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Home My WebLink AboutInvoice Cloud 2022-01-25 lnvoiceClo d" Add-On to the Biller Order Form SALES INFORMATION IC Sales Rep an Heffernan Vertical Local Gov(Util,Tax, Misc) Order Date 1/25/2022 Sales Partner Software Partner RecDesk PRODUCTS AND SERVICES Products [Cloud Pay] PAYMENT METHODS ACCEPTED Payment Types 1 [American Express] [VISA/Mastercard/Discover] [PayPal] [ACH/EFT] BILLER INFORMATION Ownership Type Government Phone (707)463-6295 Fax 1 (707)463-6740 Legal Name City of Ukiah Website URL http://cityofukiah.com/ Address 1 300 Seminary Avenue Bus.Open Date 3/8/1876 Address 2 Federal Tax ID City Ukiah *Federal Tax ID and Legal Name must match on all documents State CA ZIP 195482 BILLER CONTACT Primary Contact Name Mary Horger Phone (707)463-6233 Email Address mhorger@cityofukiah.com SIGNING AUTHORITY Name Sage Sangiacomo Title City Manager Phone 707-463-6217 Fax (707)463-6740 Email Address ssangiacomo@cityofukiah.com BILLER PRICING Description Interval Cost Type Cost HARDWARE Card Reader Type Quantity Cost per Reader Card Reader Billing Interval Shipping Addr. (if different than location address) Kiosk Type Device Quantity Per Device Txn Min Note:Biller will be charged for the minimum number of transactions listed to left each Standard/In-Door 750 month per kiosk unity.In addition,if the Biller's order includes kiosks then the terms Thru-Wall 800 and conditions of Kiosk Managed Standard SOW(and applicable schedules)are hereby Outdoor Model 850 agreed and incorporated by reference BILLER BANK INFO Note: Must include voided business check or bank letter for each unique account Billing Method Monthly Invoice Name on Account City of Ukiah Bank Name I Umpqua Bank Bank Address 607 S State St Phone 17074672244 Ukiah,CA 05482 Routing# 123205054 Last 4 Acct# 14605 DATA RETENTION Months to Keep 24 *Additional Fees apply if greater than 24 months NOTES/SPECIAL HANDLING CERTIFICATION AND AGREEMENT A. By signing below,the Biller hereby ratifies its authorization for Invoice Cloud,Inc.("Invoice Cloud")to execute debit/credit entries to its checking/deposit account(s) indicated above at the depository financial institution(s)named above and to debit/credit the same such account(s).The Biller acknowledges that the origination of ACH transactions to its account(s)must comply with the provisions of U.S.law.This authority is to remain in full force and effect until(i)Invoice Cloud has received written notification(by electronic or U.S.mail)from the Biller of its revocation in such time and manner as to allow Invoice Cloud a reasonable opportunity to act on it,but not less than 10 business days notice;and(ii)all obligations of the Biller to Invoice Cloud that have arisen under this Agreement and all other agreements have been paid in full.The Biller must also notify Invoice Cloud,in writing,(by electronic or U.S.mail)when a change in account number(s)or bank has occurred at which time this authorization shall apply to such new/changed account.This notification must be received within 10 business days of change.A fee will be charged for any returned ACH debits. B. By signing below,the Biller named: (1)has read,agreed to,ratifies the Biller Agreement,Biller T+C and other Order Forms previously executed by the Biller, and(2) certifies to Invoice Cloud that he/she is authorized to sign this Add on to the Biller Order Form;(3)certifies that all information and documents submitted in connection with this Order Form are true and complete;(4)authorizes