CORPORATE PREPAID CARD PROGRAM AGREEMENTDocuSign Envelope ID: 2E0A3C45-4664-4856-8C12-14042E097FDE
GREEN DOT PAYCARD® PROGRAM
CORPORATE PREPAID CARD PROGRAM AGREEMENT
This CORPORATE PREPAID CARD PROGRAM AGREEMENT ("Agreement") is entered into by and between
Green Dot Corporation, a corporation organized under the laws of the State of Delaware, with its principal
offices at 114 W 7th Street, Suite 240, Austin, TX 78701 ("Green Dot") and City of Clearwater a government
entity organized under the laws of the state of Florida with its offices at 600 Cleveland Street, Suite 600,
Clearwater, FL 33755 ("Company"), in consideration of the promises and undertakings set forth below, Green
Dot and Company agree as follows:
1. GENERAL OVERVIEW.
a) Company has elected to use the services of the prepaid card program ("Program") more fully described
in Exhibit A. Under the Program, designated employees or independent contractors ("Participants") will
be issued prepaid cards ("Cards") funded by Company. Notwithstanding anything to the contrary, the
parties agree that cardholders may also fund the Cards.
b) The Cards shall be issued by a FDIC -insured bank selected by Green Dot for the Program ("Bank"). All
Program funds will be held in FDIC Insured Banks. Certain programs selected by Company may require
deposits provided by Company to be held at a correspondent bank to the issuing Bank. Green Dot shall
have the right to move the Cards to a new issuing bank without written notice to Company except as
may be required by law.
c) Each Participant shall be required to enroll in the Program by submitting certain information, and his or
her participation shall be contingent on successful completion of "know your customer" due diligence and
other legal requirements. The terms and conditions governing the use of the Cards and the accounts
associated with such Cards will be supplied by Bank. Sub -Accounts shall be opened only for Participants
that are residents of the United States or its territories.
d) Funding by Company may be made to a pooled custodial account maintained for the purpose of
disbursing funds to the Cards (the Controlled Account"). To facilitate a Participant's use of Cards, a sub -
account under the Controlled Account will be established for such Participant (the "Sub -Account"). The
Controlled Account will be accessed by the Company through a pass code protected, secure web portal
and will be used to load funds to Cards, either individually or in batch files. These transactions are
processed as soon as the requests are received and funds are then available to Participants. Company
shall be able to make instant Toads to Cards as needed with no requirement for a minimum balance to
be maintained in the account, except that Company must maintain sufficient funds in the Controlled
Account to cover the disbursements that it is directing to be made to Participants. Green Dot or its
delegate shall maintain individual entries in its system, reconciled each day to amounts in each Sub -
Account, reflecting the amount of funds in the Sub -Account that are attributable to, and held on behalf of,
each Participant. Green Dot or its delegate shall also maintain such records as are required by the FDIC
to obtain "pass through" insurance coverage for each Participant whose funds are in a Sub -Account.
Additional details on Card funding are included in the Exhibit A attached hereto. Unless otherwise
prohibited by law, Company, or any successor or assign of Company, including any receiver or trustee
in bankruptcy on behalf of Company, shall maintain its right, title or interest in any funds in the Controlled
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Account.
e) Company elects to allow subsidiaries and affiliates to participate in the Program ("Participating
Subsidiary/Affiliate"). Each Participating Subsidiary/Affiliate will be given access to the Program with their
own Bank Controlled Account. Participants will be given Sub -Accounts and Cards under the Participating
Subsidiary/Affiliate. Participating Subsidiary/Affiliate may enroll in the Program by completing the
Subsidiary/Affiliate Account Request Form), a sample is attached hereto as Exhibit C.
2. COMPANY RESPONSIBILITIES.
a) Company represents and warrants that all payment data submitted to Green Dot or Bank in connection
with Participants and the Program is true, accurate and complete, and is sufficient to enable Bank to
allocate the funds among the various Sub -Accounts and honor withdrawal requests by Participants.
