WM0501428_Application_20210222

An Equal Opportunity Employer

February 22, 2021

Certified Mail
Return Receipt Requested

Mr. Scott Vinson
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Regional Operations Section
Via Email @ [e-mail]

Reference: MONITORING WELL CONSTRUCTION PERMIT APPLICATION
SPEEDWAY 6983
850 CAPITAL BLVD
RALEIGH, NORTH CAROLINA
INCIDENT NO.: 7708
MID-ATLANTIC JOB NO.: R0730.33

Dear Mr. Vinson:

Speedway LLC is pleased to submit this Monitoring Well Construction Permit application
associated with groundwater assessment at the Speedway 6983 facility located at 850 Capital
Boulevard in Raleigh, North Carolina. We propose to install two replacement monitoring wells at
1027 N. West St., which is the property across Capital Boulevard to the west and owned by the
City of Raleigh. If you have any questions, please feel free to contact me at [phone] or
Trey Marchant with Mid-Atlantic Associates, Inc. at [phone].

Sincerely,

SPEEDWAY LLC

Charles A. Chiara
Environmental Representative

Speedway LLC

Speedway Office
P.O. Box 1500
Springfield, OH 45501
Telephone [phone]
FOR OFFICE USE ONLY
PERMIT NO. ISSUED DATE
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY - DIVISION OF WATER RESOURCES
APPLICATION FOR PERMIT TO CONSTRUCT A MONITORING OR RECOVERY WELL SYSTEM
PLEASE TYPE OR PRINT CLEARLY
In accordance with the provisions of Article 7, Chapter 87, General Statutes of North Carolina and regulations pursuant thereto,
application is hereby made for a permit to construct monitoring or recovery wells.
1. Date: February 22, 2021
2. County: Wake
3.What type of well are you applying for? (monitoring or recovery): Monitoring
4. Applicant: Speedway LLC Telephone: [phone]
Applicant’s Mailing Address: 500 Speedway Drive, Enon, OH 45323
Applicant’s Email Address (if available): [e-mail]
5. Contact Person (if different than Applicant): Trey Marchant Telephone: [phone]
Contact Person’s Mailing Address: 409 Rogers View Ct, Raleigh, NC 27610
Contact Person’s Email Address (if available): [e-mail]
6. Property Owner (if different than Applicant): City of Raleigh Telephone: [phone] (Marchell Adams-David, City Manager)
Property Owner’s Mailing Address: PO BOX 590, Raleigh, NC 27602-0590
Property Owner’s Email Address (if available): [e-mail]
7. Property Physical Address (Including PIN Number) 1027 N West Street (PIN: 1704528222)
City Raleigh County Wake Zip Code 27603
8. Reason for Well(s): Two replacement monitoring wells that were abandoned propr to Capital Blvd road widening
(ex: non-discharge permit requirements, suspected contamination, assessment, groundwater contamination, remediation, etc.)
9. Type of facility or site for which the well(s) is(are) needed: UST
(ex: non-discharge facility, waste disposal site, landfill, UST, etc.)
10. Are there any current water quality permits or incidents associated with this facility or site? If so, list permit and/or incident no(s).
Speedway 6983, 850 Capital Blvd, Raleigh, NC 27603, Incident No. 7708
11. Type of contaminants being monitored or recovered:Organics (gasoline)
(ex: organics, nutrients, heavy metals, etc.)
12. Are there any existing wells associated with the proposed well(s)? If yes, how many? Yes, 3 current and multiple former.
Existing Monitoring or Recovery Well Construction Permit No(s).: Unknown
13. Distance from proposed well(s) to nearest known waste or pollution source (in feet): Approx. 200 ft to Speedway release
(from eastern well) and approx. 280 ft to Speedway release from western well
14. Are there any water supply wells located less than 500 feet from the proposed well(s)? No
If yes, give distance(s):
15. Well Contractor: Geologic Exploration, Inc. Certification No.: 1175 (NC)
Well Contractor Address: 176 Commerce Blvd, Statesville, NC 28625
PROPOSED WELL CONSTRUCTION INFORMATION
1. As required by 15A NCAC 02C .0105(f)(7), attach a well construction diagram of each well showing the following:
a. Borehole and well diameter e. Type of casing material and thickness
b. Estimated well depth f. Grout horizons
c. Screen intervals g. Well head completion details
WM0501428
d.Sand/gravel pack intervals
Continued on Reverse
PROPOSED WELL CONSTRUCTION INFORMATION (Continued)
