief Bureau of Pu,:hasrq:i ard Contracts
:.fi� L —", .................
Tide- ..........
10/26/2017
Hunte
2L-a F�ju hge-s-,S—my�c Ie a rw a Le r,r,our;
Official AgencyEmafi,
727-562-4774
Fh'o-n e N'L'i m-—be r
Agency Point.-cf-Contact-
Sue Tether
Printed,7yped Narne
Sup—T L EM -
rwate� com-
Off bai Agen it
727-56 4771'7
'17-51'" '14 7--5
P tj'."'r -------
6 N urn fll,fivfl air F F be,
(�e
Approved""#S,r,91f.0,M: Meat:
4, 4
.................
6
C rriiIoA. Soto Roslemane Cal,
Asst s!ar)t City Attorrre'r Citv C!er,:
K
Page 9 of 9
DAVID iGovervnen!F---rzItio Dam Excharce MOU,Rev '1�-2011E,,'
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
ATTACHMENTI
FLORIDA DEPARTMEN'r OF HIGHWAY SAFETY AND MOTOR VEHICLES Request For
Exempt Personal Information In A Motor Vehicle/Driver License Record
The Driver's Pril,,acv 1'rejectiol)Act, 18 United States Code sectioris 1-0l("DPPA")makcs personal infornnation contained
fru U10tor Vehicle(e,driver ficense records confidentiat and oxempt from disclosure, Jlersojlal ulfolm-,jtieu in as nr(qu.j•vellicte
or driver license record includes.bUt is U01 Iftnited to,in individual's social security nuniber,driver ficense oridentification
iluniber, mune,address and. owdical or disability int"ormation, Personil inibrination does riot include inibrguation related to
drivim:violations and driver status, Personal information Frain these records nlay only be released to individuals or
01"_e0nl zal I oils that qualify under one of tile eveniptions provided bi L)PPA,which are luted on the back of this forin.
Ill lieu of,Completing this doral,a request for hilbrinaflun UldN, be inade in leuer fbrin (oil conlpallyaocncy leftel-lIetse,,it
appropriate)stating the type of information heing requested,thio. DITA exemption(s) under which the requesi is being Inade,
a detailed description of dic holy the information will be used, and a sLatenwrit that the inforniation will not be used or
redisclosed except as provided in DPPA, irthe inforniation is provided ou letterhead it must include a statement that the
information provided is trtm and correct,signed by the authorized official) ander penalty of peijury., sated notarized,
1 not it representai ive of an organization requesting personal inforination for one or more records as described below, I
declare that nry organization is qualified tura obtain Personal inforniati0o Linder cxemption nuniber(s)
as listed on page 3 of this forum,
1 Understand that I shall noi use or redisclose this personal lnfbrniafion except as provided in DIT A and that any, use or
redisclosure in violation ofthese statutes rnay subject me to criminal sanctions and civil liability.
Complete the 1`6110Wh12 for ealch DPPA exemption being clainned. (attached additional page,if necessan')-
---------- ...........
1)PPA Description off-low Requesting Party 1 Description of how 13E'Lta 111 be use d:
Exemption QUdififoifor Exemption:
Claimed:
id
Government Agency; Municipality—City cf To confirin registered Owner information and
C9earwater Parking System tag h1forllation for the purposes of Parking
Enforcement Citations that have been issued
and inav/1-nay not be contested.
...........
...........................
.................. ..... ........... -—------------
Page I of 3
(01i'20171)
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
Obtaining personal information under false pretmiscs jS 8 state ard federal chine, Under pci�jfltjcs&pol-jutn", I dedanc
that I have as iid the forcgoinu Rcqucst.For Exemyt Perjonal Inforniation in A Pdozor Vchicle/DriNer License Record and
that file)IC1, Mled in itarellrue -#[d con ect.
