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Contract 35850
CfTY SECREr4Ry ill�il1'Yi® TeleCheck°Checks By Phones"and CONTRACT NO Zel TeleCheck Internet Check Acceptance°Agreement-Warranty This documentation and the software described constitute proprietary and confidential information protected by copyright laws,trade secret,and other laws.No part of this publication may be reproduced or distributed in any form or by any means,or stored in a database or retrieval system,without the prior written permission of TeleCheck International,Inc.©2003 TeleCheck International,Inc.All Rights Reserved. _ SERVICES PROVIDED TeleCheck®Internet Check Acceptance"Service TeleCheck®Checks By Phones"Service Professional Professional Standard—If so,what Gateway? t lL` ❑Standard—If so,what Gateway? SERVICE TELECHECK# INS NUMBER IIBILLTO NUMBER PROVIDEDTO: ILL TO: it COMPANY NAME �J_ tl�1. t i/O COMPANY NAM ORPAST-2 q � p. V� ALL DBA's F PAST 2 YEAR T ALL DBA's FOR PAST 2_I W (/�.Jf EAfAS / u 1T CONTACT r J�y J� Q��ry1� DDRE S' � ML� CONTACT (.vL E-/�gI.L.A��0ES NAMQIEy /•1�'l l l�/off �$/ J y�E I C�i ilC/'7 i AME C / �/fh�Vf�7�p BC'1 �I % l`/ �lB]LR S7� T-O Y ( NIU)113 .), (/3 f AX N /7 6 l�_ V ADDRESS ITV /IYY,• IADDRE35 1�rt/� 3� �OL f•..�/'r C -rh(bC ►'Y►Qr a� Fo /�f�� VV 1 �" u STATE/ZIP ^/� FEDERAL TAX IDn��Q t� TATE/ZIP FEDERAL TAX'ID#MERCHANT/BUSINESS WEB ADDRESS 91 MERCHANT TRANSACTION INFORMATION •V Monthly Average Number of Setup Order Confirmation Check Volume Dollar Amount Websites/Call Centers Fees Letter'(CBP ly) -Opt-Out:Subscriber agrees to send written confirmation to consumer per N CHA. SERVICE FEES iscount Rate Transaction Fee Monthly Processing Fee Mon hly Minimum __44aximum Warranty FUNDING INFORMATION Payments to TeleCheck by Merchant Financial Transaction-Debits and Credits to Merchant by TeleCheck Merchant Bank Name: Merchant Bank Name: Merchant Bank Phone It Merchant Bank Phone It ABA Transit It ABA Transit It Account#: Account#-. Bank City: Bank State: Bank City: Bank State REFERENCE AND CREDIT CHECK INFORMATION Legal Structure Cor oration Sub S Corporation Sole Proprietorship Non-Profit Partnership(check one): p P 'I. P P ❑. [, P 0 LLC ther (phase sp�ifyJ State Incorporated:-Te�/Q( Month/Year Started: (/73 1#of Employees: State/Federal Tax I O!-vv r List all Key Principals(For Vterificcaation Purposes).If more than two Key Principals,attach information on a separate page. �-.0 First Name: Last Name: Title: First Name: Last Name: Title: Social Security#: Home Address: Social Security If: Home Address: City: State: Zip Code: Home Phone It City: State: Zip Code: Home Phone It ADDITIONAL INFORMATION Use Separate Page for Additional Information,if needed. Merchant: 12.Has been the subject of a law enforcement or 1.Is a publicly traded corporation. ❑yes ❑no government investigation. ❑yes ❑no 2.Is a subsidiary of a publicly traded corporation. ❑yes ❑no If answered"yes,"please explain(on separate page) B.Is federally-insured. ❑yes ❑no 4.Is a government entity. ❑yes ❑no 13.Has had any state-issued or business license revoked. ❑yes ❑no If answered"yes,"please explain(on separate page) 5.Sells anti-telemarketing devices. ❑yes ❑no 6.Sells"credit enhancements"services/products. ❑yes ❑no 14.Has used another TEL Processor within the past 2 years. ❑yes ❑no 7.Sells identity theft protection services/products. ❑yes ❑no If so,please explain why Company is now seeking the 8.Sells services/products that facilitate the obtaining of grants. ❑yes ❑no services of another TEL Processor(on separate page) 9.Has annual revenues of $ 10.Obtains %of annual revenues from sales solicitations initiated