COMMERCIAL REQUESTER ACCOUNT …loganreg.com/Forms/CA/COMMERCIAL_APPLICATION.pdfINFORMATION SERVICES...

A Public Service Agency

COMMERCIAL REQUESTER ACCOUNTAPPLICATION INSTRUCTIONS

END USER

INF 1133E (REV. 10/98)

INFORMATION SERVICES BRANCHCOMMERCIAL REQUESTER ACCOUNT APPLICATION

The Department of Motor Vehicles (DMV) is authorized by California Vehicle Code (CVC) Section 1810.2 to establishCommercial Requester Accounts and issue requester codes for the purpose of obtaining information from DMV files.Commercial Requester Accounts are established for applicants that: (1) have a legitimate business need for the information;(2) submit completed application forms; and (3) pay the required application fee.

There are three types of Commercial Requester Accounts. Each is identified and described below with the list of forms to becompleted. A separate application, agreement, and fee required for each type. Send the required forms and fees to:

Department of Motor Vehicles Questions? Call (916) 657-5564Accounts Processing - H221P. O. Box 944231Sacramento, CA 94244-2310

*NOTE: $50 OF THE APPLICATION FEE WILL BE RETAINED BY DMV TO COVER PROCESSING COSTS.Confidential Residence Address: Residence address information is confidential and will not be released unless authorizedunder statutory authority by a state or federal statute that specifies and requires DMV to release the information.

End User – Requesters who receive information for an authorized business use.2 INF 1106E Application Commercial Requester Account (End User) *Fee: $50 (no residence address) OR2 INF 1108 Commercial Requester Account Agreement $250 (for residence address) AND1 INF 1132 Information Services Surety Bond (DO NOT COMPLETE $50,000 Surety Bond

UNTIL APPROVED FOR RESIDENCE ADDRESS)

Vendor – A person who has been approved by the department to directly receive and transmit information, accordingto DMV requirements, to another authorized intermediate vendor and/or authorized end user. Information receivedfrom DMV shall not be retained or combined with any other data on any database for any reason without prior writtenapproval from the department. A Vendor cannot use the information for their own purpose.

Intermediate Vendor – A person who has been approved by the department to directly receive and transmit information,from an End User through another authorized vendor according to DMV requirements. Information received fromDMV shall not be retained or combined with any other data on any database for any reason without prior writtenapproval from the department. An Intermediate Vendor cannot use the information for their own purpose.2 INF 1106V Application Commercial Requester Account (Vendor) *Fee: $250 application fee2 INF 1108 Commercial Requester Account Agreement $50,000 Surety Bond (for1 INF 1132 Information Services Surety Bond (DO NOT COMPLETE residence address)


Agent – A person who has been authorized by an End User requester account holder to receive record informationdirectly from the department to perform a specific business function.2 INF 1106A Application Commercial Requester Account (Agent) *Fee: $250 application fee2 INF 1108 Commercial Requester Account Agreement $50,000 Surety Bond (for2 INF 02 Agent Addendum residence address)2 INF 03 Agent Authorization1 INF 1132 Information Services Surety Bond (DO NOT COMPLETE


Additional Forms–All of the following forms may be duplicated or contact Account Processing if needed.2 INF 1110 Representative Non-Disclosure Statement is to be completed when an individual, other than an

employee, is authorized by a requester account holder to perform a specified business function. Therepresentative may not directly request or receive information from DMV. Process Servers may notuse an INF 1110 unless the information was obtained pursuant to California Vehicle Code Sections1808.22 or 1808.23. This form is to be retained at the worksite.

2 INF 1128 Employee Security Statement is to be completed by your employee(s) who are responsible for handlinginformation received from the department. This form is to be retained at the worksite.

1 INF 1213 Commercial Requester Account Notice of Change is to be completed when there is a change in thecorporate name only, corporate officers only, sole proprietor, DBA, telephone number, account contact/telephone number, street, mailing, or record storage address, billing contact, address and telephonenumber. In addition, complete this form when requesting a change in the proposed use of your account.(Retain for Future Use)

1 INF 1184 Certification of Agency is to be completed by any Registration Service who will be requesting residenceaddress information in order to process vehicle registration transactions/documents on behalf of avehicle dealer. (Contact Account Processing at (916) 657-5564 to obtain a copy of this form.)

1 INF 1106BL Requester Code Branch Locations is to be completed if each branch location is to have their ownrequester code. (Contact Account Processing at (916) 657-5564 to obtain a copy of this form.)

INF 1133E (REV 10/98)


X


DMV USE ONLY

Instructions : List name, title and driver license/identification card number (DL/ID) and the state issued of individual (sole owner), eachpartner and each corporate officer participating in the direction, control or management of the business.

Instructions : Please provide your federal employer identification, corporation number and state in which issued. If your business is requiredto be licensed by any local, state, or federal government entity (Motor Vehicles Insurance, Consumer Affairs, etc.,) or you are a state barmember, please provide the licensing information as indicated and attach a copy of the license for verification purposes.

( ) Ext.

( ) Ext.

NAME OF INDIVIDUAL, PARTNERSHIP, OR CORPORATION TELEPHONE NUMBER

FIRM OR TRADE NAME DBA

ACCOUNT CONTACT PERSON TELEPHONE NUMBER

STREET ADDRESS (PHYSICAL LOCATION) CITY STATE ZIP CODE

MAILING ADDRESS (IF DIFFERENT) CITY STATE ZIP CODE

RECORD STORAGE ADDRESS (PHYSICAL LOCATION WHERE RECORDS WILL BE MAINTAINED FOR ON-SITE INSPECTION, REVIEW OR AUDIT BY DMV OR ITS REPRESENTATIVES)(IF SAME, AS ABOVE, SO STATE CITY STATE ZIP CODE

APPLICATIONCOMMERCIAL REQUESTER ACCOUNT

(END USER)

Please print clearly or typeCheck one: Sole Ownership Partnership Corporation

DMV USE ONLYRequester Code

$

$

CHECK/M.O. NUMBER CHECK/M.O. AMOUNT

REFUND AGREEMENT NUMBER ISSUED

CA ID/DATE EXPIRES

NAME (LAST, FIRST, MI) TITLE DL/ID NUMBER AND STATE ISSUED



Federal Employer ID No. Corporation No./State Issued License Type Agency Issuing License License No. and Expiration Date

PART A: Main Office

PART B: Ownership

PART C: Licensing and Business Identification

PART D: Commercial Requester Account History and UseInstructions: Answer each question. If additional space is needed attach a separate sheet with name and address as shown above.

1. Have you, your partners, any corporate officer, or the business previously applied for, had, or have a Commercial Requester Account?Yes No If yes, enter the current/prior Agreement number/requester code(s) below.

Agreement Number ____________________________ Requester Codes _____________________________________________

2. Have you, your partners, any corporate officer, or the business been subject to a Department of Motor Vehicle administrative actionagainst a prior or current Commercial Requester Account. Yes No If yes, identify the type of action, the name of the personand/or business and the reason in the space provided.

__________________________________________________________________________________________________________

3. Have you, your partners, any corporate officer ever been convicted of any crime for a violent act, stalking, computer fraud, unauthorizeddisclosure, access or distribution of information. Yes No If yes, identify the name of the person, the violation, and the actiontaken below.

__________________________________________________________________________________________________________

4. Do you intend to sell the information to another entity? (Commercial Requester Account End Users/Agents are prohibited from resellinginformation to another entity. Accounts established for this purpose are defined as Vendors. Vendors may resell information only toapproved Commercial Requester Account End Users and cannot request information for their own purpose.) Yes No

5. Do you intend to provide a business function to a government agency and/or employer enrolled in the Employer Pull Notice Programbased on the information purchased from the department? Yes No If yes, accounts established for this purpose are definedas Government and/or Employer Pull Notice (EPN) Agents. A separate Government Agent or EPN Agent application is required.

INF 1106E (REV. 9/98) (Continued on Back)

Instructions : Please read the statement of understanding, complete the “Executed at” line and sign A, B, or C, as appropriate.I understand that false or misleading answers are cause for denial of an application and/or termination of any access agreement granted. I authorize

the Director of the Department of Motor Vehicles, or the Director’s designee, to investigate any matter or statements contained in this application.I understand that if this Application for a Commercial Requester Account is approved, I will be required to conform to the statements presented within.

