HomeMy WebLinkAboutLicense Event Notification ServiceRESOLUTION 2013-79
ADOPTED
DOC ID: 8447
THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION NO. 2013-79 WAS
ADOPTED AT THE REGULAR MEETING OF THE SOUTHOLD TOWN BOARD ON
JANUARY 15, 2013:
RESOLVED that the Town Board of the Town of Southold hereby authorizes and directs
Supervisor Scott A. Russell to execute the New York State Department of Motor Vehicles
License Event Notification Service Agreement (LENS) between the Town of Southold and the
New York State Department of Motor Vehicles, subject to the approval of the Town Attorney.
Elizabeth A. Neville
Southold Town Clerk
RESULT: ADOPTED [UNANIMOUS]
MOVER: Louisa P. Evans, Justice
SECONDER: Christopher Talbot, Councilman
AYES: Ruland, Talbot, Doherty, Krupski Jr., Evans, Russell
New York State Department of Motor Vehicles
NOTIFICATION SERVICE
LICENSE
EVENT
APPLICATION FOR (~OVERNMENT ORGANIZATIONS
AND VOLUNTEER FIRE COMPANIES
http://www, nysdmv.com/lens J
lens@dmv.state.ny,us
Please review tbr accnracy:
· Make changes if necessary.
· Sign the certification on Page 3 and have the tbnn notarized.
· Send this fbrm to: DATA SERVICES - LENS
NYS DEPARTMENT OF MOTOR VEHICLES
6 EMPIRE STATE. PLAZA, RM 422
ALBANY NY 12228
ARer we approve your application, we will send your customer number and instructions.
O~ganization Name: TOWN OF SOUTHOLD
Address:
54375 MAIN ROAD
City: SOUTHOLD State NY Zip Code: 11971
Contact Person: CHRISTINE FOSTER
Telephone: 631 765 -4333 Ext, ,5'"'007_ Fax: 631 765 1366 (optional)
E-Mail Address: ehristine.foator@town.southold.ny.us
FedemlEmployerlDNumber: I1 I11--16 r01011 Io 1319 I
Please describe in detail, how you plan to use the information fi'om LENS: The Town is attempting to lim[~ ~ its liability by insurin.q that all employees that utilize town vehicles as part o)b
~[their normal work duties have valid and up to date licenses
If your organizatioa, or any principal, agent, officer or employee associated with your organization, has ever had a LENS
or search account with DMV closed or terminate& please provide the account number(s):_
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Please select the license events for which you want notifications:
[] Accidents [] Convictions [] Suspensions/Revocations
[] License Expirations [] License Restorations [] Point Insurance Reduction Course Completions
[] Endorsements
Please estimate how many drivers you will monitor in LENS: 150
The Federal Driver's Privacy Protection Act (DPPA) (18 U.S.C. Sec. 2721 et seq.) permits government agencies (and
private persons or entities acting on their behalf) access to motor vehicle records for use in carrying out agency functions.
Your signature indicates that you, the applicant (and your officers, agents, partners, owners and employees); have read
and will comply with the DPPA; that you are a public officer or that you represent a public board or body; and that you
agree to abide by the following terms of service:
you will only enroll drivers in LENS as necessary to carry out your agency's functions. You will promptly delete
drivers from LENS when you no longer need their records.
2, you will notify DMV in writing, within 30 days, if there is any change in the information you have provided in
this application. You will file a replacement for this application within 60 days of any such request by DMV.
3. you will maintain for five years, records of all drivers enrolled in the LENS program. These records must indicate
which permissible use you have for each driver enrolled. These records must be available to DMV. upon request,
for audit purposes. If you do not maintain an office location within New York State, you will forward all records
requested to the place and location designated by the DMV. The location where you will keep records of
your drivers enrolled in LENS is:
State: /A~]/ ZipCode: [/_~}r'tT/- O~,-/C"'7
Telephone: G'-~/ - .c-~¢'~'- c'ag,,~J--J Ext. Q~"OO,~_ Fax: ~J/ - ~'~6o¢-'~- (36 ~ (bptional)
E-Mail Address: ¢_~l~."t'J"(-z~e. "~-~o~ KC' ~g~ '}L"oo,~ FT. ,~o c~'{---/n {:9 {tX/. e~ y. ~ (optional)
!
4. if you share personal information from DMV with a recipient outside your organization, you will obtain t¥om that
recipient an agreement identifying the recipient and specifying their DPPA permissible use for the information.
You will retain the agreement FOR FIVE YEARS after the date when you last shared DMV records with the
recipient. You will make the agreement available to DMV for audit purposes.
5. you will not represent yourself as an agent or employee of the DMV.
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6. yoa will defend, hold harmless and indemnify the DMV and its employees or agents from all claims, actions,
damages or losses which may be brought or alleged against them for your negligent, improper or unauthorized
use or dissemination of information provided by lhe DMV.
7. New York State will not be responsible for any omissions or errors in the information furnished to you.
8. the Commissioner of DMV may terminate this agreement at his/her discretion. Reasons for termination include
but are not limited to): t31se statements made by you; conceahnent of material facts in connection with this
application; and violation of any of the terms of service above.
9. this agreement is not transferable.
Your Siguature: ~1~~ Date:
'~ (Sign in the presence of aeotary) ..
On }j ~ [ 13 .... before me ~rsonally came
(Date) (Pearl who signed above)
to me kuown and, who by me being duly sworn, deposes and says: that hels, he. works/rzz:.~zz at
. . _ '(Addres~s)
and that he/~a~-signed his/he~ name thereto.
(Address)
Notary Public
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