The URL can be used to link to this page

Home My WebLink AboutContract 43550 (ATY 8ECRETAI7Y CONTRACT N0,r FoRTWORTH 044 Sol, CONTRACT APPROVAL 1 CORRECTION FORM -ro: Ava Ea1v DEPT: PD DATE: Aug . 22 , 2 SUBJECT: Account Validation and Certification TITLE OF DOCUMENT(S) from CLEAR 1. LT M _f acm 2. 3. X APPROVED FOR SIGNATURE—The above referenced document(s) have been reviewed by the Law Department and are approved for signature. The final version is attached. Please have three (3) original copies of the document(s) executed as set out below. RETURN TO DEPARTMENT—The above referenced document(s) are being returned to your department for corrections. Please see comments below. COMMENTS: By: Jessica Sangsvang Attorney Name REQUIRED SIGNATU ON DOCUMENT(S) ❑ VENDOR/OTHER AGENCY ❑ DEPARTMENT DIRECTOR X ASSISTANT CITY ATTORNEY ❑ ASSISTANT CITY MANAGER OFFICIAL RECORD CITY SECRETARY a CITY SECRETARY FT. WORTH,TX Fort Worth kx3ftad OFFICE OF THE CITY ATTORNEY 1 I I The City of Fort Worth * 1000 Throckmorton Street*Fort Worth,Texas 76102 I I 817-392-7600*,Fax 817-392-8359 19E4•1993•2011 �� .j 1 'I L 1 p J i�4 � 1 N WESTe Account Validation and Certification AVC R Form for CLEAR —GOVIACADEMIC AThomson Reuters business Subscriber Information ❑ New CLEAR Subscriber. Existing CLEAR Subscriber-requesting change in unmasked display. Complete AVC Form and submit with the order Complete AVC Form and Fax to 866-294-1442 or email to west.cleamvt @thormon.com Account Number(if applicable) 1003932833 Full Legal Name/Business Entity City of Fort Worth/Police Department Business UnitlDept The applicant's business operates out of (please check one) 0 a Commercial Location ❑ a Residence(i.e.a home-based business) moo 5001 Blue Mound Road Street Address � city Fort Worth Country united States State Texas Zip/Postal Code 76106 Main Company Telephone 817-392-4000 Location/ContactlExt Telephone 817-392-4239 E-Mail Address Aya.Ealy @Fortworthtexas.gov Website Address www.FortworthPD.COM Cell Phone(if no land line available) Check here if no business website available ACCOUNT/BUSINESS TYPE SECTION Select the applicable business tyge and continue to next step X Indicate Tyke of Government Select tyQe of Government Select type of Academic ❑ US—Federal ❑ Privately Funded Academic Institution (non govt funded) ❑ US—State ❑ Government Funded Academic Institution Fx� US—Local ❑ Tribal Government ❑ Other Government Please describe ❑ College/University Police for Academic Institution Q Does the requesting Business Unit/Dept have arrest power? 0 Yes ❑No CERTIFICATION SECTION FOR PRIVACY COMPLIANCE Subscriber certifies that it has read,understands and will comply with the terms of the CLEAR Subscriber Agreement including in particular(but not limited to)the Data Usage Restrictions.Subscriber understands that West is not a Consumer Reporting Agency and Subscriber will not use any CLEAR Data for any purpose regulated by the U.S.Fair Credit Reporting Act(15 U.S.C.§ 1681 et seq.)or any similar statute.Subscriber further certifies one of the following: ❑ X Subscriber is NOT one of the following types of companies/entities: ❑ Subscriber IS one of the following types of companies/entities: -Please select the applicable type below: ❑ Private detective(non-commercial use for private clients) ❑ Company involved and/or associated with inappropriate adult content ❑ Bail Bond Companies,Bounty Hunters,Repossession Firms web sites and/or adult-type web services. ❑ Dating Services ❑ Library,Association or other entity providing access via Public ❑ Internet People Locator Services Terminals ❑ Adoption Search Firms El Prison or Correctional Facility providing access to inmates/detainees F-1 Diet Centers ❑ Companies on an Alert List ❑ Credit Clinics,credit repair companies,and credit counseling firms ❑ Condominium/Homeowners Associations ❑ News agencies and journalists ❑ Utility or telecommunications provider that sells services to consumers ❑ Future Services(i.e.health clubs,timeshares,continuity clubs,etc.) ❑ Foreign Government OFFICIAL RECORD CITY SECRETARY FT.WORTH,TX 1011111 SAMInei 745.dot NEENOW Additional ertification For Cowliance ® Subscriber certifies that it is NOT involved in the following Credit fraud,identification