10.15.01A - Procedure for Credit Card Attachment
ATTACHMENT II CITY OF BOYNTON BEACH PROCUREMENT CARD PROGRAM EMPLOYEE AGREEMENT I, (name of employee), --(employee social security number), hereby request a Procurement Card. As a Cardholder,
I agree to comply with the following terms and conditions regarding my use of the Card. 1. I understand that I am being entrusted with a valuable purchasing tool and will be making financial
commitments on behalf of the City and will strive to obtain the best value for the City by using “preferred suppliers” as identified by the Purchasing Department, except when deemed
otherwise by my Department. 2. I understand that the City is liable to Bank of America for all charges made on the Card. 3. I agree to use this Card for approved purchases only and agree
not to charge personal purchases. I understand that the card may not be utilized for cash advances. I will not permit another individual to utilize the card issued to me. I understand
that the City will review the use of this Card and the related management reports and take appropriate action on any discrepancies. I acknowledge that the Card may only be used for purchases
that total less than five hundred dollars ($500) per transaction. It is my responsibility to ensure that the supplier has the City’s tax-exempt number. 4. I will follow the established
procedures for the use of the Card. The Administrative Policy Manual, Chapter 10, Section 15 – Procedures for Purchasing Credit Cards, is attached hereto and incorporated herein as Exhibit
“A”. Failure to follow the established procedures may result in either revocation of my privileges or other disciplinary actions, including, but not limited to, termination of my employment.
Should I incur charges which are contrary to the established policies and procedures, I understand that I am responsible for making restitution to the City. 5. I agree to return the
Card immediately upon request or upon termination of employment (including retirement). Should there be any organizational change that causes my department to likewise change, I also
agree to return my Card and arrange for a new one, if appropriate. I understand that the City, or Bank of
America, may suspend or cancel the Card at any time for any reason whatsoever and I shall return the Card immediately upon notification or cancellation. 6. The purchasing card issuing
company, Bank of America, will not have individual Cardholder information other than the Cardholder’s work address. No credit records, social security numbers, etc. of the Cardholder
are maintained. I understand, as a Cardholder, it will be my responsibility to assist in the reconciliation of my monthly statement. This includes: provide supporting charge slips/receipts
for all transactions appearing on the statement, review monthly statement with Department/Division Purchasing Coordinator, and signing a certified Monthly Purchasing Card Transmittal
Form with account numbers, reason for purchases, and dollar values. I further understand the importance of timely processing of documents to the Purchasing Agent (five workdays from
receipt of statement). If the Card is lost or stolen, I agree to immediately notify Bank of America at 1-888-449-2273 and the Purchasing Agent (742-6324) of the loss, verbally and in
writing. Employee Signature and Date Witness Signature and Date Print Name -Employee Print Name -Witness Purchasing Agent Date FOR OFFICIAL USE ONLY Issuance Date Department:
ATTACHMENT I CITY OF BOYNTON BEACH PURCHASING CARD REQUEST FORM Request to issue a City of Boynton Beach Purchasing Card for: Employee Name Position # Department Name Dept No. Default
Account Number: ----Fund Dept Basic Ele Obj Single Purchase Limit $ 30 Day Limit $ Address for Billing: Department/Division Purchasing Coordinator: _______________________________________
Printed Name Signature Department Head: Signature Date ______________________________________________________________________________ FOR PURCHASING USE ONLY Card Number: Single Purchase
Limit $ 30 Day Limit $ Specific Blocked MCC's: Included MCC's: Cardholders Name: Telephone: Purchasing Agent ____________________________ Date ___________________________ ____________________________
