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Home My WebLink AboutWright Express Financial Services Corporation And State Of Florida Department of Management Services - Addendum To The Fuel Card Services Agreements ADDENDUM TO THE FUEL CARD SERVICES AGREEMENT BETWEEN WRIGHT EXPRESS FINANCIAL SERVICE� CORPORATION ("WEX FSC") AND THE STATE OF FLORIDA DEPARTMENT OF MANAGEMENT SERVICES (the "STATE") . .- . Participating Entity agrees that in the event the account is not paid as agreed, WEX FSC may report the undersigned's liability for and the status of the account to credit bureaus and others who may lawfully receive such information. Participating Entity Phone # Fax# City of Winter Springs 407-327-8985 407-327-6588 Business Name and Physical Address (Do not include PO Box) ApplicanYs Taxpayer ID #(fIN, FEIN or SSN) City of Winter Springs 59 In Business Since (yyyy) Year of Incorporation (yyyy) Number of Vehicles Avg Monthiy Fuel Expenditures Avg Monthly Service Expenditures 1959 1959 100 $1000 $0 . .- . Write Participating Entity name as you wish it to appear on cards. Limit of 20 characters & spaces. Unless specified, no company name will appear on cards. ��❑��IJ�� Billing Contact Billing Address City State Zip+4 Donna Burno-Borretli 1126 East State Road 434 Winter Springs FL 32708 Designate the Fleet Contact authorized to receive all charge cards, reports, and other such information we provide from time to time and to take actions with respect to your account and account access. This is also the person designated by your company to provide all fleet vehicles, driver and other information we may request. Authorized Fleet Contact Name Title Phone # Fax # Donna Burno-Borrelli Controller 407-327-8985 407-327-6588 Mailing Address (if different from billing address) City State Zip+4 1126 East State Road 434 Winter Springs FL 32708 Emaii address (required to take advantage of product type card controls) dborrelli@winterspringsfl.org Card Controls: To help us estimate your credit needs, indicate the types of cards you anticipate using. If you provide a valid emaii address above, you can select from these product type options: ❑ All Products � Fuel 8 Service � Fuel & Fiuids with Roadside Assistance ❑ Fiiel with Roadside Assistance O Mix of card types ❑ Check here if business is exempt from motor fuels tax DEFINITIONS "AgreemenY' means: Contract No.973-163-10-1 effective Auqust 6. 2010 for Fuel Cards and Fuel Management 5ervices (the "AgreemenY') beiween the State of Florida Department of Management Services and WEX FSC. "Participating Entity" shall mean the Participating Entity as defined in the Agreement permitted to purchase services under the Agreement, as specified in the Credit Information above. All other capitalized terms used in this Addendum without definition have the meanings set foRh in the Agreement. AGREEMENTS OF WEX FSC AND PARTICIPATING ENTITY 1. This Addendum is to allow the Participating Entity to participate under the Agreement between WEX FSC and the State. It does not modify, amend or change the Agreement in any way. 2. Participating Entity represents that it is authorized or allowed by the laws of its home state to enter into this Addendum and to participate under the Agreement. 3. Participating Entity hereby requests the services of WEX FSC described in the Agreement and agrees to perform all duties of a Participating Entity under the Agreement, including, without limitation, payment of all charges on its account(s) within the time periods provided under the Agreement, payment of any fees provided in the Agreement, and cooperation with respect to providing all necesaary information for the administration of the Agreement. Participating Entity agrees to be bound by the terms and conditions of the Agreement, including, without limitation, rules for authorized and unauthorized use of cards, disputes of charges, reporting lost and stolen cards, and all other rules and provisions relating to use of Participating Entity's account. 4. Participating Entity acknowledges that its failure to make timely payment in accordance with the terms of the Agreement and/or the Addendum may result in suspension or cancellation of the account(s). The undersigned represents and warrants that he/she is duly authorized to execute this Addendum on behalf of the Participating Entity and this Addendum is the valid and binding obligation of the Participating Entity, enforceable in accordance with its terms. INFORMATION SHARING DISCLOSURE: Information regarding your transactions may be provided to the State, accepting merchants or their service providers to facilitate discounts or other promotional campaigns of interest to you. U.S.A. PATRIOT ACT: Our bank complies with Section 326 of the USA PATRIOT Act which requires all financial institutions to obtain, verify, and record information that identifies each company or person who opens an account. What this means for you: when you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents for your business. DISCLAIMER THIS IS AN APPLICATION FOR SERVICES AND SHALL NOT BE BINDING UPON WEX FSC UNTIL FINAL CREDIT APPROVAL HAS BEEN GRANTED BY WEX FSC. � �• � � . Any person signing on behalf of the Participat� Entity has been duly authorized by all necessary action of ApplicanYs governing body, and that the undersigned is authorized to make this applicatio on beha the Participating Entity. Signature: Printed Name: 1`�Qi1 i{n �—, J�'►'�, �"� Title: Gr % Date: Cf IS Complete and sign addendum. Fax to 866-527-8873. •�• Oppty Number Sales Code Plastic Type Coupon Code Account Number • 10914030 SFL2 FL2 04 04.ADDEND.CRDAPP (11/08) Wright Express Fleet Card Custom Controls* Company Name: 1. Check ONE Custom Control group below. 