I further understand that I will be required to sign an agreement which will become part of this application. This application and the agreement specifythe terms and conditions of our relationship. Any deviations will be considered by the Department of Motor Vehicles as misuse, and may result in bothrevocation of the account and refusal of subsequent applications.

I understand that according to provisions of the California Vehicle Code Section 1808.45, the willful, unauthorized disclosure of information from anydepartment record for a purpose other than the one stated in the request or the sale or other distribution of the information to a person or organizationnot disclosed in the request is a misdemeanor, punishable by a fine not exceeding $5,000 or by imprisonment in the county jail not exceeding one year,or both fine and imprisonment.

I understand that according to provisions of the California Vehicle Code Section 1808.46, any person holding a requester code who directly orindirectly obtains information from the Department of Motor Vehicles using false representations or distributes restricted or confidential information toany person or uses the information for a reason not authorized or specified in this application is liable to the Department of Motor Vehicles for civil penaltiesup to $100,000 and shall have their requester code privileges suspended for a period of up to five (5) years or revoked.

DMV USE ONLY

Proposed Use ApprovedYes No

Req. Code #


Req. Code #


Req. Code #Proposed Use Approved

Yes No

Req. Code #

Instructions: If purchasing information directly from the department, identify the name and telephone of the person to contact for informationconcerning billing and the billing address. (If same as account contact listed in Section A, so state.)BILLING CONTACT NAME (FIRST, MI, LAST) TELEPHONE NUMBER

MAILING ADDRESS CITY STATE ZIP CODE

( ) Ext.

PART E: Billing Contact and Address

PART F: Requester Information

PART G: Account Purposes, Type of Records and Address Access

PART H: Statement of Understanding, Certification Signature(s)

Instructions: Complete a separate section for each purpose and explain how the information received will be used under proposed use,select the types of records requested. Check either “yes” or “no” for confidential residence address information. If yes, the CommercialRequester Account Agreement requires the specific regulation, rule of court, federal, or state statute identified by code name and sectionnumber which authorizes the use of Department of Motor Vehicle residence address information.

Type Record Abbreviations GuideDL/ID—Driver License/Identification Card VR—Vehicle/Vessel Registration FR—Financial Responsibility OL—Occupational Licensee

1. Identify Proposed Use: _________________________________________________________________________________________________________________________________________________________

Type: VR DL OL FR Residence Address: Yes No

2. Identify Proposed Use : _________________________________________________________________________________________________________________________________________________________






EXECUTED AT (CITY) (COUNTY) ON (DATE)

A. Individual: I certify under the penalty of perjury that I am the sole owner as shown on this application, and that no other person isassociated in the ownership of the business, and that all answers and information contained within this application are true and correct.SIGNATURE

XB. Partnership: We certify under the penalty of perjury that we are co-partners as shown on this application and that no other person is

associated in the ownership of the business, and that all answers and information contained within this application are true and correct.SIGNATURE SIGNATURE

X XC. Corporation: I certify under the penalty of perjury that I am a corporate officer authorized to sign for the corporation identification number

and the state shown on this application are valid and that all answers and information contained within this application are true and correct.SIGNATURE OF CORPORATE OFFICER AUTHORIZED TO SIGN FOR CORPORATION TITLE

X XNOTE: Branch locations may be assigned separate requester codes by completing the form Requester Codes for Branch Locations

(INF 1106BL). A Separate application is required for any location operating under a different ownership.INF 1106E (REV. 9/98)

Instructions: Check the box(es) that best identifies the occupation (trade, profession, or business type) for the account.

Attorney Dismantler Insurance Company Manufacturer Process ServerAuto Dealer Financial Institution Lessor-Retailer Media Registration ServiceAuto Auction Insurance Agent/Broker Lien Sale Private Investigator Salvage PoolOther ______________________________________________________________________________________________________


DMV USE ONLY

Instructions : List name, title and driver license/identification card number (DL/ID) and the state issued of individual (sole owner), eachpartner and each corporate officer participating in the direction, control or management of the business.

Instructions : Please provide your federal employer identification, corporation number and state in which issued. If your business is requiredto be licensed by any local, state, or federal government entity (Motor Vehicles Insurance, Consumer Affairs, etc.,) or you are a state barmember, please provide the licensing information as indicated and attach a copy of the license for verification purposes.

( ) Ext.

( ) Ext.

NAME OF INDIVIDUAL, PARTNERSHIP, OR CORPORATION TELEPHONE NUMBER


ACCOUNT CONTACT PERSON TELEPHONE NUMBER

STREET ADDRESS (PHYSICAL LOCATION) CITY STATE ZIP CODE



APPLICATIONCOMMERCIAL REQUESTER ACCOUNT

(END USER)

Please print clearly or typeCheck one: Sole Ownership Partnership Corporation

DMV USE ONLYRequester Code

$

$

CHECK/M.O. NUMBER CHECK/M.O. AMOUNT

REFUND AGREEMENT NUMBER ISSUED

CA ID/DATE EXPIRES




Federal Employer ID No. Corporation No./State Issued License Type Agency Issuing License License No. and Expiration Date

PART A: Main Office

PART B: Ownership

PART C: Licensing and Business Identification

PART D: Commercial Requester Account History and UseInstructions: Answer each question. If additional space is needed attach a separate sheet with name and address as shown above.

1. Have you, your partners, any corporate officer, or the business previously applied for, had, or have a Commercial Requester Account?Yes No If yes, enter the current/prior Agreement number/requester code(s) below.

Agreement Number ____________________________ Requester Codes _____________________________________________

2. Have you, your partners, any corporate officer, or the business been subject to a Department of Motor Vehicle administrative actionagainst a prior or current Commercial Requester Account. Yes No If yes, identify the type of action, the name of the personand/or business and the reason in the space provided.

__________________________________________________________________________________________________________

3. Have you, your partners, any corporate officer ever been convicted of any crime for a violent act, stalking, computer fraud, unauthorizeddisclosure, access or distribution of information. Yes No If yes, identify the name of the person, the violation, and the actiontaken below.

__________________________________________________________________________________________________________

4. Do you intend to sell the information to another entity? (Commercial Requester Account End Users/Agents are prohibited from resellinginformation to another entity. Accounts established for this purpose are defined as Vendors. Vendors may resell information only toapproved Commercial Requester Account End Users and cannot request information for their own purpose.) Yes No

5. Do you intend to provide a business function to a government agency and/or employer enrolled in the Employer Pull Notice Programbased on the information purchased from the department? Yes No If yes, accounts established for this purpose are definedas Government and/or Employer Pull Notice (EPN) Agents. A separate Government Agent or EPN Agent application is required.

INF 1106E (REV. 9/98) (Continued on Back)

Instructions : Please read the statement of understanding, complete the “Executed at” line and sign A, B, or C, as appropriate.I understand that false or misleading answers are cause for denial of an application and/or termination of any access agreement granted. I authorize

the Director of the Department of Motor Vehicles, or the Director’s designee, to investigate any matter or statements contained in this application.I understand that if this Application for a Commercial Requester Account is approved, I will be required to conform to the statements presented within.

I further understand that I will be required to sign an agreement which will become part of this application. This application and the agreement specifythe terms and conditions of our relationship. Any deviations will be considered by the Department of Motor Vehicles as misuse, and may result in bothrevocation of the account and refusal of subsequent applications.

I understand that according to provisions of the California Vehicle Code Section 1808.45, the willful, unauthorized disclosure of information from anydepartment record for a purpose other than the one stated in the request or the sale or other distribution of the information to a person or organizationnot disclosed in the request is a misdemeanor, punishable by a fine not exceeding $5,000 or by imprisonment in the county jail not exceeding one year,or both fine and imprisonment.

I understand that according to provisions of the California Vehicle Code Section 1808.46, any person holding a requester code who directly orindirectly obtains information from the Department of Motor Vehicles using false representations or distributes restricted or confidential information toany person or uses the information for a reason not authorized or specified in this application is liable to the Department of Motor Vehicles for civil penaltiesup to $100,000 and shall have their requester code privileges suspended for a period of up to five (5) years or revoked.

