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 13. Violations: To your knowledge, have you,your company,or any current or proposed employees been convicted or fined for violations of State, Federal, or local law within the last 5 years?Are you, your company, or any current or proposed employees now under investigation for any violations of State, Federal, or local law or regulation?See instructions. Yes ❑ No X If"Yes", please provide the following information.Attach additional pages, if necessary. Date of violation or incident under investigation: Name of business or person(s) charged: Please identify the law or regulation violated or under investigation: Please identify the State, municipality, or Federal agency that initiated the charges: Additional Detail (optional): (Results)Action Taken by Court: 14. Fee: Please include the Application Fee and Administrative Fee as outlined in Attachment C. 15. Signature: False,fictitious or fraudulent statements of representations made in this application may be grounds for denial or revocation of the Commercial Use Authorization and may be punishable by fine or imprisonment(U.S. Code, Title 18, Section 1001).All information provided will be considered in reviewing this application.Authorized Agents must attach proof of authorization to sign below. By my signature, I hereby attest that all my statements and answers on this form and any attachments are true, complete, and accurate to the best. • owledge. 121711 Signatu - Date Printed Name �� Title ress-,c APPROVED AS TO FORM A / ST' id" City C erk -JAMES D. ILES, t Attorney Page 6 of 21