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HomeMy WebLinkAbout5697ASSIGNMENT OF CONTRACT THIS ASSIGNMENT OF CONTRACT is entered into on Ig ,,,, 2020 by and between MASCO PETROLEUM, INC., hereinafter referred to as "Assignor," and PETROCARD, INC. hereinafter referred to as "Assignee"; WHEREAS, heretofore the Assignor entered into a Contract with THE CITY OF BREMERTON, a copy of which Contract, together with any amendments, extensions, and/or renewals thereto, is attached and incorporated herein by this reference; and WHEREAS, it is the desire of the parties hereto that Assignor shall assign to Assignee all of their right, title, and interest to said Contract; NOW, THEREFORE, in consideration of the mutual benefits to be derived from this assignment, and other good and valuable consideration, the sufficiency of which is acknowledged, it is hereby agreed by and between the parties as follows: 1. Assignment. Assignor does herewith assign to Assignee all its right, title, and interest in and to that certain Contract above described for the balance of the unexpired term of said Contract, subject to the performance of the covenants, conditions, and stipulations of said Contract. All other terms and conditions of the Contract shall remain the same- 2. Effective Date. This Assignment is effective as of March 1, 2020. 3. Indemnification by Assignor. Assignor hereby agrees to indemnify and hold harmless Assignee from all claims, actions, suits, costs, losses, charges, damages and expenses arising out of, or in relation to the Contract with respect to any matter occurring before the date of this Assignment. 4. Indemnification by Assignee. Assignee hereby agrees to indemnify and hold harmless Assignor from all claims, actions, suits, costs, losses, charges, damages and expenses arising out of, or in relation to the Contract with respect to any matter occurring on or after the date of this Assignment. 5. Execution in Counterparts. This Assignment may be executed in counterparts, each of which shall be an original with the same effect as if the signatures thereto and hereto were upon the same instrument. 6- Governing Law. This Assignment shall be considered to have been made in and shall be interpreted under the laws of the State of Washington. IN WITNESS WHEREOF, the parties have executed this instrument effective as of the date set forth in Paragraph 2 above. ASSIGNOR: Masco Petroleum, Inc. By ?Eies Mason, President STATE OF WASHINGTON ) SS GRAYS HARBOR COUNTY ASSIGNEE: PetroCard, Inc. Laura Yellig, President On this day personally appeared before me, LAURA YELLIG, to me known to be the president of the corporation that executed the within and foregoing instrument, and acknowledged said instrument to be the free and voluntary act and deed of said corporation, for the uses and purposes therein mentioned, and on oath stated that she was authorized to execute said instrument. GIVEN under my hand and official seal on rsrm&am... mars.. a.aaaa.mm.a.JULIE E. MACMILLAN aa �;Ado NOTARY PUBLIC NO'ARY PUBLIC in an or St to of g STATE OF WASHINGTON � Washington residing atf���� My Commission Expires i4ov. 3, 2021 a �------o-.---.a..a---s...----- CONSENT OF CITY OF BREMERTON THE UNDERSIGNED DOES HEREBY CONSENT TO THE ABOVE AND FOREGOING ASSIGNMENT OF CONTRACT. DATED: F-e, 6 to, 2,P z,2 2 CITY OF BREMERTON Q-Wor Name I Its .• BREMERTON YMt tktY Oi Rlibf :fka 0PrOt!glut r Mr. Bill Tometich Masco Petroleum P.O. Box 43 Aberdeen, WA 98520 January 17, 2020 Re: Renewal Extension Notice Dear Mr. Tometich, Pursuant to the terms of the"Purchase Agreement Between the City of Bremerton and Masco Petroleum"and the"term extension"thereto,the City of Bremerton hereby exercises its option to extend said agreement for the third one-year renewal period. As the current extension period of the Agreement expires on FebriAao29, 2020,the one-year renewal will be in place beginning March 1, 2020 and expiring on February 28, 2021. Please provide an updated Certificate of Insurance. Please print 2 copies, sign and return both copies, one copy will be returned to you for your records. Please confirm receipt of this notice via email with the Contracts Administrator at: Melinda.monroe(a ci.bremerton.wa.us (360)473-5306. Sincerely, Milenka Hawkins-Bates c.7.7;=- 7 Operations Manager Thomas Knuckey, Public Works Director Greg eeler, Mayor ' J � Tom ,* Masco 'etroleum cc: File Melinda Monroe,Contracts Administrator Finance j 345 6th Street Ste 100,Bremerton,WA 98337*Phone(360)473-5306*Fax(360)473-5200 Working for and with our residents to establish Bremerton as Puget Sound's most beautiful and livable waterfront city! Client#: 94295 MASCPETR A CORDTM CERTIFICATE. OF LIABILITY INSURANCE DATE(MM/DDIYYYY)1/27/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kellie Hogan Propel Insurance PHONE 800 499-0933 FAx 866 577-1326 (A/C,No,Ext): (A/C,No): Tacoma Commercial Insurance ADDRESS: kellie.hogan@propelinsurance.com 1201 Pacific Ave,Suite 1000 INSURER(S)AFFORDING COVERAGE NAIC# Tacoma,WA 98402INSURERA:HDI Global Insurance Company 41343 INSURED INSURER B: Masco Petroleum Inc 0 tL G . PO Box 43 INSURER C Aberdeen,WA 98520 SN D INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP WLIMITS LTR INSR VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY X X EGGCD000024919 02/28/2019 02/28/2020 EACH OCCURRENCE $2,000,000_ /// DAMAGE TO RENTED CLAIMS-MADE X OCCUR/ PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- X POLICY ECT X LOC PRODUCTS-COMP/OP AGG_$2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X X EAGCD000024919 02/28/2019 02/28/2020 (EOa ace deg SINGLE LIMIT _$2,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS X AUTOS ONLY X NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY (Per accident) A UMBRELLA LIAB X OCCUR EXAGD000024919 02/28/2019102/28/2020 EACH OCCURRENCE $3,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EGGCD000024919 02/28/2019 02/28/2020 E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) WA STOP GAP E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 2TIFICATE HOLDER CANCELLATION Cityof Bremerton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 345 6th St Ste 600 ACCORDANCE WITH THE POLICY PROVISIONS. Bremerton,WA 98337-1873 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. '.016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD 1752/M3551431 CRS01 • • COMMERCIAL GENERAL LIABILITY EN AI PNC 04 11 THIS ENDORSEMENT CHANGES THE POLICY-PLEASE READ IT CAREFULLY ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person(s)or Organization(s) Where required by written Contract This insurance shall be excess over any other insurance naming the scheduled additional insured as an insured on a primary, excess, contingent,or on any other basis unless: 1. A written contract or agreement specifically requires that this insurance be primary and noncontributory. 2. The written contract is signed and executed by the named insured and additional insured prior to any "bodily injury", "property damage" or "personal and advertising injury". 3. This policy does not apply for defense or indemnity of the additional insured if state or federal law does not permit indemnification of the additional insured by the Named Insured for the claim of a third party. 