DMV USE ONLY


Req. Code #


Req. Code #


Req. Code #Proposed Use Approved

Yes No

Req. Code #

Instructions: If purchasing information directly from the department, identify the name and telephone of the person to contact for informationconcerning billing and the billing address. (If same as account contact listed in Section A, so state.)BILLING CONTACT NAME (FIRST, MI, LAST) TELEPHONE NUMBER


( ) Ext.

PART E: Billing Contact and Address

PART F: Requester Information

PART G: Account Purposes, Type of Records and Address Access

PART H: Statement of Understanding, Certification Signature(s)

Instructions: Complete a separate section for each purpose and explain how the information received will be used under proposed use,select the types of records requested. Check either “yes” or “no” for confidential residence address information. If yes, the CommercialRequester Account Agreement requires the specific regulation, rule of court, federal, or state statute identified by code name and sectionnumber which authorizes the use of Department of Motor Vehicle residence address information.

Type Record Abbreviations GuideDL/ID—Driver License/Identification Card VR—Vehicle/Vessel Registration FR—Financial Responsibility OL—Occupational Licensee



2. Identify Proposed Use : _________________________________________________________________________________________________________________________________________________________







A. Individual: I certify under the penalty of perjury that I am the sole owner as shown on this application, and that no other person isassociated in the ownership of the business, and that all answers and information contained within this application are true and correct.SIGNATURE

XB. Partnership: We certify under the penalty of perjury that we are co-partners as shown on this application and that no other person is

associated in the ownership of the business, and that all answers and information contained within this application are true and correct.SIGNATURE SIGNATURE

X XC. Corporation: I certify under the penalty of perjury that I am a corporate officer authorized to sign for the corporation identification number

and the state shown on this application are valid and that all answers and information contained within this application are true and correct.SIGNATURE OF CORPORATE OFFICER AUTHORIZED TO SIGN FOR CORPORATION TITLE

X XNOTE: Branch locations may be assigned separate requester codes by completing the form Requester Codes for Branch Locations

(INF 1106BL). A Separate application is required for any location operating under a different ownership.INF 1106E (REV. 9/98)

Instructions: Check the box(es) that best identifies the occupation (trade, profession, or business type) for the account.

Attorney Dismantler Insurance Company Manufacturer Process ServerAuto Dealer Financial Institution Lessor-Retailer Media Registration ServiceAuto Auction Insurance Agent/Broker Lien Sale Private Investigator Salvage PoolOther ______________________________________________________________________________________________________


INF 1108 (REV. 7/98)

DATE APPROVED

EXPIRATION DATE

DMV USE ONLYINFORMATION SERVICES PROGRAM

COMMERCIAL REQUESTER ACCOUNT AGREEMENTDMV AGREEMENT NUMBER_______________

Instructions: Read and complete as indicated

A. GENERAL PROVISIONS

1. This Agreement is between the State of California, Department of Motor Vehicles (DMV), hereinafter referred to as the “DMV”,and ______________________________________, hereinafter referred to as “Requester”, for the purpose of the DMVproviding information from its files for commercial uses. Each Requester selling information to another Requester will be definedas a “Vendor” for the purposes of this Agreement. Requesters receiving information for an authorized use or purpose will bedefined as an “End User” for the purposes of this Agreement.

2. To receive information, the Requester shall submit a completed Application for a Commercial Requester Account (INF 1106A,E or V) which, when approved by DMV, will be incorporated as part of this Agreement. No service to a requester shall be providedprior to DMV’s written approval and assignment of a requester code.

3. If the Requester is a DMV approved Agent acting on behalf of a dealer, vehicle manufacturer, a government entity, or employerenrolled in the Employer Pull Notice Program, authorization from the dealer, vehicle manufacturer, the government entity, oremployer to act on their behalf shall be submitted on a form prescribed by DMV.

4. The term of this Agreement shall be for twenty-four (24) months from the approval date of the original Commercial RequesterAccount Application (INF 1106A, E or V) and thereafter, renewable at two year intervals.

5. This Agreement is subject to any restrictions, limitations or provisions enacted by the California State Legislature which mayaffect the provisions or terms set forth herein. The Requester is required to comply with the applicable statutes of the CaliforniaVehicle Code (CVC) and California Code of Regulations (CCR) Title 13.

6. No alteration or variation of the terms of this Agreement shall be valid unless made in writing and signed by both parties hereto,and no oral understanding or agreement, not incorporated herein, shall be binding on either party.

7. The Requester shall not represent themselves as agents or employees of DMV. For the purposes of this agreement, theRequester includes the officers, partners, owners, and employees of the Requester.

8. Requester agrees to defend, indemnify, and hold harmless DMV and its employees or agents from any and all claims, actions,damages, or losses which may be brought or alleged against its employees or agent for the negligent, improper, or unauthorizeduse or dissemination by the Requester of information furnished to the Requester by DMV or by reason of inaccurate informationfurnished to the Requester by DMV.

9. This Agreement is not assignable by the Requester, either in whole or in part, without prior written consent of DMV.

10. a. Any promotional or informational material related to accessing the DMV’s records shall be accurate and shall be consistentwith the terms and provisions of this Agreement and Commercial Requester Account Application (INF 1106A, E or V) andshall contain only factual statements relating to the purpose and conditions of access as set forth in this Agreement.

b. The Requester shall not use the logotype in any advertising or other business materials used in the businessof the Requester. The advertising shall neither state nor infer that there is any official connection between DMV and theadvertiser, or that DMV has sanctioned or approved of either the advertisement or the advertiser’s service.

11. Requester shall notify DMV in writing within one business day of any intended or actual closure of the Requester’s businessenterprise or voluntary termination of the Commercial Requester Account and within ten working days of changes in soleownership, partnership, or corporate principal staff officers, contact person, address, or of any other change in the CommercialRequester Account Application (INF 1106A, E or V). Notification shall be sent to:

Department of Motor VehiclesInformation Services BranchAccount Processing Unit, H264P.O. Box 944231Sacramento, CA 94244-2310

12. Requester’s access to DMV information may be modified and/or terminated immediately with cause.

13. Requester’s access to DMV information may be modified and/or terminated without cause upon 30 days notice by either party.

B. INFORMATION USE

1. DMV retains ownership of all information extracted from its files.

2. Requester shall not use DMV records for any purpose except for that which has been approved by DMV.

3. Information received from DMV shall not be retained, stored, combined and/or linked with any other data on anydatabase for any reason without prior written approval from DMV. Any such written approval shall then become anattachment, subject to the terms of this agreement.

4. When information is received from DMV indicating a vehicle or vessel has a Department of Justice (DOJ) stop on the record,the Requester shall immediately notify local law enforcement of its location, if known, and the identity of the ultimate Requester(i.e., End User), if different. The vehicle shall not be sold or transferred by the Requester until a law enforcement agency clearsand removes the DOJ stop on the record.

C. SECURITY

General Security Requirements

1. Requester shall maintain the security and integrity of the information it receives. A violation of any provisions of this Agreement,whether by omission or commission, shall be grounds for action by DMV and may result in suspension or termination of serviceto the Requester. DMV may pursue appropriate administrative, civil, and/or criminal action for violation of Agreement provisionsin accordance with the CVC §1808.45, §1808.46 and §1808.47.

2. Requester shall ensure compliance with all security provisions of this agreement. If fraud or abuse is suspected or confirmed,Requester shall notify DMV’s Information Services Policy and Automation Section by telephone at (916) 657-5583 within onebusiness day.

A written notification containing all facts therein shall be prepared by the Requester within three business days and mailed toDMV at the following address:

Department of Motor VehiclesInformation Services BranchPolicy and Automation Section – H225P. O. Box 942890Sacramento, CA 94290-0001

3. Requesters shall require every employee and the system administrator having direct or incidental access to DMV records, tosign a copy of the Employee Security Statement (INF 1128) upon initial authorization for access to DMV records and annuallythereafter. A copy of the signed statement shall be maintained at the requester’s worksite for at least two years following thedeactivation or termination of the authorization and shall be available to the DMV upon demand.

4. Requester shall restrict the use and knowledge of requester codes and operational manuals to persons who have signed anEmployee Security Statement (INF 1128).

5. Requester shall maintain a current list of names and individuals authorized to access DMV records. This list shall be availableto the DMV upon demand.

6. Requester shall maintain a current list of end user terminals and the number of users for each terminal. This list shall be availableto DMV upon demand.

