Fillable MMERCIAL GROUND TRANSPORTATION CO APPLICATION AND USE PERMIT (Arizona Department of Transportation)

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MMERCIAL GROUND TRANSPORTATION CO APPLICATION AND USE PERMIT (Arizona Department of Transportation)

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CO
MMERCIAL GROUND TRANSPORTATION
APPLICATION AND USE PERMIT
Revised 07.21.2017
05-0600 R10/17 azdot.gov
1
Application is based upon the understanding that the activity intended to be provided is according to the
definitions, Grand Canyon National Park Airport operational regulations, and the applicable rules and regulations
of the Arizona Administrative Code ACC Title 17 as amended.
Pe
rmits and related vehicle decals are issued to those that are listed as part of a business entity in this
application. If membership or management of a partnership or corporation changes, the new member or
management must apply for a permit and decals in their own name(s), (PERMITS AND DECALS CAN NOT BE SOLD
OR OTHERWISE TRANSFERRED TO ANOTHER BUSINESS ENTITY).
If t
here are questions regarding the Rules and Regulations of the Grand Canyon Airport or the Arizona Revised
Statutes referenced in this application, please contact Airport Administration at (928) 638-2446.
GENERAL INFORMATION (PLEASE PRINT)
APPLICANT NAME (Responsible Party)
COMPANY NAME
DBA (Doing Business As)
BUSINESS ADDRESS
CITY
STATE
ZIP CODE
COMPANY DOT #
CONTACT NAME
EMAIL ADDRESS
( )
( )
BUSINESS PHONE
FAX
$
CHECK NUMBER
Clear
C
OMMERCIAL GROUND TRANSPORTATION
APPLICATION AND USE PERMIT
Revised 07.21.2017
05-0600 R10/17 azdot.gov
2
1. Business Entity Status (check one)
Sole Proprietorship
Partnership (List name and address of all partners on a separate sheet.)
Corporation, LLC (List name of all officers and majority stockholders on separate sheet.)
Other, where authorizing documents are filed (Explain)
2. Ve
hicle List: Please list the number and type of vehicles that will be utilizing the airport. (Attach additional sheets
if necessary.)
Vehicle Make, Model, Year
Vehicle
License #
State
Vehicle ID #
Maximum
# Passengers
Access
Fees
$
$
$
$
$
$
$
$
A
nnual Access fee currently for Non-Leaseholders is $25.00 per vehicle accessing Airport property. For Airport
Tenant/Leaseholders, this fee is $20.00 per vehicle.
3. A
uthorized Signatures:
Persons that are authorized to sign business papers, applications, etc., pertaining to this permit. Please provide
names and titles and have each person sign so that we may use this as a signature record for comparison
purposes. Attach an additional page if necessary.
PRINTED NAME
SIGNATURE
TITLE
IT IS THE APPLICANT’S RESPONSIBILITY TO SUBMIT, IN WRITING AND WITH HIS/HER SIGNATURE, CHANGES TO THE
AUTHORIZED LIST. THIS MUST BE RECEIVED BY THE AIRPORT ADMINISTRATION OFFICE DURING NORMAL BUSINESS
HOURS BEFORE THIS CHANGE WILL BE ACKNOWLEDGED.
CO
MMERCIAL GROUND TRANSPORTATION
APPLICATION AND USE PERMIT
Revised 07.21.2017
05-0600 R10/17 azdot.gov
3
PERMIT:
This Permit is made this date
by and between the ARIZONA DEPARTMENT
OF
TRANSPORTATION, ADMINISTRATIVE SERVICES DIVISION (hereinafter referred to as “the State”)
and
(hereinafter referred to as “Permittee”).
WI
TNESSETH
WH
EREAS, pursuant to Arizona Revised Statutes (“A.R.S.”) Section 28-8242, the STATE is responsible for the
operation and maintenance of the Grand Canyon National Park Airport (hereinafter referred to as “Airport”), a
public airport located in the Kaibab National Forest, Coconino County, Arizona; and
WH
EREAS, pursuant to A.R.S. Section 28-8204, the director may establish fees for use of State of Arizona owned
airports and appurtenant facilities (see Arizona Administrative Code R17-2-201 et. seq.); and
WH
EREAS, Permittee desires to be permitted to operate a commercial ground transportation business at the
Airport.
NOW
THEREFORE, in consideration of the faithful performance of the covenants and conditions set forth herein,
the parties hereby agree as follows:
TE
RM: This Permit shall commence upon execution by the State and shall be valid for the remainder of the
current calendar year. The Permittee must renew its application for subsequent terms prior to the expiration of
the current permit.