4. This insurance does not apply to the additional insured's liability to indemnify, defend or hold harmless a third party. EN AI PNC 04 11 Page 1 of 1 COMMERCIAL AUTO EN Al 50 57 09 11 THIS ENDORSEMENT CHANGES THE POLCIY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. WHO IS AN INSURED, under SECTION II— LIABILITY COVERAGE, A. COVERAGE, is amended to include as an "insured", any person or organization you are required to add as an additional insured on this policy under a written contract, agreement or permit which must be: a. Currently in effect or becoming effective during the term of the policy; and b. Executed prior to an "accident"for which coverage provided to an additional insured under this endorsement applies. The insurance provided to this additional insured is limited as follows: • 1. That person or organization is an additional insured only with respect to liability arising out of your operations performed for that additional insured as specified in the written contract, agreement or permit. 2. The limits of insurance applicable to the additional insured are those in written contract, agreement, permit or in the Declarations for this policy, whichever are less. These limits of insurance are inclusive of and not in addition to the Limit of Insurance for Liability Coverage shown in the Declarations. 3. Coverage is not provided for"bodily injury" or"property damage" arising out of the sole negligence of the additional insured. Any coverage provided hereunder will be excess over and other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary. When this insurance is in excess, we will have no duty to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that"suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insurer's rights against all those other insurers. All other terms and conditions of this policy remain unchanged. EN Al 50 57 09 11 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc. POLICY NUMBER: EAGCD00002491 7 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MASCO PETROLEUM, INC. Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): AS REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: EGGCD000024917 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: AS REQUIRED BY WRITTEN CONRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 0 POLICY NUMBER: EGGCD000024917 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations AS REQUIRED BY WRITTEN CONTRACT, , , WA Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does nota I to "bodilyinjury" or damage" or "personal and advertising injury" apply caused, in whole or in part, by: "property damage"occurring after: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or • Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: EGGCD000024917 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations AS REQUIRED BY WRITTEN CONTRACT „ WA Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section HI—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage"caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 Client#:94295 MASCPETR YYYY) (MM/DD//2020 ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1/27DATE(MM/DD/ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kellie Hogan Propel Insurance PHONE 800 499-0933 FAX (A/C,No,EM): (A/C,No): 866 577-1326 Tacoma Commercial Insurance ADDRESS: kellie.hogan©propelinsurance.com 1201 Pacific Ave,Suite 1000 INSURER(S)AFFORDING COVERAGE NAIC# Tacoma,WA 98402 HDI Global Insurance Compan 41343 INSURER A: y INSURED INSURER B: Masco Petroleum Inc 0K/41,(i) c) ,L�, PO Box 43 � 0 INSURERC: INSURER D D. Aberdeen,WA 98520 S) ® INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS I CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER (MMIDDY/YYYY) (EFF MMIDDY/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X EGGCD000024919 02/28/2019 02/28/2020 EACH OCCURRENCE $2,000,000;'" CLAIMS-MADE X OCCUR y// PREMISES(EaEoccccur ence) $100,000 VMED EXP(Any one person) $ PERSONAL&ADV INJURY $2,000,000 _ GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY ECT X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X X EAGCD000024919 02/28/2019 02/28/2020(Ee aB deD SINGLE LIMIT 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWUTNEDOSONLY AUTOS SCHEDULED BODILY INJURY(Per accident) $ A — HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY AUTOS ONLY (Per accident) $ A UMBRELLA LIAB X OCCUR EXAGD000024919 02/28/2019 02/28/2020 EACH OCCURRENCE $3,000,000 _ X EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EGGCD000024919 02/28/2019 02/28/2020 E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) WA STOP GAP E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Cityof Bremerton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 345 6th St Ste 600 ACCORDANCE WITH THE POLICY PROVISIONS. Bremerton,WA 98337-1873 AUTHORIZED REPRESENTATIVE I fir .ti.,2.4._ ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S3989752/M3551431 CRS01 COMMERCIAL GENERAL LIABILITY EN AI PNC 04 11 THIS ENDORSEMENT CHANGES THE POLICY-PLEASE READ IT CAREFULLY ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person(s)or Organization(s) Where required by written Contract • This insurance shall be excess over any other insurance naming the scheduled additional insured as an insured on a primary, excess, contingent,or on any other basis unless: 1. A written contract or agreement specifically requires that this insurance be primary and noncontributory. 2. The written contract is signed and executed by the named insured and additional insured prior to any "bodily injury", "property damage" or "personal and advertising injury". 3. This policy does not apply for defense or indemnity of the additional insured if state or federal law does not permit indemnification of the additional insured by the Named Insured for the claim of a third party. 4. This insurance does not apply to the additional insured's liability to indemnify, defend or hold harmless a third party. EN AI PNC 04 11 Page 1 of 1 • COMMERCIAL AUTO EN Al 50 57 09 11 THIS ENDORSEMENT CHANGES THE POLCIY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. WHO IS AN INSURED, under SECTION II— LIABILITY COVERAGE, A. COVERAGE, is amended to include as an "insured", any person or organization you are required to add as an additional insured on this policy under a written contract, agreement or permit which must be: a. Currently in effect or becoming effective during the term of the policy; and b. Executed prior to an "accident"for which coverage provided to an additional insured under this endorsement applies. The insurance provided to this additional insured is limited as follows: 1. That person or organization is an additional insured only with respect to liability arising out of your operations performed for that additional insured as specified in the written contract, agreement or permit. 2. The limits of insurance applicable to the additional insured are those in written contract, agreement, permit or in the Declarations for this policy, whichever are less. These limits of insurance are inclusive of and not in addition to the Limit of Insurance for Liability Coverage shown in the Declarations. 