April 5, 2023

INVITATION TO BID

BL051-23

The Gwinnett County Board of Commissioners (Principal Procurement Agency) is soliciting competitive sealed bids from qualified suppliers for the Purchase of Gasoline and Diesel Fuel on an Annual Contract with Four (4) One-Year Options to Renew.

Bids should be typed or submitted in ink and returned in a sealed envelope or container marked on the outside with the BL# and Company Name. Bids will be received until 2:50 P.M. local time on Tuesday, May 9, 2023 at the Gwinnett County Financial Services - Purchasing Division – 2nd Floor, 75 Langley Drive, Lawrenceville, Georgia 30046. Any bid received after this date and time will not be accepted. Bids will be publicly opened and read at 3:00 P.M. Apparent bid results will be available the following business day on www.gwinnettcounty.com.

Questions regarding bids should be directed to Chris Duncan, CPPB, Purchasing Associate III, at christopher.duncan@gwinnettcounty.com no later than 3:00 P.M. April 18, 2023. Bids are legal and binding upon the bidder when submitted.

Successful service provider will be required to meet insurance requirements. The Insurance Company should be authorized to do business in Georgia by the Georgia Insurance Department, and must have an A.M. Best rating of A-5 or higher.

Gwinnett County (PPA) does not discriminate on the basis of disability in the admission or access to its programs or activities. Any requests for reasonable accommodations required by individuals to fully participate in any open meeting, program or activity of Gwinnett County Government should be directed to ADA Coordinator, Gwinnett County Justice and Administration Center, 770-822-8165.

The written bid documents supersede any verbal or written prior communications between the parties.

Award will be made to the supplier(s) submitting the lowest responsive and responsible bid. The North Georgia Fuel Cooperative reserves the right to reject any or all bids, to waive technicalities, and to make an award deemed in its best interest. Bids may be split or awarded in entirety.

Award notification will be posted after award on the County website, www.gwinnettcounty.com and companies submitting a bid will be notified via email.

We look forward to your bid and appreciate your interest in the North Georgia Fuel Cooperative.

Chris Duncan, CPPB Purchasing Associate III

The following pages should be returned in duplicate as your bid: Specification Sheets, Pages 3-6 Bid Schedule, Pages 21-22 Product Supplier Confirmation, Page 23 References, Page 24

Code of Ethics Affidavit, Page 25 Contractor Affidavit, Page 26 http://www.gwinnettcounty.com/ mailto:christopher.duncan@gwinnettcounty.com

BL051-23 Page 2

1. Background The Gwinnett County Board of Commissioners will be acting as Principal Procurement Agency (PPA) for the North Georgia Fuel Cooperative (NGFC). The NGFC was formed with the specific purpose of purchasing fuels at high volumes to obtain the best discounts and lowest pricing. The NGFC is comprised of counties, cities, board of educations, and other municipalities. The NGFC consists of, but is not limited to, DeKalb County and BOE, Cobb County and BOE, Gwinnett County and BOE, Jackson County, Fulton County, Forsyth County, Dawson County, Rockdale County, City of Atlanta, City of Gainesville, City of Marietta, City of Covington, and City of Smyrna.

2. Communications Individuals, firms, and businesses seeking an award of a NGFC contract may not initiate or continue any verbal or written communications regarding a solicitation with any NGFC officer, elected official, employee or other NGFC representative without permission of the Purchasing Associate named in the solicitation between the date of the issuance of the solicitation and the date of the final contract award by the NGFC.

Violations will be reviewed by the Gwinnett County Purchasing Director. If determined that such communication has compromised the competitive process, the offer submitted by the individual, firm or business may be disqualified from consideration for award.

3. Autonomy Each governmental entity shall remain autonomous within the NGFC master agreement. Each public agency shall order, receive, and be invoiced separately. All deliveries will be coordinated with the individual agency.

All liabilities, disputes, protests, etc. between the supplier and agency shall be handled by the individual agency. No other participating public agency in the NGFC shall be liable.

4. Additions / Deletions All NGFC participants shall have the right to add, delete, or change locations, tanks, and products with written notice by an authorized agency representative to the supplier(s).

5. Provision of Participation All public agencies within the counties of the NGFC shall have the right to join the NGFC and access the master contract during the contract period. Moreover, any county adjacent to the NGFC and all agencies within said county shall have the right to join the NGFC and access the master contract within the contract period upon mutual agreement with the suppliers(s). Joining agencies and counties shall give written notice to the supplier(s) with all information required (i.e. volume, tank types and locations, start date). Ending date of the contract shall remain unchanged.

6. EPA Requirements and Regulations The NGFC shall have the right to change products listed within the contract if mandated by the Environmental Protection Agency.

BL051-23 Page 3

GASOLINE AND DIESEL FUEL SPECIFICATIONS

SUPPLIER INFORMATION: The product offered should conform to the basic requirements listed below. These requirements establish minimum performance levels and describe features deemed necessary to accomplish specific functions. Bidders are to indicate exactly what they are offering in the blank lines below. If the product meets a required item exactly as written, “COMPLY” may be used the space provided. If additional space is needed, please attach additional sheets. Any deviation that either exceeds or does not meet the minimum requirement should be noted as an exception and the exact offering described on the blank lines below the specification.

REQUIREMENTS

1. Low Sulfur Gasoline Ethanol. Minimum octane for regular grade is 87. State the minimum octane being bid.

2. Diesel fuel shall be ultra-low sulfur, #2 and shall meet ASTM specifications for #2 fuel.

3. All products shall conform to State of Georgia specifications and comply with all federal, state, and local laws and regulations. ______________________________________________________

4. Upon the completion of the contract period (which includes each subsequent renewal period), the supplier shall furnish NGFC participants an executed GUST 36 Product Supplier

Confirmation for all products delivered during the contract period (sample page enclosed –

Page 21 ) _________________________________________________________________________________

5. NGFC participants are responsible for the following taxes: Federal Excise LUST (Local

Underground Storage Tank) Government Tax, Georgia Motor Fuel Tax, Georgia Prepaid State

Tax, Georgia Environmental Assurance Fee (Georgia Underground Storage Tank), and Federal

Environmental Recovery Fee unless otherwise specified.

BID PRICE SHALL NOT INCLUDE TAXES

BL051-23 Page 4

6.

Supplier(s) shall make deliveries as indicated by each participating NGFC agency.

7.

Transport truck deliveries should be made to locations indicated by participating agencies.

Delivery shall be made by transport truck(s) for Diesel Fuel with a maximum delivery of 7,500 gallons minimum 7,200 gallons; and Unleaded Gasoline Fuel with a maximum delivery of 8,600 gallons minimum 8,000 gallons.

