Backup Documents 07/10/2018 Item #16D 9 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 160 9
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attomey Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. Don Luciano Community and Human DL 07/06/18
Services
2. County Attorney Office County Attorney Office CA..a. 1 (o KS
3. BCC Office Board of County
Commissioners / \l\\k` ,
4. Minutes and Records Clerk of Court's Office
(V\k.)
Z}u ,i T x'=(44
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Don Luciano, Grant Coordinator, Phone Number 239-252-2509
Contact/ Department Community and Human ervices
Agenda Date Item was July 10,2018 Agenda Item Number 16 D -- 1
Approved by the BCC
Type of Document ELT form HSMV 82150. Number of Original 2
Attached Documents Attached
PO number or account
number if document is N/A
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable colu • ver is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chair roan's original signa re? STAMP OKAY N/A
1 Does the document need to be sent to another agency for adds o raf signatures? If yes, DL
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be DL
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's DL
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the DL
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's DL
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip DL
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 07/10/18 and all changes made during 111;7:A2!..
the meeting have been incorporated in the attached document. The County
Attorney's Office has reviewed the changes,if applicable
9. Initials of attorney verifying that the attached document is the version approved by the
BCC, all changes directed by the BCC have been made, and the document is ready for E• rR 6d00:* `m
Chairman's signature.
®6if :
1:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
Instructions 160 9
1) There are two original HSMV 82150 form. Please return one Chairman signed form to:
Don Luciano
Grants Coordinator
Collier County Government I Community and Human Services
3339 E. Tamiami Trail, Bldg. H, Suite 211
Naples, FL 34112
I:Forms/County Forms/BCC Forms!Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1609
MEMORANDUM
Date: July 12, 2018
To: Don Luciano, Grants Coordinator
Community & Human Services
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Notice of Interest— Electronic Lien & Title Process
Florida Department of Highway Safety and Motor Vehicles
Attached is one (1) original of the document referenced above, (Agenda Item
#16D9) approved by the Board of County Commissioners on Tuesday, July 10, 2018.
The Board's Minutes and Records Department has kept one of the three original
documents as part of the Board's Official Records.
If you have questions, please feel free to call me at 252-7240.
Thank you
Attachment
I 6 0 9
FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
APPLICATION AND NOTICE OF INTEREST - ELECTRONIC LIEN AND TITLE PROCESS
2900 APALACHEE PARKWAY,MS68 RM.A332-TALLAHASSEE, FL 32399-0610
Pursuant to Chapters 319, 320, and 328, Florida Statutes, this form is to be used by financial institutions and other Lienholders
to enroll in Florida's Electronic Lien and Title (ELT) Program to secure liens electronically within Florida and to modify an ELT
account with the Department.
A ACTION REQUESTED -To Be Completed
THIS APPLICATION IS FOR: (Please check one)
✓1 Initial Enrollment in ELT Program
Change of Third Party Provider _ Change of Financial Institution Address and/or FEIN
_Notice of Inactive Participant ELT Program _ Change of Financial Institution Name
B LIENHOLDER (LH) INFORMATION –To Be Completed By Lienholder/Financial Institution
The Department assigns the Lienholder a DHSMV Customer Number upon initial enrollment and requires it on all
requested ELT actions. If the Lienholder already has an assigned DHSMV Customer Number, it is to be listed and used.
The Lienholder/Financial Institution must provide a Federal Employer Identification Number
(FEIN) and any DHSMV-assigned suffix.
List your assigned DHSMV Do You Have Any Other ELT DHSMV If Yes, What Are They?
Customer Number: Customer Numbers?
96396824 ❑ Yes ❑✓ No
Federal Employer Identification Number(FEIN): DHSMV-assigned suffix:
59-6000558
Name of Lienholder- Financial Institution/Doing Business As (DBA):
Collier County Board of County Commissioners
Note: Please include a copy of your Federal/State Charter/License with this Application.
