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STATE OF SOUTH CAROLINA

(Caption of Case)Example: Application for a Class C Charter Certificate from

John Doe dba Doe's Limo

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Submitted

BEFORE THEPUBLIC SERVICE COMMISSION

OF SOUTH CAROLINA

TRANSPORTATION COVER SHEET

tf this is your first time filing an application with the PSC, you will noihave a Docket Number. The Commission will assign one io you. tf youhave filed with the Commission before, a Docket Number wss assignedsnd should be entered above.

Telephone: l 5 3 0 (DO

Address: Fax:

Other:

Email:Y t i")Cc 80 lYXhl t" O~NOTE: The cover sheet and information contained herein neither replaces nor supplements the filing and service of pleadings or other papersas required by law. This form is required for use by the Public Service Commission of South Carolina for the purpose of docketing and mustbe filled out com letel .

NATURE OF ACTION (Check all that apply)

Application - Class A/A Restricted

Application - Class C Taxi

g Application - Class C Charter

Application — Class C Charter Bus

Application - Class C Non-Emergency

Application - Class C Stretcher Van

Application - Class E Household Goods

Application - Class E Hazardous Waste

Application

pc'k $C@r/ktI / Qll(S

Request for Reinstatement

Request for Extension to Comply with Order

Request for Order Granting Authority to Obtain a Certiftcat~e~~t,of Public Convenience and Necessity toj~&e scinded

Request for Cancellation of Certificate I()) tJ I~~;())5

Request for Suspension

Letter

Proposed Order

Publisher's Affidavit

Reservation Letter

Response

Return to Petition

Other:

c'i)

OO~O

Request for Name Change on Certificate

Request to Amend Scope of Authority

Request to Amend Tariff (rate increase, etc.)

Request to Amend Passenger Limit

Request

Exhibit

Late-Filed Exhibit

If you have any questions about this form, please contact the PUBLIC SERVICE COMMISSION at 803-896-

PUBLIC SERVICE COMMISSION OF SOUTH CAROLINA101 Executive Center Drive, Suite 100

Columbia, South Carolina 29210(Mailing address: Post Office Drawer 11649, Columbia, SC 29211)

Phone: (803) 896-5100 Fax: (803) 896-5199

APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY FOROPERATION OF MOTOR VEHICLE CARRIER

Date:

CLASS C - CHARTER

Application is hereby made for~errificate of Public Convenience.and Necessity, in accordance with the provisionof S.C. Code Ann., I'I 58-23-10, et seq. (1976), and amendments thereto.

1. Name under which business is to be conducted (corporation, partnership, or sole proprietorship, with or without trade name.)

I"QA af. 0 On'I Po sr S ree.4 r e ori ('.) 05

Street Address of Applicant

Mailing Address of Applicant (if different from street address)

5 -8g"I-h 0'lgPhone

'4 I ricitss intil I, COEmail Address

2. If the Applicant is an LLC or a corporation, a copy of the Certificate of Existence from the South CarolinaSecretary of State and the Articles of Incorporation must be attached. (If incorporated outside of SC, attach SouthCarolina Secretary of State "Foreign Corporation" Certificate.)

3. Select Entity Type: (Check one)Individual Owner/Sole Proprietorship

g Partnership - List names arid addresses of all person having an interest in the business.

Corporation - List names and addresses of two principal officers.

s 61

1 of 9

Applicant is financially able to furnish the services as specified in this application and submits the followingstatement of assets and liabilities.

BALANCE SHEET

Cash

Receivables

Assets:

Balance at ~Ti e Application is Filed:M th ~ Y

Real Estate

Buildings and Equipment (Net)

Motor Vehicles (Net)

Garage Equipment (Net)

Machinery and Tools (Net)

Supplies on Hand

Prepaids and Other Assets

Total Assets*

Liabilities and E ui

Accounts Payable

Notes Payable

Mortgages Payable

Equipment Obligations

Accrued Salaries and Wages

Other Accrued Obligations

Other Liabilities

Total Liabilities

Capital Stock

Retained Earnings

Total Equity

Total Liabilities and Equity*

e Total Assets = Total Liabilities and Equity2 of 9

PROPOSED RATES AND CHARGES FOR SERVICE

Pro osed Rates and Char es List onl maximum char es ermile or tri and/orhourl rate

4gu Fl&E e,&"~gt Pfl

cia f „'z„+& gg4'~)'r

Re uested co e of Authori Check all counties in which ou are re uestin ermission to o crateYou will only be allowed to operate in those counties checked below. You may request "Statewide"authority if you intend to operate in all counties in South Carolina.

