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STATE OF SOUTH CAROLViIA

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

John Doe dba Doe's Limo

BEFORE THEPUBLIC SERVICE COMMISSION

OF SOUTH CAROLINA

TRANSPORTATION COVER SHEET

0 I;LLc- ThOW&S dt) )

J~ ivy]n& t V ~n5(dr+4«)))))

&~iiIER.dPL09 ~ 3C 9lf Ibis is your first tirnc Slnrg sn application with ihc PSC, yoc «nql nnrbsvc a Docket Number. The Commission will assign onc so ycn. If ycuhave filed wdih ibc Commission before, a Docket Numtxu was assignedsnd should be enured above.

8e& Biq- FLv~( v 9o7-909&

t vs u- orat'a 0 8 '). ((

(Please type or print) rvSubmitted by. I-I J I C l I9

Address: 4 jl

0 /A 5 Telephone

Fax

Other

Email

NATURE OF ACTION (Check aR that apply)

NOTE: Tho cover sheet and information contained herein neither replaces nor supplements the filing and sersdce of pleadings or other papersas required by law. This form is required for nse by the Public Service Commission of South Camlina for the purpose of docketing and mustbe fille out co letel .

Application — Chiss A/A Restricted

Application — Class C Taxi

I Application - Class C Charter C+DtpDApplication - Class C Charter Bu

, Application — Class C Non-Emergeimy

Application - Class C S1retcher VanMAIL/ DMS

i Application - Class E Household Goods

Application - Class E Hazardous Waste

Application

Request for Extension to Comply with Order

Request for Order Granting Authority to Obtain a Certificateof Public Convenience and Necessity to he Rescinded

Request for Cancellation ofCertificate

Request for Suspension

Request for Reinstatement

Request for Name Chnnge on Certificate

Q Request to Amend Scope of Authority

Request to Amend Tariff (rate increase, etc.)

Request to Amend Passenger Limit

Request

Exhibit

Late-Filed Exhibit

Letter

Proposed Order

Publisher's Affidavit

Reservation Letter

Response

Renun to Petition

Other:

Ifyou have any questions about this form, please contact the PUBLIC SERVICE COMMISSiON at S03-S96-5100.

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

Columbia, South Carolina 29210

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

APPLICATION FOR CERTIFICATE OF PUBLIC CO1A'ENIENCE AND NECESSITY FOROPERATION OF MOTOR VEHICLE CARRIER

CLASS C - NON-EMERGENCY Date:

Application is hereby made for a Certificate of Public Convenience and Necessity, in accordance with the provisionof S.C. Code Aun, 5 58-23-10, et seq. (19'76), aud amendments thereto.

7ljgmAS CI 4P,

~ ivy TI" ()Name under hich busmess is to be conducted (corporation, partners p, or sole pmprietorship wi or vu out trade name.)

6Jes& ! rn( 5 ~ r. nu 5('.Str tA dresso App icaut

Q.'j Gottilmg Address o Applicant (if di ent rn street address)

o1- 0+6 C Fv oa-P one

Emu ess

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

3. Sele 'ty Type'(Check one)Individual Owner/Sole ProprietorshipPartnership - List names and address of all person having an interest in the business.Corporation — List names and addresses of two principal officers.

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Applicant is financially able to filrnish the services as specified in this application and submits the followingshttement ofassets and liabilities.

Financial Statement

Applicant's assets and liabilities are as fo11ows:

Assets:

Value ofReal Estate

Value ofMotor Vehicles

Cash on Hand

Cash in Bank

Value of Other Assets andEquipment

Lia~it~i

Mortgage/Loan on Real Estate

Loans Owed on Motor Vehicles

Business/Other Loans Owed

Other Liabilities orDebts

Total Liabilities

Total 4ssets

INSTRUCITQNS i

~VtE " Ii i i' i i i f Y ii PM5'Ib iid il &bi'tbCompany/Business Applying for a Certltfcate.

2. 'qvl oan on Real tc" means the outstanding balance on any Mortgage. Equity Line or other Loan securedby tiie Real Estate listed in item l .

3. "V e o r ehicl s" means the actual or fair estimated value ofany moving vans, trucks or other vehiclesowned by the Company/Business Applying for a Certificate.

4. " Owed on o r' '* means the outstanding balance on any loans or liens on the vehicles listed in liam 3.

5. "~iLtitklLand" is the total ofactual cash held by the Company/Business applymg for a Certificate on the day thisform ls filled out.

6. " in ther Loans " means the outstanding balance on any smafi business loan or ether unsecured loanmade by a person, bank or business to the Business/Company applying for a Certificate.

7. "Caabjitjlank" means the current balance in checking accounts, savings accounts or ibe like in the name of theCompany/Business applying for e Cerdficate. Dc nci include retirement accounts or personal bank account balances.

8. "Va e ther e 'n " should include the actual or estimated value cf items such as officeequipment {computers/furaishings), moving equipment (hand trucks/blankets/sirapping), and trailers.

9. " ' " means specific amounts/balances which the Company/Busiriess applying for a Certificateknoivs that it owes to other persons or companies; for example Franchise Peas. This does NOT include regular billssuch as electnciiy bills, security system coats, 1nsurmce, salaries, ctc.

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PROPOSED RATES AMt CHARGES FOR SERVICE

Pro osed ates d Char es

Re'stedSco t ori heck all counties in which ou are re ues i e is.iotLto o eratYou will only be allowed to operate in those counties checked below. You may request "Statewide"authority ifyou intend to operate in all counties in South Carolina.

iO Abbevino

D Aiken

U Altendate

D Anderson

0 Bambcrg

I7 B~w~t

Z Beaufort

U Ber]Ãley

Calhoun

CI Chattesn

U Cherokee

CI Chests.

Q Chesterftcid

Clarendon

Q Colleton

Darlington

~r&tt~

Ono.ch n

Q Bdgeneld

Cl Falrneld

Q Sa'dpcr

Kefshaw

Lcxington

&Marion

Marlboro

Z McCotmtctt

Newbcny

j Oconee

Orangeburg

Q Lancaster

Q La~,pickens

Mchland

FlorenceEV

gc.~~o~Greenville

Greenwood

Hampton

g Harry

Q Saluda

Spattanburg

U Union

illiamsburg

U Statewide

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DESCRIPTION OF EQUIPMRNTYou are not requited to own a vehicle to file en application. However, prior to being issued a certificate by ORS,you ~vs reqmre ave o nun a ve c c.

Maxim N ers Vehicle is% 'The nurdber ofpassengers a vehicle is equippedto carry is based on the number ofseatbelts in the vehicle, including the driver's seatbeh.)

1-7 Passengers, including driver

8-15 Passengers, including driver

YEAR dh MODEL

WHEEL-CHAIR

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INSURANCE qUOTETI& foun ST B T DThe insurance quote must be complete, listing current instuanc premiums. At the discretion of the Couunissiou, a copy ofcurrentmsutance policies may be required. Do riot pmvide a copy ofinsufance policies uuleac requested. You will uot be required topurchase msurauce until your application has been approved and an order has been issued by the PSC. THIS IS ONLY A QUOTE.

Tlie following insurance quote is for:

~ j iIIHZiP i t 4 I IIName ofApplicant

Address ofApplicantYOu g i

I, the Applicant, am familiar with the Commission's Rules and. Regulations relating to insurance requirements andthc above quote meets the minimum insurance limits prescribed. The msurancq company making this quote Isauthorized by the South Carolina Department of Insurance to do business in South Carolina,

Ifyou vvish to self-insure yourmotor vehicles for liability and property damage, you must comply with S.C. Code Ann.Sections 56-9-60 and 58-23-9 I 0. For mere information, contact thc Department of Motor Vehicles at (803) 896-8457 or(803) 896-9903.

