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HomeMy WebLinkAboutC06-375 The Ban(~!2-~ank EMPLOYER HSA FUNDING TOOL APPLICATION BUSINESS BUSINESSICORPORATE NAME Eagle County Gove rnmen t DBA NAME (IF DIFFERENT) STREET ADDRESS: 500 Broadway CITY Eagle BUSINESS PHONE (970) 328-8790 BUSINESS FAX (970) 328-8799 FEDERAL TAXID STATE: CO 84-000762 ZiP 81631 CHECK AS APPROPRIATE: 0 SOLE PROPRIETOR 0 PARTNERSHIP 0 LLC 0 NON-PROFIT 0 CORPORATION (STATE OF INCORPORATION YEAR ESTABUSHED: LENGTH OF CURRENT OINNERSHIP: COMPANYWEBSITE&URL www.eaglecounty.us DESCRIPTION OF BUSINESS &PRODUCTSISERVlCES: Government PRINCIPALS "* Required infonnatioo 1. "NAME Karen L. Sheaffer ~DRIVER'S LICENSE (STATE & NUMBER): 94 - 349 - 2 2 6 3 ~RESIDENCE ADDRESS: 711 Knob Ln TITLE: Treasurer & Public TrusteeoATEoFBIRTH 9/8/49 "SOCIALSECURIW#204-40-5 76 7 EMAIL karen. sheaffer@eaglecount "CITY Gypsum "STATE: CO "ZIP: R 1617 .us 2. "NAME TITLE "DATE OF BIRTH: ~DRIVER'S LICENSE (STATE & NUMBER): "RESIDENCE ADDRESS: "SOCIAL SECURITY#: EMAIL ~CITY: "STATE ~ZIP: HSA FUNDING TOOL USERS (Specific employees that will be using the HSA Funding Tool) 1. NAME Diana Kafka PHONE# (970) 328-8795..EMAIL diana.kafka@eaglecounty.us 2 NAME Alicia Holder PHONE# (970) 328-3508..EMAILalicia.holder@eaglecounty. s TRANSACTION PROCESSING INFORMATION (ALL INFORMATION MUST BE PROVIDED) MINIMUM FUNDING AMOUNT PER EMPLOYEE IS $10 00 MAXIMUM FUNDING AMOUNT PER EMPLOYEE IS $5 45000 FREQUENCY OF DEPOSITS TO EMPLOYEE ACCOUNTS: a WEEKLY ~ BI-WEEKL Y a MONTHLY a QUARTERLY a OTHER MONTHLY AVERAGE OF: (A) NUMBER OF EMPLOYEES ELIGIBLE TO RECEIVE HSA BENEFIT DEPOSITS: $ (B) TOTAL DOLLAR VOLUME OF BENEFIT DEPOSITS FOR (A): $ 67 .88 (C) AVERAGE DEPOSIT AMOUNT: $ 271. 53 DO YOU WISH TO RECEIVE PAYMENT CONFIRMATIONS FOR EACH PAYMENT MADE? a NO K YES - PROVIDE E-MAIL ADDRESS a b ov e four (4) ANANCIAL INSTITUTION INFORMATION BANK NAME Alpine Bank - 102103407 Eagle ACCOUNT NAME Eagle County Treasurer - Health Savings BANK ACCT# 3030021776 BANK ABA REQUIRED DOCUMENTATION FOR "KNOW YOUR CUSTOMER". THE PATRIOT ACT & UNDERWRITING PURPOSES: Information provided MUST include both items for application to be considered, 1. LEGIBLE COpy OF PRINCIPALS DRIVERS LICENSE 2. COpy OF ~ BUSINESS CHECK FOR ABOVE NAMED BANK By signing below, the Merchant named above: (1) certifies tha all information nd documents submitted in connection with this Application ara correct to the best of your knowledge and (2) authorizes The Bancorp Bank to r an ny other information regarding undersigned or its principals, proprietors or partners from third parties, if necessary, to verify any i tio on. Date: L!i1J1V--d UMENTATlON and SIGNED AGREEMENT to: 302-385-5194 Banking Services Provided by The Bancorp Bank. Member FDIC. Equal Housing Lender. The Ban~E--ifank HSA Aareement for ACH Fundina Tool December 19 ), ?00d6 ,by an This Agreement is made this day between Eagle County Government loca tedat 500 Broadway, Eagle, CO 81631 ("Merchant") & THE BANCORP BANK 405 Silverslde Road Wllminoton. DE 198011"Bancoro"l. WHEREAS, Bancorp, a Delaware-chartered banking Instnutlon, is an Originating Depository Financial Institution ("ODF!"). Pursuant to the ACH Rules of the National Automated Clearing House Assoclation ("NACHA"), which can originate commerciai Automated Clearing House ("ACH") transactions via the Federal Reserve Banks' FedLlne System or a similar such network system; and WHEREAS, Merchant desires that Bancorp act as Merchant's ODFI and permit Merchant to originate ACH transactions and Bancorp Is willing to do so but only if such origination of ACH transactions is done pursuant to the provisions of this Agreement NOW, THEREFORE, In consideration of the mutuai agreements contained herein, other good and valuebie consideration, the receipt and sufficiency of which is hereby acknowledged, and Intending to be legally bound hereby, Bancorp and Merchant agree as follows; 1. Types of Entrl.s. Bancorp wHI transmit debit and/or credit entries initiated by the Merchant to the ACH Network as provided in the NACHA Operating Rules (referred to es the "Rules") and this Agreement. 