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TransFirst/Merchant Card Processing 14Direct Sales (TF Liable) - V13.0514 APPLICATION FOR MERCHANT CARD PROCESSING STW Short Name: GSD Assoc m 194438 Sales Rep Name: Scott Jarumbo Sales Rep Code: TF-1212 Branch # (if applicable) For purposes of this application. "Processor" or "TransFirst" is TransFirst. LLC. or one of its TransFirst affiliates_.lorated at 12202 Aimort Wav_ Suite 100_ Broomfield, CO 80021 and can be contacted at (800)654-9256. Additional information can be found on the TransFirst website, www.TransFirst.com. "Merchant Bank" or "Member Bank" is Synovus Bank, d/b./a Columbus Bank 8 Trust Company located at 1148,Broad Street, 4th Floor Main Office, Columbus, GA 31901, (706) 649-4900. Processor is a registered ISO/MSP of Columbus Bank & Trust Company. 1. BUSINESS INFORMATION Legal Business Name (25 characters max) DBA Business Name (23 characters max). City of La Quinta City of La Quinta Legal Address DBA Address (Physical location, no PO Boxes) 78-495 Calle Tampico 78-495 Calle Tampico City State ZIP City State ZIP LA QUINTA CA 92253 LA QUINTA CA 92253 Legal Phone Number Legal FAX Number Legal Phone Number Legal FAX Number 760 777-7000 760 777-7105 760 777-7000 760 777-7105 Email address for Notices: (west@la-quinta.org (See "Notices" in the Merchant Card Processing Agreement included with this application for additional information relating to email address usage) Customer Service Phone Number: (760) 777-7000 Length Owned? 32 Years Months Website address; www.la-quinta.org Preferred Address for: Statements? E Legal Address ❑ DBA Address Chargebacks? El Legal Address ❑ DBA Address ® FAX (760) 777-7105 ❑ Email Address (TransLink) Contact Name: Angelica Zarco Title: Member Phone: (760) 777-7093 Any prior bankruptcies? Businesses Yes Ed No If yes, filing date? Personal: ❑ Yes ®No If yes, filing date? Business type: E I Retail ❑ Retail with tips ❑ Restaurant ❑ MOTO % ❑ Internet % ❑ Lodging ❑ Supermarket ❑ Utility ❑ Pharmacy ❑ Business to Business Detail business description (include Description of Products or Services Sold). MCC / SIC 9399 Provide separate pages if needed: Government Business License Processina INFORMAtim Taxpayer Identification Number. (Must be 9 digits) 95-3740431 Business Name: (as shown on your income tax return up to 40 characters) El EIN ❑ Social Security Number ❑ ITIN City of La Quinta Address for IRS/Compliance notices: (if different than Legal Address given above) To consent to paperless delivery of IRS notices, please review and check the box below: 78 495 Calle Tampico ❑ By checking this box, you acknowledge that you have read and agree to Consent to Paperless Delivery of Tax Related Documents located at City LA QUINTA State CA Zip 92253 www•transfirst.com/documents.htmi and included with this Application and that you consent to receiving IRS notices via paperless delivery. For purposes of paperless delivery of IRS Notices, you are required to provide a valid email address. If different from the email address already provided above, please indicate the email address where you wish to receive paperless delivery of your IRS Notices. If you consent to receive IRS/Compliance notices by paperless delivery, to have IRS/Compliance notices sent electronically, please indicate the email address where such notices should be sent (Email address required) (west@la-quinta.org Type of Ownership: Exempt Payee: ❑ Yes ® No ❑ Sole Proprietorship, Date of Birth ❑ LLC ❑ Partnership ❑ Ltd Liability Partnership ® Government Entity ❑:Trusf ❑ Professional Association ❑ Political Organization ❑ Public Corporation ❑ Private Corporation ❑ Non Profit Corporation 3. OWNER AND OFFICER -INFORMATION NOTE: PRIVACY POLICY WITH RESPECT TO THE COLLECTION AND USE OF SOCIAL SECURITY NUMBERS CAN BE FOUND AT WWW.TRANSFIRST.COM. Name of Owner/Officer and Title Social Security Percent Residential Address, City, State, Zip Residential Phone Number Owned • Number Frank Spevacek - Manager % 78-495 Calle Tampico, LA QUINTA, CA 92253 (760) 777-7000 PATRIOT4. PATRIOT ACT REQUIREMENTS - To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act requires all financial institutions t obtain, verify and record information that identifies each person (including business entities) who opens an account. What this means for you: When you open an account, w will ask for your name, physical address, date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver license or other identifying documents. Complete Section I and II for all business types except a Government Entity or Non -Profit Entity where only Section I is required Completion of Section III by Sales Re resentative is required. Section I: Business Form of Identification Items Reviewed Section Il: Individual Form of Identification Items Reviewed ❑ Govt. Issued Business License EntityBusiness Name: ❑ Drivers License Name: ❑Tax Return ❑ State ID Date of Date of Birth: Date and Place of Issuance: ❑ Entity Articles ❑Pass Passport p Date of Issuance: ❑Business Financial Statement ❑Military ID State/County of Issuance: ID/IRS Employer ID: ® Government Entity Expiration Date: Expiration Date: Section III: Site Survey Option C: ® Sales partner validated business site is consistent with application. Merchants Physical Inventory Consistent with the Business Signage: ® Yes ❑ No ELABAF0368347 Page 1 of 4 Version - 1 6/25/201412:38:31 PM 5. ., PROCESSING INFORMATION Have you ever accepted credit cards before? ❑ Yes ® No If yes, what is the Processor's name? Please provide the most recent 3 months of credit card processing statements. Number.of locations? A. If you are affiliated with an existing account, please provide existing Merchant ID#: 41399800962125 Please check this box if you are applying for processing services for additional merchant locations. If the additional locations are under common ownership, federal tax identification number, same authorized signatory, please submit the Additional Merchant Addendum as Exhibit A with this Application. Please note that all additional locations, along with the Primary location, will be subject to and governed by the terms and conditions of this Application and the Merchant Card Processing Agreement referenced in and included with this Application. If the additional locations are not under common ownership or have varying tax identification numbers and authorized signatories, you will be required to submit a separate Application for Merchant Card Processing per location. Do you bill your customers prior to goods being shipped? LJ Yes bd No If Yes, how many days?, ❑. 0-2 days ❑ 3-30 days ❑ 31-60 days ❑ 61-90 days ❑ Over 90 days What is your Return and Refund Policy? (Please be specific) How do you advertise? (check all that apply) ❑Yellow pages ❑Telemarketing ❑Catalog ❑Word of mouth ❑Publications ❑ Mass/Direct mail ❑ Internet ❑ Other, please explain: Please supply copies of advertising, including catalogs and brochures. Where applicable, provide video , audio to Radio or IVR , and Web -page screen prints. Ust the URL (www. X .com..net.org, eta. on each page. Card Types Requested? Select all that apply. ❑ All Credit Cards ❑ All Credit and PIN Based Debit Cards • ® PIN Based Debit Cards Only " 'Merchant has the right not to accept all card types. "Point Of Sale programming cannot prohibit theacceptance of credit cards; therefore, It is the merchant's responsibility to enforce this. Processor, and not Merchant Bank, will settle American Express, Pa PaITM In -Store, Discover, and JCB transactions. Credit Card Processing Methods Do you use a third party fulfillment house? Average Total Credit/Debit Card Swiped Transactions 100 % ❑ Yes ®.No Credit/Debit Monthly Sales: Manually Keyed (Card Present with Imprints) % If yes, provide name and address. Transaction Manually Keyed (Card Not Present and/or Mail Order/relephone Order) % (Ticket) Amount: eCommerce (Card Not Present) % Total (must equal 100%) 100 % Business to Business . (must be 0 - 100%) 10 % 7500 $. $ 12,000.00 Does annual American Express volume exceed $1,000,000? ❑ Yes® No Would Merchant like to receive American Express marketing materials? .❑ Yes®No Seasonal Business? ❑ Yes® No If yes, indicate by "X" the months that are ACTIVE: ®Jan ®Feb ®Mar ®Apr ®May ®Jun ®Jul ®Aug ®Sep ®Oct ®Nov ®Dec List the names of each of your independent contractors'or agents that will have access to store, process, or transmit cardholder data, including online shopping carts, payment gateways, hosting companies, and order -taking services. (Provide separate pages if needed). 