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STATE OF SOUTH CAROLINA
THE UPS STORE PAGE 81/14
(Caption of Case)Example: Application for a Class C Charter Certificate fium
Jolm Doe dbs Doe's Limo
p4&itlfI (tI& Chms L
Rem
QrttL~ flrkr&Lkir
m Lo&(w &h. ~ )(Please type or printSubmitted byt
BEFORE THK:.'UBLIC SERVICE COIrkIMISSION
OF SOUTH CAROLINA
Tl IANSPORTATION COVER SHEET
If this is yc ir firN time filing an application whh tbc PSC. you will nothave a Doe ct Number. The Commliusim& will assign one rc yr&u. If youhave filed v ltfr thc Cmnmlsucm bcfmc. a Docket Number wwa assignedand should I e emercd above.
Telephol le;
Address:
Other.
KmailtNOTE: The cover sheet and information contained herein neither replaces nor supplerr ants the brg and ice of pleadings or other papersas required by law. This foun is required for use by the Public Service Commission ol South Carolina for the purpose of docketing and mustbefilledoutcom letcl .
NATURE OF ACTION (Check all t bat apply)
g Application - Class A/A Restricted
Application - Class C Taxi
QX Application - Class C Charter gP QPgfEDApplication — Class C Charter I3us
MAR 19 N1Q Application - Class C Non-Emergency
PSCSCp Application - Class C Snatcher Van Clerks Office
Application - Class F. Household Goods
P Application - Class E Hazardous Waste
Q Application
g Request for Extension to Comply with Order
Request for Order Grantmg Authority to Obtain a Certificateof Public Convenience and Necessity to be Rescinded
Request for Cancellation of Certificate
Roqucst for Suspension
Q Request for Name Change on Certificate
Q Request to Amend Scope ofAuthority
Q Request to Amend Tariff (rate increase, etc.)
~ Q Request to Amend Passenger Limit
[ Q Request
[Q Exhibit
Late-Filed Exhibit
ll Lette.
[ Q Proposed Order
[ Q Publisher's AAidavft
[ Q Reservation Letter
[g Response
t g Return to Petition
[g Cuhcrr
g Request for Reinstatement
If you have any questions about this form, please contact the PUBLIC SE IVICE COMMISSION at 803-896-5100,
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PUBLIC SERVICE COMMSSION OF SOUTH CAROLINA101 Executive Center Drive, Suite 100
Columbia, South Carolina .'!9210
Phone: (803) 896-5100 Fax: (803) 896-5199
APPLICATION FOR CKRTIFICATK OF PUBLIC CONVK'IKNCK AND NECESSITY FOROPKRATION OF MOTOR VEHICLE CARRIKR
03/05/21D.ite:
CLASS C - CHARTER
Application is hereby made for a Certificate ofPublic Convenience and Necessity, in accordance with the provisionof S,C. Code Ann., ti 58-23-10, et seq. (1976), and arnendinents thereto.
US Currency Fntertainmcnt1.LCName under w ic & business is to e conducted (corporation, partners &p, or sole propnetors ip, with or w&t out trade name.)
106 Astalot DR
Street A dress o Applican&
Mailmg A ress ofApphcant(& diferent fn m stn eta dress)
8643768399one
[email protected] mI mai Address
Fax
2. If the Applicant is an LLC or a corporation, a copy of the Certificate &f Existence from the South CarolinaSecretary of State and thc Articles of Incorporation must be attached. ( lf incorporated outside of SC, attach SouthCarolina Secretary of State "Foreign Corporation" Certificate.)
3. Select Entity Type: (Check one)Qx Individual Owner/Sole Proprietorship
t3 Partnership - List names and addresses ofall person having an ir terest in the business.
Q Corporation — List names and addresses of two principal officers.
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Applicant is financially able to furnish the services as specified in thi. application and submits tbc followingstatement of assets and liabilities.
Financial Statement
Applicant's assets and liabilities are as follows:
et I
Value of Real Estate
Value of Motor Vehicles
Cash on ISand
Cash in Bank
Value of Other Assets andEquipmcnt
i I ~
~Liabiliti ttrMortgagor%.osn
on Real Estate
Loans Oval on Motor Vehicles
Business/ 3thcr Loans Owed
Other Lia silities or Debts
Total Lia bilitles
Total Assets
iNSTRUCTIONS:
1, "~of~e~l" means the actual or estimated market value oi any real property/buildings owned by theCompany/Business Applying for s Certificate.
2. " i n " means the outstanding balance cn ai y Mortgage, Equity I.ine or other Loan securedby the Real Fstate listed in Item 1.
3. "~Vtunti~o~V~cjqx" means the actual or fair estimated value o 'any moving vans, trucks or other vehiclesowned by the Company/Business Applying for a Certigcate.
4 ti ~e" means the outstanding balance on; ny loans or liens on the vehicles listed in Item 3.
5. "Cs~sotLHattti" is the total of actual cash held by the Company/Busii.ess applying for a Certificate on the day thisform is filled out.