2. Number of wells to be constructed in unconsolidated
material:2
3.Number of wells to be constructed in bedrock: 0
4.Total Number of wells to be constructed:2
(add answers from 2 and 3)
5.How will the well(s) be secured? Flush mounted,
bolt-down lid manhole, locking cap and lock
6.Estimated beginning construction date:3/31/21
7.Estimated construction completion date:3/31/21
ADDITIONAL INFORMATION
1.As required by 15A NCAC 02C .0105(f)(5), attach a scaled map of the site showing the locations of the following:
a.All property boundaries, at least one of which is referenced to a minimum of two landmarks such as identified roads,
intersections, streams, or lakes within 500 feet of the proposed well or well system.
b.All existing wells, identified by type of use, within 500 feet of the proposed well or well system.
c.The proposed well or well system.
d.Any test borings within 500 feet of proposed well or well system.
e.All sources of known or potential groundwater contamination (such as septic tank systems, pesticide, chemical or fuel
storage areas, animal feedlots as defined in G.S. 143-215.10B(5), landfills, or other waste disposal areas) within 500 feet
of the proposed well or well system.
SIGNATURES
The Applicant hereby agrees that the proposed well(s) will be constructed in accordance with approved specifications and conditions of
this Well Construction Permit as regulated under the Well Construction Standards (Title 15A of the North Carolina Administrative Code,
Subchapter 2C) and accepts full responsibility for compliance with these rules
Principal Geologist
Signature of Applicant or *Agent Title of Applicant or *Agent
Raymond S. Marchant, III * If signing as Agent, attach authorization agreement stating
Printed name of Applicant or *Agent that you have the authority to act as the Agent.
If the property is owned by someone other than the applicant, the property owner hereby consents to allow the applicant to construct
wells as outlined in this Well Construction Permit application and that it shall be the responsibility of the applicant to ensure that the
well(s) conform to the Well Construction Standards (Title 15A of the North Carolina Administrative Code, Subchapter 2C).
See attached Access and License Agreement See attached Access and License Agreement
Signature of Property Owner (if different than Applicant) Printed name of Property Owner (if different than Applicant)
DIRECTIONS
Please send the completed application to the appropriate Division of Water Resources’ Regional Office:
Asheville Regional Office
2090 U.S. Highway 70
Swannanoa, NC 28778
Phone: [phone]
Fax: [phone]
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
Phone: [phone]
Fax: [phone]
Mooresville Regional Office
610 East Center Avenue
Mooresville, NC 28115
Phone: [phone]
Fax: [phone]
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
Phone: [phone]
Fax: [phone]
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Phone: [phone]
Fax: [phone]
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Phone: [phone]
Fax: [phone]
GW-22MR Rev. 3-1-2016
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ACCESS AND LICENSE AGREEMENT
THIS ACCESS AND LICENSE AGREEMENT (the “Agreement”) is made effective as of the
latest date either party has signed this Agreement as shown on page 8 (the “Effective Date”) by
and between Speedway, LLC d/b/a Speedway (North Carolina), LLC, a Delaware limited
liability company authorized to conduct business in the state of North Carolina (“Licensee”) and
the City of Raleigh, a North Carolina municipal corporation (“City”).
WHEREAS, City is the owner of those lots known as Parcel ID No. 0071555 located at
901 Capital Boulevard, Raleigh, NC, and Parcel ID No. 0102572 1027 N. West Street,
Raleigh, NC (“Property”); and
WHEREAS, WilcoHess LLC merged into Speedway, its parent company, effective
January 1, 2016, and Speedway is the surviving entity;
WHEREAS, Licensee is the owner of a lot known as Parcel ID No. 0041252 located at
850 Capital Boulevard, Raleigh, NC (which Licensee refers to as #6983); and
WHEREAS, Licensee has requested permission to access portions of the Property for
purposes of conducting the Work, as described below;
NOW, THEREFORE, in consideration of the execution of this Agreement, and other