3. Coverage is not provided for"bodily injury" or"property damage" arising out of the sole negligence of the additional insured. Any coverage provided hereunder will be excess over and other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary. When this insurance is in excess, we will have no duty to defend the additional insured against any"suit" if any other insurer has a duty to defend the additional insured against that"suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insurer's rights against all those other insurers. All other terms and conditions of this policy remain unchanged. EN Al 50 57 09 11 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc. • COMMERCIAL GENERAL LIABILITY EN AI PNC 04 11 THIS ENDORSEMENT CHANGES THE POLICY-PLEASE READ IT CAREFULLY ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person(s)or Organization(s) Where required by written Contract This insurance shall be excess over any other insurance naming the scheduled additional insured as an insured on a primary, excess, contingent,or on any other basis unless: 1. A written contract or agreement specifically requires that this insurance be primary and noncontributory. 2. The written contract is signed and executed by the named insured and additional insured prior to any "bodily injury", "property damage" or"personal and advertising injury". 3. This policy does not apply for defense or indemnity of the additional insured if state or federal law does not permit indemnification of the additional insured by the Named Insured for the claim of a third party. 4. This insurance does not apply to the additional insured's liability to indemnify, defend or hold harmless a third party. EN AI PNC 04 11 Page 1 of 1 • COMMERCIAL AUTO EN Al 50 57 09 11 THIS ENDORSEMENT CHANGES THE POLCIY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. WHO IS AN INSURED, under SECTION II— LIABILITY COVERAGE, A. COVERAGE, is amended to include as an "insured", any person or organization you are required to add as an additional insured on this policy under a written contract, agreement or permit which must be: a. Currently in effect or becoming effective during the term of the policy; and b. Executed prior to an "accident" for which coverage provided to an additional insured under this endorsement applies. The insurance provided to this additional insured is limited as follows: • 1. That person or organization is an additional insured only with respect to liability arising out of your operations performed for that additional insured as specified in the written contract, agreement or permit. 2. The limits of insurance applicable to the additional insured are those in written contract, agreement, permit or in the Declarations for this policy, whichever are less. These limits of insurance are inclusive of and not in addition to the Limit of Insurance for Liability Coverage shown in the Declarations. 3. Coverage is not provided for"bodily injury" or"property damage" arising out of the sole negligence of the additional insured. Any coverage provided hereunder will be excess over and other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary. When this insurance is in excess, we will have no duty to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that"suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insurer's rights against all those other insurers. All other terms and conditions of this policy remain unchanged. EN Al 50 57 09 11 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc. POLICY NUMBER: EAGCD000024917 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MASCO PETROLEUM, INC. Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): AS REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: EGGCD000024917 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: AS REQUIRED BY WRITTEN CONRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 0 • POLICY NUMBER: EGGCD000024917 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations AS REQUIRED BY WRITTEN CONTRACT, , , WA Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or • • Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 POLICY NUMBER: EGGCD000024917 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations AS REQUIRED BY WRITTEN CONTRACT „ WA Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage caused, in whole or in part, by required by a contract or agreement, the most we your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY EN AI PNC 04 11 THIS ENDORSEMENT CHANGES THE POLICY-PLEASE READ IT CAREFULLY ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person(s)or Organization(s) Where required by written Contract This insurance shall be excess over any other insurance naming the scheduled additional insured as an insured on a primary, excess, contingent,or on any other basis unless: 1. A written contract or agreement specifically requires that this insurance be primary and noncontributory. 2. The written contract is signed and executed by the named insured and additional insured prior to any "bodily injury", "property damage" or "personal and advertising injury". 3. This policy does not apply for defense or indemnity of the additional insured if state or federal law does not permit indemnification of the additional insured by the Named Insured for the claim of a third party. 4. This insurance does not apply to the additional insured's liability to indemnify, defend or hold harmless a third party. EN AI PNC 04 11 Page 1 of 1 COMMERCIAL AUTO EN Al 50 57 09 11 THIS ENDORSEMENT CHANGES THE POLCIY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. WHO IS AN INSURED, under SECTION II— LIABILITY COVERAGE, A. COVERAGE, is amended to include as an "insured", any person or organization you are required to add as an additional insured on this policy under a written contract, agreement or permit which must be: a. Currently in effect or becoming effective during the term of the policy; and b. Executed prior to an "accident"for which coverage provided to an additional insured under this endorsement applies. The insurance provided to this additional insured is limited as follows: 1. That person or organization is an additional insured only with respect to liability arising out of your operations performed for that additional insured as specified in the written contract, agreement or permit. 2. The limits of insurance applicable to the additional insured are those in written contract, agreement, permit or in the Declarations for this policy, whichever are less. These limits of insurance are inclusive of and not in addition to the Limit of Insurance for Liability Coverage shown in the Declarations. 