05/15/1991
AGREEMENT FOR SERVICE
(Member Al:reemenl)
TUE CREDIT Bl'REAL. I.'l/CORPORAn:U OF GEOR(;IA
CREJ)lT NORTHWEST CORPORATION
I. The undersigned, desiring to use your services at the regular prices established by you from time to time, agrees to furnish
information concerning its customers with the exception of information it has received from others, upon your request
and further agrees that all information, whether oral or written, whether by report, bulletin or otherwise, will be submitted
and received subject to the following conditions:
2. Information will be requested only for our exclusive use. All information received from you will be held in strict confidence,
except to the extent that disclosure to others is required by law. Reports on employees will be requested only by our designated
representatives and employees will be forbidden to attempt to obtain reports on themselves, associates or any other persons
except in the exercise of their official duties.
3. We agree to hold The Credit Bureau, Incorporated of Georgia and Credit Northwest Corporation and all their agents harmless
on account of any expense or damage arising or resulting from the publishing or other disclosure contrary to these condi-
tions, by us, our employees or agents, of report or other information.
4. Recognizing that information is secured by and through fallible human sources and that for the fee charged you cannot
be an insurer of the accuracy of the information, we understand and agree that the accuracy of any information furnished
is not guaranteed by you and we release the Credit Bureau, Incorporated of Georgia and Credit Northwest Corporation
and their agents, employees, and independent contractors from liability for any negligence in connection with the prepara-
tion of such reports and from any loss or expense suffered by us resulting directly or indirectly from your reports or those
of your affiliated companies.
5. All reports and bulletins will be charged to the undersigned at the regular rates of the Credit Bureau, Incorporated of
Georgia/Credit Northwest Corporation in the city in which the service is rendered, such charges to be applied against the
contract price, and charges, in addition to the contract price, shall be paid for by the undersigned upon rendition of
monthly or yearly statements.
6. Written notice by either party will terminate this agreement, but the obligations and agreements of the undersigned set
forth in the second, third and fourth paragraphs above will remain in force.
7. We certify that consumer reports, as defined by the Fair Credit Reporting Act, will be ordered only when intended to be
used as a factor in establishing a consumer's eligibility for new or continued credit, collection of an account, insurance,
licensing, employment purposes, or otherwise in connection with a legitimate business transaction involving the consumer
and such reports will be used for no other purpose. Each request for a report which we intend to use for employment pur-
poses will be specifically identified to you at the time the report is ordered. We certify that consumer reports will only
be obtained for the following specific permissible purposes and for no other purpose:
"" (a) in connection with a credit transaction involving the consumer on whom the information is to be furnished
and involving the extension of the credit to, or review or collection of an account of the consumer, or
C (b) for employment purposes
~J (c) in connection with the underwriting of insurance involving the consumer
~.:' (d) in connection with a business transaction involving the consumer which is
8. We understand and agree that this letter constitutes all agreements and conditions of reporting, present and future, and
applies to all types of reports, including all types of checking services and bulletins, made by you and your affiliated com-
panies. Reports from affiliated companies shall be paid for at their prices established from time to time. No changes in
this agreement may be made except by consent in writing of an officer of The Credit Bureau, Incorporated of Georgia/Credit
Northwest Corporation.
9. The undersigned is a duly authorized representative with all powers required to execute this agreement.
Company
MONROF. r.OTTNTY (F.MF.Rr,F.Nr.y MF.DICAL
By ~~J_~.~~2..-": . ~~
Print Name: Wilhelmina Harvey
Title
Mayor /Cha irman
~~
Dated.
Service $33.00
Beginning
Mailing Address ') 1 9?
Street Address S RID P
Account Number
"9,'29,'91
at Wi L "bCb
Other
Total$33.00 Min Per
Type Business countv qovernment
Mcr::lt-hon, FT Zip
Zip
Telephone No. -.305
Month
n"E'rSE'as
<'IS <'Ihovp
Hjghway,
hn-m 21-15 7 x7 liSA
By
Date
A:t '!U'S O!,/C~
4- - d <.,) \.
