APPLICATION TERMS AND CONDITIONS:

TO ASSIGN AN EXISTING AGREEMENT TO A NEW PARTY, COMPLETE THIS FORM ON BEHALF OF THE ASSIGNEE (NEW APPLICANT). USE THIS APPLICATION TO SUBMIT YOUR REQUEST [NOTE: ASSIGNMENT OF ANY AGREEMENT IS AT THE SOLE DISCRETION OF OMNITRAX, INC OR THEIR MANAGED AFFILIATE].

STANDARD APPLICATION PROCESS IS 60-90 DAYS DEPENDING UPON THE COMPLEXITY OF THE APPLICATION. REQUEST FOR RUSH SERVICE: Once a COMPLETE application 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 Assignment Agreement is submitted to you, the agreement must be fully negotiated and executed within thirty (30) days. Thereafter, the application and materials will be archived and resubmission (including fees) will be required. Some agreements are not assignable and will be required to be terminated and a new

agreement issued. Please refer to the terms of your agreement to conclude this information before submitting the assignment application.

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 $1,000 USD ($1,403.43 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 above.

Provide Check Number :

#

NEW APPLICANT 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 newly assigned Agreement Entity and include information as it would be listed in the Agreement) :

Account Information

Is this application for a new customer account or an existing customer account?

Mailing Account Information :

Account Name :

Type of Account (please select one):

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

Mailing Street :

Mailing City :

Mailing State :

Mailing Zip Code :

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) :

Application Status

Source of Opportunity

Billing Account Information(Complete this section on behalf of the entity responsible for annual Agreement payments) :

Same as Mailing Account :

YesNo

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

Billing Email :

Billing Account Information Same as Mailing Account :

Billing Account Name :

Billing Street :

Billing City :

Billing State :

Billing Zip Code :

Billing Contact First Name :

Billing Contact Last Name :

Billing Phone Number :

Billing Email :

Section 2 - Application Location Details

Is Track usage needed ?
NOTE : Land Leases do not include the use of Track. A Track Lease Application will be required.

Nearest Milepost :

DOT Number :

Track Station (from):

Track Station (to):

Section :

Township :

Range :

Property Address/Street :

Property City :

Property State or Province :

Property County :

Property Country :

Opportunity Currency

Geographical Coordinates Required (Decimal Degrees DD):

Property Coordinate (Latitude) :

Property Coordinate (Longitude) :

Located on the (N/S/E/W) side of (landmark, intersection)

Section 2 : Assignment Details :

Agreement Type :

Application Type

Existing Agreement Customer (Assignor):

Please provide Existing Tenant/Licensee information below
(if available) :

First Name :

Last Name :

Tenant Email :

Tenant Phone :

Existing Agreement Number :

Please provide existing agreement :

Do you plan to sublease to another party? (NOTE: If yes, Letter of Consent will be required.)

Please provide Letter of Consent, if available :

Will there be modifications and or alterations

to the existing agreement, other than assignment?

Please describe the modifications required in the agreement :

Are the modifications related to Track or Utilities ?

Please attach applicable plans for your project here :

Section 3 - Commodity Item Details (Application Type) :

Product Category

Product Sub-Category

Angle between centerline of right-of-way and wireline (degrees) :

Number of RR Co.’s tracks to be crossed (Number) :

Section 3 - RAILROAD UTILITY ACCOMMODATION POLICY :

Proposed plans must adhere to the Railroad's Utility Accommodation Policy, be approved by the railroad, and a crossing agreement must be fully executed between the railroad and the applicant before construction can begin. Material and installation are to be in strict accordance with specifications of the American Railway Engineering Association and requirements of the railroad. One original of this form shall be submitted, accompanied by digital Engineer Stamped Plans, elevation section of crossing from field survey, location in respect to Mile Post, width of railroad right of way, location of adjacent structures that may impede the crossing, and all information required in Figures 1 and 2 of AREMA Specifications, Part 5. If open cutting or tunneling is necessary, details of sheeting and method of supporting tracks or driving tunnel shall be shown.

If you have not reviewed RAILROAD'S UTILITY ACCOMODATION POLICY, please review the document, prior to submittal of this application.

Provide location (i.e. city, street, railroad milepost) and engineer stamped plans of the proposed leased premises with dimensions, coordinates and directions. Also depict any planned improvements on the leased premises with dimensions from nearest track (may incur additional costs or agreements for above ground occupancy).

All specifications meet or exceed Railroad’s Utility Accommodation Policy INITIAL HERE:

OR Variance requested – PLEASE DESCRIBE IN DETAIL (Include requested variance detail in plan submission):

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

Section 3 - TECHNICAL SPECIFICATIONS FOR INDUSTRIAL TRACK :

Proposed plans must adhere to the TECHNICAL SPECIFICATIONS FOR INDUSTRIAL TRACKS, be approved by the railroad, and a track agreement must be fully executed between the railroad and the applicant before construction can begin. Material and installation are to be in strict accordance with specifications of the American Railway Engineering Association and requirements of the railroad. One original of this form shall be submitted, accompanied by digital Engineer Stamped Plans.

If you have not reviewed T ECHNICAL SPECIFICATIONS FOR INDUSTRIAL TRACKS, please review the document, prior to submittal of this application.

Provide location (i.e. city, street, railroad milepost) and engineer stamped plans of the proposed leased premises with dimensions, coordinates and directions. Also depict any planned improvements on the leased premises with dimensions from nearest track (may incur additional costs or agreements for above ground occupancy).

All specifications meet or exceed TECHNICAL SPECIFICATIONS FOR INDUSTRIAL TRACKS - INITIAL HERE:

Or Variance requested – PLEASE DESCRIBE IN DETAIL (Include requested variance detail in plan submission) :

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

By submitting this application for credit, you authorize OmniTRAX, Inc. or it's affiliates, to make any inquiries necessary to determine credit worthiness. You release your banking instruction release details that would assist to determine credit worthiness.

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize

the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein. Our terms of sale and service are NET 30 DAYS from the date listed

on the invoice. Invoices that are beyond granted terms will be assessed a late fee of 18% APR (1.5% monthly) additional Terms and Conditions apply. A $20.00 charge will apply for any NSF/Non-Sufficient Checks.

JV Test Section (Account Contact Fields/Disregard for now)

Mailing State Code

Field for Account Name lookup

Account Name 1

Please select the Mailing State first to add the account name.

Account ID from Dynamic Picklists (HIDDEN)

Account Contact First Name

Account Contact Last Name

Account Contact Emails

Opportunity Closed Date

Rush Application

Regular Application

Portal

Skip this step for PROD :

Yes

Username

Password

New Applicant Information

LIST CHECK NUMBERS :

Applicant Contact First Name :

Applicant Contact Last Name :

Applicant Contact Email :

Applicant Contact Phone :

Application Date :

Applicant Signature :