6. "Ih mal." means thc outstanding balance on any mall business loan or other unsecured loanmade by a person, bank or business to the Business/Company appiyi»g for a Certificate.
7. ~it)ILBnnk" means the current balance in checking accounts, savii gs accounts or the like in the name of theCompany/Business applying for a Certificate. Do not inckide retiren tent accounts or personal bank account balances.
tt. "~Va c t2fQths~~d~ieut" should ieclude thc actual ar e rtimated valve of items such tts oRiceequipment (computers/fumishmgs)t moving equipment (hand trucks/ 1lankets/strapping), and trailers.
9. " ' 'bts," means speciigic amounts/balances which tl ie Company/Business applying for a Certificate
knows that it cwes to other persons or companies; for examptc T:ttutc tisc Fees, This does NOT include regular billssuch as electricity bills, security system costs. insurance, salaries, etc
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PROPOSED RATES AlVD& CHARGES FOR SERVlCK
Paqz&~
200.00 per hour
Ke ' o 1 Ceck t' estinYou will only be allowed to operate in those counties checked 1 &elow. You &nay
authority ifyou intend to operate in all counties in South Carol i na,
e i o ate.request "Statewide"
X Abbevilie
g Aiken
Aliendale
X Anderson
8amberg
Barnwell
Beaufort
g Berkeley
Q Calhoun
Q Charleston
Cherokee
@Chester
g Chesterfield
Clarendon
Q Colleton
Q D~gngton
Q Dillon
Q Dorchester
Q Bdgefieid
Q Fairfieid
Florence
Q Georgetown
X Grccnv&lie
QX Greenwood
Q Hampton
Q Bony
Jasper
Kcrshaw
Q Lancaster
QX Laurens
(1 Lexington
I' Marion
t g Marlboro
[) McCormick
) j Newberry
[(g Oconee
I J Orangeburg
[ g Fickens
t j Richland
Q Safuda
QX gpartanburg
Q Sumter
Q Union
g Williamsburg
Q York
g Statewide
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DESCRIPTION OF EQUIPlt XKNT
You are not required to own a vehicle to file sn application. However, 1 rior to being issued a certificate by ORS,you will be required to have obtained a vehicle.
o 'c ' '(The m unbar ofpassengers a vehicle is equipped
to carry is based on the number ofgeeaelte in the vehicle, including tho driver's seatbelt.)
1-7 Passengers, including driver
QX g-l 5 Passengers, including driver
MARE YEAR k. MODE1 Vtwtt
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INSURANCE QUA'I E
This form ~X~I JXXEQ.The insurance quote must be complete, listing current insurance premiums. At tl e discretion of the Commission, a copy of currentinsurance policies may be required. Do not provide a copy ofinsurance policies mines requested. You will not be required tcpurchase insurance unti1 your application has been approved and an order has be sn issued by the PSC. THIS IS ONLY A QUOTE
The following insurance quote is for:
Name ofApplicant ~Address of AppIicant
u Qua Ied~~aimr)
Liability Insurance $
The ~bove quoted premium is for a term of QLimits Nmonths.
htlinimum Limits - Intrastate Onb:I-7 Passengers+ $ 25,000/50,000/25,000
8-15 Passengers+ $ 25,000/100,000/25,000
a Pass:ngers = Number of seatbelts in the vehicle,including the driver's seatbelt
arne o Insurance ompany
ome ce A s of Comp.
I, the Applicant, am familiar with. the Commission.'s Rules and Regulate ns relating to insurance requirements andthe above quote meets the minimum insurance limits prescribed. The in; turance company making this quote isauthorized by the South Carolina Department of Insurance to do busines; in South Carolina.
KQXKK;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 informadon, contact tl te Department of Motor Yehicles at (803)896-8457 or (803) 896-9903.
If you wish to apply as a self-insured for worker's compensation coven.ge m South Carolina you may do so withthe South Carolina Worker's Compensation Commission (WCC) providh d that you will be able to: 1) post a suretybond or letter-of-credit with the WCC for a minimum of $500,000, 2) al ree to pay a yearly self-insurance tax, and3) agree to pay an annual assessment to tbe South Carolina Second Injur / Fund. For more information, contact theWCC Self-Insurance Division at (803) 737-5712 or on the web at wwwn vcc.state.sc.us/self-insurance.
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BHHC-Rate for South Carolina
THE UPS STORE PAGE 87/14
Cypress insurance Company
Account Summary For U$ CURRENCY ENTER'I AINMENT
Quoted By: Keyana GrayGEICO Insurance Agency, Inc.