8. Tank wagon or split trailer load deliveries shall be made to the locations as indicated by the agencies._______________________________________________________________________________

9. All deliveries shall be made Monday through Friday, excluding holidays, within 24 hours after receipt of individual orders. Each NGFC agency may modify these conditions in the information section.

BL051-23 Page 5

10. Bid price shall be bid based on a cost “plus” basis, specifying the lowest available price to be used, “plus” shall include all delivery costs and other fees. The discount or premium shall remain fixed during the term of the contract. The referenced price on the OPIS Rack is a variable base price that will be determined by each future edition of the OPIS Rack Report. The real price shall be recomputed upon issuance of each edition of the OPIS Rack Report. The recomputed price will become effective on orders made on or after issuance date of the edition.

However, undelivered orders will not be affected. Weekly price shall be modified according to the rack average posting OPIS Rack Report. Daily OPIS Rack rate shall be calculated the same.

Including the code references on the OPIS Rack Report, the applicable price shall include the lump sum of the cost of the product and delivery to the destinations listed in the information sections. The lump sum shall be subject to applicable taxes.(OPIS Rack Report is a Gasoline and Distillate Reseller Price Report prepared by Oil Price Information Service, 8701 Georgia

Avenue, and Suite 800, Silver Springs, MD 20910.)

11. In the times of fuel shortages, this contract must take precedence over all non-governmental contracts where the shortage is not a danger to the general public. The gasoline and diesel fuel purchased by a NGFC agency will be used for emergency and public safety vehicles.

BL051-23 Page 6

12. The risk of loss remains with the successful supplier in the following situations: (a) until the product is delivered pursuant to the requirements and conditions stated herein; and (b) where the tender or delivery of the products so fails to conform to the contract as to give a right of rejection until the nonconformity is cured or accepted.

13. The successful supplier(s) warrant that:

(a) quality of product(s) delivered will be equal to or greater than quality specified;

(b) The product(s) delivered to the NGFC shall conform to any affirmation of fact or promise by the successful supplier(s), or description of the product(s); and (c) the product(s) delivered to the NGFC shall be fit for the particular purpose for which the product(s) are required.

14.

MATERIAL SAFETY DATA SHEETS: MSDS should be included in duplicate with your bid.

NOTE: All invoices shall have the bill of lading (BOL) attached.

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GWINNETT COUNTY INFORMATION AND STIPULATIONS

1. Gwinnett County uses the Veeter-Root tank monitoring system. Access to tanks is controlled by a Gwinnett County employee through the use of a manual key. Deliveries shall be authorized only by orders of the Director of the County’s Fleet Management Department or their designee. Supplier shall make deliveries in the presence of a designated Gwinnett County Board of Commissioners employee and obtain a signed receipt.

The County will not pay any invoice unless there is compliance. All deliveries shall be made Monday through Friday, excluding holidays, within 24 hours after receipt of individual orders. The County will have a person on call should an emergent situation present itself.

FUEL SITE NAMES, ADDRESSES, AND CAPACTIES

Berkley Lake Fuel Site 3275 N. Berkley Lake Rd Duluth, GA 30096 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tank UST

Seaboard Fuel Site 684 Winder Hwy Lawrenceville, GA 30045 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tank UST

Buford Fuel Site 1600 Buford Hwy Buford, GA 30518 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tank UST

Snellville Middle School Fuel Site 3155 Pate Dr Snellville, GA 30078 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Hamilton Mill Fuel Site 3608 Braselton Hwy Dacula, GA 30019 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tank UST

Snellville Tag Office Fuel Site 2825 Lenora Church Rd Snellville, GA 30078 1 each 20,000 gl Unl tank UST 1 each 20,000 gl Dsl tank UST

Lawrenceville Hwy Fuel Site 3575 Lawrenceville Hwy Lawrenceville, GA 30045 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tank UST

Southside Fuel Site 2180 Stone Dr Lilburn, GA 30047 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tank UST

Oakland Fuel Site 1801 Cruse Rd Lawrenceville, GA 30044 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tank UST

Swanson Fuel Site 620 Swanson Dr Lawrenceville, GA 30043 1 each 15,000 gl Unl tank UST 1 each 30,000 gl Dsl tank UST

Scenic Hwy Fuel Site 703 Scenic Hwy Lawrenceville, GA 30043 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tank UST

JCB Fuel Site 6160 Crescent Blvd Norcross, GA 30071 2 each 12,000 gl Unl tanks UST 1 each 12,000 gl Dsl tank UST

Total Unl Annual Usage: 1,994,737 gls Total Dsl Annual Usage: 4,078,891 gls Total Fuel Annual Usage: 6,073,628 gls

BL051-23 Page 8

FORSYTH COUNTY INFORMATION AND STIPULATIONS

1. Supplier shall make deliveries in the presence of a designated Forsyth County employee and obtain a signed receipt. The receipt is to contain the price per gallon of gasoline or diesel being delivered. The County will not pay any invoice unless this is complied with.

2. All deliveries shall be made Monday through Friday, excluding holidays, within 24 hours after receipt of order(s) to the following locations. Deliveries are authorized only by orders of Forsyth County’s Fleet Management Director or designee.

FUEL SITE NAMES, ADDRESSES, AND CAPACTIES

Site #1 Sheriff 212 Veteran’s Memorial Blvd.

Cumming, GA 30040 1 each 10,000 gl Unl tank UST

Site #2 Fleet 4140 County Way Cumming, GA 30040 1 each 10,000 gl Unl tank UST 1 each 10,000 gl Dsl tank UST

Site #3 Fire HQ 3520 Settingdown Road Cumming, GA 30040 1 each 10,000 gl Unl tank UST 1 each 10,000 gl Dsl tank UST

Site #4 Fire Station 14 800 McFarland Road Cumming, GA 30040 1 each 1,000 gl Dsl tank AST

Site #5 Fire Station 10 3680 Old Atlanta Road Cumming, GA 30040 1 each 1,000 gl DSL tank AST

Site #6 Fire Station 9 7385 Browns Bridge Road Cumming, GA 30040 1 each 1,000 gl Dsl tank AST

Site #7 Fire Station 4 3805 Canton Highway Cumming, GA 30040 1 each 1,000 gl Dsl tank AST

Site #8 Fowler 4045 Carolene Way Cumming, GA 30040 1 each 10,000 gl Unl tank AST 1 each 10,000 gl Dsl tank AST

Site #9 Fire Station 1 234 Castleberry Ind. Drive Cumming, GA 30040 1 each 1,000 gl Dsl tank AST

Site #10 Fire Station 11 4655 Pittman Rd.