by Company 15.Describe Company's specific type of business and product lines for the past 2 years: via telephone,fax or e-mail to customers for which the Company has had no existing rela- tionship with for the past 2 years 11.Sells Services/Products that facilitate obtaining grants. ❑yes ❑no r� Supplier/Trade References ({ Business Name Contact Name: Contact Phone If: Business Name: Contact Name: Contact Phone It Bank Reference { Merchant Bank Name: Bank Contact Name: Bank Phone Number: a Merchant Bank Account Routing Number: Merchant Bank Account Number: TECHNICAL INFORMATION Application Server Platform(e.g.,WebLogic,ColdFuslon): Programming Language(e.g.,Java 1c1,COM): ADMINISTRATOR INFORMATION CUSTOMER SERVICE INFORMATION Administrator Name: Customer Service Phone If: s Title: Contact Phone It Customer Service Contact Name: E-Mail Address I System Password: Customer Service Contact Phone It (we)understand that a Consumer Report of each of the officers/partners/proprietors/owners of the applicant may be requested from a Consumer Reporting Agency.A Consumer Report is a routine report on creditworthiness,frequently used by creditors.It the business is approved for Internet Check Acceptance and/or Checks By Phone,subsequent Consumer Reports may be required or used in ce tion w the maintenance,updating,r ne al or extension of the service.I(we)ag ee that all business reference,including banks,may release any and all credit and financial information to TeleCheck. (we)agree and acknowledge that the information provided in this Merchant Application Form and other relevant credit data,may be supplied to TeleCheck. Personal GuaranteeNeritication:To induce and in consideration of TeleCheck's acceptance of this Agreement,the undersigned represents that all of the information provided herein is true and cor- rea and unconditionally personally guaraA of the Subscriber obligations under this Agreement and payment of all sums due thereunder and in the event of default,hereby agrees to personally indemnify TeleC k for a Subscriber pursuant to the terms of this Agreement. ,..J� THIS AGREEMEN UD LL FCONDITIONS ON THE ATTACHED SIDES.THIS AGREME A EEN EXECU DBEHALF F AND eY l'HE AUTHORIZED MANAGEM T E H ty V AS ODATE AND IS SIGNED IN MULTIPLE COPIES EACH BEIN FF E AS N IN L.Signature ( ti _,L, � L Date Signaturtf 1,,y ���,-, i 1 tD ate /��� Printed Name i Vc,C f I i �1 sl t.]t -I t �,� V Printed Name 1 I%'U',AC,L.)��� i,k:Jt D,Irc f7i l Note.Signature required for each Owner`/Officer listed in this Merchant App�tion Form. 1�1`/I Ii your eppllcal'pn for bus ness credit's denied you f�ave the right to a wrllen elalenrenl of the epect'c reaepn �a�T ppl 'N MRrIR1M1�11CUrffYaFGl�rl Teleph 5291W16etT�IAd us T 1 B003s61054 wth'n 60 days from the dale ya of d f tl .W 'll dy 'tten statement ofr s fr,tIhederi I fh' 30d y f "gyUUU equest, Nonce.TTe FBEal2l Esu21Gred1f ppnerlvml;Act M1til Netlt f - - t g g 4 ed+t eppI...an the lass,, rece cai rstian,l agin arhal atalna ag,(pnwNetl ,,pplwhht has this capacty to- a'inning canthow):betas,all or partof this appti ant's inc me deri,es from pubic st'ance program because this b this opplcont has in good faith any ti re right under the Consumer Credit Pratectian Act Tne Federal agonry that ad Isters compliance with this law concerning this creditor is the Federal Trade Co mmis sic n,Equal Credit Opportunity,Washington,a,20580, FOR INTERNAL USE ONLY TeleCheck Sales Market Channel Sales j I Nerchant Market Merchant D I� SC: Channel Name: SIC: , 7'�� ��'� Rea ID#: Merchant p or Sales Off,e � �'G�}7 � L ID It _ AA all ad ss: 'v!t;u� 5+.r Distict Office: Approved/TeleCheck Effe CSC xel.ar ,.