theft,stalking,harassment,any unethical business practices or illegal activity nor has it worked to further such activities of its customers;nor is it on the U.S.Treasury Department Office of Foreign Assets Control(OFAC)Specially Designated Nationals and Blocked Persons List. Multiple Locations/Branches/Subsidiaries ❑ Please check here if Subscriber is subscribing to services for use at multiple locations and attach the completed Addendum to Account Validation and Certification Form- Multiple Locations("Addendum").Subscriber certifies that the Business Type and Privacy Compliance information provided in this AVC Form applies to all locations set forth in the Addendum and that the location information set forth in the Addendum is complete and accurate. Permissible Use under Gramm Leach Bliley Act Subscriber's use of the data is limited by the U.S.Gramm-Leach-Bliley Act(15 U.S.C.680 1 et.seq.)and can only be used for specific non-FORA(Fair Credit Reporting Act) purposes.Please indicate below(check box)what permitted use(s)will apply to your research needs, At least one permissible use must be selected to be granted access or the Subscriber must select the non-permissible use: ❑ Subscriber certifies there is no permissible use ❑ For use by a person holding a legal or beneficial interest relating to the consumer, ❑ For use in complying with federal,state,or local laws,rules,and other applicable legal requirements. ❑ For use as necessary to effect,administer,or enforce a transaction requested or authorized by the consumer. ❑ For use in complying with a properly authorized civil,criminal,or regulatory investigation,subpoena,or summons by federal,state,or local authorities. ❑ For use to protect against or prevent actual or potential fraud,unauthorized transactions,claims,or other liability. For use by a Law Enforcement Agency,self-regulatory organizations,or for an investigation on a matter related to public safety ❑ To persons acting in a fiduciary or representative capacity on behalf of the consumer [] For required institutional risk control or for resolving consumer disputes or inquiries. ❑ With the consent or at the direction of the consumer. Permissible Use under Drivers Privacy Protection Act Subscriber's use of the data is limited by the U.S. Drivers Privacy Protection Act (1 S U.S.C. §2721 et seq.) and can only be used for specific non-FORA (Fair Credit Reporting Act)purposes.Please indicate below(check box)what permitted use(s)will apply to your research needs. At least one permissible use must be selected to be granted access or the Subscriber must select the non-permissible use: ❑ Subscriber certifies there is no permissible use ❑X For official use by a Court,Law Enforcement Agency or other Government agency ❑ To verify or correct information provided to you by a person in order to prevent fraud,pursue legal remedies or recover a debt;skip tracing ❑ For use in connection with a civil,criminal or arbitral legal proceeding or legal research ❑ For use in connection with an insurance claims investigation or insurance antifraud activities ❑ For use by a licensed private investigator or licensed security service for legitimate DPPA purposes C]ISMA5KED OR FULL DISPLAY OF SENSITIVE PERSONAL INFORMATION SECTION Qualified Government Accounts Only—Not Applicable to Academic Accounts except for College/University Police Accounts or Businesses operating out of a residence. Complete the below section if Subscriber requests unmasked or full display of full Security Numbers,Day of Date of Birth and/or Driver's License Wallet ❑ Subscriber IS NOT requesting unmasked or full display of Sensitive Personal Information ❑x Subscriber IS requesting unmasked or full display of Sensitive Personal Information WEST PUBLISHING CORPORATION(`WEST')—AUTHORIZED SENSITIVE INFORMATION DISPLAY POLICY: West,seeks to balance overall individual privacy needs and concerns with the legitimate personal information needs of specific entities as allowed within the provisions of the U.S.Gramm Leach Bliley Act(15 U.S.C.§6521 et seq.)(U.S.GLB),U.S.Drivers Privacy Protection Act(18 U.S.C.§2721 et seq.)