Loading...
HomeMy WebLinkAbout2015-611-E AMS - Blossman Gas, Inc. dba Alliance Autogas propane vehicle fuel DocuSign Envelope ID:02FOB961-A92E-4B1E-AOE9-E5777906432F [Departmental Use Only] TITLE FY NORTH CAROLINA SERVICES AGREEMENT OVER $90,000.00 RFP — NO REIMBURSABLE EXPENSES ORANGE COUNTY This Services Agreement (hereinafter "Agreement"), made and entered into this 1st day of July, 2015, ("Effective Date") by and between Orange County, North Carolina a body politic and corporate of the State of North Carolina (hereinafter, the "County") and Blossman Gas, Inc., d/b/a Alliance Autogas, (hereinafter, the "Provider"). WITNESSETH: That the County and Provider, for the consideration herein named, do hereby agree as follows: 1. Services a. Scope of Work. i) This Services Agreement ("Agreement") is for professional services to be rendered by Provider to County with respect to (insert type of project): the provision of propane vehicle fuel pursuant to Exhibit A: Alliance Aurogas Customer Agreement, dated 7-1-2015 ii) By executing this Agreement, the Provider represents and agrees that Provider is qualified to perform and fully capable of performing and providing the services required or necessary under this Agreement in a fully competent, professional and timely manner. iii) Time is of the essence with respect to this Agreement. iv) The services to be performed under this Agreement consist of Basic Services, as described and designated in Section 3 hereof. Compensation to the Provider for Basic Services under this Agreement shall be as set forth herein. 2. Responsibilities of the Provider a. Services to be provided. The Provider shall provide the County with all services required in Section 3 to satisfactorily complete the Project within the time limitations set forth herein and in accordance with the highest professional standards. b. Standard of Care. i) The Provider shall exercise reasonable care and diligence in performing services under this Agreement in accordance with the highest generally accepted standards of this type of Provider practice throughout the United States and in accordance Revised 10/14 1 DocuSign Envelope ID:02FOB961-A92E-4B1E-AOE9-E5777906432F with applicable federal, state and local laws and regulations applicable to the performance of these services. Provider is solely responsible for the professional quality, accuracy and timely completion and/or submission of all work related to the Basic Services. ii) Provider shall be responsible for all errors or omissions of its agents, contractors, employees, or assigns in the performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to the County. iii) The Provider shall not, except as otherwise provided for in this Agreement, subcontract the performance of any work under this Agreement without prior written permission of the County. No permission for subcontracting shall create, between the County and the subcontractor, any contract or any other relationship. iv) Provider is an independent contractor of County. Any and all employees of the Provider engaged by the Provider in the performance of any work or services required of the Provider under this Agreement, shall be considered employees or agents of the Provider only and not of the County, and any and all claims that may or might arise under any workers compensation or other law or contract on behalf of said employees while so engaged shall be the sole obligation and responsibility of the Provider. v) Provider agrees that Provider, its employees, agents and its subcontractors, if any, shall be required to comply with all federal, state and local antidiscrimination laws, regulations and policies that relate to the performance of Provider's services under this Agreement. vi) If activities related to the performance of this Agreement require specific licenses, certifications, or related credentials Provider represents that it and/or its employees, agents and subcontractors engaged in such activities possess such licenses, certifications, or credentials and that such licenses certifications, or credentials are current, active, and not in a state of suspension or revocation. 3. Basic Services a. Basic Services. i) The Provider shall perform as Basic Services the work and services described herein and as specified in the County's Request for Proposals (the "RFP") "RFP Number N/A, Sole source provider, See letter attached for "N/A" issued N/A, 20N/A, and the Provider's proposal, which are fully incorporated and integrated herein by reference together with Attachments Exhibit A "Alliance Autogas Fuel Agreement", "Alliance - orange sole source document" (designate all attachments). In the event a term or condition in any document or attachment conflicts with a term or condition of this Agreement the term or condition in this Agreement shall control. Should such conflict arise the priority of documents shall be as follows: This Agreement, the County's RFP together with attachments, Provider's Proposal together with attachments. Revised 10/14 2 DocuSign Envelope ID:02FOB961-A92E-4131E-AOE9-E5777906432F ii) The Basic Services will be performed by the Provider in accordance with the following schedule: (Insert task list and milestone dates) Task Milestone Date 1. Per Exhibit A attached, Alliance will provide autogas dispensing equipment (tank,pump, and dispenser)used for dispensing autogas into Customer's vehicles. 