By:
SUPPLEMENT AGRJ.:EMENT
TO
AGREEMENT FOR SERVICE
THE CREI>IT BUREAU. INCORPORATED m' GEORGIA
An.A!'iTA. GEORGIA
Gentlemen:
This Agreement shall not supersede the Agreement for Service executed by the undersigned organization on
May 15, 1991 , but shall be considered as supplementary thereto.
We own or lease..1. remote terminal(s) suitable for integration into your computer system to permit us to access
information available to us under said Agreement for Service. We understand that, on acceptance by you of this agree-
ment, access to your computer system will be made available. We will bear the expense of and make all technical arrangements
necessary at our place of business to connect our terminal(s) to your computer system.
We agree that the terminal(s) will be operated only by certain of our employees who shall have been trained by members
of the staff of CBI. At least two of our employees shall have been so trained by CBI prior to connection of our terminal(s)
to your computer system; at least two trained operators will be available to operate the terminal(s) during the time of this
agreement.
We agree to take all necessary measures to prevent unauthorized use of the terminal(s) by any person other than
designated operators and will establish and enforce policies whereby our employees are forbidden to obtain information on
themselves or associates. "We further agree that if the terminal(s) are utilized to order or obtain reports for employment pur-
poses, that such reports will be ordered and obtained only pursuant to the CBI Employment Report Request Procedures which,
as amended from time to time, are incorporated into and made a part of this Agreement."
We agree that, with regard to the operation of the terminal(s), CBI shall not be liable for transmission distortion, inter-
ruptions or failure or for any resulting consequential or special damages whatsoever.
This agreement is not assignable. It shall be effective on the date it is accepted by CBI and shall remain in force a
minimum of 30 days, and thereafter until written notice of termination shall be given by either party, at least 30 days prior
to the termination date.
(SEAL )
ATTEST: DANNY L. KOLHAGE, CLERK
Company MONROE COUNTY (EMERGENCY MEDICAL
By ~1~E~)"",,-: '-"'--~ ~~
By,J2~~
Deputy erk
Title
Mayor /Chairrnan
Dated
May 15, 1991
ACCEPTED:
CREDIT BUREAU, INCORPORATED OF GEORGIA
By ~\
By ~kC~L
Date~ ,( fCjq (
Date
Form 9559-1-86 USA
"t_
GOVERNMENTAL AGENCY
APPLICATION FOR MEMBERSHIP
EQUIFAX
CREDIT INFORMATION SERVICES
TYPE OF GOVT.
(CITY, STATE, FED)
County
M:>nroe County Board of County Cannissioners
NAME OF AGENCY
Errergency Medical Services
ADDRESS
CITY
STATE
ZIP CODE
5192 Overseas Highway
Marathon,
FL
33050
BILLING NAME
Same as above
BILLING ADDRESS
Same as above
CITY
STATE
ZIP CODE
ATTENTION
PHONE #
Emily L. Stoll
289-6003
OFFICERS, MANAGERS, SUPERVISORS
NAME
James R. Paros
TITLE
Public Safety Director
BUSINESS ADDRESS IF DIFFERENT FROM ABOVE
ADDRESS
CITY
STATE
ZIP CODE
PHONE # 289-6004
WE WILL USE YOUR SERVICES ONLY FOR THE FOLLOWING PURPOSES:
Mail Return Service
AUTHORIZATION
THE CREDIT BUREAU, INC. OF GEORGIA
CREDIT NORTHWEST CORPORATION
I understand and agree that CBI may obtain a credit report on me as:
D
A. An individual applying for membership with CBI in my own capacity.
o
B. The owner of the sole proprietorship applying for membership with
CBI.
D
C. A partner in the partnership applying for membership with CBI.
",.",
D
D.
An officer of the corporation applying for membership with CBI.
