2020_ACH_FORM.pdf

PDF 54 KB Posted

Attached to
COOLING TOWER REPLACEMENT SERVICES
Solicitation number
25-S-030
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, operating as Events DC, in the District of Columbia. The form authorizes Events DC to initiate electronic credit entries and, if necessary, debit entries and adjustments to a contractor's designated checking or savings account at a specified depository financial institution. The form requires the contractor to provide company name, Employer Identification Number or Tax ID, depository bank details including routing and account numbers, and authorized signatory information. A voided check must be attached to complete the authorization. This ACH authorization is a required submission document for the Cooling Tower Replacement Services procurement, which involves supplying and installing eight new efficient cooling towers while removing eight existing towers at the Walter E. Washington Convention Center. The contract base term extends from the award date through September 30, 2027, with four optional one-year renewal periods available.

The ACH authorization form remains in effect until Events DC receives written notification of termination, providing the agency and the financial institution reasonable opportunity to process the request. As a required contractual document, this form enables electronic payment processing for the selected contractor upon contract award. The form should include contact information for ACH notifications and can designate a carbon copy recipient for payment notifications. Contractors must submit this authorization along with other required documentation including a Tax Certification Affidavit, W-9 form, and Disclosure Statement to ensure compliance with District of Columbia procurement requirements and to facilitate efficient payment administration throughout the contract period.

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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 .