HomeMy WebLinkAbout20223547.tiffRESOLUTION
RE: APPROVE STANDARD FORM OF AGREEMENT FOR PERSONAL IDENTIFYING
INFORMATION (PII) CERTIFICATION AND AUTHORIZE DIRECTOR OF
DEPARTMENT OF HUMAN SERVICES TO SIGN ANY AGREEMENT CONSISTENT
WITH SAID FORM
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Standard Form of Agreement for
Personal Identifying Information (PII) Certification for access to PII through a database or
automated network between the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, on behalf of the Department of Human Services, and the
State of Colorado, with further terms and conditions being as stated in said form, and
WHEREAS, after review, the Board deems it advisable to approve said form, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Standard Form of Agreement for Personal Identifying Information
(PII) Certification for access to PII through a database or automated network between the County
of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County,
on behalf of the Department of Human Services, and the State of Colorado, be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Jamie Ulrich, Director of the
Department of Human Services, be, and hereby is, authorized to sign any agreement consistent
with said form.
Cc;l-150
001/23
2022-3547
H R0094
STANDARD FORM OF AGREEMENT FOR PERSONAL IDENTIFYING INFORMATION (PII)
CERTIFICATION
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 21st day of December, A.D., 2022.
BOARD OF COUNTY COMMISSIONERS
WELL COUNTY, COLORADO
ATTEST:
t K. James, Chair
Weld County Clerk to the Board
BY:
APP
County torney
Date of signature: 01/03/A3
Mike Freeman, Pro-Tem
44WW8Ak4aittA
Perry L. Buck
Lori Saine
2022-3547
HR0094
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: December 6, 2022
TO: Board of County Commissioners — Pass -Around
FR: Jamie Ulrich, Director, Human Services
RE: State of Colorado Personal Identifying Information
Certification (PII) for the Weld County Department
of Human Services
Please review and indicate if you would like a work session prior to placing this item on the Board's
agenda.
Request Board Approval of the State of Colorado Personal Identifying Information Certification
(PII) for the Weld County Department of Human Services. The Protection of Personal Identifying
Information Act (C.R.S. S 24-74-10 1 through 108), places certain obligations and restrictions on state
agencies from collecting and sharing personal identifying information (PII). In order to ensure compliance
with obligations under Colorado Revised Statute, the State is requiring a signed PII Certification from
County entities on a contract -by -contract basis certifying that it will not use or disclose PII for purposes of
investigating for, participating in, cooperating with, or assisting in federal immigration enforcement,
including enforcement of civil laws.
This Certification form has been reviewed and approved by Legal (C. Perry).
I do not recommend a Work Session. I recommend approval of this Certification form and authorize signature
delegation to the Weld County Human Services Director to sign on a contract -by -contract basis as requested by the
State of Colorado.
Approve
Recommendation
Perry L. Buck
Mike Freeman, Pro -Tern
Scott K. James, Chair
Steve Moreno
Lori Saine
Schedule
Work Session
Other/Comments:
Pass -Around Memorandum; December 6, 2022 — Not in CMS Page 1
2022-3547
12/2,1 die.00(444
Karla Ford
From:
Sent:
To:
Subject:
Approve
Mike Freeman
Tuesday, December 6, 2022 3:28 PM
Karla Ford
Re: Please Reply - PA FOR ROUTING: PII Certification Form (Not in CMS)
Sent from my iPhone
On Dec 6, 2022, at 9:29 AM, Karla Ford <kford@weldgov.com>wrote:
Please advise if you approve recommendation. Thank you.
Karla Ford
Office Manager, Board of Weld County Commissioners
1150 0 Street, P.O. Box 758, Greeley, Colorado 80632
:: 970.336-7204 :: kfordRweldgov.com :: www.weldgov.com
**Please note my working hours are Monday -Thursday 7:00a.m.-5:00p.m.**
cimage002.jpg>
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to
which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received
this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying,
distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named
recipient is strictly prohibited,
From: Lesley Cobb <cobbxxlk@weldgov.com>
Sent: Monday, December 5, 2022 2:22 PM
To: Karla Ford <kford@weldgov.com>
Cc: Bruce Barker <bbarker@weldgov.com>; Chris D'Ovidio <cdovidio@weldgov.com>; Cheryl Pattelli
<cpattelli@weldgov.com>; Esther Gesick <egesick@weldgov.com>; Lennie Bottorff
<bottorll@weldgov.com>; HS -Contract Management <HS-ContractManagement@co.weld.co.us>
Subject: PA FOR ROUTING: PII Certification Form (Not in CMS)
Good afternoon Karla,
Please see the attached PA that has been approved for routing to all five Commissioners: PII
Certification Form (Not in CMS).
Thank you!
Lesley Cobb
Contract Management and Compliance Supervisor
Weld County Dept. of Human Services
315 N. 11th Ave., Bldg A
PO Fox A
Greeley, CO 80632
ilt (970) 400-6512
��, (970) 353-5212
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:
aoaa.- 351/7
Hello