6. BANKING INFORMATION Name and Phone Number Routing Number Bank Account Number Type of Use this account for: of Financial Institution (Shown on the bottom of check) (Shown on the bottom of the Check) Accounts ". WELLS FARGO BANK, NA (800) 745-2426 121000248 4159282482 ® checking bd dailysettlement TXPACHsetuement ® monthly billing ® TXP ACH fees 12 chargebacks ,,y ,,,..,.Z,�,., , ��o��ua� ,,,�",uuw, ,r i am uc o u an n acuvuy. Av mvm� rcan rvrc Av rvmAlry rvKVA IKAKJrtK tAliK): i ne Mercnant tlanK (dennea on page S) is authorized to initiate or transmit automatic debit and/or credit entries and/or check entries to the account identified above and in the provided voided check (if applicable) relating to the above account (") for all services contemplated under this Agreement. Said authority is oranted to Merchant Bank's Pm ssnr and their anants 7. TRADE REFERENCES Bank or Trade Name Account Number 77 Product Sold777 Phone Number 8. FEE SCHEDULE All VISA/MC/AXP/DISC/PP/JCB/Diners Credit Cards Discount Rate/Per Item Fee: 1.80 %+ $ per item Pricing Plan. Reduced Rewards All Non-Qualfed fees apply to all Visa/MCfAXP/DISC/PPMC6/0iners Card types Non -Qualified Surcharges: The following association -related fees may be added to "Fees for Access to Card Brand Services" billing bundle or be itemized on merchant statements - Cross border international transaction assessments/program support, MC network access/brand usage (NABU), MC license fee, Visa US acquirer processing fee (APF), Visa Zero Floor Limit, Visa misuse of the authorization system, Visa FANF, Visa debit integrity, MC processing integrity, Discover data usage, American Express Access and System Processing fees may apply. Further VISa/MC./AXP/DISC/PP mandated fees, including association Base 11 and kilobyte fees, may also apply. Batch Close Fee: All batch dosing and batch inquiries are considered "transactions" and will be billed at the same rate as Vlsa/MC/AXP/DISC/PP Trans Fees unless specified. Monthly Minimum Discount: Applies to Discount Rate & captured transaction fees. Qualified T&E Surcharge of .60% will apply to T&E merchant transactions. TransFreedom: In addition to your TransFreedom Monthly fee, Automatic Volume Purchase billing may apply to volume processed in excess of the current pricing tier at a rate of $20.00 per every $500.00 in additional processed volume. Please see www.TransFirstcorrr for ways to reduce processing and interchange expense. Authorization Fee: All Card Types $ 0.26 Voice Auth Fee $ 0.52 ARU Auth Fee $ 0.52 Batch Close Fee $ 0.00 - Monthly Service Fee $ 6.00 Application Setup Fee $ 0.00 Chargeback Fee $ 0.00 Monthly Minimum $ 0.00 ACH Return Fee $ 0.00 ACH Change Fee $ 0.00 Note t�roi essnYanrlits cojJfractors rrovide the�tldrtlona/products and services set forffi rn secilons 9 !0 acid 1 f in addrhon fo Purchasing Cards Corporate Cards and Kieefx> Cards-A%fercira�niBanKtloesjiot�irovidesilcli�rvJcess"NdhasnotOspo�sibilRynr"Cratiilityforttiertr,�•�• x � ,,,� � -�, ELABAF0368347 Page 2 of 4 Version - 1 6/25/201412:38:31 PM ADDITIONAL9. ❑ ACH Processing (ACH Addendum required) ❑ Check Services (CrossCheck Application required) ❑ Petro/Fleet (Petro addendum required) ❑ Voyager ❑ Wright Express (WEX) PIN Debit/EBT Debit Discount Rate: NOTE -PIN Based Debit authorization and interchange fees may apply. PIN Based Debit Per Item Fee $ 0.26 PIN Based DebtYEBT Monthly Fee $ 0.00 PIN Based Debit/EBT Application Fee $ 0.00 EBT Per Item Fee $ Wireless and Other Services Petro/Fleet (per Terminal) Setup Fee: $ Monthly Fee: $ ® Section 11.2(d) Fee (as stated in the Merchant Card Processing Agreement does not apply if checked) r EQUIPMENT OPTIONS Industry: ® Retail ❑ Retail w/ Tips ❑ Restaurant ❑ MOTO ❑QPS Retail ❑ QPS Restaurant ❑ Lodging ❑ Petro/Fleet ❑ Cash Advance Equipment shipped to: ❑ DBA ❑ Legal ❑ Agent ❑ Other` ® N/A Merchant trained by: ❑ Agent ® TransF)rst ❑ Other* Welcome Kit sent by: ❑ Agent ® TransFirst Welcome Kit shipped to: ❑ DBA ® Legal ❑ Agent ❑ Other' ❑ WA. 'If'Other was selected above, provide shipping details below. `Name: 'Address: 'City 'State: *Zip: Item Description Model Number Version or Serial # CITY Code Price Bill To PIN Based Debit I El Yes ❑ No Pin Pad PP1000SE 1 MO WA EBT Services I ❑ Cash Benefits Only ❑ Food Stamps' ❑ Both* *EBT FNS/FCS# (7 digits): Multi -Merchant ❑ Yes ® No Terminal Vx570 1 MO N/A Parent MID: Number of Child Accts: AVS ®.Yes ❑ No Invoice ® Yes ❑ No Corp/Purch Card El Yes ❑ No eCommerce ❑ Yes 63 No Verification Code 9 Yes ❑ No Quick Pymnt Sry ❑ Yes ® No Partial Auth ® Yes ❑ No Shared Line ❑ Yes ® No Auto Close ® Yes ❑ No Auto Close Time 2300 Connection Method ® Dial ❑ IP/SSL ❑ Wireless Dial Prefix I Memory Size I ❑ 512K ❑ 1 Me EMV Capabilities ❑ Contact ❑ Contactless ❑ NFC Merchant Email Address (Required): "Shipping, handling and tax will be billed in addition to the equipment price listed above. If merchant owned WAY terminal, SIM # & Serial# required. Bill To Options: Merchant, Agent, Transfirst, NIA. Codes: FUA = Free Use Addendum (Submit FUA addendum with this Application), MO=Merchant Owned, PN=Purchase New, PO=Purchased Via Other Source,PRF=Purchased Refurbished, LSE=Lease, FLS=FD Leasing, EE=Encryption Exchange,—RTL=POS Portal Rental Program or "STR=Short Term Rental. Any free use equipment provided by TransFirst is the property of Transfirst and is being provided for free use and Merchant agrees that it has read and agrees to the terms and conditions regarding the free use of the equipment as set forth In of the Merchant Card Processing Agreement located at www.transfirst.com/documents.html and included with this application. • • '. . • • • 11 • Product ❑ Transaction Central ❑ Transaction Central Plus (CC & ACH -ACH Addendum required) ❑ Transaction Express ❑ Transaction Express ACH Input Types: ®Virtual ❑ Web Services ❑ Batch ❑ Post ❑ Hosted I Industry. ❑ Retail ❑ MOTO ❑ eCommerce "Integrated Product Name: - "Integrated Website Address: '—Welcome Email Address: Item Description Model Number Version or Serial # QTY Code Price ; Bill To . , .`C,i°EJ1TU12E Batch Close Method ❑ A ❑ M TG DAD fIrAZURESk Corp/Purch Cards . `". ❑ Y Recurring Method ❑ A ❑ M Duplicate Card Accep ❑ Y Multi -User ❑ Y ECI (mqd for Internet) ❑ Y Batch Uploaded ❑ Y AVS ® y Allow Blind Credits ❑ Y Private Label ❑ Y Group ID: PL Name: PIN Based Debit y� Batch Close Method ❑ Y ,r„'1, ❑ M/A Batch Close Time: Direct Swipe ❑ Ya",.--,._ Partial Auth ❑Y " w,8r Batch Response File ❑ Y File Split ❑ Y Private Label ❑ Y r„ Convenience Fee ❑ Y Debit Only ❑ Y PIN Based Debit ❑ Y Special Instructions: *Important: it feature not selected, it will be defaulted off. If Manual Recurring is selected, Auto Recurring is also activated. it both ECI and Recurring needs to be setup under 1 MID, 2 Transaction Central setups are required. Note: A=Auto IM=Manual "Shipping, handling and tax will be billed in addition to the equipment price listed above. Bill To Options: Merchant, Agent, Transfirst, NIA. Codes: FUA = Free Use Addendum (Submit FUA addendum with this Application), MO=Merchant Owned, PN=Purchase New, PO=Purchased Via Other Source,PRF=Purchased Refurbished, LSE=Lease, FLS=FD Leasing, EE=Encryption Exchange, "RTL=POS Portal Rental Program or "STR=Short Term Rental. Any free use equipment provided by TransFirst is the property ofTransFirst and is being provided for free use and Merchant agrees that it has read and agrees to the terms and conditions regarding the free use of the equipment as set forth in of the Merchant Card Processing Agreement located at www.transfirsLcom/documents.html and included with this application. - - ELABAF0368347 Page 3 of 4 Version - 1 6125/201412:38:31 PM PLEASE CAREFULLY REVIEW THE MERCHANT CARD PROCESSING OPERATING GUIDE AND THE TERMS AND CONDITIONS OF VERSION 10.1013 OF THE MERCHANT CARD PROCESSING AGREEMENT (the -MPA'J PROVIDED TO MERCHANT AND AVAILABLE AT WWW.TRANSFIRST.COM/DOCUMENTS.HTML EACH OF WHICH .IS HEREBY INCORPORATED BY REFERENCE. IF APPLICABLE,- PLEASE ALSO CAREFULLY REVIEW THE TERMS AND CONDITIONS OF VERSION 4.0213 OF THE CARD NOT PRESENT ADDENDUM TO THE MERCHANT CARD PROCESSING AGREEMENT PROVIDED TO MERCHANT AND AVAILABLE AT WWW.TRANSFIRSTCOM/DOCUMENTS HTML WHICH IS HEREBY INCORPORATED BY REFERENCE. Agreement Signature: As the person signing below on behalf of the business designated on the above application as the Merchant, I certify that I am an owner, partner or officer of the Merchant and have been duly authorized to sign this application and to bind the Merchant to the Merchant Card Processing Agreement terns and conditions. Merchant and each guarantor signing below hereby acknowledge that they have each received and read the Merchant Card Processing Agreement and the Merchant Card Processing Operating Guide and agree to be bound by the terms and conditions contained in those documents. Merchant certifies that all information provided in this applicaflon is true, correct and complete. Merchant (and Guarantor when applicable) authorizes the Merchant Bank and Processor or their respective agents to make whatever inquiries the Merchant