Fill Nozzle Issues Report

FILL NOZZLE ISSUES REPORT AND SERVICE AGREEMENT

Parties and Recitals

Client Name:    Service Provider Name:

Effective Date:

WHEREAS, Client operates one or more fueling locations and requires timely reporting and remediation of fuel dispense equipment malfunctions including but not limited to fill nozzle faults, drips, leaks, and dispenser interface errors; and

WHEREAS, Service Provider is engaged in the inspection, maintenance, and repair of fueling equipment and possesses the skill, personnel, and insurance required to perform corrective and preventive services with respect to fill nozzle issues; and

WHEREAS, the parties desire to document the facts of a specific nozzle incident, define the scope of required remedial work, and set forth payment, term, confidentiality, and governing law provisions applicable to the response and any follow-up services.

Report Details

Pump Number:   Nozzle ID:   Fuel Product:

Incident Date:   Time:   Reported By:

 Leak visible     Drip after shutoff     No dispense     Out of service     Safety hazard present

Scope of Work

The Service Provider shall perform inspection, diagnosis, and corrective measures to restore safe and compliant operation of the impacted fill nozzle(s) and associated dispenser components. The scope may include removal and replacement of nozzle hardware, repair of breakaway valves, nozzle calibration, leak testing, and issuance of a written completion report.

Payment Terms

Agreed Repair/Service Fee: $

Late Payment Fee:   Client agrees that overdue amounts shall accrue interest or late fees as indicated above and that Service Provider may suspend further work until accounts are current.

Term and Termination

Term Start Date:   Term End Date:

Either party may terminate this Agreement for material breach if the breaching party fails to cure within days after written notice. Termination shall not relieve the Client of payment obligations for services performed prior to termination nor for costs incurred by Service Provider in reasonable reliance on the agreement.

Confidentiality

Each party agrees to hold in confidence all non-public business, technical, and operational information disclosed in connection with the assessment and remediation of the nozzle issue. Confidential information shall not include information that is or becomes generally available to the public other than by breach of this Agreement or information independently developed by the receiving party.

Liability and Insurance

Service Provider shall maintain commercial general liability and, where applicable, professional liability insurance sufficient to cover work performed under this Agreement. Except for gross negligence or willful misconduct, neither party shall be liable for incidental or consequential damages arising from performance of routine repair work under this Agreement.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the state specified by the Client: . Venue for any dispute shall lie exclusively in the courts of that state.

Entire Agreement

This document, together with any written work orders or change orders executed by the parties, constitutes the entire agreement between Client and Service Provider concerning the subject matter hereof and supersedes all prior oral or written representations, negotiations, or agreements. No amendment shall be effective unless in writing and signed by both parties.

Completion Report and Follow-up

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