HomeMy WebLinkAbout2011-04 Signatures for Banking Services
RESOLUTION NO. 201l--0~
A RESOLUTION AUTHORIZING SIGNATURES, INCLUDING FACSIMILE
SIGNATURES, FOR BANKING SERVICES ON BEHALF OF THE CITY OF ASHLAND
THE CITY OF ASHLAND RESOLVES AS FOLLOWS:
SECTION 1. The following persons are authorized to sign on behalf of the city, orders for payment
or withdrawal of money: John Stromberg, Mayor, and Barbara Christensen, RecorderlTreasurer; or
in their absence, D. L. Tune berg, Director of Finance and Administrative Services Director. Park
Commissioner JoAnne Eggers is an authorized signature to the Parks Commission bank accounts.
Such authority shall remain in force until revoked by written notice to the affected bank of the
action taken by the council of the City of Ashland.
All prior authorizations are superseded.
SECTION 2. Any designated depository ("Bank") of the City of Ashland is authorized and directed
to honor and pay any checks, drafts, or other orders for the payment of money withdrawing funds
from any account of the city when bearing or purporting to bear the facsimile signatures of the
persons listed in Section One of this resolution whether such facsirnile signatures be made by
stamp, machine, or other mechanical device. The Bank is authorized and directed to honor and to
charge the city for such checks, drafts, or other orders for the payment of money, regardless of how
or by whom such actual or purported facsirnile signatures were made, provided they resernble the
facsirnile signatures duly certified to and filed with the Bank by the city recorder or other officer of
the city.
.~<iTION 3. This resolution was duly PASSED and ADOPTED this
7'.(.O!t/, ,20] I, and takes effect upon signing by the Mayor.
I
day of
SIGNED and APPROVED this d- day of February 20 I].
Reviewed as to form:
Megan T rnton, Interim City Attorney
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Deposit Account Documentation
Signature Card
Dale: '0/ 'I ~D /I
Select One: 0 New Account
Reference Account Number:
o Supersede Existing Signature Card
BANK USE ONLY: Bank Number:
o Limited 0
Partnershi
Limited Liability Company
o Manager Managed 0
o Sole Member
o Sole 0
Pro rietorshi
o Unincorporated 0
Organization or
Association
~oe
PROPERTY MANAGEMENT ACCOUNTS MUST BE ACCOMPANIED BY APPROPRIATE OWNER AND AGENT INDEMNITIES AND PROPERTY MANAGEMENT
ACCOUNT SUPPLEMENT.
us~s 3Ploy_er l~ficOon O'm:t1s J:un2' Namlf Ie al;;ty w
AGREEMENT, TAX INFORMATION CERTIFICATION and AUTHORIZATION
You begin or continue a deposit account relationship with us by giving us information about your business and by signing this Agreement. The deposit agreement
we give you is part of your agreemen~ with us regarding use of your account and tells you the current terms governing your aa;ount. We may change the deposit
agreement at any time and will inform you of changes that affect your rights and obligations. By signing below, you acknowledge receipt of the deposit agreement.
The deposit agreement includes a provision for alternative dlsDute resolution. "
By signing below, you.authorize each person who has signed in the Designated Account Signer sedion below to operate any account opened under this signature
card now or in the Mure. The authority to operate an account indudes: authority to sign dlecks and other items and to give us other instructions to withdraw
funds; to endorse ~nd deposit checks 'and other items payable to or belonging to you to the account; and, to transact other administrative business relating to the
account, induding dosing the account. If you wish to restrict a designated signer's authority to check signing you must indicate that by checking the box to the left
of their name. We may rely on this authorization for any account opened under this signature card until we receive written notice revoking the authorization at the
office where we maintain the account, and we have a reasonable time to act upon such it.
By signing below, you certify under penalty of perjury that 1) the employer identification lJumber listed above for this organization is correct; 2) that the organization
listed above is a US person; and 3) the organization listed above ;s not subject to backup withholding because: (a) the organization is exempt from back-up
withholding, or (b) has not been notified by the Internal Revenue Service (the IRS) that it is subject to back up withholding as a result of failure to report all interest
or dividends, or (c) the IRS has notified the organization that it is no longer subjed to backup withholding. [Cross out Item 3 above If you have been notified by
the IRS that you are currently subject to backup withholding for failure to report Interest or dividends.] .
