CTR060124_FIS_WSEA_EBT_Services_Amendment_01-FE.pdf
PDF 1 MB Posted
- Attached to
- Master Agreement AZ|CTR060124
- Contract number
- CTR060124
- Issued by
- Arizona
About this file
This document is a Participating Addendum Amendment for Electronic Benefit Transfer Services, issued by the Arizona Department of Economic Security and involving Fidelity National Information Services, LLC (FIS) as the contractor. The amendment is part of the Western States EBT Alliance (WSEA) contract and includes two specific Customer Authorization (CA) Agreements: one for Undelivered Card Report Automation and another for the Pandemic Electronic Benefit Transfer (PEBT) 3.0 program.
The amendment covers two primary services: first, continuing to send Arizona the EBTDS210-4 Undeliverable EBT Card report as a batch file under a new contract (CTR060124), and second, continuing the special short-use food program (PEBT) for the 2021/2022 school year ending September 2022. Both Customer Authorization agreements have no changes to the original contract pricing, maintain the same payment terms, and are effective upon signing by both parties. The amendments are part of a broader contract between the Arizona Department of Economic Security and FIS for electronic benefit transfer services.
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Text version
PARTICIPATING ADDENDUM
AMENDMENT
Arizona Department of Economic Security
1789 W Jefferson Street, Mail Drop 1222, Phoenix, AZ 85007
CONTRACT NUMBER: AMENDMENT NUMBER: DATE:
CTR060124 01 2/1/2023
DESCRIPTION/ LABEL: Electronic Benefit Transfer Services for Western States EBT Alliance
(WSEA)
CONTRACTOR NAME: FIDELITY NATIONAL INFORMATION SERVICES, LLC (FIS)
THE ABOVE REFERENCED PARTICIPATING ADDENDUM IS HEREBY MODIFIED AS
FOLLOWS:
1. Pursuant to the Uniform Terms and Conditions, Section 5. Contract Changes, 5.1. Amendments, the purpose of this Contract Amendment is to include the following Customer Authorization (CA) Agreements:
a. No. EBTGOVS-13406 AZ Undelivered Card Report Authorization – Amendment 1
i. The purpose of this CA Agreement is to send Arizona the EBTDS210-4 Undeliverable EBT Card report as a batch file under the new contract CTR060124.
b. No. EBTGOVS-13547 AZ CA PEBT 3.0 – Amendment 1
i. The purpose of this CA Agreement is to continue the special short use food program (PEBT) for the 2021/2022 school year ending September 2022 under the new contract CTR060124.
ALL OTHER REQUIREMENTS, SPECIFICATIONS, AND TERMS AND CONDITIONS REMAIN
UNCHANGED
ACKNOWLEDGEMENT AND AUTHORIZATION
This Amendment shall be fully executed by means of electronic approval in APP.
Nila L Henson
Procurement Manager
February 14, 2023
Nila L Henson
Procurement Manager
February 14, 2023
| CTR060124_FIS_Participating Addendum_WSEA EBT Services_Amendment 01 |
| CTR060124_Amendment 1_AZCAGOVS-13406 Undelivered Card Report Automation - Amendment 1 |
| CTR060124_Amendment 1_AZ CAGOVS-13547 PEBT 3.0 - Amendment 1 |
| 2023-02-14T15:17:24-0700 | |
| Henson, Nila L |
| 2023-02-14T15:17:55-0700 | |
| Henson, Nila L |
File details come from the government source that posted it. Updated .