Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Confidential Employee Fuel Pin/Fuel Card User Agreement

  1. Confidential Employee Fuel Pin/Fuel Card User Agreement
  2. Fuel cards are issued to City vehicles and equipment, not employees. Each fuel card PIN is issued to a City employee.
    Use of a card tracks vehicle/equipment fueling. The use of a PIN tracks employee usage of fuel cards.
  3. The City’s current fuel card systems are:
    Napa Valley Petroleum (NVP) and Wright Express, Inc (WEX). The PIN assigned to you will work with both NVP and WEX fuel cards.
  4. Card Instructions: Follow the fuel pump prompts. In general, you will need the following:
    1. Check ODOMETER READING before fueling. 2. Insert vehicle’s fuel card. 3. Enter your personal PIN and press ENTER. 4. Enter Odometer reading when prompted. 5. Select Fuel Grade and begin fueling
  5. Care and use
    To avoid damage to fuel card, keep away from direct sunlight, extreme heat, and contact with objects that may damage magnetic strip. Return the fuel card to its assigned vehicle in the location designated by the Fleet Division.
  6. Do not write your PIN on any vehicle issued fuel card
    Report lost, damaged, or stolen Fuel cards immediately to the following. Peter Brestak - [email protected]
  7. By signing this document seeking a fuel card user PIN, you agree to the following:
    1. The assigned PIN is used only by you. Do not share your PIN with anyone. 2. Use of City fuel cards may only be used for fueling City vehicles and equipment. 3. If using your personal vehicle, fueling is at your own expense. Reimbursement for personal vehicle use shall be submitted to your Department and reimbursed at the current IRS rate.
  8. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  9. Leave This Blank:

  10. This field is not part of the form submission.