Company
MONROE COUNTY EMERGENCY MEDICAL SERVICES
Wilhelmina G. Harvey
Mayor/Chairman
Title
59-6000749
~9tlx~}lJf~ #
Fed. Tax ID
Signature
(SEAL )
ATTEST: DANNY L. KOLHAGE, CLERK
Printed Name'
Deputy Clerk
5192 Overseas Highw~y
ADDRESS City
M.::Ir~t-hnn. t:i'T
33050
BY:
State
Zip
Signature
Printed Name
Title Social Security #
Address
City
State zip
Signature
Printed Name
Title Social Security #
Address
City
State Zip
By
APPROVED AS TO FORM
DLEGALS~
Attame 's Office rt
- ~ -~ \
,
!
t~'i
DBl.
POLICY STATEMENT ON INTEGRITY OF CREDIT INFORMATION
Recognizing that the integrity and effective functioning of the
consumer credit system is dependent upon the furnishing, maintaining
and reporting of factual credit history information, which is a
responsibility shared by credit grantors and consumer reporting
agencies alike, our company reaffirms:
1. That consumer credit history information will be reported
in a factual, precise and objective manner.
2. That requests by consumers for reverification of challenged
information will be processed promptly.
3. That upon the request of a consumer, we will promptly
review that consumer's account, disclosing to the consumer the
factual payment record as reported to consumer reporting agencies
and/or to other creditors.
4. That unless error is discovered, the consumer will be
advised that the factual credit history information will continue to
be reported.
( SE AL )
5~Q~/
DATE
ATTEST: DANNY L. KOLHAGE, CLERK
Monroe County
COMPANY NAME
By:
Monroe County, Florida
CITY/STATE
\u:.~~ ....~
BY: SIGNATURE AND TITLE
By
D6le
E~UIFAX
( 1<1 IlII 1.\i1(}j{,\1.\110'<
'>LR\ICI S
March 29, 1991
! i h l i l'lilt f-ill !"t'dU 1/:,
_',''''-1 '" U';-::~\j ~t
1',1 !)\l\ nll'Jillll)
",,-,'tIll \h,!1J)1 Ht'dd i-I )~!/'11 'I, I
I <1);-- {l~l H 1
Ms. Emily Stoll
Monroe County Emergency Medical Services
Ambulance Billing Coordinator
5192 Over~eas Highway
Marathon, FL 33050
Dear Ms. Stoll:
Thank-you for your recent inquiry concerning CBI
membership.
To begin service with CBI, kindly complete the enclosed
application and membership forms. Return the original
to CBI and retain a duplicate for your records. You
will be notified if an escrow deposit is required. There
is a one-time fee of $125.00 for account installation
which should be remitted when returning the completed
application/membership forms.
It will take about 10 business days to process your
application once received. After your membership has
been approved, one of our representatives will contact
you to explain our services and procedures, and your
responsibilities under the Federal Fair Credit Reporting
Act. In the meantime, if you have any questions, please
contact New Member Services at one of the fOllowing
phone numbers:
DADE - (305) 937-6500 PRESS 2
BROWARD - (305) 764-6288 PRESS 2
PALM BEACH - (407) 478-2116
Thank you for your interest in Equifax Credit
Information Services.
New Member Services
Equifax Credit Information Services
:ams
Enclosures
o
w
o
-
>
a:
w
en
,...
(J)
--
,...
--
,...
w
>
I-
a
w
u..
u..
w
en
w
l-
e:(
a:
.........
,..
0)
0)
,..
c:
o
--
....
(,)
<t
c:
--
U)
E
CD
....
~
en
c:
o
--
....
(,)
<t
c:
--
U)
E
CD
....
~
en
c:
o
--
....
(,)
<t
c:
--
U)
E
CD
....
U)
~
en
c:
o
ti
<t
c:
--
U)
E
CD
....
