Backup Documents 10/27/2015 Item #16E3 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO ,
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
**NEW** ROUTING SLIP
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1.
2.
3. County Attorney Office County Attorney Office �3 tU 12.1 115
4. BCC Office Board of County 1't
Commissioners VI\V-} VD\Z ,VS
5. Minutes and Records Clerk of Court's Office a:/0Prt
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above,may need to contact staff for additional or missing information.
Name of Primary Staff Debbie Brueggeman, min, Airport Phone Number 642-7878 Ext. 34
Contact/ Department Authority
Agenda Date Item was October 27,2015 Agenda Item Number 16E3
Approved by the BCC
Type of Document Three Letters of Understanding Number of Original 3
Attached Documents Attached
PO number or account N/A
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A" in the Not Applicable column,whichever is Yes N/A(Not
appropriate. (Initial) Applicable)
1. Does the document require the chairman's original signature? SA,4 ne.i0 o 1,Cq _ N/A
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name; Agency;Address; Phone)on an attached sheet.
3. Original document has been signed/initialed for legal sufficiency. (All documents to be JAB
signed by the Chairman,with the exception of most letters,must be reviewed and signed
by the Office of the County Attorney.
4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A
Office and all other parties except the BCC Chairman and the Clerk to the Board
5. The Chairman's signature line date has been entered as the date of BCC approval of the JAB
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's a
"()
)
signature and initials are required.
7. In most cases(some contracts are an exception),the original document and this routing slip
should be provided to the County Attorney Office at the time the item is input into SIRE.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on 10/27/15 and all changes made during JAB
the meetinghave been incorporated in the attached document. The
PCounty
Attorney's Office has reviewed the changes,if applicable.
9. Initials of attorney verifying that the attached document is the version approved by the JAB
BCC, all changes directed by the BCC have been made,and the document is ready for t e 1 �
�` ..
Chairman's signature.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04,Revised 1.26.05,Revised 2.24.05;Revised 11/30/12
1 6 E 3
MEMORANDUM
Date: October 29, 2015
To: Debbie Brueggeman, Operations Coordinator
Collier County Airport Authority
From: Teresa Cannon, Deputy Clerk
Minutes & Records Department
Re: Letter of Understanding— Phillips 66 Branded Airport Dealers
Excess Liability Insurance Program for the Everglades Airpark,
Immokalee Regional Airport and the Marco Island Executive
Airport
Attached for your records, are three (3) copies of each document referenced
above, (Item #16G3) approved by the Board of County Commissioners on
Tuesday, October 27, 2015.
The Minutes and Record's Department has kept the original documents as part of
the Board's Official Record's of the Board.
If you have any questions, please feel free to call me at 252-8411.
Thank you.
'66 ii�` �,
Hry
RETURN COMPLETED FORM TO: michelle.d.miller@p66.com
or Fax#: 918-977-7897
Phillips 66-Branded Airport Dealers Excess Liability Insurance Program-LETTER OF UNDERSTANDING
I hereby request to be included (free of charge) in the Phillips 66-Branded Airport Dealers Excess Liability Insurance Program
("Program"). Once properly enrolled, I will be automatically re-enrolled in the Program effective April 1 of each year, from year to
year thereafter, so long as:
(1) I am a Phillips 66-branded fixed base operator("FBO") pursuant to a Phillips 66 branded aviation supply agreement
directly with Phillips 66 Company('Phillips 66")or through a Phillips 66 marketer, and,
(2)I meet the Program requirements.
As of April 1, 2008, the Program provides excess liability coverage in the amount of $50,000,000 per occurrence and in the
aggregate for sums which I am legally obligated to pay due to a covered occurrence during the policy period when Phillips 66-
branded fuels and lubricants are used, and arising from the activities listed below. It should be understood that the Program is
specifically linked to and only meant to respond to Phillips 66' business as a supplier of branded aviation products, and is limited
to the following activities:
a. Aviation fuel into plane services relating to sale, service, storage and supply of Phillips 66-branded aviation fuel and lubricant
products, including fueling and defueling operations.
b. Aviation fuel tank facilities relating to the storage of fuel and operation of fuel tank facilities.
c. Operation of fueling trucks and other vehicles within airport premises.
I further understand that if I have a fuel supply agreement directly with Phillips 66 or with a Phillips 66 marketer, and if I carry
primary contractual liability insurance covering my liability under that agreement, then the Airport Dealers Excess Liability
Insurance will, in addition to the coverage explained above, also provide contractual liability coverage to the same extent, subject
to policy exclusions.
II. To participate in the Program, I understand that I must maintain in effect primary liability insurance(including Products
Liability and Completed Operations Liability)in the following amounts:
a. Not less than the amounts carried at the time I received knowledge of this excess liability coverage,but
b. In any event no less than $1,000,000 combined single limit for each occurrence and in the annual aggregate with
respect to Products Liability and Completed Operations coverage. Evidence of coverage must specifically include
limits of $1,000,000 in the aggregate for Products Liability and Completed Operations coverage. Any sublimits
below$1,000,000 on a"per person"or"per passenger" basis will disqualify me from the Program.
I understand that this excess liability coverage will be afforded to me only to the extent that I maintain insurance to
comply with the above primary insurance requirements. I further understand that the Phillips 66-Branded Airport
Dealers Excess Liability insurance coverage will change without notice should my coverage expire or should the
amounts of my primary liability insurance be reduced below $1,000,000 (except in the event of a claim depleting the
underlying limit).
A properly completed Letter of Understanding is required from me in order to be covered under the Program. Once I am
enrolled in the Program, I will be automatically re-enrolled thereafter for twelve month periods effective each April 1 pursuant to
the current terms and conditions of the Program. Phillips 66 will forward a revised Letter of Understanding if there are changes to
the Program (e.g. changes in the renewal dates or policy limits). Written notice will be given in the event the Program is
terminated.
I agree and am in compliance with the above primary insurance requirements.
III. Coverage Issues and Exclusions
a. It is important to understand that this Program is considered "following form"which means that the coverage provided under
the Program will follow the same policy terms, conditions, exclusions and limitations as my primary insurance affords to my
fuel/fueling related coverage. Coverage will not "follow form" and will be more restrictive if I no longer carry $1,000,000 of
commercial underlying insurance.
b. War Risks, Hijacking and other similar perils are specifically excluded under this Program, regardless of my primary policy
coverage.