Abbeville

Aiken

Allendale

Anderson

Bamberg

Barnwell

Beaufort

@Berkeley

Calhoun

gCharleston

Cherokee

Chester

Chesterfield

Clarendon

Colleton

Darlington

Dillon

Q Dorchester

Edgefield

Fairfield

Florence

Georgetown

Greenville

Greenwood

Hampton

Horry

Jasper

Kershaw

Lancaster

Laurens

Lee

Lexington

Marion

Marlboro

McCormick

Newherry

Oconee

Orangeburg

Pickens

Richland

Selude

Spartanburg

Sumter

Union

Williamsburg

York

Statewide

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DESCRIPTION OF EQUIPMENT

You are not required to own a vehicle to file an application. However, prior to being issued a certificate by ORS,you will be required to have obtained a vehicle.

xim Nu er ofPasse e s Vehicle i E ui ed to Ca . (The number ofpassengers a vehicle is equippedto carry is based on the number of seatbelts in the vehicle, including the driver's seatbelt.)

X 1-7 Passengers, including driver

8-15 Passengers, including driver

MAKE YEAR & MODEL VINtt EMPTY WEIGHT

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INSURANCE QUOTE

This form CO L D D SIGNED by an AUTHORIZED IN U CE CO REPRESENTAT VEThe insurance quote must be complete, listing current insurance premiums. At the discretion of the Commission, a copy of currentinsurance policies may be required. Do not provide a copy of insurance policies unless requested. You will not be required topurchase insurance until your application has been approved and an order has been issued by the PSC. THIS IS ONLY A QUOTE.

The following insurance quote is for:

Name ofApp icant

Address ofApplicant

Amount of Premium: Limits uoted See Below

Liability Insurance $ Limits

The above quoted premium is for a term of (g months.

Minimum Limits - Intrastate Only:

1-7 Passengers* $ 25,000/50,000/25,000

8-15 Passengers* $ 25,000/100,000/25,000

* Passengers = Number of seatbelts in the vehicle,including the driver's seatbelt

arne o urance Company

Home Office Address of Company

I am familiar with the Commission's Rules and Regulations relating to insurance requirements and the above quotemeets the minimum insurance limits prescribed. The insurance company making this quote is authorized by theSouth Carolina Department of Insurance to do business in South Carolina.

Authoriz Insurance Company Representative's Signature

NOTICE:If you wish to self-insure your motor vehicles for liability and property damage, you must comply with S.C. CodeAnn. Sections 56-9-60 and 58-23-910. For more information, contact Vickie Coker with the Department of MotorVehicles at (803) 896-8457.

If you wish to apply as a self-insured for worker's compensation coverage in South Carolina you may do so withthe South Carolina Worker's Compensation Commission (WCC) provided that you will be able to: 1) post a suretybond or letter-of-credit with the WCC for a minimum of $500,000, 2) agree to pay a yearly self-insurance tax, and3) agree to pay an annual assessment to the South Carolina Second Injury Fund. For more information, contact theWCC Self-Insurance Division at (803) 737-5712 or on the web at www.wcc.state.sc.us/self-insurance.

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AAA OF CAROLINAPO BOX 29620CHARLOTTE, NC 28229

PRC78REJJIVE'27P/red/esurience

FREDINA BOYD

59 POPLAR ST

CHARLESTON, SC 29403

Auto InsuranceCoverage SummaryThis is your RenewalDeclarations Page

Policy Number: 41562145Underwditten by:

Progressive Northern Insurance Co

March 3, 2015

Policy Period: Mar 30, 2015 - Sep 30, 2015

Page I of 3

1-803-678&000AAA OF CAROLINA

Contact your agent for personalized service.

progressiveageat.cornOnline ServiceMake payments, check billing activity, update

policy information or check status of a da)m.

1-800-274-4499To report a claim.

The coverage, limits and policy period shown apply only if you pay for this policy to renew.

Your coverage begins on March 30, 2015 at 12:01 a.m. This policy expires on September 30, 2015 at 12:01 a.rn,

Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy fimits shown for a vehicle

may not be combined with the limits for the same coverage on another vehicle, unless the policy contract or endorsements indicate

otherwise. The policy contract is form 9610A SC (09/06). The contract is mcd)fied by forms A048 SC (07/11). Z445 SC (03/09) and

2538 (10/08)