7. Access terminals and modems shall not be left unattended while in active session unless secured by a locking device thatprevents entry or receipt of information or placed in a locked room that is not accessible to unauthorized persons. Accessterminals displaying DMV data shall display a “sign-on banner” containing some variation of the followingadmonishment: “WARNING: Unauthorized access or misuse of data may result in adverse action and/or criminal prosecution”.

8. Video terminals, printers, hardcopy printouts or any other forms of duplication of DMV approved records located in public accessareas shall be placed so that the records shall not be viewed by the public or other unauthorized persons.

9. All information received from the DMV’s files must be destroyed once its legitimate use has ended. The method of destructionof DMV records should be in a manner that it cannot be reproduced or identified in any physical or electronic form.

10. Each DMV approved Agent shall maintain a log of the request for a period of two years from the date of the request. The logshall be immediately available for review at DMV’s request. The log format shall provide the following in the order presented:

• Date of request• Type of information requested• Whether residence address was given• Identity of whom the information was provided

11. Each DMV approved Vendor shall maintain a log of the request for a period of five years from the date of the request. The logshall be immediately available for review at DMV’s request. The log format shall provide the following in the order presented:

• Date of request• Type of information requested• Whether residence address was given• Identity of whom the information was provided (including “Intermediate Vendors”)• Identify proposed use of information (as approved by DMV.)

12. Each DMV approved Vendor or Agent, must ensure that the receiver of the requested records is an approved Requester [CVC§1808.46].

INF 1108/2 (REV. 7/98)

13. Requester shall not disclose its DMV assigned requester code verbally, in writing, or when passing data electronically, to anyoneother than a DMV approved Vendor or Agent, who is not in the direct employ of the Requester or who has not signed theEmployee Security Statement (INF 1128).

14. Vendor shall block transmission of its requester code to an End User. Vendor shall not display any DMV assigned requestercode during a demonstration of on-line information service.

15. Requesters shall not sell, retain, distribute, provide, or transfer any record information or portion of the record informationacquired under this Agreement except as authorized by the DMV.

D. RESIDENCE ADDRESS ACCESS AUTHORITY

1. Upon approval for residence address access, Requester shall protect the confidentiality of any residence address received fromDMV records, pursuant to CVC §1808.47. Requester employees shall not obtain or use any confidential or restricted recordsfor any purpose other than the reason the information was requested.

2. Requester may release residence or mailing address information to an individual, other than an employee, who is acting onbehalf of the Requester provided a Representative Non-Disclosure Statement (INF 1110) acknowledging the confidentiality ofresidence address information pursuant to CVC §1808.47, is signed by the individual with whom the Requester has contractedservices. This form shall be filed at the Requester’s business location as shown on the Commercial Requester AccountApplication (INF 1106A, E or V), be completed annually, and retained for two years.

3. Requesters approved to receive confidential residence address information shall maintain a log of the request for two years fromthe date of the request. The log shall be immediately available for review at DMV’s request. The log format shall provide thefollowing in the order presented:

• Requester code used to make the request• Date of the request• Type of information requested• Points of identification used for the request (e.g., license # and DOB)• Business reason for the request

Any Requester except Dealers or Vehicle Manufacturers, including their agents, shall also maintain a copy of the business orlegal document that justifies or supports each request and be available to DMV with the log.

4. Requester’s authority to receive residence address information is based on the following:

Financial Institution Insurance Company Attorneys Statistical Research/ReportingCVC §1808.22(a) CVC §1808.22(b) CVC §1808.22(c) CVC §1808.23(c)

Dealers or Dealer Agents Vehicle Manufacturers or Vehicle Manufacturers AgentsCVC §1808.23(b) CVC §1808.23(a)

Other—Insert State or Federal Statute, below (identify by code name and section #):

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

E. AUDIT

1. Requester’s documentation supporting the reason for inquiry, including but not limited to, transaction details and billingdocuments, computer software and programs maintained for the purposes defined in this Agreement, shall be subject toinspection, review or audit by DMV or its representative for a period of two years from the date of the request at no cost to theDMV. Requester agrees to accommodate DMV’s request for an inspection, review or audit immediately upon request and toallow on-site audits during regular business hours.

2. Whenever a Commercial Requester Account is terminated with or without cause, or voluntarily closed pursuant to CCR§350.16(b), DMV may require the holder to surrender, to DMV, all records retained pursuant to CCR §350.48 and CCR§350.18(b)(4)(5), not later than the end of the third business day following the date of suspension, revocation, or closure. Thenotification to surrender the records shall be included in the notice of suspension or revocation and shall be delivered to theaddress indicated below no later than the end of the twentieth (20th) departmental business day following the Department’snotification to surrender.

Office of Investigations/AuditsCompliance Audits Unit2570 24th StreetSacramento, California 95818

INF 1108/3 (REV. 7/98)

F. FEES

1. The Requester shall pay the appropriate fees pursuant to CCR §350.44.

2. Requesters receiving information directly from the DMV shall be billed monthly. The bill shall be payable, in full, upon receipt.If any amount remains unpaid sixty (60) days after the invoice date, the Requester’s access codes may be revoked. If theRequester disputes the amount of bill and notifies DMV in writing within thirty (30) days of the invoice date, access codes maynot be revoked until thirty (30) days after DMV confirms the amount of the disputed bill and rebills the Requester.

G. SERVICE OF PROCESS

a. Requester agrees to accept service of process by registered mail to the Commercial Requester Account address last filed withDMV.

b. If Requester has no place of business in California, Requester hereby appoints:

Name of individual___________________________________________________________________________________

Business/Residence Address __________________________________________________________________________

City _______________________________________________ State ______________________ Zip Code __________

as Requester’s true and lawful agent upon whom all process may be served in any action, or actions, which may thereafter becommenced against said Requester, arising out of any cause of action by reason of the violation of said Requester or any ofthe terms and provisions of the CVC and this Agreement (Title 13, CCR 350.02 et seq.).

Requester further stipulates and agrees that, when personal service of process upon Requester’s appointee named herein,cannot be made after due diligence, that service can be made upon the Director of DMV, or in the event of the Director’s absencefrom his/her office, that service can be made upon any employee of the State of California in charge of the Director’s office, andthat such service of process shall be of the same legal force and effect as if serviced upon Requester personally; that Requesterfurther stipulates and agrees that the agency created by said appointment shall continue for and during period covered by thisAgreement when authorized by the DMV and so long thereafter as the Requester may be made to answer in damages forviolation of the laws, regulations, or rule of the court as identified in this Agreement; Requester further agrees that for the purposeof venue, whenever service is made upon the Director, the service shall be deemed to have been made upon the Requesterin the county in which Requester has or last had his appointed agent.

H. SIGNATURE REQUIREMENTS

This Agreement shall be signed by a corporate officer, partner, or sole owner of the entity designated as the Requester on theCommercial Account Application (INF 1106A, E or V) and said person shall be responsible for administering the provisions withinthis agreement and for the orientation, training and supervision of persons authorized to access DMV’s record information.

I certify under penalty of perjury, under the laws of the State of California, that I have read and understand the aforementionedstatements, and agree to comply with the requirements contained therein and, if approved to receive residence addressinformation, that measures have been instituted to ensure that each request for residence address from the files of DMV is usedpursuant to the identified federal or state statute.

Executed at _____________________________________ , ___________________________ ,____________________

Date__________________________ Signature __________________________________________________________

Print Name and Title _________________________________________________________________________________

Approved by DMV Representative:

Date__________________________ Signature __________________________________________________________


INF 1108/4 (REV. 7/98)

CITY COUNTY STATE

X

X


INF 1108 (REV. 7/98)

DATE APPROVED

EXPIRATION DATE

DMV USE ONLYINFORMATION SERVICES PROGRAM

COMMERCIAL REQUESTER ACCOUNT AGREEMENTDMV AGREEMENT NUMBER_______________

Instructions: Read and complete as indicated

A. GENERAL PROVISIONS

1. This Agreement is between the State of California, Department of Motor Vehicles (DMV), hereinafter referred to as the “DMV”,and ______________________________________, hereinafter referred to as “Requester”, for the purpose of the DMVproviding information from its files for commercial uses. Each Requester selling information to another Requester will be definedas a “Vendor” for the purposes of this Agreement. Requesters receiving information for an authorized use or purpose will bedefined as an “End User” for the purposes of this Agreement.

