01 Dl 21 0 . 02-02-2017 12

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STATE OF SOUTH CAROLINA )))))))))))))

(P1oase type or print)Submitted by:

/PATE)8432723075 P.012/012

g iOMRBEFORE THE

PUBLIC SERVICE COMMISSIONOF SOUTH CAROLINA

TRANSPORTATION COVER SHEET

DOCKETNUMBER: ~~

If this ts yaw that ttma Rtag aa app110atiaa with tha PSC, yau will naihave a Daakis Nmnbar. 'Iba Commission witt amign one ia you, If yauhava 61021 with thc Commission hafara, a Docket Nmnhar wus assignedand should ba Dniurad shove.

Telephone:

Address: Fax:

Other

Fmnti Z. A 7f/pf OJP 6WpflNOTE: Tbe cover sheet and informatioa contained herein neither replaces nor supplements the filing and service ofpleadings or other papersas required by law. Ibis foun is rnquhnd for use by the Public Service Commission of South Carolina for tbe purpose of docketing and mustbc fitlcd out co lctc

NATURE OF ACTION (Check all that apply)

Q Application - Class A/A Restricted

[+Application - Class C Taxi

Q Application - Class C Charter

Q Application - Class C Charter Bus

Q Application - Class C Non-Emcrgcncy

Q Application - Class C Stretcher Van

Q Applicafion - Class E Household Goods

Q Application - Class E Hazardous Waste

Q Application

Q Request for Extension to Comply with Order

~ Request for Order Granting Authority to Obtain a Certificate~ ofPublic Convenience and Necessity to be Rescinded

Q Request for Cancellation of Cmtificate

Q Request for Suspension

Q Request for Reinstatement

Request for Name Change on Certificate

Q Roquest to Amend Scope ofAuthority

Q Request to Amend Tariff (rate inmease, etc.)

Q Request to Amend Pan~anger Limit

Request

Q Exhibit

Late-Piled E/dnbit

QL~- ~+ ~ ~O AProposed Order

Q Publisher's Affidavit

Q Rcsorvation I,otter

Respans

Q Renunt

Other:

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

01. 0 031 pmm 03-03-1017 1 0431713073

08I03/2017 12:01 tutti P.002j012

PUBLIC SERVICE COMMISSION OF SOUTH CAROLlNA101 Executive Canter Drive, Suite 100

Columbia, South Carolina 29210(MaiTing address: Post Oflice 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

Date:

CLASS C- TAXI

Apphcation is hereby made for a Certificate ofPublic Convenience snd Necessity, in accordance with the provisionof S,C Code Ann., tl 58-23-10, et seq. (1976), and amendments thereto.

1. Name under which bushess is to be conducted (corporation, psrtnershiip, or s~lr yget~rshi, with or witboin trade name,)

tract A o App t

Mstbng A s o App cent eront om street s

ss

2, If the Applicant is an LLC or a corporation, a copy of the Certi6cate ofExistence trom the South CaroliuaS~ ofState aud the Articles of Incorporation must be attachetL (If incorporated outside ofSC, attach SouthCarolina Secretary ofState "Foreign Cotporationm Certificate.)

3, Selec tity Type; (Check one)Individual Ownen7Sole Proprietorship

0 Psrtnerabip - List names and addresses ofsll parson having an interest in the business,

E3 Corporation - List names snd addresses of two pdncipal officers,

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01:Dlu1 pm.05-03 2017 4

0510312017 12io1 Hei P.0041012

PROPOSED RATES AND CHARGES FOR SERVICE

TE~ 6~1e i'd. ~ p~w 1~

ted f 'eck all c unties which u are estin i n t te

You will only be allowed to operate in those counties checked below. Vou may request "Statewide"authority ifyou intend to operate in all counties in South Carolina.

Q Abbeville

Q Aiken

Allendale

Q Anderson

Q Bamberg

Q Bamweit

QSeaufort

Q Berkeley

Q Calhoun

Q Charieston

Q Cherokee

Q Chester

Chesterfield

Clsreudon

Q Colleton

Q Darlington

Dillon

QDo~Q Hdgefhkl

Q Fairfield

Q Florence

Q Georgetown

QG ~e

Q Greenwood

Q Hampton

gHurry

Q Jasper

Lcxmgton

Q Marion

Q Marlboro

Q Mccornuck

Q ¹wbctry

Q oconee

Orsngcburg

Q Pickens

Q Richland

Q Salads

Spartanbarg

Q Sumter

Q Union

3of9

01:01'11 p.III. 0$ 03-2017

05103/2017 12XI2 Qda ifAQN27%75 P.005(012

DESCRIPTION OF EQUIPMENT

You sre not required to own a vehicle to 6le sn application. However, prior to being issued a certi6cate by ORS,you will be required to have obtained a vehicle.

e cle i 'Thc number ofpassengers a vehicle is equipped.to cany is based on the number of~seat e in the vehicle, mchufing the driver's seatbelt,)

1-7 Passengers, including driverHV

8-15 Passengers, including driver

MAKE YEAR 4 MODEL

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01 Ol'u p.m.0$-03-10I, 0

05/03/2017 12:02 Hldd /f~75 P.006/012

'Ibis foun ST BE OMP E

INSURANCE QUOTE

by an

The insurance quote must be complete, listing current tnsunmce premiums. At tbe discretion ofthe Commission, a copy ofcurrentinsurance policies may be requtoL Do not provide a copy of insurance policies unless reques/ed. Ycu will not be required to

The following insurance quote is for.

e ofApplicant

.rp, i.: 7o P/la~Addre ofApplicant

Liability Insurance $

The above quoted premium is for a term of months.