Cumming, GA 30040 1 each 1,000 Dsl tank AST

Total Unl Annual Usage: 625,000 gls Total Dsl Annual Usage: 150,000 gls Total Fuel Annual Usage: 775,000 gls

JACKSON COUNTY INFORMATION

Jackson County Fuel Farm 131 Four Fifty Seven Drive Jefferson, GA 30549 1 each 10,000 gl Dsl tank UST 1 each 10,000 gl Unl tank UST

Total Unl Annual Usage: 180,000 gls Total Dsl Annual Usage: 46,000 gls Total Fuel Annual Usage: 226,000 gls

BL051-23 Page 9

CITY OF SMYRNA INFORMATION

Public Works 2190 Atlanta, Road Smyrna, GA 30080 1each 15,000 gl Unl tank UST 1each 15,000 gl Dsl tank UST

Total Unl Annual Usage: 144,439 gls Total Dsl Annual Usage: 104,370 gls Total Fuel Annual Usage: 248,809 gls

CITY OF COVINGTON INFORMATION

Covington Fuel Site 2194 Emory Street Covington GA 30015 1 each 15,000 gl Unl tank UST 1 each 10,000 gl Dsl tank UST

Total Unl Annual Usage: 103,640 gls Total Dsl Annual Usage: 80,076 gls Total Fuel Annual Usage: 183,716 gls

CITY OF MARIETTA INFORMATION

Station 1 / Public Safety 112 Haynes Street Marietta, GA 30060 1 each 15,000 gl Unl tank UST 1 each 1,000 gl Dsl tank UST

Station 2 149 Dodd Street Marietta, GA 30060 1 each 1,000 gl Dsl tank UST

Station 4 228 Chestnut Hill Road Marietta, GA 30064 1 each 1,000 gl Dsl tank UST

Station 5 1160 Franklin Road Marietta, GA 30067 1 each 1,000 gl Dsl tank UST

Station 6 805 Allgood Road Marietta, GA 30062 1 each 1,000 gl Dsl tank UST

Central Fueling Facility 725 North Marietta Parkway Marietta, GA 30060 1 each 20,000 gl Unl tank UST 1 each 20,000 gl Dsl tank UST

Total Unl Annual Usage: 236,870 gls Total Dsl Annual Usage: 148,247 gls Total Fuel Annual Usage: 385,117 gls

CITY OF GAINESVILLE INFORMATION

Alta Vista Fuel Site 263 Alta Vista Road Gainesville, GA 30501 2 each 10,000 gl Unl tank UST 1 each 10,000 gl Dsl tank UST

Bradford Street Site 1006 Bradford Street Gainesville, GA 30501 1 each 8,100 gl Unl tank UST 1 each 2,000 gl Dsl tank UST

Total Unl Annual Usage: 207,328 gls Total Dsl Annual Usage: 138,306 gls Total Fuel Annual Usage: 345,634 gls

Total Unl Annual Usage: 76,261 gls Total Dsl Annual Usage: 35,197 gls Total Fuel Annual Usage: 111,458 gls

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Marietta City Schools Information and Stipulations

1. Marietta City Schools will purchase fuel on an as-needed basis.

2. Fuel provided under this contract must comply with all federal and state occupational safety and health acts.

3. The fuel storage tanks are located underground.

4. All fuel must be delivered in a metered tank. Also a before and after stick measurements must be taken and recorded on the bill of lading.

5. All deliveries shall be made Monday through Friday, between the hours of 5:30 A.M. – 4:00 P.M., excluding holidays, within 24 hours after receipt of individual orders. We prefer early morning deliveries to avoid bus/tanker congestion at the facilities.

CITY OF MARIETTA SCHOOLS

145 Dodd Street Marietta, GA 30060 One 5,000 gallon Unleaded tank UST One 10,000 gallon ULDS Diesel tank UST

Total Unleaded Annual Usage: 19,610 Total Diesel Annual Usage: 109,890 gallons Total Fuel Annual Usage: 2,225,000 gallons

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Airport Building 4 Atlanta, GA 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Airport Building 6 Atlanta, GA 1 each 6,000 gl Unl tank UST 1 each 6,000 gl Dsl tank UST

City Hall 69 Mitchell Street Atlanta, GA 1 each 14,000 gl Dsl (generator)

Total Unl Annual Usage: 1,500,000 gls Total Dsl Annual Usage: 1,500,000 gls Total Fuel Annual Usage: 3,000,000 gls

CITY OF ATLANTA INFORMATION

Fire Station 1 71 Elliot Street Atlanta, GA 1 each 1,000 gl Dsl tank UST

Fire Station 5 2825 Campbelton Rd Atlanta, GA 1 each 1,000 gl Dsl tank UST

Fire Station 8 1711 Marietta Blvd Atlanta, GA 1 each 1,000 gl Dsl tank UST

Fire Station 10 477 Boulevard, SE Atlanta, GA 1 each 1,000 gl Dsl tank UST

Fire Station 12 1288 Dekalb Ave, NE Atlanta, GA 1 each 1,000 gl Dsl tank UST

Fire Station 16 1048 Simpson St, NW Atlanta, GA 1 each 1,000 gl Dsl tank UST

Fire Station 25 2349 Benjamin E. Mays Atlanta, GA 1 each 1,000 gl Dsl tank UST

Fire Station 26 2970 Howell Mill Rd., NW Atlanta, GA 1 each 1,000 gl Dsl tank UST

Fire Station 31 2406 Fairburn Rd Atlanta, GA 1 each 1,000 gl Dsl tank UST

Fire Station 38 2911 Bankhead Hwy Atlanta, GA 1 each 1,000 gl Dsl tank UST

Maddox Park 1120 North Ave, NW Atlanta, GA 1 each 12,000 gl Unl tank UST 1 each 20,000 gl Dsl tank UST

Northside Dr 1540 Northside Dr.

Atlanta, GA 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Hill Street 1146 Hill Street Atlanta, GA 1 each 12,000 gl Unl tank UST 1 each 20,000 gl Dsl tank UST

Claire Drive 23 Claire Drive SE Atlanta, GA 1 each 20,000 gl Unl tank UST 1 each 20,000 gl Dsl tank UST

Chester Ave 3150 Chester Ave Atlanta, GA 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Howell Mill 1370 Howell Mill Rd Atlanta, GA 1 each 20,000 gl Unl tank UST 1 each 20,000 gl Dsl tank UST

City Hall East 675 Ponce De Leon Atlanta, GA 2 each 12,000 gl Unl tank UST

Chastain 3995 Powers Ferry Rd Atlanta, GA 1 each 1,000 gl Unl tank UST 1 each 2,000 gl Dsl tank UST

BL051-23 Page 12

FULTON COUNTY INFORMATION

Big Creek Pumping Station 1030 Roswell-Marietta Hwy.

Roswell, GA. 30075 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Central Maintenance Facility - Lower Pump 895 Marietta Blvd.

Atlanta, GA. 30318 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Central Maintenance Facility - Upper Pump 895 Marietta Blvd.

