HomeMy WebLinkAboutAgreement A-18-618 with Heartland.pdf1
2
AGREEMENT
Agreement No . 18-618
3 THIS AGREEMENT is made and entered into on November 6, 2018, by and between the
4 COUNTY OF FRESNO, a political subdivision of the State of California ("COUNTY") and
5 Heartland Payment Systems, LLC, a Delaware limited liability company authorized to do business
6 in California, whose address is 3550 Lenox Road , Suite 3000 , Atlanta , GA 30326
7 ("CONTRACTOR").
8 Recitals
9 A. The COUNTY collects taxes, fines , fees, and other types of monetary payments
1 O from individuals and entities subject to its jurisdiction.
11 B. The COUNTY desires to permit payment of amounts owed to it by means of
12 electronic transactions .
13 C. The CONTRACTOR provides electronic check payment and processing transaction
14 services and credit and debit card payment transaction services through an Internet interface over
15 the web and an interactive telephone voice response system ("IVR").
16 D. The CONTRACTOR represents that it is ready, willing, and able to provide
17 electronic payment and processing transaction services and credit and debit card payment
18 transaction services as required by the COUNTY and subject to the terms of this agreement.
19 The parties therefore agree as follows:
20 1. DEFINITIONS
21 "Card Services" means the services provided by CONTRACTOR relating to credit
22 card and/or pin-less debit card services provided in accordance with this agreement inclusive of
23 payment and electronic funds transfer which enable Payment Transactions to be processed.
24 "Chargeback" means the reversal of a Payment Transaction previously credited to
25 a COUNTY Designated Account.
26 "Citizen" means the person , business, or entity that initiates and makes payment
27 of the COUNTY Payment and Convenience Fee through a Payment Transaction.
28 "Co-Brand" means an electronic transaction containing payment and identification
-1-
1
2
3
4
5
6
IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day
and year first hereinabove written.
CONTRACTOR
7 0Avt0 L,. &12/U::,,J Coll o~L
8
9
10
11
12
13
14
15
16
Print Name & Title s ~c..e-.i.m~
3550 0'2,Nb ~o}4-Nfi_ li.3 000
Mailing Address
17 FOR ACCOUNTING USE ONLY:
18 ORG No.:~ 0410
Account No.: 7295
19 Requisition No.:
20
21
22
23
24
25
26
27
28
COUNTY OF FRESNO
ATTEST:
, Chairperson of the
pervisors of the County of
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno , State of California
-21-
RM: DON LEWIS Phone: 727-224-1439 Fax:
Affiliate/Partner ID : Affiliate Name: Current MID:
Merchant DBA Name: DBA Phone#:
Address: # Locations:
City: State: Zip:
CS Phone #: Fax #:
Primary Contact Name: Phone #:
Authorized to Purchase: Yes No
Secondary Contact Name: Phone #:
Authorized to Purchase: Yes No
Email Address:
(Heartland InfoCentral Admin User Email Address)
Email Contact: First Name: Last Name:
Website Address:
Legal Name: Federal Tax ID / EIN:
(Please Complete – Must correspond with IRS Filing Name) (Must correspond with Legal Name)
Address: Phone #:
City: State: Zip:
XXXX
COMPANY INFORMATION
HEARTLAND CONTACT INFORMATION
GOVERNMENT AND EDUCATION
MERCHANT PROCESSING AGREEMENT
Card Only ACH Only Dual
CARD FEE SCHEDULE
Service
Requested
Discount
Rate
Discount
Per Item
Trans
Fee Dial
Trans
Fee IP Annual Volume: $ Average Ticket: $
Visa % $ $ $
MasterCard % $ $ $ Service Fee (Pass Through/Single Transaction)
COST PLUS Discover/JCB % $ $ $
PayPal % $ $ $
PIN Debit* $ $ *Plus Applicable Debit Network Fees
TSYS Authorization $ $
American Express % $ $ $
Annual Volume: $ Average Ticket: $
Note: OptBlue Annual Processing Volume > $1 Million must go Direct
OptBlue
I opt out of receiving marketing material from American Express
American Express
Merchant #:
American Express
Franchise Name:
Franchise
CAP #:
RECURRING FEES
Chargeback Fee: $ Bolletta Fee: $ Voice Auth Fee: $0.65 SRM Fee: $8.50
INTERCHANGE QUALIFICATION CARD ACCEPTANCE DEPOSIT METHOD SETTLEMENT
MOTO/Internet
Retail
Small Ticket
All Cards Accepted Standard Monthly
Daily Net
Daily Split
SALES METHOD CARD PROCESSING METHOD
On Premise Face to Face Sales % Mail Order Sales % Card Swipe %
Off Premise Face to Face Sales % Real-Time Internet % Keyed / Card Not Present %
Inbound Telephone Order Sales % Internet (keyed) % Total = 100%
Outbound Telephone Order Sales % Recurring Billing %
Total = 100%
What percentage of your Bankcard volume is future delivery 00 %
Exhibit A
ACH FEE SCHEDULE
Enable ACH Account Verification: Yes No Please provide the expected ACH data below.
