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SUMMARY
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Cleartel Communications would be the dial -tone provider for the 26 city -owned pay
phones. This is the "cost" side of operating the payphones.
J
In order to have dial -tone service in place by 3/I/09, the agreement needs to be in effect
2/1/09, to allow 30 days for the transition/install.
The City is in the CA-VZ GTE territory on Exhibit B, page 9, therefore:
• If we select the Month -to -Month option, the installation = $3120 (26 x $120 each) w
• If we select the 1 year option, the discounted is installation = $2730 (26 x $105
each) *we get a $15 conversion bonus (discount on install fee) per line.
The City is within the State of CA, on Exhibit B, page 10 , therefore:
• If we select the Month -to -Month option, the flat rate — $715.78 per month (26 x
$27.53)
• If we select the 1 year option, the discounted flat rate — $644.28 per month (26 x CH
$24.78) * we get a $2.75 discount per line.
Staff recommends that the City select the 1 year option in both cases, saving $390 on
the installation and $71.58 per month, for a total savings over 1 year of $1249.
The total cost of this contract for 1 year wou�10.462� . $11,710 if we
went month -to -month). Going forward in future years, auld be approximately
$7,732, since the 1-time installation fee would be paid in year 1.
To the best of staff s knowledge, at this time there are no other dial -tone providers
interested in competing for the antiquated, dying pay -phone business that is being phased
out by AT&T, Verizon, etc. etc. Given this, it is staffs recommendation that the City
Manager approve this agreement under his authority on a year-to-year basis, giving the
City the flexibility to decide the fate of the payphones as technology changes in the
future.
NOTES: The annual cost of this agreement will be OFF -SET by the Revenue that the
City will receive under the separate agreements with G-5, who will replace the current
agent, Q-3, for the service commissions and coin. Randy Cobb has reviewed the revenue
history and estimates a total annual revenue of $15,428. The net result of the payphone
operations will be no cost to the City, but rather a "net" revenue of approximately
$5000 the first year, and $7500 in future years, "Installation" is the transfer of phone
lines/dial-tones that is handled only by Verizon technicians, not by City staff or by
Cleartel Communications staff.
Payphone Revenue Annual Average
Coin
800
compensation
0+
*11
Total
$6,171
$4,065
$3,797
$1,395
$15,428
0 cost
-$235 cost
0 cost
0 cost
On
FIVE
G-FIVE, LLC
4554-C Caterpillar Road
P.O. Box 493731
Reckfl% CA 96049
Td: 800-644-3483
Fax. 530-243-5390
Web: www.eiive.com
PER CALL DIAL AROUND COMPENSA VON—
GWFIVE DOES IT BETTER, AND A T LOWER COST TO YOU
G-Five not only collects your dial around compensation from the three clearinghouses, but hundreds
of other carriers each quarter. We will also (1) help you resolve disputes regarding carrier payments,
(2) maintain a data history that may assist you in obtaining further true -up compensation, and (3)
work to collect your dial around compensation from those carriers who have failed to meet their
payment obligations after the tollgate was moved. AND, you will find our prices significantly below
APCC and below PPON:
Current Rates
# ANIs Annual Fee
1-4
$18 each
5-10
$ 95 lot
11-20
$145 lot
21-49
$235 lot
50-99
$345 lot
100-149
$465 lot
150-299
$615 lot
300-599
$835 lot
ANIs in excess of 599
$.05/ANI/Month
Please note that we can also assist with your billing and collection for prior periods (up to one year),
if you have not previously submitted your ANIs for compensation.
Enclosed enrollment materials and instructions are summarized on the following page. PLEASE
SUBMIT PAYMENT WITH YOUR ENROLLMENT MATERIALS.
ydecusffi xav/20060109
Member. American Public Communications Cound., California Payphone Assaaaron,Texas Payphone Association
Dial Around Agreement Instructions
✓Letter of Notification: If you are currently collecting Dial Around through another group:
1. Fill in the name of the group collecting for you.
2. Fill in the date you are switching to G-Five (for 1 st Quarter you would use
1 /1 /xx, 2nd Quarter would be 4/1 /xx, etc.)
3. Sign and copy to your company's letterhead.
4. Send a copy to the company currently collecting your Dial Around and a copy
to G-Five along with the rest of your paperwork.
✓ Request for Taxpayer Identification Number: Must be filled out even if you have already
turned one in to G-Five in the past.
✓ Dial Around Compensation Program Agreement:
1. Payphone Service Provider = The name of your company.
2. PSP Name as it appears on LEC bill = you must print the name exactly as it
appears on the bill from your Local Exchange Carrier. If the name appears
differently on different LEC bills send a copy of each spelling.
3. Address as it appears on LEC bill = follow the same rules as in #2.
4. Make sure you sign under Payphone Service Provider on the bottom left hand
corner of the page.
5. Initial on the bottom right hand corner of the page.
6. Initial on page 6.
✓ Dial Around Compensation invoice:
1. Invoice Date = Today's date.
2. Fill in the complete address, phone, and fax information for your company.
3. Fill in the quarters you wish to have submitted. If you are requesting more than
one quarter place the most recent quarter on the first line.
4. Sign and print your name at the bottom.
✓ National Payphone Clearinghouse Dial -Around Compensation Invoice:
1. Fill out using the same instructions listed above.
2. Note: If you already have a NPC ID you will be assigned a new one.
✓ Dial Around Program ANI List:
1. List all of you ANIs. If you have more than 25 ANIs please submit them on a
disk as a text file.
2. If you have any questions about how to set up a disk please call G-Five.
✓ Powers of Attorney:
Page 1: 1.
Owner = PSP name as it appears on LEC bill.
2.
Aggregator = G-Five
3.
Manager = only fill in a manager if someone outside of your company
is managing your phone.
Page 2: 1.
