2020_ACH_FORM.pdf

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Attached to
REMOVAL, SUPPLY, INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF CENTRIFUGAL CHILLER
Solicitation number
25-S-033
Issued by
District of Columbia

About this file

This is an Authorization Agreement for Automatic Deposits (ACH Credits) form issued by the Washington Convention and Sports Authority (WCSA), also known as Events DC, located in the District of Columbia. The form authorizes WCSA to initiate credit entries and, if necessary, debit entries and adjustments to a designated checking or savings account held at a specified depository. The authorization remains in effect until written termination notification is provided to both WCSA and the depository with reasonable advance notice. The form requires the contractor to provide company name, EIN or Tax ID, depository information including bank name, branch, city, state, ZIP code, transit/ABA number, and account number. The signatory must provide name, title, email address for ACH notification, phone number, and date of signature, and must attach a voided check to the form.

This ACH authorization form is associated with WCSA's Request for Proposal for the removal, supply, installation, inspection, maintenance, and repair of a centrifugal chiller at the Walter E. Washington Convention Center. The contract includes a thirty-five percent (35%) set-aside for Certified Business Enterprises (CBEs) as mandated under the Small and Certified Business Enterprise Development and Assistance Amendment Act of 2014, effective June 10, 2014. The form serves as a payment mechanism for contractors selected to perform work on this project, establishing the banking details through which WCSA will remit compensation.

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Text version

AUTHORIZATION AGREEMENT FOR AUTOMATIC DEPOSITS (ACH CREDITS)

COMPANY NAME: _____________________________________

EIN or Tax ID of the Business: ________________________________________

I (we) hereby authorize Washington Convention and Sports Authority (WCSA), hereinafter called COMPANY, to initiate credit entries and to initiate, if necessary, debit entries and adjustments for any credit entries in error to my (our) Checking Savings account (select one) indicated below and the depository named below, hereinafter called DEPOSITORY, to credit and/or debit the same to such account.

DEPOSITORY

NAME BRANCH

CITY STATE ZIP

TRANSIT/ABA NO. ACCOUNT NO.

This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable opportunity to act on it.

NAME: __ TITLE: _______________________

Email for ACH Notification: ______________________ cc: ___________________________

PHONE #: __________________________________ DATE: ________________________

SIGNATURE:

*** ATTACH A VOIDED CHECK ***

File details come from the government source that posted it. Updated .