STATE OF SOUTH CAROLINA

'Caption of Case)=sample: Application for a Class C Charter Certificate from

John Doe dba Doe's Limo

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BEFORE THEPUBLIC SERVICE COMMISSION

OF SOUTH CAROLINA

TRANSPORTATION COVER SHEET

NUMBER: gt()/& - BS~

If this is your first rime tiling an appticatlon with the PSC, you will nothave a Docket Number. The Commission will assign one to you. If youhave filed with thc Commission before. a Docket Number wai assignedaod should bc entered above.

Telephonet Fv h- ua(,e

Fax:

Other:

Email. uu I.'d.~(~NOTE: The cover shcct and information contained herein neither replaces nor supplements thc filing and service of pleadings or oth r papersas required by law. This form is required for usc by thc Public Service Commission of South Carolina for the purpose of docketing and mustbe filled out corn letel .

NATURE OF ACTION (Check all that apply)

Application - Class A/A Restricted

Application - Class C Taxi

$Q Application - Class C Charter

Application - Class C Charter Bus

g Application - Class C Non-Emergency

Application — Class C Stretcher Van

Application - Class E Household Goods

Application - Class E Hazardous Waste

Q Application

Request for Extension to Comply with Order

Request for Order Granting Authority to Obtain a Certificateof Public Convenience and Necessity to bc Rescinded

Request for Cancellation of Certificate

Q Request for Suspension

Q Request for Reinstatement

Rcque'st for Name Change on Certifica

Request to Amend Scope of Authority

Request to Amend Tariff (rate increase, ctc.)

Request to Amend Passenger Limit

Request

Exhibit

Late-Filed Exhibit

Letter

Proposed Order

Q Publishet's AffltdavREC~~H0 «scrvadon tter

SEp g 9 2015

Response pSG SC

Q Return to Petinon GLEB~s GFRGE

Other:

If you have any questions about this form, please contact the PUBLIC SERVICE COMMISSION at 803-896-5100.

PUBLIC SERVICE COMMISSION OF SOUTH CAROLINA101 Executive Center Drive, Suite 100

Columbia, South Carolina 29210(Mailing address: Post Office Drawer 11649, Columbia, SC 29211)

Phone: (803) 896-5100 Fax: (803) 896-5199

APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY FOROPERATION OF MOTOR VEHICLE CARRIER

cLAss c -~ LI +QJ 1c )Date: o( 4r — Ql&

Application is hereby made for a Certificate of Public Convenience and Necessity, in accordance with the provisionof S.C. Code Ann., $ 58-23-10, et seq. (1976), and amendtnents thereto.

1. Name under which business is to be conducted (corporation, partnership, or sole proprietorship, with or without trade naiue.)t

&l04} ave~~«~ Lt.t"

@SAN P VootCAJtreat Address ofApphcsnt

(7~& Q dt~LeS+o~ S()erik o4aet Xe"} 8ai ing Address o App icsut i i orcut trom street address

f%& ~he +suone Fax

(} ()I Reit n ~s!,C ~mai A ess

2. If the Applicant is an LLC or a corporation, a copy of the Certificate ofExistence 1'rom the South CarolinaSecretary ofState and the Articles of Incorpouuion must be attached. (If incorporated outside ofSC, attach South

Carolina Secretary of State "Foreign Corporation" Certificate.}

3. Select Entity Type: (Check one)Individual Ovvner/Sole Proprietorship

partnership — List naines and addresses of all person having an interest in the business.

g. Co oration - List names and addresses of two principal officers,

b voiCcfple gt t'rt W 6'. SG d9%lK

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Applicant is financially able to furnish the services as specified in this application and submits the followingstatement of assets and liabilities.

