HomeMy WebLinkAboutAgenda Report - November 4, 2020 C-10AGENDA ITEM (! as/ D
CITY OF LODI
,. COUNCIL COMMUNICATION
TM
AGENDA TITLE: Adopt a Resolution Authorizing the City Manager to Execute Amendment No. 1 to
the extend the Professional Service Agreement 3 years and change the authorized
amount with Invoice Cloud, of Braintree Massachusetts, for online, mobile, and
interactive voice response utility services.
MEETING DATE
PREPARED BY:
November 04, 2020
Revenue Manager
RECOMMENDED ACTION: Adopt a Resolution Authorizing the City Manager to Execute Amendment
No. 1 to the extend the Professional Service Agreement 3 years and
change the authorized amount with Invoice Cloud, of Braintree
Massachusetts, for online, mobile, and interactive voice response utility
services;
BACKGROUND INFORMATION: The Revenue Division is responsible for collecting payments for the
City of Lodi. Utility payments are currently accepted via online, kiosk, interactive voice response, drop-off
box and U.S. mail. The current system, Invoice Cloud, is being used for online, interactive voice response
payments are sufficient to meet the needs of the customers and the Finance Department.
Currently customers paying for general invoices, deposits, reconnection fees and parking permits must
come into the office to make a payment. We are proposing to add additional payment services to meet
other payment types that cannot currently be paid online. This will assist in limiting lines in office and give
customers more payment options.
Online services provided by Invoice Cloud include auto pay, paperless billing, and online payments,
which are available to customers 24 hours, and gives the customer the convenience to pay online when it
is suitable to their schedule. Please see statistics below since inception of Invoice Cloud:
Total Customers
Prior _
Auto Pay 2,349
Paperless Billing 158
% of Customers
Prior
7%
0.44%
Total Customers
Current
5,650
6,121
% of Customers
Current
18%
19%
Average Payments Per Average Payment Value % of All Payments Made
Month Per Month Online
Online Payments 8,478 (see attached for $2,322,972 26%
all -payments per month)
TOWAItA
APPROVED: sh' (Oct 22,202013:32 PDTJ
Stephen Schwabauer, City Manager
The Finance Department is requesting that the contract for Invoice Cloud and Citybase be extended 3
years and a change the estimated authorized amount to $1,155,600.00 actual costs will be based on the
number of transactions processed by Invoice Cloud.
FISCAL IMPACT: Costs for Invoice Cloud services are paid by the utilities for which online
payments are collected. Approximately 14% of the cost is a General Fund
expense. Cost for Fiscal Year 2020/21 are included in the current adopted
budget.
FUNDING AVAILABLE: Fiscal Year 2020/21 account number
10020203.72312
Monthly
$ 53,928.00
50060001.72312
Service
Amount
Months
Total
Chase
56052001.72312
15%
$ 57,780.00
Paymentech (CC
char es)
$ 20,000.00
36
$ 720,000.00
Invoice Cloud
$ 12,000.00
36
$ 432,000.00
Additional
Services
$ 1.200.00
36
$ 3,600.00
Total
$ 1,155,600.00
FISCAL IMPACT: Costs for Invoice Cloud services are paid by the utilities for which online
payments are collected. Approximately 14% of the cost is a General Fund
expense. Cost for Fiscal Year 2020/21 are included in the current adopted
budget.
FUNDING AVAILABLE: Fiscal Year 2020/21 account number
10020203.72312
14%
$ 53,928.00
50060001.72312
61%
$ 234,972.00
53053001.72312
10%
$ 38,520.00
56052001.72312
15%
$ 57,780.00
Fiscal Year 2021/22 account number
10020203.72312
14%
$ 53,928.00
50060001.72312
61%
$ 234,972.00
53053001.72312
10%
15%
$ 38,520.00
56052001.72312
$ 57,780.00
Fiscal Year 2022/23 account number
10020203.72312
14%
$ 53,928.00
50060001.72312
61%
$ 234,972.00
53053001.72312
10%
$ 38,520.00
56052001.72312
15%
$ 57,780.00
Andrew Keys
Deputy City Manager/Internal Services Director
T�WI�helk
Tana Sumner (Od 22.20201]:1] POT)
Tarra Sumner Revenue Manager
AMENDMENT NO. 1
INVOICE CLOUD
ONLINE, MOBILE, AND INTERACTIVE VOICE RESPONSE UTILITY SERVICES
THIS AMENDMENT NO. 1 TO PROFESSIONAL SERVICES AGREEMENT, made
and entered this day of October, 2020, by and between the CITY OF LODI, a municipal
corporation (hereinafter "CITY"), and INVOICE CLOUD, INC., a Delaware corporation
qualified to do business in California (hereinafter "CONTRACTOR").
WITNESSETH:
1. WHEREAS, CONTRACTOR and CITY entered into a Professional Services
Agreement on June 1, 2017 ("Agreement") a copy of which is incorporated into
Exhibit 1 and made a part hereof by this reference; and
2. WHEREAS, CITY requests to amend said Agreement to expand the Scope of
Services as set forth in Exhibit 1; and
3. WHEREAS, CITY requests to increase the annual cost by $3,600 for the additional
services set forth in Exhibit 1, and extend the term of the Agreement to an including
May 31, 2023; and
4. WHEREAS, CONTRACTOR and CITY agree that services covered under the scope
of the Agreement will continue to be subject to the terms and conditions outlined in
the Agreement; and
5. WHEREAS, CONTRACTOR agrees to said amendments.
NOW, THEREFORE, the parties agree to amend the Scope of Services and increase
the fees by $3,600.00 as set forth in Exhibit 1, and extend the term of the Agreement to and
including May 31, 2023.
IN WITNESS WHEREOF, CITY and CONTRACTOR have executed this
Amendment No. 1 on 12020.
CITY OF LODI, a municipal corporation INVOICE CLOUD, INC.
hereinabove called "CITY" hereinabove called "CONTRACTOR"
STEPHEN SCHWABAUER ROBERT LAPIDES
City Manager President
Attest:
JENNIFER CUSMIR
City Clerk
Approved as to Form:
JANICE D. MAGDICH
City Attorney
lnvoiceCloud"'
EXHIBIT 1
Add -On to the Biller Order Form
SALES INFORMATION
IC Sales Rep
Order Date
Cam Crowell
Vertical
Software Prtner
I Local Gov (Util, Tax, Misc)
5/20/2020 Sales Prtnr
FTyler - Munis
PRODUCTS AND SERVICES
Products
[Cloud Store]
PAYMENT METHODS ACCEPTED
Payment Types
[VISA/Mastercard/Discover] [ACH/EFT]
BILLER INFORMATION
Ownership Type
Legal Name
Address 1
Address 2
City
State
Government
Phone (209) 333-6800 Fax
Website URL http://www.lodi.gov
Bus. Open Date 1906
Federal Tax ID 94-6000361
*Federal Tax ID and Legal Name must match on all documents
City of Lodi
221 W. Pine Street
Lodi
CA ZIP
BILLER CONTACT
Primary Contact Name Tarra Sumner
Phone (209) 333-6800 ext 2681
Email Address tsumner@lodi.gov
SIGNING AUTHORITY
Name
Title
Phone
Fax
Email Address
BILLER PRICING
Description
Interval
Cost Type
Cost
Cloud Access Fee
Monthly
Fixed ($)
$25.00
Cloud Access Fee
Monthly
Fixed ($)
$25.00
Cloud Access Fee
Monthly
Fixed ($)
$25.00
Cloud Access Fee
Monthly
Fixed ($)
$25.00
IC Payment Transaction Fee - Credit Card
Per Transaction
Fixed ($)
$0.65
IC Payment Transaction Fee -EFT
Per Transaction
Fixed ($)
$0.75
ACH Reject Fee Non -Submitter (Chase)
Per Transaction
Fixed ($)
$6.00
Chargeback Fee Non -Submitter (Chase)
Per Transaction
Fixed ($)
$15.00
HARDWARE
Card Reader Type
Card Reader
Shipping Addr.
(if different than
location address)
Quantity Cost per Reader
Billing Interval
Kiosk Type
Device Quantity Per Device Txn Min
Note: Biller will be charged for the minimum number of transactions listed to left each
month per kiosk unity. In addition, if the Biller's order includes kiosks then the terms
and conditions of Kiosk Managed Standard SOW (and applicable schedules) are hereby
agreed and incorporated by reference
Standard/In-Door
750
Thru-Wall
800
Outdoor Model
850
BILLER BANK INFO
Billing Method
Name on Account
Bank Address
Routing #
Note: Must include voided business
check or bank letter for each unique account
Bank Name I F&M Bank
Phone 12093392582
Last 4 Acct # 1 1301
City of Lodi
121 W. Pine Street
Lodi
121108441
DATA RETENTION
Months to Keep
24
*Additional Fees apply if greater than 24 months
NOTES/SPECIAL HANDLING
CERTIFICATION AND AGREEMENT
By signing below, the Biller hereby ratifies its authorization for Invoice Cloud, Inc. ("Invoice Cloud") to execute debit/credit entries to its checking/deposit account(s)
indicated above at the depository financial institution(s) named above and to debit/credit the same such account(s). The Biller acknowledges that the origination of
ACH transactions to its account(s) must comply with the provisions of U.S. law. This authority is to remain in full force and effect until (i) Invoice Cloud has received
written notification (by electronic or U.S. mail) from the Biller of its revocation in such time and manner as to allow Invoice Cloud a reasonable opportunity to act on
it, but not less than 10 business days notice; and (ii) all obligations of the Biller to Invoice Cloud that have arisen under this Agreement and all other agreements have
been paid in full. The Biller must also notify Invoice Cloud, in writing, (by electronic or U.S. mail) when a change in account number(s) or bank has occurred at which
time this authorization shall apply to such new/changed account. This notification must be received within 10 business days of change. A fee will be charged for any
returned ACH debits.
By signing below, the Biller named: (1) has read, agreed to, ratifies the Biller Agreement, Biller T+C and other Order Forms previously executed by the Biller, and (2)
certifies to Invoice Cloud that he/she is authorized to sign this Add on to the Biller Order Form; (3) certifies that all information and documents submitted in
connection with this Order Form are true and complete; (4) authorizes Invoice Cloud or its agent to verify any of the information given, including credit references,
and to obtain credit reports (including a spouse if in a community property state); (5) agrees to pay the Monthly Access Fee through the last day of the month
following the effective date of termination as provided in the Billing Agreement; (6) agrees that Biller and each transaction submitted will continue to be bound by
the Order Form and the Biller Agreement in its entirety and any new agreement forms executed herewith; (7) If the Biller's order includes kiosks, then the terms and
conditions of Kiosk Managed Services Standard SOW (and applicable schedules) are hereby agreed and incorporated by reference.(8) agrees that Biller will submit
transactions only in accordance with the information in this Add on to the Biller Order Form and Biller Agreement and will immediately inform Invoice Cloud, by email
(contracts@invoicecloud.com) if any information in this Order Form changes, and (9) the Biller agrees and understands that outstanding sums due and owing to
Invoice Cloud., will be charged daily or monthly and debited from its current depository account. Non -sufficient funds for these debits are grounds for a change in
fees or termination of this Agreement. In the event of non-payment of any sums due, Invoice Cloud reserves the right to withdraw such sums from the current
depository account at any time to ensure payment of the same.
C. Pay by Text: Standard data rates and text messaging rates may apply based on the payer's plan with their mobile phone carrier. Payer can opt out of text messaging
at any time with Invoice Cloud. Partial payment or overpayment is not supported. Service fees may apply based on the biller set up with Invoice Cloud. Biller may not
use the service for activities that violate any law, statute, ordinance or regulation.
D. By signing below, the Biller hereby gives permission to Invoice Cloud to access his / her credit history via Trans Union, Equifax, or other credit-reporting agency.
E. This Add on to the Order Form will become effective only when counter -signed by Invoice Cloud and upon execution by the Biller of such third party agreement
required by Invoice Cloud to permit use of the payment function of the Service.
F. If the Biller's order includes kiosks, then the terms and conditions of Kiosk Managed Services Standard SOW (and applicable schedules) are hereby agreed and
incorporated by reference.
In WITNESS WHEREOF, the parties have executed this Agreement as of this day
Accepted by Biller:
X *66-e14)xeJc s
Corporate Officer
Andrew Keys
Printed Name
Deputy City Manager
Title
Accepted by Invoice Cloud, Inc.:
X F-R-�k �--
Corporate Officer
Robert Lapides
Printed Name
President
Title
InvoiceCloud"
INVOICE PARAMETERS
Invoice Parameters must be completed for each invoice tvi)e
Biller Order Form
Invoice Type
Biller Software
Fire & General Pricing Model
tyler munis Non -Submitter: Interchange Paid By
Non -Submitter
I Biller
BILLING DETAILS
Please indicate which months bills are sent by placing the bill count for each month below:
Jan
Feb I Mar
Apr
May June July
Aug Sep Oct
I Nov
I Dec
120
120 1 120
120
120 120 120
120 120 120
1 120
120
Avg Invoice $ 1 100.00 Max Invoice $ Bill Frequency
BPM 1 120
SERVICE FEES
Payment Source Description
Payment Method Minimum Fee ($) Calculation
per Transaction Type
Fee Amount
All Payment Sources
Credit/Debit
All Payment Sources
ACH/EFT
Kiosk
All Payment Methods
IVR Surcharge
All Payment Methods
PAYMENT SOURCE EXCEPTIONS
MAX PAYMENT CAP
CC Max 1 125000.00 ACH Max ($) 1 125000.00
BILLER DEPOSITORY BANK INFO
Note: must include voided business check or bank letter for each unique account
Routing # 1 121108441 Last 4 Acct # 1 1301
NOTES/SPECIAL HANDLING
InvoiceCloud'
INVOICE PARAMETERS
Invoice Parameters must be rmmnleted fnr each invoire tvne
Biller Order Form
Invoice Type
Biller Software
Parking Permits Pricing Model
Non -Submitter: Interchange Paid By
on
I Biller
BILLING DETAILS
Please indicate which months bills are sent by placing the bill count for each month below:
Jan Feb Mar Apr
May June July Aug Sep Oct
I Nov I Dec
83 83 83 83
83 83 83 83 83 83
1 83 1 83
Avg Invoice $ 1 100.00 Max Invoice $ Bill Frequency
BPM 83
SERVICE FEES
Payment Source Description
Payment Method
Minimum Fee Calculation
($)
per Transaction Type
Fee Amount
All Payment Sources
Credit/Debit
All Payment Sources
ACH/EFT
Kiosk
All Payment Methods
IVR Surcharge
All Payment Methods
PAYMENT SOURCE EXCEPTIONS
MAX PAYMENT CAP
CC Max 1 125000.00 ACH Max ($) 1 125000.00
BILLER DEPOSITORY BANK INFO
Note: must include voided business check or bank letter for each unique account
Routing # 1 121108441 Last 4 Acct # 1 1301
NOTES/SPECIAL HANDLING
InvoiceCloudv
INVOICE PARAMETERS
Invoice Parameters must be comoleted for each invoice tune
Biller Order Form
Invoice Type
Biller Software
Re connection Fees I Pricing Model
Non -Submitter: Interchange Paid By
Non -Submitter
Biller
BILLING DETAILS
Please indicate which months bills are sent by placing the bill count for each month below:
Jan Feb Mar
Apr May June July Aug
Sep Oct I Nov I Dec
400 400 400
400 400 400 400 400
400 400
1 400 1 400
Avg Invoice $ 1 100.00
Max Invoice $ Bill Frequency
BPM 1 400
SERVICE FEES
Payment Source Description
Payment Method
Minimum Fee Calculation
($)
per Transaction Type
Fee Amount
All Payment Sources
Credit/Debit
All Payment Sources
ACH/EFT
Kiosk
All Payment Methods
IVR Surcharge
All Payment Methods
PAYMENT SOURCE EXCEPTIONS
MAX PAYMENT CAP
CC Max 1 125000.00
ACH Max ($) 1 125000.00
BILLER DEPOSITORY BANK INFO
Note: must include voided business check or bank letter for each unique account
Routing # 1 121108441 Last 4 Acct # 1 1301
NOTES/SPECIAL HANDLING
lnvoiceC ou6 Biller Order Form v.,,,.,
GUB
-
.. ® EBPP ❑ Cloud Store ❑ Cloud Pay ® Pay by Text ® IVR
® OBD ® Kiosk
- - ® Visa/MasterCard/Discover ❑American Express ® ACH/EFT
310
Ownership Type: i Government Biller Contacts
Legal Name: City of Lodi ' - - ' ` Derrick Co1hn,
Finance Manager
Address 1: 310 W. Elm St Lodi Phone Number: 209-333-6800
Ext. 2620
Address 2:
Email Address:
dcotbn@lodi.gov
City:
Lodi
State:
CA
Zip:
95240
Same
Phone#
209-333-6717
Fax #: i
209-333-6717
Phone Number:
Ext.
Website URL: I Fwww,lodi.gov
Email Address:
Business Open Date: 1906
- Same
Phone
Ext.
Federal Tax ID#:
94-6000361
Note: Federal Tax ID and Legal Name must match on all documents. Email Address:
Signatory Contact: Andrew Keys Title: Deputy City Manager
Phone Number: ' 209-333-6700 Ext Email Address: akeys@lodi.gov
Notes/Special • e ■
City will migrate approx 1,800 existing Direct Debit Plan customers (ACH) to the IC platform.
Biller Fees
New Biller Implementation: $ 0.00 Paperless Presentment: $
0.40 Per Item
includes 3 email notirications
Biller Portal Access:
$
100
Monthly
IC Payment - Credit Card:
I $
F 0 65
Per Item
Additional User(s):
$
0.00
Monthly Per User
IC Payment - EFT/ACH:
$
0.75
Per Item
Online Bank Direct Access:
$
0.00
Monthly
Online Bank Direct:
$
0 25
Per Item
Invoice Presentment:
$
Monthly
EFT/ACH Reject:
$
6.00
Per Item
Encrypted Reader License
$
Monthly/Per Charge Back:
$
15.00
Per Item
Fee:
Device
Excess Data Storage # years Needed Bills Per Total Cost: $ Per Month
Needed: oast 2 Month:
® • r • sell
Name of Checking Account (As It appears on check or Bankletter):
Bank Address: Phone:
Name:
Depository Routing#: F Account#:
Your Invoice )a rnenl coffectfarls will be elechonically, de
osiled into this account.
Fees Routing#: F Account#:
Invoice and payment proces§njq fees wIl'I be electronically deducted from this account.
InvoiceCloud�
Biller Order Form ver.3.3
CERTIFICATION AND AGREEMENT
A. By signing below, the Biller hereby authorizes Invoice Cloud, Inc. ("Invoice Cloud") to initiate and execute debit/credit entries to its
checking/deposit account(s) indicated above at the depository financial institution(s) named above and to debit/credit the some such
account(s). The Biller acknowledges that the origination of ACH transactions to its account(s) must comply with the provisions of U.S. law,
This authority is to remain in full force and effect until (i) Invoice Cloud has received written notification (by electronic or U.S. mail) from the
Biller of its revocation in such time and manner as to allow Invoice Cloud a reasonable opportunity to act on it, but not less than 10 business
days notice; and (ii) all obligations of the Biller to Invoice Cloud that have arisen under this Agreement and all other agreements have
been paid in full. The Biller must also notify Invoice Cloud, in writing, (by electronic or U.S. mail) when a change in account number(s) or
bank has occurred at which time this authorization shall apply to such new/changed account. This notification must be received within
10 business days of change. A fee will be charged for any returned ACH debits.