2. To receive information, the Requester shall submit a completed Application for a Commercial Requester Account (INF 1106A,E or V) which, when approved by DMV, will be incorporated as part of this Agreement. No service to a requester shall be providedprior to DMV’s written approval and assignment of a requester code.

3. If the Requester is a DMV approved Agent acting on behalf of a dealer, vehicle manufacturer, a government entity, or employerenrolled in the Employer Pull Notice Program, authorization from the dealer, vehicle manufacturer, the government entity, oremployer to act on their behalf shall be submitted on a form prescribed by DMV.

4. The term of this Agreement shall be for twenty-four (24) months from the approval date of the original Commercial RequesterAccount Application (INF 1106A, E or V) and thereafter, renewable at two year intervals.

5. This Agreement is subject to any restrictions, limitations or provisions enacted by the California State Legislature which mayaffect the provisions or terms set forth herein. The Requester is required to comply with the applicable statutes of the CaliforniaVehicle Code (CVC) and California Code of Regulations (CCR) Title 13.

6. No alteration or variation of the terms of this Agreement shall be valid unless made in writing and signed by both parties hereto,and no oral understanding or agreement, not incorporated herein, shall be binding on either party.

7. The Requester shall not represent themselves as agents or employees of DMV. For the purposes of this agreement, theRequester includes the officers, partners, owners, and employees of the Requester.

8. Requester agrees to defend, indemnify, and hold harmless DMV and its employees or agents from any and all claims, actions,damages, or losses which may be brought or alleged against its employees or agent for the negligent, improper, or unauthorizeduse or dissemination by the Requester of information furnished to the Requester by DMV or by reason of inaccurate informationfurnished to the Requester by DMV.

9. This Agreement is not assignable by the Requester, either in whole or in part, without prior written consent of DMV.

10. a. Any promotional or informational material related to accessing the DMV’s records shall be accurate and shall be consistentwith the terms and provisions of this Agreement and Commercial Requester Account Application (INF 1106A, E or V) andshall contain only factual statements relating to the purpose and conditions of access as set forth in this Agreement.

b. The Requester shall not use the logotype in any advertising or other business materials used in the businessof the Requester. The advertising shall neither state nor infer that there is any official connection between DMV and theadvertiser, or that DMV has sanctioned or approved of either the advertisement or the advertiser’s service.

11. Requester shall notify DMV in writing within one business day of any intended or actual closure of the Requester’s businessenterprise or voluntary termination of the Commercial Requester Account and within ten working days of changes in soleownership, partnership, or corporate principal staff officers, contact person, address, or of any other change in the CommercialRequester Account Application (INF 1106A, E or V). Notification shall be sent to:

Department of Motor VehiclesInformation Services BranchAccount Processing Unit, H264P.O. Box 944231Sacramento, CA 94244-2310

12. Requester’s access to DMV information may be modified and/or terminated immediately with cause.

13. Requester’s access to DMV information may be modified and/or terminated without cause upon 30 days notice by either party.

B. INFORMATION USE

1. DMV retains ownership of all information extracted from its files.

2. Requester shall not use DMV records for any purpose except for that which has been approved by DMV.

3. Information received from DMV shall not be retained, stored, combined and/or linked with any other data on anydatabase for any reason without prior written approval from DMV. Any such written approval shall then become anattachment, subject to the terms of this agreement.

4. When information is received from DMV indicating a vehicle or vessel has a Department of Justice (DOJ) stop on the record,the Requester shall immediately notify local law enforcement of its location, if known, and the identity of the ultimate Requester(i.e., End User), if different. The vehicle shall not be sold or transferred by the Requester until a law enforcement agency clearsand removes the DOJ stop on the record.

C. SECURITY

General Security Requirements

1. Requester shall maintain the security and integrity of the information it receives. A violation of any provisions of this Agreement,whether by omission or commission, shall be grounds for action by DMV and may result in suspension or termination of serviceto the Requester. DMV may pursue appropriate administrative, civil, and/or criminal action for violation of Agreement provisionsin accordance with the CVC §1808.45, §1808.46 and §1808.47.

2. Requester shall ensure compliance with all security provisions of this agreement. If fraud or abuse is suspected or confirmed,Requester shall notify DMV’s Information Services Policy and Automation Section by telephone at (916) 657-5583 within onebusiness day.

A written notification containing all facts therein shall be prepared by the Requester within three business days and mailed toDMV at the following address:

Department of Motor VehiclesInformation Services BranchPolicy and Automation Section – H225P. O. Box 942890Sacramento, CA 94290-0001

3. Requesters shall require every employee and the system administrator having direct or incidental access to DMV records, tosign a copy of the Employee Security Statement (INF 1128) upon initial authorization for access to DMV records and annuallythereafter. A copy of the signed statement shall be maintained at the requester’s worksite for at least two years following thedeactivation or termination of the authorization and shall be available to the DMV upon demand.

4. Requester shall restrict the use and knowledge of requester codes and operational manuals to persons who have signed anEmployee Security Statement (INF 1128).

5. Requester shall maintain a current list of names and individuals authorized to access DMV records. This list shall be availableto the DMV upon demand.

6. Requester shall maintain a current list of end user terminals and the number of users for each terminal. This list shall be availableto DMV upon demand.

7. Access terminals and modems shall not be left unattended while in active session unless secured by a locking device thatprevents entry or receipt of information or placed in a locked room that is not accessible to unauthorized persons. Accessterminals displaying DMV data shall display a “sign-on banner” containing some variation of the followingadmonishment: “WARNING: Unauthorized access or misuse of data may result in adverse action and/or criminal prosecution”.

8. Video terminals, printers, hardcopy printouts or any other forms of duplication of DMV approved records located in public accessareas shall be placed so that the records shall not be viewed by the public or other unauthorized persons.

9. All information received from the DMV’s files must be destroyed once its legitimate use has ended. The method of destructionof DMV records should be in a manner that it cannot be reproduced or identified in any physical or electronic form.

10. Each DMV approved Agent shall maintain a log of the request for a period of two years from the date of the request. The logshall be immediately available for review at DMV’s request. The log format shall provide the following in the order presented:

• Date of request• Type of information requested• Whether residence address was given• Identity of whom the information was provided

11. Each DMV approved Vendor shall maintain a log of the request for a period of five years from the date of the request. The logshall be immediately available for review at DMV’s request. The log format shall provide the following in the order presented:

• Date of request• Type of information requested• Whether residence address was given• Identity of whom the information was provided (including “Intermediate Vendors”)• Identify proposed use of information (as approved by DMV.)

12. Each DMV approved Vendor or Agent, must ensure that the receiver of the requested records is an approved Requester [CVC§1808.46].

INF 1108/2 (REV. 7/98)

13. Requester shall not disclose its DMV assigned requester code verbally, in writing, or when passing data electronically, to anyoneother than a DMV approved Vendor or Agent, who is not in the direct employ of the Requester or who has not signed theEmployee Security Statement (INF 1128).

14. Vendor shall block transmission of its requester code to an End User. Vendor shall not display any DMV assigned requestercode during a demonstration of on-line information service.

15. Requesters shall not sell, retain, distribute, provide, or transfer any record information or portion of the record informationacquired under this Agreement except as authorized by the DMV.

D. RESIDENCE ADDRESS ACCESS AUTHORITY

1. Upon approval for residence address access, Requester shall protect the confidentiality of any residence address received fromDMV records, pursuant to CVC §1808.47. Requester employees shall not obtain or use any confidential or restricted recordsfor any purpose other than the reason the information was requested.

2. Requester may release residence or mailing address information to an individual, other than an employee, who is acting onbehalf of the Requester provided a Representative Non-Disclosure Statement (INF 1110) acknowledging the confidentiality ofresidence address information pursuant to CVC §1808.47, is signed by the individual with whom the Requester has contractedservices. This form shall be filed at the Requester’s business location as shown on the Commercial Requester AccountApplication (INF 1106A, E or V), be completed annually, and retained for two years.

3. Requesters approved to receive confidential residence address information shall maintain a log of the request for two years fromthe date of the request. The log shall be immediately available for review at DMV’s request. The log format shall provide thefollowing in the order presented:

• Requester code used to make the request• Date of the request• Type of information requested• Points of identification used for the request (e.g., license # and DOB)• Business reason for the request

Any Requester except Dealers or Vehicle Manufacturers, including their agents, shall also maintain a copy of the business orlegal document that justifies or supports each request and be available to DMV with the log.