Invoice Cloud or its agent to verify any of the information given,including credit references, and to obtain credit reports(including a spouse if in a community property state);(5)agrees to pay the Monthly Access Fee through the last day of the month following the effective date of termination as provided in the Billing Agreement;(6)agrees that Biller and each transaction submitted will continue to be bound by the Order Form and the Biller Agreement in its entirety and any new agreement forms executed herewith;(7)If the Biller's order includes kiosks,then the terms and conditions of Kiosk Managed Services Standard SOW(and applicable schedules)are hereby agreed and incorporated by reference.(8)agrees that Biller will submit transactions only in accordance with the information in this Add on to the Biller Order Form and Biller Agreement and will immediately inform Invoice Cloud,by email (contracts@invoicecloud.com)if any information in this Order Form changes,and(9)the Biller agrees and understands that outstanding sums due and owing to Invoice Cloud.,will be charged daily or monthly and debited from its current depository account. Non-sufficient funds for these debits are grounds for a change in fees or termination of this Agreement. In the event of non-payment of any sums due,Invoice Cloud reserves the right to withdraw such sums from the current depository account at any time to ensure payment of the same. C. Pay by Text:Standard data rates and text messaging rates may apply based on the payer's plan with their mobile phone carrier.Payer can opt out of text messaging at any time with Invoice Cloud.Partial payment or overpayment is not supported.Service fees may apply based on the biller set up with Invoice Cloud.Biller may not use the service for activities that violate any law,statute,ordinance or regulation. D. By signing below,the Biller hereby gives permission to Invoice Cloud to access his/her credit history via Trans Union,Equifax,or other credit-reporting agency. E. This Add on to the Order Form will become effective only when counter-signed by Invoice Cloud and upon execution by the Biller of such third party agreement required by Invoice Cloud to permit use of the payment function of the Service. F. If the Biller's order includes kiosks,then the terms and conditions of Kiosk Managed Services Standard SOW(and applicable schedules)are hereby agreed and incorporated by reference. In WITNESS WHEREOF,the parties have executed this Agreement as of this day 02/09/2022 20:08 UTC Accepted by Biller: �/ Accepted by Invoice Cloud, Inc.: X �GC�B �C�/29lC�GU X Corporate Officer Corporate Officer Sage Sangiacomo Robert S. Autor Printed Name Printed Name City Manager Chief Operating Officer Title Title I ,-,voice loudTM Biller Order Form BILLER ORDER FORM INVOICE TYPE PARAMETER SHEET Invoice Type Parameters must be completed for each invoice type Invoice Type Recreation Pricing Model Non-Submitter CURRENT BILLING DETAILS is I Please indicate how many bills are sent monthly by placing the bill count for each month below: JAN FEB MAR APR MAY JUN I JUL I AUG SEP I OCT I NOV DEC 148 148 1 148 1 148 1 148 148 1 148 1 148 148 1 148 1 148 148 Avg CC Avg. Bills Per 253.00 Max Invoice$ 1000.00 Bill Frequency Monthly 148 Transaction $ Month PRODUCTS AND SERVICES Products and Services [Cloud Pay] TRANSACTIONAL PRICING (Paid by Biller) Payment Source Description Payment Method Fee Rate% Fee Amount Additional Biller Pays $ Fee$ Network Fees All Payment Sources Credit/Debit/PayPal .5% $0.40 