2, ACH Rules. The Merchant agrees to comply with and be bound by the Rules in existence as of the date of this Agreement, and as amended from time to time. The duties of the Merchant set forth in this Agreement In no way limit the requirements of complying with the Rules. Any fines or lIablllties imposed against Bancorp for a vioiation of the Rules caused by an action and/or Inaction of the Merchant shall be assessed against the Merchant. 3. United States lsws. The Merchant acknowledges that It will not generate transactions that violate the laws of the United States. This includes, but is not limited to, sanction laws administered by the Office of Foreign Assets Controi (OFAC). 4. Notlflcstlons of Chsnge. Bancorp will notify the Merchant of all Notification of Change (NOC) entries received no later than two (2) business days after the receipt of the entries. The Merchant agrees to make the changes submitted within six (6) banking days of the settlement date of the originai entry or before the next "live" entry, whichever Is iater. If the Notification of Change Is Incorrect, the Merchant will generate a Refused Notification of Change and deliver It to Bancorp . 5. Finsnclsl Institution Obllgstlons. In a timely manner and in accordance with the Ruie., Bancorp will process, transmit, and seltJe for the entries received from Merchant, which com ply with the terms of this Agreement. Bancorp shall have no obligation to trensmit entries If Merchant is In default of any of Its obligations under this Agreement, Including any obligation to pay Bancorp. If at any time Bancorp has reason to believe employees of, or agents for, the Merchant have committed or are about to commit any acts of fraud or misrepresentation, Bancorp has the right, only if necessary, to refuse transmittal, and/or hold ali transferred funds for a period of one hundred-eighty (180) days. 6. WSrr8ntl.s, The Merchant shali Indemnify Bancorp against any loss, liability, or expense, including attorney's fees and expenses resulting from or arising out of any breach of any of tha foregoing warranties or agreements. 7, Provl,'onsl Oedlt. Merchant acknowledge. that the Rules make provisionai any credit given lor an entry unlll Bancorp crediting the account specified In the entry receives final settlement. if Bancorp does not receive finai settlement, it Is enUtled to a refund from the credited party and the originator of the entry shall not be deemed to have paid the party. 8, Settl.ment. The Merchant will maintain a active banking account with a depository Inslitution at ali times during the term of this Agreement. Merchant will maintain in the account available funds sufficient to cover all credit entries initiated by it. Merchant agrees to maintain a balance to cover returns and edjustments to prior funds credited. Bancorp may debit any account maintained by the Merchant or secure necessary collateral to satisfy any amount owing to Bancorp . 9. Settlement Discrepancies. If the Merchant maintains an HSA account at the Bancorp, the periodic statement Issued by Bancorp for the Merchant's account will refiect entries credited and debited to the Merchant's account. If the Merchant Identifies discrepancies between the Merchant's records and funds credited to or debited from the Merchant's account, the Merchant agrees to notify Bancorp, within a reasonable time not to exceed thirty-days (30) of the discrepancy. 10. Cancellation or Amendment of Entries. The Merchant shall have no right to cancel or amend any entrylflle after its receipt by Bancorp. However, Bancorp shall use reasonable efforts to act on a request by the Merchant to cancei an entry and/or file before transmitting it to the ACH Network or processing It as an "on-us" entry. Bancorp shall have no liability if it falls to effect the cancellation. 