of�IA' HTlrizedt fficial,
Si;11"hature ifle
Printed Naine
Date
STATE Of"
7
C 0 LYN TY 0 F
Searn To (or affirmed) and subscribed bef'ore nie this day o[ J, 2(' by
Personally Kno��qi OR Produced Identification
Tyl:.)c of Identificaion Produced__
" ka
v-)
NoTARY PUBLIC (print nai',ie) N0'1`, RY PUBLIC (slinknic)
My Commission Expires: t,b Z c)
EL IZASENUAYLY
Wcomm&pra—yeb2o
Page 2 of 3
(01/2017)
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
Pursuarit to soc;fion 119,0712(2),FS.,personal information in inotor vdhjcjs wid driver license records can he relcased for Ilia killoo-irw
py
PUTPOSCY,as Withric"A in 18 United%LatCS Cade.section 2721,
Personal infortnaticni rcRm'Cd U1 in subscction fa""shafl he cK.wbosed for use in ctmmeefiro,with gmaters ormot,,vemio so-driver sarr-tv
and flr--ft. molor vehicle ernissiuns, nxfor vChHe PIDILWt Awnationc,rccnH&or advisorjc&ptofittrulance ol"matt)j,
dealers by MOLOr whicle nutnufacturer.k.and rcinoval of,ion-ownty records Irron Liu-,origirnt'l 0%%rnC] records ofirrotor vehicle
to Carry arra".the purpost-.S oftill"S I Fmd 1V ofthc Anti C�o-'Hicfi,Act of 1992,lhc Alwoowbile Infournation D,sc.lusurc Act
1. 1,1',S,C 12-31 ct sefj,).the Clein An Act(42 US.0 7401 et sec..'.and 4-hapters 301,305-and 321-33 1 cjfliflc 49.told,subliec-, to
iihLisccOun,
i, Pro'I'Be last-. n",VOM11menT Or-Micy including any court or law unrot-mment auency,in c.arryinq out iM- functicais,or aj,,v n it'naC;t p wson
Or endiry actin-,oil lbvhalf(,-,if a Federal,Suits.or loco! in ont its frinctions,
2, For ros;in Loxinecdou widi ruatict's of motor vehicle"or Mver safety and theft:ri,.otor MiSSh)V!S:motor product
afteratroins,recalls,o, advisories,Performance monnoring oll-nitakir YcliMes.11101or vehicle parts and cleakrs,motor vehic�e rosr],ct
research Petivifies, including survey rescarch-,and removal of non-ova,cr recoids from,the Origin.,.1 omwr records 01 fin stor �rl'li 1a
mart u facturers.
3. For use in the normal cuunat of business by c:leinmsinss
ate bueor its ageris.empk)vcs.og contractors.bm ori1%.-
9
(a)to veTify theaccurac,,,of peno nal information submitted b,e-qie indiOdual to the business or its agents,employees,or comnacortri,'and
Q b)if such information as sosubmikwd is not correct or is its It correct. to Gomm the correct inn!'nnation,'but only fisr the purposcs of
Preventing Fraud fay,I-nirsuino legraV renredies against.,or rccovering,on,a debt or secud-.,fineresc against,die hollriduaL
4, For usc in connection o-ith Low civil,c,irninal,adminirmativc,or arbitral proceeding in any Federal. Swe�or local court tar-agency or
beffisre an,%,self repidalory body,including the service ol'proces. in witic'Pation of Hfigi'adon.and The expecution or
enforcement of judooneniF art(]torders,or pursuant us art order of Fedend.State,so local COLVI,
For use in research afcciviiies%and ficir use in produzing statistical repons,so long,as thin personal infornunion is nol published.
rediqclosed.rat used to contact individuals,
6, For rise by any;ws-affer or insurance support organiz0ficut,#,P".1,y a seH-insured enfit)%or lts agenis.employlM,or Con',racrors,in
connection vfit"€clain ts.invemigatior,activilics,andfraud activi,.ics.rafing or underwrifin2,
P01,rise in providing notice to ii,,e ovnc s orto%,eii or irnpounded vehicles.
8, For use by any licensed private irivegOgativc.agency or lice.nsed security service For nn, purrosc iccrinitted toiler this SUbscction
9, For use ky,an employer or its agent or insurer to obtain or vcrin`infinnnation relaring no a holder of a corarr.ercial driver's Hecrise that is
M11hrCd Under erhqpk,-r 3 13 a-fide 49,
10.For use h)crinnectioli wnh the operaiion o`privrae Loll u,asispormflon Ncifilics,
I 1.For any oil:er use ir"t response to requests for indiv:&M!F110101 VChiCic recordifffic Strate has obtainc-d the cxlircss cmiscra offfie
Person to k0om such peiso,,W inrorniation pertains.
