D-2 ELAVON SCHEDULE A - FEES.pdf

Version 2.4 11.19.2019

ASSUMPTIONS / Company PROFILE

Legal Entity Name

Business Segment

Category Description

MCC

Multiple MCCs?

Locations

Volume Average Ticket Transaction Count

VISA $250,000,000 46 6,000,000

MasterCard $100,000,000 46 1,500,000

Discover $10,581,661 46 230,090

Union Pay

American Express $18,822,487 63 299,360

JCB & Diners

PIN-Debit

Checks $32,147 183 176

EBT

Total $379,436,295 8,029,626

Projected Monthly Transaction Volume Average Ticket

669,136 $47.25

TERM

Initial Term of: 5 2

PROCESSING SERVICES AVAILABLE TO COMPANIES GENERALLY

CARD PROCESSING FEES

Billing Method: Gross

Pass-Through

Auth$ Settle $ Settle %

Visa $0.0000 $0.0350 0.00%

MasterCard $0.0000 $0.0350 0.00%

Discover $0.0000 $0.0350 0.00%

Union Pay $0.0000 Not Quoted 0.00%

PIN-Debit $0.0000 $0.0350 0.00%

AMERICAN EXPRESS PUBLIC SECTOR (Third Party Service Processing)

Pass-Through

Auth$ Settle $ Settle %

Amex Public Sector $0.0000 $0.0350 0.00%

Enhanced Pass-Through

Auth$ Settle $ Settle %

Qualified Credit Rate

Mid-Qual Credit Rate

Non-Qual Credit Rate

All Amex Public Sector authorization and wholesale discount fees, access fee, assessments, dues and other fees and charges are passed to Company at cost. Servicer Transaction processing fees include:

All Amex Public Sector authorization and wholesale doscount fees, access fee, assessments, dues and other fees and charges are passed to Company at cost. Servicer Transaction processing fees include:

Year(s) with (REQUIRED): Year(s) Renewal Term

SCHEDULE A - SCHEDULE OF FEES

Servicer may adjust Company's pricing if (i) Company's annualized Visa/MasterCard/Discover/Union Pay average ticket or volume varies from projections by more than twenty percent (20%), or (ii) Company's

Visa/MasterCard/Discover/Union Pay average ticket or volume for any month falls below fifty percent (50%) of such Visa/MasterCard/Discover/Union Pay average ticket or volume during the same month of the previous calendar year.

Interchange fees, Payment Network fees, and assessments will be assessed on all authorized or settled Transactions.

All Visa, MasterCard, Discover, Union Pay, and debit network authorization and Interchange fees, assessments, dues and other fees and charges are passed to Company at cost. Servicer Transaction processing fees include:

State of Wisconsin

Government

Government Services-Not Elsewhere Classified

Yes

DocuSign Envelope ID: 2E4FC86A-1588-4EC6-B5AB-7A85ABBF7855

SURCHARGE/CREDIT CARD COST CONTROL(C4)

AUTHORIZATION FEES - Servicer

Telecom Method IP/DIAL

Additional Fee for Telecom

Per Authorization Fee

Visa $0.0000

MasterCard $0.0000

Discover $0.0000

Union Pay $0.0000

PIN Debit $0.0000

American Express

Diners

JCB

EBT

Other Card Type

Frame Relay

Dial Back-Up for Frame Relay

Voice (VRU) Authorization $0.7500

Voice Authorization with Address Verification $0.7500

Operator-Assist Authorization $2.0000

Bank Referral Authorization $4.0000

OTHER TRANSACTION FEES

Per Transaction Fee

Bill Payment (PIN-Less Debit)

PIN Debit Flat Rate (per settled transaction) (Debit Network

Switch Fee is billed separately - per authorization)

AVS Fee (per occurrence)

ACH Fee (per occurrence)

ACH Returned Item Fee (per occurrence)

Fed Wire Settlement (per occurrence, where available)

Fed wire requires CFO Approval

Chargeback Fee (per occurrence) $7.5000

Monthly Minimum (per location)