--------..,,.,---`---'. -' 7J.. `^ ^---. _ �s'7 t-t► Y SECRETARY TeleCheck®Checks By PhoneSM and CONTRACT I�Ip e� ,, TeleCheck Internet Check Acceptance®Agreement-Warranty This documentation and the software described constitute proprietary and confidential information protected by copyright laws,trade secret,and other laws.No part of this publication may be reproduced or distributed in any formor by any means,or stored in a database or retrieval system,without the prior written permission of TeleCheck international,Inc.C 2003 TeleCheck International,Inc.All Rights Reserved. SERVICES PROVIDED TeleCheck°Internet Check Acceptance'"Service [�TeleCheck®Checks By Phones'Service Professional Professional Standard—If so,what Gateway? �t �� Standard—If so,what Gateway? SERVICE TELECHECKif NBNUMBER BILLTONUMBER PROVIDED TO: ILL TO: COMPANY NAME G a COMPANY NAM d Q ALL DBA's FOR PAST 2 YEAR (/t../J LL DBA's FOR PAST-2 YEAYS CONTACT Q CONTACT E-ApeaIL Aq�P�D ES _ NAME ` c N f G<t� AME R7(�-y Dq(H UMFfV X �BR ' ✓ti�0. (H ) 'AP s 3' (A J° /I- ,/ ram ✓ ADDRESS C ` DDRESS O� (�(, ef •1 C �, STATE/ZIP 1 FEDERALTA%ID TATE/ZIP FEDERAL TAkID9 il MERCHANT/BUSINESS WEB ADDRESS �� 0 0 l4 MERCHANT TRANSACTION INFORMATION J Monthly Average Number of Setup Order Confirmation Check Volume Dollar Amount Websites/Call Centers 'Fees Letter"(CEP ly) "Opt-Out:Subscriber agrees to send written confirmation to consumer per N CHA. SERVICE FEES Discount Rate Transaction Fee Monthly Processing Fee Mon hl Minimum " aximum Warranty G SCE C�v FUNDING INFORMATION Payments to TeleCheck by Merchant Financial Transaction-Debits and Credits to Merchant by TeleCheck Merchant Bank Name: Merchant Bank Name: Merchant Bank Phone#: Merchant Bank Phone If: ABA Transit#: ABA Transit If: Account#: Account If: Bank City: Bank State: Bank City: Bank State: REFERENCE AND CREDIT CHECK INFORMATION Legal Structure UCorporation (jSub S Corporation [Sole Proprietorship Q Non-Profit UPartnership LLC the/ (check one): /pre„e,Pec+ry) State Incorporated: �/Q( Month/Year Started: �' #of Employees:(Z State/Federal Tax I ©r-va,w~ List all Key Principals(For Verification Purposes).If more than two Key Principals,attach information on a separate page. First Name: Last Name: Title: First Name: Last Name: Title: Social Security If: Home Address: Social Security#: Home Address: City: State: Zip Code: Home Phone#: City: State: Zip Code: Home Phone#: ADDITIONAL INFORMATION Use Separate Pa a for Additional Information,if needed. Merchant: 12.Has been the subject of a law enforcement or 1.Is a publicly traded corporation. ❑yes ❑no government investigation. ❑yes Ono 2.Is a subsidiary of a publicly traded corporation. ❑yes ❑no If answered"yes,"please explain(on separate page) 3.Is federally-insured. ❑yes ❑no 13.Has had any slate-Issued or business license revoked. ❑yes ❑no 4.Is a government entity. ❑yes ❑no If answered"yes,"please explain(on separate page) j� 5.Sells anti-telemarketing devices. ❑yes ❑no vrr�vCJ 6.Sells"credit enhancements"services/products. ❑yes ❑no 14.Has used another TEL Processor within the past 2 years. ❑yes ❑no 7.Sells identity theft protection services/products. ❑yes ❑no If so,please explain why Company is now seeking the B.Sells services/products that facilitate the obtaining of grants. ❑yes ❑no services of another TEL Processor(on separate page) 9.Has annual revenues of $ 10.Obtains %of annual revenues from sales solicitations initiated by Company 15.Describe Company's specific type of business and product lines for the past 2 years: via telephone,fax or e-mail to customers for which the Company has had no existing