Fillable Vendor ACH Sign Up Forms

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Vendor ACH Sign Up Forms

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900 EAST BROAD STREET, ROOM 1104 • RICHMOND, VA • 804.646.5716 • 804.646.5989
WWW.RICHMONDGOV.COM
REV. 10/1/17
VERIFIED BY: __________
Dear Vendor:
Currently, your organization is receiving payments from the City of Richmond by check or
electronic payment (ACH). The City of Richmond's Procurement Department would like to
invite you to begin, if you have not already, receive all funds electronically by the ACH method
of payment.
We would like to extend to your company the option of receiving recurring payments by
Automated Clearing House (ACH). ACH offers many benefits to the supplier and to the City
of Richmond. You will receive funds in a timely manner as payments made by ACH are
deposited directly into the Company’s bank account, detailed invoice information, and an email
notification that the funds have been transferred to your account. Similar to using checks, ACH
payments are immediately available on the date the payment is paid to you.
As the City of Richmond's preferred payment method is ACH, we are requesting that you
include correct banking information, a point of contact, and a valid email address for
your organization. All changes can be made by logging into the Supplier Portal or by
completing the attached documentation which includes form W-9, the ACH direct deposit
form, and the EDI Payment Agreement. Forms should be emailed to
supplierregistration@richmondgov.com or faxed to 804-646-5989.
Should you have any questions about this procedure, please feel free to contact the
Procurement Office, at (804) 646-5716.
Sincerely,
The Department of Procurement Services
900 E. Broad St., Room #1104
Richmond, VA 23219
900 EAST BROAD STREET, ROOM 1104 • RICHMOND, VA • 804.646.5716 • 804.646.5989
WWW.RICHMONDGOV.COM
REV. 10/1/17
VERIFIED BY: ______
ACH
-DIRECT
DEPOSIT
FORM PAYMENT INFORMATION
This form is used for Automated Clearing House (ACH) payments from the City of Richmond.
Please attach a void check or a form from your banking institution with the banking
detail information. Forms should be emailed to supplierregistration@richmondgov.com or Faxed
to 804-646-5989.
PAYEE
I
COMPANY INFORMATION
To be completed by PAYEE
Name of Payee
SSN No. or Tax Identification No.
Contact Person
Address
Telephone Number
City State
Zip Code
Email Address
FINANCIAL INSTITUTION INFORMATION
Name
Telephone Number
Address
(street or P.O. Box, City, State and Zip Code)
Type of Depositor Account
Checking
Savings
Depositor Account Name
Routing Number
Depositor Account Number
PRIVACY ACT STATEMENT
The following information is provided to comply with the Privacy Act of 1974 (P.L.93-579). The information
will be used by the City of Richmond's Finance Department to transmit payment data, by electronic means, to
the vendor's financial institution. Failure to provide the requested information may delay or prevent the receipt
of payments through the ACH Payment System.
900 EAST BROAD STREET, ROOM 1104 • RICHMOND, VA • 804.646.5716 • 804.646.5989
WWW.RICHMONDGOV.COM
REV. 10/1/17
VERIFIED BY: _______
EDI Payment Agreement for Contractors
This Agreement is entered into as of this day of between the
City of Richmond, Virginia ("City") and:
COMPANY hereby authorizes the City to make payments for goods and services covered by
any agreement between the City and COMPANY (the "Business Agreements") utilizing at
the City's option,
electronic data interchange
("EDI"). COMPANY acknowledges and
agrees that the provisions in the Business Agreements governing the method and timing of
payment shall be amended to the extent provided in this Agreement.
An EDI payment from the City to COMPANY shall be considered timely if the payment is
completed in accordance with Richmond City Code § 21-8 I Virginia Code § 2.2-4352. If the
EDI payment cannot be completed on such date, the City's payment is timely if the funds
transfer is completed on the next business day. The EDI payment shall be deemed completed
when Company
's
Depository Institution has accepted the payment order within the meaning
of Article 4A of the Uniform Commercial Code (i.e., Virginia Code
tit
8.4A). The City may
not use an EDI payment to affect an accord and satisfaction without Company
's
written
consent thereto. The Electronic Payment Information Form is an integral part of this
Agreement
COMPANY understands and acknowledges that the City will deliver the remittance data to
Company’s designated Depository Institution.
COMPANY shall provide the City written notification of any change in the depository
institution, payment instructions, or remittance data instructions at least 15 days in advance
of such change. Such notification shall be delivered to the City's Department of Procurement
via:
Email:
supplierregistration@richmondgov.com
Fax to:
(804) 646-5989
U.S. Mail to:
City of Richmond
Department of Procurement Services
900 East Broad Street, Room 1104
Richmond, Virginia 23219
A "Trading Partner Notification of Change" request should be submitted by fax or email to
the above secure website respectively.
I