AU
THORIZATION: Permittee shall, at its sole expense, be authorized to utilize such Airport facilities as are
designated by Airport management necessary to load and/or unload passengers (see Exhibit “A”); provided
however Permittee shall not conduct, initiate and/or originate business from the Airport.
RATES, FEES AND CHARGES: Permittee shall pay the rates, fees and charges pursuant to Arizona Administrative
Code R17-2-201, Article 2, Table 1: Grand Canyon National Park Airport Fees and Charges, in effect on the date of
execution of this Permit by the State. On or before the fifteenth (15
th
) day of each month for the preceding
month, Permittee shall report all related business activity performed at the Airport, on the form prescribed by
the State. Should said Rules and Regulations be amended at any time during the term of this Permit, Permittee
shall pay the rates, fees and charges set forth in the amended Rules and Regulations for any rates, fees or
charges that accrue on and after the effective date of the amendment.
MON
THLY PAYMENTS: On or before the fifteenth (15
th
) day of each month during the term hereof and any
extensions or renewals hereof, Permittee shall pay to the State the monthly rates, fees, charges and all other
costs as described in the Permit due to the State for the preceding month. The State shall not be obligated to
invoice such fees.
CO
MMERCIAL GROUND TRANSPORTATION
APPLICATION AND USE PERMIT
Revised 07.21.2017
05-0600 R10/17 azdot.gov
4
INDEMNITY CLAUSE AND INSURANCE REQUIREMENTS
INDEMNIFICATION CLAUSE:
To th
e fullest extent permitted by law, Permittee shall indemnify, defend, save and hold harmless the State of
Arizona, its departments, agencies, boards, commissions and employees (hereinafter referred to as “Indemnitee”)
from and against any and all claims, actions, liabilities, damages, losses, Direct Damage losses, or expenses
(including court costs, attorneys’ fees, and costs of claim processing, investigation and litigation; hereinafter
referred to as “Claims”) for bodily injury or personal injury (including death), or loss or damage to tangible or
intangible property caused or alleged to be caused, in whole or in part, by the negligent or willful acts or
omissions of Permittee or any of its owners, officers, directors, agents, employees, contractors or subcontractors.
This indemnity includes any claim or amount arising out of or recovered under the Workers’ Compensation Law or
arising out of the failure of such Permittee to conform to any federal, state or local law, statute, ordinance, rule,
regulation, court decree or airport rules. It is the specific intention of the parties that the Indemnitee shall, in all
instances, except for claims arising solely from the negligent or willful acts or omissions of the Indemnitee, be
indemnified by Permittee from and against any and all claims. Indemnitee will at all times be responsible for
Direct Damages. It is agreed that Permittee will be responsible for primary loss investigation, defense and
judgment costs where this indemnification is applicable. In consideration of the award of this contract, the
Permittee agrees to waive all rights of subrogation against the State of Arizona, its officers, officials, agents and
employees for any and all losses arising from this Permit.
Th
e ‘Certificate Holder’ for all certificates of insurance shall read as follows:
State of Arizona
ADOT/ASD
Grand Canyon National Park Airport
PO Box 3399
Grand Canyon, AZ 86023
Dir
ect Damages (defined) – a loss arising naturally or directly from an occurrence and which excludes
remote, indirect, consequential, or special losses or damages; such as loss of revenue or profit.
INSURANCE REQUIREMENTS:
Permittee shall procure and maintain until all of their obligations have been discharged, including any warranty
periods under this Permit, are satisfied, insurance claims for injury to persons or damage to property which may
arise from or in connection with the performance of the work hereunder by the Permittee, their agents,
representatives, employees, contractors or subcontractors.
The insurance requirements herein are minimum requirements for this Permit and in no way limit the indemnity
covenants contained in this Permit. The State of Arizona in no way warrants that the minimum limits contained
herein are sufficient to protect the Permittee from liabilities that might arise out of the performance of the work
under this Permit by the Permittee, their agents, representatives, employees or subcontractors and Permittee is
free to purchase additional insurance.
CO
MMERCIAL GROUND TRANSPORTATION
APPLICATION AND USE PERMIT
Revised 07.21.2017
05-0600 R10/17 azdot.gov
5
A. MINIMUM SCOPE AND LIMITS OF INSURANCE: Permittee shall provide coverage with limits of liability
not less than those stated below:
1. Com
mercial General Liability – Occurrence Form
-- P
olicy shall include bodily injury, property damage, personal injury and broad form contractual liability
coverage.