3. Coverage is not provided for"bodily injury" or"property damage" arising out of the sole negligence of the additional insured. Any coverage provided hereunder will be excess over and other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary. When this insurance is in excess, we will have no duty to defend the additional insured against any"suit" if any other insurer has a duty to defend the additional insured against that"suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insurer's rights against all those other insurers. All other terms and conditions of this policy remain unchanged. EN Al 50 57 09 11 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc. SUBJECT: Award of Fuel Bid to Masco Petroleum, Aberdeen WA AGENDA BILL CITY OF BREMERTON CITY COUNCIL Study Session Date: COUNCIL MEETING Date: Department: Presenter: Phone: 2/11/15 02/19/15 PWBU Jim Orton 473-5359 Ij SUMMARY: The City of Bremerton's fuel contract with Masco Petroleum expired in 2014. Requests for Proposals (RFP) were sent to three separate fuel companies. Proposals were opened January 20, 2015. After review staff recommends that the contract be awarded to Masco Petroleum based on Oil Petroleum Information Service (OPTS) daily pricing and a margin of 5 cents per gallon. This is a three year agreement with the ability to extend the agreement for an additional three, one-year terms. ATTACHMENTS: 1) Purchase. Agreement; 2) Exhibit A; 3) Proposal sheets with costs and margins. FISCAL IMPACTS (Include Budgeted Amount): N/A STUDY SESSION AGENDA: ® No Presentation ❑ Full Presentation STUDY SESSION ACTION: 0 Consent Agenda ❑ General Business ❑ Public Hearing RECOMMENDED MOTION: Move to approve the Purchase Agreement for fuel and fuel products by Masco Petroleum of Aberdeen, WA and authorize the Mayor to finalize and execute the agreement with substantially the same terms and conditions as presented. COUNCIL ACTION: [f Approve Form Updated 11/02/12 ❑ Deny ❑ Table ❑ Continue ❑ No Action 0 06/27/2017 10:10 AM 14154847068 From RylaFAX Enterprise ->13604735360 Tue 27 Jun 2017 08:23:18 AM PDT PURCHASE AGREEMENT 02 Page 3 of 8 T'IHS AGREEMENT, made and entered into in triplicate:, this 1st day of March, 2015 by and between the City of Bremerton, hereinafter called "City", and Masco Petroleum, he naf%r called "Contractor". l nWESSETH: Thaat in consideration of the terms and conditions contained herein and attached and made a hart of this Agreement, the parties hereto covenant and agree as follows: 1. SQQrB: Contractor shall perform all work and furnish all labor, tools, material and equipment to provide: FUEL AND FUEL DISPENSING SERVICES All work email be in accordance with the Technical. Specifications for Gasoline and Diesel Fuels a Dispensing_ Folity Services, which are attached hereto as Exhibit A. Contractor shall provide and bear the expense of all equipitent, tools, materials and labor of any sort whatsoever that may be required' for the performance: of services provided for in this c retract and every part thereof, except such as are mentioned in the specifications to be flamished by the City. 2. TEAM: Services shall start Match 1, 2015 and shall end February 28, 2018. The parties may agree to three one -Yew extensions by both parties signing a letter of extension prior to cacti one year extension. 3. Q.Qhff-M--5 %h: CdY agrees to gay Contractor margins per gallon over the OPTS Weekly Pad Report, average range listed for SeattlelTacoma. The margin added to gallonage for the term of this agreement shall be: Diesel Fuels .05 (five) Per Gallon Unleaded Owline. .05 (five) Per Gallon EXCEPT T'HA'I, the City agrees to pay Contractor the Masco pump price plus S cents per gallon for fuel delivery to the City's three fire department stations located at: Station 1 911 Park Avenue, Bremerton WA Station 2 5005 Kitsap way, Bremerton, WA Station 3 3031 Olympus, Bremerton, WA 1.. 0 06/27/2017 10:10 AM 14154847068 From HyIaFAX Enterprise 413604735360 Tue 27 Jun 2017 08:23:18 AM PDT NEI Page 4 of B 4. LICENSES AND TAXES: Contractor shall possess a current Bremerton Business License and any regulatory license required to fulfill Contractor's obligations ruder this contract. B & t7 taxes shall be Paid when dile, and Contractor by this agreement assigns any payments due under this contract to the City Clerk for payment of such taxes whiclNave been declared delinque4 S. AV =11D R.EPRESBNTTATIVE: The City's Aut6rized Representative shall act as advisor and c6multant to the City in all matters relating to the contract, and responsibilities shall include,;approving'the amount, quality 4 acepptability of the services which sibi to be paid for under thedntract and approve all pay estimates prior to payment by the, City. The decision of the authorized representative in the matters described above shall be final. Tne atrthotiz d repres-htative for this project is Owen L Orton oras otherwise assigned by the Director of Public Works & Utilities. 6. MURAML Prior to commencing services under this agreement, Contractor will provide the City Risk manager with a certificate of insurance evidencing compre pensive general inability l ns gaiuce for all tractor ci ons in the mmtun ' ' ua 6f T" ,. ,1 ., IW - ;Otl0,000 per occurrence for bodily is�3m'y and prey damage. This certificate of insurance must be issued by the insurer acceptable to the City, must name the City of Brenserton an additional inswvd, and roust provide for 30 days advance notice of cancellation_ Contractor shall keep the required insurance coverage current throughout the life of the contract and shall present the City with Aubsegtyent certificates of insurance as necessary to evidence the existence of on-going insurance coverage. Certificates should be mailed to: Risk Manage City of Bmmerton 345 6" Street, Suite 600 Bremerton, WA 98337 7. D ITY: Contractor agrees to defend, indemnify and save harmless the i City, its appointed and elected offem aid employees, from and against any and all liability, loss, costs, damage and expense, including costs and attorney feea in Memo thereof because of actions, claims or lawsuits for damages resulting from personal or bodily injury, including death at anytime resulting therefrom, sustained or alleged to have been sustained by any persom or persons and on account of damage to property, arising or alleged to have arist directly or indirectly out of or in consequence of or the perforimance; of this Agreement, whether such injuries to persons or damage to property is due to the negligence of Contractor, its subcontrac tms„ agents, successors or assigns. This provision shall be inapplicable to the extent that the City is judigialiy found solely negligent for such dmage or injury. 8. NO-DIS_CRIMM : Contractor shall not discriminate in employment or services to the public on the basis of race, color, national origin, sex, religion, age, marital status, disability, or sexual orientation except for employment actions based on bona fide occiupational qualification. 9. NOTICES, Any notices required to be given shall be in writing and delivered to the following parties at the following addresses: 0 06/27/2017 10:10 AM 14154847068 From HyIaFAX Enterprise 4 13604735360 T'ue 27 Jun 2017 08:23:18 AM PDT City Clerk Masco Petroleum 345 6" Stmt Suite 600 P.O. Box 43 Bremerton, WA 98337.1873 Aberdeen, WA 98520 04 page 5 of 9 10. „APPLICABLE LAW: VENUE: This contract shall be construed and interpreted in accordance with the laws of the State of Washington and, in the event of dispute, thc; venue of any action brought hereunder shall be in Kitsap Superior Court. 11. TERMINATION: This Agreement may be terminated by either party far convenience upon thirty (30) days written notice to the other party, or for cause if either party fails substantially to perform through no fault of the; other and does not commence correction within (5) days of written notice and diligently completes the correction thereafter. Upon such lamination, City will be entitled to reports showing the status of all matters upon which Contractor is providing services to the City as of the effective date oftermination. 