Atlanta, GA. 30318 1 each 12,000 gl Unl tank UST

North Service Center 7741 Roswell Rd.

Atlanta, GA. 30338 1 each 10,000 gl Unl tank UST

Willis Mills 125 Willis Mill Rd.

Atlanta, GA. 30311 1 each 10,000 gl Unl tank UST 1 each 6,000 gl Dsl tank UST

Charlie Brown Airport 3920 Aviation Cir.

Atlanta, GA. 30336 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

South Service Center 5600 Stonewall Tell Rd.

Union City, GA. 30349 1 each 10,000 gl Unl tank UST

Stonewall Camp 5601 Stonewall Tell Rd.

Union City, GA. 30349 1 each 10,000 gl Unl tank UST 1 each 10,000 gl Dsl tank UST

Water Resources Operation Center 11575 Maxwell Road, Alpharetta, GA 30004 1 – 12,000 gl Unl tank UST 1 – 12,000 gl Dsl tank UST

Total Unl Annual Usage: 682,358 gls Total Dsl Annual Usage: 83,215 gls Total Fuel Annual Usage: 765,573 gls

FULTON COUNTY FIRE STATIONS

Fire Station #1 5165 Welcome All Road. College Park, GA 30349 1 – 1,000 gl Dsl tank AST

Fire Station #2 4121 Cascade Road, Atlanta, GA 30331 1 – 500 gl Dsl tank AST

Fire Station #3 4035 Stonewall Tell Road, College Park, GA 30349 1 – 1,000 gl Dsl tank AST

Fire Station #5 3175 Bethesaida Road, Fairburn, GA 30213 1 – 500 gl Dsl tank AST

Fire Station #7 5965 Buffington Road, College Park, GA 30349 1 – 1,000 gl Dsl tank AST

Fire Station #11 4760 Fulton Industrial Blvd, Atlanta, GA 30336 1 – 1,000 gl Dsl tank AST

Fire Station #13 5890 Plummer Road, Atlanta, GA 30331 1 – 12,000 gl Unl tank UST 1 – 6,000 gl Dsl tank UST

Fire Station #15 6720 Cedar Grove Road, Fairburn, GA 30213 1 – 1,000 gl Dsl tank AST

Fire Station #17 8675 Ridge Road, Fairburn, GA 30213 1 – 1,000 gl Dsl tank AST

Total Unl Annual Usage: 682,358 gls Total Dsl Annual Usage: 83,215 gls Total Fuel Annual Usage: 765,573 gls

FULTON COUNTY SCHOOLS

South Transportation 97 Heath Street, 71 Heath Street Fairburn, GA 30213 2 each 12,000 gl Dsl UST 1 each 12, 000 gl Unl UST

North Transportation 410 S. Main Street Alpharetta, GA 30004 2 each 15,000 gl Dsl UST 1 each 15,000 gl Unl UST

Warehouse 4415 Wickersham Drive College Park, GA 30337 1 each 8,000 gl Dsl UST

Total Unl Annual Usage: 40,000 gls Total Dsl Annual Usage: 120,000 gls Total Fuel Annual Usage: 200,000 gls

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DEKALB COUNTY INFORMATION

Fire Station #1 1619 Clifton Road Atlanta, GA 30307 1 each 1,000 gl Dsl tank UST

Fire Station #2 1316 Dresden Drive Atlanta, GA 30319 1 each 1,000 gl Dsl tank UST

Fire Station #4 4540 Flakes Mill Road Ellenwood, GA 30294 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Fire Station #6 2342 Flat Shoals Road Atlanta, GA 30316 1 each 1,000 gl Unl tank UST 1 each 1,000 gl Dsl tank UST

Fire Station #7 1776 Derrill Drive Decatur, GA 30032 1 each 1,000 gl Dsl tank UST

Fire Station #8 2711 Clairmont Road Atlanta, GA 30329 1 each 1,000 gl Dsl tank UST

Fire Station #9 3855 North Druid Hills Road Decatur, GA 30033 1 each 1,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Fire Station #10 1686 Constitution Road Atlanta, GA 30316 1 each 1,000 gl Dsl tank UST

Fire Station #11 6715 Memorial Drive Stone Mountain, GA 30083 1 each 1,000 gl Dsl tank UST

Fire Station #13 5619 Redan Drive Stone Mountain, GA 30088 1 each 1,000 gl Dsl tank UST

Fire Station #14 7207 Covington Highway Lithonia, GA 30058 1 each 1,000 gl Dsl tank UST

Fire Station #16 2750 Pleasantwood Drive Decatur, GA 30034 1 each 1,000 gl Dsl tank UST

Fire Station #17 3900 Evans Mill Road Lithonia, GA 30058 1 each 1,000 gl Dsl tank UST

Fire Station #18 4588 Barclay Drive Chamblee, GA 30338 1 each 1,000 gl Unl tank UST 1 each 10,000 gl Dsl tank UST

Fire Station #22 1859 Montreal Road Tucker, GA 30084 1 each 1,000 gl Unl tank UST 1 each 1,000 gl Dsl tank UST

Fire Station #23 1265 Brockett Road Clarkston, GA 30021 1 each 1,000 gl Unl tank UST 1 each 1,000 gl Dsl tank UST

Fire Station #24 4154 Redan Road Stone Mountain, GA 30083 1 each 1,000 gl Unl tank UST 1 each 1,000 gl Dsl tank UST

Fire Station #25 7136 Rockbridge Road Stone Mountain, GA 30087 1 each 1,000 gl Unl tank UST 1 each 1,000 gl Dsl tank UST

Fleet Maintenance, A-Shop 772 Camp Drive Decatur, GA 30032 1 each 20,000 gl Unl tank UST

Calloway Square 120 West Trinity Place Decatur, GA 30030 1 each 12,000 gl Unl tank UST

Roads & Drainage 729 Camp Road Decatur, GA 30032 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Water & Sewer 1580 Roadhaven Drive Stone Mountain, GA 30083 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

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Sanitation South Lot 1753 Fairlake Road Decatur, GA 30034 1 each 10,000 gl Unl tank UST 1 each 10,000 gl Dsl tank UST

Sanitation North Lot 2315 Chamblee-Tucker Road Chamblee, GA 30341 1 each 10,000 gl Unl tank UST 1 each 10,000 gl Dsl tank UST

Sanitation Buford Plant 4600 Buford Highway Chamblee, GA 30341 1 each 10,000 gl Dsl tank UST

Sanitation Central Lot 3689 Camp Circle Decatur, GA 30032 1 each 12,000 gl Dsl tank UST

Sanitation East Lot 1750 Rogers Lake Road Lithonia, GA 30058 1 each 10,000 gl Dsl tank UST

Sanitation Ward Lake / South Lot 3115 Ward Lake Road Ellenwood, GA 30294 1 each 12,000 gl Unl tank UST

East Police Precinct 2484 Bruce Street Lithonia, GA 30058 1 each 10,000 gl Unl tank UST

Total Unl Annual Usage: 2,117,411 gls Total Dsl Annual Usage: 2,619,655 gls Total Fuel Annual Usage: 4,737,066 gls

DEKALB COUNTY BOE INFORMATION

Sam A. Moss Service Center 1780 Montreal Road Tucker, GA 30084 2 each 10,000 gl Unl tank UST 2 each 10,000 gl Dsl tank UST

Mountain Industrial Fuel Depot (special truck access instructions) 1701 Mountain Industrial Blvd.

