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NPS Form 10-550(Rev. 11/2016) OMB Control No. 1024-0268 <br /> National Park <br /> Service <br /> Expiration Date: 11/15/2019 <br /> COMMERCIAL USE AUTHORIZATION <br /> APPLICATION FORM <br /> Some parks have additional requirements for businesses that offer services to visitors relating to the safety and welfare of the <br /> visitors and protection of the resources.These requirements may include applicable operating licenses,certificates showing <br /> proof of training, operating plans, emergency response plans, group size limitations, etc. <br /> 1. Service for which you are applying: Summer day hiking <br /> 2. Will you be providing this service in more than one park?Yes X No ❑ If"Yes", list all parks and services provided. <br /> 3. Applicant's Legal Business Name: City of Everett Parks and Community Services <br /> 4. Authorized Agents: (Name and title of owner, and any onsite person authorized to manage the operation or service.) <br /> 5. Mailing Addresses <br /> PRIMARY CONTACT INFORMATION Euan Robertson <br /> Address: 802 E Mukilteo Blvd <br /> City, State,Zip: Everett,WA98203 <br /> Email: erobertson@everettwa.gov Website: everettwa.gov <br /> Day Phone: 425.257.8396 Evening Phone: Fax: <br /> ALTERNATE CONTACT INFORMATION (Dates to contact you at this address, if seasonal. ) <br /> If same as "Primary Contact Information, check here X and go to question 6. <br /> Address: <br /> City, State,Zip: <br /> Email: <br /> Website: <br /> Day Phone: Evening Phone: Fax: <br /> 6. What is your Business Type? (Please check one below) <br /> ❑ Sole Proprietor <br /> ❑ Partnership(Print the names of each partner. If there are more than two partners,please attach a complete list of <br /> their names.) <br /> Name: <br /> Name: <br /> ❑ Corporation: (State: Entity Number: ) <br /> ❑ Non-Profit(Please attach a copy of your IRS Ruling or Determination Letter) <br /> 7. State Business License Number: Expiration Date: <br /> 8. Employer Identification Number(EIN): <br /> 9. Liability and Vehicle Insurance: <br /> Provide proof of insurance.The CUA operator must maintain General Liability insurance naming the United States of <br /> America as additional insured. Minimum coverage amount is$500,000 per occurrence. Some activities will require <br /> Page 4 of 21 <br />