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DocuSign Envelope ID: 601932A9-29F4-4C23-80F1-CEA4FACB795C
<br />v.4.10
<br />COLORADO
<br />Financfal5ervices
<br />l?epartntcrn Of Hl,... i;r
<br />DMpan of Ccnt"and Procurement
<br />21. THIRD PARTY CERTIFICATION FOR ACCESS TO PII THROUGH A
<br />DATABASE OR AUTOMATED NETWORK
<br />Pursuant to § 24-74-105, C.R.S, if Contractor is to be granted access to Personal Identifying
<br />Information through a database or automated network that is not publicly available information,
<br />Contractor certifies, and will certify annually, under penalty of perjury that Contractor has not and
<br />will not use or disclose any Personal Identifying Information, as defined by § 24-74-102(1),
<br />C.R.S., for the purpose of investigating for, participating in, cooperating with, or assisting Federal
<br />Immigration Enforcement, including the enforcement of civil immigration laws, and the Illegal
<br />Immigration and Immigrant Responsibility Act, which is codified at 8 U.S.C. §§ 1325 and 1326,
<br />unless required to do so to comply with Federal or State law, or to comply with a court -issued
<br />subpoena, warrant or order.
<br />If Contractor's agents, employees, assigns or Subcontractors require certification pursuant to § 24-
<br />74-105, C.R.S., Contractor shall require annually that its agents, employees, assigns or Subcontractors
<br />sign and date the following certifications as applicable, which shall be made available to the State
<br />upon request:
<br />For an individual: Pursuant to § 24-74-105, C.R.S., I hereby certify under the penalty ofperjury
<br />that I have not and will not use or disclose any Personal Identifying Information, as defined by §
<br />24-74-102(1), C.R.S., for the purpose of investigating for, participating in, cooperating with, or
<br />assisting Federal Immigration Enforcement, including the enforcement of civil immigration laws,
<br />and the Illegal Immigration and Immigrant Responsibility Act, which is codified at 8 U.S.C. §§
<br />1325 and 1326, unless required to do so to comply with Federal or State law, or to comply with a
<br />court -issued subpoena, warrantor order.
<br />For and entity/organization: Pursuant to § 24-74-105, C.R.S., I, ,
<br />on behalf of (legal name of entity / organization) (the
<br />"Organization'), hereby certify under the penalty ofperjury that the Organization has not
<br />and will not use or disclose any Personal Identifying Information, as defined by § 24-74-
<br />102(1), C.R.S., for the purpose of investigating for, participating in, cooperating with, or
<br />assisting Federal Immigration Enforcement, including the enforcement of civil
<br />immigration laws, and the Illegal Immigration and Immigrant Responsibility Act, which is
<br />codified at 8 U.S.C. §§ 1325 and 1326, unless required to do so to comply with Federal or
<br />State law, or to comply with a court -issued subpoena, warrant or order.
<br />I hereby represent and certify that I have full legal authority to execute this certification
<br />on behalf of the Organization.
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