Central Services Records Section
Carson City, Nevada 89711-0250
ACCOUNT NO. _________________
IR001 Package (Rev 07.2015) Page 7 of 12
State of ________________ )
County of _______________)
Being first duly sworn under penalty of perjury I hereby state:
(a) I submit I have been duly authorized to represent myself or organization(s) for which I enter into this binding agreement. Subsequently I
have read, fully understand and agree to abide by the laws and regulations now in effect and hereinafter enacted or adopted regarding
the manner in which personal information from the Department of Motor Vehicles driver’s license, registration files and records may be
obtained and the limited uses which are permitted;
(b) I understand that any sale or disclosure of information so obtained must be in accordance with the provisions of this section. Specifically,
that I must keep records of such sale or disclosure for five years for Department inspection, and that such sale or disclosure may only be
for a use permitted under law;
(c) I understand that a record will be maintained by the Department of any information which I request;
(d) I understand that a violation of the provisions of NRS 481.063 and NRS 485.316 is a criminal offense. Specifically, that it is unlawful to
make a false representation to obtain any information from the Department, or to knowingly obtain or disclose any information from the
files or records of the Department for any use not permitted by the provisions of this chapter.
(e) I understand that I and the organization(s) I represent shall keep all data, information, reports, tests, manuals, instructions, plans, system
designs, computer codes, and any documents or drawings that are related to infrastructure security received from the State of Nevada,
Department of Motor Vehicles (“Department”), or created by the agency as necessary to render performance under this Agreement,
strictly confidential. Except for the sharing of information among law enforcement agencies for law enforcement purposes under NRS
481.063 Section 6, I agree that I will not disclose any of the items as referenced in this subsection to a person who is not a party to this
agreement absent the express written consent of the Department. I further understand and agree that the Department may be required to
disclose, in certain instances, some of the above items in compliance with Nevada Public Records Law, and these instances do not
change my or my organization’s obligations to maintain confidentiality as set out above.
The confidential items, as set out above, specifically include, but are not limited to, the following items:
1) Information regarding defense in-depth strategies, Information Security Policies, Information Security Plans, Intrusion Protection /
Prevention systems, access control measures, network and/or systems architecture, security passwords, security access codes, and
security programs; access codes for software applications; and security procedures, processes, and recovery plans.
2) Specific data collected in preparation of connection to the Department’s infrastructure or information essential to the Department’s
3) Security testing results, especially if the results identify specific system vulnerabilities.
I also agree and understand that this confidentiality provision’s purpose is to prevent public disclosure that may have an impact on public
safety or security, including but not limited to, security of personally identifiable (PII) information. In addition to any other indemnification
agreements contained in this Affidavit, I further agree to indemnify, hold harmless, and defend the Department from and against all
liability, claims, actions, damages, losses, and expenses, including, without limitation, reasonable attorneys’ fees and costs, based on the
agencies release of the aforementioned items. If I must disclose some of the above items to a third party, I shall obtain the written consent
of the Department and the third party must agree, in writing, to the terms of this provision. The terms of this provision shall survive the
completion of performance under this Agreement and/or the termination of this Agreement.
I attest to the fact that I am an authorized representative for myself or of the requesting organization. I declare under penalty of perjury that the
foregoing is true and correct. Signatures must be original. Photocopies are not acceptable.
DATED this _________ day of __________________, (20 __)
Signature of Applicant Printed Name and Title (if applicable) of Applicant
Signed and sworn to before me this_________ day of __________________, (20 __)
NOTARY Public or Authorized Nevada DMV Representative (Notary Seal)
IR003 (Rev 03.2015)