HomeMy WebLinkAboutCS Electronic Payment Acceptance ServicesSTATE OF CALIFORNIA - DEPARTMENT OF GENERAL SERVICES
STANDARD AGREEMENT AGREEMENT NUMBER PURCHASING AUTHORITY NUMBER (If Applicable)
STD 213 (Rev. 02/2019)
1. This Agreement is entered into between the Contracting Agency and the Contractor named below:
CONTRACTING AGENCY NAME
City of San Rafael
CONTRACTOR NAME
Elavon
2. The term of this Agreement is:
START DATE
May 1, 2019
THROUGH END DATE
May 31, 2021
3. The maximum amount of this Agreement is:
$ 200,000
4. The parties agree to comply with the terms and conditions of the following exhibits, which are by this reference made a part of the Agreement.
EXHIBITS
TITLE
PAGES
Exhibit A
Scope of Work
6
Exhibit B
Budget Detail and Payment Provisions
3
Exhibit C *
General Terms and Conditions
9
Exhibit D
Special Terms and Conditions
17
Exhibit E
Fees and Costs
14
Exhibit F
Equipment and Software
6
Exhibit G
Agreement for Merchant Processing Services Acceptance
17
#Lena snawn wnn un us1ensrc i -v, are nereay mcorporarea oy rererence ana made part or this agreement as it attached hereto. These documents can be viewed at
https //www dgs ca gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-FolderlStandard Contract Language
IN WITNESS WHEREOF, THIS AGREEMENT HAS BEEN EXECUTED BY THE PARTIES HERETO.
CONTRACTOR
CONTRACTOR NAME (if other than an individual, state whether a corporation, partnership, etc.)
Elavon, Inc.
CONTRACTOR BUSINESS ADDRESS CITY I STATE ZIP
462 Bearcamp Road Louisville KY 40272
PRINTED NAME OF PERSON SIGNING TITLE
Beverly Baker Client Executive
CONTRACTOR AUTHO ZED SIGNATURE DATE SIGNED
� I A LAD/ 9
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STATE OF CALIFORNIA - DEPARTMENT OF GENERAL SERVICES
STANDARD AGREEMENT AGREEMENTNUMBER PURCHASING AUTHORITY NUMBER (If Applicable)
5TD 213 (Rev. 02/2019)
STATE OF CALIFORNIA
CONTRACTING AGENCY NAME
City of San Rafael
CONTRACTING AGENCY ADDRESS
CITY
STATE
ZIP
1400 Fifth Avenue
San Rafael
CA
94901
PRINTED NAME OF PERSON SIGNING
TITLE
Jim Schutz
City Manager
CONTRACTING GENCY AUT IZE SIGNATURE
DATE SIGNED
CALIFORNIA D ART NT OF GENERA SE VICES APPROVAL
EXEMPTION (If Applicable)
Paqe 2 of 2
Amendment 1 of Exhibit D Attachment III
Selected Services Signature Page
(Local Authorized Users Only)
The undersigned each agree to be bound by the terms and conditions of the
MSA 5-10-99-02 exhibits selected and signed for below. These selected exhibits
are by this reference made part of this Subscription Agreement # (insert Local
Authorized User's Contract number).
D Exhibits A - G (Merchant Services) (Category 1)
City of San Rafael
("Authorized User")
Signature:
Print Name: m Schutz
Title: City Manager
Dated: �1 - IE
Elavon
("Contractor")
Print Name: -Re
,-J eAsjO Rn
e.• ' • . '
Dated: i
U.S. Bank
(Bank) ,
Signature:3
Print Name:
Title: (�
Dated: Ll
1 of 1
Department of General Services Electronic Payment Acceptance Services MSA — Revised June 2011
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CONTRACT ROUTING FORM
INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below.
TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER:
Contracting Department: Community Services
Project Manager: Catherine Quffa Extension: 3078
Contractor Name: Elavon, Inc
Contractor's Contact: Beverly Baker Contact's Email: Beverly.Baker2@elavon.com
❑ FPPC: Check if Contractor/Consultant must file Form 700
Step
RESPONSIBLE
DESCRIPTION
COMPLETED
REVIEWER
DEPARTMENT
DATE
Check/Initial
1
Project Manager
a. Email PINS Introductory Notice to Contractor
_. „Lq ...
N
,iter a date.
n/a Imm
b. Email contract (in Word) and attachments to City
3/25/2019
NCGQ
Attorney c/o Laraine.Gittens@cityofsanrafael.org
2
City Attorney
a. Review, revise, and comment on draft agreement
3/29/2019
and return to Project Manager
(-'lick here to
Nlmm
b. Confirm insurance requirements, create Job on
enter a date.
PINS, send PINS insurance notice to contractor
Nn/a
3
Department Director
Approval of final agreement form to send to
Click or to
❑
contractor
to enter a
date
4
Project Manager
Forward three (3) originals of final agreement to
4/2/2019
NCGQ
contractor for their signature
5
Project Manager
When necessary, contractor -signed agreement
❑ N/A
agendized for City Council approval *
*City Council approval required for Professional Services
Agreements and purchases of goods and services that exceed
Or
$75,000; and for Public Works Contracts that exceed $175,000
Date of City Council approval
4/15/2019
NCGQ
PRINT
CONTINUE ROUTING PROCESS WITH HARD COPY
6
Project Manager
Forward signed original agreements to City
(I
���
Attorney with printed copy of this routing form
7
City Attorney
Review and approve hard copy of signed
agreement
I /I
8
City Attorney
Review and approve insurance in PINS, and bonds
(for Public Works Contracts)
411A-
9
City Manager/ Mayor
Agreement executed by City Council authorized
official
10
City Clerk
Attest signatures, retains original agreement and
forwards copies to Project Manager