HomeMy WebLinkAboutAgreement A-20-034 with Automated Merchant Solutions Inc..pdfAgreement No . 20-034
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1\.!lERCHANT
SYSTEMS
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1['11'"rtl Merrick Bank
135 Crossways Park Drive North, Suite A, Woodbury, NY 11797 I (800)267-2256
Experts in Electronic Payments MERCHANT PROCESSING AGREEMENT
ASSOCIATE:
Corporate/ Legal Name:
County of Fresno
Address (Physical Location):
2281 Tulare Street, Room 302
City:
Fresno
Business Phone#:
(559) 600-3471
TYPE OF BUSINESS:
APPLICATION AND FEE SCHEDULE
A Registered Service Provider of Merrick Bank Corporation ("Merrick")
ACCOUNT REP: Nancy Murphy 1030
Mailing Address :
2281 Tulare Slreet, Room 302
State: Zip: City: State: Zip:
CA 93721 Fresno CA 93721
Fax#: Website Address:
(559) 600-1484 www.co .fresno .ea.us/departments/recorder
Countv Government CHAIN MERCHANT 181 YES •NO
NUMBER OF YEARS IN BUSINESS: 20+Years BUSINESS LICENSE#:
CURRENT PROCESSOR: POS DEBIT: 181 NO •YES NETWORK:
(Z) Slur MAC (VI) Star East (Q) Star Vies/ (G) Interlink (8) Maestro (Kl EBT
TRADE REFERENCES:
Company: Contact:
Phone: Fax: Account Type:
Company: Contact:
Phone: Fax: Account Type:
Authorized Signer (First): Ml: Last: Title: Phone Number: Email Address:
Ernest Buddy Mendes Chairman Board or Superv isors or Fresno County (559) 600-5000 bmendes@fresnocountyca.gov
Alternate (First): Ml: Last: Title: Phone Number: Email Address:
Alternate (First): Ml: Last: Tille: Phone Number: Email Address:
To help the government fight the funding of terrorism and money laundering activities, Federal law requ ires all financial institutions to obtain, verify, and
record information that identifies each person who opens an account. What thls means for you : when you open an account, we may ask you ror information
that will allow us to identify you, including a copy of your driver's license or other identifying documents .
• By checking this box, Merchant opts out of accepting American Express.
THE MERCHANT PROCESSING AGREEMENT IS EFFECTIVE UPON THE SIGNING BY MERCHANT AND AUTOMATED MERCHANT SYSTEMS, INC.
Merrick Bank Corporation
By:
135 Crossways Drive North . Suite A
Woodbury, NY 11797
Rev 07 /2019gsf
Date
Automated Merchant Systems, Inc.
By:
1071 S Sun Drive. Suite 2001
Lake Mary, FL 32746
407-331-5465
Dal e
Page 1
The Fee Schedule
You understand and ac knowledge th at you have elected lo participate in the Governmen t and Education Program provided by the Payment Brands (the "Program "). The Program
allows reg istered and approved merchants (approved Merchant IDs or MIDs) to assess a variab le service fee (a ·service Fee ") on certain deb it and cred it card transact ions . Reg istration
and participation in the Program Is subject to approval by the applicable Payment Brands and you acknowledge that you may not be eli gible to participate in the Program . If reg istration
and Payment Brand approval is obtained , you agree to comply with all Program requirements . ISO may terminate , amend , modify or otherwise alter this Agreement , the Program , or the
structure , nature or amount of the Service Fee at any time with written notice to you . You authorize and direct Member Bank to settle the proceeds received for Service Fees Into the
ISO's bank account. In the event that you receive any portion of the Service Fees , you ag ree to prompUy pay such amounts to ISO . Service Fees collected by ISO will be retained
by ISO and you will not be responsible for the payment of any Fees or Third-Party Costs with the exception of the Fees listed below. Noth ing in this Section shall be deemed
to alleviate or reduce any of your other obligations under the Ag reement, includ ing , but not lim ited to, your respons ibilities with regard to Pena lties and Dispute Items and your obl igation
to pay early term ination fees , if appl icable, pursuant to Section 1 o of the Payment Processing Agreement.
Chargebacks Item Costs
Chargebacks
$ 15.00
In the event a customer disputes , refuses to pay and/or charges back the Service Fee amount to ISO , Merchant is responsible for collecting and paying the Service Fee and the
Chargeback Fee to ISO .
ACH Service Fees
Transaction Transaction Optional
Fee Return Fee Transaction
Re-Deposit Fee
$1.00 $ 5.00 $ 2.50
The ACH Transaction Fee Is a Serv ice Fee paid by the consumer. The Transaction Return Fee and Optional Transact ion Redeposit Fee is paid by the Merchant.