Tucker, GA 30084 1 each 5,000 gl Unl tank UST - w/remote fills 2 each 10,000 gl Dsl tank UST - w/remote fills

South Campus Fuel Depot (Pump Truck Required) 2901 Clifton Springs Road Decatur, GA 30034 1 each 3,000 gl Unl tank AST 2 each 5,000 gl Dsl tank AST

Total Unl Annual Usage: 200,000 gls Total Dsl Annual Usage: 2,300,000 gls Total Fuel Annual Usage: 2,500,000 gls

ROCKDALE COUNTY INFORMATION

2570 Old Covington Hwy, Conyers GA 30012 1 each 20,000 gl Unl tank UST 1 each 10,000 gl Dsl tank UST

911 Chambers Drive, Conyers GA 30012 1 each 500 gl Dsl tank UST 1 each 1,200 gl Dsl tank UST 1 each 2,300 gl Dsl tank UST

Total Unl Annual Usage: 283,200 gls Total Dsl Annual Usage: 84,000 gls

DAWSON COUNTY INFORMATION

Burt Creek Complex 946 Burt Creek Road Dawsonville, GA 30534 1 each 10,000 gl Unl tank UST 1 each 10,000 gl Dsl tank UST

Riverview Middle School 2156 Hwy 9 South Dawsonville, GA 30534 1 each 1,000 gl Unl tank UST 1 each 3,000 gl Dsl tank UST

Total Unl Annual Usage: 142,000 gls Total Dsl Annual Usage: 180,000 gls Total Fuel Annual Usage: 322,000 gls

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COBB COUNTY SCHOOL DISTRICT AND BOC INFORMATION AND STIPULATIONS

1. The CCSD wishes to pressure test all tanks belonging to the School District during the month of July in order to comply with the EPA regulations. CCG pressure tests all tanks belonging to the Government every five years to comply with the EPA regulations.

2. If not capable of delivering all fuel in a metered tank, the CCSD/CCG requires stick measure of the storage tanks before and after each delivery to be recorded on the bill of lading.

3. Goods covered by this invitation to bid shall comply with all Federal and State occupational safety & health acts.

4. The successful vendor must call 770-426-3528 before each delivery, so that staff will be available to unlock the tanks when the vendor arrives. The tanks will be measured before and after each delivery in the presence of the vendor.

COBB COUNTY SCHOOL DISTRICT INFORMATION

South Cobb Vehicle Maintenance 620 South Cobb Drive Marietta, GA 30060 1 each 12,000 gl Unl tank UST 2 each 12,000 gl Dsl tank UST

Sanders Road Vehicle Maintenance 3826 Sanders Road Marietta, GA 30060 2 each 15,000 gl Dsl tank UST 1 each 15,000 gl Unl tank UST

Baker Road Shop 2351 Baker Road Acworth, GA 30101 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Administrative-Maintenance Facility 538 Glover Street Marietta, GA 30060 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

J. J. Daniell Middle School 2900 Scott Road Marietta, GA 30066 1 each 12,000 gl Dsl tank UST

Kennesaw Warehouse 6975 Cobb Int’l Blvd Kennesaw, GA 30152 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Mabry Middle School 2700 Jims Road Marietta, GA 30066 1 each 12,000 gl Dsl tank UST

Pine Mt. Middle School 2720 Pine Mt. Circle Kennesaw, GA 30144 1 each 12,000 gl Dsl tank UST

Mars Hill Road Shop 2865-B Mars Hill Road Acworth, GA 30101 1 each 12,000 gl Unl tank UST 1 each 12,000 gl Dsl tank UST

Total Unl Annual Usage: 125,000 gls Total Dsl Annual Usage: 2,100,000 gls Total Fuel Annual Usage: 2,225,000 gls

COBB COUNTY BOC INFORMATION

Fleet Management 1940 County Services Pkwy Marietta, GA 30008 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tnk UST

McCollum – Precinct # 1 2380 N. Cobb Pkwy Kennesaw, GA 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tnk UST

BL051-23 Page 16

COBB COUNTY BOC INFORMATION

Austell – Precinct # 2 4700 Austell Rd Austell, GA 1 each 15,000 gl Unl tank UST 1 each 6,000 gl Dsl tnk UST

Cumberland – Precinct # 3 1901 Cumberland Pkwy Smyrna, GA 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tnk UST

Lower Roswell –Precinct # 4 4700 Lower Roswell Rd Marietta, GA 1 each 15,000 gl Unl tank UST 1 each 500 gl Dsl tnk UST

Midway – Precinct # 5 4640 Dallas Hwy Marietta, GA 1 each 15,000 gl Unl tank UST 1 each 15,000 gl Dsl tnk UST

Main Water System 680 South Cobb Dr Marietta, GA 1 each 20,000 gl Unl tank UST 1 each 20,000 gl Dsl tnk UST

Cobb County Transit (CCT) 463 Commerce Park Dr Marietta, GA 1 each 10,000 gl Dsl tank UST 1 each 15,000 gl Dsl tank UST

Noonday Treatment Plant 415 Shallowford Rd Kennesaw, GA 1 each 2,500 gl Unl tank UST 1 each 1,000 gl Dsl tnk UST

Northwest Treatment Plant Old Hwy 41 Kennesaw GA 1 each 2,500 gl Unl tank UST 1 each 1,000 gl Dsl tnk UST

Sutton Treatment Plant 5175 Atlanta Road Smyrna, GA 1 each 2,500 gl Unl tank UST 1 each 2,500 gl Dsl tnk UST

South Cobb Treatment Plant 490 Lee Industrial Blvd Austell, GA 1 each 2,500 gl Unl tank UST 1 each 1,000 gl Dsl tnk UST

Station # 14 Mountain View 2905 Library Lane Marietta, GA 1 each 1,500 gl Unl tank UST 1 each 1,500 gl Dsl tnk UST

Total Unl Annual Usage: 1,500,000 gls Total Dsl Annual Usage: 850,000 gls Total Fuel Annual Usage: 2,350,000 gls

ALANTA PUBLIC SCHOOLS SYSTEM INFORMATION AND STIPULATIONS

1. Atlanta Public Schools will purchase fuel on an as-needed basis.

2. Fuel provided under this contract must comply with all federal and state occupational safety and health acts.

3. The fuel storage tanks are located underground.

4. Atlanta Public Schools may pressure test all tanks belonging to APS during the month of July to comply with the EPA regulations.

