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NPS Form 10-550(Rev. 11/2016) OMB Control No. 1024-0268 <br /> National Park Service Expiration Datc; 11/15/2019 <br /> 13. Violations: <br /> To your knowledge, have you, your company, or any current or proposed employees been convicted or fined for violations <br /> of State, Federal, or local law within the last 5 years?Are you, your company, or any current or proposed employees now <br /> under investigation for any violations of State, Federal, or local law or regulation? See instructions. <br /> Yes ❑ No X If"Yes" please provide the following informat'on.Attach additional pages, if necessary. <br /> Date of violation or incident under investigation: <br /> Name of business or person(s)charged: <br /> Please identify the law or regulation violated or under investigation: <br /> Please identify the State, municipality, or Federal agency that initiated the charges: <br /> Additional Detail (optional): <br /> (Results)Action Taken by Court: <br /> 14. Fee: <br /> Please include the payment receipt from pay.gov for the Application Fee and Management Fee as outlined in Attachment <br /> C. <br /> 15. Signature: <br /> False, fictitious or fraudulent statements of representations made in this application may be grounds for denial or <br /> revocation of the Commercial Us&Authorization and may be punishable by fine or imprisonment(U.S. Code, Title 18, <br /> Section 1001).All information provided will be considered in reviewing this application.Authorized Agents must attach <br /> proof of authorization to sign below. <br /> By my signature, I hereby attest that all my statements and answers on this form and any attachments are true, complete, <br /> and ccurate to the best of my knowledge. G� <br /> A )CA C l ( 9 I <br /> Signature Date <br /> Printed Name L121 n Cull-WI UV's) Title E z Di 2 <br /> duillill II II Or <br /> _� <br /> 155.1 cz- I aMq11),& <br /> APEWED h 2101 i ar <br /> CIO ",mey <br /> • <br /> Page 6 of 22 <br /> ATT T:, <br /> // . , <br /> (A ity Clerk <br />