B. By signing below, the Biller named: (1) has read, agreed to, and acknowledges receipt of the Biller Agreement, BillerT+C and other Order
Forms executed by the Biller, and (2) certifies to Invoice Cloud that he/she is authorized to sign this Order Form; (3) certifies that all
information and documents submitted in connection with this Order Form are true and complete; (4) authorizes Invoice Cloud or its agent
to verify any of the information given, including credit references, and to obtain credit reports (including a spouse if in a community
property state); (4) agrees to pay the Monthly Access Fee through the last day of the month following the effective date of termination
as provided in the Billing Agreement; (5) agrees that Biller and each transaction submitted will be bound by the Order Form and the Biller
Agreement in its entirety; (6) agrees that Biller will submit transactions only in accordance with the information in this Order Form and Biller
Agreement and will immediately inform Invoice Cloud, by email (contracts@invoicecloud.com) if any information in this Order Form
changes, and (7) the Biller agrees and understands that outstanding sums due and owing to Invoice Cloud., will be charged daily or
monthly and debited from its current depository account. Non -sufficient funds for these debits are grounds for a change in fees or
termination of this Agreement. In the event of non-payment of any sums due, Invoice Cloud reserves the right to withdraw such sums from
the current depository account at any time to ensure payment of the some.
C. Pay by Text: Standard data rates and text messaging rates may apply based on the payer's plan with their mobile phone carrier. Payer
can opt out of text messaging at any time with Invoice Cloud. Partial payment or overpayment is not supported. Service fees may apply
based on the biller set up with Invoice Cloud. Biller may not use the service for activities that violate any law, statute, ordinance or
regulation.
D. By signing below, the Biller hereby gives permission to Invoice Cloud to access his / her credit history via Trans Union, Equifax, or other credit-
reporting agency.
E. The Order Form and the Biller Agreement will become effective only when counter -signed by Invoice Cloud and upon execution by the
Biller of such third party agreement required by Invoice Cloud to permit use of the payment function of the Service.
In WITNESS WHEREOF, the parties hereto have executed this Agreement as of this da
Accepted by biller:
X1-7�-
Corporate Officer
Andrew Keys
Printed Name
I Deputy City Manager
Title
n -m City Al WWI
Accepted by Invoice Cloud:
X f i..
Robert Lapides
Printed Name
President~ Government, Utilities & Business
Title
ATTEST:
NIFER FERRAIOLO
City Clerk
invoioeC oud'
Invoice Parameters
Biller Order Form ver. 3.3
•
U61ily • • - 4/13/2017
Invoicing Parameters sheet must be completed for each invoice f e.
- - Tyler MUNIS • • - Non -Submitter (Chase)
• - - • • ®Visa ® MasterCard M Discover ❑Amex ®EFT/ACH
MEBPP ❑Cloud Store ❑ Cloud Fay ® OBD ® IVR ®Kiosk ❑ Single Sign On
Billing Frequency: Monthly Number of Bilis: 30,000
I
Number of Cycles:
20
Number of Installments:
i
Average Invoice Amount:
$302
Highest Invoice Amount: $
125,000
Billing Months (please select the applicable months below):
❑Jan ❑Feb ❑Mar ❑Apr ❑May ❑Jun ❑ Jul ❑ Aug ❑ Sept ❑Oct ❑ Nov ❑ Dec ® All
. .. - ®1St - l 0th ® 11th - 20th ® 21 5} - 31 It
• • • ®Biller ❑ Template ❑ Bill Print Vendor (please complete below)
Card Readers: Choose an item. QTY Choose an Provided by: ❑ Sales Rep ❑ Operations
item.
Per Unit Price: $ Shipping Address:
Choose an item. (if different than location
Total Due: $ 1 address)
Item Paid by payer Item Paid by Biller Won-Submiffer
❑
Credit Card: ❑
Credit
❑Flat Fee Pricing per Item, fees, dues assessments +
with $ Minimum
Card:
El Interchange, fees, dues assessments +
Authorization $ r- + F- %BP
❑
EFT/ACH: $ per item ❑
EFT/ACH: $
per item
❑
Flex Pay ACH: $
per item ❑
Flex Pay ACH: $
per item
Item Paid b ❑ er Item
Paid b Biller
❑ Credit Card:
❑ Credit ❑Flat Fee Pricing per Item, fees, dues assessments +
with Minimum Card: ®Interchange, fees, dues assessments +
(Without visa Acceptance) Authorization $ iF- + F— %BP
$ Per item ❑ EFT/ACH: $ Per Item
❑ EFT/ACH:
— - -
Credit Card
:E]EFT/ACK
• • - a • • -• • o •zR •■ • Z • ■•
Service Fee: $ Max Cap for Credit Cards: $
Service Fee:
$ ❑
Paid by payer ❑ Paid by Biller
ANIL
❑ I Paid by payer Service Fee + $ Z Paid by Biller $ 0.50 per item surcharge
Notes/Special ■ s r -
7 "
City of Lodi, CA Biller Agreement
1. License Grant & Restrictions. Subject to execution by Biller of the Invoice Cloud Biller Order Form incorporating this Agreement, Invoice
Cloud hereby grants Biller a non-exclusive, non -transferable, worldwide right to use the Service described on the Biller Order Form until
termination as provided herein, solely for the following purposes, and specifically to bill and receive payment from Biller's own customers, for
Services that are referenced in the Biller Order Form. All rights not expressly granted to Biller are reserved by Invoice Cloud and its licensors.
Biller will provide to Invoice Cloud all Biller Data generated for Biller's Customers. Unless otherwise expressly agreed to in writing by Invoice
Cloud to the contrary, Invoice Cloud will process all of Biller's Customers' Payment Instrument Transactions requirements related to the Biller
Data and will do so via electronic data transmission according to our formats and procedures for each electronic payment type selected in the
Biller Order Form. In addition, Biller will sign all third party applications and agreements required for the Service including without limitation
payment and credit card processing agreements and merchant agreements. For invoice types listed on the Order Form (e.g. real estate taxes,
utility bills, birth certificates, parking tickets, event tickets, etc.), Biller will not use the credit card processing, ACH or check processing of any
bank, payment processor, entity, or person, other than Invoice Cloud via electronic data transmission or the authorization or processing of
Biller's Customers' Payment Instrument Transactions for each electronic payment type selected in the Biller Order Form throughout the term
of this Agreement.
Biller shall not: (i) license, sublicense, sell, resell, transfer, assign, distribute or otherwise commercially exploit or make available to any third
party the Service in any way; (ii) modify or make derivative works based upon the Service; (iii) Recreate, "frame" or "mirror" any portion of
the Service on any other server or wireless or Intemet-based device; (iv) reverse engineer or access the Service; or (v) copy any features,
functions or graphics of the Service.
2. Privacy & Security. Invoice Cloud's privacy and security policies may be viewed at http,//wwwinyoiceeloud.com/privacy.html. Invoice
Cloud reserves the right to modify its privacy and security policies in its reasonable discretion from time to time which modification shall not
materially adversely impact such policies. Invoice Cloud will maintain compliance with current required Payment Card Industry (PCI) standards
and Cardholder Information Security standards.
3. Account Information and Data. Invoice Cloud does not and will not own any Customer Data, in the course of providing the Service. Biller,
not Invoice Cloud, shall have sole responsibility for the accuracy, quality, integrity, legality, and reliability of, and obtaining the intellectual
property rights to use and process all Customer Data. In the event this Agreement is terminated, Invoice Cloud will make available to Biller a
file of the Customer Data within 30 days of termination of this Agreement (or at a later time if required by applicable law), if Biller so requests
at the time of termination. Invoice Cloud reserves the right to remove and/or discard Customer Data with 30 days notice except as prohibited
by applicable law or in the event of exigent circumstances which makes prior notice impracticable, and in which case, notice will be provided
promptly thereafter.
4. Confidentiality / Intellectual Property Ownership. Invoice Cloud agrees that it may be furnished with or otherwise have access to
Customer Data that the Biller's customers considers being confidential. Invoice Cloud agrees to secure and protect the Customer Data in a
manner consistent with the maintenance of Invoice Cloud's own Confidential Information, using at least as great a degree of care as it uses to
maintain the confidentiality of its own confidential information, but in no event use less than commercially reasonable measures. Invoice Cloud
will not sell, transfer, publish, disclose, or otherwise make available any portion of the Customer Date to third parties, except as required to
perform the Services under this Agreement or otherwise required by applicable law.
Invoice Cloud (and its licensors, where applicable) owns all right, title and interest, including all related Intellectual Property Rights, in and to
the Invoice Cloud Technology, the Content and the Service and any enhancement requests, feedback, integration components, suggestions,
ideas, and application programming interfaces, recommendations or other information provided by Biller or any other party relating to the
Service. In the event any such intellectual property rights in the Invoice Cloud Technology, the Content or the Service do not fall within the
specifically enumerated works that constitute works made for hire under applicable copyright laws or are deemed to be owned by Invoice
Cloud, Biller hereby irrevocably, expressly and automatically assigns all right, title and interest worldwide in and to such intellectual property
rights to Invoice Cloud. The Invoice Cloud name, the Invoice Cloud logo, and the product names associated with the Service are trademarks
of Invoice Cloud or third parties, and no right or license is granted to use them.
Biller agrees that during the course of using or gaining access to the Service (or components thereof) it may be furnished with or otherwise
have access to information that Invoice Cloud considers to be confidential including but not limited to Invoice Cloud Technology, customer
and/or prospective customer information, pricing and financial information of the parties which are hereby deemed to be Invoice Cloud
Confidential Information, or any other information by its very nature constitutes information of a type that any reasonable business person
would conclude was intended by Invoice Cloud to be treated as proprietary, confidential, or private (the "Confidential Information"). Biller
agrees to secure and protect the Confidential Information in a manner consistent with the maintenance of Invoice Cloud's rights therein, using
at least as great a degree of care as it uses to maintain the confidentiality of its own confidential information, but in no event use less than
reasonable efforts. Biller will not sell, transfer, publish, disclose, or otherwise make available any portion of the Confidential Information of
the other party to third parties (and will ensure that its employee and agents abide by the requirements hereof), except as expressly authorized
in this Agreement or otherwise required by applicable law.
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5. Billing and Renewal. Invoice Cloud fees for the Service are provided on the Biller Order Form. Invoice Cloud's fees are exclusive of all
taxes, levies, or duties imposed by taxing authorities, Invoice Cloud may assess and/or collect such taxes, levies, or duties against Biller and
Biller shall be responsible for payment of all such taxes, levies, or duties, excluding only United States (federal or state) taxes based solely on
Invoice Cloud's income. All payment obligations are non -cancellable and ail amounts or fees paid are non-refundable. Unless Invoice Cloud in
its discretion determines otherwise, all fees will be billed in U.S. dollars. If Biller believes Biller's bill or payment is incorrect, Biller must
provide written notice to Invoice Cloud within 60 days of the earlier of the invoice date, or the date of payment, with respect to the amount in
question to be eligible to receive an adjustment or credit; otherwise such bill or payment is deemed correct. invoice Cloud reserves the right to
modify any pricing with respect to fees owed by the Bitter upon thirty days written notice to Biller based on increases incurred by invoice
Cloud on fees, assessments, and the like from credit card processers, bank card issuers, payment associations, .ACH and check processers.
6. Term and Termination. The initial term of this Agreement shall be for a period of one (3) years ("Initial Term") commencing on the
Effective Date on the Biller Order Form and will renew for each of additional successive three (3) year terms ("Renewal Term") unless
terminated as set forth herein. This Agreement may be terminated by either party effective at the end of the Initial or any Renewal Term by
such party providing written notice to the other party of its intent not to renew no less than ninety (90) days prior to the expiration of the then -
current term. Additionally, this Agreement may be terminated by either party with cause in the event of a material breach of the terns of this
Agreement by the other party and the breach remains uncured for a period of 30 days following receipt of written notice by the breaching party.
For example, any unauthorized use of the Invoice Cloud Technology or Service by Biller, or its authorized users will be deemed a material
breach of this Agreement. Upon any early termination of this Agreement by Invoice Cloud as a result of the breach, Biller shall remain liable
for all fees and charges incurred, and all periodic fees owed through the end of the calendar month following the effective date of termination.
Upon any termination or expiration of this Agreement, Bitter's password and access will be disabled and Biller will be obligated to pay the
balance due on Biller's account computed in accordance with the Charges and Payment of Fees section above. Biller agrees that invoice Cloud
may charge such unpaid fees to Biller's Debit Account or credit card or otherwise bill Biller for such unpaid fees.
7. Invoice Cloud Responsibilities. Invoice Cloud represents and warrants that it has the legal power and authority to enter into this Agreement.
Invoice Cloud warrants that the Service will materially perform the functions that the Biller has selected on the Order Form under normal use
and circumstances and that. Invoice Cloud shall use commercially reasonable measures with respect to Customer Data to the extent that it
retains such, in the operation of the Service; provided that the Biller shall maintain immediately accessible backups of the Customer Data. In
addition, Invoice Cloud will, at its own expense, as the sole and exclusive remedy with respect to performance of the Service, correct any
Transaction Data to the extent that such errors have been caused by Invoice Cloud or by malfunctions of Invoice Cloud's processing systems.
8. Limited Warranty EXCEPT AS PROVIDED IN SECTION 7, THE SERVICES AND ALL CONTENT AND TRANSACTION DATA IS
PROVIDED WITHOUT ANY EXPRESS, OR IMPLIED WARRANTY, INCLUDING, WITHOUT LIMITATION, ANY IMPLIED
WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND ALL OTHER WARRANTIES ARE
HEREBY DISCLAIMED TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW BY INVOICE CLOUD AND ITS
LICENSORS AND PAYMENT PROCESSORS. INVOICE CLOUD AND ITS LICENSORS AND PAYMENT PROCESSORS DO NOT
REPRESENT OR WARRANT THAT (A) THE USE OF THE SERVICE WILL BE UNINTERRUPTED OR ERROR -FREE, OR OPERATE
IN COMBINATION WITH ANY OTHER HARDWARE, SOFTWARE, SYSTEM OR DATA, (B) THAT THE SERVICE WILL NOT
DELAY IN PROCESSING OR PAYING, OR (C) THE SERVICE WILL MEET REQUIREMENTS WITH RESPECT TO SIZE OR
VOLUME. Invoice Cloud's service may be subject to limitations, delays, and other problems inherent in the use of the internet and electronic
communications. Invoice cloud is not responsible for any .delays, delivery failures, or other damage resulting from such problems. Biller
represents and warrants that Biller has not falsely identified itself nor provided any false information to gain access to the Service and that
Biller's billing information is correct.
9. Biller's Responsibilities. Biller represents and warrants that it has the legal power and authority to enter into this Agreement. Biller is
responsible for all activity occurring under Biller's accounts and shall abide by all applicable laws, and regulations in connection with Biller's
and/or its customers' and a payers' use of the Service, including those related to data privacy, communications, export or import of data and
the transmission of technical, personal or other data. Biller shall: (i) notify Invoice Cloud immediately of any unauthorized use of any password
or account or any other known or suspected breach of security; (ii) report to Invoice Cloud and immediately stop any copying or distribution
of Content that is known or suspected to be unauthorized by Biller or Biller's Users; and (iii) obtain consent from Biller's customers and payers
to receive notifications and invoices from Invoice Cloud. Invoice Cloud is not responsible for any Biller postings in error due to delayed
notification from credit card processor, ACH bank and other related circumstances. Biller agrees and acknowledges that in the event that Biller
has access to, receives from, creates, or receives protected health information, or Biller has access to, creates, receives, maintains or transmits
on behalf of electronic protected health information (as those terms are defined under the privacy or security regulations issued pursuant to the
Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and Subtitle D of the Health Information Technology for Economic
and Clinical Health Act provisions of the American Recovery and Reinvestment Act of 2009 ("ARRA '),during the performance under this
Agreement, it will comply with all such law, regulations and rules related thereto.
Biller is required to ensure that it maintains a fair policy with regard to the refund, return or cancellation of services and adjustment of
Transactions. Biller is also required to disclose a refund, return or cancellation policies to Invoice Cloud and any applicable payment processors
and Biller's Customers, as requested. Any change in a return/ cancellation policy must be submitted to Invoice Cloud, in writing, not less than
21 days prior to the effective date of such change. If Biller allows or is required to provide a price adjustment, or cancellation of services in
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connection with a Transaction previously processed, Biller will prepare and deliver to Invoice Cloud Transaction Data reflecting such
refund/adjustment within 2 days of resolution of the request resulting in such refund/adjustment. The amount of the refund/adjustment cannot
exceed the amount shown as the total on the original Transaction Data. Biller may not accept cash or any other payment or consideration from
a Customer in return for preparing a refund to be deposited to the Customer's account; nor may Biller give cash/check refunds to a Customer
in connection with a Transaction previously processed, unless required by applicable law
10. Indemnification. Invoice Cloud shall indemnify and hold Biller, employees, attorneys, and agents, harmless from any losses, liabilities,
and damages (including, without limitation, Biller's costs, and reasonable attorneys' fees) arising out: (i) failure by Invoice Cloud to implement
commercially reasonable measures against the theft of the Customer Data; or (ii) its total failure to deliver funds processed by Invoice Cloud
as required hereunder (which relates to payments due from Invoice Cloud for Transaction Data). This indemnification does not apply to any
claim or complaint relating to Biller's failure to resolve a payment dispute concerning debts owed to Biller or Biller's negligence or willful
misconduct or violation of any applicable agreement or law.
11. Fees.
Invoice Cloud will not charge fees related to the initial setup, initial implementation and personalization of its standard Service unless a fee is
included in the Biller Order Form. Invoice Cloud will charge the Biller or payer fees as provided in the Biller Order Form. In addition, Invoice
Cloud reserves the right to charge for changes to the setup, implementation or personalization performed after the completion of initial setup
or implementation and any other requested work or changes including the following services, at its then standard rates:
■ new file/biller set up
• template changes
• custom reports and other custom development Not to Exceed
• new bill printer support
• invoice file format changes resulting in revision of integration/data translation $635,000
• re -implementation of a site/system and/or new billing system
• payment file revisions
• loading pdfs and importing/loading invoices
• conversion of biller customer registrations/passwords (post initial implementation)
• balance forward of invoices
■ other out of scope services
12. Limitation of Liability. INVOICE CLOUD'S AGGREGATE LIABILITY SHALL BE UP TO AND NOT EXCEED THE AMOUNTS
ACTUALLY PAID BY AND/OR DUE FROM BILLER IN THE TWELVE (12) MONTH PERIOD IMMEDIATELY PRECEDING THE
EVENT GIVING RISE TO SUCH CLAIM. IN NO EVENT SHALL INVOICE CLOUD AND/OR ITS LICENSORS BE LIABLE TO
ANYONE FOR ANY INDIRECT, PUNITIVE, SPECIAL, EXEMPLARY, INCIDENTAL, CONSEQUENTIAL (INCLUDING LOSS OF
DATA, REVENUE, PROFITS, USE OR OTHER ECONOMIC ADVANTAGE) ARISING OUT OF, OR IN ANY WAY CONNECTED
WITH THIS SERVICE, EVEN IF THE PARTY FROM WHICH DAMAGES ARE BEING SOUGHT OR SUCH PARTY'S LICENSORS
HAVE BEEN PREVIOUSLY ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. Certain states and/or jurisdictions do not allow the
exclusion of implied warranties or limitation of liability for incidental, consequential or certain other types of damages, so the exclusions set
forth above may not apply to Biller.