4. Requester’s authority to receive residence address information is based on the following:

Financial Institution Insurance Company Attorneys Statistical Research/ReportingCVC §1808.22(a) CVC §1808.22(b) CVC §1808.22(c) CVC §1808.23(c)

Dealers or Dealer Agents Vehicle Manufacturers or Vehicle Manufacturers AgentsCVC §1808.23(b) CVC §1808.23(a)

Other—Insert State or Federal Statute, below (identify by code name and section #):

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

E. AUDIT

1. Requester’s documentation supporting the reason for inquiry, including but not limited to, transaction details and billingdocuments, computer software and programs maintained for the purposes defined in this Agreement, shall be subject toinspection, review or audit by DMV or its representative for a period of two years from the date of the request at no cost to theDMV. Requester agrees to accommodate DMV’s request for an inspection, review or audit immediately upon request and toallow on-site audits during regular business hours.

2. Whenever a Commercial Requester Account is terminated with or without cause, or voluntarily closed pursuant to CCR§350.16(b), DMV may require the holder to surrender, to DMV, all records retained pursuant to CCR §350.48 and CCR§350.18(b)(4)(5), not later than the end of the third business day following the date of suspension, revocation, or closure. Thenotification to surrender the records shall be included in the notice of suspension or revocation and shall be delivered to theaddress indicated below no later than the end of the twentieth (20th) departmental business day following the Department’snotification to surrender.

Office of Investigations/AuditsCompliance Audits Unit2570 24th StreetSacramento, California 95818

INF 1108/3 (REV. 7/98)

F. FEES

1. The Requester shall pay the appropriate fees pursuant to CCR §350.44.

2. Requesters receiving information directly from the DMV shall be billed monthly. The bill shall be payable, in full, upon receipt.If any amount remains unpaid sixty (60) days after the invoice date, the Requester’s access codes may be revoked. If theRequester disputes the amount of bill and notifies DMV in writing within thirty (30) days of the invoice date, access codes maynot be revoked until thirty (30) days after DMV confirms the amount of the disputed bill and rebills the Requester.

G. SERVICE OF PROCESS

a. Requester agrees to accept service of process by registered mail to the Commercial Requester Account address last filed withDMV.

b. If Requester has no place of business in California, Requester hereby appoints:

Name of individual___________________________________________________________________________________

Business/Residence Address __________________________________________________________________________

City _______________________________________________ State ______________________ Zip Code __________

as Requester’s true and lawful agent upon whom all process may be served in any action, or actions, which may thereafter becommenced against said Requester, arising out of any cause of action by reason of the violation of said Requester or any ofthe terms and provisions of the CVC and this Agreement (Title 13, CCR 350.02 et seq.).

Requester further stipulates and agrees that, when personal service of process upon Requester’s appointee named herein,cannot be made after due diligence, that service can be made upon the Director of DMV, or in the event of the Director’s absencefrom his/her office, that service can be made upon any employee of the State of California in charge of the Director’s office, andthat such service of process shall be of the same legal force and effect as if serviced upon Requester personally; that Requesterfurther stipulates and agrees that the agency created by said appointment shall continue for and during period covered by thisAgreement when authorized by the DMV and so long thereafter as the Requester may be made to answer in damages forviolation of the laws, regulations, or rule of the court as identified in this Agreement; Requester further agrees that for the purposeof venue, whenever service is made upon the Director, the service shall be deemed to have been made upon the Requesterin the county in which Requester has or last had his appointed agent.

H. SIGNATURE REQUIREMENTS

This Agreement shall be signed by a corporate officer, partner, or sole owner of the entity designated as the Requester on theCommercial Account Application (INF 1106A, E or V) and said person shall be responsible for administering the provisions withinthis agreement and for the orientation, training and supervision of persons authorized to access DMV’s record information.

I certify under penalty of perjury, under the laws of the State of California, that I have read and understand the aforementionedstatements, and agree to comply with the requirements contained therein and, if approved to receive residence addressinformation, that measures have been instituted to ensure that each request for residence address from the files of DMV is usedpursuant to the identified federal or state statute.

Executed at _____________________________________ , ___________________________ ,____________________

Date__________________________ Signature __________________________________________________________


Approved by DMV Representative:

Date__________________________ Signature __________________________________________________________


INF 1108/4 (REV. 7/98)

CITY COUNTY STATE

X

X

PURPOSE

This is an agreement between the Surety and the Principal under which the Surety, its successors and assignees, are jointly and severallyliable and agree to be responsible for payment up to $50,000 for any final judgment(s) or indebtedness due the department against thePrincipal, subject to the following governing provisions and conditions.

GOVERNING PROVISIONS

(1) The provisions of Article 3 (commencing with Section 1800) of Chapter 1 of Division 2 of the Vehicle Code(2) The provisions of Chapter 2 (commencing with Section 995.010) of Part 2 of Title 14 of the Code of Civil Procedure(3) Rules and Regulations, of Article 5 (commencing with Section 350.2) of Chapter 1 of Division 1 of Title 13, Code of Regulations

CONDITIONS

The Principal is required to have on file with the California Department of Motor Vehicles (DMV) a bond in the sum of $50,000. The bondshall be issued by an admitted insurance or bonding company that is licensed by the Department of Insurance to do business in California.The Principal shall:

(1) Hold DMV harmless for monetary loss(es) caused by the Principal’s misuse of the information obtained directly from DMV, up to the$50,000 secured by the bond.

(2) Pay to DMV monies due for application fees and DMV costs related to the release or access of information from DMV records to thePrincipal.

(3) Pay to DMV, its officers, and any other person(s), civil penalties or damages caused to DMV or to such persons by the Principal, itsrepresentative or agent, or by any person to whom the Principal sells, gives, or furnishes information received directly or indirectlyby the Principal from DMV in any amount up to the $50,000 secured by the bond based on the following acts or omissions:(a) Obtaining information from DMV by false or misleading representation(s).(b) Using information obtained from DMV for any purpose other than specified in the Principal’s application for a commercial

requester account, and/or(c) Selling, giving, or furnishing any information obtained from DMV records to a third party not specifically authorized and

approved by the department.

The Bond shall be deemed continuous, remain in full force and effect and run concurrently with the period for which the commercialrequester account is authorized by the department.

This bond shall be canceled by the Surety in accordance with the provisions of Article 13, Sections 996.310 et seq. of Chapter 2 of Title 14of the California Code of Civil Procedure. The Principal shall cancel by notifying DMV in writing, thirty days prior to cancellation date atDepartment of Motor Vehicles, Accounts Processing MS H221, PO Box 944231, Sacramento, CA 94244-2310.

In witness whereof the said Principal and Surety have signed this __________ day of _________________________19/20 _________ ,

_____________________________________________________ __________________________________________________

I certify under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct and that I have executed theforegoing bond under an unrevoked power of attorney.

Executed at _________________________________________ on, ____________________________________19/20 ________ ,

__________________________________________________

__________________________________________________

COMMERCIAL REQUESTER ACCOUNT SURETY BOND

SURETY COMPANY NAME COMMERCIAL REQUESTER ACCOUNT BUSINESS NAME OF PRINCIPAL

PLACE OF BUSINESS ADDRESS PLACE OF BUSINESS ADDRESS

CITY STATE ZIP CODE CITY STATE ZIP CODE

CITY/STATE DATE

x

SIGNATURE OF ATTORNEY-IN-FACT FOR SURETY

PRINT OR TYPE NAME OF ATTORNEY-IN-FACT FOR SURETY

INF 1132 (REV. 8/98)

REQUESTER ACCOUNT NUMBER BOND NUMBER

(OFFICIAL SEAL)

x


PRINT OR TYPE NAME OF PRINCIPAL OFFICER AUTHORIZED TO SIGN SIGNATURE OF PRINCIPAL

INF 1110 (REV. 9/95)


INFORMATION SERVICES PROGRAM

REPRESENTATIVENON-DISCLOSURE

STATEMENT(To be completed by Representative)

COMPANY OR GOVERNMENTAL ENTITY NAME COMPANY NAME AND/OR INDIVIDUAL NAME

PHYSICAL ADDRESS PHYSICAL ADDRESS

MAILING ADDRESS MAILING ADDRESS

NAME OF CONTACT PERSON TELEPHONE NUMBER NAME OF CONTACT PERSON TELEPHONE NUMBER

REQUESTER REPRESENTATIVE(Commercial or Government Requester Account Holder) (Representative of Requester)

This form must be completed and RETAINED AT THE WORKSITE of the Requester Account Holder with a writtenagreement between the Representative and the Requester Account Holder for the life of the agreement and for twoyears following the deactivation or termination of the agreement. This completed form and the agreement must bemade available upon request to DMV Audit Staff.