n the event of duplicate payments, overpayment, fraudulent payment, or payment made in
error, COMPANY agrees to return any such payment to the City, after the City first provides
information to COMPANY documenting any duplicate payment, overpayment, fraudulent
900 EAST BROAD STREET, ROOM 1104 • RICHMOND, VA • 804.646.5716 • 804.646.5989
WWW.RICHMONDGOV.COM
REV. 10/1/17
VERIFIED BY: ________
payment, or payment in error. Any return shall, at Company’s option, be made by EDI
payment in accordance with the rules of the National Automated Clearing House
Association, or by check.
The City shall be responsible for making all payments required pursuant to the Business
Agreements and for any loss of payment prior to the point at which Company’s Depository
Institution shall have accepted the payment order, except that COMPANY shall be
responsible for any loss which may arise by reason of any error, mistake, or fraud regarding
the information provided by COMPANY herein, or any subsequent changes thereto. The
City shall bear any other loss, except to the extent that such loss arises by reason of the
negligence or willful misconduct of COMPANY. In the event that payment timely initiated
by the City has not been received by Company by the due date thereof because of failure or
delay by the funds transfer system or rejected by Company’s bank, the City shall pay
COMPANY as soon as practicable after such failure or delay is discovered and the City shall
not be in breach of the Business Agreements for failure to make payment
Each party shall bear the respective fees and other charges assessed by its designated banks
and third party service providers.
Each party may terminate this Agreement upon a (30) day notice to the other, but this
Agreement will remain in effect as to all funds transfers that have been initiated by the City
and not canceled prior to termination hereof In the event of any inconsistency between this
Agreement and any other Business Agreement addressing the subject matter of this
Agreement, this Agreement shall control.
This Agreement is governed by and interpreted in accordance with the laws of the
Commonwealth of Virginia.
Company Name
Name Printed
Signature
click to sign
signature
click to edit
900 EAST BROAD STREET, ROOM 1104 • RICHMOND, VA • 804.646.5716 • 804.646.5989
WWW.RICHMONDGOV.COM
REV. 10/1/17
VERIFIED BY: ________
PURCHASE TERMS AND CONDITIONS
This order is made pursuant to authority given to the City under Chapter 21 of the Code of the City of
Richmond, as amended. If this order is made pursuant to an existing City contract, the terms and conditions
of that contract govern this order. If this order is not made pursuant to an existing City contract, the
following terms and conditions govern this order:
1.
Compliance with Laws. The Contractor shall comply with all laws, regulations, and rules
applicable to the performance of the contract represented by this order.
2.
Discount. If a discount for prompt payment is allowed, the discount period begins on the
date of the City’s receipt of the goods or services ordered or the date of the City’s receipt of a
proper invoice, whichever is later.
3.
Employment Discrimination. If the amount of this order is greater than $10,000, the
provisions of section 21-70 of the Code of the City of Richmond are incorporated by reference
into this order.
4.
Forum Choice. Any legal proceeding arising from this order must be brought and
maintained only in the Circuit Court of the City of Richmond, Virginia.
5.
Governing Law. This order, its performance, and any dispute arising thereunder are
governed by the laws of the Commonwealth of Virginia without regard to its conflict of laws
principles.
6.
Modification. No substitution, change, or deviation from the specifications contained in or
incorporated into this order will be made unless the City cancels this order and issues a
replacement order.
7.
Prompt Payment. Payment by the City is due no later than 45 days after the City’s receipt
of the goods or services ordered or 45 days after the City’s receipt of a proper invoice,
whichever is later.
8.
Approved Purchase Orders. An executed contract does not commit the City to any dollar
expenditures. Orders placed against a contract will be through fully approved purchase orders
issued by the City. By signing the contract, the Contractor agrees not to accept orders from
the City without a fully approved purchase order. Any purchase order or contract made
contrary to Chapter 21or any purchase order or contract made when sufficient funds are not
available is not approved, and the City shall not be bound thereby. Acceptance of other
orders is at the Contractor’s sole risk.
9.
Shipping. Unless otherwise stated in this order, all prices are net F.O.B. Destination with
transportation charges prepaid.
10.
Taxes. The City is exempt from the State Sales and Use Tax on tangible personal property
purchased or leased for its use or consumption and will provide a certificate of exemption upon
request.
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Vendor ACH Sign Up Forms

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Completed 16 July 2020

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