__________________________________________________ I certify that I received the Bank of America VISA Purchasing Card listed above and a copy of my signed agreement with the City of
Boynton Beach for the use of the card. I have also received a copy of the Administrative Policy Manual, Chapter 10, Section 15, Procedure for Purchasing Credit Cards, and understand
it is my responsibility to comply with these procedures and safeguard the use of the credit card to official City business. 3
I understand that failure to use this Purchasing Card in accordance with all rules and regulations may require relinquishing the card and may result in disciplinary measures. Employee
Signature: Date: 4
ATTACHMENT IV CITY OF BOYNTON BEACH MONTHLY PURCHASING CARD TRANSMITTAL FORM Department Name and Number: Statement Date: Statement Account Number: Item Fund Dept Basic Ele Obj Statement
Amount Dispute Amount Total To Be Paid $ $( ) $ $ $( ) $ $ $( ) $ $ $( ) $ $ $( ) $ $ $( ) $ $ $( ) $ $ $( ) $ $ $( ) $ $ $( ) $ Totals $ $( ) $ I certify that the transaction charges
reflected on the attached monthly VISA statement are for official business purposes and request that they be paid against the above listed account numbers. Cardholder's Signature Date
Telephone Number Department Head Signature Date 5
ATTACHMENT V CITY OF BOYNTON BEACH PURCHASING CARD CARDHOLDER STATEMENT OF DISPUTED ITEMS AGENCY NAME CARDHOLDER NAME CARDHOLDER PHONE NUMBER BILLING CYCLE END DATE TRANSACTION DATE
MERCHANT NAME/DESCRIPTION AMOUNT POSTING DATE REFERENCE NUMBER $ Check the description appropriate to your dispute. If you have any questions contact Bank of America at 1-800-538-8788.
Alteration of Amount: The amount of the sale receipt or charge has been altered from $ ____________ to $ _____________. (Include copy of the sales draft/receipt). Unauthorized
Mail or Phone Order: I certify the charge listed above was not authorized by me or any person authorized by me to use this account. I have not ordered merchandise by phone or mail, or
received goods and services as represented above. Cardholder Dispute: I did participate in the above transaction, however, I dispute the entire charge, or a portion, in the amount
of $__________ because ___________________________________________ __________________________________________________________________________________ Credit Not Received: The merchant
has issued me a credit for the transaction listed above; however, the credit has not posted to my account. The date on the credit/receipt is between 30 and 90 days old. (Include a copy
of the sales draft/receipt). Imprinting of Multiple Slips: The above transaction represents multiple billing to my account. I only authorized one charge from this merchant for $ ___________.
I am still in possession of my card. Merchandise Not Received: My account has been charged for the above transaction, but I have not received this merchandise. I have contacted the
merchant. 6
Merchandise Returned: My account has been charged for the transaction listed above, but the merchandise has been returned. Provide a description of the circumstances. (Please include
postal receipt if applicable). Inadequate Description/Unrecognized Charge: I do not recognize this charge. Please supply a copy of the sales draft for my review. Dispute Resolved
Since Filing a Dispute: Dispute with merchant has been resolved and I wish to withdraw my original dispute filed on ___________________ (Provide copy). __________________________ _______
______________________________________ Authorized By Date Cardholder Signature Date 7
ATTACHMENT III CITY OF BOYNTON BEACH PURCHASE CREDIT CARD TELEPHONE ORDER FORM TELEPHONE ORDER DATE: __________________ VENDOR NAME: ____________________________ TELEPHONE: ______________
ADDRESS: ________________________________ FAX NO.: __________________ CITY: __________________________ STATE ______ ZIP CODE ___________ VENDOR CONTACT NAME: _________________________________________
____ SHIP TO: ___________________________________ ____________________________________ ____________________________________ ATTN: VISA CONFIRMATION FAX NO.: ______________ VISA NUMBER:
________________________________ EXPIRE DATE: __________ (NO ITEM LISTED BELOW IS TO EXCEED $200.00) QUANTITY CATALOG NO. DESCRIPTION UNIT PRICE TOTAL CARDHOLDER SIGNATURE: __________________________
__________________ CARDHOLDER NAME (PRINT): __________________________________________ DEPARTMENT N 8