Minimum Limits - Intrastate Only:

1-7 Passengersa $ 25,000/50,000/25,000

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

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

e o Insurance ompany

/ ( s-ome tce ess 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.

Authorized Insurance Company Representative's Signature

2H?XI'f

you wish to self-insure your motor vehicles for liability and property damage, you must comply with S.C. CodeAnn. Sections 56-9-60 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 Worker's Compensation Commission (WCC) provided that you will be able to: 1) post a suretybond or lettermf-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

mmuu pm. m-os-rorr r 8431usrrr

05/03/2017 12:02 ))Md P.007/012

OPTIaNS

Iyehictes/Medalli n 'mitof UsbIUttl. 250DO/5000C/25000Uninsured Materi tS 2500D/500DO

Vnderrnsured Mate, i its 25000/50000oersonel Injury Prat ntianDeouctibjs Per Acti ent

Aggregate Oeducgple

Pure premium per Insu e8 Unitpremium Taxes 8, Fees,fL65sa)

Annual PremiumRisk Managementfee

IiI.'Oan Ssinad 5 ksx4 mmpsisnsalrj

Total Oue

SD

52r151551

52,15252ZS

52,457

Deposit l20asl

No.of lnstsllme tsI'Ianthiy InscaOment

I)SS Fes/Inrtallm,nt)

Broker Commis el on t12 SS)

Number of Sha res

Si12

5150

5227131

Insurance pallcy ls issued,by Onyx insurance Company, Inr A Rlsknetentlon group. A Risk Retentlan tfraup may not besubject to ail of the lnsur'ence jevrs or regulations of yaur State. Rate Insurance Insalvency guaranty funds ere notavellabla for Risk RetentIIsn Groups.

Thank you,

01:01:11 p.m. OS 03-RD17 8

05l0312017 12:02 Wd tFA103432723075 P.008l012

arne o App cant

1. Are there currently any outstanding 'udgments against the Applicant?

0 Yes 0

IfYes, indicate nature efjudgement(s) against applicaht.

2. Is Applicaut familiar with aH statutes snd mgulations, including safety regulations aud governing for-hire motorcarrier o erations in South South Carolina, snd does Applicant agree to operate iu compliance with thesestatu ami regulations7

Yes 0 No

3. Is Appli t aware of the Commission's insurance requirements and the insurance premium costs associatedthere 7

Yes O No

6 oft

01:01:11P.m.o&-DZ-2017 9

05IOSI2017 12:02 igtki IfI005432723075 P.OOSI012

l. Applicant understands that all drivers nmst be a minhmun of lg years ofage.

Q No

2, Applicant understands that a certified copy ofthe driver's three (3) year driving record issued by the SC DMVand such record ftom the DMV of the state in which the driver ls or has been domiciled for such period mustbe msinta'i d in the Applicant's business office.

Yes Q No

3. Applicant understands that a~ history background cheek from the state where the driver currently livesmust be ed in the Applicant's business office.

es Q No

4, Appficant understands that all drivers opamting a vehicle under a Chss C Taxi Certificate must have intheir possession when operating a charter vehicle, a vaHd driver's license issued by the SC DMV or the currentstate ofr 'nce of the driver.

Yes Q No

5. Applicant uuderstands that aH Class C Taxi Certificate holders are prohibited f'mm employmg oz leasingvehicles to dtivers who are registered, or~ to be registered, as sex offenders with the South CarolinaState Law Enforcement Divisien or any national registry of sex offenders.

Yes Q No

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01:Ot:21 p.m. 05-D3- jM 7 S4l '123D75

0510312017 12:03 IBSS P.OI 0/012

PUBLIC SERVICB COMMISSION OF SOUTH CAROLINAPOST OFFICE DRAutBR 11649

COLUMBIA, SOUTH CAROLINA 29211

Applicant is familiar with the provision of S.C. Code Axm. $58-23-10, et seq.(19763, and amendments thereto,and R.103-100 through R.103-241 of the Comxmssion's Rules and Regulations for Motxxr Caxrlers (Volume 26,S.C. Code Ann. Regs„1976), and 1438-400 through R.38-303 ofthe Department ofPublic Safety's Rules andRegulations for Motor Csxriers (Volume 23A, S.C. Code Ann., 1976) and amendments thereto, and herebypromises comphance therewith,

The Applicant for the Certilicate ofPublic Convenience and Necessity ss set forth in the foregoing, swear oraf5xm that all statements contained in the above application are true and correct.

i e o App cant e.g. P er, etc.

8 of9

cpchmiedin, Janice

From:Sent:To:Subject

Leon Halloway &I'ahalloway@gpnaihcom&

Wednesday, M'ay 24, 2017 135 PM

Schmieding, Janicefrom leon halloway

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