Underwriting CompanyProgressive Northern Insurance Co

P.O. Box 6807

Cleveland, OH 441011-800-876-5581

Drivers and household residentsFredina Boyd

)ames Campbell

Add|))onal information

Named insured

n)rm 6489 sc (os/) n NICan/)nued

Outline of coverage2006 CHEVROLET MONTE CARLO

VIN 2GTWMI 6K569249060

Garaging ZIP Code: 29403

Primary use of the vehicle. Pleasure

Policy Number: 41562145

Fredina Boyd

Page2 of 3

Limits Oeduttrble Premium

Liability To Others

Bodily Injury Liability

Property Damage Liability

Uninsured Motorist

Bodily Injury

Property Damage

Underinsured Motorist

Bodily Injury

Property Damage

Medical Payments

ComprehensiveComprehensive Window Glass

Collision

Rental Reimbursement

Total premium for 2006 CHEVROLET

2004 FORD EXPEDITION

VIN 1FMFU1 6W44LB43291

Garaging ZIP Code: 29403

Primary use of the vehide: Commute

$ 50,000 each person/5 I 00,000 each acddent

$ 50,000 each accident

$ 50,000 each person/f100,000 each accident


$ 50,000 each person/$ 100,000 each accident


$2,000 each person

Actual Cash Value

Aetna I Cash Value

up to $ 30 each day/maximum 30 days

Ltmtts

$495

43

$ 200

79

60

$ 500 151

ID glass

$ 500/$0 glass 324

25

$1,177

Oedunrble Premium

Liability To Others

Bodily Injury Liability

Property Damage Liability

Uninsured Motorist

Bodily Injury

Property Damage

Underinsured Motorist

Bodily Injury

Property Damage

Medical Payments

ComprehensiveComprehensive Window Gian

$ 50,000 each persorV$ 1 00,000 each accident

$ 50,000 each acodent

$ 50,000 each person/$ 100,000 each acrident

$ 50,000 each acddent



$2,000 each person

Actual Cash Value

$ 200

$ 0

$ 500$0 glass

$ 496

67

50

145

Collision

Rental Reimbursement

Roadside Assistance

Total premium for 2004 FORD

Subtotal policy premium

South Carolina Uninsured Motorist Fund charge

Total 6 month policy premium and fees

Actual Cash Value

up to $ 30 each day/maximum 30 days

$ 500/$0 glass 221

25

17

$1,056

$2,233.00

2.00

$2,235.00

Premium discountsPdrtqr

41562145 Home Owner, Multi-Car and Continuous Insurance: Diamond

Corm 9489 SC t09/11) CoououedNj

Lienholder informationWe send certain notices such as coverage summaries and cancellation notices to the following:

Vehicle Lienholder

Policy Number: 41562145

Fredina Boyd

Page3 of 3

2006 CHEVROLET MONTE CARLO

2GIWMI6K569249060Rmc Financial Servic

N Charleston, SC 29406

2004 FORD EXPEDITION

I FMFU16W44LB43291

CREDIT ACCEPTANCE

SOUTHFIELD, Ml 48037

rrrrn 6/ss sc (090 ) )

Fax recipient informationTo:

Fax ry:

Number of pages faxed: 3

PRD8REJ3/bEE'R/YE'Insurance

Policy Number: 41562145Underwritten by:

Progressive Northern insurance Co

Policyholder:Fredina Boyd

July1, 2013

Page 1 of 1

t 403-678-4000AAA OF CAROUNA

Contea your agent for personalized service.

Here are the policy documents you requestedVerification of InsuranceVerification of Insurance

Thank you for choosing Progressive.

Progressive offers several convenient service options:Contact your agent for personalized service and counsel when you are thinking about making changes to your policy.

Visit progressiveagent.corn 24 hours a day to view and pdint policy documents, quote a change to your policy, updatepolicy information, and view claims information. While on progressiveagent.corn be sure to provide us with your e-mail

address to receive reminders about upcoming payments, transaction confirmations, and claims instructions.

Call our Customer Service number, 1-800-876-5581, to make or confirm payments over the phone, order ID cards and

Dedarations pages, and more.

AAA OF CAROLINAPO BOX 29620CHARL01TE, NC 28229NAIC Company Code: 38628

Yerification of Insuranre forFredina Boyd

P8ÃiFEff/YEDRIVE'Insunrnnn

Policy Number: 41562145Underwniten by:


Policyhoider:

Fredma Boyd

Page1 oi1

July I, 201 5

AAA OF CAROLINA1-803-628-4000Contact your agent for personalized rewire.

Customer Service1-800-876-558124 hours a day, 7 days a week

This vedification of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by

the polides listed herein. Notwithstanding any requirement, term or condition of any contract or other document with

respect to which this verification of insurance may be issued or may pertain, the insurance afforded by the policies

described herein is subject to all the terms, exclusions and conditions of the policies.

Please accept this letter as verification of insurance for this policy.

Policy and driver information

Policy number:

Policy state:

Policy period

41562145

South Carohna

Mar 30, 2015- Sep 30, 2015

There was no lapse in coverage during this poiiryperiod.