X

EXECUTED AT CITY COUNTY STATE

DATE SIGNATURE OF REPRESENTATIVE

NAME AND TITLE OF SIGNATORY

A Representative is an individual, other than an employee, authorized by a requester account holder to perform aspecified business function. The Representative may not directly request or receive information from DMV.

I hereby acknowledge that, pursuant to California Vehicle Code (CVC) Section 1808.21, any residence/mailingaddress in any record obtained from the California Department of Motor Vehicles is confidential information. I havealso read and understand the provisions of Section 1808.47 CVC:

“Any person who has access to confidential or restricted information from the department shallestablish procedures to protect the confidentiality of those records. If confidential or restrictedaddresses are released to any agent of a person authorized to obtain restricted addresses asprovided in Section 1808.21, 1808.22, 1810.2, or 1810.7, the person shall require the agent totake all steps necessary to ensure confidentiality of these addresses and prevent any release ofthe information to a third party. No agent shall obtain or use any confidential or restrictedrecords from requester code holders for any purpose other than the reason the information wasrequested by the requester code holder who originally obtained the information.”

I further understand that if I am a Process Server, I must obtain my own requester account and may not receiveinformation from another party; therefore, I do not qualify to use this form or act as a Representative on behalf ofanother for process serving unless the information was obtained pursuant to 1808.22 or 1808.23 CVC.

Pursuant to the above, I understand that the following are my responsibilities:

1. To protect the confidentiality of any residence/mailing address information provided to me by and on behalf ofRequester.

2. To promptly notify DMV of any indication of misuse or unauthorized disclosure of confidential or restricteddepartmental information.

I understand and acknowledge that any failure to maintain confidentiality is both civilly and criminallypunishable pursuant to Sections 1808.45 and 1808.46 CVC.

I certify under penalty of perjury, under the laws of the State of California, that the above statements are true andcorrect.

INF 1128 (REV. 3/97)

X

X


INFORMATION SERVICES BRANCH

EMPLOYEE SECURITY STATEMENT

(To be completed by Employer and Employee)

EMPLOYEE REQUESTER AND EMPLOYEREMPLOYEE NAME: COMPANY OR GOVERNMENT ENTITY NAME:

DRIVER LICENSE OR IDENTIFICATION CARD NO. AND STATE: PHYSICAL ADDRESS:

EMPLOYEE ADDRESS: MAILING ADDRESS:

This form must be completed annually and RETAINED AT THE WORKSITE of the Requester Account Holder with a current list ofemployees who are authorized direct or incidental record access for the life of the agreement and for two years following the deactivationor termination of the agreement. This current completed form, the list, and the agreement must be made available upon request to DMVAudit Staff.

By signing this form, the employee has read, understands, agrees to its contents and realizes the penalties for non-compliance to its terms.

The Department of Motor Vehicles (DMV) collects confidential and personal information from the public to administer the various programsfor which it has responsibility. DMV is committed to protect this information from unauthorized access, use, or disclosure. The followingpolicies and regulations have been adopted to address commercial and governmental employees’ responsibilities for handling andprotecting information obtained from the DMV. I understand the following are my responsibilities:

1. As an employee of a requester, I may access information only when necessary to accomplish the responsibilities of my employment.I may not access or use information from the DMV for personal reasons. (Examples of inappropriate access or misuse of DMVinformation include, but are not limited to: making personal inquiries or processing transactions on my own records or those of myfriends or relatives; accessing information about another person, including locating their residence address, for any reason that isnot related to my job responsibilities.)

2. I may disclose DMV information only to individuals who have been authorized to receive it through the appropriate procedures asregulated by DMV. Requesters of information must complete the appropriate forms, submit them to DMV as specified, and pay allapplicable fees. In the case of confidential or personal information, a proper accounting of all disclosures must be made, and thesubject must be notified in accordance with statute and DMV directives. (Examples of unauthorized disclosures include, but are notlimited to: telling someone the address of another person when it is not an authorized disclosure or part of my job responsibilities.)

3. To keep the requester code and/or password confidential. I must take reasonable precautions to maintain the secrecy of the requestercode assigned to the company or government entity that I am employed by, and/or my password. Reasonable precautions includenot telling or allowing others to view my password or requester code; securing my terminal with a locking device if one has beenprovided; storing user documentation to sensitive programs in a secure place; and reporting any suspicious circumstances orunauthorized individuals I have observed in the work area to my supervisor.

4. To promptly notify DMV and an officer of the company named above of any indication of misuse or unauthorized disclosure ofconfidential or restricted information by any officer or employee of this company or government entity.

5. I hereby acknowledge that pursuant to California Vehicle Code Section 1808.21 any residence address in any record obtained fromDMV is confidential information.

I have read and understand the security policies and regulations stated above. I understand that failure to comply with these policies andregulations may result in disciplinary action in accordance with Section 19572 of the government code, federal laws and regulations, and/or civil or criminal prosecution in accordance with applicable statutes against me and/or my employer. I further understand that I canundergo disciplinary action from my employer up to and including termination from employment.

I certify under penalty of perjury, under the laws of the State of California, that the foregoing statements are true and correct.


DATE EMPLOYEE SIGNATURE

DATE EMPLOYER

Department of Motor VehiclesAccounts Processing Unit - H221P.O. Box 944231Sacramento, CA 94244-2310

INFORMATION SERVICES PROGRAM

COMMERCIAL REQUESTER ACCOUNT NOTICE OF CHANGESUBMIT WITHIN 10 DAYS OF OCCURRENCE

REQUESTER CODE(S) AGREEMENT NO. TELEPHONE NUMBER

NAME OF INDIVIDUAL, PARTNERSHIP, OR CORPORATION

FIRM OR TRADE NAME

DBA

PLEASE REPORT ALL CHANGES IN THE APPROPRIATE SPACES

PART B: CORPORATE OFFICERS.NOTE: A CHANGE IN OFFICER(S) OR IN CORPORATE NAME (SAME OFFICERS) REQUIRES COMPLETION OF THIS FORM. A CHANGE IN

SOLE OWNER , PARTNER, SALE OF COMPANY, OR COMPANY MERGER REQUIRES A NEW APPLICATION AND AGREEMENT.

INSTRUCTIONS: Please list all current and new officers.NAME (LAST,FIRST,MI) TITLE DL/IDNUMBER AND STATE ISSUED

NAME (LAST,FIRST,MI) TITLE DL/ID NUMBER AND STATE ISSUED

NAME (LAST,FIRST,MI) TITLE DL/ID NUMBER AND STATE ISSUED

NAME (LAST,FIRST,MI) TITLE DL/IDNUMBER AND STATE ISSUED

NEW FIRM NAME

NEW MAILING ADDRESS NEW DAYTIME PHONE NUMBER

NEW CONTACT PERSON NEW DAYTIME PHONE NUMBER

RECORD STORAGE ADDRESS (PHYSICAL LOCATION WHERE RECORDS WILL BE MAINTAINED FOR ON-SITE INSPECTION, REVIEW OR AUDIT BY DMV OR ITS REPRESENTATIVES)

CITY STATE ZIP CODE

BILLING CONTACT NAME (FIRST,MI,LAST)


NEW ACCESS CONTROL ADMINISTRATOR—NAME (LAST,FIRST,MI) TITLE DL/ID NUMBER AND STATE ISSUED

NEW REVIEW SECURITY ADMINISTRATOR—NAME (LAST,FIRST,MI) TITLE DL/ID NUMBER AND STATE ISSUED

PLEASE PRINT CLEARLY OR TYPE

Check one: Sole Ownership Partnership Corporation


PART E: BRANCH(S) LOCATIONINSTRUCTIONS: Please complete the Commercial Requester Account Requester Codes for Branch Location, INF1106BL.