. If the organization listed above is a foreign entity use the applicable Fonn w-a (for additional infonnation please see IRS Pub 515 Withholding of Tax on Non-Resident
Aliens or Foreign Entities). The term "United States person" means: A citizen or resident of the United States, a partnership created or organized in the United Stales or under
the law of the United States or of any State, a corporation created or organized in the United States or under the law of the United States or of any State, or any estate or trust
other than a forei n estate or forei n trust
By signing below, this organization hereby agrees to be bound to the above Agreement, Tax Infonnation Certification and Authorization. Further, any
person .signing this_Agreement for the Organization certifies that they are duly au lZed to do so as evidenced bv attached bankina resolution/contract
for de osit of mone s CA Public Funds onl or existin bankin resolutions/ act for de osit of mone s CA Public Funds onion file with us.
The Internal Revenue Service does not require your consent to any pro n of this document other than the certifications required to avoid
backu withholdin .
By: V3M!..eAeA rJ-H?ISlRAJSe;<..J
Type or Print NamelTitle of Authorized Signer
ORGANIZATION LEGAL NAME:
This name must matdl the name on the charter or other legal document creating the
entity. This WDUI(tthe nam~7e ~~
ORGANIZATION ;~E NAME (dba):
Any organization conducting business under a name other than its full legal name
must provide a copy of its registered trade, assumed"or fictitious name filing.
TYPE OF BUSINESS
(CHECK ONE):
o Corporation
[iYGovernment
Authorityl Agency:
o Joint Venture
DESCRIPTIVE ACCOUNT TITLE:
o General
Partnership
ADDRESS FOR STATEMENT:
G~.sf
;?o
By:
STATE OF FORMATION:
ewe may require that you provide copies of your
com n charter or formation documents.
limited Liability
Partnershi
Member Managed
Agency Account-
e:
Other - type:
17.5:10
Signature
T e or Print NameITrtle of Authorized Si ner Si nature
use su lemental a es as needed for additional si ners
Name
",. '.,',',"
'MENlf,MU,SlfJBE:eR0"'ESS~DiBXi!U;tE'8.p,.NK(eF:)>;MERICA'J:JNI.T,t;ISTED1BEliOW,:':,;;', -, ,. ", '..":" :':.':',c ,:' ;,:c'
.. ,";r~?~~~~f~;~~\~~;~;::~~~I~-:~\~.~j!lW~~~~'~~~i~~i~~T~~~~:~~~~;~:~~~~~~1~~1~;~if~~~~i~~i:~f~~~~;:~~t~;.~ .,' ..C, .':~." -.-,'" ..:~"~~~d~;~~;:,;
:~F~f'~~llK:P,~:~!~ ::
.. ....
00-35.2653NSBW 09-01-2006
Page 1 of 1
o 2006 Bank of America Corporation
Signature Block Form for InForum Gold Checks
Agency: Ci ty of Ashland, Contact:
Date:
o AP Oleck
(with cI1edt
stub on lop)
o AP Check (with
cI1edt stub on
bottom)
o PY Check
(with meek
stub on top)
o PY Check (with
cI1edt stub on
bottom)
o New )(I Olange to existing check (fill
Oleck out only the fields that are
manglng)
Agency Address:
Agency Oty:
Agency Phone#:
Bank Name:
Bank Address:
Agency State:
Agency Zip:
Bank Brandl:
Bank Oty: '
Bank Phone#:
Bank State:
Bank Zip:
Fraction (upPer It. hand comer):
To prepare for printing checks, we nero to create your check form using Oystal Report Writer and install it on your
system. Before we can do that, please complete the following tasks:
1. Fill out one of these forms for each check you would like us to create. (One for each additional agency you write
checks for.)
2. Use the boxes below to provide 1, 2, or 3 signature samples, depending on how many signatures you would like to
have printed on your checks. (Provide only one signature per box. If you print only one signature on your checks,
use only the first box, if you print two signatures, use the first two txixes, if you print three signatures, use all three
boxes.) ,
3. Please use the line below the box to state the signer's job title if desired.
4. Attach a voided check to this form.
5, Send this form (the original, unfolded) to the attention of your Eden Systems Project Coordinator.
NOTE: DO NOT SIGN ON OR OUTSIDE OF THE BOX
Signature #1 (required)
L~~ c;~wJ
I "'~"'~" n",,_)
Signature #2 (optional)
I
I'.~"'~ .n... ,-""
Signature #3 (optional)
I "'.....~.3 ,''''''''',,)
G:\DOCUmenls\Oepartmenls\PrOjecl Coordlilatlon\Docs - Olenl\lOCk-off Meeting llocuments\lnForum Gold Smndard Fonns Info and Questlonnalre.doc
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t.lsl saved by )waldo on 3/12/20033:10 PM