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***

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.

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 $5,000 USD ($6,342 CAD) to:

OmniTRAX Holdings Combined, Inc.

PO Box 209979
Dallas, TX 75320-9979

Provide Check number

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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) :

Railroad Acronym

RR Record ID

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

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

Account Information

Is it a new Account or Existing Account?

Mailing Account Information :

Account Name :

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

Same as Mailing Account

YesNo

Billing Account Same as Mailing Account :

Billing Account Name :

Billing Contact First Name :

Billing Contact Last Name :

Billing Contact Phone Number :

Billing Street :

Billing City :

Billing State :

Billing Zip Code :

Billing Contact Email (where to send invoices) :

New Billing Account :

New Billing Account Name :

Billing Street :

Billing City :

Billing State :

Billing Zip Code :

Billing Contact First Name :

Billing Contact Last Name :

Billing Contact Phone Number :

Billing Contact Email (where to send invoices) :

Project Details :

Identify what type of Project Applicant is requesting?

Description of Project :

Section 2 - Application Location Details

Will track operations be impacted by the applicant’s project?

Railroad :

Nearest Milepost :

Nearest DOT Crossing No. :

Track Station (from) :

Track Station (to) :

NOTE: If Milepost or Track Stations are not known, please indicate the nearest road intersection here :

Subdivision

Property Address/Street :

Property City :

Property County :

Property State or Province :

Property Country :

Opportunity Currency

Section :

Township :

Range :

Degrees of Property Angle (if Track Crossing is required) :

Geographical Coordinates Required :

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

Property Coordinate (Latitude) :

Property Coordinate (Longitude) :

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

Existing Lease Number (if applicable) :

Section 3 - Commodity Item Details (Application Type) :

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. Materials and installation are to be in strict accordance with specifications of the American Railway Engineering Association and requirements of the railroad. Submission of this form shall be accompanied with 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 Accommodation 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 :

Check if the Variance to policy is requested :

Yes

If a variance to the policy is requested – PLEASE DESCRIBE IN DETAIL (Include requested variance detail in plan submission):

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

Page 4

Section 4 : Product Details (MN) :

Application Type

Application Type API Name2

Agreement Type

Application Status :

Source of Opportunity :

Product Category

Product Sub-Category

Section 4: Product Details

Sub-Category

Preliminary Engineering ReviewQuiet Zone Application Quiet Zone Application

Quantity

PE Price US

Sub-Category

Preliminary Engineering ReviewQuiet Zone Application Quiet Zone Application

Quantity

PE Price Canada

PRELIMINARY ENGINEERING INFORMATION SECTION :

Will another party be performing the work?

If yes, a Right of Entry application will need to be submitted from the Contractor once the Preliminary Engineering Plans are approved.

Estimated area of railroad’s land to be impacted, if applicable :

Detailed description of intended use of railroad’s premises :

How will applicant access railroad’s property?

Will hazardous materials be involved?

If Yes, describe :

Will improvements be constructed on the railroad’s premises? (Ensure the improvements are depicted on Engineering Plans)

If Yes, describe :

Will applicant be storing materials or equipment during the project ?

If Yes, describe what will be stored:

If yes, please include verifying documents of Public Road ROW :

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 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.

Applicant Contact Information

List Check Number :

Applicant Contact First Name :

Applicant Contact Last Name :

Applicant Contact Email :

Applicant Contact Phone :

Application Submission Date :

Applicant Signature :

Opportunity Closed Date

Rush Application

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