11. Rejection of Entries. Bancorp may reject any entry. including an "on-us" entry, which does not comply with the requirements of Sections 2 and 3 of this Agreement and may reject any entry if the Merchent is not otherwise in compliance with the terms of the Agreement. Bancorp shall notify the Merchant of such rejection no later than the business day such entry would otherwise have been transmitted by Bancorp to the ACH Network or, in the case of an on-us entry, Its effective entry date. It shall be the responslbillty of the Merchant to remake any entries or files rejected by Bancorp. 12. Name snd Account Number InconSistency. The Merchant acknowledges that, if an entry describes the receiver inconSistently by name and account number, payment of the entry may be made on the basis of the account number even if It Identifies a person different from the named receiver. 13, Contingency, In the event the Merchant cannot create or transmit an ACH fiie due to hardware or communications outage, It is the responsiblllty of the Merchant to have contingency procedures in place. In the event Bancorp cannot process the file through normal channeis, every effort wlli be taken by Bancorp to find alternate means to process the file. Bancorp will not be held liable for delayed files in any case resulting from hardware or communication outages. 14, Fees. The Merchant will compensate Bancorp for providing the services referred to herein at a fixed rate of $0.00 per month. These charges may change at any time with written notice to the Merchant. If such a rate change occurs, the Merchant has the right to terminate this contract, In writing, within 90 days of the notice of the rate change. 15, Amendment. to Agreement. From time to time, Bancorp may amend any of the terms and conditions contained in this Agreement, including any schedules attached hereto. Any modification of the Agreement (including change of address) or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representaUve of each party. All Notices of change shall made at least thirty (30) days prior to and be noticed by certified mall, return receipt requested, to the addresses listed hereln for the respective parties. Such amendments shall become effective upon receipt of notice by Merchant or such later date as may be stated in Bancorp's notice to the Merchant. 16, Term & Termlnstlon of Agreement. The IniUalterm of this Agreement shall commence on the date first set forth above and remain In effect for a period of two (2) years ("Initial Term"). Mer the expiration of the InlUal Term, this Agreement will renew automatically for successive one (1) yeer periods (each, a "Renewal Term") unless either Bancorp or Merchant shall give written notice to the other of non-renewai at least ninety (90) deys prior to the commencement of any such Renewai Term. Any termination of this Agreement shall not affect eny of Bancorp's rights or the Merchant's obligations with respect to any entries Initiated by the Merchant prior to such termination, or the payment obligations of the Merchant with respect to services performed by Bancorp prior to termlnetlon, or any other obligations that survive termination of this Agreement. In the event the Merchant originated debit entries, the Merchant agrees to maintain an account with Bancorp to settle chargeback's for a period of ninety (90) days subsequent to the settlement date of the last debit file originated. Bancorp shall have no obligation to transmit entries if the Merchant is In default of Its Obligation under this Agreement, Including the obligation to pay Bancorp for each credit entry. 17. Lisblllty. Bancorp shall be responsible only for performing the services expressly provided for in the Agreement, and shall be liable only for Its gross negligence or willful misconduct In performing those services. In no event shall Bancorp have any lIablllty for any consequentiai, special, punitive, or indirect loss or damage, which the Merchant may Incur or suffer in coonection with this Agreement. In addition, Bancorp shall be excused from falling to act or delay in acting if such faiiure or delay Is caused by legal constraint, Interruption of transmission or communications faCllltles, equipment failure, war, emergency conditions, or other conditions beyond Bancorp's control. Bancorp shall not be held liable for any delay by an ACH Operator or Receiving Depository Flnanciai