Bank or Processor deems appropriate to investigate and verify any of the credit, financial and other information given by Merchant for the purpose of this application, including credit references and to obtain credit reports on each person signing below. Credit or other information on Merchant, owners, officers and any.guarantors of the Merchant may be requested for purposes of this application and during the merchant processing relationship pursuant to the MPA. If'RTL' or'STR' is indicated in Section 10, then by signing below and upon receiving delivery of the POS Portal rental equipment, Merchant represents that Merchant has read and agrees to be bound by the terms of the POS Portal Rental Agreement Merchant authorizes POS Portal, Inc. ("POS Portal") to verify the application information and receive and exchange information about Merchant, including requesting reports from consumer reporting agencies. If 'FLS' is indicated, then by signing below and upon receipt of the First Data Global Leasing (FDGL) equipment, Merchant represents that Merchant has read and agrees to be bound by the terms of the Equipment Lease Agreement. Processor will settle your American Express@, PayPal InStore Checkout and Discover@ transactions and (a) Merchant will receive one consolidated statement from Processor that will reflect Merchant's Visa, MasterCard, American Express, PayPal In -Store Checkout and Discover transactions; (b) Merchant's American Express, PayPal In -Store Checkout and Discover settlement funds will be paid at the same time and in the same manner as Merchant's Visa and MasterCard settlement; and (c) Merchant will not have a direct relationship with American Express, PayPal or Discover and the terms set forth in the MPA for American Express, PayPal In -Store and Discover transactions will apply. By signing below, Merchant agrees to be bound by the PayPal Operating Regulations for In -Store Checkout and the American Express merchant requirements contained in the Operating Guide. Merchant consents to the disclosure of transaction data, merchant data and other information about the Merchant to American Express and to the use by American Express of such information to perform its responsibilities in connection with the provision of its services, to promote the American Express Network, perform analytics and create reports, and for any other lawful business purposes including marketing purposes. Merchant agrees American Express may use any information in this application to screen and/or monitor Merchant in connection with American Express card marketing and administrative purposes. If the TransFreedom Program is selected above, then by signing Merchant acknowledges, accepts and agrees that pricing is based upon processed volume and average ticket size and that this pricing may be subject to Automatic Volume Purchase billing, in addition to the TransFreedom monthly fee, if Merchant's actual processing volume exceeds its current pricing tier. Merchant accepts and agrees that it is obligated for all monthly pricing based on its processed volume and average ticket size, including any applicable Automatic Volume Purchase billing. If Check Services is selected above, then CrossCheck acceptance shall be added to this application and by signing below, Merchant agrees to be bound by and perform in accordance with all the terms and conditions and provisions of the Check Services Agreement and as set forth by CrossCheck. Merchant acknowledges that the Terms and Conditions for Check Service will be sent to Merchant upon approval by CrossCheck. By electing to process Credit Card and/or Debit Card transactions and by signing this application, Merchant grants consent and authorization to Merchant Bank or its agents or designated representatives to initiate automatic debit and credit entries and adjustments to the Settlement Account and any Reserve Account through the ACH Settlement Process for the amounts due under the MPA in accordance with the terms and conditions of. the MPA. By electing to process ACH transactions and by signing this application, Merchant grants consent and authorization to Processor or its agents or designated representatives to initiate automatic debit and credit entries and adjustments to the Settlement Account and any Reserve Account through the ACH Settlement Process for the amounts due under the Automated Clearing House (ACH) Addendum and ACH Terms and Conditions provided and available at W W W.TRANSFIRST.COM/DOCUMENTS HTML, which are incorporated by this reference. By signing below Merchant acknowledges that it has been provided, has read and agrees to be bound by the ACH Addendum, and the ACH Terms and Conditions (v3.0412TC for TC Plus or v1.0412TXP for TXP ACH depending on processing services selected in Section 9). Merchant certifies that Merchant does not and will not provide, offer or facilitate gambling services, including offering or facilitating internet gambling services, or establishing quasi -cash, credits or monetary value of any type that may be used to conduct gambling. Any unilateral alteration, strikeover or modification to the preprinted text or line entries of the application or MPA shall be of no effect. Merchant acknowledges that the parties may produce and rely upon a copy or electronically stored image of the merchant application and MPA for all legal purposes. Frank J cek, Ci Print Name 2) Merchant Signature (Owner or Officer) Date Print Name Title 1) Guarantor Signature Date Print Name (No titles) 2) Guarantor Signature Date Print Name (No titles) ELABAF0368347 Page 4 of 4 Version - 1 6/25/201412:38:31 PM Card Organization Disclosure Page Merchant Services Provider Contact Information Name: TransFirst, LLC Address: 12202 Airport Way, Ste 100, Broomfield, CO 80021 URL: www.TransFirst.com Customer Service #:. 800-654-9256 Member Bank/Merchant Bank Information The Bank's mailing address is.Synovus Bank, d/b/a Columbus Bank and Trust Company, located at 1148 Broad Street, 4th Floor Main Office, Columbus, GA,31901, and the phone number is (706) 649-4900. Important Member Bank Responsibilities • The Bank is the only entity approved to extend acceptance of Visa and MasterCard products directly to a Merchant. • The Bank must. be a principal (signer) to the Merchant Card Processing -Agreement. • The Bank is responsible for educating Merchants on pertinent Visa and MasterCard Rules with which Merchants must comply; but this information may be provided to you by Processor. • The Bank is responsible for and must provide settlement funds to the Merchant. • The Bank is responsible for all funds held in reserve that are derived from settlement. Important Merchant Responsibilities • Ensure compliance with cardholder data security and storage requirements. • Maintain fraud and chargebacks below thresholds. • Review and understand the terms of the Merchant Card Processing Agreement. • Retain a signed copy of this Card Organization Disclosure Page. • Comply with Visa Regulations. You may download a copy from Visa's website at: http://usa.visa.com/merchants/operations/op eaulations.html. • Comply with MasterCard Regulations. You may download a copy from MasterCard's website at: hftp://www.mastercard.com/us/merchantfsupporttruies.htmi . • Ensure compliance with American Express Program Requirements. • Ensure compliance with Discover Card Acceptance regulations. • Ensure compliance with PayPal Operating Regulations for In -Store Checkout. The responsibilities above do not replace the terms of the Merchant Card Processing Agreement and are provided to ensure the Merchant understands some important obligations of each party and that the Bank is the ultimate authority should the Merchant experience any problems. Merchant Information (* = Required) *Business Legal Name (Printed): *Business Address: *Business Phone: *Signature of Owner or Officer: *Printed Name of Owner or Officer: *Title: *Date: City of La Quinta 78-495 Calle Tampico LA QUINTA. CA 92253 760 777-7000 Frank Sp Manager 6/25/2014 ELABAF0368347 Version -1 6/25/2014 12:38:32 PM Consent to Paperless Delivery of Tax -Related Documents Please read this information carefully and print or download a copy for your files. You may elect to receive tax -related documents from TransFirst, LLC or its affiliates ("TransFirst") via electronic delivery either via email or delivered through a web interface, where you can go to a web site and download the statement. However, IRS guidelines require that you must first review these disclosures and provide your affirmative consent to receiving information in an electronic format. This Consent to Paperless Delivery ("Consent") is effective until withdrawn by you. This is your copy of the Consent. By agreeing to accept required tax —related documents electronically, you also agree that: 1. Your computer