Page 1 of 2 Phillips 66 Excess Liability LOU
mdm 8-31-15
Vz r
c. Regardless of the underlying coverage, Environmental Disturbance and Pollution are not covered.
d. No coverage is afforded to expenses related to a product recall.
e. No coverage is afforded for Nuclear, Date Recognition or Asbestos exposures.
f. No coverage is afforded if I have a Dealer Commingling Amendment.
g. The Program will not respond if I carry insurance limits of$250,000,000 or more.
h. The$50,000,000 aggregate limit is the total limit available to me. If there is a"catastrophic"loss that erodes the aggregate to
$0, there will be no further coverage for me under the Program. I will consider this possibility when deciding on the limits of
liability I purchase under my primary insurance program.
IV. I understand it is my responsibility to report any incident involving the use of Phillips 66-branded aviation fuels and/or lubricants
that involves bodily injury to third parties and/or damage to property of others, even if such a potential claim is not expected to
exceed the limits of my primary insurance. When an incident is reported, a copy of an accident report with the details of the
incident should be faxed to Phillips 66 General Aviation Technical Support at 918-662-6085 within 72 hours of the incident.
V. DIRECT DEALERS ONLY-I understand that as a direct dealer who is obtaining aviation fuel directly from Phillips 66(rather than
through a Phillips 66 marketer), I must have a current, active, and fully executed Phillips 66 branded aviation supply agreement
on file with Phillips 66 to be included in the Program.
VI. I UNDERSTAND THAT UPON RECEIPT BY PHILLIPS 66 OF THIS COMPLETED, SIGNED, AND DATED LETTER OF
UNDERSTANDING, MY COVERAGE UNDER THE PHILLIPS 66-BRANDED AIRPORT DEALERS EXCESS LIABILITY
INSURANCE PROGRAM WILL COMMENCE AND BE IN EFFECT THROUGH THE PREVIOUSLY IDENTIFIED POLICY
PERIOD, AND WILL BE AUTOMATICALLY RENEWED FROM YEAR TO YEAR THEREAFTER AS LONG AS I MEET THE
PROGRAM REQUIREMENTS. NO COVERAGE IS PROVIDED UNLESS A COMPLETED LETTER OF UNDERSTANDING
HAS BEEN RECEIVED AND CONFIRMED BY PHILLIPS 66,AND PROVIDED THE STATED REQUIREMENTS ARE MET.
(Please PRINT clearly):
FBO Name Collier County Airport Authority I Airport ID KX01
Mailing Address PO Box 689, 650 E.C.Airpark Rd j Airport Name Everglades Airpark
City, State,ZIP Everglades City, FL 34139 I Airport City, State Everglades City, FL
For Marketer-supplied FBOs: name of the Marketer who supplies my Phillips 66-branded aviation fuel:
Marketer Name World Fuel Services
As evidenced by my signature below, I understand, agree to,and am in compliance with this Letter of Understanding in order to
be included in the Phillips 66-Branded Aviation Airport Dealers Excess Liability Insurance Program:
FBO DEALER: J Approved as to form and legality
Signed By:
(on behalf of the FBO) �`
Name Printed: T 1 'M N A'N.) Assistant County ttorney q��.
Title: CNA L vNewpt
(This box to be completed by Phillips 66 Company)
Date ►O p.-11\5
ENROLLMENT CONFIRMATION
FBO's P66 Brand Date:
I Date Enrollment Is Effective:
ArtT Enrollment Confirmed by:
DWI T.E. t C1ork
Page 2 of 2 Phillips 66 Excess Liability LOU
Attest as to Chairman's mdm 8-31-15
3
�II�
16F3
(7.3
RETURN COMPLETED FORM TO: michelle.d.miller@p66.com
or Fax#: 918-977-7897
Phillips 66-Branded Airport Dealers Excess Liability Insurance Program-LETTER OF UNDERSTANDING
I hereby request to be included (free of charge) in the Phillips 66-Branded Airport Dealers Excess Liability Insurance Program
("Program"). Once properly enrolled, I will be automatically re-enrolled in the Program effective April 1 of each year, from year to
year thereafter, so long as:
(1) I am a Phillips 66-branded fixed base operator("FBO") pursuant to a Phillips 66 branded aviation supply agreement
directly with Phillips 66 Company('Phillips 66")or through a Phillips 66 marketer, and,
(2)I meet the Program requirements.
As of April 1, 2008, the Program provides excess liability coverage in the amount of $50,000,000 per occurrence and in the
aggregate for sums which I am legally obligated to pay due to a covered occurrence during the policy period when Phillips 66-
branded fuels and lubricants are used, and arising from the activities listed below. It should be understood that the Program is
specifically linked to and only meant to respond to Phillips 66' business as a supplier of branded aviation products, and is limited
to the following activities:
a. Aviation fuel into plane services relating to sale, service, storage and supply of Phillips 66-branded aviation fuel and lubricant
products, including fueling and defueling operations.
b. Aviation fuel tank facilities relating to the storage of fuel and operation of fuel tank facilities.
c. Operation of fueling trucks and other vehicles within airport premises.
I further understand that if I have a fuel supply agreement directly with Phillips 66 or with a Phillips 66 marketer, and if I carry
primary contractual liability insurance covering my liability under that agreement, then the Airport Dealers Excess Liability
Insurance will, in addition to the coverage explained above, also provide contractual liability coverage to the same extent, subject
to policy exclusions.
II. To participate in the Program, I understand that I must maintain in effect primary liability insurance(including Products
Liability and Completed Operations Liability)in the following amounts:
a. Not less than the amounts carried at the time I received knowledge of this excess liability coverage, but
b. In any event no less than $1,000,000 combined single limit for each occurrence and in the annual aggregate with
respect to Products Liability and Completed Operations coverage. Evidence of coverage must specifically include
limits of $1,000,000 in the aggregate for Products Liability and Completed Operations coverage. Any sublimits
below$1,000,000 on a"per person"or"per passenger" basis will disqualify me from the Program.
I understand that this excess liability coverage will be afforded to me only to the extent that I maintain insurance to
comply with the above primary insurance requirements. I further understand that the Phillips 66-Branded Airport
Dealers Excess Liability insurance coverage will change without notice should my coverage expire or should the
amounts of my primary liability insurance be reduced below $1,000,000 (except in the event of a claim depleting the
underlying limit).