Merchant: County of Fresno
Date
Erne s t Buddy Mendes , Chairman of the Board of Sup rvi s ors
Print Name
ATTEST:
BERN ICE E . S EIDE L
C lerk of t he Boar d of Supervi sors
Cou nty of Fr esno , St ate of California
By Si 1S~ ~~9.'f)
Deputy
Title of the Count of Fre s no
Page 2
MERCHANT SIGNATURE AUTHORIZATION
Name of Entity: County of Fresno
The undersigned certifies and agrees to as follows :
1. The undersigned and any of the persons identified below are duly authorized to sign this
Merchant Processing Agreement and bind the entity indicated above to it. If any official
indicated below resigns or is replaced , that official 's successor(s) in office shall be
deemed to have signed this certification and the Merchant Process ing Agreement. These
persons also have the authority to perform the duties and funct ions defined in 2 , 3 and 4
below.
TITLE PRINT NAME SIGNATURE
Chairman Board of Supervisors Ernest Buddy Mendes -:::I-A~ j/ ~-1,I nf FrPc::nn rn,mtv ....
I -
v'
2. The persons listed below are duly authorized to act for and on behalf of the entity ind icated
above in any manner re lating to th is Merchant Processing Agreement and any add itional
merchant location forms .
3. Both AMS and Merrick Bank may rely on the authority granted in this certification and the
undersigned official represents and warrants that th is certification shall remain in full force
and effect until revoked upon written notice to AMS .
4 . The following are the names , titles and genuine signatures of the persons authorized by
this certificat ion to perform ongoing organizational processes and updates:
Assessor Recorder Paul Dictos
Dir.of Internal Srvc/Chief Info Robert W Bash
I have subsc ribed my name as the offici al indicated above as of _________________ (date )
Signatu re: ____________________ Pri nt Name : ________________ _
Ti tl e: ____________ _
MERCHANT IN QUIRY:
Has Merchant or Owners/Principals ever been terminated from accepting payment cards from any payment network for this busi ness or any other businesses?
ONO 0 YES (1f yes . please explain)
How Many Chargebacks Last Year? Total Amount: S
Please Mark all Card Types Acce pted and Initial He re : ____ (1n1t1als) 'forDetalsonhowthesetransactJonsquahfyateachie'J81,pleaserefertoyouMe«:tiant0peratJngGude
181 Debit Cards: V/MC (consumer signatur e cards/ all foreign iss ued cards/ PIN debit ca rds) 181 Oth er Cards: V/MC/OISC /AMEX (business cred1Vdeb1t consumer cred1 1, & all for eign issued cards)
Page 3
Disclosure Page
(Processor Copy)
Member Bank Information
Name :
Address :
Phone :
Merri ck Bank , a Utah state chartered bank
135 Crossways Park Drive North , Suite A ,
Woodbury , NY 11797
(800 )267-2256
Important Member Bank Responsibilities
1. Membe r Bank is the only party to the Merchant Processing Agreement approved to accep t
V isa products directly from a Merchant.
2 . Member Bank must be a princ ipal (s igner) to the Merchant Processing Agreemen t.
3. Member Bank is respons ible for educating the Merchant on pertinent V isa U .S.A. Inc.
Operating Regulations w ith which the merchant must comply .
4 . Member Bank is responsible for and must prov ide settlement funds to the Merchant.
5. Member Bank is respons ible for all funds held in reserve that are derived from settlement.
Merchant Information
Merchant Name :
Merchant Address :
Merchant Phone:
County of Fresno
2281 Tulare St reet, Room 302
Fresno, CA 93721
(559) 600-3471
Important Merchant Responsibilities
1. Ensure compliance with cardholder data security and storage requirements.
2 . Maintain fraud and chargebacks below thresholds.
3. Review and understand the te rms of the Merchan t Processing Agreement.
4. Comply with V isa Operating Regulations .
The responsibilities listed above do not supersede terms of the Merchant Processing Agreement
and are provided to ensure Merchant understands some important obligations of each party.
I -a, I -&.oixO
Merchant's Slgna Date
Ernest Buddy Mende s , Chairman of the Board of Supervisors of the County of Fresno
Merchant's Printed Name & Title
ATTE ST:
BERNI C E E . SE IDE L
Cl e rk of the Board of Supervisors
County of Fresno , State of California
Page 8
Disclosure Page
(Merchant Copy)
Member Bank Information
Name :
Address :
Phone :
Merrick Ban k, a Utah state chartered bank
135 Crossways Park Drive North , Su ite A ,
Woodbury, NY 11797
(800)267-2256
Important Member Bank Responsibilities
1. Member Bank is t he only party to the Merchant Processing Agreement approved to accept
Visa products directly from a Merchant.
2. Member Bank must be a principal (s igner) to the Merchant Processing Agreement.
3 . Member Bank is responsible for educating the Merchant on pertinent V isa U.S.A. Inc.