U)
~
en
'CCIlt:..
c:;=oOGi
C'lI Q.. U
_ >-CIl~:;::
i~::!!o
l/)'Ellai5
-.. CIl .. C 0
CIlUO~>
g!EllQ..5
l/)W_ >-iii
6~ElEI.E
O~~~E
~ CIlc:( g.~
5~5a:c:(
.cGiO~,&
c:(u.c:-::3
l!! ~ Cl~ 0
,g ,Cj/ 5 a: 1:
CW"OI-
E ~~ c:( g:
ClC'lll/)CCIl
.t:E-c:(u
'Ci:Cc~
~Q..2iii
o~iV.cg
,goEO.=
l/)WOCC
t: .!! C oC'll >-
o - lEI
g.~.!!::3 l/)
a:.c.cOc:(
C'lI->_
S:Z:::3 .Qj
E'E~~:;=
BE CIl ClLi: ~
u co....
c:( 1;':s; a: .:
Cl Q. ... 0 CIl
c_oc:(g>
:gCI-'CCIl
>31Cll.!!g:
OCll>-CIl
Q:Q:~lJ:!!
I-
Z
w
::E
l-
i
::E
o
U
I/)
(3
w
w
:x:
I-
10... a.> Q) 0 .....
15.23:;15
ro~cDCi~
..c-ugo
-~~a.o.
.~ .0 % :; .~ ui
::l~~Oo~
O_CIl=-Q)
>'cE~~c
.EQ)Q)o~:;
Q)~EcQ)g,
O'JCicQ)>
"0 Q) .- E :;:: .E
~~;?:-:~CIl"O
Q.o=Ei)c:
"O-~Ec:&.
c: Q) 0' O.!: Ul
<OE_u~~
C:'- Ul Q) Q)
oEQ)~Q),g
'en 0 -5 _ en"C
Ul 0._ CIl >- c:
.- Ul .r;: Q) 'jij CIl
EU <I>g.::l <I>
I/) ::l E ~ .!: .2
_"O"Ooc~
uec:.!!?oQ)
WQ.CIlClluUl
w
~
a:
o
o
N
w
e
o
u
'"
O>~
,!:~'-o
EroJ2z
2=0'
Q) (I) .- '-
'-Q)t::'tn
t::(I)ctJ..o
R~~gc:
Q) "C.s:. c: ,2
r~'O''''~1;j
o al '" ;= .'" E
g.~ -g ~ G <5
a: .~ :.!2 m ~
U"''''giij.",
~ ~ E '" '0 al
Q<~:agC3
o
IJ')
~ '"
Q)cn~
"8.5 g
<J~",
B 8::0
.~ al.~
1: Q) en en
o (/) a... CJ
2'.9 ~ e
a:~~E
o.~ ::J :3
WCuO
~~.E~
o
IJ')
~
N
IJ')
~
W
~
a:
o
~
"t
. ~
.... 'E CD
0"'1:
I-~~n
a:o"''O
I Q) g> iij
s::.'~ =0 (J)
f! ~'> ~
caU)onJ
~ge-i
QI- "'.0 :
5~Eca :
0.0::: o.~ .
ti~~~!;;:
c:(:2(,J~Cl
w
e
o
u
'"
o~g>
- 0'-
M8~
1-8",'0
If B g> iij
~'~:2g)
~~ej
a:B~~
G)-Q)..Q
;:.~ ~ ~
E E U) 'ii) f-
~~B~(3
IJ')
o
o
CD
o
o
w
~
a:
IJ')
en
ai
!
IJ')
en
ai
:
Q;
:;
'0 a.
U .!!! ia ~
~:a.~~~J
~~~~o~
'c ~ : .E .e -;
- .2 ; 0 ~ ~ -5
11;j"'Q;c:2'",
fiE"fiQj~~~
i ~ C5 ; ~ Q.~
~._E._<J",.