system meets the hardware and software requirements stated below under "System Requirements"; and 2. You will promptly notify TransFirst of any change in your e-mail address by providing ,your merchant taxpayer identification number and merchant name as it appears on your Form W-9 either by calling TransFirst at (800) 654-9256, or by writing to: TransFirst, LLC 12202 Airport Way, Suite 100 Broomfield, Colorado 80021 c/o IRS Account Maintenance Consent to Paperless Delivery of Tax -Related Documents By clicking on the "I have read the Consent and consent to paperless delivery" checkbox, you acknowledge that you have read and understand this Consent, and that you affirmatively consent to receive and acknowledge that you can access, receive, print and retain your tax -related documents (including IRS Form 1099) electronically. You agree that such information may be communicated online by posting notices, disclosures and other communications on our website or by sending such information to you by e-mail. Your consent to receive tax -related documents electronically will be effective until withdrawn (see "Withdrawal of Consent"). If you do not specifically consent to. the electronic delivery of tax -related documents by clicking the applicable checkbox, you will continue to receive paper copies of all required tax -related documents, including Form 1099. Additional Paper Copies In addition to consenting to and obtaining electronic copies, you may request additional paper copies of your tax -related documents by contacting TransFirst as provided above. Requesting a paper copy of your tax -related documents will not be considered a withdrawal of your consent for paperless delivery. You must formally withdraw consent to begin regularly receiving a paper copy of your future tax -related documents. Notification of Change to E-mail Address You agree to notify us promptly if your e-mail address or other account information changes by contacting us as provided above. For information that is required by law to be sent to you, including Form 1099, if we receive an electronic notice that an e-mail is undeliverable due to an incorrect or inoperable e-mail address, we will resend such information via U.S. Postal Service. Withdrawal of Consent Withdrawal of consent to paperless delivery is prospective only. Any withdrawal ensures that future tax -related documents will be delivered to. you as a paper document, but does not apply to any document that has already been furnished to you electronically. You may withdraw your Consent to paperless delivery by providing written notice either (1) by mail at the address set forth above; or (2) by email to etaxoptout@transfirst.com. TransFirst may take up to 10 business days after receipt to process your request. In each case, state that you are withdrawing consent to paperless delivery of tax -related documents, and provide the merchant's taxpayer identification number and the merchant's name'as it appears on its Form W-9. System Requirements To access your electronic tax -related documents, you need to be able to read Adobe PDF files. To do this, you must have Adobe Acrobat Reader installed on your computer. It can be downloaded for free at http://get.adobe.com/reader/. You also need to have a computer with Internet access that supports the use of a browser that supports 128-bit encryption, and will need to have JavaScript enabled in your browser. You need hardware as necessary to support this software. In order to keep copies for your records, you will need to have access to a printer or have the ability to download information. Agreement You understand and intend that your clicking on the "I have read the Consent and consent to paperless delivery" checkbox shall operate as your signature and you acknowledge that you have read the Consent and have printed or downloaded a copy for your records. You further acknowledge that you affirmatively consent to receive your tax -related documents, including IRS Form 1099 electronically. Tax -related documents will remain available electronically for at least one year after the date the document is first made available to you electronically. Notice of termination TransFirst reserves the right to stop paperless delivery of your tax -related .documents at any time by giving you notice. If TransFirst does so, TransFirst will send you paper copies of your tax= related documents. 78-495 CALLS TAMPICO 760.777.7000 LA QUINTA, CALIFORNIA 92253 Fax 760.777.7101 www.la-quints: org September 2, 2014 Mr. Scott Jarumbo (TF-1212) TransFirst 12202 Airport. Way,- Suite 100 Broomfield;.ICO 80021 Re:. Request to Add a Second Authorized Signer/Officer to the Merchant Card Processing Agreement Executed June 25, 2014.by the City of- La Quinta MID# 413998009692125 Dear Mr. Jarumbo: Please add.the position of Finance Director/City Treasurer to the City of La Quinta's Merchant Card Processing account as an additional authorized signer. The position is currently held by Rita Conrad whose signature is below for your files: Attached is Chapter 2.12 of the La Quinta Municipal Code, certified by the La Quinta City Clerk as evidence as my authority as City Manager to delegate signing authority to the City's Finance Director/City Treasurer. If acceptable, henceforth, authorized signers on this account will be one of the following: Frank J. Spevacek, City Manager OR Rita Conrad, Finance Director/City Treasurer Please contact me should you have any questions .or need additional information. Thank you. Yours truly, Frank J. pe cek City Man C Rita Conrad 'Finance Director / City Treasure Enclosure: Municipal Code Chapter 2.12, certified V6.0714 :TMNSFI RST 12202 Airport Way, Suite 100 Broomfield, CO 80021 MID: 413998009692125 Ph: 1-877-209-1360 Fax: 303482-8194 Legal or DBA Name: City of La Quinta Merchant Pricing Change Form PRICING (Select one): ❑QMNRC ❑DlHerentlal []Pass Through ❑TransFreedom PROCESSING TYPE: ❑Retell ❑MOTO ❑TTC Fee Category: Voice/ARU Auth Fee Chargeback Fee Vlsa/MCIAXPIDISC/PPWC81 Discount Rate Authorization Fee Per Item Fee Diners Cards 11 a licable $ $ Qualified or Plus Rate: All Card Types Batch Close Fee Retrieval Fee (Retail, MOTO, Internet) $ $ Mid -Qualified Surcharge: Monthly Minimum Discount Application Setup Fee (Retail Only) % Non Qualified or Monthly Service Fee Reprogramming Fee Differential Surcharge: % } Retail, MOTD,.Internal) Rewards Surcharge: % } �<�� TransFreedom Monthly Fee Terminal Support Fee (Retail Only) ❑ with Qualified Rewards at Pass Thru rr' rr °' __ _ :: $ $ ❑ Standard Card Check Card Rebate: Rebates Annual Fee: $ (Signature Based) ❑ Card Rebates Full Difference $ Start Date: ❑ �.: ri Fees for Access to Card Brand, ACH Return Fee ❑ Merchant Savings Club Services (see Nan-Qualifed $ es -.f $ MonthlyFee $Surch Tlia-lodtoiy'li cje7arndw 66.04ad!o:'Foaa rot Ad M to Cuid'arand,5601cos -billing handle or: be itemlirid ;on merchant statements'. Cross border hiteniatlonal transaction assessments/program support. MC network accesslbrand usage (NABU). MC license fee, Visa US acquirer processing fee (APF), Vise Zero Floor Limit, Mae misuse of the authorization system, Visa FANF, Visa debit Integrity, MC processing Integrity, Discover date usage and American Express Access and System Processing fees. Further Visa/ MC / AXP / DISC I PP mandated fees, including association Base II and kilobyte fees and Visa I MC 1 AXP / DISC / PP assessments, may also apply. Batch Close Fee: Ali batch closing and batch inquiries are considered 9ransactions' and will be bitted at the same rate as Visa / MC / AXP / DISC/PP Trans Fees unless specified, Monthly Minimum Discount: Applies to Discount Rate & captured transaction fees. Qualified T&E Surcharge of .60% will apply to T&E merchant transactions. TraneFroedom: In addition to your TransFreedom Monthly fee, Automatic Volume Purchase billing may apply to volume processed In excess of the current pricing tier at a rate of $20.00 per ikoiy S50a,00 fn' addlUcnal ued vofiirne: Otola:P�cascarsad itac�Lacto�Rcn ujet:HL¢ pdilonit(rlucl� Ag(f7rpeA yettotrl� hhu bcv.r+ddrT.(Cn,tq<I utchaNtrig Cittzl_s, Cnt±trrer nnma }lndfWnt,Cttrefe. titercrpet {tan .flnesru iris sued si+t:Y7t9•:&rttL112An01a. .... G1v!`N.'.f&?.bA ADDITIONAL SERVICES AND TERMS ❑ ACH Processing (ACH Addendum required) ❑ Check Services (Crosscheck Application required) ❑ PalroiFleat (Petro Addendum requited) . ❑ Voyager ❑ Wright Express WEX AiN Deti1GEBTx= - PIN Based Debit Per Item Fee' PIN Based Debit Monthly Fee PIN Based Debit Application Fee EBT Per Item Fee Network Release Fee $ $ .