Fee Type Dollar Percentage Annual ACH Volume $
Transaction Fee $ % Average ACH Ticket Amount $
Service Fee $ % Average Number of ACH Transaction per Month
Return Item Fee $5.00 High ACH Ticket Amount $
Re-presentment Fee* $2.00 High Ticket Frequency
*Re-presentment (Limitation of 2 per NACHA guidelines)Max ACH Limit $
Note: For High Ticket Transactions, an additional 15bp will be assessed on the amount above $10,000.
ACH PROCESSING METHOD
Note: Must equal 100% Single ACH Debit Recurring ACH Debit Credit
CCD (Corporate Credit or Debit) % % %
PPD (Prearranged Payment and Deposit) % % %
TEL (Telephone) %
WEB % % %
ACH Debit (PPD/CCD/WEB) ACH Conversion – Certification Required (BOC/ARC/POP)
ACH TEL (IVR / Other TEL Entry Types*) Terminal Type:
Vendor: Heartland Third Party:
*Merchant can accept ACH payments via Cashier/Virtual
terminal; however, call must be recorded and be available
as proof of authorization.
Check Reader/Imager:
Virtual Terminal:
Number of Terminals:
ACH DESCRIPTOR
Phone number as it will appear on customer statements:
Company name as it will appear on customer bank statements (Max 16 Characters):
AUTHORIZATION METHOD (Not applicable to ACH Conversion)
Which authorization procedure does Merchant utilize to confirm customers consent to an ACH Debit:
Signed written authorization from customer (Does not apply to Web)
Heartland provides Authorization Form Template
Merchant created Authorization Form
Web Authorization (Applies to Web only)
Customer provides electronic signature Customer logs in a username and password
Recorded Verbal Authorization (Tel Only)
Heartland provided script Merchant created script
If utilizing Recorded Verbal Authorization; check one of the following:
Hosted secure IVR (Automated or Live Agent) recording services offered by Heartland
Merchant has existing recording service to capture verbal customer authorizations
How are recordings stored:
Via website URL:
Via phone: #:
REQUIRED: When Merchant utilizes their own Authorization Script this must be submitted with ACH Application.
Exhibit A
<Insert Detail/Discription>
<Insert Preferred Email>
rocessed by HPS: Yes
MERCHANT DETAIL
Type of Business: Public Private Date Business Started:1894 Business is Conducted : 100% Consumer
Type of Ownership: Corporation Government Municipalities Are web based sales p
What Products and / or services do you provide:
Is there a peak week / date in the month for processing recurring transactions: (i.e., 1st and 15th): n/a
Define your Refund Policy:Duplicate payments and payments made in error only.
PCI Compliance
Is your business PCI Compliant: Yes No
Does your company utilize a Data Storage Entity or Merchant Servicer that has access to card member data
(i.e., Payment gateway or data warehouse, etc.): Yes No
If yes, provide the name of the Data Storage Entity or Merchant Servicer being utilized:
PCI DSS and Card Network rules prohibit storage of sensitive authentication data after the transaction has been
authorized (even if encrypted). If you or your POS system store, process, or transmit full cardholder’s data, then you
(merchant) must validate PCI DSS compliance. If you (merchant) utilize a payment application the POS software must
be PA DSS (Payment Application Data Security Standards) validated where applicable. If you use a payment gateway,
they must be PCI DSS Compliant.
As required under the Payment Card Industry Data Security Standard (PCI DSS), I do hereby declare and confirm the
following:
Merchant will maintain full PCI DSS compliance at all times and will notify Heartland when it changes its point of sale
software, system, application or vendor: Yes No N/A
Do your transactions process through any other Third Parties (i.e. web hosting companies, gateways, corporate
office): Yes No N/A
Merchant utilizes the services of a PCI SSC Qualified Integrator Reseller (QIR) when POS payment applications are
utilized: Yes No N/A
The signing merchant listed below has experienced an account data compromise.*:
Yes No N/A I have never accepted payment cards.)
If yes, what was the date of the compromise: Copy of the completed Forensic Investigation is required with the Application.
The signing merchant listed below is storing Sensitive Authentication Data** (even if encrypted) after the transaction
has been authorized: Yes No N/A I have never accepted payment cards.)