Attest = The portion located on the bottom left corner of the page must
be signed by a witness 18 years or older.
2.
Owner = Full Legal Name of Owner MUST match the name you entered
on the owner line on the first page.
3.
By = Your signature.
4.
Print your name below and fill out your title and the address your bills
are sent to.
Page 3: 1.
If you have a manager have him/her fill out the Manager information.
2.
Make sure you have someone witness on the manager page if necessary.
ydalm
REQUEST FOR TAXPAYER IDENTIFICATION NUMBER
Return to: G-Five, LLC Fax #: 530-243-5390
P.O. Box 493731
Redding, Ca 96049-3731
As a business we are required to file Forms 1099. In order to properly
complete our reporting requirements, we need certain information from you.
Please complete the following and return to the address shown above.
Thank you for your assistance.
Please check one box one and provide name and Taxpayer identification Number/SS#.
[ ] Individual/Sole Proprietor
Name
Social Security Number
Federal Employer Identification Number
[ ] Corporation [ ] Partnership [ ] Estate or Trust
Full Business Name
Federal Employer Identification Number ? 57 - (0 4 (a p 7
Business Address 3 ZC0 E. --g1tq u'(
Mailing Address
Signature
Telephone Number 2 60 - 3 ZZ— o03_f 6
Fax Number Q-- 3 ZZ. --`LZqS--
Title
&
Date
Please Note:
Corporations, Partnerships and Estate of Trusts must file under their
Federal ID# and entity name.
Sole Proprietors must file under their Name and SS # - unless - they have
an EIN# assigned to them, then they must file under their name and EIN#.
2008
U-141 VL'
DIAL AROUND COMPENSATION PROGRAM AGREEMENT
Payphone Service Provider (PSP) __ a W v a-(-- Y`r i rk Sail 11
PSP Name as it appears on LEC bill
Please attach a copy of the cover page for one of your LEC telephone bills.
Address as it appears on LEC bill 000 - -7-q k 47— 0a h r t,J
City -Pram rim S. State e
Zip . 9Z Z 6 Z
Phone 3 z Z - F 3 q (- FED TAX ID or SS# 957— ( 0 d 07 S7
Fax 7 (- 0 2Z - 9.3 qS LEC(s) for which information is being submitted: 3 / _
Service: Payphone Service Provider (PSP) appoints G-Five as its exclusive agent for billing and collection, including routine, ordinary
dispute resolution and processing of "Dial -Around Compensation" ("DAC% subject to the "Terms and Conditions" attached.
Fees: Monthly processing fees for each PSP, as per Schedule A. All fees, expenses ('including cost, if any, to obtain LEC-generated per -
call tracking information), and applicable taxes (if any) shall be withheld by G-FIVE from amounts collected and otherwise forwardable
to PSP.
In the event of a change in the form of compensation from the current per -call calculation, G-FIVE reserves the right, in its sole discretion,
to substitute a new Schedule A.
Billigg Schedule: 0) PSP will provide G-FIVE with updated Data Forms (on computer diskette where possible) within 15 days following
the end of each calendar quarter. (ii) G-Five will bill Carriers within approximately 25 days following the end of each calendar quarter.
OR) G-FIVE will forward amounts collected from Carriers, with accompanying statement, to PSP within approximately 15 days of receipt.
Term of Agreement: The term of this Agreement shall commence upon G-FIVE's execution of this Agreement ("Effective Date") and,
unless sooner terminated for cause as provided in the Terms and Conditions attached, shall expire one year from the Effective Date. This
Agreement shall be automatically renewed for a period of one year on the anniversary date to its execution, and on each subsequent
anniversary date thereafter, unless either party hereto shall notify the other party hereto of its intention to not renew this Agreement, such
notice to be given not less than 30 days and no more than 90 days prior to such anniversary date.
IN WITNESS WHEREOF, and of the "Terms and Condition" and Schedule A attached hereto, the undersigned have entered into
this Agreement effective this//day of. 2012
Payphone Service Provider G-FfVE
BY J By
David H. Re , City Manager
(Print Nam)
—ArTFEST: . .
Robert J. Berg C.F.O.
CEerk - _
This ent is su 7Jec
i�to a ertns and Conditions" attached hereto, and to Schedule A attached hereto, each of which are
ncorPLIfited herein by reference. The Power of Attorney attached hereto must be signed by an officer of the PSP and a witness and
-eturned with this contract.
da=t,.sgm APPROVED BY CITY MANAGER (Initials of PSP)
I
G-FIVE
SCHEDULE "A"
DIAL AROUND COMPENSATION PROGRAM ANNUAL FEE SCHEDULE
(California)
# A1VI's ANNUAL FLAT FEES
(Payment must accompany
Enrollment Materials)
1-4
$18 each
5-10
$95 lot
11-20
$145 lot
21-49
$235 lot
50-99
$345 lot
100-149
$465 lot
150-299
$615 lot
300-599
$835 lot
ANIs in excess of 599
$.05/ANI/Month
• No set-up fee
• Non -Diskette Data Entry Fee: If total ANIs submitted are greater than 25 and ANIs are not
submitted on a diskette, there is a 15 % additional data entry fee.
• Update Fee: Larger of $20.00 or fee class upgrade for adding 15 or more ANIs to account.
• Back Quarter Fees: The Iesser of 15 % of whatever is collected, or Annual Flat Fees (divided
by quarter) .
2
TERMS AND CONDITIONS
TO DIAL AROUND COMPENSATION PROGRAM AGREEMENT
1. Definitions:
(a) "Agreement" shall mean this G-FIVE "Dial Around Compensation Program Agreement", including these Terms
and Conditions and Schedule A.
(b) "G-FIVE" shall mean G-FIVE LLC, a California Limited Liability Company with its principal place of business
at 4554 Caterpillar Road, P.O. Box 493731, Redding, Ca 96049.