$ $ $ (Semiannuafy) 'Debit Discount Rate: NOTE- PIN Based Debit authorization and.interchatt a fees.ma .. apply, r=Tit'IRiaC:rORYri®RbYIIFLORStCHetl ro §s;Pirocebb/n``Seiylcet�.z. TC TC Plus TC Setu Fee One rime TC MonthlGatewaFee$ (par TXP Fee $ TXP C1 ACH TXP Packs a Setup Fee one time erPos TXP Package Monthly Fee $ ilerPos Integration Fee $ ACH Discount Rate % ACH Trans Fee $ ACH Return Fee $ Fraud Check Fee $ YYI�&/d9+siarftl:`OrtNePI,SBI'Vid#s ` , �- _ _. Wireless Se . tup Fee $ I One Tbne/PerTermina/ Wireless Monthly Gatewa Fee $ TerminsQ Administrative Service Fee $ (Annually) ❑ Monthly PCI Quarterly Program Fee' $ Petro/Fleet (per Terminal) Other Fee: <$ ao.co Other Fee: $ 011 �^�'^^ ❑ Semiannually 'Fee will be reduced to $ for ongoing Setup Fee: $ : _ - Breach Coverage Fee support once compliance is validated Monthly Fee: $ Description: Acth-natMonthy Fee Description: AwRNKT� F•o• 26e ... .._ $ PCI Monthly Non Validation Fee.$ The undersigned certify and affirm, under penalty of perjury, that all changes and/or instructions contained herein have been fully authorized and approved by the Board of Directors or other managing body or person of the Merchant. By completing the change in authorized signer Section, Merchant agrees that the authorized signer on the Initial- merchant application is no longer authorized. -Aulhorized Signer Merchant/Guarantor Signat Date Printed Name:.. 1� r Direct Sales (TF Liable) - V13.0514. APPLICATION FOR MERCHANT CARD PROCESSING STWShortName: GSD Assoc#: 194438 Sales Rep Name: •SCOtt Jarumbo Sales Rep Cade: TF-1212 Branch # (if applicable) For purposes of this application, "Prodeibior' or "TransRrst" Is TransFirst, LLC, or.one of its TransFirst affillatas, located at 12202 Airport Way, Suite 100, Broomfield, CO 80021 and can be contacted at (800)654-9256. Additional information can be found on the TransFirst website, www TransFirst cosh 'Merchant Bank' or'Member Bank' is Synovus Bank, d/b/a Columbus Bank 8 Trust Company located at 1148.Broad Street, 4th Floor Main Office. Columbus, GA 31901, (706) 649.4900. Processor is a registered ISOIMSP of Columbus Bank 3 Trust Company. 1. BUSINESS INFORMATION Legal Business Name (25 characters max) DBA Business Name(23.charactersmax)• City of La Qtiinta Citv of La Qu'inta Legal Address DBA Address (Physical location, no PO Boxes) 78-495 Calle Tampico 18-495 Calle Tampico City State ZIP City State ZIP LA QUINTA CA '92253 LA QUINTA CA 92253 Legal Phone Number Legal FAX Number Legal Phone Number Legal FAX Number 760 777-7000 760 777-7105 760 777-7000 • 76Q 777-7106 Emall address for Notices: bhOM@la-gultita.org - (Sse'NatlbW in the MerrhaM Card Processing ggreamenl inducted -with this application for adoonel IMonnation relating to email address usage.) Customer.ServIce Phone Nurriber. (760) 777 7000 LengthOwned7M-Years Months Websiteaddress www.la�quinta.org Preferred Address for. Statements? ® Legal Address ❑ DBA Address Chargebacks? ® Legal Address 0 DBA Address ® FAX (760) 777-7105 ❑EmaH Address (TransLlnk) Contact Name: Angelica Zarco Title: Member Plione: (760) 777-7093 Any prior bankruptcies? Businessfl Yes Rl No If yes, tiling date? Personal: ❑ Yes ® No if yes, filing date? Business type: 5a Retail. J3 Retail with lips Restaurant 0 MOTO % ❑ Internet % [ Lodging P Supermarket Utility E3 Pharmacy ❑ Business to Business % Detail business description (include Description of Products or Services Sold). I MCC /•SIC 9399 Provide, separate pages if needed G v • m u inesS Lf ns P Less — INFORMATION— Taxpayer Identification Number. (Must be 9 digits) 95-3740431 Business Name: (as shown on your Income tax return up to 40 characters) 63 EIN [ social Security Number [ ITIN City of La Quinta. Address for IRS/Compliance notices: (if different than Legal Address given above) To consent to paperless delivery of IRS notices, please review and check the box below: 78-495 Celle Ta"rnpico [] By checking this box, you acknowledge that you have read and agree to Consent to Paperless Delivery of Tax Related Documents located at www.trensfirst.com/documents.html"and included with this Application and that City LA QUINTA" . State CA Zip 92253 you consent to receiving IRS notices via paperess delivery. For purposes otpapedess delivery of IRS Notices, you are required to provide a valid email :address. If different from the email address. already provided above, please indicate the emall address where you wish to receive paperless delivery of your. IRS Notices." If you consent to receive IRS/Comptlance notices by paperess delivery, to have IRS/Compliance notices sent electronically, please indicate the email address wheresuch notices should be sent (Emall address required) IwestMa-guinta.org Type of Ownership:. Exempt Payee: ❑ Yes la No ❑ Sole Proprietorship, Date of Birth ❑ LLC 0 Partnership ❑ Ltd Liability Partnership 0 Government Entity [3Trusf ❑ Professional Association ❑ Political Organization ❑ Public Corporation ❑ Private Corporation ❑ Non Profit Corporation 3. OWNER AND OFFICER INFORMATION NOTE: PRIVACY POLICY WITH RESPECT TO THE COLLECTION AND USE OF SOCIAL SECURITY NUMBERS CAN -BE FOUND AT WWWTRANSFIRST.COM. Name of Owner/Officer and Title Social Security Percent Residential Address. City, State. Zip Residential Phone Number Owned- Number Frank Spevacek -'Manager % 78-495 Calle Tampico, LA QUINTA, CA 92253 (760) 777-7000 4. PATRIOTACT / SITE SURVEY PATRIOT ACT REQUIREMENTS - To help the'govemment fight the funding of terrorism and money laundering activities, the USA Patriot Ad requires all financial institutions to obtain, verify and record information that identifies each person (including business entitles) who opens an' akxount What this means for you: When you open an account, w will ask for your name,. physical address, date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver Ilednse or other identifying"documents. Complete .Section 1 and II 'for all business types except a Govemment Entity or Non -Profit Entity where only Section I is required Cornletion of Section 111 by Sales Re resentative Is required. Section I: Business Form of Identification Items Reviewed Section II: Individual- Form of Identification Items Reviewed ❑.GovL Issued Business License En tity Business Name:. ❑ Driver's License Name: ❑ Tax Return ❑ State t0 Date of Birth: DUID#. Date and Place of Issuance: [ Entity Articles [ Passport Date of Issuance: ❑"Business Financial Statement ❑ Military ID State/County of Issuance: ID/IRS Employer ID: ® Government Entity " Expiration Date: Expiration Date: Section III: Site Survey Option C:."® Sates partner validated business site is consistent with application. 'Merchant's Physical Inventory Consistent with the Business Signage:la Yes 0 No ELABAF0368347 Page 1 of 4 Version -1 6/25/201412:38:31 PM 5. CARD PROCESSING INFORMATION Havayou war accepted credit cards before? 13Yes ®No B yes, what is the Processoes name? Please provide the most recent 3 months of credit card processing statements. Nurnber.of locatlons? 3 . if you are afiliated.with an existing account,. please provide existing Merchant IDit. 41399800962125 IU Please tdteclk this box a you are applying for•processing services for additional merchant locations. B the additional locations are under common ownership, federal tax, Identification number, same authorized signatory, please submit the Additional Merchant Addendum as Exhibit A with this Application. Please note that all additional locations, along with the Primary location, will be subject to and governed by the terms and conditions of this Application and the Merchant Card Processing Agreement referenced in and included with this Application. If the additional locations are ndt under common ownership or have varying tax identification numbers and authorized signatories, you will be required to submit a separate Application for Merchant Card Processing per location. Do you bill your customers prior to goods beings ipped? ' es No If Yes,,how many days?•. 0. 0_2 days )] 330 days •0 31-60 days p 61-90 days ❑ Over 90 days What is ycurRetUrr1 and Refund Policy? (Please be specilic) ' How do you advertise? (check all that apply) Yellow pages Telemarketing 13 Catalog 0 Word of mouth El Publications ❑ MassiDirect mail Internet 0 Other, please explain: , Freese tNpplyiapies of adveNdnd. Including catalogs and brochures. Where lw video ffVh audio to o or IVRL and Wib- a screen print& tlst the URL .net. etc do each page. Card Types.Requested? Select all'that apply. ❑ AO Credit Cards ❑ All Credk,and PIN Based Debit Cards ® PIN Based Debit Cards Only'• •Merchant has the right not to accept all card types. "Point Of -Sale programming cannot prohibit the.s�cceptance of credit cards; therefore, it is the merchant's res onsibil' to enforce this. Processor, and not Merchant Ban will settle American Express, Pa Pal In -Store, Discover and JCB transactions. Credit Card Processing Methods Do you use a third party fulfillment house? Average Total CredMb(t Card Swiped Transactions 100 % ❑ Yes ®No Cred'NDeblt -Monthly Sales: Manually Keyed (Card Present with /mpdnts) % It yes, provide name and address. Transaction Manually Keyed (Card Not Present andforM60 OrdedTelephone Order) % (Ticket) Amount: eCommerce (CardNotPresent) % Total (must aqual 100%) 100 % $ 75.00 $12,000.00 Business to Businesa . (must be 0 -100%) 10 % Does annual American Express volume exceed.