valuable and good consideration, the receipt and sufficiency of which is hereby acknowledged,
Licensee and City agree as follows:
1.Work. The term "Work" shall be defined to include the installation, inspection, and
periodic sampling and eventual abandonment and filling of groundwater monitoring wells and
other tasks as described in the attached Exhibit "A" which may be revised from time to time, with
such revisions being incorporated herein by reference as a revised Exhibit A upon the City’s prior
written approval of the revised scope of Work. Licensee shall contact Billy Jackson
([e-mail], 919-996-2984) or designee(s) and Gary Claiborne
([e-mail], 919-996-2677) to determine the precise location for installation
of any new monitoring well(s). The Work will be performed by a North Carolina licensed well
contractor at the direction of Licensee. As between Licensee and the City, Licensee agrees to be
solely responsible for all costs and expenses incurred in performing the Work contemplated
hereunder, and City shall have no obligation or responsibility for such costs or expenses.
2.Grant of License. City hereby grants to Licensee, its authorized agents, employees,
successors, assignees, contractors, and sub-contractors, including Mid-Atlantic Associates, P.A.
(hereinafter, all are collectively referred to as the “Performing Entities”), for the benefit of the
Property, a non-exclusive license (“License”) for access to the Property to enter the Property for
the express and limited purpose of performing the Work pursuant to the terms of this Agreement
including any revised Exhibit A. The City shall in all other respects as owner of the Property be
able to make all lawful uses of the Property not inconsistent with the terms of this Agreement.
DocuSign Envelope ID: C8B50715-E64E-4DE9-9544-3D46E2EC8504
Access and License Agreement
Between: City of Raleigh, NC and Speedway LLC
Page 2 of 7
3.Terms of License. The Performing Entities shall exercise their rights under the License
subject to the following conditions:
(a) Notice of Entry. Except in the event of an emergency, the Performing Entity shall
notify the City, by notice to Billy Jackson ([e-mail], 919-996-
2984) or designee(s) and Gary Claiborne ([e-mail], 919-996-
2677) or designee at least one week prior to the Performing Entity’s entry upon the
Property (the “Pre-Entry Notice”). Pre-Entry Notice shall not be given during the
weekends or holidays; any Pre-Entry Notice give on the weekends or holidays shall be
null and void.
(b) Timing and Duration of Entry. Except in the event of an emergency, each access
event shall occur Monday through Friday, during normal business hours, and is not
expected to require more than one (1) consecutive day. The Term of this Agreement
shall be as set forth herein unless Licensee provides to the City prior notice of
termination. City expressly recognizes that the government agencies having
jurisdiction over the Work may require sampling to occur quarterly or bi-annually after
the installation of any new wells has occurred, and such agencies may require
additional Work, the scope of which will be incorporated into a revised Exhibit A upon
the written approval by City.
(c) Access route. The Performing Entities shall consult with and obtain approval from
Billy Jackson ([e-mail], 919-996-2984) or designee(s)
regarding the route to access the proposed Work location(s). The City expressly
reserves the ability to alter the route of access upon discussion with the Performing
Entity. Any Performing Entity who desires to remove trees or ground vegetation to
access or perform Work shall obtain prior written approval from Billy Jackson and the
City’s Urban Forester (Zachary Manor).
(d) Emergency Access. In the event of an emergency that requires any Performing Entity
to access the Property without prior notice pursuant to paragraph 3.a. or on a weekend
or holiday, the Performing Entity shall notify the City pursuant to Paragraph 3.a. no
later than 48 hours following entry onto the Property with the reason for the entry.
(e) Compliance with Laws, Regulations, and Ordinances. Prior to conducting the
Work, Licensee, at its sole cost and expense, shall have obtained any and all necessary