(c) "DAC" shall mean (i) the "Dial -Around Compensation" to which PSP is entitled by virtue of the FCC Order
of May 8, 1992, in FCC Docket No. CC 91-35, including the revisions in the FCC Telcom Bill, Section 276, in October 1996,
and any subsequent order(s) of the FCC, or Federal or State Court Orders, as such compensation may be adjusted from time to
time hereafter, or any comparable order issued by a state governmental authority, or (ii) the "Dial -Around Compensation:
otherwise paid by Carriers.
(d) "Data Format" shall mean the forms provided by G-FIVE to PSP for the collection of the data necessary for
G-Five to carry out its obligations under this Agreement, as amended by G-FIVE from time to time, which PSP will, at the option
of G-FIVE, provide on a pre -formatted computer readable disk supplied by either G-FIVE or PSP, with the information to be
recorded on said disk and returned to G-FIVE, said disk to be included within the definition of "Data Forms."
(e) "FCC" shall mean the Federal Communications Commission.
(f) "PSP" shall mean Payphone Service Provider that is the person, corporation or other entity entering into this
agreement with G-FIVE.
(9) "ANI" or "ANIs" shall mean Automatic Number Identifiers, including any subsequent formats or variations that
may be made to the original ANI forms.
(h) "Carrier" shall mean the network company who transported the call, the company who owns the dial around
number involved, or a variation of either of these.
(i) "Taxes" shall mean all federal, state, or local taxes levied or based on any charges or services provided
hereunder, but excluding any taxes based on G-FIVE's income.
Power of Attornev/Letter of Agency:
PSP will execute a Power of Attorney (aka Letter of Agency) in the form attached hereto (which form is incorporated
by this reference as though fully set forth herein), and any other documents requested from time to time by &FIVE, for the
purpose of establishing G-FIVE's exclusive authority to bill and collect DAC on behalf of PSP.
Billing Dispute Resolution:
G-FIVE will make reasonable efforts, as G-FIVE, in its sole discretion, deems necessary, to process billing or collection
disputes that arise in the ordinary course of business in its collection of DAC from Carriers. At G-FIVE's sole discretion, PSP
will reimburse G-FIVE for long distance telephone, fax transmission, postage, messenger service, and other similar expenses
incurred by G-FIVE in connection with any such billing or collection dispute. G-FIVE agrees to provide PSP with a quarterly
report of all disputed ANIs as reported by Carriers. PSP shall promptly provide G-FIVE with all documentation that G-FIVE
believes to be necessary in order to resolve a dispute with a Carrier. G-FIVE shall not be obligated to attempt to resolve any
dispute that cannot be addressed with reasonable effort in the ordinary course of business, and shall not be obligated to instigate
legal action on behalf of PSP to resolve any dispute.
4. Limitations
(a) G-FIVE shall be under no obligation to verify any information contained on a Data Form, or to provide billing
and collection services, in the event that any Data Form currently on file with G-FIVE is incomplete or inaccurate, or in the event
the customer has purchased the data directly from the Carrier, or in the event the data has been produced or provided exclusively
by the carrier. If PSP submits information necessary for G-FIVE to carry out its obligations hereunder on the PSP's computer
readable disk, such disk shall be free of any computer viruses and PSP shall compensate G-FIVE for any loss incurred by G-FIVE
arising from any computer virus on a disk submitted by such PSP.
(b) Under no circumstances shall &FIVE be liable to PSP for any amount in excess of the DAC collected by 0-
FIVE on PSP's behalf, net of fees, expenses and taxes, if any, as described in this Agreement. G-FIVE shall not be liable to PSP
for any interest earned by.G-FIVE on DAC collected by G-FIVE and forwarded to PSP's in accordance with this Agreement.
(c) The DAC collected by G-FIVE shall be deposited in financial institutions selected by G-FIVE in its sole
discretion. G-FIVE shall segregate the DAC collected from other account(s) maintained by G-FIVE at such institution (but not
necessarily from DAC collected by G-FIVE for other PSPs). Under no circumstances shall G-Five be liable to PSP for any losses
resulting from a failure of such financial institution(s).
(d) In the event that G-FIVE is made subject to any order or directive of any court, administrative agency,
governmental body or other entity which G-FIVE reasonably believes imposes upon G-FIVE the legal obligation to forward
amounts collected on PSP's behalf to any person or entity other than PSP, then G-FIVE shall promptly notify PSP of such order
or directive and thereafter comply with such order or directive, but under no circumstances shall G-FIVE be liable to PSP for
any amounts collected by G-FIVE on PSP's behalf and forwarded to such other person or entity.
(e) G-FIVE shall maintain the confidentiality of all information provided to G-FIVE by PSP in connection with G-
Five's duties hereunder, in accordance with the usual and customary degree of care used to maintain the confidentiality of
commercial proprietary data, whether such information is contained on a Data Form or otherwise. However, nothing in this
Agreement or otherwise shaA subject G-FIVE to any liability for compliance with any order for records or information pertaining
to PSP or otherwise from any court, administrative agency, or governmental body. G-FIVE shall notify PSP in the event that
it receives any such order.
M In the event that G-FIVE inadvertently forwards to PSP an amount in excess or the amounts due to PSP under
this Agreement, PSP shall promptly refund such excess to G-FIVE. Alternatively, G-FIVE may, in its sole discretion, withhold
such excess from future payments otherwise due to PSP.
(g) G-FIVE shall not be Iiable for failure to provide the services in this Agreement if such failure is due to any
cause or condition beyond its reasonable control, including but not limited to acts of God or the public enemy, riots or civil
disorders, acts of Government in either its sovereign or contractual capacity, fires floods, epidemics, quarantine restrictions,
strikes, shortages of labor or materials, freight embargoes, unusually severe weather, breakdowns, electrical power failures,
operational failures, communication failures, unavoidable delays, failure of PSP to provide timely and accurate Data Forms in
the format supplied by G-FIVE, or other similar causes, and G-FIVE shall not have liability for losses, expenses or damages,
ordinary, special or consequential, resulting directly, or indirectly from such causes.