Merchant utilizes an EMV enabled terminal: Yes No N/A
*An Account Data Compromise is any incident that results in unauthorized access to payment card data and/or
Sensitive Authentication Data.
**Sensitive Authentication Data is security related information (Card Verification Values, complete Magnetic Stripe
Data, PINs, and PIN blocks) that is used to authenticate cardholders.
Please note that if you have indicated that your organization has experienced an account data compromise in the past, a
PCI DSS Level 1 Compliance Assessment may be required upon Heartlands request. A compromise of cardholder data
from your location(s) may result in the issuance of fines and/or penalties by the card brand, for which you will be
responsible under your Merchant Agreement, notwithstanding this Compliance Statement.
It is imperative that you notify Heartland immediately should the information on this Compliance Statement
change.
STATEMENT OPTIONS DISPUTE LETTERS
Statement Type: Standard Mail Options: Legal DBA
Mail Statements To: Suppress Statements Legal Electronic Options* Email Fax (*Select mail option as backup)
All Electronic Communications (Including ACH Returns):
Same Email as InfoCentral Preferred Email Address:
Exhibit A
60
AUTHORIZED SIGNER(S) INFORMATION
(1) Authorized Signer Name: Title:
SSN:n/a DOB:n/a Driver’s License #:n/a
Home Address n/a City:n/a ST:n/a Zip:n/a
(2) Authorized Signer Name: Title:
SSN:n/a DOB:n/a Driver’s License #:n/a
Home Address: n/a City:n/a ST:n/a Zip:
Note: If there are more than two Owners, Officers or Managing Agents, complete the “Additional Owner/Officer Information
Page for Merchant Processing Agreement”.
DEBIT / CREDIT AUTHORIZATION
By signing below, Merchant certifies that any verification of business provided is for a business account in good
standing and that the business name on the account is the same as the business name on the enclosed Heartland
Payment Systems Merchant Application. Merchant hereby authorizes Acquirer to debit and credit Merchant's
checking/savings/GL Account. This authority shall remain in full force until (a) Acquirer has received written notification
from Merchant of its termination; and (b) all obligations of Merchant to Acquirer under this Agreement have been paid in
full.
Depository Bank Name: Phone #:
City: ST: Zip:
CARD TRANSIT ROUTER / ABA NUMBER (9 digits) ACCOUNT NUMBER (14 digits)
ACCOUNT TYPE (check one) Checking Savings
FUNDS TRANSFER METHOD Deposits Fees Both Name as it appears on Account:
UNT NUMBER (14 digits)
ACH TRANSIT ROUTER / ABA NUMBER (9 digits) ACCOUNT NUMBER (14 digits)
ACCOUNT TYPE (check one) Checking Savings
FUNDS TRANSFER METHOD Deposits Fees Both Name as it appears on Account:
UNT NUMBER (14 digits)
TRANSIT ROUTER / ABA NUMBER (9 digits) ACCO
ACCOUNT TYPE (check one) Checking Savings
FUNDS TRANSFER METHOD Deposits Fees Both Name as it appears on Acc ount:
TRANSIT ROUTER / ABA NUMBER (9 digits) ACCO
ACCOUNT TYPE (check one) Checking Savings
FUNDS TRANSFER METHOD Deposits Fees Both Name as it appears on Acc ount:
AGREEMENT ACCEPTANCE, CERTIFICATION and CONSUMER REPORT AUTHORIZATION
Has your business filed Bankruptcy, had Judgments or Liens within the last 3 years: Yes No
Merchant authorizes Acquirer, reporting agency employed by Acquirer, or any agents thereof, to investigate the
references, statements or data provided by Merchant or the undersigned for purposes of all matters generally connected
to this business relationship. I further certify that I have received, read, understand and agree to the Merchant
Processing Agreement Terms and Conditions which together with this application shall constitute the agreement(s)
between the parties. I further certify that this business or any Owner/Officer/Authorized Signer has
never been terminated by any Card Brand.
X
(1) Authorized Signer Signature Print Name & Title Date
X
(2) Authorized Signer Signature Print Name & Title Date
THE TERM OF THIS AGREEMENT IS 60 MONTHS
01/23/18
Exhibit A
Exhibit B
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as “County”),
members of a contractor’s board of directors (hereinafter referred to as “County Contractor”), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
“A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest”
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member’s name, job title (if applicable), and date this disclosure is being made.
(2) Enter the board member’s company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a.The name of the agency/company with which the corporation has the transaction; and
b.The nature of the material financial interest in the Corporation’s transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit B
(1) Company Board Member Information:
Name: Date:
Job Title:
(2) Company/Agency Name and Address:
(3) Disclosure (Please describe the nature of the self-dealing transaction you are a party to):
(4) Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233 (a):
(5) Authorized Signature
Signature: Date: