Mount Rainier National Park 12/7/2018 (2)

NPS Form 10-550(Rev. 11/2016) OMB Control No. 1024-0268 National Park Service Expiration Date: 11/15/2019 increased coverage; see Park-Specific CUA Insurance Requirements("Attachment B").Auto Liability insurance is also required at the minimum coverage amounts described below. COMMERCIAL GENERAL LIABILITY INSURANCE Single Purpose Activities(includes day and overnight hiking, photography and $500,000 art classes, bicycling, and group camping) Climbing $1,000,000 Commercial Vehicle Insurance—Passenger Transport Minimum per Occurrence Liability (bodily injury and property damage) Limits* Up to 6 passengers $1,000,000 7—15 passengers $1,500,000 16—25 passengers $3,000,000 26+ passengers $5,000,000 Indicated minimum per occurrence liability limit or minimum State liability requirement in State of operation, whichever is greater. 10. Will your business operate vehicles(car,truck,van, bus,taxicab,vessel, aircraft, etc.)within NPS boundaries?Yes ❑ No If"Yes,"please give a description of each vehicle. Use additional paper, if necessary.All vehicles are required to be registered and the operators are required to have the proper licenses to operate them commercially, as required by law or regulation. Make/Model of Vehicle License Number Year . Max#Passenger Capacity Own/Rent Ford Transit 350 68309D 2018 14 Own Ford E450 Super Duty 52306D 2011 14 Own Ford E350 Clubwagon 58124D 2003 12 Own 11. Employee Licenses and Certifications: Parks typically require proof of applicable licenses, registrations and certificates of training,such as;valid driver's or pilot's license,fishing license,vessel registration, dive certification, CPR certification, or others. Provide copies of licenses and certifications required by"Attachment A". 12. NPS Employment: Are you, your spouse, or minor children employed within the National Park Service? Yes ❑ No X If"Yes", please provide information below: Employee Name: Title: Park and Office Where Employed: Page 5 of 21