Courtesy Ground transportation Application packet - John Wayne ...

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JOHN WAYNE AIRPORT GROUND TRANSPORTATION SECURITY DEPOSIT/FAITHFUL PERFORMANCE BOND REQUIREMENT All applicants must submit a security deposit. Use the calculation formula below to decide what your required security deposit will be. The minimum deposit is $33.75 to a maximum that is determined after completing the calculation formula below. Calculation Formula Estimated number of monthly trips __________ x $2.25 a Trip = $_________ Monthly Fee, x 3 Months = $__________ Security Deposit Examples: Estimated number of monthly trips 5 x $2.25 a Trip = $ 11.25 Monthly Fee, x 3 Months = 33.75 Security Deposit Estimated number of monthly trips 26 x $2.25 a Trip = $ 58.50 Monthly Fee, x 3 Months = 175.50 Security Deposit Estimated number of monthly trips 72 x $2.25 a Trip = $ 162.00 Monthly Fee, x 3 Months = 486.00 Security Deposit JWA reserves the right to increase the security deposit submitted by the applicant upon reviewing the actual monthly trips made by the applicant. c:\users\lsantos\appdata\local\microsoft\windows\temporary internet files\content.outlook\c64uhwfc\security deposit - calculation sheet.docRevised: 10/03/06 – ky
County of Orange Request for Waiver of Workers’ Compensation Insurance Requirement (To be completed by business, submitted to Purchasing or appropriate County Department. Department attaches to Risk Assessment or Modification of Insurance Terms form and submits to CEO/RISK Management ) Business Information: Legal Name: Address: Legal Form: Sole Proprietorship Limited Partnership Contact Name: General Partnership Corporation Other: Telephone: Email: County Information: Department: John Wayne Airport Contract/Purchase Number: Customer ID # Contact Name: Erika Cortina Telephone: 949-252-6037 Fax: 949-252-6053 Nature of Work: Ground Transportation On County Property YES NO DECLARATIONS: With respect to the above named business, I hereby declare and warrant that the business has no employees other than the owners, officers, directors, or partners who have elected to be exempt from Workers’ Compensation coverage. I further warrant that I understand the requirements of Section 3700 et seq. of the named business. I agree to comply with the code requirements and all other applicable laws and regulations regarding Workers’ Compensation, payroll taxes, FICA and tax withholding and similar employment requirements. I further agree to hold the County of Orange harmless from loss or liability that may arise from the failure of the above-named business to comply with any such laws or regulations. I, therefore, request that the County of Orange waive its requirement for evidence of Workers’ Compensation Insurance regarding the above referenced work. Name (print): Signed: Date:
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