HomeMy WebLinkAboutCAG2023-356 - Original - CARFAX - Police Crash Assistance Enrollment Form - 04/22/2016 CARFAX POLICE
CRASH ASSISTANCE
® � Solve Crimes Faster,Keep Communities Safer
ENROLLMENT FORM FOR LAW ENFORCEMENT
Official Agency Name(must provide FULL name) ("Agency"): City of Kent Police Department
Agency ORI Number: W A - 0 1 7 0 7 0 0
Name of Chief of Police or Sheriff: Chief Ken Thomas Number of Sworn Officers: 147
Address: 220 Fourth Avenue South City: Kent
County: King State: Washington Zip: 98032
Estimated number of motor vehicle accident reports per year: 2,600
Enrollment in the CARFAX Police Crash Assistance Program ("Program") allows Agency personnel access to the CARFAX Vehicle
History Service ("VHS"), the CARFAX Investigative Data Sharing Program ("Data Sharing Program"), the CARFAX E-Commerce
Program ("E-Commerce"), and such other programs that CARFAX may offer participants of the Program from time-to-time during the
Term, in exchange for motor vehicle accident reports data created or collected by Agency.
Agency does not wish to access(please check all that are applicable):
❑ Investigative Tools
171 Data Sharing Program
10 E-Commerce
Additional Information required for E-Commerce
Does applicable state or local law or regulation require that motor vehicle accident reports can only be provided to specific,
interested parties(as defined by such law or regulation)? I7IYes ❑No
If"yes,"CARFAX will work with Agency to address such requirements.
Amount to be reimbursed to Agency for each accident report sold through E-Commerce(collectively,"Reimbursed Fee"):
Required by Law: $
Convenience Fee Charged by Agency: $
By signing below, I represent that I am duly authorized to execute this Application on behalf of Agency and bind Agency to the CARFAX
Police Crash Assistance Program Terms and Conditions:
Signature: C Title: st tq. t Af-JT tr.
Lj/Z-21 IZ4D
Printed Name: t C_ Date: I
Send completed form to: Elena Castor I EMAIL: elenacastor@carfax.com ( FAX: 1-866-304-7523
PCA Enrollment Form—04116
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