13. Export Control. The Biller agrees to comply with United States export controls administered by the U.S. Department of Commerce, the
United States Department of Treasury Office of Foreign Assets Control, and other U.S. agencies.
14. Notice. Either party may give notice by electronic mail to the other party's email address (for Biller, that address on record on the Biller
Order Form, or by written communication sent by first class mail or pre -paid post to the other party's address on record in Invoice Cloud's
account information for Biller, and for Invoice Cloud, to Invoice Cloud, Inc., 30 Braintree Hill Office Park, Suite 303, Braintree, MA 02184
Attention: Client Services. Such notice shall be deemed to have been given upon the expiration of 48 hours after mailing or posting (if sent by
first class mail or pre -paid post) or 12 hours after sending (if sent by email).
15. Assignment. This Agreement may not be assigned by either party without the prior written approval of the other party, but may be assigned
without such party's consent to (i) a parent or subsidiary, (ii) an acquirer of assets, or (iii) a successor by merger. Any purported assignment in
violation of this section shall be void.
16. Insurance.
Invoice Cloud agrees to maintain in full force and effect during the term of the Agreement, at its own cost, the following coverages:
a. Commercial General or Business Liability Insurance with minimum combined single limits of One Million ($1,000,000) each
occurrence and Two Million ($2,000,000) general aggregate.
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b. Umbrella Liability Insurance with minimum combined single limits of Five Million ($5,000,000) each occurrence and Five Million
($5,000,000) general aggregate.
c. Automobile Liability Insurance with minimum combined single limits for bodily injury and property damage of not less than One
Million ($1,000,000) for any one occurrence, with respect to each of the Invoice Cloud's owned, hired or non -owned vehicles assigned
to or used in performance of the Services.
d. Errors and Omissions Insurance (Professional Liability and Cyber Insurance) with limits of liability of at least One Million Dollars
($1,000,000) per claim and in the aggregate.
17. Immigration Laws. For Services performed within the United States, Invoice Cloud will assign only personnel who are either citizens
of the United States or legally eligible to work in the United States. Invoice Cloud represents and warrants that it has complied and will comply
with all applicable immigration laws with respect to the personnel assigned to the Biller.
18. General. With respect to agreements with municipalities, localities or governmental authorities, this Agreement shall be governed by the
law of the state wherein such municipality, locality or governmental authority is established, without regard to the choice or conflicts of law
provisions of any jurisdiction. With respect to Billers who are not with municipalities, localities or governmental authorities, this Agreement
shall be governed by Massachusetts law and controlling United States federal law, without regard to the choice or conflicts of law provisions
of any jurisdiction. No text or information set forth on any other purchase order, preprinted form or document (other than an Biller Order, if
applicable) shall add to or vary the terms and conditions of this Agreement. If any provision of this Agreement is held by a court of competent
jurisdiction to be invalid or unenforceable, then such provision(s) shall be construed, as nearly as possible, to reflect the intentions of the invalid
or unenforceable provision(s), with all other provisions remaining in full force and effect. No joint venture, partnership, employment, or agency
relationship exists between Biller and Invoice Cloud as a result of this agreement or use of the Service. The failure of either party to enforce
any right or provision in this Agreement shall not constitute a waiver of such right or provision unless acknowledged and agreed to by Invoice
Cloud in writing. All rights and obligations of the parties in Sections 4, 6, 10, 12, 14 and 18 shall survive termination of this Agreement. This
Agreement, together with any applicable Biller Order Form, comprises the entire agreement between Biller and Invoice Cloud and supersedes
all prior or contemporaneous negotiations, discussions or agreements, whether written or oral between the parties regarding the subject matter
contained herein. Biller agrees that Invoice Cloud can disclose the fact that Biller is a paying customer and the edition of the Service that Biller
is using.
Additional terms and conditions and definitions applicable to this Agreement and the Biller Order Form are found at
www.invoicecioud.00m/termsandconditions (the "Biller T+C") and are agreed to by Invoice Cloud and the Biller.
,A nd w to form
DWdY City Atter' W Arp,
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BILLERS TERMS AND CONDITIONS mnvw.ini,oiceeloud.eomlterntsandeonditi'aus
1. Definitions.
As used in the Agreement and in any Biller Order Form now or hereafter
"Agreement" or "Biller Agreement" means these terms and conditions, any Biller Order Form, whether written or submitted online and any
materials available on the Invoice Cloud website specifically incorporated by reference herein;
"Biller Data" means invoices and bills of the Biller;
"Biller Order Form" means the order form referencing the services to be performed by Invoice Cloud and any add on services under any add on
Biller Order Form.
"Chargeback" is a reversal of a Transaction initiated by a credit card company, processor, bank or other financial institution that Biller
previously presented to Invoice Cloud under this Agreement;
"Content" means the information and documents contained or made available to Biller by Invoice Cloud in the course of using the Service;
"Customer" shall include customers, taxpayers and users of services of Biller;
"Customer Data" means any data, information or material provided or submitted by Biller or its Customers to the Service or the Biller's
customers and/or payers in die course of using the Service;
"Effective Date" means the earlier of either the date this Agreement is accepted by executing a Biller Order Form;
"Intellectual Property Rights" means unpatented inventions, patent applications, patents, design rights, copyrights, trademarks, service marks,
trade names, domain name rights, mask work rights, know-how and other trade secret rights, and all other intellectual property rights,
derivatives, integration components and application programming interfaces thereof, and forms of protection of a similar nature anywhere in
the world;
"Integration Components" means software, which integrates the Service with third party software, and any updates or revisions thereto.
"Invoice Cloud" means collectively Invoice Cloud, Inc., a Delaware corporation;
"Invoice Cloud Technology" means all of Invoice Cloud's proprietary technology (including software, hardware, products, processes,
algorithms, user interfaces, know-how, techniques, designs and other tangible or intangible technical material or information) made available to
Biller or otherwise developed by Invoice Cloud in providing the Service;
"Payment Instrument Transaction" is transaction conducted between Biller and its Customers with respect to an account, or evidence of an
account, authorized and established between a Customer and a credit card association or issuer, or representatives or members thereof that
Biller accepts from Customers as payment for the Services. Payment Instrument Transactions include, but are not limited to, transactions
processed by credit and debit cards, ACH, EFT and Check 21 transactions, stored value cards, loyalty cards, electronic gift cards, authorized
account or access numbers, paper certificates and credit accounts.
"Order Form" or "Biller Order Form" means the form evidencing the initial subscription for the Service and any subsequent Biller Order Form,
specifying, among other things, the services contracted for, the applicable fees, the billing period, and other charges as agreed to between the
parties, each such Biller Order Form to be incorporated into and to become a part of this Agreement (in the event of any conflict between the
terms of this Agreement and the terns of any such Biller Order Form, the terms of this Agreement shall prevail);
"Reserve Account" means a Biller account which is maintained in order to protect Invoice Cloud against the risk of, among other things,
existing, potential, or anticipated Chargebacks and to satisfy the other obligations under the Agreement.
"Service(s)" means Invoice Cloud's billing and payment service, the Content, the Invoice Cloud Technology and other corporate services
identified on the Biller Order Fort, developed, operated, and/or maintained by Invoice Cloud, accessible via www.invoicecloud.com or
another designated web site or IP address, or ancillary online or offline products and services provided to Biller by Invoice Cloud, to which
Biller are being granted access under this Agreement, including the Invoice Cloud Technology and the Content;
"Submitter" means the Biller's status under the Agreement and Order Form where Biller's Customers submit Transaction Data directly to the
payment processor or credit card processor who then processes the Transaction Data with the associated convenience fee being paid to Invoice
Cloud and Invoice Cloud being responsible to pay the applicable convenience to the payment processor.
"Transaction" is a transaction conducted between a Customer and Invoice Cloud (on behalf of Submitter) utilizing either a Payment Instrument
or a bill presentment in which consideration is or to be exchanged or tax is or to be due between the Customer and Biller;
"Transaction Data" means is the written or electronic record of a Transaction, including but not limited to an authorization code or settlement
record and Biller Data.
2. Biller's Responsibilities. (a)Biller is responsible for all activity occurring under Biller's accounts and shall abide by all applicable
laws, and regulations in connection with Biller's and/or its customers' and a payers' use of the Service, including those related to data privacy,
communications, export or import of data and the transmission of technical, personal or other data. Biller shall: (i) notify Invoice Cloud
Invoice Cloud Biller Terms and Conditions (v3.0) I
immediately of any unauthorized use of any password or account or any other known or suspected breach of security; (ii) report to Invoice
Cloud and immediately stop any copying or distribution of Content that is known or suspected to be unauthorized by Biller or Biller's Users;
and (iii) not impersonate another Invoice Cloud user or provide false identity information to gain access to or use the Service. Biller may not:
(i) send or store material containing software viruses, worms, Trojan horses or other harmful computer code, files, scripts, agents or programs;
(iii) interfere with or disrupt the integrity or performance of the Service or the data contained therein; or (iii) attempt to gain unauthorized
access to the Service or its related systems or networks. Biller shall not: (i) license, sublicense, sell, resell, transfer, assign, distribute or
otherwise commercially exploit or make available to any third party the Service in any way; (ii) modify or make derivative works based upon
the Service; (iii) Recreate, "frame" or "mirror" any portion of the Service on any other server or wireless or Intemet-based device; (iv) reverse
engineer or access the Service; or (v) copy any features, functions or graphics of the Service.
Invoice Cloud is not responsible for any Biller postings in error due to delayed notification from credit card processor, ACH bank and other
related circumstances.
Biller agrees to provide Invoice Cloud with complete and accurate billing and contact information. This information includes Biller's legal
company name, street address, e-mail address, and name and telephone number of an authorized billing contact and License Administrator,
Biller agrees to update this information within 30 days of any change to it.
(b) Biller is required to ensure that it maintains a fair policy with regard to the refund, return or cancellation of services and adjustment of
Transactions. Biller is also required to disclose any refund, return or cancellation policies to Invoice Cloud and any applicable payment
processors and Biller's Customers, as requested.
Any change in a return/ cancellation policy with the transactions underlying the Transaction Data must be submitted to Invoice Cloud, in
writing, not less than 21 days prior to the effective date of such change,
If Biller allows or is required to provide a price adjustment, or cancellation of services in connection with a Transaction previously processed,
Biller will prepare and deliver to Invoice Cloud Transaction Data reflecting such refund/adjustment within 2 days of resolution of the request
resulting in such refund/adjustment. The amount of the refund/adjustment with respect to Transactions under the Service cannot exceed the
amount shown as the total on the original Transaction Data. Biller may not accept cash or any other payment or consideration from a Customer
in return for preparing a refund to be deposited to the Customer's account; nor, with respect to credit card transactions, may Biller give
cash/check refunds to a Customer in connection with a Transaction previously processed, unless required by applicable law.
Individual users, when they initially log in, may be asked whether or not they wish to receive marketing and other non-critical Service -related
communications from Invoice Cloud from time to time. They may opt out of receiving such communications at that time or at any subsequent
time by changing their preference under httn:llwww.iitvtrieeclnttd.cnmlorivacv:#. - I Note that because the Service is a hosted, online
application, Invoice Cloud occasionally may need to notify all users of the Service (whether or not they have opted out as described above) of
important announcements regarding the operation of the Service.
The following is only applicable to any Biller who is a Submitter, and for AMEX credit card charges:
As to all Transactions Biller submits to Invoice Cloud for processing, Biller represents and warrants that:
(1) The Transaction Data represents payment or refund of payment, for a bona fide transaction.
(2) The Transaction Data represents an obligation of the Customer for the amount of the Transaction and the accuracy of all Transaction
Data.
(3) The Transaction Data does not involve any element of credit for payment of a previously dishonored payment or for any other purpose
than payment for a current transaction and future payments as agreed upon by the customer.
(4) The Transaction Data is free from any material alteration not authorized by the Customer.
(5) The amount charged for the Transaction is not subject to any dispute, setoff, or counterclaim.
(6) Neither Biller nor its employees has advanced any cash to the Customer in connection with the Transaction, nor have you accepted
payment for effecting credits to a Customer.
(7) Biller has made no representations or agreements for the issuance of refunds except as it states in your return/cancellation policy, which
has been previously submitted to Invoice Cloud in writing, and which is available to the Customer.
(8) Any transaction submitted to Invoice Cloud to credit a Customer's account represents a refund or adjustment to a Transaction
previously submitted to Invoice Cloud,
(9) Biller has no knowledge or notice of information that would lead it to believe that the enforceability or collectability of the subject
Transaction Data is in any manner impaired. The Transaction Data is in compliance with all applicable laws, ordinances, and regulations.
The Transaction Data is originated in compliance with this Agreement and any applicable agreements.
(10) For a Transaction where the Customer pays in installments or on a deferred payment plan, a Transaction Data record has been
prepared separately for each installment transaction or deferred payment on the date(s) the Customer agreed to be charged. All
installments and deferred payments, whether or not they have been submitted to Invoice Cloud for processing, shall be deemed to be a part
of the original Transaction.
Invoice Cloud Biller Terms and Conditions (0.0)
(11) Biller has not submitted any Transaction that it knows or should have known to be either fraudulent, illegal, or otherwise in violation
of any provision of this Agreement or other applicable agreements,
(12) All Transaction Data is complete and accurate (including with respect to total due fields) and Invoice Cloud is not liable or
responsible for any incomplete or inaccurate Transaction Data.
3. Chargebacks I£ Biller is subject of excessive Chargebacks, in addition to our other remedies under this Agreement, invoice Cloud
(or the payment processor) may take the Following actions: (i) request that Biller in every ease commence issuing refund and related payments
directly to Customer; (ii) notify Biller ofa new tate that will be charged to process Chargebacks; (iii) collect from Biller an amount reasonably
determined by Invoice Cloud (or the payment processor) to be sufficient to cover anticipated CharlIcbacks and all related fres, penalties,
expenses, and fines or request a Reserve Amount (where a Reserve Account is noted under die Biller Order Farm or as otherwise required
under the terms of this Agreement or other agreement with Invoice Cloud or any payment processor); or (Iv) terminate the Agreement. Biller
also agrees to pay any and all penalties, fees, fines and costs assessed against Invoice Cloud (or the payment processor) relating to your
violation of this Agreement, or other agreement related thereto,
Bitter agrees that it is fully liable if any Transaction, For which Invoice Cloud has provided Biller credit or paid Biller, is the subject of a
Chargeback or ACH rejects or reversals or other refunds or credits. To the extent Invoice Cloud hes paid or may be called upon to pay a
Chargeback, refund or adjustment for or on the account of a Customer and Bitter does not reimburse us as provided for in this Agreement, or
has insufficient fltnds to draw front in the Billers Debit Account (to the extent applicable as provided in Section 4 below) then for the purpose
of our obtaining reimbursement of such suns paid or anticipated to be paid, Biller shall indemnify, defend and hold Invoice. Cloud harmless
therefrom. The Billers Debit Account will contain sufficient funds to cover any estimated exposure based on reasonable criteria for
Chargebacks, ACH rejects or reversals, credits, returns, and all additional liabilities anticipated under this Agreement, including, but not limited
to Chargebacks, fines, fees and penalties, Invoice Cloud may (but is not required to) apply funds in the Billers Debit Account (to the extent
applicable as provided in Section 4 below) toward, and set offany funds that would otherwise be payable to Biller against, the satisfaction of
any amounts which are or may become due from Biller pursuant to this Agreement, invoice Cloud may, at its sole discretion, collect fees
related to Ch.orgcbacks and ACI•I rejects and reversals, or other refimds or credits from Biller's customers.
The following are some of the most common reasons for Chargebacks; in no way is this intended to be an exhaustive list of possible
Chargeback reasons:
(1) Failure to issue a refund to a Customer as required.
(2) Invoice Cloud did not receive Biller's response to a Retrieval Request within 7 days or any shorter time period required by the Payment
Brand Rnhles.
(3) A Customer disputes the Transaction, or claims that the Transaction is subject to a set-off, defense, or counterclaim
Invoice Cloud may meive a Chargobaek from a Transaction, an AMEX credit card Service or otherwise, where the possibility of Cha rgchacks
are noted as part of the Service, Some common treasons for Chargebarics are listed. In the event that Invoice Cloud receives a Chargeback,
Biller shall reimburse Invoice Cloud for such Chorgeiracks (which may include Invoice Cloud withdrawing such amounts from the Biller's
Debit Account), In addition, Biller shall be responsible to Invoiee Cloud for charges against any reserves required by payment or credit carol
processors; and any Chargebacks, by any party, including without limitation Chargebacks claimed by any payment and credit card processors,
bank, or other financial services organization.. To the extent permitted by applicable Jaw. Bitter shall indemnify and hold Invoice Cloud, its
licensors and Invoice Cloud's, subsidiaries, affiliates, officers, directors, employees. attorneys, agents, and payment processors harmless from
and against any and all claims, costs, damages, losses, liabilities and expenses (including attorneys' fees and costs) arlsing out of or in
connection with any claim, cause of action, lawsuit, administrative or criminal investigation, charge, action or claim alleging; (i) charge against
any reserves required by payment or credit card processors; (ii) a Chargeback, by any party, including without limitation Chargebacks claimed
by any payment and credit card processors, bank, or other financial services organization; (iii) that use of any Customer Data infringes the
rights of a third party; (iv) a violation by Biller of Bitter's representations and warranties or she breach by Biller or Killer's Users or this
Agreement including without limitation incomplete or inaccurate Transaction Data; or (v) relating directly or indirectly to Biller's or its
authorized users' use of the Service. Invoice Cloud may receive a Chargeback from a Transaction where Biller has a submitter agreement, an
AMEX credit card Servicc or otherwise, where the passibility of Chargebacks are noted as part of the Sorvicc. In the event that Invoice Cloud
receives a Chargeback, Biller shall reimburse invoice Cloud for such Chargebacks (which may include Invoice Cloud withdrawing such
amounts from the Biller's Debit Account).
4, Certain Contractual Terms. The following only applies to the extent not otherwise addressed in the Agreement:
LIMITED WARRANTY: THE INTEGRATION COMPONENTS ARE PROVIDED "AS IS". ALL WARRANTIES, EXPRESSED OR
IMPLIED ARE HEREBY DISCLAIMED WITH RESPECT TO THE INTEGRATION COMPONENTS INCLUDING BUT NOT LIMITED
TO THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR AGAINST LATENT
DEFECTS.