Company agrees that Bank and Green Dot may rely on such data without any obligation to verify it.
b) Company shall deposit the funds due to Participants into the designated Controlled Account by wire
transfer or ACH transfer or other means, at the discretion of Company. Along with each transfer of funds
by Company to the Controlled Account, Company shall provide, in the format specified by Green Dot, the
identity of, and the amount of such funds due to, each Participant ("Disbursement Detail"). Company
acknowledges that funds will be made available to Participants commencing on the business day the
cleared funds are received and the corresponding Disbursement Detail. Neither Green Dot or Bank shall
have any obligation to make any funds available to Participants for whom the Disbursement Detail is
missing or incomplete or if records indicate that insufficient funds are available to complete a transaction.
c) Subject to Section 7 and 8 hereof, Green Dot may permit Company to maintain an inventory of instant
issue Cards at its locations subject to the following terms:
i. Card Ordering: Card orders will be shipped to the designated employer locations by the Card
manufacturer and will arrive via a bonded and approved carrier. Card orders must be signed for
upon arrival. All Cards must be placed at the time of receipt into inventory in a secured area. An
employee designated by management should be appointed to ensure the physical and procedural
security policies are implemented.
ii. Card Inventory: Physical security of the Cards in inventory must be maintained at all times. Cards
must be stored in a controlled environment, such as a safe, with access limited to employees who
have successfully passed background screening checks. An inventory log must account for the
number of Cards received, Cards used, Cards spoiled (Cards that cannot be used due to damage,
tampering or expiration) and remaining Cards that should balance to the number of Cards on
hand at any time. An explanation of spoilage should be included on the log. Any inventory
discrepancy must be reported to Green Dot as soon as detected. Company shall bear all risk of
loss associated with unauthorized activity on Cards or related funds on deposit resulting from
unauthorized access to or theft of Card plastics in its possession or control. If Company is
disbursing Cards, Company shall deliver to each Participant the Enrollment Materials provided to
it by Green Dot.
iii. Enrollment Materials: The Enrollment Materials include, without limitation, the Cardholder
Agreement, a Card, a Direct Deposit Authorization Form, disclosures as may be required by
applicable law and regulation and other materials. Company covenants and represents that it will
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provide Enrollment Materials to each Participant when Company provides a Card from its
inventory.
iv. Card Destruction: Green Dot may request return or destruction of unused Cards (1) that are
compromised or tampered with; (2) that are on expired Card stock; (3) that are damaged or
defective; and (4) that are in the possession of the Company after the program is terminated.
Cards to be returned to Green Dot should be securely packaged. A copy of the inventory log
should be included with the shipment.
d) Company shall comply with applicable law and card network rules in connection with its obligations under
the Agreement. Company represents and warrants that it shall not use the Program, and shall use its
best efforts to prevent itself from being used, for any illegal purpose or activity, including without limitation,
money laundering.
e) Company shall be solely responsible for compliance with federal, state and local laws, rules and
regulations relating to compensation and employment matters.
f) Company shall offer all employees alternative to the Card methods of payment in accordance with
applicable laws.
g) Company shall keep records of all transactions and activities performed under this Agreement for a period
of not less than six (6) years after the expiration or termination of this Agreement.
3. GREEN DOT RESPONSIBILITIES.
a) Green Dot shall provide or contract for all such functions and services necessary to create, operate and
administer the Program.
b) Green Dot shall provide account set up and enrollment assistance for all Participants to ensure that Cards
are delivered to Participants. Green Dot shall grant user level access to Company and Participants to the
systems used to support the Program.
c) Green Dot shall comply with applicable law and card network rules in connection with its obligations under
the Agreement.
d) Green Dot shall provide Participants with operator -assisted customer service which is available 24x7, in
addition to providing web based services for Participants and Company to access their respective
information.
e) Green Dot shall provide training services on the Program to Company to enable Company to inform
Participants on how to use the Program and take advantage of the various Program features.
f) In its discretion, Green Dot or Bank may provide other ancillary services that Participants may use to
access their funds.