12. A'TTORNEY'S FEES AN12 COSTS: in the event of any action or proceeding brought by either party against the tither under this contract, each party is responsible for its own attorneys' fees and costs. 13. ASSIGNMENT': The rights and obligations established by this Agreement, except the receipt of payment, may not be assigned without the written consent of the City. 14. RMLE AGREEMENT: This Agreement constitutes the entire agreement between the patties and both Parties acknowledge that there are no other agreettenta, written or oral, that have not been fully set tbrth in the text of this Agreement. IN WITNESS WHEREOF the parties have executed this Agreement on the day and year written below. CfI'Y OF BREMERTON �_._. 7 By: Patty ayor Date: 06 —:y% —/7 APPROVED AS TO FORK, MASCO PETROLEUM 0�� i Br ort ' y 'homey &ALft0LAVn+W vuauc waxtcsu =h=4N9M&ftI taAsva rdwimn oe-to.aw 3. EXHIBIT A TECHNICAL SPECIFICATIONS FOR GASOLINE AND DIESEL FUELS & DISPENSING FACILITY SERVICES The City of Bremerton operates a fleet of approximately 350 vehicles using the following fuels: Diesel 100 Unleaded Gasoline 250 Experienced annual consumption in gallons; Diesel 70,000 Unleaded Gasoline 100,000 Consumption figures are rounded but are within 10% of 2013 actuals. These numbers are given for estimating purposes only. They do not represent guaranteed or implied quantities or order for fuels. The "mix' of use is presented for estimating purposes only. Octane ratings are/shall be those commonly accepted as the industry standard prescribed by the vehicle manufacturers. Biodiesel, if available, shall have a minimum blend of 5% and a maximum blend of 20%. The dispensing facility for all commodities included herein shall be within five (5) minute drive, unhindered by traffic, of the City of Bremerton Equipment Services Maintenance facility located at 100 Oyster Bay Ave. N. Bremerton. A CARD LOCK SYSTEM The following specifications pertain to the "Card Lock" system and represent the minimum standards acceptable to the City. For security reasons it is desirable to utilize a one (1) card system with the following specifications; a) Each listed vehicle will have its own assigned fuel card that corresponds with the vehicle numbering system used by the City of Bremerton. b) Each listed operator will be issued a unique Personal Identification Number (PIN) to be issued by the contractor in a four (4) digit numerical format. EXHIBIT A 2. Equipment Services will advise the contractor when new or replacement cards/PIN numbers are required. 3. Vehicle cards and or PIN numbers will be provided within seven (7) calendar days following the request from Equipment Services Division. B. REPORTING The following specifications pertain to the "Reporting" system and represent the minimum standards acceptable to the City; 1. All reports will be submitted to the Equipment Services Division. The reporting system shall have the capability to produce reports requested by the City in a variety of sorts, including but not limited tp: a) By vehicle: Vehicle numbering must match the city's vehicle numbering system utilizing 4 to 6 digits (example 1425 or 111425). b) By operator/driver c) By date and time of purchase d) By location of purchase e) By type and quantity of fuel 2. Monthly reports and statements shall be in electronic format which can easily be inputted into the City of Bremerton's asset management system. 3. The City of Bremerton will accept and pay invoices monthly. The City does not pay from statements. Contractor shall submit monthly billing in a format that includes: a) Billing period dates b) Invoice number c) Date and time of purchase d) Vehicle number e) Driver name f) Odometer reading g) Product EXHIBIT A h) Gallons delivered by grade i) Price per gallon by grade j) Plus margin per gallon k) Appropriate tax 1) Extended price All fueling receipts shall be posted in dated order for each vehicle and include all information shown in 3 above. C. The following specification pertains to hours and conditions of service and access and are predicated on the City's need to respond to the emergency needs of its citizens regardless of hour, day, weather conditions and other acts of nature. 1. Access of fueling services shall be twenty-four (24) hours per day, seven (7) days per week including holidays. 2. A twenty four (24) hour emergency telephone number will be posted and clearly visible on the pumps or at another appropriate on-site location with instructions as to how to contact the Vendor to report emergencies or service failure. Contractor will provide twenty-four (24) hour repair service coverage. Service response will be no longer than two (2) hours from the time the call is placed. 3. Contractor agrees to provide the City with an uninterrupted source of fuels in the event of emergencies caused wholly or in part by embargoes, civil unrest, and national emergency, acts of nature or re -implementation of allocations. 4. The Contractor shall provide and demonstrate emergency power generation, or a means of connecting emergency power generation, to ensure the continued operation of pumps and accounting systems in the event of natural or catastrophic events that disrupt normal electrical operation of the fueling facility. 5. Allocations and availability of fuels shall not be less than one hundred percent (100%) of fuels purchased during the past full year with delivery available on a monthly average basis. 6. Preference may be given to firms offering card lock services throughout Western Washington. Availability of interstate services is desirable. D. PRICING AND BASIS OF BID AWARD The contract will be awarded for a three (3) year term beginning March V 2014. Thereafter, the City retains the option to extend the contract annually for up to three (3) additional one (1) year terms. EXHIBIT A Bids will be received and a contract awarded on an All or None basis. The contract will not be split between two or more contractors. 3. Bidder must bid and provide all fuel products listed. Products provided shall be priced at the average range of Oil Price Information Service (OPIS) Weekly Pad Report. Bidders will specify a firm, fixed margin above the average range price listed for Seattle/Tacoma, as reported in the publication. These margins will be used for bid evaluation. The weekly per gallon price will be determined by adding the "margin price" (for each type of fuel) to the average listed OPIS PAD 4/5 Report for Seattle/Tacoma, published weekly, except for the last week in June and December. Bids will be evaluated using the margin bid applied to Experienced Annual usage for all product combined. The lowest average overall margin, based on Experience Annual usage, will be used to determine award. 6. Margins shall be fixed for the term of this agreement including any contract extension periods. 