INVOICE CLOUD'S AGGREGATE LIABILITY SHALL BE UP TO AND NOT EXCEED THE AMOUNTS ACTUALLY PAID BY
AND/OR DUE FROM BILLER IN THE TWELVE (12) MONTH PERIOD IMMEDIATELY PRECEDING THE EVENT GIVING RISE TO
SUCH CLAIM. IN NO EVENT SHALL INVOICE CLOUD AND/OR ITS LICENSORS BE LIABLE TO ANYONE FOR ANY INDIRECT,
PUNITIVE, SPECIAL. EXEMPLARY, INCII)ENTAL, CONSEQUENTIAL (INCLUDlI+1Q LOSS OF DATA, REVENUE, PROFITS, USE
OR OTHER ECONOMIC ADVANTAGE) ARISfNG OUT OF, OR IN ANY WAY CONNECTED WITH THIS SERVICE, EVEN IF THE
PARTY FROM WHICH DAMAGES ARE BEING SOUGHT OR SUCH PARTY'S LICENSORS HAVE BEEN PREVIOUSLY ADVISED
OF THE POSSIBILITY OF SUCH DAMAGES, Certain states and/or jurisdictions do not allow the exclusion of implied warranties or
limitation of liability for incidental, consequential or certain other types of damages, so the exclusions set forth above may not apply to Biller.
To the extent that the Biller's Agreement does not have a Biller indemnification, limited warranty or limitation ofllability clause respectively.
or to the aXlent that there is no Biller Agreement, the clauses in this Section 4 shall apply, shall control and be binding on the Biller. Whcrc
Invoice Cloud Biller Terms and Conditions (v3.0)
there is no Biller Agreement, the terms of these Biller Terms and Conditions (and any order forms) shall be the sole and entire agreement
between the parties.
5. Biller Deposit Account Automatic Debit (Applicable where Biller Debit Account has been designated on the Biller Order
Form)
Where Biller authorizes Invoice Cloud's receipt of all fees and periodic fees referenced in the Bitier Order Farm - from payments made by
Customers, or from credit card proccssers, bank card issuers, payment associations. ACH and cheek processus, as applicable. Except where
prohibited by applicable law. Bitter shall establish a Deposit Account(s) whereby Invoice Cloud will automatically withdraw From the Biller's
account(s) used for this purpose ("Biller's Debit Account(s)") the fees and periodic fees rcferonced in the Order Form and any Chargebacks,
ACH rejects or reversals, refunds and other fees due hereunder resulting therefrom. Biller shall be responsible for and pay all fees or charges
relating to Biller's Debit Account and the automatic debit racility, in accordance with the terms thereof. In addition, with respect to any
invoices and/or payments that are processed through the Service, the RiIter's agreements with all such credit card processed, bank card issuer&.
ACFI and check processers shalt requite remittance and payment to Invoice Cloud, of all fees and to no other account. Biller shall maintain
sufficient funds in the Biker's Debit Account to pay all periodic fees, Chargebacks, ACH rejects, reversals refunds and other fees due
hereunder resulting therefrom.
Encrypted Card Readers. (Applicable where Card Readers has been designated on the Biller Order Form)
Encrypted Card Readers (or Card Readers as described in the Biller Order Form), are provided to the Biller for their use under license fee
provided in the Biller Order Form. Invoice Clouds provides to Biller tate products on license. Biller will be fully responsible for all products
including without limitation all risk orloss and damage to products while in its possession tlroontrol, save nomtal wear and scar.
Where Invoice Cloud provides encrypted card readers, the following additional terms apply (with "products" or "device" in this Section 6
referring to the encrypted card readers):
a. Invoice Cloud and the manufacturer warrants that the products provided pursuant to this Agreement will perform in
accordance with the manufacturer's published specifications, Should this product fail to conform to manufacturer's spcoifications.. Repair parts
and replacement products will be firmished on an exchange basis and will be either reconditioned or new as specified below. This limited
warranty does not include service to repair damage to the product resulting front accident, disaster, unreasonable use, misuse, abuse, customer's
negligence, Reset[or's negligence, or non -manufacturer modification of the product. Invoice Cloud reserves the right to examine the alleged
defective goods to determine whether dtc warranly is applicable. Without limiting due generality of the foregoing, Invoice Cloud and
mamnfacturer specifically disclaims any liability or warranty for goods resold in other than manufacturer's original packages, and for goods
modified, aitared, or treated by customers. Service may be obtained by delivering the product during the warranty period as instructed by
Invoice
The following is the repair and replacement policy:
Replacement Requests — Biller to notify Invoice Cloud that the device is not working, via email, phone call or help desk ticket
Invoice Cloud will update and or open a new ticket for the swap replacement request.
Biller must provide the serial numberefthedeWice that is not working.
Replacement device will be shipped to the Biller the same day if request is submitted by 2 pm CST. Requests received after 2pm CST will
be processed the following business day.
Shipping Method: Replacement devices will be shipped via Fed Ex 1-3 day at no charge to the Biller. If the Biller needs the device
ovemighted there is an additional cost of 535.00 per device.
Biller have 14 business days to return to the device that is not working to Invoice Cloud, Inc. 1148 Vickery Lane, Cordova, TN 38016,
delivery or postage pre -paid. Failure to return the non -working device may result in additional fees and charges to the Biller.
Invoice Cloud shall use reasonable ctTorts to provide the encrypted card reader service in an uninterrupted, continumis fashion. Biller
understands and agrees that services may be periodically off line or otherwise inoperable in order for Invoice Cloud to perterm maintenance,
install or test soRware, or for other commercially reasonable business purposes and that during such time services may not be provided.
Biller further understands and agrees that from time to time services may be off line or otherwise inopemblc as a result or the failure of
equipment or services provided to manufacturer by third parties (for example, public or private tolccommumieations services or internet
nodes or Ike iIities, oyemlI Internet congestion, unavailability of generic internet services, such as DNS services), and that during such time
Services may act be provided. Furthermore, Biller understands and agrees that the provisions of services and other performances hereunder
will be excused for any of the reasons set forth herein. In the even[ of unforeseen network, or equipment failuro, manufacturer will use
commercially reasonable efforts to restore the Services in a reasonability prompt fashion, Manufacturer may from tine to time, in its sale
discretion, modify the manner in which it provides services, and modify its software and systems, all of which may msuIt in a change in the
ruanner in which manufacturer provides the software and systems provided, however, that such modifications and/or changes do not degrade
the love] of, or have a material adverse impact upon the features and functionality of the Services.
c. EXCEPT AS PROVIDED IN THIS SECTION 6, INVOICE CLOUD AND MANUFACTURER MAKES NO OTHER
WARRANTY, EXPRESS OR IMPLIED, AND INVOICE CLOUD MANUFACTURER DISCLAIMS ANY WARRANTY OF ANY OTHER
KIND, INCLUDING ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. BILLER AGREES S
THAT THE MANUFACTURER PRODUCT IS OFFERED AS IS.
d. Responsibilities of Hit Ier. Biller will be responsible for Ilio following: (i) Providing Invoice Cloud with a static IP
address or a specific range of static IF addresses, (ii) Confidentiality of End User's Data. Biller is solely responsible for ensuring the secure
transmission of any data that Biller transmits to Invoice Cloud ("BiIler Transmitted Information"), and Invoice Cloud and Manufacturer wi1I
have no liability therefore. (provided that manufacturer will use Biller Transiniued Infonnatien ouly for purposes of this Agreement). 13iIler is
Invoice Cloud Biller Terms and Conditions (v3.0)
solely responsible for implementing security measure, procedures, and standards or any othra best practice available to protect She
con rtdcniiality of Biller Transmitted Information, (iii) protecting the confidentiality of any information stared on Killer's servers, and (iv)
using the Services in the manner instructed by invoice Cloud manufacinrer and otherwise is the manner intended.
e. Network Security. Bilter shall be solely responsible for ensuring that Authorized Biller Employees are not security
risks. Upon Invoice Cloud's request, Biller will provide invoice Cloud with any information reasonably necessary for Invoice Cloud to
evaluate security issues relating to any Authorized 8 iller Employee. Each party will be solely responsible for the selection, implementation,
and maintenance of security procedures and policies that are sufficient to ensure that (a) such party's use of the Network Connection is secure
and is used only for authorized purposes, and (b) such party's business records and data are protected against improper access, use, loss,
alteration or destruction.
f. 13iIler shall provide Invoice Cloud with physical access to the devices upon request after reasonable advance notice.
Biller shall not, nor allow any Third Party to, modify, repair, rclacato, sell, icase. assign, encumber, or otherwise tampw with any of the devices
without Invoice Cloud's express written consent. Any change of the location of the dcviccs may warrant that Biller pay invoice Cloud any
additional installation and related charges associated with such relocation, charged by Invoice Cloud's third party vandors, AI the end of the
term. Biller shall be responsible to re tum all devices, freight prepaid by Invoice Cloud, to Invoice Cloud at the place from which dcviccs was
shipped (or as otherwise designated by Invoice Cloud) in as good condition as exists at the corruncneetnent of the harm, reasonable wear and
tear, and casualty, in respect thereto excepted. Bilfer shall use devices at all times in a workmanlike manner and in such manner as will not
damage or injure the devices except by the ordinary wear and tear of such devices. In the event of damage to any devices, Biller shall notify
Invoice Cloud who shall replace or repair the devices at Biller's expense.
Devices and all parts and components thereof shall retain its character as personal property and all right, title and interest thereto
shall not pass to Biller but Title and ownership shall remain exclusively with invoice Cloud. Biller shall be and shall have the duties of a bailee
of the devices. Biller shall not remove, conceal or otherwise interfere with the title or ownership plate of invoice Cloud affixed to devices until
and unless devices is purchased and full payment therefor is made as herein provided. If Biller sells, assigns or attempts to sell or assign
devices or any interest tlhcroin, or if Biilcr defaults in any of the covenants, conditions or provisions of tlhis Agreement, it is agreed that Invoice
Cloud may immediateiyand with notice take possession ofdevices where found and to remove and keep or dispose of the same and any unpaid
fees shall at once become due aihd payable, if any step is takers by legal action or otberwise by Invoice Cloud to recover possession of devices.
or otherwise enforce this Agreement or to collect moneys due hereunder Bi[ter shall pay invoice Cloud the equivalent of the at meys expended
or charges incurred by Invoice Cloud in such behalr, including reasanablo attorneys fees.
p
totom/ L-
Deputy A City ora ! 1 , i�
Invoice Cloud Bitter Terms and Conditions (0.0)
CHASE 0 Paymentech"
14221 Dallas Parkway, Dallas, Texas 75254 • 4 Northeastern Blvd, Salem, NH 03079-1952
Sales Phone (603) 896-8324 • Sales Fax (603) 896-8701
www.chasepaymentech.com
COMPANY• • •
Federal regulations require that we collect and retain for our records information to verify merchant identity
COMPANY LEGAL NAME: City of Lodi TAXPAYER ID 94-6000361
REGISTERED TRADE
IF
YEAR BUSINESS STARTED
1906
NAME
PHYSICAL STREET ADDRESS:
310 W. Elm St
(NO PO BOX OR PAID MAIL BOX)
CITY Lodi STATE
CA
ZIP CODE 95240
PRIMARY CONTACT
Andrew Keys
TELEPHONE#
209-333-6700
TYPE OF ENTITY
[]INDIVIDUAL /SOLE PROPRIETOR ❑PARTNERSHIP []CORPORATION ®GOVERNMENT
❑LLC" • IF LLC, TAXED AS: []DISREGARDED ENTITY ❑CORPORATION ❑PARTNERSHIP
TYPE OF OWNERSHIP:
❑ PUBLIC ❑ PRIVATE ❑ NON PROFIT ❑ SUBSIDIARY OF PUBLIC COMPANY ®OTHER: Government
STATE OF FORMATION
CA
DATE OF FORMATION (MM/DD/YYYY) 01/01/1906
TRADING SYMBOL
FISCAL YEAR END (MM/DD/YYYY)
1[
-7i]
S MERC T EVER FILED BANKRUPTCY? ]FIF
ff
YES, WHAT CHAPTER?
FILING DATE:
EMERGENCE DATE:
YES M%02
-
'OWNERS
OWNERS MUST PROVIDE• OWNER SIGNING AUTHORIZES
INVESTIGATION, TO OBTAIN AND REVIEW THIRD PARTY CREDIT BUREAU REPORTS ON SUCH OWNER. OWNERSHIP DETAILS MUST BE PROVIDED FOR FACH
INDIVIDUALTHIS
• OR OWNERSHIP
SOCIAL SECURITY BIRTHDATE
NAME OR OR
TAX ID NUMBER DATE OF INCORPORATION
STREET ADDRESS TELEPHONE NUMBER
CITY
STATE ZIP CODE
SIGNATURE
PERCENT OWNERSHIP
SOCIAL SECURITY BIRTHDATE
NAME
OR OR
[TAXIDNUMBER
DATE OF INCORPORATION
STREET ADDRESS
TELEPHONE NUMBER
CITY
STATE Z!P CODE
SIGNATURE
PERCENT OWNERSHIP
DO YOU HAVE ANY ADDITIONAL OWNERS (NOT LISTED ABOVE) THAT HAVE 10% OR GREATER OWNERSHIP, EITHER DIRECTLY OR INDIRECTLY?
❑ YES OWNER ADDENDUM REQUIRED (SALES REPRESENTATIVE WILL PROVIDE) ® NO
... _.._............ _ . ......................
NOTE: IF AN ENTITY/PARENT COMPANY IS LISTED IN SECTION 2 ABOVE THAT HAS 10•/ OR GREATER OWNERSHIP OF THE APPLICANT, IDENTIFY ANY OWNERS
(INDIVIDUALS AND/OR ENTITIES) OF THE ENTITY/PARENT COMPANY THAT ULTIMATELY HAVE 10% OR GREATER OWNERSHIP IN THE APPLICANT ON THE ADDITIONAL
OWNER/OFFICER ADDENDUM (SALES REPRESENTATIVE WILL PROVIDE)
&-v 31/15
Page 1 of 2 Paymentech Contract No. 063576
®KEY DECISION
COMPANY PRESIDENT:
Andrew Keys, Deputy City Manager
(RESIDENTIAL ADDRESS IS PREFERRED, BUT IF NOT AVAILABLE BUSINESS ADDRESS IS ACCEPTABLE)
STREET ADDRESS 11
310 W. Elm St
CITY
Lodi
STATE CA ZIP CODE %240
COMPANY CFO:
(RESIDENTIAL ADDRESS IS PREFERRED, BUT IF NOT AVAILABLE BUSINESS ADDRESS IS ACCEPTABLE)
STREET ADDRESS
CITY
STATE ZIP CODE
IS THERE ANYONE NOT LISTED ABOVE WHO HAS THE AUTHORITY TO MAKE FINANCIAL DECISIONS OR CONTROL COMPANY POLICY ON BEHALF OF YOUR BUSINESS?
❑ YES OWNER ADDENDUM REQUIRED (SALES REPRESENTATIVE WILL PROVIDE) 'MNO
AUTHORIZED ADMINISTRATOR FOR ACCOUNT BOARDING AND IMPLEMENTATION
AUTHORIZED ADMINISTRATOR FOR PURPOSES OF ACCOUNT BOARDING AND IMPLEMENTATION MEANS AN OWNER, PARTNER, OFFICER, EMPLOYEE OR OTHER AGENT
OF THE MERCHANT THAT HAS BEEN APPOINTED BY AN EXECUTIVE OF MERCHANT AND WHO IS DULY AUTHORIZED TO PROVIDE INFORMATION AND EXECUTE
DOCUMENTATION ON BEHALF OF AND RELATED TO MERCHANT IN ORDER TO FACILITATE THE INITIAL SET UP OF MERCHANTS'S ACCOUNT WITH CHASE PAYMENTECH.
PER CHASE PAYMENTECH POLICY, AUTHORIZED ADMINISTRATORS ARE NOT PERMITTED TO MODIFY THE MERCHANT'S ACCOUNT WITH CHASE PAYMENTECH AFTER
COMPLETION OF THE INITIAL SET UP OF MERCHANTS'S ACCOUNT. SUCH CHANGES MUST BE MADE, BY AN EXECUTIVE OR FINANCIAL CONTACT, AS APPLICABLE AND AS
THOSE ROLES ARE DEFINED BY MERCHANT.
NAME (please print) Andrew Keys
TITLE (please print)
Deputy City Manager
TELEPHONE NUMBER 209-333-6700 EMAIL ADDRESS: akeys@lodi.gov
SIGNATURE DATE: 0 �}
CERTIFICATION
I, the undersigned, being an officer/principal of COL represent and warrant that the statements made on this document are correct and factual. JPMorgan Chase Bank,
N.A ("Member") and Paymentech, LLC ("Paymeritech" or "Chase Paymentech") are authorized to conduct any necessary investigation, including without limitation,
authorization for a bank to release standard banking information.
(Photocopy of signature below is valid for the release of information and will remain valid until the termination or expiration of the Merchant A reemeno
NAME (please print)
Andrlew Keys
TITLE (please print)
Deputy City Manager
SIGNATURE!
l^ r L i-
DATES/
(IF THE SIGNER HAS NOT ALREADY PROVIDED IT ABOVE, A RESIDENTIAL ADDRESS IS PREFERRED, IF AVAILABLE (NO PO BOX OR PAID MAILBOX). IF NOT AVAILABLE
BUSINESS ADDRESS IS ACCEPTABLE.
STREET ADDRESS 310 W. Elm St
CITY
Lodi
STATE
CA
ZIP CODE
95240
PAYMENTECH INTERNAL USE ONLY
*Note: Each Merchant is required to submit a W9 with this application, regardless if Paymentech will be utilizing the Submitter's TIN for IRS
reporting purposes.
DWAty C11Y ASWMY
ATTEST:
NIFER FERRAIOLO
City Clerk
Page 2 of 2 Paymentech Contract No. 063576
CHASE O"
Paymentech
SUBMITTER MERCHANT
PAYMENT PROCESSING INSTRUCTIONS AND GUIDELINES
Paymentech, LLC ("Paymentech" or "we", "us" or "our" and the like), for itself and on behalf of JPMorgan Chase Bank, N.A.
("Member"), is very excited about the opportunity to join Invoice Cloud, Inc. in providing you with state-of-the-art payment
processing services. When your Customers pay you through Invoice Cloud, Inc., you may be the recipient of a Card funded payment.
The organizations that operate these Card systems (such as Visa U.S.A., Inc. and MasterCard International Incorporated; collectively,
the "Payment Brands") require that you (i) enter into a direct contractual relationship with an entity that is a member of the Payment
Brand and (ii) agree to comply with Payment Brand Rules as they pertain to applicable Card Transaction you submit through Invoice
Cloud, Inc.. You are also required to fill out an Application with Paymentech. The Application provides Paymentech with
information relative to your processing practices and expectations.
By executing this document, you are fulfilling the Payment Brand Rule of entering into a direct contractual relationship with a
member, and you are agreeing to comply with Payment Brand Rules as they pertain to Transactions you submit for processing through
the Invoice Cloud, Inc. service. We understand and acknowledge that you have contracted with Invoice Cloud, Inc. to obtain Card
processing services on your behalf and that Invoice Cloud, Inc. may have agreed to be responsible for your obligations to us for such
Transactions and as set forth in these guidelines.
