HomeMy WebLinkAbout20211358.tiffADDENDUM TO THE FUEL CARD SERVICES AGREEMENT BETWEEN
WEX BANK, FORMERLY WRIGHT EXPRESS FINANCIAL SERVICES CORPORATION ("WEX")
AND THE NATIONAL JOINT POWERS ALLIANCE (NJPA)
CREDIT INFORMATION
Participating Entity has requested a credit account pursuant to the Vendor Agreement #042016-WEX (Agreement), ("Agreement") entered into between the National Joint
Powers Alliance ("NJPA") and WEX Bank, formerly Wright Express Financial Services Corporation ("WEX"). By enrolling in this Program, the Participating Entity named
below agrees that in the event their account is not paid as agreed, WEX 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
Weld County Government
Phone #
(970) 400-4445
Fax#
(970) 352-9019
Headquarters Name and Physical Address (Do not include PO Box)
Weld County Administration Bldg. 1150 O Street Greeley, CO 80631
NJPA Member ID Number
8903
Applicant's Taxpayer ID # (TIN, FEIN or SSN)
84-6000813
In Business Since (yyyy)
1862
Year of Incorporation (yyyy)
1862
Number of Vehicles
12
Avg Monthly Fuel Expenditures
$1000
Avg Monthly Service Expenditures
$0
ACCOUNT SETUP INFORMATION
Writ
�Paarticip®®gEnntity
®
name
as you
e
wish
it to appear on cards. Limit of 20 characters & spaces. Unless specified, no company name will appear on cards.
Billing Contact
Barbara Connolly
Billing Address
same
City
State
Zip+4
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
Barbara Connolly
Title
Controller
Phone #
(970) 400-4445
Fax #
(970) 352-9019
Mailing Address (if different from billing address)
City
State
I Zip+4
Email address (required to take advantage of product type card controls)
bconnolly@weldgov.com
r
Check here if business is exempt from motor fuels tax
TERMS
1. This Addendum is to allow the Participating Entity to participate under the Agreement between WEX and NJPA. It does not modify, amend or change the Agreement in
any way.
2. Participating Entity hereby requests the services of WEX described in the Agreement and agrees to perform all duties required under the Agreement, including, without
limitation, timely payment of all charges (including any additional fees) on its account(s). 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. Additional terms that govern this Participation Addendum between Company and Issuer are set forth in
Schedules A and B attached hereto and incorporated by reference.
3. Participating Entity acknowledges that its failure to make timely payment in accordance with the terms of the Agreement, or for government entities subject to a Prompt
Payment Act, may result in suspension or cancellation of the account(s).
4. INFORMATION SHARING DISCLOSURE: Information regarding your transactions may be provided to NJPA accepting merchants or their service providers.
5. Comphance with, ederalLaw•,complies with e t taw which requires all financial institutions to obtain, verify, and m � informationidentifies each
s
company orx r o;who o t. Wha flee* for (you' Vl n. you open atr account, we wilt exalt *yew nom, , date of -birth, anti other
information t t allow ti5 tQ . . ' We m ask to see your ditvp?s license or other identfyying documents' for your busin` ess.
6. DISCLAIMER: THIS IS AN APPLICATION FOR SERVICES AND SHALL NOT BE BINDING UPON WEX UNTIL FINAL CREDIT APPROVAL HAS BEEN GRANTED
BY WEX.
7. This Addendum shall become effective July 20. 2016.
PARTICIPATING ENTITYAUTHORIZED SIGNATURE REQUIRED
Any person signing on behalf of the Participating Entity has been duly authorized by all necessary action of Applicant's governing body, and that the undersigned is
authorized to make this ap licati n and ccept the terms referenced herein on behalf of the Participating Entity.
Signature: Print Name: MtkE F EEm,n /
Title: b(t, 13coc? at Weld etxtnili C rcv miss loners Date: 1 D -I I - I b
Complete and sign addendum. Fax to 1-866-527-8873.
FOR OFFICE
USE ONLY
Oppty Number
Sales Code
10900203
Plastic Type
NJPA
Coupon Code
NJA
Account Number
04
04.ADDEND.CRDAPP (1/12)
C mmur:CAj-i0t .5
05/aLit81
cc:ACT((3C.ICo
FSCOw3, FTC 05)
O51 'Olat
2021-1358
X00-70
Hello