Mobile Service Provider Application and Permit

10 MOBILE SERVICE PROVIDER APPLICATION AND PERMIT Company Applicant Name Authorized Representative Title Mailing Address Business Telephone ________________________ Mobile Telephone Email Address Service or work to be performed The Applicant shall provide the following information to Johnston Regional Airport 1 The Applicant's Articles of Incorporation , Articles of Organization , or Certificate of Limited Partnership filed with the Secretary of State , or , if the Applicant is a general partnership , a copy of the partnership agreement 2 If the name of the person making the application is not listed on the Applicant ' corporate documents as having the authority to legally bind the Applicant , then the Applicant must provide a letter signed by one of the Applicant's officers , including contact information , that the representative is authorized to act on behalf of and bind the Applicant 3 A detailed explanation of the intended type and scope of services to be provided by the Applicant 4 A copy of any certificate s or rating s required by the FAA for the service s to be provided or the work to be performed 4 A statement as to why it is impossible or impractical for the Applicant to lease space at the Airport to provide the service s or work to be performed 5 A certificate of insurance in the amount s required by the Airport's Minimum Standards for the service s provided or work to be performed , listing the Johnston County Airport Authority as additional insured Upon the granting of this Permit , the Applicant agrees as follows 1 FEE PAYMENT The Applicant agrees to pay all fees as set forth in the Johnston County Airport Authority Rates and Charges Fee Schedule , as may be amended from time to time , as well as any late fees , interest and penalties 2 TRANSFER This Permit may not be assigned or transferred , and the Applicant cannot provide any services other than those approved by the Authority as set forth in this Permit { 00526370 DOCX V J136024288 ; } 1PageMOBILE SERVICE PROVIDER APPLICATION AND PERMIT 3 INFORMATION CHANGES The Applicant will notify the Airport Director within ten 10 days of any change to the information provided pursuant to this Application and Permit 4 SECURITY AND SAFETY Applicant will abide by all security and safety procedures at the Airport and shall not enter any area of the Airport unnecessary to perform the services provided 5 RULES AND REGULATIONS Applicant acknowledges that it has been provided with a copy of the Rules and Regulations of the Airport and will abide by the Rules and Regulations , as well as all applicable state and federal laws , ordinances and regulations 6 RELEASE OF LIABILITY It is understood and agreed that Applicant's activities shall be at the sole risk of the Applicant and that the Authority and Airport will not be held responsible for the Applicant's activities or damage caused by Applicant to any person or property 7 INDEMNITY Applicant agrees to indemnify and hold the Authority and the Airport , and their officers , agents , employees , insurers , successors and assigns , harmless from and against any and all liabilities , judgments , costs , damages , expenses , claims , actions or demands of any kind and nature , by any person whatsoever on account of property damage , injury or death of a person arising from Applicant's activities , use or occupation of the Airport , including acts of Applicant's agents , and Lessee shall give the Authority prompt notice of any such claims filed against Applicant or the Authority or the Airport 8 INSURANCE Applicant agrees to keep in effect during the term of this Permit insurance as required by the Minimum Standards and to immediately notify the Airport of any changes to its insurance 9 TERM This Permit shall be valid for a period of one 1 year from the date signed by the Airport Director This the day of , 20 JOHNSTON COUNTY PERMITTEE AIRPORT AUTHORITY By By Airport Director Name ______________________________ Title ATTEST BY ATTEST BY _____________________________ _________________________________ Witness Witness { 00526370 DOCX V J136024288 ; } 2Page