The following information is designed to inform and assist you as we begin our relationship.
1. Your Acceptance of Cards
• You agree to comply with all Payment Brand Rules, as may be applicable to you and in effect from time to time. You understand
that we may be required to modify these instructions and guidelines in order to comply with requirements imposed by the
Payment Brands.
■ In offering payment options to your customers, you may elect any one of the following options. These acceptance options above
apply only to domestic transactions:
(1) Accept all types of Visa and MasterCard cards, including consumer credit and debit/check cards, and commercial credit and
debit/check cards;
(2) Accept only Visa and MasterCard credit cards and commercial cards (If you select this option, you must accept all consumer
credit cards (but not consumer debit/check cards) and all commercial card products, including business debit/check cards); or
(3) Accept only Visa and MasterCard consumer debit/check cards (If you select this option, you must accept all consumer
debit/check card products (but not business debit/check cards) and refuse to accept any kind of credit cards).
• If you choose to limit the types of Visa and MasterCard cards you accept, you must display appropriate signage to indicate
acceptance of the limited acceptance category you have selected (that is, accept only debit/check card products or only credit and
commercial products).
■ For recurring transactions, you must obtain a written request or similar authentication from your Customer for the goods and/or
services to be charged to the Customer's Card, specifying the frequency of the recurring charge and the duration of time during
which such charges may be made.
2. Settlement
• Upon our receipt of your Transactions, we will process your Transactions to facilitate the funds transfer between the various
Payment Brands, you and Invoice Cloud, Inc.. Unless otherwise agreed to by the parties, after we receive credit for such
Transactions, we will provide provisional credit to one or more of the Bank Account(s) you designate herein under the "Funding
Schedule" section.
• You must not submit Transactions for payment until the goods are delivered, shipped, or the services are performed. If a
Customer disputes being charged for merchandise or services before receiving them, the result may be a Chargeback to you.
3. Chun eg backs
• You may receive a Chargeback for a number of reasons. The following are some of the most common reasons for Chargebacks,
but in no way is this meant to be an exhaustive list of all Chargeback reasons:
(1) You, do not issue a refund to a Customer upon the return or non-delivery of goods or services;
(2) An authorization/approval code was required and not obtained;
INTERNAL PAYMENTECH USE Rev 01/14
Merchant Name: City of Lodi Page 1 of 3 Paymentech Contract No. 063576
(3) The Transaction was fraudulent;
(4) The Customer disputes the Card sale or the signature on the sale documentation, or claims that the sale is subject to a set-off,
defense or counterclaim; or
(5) The Customer refuses to make payment for a Card sale because in the Customer's good faith opinion, a claim or complaint
has not been resolved, or has been resolved by you but in an unsatisfactory manner.
4. Data Security and Privacy
• By signing below, you represent to us that you do not have access to any Card Information (such as the Customer's primary
account number, expiration date, security code or personal identification number) and you will not request access to such Card
Information from Invoice Cloud, Inc.. In the event that you do happen to receive Card Information in connection with the
processing services provided by Invoice Cloud, Inc. or Paymentech under these guidelines, you agree that you will not use it for
any fraudulent purpose or in violation of any Payment Brands or applicable law and you will comply with all applicable Payment
Brand Rules and Security Standards. If at any time you believe that Card Information has been compromised, you must notify us
promptly and assist in providing notification to the proper parties. You must ensure your compliance with all Security Standards
that are applicable to you and which may be published from time to time by the Payment Brands. If any Payment Brand requires
an audit of you due to a data security compromise event or suspected event, you agree to cooperate with such audit. You may not
use any Card Information other than for the sole purpose of completing the Transaction authorized by the Customer for which the
information was provided to you, or as specifically allowed by Payment Brand Rules, or required by law. In the event of your
failure, including bankruptcy, insolvency or other suspension of business operations, you shall not sell, transfer or disclose any
materials that contain Transaction information or Card Information to third parties.
5. Funding Schedule
• In order to receive funds from Paymentech, you must maintain one or more bank account(s) at a bank that is a member of the
Automated Clearing House ("ACH") system and the Federal Reserve wire system (the "Bank Account"). You must designate at
least one Bank Account for the deposit and settlement of funds and the debit of any fees and costs associated with Paymentech's
processing of the Transactions (all such designated Bank Accounts shall be collectively referred to herein as the "Settlement
Account"). You authorize Paymentech to initiate electronic credit and debit entries and adjustments to your Settlement Account
in accordance with this Section 5. We will not be liable for any delays in receipt of funds or errors in Settlement Account entries
caused by third parties, including but not limited to delays or errors by the Payment Brands or your bank.
• Unless otherwise agreed to by the parties, the proceeds payable to the Settlement Account shall be equal to the amounts received
by us in respect of your Card transactions less all Chargebacks, Customer refunds and other applicable charges. Such amounts
will be paid into the Settlement Account promptly following our receipt of the funds. If the proceeds payable to the Settlement
Account do not represent sufficient credits, or the Settlement Account does not have a sufficient balance to pay amounts due from
you under these guidelines, we may pursue one or more of the following options: (i) demand and receive immediate payment for
such amounts; (ii) debit a Bank Account for the amount of the negative balance; (iii) withhold settlement payments to the
Settlement Account until all amounts are paid, (iv) delay presentation of refunds until a payment is made to us of a sufficient
amount to cover the negative balance; and (v) pursue any remedies we may have at law or in equity.
• Unless and until we receive written instructions from you to the contrary, all amounts payable by Paymentech to you will be
deposited in the Settlement Account designated and authorized by you as set forth below:
Name of Bank: F & M Bank
ABA No.: 121108441
Account No.: 0010001301
Account Name: City of Lodi - Main
Reference:
INTERNAL PAYMENTECH USE Rev 01/14
Merchant Name: City of Lodi Page 2 of 3 Pa mentech Contract No. 063576
6. &1fln 'o
"Application" is a statement of your financial condition, a description of the characteristics of your business or organization, and
related information you have previously or concurrently submitted to us, including credit and financial information.
"Card" is an account, or evidence of an account, authorized and established between a Customer and a Payment Brand, or
representatives or members of a Payment Brand that you accept from Customers as payment for a good or service. Payment
Instruments include, but are not limited to, credit and debit cards, stored value cards, loyalty cards, electronic gift cards, authorized
account or access numbers, paper certificates and credit accounts.
"Chargeback" is a reversal of a Transaction you previously presented to Paymentech pursuant to Payment Brand Rules.
"Customer" is the person or entity to whom a Card is issued or who is otherwise authorized to use a Payment Instrument.
"Member" is JPMorgan Chase Bank, N.A. or other entity providing sponsorship to Paymentech as required by all applicable Payment
Brand. Your acceptance of Payment Brand products is extended by the Member.
"Payment Brand' is any payment method provider whose payment method is accepted by Paymentech for processing, including, but
not limited to, Visa, U.S.A., Inc., MasterCard International, Inc., Discover Financial Services, LLC and other credit and debit card
providers, debit network providers, gift card and other stored value and loyalty program providers. Payment Brand also includes the
Payment Card Industry Security Standards Council.
"Payment Brand Rules" are the bylaws, rules, and regulations, as they exist from time to time, of the Payment Brands.
"Card Information " is information related to a Customer or the Customer's Card, that is obtained by you or Invoice Cloud, Inc. from
the Customer's Card, or from the Customer in connection with his or her use of a Card (for example a security code, a PIN number, or
the customer's zip code when provided as part of an address verification system). Without limiting the foregoing, such information
may include a the Card account number and expiration date, the Customer's name or date of birth, PIN data, security code data (such
as CVV2 and CVC2) and any data read, scanned, imprinted, or otherwise obtained from the Payment Instrument, whether printed
thereon, or magnetically, electronically or otherwise stored thereon.
"Paymentech", "we", "our", and "us" is Paymentech, LLC, a Delaware limited liability company, having its principal office at 14221
Dallas Parkway, Dallas, Texas 75254.
"Security Standards" are all rules, regulations, standards or guidelines adopted or required by the Payment Brands or the Payment
Card Industry Security Standards Council relating to privacy, data security and the safeguarding, disclosure and handling of Payment
Instrument Information, including but not limited to the Payment Card Industry Data Security Standards ("PCI DSS"), Visa's
Cardholder Information Security Program ("CISP"), Discover's Information Security & Compliance Program, American Express's
Data Security Operating Policy, MasterCard's Site Data Protection Program ("SDP"), Visa's Payment Application Best Practices
("PABP"), the Payment Card Industry's Payment Application Data Security Standard ("PA DSS"), MasterCard's POS Terminal
Security program and the Payment Card Industry PIN Entry Device Standard, in each case as they may be amended from time to
time.
"Transaction" is a transaction conducted between a Customer and you utilizing a Card in which consideration is exchanged between
the Customer and you.
Please acknowledge your receipt of these instructions and guidelines and your agreement to comply therewith.
Agreed and Accepted by:
City of Lodi
MERCHANT LEGAL NAME (Print or Type)
310 W Elm St, Lodi, CA 95240
Add;*ss (Print or Type)
By (authorized signature')
By, Name, Title (Print bf Type)
C/�*Q 7
Date
Agreed and Accepted by:
PAYMENTECH, LLC for itself and on behalf of
JPMORGAN CHASE BANK, N.A.
By:
Print Name: David Miller
Title: Vice President, Credit Operations
Address: 4 Northeastern Boulevard, Salem, NH 03079
Appmed W to 10M
INTERNAL PAYMENTECH USE
Merchant Name: City of L
�NNIFER�- FERRAIOLO
City Clerk
Rev 0 1/ 14
Schedule A to Merchant Agreement Merchant Name: Invoice Cloud, Inc.
For Transactions for: City of Lodi
CHASE ! F
Paymentech
Assumptions
Schedule A to Merchant Agreement
Annual Payment Transaction Volume 36,000 Average Transaction Amount 9 $302.00
Visa Authorizations
1. Processing Fees - (Fees applIed . -
Transaction -- . .Fees
Visa Settled Transactions See Volume Schedule
MasterCard Settled Transactions
See Volume Schedule
American Express Conveyed Transactions
No Charge
Diners Settled Transactions
See Volume Schedule
Discover Settled Transactions
See Volume Schedule
JCB Settled Transactions
No Charge
Visa Authorizations
See
Volume Schedule
MasterCard Authorizations
See
Volume Schedule
American Express Authorizations
See
Volume Schedule
Diners Authorizations
See
Volume Schedule
Discover Authorizations
See
Volume Schedule
JCB Authorizations
See
Volume Schedule
2. Per Incidence Fees — charged every tine your account incurs one of the below sterns
Visa Auth Reversal - Visa authorization reversal misuse prevention
MasterCard Auth Reversal - Visa authorization reversal misuse prevention
Audio Response Unit Authorization — Charged when voice auth is handled by automated system
Voice Authorization - Charged when you call the Voice Auth phone number to authorize a credit
card
Voice AVS Request - Charged to speak to voice operator for each Voice Address Verification
Voice Authorization Reversal - Charged for each voice authorization reversal
Voice AVS Authorization - Charged per each voice Address Verification Service authorization
Voice Operator Assist - Charged for each voice operator assistance
Visa, MasterCard, Diners, Discover or JCB Settled Chargeback Processed or Represented
Visa, MasterCard, Diners, Discover or JCB Collection, Pre -Arbitration or Compliance
See Volume Schedule
See Volume Schedule
$.50
$.90
$.90
$.90
$1.75
$1.75
$7.00
$10.00
Per Incidence --s — Funding Related
ACH Transfer Fee - Charged for each ACH (transmission of funds) sent to your account $.50
Wire Transfer Fee - Per each funding via wire transfer $10.00
Infernal Paymentech Us9�nly_: Rev 04117
Pavmentech Contract No.: 063576 Page 1 of 4 Date: April 14, 2017
Schedule A to Merchant Agreement Merchant Name: Invoice Cloud, Inc.
For Transactions for: City of Lodi
3. One Time and Periodic Fees
Monthly Paymentech Gateway Fee (per division) I No Charge
4. Other Fee3
Monthly Fax/Mail Reporting Fee - Charged each month Paymentech faxes or mails statements $50.00
(whether at the request of Merchant or because delivery to a valid email address has failed)
Postage, Supplies, Equipment & Other Services — service fees will be charged at the time of order Current Market
5. Payment Brand Fees — Assessed on each transaction.
The Payment Bands assess fess on each transaction
Per Incidence Fees — Miscellaneous Transaction Related
referred to herem as Payment Brand Fees consist of interchange
Rejected Transaction
$.03
Paymentech Gateway Transaction
$.01
Point of Sale Terminal Item Authorized
$.02
Point of Sale Terminal Item Authorized Wireless
$.02
Point of Sale Terminal Item Authorized TCP/IP
$.02
Point of Sale Terminal Item Authorized Special/Misc.
$.02
Point of Sale Terminal Item Authorized Frame Relay
$.02
Point of Sale Terminal Item Authorized Lease Line
$.02
Point of Sale Terminal Item Authorized Netconnect TCP/IP
$.02
Point of Sale Terminal Item Deposited
$.02
Point of Sale Terminal Reject Transaction
$.02
3. One Time and Periodic Fees
Monthly Paymentech Gateway Fee (per division) I No Charge
4. Other Fee3
Monthly Fax/Mail Reporting Fee - Charged each month Paymentech faxes or mails statements $50.00
(whether at the request of Merchant or because delivery to a valid email address has failed)
Postage, Supplies, Equipment & Other Services — service fees will be charged at the time of order Current Market
5. Payment Brand Fees — Assessed on each transaction.
The Payment Bands assess fess on each transaction
processed through their network(s) These fees, generically
fees, assessments. data usage fees, and access fees.
referred to herem as Payment Brand Fees consist of interchange
Payment Brand Fees - Interchange Fees Paymentech
will "pass through" to merchant an amount equal to the applicable
interchange rate established by the Payment Brands.
Pass -Through
MasterCard
• •
-
• •
Discover Settled
_ • •
Pass -Through
Visa Acquirer Processing Fee
$0.0195 1 $0.0155
internal Paymentecb Use Only: Rev 04117
Paymentech Contract No.: 063576 Page 2 of 4 Date: April 14, 2017
Schedule A to Merchant Agreement Merchant Name: Invoice Cloud, Inc.
For Transactions for: City of Lodi
Payment Brand Fees - Data Usage Fees Credit Debit
MasterCard Network Access and Brand Usage (NABU) Fee (Charged per Authorization and r$0.01195 $0.0195
per Refund)
Discover, Diners, & JCB Card Data Usage Fee $0.0195 1 $0.0195
Payment Brand -s — Access Fees.
feelrate established by the PaYMPW Brands . .ur convenience, the C01rent access fees1rates are set foilh bolow.
MC Acquiring License Fee* Charged on MasterCard Gross Sales volume. See
.004%
Additional information under Payment Brand Fees below.
•010%
MC Digital Enablement/Card Not Present Charged on MasterCard Card Not Present Gross Sales
Fee volume.
Discover, Diners, or JCB Network
Charged by Discover on all authorizations for card
$.0025
Authorization Fee
transactions that are settled through the Discover Network
Charged by MasterCard when a merchant uses the address
verification service to validate a cardholder address
$.01
MC Auth Access Fee — AVS Card Present
MC Auth Access Fee — AVS Card not present
$.01
Charged by MasterCard when an authorization is reversed
MC Auth Access Fee
or the authorization is provided by MasterCard if the card
$.005
issuer is not available
MC Card Validation Code 2 Fee
Charged by MasterCard when a merchant submits the Card
$,0025
Validation Code 2 (CVC2) in an authorization reauest
MC SecureCode Transaction Fee
Charged on MasterCard SecureCode transactions that are
$0.03
sent for verification
MC Account Status Fee - Intra -regional
Charged by MasterCard or Visa when a merchant uses this
$.025
MC Account Status Fee - Inter -regional
$.03
service to do an inquiry that a card number is valid
i Visa Zero $ Acct Verification Fee
$.025
MC Processing Integrity Fee
Charged when a card is authorized but not deposited and
the authorization is not reversed in a timely manner.
Pre Authorization
$.045
Final Authorization*
*the minimum fee amount for a Final Authorization is $.04
.250%
Visa Misuse of Authorization Fee
$.093
Visa Zero Floor Limit Fee
Charged when a transaction is deposited but never
$.20
authorized
Applies to Visa Debit and Prepaid transactions that do not
Visa Transaction Integrity Fee
meet qualification criteria for Custom Payment Service $.10
(CPS) categories.
MC Ineligible Chargeback Blocking Fee
Charged when a fraud related Chargeback is blocked by
$3.00
MasterCard.
MasterCard Cross Border Assessment Fee
.60%
Visa International Service Assessment Fee Charged by MasterCard, Visa, Discover, Diners and JCB on
.80%
Discover, Diners, & JCB foreign bank issued cards
80%
International Service Fee
MC International Support Fee .85%
Visa Interregional Acquiring Fee (IAF) .45%
(other MCC's) Additional fee charged by Visa, MasterCard, Discover,
Visa Interregional Acquiring Fee (IAF) Diners and JCB on foreign bank issued cards .90%
(high risk MCC's)
Discover, Diners, & JCB
50%
International Processing Fee
Visa Partial Auth Non -Participation Fee
Applies to Petroleum merchants using automated fuel
$•01
pumps that do not support Partial Authorization.
MC Global Wholesale Travel Transaction
Applies to Travel merchants for transactions qualifying at the
1.57%
Program 1326 Fee
MasterCard Commercial Business -to -Business interchange
Internal Paymentech Use Only. Rev 04/17
Paymentech Contract No.: 063576 Page 3 of 4 Date: April 14, 2017
Schedule A to Merchant Agreement Merchant Name: Invoice Cloud, Inc.
For Transactions for: City of Lodi
I category.
Visa Global 1326 Virtual Payment Service Applies to Travel merchants for transactions qualifying at the 1.55%
I Fee Visa Global 13213 Virtual Payments interchange category.
6. Periodic Fees
Visa Fixed Acquirer Network Fee - Visa Fixed Acquirer Network Fee is a monthly fee assessed by Visa per tax ID
based on Merchant Category Code (MCC), dollar volume, number of merchant locations, and whether the physical Visa Pass -Through
card is present or not present at the time of the transaction. This fee can vary monthly.
MasterCard Merchant Location Fee — MasterCard Merchant Location Fee of $1.25 will be applicable for each
month with $200.00 or more in MasterCard volume. This fee will be assessed annually in May based on the previous 12 $1.25
months activity.
Payment Brand Fees
A substantial amount of the fees that we charge for processing Transactions consists of charges that we must pay to the Payment
Brands and card issuing banks (or that are otherwise charged to us by the Payment Brands and card issuing banks) under the
Payment Brand Rules. These charges (collectively referred to in this Schedule A as "Payment Brand Fees") include, but are not
limited to, interchange, assessments, file transmission fees, processing fees, network access fees, and cross border fees. Whether a
particular Payment Brand Fee applies is based on several factors, like the type of Payment Instrument presented, specific
information contained within the Transaction, how and when the Transaction is processed, and the merchant's domicile and industry.