PART F: DIRECT ON-LINE REQUESTERS ONLY

INF 1213 (REV. 9/98)

( )

PART A: INFORMATION ON RECORD

PART C: REPORT OF NEW FIRM NAME, MAILING ADDRESS, PHONE NUMBER, CONTACT PERSON, AUTHORIZEDPERSON OR STORAGE.

PART D: BILLING CONTACT AND ADDRESS

( )

( )

Return completed form to:

PART G: ACCOUNT PURPOSES, TYPE OF RECORDS AND ADDRESS ACCESS(NOTE: PROVIDE NEW OR ADDITIONAL INFORMATION)

INSTRUCTIONS: Complete a separate section for each purpose and explain how the information received will be used under proposed use, select the typesof records requested. Check either “yes” or “no” for confidential residence address information. If yes, the Commercial Requester Account Agreement requiresthe specific regulation, rule of court, federal, or state statute identified by code name and section number which authorizes the use of Department of MotorVehicle residence address information.

Type Record Abbreviations Guide

DL/ID-Driver License/Identification Card VR-Vehicle/Vessel Registration FR-Financial Responsibility OL-Occupational Licensee

1. Identify Proposed Use: ___________________________________________________________________________

______________________________________________________________________________________________



______________________________________________________________________________________________



______________________________________________________________________________________________



______________________________________________________________________________________________


PART H: STATEMENT OF UNDERSTANDING, CERTIFICATION SIGNATURE(S)

INSTRUCTIONS: Please read the statement of understanding, complete the “Executed at” line and sign A, B, or C, as appropriate.

I understand the false or misleading answers are cause for denial of an application and/or termination of any access agreement granted. I authorize theDirector of the Department of Motor Vehicles, or the Director’s designee, to investigate any matter or statements contained in this application.

I understand that if this Application for a Commercial Requester Account is approved, I will be required to conform to the statements presented within.I further understand that I will be required to sign an agreement which will become part of this application. This application and the agreement specify revocationof the account and refusal of subsequent applications.

I understand that according to provisions of the California Vehicle Code Section 1808.45, the willful, unauthorized disclosure of information from anydepartment record for a purpose other than the one stated in the request or the sale or other distribution of the information to a person or organization notdisclosed in the request is a misdemeanor, punishable by a fine not exceeding $5,000 or by imprisonment in the county jail not exceeding one year, or bothfine and imprisonment.

I understand that according to provisions of the California Vehicle Code Section 1808.46, any person holding a requester code who directly or indirectlyobtains information from the Department of Motor Vehicles using false representations or distributes restricted or confidential information to any person oruses the information for a reason not authorized or specified in this application is liable to the Department of Motor Vehicles for civil penalties up to $100,000and shall have their requester code privileges suspended for a period of up to five (5) years or revoked.

DMV USE ONLY

Proposed UseApproved

Yes No

_______________Req. Code #


Yes No

_______________Req. Code #


Yes No

_______________Req. Code #


Yes No

_______________Req. Code #


A Individual : I certify under the penalty of perjury that I am the sole Owner as shown on this application, and that no person is associated in the ownershipof the business, and that all answers and information contained within this application are true and correct.SIGNATURE

X

B. Partnership : We certify under the penalty of perjury that we are co-partners as shown on this application and that no other person is associated in theownership of the business, and that all answers and information contained within this application are true and correct.SIGNATURE SIGNATURE

X X

C. Corporation : I certify under the penalty of perjury that I am a corporate officer authorized to sign for the corporation identification number and the stateshown on this application are valid and that all answers and information contained within this application are true and correct.SIGNATURE OF CORPORATE OFFICER AUTHORIZED TO SIGN FOR CORPORATION TITLE

X

INF 1213 (REV. 9/98)

NAME

ADDRESS STREET CITY STATE ZIP CODE

DRIVER LICENSE NUMBER TELEPHONE NUMBER

( )


DATE SIGNATURE OF DEALER OR MANUFACTURER

PLEASE PRINT THE FOLLOWING INFORMATION REGARDING THE AGENT YOU ARE AUTHORIZING

NAME

ADDRESS STREET CITY STATE ZIP CODE

DEALER/MANUFACTURER LICENSE NUMBER DAYTIME TELEPHONE NUMBER

( )

I hereby certify, under penalty of perjury, that the party specified below is authorized to act as my agent for thepurpose of obtaining information from the Department of Motor Vehicles pursuant to Vehicle Code Section1808.23.

In making this authorization, I agree to:

Hold the Department harmless from any monetary loss to the Department by reason of the use of informa-tion obtained from the Department by this agent; and

Pay to the Department, its officers, and any other person(s) all civil damages occasioned to the Departmentor such persons by reason of the following acts or omissions by this agent:

(a) obtaining information from the Department by means of false or misleading representations, or

(b) selling, giving, or otherwise furnishing any information obtained from Department records to any thirdparty not specifically authorized and approved by the Department.

PLEASE PRINT THE FOLLOWING INFORMATION REGARDING YOUR OWN BUSINESS:

X

I certify, under penalty of perjury, that the foregoing is true and correct.


INFORMATION SERVICESCERTIFICATION OF AGENCY

PLEASE CHECK THE APPROPRIATE BOX BELOW:

My business is a vehicle dealership licensed to do business in the state of California.My business is a vehicle manufacturer licensed to do business in the state of California.

INF 1184 (NEW 2/91)

Instructions: Please complete the execution statement. Partnerships require signature of all partners (if more than two, sign on the same lineand print name). Corporations require the signature of corporate officer authorized to sign for corporation.


A. Individual: I certify under the penalty of perjury that I am the sole owner of the business and that no other person is associated in theownership of the business, and that all answers and information contained within this application are true and correct.SIGNATURE

X

B. Partnership: We certify under the penalty of perjury that we are co-partners and that no other person is associated in the ownership of thebusiness, and that all answers and information contained within this application are true and correct.

Commercial Requester Account ApplicationRequester Codes for Branch Locations

NOTE: Complete only if you want any branch location to have their own separate requester code(s).

INF 1106BL (NEW 5/95)


Req CodeAccess

SAME BASIC

SIGNATURE SIGNATURE

X X

C. Corporation: I certify under the penalty of perjury that I am a corporate officer authorized to sign for the corporation and that all answers andinformation contained within this application are true and correct.SIGNATURE OF CORPORATE OFFICER AUTHORIZED TO SIGN FOR CORPORATION TITLE

X X

CONTACT PERSON (LAST, FIRST, MI) TELEPHONE NO.

STREET ADDRESS CITY STATE ZIP CODE





DMV USE ONLYRequester Code(s)

PART A: Main Office

PART B: Billing Information

PART C: Branch(es)

PART D: Branch Contact Person and Address Information

PART E: Execution Statement and Signatures

NAME OF INDIVIDUAL, PARTNERSHIP, OR CORPORATION REQUESTER CODE (IF ISSUED) AGREEMENT NUMBER (IF ISSUED)





Additional requester codes may be assigned to branch locations. The monthly billing invoice is automatically mailed to the branch unless youindicate that you want the billing invoice mailed to the main office. (Check one box only) Main Office Branch(es)

Instructions: Complete the following information for each branch location: The name of the contact person (if not the same as main office),telephone number, the street and mailing address (if different) for each branch. Requester Code Access: If the main office and specifiedbranch(es) are to have the same type of access mark “same”. If receiving residence address information and the branch(es) are to be restrictedto basic record information only mark “Basic”. If more space is needed, see Part F on reverse side of form.

Commercial Requester Account ApplicationRequester Codes for Branch Locations

(Continued)

If additional space is needed, you may photocopy this side or request additional copies by contacting the Account Processing Unit,P. O. Box 944231, Mail Station H221, Sacramento, CA 94244-2310 (916) 657-5564. Complete the page number as indicated.

Page _____ of _____

________________________NAME OF MAIN OFFICE




























Req CodeAccess

SAME BASICPART F: Branch Contact Person and Address Information

INF 1106BL (NEW 5/95)

DMV USE ONLYRequester Code(s)

COMMERCIAL REQUESTER ACCOUNT …loganreg.com/Forms/CA/COMMERCIAL_APPLICATION.pdfINFORMATION SERVICES...

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