Monthly Minimum Start Date to be the Effective Date of the MSA

Other Fee

3Delta - Level 3 Solutions

Setup Fee

Other Setup Fee

Monthly Fee $5 Statement Fee

Per Transaction Fee

Other Fee

Merchant Connect Basic/Payment Insider

Setup Fee Waived

Monthly Fee Waived

Merchant Connect Premium/Payment Insider

Setup Fee Waived

Monthly Fee 1 User Waived

2-5 Users Waived

6-10 Users Waived

11+ Users Waived

OCM Setup Fee

Monthly Maintenance Fee 1-5 Users $49.00

6-10 Users N/A

11+ Users N/A

ACS Reporting

Setup Fee (per MID) Per Request

Monthly Fee N/A

Customized Reporting

Setup Fee Per Request

Monthly Fee N/A

PIN-Debit BIN Reporting

Setup Fee (per MID) Per Request

Monthly Fee N/A

CANADIAN CARD PROCESSING FEES

CANADIAN AUTHORIZATION FEES - Servicer

CANADIAN OTHER TRANSACTION FEES

FOREIGN NETWORK

CANADIAN REPORTING

REPORTING

Networks

Foreign Network:

Debit Credit

$0.062 $0.062

#N/A #N/A

Debit Credit

$0.028 $0.028

#N/A #N/A

Debit Credit

$0.035 $0.035

#N/A #N/A

PROFESSIONAL SERVICES

EQUIPMENT/SOFTWARE

Currency USD Please be sure to use the correct currency.

Equipment Type Purchase or Rental Price /Unit (US$) Monthly Fee(US$) Application

Ingenico Desk 3500 Purchase $300.00

Ingenico Desk 5000 Purchase $450.00

Ingenico Move 5000 with comm base Purchase $999 + $20 SIM card $20.00

Ingenico ipp315 pin pad Purchase $280.00

Ingenico Link 2500 (Converge) Purchase $199.00

Ingenico Move 5000 w/o comm base Purchase $734 + $20 SIM card $20.00

DCC & MCC

ACCOUNT IMPLEMENTATION & MAINTAINENCE FEES

ELECTRONIC GIFT CARDS

ELECTRONIC GIFT CARDS (CANADA)

PAYCENTRIC BILL PAY SERVICES

ACCULYNK (INTERNET PIN-BASED DEBIT CARDS SERVICES)

PAYMENT NAVIGATOR SERVICES

CONVERGE SERVICES

Services Per Trans Fee Per Mid Set up Per Mid Monthly Fee Per Mid Annual Fee

Converge Services Waived Waived Waived N/A

Converge with Tokenization $0.100 $149.00 $29.00 N/A

PETROLEUM SERVICES

ELECTRONIC CHECK SERVICE: SERVICE LEVEL AND PROCESSING FEES

Service: ECS

0.30$

3.00$

2.00$

15.00$ (Mandatory) Monthly Min:

ECS Paper Conversion

Conversion with Verification Per Trans Fee:

Conversion Only Per Trans Fee:

Per Return Fee:

NSF Service Fee Processing (if enrolled):

Using a third party network or gateway below requires Servicer to add an additional fee per authorization. For foreign networks, this is a separate authorization fee, and for gateways, this Servicer fee will be added to the Servicer authorization fee noted in the Card Processing Fee section, above.

Dial

TSYS Acquiring Solutions (Vital)

Purchase or Rental

IP

IP SSL

Notes: 1) Company will pay a unit swap and for the shipping and handling of any replacement equipment. The fee varies according to the type of terminal. 2) See additional pricing sheet as needed. 3) Rentals cancelled within the first 24 months will be charged a $200 restocking fee if the monthly rental fee is greater than $5 and a $75 restocking fee if the monthly rental fee is $5 or less. 4) Rental equipment may be new or used and is dependent on inventory available at time of order. All used equipment is inspected and refurbished upon return before being re-deployed. 5)Rentals are month to month and may be terminated at any time by Company.