01-01-2016 2. Per Exhibit A attached, Alliance Autogas will be the sole provider delivering propane vehicle fuel as needed to fill tank of autogas dispensing equipment. Propane purchases for non-transportation uses will remain unrestricted. The initial price of propane vehicle fuel will be determined by the average weekly pipeline price, plus a set premium per gallon. This premium is to offset the cost of the private fueling station that the Provider will maintain for County refueling. Tracking from the date of first fuel delivery, if the County purchases the annual volume of propane estimated, the County will have the option of switching from the initial price per gallon (pipeline + premium + any taxes) to match the propane price in the State Contract for the remainder of the agreement period. 01-01-2016 3. Per Exhibit A attached, if not renewed or upon termination of the agreement, Alliance or designated partner shall have 60 days to remove its fueling infrastructure property used for the delivery of Autogas. 12-01-2020 or earlier based on conditions defined in this contract. 4. 5. 6. 7. 8. 9. 10. iii) Should County reasonably determine that Provider has not met the Milestone Dates established in Section 3(a)(ii), County shall notify Provider of the failure to meet the Milestone Date. The County, at its discretion may provide the Provider seven (7) days to cure the breach. County may withhold the accompanying payment without penalty until such time as Provider cures the breach. In the alternative, upon Provider's failure to meet any Milestone Date the County may modify the Milestone Date schedule. Should Provider or its representatives fail to cure the breach within seven (7) days, or fail to reasonably agree to such modified schedule, County may immediately terminate this Agreement in writing, without penalty or incurring further obligation to Provider. This section shall not be interpreted to limit the definition of breach to the failure to meet Milestone Dates. 4. Duration of Services a. Term. The term of this Agreement shall be from 07-01-2015 to 12-01-2020. b. Scheduling of Services i) The Provider shall schedule and perform its activities in a timely manner so as to meet the Milestone Dates listed in Section 3. Revised 10/14 3 DocuSign Envelope ID:02FOB961-A92E-4131E-AOE9-E5777906432F ii) Should the County determine that the Provider is behind schedule, it may require the Provider to expedite and accelerate its efforts, including providing additional resources and working overtime, as necessary, to perform its services in accordance with the approved project schedule at no additional cost to the County. iii) The Commencement Date for the Provider's Basic Services shall be 07-01-2015. 5. Compensation a. Compensation for Basic Services. Compensation for Basic Services shall include all compensation due the Provider from the County for all services under this Agreement. The maximum amount payable for Basic Services is Four-hundred fifty-five thousand Dollars ($455,000). In the event the amount stated on an invoice is disputed by the County, the County may withhold payment of all or a portion of the amount stated on an invoice until the parties resolve the dispute. Payment for Basic Services shall become due and payable in direct proportion to satisfactory services performed and work accomplished. Payments will be made as percentages of the whole as Project milestones as set out in Section 3(a)(ii) are achieved. (For example, if there are 10 Project Tasks with Milestone Dates then Provider may invoice for the first 10% of the whole upon County's acknowledgement of the satisfactory completion of Task one. Upon the County's acknowledgement that the second Task has been satisfactorily completed Provider may invoice for the next 10% of the whole.) b. Additional Services. County shall not be responsible for costs related to any services in addition to the Basic Services performed by Provider unless County requests such additional services in writing and such additional services are evidenced by a written amendment to this Agreement. 6. Responsibilities of the County a. Cooperation and Coordination. The County has designated (Brennan Bouma) to act as the County's representative with respect to the Project and shall have the authority to render decisions within guidelines established by the County Manager and/or the County Board of Commissioners and shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. 