Please note that Paymentech, LLC ("Chase") may, from time to time, elect not to charge you for certain existing, new or increased
Payment Brand Fees. If we elect not to charge you, we still reserve the right to begin charging you for existing, new or increased
Payment Brand Fees at any time in the future, upon notice to you. No such Payment Brand Fees will be imposed retroactively.
Additional information about significant Payment Brand Fees (Interchange and Assessments), can be found at:
www.chaseoaymentech.comlinterchange and assessment underst_anding.htmi
*MasterCard assesses the MasterCard Acquiring License Fee annually to each Acquirer based on the total annual volume of
MasterCard -branded sales (excluding Maestro PIN debit volume) of its U.S. domiciled merchants. To fairly distribute the fee across
all Paymentech MasterCard -accepting merchants, a rate of .004% will be applied to all of your MasterCard gross sales transactions.
Amount due u on Termination
In addition to the other amounts due under this Agreement (including without limitation, the fees and charges described in this
Schedule A), you may owe an amount in the event you terminate this Agreement. Whether you will owe that amount, and how
much you will owe, will be determined in accordance with the terms of the Agreement, including, without limitation, the "Termination"
section.
Tier 1
First 1,000,000
1 —1,000,000
$.03
.05%
$.03
$.10
Tier 2
Next 9,000,000
1,000,001 — 10,000,000
$.02
.03%
$.02
$.05
Tier 3
Over 200,000
10,000,001 +
$.01
.02%
$.01
$.035
The above grid applies to Bank Card, Discover, and Diners transactions beginning as of the date of the first submission of Bank Card
Transactions to Paymentech and continues for the term of the Agreement. We agree to rebate fees only in the case where we fail to
reduce the transaction fee when Merchant's volume reaches the next grid level.
lniemal Paymentech Use Only: Rev 04/17
Pavmentech Contract No.: 063576 Page 4 of 4 Date: April 14, 2017
Pricing Schedule to Agreement
Electronic Check (eCheck)
CHASE Op I"
Paymentech
Merchant Name: Invoice Cloud, Inc.
For Transactions for: City of Lodi
Pricing Schedule to Agreement
Electronic Check (eCheck)
Electronic Check (eCheck) Assumptions
Annual eCheck Transactions
1. Common Transaction Types
36,000 , 1 Avg eCheck Transaction Amount 1 $302.00
eCheck Validation (Online Only) - This fee is assessed when using a 'Validate Only' action code
and when the transaction passes Validation. Validation includes format and data edit checks bank See Volume Schedule
routing number checks and comparison to Paymentech proprietary internal negative file. Note:
Validation also occurs with every deposit transaction in batch at no charge.
eCheck ACH Transaction — This fee is assessed for successfully deposited eCheck transactions See Volume Schedule
indicating the bank account has been successfully debited or credited.
eCheck Prenote Transaction — This fee is assessed when a prenote transaction is run which is a I See Volume Schedule
zero dollar transaction that determines whether the account number information is valid.
eCheck Redeposit Transaction — This fee is assessed when an ACH return occurs and the
merchant has authorized Paymentech to resubmit the item to the ACH network. Only transactions $.035
returned for insufficient or uncollected funds can be resubmitted.
eCheck ECP Deposit Check (Facsimile Draft) Deposit - Paper (Facsimile) Drafts are created
when a transaction is not eligible for ACH processing. The transaction is sent to the bank outside of $5.00
the ACH network.
eCheck Redeposit Paper Draft - This fee is assessed when a paper return occurs and the
merchant has authorized Paymentech to resubmit the item through the banking system (e.g. NSF $.04
Returns / Uncollected Funds).
2. Per Incidence Fees — charged every time your account incurs one of the below items
ACH Return/ACH Dishonored Return Processed/Represented - This fee is assessed every
time an item which has been presented for deposit into the ACH network is returned by the RDFI
(consumer bank) or when Paymentech dishonors a late return originally initiated from the RDFT.
eCheck Notification of Change — This fee is assessed when Paymentech receives a change
notice from RDFIs (consumer's bank) on bank format changes (Routing/Account Number). This
information is conveyed back to our clients as a NOC when an old or previous Routing/Account
Number is used. This is particularly important for clients who store consumer profiles.
Deposit Matching - This fee is assessed whenever a transaction that is submitted with old
routing/bank account information is updated by our NOC system with the corrected bank information.
The system updates are based on Notification of Changes that have been stored in our NOC
database.
Facsimile Draft Return/Dishonored Paper Return Processed/Represented - This fee is
assessed for those items which have been presented to the RDFI as Paper Drafts but have been
returned or when Paymentech dishonors a late return.
$.25
$.07
$.75
$.10
Internal Pawnentech Use Only: Rev 01/17
Paymentech Contract No: 063576 Page 1 of 2 Date: April 14, 2017
Pricing Schedule to Agreement
Electronic Check (eCheck)
For Transactions for: City of Lodi
3. Other.Fees -
Merchant Name: Invoice Cloud, Inc.
eCheck ACH Unauth Entry Fee - This is a mandatory pass through fee used to compensate the
issuing banks involved in processing all unauthorized returns through the ACH network; R05, R07, $4.50
R10, R29, R51. This fee is assessed to each unauthorized return received daily as set forth by the
ACH network and is a non-negotiable rate.
eCheck Annual Volume Schedule
Tier Level eCheck Volume Range Per Validation Per eCheck ACH / eCheck Prenote
Transaction Volume Transaction Transaction
®First 1,000,000 111 111 1 11 1�1
Next 9,000,11411"V_I I 1111141011im=1 1$.035
-
Over 10,000,000 10,000,001 + $.025
The above grid applies to ECP transactions beginning as of the date of the first submission of ECP Transactions to Paymentech and
continues for the term of the Agreement. We agree to rebate fees only in the case where we fail to reduce the transaction fee when
Submitter's volume reaches the next grid level.
ln€emal Paymentech Use Only,, Rev 01/17
Paymentech Contract No: 063576 Page 2 of 2 Date: April 14, 2017
CHASE CO -—Merchant Services • 4 Northeastern Soulevard, Salem, NH 03079.1952 • www.chasepaymentech.com •
Phone: (603) 896-6000 • Fax! (603) 896-8715 • Merchant_Services@GInasePaymentech.corn
Paymentech
Addendum to Application for Merchant Account with Chase Paymentech
New Division Request
Date: 4/14/17
Company ID#: 63576
Projected Live Date: 7/14/17
Company Legal Name: Invoice Cloud, Inc
Contact Name: Robert Lapides Phone #: 781-848-3733
Fax #: 877-256-8330 Email Address: blapides@invoicecioud.com
Transactions processed for this new set up request belong to:
Merchant whose company legal name is represented above...
OR
An Additional Company whose legal name is: City of Lodi
❑ partially owned 91 affiliate ❑ registered DBA or ❑ other
On behalf of Invoice Cloud Inc
(Company Legal Name)
Robert Lapides President, GUB Division
(Print Name) (Title)
verify that the account set-up information is accurate, that I have the authority to make such a request and
thus. it should be used to set up an additional account for our company.
and is a ❑ wholly-owned
of the merchant noted above.
1. Please be sure to include the information below for all employees who need to access Transaction History ana Kepon:
Center via Paymentech Online
2. Standard reporting consists of financial and chargeback activity reports; some reports may have fixed default levels.
3. Please note: You, the merchant, are responsible for advising Chase Paymentech of changes in Paymentech Online
contacts. Chase Paymentech assumes no responsibility or liability of any kind for Merchant's failure to advise Chase
Paymentech of changes to or elimination of Paymentech Online Users.
Please be sure to complete all fields below.
E Mr. ❑ Mrs. ❑ Ms. Name: Robert Lapides Title: President, GUB Division
Phone #: 781-848-3733 Fax #: 877-256-8330
Address: 30 Braintree Hill Office Park, Suite 303 City: Braintree
State/Prov: MA Zip/Postal Code: 02184 Country: USA
Email Address: blapides@invoicecloud.com
Does this User require access to: ❑ Transaction History ❑ Report Center 0 Both
Account Masking: ❑ First 6/Last 4 Z Last 4
Should this User's access mirror another Users access? ❑ Yes, provide User ID
Does this User have an existing User ID? ❑ Yes, provide User ID
Mr. 0 Mrs. ❑ Ms. Name: Martha Greer Title: SVP of Operations
Phone #: 781-848-3733 Fax #: 877-256-8330
Address: 30 Braintree Hill Office Park, Suite 303 City: Braintree
State/Prov: MA Zip/Postal Code: 02184 Country: USA -
Email Address: mgreer@invoicecloud.com
Does this User require access to: ❑ Transaction History ❑ Report Center F!] Both
Account Masking: ❑ First 6/Last 4 91 Last 4
Should this User's access mirror another Users access? ❑ Yes, provide User ID
Does this User have an existing User ID? ❑ Yes, provide User ID
• • • • • - o • • • ' o =6110MI V41 MISMIMMA•
Rev10/21/2015 i NewDivision/cboo
CHASE07' Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • wvaw.chasepaymentech.com •
Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com
Raymentech
Phone #: 781-353-2415 Fax #: bt t-1-5b-tsssu
Address: 30 Braintree Hill Office Park, Suite 303 City: Braintree
State/Prov: MA Zip/Postal Code: 02184 Country: USA
Email Address: bchestna@invoicecloud.com
Does this User require access to: EE Report Center ❑ None
Acco untMaskin7,. ❑ First 6/1-ast 4 R Last 4
Chargeback Contact: (required) MCA eMerchant Chargeback Analyst — one who works the chargebacks)
M RA ((Merchant Retrieval Analyst — one . works
NOTE: If no contact information is provided below MCAIMRA roles will be asst ned to the IQAIMRRA contact noted above
❑ Mr. ❑ Mrs. ❑ Ms. Name: Title:
Phone #: Fax #:
Address: City:
State/Prov: Zip/Postal Code: Country:
Email Address:
Does this User require access to: ❑ Report Center ❑ None
Account Masking: ❑ First 6/1-ast 4 ❑ Last 4
Section 4: Business Unit (if different from division name)
Parent Business Unit Parent Bus.Unit #
Name (if applicable): (up to 30 bytes) (if applicable):
Business Unit Name: City of Lodi (up to 30 bytes) Business Unit #:
Section 5: Existing Funds Transfer Instruction (FTIY (if new t�anktng see New Bank Account Information section)
If funds should be deposited to an existing funds transfer instruction please complete the following:
Will this division utilize an existing Funds Transfer Instruction # (FTI#)?
If yes, provide existing FTI #
(If FTI # is not provided a NEW Funds Transfer Instruction (FTI#) will be created)
Section• • •n (if new banking see New Bank Account Information
If funds should be deposited to an existing bank account but require a NEW Funds Transfer Instruction please
complete the following:
Will funds be deposited into an existing Bank Account already set up with Chase Paymentech?
If yes, provide existing Bank Account #
_(If existing Bank Account # is supplied the New Bank Account section does not need to be completed)
Rev10/21 /2015 2 NewDivision/cboo
CHASE Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com •
Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com
Paymentech
f- a,.,i ,t thnnh, .f Al"IAi Rank Accniint i.c re-rrurrPrl)
Check only one
of the 7 options
Settlement Currency in which we will Deposit complete all sections
fun• to you (Countryyour
below❑ tion #1 [f
USo USA A Only
Option #2 ❑
CAD CAN B1 and B
Option #3 ❑
USD CAN 62 and 63 D3 D4
Option #4 ❑
USD Int'I C1 to C3, D1. D3. D4
(list country funds are being deposited in
Option #5 ❑
❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑HKD, Euro Bank or SAME as C1 and/orQ-2 03
❑DKK, ❑CHF, ❑NOK, ❑SEK, ❑NZD, presentment/settlement currency
❑ZAR
Option # 6 ❑ ❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑HKD, If DIFFERENT than Settlement C1 andlor C2. C3, D1
❑DKK, ❑CHF, ❑NOK, ❑SEK, ❑NZD, Currency andlar D2. D4
❑ZAR, ❑USD Intl
list count funds are being deposited in
Option #7 ❑ ❑Euro, ❑GBP, ❑ JPY, ❑AUD, ❑HKD, CAN 61 to 63, D1. D4
❑DKK, ❑CHF, ❑NOK, ❑SEK, ❑NZD,
❑ZAR
Note: If this request relates to an account not held at JPMorgan Chase Bank, National Association or Chase Bank
LISA, National Association, please attach an original voided check (starter check and bank statements not
applicable) or a bank letter of verification In order to allow processing of this request.
Section A: U.S. Bank Account Information (Select Only One Method of Transfer)
Q ACH 1 2 1 1 0 11 14 1 4 1 1 (A13A #)
❑ Wire Transfer (See note below) (Fedwire #)
BIC/Swift Transfer (See note below) :7t(Swift Code: 8 to 11 characters)
Note: BIC/Swift code is required if your division is located outside of the U.S. or Canada and is settling funds in USD and will
be the method of transfer as a default.
Wire transfer requires both ACH ABA Routing # and Fedwire #.
Special Wire Instructions: (66 characters)
Bank Account #: 0010001301 Company Name: City of Lodi
(as appears on bank account)
Financial Institution Name: F & M Bank
City: Lodi State: CA Zip/Postal Code: 95240 Country: United States
2 Checking or ❑ Savings
CanadianSection B: . Only)
B1 Institution Number: EFT Branch Transit Number:
B2 BIC/Swift Code: (8 to 11 characters) (required if settlement is USD)
B3 Bank Account # Company Name:
(as appears on bank account)
Financial Institution Name:
City: Province: Postal Code: Country: Canada
❑ Checking or ❑ Savings
Rev1 0/21/2015 3 NewDivision/cboo
CHASE C/ Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com
Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com
Paymentech
Section C: International Final Destination Bank Account Information (Account Where the Funds are Deposited)
C1 BIC/Swift Code: (8 to 11 characters) I I I I I I I I—
C2 Sort Code: (Required in Great Britain Only) i
C3 IBAN/Bank Account #
(IBAN required for all Banking located in European Union Countries)
Company Name: (As appears on Bank account)
Financial Institution Name:
City: State/Province: Postal Code: Country:
Special Wire Instructions: (60 characters)
Section D: .. • ing/Clearing Account Information
(Foi InternationalDeposits going' • • •• not • only)
D1 BIC/Swift Code: (8 to 11 characters)
D2
Sort Code: (Required in Great Britain Only)
D3
Wire Transfer: (USA Only)
(Fedwire #)
D4 Financial Institution Name:
City: State/Province: Postal Code: _ Country:
Special Wire Instructions: (60 characters)
ProductsSection 8:
Please indicate if you will be using any of the following additional services. Please note that some of these services may require an
additional contract addendum, registration and/or information if you currently do not have the service. (For information on these services,
tease contact your Chase Pa mentech Relationship Manager
1. ❑ Account Updater (Visa, MasterCard and Discover for US and Canada Only, Visa and MasterCard for UK OON):
❑Submitting or ❑Extracting (if extracting Indicate # of Days: (1-180 days) (if Orbital Gateway default is Submitting)
Account Updater Visa EU Merchant ID required
2. ❑ MC/IM/SW SecureCode (aka UKDM)
3. ❑ MCID — MasterCard Assigned ID (6 digit numeric ID required)
4. ❑ Static AAV (Participation requires MD Secure. MasterCard Assigned ID and a MasterCard assigned 28 alpha/numeric code required)
5. ❑ Authorization Recycling Output Options: ❑ Total (recommended) ❑ Standard
# of recycle attempts: (Default is 3 if left blank) # of days between attempts: (Default is 3 if left blank)
TaxpayerSection 9: . .. for
Transaction Division's Taxpayer ID: 94-6000361 Legal Entity Name: Cay of Lodi
As shown on our income Tax Return re aired for Canadian divisions if jorocessino.Discover andlor Diners
Section1 • • • for •.
1099K Contact Name: -Andrew Keys Email address : akeys@lodi.gov
7-=
Contact to receive the 1099K mailing at the address supplied on the W-9, required with W -91s only
Section1: Transaction Division Informatioorapproval and transactionprocessing)
Transaction Division Name: City of Lodi -Utility
(This field is limited to 30 characters, including spaces)
Currency (list only 1 each per division) Settlement: US Presentment: US
*** If Cross Currency, please provide both the Presentment and the Settlement Currencies"*'
Division Location Street Address: 310 W. Elm St
(Must be a street address, P.O. Boxes not acceptable)
City: Lodi State/Province: CA
(City, State and Postal Code will be utilized for Retail transactions as the primary information on the customer's statement)
Zip/Postal Code: 95240 Country: USA
Rev10/21 /2015 4 NewDivision/cboo
CHASE CP Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com
Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com
Paymenteth
Section 10a: Transaction Division Information (ReqUlred for credit approval aiid trarisactiori Processing)
The following held appears on the customer's statement and identifies the merchant name for the consumer and credit card
organizations. To further aid consumer recognition, Visa has sanctioned that the full merchant legal name or the abbreviation
of the merchant name be utilized. The abbreviation must be separated from product information by an asterisk(*), which must
appear in the 4th, 8th or 13th position. The asterisk cannot be used for Retail Merchants.
Cardholder Descriptor (Forall card types with the exception of American Express):
C
1 i
1 t
y o
I f
L
1 o
1 d
i
Customer Service Phone # Customer Service Phone # Re uired for Mail Order, Recurring, and Retail):
2 1 0 1 9 1 - 1 3 1 3 3- A 1 7 1 1 1 7
URL URL is ❑ tional, if phone number is provided above):
Internet service providers and ecommerce merchants may utilize a URL instead of Customer Service Phone if not processing any Mail-
order transactions; URL must only be 13 characters and must contain the top level domain or suffix (example ".com").
ProductlService Description Enterproduct/service information; example: clothing, books, membership, etc.)
u t i l i t y
MCC Code (Provide MCC utilized for previous processing (this will be considered in conjunction with the product/service description):
Optional
Maximum Sales Transaction Amount $ 125,000.00
Avg. Transaction Price: $ $302.00
Maximum Refund Transaction Amount $ 25000.00
Avg. # Trans. Per Year: 72000 (Settled Only)
(Default $25,000 U.S. Dollars or equivalent international currency per transaction)
Projected Refund %: 5613 %
How will your customer
How do you market this
Please select the consumer's
Please check if
provide credit card information
product or service?
payment option for this
applicable:
when they order your product
(Select only those that apply)
division:
❑' Bill Payment
or service?
❑ Catalog
(Select only one)
A Bill Payment transaction is
(Select only one)
❑ Direct Mail
❑� Single payments
a transaction for an ongoing
cycle that is
Retail
� Internet
❑ Installment payments
known and agreed upon in
knoservice/billingnna
Mail Order
❑ Space Ad
❑ Deferred payments
advance by the merchant
(Marketing Material Required)
❑ Television
❑ Recurring payments
and cardholder.
■ Internet(transactions
❑ Outbound Telemarketing
managed by
(i.e. membership or
Insurance, etc.)