Lease

ACH- Echeck Check not present

Returns Management***

**Collections service options are not available for ACH Echeck, WEB, TEL, PPD, or CCD Transactions

***No return or resubmission fees apply to returned conversion with guarantee transactions

Imaging Option Fees:

Cash Office Image (COI)

ECS Equipment/Software per license/unit (includes Magtek Excella and bay6 software)

COI Software License Fee per license

COI Maintenance Fee per year

Centralized/Enterprise Image (CI)

CI Software License Fee per license

CI Maintenance Fee per year

Outsourced Image (OI)

Initial & Reorder Supplies/Submission Slips

UPS Set-Up Fee

Courier:

Initial & Reorder Supplies/Submission Slips

Company-directed Delivery:

Initial & Reorder Supplies/Submission Slips

Paper Check Request Fees from OI IP Site per item (available for 45 days from Transaction date)

^ Pass-though fees include any applicable taxes, shipping, handling or rush order charges.

Optional ECS Services

NON-PROCESSING SERVICES AVAILABLE TO COMPANIES GENERALLY

HOSTED GATEWAY SERVICES

SAFE-T SERVICES

Safe-T Solo™ Per Month/Per MID

$35

$94.99

New or Existing Company Existing

Yes/No

Gateway Yes

Acquiring Yes

If Connectivity, will Service Web Site UI be used? Yes

Yes/ No

Encryption Yes

Tokenization Yes

Encryption License

OnGuard <-- Please select Encryption License

If Voltage Encryption, what is the Company Tier?

Annual Credit Card Volume

Annual Number of Transactions (all payment types)

Projected Monthly Transaction Volume

Yes/No

Will Company purchase equipment from Elavon? Yes

Is the Company licensing Simplify Software ? Yes

Yes <-- Professional Service fees are captured in a Statement of Work. (SOW).

Currency USD Please be sure to use the correct currency.

(a.) Company Boarding and Validation Fees:

Implementation Fee $299.00 US$

*The Per Transaction fee applies to the original ECS transaction, voids/reversals, declines, and to any resubmissions of returned Items.

Services

Safe -T Services

SAFE-T LINK™

Transportation costs for Paper Check pick-up and delivery will be passed through to Company without mark-up. Costs for supplies will be paid by Company direct to UPS.

Transportation costs for Paper Check pick-up and delivery will be paid by Company direct to their selected courier service. Costs for supplies will be paid by Company to Servicer, and will be passed-through to

Company.

Safe-T Solo Discounted Program Fee

Safe-T Solo Standard Program Fee

All Level 4 Companies (or other Public Sector agencies qualified to opt-in) that validate PCI DSS compliance on an annual basis (with initial validation to occur no later than 90 days after account approval) are eligible for the Safe-T Solo Discounted Program Fee, which includes a Discounted PCI Program Fee. Company acknowledges that if Company has not validated PCI DSS compliance within 90 days of account approval, or in subsequent years on or before the anniversary date of account approval, Company will no longer be eligible for the Discounted Safe-T Solo Program Fee and will be required to pay the full, undiscounted monthly Safe-T Solo Standard Program Fee noted above until Elavon is provided with validation of Company’s PCI DSS compliance.

Tier 1 Merchant - > 6 Million Payment Transactions

SAFE-T SOLO™

$380,000,000.00

8,000,000 per POS Device (one time fee)

Are there professional services included for this engagement?

670,000

(b.) Security Services Fees:

(i) Recurring Fees (Select option below)

Un-Bundled

FALSE

$0.010 US$ per Transaction (billed monthly)

$0.010 US$ per Transaction (billed monthly)

If Company has elected Oracle as its POS application, the following additional fees apply:

Monthly Support Fee per Company Location $20.00 US$

Implementation Fee per Company Location (one time fee) $500.00 US$

Connectivity Fee per Transaction $0.00 US$

(if Elavon acquiring, billed monthly )

Site Add/ Change Fees (per occurrence) $135.000 US$

POS Devices and Related Software

POS Device Types Purchased # of POS Device Units Purchased POS Device Cost Per Unit