$1,000,000T E3 Yes® No Would Merchant like to receive American Express marketing materials? Yes No Seasonal Business! Q Yes® No 9yes, Indicate by 9C the months that are ACTIVE: ®Jan ®Feb ®Mar ®Apr ®May ®Jun ®Jul ®Aug ®Sep ®Oct ®Nov®Dec List the names of each of your independent contractorwor agents that will have access to store, process, or transmit cardholder data, including online shopping carts, payment gateways, hosting companies, and order -taking services. (Provide separate pages if needed). 6. BANKING INFORMATION Name and Phone Number Routing Number Bank Account Number Type of Use this account for': of Financial Institution (Shown on the bottom of check) (Shown on the bottom of the Check) Accounts +• WELLS FARGO BANK, NA (800) 745-2426 121000248 4159282482 ® checking deity settlement TXP ACH settlement ® monthly billing 13 TXP ACH fees ® chargebacks .. ..-..-.y ...-................ �... ............... ........ w wo...... -•. ....., •w.n�. n..,nvnw.wn rvn n�, vrnn, n. r„nua ,raw•arcn tn�.nr: , nn mmuwn, onnn ruaunw un pnyn �r u uumrnaw w Initiate or tmitsmitautomatic debit and/or credit entries'endlor check entries to the account identified above and in the provided voided ehecR (if applicable) relating to the above account (") for all services eonlemntated under this Aareemenr Said authadty rs arantwd In M-4—t Ranlr•s Prtvncen. o-A thurr a..o..t- 7. Ae Bank or Trade Name Account Number Product Sold Phone Number SCHEDULE8. FEE Ali VISAIMC/AXP/DISC/PP/JCB/Diners Credit Cards Discount RatelPer Item Fee: 1.80 e/. + $ per item Pdcing Plan. Reduced Rewards • Ali Non-Qwi led roes apply to an Wsa1Pk1 *?1D1SG0PkJdB1D1nars Card types Non4dii iedSurcharrg• es: The following assodatkinie(ated fees may be added to'Feas for Access to Card Brand Services• billing bundle or be itemized on merchant statements - Cross border intemational transaction assessmenWprogrem support, MC network.accessibrand usage (NABU), MCJloense fee, Visa US aogtiirer processing fee (APE), Visa Zero Floor Limit Visa ukuse of the apthorbetion system, Visa FANF, Visa debit integrity, MC processing integrity, Discover data usage, American Express Access and System Processing fees may apply. Further V salMCIAXP/DISC(PP mandated fees, including association Base II and kilobyte fees, may also apply. Batch Close Fee: All.batch dosing and batch inquiries are considered'transactione and will be billed at the'same rate as Vtsa/MC/AXP/DISC/PP Trans Fees unless specified. Monthly Minimum Discount: Applies to Disocunt Rate & captured transaction fees. Qualified T&E Surcharge of .60ga will apply to T&E merchant transactions. TransFteedcm: In addition 'to your TrdnsFreedom Monthly fee, Automatic Volume Purchase billing may apply to volume processed in excess of the current pricing tier et a rate of $20.00 per every $500.00 in additional processed volume. Please sea www.TnnsFlrstcom for ways to reduce processing and Interchange expense. Authorfzatfon Fee. All Card Types $ 026 Voice Auth Fee $ 0.52 ARU Auth Fee $ 0.52 Batch Close Fee $ 0.00 Monthly Service Fee $ 6.00 Application Setup Fee $ 0.00 Chargeback Fee $ 0.00 Monthly Minimum $ 0.00 ACH Return Fee $ 0.00 ACH Change Fee $ 0.00 IELABAF0368347 Page 2 of 4 Version -1 6/25/201412:38:31 PM 9. ADDITIONAL ❑ ACH Processing (ACH Addendum required) ❑ Check Services (CrossCheck Application required) ❑ Petro/Fleet etro addendum required) ❑ Voyager U Wright Express (VEX) PIN DebibEBT Debit Discount Bate: NOTE -PIN Based Debt authorization and interchange fees may apply. PIN Based Debit Per Item Fee $ • 0.26 PIN Based Debk/EBT Monthiyfee $ 0.00 PIN Based DebWBTApplication Fee $ 0.00 EBT Per Item Fee $ Wheless and Other Services PeMo/Fleet (per Terminal) Setup Fee: $ Monthly Fee: $ ® Section 112(d) Fee (as stated in the Merchant Card Processing Agreement does not apply -If checked) t EQUIPMENT OPTIONS mdUsY• ® Retalll] Retail w/Tips -Restaurant ❑ MOTO ❑ QPS Retail ❑ QPS Restaurant ❑ Lodging ❑ PetrolFleet' ❑ Cash Advance Equipment shipped Is DBA ❑ Legal 0 A Ant ❑ Other' ® WA Merchant trained byAgent Ea TransMrst 13 Other' Wetoome l(tsent W...❑ eht ®TrantiRmt Welcome IM shipped. W U DBA Ea Legal ❑ Agent '❑ Other' ' WA •a.'Other was selected above, provide shipping details below. 'Name: 'Address: 'CtlY 'State: 71p: Kent Description Model Number Version or ..Serial # . QTY Code Price Bill To w, PINBased Debit ® Yes O No Pin Pad PP1000SE 1 MO WA EBT Servloes Cash Benefits Only 0 Food Stamps' E38W •E8T FNS/FCS# (7 digits): Mulamerdhant 1 E3 Yes ® No Terminal Vxb70 1 MO . WA Parent MID: Number of Child Accts: AVS ®.Yea 13 No Invoice !ia Yes 13 No CorplPurdh Card 12 Ywj3 No eComineree 0 Yes 63 No VeriBcatlon Code Yas Na Ouidx Pymnt Sry Yes No Partial Auth' • ® Yea No' Shared tine . 0 Yes 12 No Auto Close Yes13 No Auto Close Time RO Connection Method Dlel 0 IP/SSL Wireless Dihd Prefix Memory sine ❑ 512K 1 Meg EMV Capabilities Contact 0 Contadess 0 NFC Merchant EMO Address(Required).* -Shipping, handling and tax will be billed in addition to the equipment price Ist•d above merchant owned WAY terminal, SIM required. Bill To Options: Merchant, Agent, T rst, WA. Coda$: RIA = Free Use Addendum (Submit FUA addendum with this Application), MO -Merchant Owned, PN=Purchase New. PO=Purchased Via Other Scum7a,PRF=Putdhased Refurbished, LSE -Lease, FLS'FD Leask,& EE=EnaYptlon Exdhangai "RTL-POS Pottal Rental Program or "STR�hod term Rental. Any free use equipment provided by TransFrst is the property of Tonal Irst and is being provided for bee uae and Merchant agrees that it has read and agrees to the terms and conditions regartling the free use of the equipment as set forth In of the Merchant Card Processing Agreement located at vANwtransfhsLoomkb6iments.hfiT4 and indttded with this appllcallan. 'Product ❑ Transaction Central ❑ Transaction Central Plus (CC & ACH -ACH Addendum required) • ❑ Transactlon Express ❑ Transaction E xprass ACH —0-Web MputTYp Virtual Services ❑ Batch ❑ Post ❑ Hosted Industry ❑ Retail MOTO E3 eCommerce —Integrated Product Name: " '"Indegrated Webelle Address: —Welcome Emall Address: Item Description " Model Number Version or Serial 0 QTY Code Price , Bill To D Batch Close Method ❑ A ❑ M CorpiPurch Cards ❑ Y ReeurttngMathod A El M Duplicate CardAceep Y Muld-User MY . ECl ingdforkwneq Y Batch Uploaded ❑ Y Avs ® Y Allow Blind Credits ❑ Y Private Label Y Group ID: PL Name: PIN Based Debit Y P Law, �t Batch pose Method ❑ WA Batch Close Time: Direct Swipe Y PaNalAuth ❑•Y. Batch Response Fite ❑ Y File Split Y Private Label • )] Y Convenience Fee ❑ Y Debit Only Y PIN Based Debit . Y special Instru dorm- 'Imparmnt$k bnratm%drd.nwmbode%uW L $rNmwltecau arawaad.aalo RawftleWee scented. ltbothECIand Reaming. WelobesetwpuMariM0.2Trarnacim CaMawWpssrarsqu d.►lots:A•IWmrM•Mamm1 . "Shipping. handling and tax VVM be billedaddalon to the-mquipment price IRWd above. Bill oOptions: Merchsnt, Agent, Transfirst, Cares: FUA. Free Use Addendum (Summit FUA addendum with this Appilcatlon). MO -Merchant Owned. PH-Purdhaw New, PO --Purchased Via Other Scuoe PRF=Purchased RefurbWuK% LSE•Lease, FLS-FO Leasing, EE-Encryption&.c hang% "RTL=POS Portal Rental Program or-M-Shod Term Renal. Any free use equrpmdrd provided by TransFirst to the property of TransFust and Is being provided for.free use and Merchant agrees that it has read and agrees to the terms and conditions regarding the free use of the equipment as set forth in of the Merchant Card Pracessbhg Agreementlocated 8t.wwW.tnMsftLcomftbcumerits.htQ and included with this application. ELAB00366347 Page 3 of 4 Version -1 612SM01412:38:31 PM PLEASE. CAREFULLY REVIEW THE MERCHANT CARD PROCESSING OPERATING GUIDE AND THE TERMS AND CONDITIONS OF VERSION 10.1013 OF -THE MERCHANT CARD PROCESSING. AGREEMENT (the 'MPA' PROVIDED TO MERCHANT AND AVAILABLE AT WWW7RANSFIRST.COMIDOCUMENTS.HTML EACH OF WHICH JS HEREBY INCORPORATED BY REFERENCE. IF APPLICABLE,' PLEASE ALSO. CAREFULLY REVIEW THE TERMS AND CONDITIONS OF VERSION 4.0213 OF THE CARD NOT PRESENT ADISENDUM TO THE MERCHANT CARD PROCESSING AGREEMENT PROVIDED -TO MERCHANT AND.AVAIi ABLE AT WWW.TRANSFIRST.COMIDOCUMEMIS.HTML WHICH IS HEREBY INCORPORATED BY REFERENCE. Agreement Signahae: As the poison signing below on behalf of the business designated on the above application as the Merchant, I certify that I am an owner, partnef or officer of the Merchant and have been duly authorized to sign this application and to bind the Merchant to the Merchant Card Processing Agreement terms and condttfons. Merchant and each guarantor aiong below hemby-acknowledge that