Exhibit G - PII Certification - Organization.pdf
PDF 83 KB Posted
- Attached to
- ACP Client Data Removal Services
- Solicitation number
- RFP AADA 2027000046 2
- Issued by
- Denver County, Denver City, Colorado
About this file
This is a Personal Identifying Information (PII) Certification document issued by the State of Colorado for third-party entities and organizations seeking access to PII through a database or automated network. The certification, governed by Colorado Revised Statutes 24-74-105, requires authorized representatives of organizations to certify under penalty of perjury that they will not use or disclose Personal Identifying Information as defined by C.R.S. 24-74-102(1) for purposes of investigating, participating in, cooperating with, or assisting Federal Immigration Enforcement, including civil immigration law enforcement and provisions under the Illegal Immigration and Immigrant Responsibility Act (8 U.S.C. §1325 and §1326), unless legally required to do so through Federal or State law compliance or in response to a court-issued subpoena, warrant, or order.
The certification requires the signatory to affirm full legal authority to execute the document on behalf of the organization and includes standard fields for signature, printed name, title, and date of execution. This document serves as a compliance requirement for any organization seeking to access Colorado state databases or automated networks containing PII and represents a contractual commitment to restrict PII usage in accordance with state immigration-related restrictions.
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Text version
Exhibit G 1
Exhibit G - PII Certification
State 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:
File details come from the government source that posted it. Updated .