4. FEES AND CHARGES. Company acknowledges that certain fees and charges are to be paid by Participants,
and that such fees and charges shall be set forth in a disclosure statement that will be provided by Green
Dot and included in the Enrollment Materials. The current Program fees for Participants are set forth in
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Schedule A hereto. Green Dot reserves the right to change the fees with appropriate prior written notice to
Participants.
5. TERM OF AGREEMENT.
a) The Agreement shall continue in full force and effect unless terminated as provided herein. Either party
may terminate this Agreement for convenience at any time upon one hundred and eighty (180) days'
notice.
b) Green Dot may terminate this agreement upon thirty days written notice (or less if thirty days is not
allowed under such law, rule or regulation) of a change in applicable law, rule or regulation which renders
Green Dot's performance under this Agreement impractical, impossible or unprofitable in Green Dot's
discretion.
c) Either party may terminate this Agreement upon thirty (30) days prior written notice to the other party, if
such party breaches or violates any provision of this Agreement and any such default, breach or violation,
as described in such notice with specificity and in reasonable detail, is not remedied in all material
respects within the applicable thirty (30) day notice period.
d) In addition, either party may terminate this Agreement upon written notice if the other party becomes the
subject of a voluntary bankruptcy petition or any other voluntary proceeding relating to insolvency; or (ii)
without prior notice if the other party becomes the subject of an involuntary petition in bankruptcy or any
other involuntary proceeding relating to insolvency, receivership or liquidation, and such voluntary
petition or proceeding is not dismissed within the ten (10) day notice period.
e) Upon termination of this Agreement for any reason all fees and charges then owed by Company to Green
Dot shall immediately be due and payable. Participants shall be permitted to use Cards after termination
to access their funds in the relevant Sub -Account. Company shall immediately return all Cards in its
possession that have not been issued to a Participant to Green Dot, under the procedures specified by
Green Dot.
6. SYSTEM AND TRANSACTION MONITORING. Green Dot reserves the right for Green Dot or its
subcontractors to monitor Card activity, and to refuse to issue a Card, cancel a Card previously issued to a
Participant or temporarily suspend usage of a Card or the Program, due to actual or suspected fraud or
unauthorized use, and to comply with applicable law, card network rules and bank safety and soundness
requirements. Except as prohibited by applicable law, Bank shall disburse to the Participant any funds
remaining on a cancelled Card and any funds in the Controlled Account to the Company.
7. DATA SECURITY.
a) Company acknowledges that it is responsible for the security of all Cards, cardholder data and related
Participant information in its possession or which it accesses. In connection with this Agreement,
Company shall comply with generally accepted and applicable security controls, standards, and
regulations as well as other requirements for the safeguarding of Cards and cardholder information which
may be required by applicable law, rule, regulation including but not limited to network rules, and any and
all reasonable requirements as set forth in writing by Green Dot. Without limiting the generality of the
foregoing, in addition to other requirements which may be imposed on Company by Green Dot, Bank or
the card network, Company shall remit information to Green Dot in a secure or protected format, such as
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encryption. Green Dot shall use reasonable commercialefforts to give Company notice of all material
changes to the Program which are being made to comply with changes in law or card network rules,
including industry rules related to applicable security controls, standards, and regulations.
b) To ensure that Company is complying with the requirements of this Section 7, Green Dot may request
Company to provide the details of the security systems used by Company and may carry out an
inspection or audit of Company's systems. Company agrees to cooperate fully with any such requested
audits. Regardless of contract termination, Company will continue to treat Cards and Participant data as
confidential.
c) Company shall promptly notify Green Dot once it has knowledge of or reasonably suspects that there
has been any unauthorized access, use or disclosure of any non-public personal information, Card or
Participant information, and shall promptly furnish to Green Dot the known details of any such data
incident, and take such action as may be necessary to prevent a reoccurrence of any such incident.
