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=[[3=rJ=II1=Ii=rJ=r <br />CARFAXFORPOLICE.COM <br />ENROLLMENT FORM FOR LAW ENFORCEMENT <br />Official Agency Name (must provide FULL name) ("Agency"): Kittitas' County Sheriffs Office <br />Agency ORI Number: WA0190000 <br />Name of Chief of Police or Sheriff: Sheriff Gene Dana Number of Sworn Officers : ______ _ <br />Address : 3 07 W ,"Umpla"um Rd . City : Ellensburg <br />County : .!.:K~itt~it~a!!..s ____________ 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 [gI Yes D No <br />CARFAX E-Commerce Service DYes [gI No (If Yes , please provide the additional information requested below) <br />Additional. information required for the CAR FAX 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)? DYes D 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 />S;gn~"e 4~ <br />Printed Name:; ~ ~ ~: Title : Sheriff <br />Date : '} 1111 i <br />Send completed form to: Meghan Edwards I EMAIL: meghanedwards@carfax.com ] I FAX: 866-304-7523 <br />peA Enrollment Form -02/17