governmental permits and approvals for the Work and shall, upon request, provide
Billy Jackson ([e-mail], 919-996-2984), or other designee
with copies of any and all such permits and approvals. The Performing Entities shall
undertake the Work in a manner consistent with that degree of skill and care ordinarily
exercised by practicing professionals performing similar services in the same locality,
at the same site and under the same or similar circumstances and conditions such that
it will comply with the North Carolina state statutes and rules and local City Code
provisions applicable to the performance of the Work. The Performing Entities shall
be responsible for the proper handling and disposal of any contaminated equipment,
environmental media or other materials resulting from performance of the Work.
(f) City Access to the Work. The City and its contractors and consultants shall have
access to the Property at all times during the performance of the Work so long as the
DocuSign Envelope ID: C8B50715-E64E-4DE9-9544-3D46E2EC8504
Access and License Agreement
Between: City of Raleigh, NC and Speedway LLC
Page 3 of 7
City and its representatives (i) observe all applicable federal, state and local laws,
regulations and safety standards and (ii) do not unreasonably impede or otherwise
unreasonably interfere with the performance of the Work, except as required for the
enforcement of any City Code provisions that apply to the performance of the Work.
(g) Restoration of the Property. Licensee shall restore the Property to the satisfaction of
the City. If Licensee shall fail to restore the Property within fourteen (14) days of the
final completion of the Work, the City may, at the City’s option (but shall not be
obligated to) restore the Property disturbed by the Work, and Licensee shall within
thirty (30) days of demand and related documentation therefore, pay the City for the
cost thereof. The City shall provide notice and demand to Licensee at least ten (10)
business days prior to exercising its option to restore the Property.
(h) Mutual Cooperation. Licensee agrees to coordinate its activities with City to
minimize any inconvenience to, or interruption of, the normal use and enjoyment of
the Property by City. City agrees to cooperate with Licensee and the Performing
Entities in the scheduling and performance of the Work.
(i) Reports. Prior to finalizing any report involving the Work, Licensee will provide a
draft of such report to the City, for the City’s review and comment. The City will
provide its comments to Licensee within 20 business days of receiving such draft
report. Licensee will also provide to the City, copies of all written reports that are
provided to government agencies having jurisdiction over the Work and the Property.
(j) Completion of the Work. Upon completion of the Work, Licensee shall provide
written notice and appropriate documentation to the relevant government agencies, and
to City, that Licensee considers that the Work has been completed as required under
applicable law. Determination by the government agencies having jurisdiction that the
Work has been completed shall be conclusive and bind on City and City's successors
and assigns.
4. Mechanics’ Liens. Licensee shall not permit any mechanic’s lien to be placed upon or
encumber all or any portion of the Property caused by or resulting from any Work performed,
materials furnished, or obligations incurred by or at the request of the Performing Entities, and in
the case of the filing of any such lien, Licensee will promptly pay, bond, or otherwise discharge
the same. If default in payment, bond, or discharge shall continue for thirty (30) days following
the imposition of such lien, the City shall have the right, at the City’s option, of paying the same
without inquiry to the validity thereof, and any amounts paid, including expenses and interest, shall
be paid by Licensee on demand by the City supported by related documentation. On or before
ninety (90) days after completion of the Work, Licensee shall deliver to the City, lien waiver
affidavits evidencing full payment of all Performing Entities providing labor or materials in
connection with the Work conducted under this Agreement.