BALANCE SHEET

Cash

Receivables

Assets:

Balance at Ti e Application is Filed:Month Veer ~IS

Real Estate

Buildings and Equipment (Net)

Motor Vehicles (Net)

Garage Equipment (Net)

Machinery and Tools (Net)

Supplies on Hand

Prepaids and Other Assets

Total Assets*

Accounts Payable

Notes Payable

Mortgages Payable

Equipment Obligations

Accrued Salaries and Wages

Other Accrued Obligations

Other Liabilities

Total LiabiTities

Capital Stock

Retained Earnings

Total Equity

Total Liabilities and Equity*

* Total Assets - Total Liabilities and Equity2of9

PROPOSED RATES AND CHARGES FOR SERVICE

ro osed t d r es List nl m 'rn har es er i eo tri an orhourl

fad.S'weeds~ $Z PasS~.)~- g

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e ted Sco o uth 'c coun i in hich are re uestin is i nto o er te

You will only be allowed to operate in those counties checked below. You may request "Statewide"

authority if you intend to operate in all counties in South Carolina.

Abberdlle

Q Aiken

Allendale

Q Anderson

Q Bamberg

Bamwelt

Q Beaufort

Berkeley

Calhoun

Q Charleston

Cherokee

Q Chester

Chesterfield

Clarendon

Colleton

Darlington

Q Dillon

Dorchester

Edgefield

Fairfield

Florence

P Georgetown

Creenville

tlreenwood

Q Hemp~on

Herry

Jasper

Kershaw

Lancaster

Q Laura s

Q Lee

Q Lexington

Q Marion

Marlboro

Q McCormick

Q Newberry

Q Oconee

Orangcburg

Pickens

Richland

Selude

Q Spartanburg

Q Sumter

Vnion

Q Williamsburg

Q York

Statewide

3 of 9

DESCRIPTION OF EQUIPMENT

You are not required to own a vehicle to file an application. However, prior to being issued a certificate by ORS,

you will be required to have obtained a vehicle.

axi m umber ofPas Vehicle is E ui ed Ca (The number of passengers a vehicle is equippedto carry is based on the number of~ in the vehicle, including the driver's seatbelt.)

i =I Passengers, including driver

JK 8-15 Passengers, including driver

YEAR k. MODEL EMPTY WEIQHT

4 of9

INSVRAlh(CE QVOTE

This form UST B MPLKTKD D SIGNKD by an AV HORI KD INSVRANC MPATATIVK.

The insurance quote must be complete, listing current insurance premiums. At the discretion of the Commission, a copy of currentinsurance policies may be required. Do nct provide a copy of insurance policies unless requested. You will not be required tc

The following insurance quote is for~m

(-'r(oifhst MTObA~ L thh&strhm Sqr hftte- LLtName of Applicant

&5 @r'ide(a 4.L,l ra~iAddress ofApplicant

Amount of Pr i m: no ed: See B lo

Liability Insurance $

The he eq eteettem 'efe term f

Limits

months.

Minimum Limits - Intrastate Only:

1-7 Passengers" $ 25,000/50,000/25,000

8-15 Passengers* $ 25,000/100,000/25,000

A(v~i n

* Passengers - Number of seatbelts in the vehicle,including the driver's seatbelt

arne of Insurance Company

ome ce ress o ompany

I am familiar with the Commission's Rules and Regulations relating to insurance requirements and the above quotemeets the minimum insurance limits prescribed, The insurance company making this quote is authorized by theSouth Carolina Department of Insurance to do business in South Carolina.

ate uthorized Insurance Company Representative's Signature

5QTTCK:If you wish to self-insure your motor vehicles for liability aud property damage, you must comply with S.C. CodeAnn. Sections 56-9R and 58-23-910. For more information, contact Vickie Coker with the Department of MotorVehicles at (803) 896-8457.

If you wish to apply as a self-insured for worker's compensation coverage in South Carolina you may do so withthe South Carolina Workef's Cotnpensation Commission (WCC) provided that you will be able to: I) post a suretybond or letter-of-credit with the WCC for a minimum of $500,000, 2) agree to pay a yearly self-insurance tax, and3) agree to pay an annual assessment to the South Carolina Second Injury Fund. For more information, contact theWCC Self-Insurance Division at (803) 737-5712 or on the web at www.wcc.state.sc.us/self-insurance.