One GEICO BlvdFredericksburg, VA 22412Phone -(800) 841-3000
DOT tt UnknownMC ff: Unknown
Vehicle Information
Revision: 3SC2020R02
BHHC-Rate Version: 8.7.4658,1
Unit
1 2013 FORD E350 (64271)Radius: Up to 25 Miles
Lia~iliti UM UIM ~lied Pa
1,303 86 128 N/A
~PD D ~DD AI/L U~Sub Totat
N/A N/A N/A 1,517
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Exhibit F't i ii be ~FWA
ASHLEY HANEY
Name ofApp icant
I. Are there currently any outstanding judgments against tl}e Apphcant"
Q Yes Q» No
If Yes, list judgements here:
2. Is Applicant familiar with all statutes and regulations, including safet / regulations and governing for-hire motorcarrier operations in South South Carolina„and does Applicant agree to operate in compliance with thesestatutes and regulations'
0 Yes Q No
3. Is Applicant aware of the Commission's insurance requiretnents and t he Insurance premium costs associatedtherewith'»
Yes Q No
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Ex i t ver ua i Loots
1, Applicant understands that ail drivers must be a minimum of 18 years ofage.
Qs Yes Q No
2. Applicant understands that a certified copy of the driver's three (3) ye 4'riving record issued by the SC DMVand such record from the DMV of tbe state iu which tbe driver is or h; s been domiciled for such period mustbe maintained in the Appiicant's business office.
Yes Q No
3, Applicant understands that a criminal history background check froin he state where the driver currently livesmust be maintained in the Apphcant's business office.
Qs Yes Q No
4. Applicant understands that all drivers operating a vehicle under a Clas i C Certlficate must have intheir possession when operating a charter vehicle, a valid driver's been se issued by the SC DMV or the currmtstate ofresidence of the driver,
Qs Yes
5. Applicant understands that all Class C Certificate holders are prohibite l from employing or leasingvehicles to drivers who are registered, or required to be registered, as s .'x offenders with the South CarolinaState Law Rnforcernent Division or auy national registry of sex offend 1's.
Qs Yes Q No
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FUBLIC SERVICE COMMISSION OF SOUTH CAROLINA101 EXECUTIVE CFNTER DRIVE, SL'TE 100
COLUMBIA, SOUTH CAROLiNA 2 9210
Applicant is familiar with the provision of S.C, Code Ann, $58-23-10, et seq.(1976), and amendments thereto,and R.103-100 through R.103-241 of thc Commission's Rules aud Reg ulations for Motor Camera (S.C. CodeAnn. Regs.„1976), and R.38-400 through R.38-503 of the Department ofPublic Safety's Rules and Regulationsfor Motor Camers (Volume 2„S.C. Code Ann., 1976) and amendmeni I thereto, and hereby promises compliancetherewith.
S,C. Code Ann. Seciion 58-3-250 states, in patt, that every final order yf the Commission must be served byelectronic service, registered or certified mail„upon the parties to the 1 roceeding or their attorneys.
Please check the applicable boiuThe Applicant AGREES to receive future Commission orders related to the ttppticaufs authority in South Carolina
+ through the Commission's escrvicc System. The Applicant authorizes the C ommission to serve its ordem by using the e-mail address as it appears on page one of this Application To sign up for es srvice nodftcations, plcasc visit www.psc.sc.gov to create a My DMS account,
+ The Appgcant DOES NOT AGREE to reccivc future Commission orders re ated to the App0cant's authority in SouthCarolina through the Commission's eServicc System.
The Applicant for the Certificate of Public Convenience and Necessity as set forth in the foregoing, swear ora8irm that all statements contained in the above application are true tu.d correct.
ASHLEY HANEY
Applicant s Signature
OWNERTitle of App icant (e.g. President, Owner, etc,)
STATE OF SOUTBQAROLINA
COUNTY OF
SWORN TO BEF ME
so uJ! no
s IO~P
" f/i "O& eo ~ & ~ uow'
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CERTlFlED TO BE 4 TRVE AND CORRECT COFT
45 TAKEN FROM AND COMPARED VfYTH THE
OR3GWAt. ON FfLE IM Mt5 OFRCE
F?b 95 2M1REFEREE ID2 202760
OIOAt845% F2P841 4I1~|Al APNEA Cl ~IP82882.42. 2LC
~lilllgf+gl5g
STAVE OF SOUTH CAROLYNSECHETATEY OF STATE
e 828 8 5882 8 C888812P~ PM?R8??mp?PP24844844 88~~~ 2884 X8488.2C4 488 Ppm 548888~ t48?P8 44 I pws. 88~
428~ 8888242 84822+88~ 888822~mpm~~'05 ct A48 18276 82248C?242m? C42288 88 L?888 88m?8?o84 48
2 T842 848p8288 88 lppp~~@tee af m~'L42AAppOpm 2882p888828e. C84?8828 ~
8R8422 48888m488 428~ct cpp amm?8P '428m?~ 88
~42?a
188~ 2m4 82p?8888p~~ 5
C48
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ppppp4'pt p tTIQfNQw Ixy Pt'~phd~ef peep
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CERTiFIED TD BE A TRUE AND CORRECT CtOPY
AS TAKEN FRDff AND COMPARED ff/ITH ltE-CtfLI3mINAL-CW FILE Ifti THIS OFFICE
Feb 85 2021REFEREItfCE ID: 702769~~ e Page ACtEBeheaeEI=D ta~~ C~ed "~ SIIEW SS VnE S-.CP
Qg Fff 15L?' 9k %Sf' 8 C4@B SKVPKf TIF %48. 3 3m,) Dm ..;.
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