Effective date: Mar 30, 2015

Drivers: Fredina Boyd Insured Driver

James Campbell

Address: 59 Poplar St

Charleston, SC 29403

Vehicle informationVehicle:

Vehide identification number:

Uenholder:

2006 Chevrolet Monte Carlo

201WMI6K569249060

Rmc Financial Servic

1922 Remount Rd

N Charleston, SC 29406

Coverage information

Bodily Injury Liability:

Property Damage Liability:

Collision:

Comprehensive:


$ 50,000 each auident

Deductible: $ 500 deductible

Deductible; $ 500 deductible

Form VOI 107/11)

AAA OF CAROLINAPO BOX 29620CHARLOTTE, NC 28229NAIC Company Code: 38628

Verification of Insurance forFredina Boyd

PE88ÃEJJIYEeDRIVE'azsurrusu

Policy Number. 41562145Underwritten by:


Policyholder:

Fredina Boyd

Pager or1

July I, 2015

AAA OF CAROLINA

1-803-678-4000Contactyouragentfor personalized service.

Customer Service1-8004376-558124 hours a day. 7 days a week

This verification of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded bythe policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document withrespect to which this verification of insurance may be issued or may pertain, the insurance afforded by the policiesdescribed herein is subject to all the terms, exclusions and conditions of the policies.

Please accept this letter as verification of insurance for this policy.

Policy and driver information

Policy number:

Policy state

Policy period

41562145

South Carolina

Mar 30, 2015 - Sep 30, 2015

There was no lapse in coverage during this policy period.

Effective date: Mar 30, 2015Drivers: Fredina Boyd Insured Driver

James Campbell

Address: 59 Poplar St

Charleston, SC 29403

Vehicle informationVehicle

Vehide identification number:

Lienholder;

2004 Ford Expedition

I FMFU16W44LB43291

Credit AcceptancePo Box 513

Southfield, Ml 48037

Coverage informationBodily Injury Liability

Property Damage Liability:

Collision:

Comprehensive:





Form vol Inr/I 31

Exhibit Fit Willin and Able FWA

Name of Applicant

I. Are there currently any outstanding judgments against the Applicant?

0 Yes g No

IfYes, indicate nature ofjudgement(s) against applicant.

2. Is Applicant familiar with all statutes and regulations, including safety regulations and governing for-hire motorcarrier operations in South South Carolina, and does Applicant agree to operate in compliance with thesestatutes and regulations?

@ Yes 0 No

3. Is Applicant aware of the Commission's insurance requirements and the insurance premium costs associatedtherewith?0 Yes Pl No

6of9

Exhibit on Driver ualifications

1. Applicant understands that all drivers must be a minimum of 18 years of age.

Yes Q No

2. Applicant understands that a certified copy of the driver's three (3) year driving record issued by the SC DMVand such record from the DMV of the state in which the driver is or has been domiciled for such period mustbe maintained in the Applicant's business office.

Q Yes Q No

3. Applicant understands that a criminal history background check from the state where the driver currently livesmust be maintained in the Applicant's business office. Yes Q No

4. Applicant understands that all drivers operating a vehicle under a Class C Certificate must have intheir possession when operating a charter vehicle, a valid driver's license issued by the SC DMV or the currentstate of residence of the driver.

P Yes Q No

5. Applicant understands that all Class C Certificate holders are prohibited from employing or leasingvehicles to drivers who are registered, or required to be registered, as sex offenders with the South CarolinaState Law Enforcement Division or any national registry of sex offenders.

5i Yes Q No

7of9

PUBLIC SERVICE COMMISSION OF SOUTH CAROLINAPOST OFFICE DRAWER 11649

COLUMBIA, SOUTH CAROLINA 29211

Applicant is familiar with the provision of S.C. Code Ann. II58-23-10, et seq.(1976), and amendments thereto,and R.103-100 through R.103-241 of the Commission's Rules and Regulations for Motor Carriers (Volume 26,S.C. Code Ann. Regs., 1976), and R.38-400 through R.38-503 of the Department of Public Safety's Rules andRegulations for Motor Carriers (Volume 23A, S.C. Code Ann., 1976) and amendments thereto, and herebypromises compliance therewith.

S.C. Code Ann. Section 58-3-250 states, in part, that every final order of the Commission must be served byelectronic service, registered or certified mail, upon the parties to the proceeding or their attorneys.

Please check the applicable box:e Applicant AGREES to receive future Commission orders related to the Applicant's authority in South Carolina

through the Commission's eService System. The Applicant authorizes the Commission to serve its orders by using the e-mail address as it appears on page one of this Application. To sign up for eService notifications, please visit www.psc.sc.gov to create a My DMS account.

The Applicant DOES NOT AGREE to receive future Commission orders related to the Applicant's authority in SouthCarolina through the Commission's eService System.

The Applicant for the Certificate of Public Convenience and Necessity as set forth in the foregoing, swear oraffirm that all statements contained in the above application are true and correct.

Title of Applicant (e.g. President, Owner, etc.)

STATE OF SOUTH CAROLINA

rOUNTY ()I )

=-==o=aZ -tva-.r ~Jell, 20/u

=. -Noi" ty Public -: .

gg (hill r-.Commission Expires a " " . -'-%55CI24 2(if/

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Documents