8. LIMITATIONS ON LIABILITY AND SPECIAL DAMAGES.
a) Company acknowledges that the Program is supported by a complex combination of hardware and
software systems that are hosted by and/or interfaced with numerous other service providers and,
accordingly, system and operational failures, malfunctions and other errors may occur from time to time
resulting in, among other things, system access denials and/or delays, and periods when usage is
suspended. Green Dot shall use commercially reasonable efforts to minimize system and operational
problems, but it is inevitable that some problems will occur. In addition, it is possible that system and
operational problems may occur due to numerous matters beyond the reasonable control of Green Dot,
including force majeure. With respect to the foregoing, and any other claim that Company, Participants
may ever have in connection with the electronic payment services provided pursuant to this Agreement,
Green Dot shall not be liable to Company, Participants or any other party for any reason other than its
breach of this Agreement, willful misconduct, or gross negligence.
b) No claim may be asserted against Green Dot by Company more than two (2) years after the date such
claim accrued.
c) GREEN DOT AND/OR BANK'S AGGREGATE LIABILITY FOR ANY AND ALL CAUSES OF ACTION
UNDER THIS AGREEMENT SHALL BE LIMITED TO ACTUAL DAMAGES NOT TO EXCEED CARD
FEES ACTUALLY RECEIVED BY GREEN DOT IN CONNECTION WITH THIS AGREEMENT WITHIN
A TWELVE-MONTH PERIOD PRECEDING THE FIRST CLAIM. IN NO EVENT SHALL EITHER PARTY
BE LIABLE UNDER ANY THEORY OF TORT, CONTRACT, STRICT LIABILITY OR OTHER LEGAL OR
EQUITABLE THEORY FOR ANY EXEMPLARY, PUNITIVE, SPECIAL, INCIDENTAL, INDIRECT OR
CONSEQUENTIAL DAMAGES, INCLUDING, WITHOUT LIMITATION, LOST PROFITS, LOSS OF
BUSINESS, OR BUSINESS OPPORTUNITY, EACH OF WHICH IS HEREBY EXCLUDED BY
AGREEMENT OF THE PARTIES REGARDLESS OF WHETHER A PARTY HAS BEEN ADVISED OF
THE POSSIBILITY OF SUCH DAMAGES.
9. DISCLAIMER OF WARRANTIES. GREEN DOT SPECIFICALLY DISCLAIMS ALL WARRANTIES OF ANY
KIND, EXPRESS OR IMPLIED ARISING OUT OF OR RELATED TO THIS AGREEMENT, INCLUDING,
WITHOUT LIMITATION, ANY WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR
PURPOSE EACH OF WHICH IS HEREBY EXCLUDED BY AGREEMENT OF THE PARTIES. BOTH
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PARTIES HEREBY AGREE THAT GREEN DOT'S OBLIGATIONS TO COMPANY ARE RELATED TO
PROVIDING A PREPAID CARD PROGRAM TO COMPANY AND THAT THIS AGREEMENT IS A SERVICE
AGREEMENT FOR PURPOSES OF THE UNIFORM COMMERCIAL CODE AND THEREFORE THE
PROVISIONS OF THE UNIFORM COMMERCIAL CODE SHALL NOT APPLY TO THIS AGREEMENT.
10. CONFIDENTIALITY.
a) The parties agree that certain confidential information may be exchanged by the parties, including the
provisions of this Agreement and accordingly, agree that they will not, without the written consent of the
other, intentionally disclose the terms hereof or any other information marked confidential or reasonably
understood to be confidential under the circumstances, whether disclosed orally or in written form, and
that all such terms shall be held in confidence and revealed only to employees, agents, lenders or other
persons having a need to know such terms in the course of such person's employment or business
relationship with such party.
b) Company shall not use, divulge, or grant any third party access to, Participant or Card transaction
information, except to carry out its obligations under this Agreement and as required by law.
c) The parties further agree that any obligations to protect Confidential Information is set forth herein shall
survive termination of this Agreement for a period of three years, except that as to any Confidential
Information designated in writing by the disclosing party to be a "trade secret" or is personal information
of the Participant, such obligations shall continue indefinitely unless otherwise agreed in writing by the
disclosing party. If a party is required by court order or other governmental authority to disclose any
confidential information of the other party, the party pursuant to the order shall notify the disclosing party
(to the extent permitted by applicable law) and cooperate in any disclosing party's effort to obtain a
protective order at the disclosing party's cost.