they have each received and read the Merchant Card Processing Agreainent and the Merchant Card Processing Operating Guide and agree to be bound by the temps and eondtitons coniained In those documents. Merchant certifies (hat all Information provided in this application is true, correct and complete. Merchant (and Guarantor when applicable) authorizes the Merchant Bank and Processor or their respective agents to make whatever inquiries the Merdiant Bank or Processor deems appropriate to investigate and verify any of the credit finandal and other I fomhation.gNen by Merchant for the purpose of this application, Including credit references and to obtain credit reports on each person signing below. Creed or other information on Merchant owneiv officers and any.guarardor3 of the Merchant may be requested for purposes of this application and during the merchant procgwing relationship pursuant to the MPA ff'RTL' or WM ro Indicated in Section 10, then. by signing below and upon receiving delivery of the POS Portal rental equipment, Merchant represents that Merchant has read and agrees to be bound -by the tarns of the P05 Portal Rental Agreement Merchant authorizes POS Portal, Inc. tPOS Porfall to verify the application information and receive and exchange Information about Merchant; Including requesting reports from consumer reporting agendas. If TIZ Is Indicated, then by signing below and. upon receipt of the First Data Global Leasing (FDGL) equipment Merchant represents that Merchant has read and, agrees to bebourhd by the terms of the EquTpmenl Lease Agreement Processor will settle your Ameilcan.Express®, PayPal InStore Checkout and Discover® transactions and (a) Merchant will receive one consolidated statement from Processor that will reflect Merchant's Visa, Mastercard; American Express, PaWal InStore Checkout and Discover transactions; (b) Merchant's American Express, PayPal In -Store Checkout and Discover settlement funds will be.patd at the same time and In the same -manner as'Mercharifs Mae and MasterCard settlement; and (c) Merchant win not have *a direct relationship with American Express, PayPal or Discover. and the temps set forth in the MPA for American Express, PayPal In -Store and Discover Iransaodtons will apply. By signing below, Merchant agrees to be bound by the PayPal Operating Regulations: for inStore Chedmut and the American Express merchant requirements contained In the Operating Guide. Merchant consents to the disclosure of transaction data, merchant data and other infcrtnefton about the Mer> rant to Amedcan•Express and to the use by American.Express of such information to perform its responsibilities. in connection with the provision of its services, to promote t he American Express, Network, perform enallygc s and create reports. and for any other lawful business purposes including marketing purposes. Merchant agrees American Express -may use eriy rnformation In this application to screen arid/or monitor Merchant in connection with American Express card marketing and administrative purposes. If the TransFreedom'Progiam o'selected abdV% then by signing Merchant acknowledges, accepts and agrees that pricing is based upon processed volume and average ticket slze'apd that this pig may su*ct to Automatic Volcmhe Purchase bliilng,'in addition to the TransFreedom monthly fee, if Merchant's actual processing volume exceeds its current pricing tie' Merchant accepts and agrees that it is obligated for oil inor * pricing based on Its processed volume and average ticket size, induding any applicable Automate Volume Purchase blil'uhg. If Check Services Is selected above, then CrossChedk acceptance shall be added to t Wapptication and by signing below, Merchant agrees to be bound by and perform in accordance with all the terms and eofiiditorn.and provisions of the Check Services Agreement and as set forth by CrossCheck. Merchant ackngwledges that the Terms and Conditions for Check Service will be sent to Merchant upon approval by Crosscheck. By; electing to process Credit Card andfor Debt Card transactions and by signing this eppliceton. Merchant grants consent and authorization to Merchant Bank or )lo agents or designated representativea.lo tnilfate aurtomatic debit and oaedit entities'and adjustments to ire Settlement Account and any Reserve Account through the ACH Settlement Process for the amounts due under the MPAin atcordarroewitithe'terms and conditions of the MPA �yb to pr ooess ACH transactions and bysiingihisappiicetloconsent and authorization to Processor or its agents or designated representatives to•Tndiate automatic end "aeofd omhies ad aoijustments" to theSettlement Aeoountanunt Through the ACH Settlement Process for the amounts due under•Ihe ArRomaled Clearing House ) Addemdcim and ACH Terror and Condigora provided and available at W W W.TRANSFIRST.COMIOOCUMENTS.FITML which are incorporated by this referenoxi By sigrhing below Merchant aclanmVledges thaf it has boon provided, tuns read and this to be bounil by the ACH Addendum, and the ACH Temps and Conditions (43.0412TC for TC Phu or v1041217� for T XP ACH M pendlog oaproicesstng"eervir selected in S d l 9). Merchant certijres' That Merchant does not and will not provide, offer or faaVtate gambling services, including offering or facilitating Internet gambling services, or establishing quasi -cask ash credits or monetary value of arty type that may used to conduct gambling. - Any dnilateratelteraton. stn'keover or modification to the preprinted text or line entries of the application or MPA shall be of no efted. Merchant acknowledges that the parties may produce and rely upon a copy or electronically stored image of the -merchant application and MPA for all legal purposes. 2. MERCHANT(s) 51GNATUI 2) Merchant Signafthe (Owner or Officer) Date Print Name. " Title z Guarentor Signature Date Pdnt Name (NO titles) Guarantor Signature Date Print Name (No lilies) 'EW- A`F0368W Page 4 of 4 Version-1 6/25/201412:38:31 PM Card Organization Disclosure Page ..Merchant Services Provider Contact information Name: Tran$First. LLC Address: 12202 Airport Way. Ste 100, Broomfield. CO 80021 URL• www.TrensFirst.com Customer Service # . 800.46 2fi6 Member BankWorchant Bank Information The Bank's making address Is.Synovus Bank, d/b/a Columbus Bank and Trust Company, located at 1148 Broad Street, 4th Floor Matn Office, Columbus, GA;31901, andthe*wne number is (706) 649-4900.' .Im ortant Member Bank Responsibilities P. The Bank is the only entity approved to extend acoeptance of Visa and MasterCard products directly to a Merchant • :.The Bank must,be a principal (signer) to the Merchant Card Processing9em gceent. The Bank Is responsible for educattng•Merchants on pertinent Visa and MasterCard Rules with which Merchants must comply; but this information may.be-provided.to you by Pr6cessor. • The Bank is responsible Wand must provide settlement funds to the Merchant • : The Bank is responsible.for all funds held in reserve that are derived from settlement important Merchant Responsibilities • : Ensure compliance with cardholder data security and storage requirements. - ' Malntain.fraud and chargebacks below thresholds. Review and understand- the terms of the Merchant Card Processing Agreement. Retain. a signed copy of this Card Organization Disclosure Page. Comply with Visa Regulations: You may download a copy from Visa's website at h sl��usa-i+,�a:com/riierchants/=radons/oR Mgulallons.htmi . Comply with MasterCard Regulations. You may download a copy from MasterCard's website at: bWJlw iiir stercard.com/us/merchantfsupnorthules.htmi .. •...Ensure compliance with American Express Program Requirements. • Ensure compliance with Discover Card Acceptance regulations. Ensurecompliance with PayPal Operating Regulations for In -Store Checkout The responsibllties. above do. not replace the terms of the Merchant Card Processing Agreement and -are provided to ensure the Merchant understands some important obligations of each party and that the Bank is•the ultimate authority should the Merchant experience any problems. Mercharitlntbimation (•. = Required) *Business Legal Name (Printed): City of Le Quints 'Business Address: 7&495 Calla Tampico IA QUINTA. CA 92253 •Business Phone' 01777-7000 `Signature of Owner or Officer. 