• Gen
eral Aggregate $2,000,000
• Products – Completed Operations Aggregate $1,000,000
• Personal and Advertising Injury $1,000,000
• Blanket Contractual Liability – Written and Oral $1,000,000
• Fire Legal Liability $50,000
• Each Occurrence $1,000,000
a. Policy shall be endorsed to include the State of Arizona, Arizona Department of Transportation as
an additional insured with respect to liability arising out of the activities performed by, or on
behalf of, the Permittee, any of its contractors or subcontractors., involving automobiles owned,
leased, hired and/or non-owned by the Permittee.
b. Policy shall contain a waiver of subrogation endorsement as required by this written agreement
in favor of the State of Arizona, Arizona Department of Transportation for losses arising from
work or activities performed by or on behalf of the Permittee or any of its contractors or
subcontractors.
2. Business Automobile Liability
Bodily Injury and Property Damage for any owned, leased, hired, and/or non-owned vehicles
used in the performance of this Permit.
Co
mbined Single Limit (CSL) of $5,000,000 for vehicles with a capacity of nine (9) or more
passengers.
Co
mbined Single Limit (CSL) of $2,000,000 for vehicles with a capacity of five (5) to eight (8)
passengers.
Combined Single Limit (CSL) of $1,000,000 for vehicles with maximum capacity of four (4) or
fewer passengers.
a. Po
licy shall be endorsed to include the State of Arizona, Arizona Department of Transportation as an
additional insured with respect to liability arising out of the activities performed by, or on behalf of,
the Permittee, any of its contractors or subcontractors., involving automobiles owned, leased, hired
and/or non-owned by the Permittee.
b. Policy shall contain a waiver of subrogation endorsement as required by this written agreement in
favor of the State of Arizona, Arizona Department of Transportation for losses arising from work or
activities performed by or on behalf of the Permittee or any of its contractors or subcontractors.
CO
MMERCIAL GROUND TRANSPORTATION
APPLICATION AND USE PERMIT
Revised 07.21.2017
05-0600 R10/17 azdot.gov
6
3. Worker’s Compensation and Employers Liability
Wo
rkers’ Compensation Statutory
Employers’ Liability Each Accident $1,000,000
Disease – Each Employee $1,000,000
Disease – Policy Limit $1,000,000
a. Po
licy shall contain a waiver of subrogation endorsement as required by this written agreement in
favor of the State of Arizona, Arizona Department of Transportation for losses arising from work or
activities performed by or on behalf of the Permittee or any of its contractors or subcontractors.
b. This requirement shall not apply to: Separately, EACH Permittee or subcontractor exempt under
A.R.S. 23-901, and when such Permittee or subcontractor executes the appropriate waiver (Sole
Proprietor/Independent Contractor) form.
B. ADDITIONAL INSURANCE REQUIREMENTS: The policies shall be endorsed to include the following
provisions:
1. Th
e Permittee’s policies, as applicable, shall stipulate that the insurance afforded the Permittee shall
be primary and that any insurance carried by the Department, its agents, officials, employees or the
State of Arizona shall be excess and not contributory insurance, as provided by A.R.S. § 41-621 (E).
2. Insurance provided by the Permittee shall not limit the Permittee’s liability assumed under the
indemnification provisions of this Contract.
C. NOTICE OF CANCELLATION: Each insurance policy required by the insurance provisions of this
Contract shall provide the required coverage and shall not be suspended, voided, canceled, or reduced in
coverage or in limits except after thirty (30) days prior written notice has been given to the State of
Arizona. Such notice shall be sent directly to the address below and shall be sent by certified mail, return
receipt requested.
Ai
rport Manager
Grand Canyon National Park Airport
PO Box 3399
Grand Canyon, AZ 86023
D. ACCEPTABILITY OF INSURERS: Insurance is to be placed with duly licensed or approved non-admitted
insurers in the State of Arizona with an “A.M. Best” rating of not less than A- VII. The State of Arizona in
no way warrants that the above required minimum insurer rating is sufficient to protect the Permittee
from potential insurer insolvency.