# of POS Device to receive Encryption

Terminal Application

Encryption Terminal

Application License Fee per POS Device

Tetra Lane 3000 1 $529.00 1 $45.00

Tetra Lane 5000 1 $729.00 1 $45.00

Tetra Lane 7000 1 $826.00 1 $45.00

Tetra Lane 8000 1 $911.00 1 $45.00

POS Device Grand Total 4 4

POS Device Types Purchased

# of POS Devices to receive Simplify software

Simplify License Fee per

POS Device

Shipping Cost per POS

Device

Total Cost Per POS

Device

Tetra Lane 3000 1 $60.00 $0.00 $634.00

Tetra Lane 5000 1 $60.00 $0.00 $834.00

Tetra Lane 7000 1 $60.00 $0.00 $931.00

Tetra Lane 8000 1 $60.00 $0.00 $1,016.00

0 $0.00

POS Device Grand Total 4

Grand Total

$634.00

$834.00

$931.00

$1,016.00

$0.00

$3,415.00

Other Equipment # of Units Cost per Unit Total Cost

$0.00

$0.00

$0.00

$0.00

$0.00

Other Equipment Grand Total 0 $0.00 $0.00

Annual Simplify Software Support Services Fees

(Note: This table is only to be used for payment terminals and related software. All of other equipment should be identified in the “Other Equipment” table set forth below. All cost and expenses of shipping shall be paid by Company whether or not the shipping amount is indicated below.)

SAFE-T LINK SOFTWARE AND EQUIPMENT

Security Fee- Tokenization

Security Fee- Encryption

If Company has elected to purchase equipment or license software from Elavon, the following sections must be completed, as applicable. The applicable encryption Application for VeriFone equipment will be an Application provided by VeriFone, Inc. The application encryption Application for Ingenico equipment will be an Application provided by Voltage Security, Inc.

(a) Purchased Equipment and Software. Company has elected to purchase equipment and license software from Elavon with the following specifications at the following specified costs:

Hardware/Software bundles/Purchased Equipment (Safe-T Service Only)

Quantity Cost per Bundle (US$) P2PE Setup Fee* Y/N

Total Cost per

Bundle (US$)

1 $529.00 Yes $584.00

1 $729.00 Yes $784.00

1 $826.00 Yes $881.00

1 $911.00 Yes $966.00

$0.00

*Point to Point Encryption (P2PE) setup Fee is $55 per bundle.

$3,215.00

Pricing includes total applicable P2PE setup fees and equipment bundle cost.

Annual P2PE Certification Fees

Annual P2PE Maintenance Per POS Device: # of POS Devices

Total Annual P2PE

Maintenance Fees (US$):

$35.00 1 $35.00

Annual Simplify Software Support Services Fees

Annual Simplify Annual Maintenance Per POS Device: # of POS Devices

Total Annual Simplify

Maintenance Fees (US$):

$12.00 1 $12.00

CONVENIENCE FEE AND GOVERNMENT/PUBLIC INSTITUTION SERVICE FEES (GPISF)

(d) Additional Equipment and Software License Purchases. In the event that Company elects to purchase additional equipment or license additional instances of software from Elavon. Company and Elavon shall execute a supplement order form provided by Elavon (a "Supplemental Order").

In addition to the specific Equipment identified in the bundle description below, each of the bundles include Simplify Software, Voltage encryption Application, encryption application loading, key injections and standard shipping. The price set forth below includes the fees for the items included in the bundle, excluding any support fees which are additional and set forth above.

Bundle 65 - Lane 5000, CommBox & RS232 Cable, 1yr Manufacturer Warranty

Bundle 77 - Lane 7000, CommBox & RS232 Cable, 1yr Manufacturer Warranty

Bundle 89 - Lane 8000, CommBox & RS232 Cable, 1yr Manufacturer Warranty

SAFE-T SERVICE WEBSITE FEES <-- If yes is selected on line 1033 (Service Web Site), please complete the Service Web Fees section.

Bundle 53 - Lane 3000, CommBox & RS232 Cable, 1yr Manufacturer Warranty

Equipment Bundles Grand Total (US$)

Equipment Bundles

(c) Company Equipment. If Company will receive Encryption Services and will utilize POS Devices not purchased from Elavon in connection with the SAFE-T Services, the following section must be completed with respect to such POS Devices:

Sharon Hughes

10/5/2020 | 11:10 AM CDT

Treasury Manager