5. Insurance. Licensee must attach to the signed copy of this Agreement submitted to the
City a certificate of its liability insurance showing the City as an additional insured on a binder
that shows the following minimum coverages:

Commercial General Liability - Combined single limit of no less than $1,000,000 each
occurrence and $2,000,000 aggregate. Coverage shall not contain any endorsement(s) excluding
DocuSign Envelope ID: C8B50715-E64E-4DE9-9544-3D46E2EC8504
Access and License Agreement
Between: City of Raleigh, NC and Speedway LLC
Page 4 of 7
nor limiting Product/Completed Operations, Contractual Liability or Cross Liability.

Automobile Liability - Limits of no less than $1,000,000 Combined Single Limit. Coverage
shall include liability for Owned, Non-Owned and Hired automobiles. In the event a Performing
Entity does not own automobiles, said entity agrees to maintain coverage for Hired and Non-
Owned Auto Liability, which may be satisfied by way of endorsement to the Commercial General
Liability policy or separate Auto Liability policy. Automobile coverage is only necessary if
vehicles used in the provision of services under this Agreement are brought onto the Property.

Worker's Compensation & Employers Liability - Worker's Compensation Insurance in
accordance with North Carolina General Statute Chapter 97 with statutory limits and employers
liability of no less than $1,000,000 each accident.

Additional Insured - The Policy must include an endorsement showing the City as an
additional insured on the Commercial General Liability and Auto Liability. The additional insured
language shall read 'City of Raleigh is named additional insured as their interest may appear'.

Certificate of Insurance - Licensee shall provide City with a Certificate of Insurance
evidencing that all coverages, limits and endorsements required herein are maintained and in full
force and effect, and Certificates of Insurance shall provide a minimum thirty (30) day notice prior
to cancellation or any changes in coverage. If Licensee receives a non-renewal or cancellation
notice from an insurance carrier affording coverage required herein, or a notice that coverage no
longer complies with the insurance requirements herein, Licensee agrees to notify the City within
ten (10) business days with a copy of the non-renewal or cancellation notice, or written specifics
as to which coverage is no longer in compliance. The Certificate Holder address should read:

City of Raleigh
Post Office Box 590
Raleigh, NC 27602-0590

Umbrella or Excess Liability - The minimum liability limits required above may be
satisfied under an Umbrella or Excess Liability policy. There is no minimum Per Occurrence limit
of liability under the Umbrella or Excess Liability, however, the Annual Aggregate limits shall not
be less than the highest “Each Occurrence” limit for required policies. The City of Raleigh must
be endorsed as an 'Additional Insured' on the Umbrella or Excess Liability, unless the Certificate
of Insurance states the Umbrella or Excess Liability provides coverage on a 'Follow-Form' basis.

All insurance companies must be authorized to do business in North Carolina and be
reasonably acceptable to the City of Raleigh's Risk Manager.

Licensee shall require its Performing Entities who will enter onto the Property or otherwise
conduct Work on the Property to meet the insurance requirements set forth above.

Licensee is permitted to use self-insurance to comply with its obligations under this section
and will provide evidence of self-insurance to the City.
DocuSign Envelope ID: C8B50715-E64E-4DE9-9544-3D46E2EC8504
Access and License Agreement
Between: City of Raleigh, NC and Speedway LLC
Page 5 of 7

6. Indemnification. Speedway hereby releases and forever discharges the City, its agents
and employees, from any and all claims, demands, rights of action or causes of action, present or
future, whether the same be known, anticipated or unanticipated (collectively “Claims”) resulting
from or arising out of Licensee’s performance of the Work, except to the extent such Claims result
from or arise out of the City’s acts or omissions. Regarding the abandonment of groundwater
monitoring wells which were previously installed on the Property by Licensee, said abandonment
shall not operate to release Licensee of any contractual or regulatory liability in connection with
such abandoned wells or the groundwater contaminants which were monitored by such wells.
Furthermore, Licensee shall indemnify and defend (with legal counsel reasonably acceptable to
the City) the City and its respective employees and agents from and against any and all Claims,
liabilities, losses, damages, penalties, fines, costs and expenses (including reasonable attorneys’
and consultants’ fees) caused by the acts or omissions of the Performing Entities in conducting the
Work. This release and indemnification obligation shall survive the expiration or early termination
of this Agreement.