C
OMMERCIAL GROUND TRANSPORTATION
APPLICATION AND USE PERMIT
Revised 07.21.2017
05-0600 R10/17 azdot.gov
7
E. VERIFICATION OF COVERAGE: Permittee shall furnish the State of Arizona with certificates of insurance
(ACORD form or equivalent approved by the State of Arizona) as required by this Contract. The
certificates for each insurance policy are to be signed by an authorized representative. All certificates and
endorsements are to be received and approved by the State of Arizona before a permit is granted. Each
insurance policy required by this Contract must be in effect at or prior to issuance of a permit under this
Contract and remain in effect for the duration of the permit. Failure to maintain the insurance policies as
required by this Contract, or to provide evidence of renewal, is a material breach of contract. All
certificates required by this Contract shall be sent directly to the Department. The State of Arizona,
Arizona Department of Transportation shall be noted on the certificate of insurance. The State of Arizona
reserves the right to require complete copies of all insurance policies required by this Contract at any
time.
F. SUBCONTRACTORS: Permittees’ certificate(s) shall include all subcontractors as insureds under its
policies or Permittee shall furnish to the State of Arizona separate certificates and endorsements for
each subcontractor. All coverage’s for subcontractors shall be subject to the minimum requirements
identified above.
G. APPROVAL: Any modification or variation from the insurance requirements in this Contract shall be
made by the Department of Transportation, Safety & Risk Management Division, whose decision shall be
final. Such action will not require a formal Contract amendment, but may be made by administrative
action.
H. CLAIMS: Permittee shall give the State and the State shall give the Permittee prompt and timely notice of
any claim made or service of process in any suit concerning any injury or damage. Any enumeration of
specific insurance coverage amounts shall not limit or restrict the Permittee indemnity covenant set forth
in this Permit.
R
ULES AND REGULATIONS: Permittee shall observe and comply with all laws, ordinances, rules, regulations and
orders of the United States Government, the State of Arizona, the County of Coconino and all agencies thereof
which may be applicable to its operations or to the operation, management, maintenance or administration of
the Airport now in effect or hereafter promulgated.
Th
e State reserves the right to exercise its authority under any Arizona Revised Statutes and Rules and
Regulations thereto.
S
ECURITY PLAN: The State reserves the right to implement an Airport Security plan in a form acceptable to the
Federal Aviation Administration limiting access of persons, vehicles and aircraft in and around the airfield and
terminal areas of the Airport and to modify that plan from time to time as it deems necessary to accomplish its
purposes. Permittee’s activity shall at all times comply with the Security Plan.
C
OMMERCIAL GROUND TRANSPORTATION
APPLICATION AND USE PERMIT
Revised 07.21.2017
05-0600 R10/17 azdot.gov
8
PERMITTEE’S ACKNOWLEDGEMENTS: By signing the permit application, the Permittee affirms they shall abide
by the following acknowledgements which are conditions of this Permit:
A. Exclusive Rights: Permittee is an independent contractor and not an agent of the State for any activity
conducted by Permittee at the Airport location. Permittee agrees that no provision herein shall be construed to
grant an exclusive aviation right as set forth in the Federal Aviation Act of 1958 ̕̕̕̕̕̕§§308 (a); 49 U.S.C. ̕̕̕̕̕̕§§1349.
B. Airport Safety: Permittee agrees that the State shall have the sole right to impose future restrictions or
obligations on Permittee’s activities necessary for the safety, preservation of Airport facilities and protecting
of the public interest.
TE
RMINATION: The State shall have the right to terminate this Permit in the event it is required by the Federal
Aviation Administration, any of the following defaults continues unabated after the expiration of thirty (30) days
following Permittee’s receipt of written notice from the State advising of the default:
• That Permittee fails to timely pay any fee due hereunder, or a determination by the state that Permittee
has refused or failed to perform or keep any of the covenants, terms or conditions on its part to be observed
or performed herein
• That Permittee is in default or arrears on any other account in which the State of Arizona is an aggrieved
party
• The State shall have the additional right to terminate this Permit for the convenience of the State
without cause upon the giving of One Hundred Eighty (180) days written notice to the Permittee. In addition,
the State reserves the right to immediately terminate this Permit in the event the State determines it is
necessary for safety or similar reasons or it is in the best interest of the State.
• Further, this Permit is subject to cancellation by the Governor pursuant to the terms of A.R.S. §38-511.
I
N WITNESS WHEREOF, the parties hereto have caused this Permit to be executed on the date and year first
above written.
THE STATE: PERMITTEE:
By:
By:
Print Name
Print Name
Title
Title
Date
Date
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MMERCIAL GROUND TRANSPORTATION CO APPLICATION AND USE PERMIT (Arizona Department of Transportation)

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Completed 20 July 2020

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