(h) G-FIVE shall not be liable for any claim, loss, damage or expense caused by G-FIVE's performance or failure
to perform hereunder which is not reported to G-FIVE in writing by PSP within ninety days of PSP's first opportunity to discover
such performance or failure to perform.
(i) Use of LEC-generated per-calI tracking information: PSP may have subscribed through G-Five for purchase
of LEC-generated per -call tracking information. G-Five is not an agent or reseller of this LEC-generated per -call tracking
information and does not guarantee the accuracy of this tracking information, and shall not be liable to PSP for any loss, including
consequential damages, to PSP arising out of any inaccuracy (actual or alleged) of this tracking information.
5. Termination:
(a) This Agreement shall be automatically renewed for a period of one year on the anniversary date of its execution,
and on each subsequent anniversary date thereafter, unless either party hereto shall notify the other party hereto of its intention
to not renew this Agreement, such notice to be given not less than 30 days and no more than 90 days prior to such anniversary
date.
(b) G-FIVE or PSP may terminate this Agreement for cause upon thirty days written notice to the other party,
specifying the causes for termination. For purposes of this subsection, "cause" shall include any material breach of this
Agreement, any unauthorized attempt to assign rights or obligations under this Agreement, any intentional misstatements made
on a Data Form, or any assignment for the benefit of creditors or insolvency of the other party. However, if within the thirty
day period following the giving of notice of the termination of the Agreement hereunder, the conditions giving rise to the
termination shall be cured, then the Agreement shall not be terminated and shall continue in full force and effect. The right to
terminate this Agreement for cause shall not be the exclusive remedy for breach of this Agreement, and shall and shall not be
construed as prejudicing or limiting any other rights that any party may have under this Agreement or at law or in equity.
(c) G-FIVE may terminate this agreement at any time, upon thirty days written notice, if market events, FCC
regulations, or any other Governmental rule or regulation makes this contract undesirable or unprofitable, which terms are defined
and interpreted by G-FIVE in its own and sole discretion. Termination by G-FIVE under this subsection shall be considered good
cause per the terms of this agreement.
(d) Within 64 days following a termination or expiration of this Agreement in the manner described in this Section
5, G-FIVE shall send a final statement of account to PSP and disburse all remaining amounts due and owing to PSP pursuant to
this Agreement.
6. No Guarantee:
G-Five does not guarantee or warrant the profitability of this agreement with the PSP. G-FIVE shall not be responsible
to PSP for any loss incurred as a result of this agreement.
Indemnification:
PSP shall indemnify, defend and hold harmless G-FIVE from and against any claims, demands, actions, damages,
liabilities, losses, including reasonable fees and damages, including reasonable fees and expenses of counsel payable when and
as incurred, arising in any manner out of the subject matter of this Agreement and brought or asserted by any party other than
PSP, including but not limited to any action brought by a Carrier alleging G-FiVE's excessive billing of DAC on behalf of PSP.
The indemnification obligations described in this paragraph shall survive the termination of this Agreement. Any amounts that
become due and owing to G-FIVE pursuant to the operation of this paragraph may, at the discretion of G-FIVE, be withheld from
amounts otherwise to be forwarded to PSP due pursuant to any contract PSP has with G-FIVE.
8. Miscellaneous:
(a) This Agreement may not be sold, assigned, or transferred by PSP without prior written approval of G-FIVE,
which approval shall not be unreasonably withheld or delayed, G-FIVE may freely assign any part or all of its rights and
obligations under this Agreement to any other person or entity, if such person or entity is either controlled by, or under common
control, with G-FIVE, including but not limited to any wholly -owned subsidiary of G-FIE, or any organization whose Board
of Directors or other similar governing body is composed of individuals serving as G-FIVE's Board of Directors, or if it is a
successor entity to G-FIVE.
(b) Any notices to be given hereunder shall be in writing and shall be deemed to have been duly and properly given
after confirmation of receipt of such notice, via services used in the ordinary course of business, addressed to the person signing
this Agreement on behalf of each party at the address given herein, or to such other person at such other address as a party hereto
may designate in writing to the other party hereto from time to time.
(c) This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof
and all prior or contemporaneous agreements and/or representations of the parties respecting the subject matter hereof, whether
written or oral, are merged herein and shall be of no further force or effect.
(d) This Agreement may only be amended by a writing executed by each party hereto. Upon execution of this
Agreement, the PSP has agreed to terms contained in this printed form Agreement. The PSP may not vary or alter the terms
contained in this printed form Agreement by making changes to the printed form. Any changes to this printed form Agreement
shall be effective only if the initials of any authorized officer of G-FIVE and of the PSP appear directly beside each such revision
to this printed form Agreement. No course of dealing or failure of any party to strictly enforce any term, right or condition of
5
this Agreement shall be construed as a waiver of such term, right or condition.
(e) G-Five shall have the right in its sole discretion, in addition to such other permitted remedies, to offset dial
around compensation otherwise owing to PSP pursuant to this Agreement, against any unpaid dial around program fees or damages
incurred by G-FIVE as a result of any breach or default of contract or duty owing by PSP to G-RVE under this Agreement_
(0 This agreement is deemed entered into in Orange County, California.
(g) Venue for any lawsuit brought to enforce or rescind this agreement, or arising out of a breach of this agreement,
or otherwise involving this agreement, shall be in Orange County, California.
(h) If any party brings suit to enforce or rescind this agreement, or seeking damages arising from a breach of this
agreement, the prevailing party shall be entitled to attorney fees and costs.