rela- tionship with for the past 2 years 11.Sells Services/Products that facilitate obtaining grants. ❑yes ❑no SupplierJTrade References Business Name: Contact Name: Contact Phone#: Business Name: Contact Name: Contact Phone#: Bank Reference Merchant Bank Name: Bank Contact Name: Bank Phone Number: r Merchant Bank Account Routing Number: Merchant Bank Account Number: TECHNICAL INFORMATION Application Server Platform(e.g.,WebLogic,ColdFusion): Programming Language(e.g.,Java 1.1,COM): ADMINISTRATOR INFORMATION CUSTOMER SERVICE INFORMATION Administrator Name: Customer Service Phone#: Title: IContact Phone#: Customer Service Contact Name: E-Mail Address: System Password: Customer Service Contact Phone#: I(we)understand that a Consumer Report of each of the officers/partners/proprielors/owners of the applicant may be requested from a Consumer Reporting Agency.A Consumer Report is a routine report on credit worthiness,frequently used by creditors.If the business is approved for Internet Check Acceptance and/or Checks By Phone,subsequent Consumer Reports may be required or used in connection with the maintenance,updating,renewal or extension of the service.I(we)agree that all business reference,including banks,may release any and all credit and financial information to TeleCheck.I(we)agree and acknowledge that the information provided In this Merchant Application Form and other relevant credit Bala,may be supplied to TeleCheck. Personal GuaranteelVerltication:To induce and in consideration of TeleCheck's acceptance of this Agreement,the undersigned represents that all of the information provided herein Is true and cor- rect and unconditionally personally guarantees pad ante of the Subscriber obligations under this Agreement and payment of all sums due(hereunder and in the event of default,hereby agrees to personally indemnity TsIeC ck for and all fu s d from Subscriber pursuant to the terms of this Agreement. THIS AGREE MEN LID LL F TH RM AND CONDITIONS ON THE ATTACHED SIDES.THIS AGREEME EEN E%ECU BEHALF F AND BY THE AUTHORIZED MANAGE M T E H P Y AS OFT EF T E DATE AND IS SIGNED IN MULTIPLE COPIES EACH BEIN F T E AS N O N L. �� Signature - Date<z Signature Date: Printed Name Y C I I �� I r-I I�.! -I V .) 1},�� Printed Name k/t'u-U(_/7 ri'�.`I 1zt111b �/VIL1'k 1)1 1 C c Fi r Note.Signature required for each Owne/Officer listed in this Merchant Appl'etion Form 7'yr 1,a r� rh4hr,d BsWcmlGo�:rgm Ikatb r� ��S�s' II your applkatlon M Ws ness credit Is den ed YW have the dght to a wdaen statement of the spec I c reason b the I To th In 1 S77 I 1 Tjh r Sa 1 1 tl.,Hous ,TX l t e0038Ete51 nlM1in Ixl days Imm the dale you ere iwlilied of our dec s m.Wa w II send you a wdaen statement of,eas for the dental MIM1In]p tlays of rece wng y gpest. C d Notice The Federal Equal Credit Oppodunily Acl prohibits creditors from discnml,uling ega'nsl creel t applicants on the basis of race,color,rellg on,nahmal prlg,n.sew,madlal statue,age(prwidetl the epplkanl has IM1e capacity to enter i III a binding cpnlractJ;because all or pert of the epplkanl's income derives from public assistance program;or because the applicant has in good Iai1M1 asercise0 any right untler the Consumer Credit Pmleclion Acl.The Federal agency Ihel admin I-.compliance wi1M1 this law concerning thu creditor Is the Fetleret Trade Commission,Equal Credit Opportunity,Weshinglcn,OC..5eq. FOR INTERNAL USE ONLY ,;. TeleCheck Sales Market Channet Sales ;:j -S Nerchant Market Merchant 1 i� �11 _.,/ SC: Channel Name: - ' � SIC: ;"81{f R�, '..' ([[ 1.