11. INDEMNIFICATION. Company acknowledges and agrees to indemnify Green Dot for any and all losses,
liabilities, claims, damages, penalties, judgments, costs and expenses (including reasonable attorney fees)
which arise or directly or indirectly relate to the gross negligence, willful misconduct, or breach of Company
under this Agreement. Company's indemnification of Green Dot shall not be construed as a waiver of
Company's sovereign immunity. The value of Company's indemnification of Green Dot is limited to the
limitations of §768.28, Florida Statutes, to the extent such limitations apply to Company's
indemnification hereunder. This indemnification is not intended to nor shall be interpreted as limiting or in
any way affecting any defense Company may have under §768.28, Florida Statutes or as consent to be sued
by third parties except as permitted by such Statutes.
12. ENTIRE AGREEMENT AND MODIFICATIONS. This Agreement constitutes the entire agreement between
the parties with respect to the subject matter and supersedes any and all prior understandings or agreements
relating thereto, whether written or oral. Modifications to this Agreement must be in writing and signed by
each party to be effective; provided, however, if any provision of this Agreement is found to be invalid or
unenforceable such provision shall be deemed severed from this Agreement and all of the other provisions
hereof shall remain in full force and effect as if such provision had never been included herein.
13. GOVERNING LAW. This Agreement, as well as the rights and duties of the parties hereunder, shall be
governed by, interpreted under and enforced in accordance with the laws of the State of Florida, without
regard to choice of law and conflict of law statutes. Any suit, action or proceeding under this Agreement shall
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be brought in the state or federal courts located in Pinellas k lcberough County, Florida, and the Parties
hereby irrevocably consent and unconditionally submit to the personal jurisdiction and venue of such courts.
14. WAIVER OF JURY TRIAL. EACH PARTY HERETO IRREVOCABLY AND UNCONDITIONALLY WAIVES
ALL RIGHT TO TRIAL BY JURY IN OR TO HAVE A JURY PARTICIPATE IN RESOLVING ANY DISPUTE,
ACTION, PROCEEDING OR COUNTERCLAIM, WHETHER SOUNDING IN CONTRACT, TORT OR
OTHERWISE, ARISING OUT OF OR RELATING TO OR IN CONNECTION WITH THIS AGREEMENT OR
ANY OF THE TRANSACTIONS CONTEMPLATED HEREBY.
15. AUTHORITY, BINDING EFFECT. Each party hereby represents and warrants to the other that (a) its
execution, delivery and performance of this Agreement has been duly authorized and approved, and (b)
neither its execution or delivery of this Agreement, nor its performance hereunder, will violate or conflict with
any term or condition of its organizational or other governing documents, or any other agreement or directive
of any kind or nature to which it is a party or by which it is otherwise bound.
16. ASSIGNMENT. The Agreement will be binding on and inure to the benefit of each of the parties, their
successors and assigns. It may not be assigned or transferred, in whole or in part, by the Company without
the written consent of Green Dot. Any such assignment or transfer without consent will be void.
Notwithstanding the foregoing, Green Dot may assign this Agreement without Company's prior consent if the
assignment is made to (a) any corporation which is a successor to Green Dot either by merger or
consolidation, (b) a purchaser of all or substantially all of Green Dot's or the Program's assets, or (c) a
corporation or other entity which shall directly or indirectly control, be under the control of, or be under
common control of Green Dot.
17. COUNTERPARTS AND ELECTRONIC COPIES. This Agreement may be executed in counterparts and
delivered by electronic means such as, but not limited to facsimile or scanned e-mail, and all such
counterparts and methods shall constitute one and the same document.