If you wish to apply as a self insured for worker's compebsation coverage-in South Carolina you may do so with the SouthCarolina Worker's Compensation Commission (WCC) pmvided that you will be abie to I ) post a surety bond or letter-of-crcdir, with the WCC for a minirnuin of$500,000, 2) agree to pay a yearly self-insurance tax, and 3) agree to pay anannual assessment to the South Carohna Second Injury Fund. For more information, contact the WCC SelfInsuranceDivision at (803) 737-5712 or on the web at wvvw.wcc.state.sc.us/self-insurance.

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As Ogpu'ERTIFICATE OF UABILITY IIIIISURANCETHIS CERTIRCATE IS ISSUED ADA MATTER QF tNFDRSIATIQN ONLY AND CONFERS NO RIBII70 UPON TNE CERTIRCATE HOIOER THIS

CERTIFICATE DOES NOT AFRRSATIVEUT Olt NEGATIVELY AISENDL Ealulsu OR ALTER THE CQVERAEE AFFQRDEQ BY THE POLICIESBELOW. THS CERTIFICATE OF INSURANCE DOES NDTC~A COIITRAOT BElWEEN TNE ISSUINS INSURER(SLAu~REPRESENTATIVE QR PRODUCER, ARD THE CERtIFICATE HDLDEILBIPQRTAHTJ If the erEEmnc holdsr is an ADDITIONAL INSURED, thn Pogcy(iss) must have ADDITIONAL EISURED provislans Drtre emlcissd.If sUERQGATIQIII Is wAIYED, sirsisct to the tenne End cnndidons ofme Fo fey, caftan pc 2 cise msy re«Fohn EN sndummnsnL A staten»nt onthis osrtificste does not confer ri ids la ths nsrhlicale hcrdmin Esu ol such enotcosemsnt sbPNCCUCEN

MtsX insurance Servicesr Inc.6B Libefttf Suite 200AlisQ Weio, CA 92055Ltcgnse Sl 0800300

INSUNED

ALICIA THOMAS441 3.SouthtforouSh RdFIOrenca„SC 20001

Ltntse ffcFarlin9 33hd330

msusurh fdn«SESIITD«Lf nceWool»EN

CERTIFICATENUIIBER: 9003100ILI1076REVISION IEIIBER: S

THIS fs TC CSNIIPY THAT THE Pep CISE OF msUNANCE USIEO BELOW HAVE SEEN mSUEO TO THE INSURED NANKQ ABOVE FOR THE PCLTCY PERIOD

WOICATEC. NOTWITHSTANDING /INY REQUIREMENT, TERM QR CCRMlQN OF ANY CONSNAcr OR OTHER OOCUIVEIJT WIIH RESPECT TO WHICH THIScutllFICATE MAY BE JESUED CR SIAY PENTA!N, THE lllfBURANch AFFORDED BY THE POUclss DEscRIEEC HEREIN rssUBJEcTTo ALL~,EIICLUEIONSJSNO CONDITIONS OF SUCH PoucfES. Uuns SHOWN SIAY HAVE SEEN REDUCED BY PAID CLAIMS.

INSNLos

A X ccuussohh aENEESL

uusun'Afunutfm X'n N

DENLADCNECATEJJ»ITN«NUES PEf«X PDIJCY Jeer 'cc

BLS 00000760 07I1712021 07/17I2022

I 1 0000DDNEOENPI mn«NI I 1 000

I Jov suuNY I 000 000s 2 000000.I .200000D

AM'lrfoDoooeo

PINEDAUTOS ONlY

]SCHEDULEDEurusNeo»CNINEDAlflcs Ou.v

Uellr

EDDLY mluNYI«» oenr«IsoDLY sul@Y Fun@knoll s

Q cccunftnmalon DOCH DCCUNNENCL

ncolsslod UINWENEAflollJwo nnLoosoo neo«onEJNANY pccpsercnnosmn«sxmufnsOP~ENESCLUDENShod loofe NNJ