� Re?ID#: [j Merchant p or Sales Offi L—! ID#: AA 11 ail ad ess: mil}ui� +i•r Disrict Office: r Approved/TeleCheck "Effec r, � lN� V <5 Management(Signature): v� - Date: z.T_,..,.....,1.c............ ....onnv c au ,,.__o.,.on - _. n ncnoC"ovvorr,� City of Fort Worth, Texas Mayor and Council Communication COUNCIL ACTION: Approved on 8/28/2007 DATE: Tuesday, August 28, 2007 LOG NAME: 60TELECHECK REFERENCE NO.: **C-22346 SUBJECT: Authorize Execution of an Agreement with TeleCheck for their TeleCheck Electronic Check Acceptance Warranty Service RECOMMENDATION: It is recommended that the City Council authorize the City Manager to execute an agreement with TeleCheck. This agreement will provide for TeleCheck Services, Inc., to support a "check by phone" service that will be integrated with the existing Selectron Interactive Voice Response (IVR) System for the Water Department. BACKGROUND This agreement will establish support for an enhanced service option by offering an additional payment opportunity for customers who prefer to use the telephone IVR system. The IVR system is a key component for customer convenience by offering an automated self-service option that is available 24 hours a day. The IVR system can readily provide pertinent information such as account balance, the last five bill amounts and the last five dates when payments were received. TeleCheck Services, Inc., is the world's leading check acceptance company and provides electronic check verification and guarantee of funds. TeleCheck will support the upcoming "Check and Credit Card by Phone" customer service enhancement which will offer customers the ability to pay their bill over the phone using an electronic check, credit or debit cards. TeleCheck will provide collection services eliminating risks associated with receipt of checks for payments on accounts and ultimately will improve cash flow. The credit/debit card payment option will be supported by Pay Pal who is an existing business partner. Pay Pal has been the supporting vendor for "H2Online", the Water Department's online account history and payment service, which has been extremely well received by customers since implementation. DISCUSSION: M&C P-10493, approved December 12, 2006, authorized an upgrade to the Selectron Interactive Voice Response (IVR) System for the Water Department to expand services to customers to allow customers to pay their water bills by electronic check via the telephone. Selectron partners with Telecheck to process electronic checks through the VeriSign gateway. The initial term of the agreement is for 12 months. An automatic renewal exists for successive 12 month terms until terminated as specified within the agreement. The Water Department shall pay an initial one time setup fee of $150 then a $5 monthly processing fee plus a $.20 per transaction fee and 2.39 percent discount rate. An annual estimated cost for the usage fees is projected to be $395,628 based on historical payment trends using the assumption of a 5 percent utilization for customers historically using mail/lockbox and 25 percent utilization for customers paying as a result of delinquency action. Logname: 60SOUTHWEST Page 1 of 2 FISCAL INFORMATION/CERTIFICATION: The Finance Director certifies that funds will be included in the 2007-2008 proposed operating budget of the Water& Sewer Fund. TO Fund/AccountlCenters FROM Fund/AccountlCenters PE45 539120 0604007 $197,814.00 PE45 539120 0704007 $197,814.00 Submitted for City M2inager's Office-W. Marc Ott (8476) Originating De ap rtment Head: Frank Crumb (8246) Additional Information Contact: Anthony Snipes (8819) i Logname: 60SOUTHWEST Page 2 of 2 M&C Rpquesfgeview Page 1 of 2 City of FortWorth Employee Intranet wwwdwnet.org FoN3� !