5. If not capable of delivering all fuel in a metered tank, APS requires stick measure of the storage tanks before and after each delivery to be recorded on the bill of lading.

BL051-23 Page 17

6. The successful bidder must call 404-802-5539 before each delivery, so that we can have someone meet the vendor with the keys to unlock the tanks. The tanks will be measured before and after each delivery in the presence of the vendor.

7. Primary delivery time for APS is between 8:30 a.m. to 3:30 p.m.

ATLANTA PUBLIC SCHOOLS SYSTEM INFORMATION

Location: APS Fleet Maintenance 1631 LaFrance Street Atlanta, GA 30307 Type: Ultra Low Sulfur Diesel and 87 Octane Gasoline Day: Monday – Friday Time: 8:00 am to 3:30 pm Storage: 1 @ 15,000 gallon capacity

1@ 4,000 gallon capacity

Location: APS Transportation 1661 Metropolitan Atlanta, GA 30315 Type: Ultra Low Sulfur Diesel

Day: Monday – Friday Time: 7:30 am- 1:30 pm and 3:00 pm - 5:00pm Storage: Two fuel tanks, 15,000 gallon capacity

Location CLL Building 130 Trinity Ave.

Atlanta, Georgia 30303 Type: Ultra Low Sulfur Diesel Day: Monday – Friday Time: 7:30 am-1:30 pm and 3:00 pm - 5:00 pm Storage: One fuel tank, 800 gallon capacity

Location: Price Middle l 1670 Benjamin W. Bickers Drive, SW Atlanta, Georgia 30315 Type: Ultra Low Sulfur Diesel Day: Monday – Friday Time: 7:30 am - 1:30 pm and 3:00 pm - 5:00 pm Storage: One fuel tank, 100 gallon capacity

Location: Benjamin Mays High School 3450 Benjamin E. Mays Drive, SW Atlanta, GA 30311 Type: Ultra Low Sulfur Diesel Day: Monday – Friday Time: 7:30 am-1:30 pm and 3:00 pm - 5:00 pm Storage: One fuel tank, 100 gallon capacity

Location: North Atlanta High School 4111 Northside Pkwy, NW Atlanta GA, 30327 Type: Ultra Low Sulfur Diesel Day: Monday – Friday Time: 7:30 am – 1:30 pm and 3:00 pm – 5:00 pm.

Storage: One fuel tank , 100 gallon capacity

Total Unl Annual Usage: 76,000 gls Total Dsl Annual Usage: 838,000 gls Total Fuel Annual Usage: 914,000 gls

HENRY COUNTY BOC INFORMATION

Fleet Services 121 Work Camp Road McDonough, GA 30523 1 each 15,000 gal. Unleaded tank 1 each 15,000 gal. Diesel tank

Fleet Services 680 Fairview Road Stockbridge GA 30251 1 each 10,000 gal Unleaded tank 1 each 10,000 gal Diesel tank

Total Unleaded Annual Usage: 750,000 gal.

Total Diesel Annual Usage: 150,000 gal.

Total Fuel Annual Usage: 900,000 gal.

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NGFC Municipality Payment Terms Gwinnett County BOC and BOE Net 30 Days or Net 15 Days using E-Payables City of Atlanta Net 30 Days City of Covington Net 30 Days Fulton County Net 30 Days City of Marietta Net 30 Days City of Marietta Schools Net 30 Days Forsyth County Net 30 Days; unless discount is provided for Net 15 Days Jackson County Net 30 Days Dawson County BOC and BOE Net 30 Days City of Gainesville Net 30 Days City of Smyrna Net 30 Days Cobb County BOE Net 30 or .0100 cpg/Net 10 Cobb County BOC Net 30 Days DeKalb BOC Net 30 Days DeKalb BOE Net 30 Days Rockdale County Net 30 Days Atlanta Public Schools Net 30 Days

NGFC Municipality Delivery Information Gwinnett County BOC and BOE Information in bid document City of Atlanta 8:00am - 6:00pm Monday thru Thursday City of Covington 8:00am - 4:00pm, Monday - Friday Fulton County Big Creek Pumping Station: 8:00am – 3:30pm, Monday -

Friday Central Maintenance Facility: 8:00am - 3:30pm, Monday - Friday Charlie Brown Airport: 24/7 Willis Mill: 8:00am -3:30pm, Monday - Friday North Service Center: 24/7 South Service Center: 24/7 Stonewall Camp: 8:00am -3:30pm, Monday - Friday

City of Marietta 8:00am-4:00pm / Monday Thru Sunday Forsyth County Monday through Friday, excluding holidays, 8:00 – 5:00.

After hours deliveries can be made if required Jackson County 24 hours / 7 days a week Dawson County BOC and BOE 8:00am - 5:00pm, Monday - Friday City of Gainesville 8:00am - 5:00pm, Monday - Friday City of Smyrna 8:00am - 4:00pm, Monday - Friday Cobb County BOE Baker Rd bus shop: 6 am – 10 am

Mars Hill Rd bus shop: 6 am – 10 am Sanders Rd bus shop: 6 am – 10 am South Cobb bus shop: 6 am – 10 am Maintenance Bldg. on Glover St: 6 am – 10 am Warehouse: 6 am – 10 am Mabry Middle School: 6 am – 7 am Pine Mountain Middle School: 10 am – 1 pm Walton High School: 10 am – 1 pm Daniell Middle School: 10 am – 1 pm

Cobb County BOC 24 hours / 7 days a week

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DeKalb BOC 8:00 am to 12:00 pm for 7500 gallons Monday - Friday and 1000 gallons 7:00 to 5:00 pm Monday - Friday

DeKalb BOE Normally 5:30am to 5:00pm Monday thru Friday.

Additional hours can be done with prior arrangement, preferably w/ 24hrs notice minimum. We prefer early morning deliveries to avoid bus/tanker congestion at the facilities.