Yes All Payment Sources ACH/EFT $0.75 Yes TRANSACTIONAL PRICING EXCEPTIONS SERVICE FEES(Paid by Payer) Payment Source Description Payment Method Fee Amount Calculation Max Min. Fee(S) per Type Payment$ Transaction All Payment Sources Credit/Debit $1000.00 All Payment Sources ACH/EFT $125000.00 IVR Surcharge All Payment Methods SERVICE FEE EXCEPTIONS i BILLER BANK ACCOUNT(FOR DEPOSITS AND CHARGEBACKS) Note:must include voided business check or bank letter for each unique account Routing# 123205054 Last 4 Acct# 4605 NOTES/SPECIAL HANDLING 11111111 ®11formStacksign tDocument Completion Certificate Document Reference Od49eb42-8cb6-4cf3-alc3-317ed2229193 Document Title Invoice Cloud / City of Ukiah - Add-on Contract Document Region Northern Virginia Sender Name Dan Heffernan Sender Email dheffernan@invoicecloud.com Total Document Pages 4 Secondary Security Not Required Participants 1. Mary Horger (mhorger@cityofukiah.com) 2. Sage Sangiacomo (ssangiacomo@cityofukiah.com) Document History Timestamp Description 01/26/2022 18:20PM EST Document sent by Dan Heffernan (dheffernan@invoicecloud.com) . 01/26/2022 18:20PM EST Email sent to Mary Horger (mhorger@cityofukiah.com) . 01/26/2022 18:20PM EST Email sent to Dan Heffernan (dheffernan@invoicecloud.com) . 02/09/2022 13:59PM EST Dan Heffernan sent a reminder email to Mary Horger at mhorger@cityofukiah.com. 02/09/2022 14:46PM EST Document viewed by Mary Horger (mhorger@cityofukiah.com) . 12.12.163.2 Mozilla/5.0 (Windows NT 10.0; Win64; x64) ApplewebKit/537.36 (KHTML, like Gecko) Chrome/98.0.4758.80 Safari/537.36 Edg/98.0.1108.43 02/09/2022 14:50PM EST Document viewed by Mary Horger (mhorger@cityofukiah.com) . 12.12.163.2 Mozilla/5.0 (Windows NT 10.0; Win64; x64) ApplewebKit/537.36 (KHTML, like Gecko) Chrome/98.0.4758.80 Safari/537.36 Edg/98.0.1108.43 02/09/2022 14:51PM EST Mary Horger (mhorger@cityofukiah.com) has agreed to terms of service and to do business electronically with Dan Heffernan (dheffernan@invoicecloud.com) . 12.12.163.2 Mozilla/5.0 (Windows NT 10.0; Win64; x64) ApplewebKit/537.36 (KHTML, like Gecko) Chrome/98.0.4758.80 Safari/537.36 Edg/98.0.1108.43 02/09/2022 14:51PM EST Approved by Mary Horger (mhorger@cityofukiah.com) . 12.12.163.2 Mozilla/5.0 (Windows NT 10.0; Win64; x64) ApplewebKit/537.36 (KHTML, like Gecko) Chrome/98.0.4758.80 Safari/537.36 Edg/98.0.1108.43 02/09/2022 14:51PM EST Email sent to Sage Sangiacomo (ssangiacomo@cityofukiah.com) . 02/09/2022 15:07PM EST Document viewed by Sage Sangiacomo (ssangiacomo@cityofukiah.com) . 12.12.163.2 Mozilla/5.0 (Windows NT 10.0; Win64; x64) ApplewebKit/537.36 (KHTML, like Gecko) Chrome/98.0.4758.82 Safari/537.36 02/09/2022 15:07PM EST Document viewed by Sage Sangiacomo (ssangiacomo@cityofukiah.com) . 12.12.163.2 Mozilla/5.0 (Windows NT 10.0; Win64; x64) ApplewebKit/537.36 (KHTML, like Gecko) Chrome/98.0.4758.82 Safari/537.36 02/09/2022 15:08PM EST Sage Sangiacomo (ssangiacomo@cityofukiah.com) has agreed to terms of service and to do business electronically with Dan Heffernan (dheffernan@invoicecloud.com) . 12.12.163.2 Mozilla/5.0 (Windows NT 10.0; Win64; x64) ApplewebKit/537.36 (KHTML, like Gecko) Chrome/98.0.4758.82 Safari/537.36 02/09/2022 15:08PM EST Signed by Sage Sangiacomo (ssangiacomo@cityofukiah.com) . 12.12.163.2 Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/98.0.4758.82 Safari/537.36 02/09/2022 15:08PM EST Document copy sent to Sage Sangiacomo (ssangiacomo@cityofukiah.com) . 02/09/2022 15:08PM EST Document copy sent to Mary Horger (mhorger@cityofukiah.com) .