A properly completed Letter of Understanding is required from me in order to be covered under the Program. Once I am
enrolled in the Program, I will be automatically re-enrolled thereafter for twelve month periods effective each April 1 pursuant to
the current terms and conditions of the Program. Phillips 66 will forward a revised Letter of Understanding if there are changes to
the Program (e.g. changes in the renewal dates or policy limits). Written notice will be given in the event the Program is
terminated.
I agree and am in compliance with the above primary insurance requirements.
III. Coverage Issues and Exclusions
a. It is important to understand that this Program is considered "following form"which means that the coverage provided under
the Program will follow the same policy terms, conditions, exclusions and limitations as my primary insurance affords to my
fuel/fueling related coverage. Coverage will not"follow form" and will be more restrictive if I no longer carry $1,000,000 of
commercial underlying insurance.
b. War Risks, Hijacking and other similar perils are specifically excluded under this Program, regardless of my primary policy
coverage.
Page 1 of 2 Phillips 66 Excess Liability LOU
mdm 8-31-15
16E3
c. Regardless of the underlying coverage, Environmental Disturbance and Pollution are not covered.
d. No coverage is afforded to expenses related to a product recall.
e. No coverage is afforded for Nuclear, Date Recognition or Asbestos exposures.
f. No coverage is afforded if I have a Dealer Commingling Amendment.
g. The Program will not respond if I carry insurance limits of$250,000,000 or more.
h. The$50,000,000 aggregate limit is the total limit available to me. If there is a"catastrophic" loss that erodes the aggregate to
$0, there will be no further coverage for me under the Program. I will consider this possibility when deciding on the limits of
liability I purchase under my primary insurance program.
IV. I understand it is my responsibility to report any incident involving the use of Phillips 66-branded aviation fuels and/or lubricants
that involves bodily injury to third parties and/or damage to property of others, even if such a potential claim is not expected to
exceed the limits of my primary insurance. When an incident is reported, a copy of an accident report with the details of the
incident should be faxed to Phillips 66 General Aviation Technical Support at 918-662-6085 within 72 hours of the incident.
V. DIRECT DEALERS ONLY-I understand that as a direct dealer who is obtaining aviation fuel directly from Phillips 66(rather than
through a Phillips 66 marketer), I must have a current, active, and fully executed Phillips 66 branded aviation supply agreement
on file with Phillips 66 to be included in the Program.
VI. I UNDERSTAND THAT UPON RECEIPT BY PHILLIPS 66 OF THIS COMPLETED, SIGNED, AND DATED LETTER OF
UNDERSTANDING, MY COVERAGE UNDER THE PHILLIPS 66-BRANDED AIRPORT DEALERS EXCESS LIABILITY
INSURANCE PROGRAM WILL COMMENCE AND BE IN EFFECT THROUGH THE PREVIOUSLY IDENTIFIED POLICY
PERIOD, AND WILL BE AUTOMATICALLY RENEWED FROM YEAR TO YEAR THEREAFTER AS LONG AS I MEET THE
PROGRAM REQUIREMENTS. NO COVERAGE IS PROVIDED UNLESS A COMPLETED LETTER OF UNDERSTANDING
HAS BEEN RECEIVED AND CONFIRMED BY PHILLIPS 66,AND PROVIDED THE STATED REQUIREMENTS ARE MET.
(Please PRINT clearly):
FBO Name Collier County Airport Authority I Airport ID KIMM
Mailing Address 165 Airpark Blvd I Airport Name Immokalee Regional Airport
City, State,ZIP Immokalee, FL 34142 I Airport City, State Immokalee, FL
For Marketer-supplied FBOs: name of the Marketer who supplies my Phillips 66-branded aviation fuel:
Marketer Name World Fuel Services
As evidenced by my signature below, I understand,agree to,and am in compliance with this Letter of Understanding in order to
be included in the Phillips 66-Branded Aviation Airport Dealers Excess Liability Insurance Program:
FBO DEALER: j
<//failteae._
Approved as to form and legalit}
Signed By:
(on behalf of the FBO)
Assistant Coun ttornev ‘A'‘
Name Printed: T► tM N A w)C
Title: CA-VA y COQ
(This box to be completed by Phillips 66 Company)
Date t O a:1 5
ENROLLMENT CONFIRMATION
-�+�
IV -r FBO's P66 Brand Date:
Z T E.
q, coo Date Enrollment Is Effective: _
Enrollment Confirmed by
Attest as to Chairman's
sigiature only. Page 2 of 2 Phillips 66 Excess Liability LOU
mdm 8-31-15
RETURN COMPLETED FORM TO: michelle.d.miller@p66.com
or Fax#: 918-977-7897
Phillips 66-Branded Airport Dealers Excess Liability Insurance Program-LETTER OF UNDERSTANDING
I hereby request to be included (free of charge) in the Phillips 66-Branded Airport Dealers Excess Liability Insurance Program
("Program"). Once properly enrolled, I will be automatically re-enrolled in the Program effective April 1 of each year, from year to
year thereafter,so long as:
(1) I am a Phillips 66-branded fixed base operator("FBO") pursuant to a Phillips 66 branded aviation supply agreement
directly with Phillips 66 Company('Phillips 66")or through a Phillips 66 marketer, and,
(2)I meet the Program requirements.
As of April 1, 2008, the Program provides excess liability coverage in the amount of $50,000,000 per occurrence and in the
aggregate for sums which I am legally obligated to pay due to a covered occurrence during the policy period when Phillips 66-
branded fuels and lubricants are used, and arising from the activities listed below. It should be understood that the Program is
specifically linked to and only meant to respond to Phillips 66' business as a supplier of branded aviation products, and is limited
to the following activities:
a. Aviation fuel into plane services relating to sale, service, storage and supply of Phillips 66-branded aviation fuel and lubricant
products, including fueling and defueling operations.
b. Aviation fuel tank facilities relating to the storage of fuel and operation of fuel tank facilities.
c. Operation of fueling trucks and other vehicles within airport premises.
I further understand that if I have a fuel supply agreement directly with Phillips 66 or with a Phillips 66 marketer, and if I carry
primary contractual liability insurance covering my liability under that agreement, then the Airport Dealers Excess Liability
Insurance will, in addition to the coverage explained above, also provide contractual liability coverage to the same extent, subject
to policy exclusions.