Atlanta Public Schools 8:00am - 5:00pm, Monday – Friday, occasional weekends

NGFC Municipality Annual Volumes by Location Gwinnett County BOC and BOE Fuel Site Gallons Dispensed

(Diesel and Unleaded)

JCB 341,516

Snell MS 102,787 Berkley Lake 482,204 Oakland 527,471 Southside 291,182 Swanson 836,039 Ham Mill 415,576 Buford 580,170 Seaboard 558,094 Scenic Hwy 708,831 L’ville Hwy 616,319 Snell Tag 606,128

Maddox Park 321,178 Northside Dr 178,746 Hill Street 292,458 Claire Drive 645,444 Chester Ave 54,320 Howell Mill 293,970 City Hall 36,073 Chastain 51,712 Airport Building 4 151,108 Airport Building 6 22,770 Fire Station 1 14,866 Fire Station 5 6,784 Fire Station 8 4,821 Fire Station 10 10,922 Fire Station 12 18,156 Fire Station 16 8,330 Fire Station 25 8,332 Fire Station 26 7,723 Fire Station 31 5,994 Fire Station 38 11,497

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Fulton County Big Creek Pumping Station 48,150 Central Maintenance Facility 143,600 Charlie Brown Airport 160,000 Willis Mill 22,200 North Service Center 28,700 South Service Center 88,000 Stonewall Camp 165,400 Fire Stations 50,000

City of Marietta Public Works 220,085 Public Safety 137,260 Fire Station No.2 6,619 Fire Station No.4 3,949 Fire Station No.5 5,306 Fire Station No.6 3,903 Marietta City Club 8,000

NGFC Municipality Annual Volumes by Location Forsyth County

212 Veteran’s Memorial Blvd. 151,500 4140 County Way 151,500 3520 Settingdown Road 151,500 800 McFarland Road 38,750 3680 Old Atlanta Road 38,750 7385 Browns Bridge Road 38,750 3805 Canton Highway 38,750 4045 Carolene Way 151,500 234 Castleberry Ind. Dr.

38,750

Dawson County BOC and BOE Burt Creek Complex 222,000 Riverview Middle School 100,000

City of Gainesville Alta Vista Fuel Site 367,690 Bradford Street Site 122,268

Atlanta Public Schools 1631 LaFrance Street 84,000 1661 Metropolitan 830,000

BL051-23 Page 21 Failure To Return This Page As Part Of Your Bid Document May Result In Rejection Of Bid.

COMPANY NAME _____________________________________________________________________________________________________________

BID SCHEDULE

**Total price will be based on (Weekly Discount/Mark-Up + price per gallon) x Estimated Annual Quantity not including taxes**

ITEM

EST.

ANNUAL

QTY.

UNIT DESCRIPTION

WEEKLY

DISCOUNT/

MARK-UP

DAILY

DISCOUNT/

MARK-UP

PRICE PER

GALLON

(OPIS)*

TOTAL**

1 15,799,062 Gal. Diesel Fuel, ultra-low sulfur, #2 Full Transport Load Quantity

$1.22

2 3,629,094 Gal. Diesel Fuel, ultra-low sulfur, #2 Tank Wagon Load Quantity

$1.22

3 11,686,222 Gal. Low Sulfur Gasoline Ethanol Full Transport Load Quantity

$1.30

4 2,981,274 Gal. Low Sulfur Gasoline Ethanol Tank Wagon Load Quantity

$1.30

5 40,000 Gal. Diesel Exhaust Fluid

$1.79

BID TOTAL $

* For evaluation purpose only State cost of split deliveries $ _________________________This is for different location sites and does not apply to multiple tanks at one site. Primary site cannot be charged in fee.)

State pump fee $ State short load fee $ (less than 7,200 gallons – Diesel; less than 8,000 gallons – Unleaded))

North Georgia Fuel Cooperative requires pricing to remain firm for the duration of the initial term of the contract. Failure to hold firm pricing for the initial term of the contract will be sufficient cause for the NGFC to declare bid non-responsive. Contract to begin on August 31, 2017.

Unless otherwise noted, quoted prices will remain firm for four (4) additional years. NGFC reserves the right to negotiate pricing/discounts for the additional renewal periods based on increased volumes from increased participation.

If a percentage decrease will be part of this bid, please note this in the space provided.

1st renewal period 2nd renewal period

3rd renewal period 4th renewal period

BL051-23 Page 22 Failure To Return This Page As Part Of Your Bid Document May Result In Rejection Of Bid.

BID SCHEDULE (CONTINUED)

If a percentage increase will be a part of this bid, please note this in the space provided.

1st renewal period 2nd renewal period

3rd renewal period 4th renewal period

TERMINATION FOR CAUSE:

The NGFC and any of its participants may terminate this agreement for cause upon ten (10) days prior written notice to the Service Provider of the Service Provider's default in the performance of any term of this Agreement. Such termination shall be without prejudice to any of the NGFC and its participant’s rights or remedies provided by law.

TERMINATION FOR CONVENIENCE:

The NGFC and its participants may terminate this Agreement for its convenience at any time upon 30 days written notice to the Service Provider. In the event of the NGFC and any of its participant’s termination of this Agreement for convenience, the Service Provider will be paid for those services actually performed. Partially completed performance of the Agreement will be compensated based upon a signed statement of completion to be submitted by the Service Provider who shall itemize each element of performance.

TERMINATION FOR FUND APPROPRIATION

The NGFC and any of its participants may unilaterally terminate this Agreement due to a lack of funding at any time by written notice to the Supplier(s). In the event of the NGFC and its participant’s termination of this Agreement for fund appropriation, the Supplier(s) will be paid for those services actually performed. Partially completed performance of the Agreement will be compensated based upon a signed statement of completion to be submitted by the Contractor which shall itemize each element of performance.

Certification of Non-Collusion in Bid Preparation Signature Date

In compliance with the attached specifications, the undersigned offers and agrees, if this bid is accepted by the Board of Commissioners within 90 days of the date of bid opening, to furnish any or all of the items upon which prices are bid, at the price set opposite each item, delivered to the designated point(s) within the time specified in the bid schedule.

Legal Business Name Federal Tax ID (If your company is an LLC, you must identify all principals to include addresses and phone numbers in your submittal)

Address

Does your company currently have a location within Gwinnett County? Yes No

Representative Signature Printed Name

Telephone Number Fax Number E-mail address

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PRODUCT SUPPLIER CONFIRMATION

State of

County of

Personally came , who being first sworn, on oath deposes and says as follows:

1) My name is and that I am the of , Product Supplier (Supplier) (Title) to the USTs located at

(Facility Name and Address)

2) That in my capacity of of Supplier, I am familiar (Title) with the books and records maintained in the regular course of Supplier’s business, especially concerning the sale of petroleum and the collection of and payment by Supplier of Environmental Assurance Fees (EAFs) for participants in the Georgia Underground Storage Tank (GUST) Trust Fund to the State of Georgia.

3) That the records of Supplier show that EAFs were collected on all petroleum product delivered to

(Facility Name and Address) and that all EAFs so collected were properly and timely remitted to its distributor, for payment to the GUST Trust Fund or directly to the Gust Trust Fund as provided by the Underground Storage Tank Act and The Rules for Underground Storage Tank Management.

4) That I am aware that the Environmental Protection Division will rely on the representations made and information provided herein in determining whether is a participant in the GUST Trust Fund for the facility located at , and I further warrant and represent that Supplier’s records of EAF collection and payment are available for inspection and audit by the employees or authorized agents of the Georgia Environmental Protection Division or State of Georgia.