(Please complete Internet
El Other
merchant/submitter)
Transactions section)
Section1•Transactions
Please provide full website address: www.invoicecloud.com/Lodi
If Internet is selected and the website is not yet available to consumers, please complete a Marketing Material Supplement
form which you may obtain from Merchant Services or our Account Executive.
If Internet, please advise: Can a consumer place their Is the website secure (i.e., will the information that the
(Select those that apply) order and provide credit card consumer provides, such as their name and credit card
0 SSL info (or electronic check) via number, be encrypted) so that it can't be read or
❑ SET this website? intercepted by others?
❑ No encryption method 0 Yes or ❑ No EE Yes or ❑ No
' delivery of ...ds and services
Do you stock product? ❑ YesANo Do you fill your own merchandise orders? NYes El
Do you own the product at the time of sale? XYes ❑ No If no, who is your fulfillment service bureau?
Do you provide custom orders at time of sale? ❑ Yes 0 No
Do you drop ship the product? ❑ Yes Q No Fulfillment Contact:
If yes, what %: Phone #:
When will you charge your customer for an order?
❑ Bill Advanced ❑ Bill on Order 0 Bill after Shipment ❑ Bill Arrears ❑ Other:
Rev10/21/2015 5 NewDivision/cboo
CHASE O ' Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com •
PaymentechPhone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com
Please indicate if you will be using any of the following additional card types/methods of payment. Please note that some of these
services may require an additional contract amendment, pricing and/or information if you currently do not have the service.
For information on these services, lease contact ❑err Chase Pa mentech Relationsifi Maria er
❑O visa W MasterCard
(As a default Discover will be enabled except for those merchants that are retained by Discover, or do not have a company location
address in the United States. Discover Diners and JCB will be enabled whenever Visa and MC are enabled.)
❑ Discover Conveyed (US only]
Discover Service Establishment # (SE#) (15 bytes)
❑ Discover Canada (CAD only) ❑ Discover Diners Canada (CAD only) ❑ Visa Debit (CAD only)
❑ American Ex ress(conveyed)
American Express Service Establishment # (SE#) Li (10 bytes)
As a rule: (US SE should begin with "1-8", International SE should begin with a "9'; Canadian SE should begin with a "93", International
SE valid on some cross currency divisions dependent on presentment currency)
AMEX Parameter Information
Cardholder Descriptor, (Appears on your American Express cardholderstatement)(All other card types use descriptor in Section 5)
(20 bytes)
TAA #1: (22 bytes) TAA #2: (22 bytes)
TAA #3: (22 bytes) TAA #4: (22 bytes)
Do you support American Express Partial Authorization? How have you been classified as a merchant by American
(Please select one of the following options if applicable) Express? (Please select one of the following options if applicable)
❑ Auth and Balance Return ❑ Aggregator
❑ Partial Auth ❑ Petroleum
❑ Both ❑ Neither
❑. Electronic Check Processing Parameter (U.S. and CAD only)
Company Name:
C i ty o f L o d i
Item Description:
Preferred Delivery Method: (select only one)
How do you obtain authorization from consumers? (Select only one)
R Best Possible (U.S. only)
❑ Written consent (U.S. and Canada)
❑ Telephone (U.S. Only)
ACH/EFT U.S. and Canada
0 Internet (U.S. Only)
Redeposit Parameter: Indicate # of days: p The default is "1"
ECP Maximum Sale Transaction Amount: ECP Maximum Refund Transaction Amount:
If no amounts provided default will match Credit Card Transaction Amounts
❑ PlNiess ❑ei71t (Notappllcatrle for retail merchants
Please select the network vendors that you have approval from: NYCE ❑ STAR ❑ Pulse ❑ Accel ❑
❑ PIN Based Debit (Applicable to retail merchants on) Vl See PIN Based Debit attributes in section T mrinals 5oftwa and PIN Ba Debi
❑ giLCard (U.S. Currency Only, please see your Relationship Manager for further documentation requirements)
❑*Salem Front -End or ❑*"Tampa Front -End If Tampa Software or Equipment being utilized:
*Salem Front -End are transactions that are processed via a direct connection to Chase Paymentech or direct to Orbital Gateway
**Tampa Front -End are transactions that are processed via a Software or Terminal through our Paymentech Network Services platform
(If neither are selected setup will be determined based upon current processing method)
Rev10/21/2015 6 NewDivision/cboo
CHASE r/ Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com •
Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com
Paymentech
❑ Green Dot (U. S. only)
❑ JCB (For Yen only)
❑ International Maestro (Transaction type restrictions may apply below for eCommerce and Recurring transactions)
MC 5ecureCode (Required for IM eCommerce, and/or MCID and Static AAV)
MCID aka MasterCard Assigned ID (Required with Static AAV)
Static AAVIMARP (Required for IM Recurring MC Secure, MCID and a MasterCard assigned 28 alpha/numeric code required)
❑
European Direct Debit For EURO only: (Valid only for Euro currency divisions)
Descriptor I I I I(16 bytes)
Default will be the first 16 characters of your Cardholder Descriptor unless otherwise noted
Redeposit Parameter:
Creditor ID (Provide if existing):
Creditor ID will be provided by Chase Paymentech if not existing
❑ European Direct Debit For GBP only. (Valid only for GBP currency divisions)
Descriptor 1 (7 bytes)
Default will be the first 7 characters of your Cardholder Descriptor unless otherwise noted
Country : UK only
S.
Indicate # of days:
The default is "1"
Redeposit Parameter:
Indicate # of days: default is "I"
Payer Email Address:
Note: (Must be a unique email adclress belonging to the merchants business and must be working at the time of account creation. No two
accounts or divisions can share the same Payer email address.)
Customer Service Email Address:
Descriptor: P I A I Y I P A L* 18 bytes
Primary Contact Name:
Email Address:
Business Name:
(75 character limit and must not contain the following characters &, <, and >.)
Customer Service Phone#
Primary Sales Venue
❑ eBay
❑ Other Marketplace
❑ Other
❑ My Own Website
http:
Phone:
Avg Trans Price:
Avg TransNr:
Annual Revenue
(Percentage of annual revenue from online sales)
Authentication Method:
The method by which you (the merchant) will authenticate your customer with PayPal — you must
choose only one)
❑ PayPal Direct
❑ Cardinal Commerce Centinel (if Cardinal Commerce, complete the next section):
Cardinal Commerce
Are you using CommercialWare Software to facilitate vour Paypal Integration? Yes ❑
Time Zone (based on merchant's location): SSL Security: (select one) ❑ HTTP or ❑ HTTPS
Technical Contact Name: Phone:
Email Address:
Rev10/21/2015 7 NewDivision/cboo
CHASEMerchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com •
Paymenteeh Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com
1. Who will be submitting transactions to Chase Pa mentech?
N Merchant ❑ Other Co. Name: Invoice Cloud (i.e. fulfillment co. or ecommerce provider)
If known, please provide the Presenter ID # (PID): or Submitter # (SU):
2. Will this division utilize?
❑ PayPal/VeriSign
❑ CyberSource — ❑ CyberSource Initiated or ❑ Paymentech Initiated
3. NetConnect Batch and/or Online Authorization?
Will you use NetConnect Batch for connectivity? ❑ Yes
Will you use NetConnect Online Authorization for connectivity? ❑ Yes
NetConnect Contact Name: _ Phone #:
NetConnect Email Address: User ID:
!f exisin
4. Will you be using the Orbital Payment Gateway?
Primary Contact: Tony Cordova
Address. 642 E Washington St. City: Brownsville
State: TX Zip/Postal Code: 78520 Country: USA
Phone #: 956-542-6825 Email (required): tcordova@invoicecloud.com
Primary contact must be a contact at this company for security purposes
Primary Contact Level of access: ❑ *Merchant or ❑ **Chain (default is Merchant)
*Merchant level – only permitted divisions are available. **Chain level - every new division created will automatically be available
Auto -Settle Time: none AM/PM Merchant Time Zone: VT Import
(If blank, default will be no auto -settle time) Functionality?
To meet 10 p.m. EST Host window, this should be set no later Note: The auto -settle time is based in the ❑ Yes
than 8 p.m. to allow Gateway to settle. I merchants time zone. (U.S. time zones only)
Profile Management required? ❑ Yes Level of access required: (default is merchant level)
Level of access: ❑ *Merchant or ❑ **Chain (default is Merchant)
*Merchant level – only requested divisions are available. **Chain level - every new division created will automatically be available
Auth Recycling? ❑ Yes If Yes, # of recycle attempts: # of days between attempts:
(Default is 1, maximum of 4) (Default is 3, maximum of 4)
Hosted PayPage (HPP)? ❑ Yes
HPP Contact Name: Profile Manacle required
required
Address: City:
State: Zip/Postal Code: Country:
Phone #: Email (required):
5. Will you be using the iTerminal? (U.S Retail divisions onl _—
Primary Contact:
Address: City:
State: Zip/Postal Code: Country:
Phone #: Email: (required)
Primary contact must be a contact at this company for security purposes
Primary Contact Level of access: ❑ *Merchant or ❑ **Chain (default is Merchant)
*Merchant level – only requested divisions are available. **Chain level - every new division created will automatically be available
Auto -Settle Time: AM/PM Merchant Time Zone: .
(If blank, default will be no auto -settle time) Note: The auto -settle time is bases in the merchants time zone.
To meet 10 p.m. EST Host window, this should be set no later than (U.S. time zones only)
8 p.m. to allow Gateway to settle.
Maatek Reader needed? ❑ Yes (if Yes, Magtek Readers are purchase only, see Shhoping Details if required)
Rev10/21/2015 8 New Division/cboo
CHASE C o
Paymentech
Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com •
Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant—Services@ChasePaymentech.com
Section 13: Terminal, Software and Pin Based Debit
1. Point -of -Sale Software:
POS Software Name:
Capture Type: Communication Method: NetConnect Only:
(select only one) (select only one) Where is software hosted/configured?
❑ Host Capture ❑ Dial Dial Out Prefix (9,8, etc): (select only one)
❑ Terminal Capture ❑ VPN/Frame ❑ Corporate Location
(Default is Host where applicable) ❑ NetConnect (If NetConnect, see next sections) ❑ Division Location
NetConnect Only: Contact Name: Phone #:
Email Address:
2. 1= ui ment[Terminals Information: (Retail)
Purchase/Rental Options:
Capture Type:
Communication Method:
(select only one — see Shippinq Details if required)
(select only one)
(select only one)
❑ Purchase (U.S. Only)
❑ Host Capture
❑ Dial Dial Out Prefix (9,8, etc):
❑ Rental (U.S. and Canada Only)
❑ Terminal Capture
❑ Wireless ESN/MAN #
F-1 Use existing equipment
Default is Host where applicable)
( libl)
(ESN or MAN numbers needed for programming
of existing wireless equipment)
❑ NetConnect (Please see next section
If purchase or rental, date needed by:
Terminal quantity? Terminal/Equipment Type:
for required NetConnect Contact Information)
NetConnect Only: Contact Name: Phone #:
Email Address:
if Chase Mobile Checkout required please re uest a Chase Mobile Checkout Transaction and Re ort Access Form
3. PIN Pad: (Retail)
PIN Pad Type and quantity? (for P/N Debit Only) Quantity:
Injection - Will you be using the Chase Paymentech Encryption Key ❑ or you do own your own Encryption Key? C]
Who will be injecting the Encryption Key into your PIN Pad? (select only one — see Shipping Details if required)
❑ Chase Paymentech Solutions ❑ Other -- Vendor Name:
4. PIN Debit: (Applicable to retail merchants only)
PIN Debit requires a PIN Pad - please complete PIN Pad section if applicable
If checked above, this division will be setup for the following network vendors with the exception of EBT:
(Pulse, NYCE, STAR, Interlink, Maestro, ACCEL, Alaska Options, Jeanie, AFFN, and CU24)
EBT required? ❑ Yes FCS #: (required if processing food stamp transactions)
5. Shipping Details: Equipment/Kits/PIN Pads/ Imprinters Ship To Address (if different from division location)
Attention to:
Please ensure a ship to contact will be available to accept shipment (Default will be store manager)
Ship to Address:
City: State/Prov: Zip/Postal Code: Country: -
Ship to contact's phone #: Ship to contact's email:
6. Kits and Imprirlters: (Additional charges may apply)
Do you require a "Re -Program" Kit? ❑ Yes Do you require a Welcome Kit? ❑ Yes
(Overlay, Quick Reference Guide, etc.) (includes sales drafts, credit drafts, etc)
Do you require an Imprinter Plate? ❑ Yes Do you require an Imprinter? ❑ Yes
Type of Imprinter required: ❑ With Dater ❑ Without Dater
Rev10/21/2015 9 New Division/cboo
CHASE! 1 _' Merchant Services • 4 Northeastern Boulevard, Salem, NH 03079-1952 • www.chasepaymentech.com •
Paymentech Phone: (603) 896-6000 • Fax: (603) 896-8715 • Merchant_Services@ChasePaymentech.com
I, Andrew Keys Deputy City Manager represent and
(Print Name) (Title)"
warrant: (a) I am duly authorized by Merchant to submit the information provided herein and execute this
document on behalf of Merchant; (b) I am duly authorized to provide the banking information set forth herein for
the purposes outlined, including the transfer of funds; (c) I am duly authorized to grant access to the information
contained and outlined herein to all contacts listed throughout the document; and (d) all information provided
herein on behalf of Merchant is true and accurate.
Signer's name must appear as Executive Contact or Financial Contact outlined herein.
Signature Date
Wimichy AWWWY
ATTEST:
IVNNIFER FERRAIOLO
'City Clerk
Rev10/21/2015 10 New Division/cboo
Form W-9 (Rev. 12-2014)
Note. If you are a U.S. person and a requester qKw you a form other than Form
W-9 to request your TIN, you must use the requester's form if it is substantially
similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are considered a U.S.
person if you are:
• An individual who is a U.S, citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or organized in the
United States or under the laws of the United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in
the United States are generally required to pay a withholding tax under section
1446 on any foreign partners' share of effectively connected taxable Income from
such business. Further, In certain cases where a Form W-9 has not been received,
the rules under section 1446 require a partnership to presume that a partner is a
foreign person, and pay the sectlon 1446 withholding tax. Therefore, if you are a
U.S. person that Is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your U.S. status
and avoid section 1446 wkhhokling on your share of partnership Income.
In the cases below, the following person must give Form W-9 to the partnership
for purposes of establishing its U.S, status and avoiding withholding on its
allocable share of net income from the partnership conducting a trade or business
in the United States:
• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the
disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally,
the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and
- In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a
grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a foreign bank
that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use
the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax
on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a nonresident
alien Individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on
certain types of income. However, most tax treaties contain a provision known as
a "saving clause." Exceptions specified in the saving clause may permit an
exemption from tax to continue for certain types of income even after the payee
has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception contained in the
saving clause of a tax treaty to claim an exemption from U.S. tax on certaln types
of income, you must attach a statement to Form W-9 that specffles the following
five items:
1. The treaty country. Generally, this must be the same treaty under which you
claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the saving
clause and its exceptions.
4. The type and amount of income that qualifies for the exemption from tax.
5. Sufficient facts to justify the exemption from tax under the terms of the treaty
article.
Example. Article 20 of the U.S.-China income lax treaty allows an exemption
from tax for scholarship Income received by a Chinese student temporarily present
In the United States. Under U.S. law, this student will become a resident alien for
tax purposes if his or her stay In the United States exceeds 5 calendar years.
However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30,
1984) allows the provisions of Article 20 to continue to apply even after the
Chinese student becomes a resident alien of the United States. A Chinese student
who qualifies for this exception (under paragraph 2 of the first protocol) and is
relying on this exception to claim an exemption from tax on his or her scholarship
or fellowship Income would attach to Form W-9 a statement that includes the
information described above to support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certaln payments to you must
under certain conditions withhold and pay to the IRS 28% of such payments. This
Is called "backup withholding." Payments that may be subject to backup
withholding Include interest, tax-exempt interest, dividends, broker and barter
exchange transactions, rents, royalties, nonemployee pay, payments made In
settlement of payment card and third party network transactions, and certain
payments from fishing boat operators. Real estate transactions are not subject to
backup withholding.
You will not be subject to backup withholding on payments you receive if you
give the requester your correct TIN, make the proper certifications, and report all
your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Pan II instructions on page
3 for details),
Page 2
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding because you did
not report all your interest and dividends on your tax return (for reportable interest
and dividends only), or
5. You do not certify to the requester that you are not subject to backup
withholding under 4 above (for reportable interest and dividend accounts opened
after 1983 only).
Certain payees and payments are exempt from backup withholding. See Exempt
payee code on page 3 and the separate Instructions for the Requester of Form
W-9 for more information.
Also see Special rules for partnerships above.
What is FATCA reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign
financial institution to report all United States account holders that are specified
United States persons. Certain payees are exempt from FATCA reporting. See
Exemption from FATCA reporting code on page 3 and the Instructions for the
Requester of Form W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you claimed to be
an exempt payee if you are no longer an exempt payee and anticipate receliving
reportable payments in the future from this person. For example, you may need to
provide updated information if you are a C corporation that elects to be an S
corporation, or if you no longer are tax exempt. In addition, you must furnish a new
Form W-9 if the name or TIN changes for the account; for example, if the grantor
of a grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are
subject to a penalty of $50 for each such failure unless your failure is due to
reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you make a
false statement with no reasonable basis that results in no backup withholding,
you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying certifications or
affirmations may subject you to criminal penalties including fines and/or
imprisonment.
Misuse of TINs. If the requester discloses or uses TINS in violation of federal law,
the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line blank. The
name should match the name on your tax return.
If this Form W-9 is for a joint account, list first, and then circle, the name of the
person or entity whose number you entered in Pan I of Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If you have
changed your last name without informing the Social Security Administration (SSA)
of the name change, enter your first name, the last name as shown on your social
security card, and your new last name.
Note. ITIN applicant: Enter your individual name as it was entered on your Form
W-7 application, line 1 a. This should also be the same as the name you entered on
the Form 1040/1040A/1040EZ you filed with your application.
b. Sole proprietor or single -member LLC. Enter your individual name as
shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade,
or "doing business as" (DBA) name on line 2.
c. Partnership, LLC that is not a single -member LLC, C Corporation, or S
Corporation. Enter the entity's name as shown on the entity's tax return on line 1
and any business, trade, or DBA name on line 2.
d. Other entities. Enter your name as shown on required U.S. federal tax
documents on line 1. This name should match the name shown on the charter or
other legal document creating the entity. You may enter any business, trade, or
DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
disregarded as an entity separate from its owner is treated as a "disregarded
entity." See Regulations section 301.7701-2(c)(2)(IID. Enter the owner's name on
line 1. The name of the entity entered on line 1 should never be a disregarded
entity. The name on line 1 should be the name shown on the income tax return on
which the income should be reported. For example, if a foreign LLC that is treated
as a disregarded entity for U.S. federal tax purposes has a single owner that is a
U.S. person, the U,S. owner's name is required to be provided on line 1. If the
direct owner of the entity is also a disregarded entity, enter the first owner that is
not disregarded for federal tax purposes. Enter the disregarded entity's name on
line 2, "Business name/disregarded entity name." If the owner of the disregarded
entity is a foreign person, the owner must complete an appropriate Form W-8
instead of a Form W-9. This is the case even If the foreign person has a U.S. TIN.
iForm W-9 (Rev. 12-2014)
Line 2
If you have a business name, trade name, DBA name, or disregarded entity name,
you may enter it on line 2.