II. To participate in the Program, I understand that I must maintain in effect primary liability insurance(including Products
Liability and Completed Operations Liability)in the following amounts:
a. Not less than the amounts carried at the time I received knowledge of this excess liability coverage, but
b. In any event no less than $1,000,000 combined single limit for each occurrence and in the annual aggregate with
respect to Products Liability and Completed Operations coverage. Evidence of coverage must specifically include
limits of $1,000,000 in the aggregate for Products Liability and Completed Operations coverage. Any sublimits
below$1,000,000 on a"per person"or"per passenger" basis will disqualify me from the Program.
I understand that this excess liability coverage will be afforded to me only to the extent that I maintain insurance to
comply with the above primary insurance requirements. I further understand that the Phillips 66-Branded Airport
Dealers Excess Liability insurance coverage will change without notice should my coverage expire or should the
amounts of my primary liability insurance be reduced below $1,000,000 (except in the event of a claim depleting the
underlying limit).
A properly completed Letter of Understanding is required from me in order to be covered under the Program. Once I am
enrolled in the Program, I will be automatically re-enrolled thereafter for twelve month periods effective each April 1 pursuant to
the current terms and conditions of the Program. Phillips 66 will forward a revised Letter of Understanding if there are changes to
the Program (e.g. changes in the renewal dates or policy limits). Written notice will be given in the event the Program is
terminated.
I agree and am in compliance with the above primary insurance requirements.
III. Coverage Issues and Exclusions
a. It is important to understand that this Program is considered "following form" which means that the coverage provided under
the Program will follow the same policy terms, conditions, exclusions and limitations as my primary insurance affords to my
fuel/fueling related coverage. Coverage will not"follow form" and will be more restrictive if I no longer carry $1,000,000 of
commercial underlying insurance.
b. War Risks, Hijacking and other similar perils are specifically excluded under this Program, regardless of my primary policy
coverage.
Page 1 of 2 Phillips 66 Excess Liability LOU
mdm 8-31-15
16E3
I 7
't1 66 Il"
c. Regardless of the underlying coverage, Environmental Disturbance and Pollution are not covered.
d. No coverage is afforded to expenses related to a product recall.
e. No coverage is afforded for Nuclear, Date Recognition or Asbestos exposures.
f. No coverage is afforded if I have a Dealer Commingling Amendment.
g. The Program will not respond if I carry insurance limits of$250,000,000 or more.
h. The$50,000,000 aggregate limit is the total limit available to me. If there is a'catastrophic"loss that erodes the aggregate to
$0, there will be no further coverage for me under the Program. I will consider this possibility when deciding on the limits of
liability I purchase under my primary insurance program.
IV. I understand it is my responsibility to report any incident involving the use of Phillips 66-branded aviation fuels and/or lubricants
that involves bodily injury to third parties and/or damage to property of others, even if such a potential claim is not expected to
exceed the limits of my primary insurance. When an incident is reported, a copy of an accident report with the details of the
incident should be faxed to Phillips 66 General Aviation Technical Support at 918-662-6085 within 72 hours of the incident.
V. DIRECT DEALERS ONLY-I understand that as a direct dealer who is obtaining aviation fuel directly from Phillips 66(rather than
through a Phillips 66 marketer), I must have a current, active, and fully executed Phillips 66 branded aviation supply agreement
on file with Phillips 66 to be included in the Program.
VI. I UNDERSTAND THAT UPON RECEIPT BY PHILLIPS 66 OF THIS COMPLETED, SIGNED, AND DATED LETTER OF
UNDERSTANDING, MY COVERAGE UNDER THE PHILLIPS 66-BRANDED AIRPORT DEALERS EXCESS LIABILITY
INSURANCE PROGRAM WILL COMMENCE AND BE IN EFFECT THROUGH THE PREVIOUSLY IDENTIFIED POLICY
PERIOD, AND WILL BE AUTOMATICALLY RENEWED FROM YEAR TO YEAR THEREAFTER AS LONG AS I MEET THE
PROGRAM REQUIREMENTS. NO COVERAGE IS PROVIDED UNLESS A COMPLETED LETTER OF UNDERSTANDING
HAS BEEN RECEIVED AND CONFIRMED BY PHILLIPS 66,AND PROVIDED THE STATED REQUIREMENTS ARE MET.
(Please PRINT clearly):
FBO Name Collier County Airport Authority I Airport ID KMKY
Airport
Mailing Address 2005 Mainsail Drive, Suite 1 I Airport Name Marco Island Executive Air P
City, State,ZIP Naples, FL 34113 I Airport City, State Naples, FL
For Marketer-supplied FBOs: name of the Marketer who supplies my Phillips 66-branded aviation fuel:
Marketer Name World Fuel Services
As evidenced by my signature below, I understand,agree to, and am in compliance with this Letter of Understanding in order to
be included in the Phillips 66-Branded Aviation Airport Dealers Excess Liability Insurance Program:
FBO DEALER: Approved as to form and legality
/
Signed By: `�i�/c�lr� ��� _44 pkv
(on behalf of the FBO)
Assistant County Attorney q,Qc1 IIS
Name Printed: TIM MAN LE.
Title: Vek % AMAA►
(This box to be completed by Phillips 66 Company)
Date 1O1 a-,lis ENROLLMENT CONFIRMATION
FBO's P66 Brand Date:
aes -
[Wi 'P t E. BRO Clerk Date Enrollment Is Effective:
Enrollment Confirmed by:
esf as-tai`Chairman's
StatllrE only. Page 2 of 2 Phillips 66 Excess Liability LOU
mdm 8-31-15
(
1 6
E
Teresa L. Cannon
From: Brueggeman, Debra
Sent: Monday, November 02, 2015 5:09 PM
To: Teresa L. Cannon
Subject: FW: P66 Excess Liability Program
Attachments: Marco Island Executive Airport LOU.pdf; Everglades Airpark LOU.pdf;Immokalee
Regional Airport LOU.pdf
Teresa,
Just in case you need these for your file----we received these back from Phillips 66 with the "Enrollment Confirmation"
initialed by the vendor.