TYPE OF BUSINESS/FINANCIAL INSTITUTION: (PLEASE CHECK ONE)
I 1 Florida Bank — Federal Credit Union
I Florida Credit Union Federal Savings&Loan
Florida Thrift&Loan — Out of State Bank
Florida Savings&Loans _ Out of State Credit Union
HFlorida Finance Company = Out of State Finance Company
National Bank Out of State Savings&Loans
✓ I Other: County government Out of State Thrift&Loan
LH Mailing Address (Used for Your Titles): City: State: Zip:
3339 E. Tamiami Trail, bldg H, Ste 211 Naples, FL 34112
LH Physical Address: City: State: Zip:
3299 E. Tamiami Trail, Ste 700 Naples, FL 34112
NAME OF ELT THIRD PARTY PROVIDER: (PLEASE CHECK ONE)
nAuto Data Direct, Inc., 1379 Cross Creek Circle,Tallahassee, FL 32301 www.ADD123.com
Office: 1-850-877-8804 Toll-Free: 1-866-923-3123 Fax: 1-850-877-5910
AutoTitles America, Inc. 6807 53rd Avenue East, Bradenton, FL 34203 www.AutoTitlesAmerica.com
Office: 1-855-526-0855 Fax: 1-941-739-8846
Dealer Support Services, Inc., 1511 E. Lake Parker Drive, Suite 2, Lakeland, FL 33801 www.dmvelt.com
Office: 1-863-937-9739 Toll-Free: 1-800-848-8751 Fax1-863-937-9750
Decision Dynamics, Inc., P. O. Box 2078, Lexington, SC 29072 infoAetitlelien.com
Office: 1-803-808-0117 Fax: 1-803-808-3780
FDI Collateral Management, 9750 Goethe Road, Sacramento, CA 95827 www.dealertrack.com
Office: 1-916-368-5300
Florida ELT, 700 S. Royal Poinciana Blvd.#701, Miami Springs, FL 33166 www.floridaELT.com
Office: 1-888-675-7477 Fax: 1-954-449-6028
INSTeTAG, Incorporated, 427 N. Magnolia Avenue, Orlando, FL 32801 Salesninstetaq.com
Office: 1-407-254-0806 Ext. 2 Fax: 1-407-254-5988
PDP Group, Inc., 10909 McCormick Road, Hunt Valley, MD 21031 contactasimplyelt.com
Office: 1-410-584-2099
Secure Title Administration, Inc., 2975 Breckinridge Blvd., Duluth, GA 30096 securetitleinfoAsecureTA.com
Toll-Free: 1-866-742-1466
Title Technologies, Inc., 14850 Montfort Drive, Suite 190, Dallas,TX 75254 ELTSupport(a�TitleTec.com
Office: 1-866-689-0578 Option 2–Sales Fax: 1-214-239-4563
VINtek Inc., 1735 Market Street, Suite 900, Philadelphia, PA 19103 cros.salesPdealertrack.com
Office: 1-877-488-0517 Option 9-Sales
•
HSMV 82150–Revised 04/03/17 Page 1 of 3
1609
Participating Lienholders agree to the following conditions and requirements:
• Lienholder/financial institutions mustcontractwith one of DHSMV's approved ELT Third Party Providers for
transmission of all vehicle and title data.
• Lienholder/financial institutions must complete Sections Aand B,then complete this form electronically and send a
signed original copy to the selected Third Party Provider with a copy of the Lienholder's Federal/State
Charter/License, if applicable.
• This completed application must be submitted electronically to DHSMV by the authorized ELT Third Party Provider
named in Section B. The Third Party Provider must retain the original signed completed application and all other
documentation on file for audit purposes.
• Lienholder must provide the DHSMV Customer Number assigned by DHSMV to all loan recipients,motor vehicle,
mobile home, and vessel dealers applying for title on the form HSMV 82040"Application for Certificate of Title
With/Without Registration"utilizing selected Lienholderservices.
• Lienholder must work directly with the contracted Third Party Provider's Help Deskto resolve all ELT discrepancies
and data transmission issues.
• Lienholder must protect the confidentiality of the information and data to which Lienholder has access. At no time will
the Lienholder furnish to any person,association,or organization any motor vehicle, mobile home,vessel,or title data
received from DHSMV without DHSMV's priorwritten consent.
• Lienholder has no proprietary rights to the information received from DHSMV.
• Lienholder understands that DHSMV and its employees shall not be liable to the Lienholder for any damage,costs,
lost production,or any other loss of any kind for failure of DHSMV's equipment,hardware,or software or for the loss
of consequential damages that are the result of any othertype of failure.