(i) If any portion of this Agreement is invalid or unenforceable for any reason, then the remainder of this
Agreement shall continue in full force and effect, excepting only the invalid or unenforceable portion of this Agreement.
6) This Agreement shall be construed in accordance with the laws of the State of California.
(End of Terms and Conditions)
_6'Uhi_
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ydacust7.agm
National pa�qnej,316�a�mg'house Dial=fir
ou>adCompensation .Invoice
0.
>t:uicumat,'BeATelecommtm:catiomeryic.Ynj
Invoice Date: 0 Please ✓this box if this is an Address CHANGE!
Company Name: (2[ 4-y_ di- �af- m
Company Address: 32C)z:, e-7 Take.g mr. "V
Company Address: iaer/m ;7 4- Z 62--Cr
City state Zip Code
Company Phone No. c , ) Z- Z
Company Fax No. es } Z 2 - S-r, 3 y
NPC ID: (Note new I& are only. digits)
(New owners will be assigned an ID by the NPC.)
Re nesting Compensation for the following uarter s :
(Please do not submit actual ANIs on this form. ANIs must be submitted separately.)
QTR/YR: 1 Total number of ANIs:
(Use additional spaces below if submitting multiple/old quarters.)
QT RIYR:
/ Total number of ANIs:
QTR/YR: / Total number of ANIs:
QTR/YR: / Total number of ANIs:
QTR/YR: / Total number of ANIs:
I, the undersigned, attest that all of the payphones being submitted on this invoice for dial around
compensation are all payphones as defined by the FCC in the 1996 report and order as: "any telephone made
available to the public on a fee -per -call basis, independent of any commercial transaction, for the purpose of
making telephone calls, whether the telephone is coin -operated or is activated either by calling collect or using a
calling card This definition of `payphote' excludes from the compensation mechanism phones in hotel rooms,
dormitory roams, or hospital rooms. Additionally, inmate lines were not compensable for Dial -Around
Compensation until October 7, 1997.
Signature of Payphone Owner or Payphone Owner's Representative:
za(Required)
Gt 17 (Typed or Printed Name)
(Title)
Please note: This National Pavphone Clearinghouse invoice
must accompany your quarterly submission.
mw=vc .dmuwos
DIAL AROUND COMPENSATION INVOICE
(For Carriers Not Using National Payphone Clearing House)
Invoice Date: - - ❑ Please check this box if this is an Address CHANGE!
Company Name:
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Company Address:
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%-a ksrti-R-z &7a rtyon LJ a-Y
(ZIrIA s rlil Gj Z2.LZ
Company Phone No.: 7 bo — 3 Z z — 9.396
Company Fax No.: 760 3 Z2- Y345
Requesting Compensation for the following Ouarters(s):
(Please do not submit actual ANIs on this form. ANIs must be submitted separately.)
QTR/YR: / Total number of ANIs:
(Use additional spaces below if submitting multiple/old quarters.)
QTR/YR: / Total number of ANIs:
QTR/YR: 1
Total number of ANIs:
QTR/YR: /
Total number of ANIs:
QTR/YR: 1
TotaI number of ANIs:
I, the undersigned, attest that all of the payphones being submitted under this invoice for dial around compensation are
all payphones as defined by the FCC in the 1996 report and order as: "any telephone made available to the public on
a fee per -call basis, independent of any commercial transaction, for the purpose of making telephone calls, whether the
telephone is coin -operated or is activated either by calling collect or using a calling card. This definition of payphone'
excludes from the compensation mechanism phones in hotel rooms, dormitory rooms, or hospital rooms. Additionally,
inmate lines were not compensable for Dial Around Compensation until October 7, 1997
Signature of Payphone Owner or Payphone Owner's Representative:
- - , _ eu &a- (Required)
1ectn dy_ (2066 (Typed or Printed Name)
T .PL d c vvw - Ca". (Title)
ydacust&ftm
DIAL AROUND PROGRAM ANI LIST
Please complete ANI information below. If submitting over 25 ANIs, ANIs musst be submitted on diskette.
Diskette format:
Starting Position No. of Spaces in Field
ANI 1 10
AM ANI
r )
ydatamt6-frm
ALL BLANKS MUST BE COMPLETED. THIS FORM MAY NOT BE CHANGED OR
AMENDED. FAILURE TO COMPLETE AND RETURN THIS FORM MAY DELAY
PAYMENT OF COMPENSATION.
POWER OF ATTORNEY
The undersigned navnhone services nrovider. [ _ r(y &C rI 2ilmi YPr;nas("Owner"l_
and the undersigned aggregator, 1,Axu i cl 14 ("Aggregator"), and (if
applicable) the undersigned manager, _ (Aor@ ("Manager"), hereby agree
as follows for their own benefit and for the benefit of Ciheinnati Bell Telephone Company d/b/a National
Payphone Clearinghouse ("CBT"):
1. Recitals.
1.1 Owner is a payphone services provider and is entitled under applicable law to receive
compensation for completed calls using Owner's payphones.
1.2 CBT operates a clearinghouse operation under the name "National Payphone
Clearinghouse" to facilitate the payment of compensation due to Owner and other payphone services
providers.
1.3 Aggregator is in the business of collecting and submitting data on behalf of Owner to the
National Payphone Clearinghouse ("NPC") and of receiving and distributing Owner's compensation
received through the NPC.
1.4 Manager is in the business of collecting and submitting data on behalf of Owner to
Aggregator and/or the NPC.
2. Appointment. Owner hereby appoints Aggregator and Manager, and Aggregator and Manager
each hereby accepts such appointment, as Owner's true and lawful attorney -in -fact with full power and
authority in the place and stead of Owner or in Owner's name to take any and all action and to execute
any and all documents which may be necessary or desirable in connection with Owner's receipt of
compensation through the NPC and, without limiting the generality of the foregoing, Owner hereby gives
Aggregator and Manager the power and right, on behalf of Owner, to do the following:
2.1 to submit data, records and other information of Owner demonstrating Owner's eligibility
for compensation through the NPC;
2.2 to receive funds due to Owner that are paid through the NPC, and to receive related
reports and documentation from the NPC;
2.3 to settle or compromise any disputes relating to compensation due to Owner paid through
the NPC; and
2.4 generally to do all acts and things which Aggregator or Manager deems necessary to
effect the intent of this Power of Attorney, all as fully and effectively as Owner might do.