Institution In processing any credit or debit entry the Merchant originates, nor shall It be held lIabie for the failure of a third party to process, credit, or debit any such entry, or for other acts of omission. The Merchant hereby Indemnifies Bancorp against any loss, or damage, attorneys' fees or liability Incurred by It on account of the Merchant's breach of this agreement, with respect to any entries Initiated by the Merchant. Therefore, said Indemnity shall not apply to any loss, damage, attorney fees or liability resulting from Bancorp negligence. In the event an agent of the Merchant delivers any entry or file of entries to Bancorp, Bancorp Banking Services Provided by The Bancorp Bank. Member FDIC. Equal Housing Lender. shall be fully protected in acting In reliance on such entry or file of entries, and it need not Inquire of the Merchant as to whether the agent is duly authorized. In the event that any action is filed in relation to this Agreement or the reiationship created hereby, the unsuccessful party in the action shall pay to the successful party, in addition to all sums awarded by the Court, a reasonable sum for the successful party's attorneys' fees. 18. Jurisdiction. This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of Delaware. The undersigned understand and agree that any dispute arising out of and/or in the course of the relationship established by this Agreement, or by the Agreement itself, shall be decided, unless mutually resolved by the parties hereto, in the Courts of the State of Delaware, and specifically in New Castle County, Delaware, and, the undersigned hereby submit to said jurisdiction. If any provision of this Agreement or any application thereof to any person or circumstance shall be held to be Invalid by a court of competent jurisdiction or unenforceable to any extent, the remainder of the Agreement and the application thereof to other persons or circumstances shall not be affected thereby and shall be enforced to the greatest extent allowable by law. 19. Miscellaneous. This Agreement, including any attached schedule, is the complete and exciuslve statement of the agreement between Bane orp and Merchant with respect to the subject matter and supersedes any prior agreement(s) between Bancorp and Merchant with respect to such subject matter. The Merchant may not assign this Agreement or any of the rights or duties hereunder without Bancorp's prior written consent. Bancorp may waive enforcement of any provision of this Agreement. Any such waiver shall not affect Bancorp's rights with respect to any other transaction or modify the terms of this Agreement. This Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective legal representatives, successors, and assigns. This Agreement Is not for the benefit of any other person, and no other person shall have any right against Bancorp or Merchant hereunder. In the event that any provision of this Agreement shall be determined to be invalid, Illegal, or unenforceable to any extent, the remainder of this Agreement shall not be HSA ACH Merchant Agreement- The Bancorp Bank@ 2004 Rev 1/25/2006 impaired or otherwise affected and shall continue to be valid and enforceable to the fullest extent permitted by law. This Agreement shall be governed by and construed in accordance with the laws of the state in which Bancorp Is located. This Agreement contains the entire understanding between the undersigned concerning its maller, and no representations, inducements, promises and/or agreements, oral or otherwise, between the parties with reference to the Agreement and not embodied in this Agreement shall be of any force and/or effect. Furthermore, any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated In this Agreement. IN WITNESS WHEREOF, the parties to this Agreement have caused it to be executed, with a complete understanding of the contents hereof, on the day and year first set forth bov reed and Acce ted: ~ Merchant peJet NamelTitle I I (J,J I c; / t I Date f ' " / c ~ C( II""'?C(.-, I C t(,11 t j ('':7 Off reI tJ/ Co ~~~) /tl'>frJ The Bancorp Bank NamelTitle Date 3 Confidential