Operating Regu lations with which t he merchant must comply.
4. Member Bank is respons ible fo r and must provide settlement funds to the Merchant.
5 . Member Bank is respons ible for all funds he ld in reserve that are derived from settlement.
Merchant Information
Merchant Name:
Merchan t Address :
Merchant Phone :
County of Fresno
2281 Tulare Street, Room 302
Fresno , CA 93721
(559) 600-347 1
Important Merchant Responsibilities
1. Ensure compliance with cardholder data security and storage requ irements .
2 . Mainta in fraud and chargebacks below thresholds .
3 . Review and understand the terms of the Merchant Processing Agreement.
4 . Comply with Visa Operating Regulations .
The respons ibilities listed above do not supersede te rms of the Merchant Processing Agreement
and are provided to ensure Merchant understands some important obligations of each party.
~4,~~
Merchant's Signat
1-&\-J.WQ
Date
Ernest Buddy Mendes, Chairman of t he Board of Supervisors of the County of Fresno
Merchant's Printed Name & Title
ATTEST :
BERN ICE E . SE IDE L
Clerk of the Board of Superv isors
County of Fre sno , Sta te of Ca lifo rni a
By Sus~:i¼sbc:f)
Deputy
Page9
Fonn W-9 Request for Taxpayer Give Form to the
(Rev. October 2018) Identification Number and Certification requester. Do not
Department of Iha Treasury
Internal Revenue Service • Go to www.irs.gov/FormW9 for instructions and the latest info rmation.
send to the IRS .
1 Name (as shown on your Income tax return). Name Is required on this line; do not leave this line blank.
CO UNTY OF FRESNO
2 Business name/disregarded entity name, tt different from above
C')
Cl) 3 Check appropriate box !or federal lox classifocatlon of the person whose name Is entered on line 1. Check only one of the 4 Exemptions (codes apply only to
O') following seven boxes. certain entitles, not Individuals; see "' a. Instructions on page 3):
C • lndividuaVsole proprietor or 0 C Corporation 0 S Corporation D Partnership D TrusVeslale 0 . ., single-member LLC Exempt payee code ~I any) GI C
C. 0 • ~'fl Limited liability company. E;nler tho lax cloocification (C-C corp orati on, S:S corporation , P=Partnarship) • os Note: Check the appropriate box In the line above for the tax classlllcatlon of the slngle·mcmber owner. Do not chock Exempllon from FATCA reporting .. ., LLC ir the LLC Is classttled as a single-member LLC that Is disregarded from the owner unless the owner or the LLC Is ·E-= another LLC that Is not disregarded from ·the owner for U.S. federal tax purposes. Olhervvlse, a single-member LLC that code or any)
D. 0 ls disregarded from the owner should check the appropriate box for the tax classiflcatlon or ils owner. i:: ·o 0 Other (see Instructions) • GOVERNMENT (Applios to account, rrwtlrainrlovtslda 11111 U.SJ Cl)
C. 5 Address (number, street, and apt. or sutte no .) See Instructions. Requester's name and address (optlonaQ II)
Cl)
PO BO X 1247 Cl)
U)
6 City, state. and ZIP code
FRESNO, CA 93715
7 Lisi account number(s) here (optlonaQ
•:S:T •& Taxpayer Identification Number {TIN)
I Social security number I Enter you~ TI N in_ the app:o~ri~te box. :"~ TIN provided must match t~e name given on line 1 to avoid
backup withholding. For md1v1duals, this ,s generally your social security number (S SN). However, for a
resident alien, sole proprietor, or disregarded entity, sec the Instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
[IIJ -DJ -I I I I I
or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter. • Certification
Under penalties of perjury, I certify that:
1. The number shown on this form Is my correct taxpayer identification number (or I am wa iting for a number to be Issued to me); and
2. I am n ot subject tci backup withholding because: (a) I am exempt from backup withhold ing, or (b} I have not been notified by the lntemal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withhold Ing; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all Interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest pa id,
acquisition or abandonment of secured property, cancellation or debt, contributions to an ind ividual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TlN. See the instructions for Part 11, later.
Sign
Here
Signature of
U.S. person •
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and Its Instructions, such as leg islatlori enacted
after they were published, go to www.irs .gov/FormW9 .
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), i ndividual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following .
• Form 1099 -INT (interest earned or paid)
Cat. No . 10231X
Date •
• Form 1 ogg_DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of Income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1 oga-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acqu isit ion or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a res ident
ali en), to provide your correct TIN.
If you do nor return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
l ater.
Form W-9 (Rov . 10-2018)
AMS -MERRICK LOCATION ADDENDUM
P.RIMARY.;MERCHANTj lNF..ORMATION::;.c<, ·_::J Location No: 1 Date:
Legal Name: Coun!i'. of Fresno Bank Chain: 203342
Main Contact: Paul Dictos Title: Assessor-Recorder Merchant Num.ber: 317730298179 .....
