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Illllliiiii Ili -id' <br />IC Sales Rep � n <br />Order Date 91.16/2 0.19 <br />Sales Prtnr Ys1,!!T2T' 'aOftw'lfe <br />Vertical Utility <br />Biller Order Form <br />Software Prtnr Sy5ten)s anct Wtwafe <br />IC Division 1s5i <br />Payment Types <br />--------- --- <br />[31 Arw,-rhmiq Express <br />............ <br />0, m, i i/F rT visa/Mach'4 Coui CMA Only <br />..... .. ... ............... <br />BILLER INFORMATION <br />.... .. ....... ........ <br />Ownership Type <br />Wy <br />- ----- ----- ---- <br />Phone <br />574-233-0311 Fax <br />574-235-9728 <br />Legal Name <br />- — --- ---------------- - - ---- - - - <br />City of South Bend <br />------- - - - - ---------- -------------------- <br />Website URL <br />%vww.southbendin.gov <br />Address 1 <br />-- - ............. . . . ........... .. <br />227 West Jefferson Boulevard <br />Bus, Open Date <br />. ......... <br />01/01/1865 <br />......... .............. . . <br />Address 2 <br />u it"e' 1'3­1'6'�'Public Works Dep�) <br />. . ......... <br />Federal Tax ID <br />1-1.1- - . ... ...... <br />35-6001201 <br />- <br />City South Bend - - - ------------- - ------------- f, - ' JN <br />,,,..,........State .... ....... ............ ... <br />ZIP <br />rederc4 7 ax 0 andt <br />BILLER CONTACTS <br />... . <br />. ........... ......... <br />P'ro eci�Mana;�r­" <br />Stan Harris <br />..... .... ... <br />Technical Support <br />Stan Harris <br />Phone <br />...... .. .. <br />574-233-0311 <br />...... . . . .............................. <br />. . ........ <br />Phone <br />.............. ........... . ....... - <br />574-233-0311 <br />]'1xx'E <br />Email Address <br />stanharris@roic-miami.com <br />' - <br />'Th, <br />Email Address <br />. . . . .................. <br />stanViarris@roic-miami,com <br />Ma'r'l <br />Kim o m ps p o" n <br />— ------- -------------- - - -- ----- - <br />Billing/Accounting <br />. . ......... ------------------ <br />Kim Thompson <br />Phone <br />.............................. <br />574-233-031.3. <br />E'Xi .. .. ... ............ <br />................... P-h---o--ne <br />-5--7-4--2--3-3 0-3-1� 1- ............. <br />Ext <br />Email Address <br />kthampso@southbend1n.gov <br />`LL <br />Email Address <br />kthompso@southberidIn.gov <br />......................... .. . . ........................ <br />SIGNATORY AUTHORITY <br />. .. . ....... <br />. . . ....... . .... . . ........ <br />Name <br />Board of Public Works (-BP"-WJ-Me'r-n b"e'r's ........ <br />— - ---- <br />. .. ......... <br />Title Board of Public Works (BPW� Members , <br />"Email <br />Phone <br />SiZi��-0311 - I . . . .. ................. . . <br />Fax 574-235-9728 <br />Address I -��artin@'sout�iberidin.gov <br />........ .. <br />Description <br />Interval <br />Cost Type <br />Cost <br />. . . ....... <br />Biller Portal Access Fee <br />Monthly <br />Fixed <br />0„00 <br />........ . ..... . . <br />ACH Reject Fee Non-Submitter (Chase) <br />. ............... ........ . ....... ..... ......... . <br />.... ........ <br />Per Item <br />.. . ....... <br />Fixed <br />- ----- . ....... .. - <br />7.50 <br />. . . ... . . . . . . ...... ... ..... ..................... <br />C argeback Fee Non-Submitter (Chase) <br />--- . ... .. . ................ . ... - <br />. ...... .... ............. . . . <br />Per Item <br />......................... . . . . . ................ <br />Fixed ($) <br />7.50 <br />---- ---- ------ - ------------------- <br />IC IVR Payment Transaction Fee - EFT <br />. .... <br />"I ' `--Credit- - -C' <br />Per Item <br />- - — -- - -------- <br />Fixed <br />------------ .. .............- <br />35 <br />............... . . . . ..... . ........... ---------------------- ----- <br />j"� V, R'Pa'y"m-ent Transaction Fee Card <br />11 .. . . . . . . . . .... . .. ......................... .......................................... . . . . . . . .. . . . . . . .......... ...... ................................. <br />. ..... ----P"e,r Itern ..... ..... . .. <br />"Fix Fixed —($) <br />- - ------- 3-5- <br />Invoice Presentment For Paperless Customers <br />.................. .... . -- - ------------ -­­­­ <br />. . ........... -- -- .... ...... ... <br />Per Iterri <br />-------------- -,—, ---- ....... . <br />Fixed <br />........ <br />IC Payment Transaction Fee - EFT <br />--------- ...... . ... -- ...................... <br />- - <br />Per Item <br />- .. .... <br />----------- <br />Fixed ... <br />- - - - ------- <br />.......................... <br />OBD Access Fee <br />-' —''IFee -Ba <br />Per Item. <br />Fixed <br />I <br />0.00 <br />Ell r'i ent Tra ns a cti on - 0nTn e Bank .................. ........ --------- - --------- <br />y <br />. . . ... ........... <br />Per tern <br />Fixed <br />.17 <br />BILLER <br />Note: Must include voided business check or bank let ter for each unique aerCoajysj <br />Billing Method [_C_HN/lc_nth ............. . . ............................ .. . ..... . . . . . ........ . .. ..... <br />Name on Account City o South Bend Bank Name Bank <br />Bank Address Michigan Street South BendIndiana 46 <br />�i66­i�' Phone , <br />1-1- 1 1 " � - � .............. - . . . . . ....... . ............... f1'�a'?2�11? -1111111111 <br />Routing # I L212128 Last 4 Acct # '� " _J <br />Mont hstoKeep �2.4Additional items appiV if greater than 24 months <br />...... . . . .... - ... . ....... <br />NOTES/SPECIAL HANDLING <br />This is an S&S and Encluesta implerneritation. PayGo will be charged at an absorbed price of $1.95 per transaction, <br />v5 1 <br />