3 . A rra Ments. Owner, Aggregator and Manager acknowledge and agree as follows:
3.1. CBT will incur no HaWly to Oww, Aggregator or Manager (a) as a result of the failure
of Aggregator, Manager or owner to ti mM arxwrate and timoly data to the NPQ or (b) by acting upon
any data, request fur compensation, notice, or other communication from Aggregator, Managw'or Owner
that appears on its face to be in order or that CBT reasonably beHeves to be gemdne.
3.2 CBT will not be liable for any payments made by it in good faith based on the. data
submitted by Aggregator, Manager or Owner, and if any such payment is subsequently determined to
have been made in error, the sole rocoume of any person or entity to whom payment was due, but not
made, will be to recover from the recipient of such payment.
14. Termination of Power of Attorney. This Power of Attorney will remain m effect until CBT
receives written notice of termination from Owner. Aggregator or Manager. Any termination with respect
to Manager will not affect this Power of Attorney with respect to Aggregator. Any termination with
respect to Aggregator will not affect this Powers of Attorney with respect to Manager. Termination
notices must be sent to the fallowing address:
National Payphone Cleatinglrouse
221 East Fourth Street, I21-SW
Cincinnati, Ohio 45202
Attrt: Operations Manager
S. Governing Law. This Power of Attorney will be governed by Ohio taw.
ATTEST:
Date: -- _ - 2008
2
OWNER
fus x�asaron� '
Print Name: David Rd&jg& --+
Title:. City iKanager
Owner's Address:
3200 E. Taliguita Canyon Way
Palm Springs, CA 92263
APPROVED BY CITY MANA�-'-R
5
ATTEST:
Print Name: Ronald McPherson
Title: CEO
Date: , 2008
ATTEST:
Print Name:
Title:
Date: 52008
AGGREGATOR:
G-Five, LLC
FULL LFOAL N&-A Of M0M0AWW
9 l ... =- ` �4
'1tr �� •,.64 �� J.i' ' R.�
By,
Print Name: Robert J. Berg
Title: CFO
Aggregator's Address:
P.O. Box 493731
Redding, 6 4
MANAGER:
FULL LWAL NMi E OF MANAOFR
By:
Print Name:
Manager's Address:
NOTE: ALL CONFIDENTL4L/PROPRIETARY INFORMATION RECEIVED BY THE
NPC BECOMES THE PROPERTY OF THE NPC AND IS NONRETURNABLE!
THIS FORM IS A LEGAL DOCUMENT THAT MAY NOT BE CHANGED OR AMENDEDI I I
0419269.03
3
G-FIVE OPERATOR SERVICES AFFILIATE AGREEMENT
(Pstovmim; CiJmm TxuwoNNECr,1Nc.)
This G-Five Operator Services Affiliate Agreement ("Agreement") for operator service calls, and other services is hereb}
entered into on this day of 20Cf("Start Date") by and between G-Five LLC, a California limited habilit}
company ("G-5"), and &8geAldr Customer"), based on the following, including the Terms anc
Conditions set forth on page o:
Compensation Schedule
G-FjW LLC
By
Robert J. Berg, Authorized Agent
APPRO ra
By 6
City 461tDkney
Date
ATTEST:
City of Palm Springs, California
By
City Clerk
APPROVED By CITY MAN'ACER
Total Number of ANIs Being initially
Submitted with this Agreement
Z: iafn.doG206211 I7
(See Exhibit 1)
CUSTOMM
Byz
(Signature)
_David H_ Ready,, City Manager
(Printed Name and Title)
2- / / O
(Date of Signature)
OX of lz*& M ,S l fll
(Legal B siness Name)
-T
3zon c-, U3-�(
(P.O. Box or Street Address)
cA �ZZ.(-z
(City, State, Zip)
7�6 U- 3zz-83� b
(Business Telephone Number)
760 -3z7-- 73-{r
(Business Fax Number)
_Anc(V.e�10,a[E!%a/M StLJ —era, .,j
(Email Address) 01 -7-
EXHIBIT 1--NATIONAL G-FIVE/CTI 0+ COMMISSION SCHEDULE
Interstate
Interstate
Intrastate
Intrastate
IntraLATA
Intral-ATA
Commission
PIF
Commission
Max
Commission
Max
Options
PIF
PIF
Alabama
55
$3.00/$4.00
55
55
Arizona
55
$3.00/$4.00
55
$1.50
55
$1.50
Arkansas
55
$3.00/$4.00
55
55
California
63
$4.00
63
$1.00
63
$1.00
Colorado
55
$3.00/$4.00
55
55
Connecticut
55
$3.00/$4.00
55
$0.50
55
$0.50
Delaware
55
$3.00/$4.00
55
$1.00
55
$1.00
Florida
55
$3.00/$4.00
55
55
Georgia
55
$3.00/$4.00
55
55
Hawaii
55
$3.00/$4.00
55
55
Idaho
55
$3.00/$4.00
55
$3.00
55
$3.00
Illinois
55
$3.00/$4.00
55
55
Indiana
55
$3.00/$4.00
55
55
Iowa
55
$3.00/$4.00
55
55
Kansas
55
$3.00/$4.00
55
$3.00
55
$3.00
Kentucky
55
$3.00/$4.00
55
55
Louisiana
55
$3.00/$4.00
55
55
Maine
55
$3.00/$4.00
55
$3.00
55
$3.00
Maryland
55
$3.00/$4.00
55
$0.25
55
$0.25
Massachusetts
55
$3.00/$4.00
55
55
Michigan
55
$3.00/$4.00
55
55
Minnesota
55
$3.00/$4.00