0f°melt? Debbie53�uxecggenuuc I Operations Coordinator
3CI
oJCollier County Airport Authority
2005 Mainsail Drive, Suite 1 I Naples, FL 34114
tel (239) 642-7878 x34 I fax (239)394-3515
website I map I email I flyMKY flvIMM Li
From: LobbJustin
Sent: Monday, November 02, 2015 3:33 PM
To: BrueggemanDebra
Subject: FW: P66 Excess Liability Program
4S1 Justin E. Lobb I Airport Manager
ca p Collier County Airport Authority
3 2005 Mainsail Drive, Suite 1 I Naples, FL 34114
tel (239) 642-7878 x35 I cell (239) 571-0232 I fax (239)394-3515
website I map I email I flyMKY flvIMM Lal
From: Lunsford, Mariah (Key Personnel) [mailto:Mariah.Lunsford@acontractor.p66.com]
Sent: Monday, November 02, 2015 3:31 PM
To: LobbJustin
Cc: Miller, Michelle D.; Lisa Earnshaw
Subject: RE: P66 Excess Liability Program
Good afternoon—
Attached are the completed Letters of Understanding for the following FBOs: Everglades Airpark, Immokalee Regional
Airport, and Marco Island Executive Airport. Please keep a copy of each for your records.
Let me know if there is anything else.
1
Thank you, 1 6 3
Mariah Lunsford I Analyst I Phillips 66 Company IAB-991-04 1 411 S. Keeler Ave. I Bartlesville, OK I Ph. 918.977.2223 Fax
918.977.8164 I Mariah.lunsford contractor.p66.com
We are Phillips 66!
In C&CS, we OWN IT!-Operational Excellence/Winning Attitude/Needs/Integrity/Teamwork
From: Lisa Earnshaw [mailto:LEarnshaw(awfscorp.com]
Sent: Monday, November 02, 2015 1:54 PM
To: Lunsford, Mariah (Key Personnel); Miller, Michelle D.
Subject: [EXTERNAL]FW: P66 Excess Liability Program
From: LobbJustin [mailto:JustinLobbOcolliergov.net]
Sent: Monday, November 02, 2015 2:38 PM
To: Lisa Earnshaw
Subject: RE: P66 Excess Liability Program
Good afternoon Lisa,
Please see the attached, signed supplemental insurance documents for the Collier County Airports: Marco Island,
lmmokalee,and Everglades. Please let me know if you need any additional information.
Regards,
'tQ Justin E. Lobb I Airport Manager
Collier County Airport Authority
2005 Mainsail Drive, Suite 1 I Naples, FL 34114
ca'
tel (239) 642-7878 x35 I cell (239) 571-0232 I fax(239)394-3515
website I maoI email I flvMKY flyIMM Li
Under Florida Law,e-mail addresses are public records.If you do not want your e-mail address released in response to a public records request,do not send
electronic mail to this entity.Instead,contact this office by telephone or in writing.
2
r—.
RETURN COMPLETED FORM TO: michelle.d.miller@p66.com
or Fax#: 918-977-7897
Phillips 66-Branded Airport Dealers Excess Liability Insurance Proeram-LETTER OF UNDERSTANDING
I hereby request to be included (free of charge) in the Phillips 66-Branded Airport Dealers Excess Liability insurance Program
("Program"). Once properly enrolled. I will be automatically re-enrolled in the Program effective April 1 of each year,from year to
year thereafter,so long as:
(1)I am a Phillips 66-branded fixed base operator("FBO")pursuant to a Phillips 66 branded aviation supply agreement
directly with Phillips 66 Company('Phillips 66")or through a Phillips 66 marketer,and,
(2)I meet the Program requirements.
As of April 1, 2008, the Program provides excess liability coverage in the amount of$50,000,000 per occurrence and in the
aggregate for sums which I am legally obligated to pay due to a covered occurrence during the policy period when Phillips 66-
branded fuels and lubricants are used, and arising from the activities listed below. It should be understood that the Program is
specifically linked to and only meant to respond to Phillips 66'business as a supplier of branded aviation products,and is limited
to the following activities:
a. Aviation fuel into plane services relating to sale,service,storage and supply of Phillips 66-branded aviation fuel and lubricant
products,including fueling and defueling operations.
b. Aviation fuel tank facilities relating to the storage of fuel and operation of fuel tank facilities.
c. Operation of fueling trucks and other vehicles within airport premises.
I further understand that if I have a fuel supply agreement directly with Phillips 66 or with a Phillips 66 marketer, and if I carry
primary contractual liability insurance covering my liability under that agreement, then the Airport Dealers Excess Liability
Insurance will, in addition to the coverage explained above,also provide contractual liability coverage to the same extent,subject
to policy exclusions.
Il. To participate in the Program,I understand that I must maintain in effect primary liability insurance(Including Products
Liability and Completed Operations Liability)in the following amounts:
a. Not less than the amounts carried at the time I received knowledge of this excess liability coverage,but
b. In any event no less than $1,000,000 combined single limit for each occurrence and in the annual aggregate with
respect to Products Liability and Completed Operations coverage. Evidence of coverage must specifically include
limits of$1,000,000 in the aggregate for Products Liability and Completed Operations coverage. Any sublimits
below$1,000,000 on a"per person"or"per passenger"basis will disqualify me from the Program.
I understand that this excess liability coverage will be afforded to me only to the extent that I maintain insurance to
comply with the above primary insurance requirements. I further understand that the Phillips 68-Branded Airport
Dealers Excess Liability insurance coverage will change without notice should my coverage expire or should the
amounts of my primary liability Insurance be reduced below $1,000,000 (except in the event of a claim depleting the
underlying limit).
A properly completed Letter of Understanding is required from me In order to be covered under the Program. Once I am
enrolled in the Program. I will be automatically re-enrolled thereafter for twelve month periods effective each April 1 pursuant to
the current terms and conditions of the Program. Phillips 66 will forward a revised Letter of Understanding if there are changes to
the Program (e.g. changes in the renewal dates or policy limits). Written notice will be given in the event the Program is
terminated.
I agree and am in compliance with the above primary insurance requirements.
III. Coverage Issues and Exclusions
a. It is important to understand that this Program is considered"following form"which means that the coverage provided under
the Program will follow the same policy terms, conditions, exclusions and limitations as my primary insurance affords to my
fuel/fueling related coverage. Coverage will not"follow form"and will be more restrictive if I no longer carry$1,000,000 of
commercial underlying insurance.
b. War Risks, Hijacking and other similar perils are specifically excluded under this Program, regardless of my primary policy
coverage.