7. Insurance a. General Requirements. Provider shall obtain, at its sole expense, Commercial General Liability Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may be required by Owner's Risk Manager as such insurance requirements are described in the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is incorporated herein by reference and may be viewed at htip://orangecounlync.gov/purchasing/contracts.asp). If Owner's Risk Manager determines additional insurance coverage is required such additional insurance shall consist of N/A (if no additional insurance required mark N/A as being not applicable). Provider shall not commence work until such insurance is in effect and certification thereof has been received by the Owner's Risk Manager. Revised 10/14 4 DocuSign Envelope ID:02FOB961-A92E-4B1E-AOE9-E5777906432F 8. Indemnity a. Indemnity. The Provider agrees to defend, indemnify and hold harmless the County from all loss, liability, claims or expense, including attorney's fees, arising out of or related to the Project and arising from bodily injury including death or property damage to any person or persons caused in whole or in part by the negligence or misconduct of the Provider except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this provision to require the Provider to indemnify the County to the fullest extent permitted under North Carolina law. 9. Amendments to the Agreement a. Changes in Basic Services. Changes in the Basic Services and entitlement to additional compensation or a change in duration of this Agreement shall be made by a written Amendment to this Agreement executed by the County and the Provider. The Provider shall proceed to perform the Services required by the Amendment only after receiving a fully executed Amendment from the County. 10. Termination a. Termination for Convenience of the County. This Agreement may be terminated without cause by the County and for its convenience upon seven (7) days prior written notice to the Provider. b. Other Termination. The Provider may terminate this Agreement based upon the County's material breach of this Agreement; provided, the County has not taken all reasonable actions to remedy the breach. The Provider shall give the County seven (7) days' prior written notice of its intent to terminate this Agreement for cause. c. Compensation After Termination. i) In the event of termination, the Provider shall be paid that portion of the fees and expenses that it has earned to the date of termination, less any costs or expenses incurred or anticipated to be incurred by the County due to errors or omissions of the Provider. ii) Should this Agreement be terminated, the Provider shall deliver to the County within seven (7) days, at no additional cost, all deliverables including any electronic data or files relating to the Project. d. Waiver. The payment of any sums by the County under this Agreement or the failure of the County to require compliance by the Provider with any provisions of this Agreement or the waiver by the County of any breach of this Agreement shall not constitute a waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. 11. Additional Provisions Revised 10/14 5 DocuSign Envelope ID:02FOB961-A92E-4131E-AOE9-E5777906432F a. Limitation and Assignment. The County and the Provider each bind themselves, their successors, assigns and legal representatives to the terms of this Agreement. Neither the County nor the Provider shall assign or transfer its interest in this Agreement without the written consent of the other. b. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. c. Compliance with Laws. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all anti-discrimination laws. Pursuant to the terms of North Carolina General Statute 153A-449(b) no county may enter into a contract with a contractor unless the contractor and the contractor's subcontractors comply with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes. Where applicable, failure to maintain compliance with the requirements of Article 2 of Chapter 64 of the General Statutes constitutes Provider's breach of this Agreement. By executing this Agreement Provider affirms Provider is in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. d. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County, North Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding arbitration may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. e. Entire Agreement. This Agreement, together with the RFP and its attachments and the Proposal and its attachments, represents the entire and integrated agreement between the County and the Provider and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. f. Severability. If any provision of this Agreement is held as a matter of law to be unenforceable, the remainder of this Agreement shall be valid and binding upon the Parties. g. Ownership of Work Product. Should Provider's performance of this Agreement generate documents, items or things that are specific to this Project such documents, items or things shall become the property of the County and may be used on any other project without additional compensation to the Provider. The use of the documents, items or things by the County or by any person or entity for any purpose other than the Project as set forth in this Agreement shall be at the full risk of the County. h. Non-Appropriation. Provider acknowledges that County is a governmental entity, and the validity of this Agreement is based upon the availability of public funding under the authority of its statutory mandate. Revised 10/14 6 DocuSign Envelope ID:02FOB961-A92E-4131E-AOE9-E5777906432F In the event that public funds are unavailable and not appropriated for the performance of County's obligations under this Agreement, then this Agreement shall automatically expire without penalty to County immediately upon written notice to Provider of the unavailability and non-appropriation of public funds. It is expressly agreed that County shall not activate this non-appropriation provision for its convenience or to circumvent the requirements of this Agreement, but only as an emergency fiscal measure during a substantial fiscal crisis. In the event of a change in the County's statutory authority, mandate and/or mandated functions, by state and/or federal legislative or regulatory action, which adversely affects County's authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to County upon written notice to Provider of such limitation or change in County's legal authority. i. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. j. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Provider's Name & Address Attention: Brennan Bouma Blossman Gas, Inc. Attn: Michael Phillips P.O. Box 8181 2091 US Highway 70 Hillsborough, NC 27278 Swannanoa, NC 28778 [SIGNATURE PAGE TO FOLLOW] Revised 10/14 7 DocuSign Envelope ID:02FOB961-A92E-4B1E-AOE9-E5777906432F IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have hereunder set their hands and seal, all as of the day and year first above written. ORANGE COUNTY: PROVIDER: 5DOCUSIg'ned by: DocunSig��neQd�by�: By: I By. FA oun ygfV�anager Mic a�l3livffo�F... Law Enforcement Specialist Blossman Gas, Inc. Revised 10/14 8 DocuSign Envelope ID:02FOB961-A92E-4B1E-AOE9-E5777906432F WAIIianceAutoGas POVVEMD BY PROFANE L. May 7, 2015 Brennan Bouma Sustainability Coordinator Orange County Government PO Box 8181 Hillsborough,NC 27278 Subject: Sole Source Provider Dear Mr.Bouma, This letter is to notify you that Blossman Services Inc./Alliance AutoGas is the only vendor capable of providing a turnkey solution for the conversion of your fleet of Ford E-350 and E-450 vans, Ford Expeditions, and E-150 trucks using the PRINS VSI Bi-fuel(Propane AutoGas and gasoline) system. Blossman Services Inc.is the manufacturer of record for the PRINS VSI Bi-fuel system and is the only certified distributor of the PRINS system in the United States. Any EPA certification for the PRINS VSI Bi-fuel system must be issued in the name of Blossman Services Inc. Blossman Services Inc.is the only vendor in the United States that can provide the necessary Certificates of Conformity for the PRINS system. Our turnkey solution is all inclusive and provides the following: • EPA certified PRINS VSI Bi-fuel systems for fleet of listed vehicles. • 3 year, 36,000 mile warranty • Conversion of the fleet OR training and certification of Orange County automotive technicians to perform PRINS conversions on County vehicles. • Initial and ongoing operational and safety training and ongoing technical and customer support. • Propane AutoGas fueling infrastructure (equipment at no cost to Orange County based on 5 year fuel supply agreement). • Propane AutoGas fuel based on Dixie Pipeline prices. This is the same sole sourced, turn-key solution provided to Pickens County Sheriff's Office, Anderson County and Iredell County as well as many other municipalities for their conversion projects through ARRA grant funding and CFAT grant funding. Utilizing a turn-key approach to your alternative fuel project will provide confidence that the program will be successful. This approach will also assist in meeting the requirements of the project. We look forward to assisting Orange County"Clean Fuels for the Future" AutoGas project. Sincerely, Mike Phillips DocuSign Envelope ID:02FOB961-A92E-4131E-AOE9-E5777906432F MEMORANDUM To: Bonnie Hammersley, Orange County Manager From: Brenan Bouma, Sustainability Coordinator Date: September 11, 2015 Subject: Orange County Propane Vehicle Fuel Purchase Agreement Background In June 2015, the Board of County Commissioners (BOCC) approved the receipt of grantfunding to implement a propane vehicle conversion and fueling