Laserfiche WebLink
13 13131313[k <br />CARFAXFORPOLICE.COM <br />ENROLLMENT FORM FOR LAW ENFORCEMENT <br />Official Agency Name (must provide FULL name) ("Agency"): Kittitas County heriff's Office <br />Agency ORI Number: WA0190000 <br />Name of Chief of Police or Sheriff: Sheriff Gene Dana Number of Sworn Officers: <br />Address: 307 W. Umptanum Rd. City: Ellensburg <br />County: Kittitas <br />State: Washington Zip: 98926 <br />Estimated number of motor vehicle accident reports per year: <br />Enrollment in the CARFAX For Police Program allows Agency to subscribe, in exchange for motor vehicle accident reports data created or <br />collected by Agency, to the CARFAX investigative tools ("Investigative Tools"), the CARFAX E -Commerce Service, and such other tools and <br />services that CARFAX may offer participants of the CARFAX For Police Program. <br />Agency wishes to subscribe to: <br />Investigative Tools E Yes ❑ No <br />CARFAX E -Commerce Service [:1 Yes [] No (if Yes, please provide the additional information requested below) <br />Additional information required for the CARFAX E -Commerce Service: <br />Does applicable state or local law or regulation require that motor vehicle accident reports can only be provided to specific interested parties <br />(as defined by such law or regulation)? ❑ Yes ❑ No <br />Amount to be reimbursed to Agency for each accident report sold through the CARFAX E -Commerce Service: $. <br />By signing below, I represent that I am duly authorized to execute this Enrollment Form on behalf of Agency and bind Agency to the CARFAX <br />For Police Program Terms and Conditions: <br />Signature: C/000 Title: Sheriff <br />Printed Name:t. <br />Date: <br />Send completed form to: Me9han Edwards I EMAIL: meghanedwards@carfax.com ] I FAX: 866-304-7523 <br />PCA Enrollment Form - 02/17 <br />