Page 1 of 2 Philips 66 Excess Liability LOU
mdm 8-31.15
;I
J g j`�
c. Regardless of the underlying coverage,Environmental Disturbance and Pollution are not covered.
d. No coverage is afforded to expenses related to a product recall.
e. No coverage is afforded for Nuclear,Date Recognition or Asbestos exposures.
f. No coverage is afforded if I have a Dealer Commingling Amendment.
g. The Program will not respond if I carry insurance limits of$250,000,000 or more.
h. The$50,000,000 aggregate limit is the total limit available to me. If there is a"catastrophic'loss that erodes the aggregate to
$0,there will be no further coverage for me under the Program. I will consider this possibility when deciding on the limits of
liability I purchase under my primary insurance program.
IV. I understand it is my responsibility to report any incident involving the use of Phillips 66-branded aviation fuels and/or lubricants
that involves bodily injury to third parties and/or damage to property of others, even if such a potential claim is not expected to
exceed the limits of my primary insurance. When an incident is reported, a copy of an accident report with the details of the
incident should be faxed to Phillips 66 General Aviation Technical Support at 918-662-6085 within 72 hours of the incident.
V. DIRECT DEALERS ONLY-I understand that as a direct dealer who is obtaining aviation fuel directly from Phillips 66(rather than
through a Phillips 66 marketer), I must have a current,active,and fully executed Phillips 66 branded aviation supply agreement
on file with Phillips 66 to be included in the Program.
VI. I UNDERSTAND THAT UPON RECEIPT BY PHILLIPS 66 OF THIS COMPLETED, SIGNED, AND DATED LETTER OF
UNDERSTANDING, MY COVERAGE UNDER THE PHILLIPS 66-BRANDED AIRPORT DEALERS EXCESS LIABILITY
INSURANCE PROGRAM WILL COMMENCE AND BE IN EFFECT THROUGH THE PREVIOUSLY IDENTIFIED POLICY
PERIOD, AND WILL BE AUTOMATICALLY RENEWED FROM YEAR TO YEAR THEREAFTER AS LONG AS I MEET THE
PROGRAM REQUIREMENTS. NO COVERAGE IS PROVIDED UNLESS A COMPLETED LETTER OF UNDERSTANDING
HAS BEEN RECEIVED AND CONFIRMED BY PHILLIPS 66,AND PROVIDED THE STATED REQUIREMENTS ARE MET.
(Please PRINT clearly):
FBO Name Collier County Airport Authority I Airport ID KMKY
Mailing Address 2005 Mainsail Drive,Suite'I j Airport Name Marco Island Executive Airport D-
City,State,ZIP Naples,FL 34113 j Airport City,State Naples, FL
For Marketer-supplied FBOs: name of t e arketer who s plies my Phillips 66-branded aviation fuel:
Marketer Name World Fuel Services s ce_n i7 y‘���o.n
As evidenced by my signature below, I understand,agree to,and am in compliance with this Letter of Understanding In order to
be included in the Phillips 66-Branded Aviation Airport Dealers Excess Liability Insurance Program:
FBO DEALER: -• /� Approved as to form and legality
Signed By: / �/��NC..Q 41e ,.X(�•gyp! nA.ti`�
(on behalf of the F60l Assistant County Attorney Q taq'1r5
Name Printed: Tito 'JAW t;,.2.
Title: CAA 1 tt MV►.IOn tJ .
(This box to be completed by Phillips_66 Company)
Date 10 la-1 1\5
ENROLLMENT CONFIRMATION
Fd0's PP66 Brand Date:
7-720T: 5/S11 13
_ U 2`i 15
C ICI T E. E3i0 Ci.i Date Enrollment is Effec ive:
r _ , '- Enrollment Confirmed by:
it
ftest as-tb Chairman's
- signature only. Page 2 of 2 Phillips 66 Excess Liability LOU
mdm 8-31-15
3
i6E
66
RETURN COMPLETED FORM TO: michelle.d.miller@p66.com
or Fax#: 918-977-7897
Phillips 66-Branded Airport Dealers Excess Liability Insurance Proeram-LETTER OF UNDERSTANDING
I hereby request to be included (free of charge) in the Phillips 66-Branded Airport Dealers Excess Liability Insurance Program
("Program'). Once property enrolled,I will be automatically re-enrolled in the Program effective April 1 of each year,from year to
year thereafter,so lona as:
(1)I am a Phillips 66-branded fixed base operator(°FBO")pursuant to a Phillips 66 branded aviation supply agreement
directly with Phillips 66 Company(Phillips 66")or through a Phillips 66 marketer,and,
(2)1 meet the Program requirements.
As of April 1, 2008, the Program provides excess liability coverage in the amount of$50,000,000 per occurrence and in the
aggregate for sums which I am legally obligated to pay due to a covered occurrence during the policy period when Phillips 66-
branded fuels and lubricants are used, and arising from the activities listed below. It should be understood that the Program is
specifically linked to and only meant to respond to Phillips 66'business as a supplier of branded aviation products,and is limited •
to the following activities:
a. Aviation fuel into plane services relating to sale,service,storage and supply of Phillips 66-branded aviation fuel and lubricant
products,including fueling and defueling operations.
b. Aviation fuel tank facilities relating to the storage of fuel and operation of fuel tank facilities.
c. Operation of fueling trucks and other vehicles within airport premises.
I further understand that if I have a fuel supply agreement directly with Phillips 66 or with a Phillips 66 marketer, and if I carry
primary contractual liability insurance covering my liability under that agreement, then the Airport Dealers Excess Liability
Insurance will,in addition to the coverage explained above,also provide contractual liability coverage to the same extent,subject
to policy exclusions.
II. To participate In the Program,I understand that I must maintain in effect primary liability Insurance(including Products
Liability and Completed Operations Liability)in the following amounts:
a. Not less than the amounts carried at the time I received knowledge of this excess liability co_yerage,but
b. In any event no less than $1,000,000 combined single limit for each occurrence and in the annual aggregate with
respect to Products Liability and Completed Operations coverage. Evidence of coverage must_speclfically Include
limits of $1,000,000 in the aggregate for Products Liability and Completed Operations coverage. Any sublimits
below$1,000,000 on a"per person"or"per passenger"basis will disqualify me from the Program.