(U.S.DPPA)and other laws. As a general rule,unmasked and full display of sensitive data on West Public Records Databases is truncated. In order to help ensure that access to authorized unmasked and full display of sensitive data is warranted,West requires validation on a regular basis as necessary for each account requesting access to unmasked and full display of sensitive personal information to certify that the unmasked and full display of personal information is needed,and will only be used in connection with legitimate Government business.West,in its sole discretion,reserves the right to discontinue access to unmasked and full display of personal information. All CLEAR Users on this account will be granted access to the some type ofpersonal innformation upon approved credentialing Information Protection Affirmation Subscriber shall be fully responsible for any unauthorized collection, access, use, and disclosure of Personal Information subject to this Agreement. Without limiting the foregoing,Subscriber shall employ appropriate administrative,physical,and technical safeguards in order to sufficiently protect the Personal Information and information assets and resources in question. Subscriber shall immediately notify West of any Information Protection Incident that may result in the unauthorized collection, access, use or disclosure of Personal Information subject to this Agreement. Subscriber shall make all reasonable efforts to assist West in relation to the investigation and remedy of any such Information Protection Incident and any claim,allegation,action,suit,proceeding or litigation with respect to the unauthorized access,use or disclosure of Personal Information. For purposes of its obligations hereunder,the acts or omissions of Subscriber's employees,shall also be deemed the acts or omissions of Subscriber. 10/1/11 SAMInet 745.dct Aippropuriate Use Standard West provides computer devices,networks,and other electronic information systems to meet missions,goals,and initiatives and must manage them responsibly to maintain the confidentiality,integrity,and availability of its information assets.The use of any West information asset will be for legitimate business purposes only and in accordance with all applicable West corporate policies. Any access to or use of non-public personally identifiable information must be in accordance with all applicable law. No individual shall access records that require a permissible purpose unless such a purpose exists. It is your responsibility to seek guidance and clarification in case of any question about the proper use of West resources,including but not limited to the use of non-public personally identifiable information. All employees,associated with the Subscriber,including all personnel must adhere to these requirements. Please acknowledge that you and authorized persons underyour account(s)agree to limit the use of this information,as described above,and to comply with the provisions of the U.S.Gramm Leach Bliley Act(15 U.S.C.§6821 et seq.)(U.S.GLB),U.S.Drivers Privacy Protection Act(18 U.S.C.§2721 et seq.)(U.S.DPPA)and all other applicable federal,state,and local laws,rules,and regulations. Your signature below as"authorized Representative"certrfles that you are the authorized signatory for this account(s.) AUTHORIZED REPRESENTATIVE FOR CERTIFICATION I hereby certify that I am authorized to execute this Account Validation and Certification Form on behalf of the Subscriber listed above and that statements I have provided in this form are true and correct. Further,I hereby certify that the Subscriber agrees to the terms and conditions set forth in this form and understand that I may periodically be required to re-certify information provided herein but not more than once every two years. Printed Name Charles Daniels Title Assistant City Manager Once this document is completed and signed by an authorized representative of the Subscriber,please provide it to your West Sales Representative with a signed order. Date d , f All information is subject to verification and approval by West Signature X Site Inspection contact if a different authorized representative is listed above. Name Aya Ealy ;!;� 'Q 44 Telephone Number 81 7-392-4239 rtwo Duo �o o by: 0. 0 0 a 0 d o . d d 1' l 000000C)GO y FOFFICIAL RECORD CITY SECRETARY FT:WORTH,TX HO M&C REQUIRED 101/1/11 SAM[net 745.dot