55
55
Mississippi
55
$3.00/$4.00
55
55
Missouri
55
$3.00/$4.00
55
55
Montana
55
$3.00/$4.00
55
55
Nebraska
55
$3.00/$4.00
55
$2.00
55
$2.00
Nevada
55
$3.00/$4.00
55
55
New Hampshire 55
$3.00/$4.00
55
$3.00
55
$3.00
New Jersey
55
$3.00/$4.00
55
55
New Mexico
55
$3.00/$4.00
55
$2.00
55
$2.00
New York
55
$3.00/$4.00
55
$1.50
55
$1.50
North Carolina
55
$3.00/$4.00
55
55
North Dakota
55
$3.00/$4.00
55
$1.00
55
$1.00
Ohio
55
$3.00/$4.00
55
55
Oklahoma
55
$3.00/$4.00
55
$1.00
55
$1.00
Oregon
55
$3.00/$4.00
55
$3.50
55
$3.50
Pennsylvania
55
$3.00/$4.00
55
$1.00
55
$1.00
Rhode Island
55
$3.00/$4.00
55
$0.45
55
$0.45
South Carolina
55
$3.00/$4.00
55
$1.00
55
$1.00
South Dakota
55
$3.00/$4.00
55
$2.00
55
$2.00
Tennessee
55
$3.00/$4.00
55
55
Texas
55
$3.00/$4.00
55
$1.00
55
$1.00
Utah
55
$3.00/$4.00
55
$3.00
55
$3.00
Vermont
55
$3.00/$4.00
55
55
Virginia
55
$3.00/$4.00
55
$1.00
55
$1.00
Washington
55
$3.00/$4.00
55
$3.00
55
$3.00
West Virginia
55
$3.00/$4.00
55
55
Wisconsin
55 ,
$3.00/$4.00
55
$0.75
55
$0.75
Wyoming
55
$3.00/$4.00
55
$3.00
55
$3.00
Washington DC
55
$3.00/$4.00
55
55
International Commission Rate for All States: 23%, PIF $3.00
State: C14 (Please submit separate sheet for each State)
Enter Interstate Per -Call PIF Amount Here:
Enter Intrastate Per -Call PIF Amount Here:
$_
zg5kk=ff/2Da30s06
Enter IntralATA Per -Call PIF Amount Here:
$_
Customer Initials:
EXHIBIT 2
FOR
DIRECTORY ASSISTANCE PRODUCT
Directions: Please review option for the Directory Assistance product. Then check if you wish to use this directory
assistance for your payphones.
qO
(Check) Yes, I will use the DIRECTORY ASSISTANCE/411 Product for Domestic Calls
(Check) Yes, I understand I will need to program my payphone to route calls to the following
DIRECTORY ASSISTANCE1411 Toll Fr u access Number:
Fee Schedule
Toll Free Access Number: 866-216-1043
(Customer must participate in one of G-Five's 0+/4- Commission Plans to receive DA
at the following rates.)
$.36 per Domestic Call
Note: for Non Mainland International Calls, the Operator will refer callers to the AT&T toll free number.
=iex2f20046713
Customer Initials:
i
LETTER OF AGENCY
I, C //
I OFAA</iy S�°�/NCj' S (Company Name) hereby authorize G-FIVE LLC to act
on my behalf for my payphone(s) (see List of ANIs attached) with regard to services provided under the
G-Five/CTI Program. This Letter of Agency (LOA) supercedes any previous LOA, which may have been
signed related to the same or similar services. This LOA shall remain in effect until written notice
provided to G-FIVE LLC.
(Check which Services Apply)
N Operator Services 0+ and 0-
❑ Directory Assistance Services
G-FIVE, LLC
By
Robert J. Berg, Authorized Agent
yailoa
CUSTOMER
_Og.,1d 14. O?eMuk�
(Print Name and Title of Authorized Individual)
-ZA (A9
(Date of signature)
t�h�tl_ as� �a �w.Spll i1�j�'
(Legal Business Name)
(DBA, if different from above)
3Zco Tcjf tk9, 6a r, (-Jay
(P.O. Box or Street Address)
Pglrn,� <<►�s�. quiz
(city, State, zip)
7ba- ,3Z2-,F5gC
(Business Telephone Number)
7F0-322-
(Business Fax Number)
�t<iKdy . 4" (-2 4 (ter s r�.c5,, —C� .J ® v
(E,Mail Address)
REQUEST FOR TAXPAYER IDENTIFICATION NUMBER
Return to; G-Five, LLC
P.O. Box 493731
Redding, Ca 96049
As a business we are required to file Forms 1099. In order to properly
complete our reporting requirements, we need certain information from
you. Please complete the following and return to the address shown
above. Thank you for your assistance.
Please check one box only and provide name and Taxpayer Identification Number/Ss#.
[ ] Individual/Sole Proprietor
Name
Social Security Number
Federal Employer Identification Number
[ ] Corporation [ ] Partnership [ ] Estate or Trust
Full Business Name
Federal Employer Identification Number 7 .5- - —�, 0 O 6 7 .s 7
A�.1M r l n gs
v-
S
Business Address Z`� E %z�tBir r
Mailing Address
Signature Title
Telephone Number —7�0 .3 7-Z- Date
Fax Number 760- .3ZZ- 83ys
Please Note:
Corporations, Partnerships and Estate of Trusts must file under their
Federal ID# and entity name.
Sole Proprietors must file under their Name and SS # - unless - they
have an EIN# assigned to them, then they must file under their name and
EIN#.