I understand that this excess liability coverage wilt be afforded to me only to the extent that I maintain Insurance to
comply with the ebove oilman" insurance requirements. I further understand that the Phillips 66-Branded Airport
Dealers Excess Liability insurance coverage will change without notice should my coverage expire or should the
amounts of my primary liability insurance be reduced below $1,000,000 (except in the event of a claim depleting the
underlying limit).
A properly completed Letter of Understanding is required from me in order to be covered under the Program. Once I am
enrolled in the Program. I will be automatically re-enrolled thereafter for twelve month periods effective each April 1 aurst-rant to
the current terms and conditions of the Program. Phillips 66 will forward a revised Letter of Understanding if there are changes to
the Program (e.g. changes in the renewal dates or policy limits). Written notice will be given in the event the Program is
terminated.
I agree and am in compliance with the above primary Insurance requirements.
III. Coverage issues and Exclusions
a. It is important to understand that this Program is considered"following form"which means that the coverage provided under
the Program will follow the same policy terms, conditions, exclusions and limitations as my primary insurance affords to my
fuel/fueling related coverage. Coverage will not"follow form and will be more restrictive if I no longer carry$1,000,000 of
commercial underlying insurance.
b. War Risks, Hijacking and other similar perils are specifically excluded under this Program, regardless of my primary policy
coverage.
Page 1 of 2 Phillips 66 Excess Liability LOU
mdm 8-31-15
(c0
16 F 3
= des ;ry
c. Regardless of the underlying coverage, Environmental Disturbance and Pollution are not covered.
d. No coverage is afforded to expenses related to a product recall.
e. No coverage is afforded for Nuclear,Date Recognition or Asbestos exposures.
f. No coverage is afforded if I have a Dealer Commingling Amendment.
g. The Program will not respond if I carry insurance limits of$250,000,000 or more.
h. The$50,000,000 aggregate limit is the total limit available to me. If there is a°catastrophic'loss that erodes the aggregate to
$0,there will be no further coverage for me under the Program. I will consider this possibility when deciding on the limits of
liability I purchase under my primary insurance program.
IV. I understand it is my responsibility to report any incident involving the use of Phillips 66-branded aviation fuels and/or lubricants
that involves bodily injury to third parties and/or damage to property of others, even if such a potential claim is not expected to
exceed the limits of my primary insurance. When an incident Is reported, a copy of an accident report with the details of the
Incident should be faxed to Phillips 66 General Aviation Technical Support at 918-662-6085 within 72 hours of the incident,
V. DIRECT DEALERS ONLY-I understand that as a direct dealer who is obtaining aviation fuel directly from Phillips 66(rather than
through a Phillips 66 marketer), I must have a current, active, and fully executed Phillips 66 branded aviation supply agreement
on file with Phillips 66 to be included in the Program.
VI. I UNDERSTAND THAT UPON RECEIPT BY PHILLIPS 66 OF THIS COMPLETED, SIGNED, AND DATED LETTER OF
UNDERSTANDING, MY COVERAGE UNDER THE PHILLIPS 66-BRANDED AIRPORT DEALERS EXCESS LIABILITY
INSURANCE PROGRAM WILL COMMENCE AND BE IN EFFECT THROUGH THE PREVIOUSLY IDENTIFIED POLICY
PERIOD,AND WILL BE AUTOMATICALLY RENEWED FROM YEAR TO YEAR THEREAFTER AS LONG AS I MEET THE
PROGRAM REQUIREMENTS. NO COVERAGE IS PROVIDED UNLESS A COMPLETED LETTER OF UNDERSTANDING
HAS BEEN RECEIVED AND CONFIRMED BY PHILLIPS 66,AND PROVIDED THE STATED REQUIREMENTS ARE MET.
(Please PRINT clearly):
FBO Name Collier County Airport Authority (Airport ID KX01
te
Mailing Address PO Box 689,650 E.C.Airpark Rd I Airport Name Everglades Airpark
City,State,ZIP Everglades City.FL 34139 j Airport City,State Everglades City, FL
For Marketer-supplied FBOs: name oft e Marketer who supplies my Phillips 66-branded aviation fuel:
Marketer Name World Fuel Services JAZC QJ. A"J o i✓
As evidenced by my signature below,I understand,agree to,and am in compliance with this Letter of Understanding in order to
be included in the Phillips 66-Branded Aviation Airport Dealers Excess Liability Insurance Program:
FE10 DEALER: / �Q /' �r Approved as to form and legality
Signed By: �i'�(/
(on behalf of the EGO) a.. t��^� \\G
Name Printed: T 1 M NIA •3C. Assistant County ttorney q`' te
Title: C-)1"k AA 1L v i
Date 10 a1 h5 IThis box to be completed by Phillips 66 Cvmpanyl
ENROLLMENT CONFIRMATION
FBO's P66 Brand Date: 5 3 t 13
T Date Enrollment Is Effec."ve: \` 21 ‘S
ATT S7t Enrollment Confirmed by: ►,��
CkYvl T��.��� ,Clerk c_______ I
4,
Page 2 of 2 Phillips 66 Excess Liability LOU
Attest as to Chairman's mdm 8-31-15
^irij0^}1( only. �
(.-:4-'1
te,1
1 '‘ ,0.7 E 3 ___...._ .
...„...,it l
RETURN COMPLETED FORM TO: michelle.d.miller@p86.com
or Fax#: 918-977-7897
Phillips 66-Branded Airport Dealers Excess Liability Insurance Program-LETTER OF UNDERSTANDING
I. I hereby request to be included(free of charge) in the Phillips 66-Branded Airport Dealers Excess Liability Insurance Program
("Program"). Once properly enrolled. I will be automatically re-enrolled in the Program effective April 1 of each year,from year to
year thereafter,so long as:
(1) I am a Phillips 66-branded fixed base operator("FBO°)pursuant to a Phillips 66 branded aviation supply agreement
directly with Phillips 66 Company(Phillips 66")or through a Phillips 66 marketer,and,
(2)I meet the Program requirements,
As of April 1, 2008, the Program provides excess liability coverage in the amount of$50,000,000 per occurrence and in the
aggregate for sums which I am legally obligated to pay due to a covered occurrence during the policy period when Phillips 66-
branded fuels and lubricants are used, and arising from the activities listed below. It should be understood that the Program is
specifically linked to and only meant to respond to Phillips 66'business as a supplier of branded aviation products,and is limited
to the following activities:
a. Aviation fuel into plane services relating to sale,service,storage and supply of Phillips 66-branded aviation fuel and lubricant
products,including fueling and defueling operations.
b. Aviation fuel tank facilities relating to the storage of fuel and operation of fuel tank facilities.
c. Operation of fueling trucks and other vehicles within airport premises.