7. Miscellaneous.

(a) This Agreement shall be governed by and construed in accordance with the laws of the
State of North Carolina, and sole and exclusive venue for any civil action between the
parties shall be Wake County Civil Superior Court or the United States District Court
for the Eastern District of North Carolina.

(b) The Term of this Agreement shall expire three (3) calendar years from its Effective
Date, but the Term may be extended by written agreement of the City and Licensee.
Notwithstanding the foregoing, if the City’s redevelopment plans require the removal,
replacement or relocation of any groundwater monitoring wells or other Licensee
equipment, during the term of this Agreement, Licensee shall be responsible for all
costs of such removal, replacement or relocation following notification by the City.

(c) This Agreement may be modified or amended only by mutual, written agreement of
Licensee and the City, or their successors and assigns. Licensee and the City may
amend this Agreement to supplement the Work described herein by providing a revised
Exhibit A. This Agreement constitutes the entire agreement between the parties hereto
with respect to the transactions contemplated herein, and this Agreement supersedes all
prior oral or written agreements, commitments, or understandings with respect to the
matters provided herein.

(d) Licensee and the City agree that this Agreement may be executed in counterparts and
that when so executed by Licensee and the City shall constitute one Agreement binding
on Licensee and the City hereto. Licensee and the City agree that a facsimile or email
copy of the Agreement shall be deemed as binding and valid as the original.

(e) Except as otherwise expressly provided herein, the remedies herein shall be cumulative
and shall not preclude any party from asserting any other rights or seeking any other
DocuSign Envelope ID: C8B50715-E64E-4DE9-9544-3D46E2EC8504
Access and License Agreement
Between: City of Raleigh, NC and Speedway LLC
Page 6 of 7
remedies against any other parties, or such other parties, successors or permitted
assigns, as provided herein or by applicable law. Nothing contained herein shall
preclude a party from seeking equitable relief where appropriate. Neither waiver by
any of the parties hereto of a breach of or a default under the provisions of this
Agreement, nor the failure of any of the parties on one or more occasions to enforce
any of the provisions of this Agreement or to exercise any right or privilege hereunder
shall thereafter be construed as a waiver of any subsequent breach or default of a similar
nature or as a waiver of any such provisions, rights, or privileges hereunder.

(f) Except as otherwise specified herein, any notices that either Party hereto is required or
desires to give to the other hereunder shall be deemed to have been properly given for
all purposes if (i) delivered with a written receipt of delivery, (ii) mailed by registered
or certified mail of the United States Postal Service, return receipt requested, postage
prepaid, or (iii) delivered to a nationally recognized overnight courier service for next
business day delivery, to its addressee at such party’s address as set forth below, or (iv)
delivered via telecopier, facsimile transmission, or electronic mail to the facsimile
number or email address listed below. Each such notice, demand or request, shall be
deemed to have been given upon actual receipt or refusal by the addressee.

If to SPEEDWAY, LLC:
Speedway LLC.
500 Speedway Drive
Enon, Ohio 45323
Attn: Charles Chiara
Phone: [phone]
Fax: [phone]
EMAIL: [e-mail]

If to the CITY:
City of Raleigh
222 West Hargett Street
Raleigh, North Carolina 27601
Attn: Ruffin L. Hall
FAX #: [phone]
EMAIL: [e-mail]

With a copy also sent to:
City Attorney’s Office
Attn: Carolyn A Bachl, Senior Associate City Attorney
One Exchange Plaza, Suite 1020
Raleigh, North Carolina 27601
FAX #: [phone]
EMAIL: [e-mail]

DocuSign Envelope ID: C8B50715-E64E-4DE9-9544-3D46E2EC8504
Access and License Agreement
Between: City of Raleigh, NC and Speedway LLC
Page 7 of 7
Notices may be given on behalf of any party by its legal counsel. Either party may,
from time to time, by notice as herein provided, designate a different address to which
notice to it shall be sent.