2001
G-FIVE "COLLECT CALLS DIAL *11 sM" AFFILIATE AGREEMENT
(PROVIDER: CUSTOM 1V1.ECONNECr, INC.)
This G-Five "Collect Calls Dial *I I"' Affiliate Agreement ("Agreement") for the completion of *I I Collect calls, m
hereinafter described, and other services, is hereby entered into on this t-/11 day o 2tp�("Start Date',) by anc
between G-Five LLC, a California limited liability company ("G-5',_and G�/TY d�r�AG S�/tiM�S ("Customer"),
based on the following, including the Terns and Conditions set forth on page two and the Compensation Schedule set forth on Exhibit
GFIVE, LLC
By
Robert J. Berg, Authorized Agent
P.O. Box 493731
Redding, CA 96049
Date /• >-6 • d!
zsmragm . doc1200303 I 9
ATTEST:
City Palm Springs, California
City Clerk
CUSTOMER
By
I
David H. Ready, City Manager
(Print Name and Title of Authorized Individual)
f Lod -
(Date of Signature)
(Legal Busmess Name)
(DBA, if different from above)
TaA U�r� &Lyon L-jay
(P.O. B x or Street Address) r
a (rvr
(City, State, Zip)
(Business Telephone Number)
7�d-32.Z -�3
(Bus ines Fax Number)
Kd _
(Business E- ail Address)
APPROVED BY CITY MANAGER
EXHIBIT 1
NATIONAL COMPENSATION RATES for *XI
SEE ATTACHED EXHIBIT 1 STATE DISPLAY FOR THE *11 PLAN OPTIONS AND INTRASTATE RATES AVAILABLE FOR YOUR
STATE. THEN SELECT FROM PLAN A, PLAN B-I, PLAN C (CALIFORNIA ONLY), OR PLAN C-MODIFIED. RATES SUBJECT
TO CHANGE WrMOUT NOTICE.
PLAN A
I0 % Debt
COMMISSION RATE
INTRASTATE CALLS 55 %-See Attached State Display for Additional Information
INTERSTATE CALLS 53 %, including flat commissionable PIF, not pass thru, of $3.50
INTERNATIONAL 23%, including flat commissionable PIF, not pass thru, of $3.00
CANADIAN 10 %
❑ Yes, I wish to select PLAN A. CUSTOMER INITIALS
G-FIVE INITIALS
PLAN A — PROGRAM: PAYPHONES TO DEDICATED ACCESS NUMBER: 866-206.4604
PLAN B-1
8 % Debt
COMMISSION RATE
INTRASTATE CALLS 50%-See Attached State Display for Additional Information
INTERSTATE CALLS 53 %, including flat commissionable PIF, not pass thru, of $3.50.
INTERNATIONAL 23%, including flat commissionable PIF, not pass thru, of $3.00.
CANADIAN 10%
❑ Yes, I wish to select PLAN B-1. CUSTOMER INITIALS
G-FIVE INITIALS
PLAN 13-1 — PROGRAM PAYPHONES TO DEDICATED ACCESS NUMBER: 866-2064605
PLAN C AVAILABLE FOR CALIFORNIA PAYPHONES ONLY
8% Debt
COMMISSION RATE
INTRASTATE CALLS -California 60%, including PIF pass thru of $3.00; Commissionable non subscriber fee of $2.00
INTERSTATE CALLS 60%, including PIF pass thru of $3.50; Commissionable non subscriber fee of $3.50
INTERNATIONAL 23 %, including flat commissionable PIF, not pass thru, of $3.00.
CANADIAN 10 %
® 'Yes, I wish to select PLAN C. CUSTOMER INITIALS_
G-FIVE INITIALS
PLAN C — PROGRAM PAYPHONES TO DEDICATED ACCESS NUMBER: 866-206-4606
PLAN C-MODIFIED
8 % Debt
COMMISSION RATE
INTRASTATE CALLS 60%- See Attached State Display for Additional Information
INTERSTATE CALLS 60%, including PIF pass thru of $3.50 and $3.50 Commissionable NSF.
INTERNATIONAL 23 %, including flat commissionable PIF, not pass thru, of $3.00.
CANADIAN 10 %
❑ Yes, I wish to select PLAN C-MODIFIED. CUSTOMER INITIALS
G-FIVE INITIALS
PLAN C — MODIFIED -PROGRAM PAYPHONES TO DEDICATED ACCESS NUMBER: 866-2064606
. —P — i rmnon) �n
EYMIT 2
FACEPLATE and STICKER ORDER FORM AND LICENSE AGREEMENT
(COLLECT CALLS DIAL *I I sm)
Indicate Phone Type
Company
I & Number of each
- jL. //�� aJ ri .,
Contact C(rt C ✓ Pmtel
Address _ ZAta 4-0-kf U' C+7- 04KyCW. 1ntellicalI
City, State & Zip �f /li? 64 2Z1 Z Ernest
Phone ZZ �3 6 Elcotel
Fax '76n-
Email Q tgdj� . o
�-
GTE Style Housing: Quand License Fee Total Fee
• Stainless Steel Faceplate $13_00
• Chrome Faceplate SI3.00
• Self Adhesive Stickers (metal) ] I NO CHARGE
Total Faceplates ordered:
$13.00
Total Stickers ordered:
NO CHARGE
I . This order form must be submitted to G5 in its Redding California office.
2. CTI will send the faceplates directly to Customer, along with:
a. CTI Acknowledgment of Installation Form
b. Fully executed copy of this order form Iicense agreement
3. Customer must install faceplates on its pay telephones and return the CT! Acknowledgment of
Installation Form indicating it has done so within 30 days of receipt to G5 in its Redding California
office. Failure to do so is a breach of this contract.
4. Customer has read and agrees to the terms and conditions set forth on the second page hereto.
CUSTOMER
Signature
Date
zfacepla-doc/20030306
G-5
Signature
Date
CTI
Signature
Date