I further understand that if I have a fuel supply agreement directly with Phillips 66 or with a Phillips 66 marketer, and if I carry
primary contractual liability insurance covering my liability under that agreement, then the Airport Dealers Excess Liability
Insurance will,in addition to the coverage explained above,also provide contractual liability coverage to the same extent,subject
to policy exclusions.
II. To participate in the Program,I understand that I must maintain in effect primary liability insurance(including Products
Liability and Completed Operations Liability)In the following amounts:
a. Not less than the amounts carried at the time i received knowledge of this excess liability coverage,but
b. In any event no less than $1,000.000 combined single limit for each occurrence and in the annual aggregate with
. respect to Products Liability and Completed Operations coverage, Evidence of coverage must specifically include
jimits of $1.0Q0.000 in the aggregate for Products Liability and Completed Operations coverage. Any sublimits
below$1,000,000 on a"per person"or"per passenger"basis will disqualify me from the Program.
I understand that this excess liability coverage will be afforded to me only to the extent that I maintain Insurance to
comply with the above primary insurance requirements. I further understand that the Phillips 66-Branded Airport
Dealers Excess Liability Insurance coverage will change without notice should my coverage expire or should the
amounts of my primary liability Insurance be reduced below $1,000,000 (except in the event of a claim depleting the
underlying limit).
A properly completed Letter of Understanding is required from me in order to be covered under the Program. Once I am
enrolled in the Program. I will be automatically re-enrolled thereafter for twelve month periods effective each April 1 pursuant to
the current terms and conditions of the Program. Phillips 66 will forward a revised Letter of Understanding if there are changes to
the Program (e.g. changes in the renewal dates or policy limits). Written notice will be given in the event the Program is
terminated.
I agree and am in compliance with the above primary Insurance requirements. i?
III. Coverage Issues and Exclusions
a. It is important to understand that this Program is considered"following form"which means that the coverage provided under
the Program will follow the same policy terms, conditions, exclusions and limitations as my primary insurance affords to my
fuel/fueling related coverage. Coverage will not"follow form"and will be more restrictive if I no longer carry$1,000,000 of
commercial underlying insurance.
b. War Risks, Hijacking and other similar perils are specifically excluded under this Program, regardless of my primary policy
coverage.
Page 1 of 2 Phillips 66 Excess Liability LOU
mdm 8-31-15
16 E 3
J4: ,ss 1`
c. Regardless of the underlying coverage, Environmental Disturbance and Pollution are not covered.
d. No coverage is afforded to expenses related to a product recall.
e. No coverage is afforded for Nuclear,Date Recognition or Asbestos exposures.
f. No coverage is afforded if I have a Dealer Commingling Amendment.
g. The Program will not respond if I carry insurance limits of$250,000,000 or more.
h. The$50,000,000 aggregate limit is the total limit available to me. If there is a"catastrophic"loss that erodes the aggregate to
$0, there will be no further coverage for me under the Program. I will consider this possibility when deciding on the limits of
liability I purchase under my primary insurance program.
IV. I understand it is my responsibility to report any incident involving the use of Phillips 66-branded aviation fuels and/or lubricants
that involves bodily injury to third parties and/or damage to property of others, even if such a potential claim is not expected to
exceed the limits of my primary insurance. When an incident is reported, a copy of an accident report with the details of the
incident should be faxed to Phillips 66 General Aviation Technical Support at 918-662-6085 within 72 hours of the incident.
V. DIRECT DEALERS ONLY-I understand that as a direct dealer who is obtaining aviation fuel directly from Phillips 66(rather than
through a Phillips 66 marketer), I must have a current, active,and fully executed Phillips 66 branded aviation supply agreement
on file with Phillips 66 to be included in the Program.
Vi. I UNDERSTAND THAT UPON RECEIPT BY PHILLIPS 66 OF THIS COMPLETED, SIGNED, AND DATED LETTER OF
UNDERSTANDING, MY COVERAGE UNDER THE PHILLIPS 66-BRANDED AIRPORT DEALERS EXCESS LIABILITY
INSURANCE PROGRAM WILL COMMENCE AND BE IN EFFECT THROUGH THE PREVIOUSLY IDENTIFIED POLICY
PERIOD, AND WILL BE AUTOMATICALLY RENEWED FROM YEAR TO YEAR THEREAFTER AS_LONG AS I MEET THE
PROGRAM REQUIREMENTS. NO COVERAGE IS PROVIDED UNLESS A COMPLETED LETTER OF UNDERSTANDING
HAS BEEN RECEIVED AND CONFIRMED BY PHILLIPS 66,AND PROVIDED THE STATED REQUIREMENTS ARE MET.
(Please PRINT clearly):
FBO Name Collier County Airport Authority i Airport ID KIMM
Mailing Address 165 Airpark Blvd I Airport Name Immokalee Regional Airport
City,State,ZIP Immokalee.FL 34142
y I Airport City,State Immokalee, FL
For Marketer-supplied FBOs: name ofa Marketer who supplies my Phillips 66-branded aviation fuel:
Marketer Name World Fuel Services 7A .f*j r\c c.)%n
As evidenced by my signature below,I understand,agree to,and am in compliance with this Letter of Understanding In order to
be included In the Phillips 66-Branded Aviation Airport Dealers Excess Liability Insurance Program:
FBO DEALER: 1 Approved as to form and legalit)
Signed By: / , �'-- . •
(on behalf of the F80)
Assistant Coun ttornev o kaa\\‘5
Name Printed: T i AA N A IOC £
Title: C-lA#%\i�wti 12
)0 a1 }G (This box to be completed by Phillips 66 Company)
Date J ENROLLMENT CONFIRMATION
: l Y 3
FBO's P66 Brand Date: e5 1 1 3
E M �`
DWI .:- coE. El • •s vsirk Date Enrollment Is Ef lye: 4 2'l 15
_ . Enrollment Confirmed by..j�,
Attest as t4.Chairman's •
signature only. .' Page 2 of 2 Mines 88 Excess Liability LOU
'-• mdm 8-31-15
/-7jl
_