project(see abstract item attached for project description). The contract associated with this project was signed in Mid-August and then countersigned by the grant funder(NC State University) on the 1St of September. Our sole-source vendor for the equipment and refueling package is Alliance Autogas. In order for Alliance Autogas to provide this propane vehicle conversion and refueling package, they require their clients.to sign a fuel purchase agreement. Under this agreement, Orange County will purchase all of the propane used in our vehicles from Alliance Autogas, or Blossman Services Inc. their parent company, over the next 5 years. The initial price per gallon will be set by the average weekly wholesale price, plus 59 cents. There is no minimum required purchase, however, if we use the amount of fuel estimated in the grant after the first year of the project, we have the option to switch to the state contract price for propane. These terms are laid out in more detail within the attached fuel purchase agreement. Analysis Depending on variations in the weekly average fuel price, propane may or may not be the least-cost option. Fortunately, drivers of these vehicles will be able to select the fuel that they use with the push of a button. Conclusion The five-year term and per-gallon price set by this fuel purchase agreement have been reviewed by an independent representative of the NC Clean Energy Technology Center, and have been found to be on- par or better compared with propane vehicle industry averages for this type of project. Staff recommends signing this agreement to enable this BOCC-approved project to move forward. Best regards: Brennan Bouma Sustainability Coordinator, Asset Management Services DocuSign Envelope ID:02FOB961-A92E-4B1E-AOE9-E5777906432F Orange County Board of Commissioners Agenda Regular Meeting Note: Background Material June 16, 2015 on all abstracts 7:00 p.m. available in the Southern Human Services Center Clerk's Office 2501 Homestead Road Chapel Hill, NC 27514 Compliance with the "Americans with Disabilities Act" -Interpreter services and/or special sound equipment are available on request. Call the County Clerk's Office at(919)245-2130. If you are disabled and need assistance with reasonable accommodations,contact the ADA Coordinator in the County Manager's Office at(919)245-2300 or TDD#644-3045. 1. Additions or Changes to the Agenda PUBLIC CHARGE The Board of Commissioners pledges to the residents of Orange County its respect. The Board asks its residents to conduct themselves in a respectful, courteous manner, both with the Board and with fellow residents. At any time should any member of the Board or any resident fail to observe this public charge, the Chair will ask the offending person to leave the meeting until that individual regains personal control. Should decorum fail to be restored, the Chair will recess the meeting until such time that a genuine commitment to this public charge is observed. All electronic devices such as cell phones, pagers, and computers should please be turned off or set to silent/vibrate. 2. Public Comments (Limited to One Hour) (We would appreciate you signing the pad ahead of time so that you are not overlooked.) a. Matters not on the Printed Agenda(Limited to One Hour—THREE MINUTE LIMIT PER SPEAKER—Written comments may be submitted to the Clerk to the Board.) Petitions/Resolutions/Proclamations and other similar requests submitted by the public will not be acted upon by the Board of Commissioners at the time presented. All such requests will be referred for Chair/Vice Chair/Manager review and for recommendations to the full Board at a later date regarding a) consideration of the request at a future regular Board meeting; or b) receipt of the request as information only. Submittal of information to the Board or receipt of information by the Board does not constitute approval, endorsement, or consent. b. Matters on the Printed Agenda (These matters will be considered when the Board addresses that item on the agenda below.) 3. Announcements and Petitions by Board Members (Three Minute Limit Per Commissioner) 4. Proclamations/Resolutions/ Special Presentations a. Proclamation Recognizing Carrboro High School Women's Soccer Team Winning the 2015 State Championship DocuSign Envelope ID:02FOB961-A92E-4131E-AOE9-E5777906432F 5. Public Hearings a. Unified Development Ordinance Text Amendment — Impervious Surface Regulations (No Additional Public Comments Accepted) 6. Consent Agenda • Removal of Any Items from Consent Agenda • Approval of Remaining Consent Agenda • Discussion and Approval of the Items Removed from the Consent Agenda a. Minutes b. Motor Vehicle Property Tax Releases/Refunds c. Fiscal Year 2014-15 Budget Amendment 410 d. Application for North Carolina Education Lottery Proceeds for Chapel Hill — Carrboro City Schools (CHCCS) and Contingent Approval of Budget Amendment 