18. NO THIRD PARTY BENEFICIARIES. Nothing in this Agreement, express or implied, is intended or shall be
construed to confer upon any person or entity, other than the parties and their respective successors and
permitted assigns, any right, remedy or claim under or by reason of this Agreement.
19. FORCE MAJEURE. Neither party hereto, nor Bank, shall be liable for any failure to perform its obligations
under this Agreement due to: (i) acts of God, such as fires, floods, electrical storms, unusually severe weather
and natural catastrophes; (ii) civil disturbances such as strikes and riots; (iii) acts of aggression, direct or
consequential, such as explosions, wars, and terrorism; (iv) failure of any third party service provider to
adequately provide such services, including, without limitation ATM network services, telecommunication
services, and merchant point-of-sale services; and (v) failures in electric power, computer or
telecommunications services or equipment of a third party (each, a "Force Majeure"). In such event, the
performance of such party's obligations shall be suspended during the period of existence of such Force
Majeure event and the period reasonably required thereafter to resume the performance of the obligation.
The party experiencing the Force Majeure event shall use reasonable efforts to minimize the consequences
of such event.
20. COMPLIANCE WITH FEDERAL LAW. The Program complies with federal law which requires all financial
institutions to obtain, verify and record information that identifies each Company or Participant who opens an
account. Bank directly or through Green Dot may ask Company or Participant for the name, address, date
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of birth, and other information that will allow Bank to identify the Company and/or Participant. The Bank
reserves the right to not open an account or suspend an existing account as required for compliance with
these rules.
21 NOTICES. Any notice, request, consent or other communication to any party hereto must be in writing and
shall be deemed effective when delivered in person, sent by email, if promptly confirmed in writing, or on the
fourth day from the date posted by registered mail, return receipt requested, with postage prepaid, addressed
as set forth in the recitals. Notwithstanding the foregoing, legal notices to Green Dot and/or Bank shall be
sent to legalnotices@greendotcorp.com and shall be deemed effective (and to have been received) on the
earlier of (i) when delivered to the recipient's email server, (ii) when the recipient has read the email as stated
in an automated message received by the sender, or (iii) one hour after sending unless within 24 hours of
sending the email the sender receives an automated message that it was not delivered.
NOW THEREFORE, Green Dot and Company have executed this Agreement by their duly authorized
representatives to be effective on the date fully executed.
COMPANY: CITY OF CLEARWATER
Signature:
Name:
Title:
Date:
Jennifer Poirrier
Interim City Manager
GREEN DOT CORPORATION
Signature: flcx atfagr!S
Name: ALEX BARTELS
Title: GM of wage & Corporate Disbursements
Date:
12/6/2022
Owen Kohler
Assistant City Attorney
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Exhibit A
DESCRIPTION OF PREPAID CARD PROGRAMS
A. PAYROLL CARD PROGRAM:
a. Company may elect to use the Green Dot! PayCard Payroll Card program to enable the payment
of payroll and other work related incentives to its employees, independent contractors or other
vendors.
b. For all payroll cards, Company represents and warrants that it complies with applicable laws and
regulations concerning payment of wages to the Participants, including, but not limited to 1-9 form
completion, timeliness of payments, procedures to pay wages, calculation of net pay, distribution of
wage statements and handling and reporting amounts withheld or deducted from each Participant's
pay, and obtaining consent, as may be required by law, of each employee who has elected to
participate in the Program. By signing the attached Exhibit B, Company is requesting the removal of
the independent identity verification requirement and agrees to retain the employee identity
documents as required by the applicable laws and regulations governing the verification of employees
by employers.
c. Payroll card funding.
i. Batch File Payroll Initiation or API: Company sends Green Dot an encrypted file via Secure
File Transfer Protocol ("SFTP") instructing the Green Dot system how much money to load to
each paycard. Separately Company sends the funds to the Bank in one aggregate ACH or
wire transaction prior to the posting date and time.