1t0CATION :E INF0RMATl0N:-;_'~,L:'.:;/;:"·;:·\;,;;U::;::c.l Sales Rep :Nancy Murphy 1030
OBA: Fresno Coun~ Recorder's Office Statement OBA (23 Chr.): Fresno Cn!Y Rec Coel'. Web SIC: 9399
Location Address: 2281 Tulare Street, Room 302 City: Fresno ST: ~ Zip: 93721
Malling Address: 2281 Tulare Street, Room 302 City: Fresno ST: ~ Zip: 93721
Customer Service Phone Number: {559) 800-1634 Phone#: {559) 600-3471 Fax#: {559) 800-1484
Main Contact: Georgina Luna Title: Recording Manager Email: 9lluna@fresnocoun!}'.ca .9ov
Avg Ticket: S15.00 Max: ---Monthly Vol: S1500.00 Swlpe¾ __ o_ Keyed¾ __ o_ MOTO¾ ___ o Internet% --1Q.Q_
Merchant Products or Services Offered (be specific): Conies of official records .
Tennlnal / Payment Application: Eagle Recorder Version: Eaale. Recorder 2019.1
Does Merchant Use Independent Servicer (store, maintain, or transmits card holder data)? (If yes, provide the following)
Servicer I Payment App. Manufacturer: BridgePaj'. Network Solutions I T:iler Technologies Phone:
American Express (10 Digits): American Express Annual Volume:
Program: Service Fees: Account Name: AMS"Service Fee MIO: 73029B1B2 Rate: s2.so Service Fee eer transaction
· iSIJE(INF.0RMA1'10N:;:;~::,,-;:;:,~,i:x;.r:;:. ;;· ·,::'''.:.:i.:iJ I
Merchant Type: Internet Website
Building Type: Office Building Area Zoned: Commercial Square Footage: More Than 10000 Merchant: Owns
Landlord: Contact: Phone:
Fulfillment Co. Contact: Phone:
This Location Is Open for Business: 181 Yes •No Inspected By: Date:
:MOIO:;.;'.ECOMMERCEiQUESTIONNAIRE s.-J Comofete If Processlna Less Than 70 % Card Present
Sell To: Business: ___..1L_'/a Public: .....!!§_% NaUonallv Does the Merchant Own Product/lnventory? YES
Marketing: Are Products Stored at the Business Location? YES ---tr No. Where?
Orders Processed by: Merchant If Processing Internet Transactions (Please Complete The Followlng)
Cards Processed by: Consumer Internet transactions encrypted by SSL or Better? YES
When Is the cardholder Charged? Time or Order Digital Certificate Utilized? YES Exp Date: ---
How many days to rumn orders? 1-7 Davs Certificate Number:
Shipped by: Merchant Certificate Issuer: Individual
Products Shipped by: US Mall URL: //https ://rresnocountyca-web.tylerhoslneVweb/user/disclalmer
Delivery Receipt Requested? NO
tf0kBAN°K.!Acco.uN'.tiNEORMATt0Jj:i".'.-i::·~:I
This area should be completed for Added/Subsequent locations with DDA other than main location. Please Include a Voided Check.
If this is a "Deposit Only" account then a letter from the Financial Institution verifying Transit and Routing Number and DDA# is required.
Account Type: ACH Deposit Routing/Transit# ACH Deposit Account Number Bank Name:
CK I l I -· I Bank of the West
Account Type: ACH Fees Routing/Transit# ACH Fees Account Number Contact: Phone:
CK I
. -l I I Ly Huynh (BOO) 676--4549
Merchant hereby authorizes Merrick and Automated Merchant Systems, Inc. to lntuate credit and/or debit entries for amounts originating under the Merchant
Processing Agreement (via ACH or otherwise) Including any reversals or adjustments on original entries to the Merchant's Bank Account (as defined In the Merchant
Processing Agreement). NOTE: Attach Voided Check
The Merchant agrees to abide by the terms & conditions contained In the .Merchant Processing Agreement signed on provided, however, that the term of
the Merchant Processing Agreement relating to the above-referenced Additional Location shall be for the same length of time as the lnltlal Tenn (defined In the
Merchant Processing Agreement), and such Initial Tenn for the Additional Location shall commence on the date signed by OfflcerfOwner, Indicated below.
Ernest Buddy Mendes <;;" --i-/1..., J ..J ~ ~ ; rh~irman of the Board I -d-\-'J.D:X)
Printed Officer/Owner Name
ATTEST:
BERNICE E . SEIDEL
Clerk of the Board of Supervisors
County of Fresno, State of California
By &s~ bshpf>
Deputy
~ Signatu,;Q
V
Title
of Supervisors of the
County of Fresno
Date