410-A Related to CHCCS Capital Project Ordinances e. Orange County ABC Board Travel Policy f. JCPC Certification FY 2015-2016 g. Dedication of Right of Way and Permanent Drainage Easements Servicing the Churton Street Access and Public Transportation Improvements h. Resolution on Rescinding Preemption of Local Tobacco Control i. Authorization for County Manager to Award County Detention Facility Professional Services Agreement j. Eno-Haw Regional Hazard Mitigation Plan k. Propane Vehicle Conversion and Refueling Grant Acceptance and Approval of Budget Amendment 410-B 1. Bicycle and Pedestrian Safety Report m. Authorization for County Manager to Award Buckhorn Mebane Sewer Phase 2 Extension Construction Contract and Professional Services Agreement 7. Regular Agenda a. Approval of Fiscal Year 2015-16 Budget Ordinance, County Grant Projects, and County Fee Schedule b. Approval of the Five-Year Capital Investment Plan and Adoption of the Orange County CIP Projects of$22,793,345 for FY2015-16 8. Reports a. Orange County Sustainability and Environmental Responsibility Update 9. County Manager's Report 10. County Attorney's Report 11. Appointments a. Advisory Board on Aging—Appointments b. Agricultural Preservation Board—Appointments c. Alcoholic Beverage Control (ABC) Board—Appointments DocuSign Envelope ID:02FOB961-A92E-4131E-AOE9-E5777906432F d. Arts Commission—Appointment e. Board of Health—Appointments f. Chapel Hill Planning Commission—Appointment g. Durham Technical College Board of Directors —Appointment h. Human Relations Commission—Appointments i. Nursing Home Community Advisory Committee—Appointment 12. Board Comments (Three Minute Limit Per Commissioner) 13. Information Items • June 2, 2015 BOCC Meeting Follow-up Actions List • Tax Collector's Report-Numerical Analysis • Tax Collector's Report- Measure of Enforced Collections • Tax Assessor's Report- Releases/Refunds under $100 • Memorandum Regarding the Operation of Mobile Food Vending Units within Orange County • Blackwood Farm Park Opening Ceremony Flyer • Memorandum Regarding Physical Assessment, Former Chapel Hill Town Hall, 100 West Rosemary Street • Memorandum Regarding Sit to Stand Work Environment • Memorandum Regarding Southern Branch Library Siting Update; Carrboro Arts & Innovation Center Working Group Update • BOCC Chair Letter Regarding Petitions from June 2, 2015 Regular Board Meeting • Regional Partnership Workforce Development Board 2013-2014 Annual Report 14. Closed Session 15. Adjournment Note: Access the agenda through the County's web site, www.orangecountync.gov Orange County Board of Commissioners' regular meetings and work sessions are available via live streaming video athtlp://www.oran_eg countync._og v/departments/board—of county_commissioners/videos.php and Orange County Gov-TV on channels 1301 or 97.6 (Time Warner Cable). DocuSign Envelope ID:02FOB961-A92E-4B1E-AOE9-E5777906432F 7111/12/2015 E(MM/DD/YYYY) ACCORD® CERTIFICATE OF LIABILITY INSURANCE 7/1/2016 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 endorsement(s). CONT PRODUCER Lockton Comparnes NAMEACT 444 W.47th Street,Suite 900 PHONE FAx Kansas City MO 64112-1906 E MAILo Ext: A/C,No (816)960-9000 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance Company 23043 INSURED BLOSSMAN GAS,INC. INSURER B: 1318256 PO BOX 1110 INSURER C: OCEAN SPRINGS,MS 39564-4637 INSURER D INSURER E INSURER F COVERAGES BLOGA01 CERTIFICATE NUMBER: 13760478 REVISION NUMBER: XXXXXXX 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 LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY • X COMMERCIAL GENERAL LIABILITY N N TB2641438890035 7/1/2015 7/1/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE 1XI OCCUR PREMISES Ea occurrDence $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRO- JECT X POLICY LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ • AUTOMOBILE LIABILITY ITT ITT AS2641438890025 7/1/2015 7/1/2016 COMBINED SINGLE LIMIT $ Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED ALL AUTOS AUTO SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX NON-OWNED PROPERTY DAMAGE $ XrXrXrXrXrXrXr HIRED AUTOS AUTOS Per accident $ XXXXXXX UMBRELLA LIAB OCCUR NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS-MADE AGGREGATE $ XXXXXXX DED RETENTION$ $ XXXXXXX • AND EMPLOYERS'LIABILITY WORKERS COMPENSATION N WA764D438890015 7/1/2015 7/1/2016 X STATUTE EERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L.EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? IN I (Mandatory in NH) 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 13760478 ORANGE COUNTY ASSET MANAGEMENT SERVICES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 8181 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 131 W.MARGARET LANE, SUITE 300 ACCORDANCE WITH THE POLICY PROVISIONS. HILLSBOROUGH NC 27278 AUTHORIZED REPRESENTATIV Z2 ©1988L 014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD