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CS 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 y - 2 - %2q Paqe 1 of 2 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 RAFq�` 1, yo ,rY WITH P, 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