.gQ)~E~~
=",~2'-Ul:O'"
~ Q; co '5 ~ '(j) "E
~ ~ ~ .~ ~ 8..~
w
e
o
o
.5
'"
~~
= "0
('1j '>
~~
"'j .5 '"
ri;l8
&.~a
Ql '" '"
a:-E=
~g)~
2~c(
u u '"
~.s-E
o
o
N
o
o
l ~ ,~ "ti -g Q; .9 ~
-_e>~<u-g~~
,~ {ij :> ~ E ~ 5 9
~ g> vi .!: ~ '" a. ~
en'~ . CtJ L.. c: Q} -
CIlQ):JE~Q)~C
..c > >- Q) -Q) ._
i\;!8ciUio..c~~
CIl Ul .~ 5 c: ~ "U c:
"OQ)a:-o.r;:c:<I>
en ~ 0 a ~ en ('lj o~
&ct:~~_a>~
<<d?~Ejg~~Q)
-==a..(1) "'-en
~E -liig>c:~lii
-o~Eogc:~ui
-L(') .::: <<Sow en
o~=~UlE ~~
~Q;~<9C1lo~~'iii
0> "Oc:-cn:):;,
Ul 0 Ul c: .- .!: -6 O..c
CIl . "'CIlOlQ)c:::lOl
.r;:~uii'3~~';;; g,:e
1/)c:.!!!c:::l::3.r;:.....o
(3::lCllCllUlU-Q)o.
W 8 en ~ ~ ~.~ ~ ~
o
It!
o
o
<<i
~
~
(ij ~~~
-eo~~
:fo..<>>~
1~8~
tl~oal
coons
!-Ulo.
J!!~~~
CDotl",
~"""'g
c.~:ge
c: .~ 0 Q)
-<>>'-05
OO>o~
cal
~~
-.:e
~o.
I~
tlo
c ~
! .- E
.!~o
CDUl-
~~~
a Q).5
cEo.
iij~.5
o
o
o
o
~
IJ')
IJ')
N
...
~ ~
Q)Eo'E
",g>ocSl
G,l= <>>..c: &m
.2e~~:;E
~~E.9-",
~I:'tlf!giij
.. .- Q) <U CI) E
&g'ffiE=~
c{gE~~~
!::;'O::Jeco
;;,ucua._
Qlg)~31ftiij
~"O '" 0.'" ;=
:;-5o~-S~i?
:=;.s o..913;t
....
CD
o
o
""
-i
~
Ul
~c
o '"
~8
I- 0 '" .
"'j B.~ :
~ .~ :2 ~
2-~e~
a:.9~Q)
~~~ii
~~ Bo~
UQ)U'>O
c(:!2a~
Ul
~c
o "
~~8
!;;;o'"
I"'g>~
'G'~i!~
:ameN
c1l.9 ~ ~
~~~-fa
~E g.~
~~a~
en
en
o
o
o
CII III
::.0
~~
CII'O
(J I1l
Ceo
.!!:! ...
Gig Q)
e- >- :a
C11C1l .!!!
a; g .';
.g~~~
~a:~~
... '.c I1l
::3 . ~ III
o . Q. E
>. CII ..
'0=5.2
'OU-:;:::c
1lI"(Jo
=~~~
~::30U
I/)IIlU:;::
(3s-g~
WOI1lZ
o
o
lI'i
~
IJ')
"1
~
~
0';'
g.'iii
iij cdl
oS.::.:.>
~&li
I "fit:::
r",8.
oca~
Q. '0 Ul
~.9B
-8 g.:s
f! I: g
....~'"
C\I
o
IJ')
IJ')
N
I
!E~'E
cucnocR
3 '0 ~i 8,!
-cQ)'-:;E
~~~R-CD
~"'~f!giij
tE'tl~~E
g>>8c:&.9~~
I cucnoco
,,~EBa._
oI8~ 3l ftlii
lO::'Ou-o.",;=
'iiiOlo-Eal,g
:=;:X:~.913;=
co
CO
o
o
""
--i
'1
IJ')
IJ')
N
~h. ~.:.;:
'~C3 e ~
::J_- _
1l0!ii:!5!