12.For bi.4-distribution for rurvelvs.markeling or solicitairons if th�,State has obtained.tiara cxpress coo&cni offlic parson to%"I'lorn such
persomd information pertains,
13.F Use by snlrequeSW, if 1"ri-reques'cr dernonsirnms it has obutined the written conseW of The indi%-idoml tcr whcm-�the iril'orryolfioll
perl"ims
14.For any other t.€srt sirecjflcally awlim-ized undcr the hwv or rd-le Stat".tl,,w holds die record,if such ose is related to th,,rppemfion or ii,
mosor"-duCIC OrP&JEC Sr'IFCI$,%
Page I of-I
0L"'2 17)
DocuSign Envelope ID: 8E733D81-5076-4FA1-8906-9C8F1A993A58
C1 '1' -Y' ' OF CLEARWA 'rERr
Ht&1, i k �'�li I!' r�w'ldt:ttslf' i ..17:tii6ltfEi±.B't ;,:7r'r.1 "6 'aE
W Pel "'s b, �� i al."t.��' 61
�
Jame 7, 2017
Patrick Lineberry
Government nalystml .A.V.l, , Liason
Division of Motorist Services-Data Listing Emit
Florida Department of Highway Safety and Motor Vehicles
2900 Apalachee Parkway,A236, MS 78
Tallahassee, Florida 32399-0500
Dear Mr. Lineberry,
I, Clearwater City Manager William Horne, delegate the authority to execute, on behalf of the
City, the Clearwater Parking System DAVID Memorandum m cif Understanding ( 'COU) arse related
amendments, as necessary to Hunter Hughes, Parking Manager for the City.
Thank you.
William P., Horne, 11
City Manager
SetUR9D
Certificate Of Completion
Envelope Id: 8E733D8150764FA189069C8F1A993A58 Status: Completed
Subject: Please DocuSign these documents: Review Sheet for PREVIOUS Data Exchange MOU
Source Envelope:
Document Pages: 15 Signatures:6 Envelope Originator:
Certificate Pages:6 Initials:0 Patrick Lineberry
AutoNav: Enabled PO Box 6669
Envelopeld Stamping: Enabled Portland, OR 97228
Time Zone: (UTC-05:00)Eastern Time(US&Canada) patricklineberry@flhsmv.gov
IP Address:207.156.9.1
Record Tracking
Status: Original Holder: Patrick Lineberry Location: DocuSign
10/19/2017 patricklineberry@flhsmv.gov
Signer Events Signature Timestamp
Bennett White DPm.ecnwGl� km 8lgnedby: Sent: 10/19/2017
Bennettwhite@flhsmv.gov Viewed: 10/20/2017
132
Security Level: Email,Account Authentication 4s4622BDE3BF4BA Signed: 10/20/2017
(None)
Using IP Address:207.156.9.1
Electronic Record and Signature Disclosure:
Accepted: 10/20/2017
ID:8d9cb778-7d30-487c-afce-73b40133c7fb
Robert Kynoch by, Sent: 10/20/2017
RobertKynoch@flhsmv.gov ED—Signed
b� tzVw . Viewed: 10/20/2017
Director of Motorist Services WEHA47ABE4s6_ Signed: 10/20/2017
FL Dept HSMV
Using IP Address:207.156.9.1
Security Level: Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Lisa Bassett Sent: 10/20/2017
LisaBassett@flhsmv.gov -- -- Viewed: 10/20/2017
(
—D—Signed by:
Chief of Purchasing and Contracts Signed: 10/20/2017
FL Dept HSMV
Using IP Address:207.156.9.1
Security Level: Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Kelley Scott E
D—Signed by- Sent: 10/20/2017
KelleyScott@flhsmv.gov V""V"I Off Viewed: 10/24/2017
Director of Administrative Services 633CAc39c2o1454 Signed: 10/24/2017
Florida Department of Highway Safety and Motor
Using IP Address: 199.254.101.109
Vehicles
Security Level: Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Signer Events Signature Timestamp
Jamie DeLoach OD...Signed by: Sent: 10/24/2017
Jamie DeLoach@flhsmv.gov Am« v�� Viewed: 10/25/2017
Chief of Staff NKB 99149OB7AA52486 Signed: 10/25/2017
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
Becky Parramore Completed Sent: 10/25/2017
BeckyParramore@flhsmv.gov Viewed: 10/26/2017
Leasing Consultant Signed: 10/26/2017
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 (
—D—Signed by-. Sent: 10/26/2017
LisaBassett@flhsmv.gov � Viewed: 10/26/2017
Chief of Purchasing and Contracts Signed: 10/26/2017
FL Dept HSMV
Using IP Address:207.156.9.1
Security Level: Email,Account Authentication
(None)
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
Data Listing Unit Sent: 10/26/2017
Data Listing Unit@flhsmv.gov [:::C:OPIED
Security Level: Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Hunter Hughes Sent: 10/26/2017
hunter.hughes@myclearwater.com OPIE Viewed: 8/23/2018
Security Level: Email,Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 10/26/2017
Certified Delivered Security Checked 10/26/2017
Envelope Summary Events Status Timestamps
Signing Complete Security Checked 10/26/2017
Completed Security Checked 10/26/2017
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
Electronic Record and Signature Disclosure created on:9/22/2015
Parties agreed to: Bennett White
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
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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
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To let us know of a change in your e-mail address where we should send notices and disclosures
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** These minimum requirements are subject to change. If these requirements change, we will
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