(Signature)

Sworn to and subscribe before me this Day of , 20

Notary Public My Commission Expires (Seal)

BL051-23 Page 24 Failure to return this page as part of your bid document may result in rejection of bid

REFERENCES

Gwinnett County requests a minimum of three, (3) references where work of a similar size and scope has been completed.

1. Company Name

Brief Description of Project

Completion Date

Contact Person

Telephone Facsimile

E-Mail Address

2. Company Name

3. Company Name

COMPANY NAME _________________________________________________________________________

BL051-23 Purchase of Gasoline and Diesel Fuel on an Annual Contract Page 25

CODE OF ETHICS AFFIDAVIT

PLEASE RETURN THIS FORM COMPLETED WITH YOUR SUBMITTAL. SUBMITTED FORMS ARE

REQUIRED PRIOR TO EVALUATION.

In accordance with Section 54-33 of the Gwinnett County Code of Ordinances the undersigned bidder/proposer makes the following full and complete disclosure under oath, to the best of their knowledge, of the name(s) of all elected officials whom it employs or who have a direct or indirect pecuniary interest in or with the bidder/proposer, its affiliates or its subcontractors:

1. __________________________________________________________________________________________

Company Submitting Bid/Proposal

2. Please select one of the following:

No information to disclose (complete only section 4 below) Disclosed information below (complete section 3 & section 4 below)

3. If additional space is required, please attach list:

Gwinnett County Elected Official Name Gwinnett County Elected Official Name

Gwinnett County Elected Official Name Gwinnett County Elected Official Name

4. BY:

Authorized Officer or Agent Signature

Printed Name of Authorized Officer or Agent

Title of Authorized Officer or Agent of Contractor

Sworn to and subscribed before me this day of , 20

Notary Public

(seal)

Note: See Gwinnett County Code of Ethics Ordinance EO2011, Sec. 54-33.

The ordinance will be available to view in its’ entirety at GwinnettCounty.com

BL051-23 Purchase of Gasoline and Diesel Fuel on an Annual Contract Page 26

CONTRACTOR AFFIDAVIT AND AGREEMENT

(THIS FORM SHOULD BE FULLY COMPLETED AND RETURNED WITH YOUR SUBMITTAL)

By executing this affidavit, the undersigned contractor verifies its compliance with The Illegal Reform

Enhancements for 2013, stating affirmatively that the individual, firm, or corporation which is contracting with the Gwinnett County Board of Commissioners has registered with and is participating in a federal work authorization program* [any of the electronic verification of work authorization programs operated by the United States Department of Homeland Security or any equivalent federal work authorization program operated by the United States Department of Homeland Security to verify information of newly hired employees, pursuant to the Immigration Reform and Control Act, in accordance with the applicability provisions and deadlines established therein.

The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services or the performance of labor pursuant to this contract with the Gwinnett County Board of Commissioners, contractor will secure from such subcontractor(s) similar verification of compliance with the Illegal Immigration Reform and Enforcement Act on the Subcontractor Affidavit provided in Rule 300-10-01-.08 or a substantially similar form. Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the Gwinnett County Board of Commissioners at the time the subcontractor(s) is retained to perform such service.

E-Verify * User Identification Number Date Registered

Legal Company Name

Company Address

BY: Authorized Officer or Agent Date (Contractor Signature)

Title of Authorized Officer or Agent of Contractor

Printed Name of Authorized Officer or Agent

SUBSCRIBED AND SWORN

BEFORE ME ON THIS THE

_______ DAY OF ______________________, 202__

Notary Public My Commission Expires:

For Gwinnett County Use Only:

Document ID #_________________ Issue Date:_____________________ Initials: _______________________

* As of the effective date of O.C.G.A. 13-10-91, the applicable federal work authorization program is “E- Verify” operated by the U.S. Citizenship and Immigration Services Bureau of the U.S.

Department of Homeland Security, in conjunction with the Social Security Administration (SSA).

BL051-23 Page 27

STANDARD INSURANCE REQUIREMENTS

1. Statutory Workers' Compensation Insurance

(a) Employers Liability:

Bodily Injury by Accident - $100,000 each accident Bodily Injury by Disease - $500,000 policy limit Bodily Injury by Disease - $100,000 each employee

2. Commercial General Liability Insurance

(a) $500,000 limit of liability per occurrence for bodily injury and property damage

(b) The following additional coverage must apply:

1986 (or later) ISO Commercial General Liability Form Dedicated Limits per Project Site or Location (CG 25 03 or CG 25 04) Additional Insured Endorsement (Form B CG 20 10 with a modification for completed operations or a separate endorsement covering Completed Operations) Blanket Contractual Liability Broad Form Property Damage Severability of Interest Underground, explosion, and collapse coverage Personal Injury (deleting both contractual and employee exclusions) Incidental Medical Malpractice Hostile Fire Pollution Wording

3. Auto Liability Insurance

(a) $500,000 limit of liability per occurrence for bodily injury and property damage

(b) Comprehensive form covering all owned, non-owned, leased, hired, and borrowed vehicles

(c) Additional Insured Endorsement

(d) Contractual Liability

4. Umbrella Liability Insurance - $1,000,000 limit of liability

(a) The following additional coverage must apply Additional Insured Endorsement Concurrency of Effective Dates with Primary Blanket Contractual Liability Drop Down Feature Care, Custody, and Control - Follow Form Primary Aggregates: Apply Where Applicable in Primary Umbrella Policy must be as broad as the primary policy

5. Gwinnett County Board of Commissioners (and any applicable Authority) should be shown as an additional insured on General Liability, Auto Liability and Umbrella Liability policies.

6. The cancellation should provide 10 days notice for nonpayment and 30 days notice of cancellation.

7. Certificate Holder should read:

Gwinnett County Board of Commissioners 75 Langley Drive Lawrenceville, GA 30046-6935

8. Insurance Company, except Worker' Compensation carrier, must have an A.M. Best Rating of A-5 or higher. Certain

Workers' Comp funds may be acceptable by the approval of the Insurance Unit. European markets including those based in London and domestic surplus lines markets that operate on a non-admitted basis are exempt from this requirement provided that the contractor’s broker/agent can provide financial data to establish that a market is equal to or exceeds the financial strengths associated with the A.M. Best’s rating of A-5 or better.

9. Insurance Company should be licensed to do business by the Georgia Department of Insurance.

10. Certificates of Insurance, and any subsequent renewals, must reference specific bid/contract by project name and project/bid number.

11. The Contractor shall agree to provide complete certified copies of current insurance policy (ies) or a certified letter from the insurance company (ies) if requested by the County to verify the compliance with these insurance requirements.

12. All insurance coverages required to be provided by the Contractor…