• Lienholder must comply with all applicable Florida Statutes and DHSMV policy and procedures as an ELT program
participant.
Note: Applicant must have entered into a contract with Third Party Provider before applying to become an ELT
Lienholder participant. If applicant is changing Third Party Provider: (1) all pending transactions with the
previous Third Party Provider must be complete; (2) a contract must be signed with the new Third Party
Provider and; (3)the Department must be notified prior to using the new provider's services.
LH ADMINISTRATIVE CONTACT INFORMATION (List Below)
Name:Don Luciano Phone#/Ext:239-252-2509
Email Address:donald.luciano@CollierCountyFL.gov Fax#:239-252-2638
LH DATA PROCESSING CONTACT INFORMATION (If Applicable List Below)
Name: Phone#/Ext:
Email Address: Fax#:
LH AUTHORIZED REPRESENTATIVE/COMPANY CONTACT INFORMATION (For DHSMV Field Support Center List Below)
Name:Don Luciano Phone#/Ext:239-252-2509
Email Address:donald.luciano@CollierCountyFL.gov Fax#:239-252-2638
LH INFORMATION PROVIDED BY (List Below)
Name:Don Luciano Phone#/Ext:239-252-2509
Email Address:donald.luciano@CollierCountyFL.gov Fax#:239-252-2638
DHSMV WILL USE THE FOLLOWING INFORMATION FOR WORK PROJECTIONS AND UNDERSTANDING PROJECT
DEVELOPMENT SCOPE IN ORDER TO PROVIDE EFFICIENT ASSISTANCE.
Approximate Number of Paper(Hard Copy) Titles On Hand: o
Approximate Number of Titles Processed Weekly: 1-2/month
LH DESIGNEE NAME (Printed Name Below)
Name:Andy Solis Phone#/Ext:239-252-8602
Email Addres . ndy.solis@CollierCountyFL.gov Fax#:239-252-8602
Title: C IC n of t ' • d Company:Collier County Board of County Commissioners
LH D IGSignature,-el'• • • . Date (mm/dd/yyyy):
y y #, CRYSTAL K..KINZEL, _,
INTERIM CLERK_ Approved as to form and legality
AIN
Mt t to h`, T S Page 2 of 3 Assistant County Alto 1, ao�
HSMV 82150-Revised 04/03/17 g
signature o ly. cQ
1609
C THIRD PARTY PROVIDER (TPP) AUTHORIZATION—To Be Completed By Third Party Provider
Requested ELT Start or End Date for Lienholder: Start End
(mm/dd/yyyy)
I certify that the entity above meets the requirements to become an authorized electronic Lienholder(ELT). The entity will abide
by all laws, rules, procedures, and contractual obligations required. I will ensure that all lien transactions are done in
accordance with laws and Department procedure. I further certify that state and county fees collected will be remitted
electronically in accordance with state law. I understand that failure to comply with any laws, rules, or contractual terms shall be
grounds for the Department to revoke my authorization to use the ELT system.
The applicant agrees to comply with section 119.0712 (2), Florida Statutes, and the Federal Driver's Privacy Protection Act
(18 U. S. C. § 2721 et seq.). The applicant agrees that all personal information governed by these statutes will be used or
redisclosed by the applicant only as permitted by these statutes. Any use or redisclosure of such personal information by the
applicant except as permitted by these statutes will result in DHSMV revoking applicant's ability to use the system.
Under penalty of perjury, I do swear and affirm that the information contained in this application is true and correct and that
applicant will abide by all laws of Florida and all applicable rules, policies, and procedures of the Department of Highway Safety
and Motor Vehicles.
ELT THIRD PARTY PROVIDER DESIGNEE (Printed Name Below)
Name: Phone#/Ext:
Email Address: Fax#:
Title: Company:
ELT THIRD PARTY PROVIDER DESIGNEE (Signature Below) Date (mm/dd/yyyy):
For Department Use Only
Name of DHSMV Reviewer: Date (mm/dd/yyyy):
PLEASE CHECK APPLICABLE BOX(ES)
Approved
Not Approved - List Reason(s):
Further Action Needed — List Action(s):
HSMV 82150—Revised 04/03/17 Page 3 of 3