Application To The Southeastern Pennsylvania ...

1 Application To The Southeastern Pennsylvania transportation authority For A Right of Entry Permit Instructions Following are the instructions and forms for applying for right of entry onto SEPTA property. Submit your Application and check for fee payment of $750. You must submit a fully completed Application Form and Agreement. Please be sure you provide the complete legal name of the applicant, and are explicit in the proposed use of the property. Please send the original Application to SEPTA, Office of the Chief Engineer, 1234 Market Street, 13th Floor, Philadelphia, PA 19107-3780, and retain a copy for your records. 1. Any Application fees must be paid at the time of submission of your Application . All fees are non-refundable. Please make your check payable to SEPTA. 2. Once executed the applicant will be bound by the terms and conditions set forth in the right of entry agreement.

2 3. Applicant acknowledges that SEPTA is not responsible for any costs associated with the Work. Permittee must reimburse SEPTA for all costs that SEPTA incurs in connection with this Application ( Application ), Agreement and Permit. Without limiting the foregoing, applicant must reimburse SEPTA for all costs that SEPTA incurs in connection with the review of the applicant s plans, drawings or other submissions and flag service and other protection. 4. SEPTA will bill applicant for SEPTA s costs, expenses and labor charges at SEPTA s standard force account rates. All payments due from applicant to SEPTA shall be due and payable within thirty (30) calendar days from the date of invoice. Applicant has no right to set off against any payment due any sums which applicant may believe are due to it from SEPTA for any reason. In the event that applicant fails to pay, when due, any amount payable by it, applicant must pay SEPTA, together with such overdue payment, interest at an annual rate of six (6) percent calculated from the date the payment was due until paid.

3 All payments due from applicant to SEPTA hereunder must be: (i) made by check drawn from currently available funds; (ii) made payable to Southeastern Pennsylvania transportation authority ; and (iii) mailed with a copy of the invoice to: Southeastern Pennsylvania transportation authority , Box 7780-4044, Philadelphia, PA 19182-4044. All payments are deemed made only upon receipt by SEPTA of collected funds. 5. SEPTA notifies the applicant that certain words in this Application have specific meanings and that applicant must answer the questions below consistent with those meanings. Hazardous Substance and Hazardous Substances mean without limitation, flammables, explosives, radioactive materials, asbestos, polychlorinated biphenyls (PCB s), chemicals known to cause cancer or reproductive toxicity, pollutants, contaminants, hazardous wastes, toxic substances or related materials, petroleum and petroleum products, and substances declared to be hazardous or toxic under any law or regulation now or hereafter enacted or promulgated by any government that has jurisdiction over the Work and/or the SEPTA property.

4 Septa Property means the real estate, right-of-way, building or other property which SEPTA owns, leases, maintains, occupies, possesses or controls and which is associated with the Work that Permittee intends to perform. References herein to on SEPTA property or on the SEPTA Property mean on, under, over or adjacent to the SEPTA Property, whatever is appropriate. Work means the activities identified in the Application which Permittee intends to perform on the SEPTA Property. SEPTA Infrastructure Use Only SEPTA Legal Use Only SEPTA File Number: Permit Authorized by: SEPTA Permit Number: Permit Authorization Date: / / Application Reviewed by: Application Approval Date: / / SEPTA - RIGHT OF ENTRY Application FORM APPLICANT INFORMATION The Application fee of $750 is enclosed (mail-in applications only). Check # Legal Name of Applicant (party to agreement) Tax ID # Mailing Address: Billing Address: Street Street City City State Zip State Zip Name of Contact Billing Contact Title Title Phone # ( ) Fax # ( ) Phone # ( ) Fax # ( ) E-Mail Address E-Mail Address PROPERTY INFORMATION Location of property (provide all applicable information) Street Address: Railroad/Transit Line Name: Milepost: Nearest Station Sketch of Property: attach a sketch of the worksite that depicts the SEPTA Property, adjacent streets, buildings , facilities and utilities in close to proximity to the work.

5 Duration of occupancy From _____/_____/_____ To _____/_____/_____ Work to be performed is: Within _____ Ft of the tracks. (If within 25ft of center of the rail, a flagman is required at your expense.) or At a location that may impede SEPTA s use of the facility. Yes ___ No___. If yes, attach complete description of potential conflict. Applicant's intended purpose for this right-of-entry (be specific) : Attach description Were services to be performed requested by SEPTA? G Yes G No Requested by whom? Is the intended purpose of this work related to G environmental sampling G environmental investigation G environmental remediation Does the Applicant intend to use, disturb, transport or remove Hazardous Material? G Yes G No If the above question answered yes, (i) identify the Hazardous Substances, (ii) Explain the work associated therewith and (iii) identify the Governmental agencies with which the applicant has had contact regarding the Hazardous Substance or proposed environmental test or studies (Attach answer) THE Work associated with this Application CANNOT place a permanent facility or structure on SEPTA property such as, but not limited to, an underground pipe, overhead wire or support structure WITHOUT a separate easement agreement and RIGHT of WAY Application .

6 I/We understand that submission of this Application does not authorize occupation of or entry on the property. Exact fees and insurance requirements will be forwarded after the Application has been reviewed and approved by SEPTA. Signed ____ ____ Date ____/____/____