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HomeMy WebLinkAboutC24-356 State of ColoradoSTATE OF COLORADO THIRD PARTY ENTITY / ORGANIZATION CERTIFICATION FOR ACCESS TO PII THROUGH A DATABASE OR AUTOMATED NETWORK Pursuant to § 24-74-105, C.R.S., I, _________________________________________________, on behalf of ____________________________________________________________________ (legal name of entity / organization) (the “Organization”), hereby certify under the penalty of perjury that the Organization has not and will not use or disclose any Personal Identifying Information, as defined by § 24-74-102(1), C.R.S., for the purpose of investigating for, participating in, cooperating with, or assisting Federal Immigration Enforcement, including the enforcement of civil immigration laws, and the Illegal Immigration and Immigrant Responsibility Act, which is codified at 8 U.S.C. §§ 1325 and 1326, unless required to do so to comply with Federal or State law, or to comply with a court-issued subpoena, warrant or order. I hereby represent and certify that I have full legal authority to execute this certification on behalf of the Organization. Signature: ________________________________ Printed Name: ________________________________ Title: ______________________________________ Date: ______________________________________ Docusign Envelope ID: 966342E2-3128-4D52-801A-092AC69BC24F Jeff Shroll Jeff Shroll 2024-08-15 County Manager Board of County Commissioners of Eagle County (a political subdivision of the state of Colorado)