_H Home I Council Agenda I M&C I Employee Directory I ACToday I Enip"Cfassifleds I PRS I IT Online I Departments I We Map Print M&C COUNCIL ACTION: Approved on 8/28/2007 DATE: 8/28/2007 REFERENCE NO.: **C-22346 LOG NAME: 60TELECHECK CODE: C TYPE: CONSENT PUBLIC HEARING: NO SUBJECT: Authorize Execution of an Agreement with TeleCheck for their TeleCheck Electronic Check Acceptance Warranty Service RECOMMENDATION: It is recommended that the City Council authorize the City Manager to execute an agreement with TeleCheck. This agreement will provide for TeleCheck Services, Inc., to support a "check by phone" service that will be integrated with the existing Selectron Interactive Voice Response (IVR) System for the Water Department. BACKGROUND This agreement will establish support for an enhanced service option by offering an additional payment opportunity for customers who prefer to use the telephone IVR system. The IVR system is a key component for customer convenience by offering an automated self-service option that is available 24 hours a day. The IVR system can readily provide pertinent information such as account balance, the last five bill amounts and the last five dates when payments were received. TeleCheck Services, Inc., is the world's leading check acceptance company and provides electronic check verification and guarantee of funds. TeleCheck will support the upcoming "Check and Credit Card by Phone" customer service enhancement which will offer customers the ability to pay their bill over the phone using an electronic check, credit or debit cards. TeleCheck will provide collection services eliminating risks associated with receipt of checks for payments on accounts and ultimately will improve cash flow. The credit/debit card payment option will be supported by Pay Pal who is an existing business partner. Pay Pal has been the supporting vendor for"H2Online", the Water Department's online account history and payment service, which has been extremely well received by customers since implementation. DISCUSSION: M&C P-10493, approved December 12, 2006, authorized an upgrade to the Selectron Interactive Voice Response (IVR) System for the Water Department to expand services to customers to allow customers to pay their water bills by electronic check via the telephone. Selectron partners with Telecheck to process electronic checks through the VeriSign gateway. The initial term of the agreement is for 12 months. An automatic renewal exists for successive 12 month terms until terminated as specified within the agreement. The Water Department shall pay an initial one time setup fee of$150 then a $5 monthly processing fee plus a $.20 per transaction fee and 2.39 percent discount rate. An annual estimated cost for the usage fees is projected to be $395,628 based on historical payment trends using the assumption of a 5 percent utilization for customers historically using mail/lockbox and 25 percent utilization for customers paying as a result of delinquency action. http://www.cfwnet.org/council_packet/mc_review.asp?refnum=C-22346 9/6/2007 M&C RequestReview Page 2 of 2 FISCAL INFORMATION/CERTIFICATION: The Finance Director certifies that funds will be included in the 2007-2008 proposed operating budget of the Water & Sewer Fund. TO Fund/Account/Centers FROM Fund/Account/Centers PE45 539120 0604007 $197,814.00 PE45 539120 0704007 $197,814.00 Submitted for City Manager's Office by: Marc Ott (8476) Originating Department Head: Frank Crumb (8246) Additional Information Contact: Anthony Snipes (8819) ATTACHMENTS http://www.cfwnet.org/council_packet/mc_review.asp?refnum=C-22346 9/6/2007