ii. ACH Direct Deposit: Company may enter the employee's paycard routing and account
number into its direct deposit payroll software and originate ACH payroll transactions. This is
the same process the Company would use for direct deposit to a bank account.
iii. Off Cycle Batch File: Company may send Green Dot an encrypted file via SFTP instructing
the Green Dot system to Toad funds, make corrections, and perform off -cycle payments on a
24x7x365 basis. Employees' cards are funded from a prefunded disbursement account at the
Bank or correspondent bank. This method could be used by the Company for both regular
payroll as well as exception/off-cycle pay. The batch funding process for regular payroll would
mitigate ACH fees accessed by the Company's banking partner.
iv. Web Portal: The Green Dot team's proprietary employer Web portal offers password protected
access to a secure website where you can load funds to cards, either individually or in batch
files. Transactions are processed and funds are available to cardholders immediately upon
file processing. Employee's cards are funded from a prefunded disbursement account at the
Bank or correspondent bank.
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B. GENERAL PURPOSE CARD PROGRAM:
a. Company may elect to use the Green Dot General Purpose Card Program to provide
miscellaneous incentives and gifts to its employees, independent contractors and customers.
b. All cardholders using a Green Dot General Purpose Card Program will be subject to a verification
process. Green Dot and the Bank is required by federal law to maintain a strict anti -money
laundering ("AMC) program. The Cardholder Identification Process ("CIP") is a component of the
overall AML Program. This process gathers personal identifiable information from the cardholder
(name, physical address, date of birth and social security number) and passes it through a third
party compliance database to verify cardholder identity. The process to conduct an identity check
is for verification of the cardholder only and does not pull from credit data or impact a consumer's
credit score. Cardholders who are not successfully verified through this process will not be
permitted to open a prepaid account with the Program.
c. General purpose card funding. The parties agree that cardholders may fund the Cards in
accordance with the terms and conditions that accompany the Cards (the "Cardholder
Agreement").
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Exhibit B
GREEN DOT PAYCARD PREPAID PAYROLL CARD PROGRAM
CERTIFICATION OF COMPLIANCE WITH THE IMMIGRATION REFORM AND
CONTROL ACT OF 1986 AND PAYROLL CARD ISSUING BANK REQUIREMENTS
COMPANY INFORMATION
Company Name:
Address:
City, State, Zip: Cleft rr,Pt-
City of Clearwater
Std Cleveland Stree. Sum 600
Employment Eligibility Verification Requirements
The Immigration Reform and Control Act of 1986 (IRCA) requires employers to verify that all newly -hired
employees present "facially valid" documentation verifying the employee's identity and his or her legal
authorization to accept employment in the United States, which includes both citizens and noncitizens. The 1-9
form (Employment Eligibility Verification Form) is provided by the federal government for that purpose. Every
employee hired after November 6, 1986 must complete an 1-9 form at the time of hire. Each employer is
responsible for ensuring that the forms are completed properly, and in a timely manner. The employee must
present a document, or a combination of documents that establishes both his or her identity, and his or her legal
authorization to work in the United States.
Employers must retain a copy of the 1-9 for a) three years after the employee is hired or b) one year after their
employment is terminated, whichever is LATER. This means retention for a total 4 years for an employee who
has ended employment at three years, for example (1 year after termination.) The 1-9 must be retained as long
as the employee is employed with the company.
Document Retention
As a participant in the Payroll card program and due to Bank's obligation to have access to documentation
verifying the employee's identity for a longer such period, Employer agrees to retain a copy of the 1-9 form or an
electronic record of the information used to complete the form (including the document type, issuing authority,
document number, and expiration date) for five (5) years after the employee is terminated from employment.
Employer also agrees to retain the date the employee was hired. For the avoidance of doubt, nothing set forth
herein shall require the Client to copy and preserve any supporting documentation for any Form 1-9 that Client
is not otherwise required to copy and preserve under applicable law.