2. All cards you designate as Custom Control Cards will initially be set up with the preset limits shown below. You cannot use this form to chanqe the preset `iimits. 3. Once you receive your User ID and Password from us, you must log in to WEXOn/ine.com to review or change these preset limits** or to further customize controls (e.g. set time and day controls). 4. Be sure to keep your User ID and Password readily accessible as only YOU can make changes to these controls and limits. • • • -• -� •-� � FUEL 8� FLUIDS Transactions per Day $ per Transaction $ per Day Fuel 3 $200 $500 Oil & Fluids 2 $200 $500 Roadside Assistance 2 $200 $500 ❑ FUEL � SERVICE Fuel 3 $200 $500 Parts & Service 2 $500 $1,000 Quick lube 2 $300 $500 Oil & Fluids 2 $200 $500 Roadside Assistance 2 $200 $500 ❑ ALL PRODUCT TYPES Fuel 3 $200 $500 Parts & Service 2 $500 $1,000 Quick Lube 2 $300 $500 Oil & Fluids 2 $200 $500 Roadside Assistance 2 $200 $500 General Merchandise 2 $100 $200 Valid Email address: "Please note that purchase authority resfriction may not be enforced if e/ectronic authorization is inoperative...e.g., during system outage. Additional Terms By signing below, you request the controls ("Controls") indicated above will be applied to your account. The availability and effectiveness of such Controls is dependent upon each merchanYs adoption of card specifications and the information transmitted to us by them. You understand and acknowledge that only transactions submitted to us for authorization are subject to Controls and that such Controls can only be enforced when the merchant provides sufficient information as part of the authorization. We reserve the right to modify Controls upon notice to you when such Controls, in our opinion, are set at a level such that they are ineffective and not in accordance with the goals of the Controls program. Default values will be assigned by us. You can modify these default settings by making your own election(s) through our online product. Additional important information related to Controls is also available online. We shall not be responsible for the prudence of any particular Control level you select. The existence and/or use of Controls shall not affect your liability for unauthorized use of Cards. You remain liable for transactions with unreported lost or stolen Cards and/or Card numbers and Driver ldentification Numbers. You also will remain responsible to review fraud control data provided by us, such as purchase reports, for the purpose of detecting fraud that occurs within Control paremeters. X �. KEVIN L;. SMITH 9/15/2011 Signature Print Date Complete, sign and fax with Fleet Card Information form to 866-527-8873. Questions? Please call us at 866-527-8870. OPTY: 04. FLTDTA. PTC(11 /10) Wright Express Fleet Card Information Limit punctuation to the � _ & , Company Name: following characters: • � •- � • . . . Select ONE of the following columns below to appear on the secon,;= line of your cards. ❑ Vehicle Description ❑ Customer Vehicle ID ❑ License Plate ❑ None License Card Type* Department Plate State Vehicle Description Customer Vehicle ID 8 character limit 10 character 2 char 17 character limit Fuel � Custom 17 character limit limit Only Control ��'��"�: G27H3P ME Q6 C1�evy Mini Van ❑ ❑ Unit 3827-A Service i. POLICE CY 7953 FL 2010 BMW MOTOR CY � ❑ W610388069ZT15015 2. POLICE CY 7954 FL 2010 BMW MOTOR CY � ❑ W610388069ZT15014 3. POLICE CY 7922 FL 2010 BMW MOTOR CY � ❑ W610388069ZT15019 a. POLICE CY 7923 FL 2010 BMW MOTOR CY � ❑ WB10388069ZT15016 5. ❑ ❑ 6. ❑ ❑ 7. ❑ ❑ 8. ❑ ❑ 9. ❑ ❑ 10. ❑ ❑ */f you se/ected Custom Control for any card above, you must complete the aftached Custom Controls Form to se/ect one of the three product groups you would like applied to your Custom Control Card(s). �- •- � • . . .- . -. . - . Last First M.I. Driver ID (No duplicates) 12 character limit 11 character limit Leave blank if you want us to assign Select either: ❑ 4 di its or ❑ 6 di its st��E: Smrth Jc�hn A 8659 �. MAYHUGH B 80 2. QUICK C 81 3. ANGELOFF M 82 4. CHRISTIANSEN M 83 5. 6. 7. 8. 9. 10. X �� KEVIN L SMITH 9/15/2011 Signatur Print Date If you selected all FUEL ONLY cards, STOP HERE, sign and fax this form to 866-527-8873. Questions? Please call us at 866-527-8870. OPTY: 04. FLTDTA. PTC(11 /10)