(g) Notwithstanding any other provisions of this Agreement, this Agreement and all
materials submitted to the City by Licensee are subject to the public records laws of
the State of North Carolina and it is the responsibility of Licensee to properly designate
materials that may be protected from disclosure as trade secrets under North Carolina
law as such and in the form required by law prior to the submission of such materials
to the City. Licensee understands and agrees that the City may take any and all actions
necessary to comply with federal, state, and local laws and/or judicial orders and such
actions will not constitute a breach of the terms of this Agreement. To the extent that
any other provisions of this Agreement conflict with this paragraph, the provisions of
this section shall control.

(h) To the extent permitted by North Carolina law, the parties hereto for themselves, their
agents, officials, employees and servants agree not to discriminate in any manner on
the basis of race, color, creed, national origin, sex, age, handicap, or sexual
orientation with reference to the subject matter of this Agreement. The parties further
agree, to the extent permitted by law, to conform with the provisions and intent of
City of Raleigh Ordinance 1969-889, as amended. This provision is hereby
incorporated into this Agreement for the benefit of the City of Raleigh and its
residents, and may be enforced by action for specific performance, injunctive relief,
or other remedy as provided by law. This provision shall be binding on the successors
and assigns of the parties with reference to the subject matter of this Agreement.
(i) Each of the undersigned hereby represents and warrants that it is authorized to
execute this Agreement on behalf of the respective parties to the Agreement and that
this Agreement, when executed by those parties, shall become a valid and binding
obligation, enforceable in accordance with its terms. City further represents and
warrants that it has full authority to grant access to all areas of the Property, including
the common areas to Licensee and the Performing Entities.

(j) This Agreement may be assigned by City to any purchaser of the Property. This
Agreement shall be binding upon and shall inure to the benefit of the parties'
respective representatives, successors, heirs, and assigns.

The remainder of this page is blank intentionally.
DocuSign Envelope ID: C8B50715-E64E-4DE9-9544-3D46E2EC8504
IN WITNESS WHEREOF, the parties hereto have executed this Contract by digital signature, under seal, on the respective
dates below, and this Contract shall be effective upon the date of the City’s signature.

CONTRACTOR: CITY:

CITY OF RALEIGH
a North Carolina municipal corporation

By: By:

____________________ (SEAL) ____________________
Signature Signature

____________________ ____________________
Name Name

____________________ ____________________
Title Title

____________________
Department

_____________________ ____________________
Date of Signature Date of Signature

ATTEST: ATTEST:

____________________ ____________________
Signature City Clerk (or designee)

____________________
Name

____________________
Title

This instrument has been pre-audited in the
manner required by the Local Government Budget
and Fiscal Control Act.

______________________
Chief Financial Officer (or designee)
DocuSign Envelope ID: C8B50715-E64E-4DE9-9544-3D46E2EC8504
City Manager's Office
Devereaux Meadows Acc. and Lic
Speedway, LLC dba Speedway (North Carolina), LLC
Marchell Adams-David
0000001226
Manager
Kelley Ryan
DocuSign Envelope ID: FC3EA92B-CC5C-462F-9E61-6C91472935AB
City Manager
Administrative Assistant
John M. Helms
-
February 10, 2021
February 12, 2021
UPDATED AUG '20
Note: all shown wells on City property were
abandoned in 2016. Proposed replacement
wells (2) are circled in red. Wells to be
located as close to the original location as
site circumstances will allow.
DocuSign Envelope ID: C8B50715-E64E-4DE9-9544-3D46E2EC8504
CERTIFICATE OF
SELF-INSURANCE COVERAGE DATE: October 30, 2020
SELF INSURER