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Audit
In addition, as a participant in the Payroll card program, Company agrees that at Issuing Bank's sole
discretion, Bank, its authorized representatives, or agents and any government entity with regulatory or
supervisory authority over Bank, shall have the right to request copies of 1-9 forms and the electronic
record of the information used to complete the 1-9, as described in the paragraph above, to inspect, audit,
and examine the documents and records to determine Company's compliance with 1-9 data collection
and retention requirements. Company agrees to make best efforts to provide such documentation within
two (2) business days of the request by Bank, but in no case no later than four (4) business days from
the date of such request. If the requested documentation is not provided within four (4) business days,
at Bank's election, the affected payroll cards may be suspended until such time as the information is
provided.
By signing below, the authorized Company Representative certifies that it is in compliance with The Immigration
Reform and Control Act of 1986 and agrees to comply with the Document Retention and Audit provisions as
described above.
Signature of an Authorized Company Representative
Printed Name of Representative:
Title of Representative:
Date:
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Employee/Cardholder Fee Schedule
Schedule A
Cardholder Fees
Domestic POS Signature Purchase
International POS Signature Purchase (1)
Domestic POS PIN Purchase (Including Cash Back)
ACH Transfer to Bank Account
ChekToday — Check Authorization (2)
Card to Card Transfer
Request a Check
Money Order at US Postal Service (3)
Interest Bearing Savings Account
Over the Counter Bank Cash AdvanceWthdrawal
Direct Deposit
Domestic ATM Cash Withdrawals — Allpoint (4) & MoneyPass
POS Decline (Domestic)
POS Decline (International)
International POS PIN Purchase
Domestic ATM Cash Withdrawal — Out of Network
International ATM Cash Withdrawal — Out of Network
Domestic ATM Balance Inquiry (Allpoint & MoneyPass)
Domestic ATM Balance Inquiry — Out of Network
International ATM Balance Inquiry — Out of Network
Domestic ATM Withdrawal Decline (Allpoint, MoneyPass)
Domestic & International ATM Withdrawal Decline (Out of Network)
Bill Payment
Employer Issued
CSR Issued
Personalized Card — First Time (Voluntary)
Companion Card
Website Account Access
...........
IVR & Live Agent Account Assistance
Text Alerts (unlimited messages)
Printed & Mailed Statement
$0.50
$0.50
NO CHARGE (1)
$2.99
$2.99 (1)
NO CHARGE
$0.99
$0.99
$0.75 ..
$0.75_
NO CHARGE
NO CHARGE
NO CHARGE (5)
NO CHARGE (5)
NO CHARGE (5)
NO CHARGE
NO CHARGE
NO CHARGE (6)
NO CHARGE (7
DocuSign Envelope ID: 2E0A3C45-4664-4856-8C12-14042E097FDE
Overdraft/Negative Balance — Per Incident
Monthly Maintenance
Bill Pay Reversal
Convenience Check (Unauthorized, Stop Payment, Returned,
Lost/Stolen)
Convenience Check (Copy)
NO CHARGE
NO CHARGE (8)
NO CHARGE
$25.00
$10.00
1. International ATM Cash Withdrawal, POS Signature Purchase and POS PIN Purchase Surcharge — 3% of
transaction amount
2. Cardholder can cash a ChekToday at Walmart for free.
3. When a money order is employee's first transaction for a pay period for the full amount of their pay, rapid! also refunds the
amount of the USPS charge (which range from $1.05 - $1.50 per money order) to the employee's card account.
4. Cardholder has surcharge free access to this network.
5. Free if sent via USPS First Class, Standard Overnight Mailing Fee $25, Rush Ovemight Mailing Fee $35, Saturday
Delivery Expedited Mailing Fee $55.
6. Standard carrier rates may apply.
7. Upon request, employee may receive 1 free statement mailed to their home/month. Additional printed/mailed statements
are subject to a fee of $1.50. Statements are available free of charge on the cardholder website.
8. Inactivity fee of $4.95 per month is assessed after 6 months with no balance changing transactions.
Signature of an Authorized Company Representative
Printed Name of Representative
Title of Representative
Date