5 of 9

Exhibit Fit Willin nnd Able W

4(00&( IVlog/ (K L~ 5(%w St~&c&Sarne o Applicant

l. Are there currently any outstanding judgments against the Applicaiit?

Q Yes No

If Yes, indicate nature ofjudgement(s) against applicant.

2. Is Applicant familiar with all statutes snd regulations, including safety regulations and governing for-hire motorcarrier operations in South South Carolina, and does Applicant agree to operate in compliance with thesestatutes and regulations? Yes

3. Is Applicant aware of the Commission's insurance requirements and the insurance premium costs associatedtherewith? Yes

6af9

Exhibit on Driver ttahfieations

l. Applicant understands that all drivers must be a minimum of la years of age.

tl Yes Q No

2. Applicant understands that a certified copy of the driver's three (3) year driving record issued by the SC DMVand such record from the DMV of the state in which the driver is or has been domiciled for such period mustbe maintained in tbe Applicant's business office.

P Yes Q No

3. Applicant understands that a criminal history background check from the state where the driver currently livesmust be maintained in the Applicant's business office. Yes Q No

4. Applicant understands that all drivers operating a vehicle under a Class CAR Certificate must have intheir possession when operating a charier vehicle, a valid driver's license issued by the SC DMV or the currentstate of residence of the driver.

Yes Q No

5. Applicant understands that all Class C~ Certificate holders are prohibited from employing oi leasingvehicles to drivers wbo are registered, or required to be registered, as sex offenders with the South CarolinaState Law Enforcement Division or any national registry of sex offenders.

Yes Q No

PUBLIC SERVICE COMMISSION OP SOUTH CAROLINAPOST OFFICE DRAWER 11649

COLUMBIA, SOUTH CAROLINA 29211

Applicant is familiar with the provision of S.C. Code Ann. II58-23-10, et seq.(1976), and amendments thereto,and R.103-100 through R.103-241 of the Commission's Rules and Regulations for Motor Carriers (Volume 26,S.C. Code Ann. Regs., 1976), and R,38-400 through R.38-503 of the Department of Public Safety's Rules andRegulations for Motor Carriers (Volume 23A, S.C. Code Ann,, 1976) and amendments thereto, and herebypromises compliance therewith

S.C. Code Ann. Section 58-3-250 states, in part, that every fmal order of the Commission must be served byelectronic service, registered or certified mail, upon the parties to the proceeding or their attorneys.

Please check the applicable boxl

e Applicant AGREES to receive future Commission orders related to the Applicant's authority in South Carolinathrough the Commission's eService System. The Applicant authorizes the Commission to serve its orders by using the e-mail address as it appears on page one of this Application.

The Applicant DOES NOT AGREE to receive fuhue Commission orders related to the Applicant's authority in SouthCarolina through the Commission's eService System.

The Applicant for the Certificate of Public Convenience and Necessity as set forth in the foregoing, swear oraffirm that all statements contained in the above application are true and correct.

itic o pplicant (e.g. resident„wner, etc.)

STATE OF SOUTH CAROLINA

COUNTY OF

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Commission Expires

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0+ce ofSecretary ofState Mark Hammond

Certificate of Existence

I, IIark Hammond, Secretary of State of South Carolina, Hereby Certify that:

GLOBAL MOBILE LIMOUSINE SERVICES LLC, a limited liability company dulyorganized under the laws of the State of South Carolina on September 24th,2015, with a duration that is at will, has as of this date filed all reports due thisoffice, paid all fees, taxes and penalties owed to the State, that the Secretary ofState has not mailed notice to the company that it is subject to being dissolved byadministrative action pursuant to S.C.Code Ann. $33-44-809, and that thecompany has not filed articles of termination as of the date hereof.

Given under my Hand and the GreatSeel of the State of South Carolina this24th day of September, 2016,