Line 3
Check the appropriate box in line 3 for the U.S. federal tax classification of the
person whose name is entered on line 1. Check only one box in line 3.
Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a
partnership for U.S. federal tax purposes, check the "Limited Liability Company"
box and enter "P" in the space provided. If the LLC has filed Form 8832 or 2553 to
be taxed as a corporation, check the "Limited Liability Company" box and in the
space provided enter "C" for C Corporation or "5" For $ corporation. If it is a
single -member LLC that is a disregarded entity, do not check the "Limited Liability
Company" box; instead check the first box in line 3 "Individual/sole proprietor or
single -member LLC."
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting, enter in the
appropriate space in line 4 any code(s) that may apply to you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from backup
withholding.
• Except as provided below, corporations are exempt from backup withholding
for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments made in
settlement of payment card or third party network transactions.
• Corporations are not exempt from backup withholding with respect to attorneys'
fees or gross proceeds paid to attorneys, and corporations that provide medical or
health care services are not exempt with respect to payments reportable on Form
1099-MISC.
The following codes identify payees that are exempt from backup withholding.
Enter the appropriate code in the space in line 4.
1—An organization exempt from tax under section 501(a), any IRA, or a
custodial account under section 403(b)(7) if the account satisfies the requirements
of section 401(f)(2)
2—The United States or any of its agencies or instrumentalities
3—A state, the District of Columbia, a U.S. commonwealth or possession, or
any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies, or
instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the United
States, the District of Columbia, or a U.S. commonwealth or possession
7—A futures commission merchant registered with the Commodity Futures
Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the Investment
Company Act of 1940
10—A common trust fund operated by a bank under section 584(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from tax under section 664 or described in section 4947
The following chart shows types of payments that may be exempt from backup
withholding. The chart applies to the exempt payees listed above, 1 through 13.
IF the payment is for ...
THEN the payment is exempt for...
Interest and dividend payments
All exempt payees except
for 7
Broker transactions
Exempt payees 1 through 4 and 6
through 11 and all C corporations. S
corporations must not enter an exempt
payee code because they are exempt
only for sales of noncovered securities
acquired prior to 2012.
Barter exchange transactions and
Exempt payees 1 through 4
patronage dividends
Payments over $600 required to be
Generally, exempt payees
reported and direct sales over $5,0001
1 through 52
Payments made in settlement of
Exempt payees 1 through 4
payment card or third party network
transactions
1 See Form 1099-MISC, Miscellaneous Income, and its instructions.
Page 3
2 However, the following payments made to a corporation and reportable on Form
1099-MISC are not exempt from backup withholding: medical and health care
payments, attorneys' fees, gross proceeds paid to an attorney reportable under
section 6045(f), and payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify payees
that are exempt from reporting under FATCA. These codes apply to persons
submitting this form for accounts maintained outside of the United States by
certain foreign financial institutions. Therefore, if you are only submitting this form
for an account you hold in the United States, you may leave this field blank.
Consult with the person requesting this form if you are uncertain if the financial
institution is subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with "Not Applicable" (or any
similar indication) written or printed on the line for a FATCA exemption code.
A—An organization exempt from tax under section 501(a) or any individual
retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a U.S. commonwealth or possession, or
any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or more
established securities markets, as described in Regulations section
1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated group as a
corporation described in Regulations section 1.1472-1(c)(1)(i)
F—A dealer in securities, commodities, or derivative financial instruments
(including notional principal contracts, futures, forwards, and options) that is
registered as such under the laws of the United States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an entity
registered at all times during the tax year under the Investment Company Act of
1940
I—A common trust fund as defined in section 584(a)
J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
Note. You may wish to consult with the financial institution requesting this form to
determine whether the FATCA code and/or exempt payee code should be
completed.
Line 5
Enter your address (number, street, and apartment or suite number). This is where
the requester of this Form W-9 will mail your information returns.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and you do not
have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer
identification number (ITIN). Enter it in the social security number box. If you do not
have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter either your SSN
or EIN. However, the IRS prefers that you use your SSN.
If you are a single -member LLC that is disregarded as an entity separate from its
owner (see Limited Liability Company (LLC) on this page), enter the owner's SSN
(or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC
is classified as a corporation or partnership, enter the entity's EIN.
Note. See the chart on page 4 for further clarification of name and TIN
combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
for an SSN, get Form SS -5, Application for a Social Security Card, from your local
SSA office or get this form online at www,ssa.gov. You may also get this form by
calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
Identification Number, to apply for an ITIN, or Form SS -4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN online by
accessing the IRS website at www.irs.gov/businesses and clicking on Employer
Identification Number (EIN) under Starting a Business. You can get Forms W-7 and
SS -4 from the IRS by visiting IRS.gov or by calling 1 -800 -TAX -FORM
(1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN
and write "Applied For" in the space for the TIN, sign and date the form, and give it
to the requester. For interest and dividend payments, and certain payments made
with respect to readily tradable instruments, generally you will have 60 days to get
a TIN and give it to the requester before you are subject to backup withholding on
payments. The 60 -day rule does not apply to other types of payments. You will be
subject to backup withholding on all such payments until you provide your TIN to
the requester.
Note. Entering "Applied For" means that you have already applied for a TIN or that
you intend to apply for one soon.
Caution: A disregarded U.S, entity that has a foreign owner must use the
appropriate Form W-8.
Form W-9 (Rev. 12-2014)
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or resident alien,
sign Form W-9. You may be requested to sign by the withholding agent even if
items 1, 4, or 5 below indicate otherwise.
For a joint account, only the person whose TIN is shown in Part I should sign
(when required). In the case of a disregarded entity, the person identified on line 1
must sign. Exempt payees, see Exempt payee code earlier.
Signature requirements. Complete the certification as indicated in items 1
through 5 below.
1. Interest, dividend, and barter exchange accounts opened before 1984
and broker accounts considered active during 1983. You must give your
correct TIN, but you do not have to sign the certification.
2. Interest, dividend, broker, and barter exchange accounts opened after
1983 and broker accounts considered inactive during 1983. You must sign the
certification or backup withholding will apply. If you are subject to backup
withholding and you are merely providing your correct TIN to the requester, you
must cross out item 2 in the certification before signing the form.
3. Real estate transactions. You must sign the certification. You may cross out
item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not have to sign
the certification unless you have been notified that you have previously given an
incorrect TIN. "Other payments" include payments made in the course of the
requester's trade or business for rents, royalties, goods (other than bills for
merchandise), medical and health care services (including payments to
corporations), payments to a nonemployee for services, payments made in
settlement of payment card and third parry network transactions, payments to
certain fishing boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of secured
property, cancellation of debt, qualified tuition program payments (under
section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct TIN, but you
do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
Give name and SSN of:
1. Individual
The individual
2. Two or more individuals Qoint
The actual owner of the account or,
account)
if combined funds, the first
individual on the account'
3. Custodian account of a minor
The minor'
(Uniform Gift to Minors Act)
4. a. The usual revocable savings
The grantor -trustee'
trust (grantor is also trustee)
b. So-called trust account that is
The actual owner'
not a legal or valid trust under
state law
5. Sole proprietorship or disregarded
The owner'
entity owned by an individual
6. Grantor trust filing under Optional
The grantor'
Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)(i)
(A))
For this type of account:
Give name and EIN of:
7. Disregarded entity not owned by an
The owner
individual
8. A valid trust, estate, or pension trust
Legal entity'
9. Corporation or LLC electing
The corporation
corporate status on Form 8832 or
Form 2553
10. Association, club, religious,
The organization
charitable, educational, or other tax-
exempt organization
11. Partnership or multi -member LLC
The partnership
12. A broker or registered nominee
The broker or nominee
13. Account with the Department of
The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
14. Grantor trust filing under the Form
The trust
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(1)
(8))
' List first and circle the name of the person whose number you furnish. If only one person on a
joint account has an SSN, that person's number must be furnished.
2 Circle the minor's name and furnish the minor's SSN.
Page 4
3 You must show your individual name and you may also enter your business or DBA name on
the "Business name/disregarded entity" name line. You may use either your SSN or EIN (If you
have one), but the IRS encourages you to use your SSN.
4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the
personal representative or trustee unless the legal entity itself is not designated in the account
title.) Also see Special rules for partnerships on page 2.
"Note. Grantor also must provide a Form W-9 to trustee of trust.
Note. If no name is circled when more than one name is listed, the number will be
considered to be that of the first name listed.
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal information such as your
name, SSN, or other identifying information, without your permission, to commit
fraud or other crimes. An identity thief may use your SSN to get a job or may file a
tax return using your SSN to receive a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a notice from
the IRS, respond right away to the name and phone number printed on the IRS
notice or letter.
If your tax records are not currently affected by identity theft but you think you
are at risk due to a lost or stolen purse or wallet, questionable credit card activity
or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
Form 14039.
For more information, see Publication 4535, Identity Theft Prevention and Victim
Assistance.
Victims of identity theft who are experiencing economic harm or a system
problem, or are seeking help in resolving tax problems that have not been resolved
through normal channels, may be eligible for Taxpayer Advocate Service (TAS)
assistance. You can reach TAS by calling the TAS toll-free case intake line at
1-877-777-4778 orTTY/TDD 1-800-829-4059.
Protect yourself from suspicious emails or phishing schemes. Phishing is the
creation and use of email and websites designed to mimic legitimate business
emails and websites. The most common act is sending an email to a user falsely
claiming to be an established legitimate enterprise in an attempt to scam the user
into surrendering private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does
not request personal detailed information through email or ask taxpayers for the
PIN numbers, passwords, or similar secret access information for their credit card,
bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS, forward this
message to phishing®irs.gov. You may also report misuse of the IRS name, logo,
or other IRS property to the Treasury Inspector General for Tax Administration
(TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal
Trade Commission at: spam@uce.gov or contact them at www.ftc.gov/idtheft or
1-877-IDTHEFT (1-877-438-4338).
Visit IRS.gov to learn more about identity theft and how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct
TIN to persons (including federal agencies) who are required to file information
returns with the IRS to report interest, dividends, or certain other income paid to
you; mortgage interest you paid; the acquisition or abandonment of secured
property; the cancellation of debt; or contributions you made to an IRA, Archer
MSA, or HSA. The person collecting this form uses the information on the form to
file information returns with the IRS, reporting the above information. Routine uses
of this information include giving it to the Department of Justice for civil and
criminal litigation and to cities, states, the District of Columbia, and U.S.
commonwealths and possessions for use in administering their laws. The
information also may be disclosed to other countries under a treaty, to federal and
state agencies to enforce civil and criminal laws, or to federal law enforcement and
intelligence agencies to combat terrorism. You must provide your TIN whether or
not you are required to file a tax return. Under section 3406, payers must generally
withhold a percentage of taxable interest, dividend, and certain other payments to
a payee who does not give a TIN to the payer. Certain penalties may also apply for
providing false or fraudulent information.
CHASEIN STM Government Owned Addendum
Paymentech (Municipal Utilities, Municipalities, Gov't Agencies)
Rev. GOV 08/2018
This Addendum supplements the Merchant Application And/or Agreement executed and submitted by
City of Lodi (Merchant Legal Name - "Merchant"). As such, this Addendum shall (i)
be deemed incorporated into and a part of Merchant's Application to establish a Merchant account with
Paymentech, LLC and JPMorgan Chase Bank, N.A. and (ii) in accordance with such Merchant Application
and Agreement, constitute a part of the entire Agreement governing all Merchant accounts.
FUNCTION
Merchant is a Government Entity. Function of Merchant.
Utility
Authorized Purpose of Government Entity?
Utility
Government Website URL
www.lodi.gov
Authorized Representative
I, the undersigned, certify:
• that I am an officer or other authorized representative of
the Merchant ("Authorized Representative") and
• that I am duly authorized to enter into agreements on
behalf of Merchant and to legally bind Merchant to such
agreements.
• that I am duly authorized to submit this Addendum and
all information contained herein on behalf of the
Merchant.
Authorized Representative:
By submitting this Addendum, Merchant, through the
undersigned Authorized Representative
• represents and warrants that the person submitting this
Addendum is duly authorized to enter into agreements
on behalf of Merchant and to legally bind Merchant to
such agreements.
• represents and warrants that all information contained
within this Addendum is true, complete and not
misleading.
Andrew Keys
X WSOPDI-)
Signature Print Name Date
Ap md ISM !D &M = '-i(-
r+
Debut Clry ►tt"Y
Page 1 of 1
ATTEST:
4ityNIFER . FERRAIOLO
Clerk
Fiservdnvoice Cloud Needs Analysis
Biller/Company Name
Payment Types (utilities, insurance,
Effective Date
City of Lodi
cable, taxes, etc)
4/14/17
Utilities
debit of reversals
BILLER CONTACT INFO:
Name
Title
Phone/email
Andrew Keys
Deputy City Manager
akeys@lodi.gov, 209-333-6700
Remittance Addresses (Asterisk* Denotes Default Remittance Address - address if paper check is
mailed)
Remit Center Address
*310 W. Elm St
Biller Names (Any name or DBA printed on your remittance coupons)
City of Lodi -Utilities
City of Lodi -Water & Sewer
City of Lodi -Water
City of Lodi -Sewer
City of Lodi -Sewer & Water
— A
k—,\,
Reversals will go thru Invoice Cloud as data file with debit to merchant DDA
Bank Settlement Info
Bank Name
Routing #
Account #
— for settlement and
— A
k—,\,
MC)\w�
debit of reversals
, -_�
Account Number Information
How many characters are in each account number?
Are account numbers: 4 Numeric ❑ Alpha -numeric
Please list all of the acceptable account masks (i.e. ###, ##-#, ###.#) :
Does anything need to be removed from the account number fe.g. dashes spaces, etc...)—? Yes No
If yes, please explain
Does the account number have logic associated with it to help in identifying products, locations, etc...? ❑Yes ❑No
If yes, please explain
Is the account number clearly and completely visible to the customer on the bill? []Yes [:]No
Are there edit or mod checks associated with the account number? ❑Yes ❑No
If yes, please attach a copy of the mod calculation.
Are the account numbers static or do they change frequently? ❑Yes [:]No
If they change, what action can make it change?
Fisery/Invoice Cloud Needs Analysis
Invoice Cloud assigned Company ID: _
Map ID and Posting ID will be assigned by Fisery and provided via email
Business Owner/Contact name:
Private or Publicly held?
If Public, ticker symbol:
Traded on NASDAQ OR NYSE:
Web Address:
CITY COUNCIL
DOUG KUEHNE, Mayor
ALAN NAKANISHI,
Mayor Pro Tempore
MARK CHANDLER
BOB JOHNSON
JOANNE MOUNCE
June 21, 2017
CITY OF LODI
MasterCard International Incorporated
2200 MasterCard Boulevard
O'Fallon, MO 63368-7263
CITY HALL, 221 WEST PINE STREET
P.O. BOX 3006
LODI, CALIFORNIA 95241-1910
(209) 333-6702 / FAX (209) 333-6807
www.lodi.gov_ eitvalerk0,Iodi.aov
Attention: RPPS Business Implementations
STEPHEN SCHWABAUER
City Manager
JENNIFER M. FERRAIOLO
City Clerk
JANICE D. MAGDICH
City Attorney
Effective immediately, MasterCard is authorized by this letter to initiate ACH debit entries to be issued by the MasterCard
Settlement Bank, currently JP Morgan Chase Bank, from time to time against the account noted below. We hereby confirm
that all debits associated with such ACH debit entries will be honored and will be final when made, and no entry shall be
reversed without written consent of both MasterCard and ourselves. Our signatures below represent that we are authorized
to provide these instructions to you and you are authorized to rely on these instructions.
We understand that written notice of revocation of this authorization must be sent to MasterCard International Incorporated.
ICA Number:
012363
Routing and Transit Number:
121108441
Account Number:
0010001301
Name of Financial Institution:
F & M BANK
Address Line #1:
121 W. Pine St
Address Line #2:
CA
City:
Lod
State:
CA
ZIP Code:
95240
Sincerely,
Biller's Organization
City of Lodi
Biller's Contact Name:
Andrew Keys
Biller's Address #1:
310 W. Elm St
Biller's Address #2:
City:
Lodi
State:
CA
ZIP Code:
95240
Biller's Phone Number:
209-333-6700
Biller's Signature:
MasterCard Confidential and Proprietary
07/13/10: ACH Debit Authorization Letter
RESOLUTION NO. 2020-249
A RESOLUTION OF THE LODI CITY COUNCIL AUTHORIZING THE CITY MANAGER
TO EXECUTE AMENDMENT NO. 1 TO THE PROFESSIONAL SERVICES
AGREEMENT FOR ONLINE, MOBILE, AND INTERACTIVE VOICE RESPONSE
UTILITY SERVICES WITH INVOICE CLOUD, OF BRAINTREE, MASSACHUSETTS,
THEREBY EXPANDING THE SCOPE OF SERVICES, EXTENDING THE TERM, AND
INCREASING THE ESTIMATED AUTHORIZED AMOUNT
WHEREAS, the City processes and collects all payments for utilities, parking permits,
general invoices, reconnection fees, and deposits; and
WHEREAS, Invoice Cloud is our current provider for online, mobile, and
interactive voice response services; and
WHEREAS, Invoice Cloud is compatible with the City's current software system to
process payments; and
WHEREAS, staff recommends that the City Council authorize the City Manager to
execute Amendment No. 1 to the Professional Services Agreement with Invoice Cloud to add
additional services to meet other payment types that cannot currently be paid online, extend the
term of the agreement to May 31, 2023, and increase the estimated authorized contract amount
to $1,155,600 payable over the next three years.
NOW, THEREFORE, BE IT RESOLVED that the Lodi City Council does hereby
authorize the City Manager to execute Amendment No. 1 to the Professional Services
Agreement with Invoice Cloud, of Braintree, Massachusetts, for online, mobile, and interactive
voice response utility services, thereby expanding the scope of services, extending the term of
the agreement to May 31, 2023, and increasing the estimated authorized amount to $1,155,600
payable over three years, with the actual cost based on the number of transactions; and
BE IT FURTHER RESOLVED, pursuant to Section 6.3q of the City Council Protocol
Manual (Res. No. 2019-223), the City Attorney is hereby authorized to make minor revisions to
the above -referenced document(s) that do not alter the compensation or term, and to make
clerical corrections as necessary.
Dated: November 4, 2020
I hereby certify that Resolution No. 2020-249 was passed and adopted by the City
Council of the City of Lodi in a regular meeting held November 4, 2020, by the following vote:
AYES: COUNCIL MEMBERS — Chandler, Nakanishi, and Mayor Kuehne
NOES: COUNCIL MEMBERS — None
ABSENT: COUNCIL MEMBERS — Mounce
ABSTAIN: COUNCIL MEMBERS — None
(JENNIFER CUSMIR
City Clerk
2020-249