Marathon Petroleum Corporation
539 South Main Street
Findlay, OH 45840
419-422-2121

This Certificate is issued to the Beneficiary noted below. The Certificate
does not amend, extend or alter the coverage described below.
COVERED ENTITY OR ENTITIES
NAMED BENEFICIARY

City of Raleigh
Post Office Box 590
Raleigh, NC 27602-0590

All wholly owned subsidiaries including:

Speedway LLC

COVERAGES

THIS IS TO CERTIFY THAT THE ABOVE-NAMED COVERED ENTITY OR COVERED ENTITIES PARTICIPATE IN MARATHON
PETROLEUM CORPORATION’S CORPORATE INSURANCE PROGRAMS, WHICH CARRY THE SELF-FUNDED INSURANCE
LIABILITIES AS DESCRIBED BELOW.
CD
LTR
TYPE OF INSURANCE POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE LIMITS

GENERAL LIABILITY

Self-Insured

July 1, 2020

July 1, 2021

Per occurrence
Contractual Liab.
Prod/Comp ops
Aggregate

$1,000,000
$1,000,000
$1,000,000
$2,000,000

AUTOMOBILE LIABILITY

Self-Insured

July 1, 2020

July 1, 2021

Per occurrence

$1,000,000

POLLUTION INSURANCE

Self-Insured

January 1, 2020

January 1, 2021

Per occurrence
Aggregate

UMBRELLA/EXCESS LIABILITY

Self-Insured

July 1, 2020

July 1, 2021

Per occurrence

WORKERS’ COMPENSATION
AND EMPLOYERS LIABILITY

Self-Insured

July 1, 2020

July 1, 2021

Statutory

$1,000,000

DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS: RE: Parcel ID No. 0071555 Located at 901 Capital Blvd, Raleigh, NC and Parcel ID No.
0102572, 1027 N. W St., Raleigh, NC. City of Raleigh is named additional insured as their interest may appear per the written terms of the contract/agreement with the
exception of workers comp. Thirty (30) days prior written notice will be sent for cancellation of policies.

EACH COVERED ENTITY IS AFFORDED COVERAGE UNDER MARATHON PETROLEUM CORPORATION’S INSURANCE PROGRAMS SET
FORTH ABOVE TO SATISFY INSURANCE REQUIREMENTS OF ANY CONTRACT ENTERED INTO BETWEEN BENEFICIARY AND ANY
COVERED ENTITY. THIS CERTIFICATE OF SELF-INSURANCE PROGRAM DOES NOT IMPOSE ANY LIABILITY OR OBLIGATION ON
MARATHON PETROLEUM CORPORATION OR ANY COVERED ENTITY OR EXPAND OR ALTER ANY LIABILITY OR OBLIGATIONS OF THE
COVERED ENTITY UNDER THE APPLICABLE CONTRACT.
CERTIFICATE HOLDER

City of Raleigh
Post Office Box 590
Raleigh, NC 27602-0590

CANCELLATION
SHOULD ANY COVERED ENTITY CEASE TO PARTICIPATE IN
MARATHON PETROLEUM CORPORATION’S INSURANCE PROGRAMS
BEFORE THE APPLICABLE EXPIRATION DATE SET FORTH ABOVE,
MARATHON PETROLEUM CORPORATION WILL MAIL 30 DAYS
WRITTEN NOTICE TO THE CERTIFICATE HOLDER, BUT FAILURE TO
DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND
UPON THE MARATHON PETROLEUM CORPORATION, ANY COVERED
ENTITY OR THEIR RESPECTIVEEMPLOYEES, AGENTS OR
REPRESENTATIVES.
By:
Cindy Hauenstein
Authorized Representative, Marathon Petroleum Corporation

CLAIMS MADE

ALL OWNED AUTO
HIRED AUTOS

Sudden and Accidental
COMMERCIAL GENERAL LIABILITY
DocuSign Envelope ID: C8B50715-E64E-4DE9-9544-3D46E2EC8504