7. Contractor will be responsible for all set-up and materials costs for initializing the system for City use, including required vehicle cards and driver PIN. E. BULK FUEL DELIVERY The City of Bremerton owns and maintains four (4) above ground bulk fuel tank located at each of the Fire Stations within the city. This fuel delivery shall be made part of this bid and will show price of each fuel by gallon to include the standard margin and the delivery cost (per gallon). Delivery locations are included below; Station 1- 911 Park Ave. Bremerton,WA Station 2- 5005 Kitsap Way Bremerton,WA Station 3- 3031 Olympus Bremerton, WA Client#: 94295 MASCPETR ACORDTM CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDIYYYY) LTR TYPE OF INSURANCE 2/28/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER NAME: T Kellie Hogan Propel Insurance (A N 800 499-0933 FAX 866 577-1326 Ext): AIC, No Tacoma Commercial Insurance E-MAIL ADDRESS: kellie.hogan@propelinsurance.com 1201 Pacific Ave, Suite 1000 MED EXP (Any one person) S Tacoma, WA 98402 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: HDI Global Insurance Company 41343 GENERAL AGGREGATE $ 2,000,000 INSURED INSURER B : Masco Petroleum Inc AUTOMOBILE X X PO Box 43 INSURER C : X Aberdeen, WA 98520 INSURER D: 02128/2018 COMBINED SINGLE LIMIT Ea accident $2,000,000 INSURER E: INSURER F: PROPERTY DAMAGE Per accident $ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDILS NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X X EGGCD000024917 2/28/2017 0P8/201 8 EACH OCCURRENCE $2,000,000 PREMGGISESOEaoccTu ence $100000 MED EXP (Any one person) S PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: x POLICY F-1 ECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS X AUTOS X X EAGCD000024917 2/28/2017 02128/2018 COMBINED SINGLE LIMIT Ea accident $2,000,000 BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE EXAGD000024917 2/28/2017 02128/2018 EACH OCCURRENCE s3,000,000 AGGREGATE s3,000,000 DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? F_N1 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A EGGCD000024917 WA STOP GAP 2/28/2017 02/28/201 PER OTH- E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE S1 000 000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Bremerton Financial Services 345 Sixth St Ste 600 Bremerton, WA 98337-1873 ACORD 25 (2014/01) 1 of 1 #S2605465/M2604757 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BMD00 COMMERCIAL AUTO EN Al 50 57 09 11 THIS ENDORSEMENT CHANGES THE POLCIY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. WHO IS AN INSURED, under SECTION II — LIABILITY COVERAGE, A. COVERAGE, is amended to include as an "insured", any person or organization you are required to add as an additional insured on this policy under a written contract, agreement or permit which must be: a. Currently in effect or becoming effective during the term of the policy; and b. Executed prior to an "accident" for which coverage provided to an additional insured under this endorsement applies. The insurance provided to this additional insured is limited as follows: 1. That person or organization is an additional insured only with respect to liability arising out of your operations performed for that additional insured as specified in the written contract, agreement or permit. 2. The limits of insurance applicable to the additional insured are those in written contract, agreement, permit or in the Declarations for this policy, whichever are less. These limits of insurance are inclusive of and not in addition to the Limit of Insurance for Liability Coverage shown in the Declarations. 3. Coverage is not provided for "bodily injury" or "property damage" arising out of the sole negligence of the additional insured. Any coverage provided hereunder will be excess over and other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary. When this insurance is in excess, we will have no duty to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insurer's rights against all those other insurers. All other terms and conditions of this policy remain unchanged. EN Al 50 57 09 11 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc. POLICY NUMBER: EAGCD000024916 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MASCO PETROLEUM, INC. Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization (s): AS REQUIRED BY WRITTEN CONTRACT IInformation required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the "loss" under a contract with that person or organization. CA 04 4410 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will. pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 C Insurance Services Office, Inc., 2012 CG 2010 0413 POLICY NUMBER: EGGCD000024916 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE V/ Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations AS REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the persons) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we, will pay on behalf of the additional insured is the', amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY EN Al PNC 04 11 THIS ENDORSEMENT CHANGES THE POLICY - PLEASE READ IT CAREFULLY ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person(s) or Organization(s) Where required by written Contract This insurance shall be excess over any other insurance naming the scheduled additional insured as an insured on a primary, excess, contingent, or on any other basis unless: A written contract or agreement specifically requires that this insurance be primary and noncontributory. 2. The written contract is signed and executed by the named insured and additional insured prior to any "bodily injury", "property damage" or "personal and advertising injury". 3. This policy does not apply for defense or indemnity of the additional insured if state or federal law does not permit indemnification of the additional insured by the Named Insured for the claim of a third party. 4. This insurance does not apply to the additional insured's liability to indemnify, defend or hold harmless a third party. EN Al PNC 04 11 Page 1 of I COMMERCIAL AUTO CA 99 48 03 06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLLUTION LIABILITY - BROADENED COVERAGE FOR COVERED AUTOS - BUSINESS AUTO, MOTOR CARRIER AND TRUCKERS COVERAGE FORMS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. A. Liability Coverage is changed as follows: 1. Paragraph a. of the Pollution Exclusion ap- plies only to liability assumed under a contract or agreement. 2. With respect to the coverage afforded by Para- graph A.1. above, Exclusion B.6. Care, Cus- tody Or Control does not apply. B. Changes In Definitions For the purposes of this endorsement, Paragraph D. of the Definitions Section is replaced by the following: D. "Covered pollution cost or expense" means any cost or expense arising out of: 1. Any request, demand, order or statutory or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants"; or 2. Any claim or "suit" by or on behalf of a gov- ernmental authority for damages because of testing for, monitoring, cleaning up, remov- ing, containing, treating, detoxifying or neu- tralizing, or in any way responding to or as- sessing the effects of "pollutants". "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, disper= sal, seepage, migration, release or escape of "pollutants": a. Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto'; or b. After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered; disposed of or abandoned by the "in'' sured". Paragraphs a. and b. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with re- spect to "pollutants" not in or upon a cov- ered "auto" if: (1) The "pollutants" or any property, in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of a covered "auto"; and (2) The discharge, dispersal, seepage!' migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. CA 99 48 03 06 © ISO Properties, Inc., 2005 Page 1 of 1, 0 City of Bremerton RFP -Gasoline & Diesel Fuels & Dispensing Facility Services Bid Closes Spm January 20, 2015 PROPOSAL DOCUMENT The following are the margins bid over the OPIS Weekly Pad Report, average range listed for Seattle/Tacoma: FUEL TYPE DIESEL REGULAR UNLEADED MARGIN PER GALLON r�s In words Fl 1J -C. Cf��\-�-s as In words t Ut' C CVNA Signed for Bidder., Title 8/. / SUBMIT T0: City Clerk City of Bremerton 3456 1h Street, Suite 600 Bremerton WA 98337 January 2, 2015 City of Bremerton — Fuel EXHIBIT A 2. Bids will be received and a contract awarded on an All or None basis. The contract will not be split between two or more contractors. 3. Bidder must bid and provide all fuel products listed. 4. Products provided shall be priced at the average range of Oil Price Information Service (OPIS) Weekly Pad Report. Bidders will specify a firm, fixed margin above the average range price listed for Seattle/Tacoma, as reported in the publication. These margins will be used for bid evaluation. The weekly per gallori price will be determined by adding the "margin price" (for each type of fuel) to the average listed OPIS PAD 4/5 Report for Seattle/Tacoma, published weekly, except for the -last week in June and December. 5. Bids will be evaluated using the margin bid applied to Experienced Annual usage for all product combined. The lowest average overall margin, based on Experience Annual usage, will be used to determine award. 6. Margins shall be fixed for the term of this agreement including any contract extension periods. 7. Contractor will be responsible for all set-up and materials costs for initializing the system for City use, including required vehicle cards and driver PIN. E. BULK FUEL DELIVERY The City of Bremerton owns and maintains four (4) above ground bulk fuel tank located at each of the Fire Stations within the city. This fuel delivery shall be made part of this bid and will show price of each fuel by gallon to include the standard margin and the delivery cost (per gallon). Delivery locations are included below; Station 1- 911 Park Ave. r\ IY\ccSc.0 \'ly" � Bremerton,WA5 d:e�t=� Station 2- 5005 Kitsap Way C -C) Bremerton,WA Station 3- 3031 Olympus UV\c�,sco `� Bremerton, WA ' 0 u IA O N LO co O Q Z w W 0 W m a M X m O a 0 0 � M v m Ll 00 C: D rn o N v v Ev L �G - V) O L CO U O � E a >- Ln E +, +, :T L1 U U m m U. W =Y f- Lr ` N LL - 0-9 111 U , q r Z 2 UJ LL 0cc 0 0 u IA O N LO co O Q Z w W 0 W m a M X m O a 0 0 � M v m Ll 00 C: D rn o N v v Ev L �G - V) O L CO U O � E a >- Ln E +, +, :T L1 U U m m a 4E VV MD ° n( �':. QAlV1 The following.are the margins bid over the OPIS Week4y Pad Report, average range listed for Seattle/Tacoma: City of Bremerton RFP -Gasoline & Diesel Fuels & Dispensing Facility Services Bid Closes Spm January 20, 2015 PROPOSAL DOCUMENT FUEL TYPE DIESEL REGULAR UNLEADED MARGIN PER GALLON 'i o-140 aei-TM►s D*111 TAcowA oPIS Cournwc:- AVePAb& In words 499 CV4M acQ.-- rk6 pfRiW Tth-UwA oPIS CorrRpcT A,3E• 140.10 oVEV- IliE DAIL`4 ALRYNA 0915 CoN�1z�4tT A'�o. In words te-M c0ey- THE DA11y'Mgy%•A 69%S A\\Ax- 7-U- A �SO•oo pt-t,1vE� F'F'E w� L.l �E, A9p�.tL.Pf�l,rt �'aL A Dt"L'c��l �'v1r9DE, 7-U- A gv1,K Pue� 51,E Signed for Bidder -- SUBMIT T0: City Clerk City of Bremerton 3456 1h Street, Suite 600 Bremerton WA 98337 Title Mr04UL- J January 2, 2015 1 City of Bremerton — Fuel APP Associated Petroleum Products, Inc. I Corporate Headquarters 2320 Milwaukee Way, Tacoma, Washington 98421 Tall Free .(800) 929.5243 1 Local .(253) 627.61 9 1 Fax. (253) 627.3637 January 05, 2015 City of Bremerton 3456 th St, Suite 600 Bremerton, WA 98337 SUBMISSION FOR FUEL RFP IU610YA IF�1rZu Fueling Success Location ProductDelivery Margin Index Description Bremerton ULSD #2 Clear Cardlock $0.1000 Daily Tacoma OPIS Contract Average Bremerton UNL87E10 Cardlock $0.1000 Daily Tacoma OPIS Contract Average BULK FUELS: Location Product Description Delivery Margin Index 911 Park Ave ULSD 0 Clear Tank Wagon $0.1000 Daily Tacoma OPIS Contract Average 911 Park Ave UNL87EI0 Tank Wagon $0.1000 price Tacoma OPTS Contract Average 5005 Kitsap Wy ULSD #2 Clear Tank Wagon -'Daily $0.1000 Daily Tacoma OPIS Contract Average 3031 Olympus ULSD #2 Clear Tank Wagon $0.1000 Daily Tacoma OPIS Contract Average A delivery fee of $50.00 will pe applicable for a delivery made to any bulk fuel site APP Terms 81 Conditions Bulk fel invoices billed as NET 30 Cardlock fuel invoices are monthly. NET 15 r Y67 VpIGY14l1V11 - ••C1011111_y1{ Base Price (OPIS Posting plus WA Hazardous Substance Fee WA B&O WA State Excise Tax Federal Excise Tax Federal Oil Spill Federal LUST Fuel Surcharge Environmental Surcharge ble margin) 0.7000% calculated on base price 0.4840% calculated on base price 0.3750 per gallon 0.2430 per gallon 0.0019 per gallon 0.0010 per gallon 0.2500% calculated on base price 0.5000% calculated on base price "Please note our system round's to the 9 for pricing Sincerely, ASSOCIATED PETROLE 1V---� sbe — Nick Schoenfelder Pricing & Supply Managei PRODUCTS, INC. 76( Client#: 94295 MASCPETR -57 ACORDT. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)1/27/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER I CONTACT Kellie Hogan Propel Insurance PHONE 800 499-0933 FAx (AIC,No,Ext): (A/C,No): 866 577-1326 Tacoma Commercial Insurance ADDRIESS: kellie.hogan@propelinsurance.com 1201 Pacific Ave,Suite 1000 Tacoma,WA 98402 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:HDI Global Insurance Company 41343 INSURED INSURER B Masco Petroleum Inc PO Box 43 INSURERC: Aberdeen,WA 98520 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE POLICY EFF POLICY EXP TYPE OF INSURANCE NW SR VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X EGGCD000024919 02/28/2019 02/28/2020 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 _ X POLICY ECOT X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X X EAGCD000024919 02/28/2019 02/28/2020 COMBccINEDident)SI �2,000sNGLE LIMIT 000 (Ea a X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X AUTOS ONLY X NON-OWNED PROPERTY DAMAGE AUTOS ONLY (Per accident) A UMBRELLA LIAB X OCCUR EXAGD000024919 02/28/2019 02/28/2020 EACH OCCURRENCE $3,000,000 x EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EGGCD000024919 02/28/2019 02/28/2020 E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) WA STOP GAP E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Bremerton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 345 6th St Ste 600 ACCORDANCE WITH THE POLICY PROVISIONS. Bremerton,WA 98337-1873 AUTHORIZED REPRESENTATIVE &.w;ol ' � _ ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S3989752/M3551431 CRS01 This page has been left blank intentionally. COMMERCIAL GENERAL LIABILITY EN Al PNC 04 11 THIS ENDORSEMENT CHANGES THE POLICY-PLEASE READ IT CAREFULLY ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person(s)or Organization(s) Where required by written Contract This insurance shall be excess over any other insurance naming the scheduled additional insured as an insured on a primary, excess, contingent, or on any other basis unless: 1. A written contract or agreement specifically requires that this insurance be primary and noncontributory. 