'Printed Name of Owner'or Officer. `Title:.: iu�,ananer 'Date: W5/2014 ELASAF0368347 Version -1 8/25/201412:38.32 PM Consent to Paperless Delivery of Tax -Related Documents Please read this information carefully and print or download a copy for your files. You may elect to receive tax -related documents from TransFirst, LLC or its affiliates (" TransFirst") via electronic delivery either via email or delivered through a web interface, where you can go to a web site and download the statement. However, IRS guidelines require that you must first review these disclosures and provide your affirmative consent to receiving information in an electronic format. This Consent to Paperless Delivery ("Consent") is effective until withdrawn by you. This is your copy of the Consent. By agreeing to accept required tax —related documents electronically, you also agree that: 1 Your. computer system meets the hardware and software requirements stated below under "System Requicementg"; and, 2.. You will promptly notify TransFirst of any change in your a -mail address by providing Yourmerchant taxpayer identification number and merchant name as it appears on your Form W-9 either by calling TransFirst at (800) 654-9256, or by writing to: TransFirst, LLC 12202 Airport Way, Suite 100 Broomfield, .Colorado 80021 ` c% lP S Account Maintenance consent to Paperless Delivery of Tax -Related Documents By -clicking on the "I have read -the Consent and consent to paperless deli�ery" checkbox, you acknowledge. that you have read and understand this Consent, and that you affirmatively consent to receive and acknowledge that you -can access, receive, print and retain your tax -related documents (including IRS Form 1099) electronically. You agree that such information may be communicated online by posting notices, disclosures and other communications on our Website or by'sending such information. to you by a=mail. Your consent to receive tax -related documents electronically will be effective until withdrawn (see"Withdrawal of Consent"). If you do not specifically consent to the electronic delivery of tax -related documents by clicking the applicable checkbox, you will continue to receive paper copies of all required tax -related documents, includinglorm 1099. Additional Paper Copies In addition to consenting to and obtaining electronic copies,. you may request additional paper copies of your tax -related documents by contacting •TransFirst as provided above. Requesting a paper. copy of your tax=related ,documents will not be considered a withdrawal of your consent for paperless delivery. You must formally withdraw consent to begin regularly receiving a paper cd of your future tax -related documents. Notification of Change to E-mail Address You agree to notify us promptly if your e-mail address or other account information changes by contacting us as provided above. For information that is required by law to be sent to you, including Form 1099, if we receive an electronic notice that an e-mail is undeliverable due to an incorrect or inoperable e-mail address, we will resend such information via U.S. Postal Service. Withdrawal of Consent Withdrawal of consent to paperless delivery is prospective. only. Any withdrawal ensures that future tax -related documents will be delivered to. you as a paper document, but does not apply to any.document that has already been furnished to you electronically. You may withdraw your Consent to paperless delivery by providing written notice either (1) by mail at the address set forth above; or (2). by email to etaxoptout@transfust.com. TransFirst may take up to 10 business days after receipt to process your request.' In each case, state that you are withdrawing consent to paperless delivery of tax -related documents, and provide the merchant's taxpayer identification nuinber and the merchant's name'as it appears on its Form W-9. System. Requirements To access your electronic tax-related'documents, you need to be able to read Adobe PDF files. To do this, you must have Adobe Acrobat Reader installed on your computer. It can be downloaded for free. at bo://eet.adobe.com/redddr/.' You also need to have a computer with . Internet access that supports the use of a.browser that supports 128-bit encryption, and will need to have JavaScript enabled in your browser. You need hardware as necessary to support this sof fare. In order to keep copies for your records, you will need to have access to a printer or have the ability to download information. Agreement You.understand and intend that your clicking on the "I have read the Consent and consent to paperless delivery'.' checkbox shall operate as your signature and you acknowledge that you have read.the Consent and have printed or downloaded a copy for your records. You further acknowledge that you affirmatively consent to receive your tax -related documents, including IRS Form 1099 electronically. Tax -related documents will remain available electronically for at least one. year. after the date the document is first made available to you electronically. Notice of termination - TransFirst reserve$ the right to stop paperless delivery of your tax -related documents at any time by giving you notice. If TransFirst does so, TransFlrst will send you paper copies of your tax= related documents.. ar7/2014 ` La Quinta Municipal Code (La Quints, California) UP Previous Next Main Collapse Seam Print No Frailties Title 2 ADMINISTRATION AND PERSONNEL Chapter 2.12 DMECTOR OF FIMNCE AND GENERAL SERVICES 2.12.010 Office created. The office of the director of finance and general services is created and established. The director of finance and general services shall be the chief fiscal officer of the city. (Ord 2 § 1, 1982) . 2.12 020Appointnient. The.director of finance and general services shall be appointed by the city manager, and he shall serve at and during the pleasure of the city manager. The director of finance and general services shall be qualified by sufficient technical accounting training, skill and experience to be proficient in the office and shall show evidence of executive ability. (Ord. 2 § 1, 1982) 2:12.030 Duties. The duties of the director of finance and general services shall be as follows: A.. To serve as chief. fiscal officer of -the city; B. To serve as city treasurer as established pursuant to Section 36501 of the Government Code of the state; C. To perform all financial and accounting duties imposed upon the city treasurer by Sections 41000 through 4.1.007 of the Government Code; D; To assist and advise the administration and the city council in all matters pertaining to city finances; E. To perform all financial and accounting duties imposed upon the city clerk by Sections 40802 through 40805 of the Government Code; F. To develop and maintain, in accordance with the state laws and city ordinances and the best accepted procedures, adequate financial. records, reports and budgetary control of all receipts, disbursements and reserves of the city; G,-. To supervise the keeping of current inventories of all property of the city departments, offices and agencies; H. To Pre 'be. and develop accounting forms, reports and procedures in conjunction with administrative needs and requests, and as required by law; I. To`audit all demands in accordance with Sections 3.16.020 through 3.16.050 and 3.16.080 of this code; J.: To.prepare annually for budget purposes an estimate of revenues for the city manager, and assist the city manager in compiling the annual budget in accordance with the prescribed chart of accounts and accepted procedures; KI To assist the city council and the city manager in formulating a long-range financial plan and program; L. To perform such purchasing duties as delegated to the director of finance and general services by the city manager; and , M. To perform such other duties related to administrative and general services for the municipal government and business operations as may be delegated to the- director of finance and general services by the city manager. (Ord 103 § 1, 1987; Ord. 2 § 1, 1982) htto://o code:us/codeMaa aims/ 1/2 art/2014 La Quinta Municipal Code (La Quinta, California) 2.12:040 Independent audit. The council shall require annually an independent audit of the accounts and records of the treasurer and department of finance. and general services. This auditor shall be selected by council and shall be qualified as a certified public accountant. (Ord..2 § 1, 1982) httn•//nr ;%tic%;fyfi. lxuinta/ 2/2 OFFICE OF THE CITY CLERK TEL (760) 777-7103 SUSAN MAYSELS; CITY CLERK TERESA THOMPSON, DEPUTY CITY CLERK PAm NIETo, ADMINISTRATIVE TECHNICIAN ANNA ORTIZ, ADMINISTRATIVE ASSISTANT STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) CITY OF LA QUINTA ) I, SUSAN MAYSELS, City Clerk of the City of La Quinta, California, do hereby certify that the foregoing Chapter. 2.12 of the La Quinta Municipal Code containing Sections 2.12.010, 2.12.020, 2.12.030 and 2.12.040 is a full, true and correct copy of Chapter 2.12 entitled: 'D/RECTOR .OF FINANCE AND GENERAL SERVICES. Chapter 2.12 of the La Quinta Municipal Code was adopted by the La 'Quinta City Council via Ordinance 2 on May 1, 1982 and amended by the La Quinta City Council via Ordinance 103 on January 16, 1987. Dated: August 7. 2014 SUSAN MAYSELS, City Ork City of La Quinta, Californ 78-495'CALLETAMPICO, LAQUINTA, CA 92253