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APPLICATION TERMS AND CONDITIONS:

Complete application package will include completion of all applicable fields, engineer stamped plans, certificate of insurance and confirmation of payment. Incomplete applications, including missing information in required fields, may result in processing delays. Applications submitted without the required fees will not be processed.

Please note, if the submitted application and prints require review by any independent environmental (HAZMAT) or other outside consultants, this review will be at applicant’s sole cost and in addition to the aforementioned fees.

***Canadian residents/businesses: this fee is a taxable supply, please include applicable GST***

STANDARD APPLICATION PROCESS IS 60-90 DAYS DEPENDING ON THE COMPLEXITY OF THE APPLICATION. REQUESTS FOR RUSH SERVICE IS AVAILABLE WITH AN ADDITIONAL FEE. Once a COMPLETED application package and required fees are received, including the rush fee of $1,500 USD ($1,903 CAD), a draft agreement will be made available for review within twenty-one (21) business days, assuming submission of completed application. Please be sure to mark the RUSH box below for projects requiring expedited review.

If the application is approved, the applicant agrees to reimburse property owner for any cost incurred by property owner incident to installation, maintenance, and/or supervision necessitated by this installation and further agrees to assume all liability for accidents or injuries which arise as a result of this installation as provided in the agreement to be executed. In addition, annual fees will be assessed pursuant to a written lease agreement.

Once an executable agreement is submitted to you, this agreement must be fully negotiated and executed within thirty (30) days. If not executed, the application and materials will be archived and resubmission (including fees) will be required.

A Standard Right of Entry is to access property for up to thirty (30) days. Beyond thirty (30) days, you will be responsible for an additional fee of $3,500 ($4,861.80 CAD). You also have the option to purchase a six (6) month Right of Entry for $20,000 ($27,781.60 CAD).

PLEASE INITIAL HERE INDICATING YOUR UNDERSTANDING OF THIS POLICY :

Upon submission of your application you will be provided with an opportunity number, please ensure to reference the opportunity number on the method of payment to ensure proper allocation. Send payment for the non-refundable fee of $4,000 USD
($5,556.82 CAD) to:

OmniTRAX Holdings Combined, Inc.
PO Box 209979
Dallas, TX 75320-9979

	RUSH
Check the box if this is a RUSH application. Add $1,500 USD ($1,903 CAD) in addition to the application fee listed below.

Provide Check number

CERTIFICATE OF INSURANCE

Upon submission of your application, you are required to submit a Certificate of Insurance. In addition, you will be required to obtain a CG 24 17 10 endorsement. Please ensure to name the Railroad as the Certificate Holder and that all required coverages are evidenced. Please review the templates for Certificate of Insurance and CG 24 17 10 Endorsement, linked here.

Railroad (Certificate Holder)

RR Acronym

RR Record ID

Please attach the Certificate of Insurance, including all required coverages and naming the selected Certificate Holder

Section 1 - Customer Account Information (Complete this section on behalf of the Agreement Entity and include information as it would be listed in the Agreement) :

Mailing Account Information :

Account Name :

Mailing Address :

Mailing Street :

Mailing City :

Mailing State :

Mailing Zip Code :

Type of Account (please select one):

Federal Tax Identification number (U.S. Leases):

Account Contact First Name :

Account Contact Last Name :

Account Contact Title :

Account Contact Email :

Account Contact Phone :

If applicable, state/province of incorporation or organization :

Email Address Where Notices Can be Sent to :

Overnight Delivery Service Address (if different) :

Billing Account Information :

Same as Mailing Account

YesNo

Billing Account Information Same as Mailing Account :

Billing Account Name :

Billing Contact First Name :

Billing Contact Last Name :

Billing Phone Number :

Billing Street :

Billing City :

Billing State :

Billing Zip Code :

ABV. APP TYPE

Billing Email :

New Billing Account Information :

Billing Account Name :

Billing Contact First Name :

Billing Contact Last Name :

Billing Phone Number :

Billing Street :

Billing City :

Billing State :

Billing Zip Code :

ABV. APP TYPE

New Billing Email :

Date range for the use of the Railroad’s property :

A Standard Right of Entry is to access property for up to thirty (30) days. Beyond thirty (30) days, you will be responsible for an additional fee of $3,500 ($4,375 CAD). You also have the option to purchase a six (6) month Right of Entry for $20,000 ($25,000 CAD).

INDICATE DATE RANGE FROM :

INDICATE DATE RANGE TO :

When do you need to receive this agreement from the Railroad? (Please allow 60 days for processing of this request, 30 if Rush)

Section 2 :

Purpose of Right of Entry :

[Calc] Purpose of Right of Entry

An existing agreement will be required at this location. You may move forward with submission of your Right of Entry application, however if there is not an existing agreement in this location, one will be required to be executed prior to granting a Right of Entry.

EXISTING AGREEMENT OR PRELIMINARY ENGINEERING APPROVAL NUMBER :

Lease Number :

Will there be any activity, material, vehicles or equipment within 50 feet of a railroad track in connection with your project?

Within 25 feet?

Will there be any excavation involved?

Please include shoring plans :

Will there be roadway resurfacing completed?

Will the roadway grade be altered ?

Purpose of your entry request : (This must be detailed and complete; attach engineering plans, shoring plans, if applicable, and details to support).

Please attach the detailed, Engineer Stamped, plans for your project here :

Entry Site Location :

DOT Number :

Property Street:

Property City :

Property County :

Property State or Province :

Property Country :

Opportunity Currency :

Railroad Mile Post :

Geographical Coordinates Required (Decimal Degrees DD):

Coordinates can be found online using Google Maps. (Example - Latitude: 39.720312 Longitude: -104.955415)

Property Coordinate (Latitude range : 0 to 90) :

Property Coordinate (Longitude range : -180 to 0) :

Subdivision :

Other Pertinent location information :

Application Type Default

Agreement Type Default

Application Status

Source of Opportunity :

Section 4 : MN USD Product Details :

Quantity :

USD Price Book Entry ID :

USD - Env- Product Sub-Category :

Right of Entry 30 Day Right of Entry (Environmental)

USD Env Product ID

USD - Non-Env -Product Sub-Category :

Right of Entry 30 Day Right of Entry (Non-Environmental)

USD Non-Env Product ID

Section 4 : MN CAD Product Details :

Quantity :

CAD Price Book Entry ID :

CAD - Env- Product Sub-Category :

Right of Entry 30 Day Right of Entry (Environmental)

CAD Env Product ID

CAD - Non-Env -Product Sub-Category :

Right of Entry 30 Day Right of Entry (Non-Environmental)

CAD Non-Env Product ID

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