~ I: 8"" :
a:E~'O~ai
1~t!~.E~
1:::J cn.~ c.:!:
8.UUlo.=-g
Ql"'~ciij.-
a:=<~oa
..!!g)u<1liij",
'i :2 e E .E; ;;
liei5~Eg
~a..",,,,.!!~
'"
o
o
IJ')
""
o
1
'0
.S!
a.
a.
c '"
QI '"
EN
~o
I~
r'~
8.31
Q)cnc:i
a: '" Gl,
-8 ",.E
ca E ~
.= ~ .E;
'"
o
1
Ul
c
~ '" .
tl Q 8 !
~~ <1l i
~",g>i
0'- .
....~~ ~
&"'00.
I: '" o.g
!.9l!!~
QlO!"'.o
~ .Il ~ ~
i ~ Vi .~
:=;:EBe
IJ')
CD
o
Cl
eo
W
:x:
l-
I/)
W
llI::
e(
::E.
W
z.....
o!!!
i=~
e(o
::EQ.
a:w
Ou
U-z
Zw
-a:
!!?~
u!!:
we
..Q f',L
i-!!! i .~ \1
g.~ ~ '5
B:'~fiiVi
.- 5l &l.c 8.
~cn""1iiQ)
~~~==
'n; 'O5.l!! ~
::!E~8~'O
E ~ '" E ~
.at:'-.S!:i
~8~~-
It)
"!
J
~ '"
tl Q 0 i
~ l8 ~ i
~ c;.~ i
i'~ ~ ol
cGle!.
!l! Ul o.g
Igf!?~
QlO! "'-fa
~.g 8.~
=C:-Q)
:;~a~
en
co
o
o
c
co~ 0
",oQ)U)-
'O.f;j"i.", .~
5 :J co ~.g
.- .... C ::J en
'f~~'ECDUl
t:.s~~.s.fi
8.C:lCf.lc:::1ii
8 u Ul._ E
· O<>>c
a:>--<JoGl :
..!! o.~~'''':a :
:;::8U::tl~.o~
e E 0 dl 0 S 'S
:ij'!~6:E~.~
....
o
o
.c
(J
I1l
CII
m
E
'0-
Ia~
CII~-
'0 o III
."...~
em.,..
o 00 CD
000...
It)N...
CDCDN
~;i;~
~":'.,
It) It) It)
000
MMM
l-
e(
I/)
:)
.....
.....
e(
(J
o
C!
o
o
M
1
QI
_<J
~.~
-'"
.coo
~S!!
~~
E!.~
~ &~
cOli
2"fi",
~E'"
=~.!
a:E fU'
:&::!EE
1
C\I
IJ')
o
It)
~
IJ')
"'0
.:!:~
s~
I: .
'" :
.!!! 1a ~ ~
Q) C... :
0'- a. .
.~ E ~ ~
3l ~ 00 ~
00::/0 !
00 Gl W :
W 8 ~ :
U~ 5 :
~tl~~
cl) 0 :
w.= g :
~ e I: :
ii:=Ool
l-"'U8
Z 0 ..-
6.i!~g
-'-faE-=
sa 16 ~.s
0>::1'-
Wmo.E
IJ')
IJ')
N
IJ')
"!
1
'1
r
8.
QI
a:
~
~
13
c
~
'5
0'
oS
N
~
J)
~S
1
,:
o
t
a:
9
It)
;;;
.
i
c:
-
tn
j
8
lI'i
C\I
]
~
c
.2
i
I
oS
o
~
U}
N
{,A-
><
0:::1{)
o ,.....
t; C\i
wER-
0:::
HUJ
ClUJ
W
wo
Zo
~ct
z..J
Oct
;:)
o
>
o
~
(f)
a:
w
:2
~~
(f)
{,A-::J
a
zCo
...:!;'-I
u
C/)
w
~
...:
C/)