2. The written contract is signed and executed by the named insured and additional insured prior to any "bodily injury", "property damage" or"personal and advertising injury". 3. This policy does not apply for defense or indemnity of the additional insured if state or federal law does not permit indemnification of the additional insured by the Named Insured for the claim of a third party. 4. This insurance does not apply to the additional insured's liability to indemnify, defend or hold harmless a third party. EN AI PNC 04 11 Page 1 of 1 This page has been left blank intentionally. COMMERCIAL AUTO EN Al 50 57 09 11 THIS ENDORSEMENT CHANGES THE POLCIY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. WHO IS AN INSURED, under SECTION II — LIABILITY COVERAGE, A. COVERAGE, is amended to include as an "insured", any person or organization you are required to add as an additional insured on this policy under a written contract, agreement or permit which must be: a. Currently in effect or becoming effective during the term of the policy; and b. Executed prior to an "accident" for which coverage provided to an additional insured under this endorsement applies. The insurance provided to this additional insured is limited as follows: 1. That person or organization is an additional insured only with respect to liability arising out of your operations performed for that additional insured as specified in the written contract, agreement or permit. 2. The limits of insurance applicable to the additional insured are those in written contract, agreement, permit or in the Declarations for this policy, whichever are less. These limits of insurance are inclusive of and not in addition to the Limit of Insurance for Liability Coverage shown in the Declarations. 3. Coverage is not provided for "bodily injury" or "property damage" arising out of the sole negligence of the additional insured. Any coverage provided hereunder will be excess over and other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary. When this insurance is in excess, we will have no duty to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insurer's rights against all those other insurers. All other terms and conditions of this policy remain unchanged. EN AI 50 57 09 11 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc. POLICY NUMBER: EAGCD000024917 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MASCO PETROLEUM, INC. Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): AS REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 POLICY NUMBER: EGGCD00002491 7 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: AS REQUIRED BY WRITTEN CONRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 0 POLICY NUMBER: EGGCD000024917 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations AS REQUIRED BY WRITTEN CONTRACT, , , WA Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage" occurring after: caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 0413 POLICY NUMBER: EGGCD000024917 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations AS REQUIRED BY WRITTEN CONTRACT WA Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for "bodily injury" or If coverage provided to the additional insured is "property damage" caused, in whole or in part, by required by a contract or agreement, the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included in the "products-completed operations 1. Required by the contract or agreement; or hazard". 2. Available under the applicable Limits of However: Insurance shown in the Declarations; 1. The insurance afforded to such additional whichever is less. insured only applies to the extent permitted This endorsement shall not increase the applicable by law; and Limits of Insurance shown in the Declarations. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 COMMERCIAL GENERAL LIABILITY EN AI PNC 04 11 THIS ENDORSEMENT CHANGES THE POLICY -PLEASE READ IT CAREFULLY ADDITIONAL INSURED - PRIMARY AND NON-CONTRIBUTORY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person(s)or Organization(s) Where required by written Contract This insurance shall be excess over any other insurance naming the scheduled additional insured as an insured on a primary, excess, contingent, or on any other basis unless: 1. A written contract or agreement specifically requires that this insurance be primary and noncontributory. 2. The written contract is signed and executed by the named insured and additional insured prior to any "bodily injury", "property damage" or"personal and advertising injury". 3. This policy does not apply for defense or indemnity of the additional insured if state or federal law does not permit indemnification of the additional insured by the Named Insured for the claim of a third party. 4. This insurance does not apply to the additional insured's liability to indemnify, defend or hold harmless a third party. EN AI PNC 04 11 Page 1 of 1 This page has been left blank intentionally. COMMERCIAL AUTO EN Al 50 57 09 11 THIS ENDORSEMENT CHANGES THE POLCIY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. WHO IS AN INSURED, under SECTION II— LIABILITY COVERAGE, A. COVERAGE, is amended to include as an "insured", any person or organization you are required to add as an additional insured on this policy under a written contract, agreement or permit which must be: a. Currently in effect or becoming effective during the term of the policy; and b. Executed prior to an "accident" for which coverage provided to an additional insured under this endorsement applies. The insurance provided to this additional insured is limited as follows: 1. That person or organization is an additional insured only with respect to liability arising out of your operations performed for that additional insured as specified in the written contract, agreement or permit. 2. The limits of insurance applicable to the additional insured are those in written contract, agreement, permit or in the Declarations for this policy, whichever are less. These limits of insurance are inclusive of and not in addition to the Limit of Insurance for Liability Coverage shown in the Declarations. 3. Coverage is not provided for"bodily injury" or"property damage" arising out of the sole negligence of the additional insured. Any coverage provided hereunder will be excess over and other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary. When this insurance is in excess, we will have no duty to defend the additional insured against any "suit" if any other insurer has a duty to defend the additional insured against that "suit." If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insurer's rights against all those other insurers. All other terms and conditions of this policy remain unchanged. EN AI 50 57 09 11 Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Copyright, Insurance Services Office, Inc. This page has been left blank intentionally.