friohdnneo no»DEEDS«met« cocpEnlfricnseofoo

SJAEUENCN

NCCIDJHI'LJESEASE-

Eh

Dssbonfmn CFcpENellcrs J Lccdllcss I vuscLNS f»ccfoc osL J»use»» f»nn«n s~n» I o oso«od is no» «yno linulneRB: 700 S. Padmr Drive, Suite 0, Roienca SC 29501certi«Efcate Holder is included as an additional infused in ong odnto Um Consent Linhility poncy perwrluun connect perattached endorsement.Please also aar nttschnn num»no«N»nt sooth» o«c»need nudltlonal Insured covermle that lncludesl Tender the defense andIndemnity of any c!alm or suit" to en inaurers whom atso haveinsurance available to theiuldidonal insured.

Sf 100S-201 0 ACORD CORPORATION. AE nglns resdsvod.»AcoRQ mone End logo are gistered insrks ofACQRDPrifdsd by LML on lhfpfomhor ech EDES»f DDSEAM

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INSURANCE

Coverage ls Provided lntOhio Security Insurance Company

175 Berkeley St., Boston, MA 02118

Commercial General LiabilityI3entarntions

Basis: Occurrence

Policy Number:DLS (22) 00000764Policy Period:Prmn 07/17/2021 Ta 07/I7/2022f2101 am Standard Timeal insured Mailing Location

ALlCIA THOMAS (949) 334-3330MPX INSURANCE SERVICES INC

SUhllWI/LRY OF LIMtTS ARR CRDRRES

DammerntalgeneralLlahigtyLimits nftasarnace

Each Occurreace LimitDamage To Premises Rented To You Limit (Any One Premises)tyiedicnl Expense Limit (Anv Oae Person)Personal and Advertising Inlury LimitGeneral Aggregate Limit (Other than Products - Corn~lated Operations)Products - Completed Operations Au~gate Limit

1, 000, 0001,000,000

15,0001,000,0002,000,0002p000,000

Etgflsnstion ofghsrDes

DESDDIPTIN

General Liabinty Schedule Totals

CertITDIed Acts of Terrorism Coverage

Total Advance Charges;

PREMIDlig

779.003.00

578200Note: This is uot e bill

to tepcrt 0 cfsfm, cuff your Agent ur 2-S44&2a-24ar

DS 70 22 01 08Iutla/21 00000100 POISVCS 200 NCXFPPNO INSUFIEO COPY unun PACE 22 OF 10

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Kxhibit Fit %HIin and Ab A

l. Is there currently any outstandin~udgments against the Applicazit7Q Yes ~NoIfYes, list judgements liere:

2. Is Applicant familiar with all statutes aud regulatious, iucIuding safety regulations and govemmg for-hire motorcarrier operations m South South Carolina, and does Applicant agree to opemte in compliance with thesestatutes and regulations'?

Q Yes QNo

3 Is Ap Iicaut aware of the Commission's insuraricc requirements and the insurance premium costs associatedt e 'th7

Yes Q No

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Kxhi tun Driver ualificntious

p.11

l. Applicant understands that drivers must possess at least a current American Red Cross Standard First Aid andCPR Certificate or its equivalent, and records that verify/record such training must be kept on isle at thecompany's primary place ofof business within South Carolina.

Q No

Applicant understands that drivers mast be in compliance with all OSHA regulations.

0 No

3. Applicant uud~ that drivers must. be trained in the usc ofall vehicle installed safety equipment such astwo-way radios, fvst-aid kits, 5re extinguishers, and other equipment as outlined in PSC Regulations.

0 No

4. Applicant understands that drivers must be able to physically perform actions necessary to assist personswith disabilities, including wheelchair users.

Q No

5. Applicant understands that drivers must wear a professional uniform and photo identificafion badge thateasily identi6es the driver arid the company for whom the driver works.

0 No

6. Applicant understands that drivers must complete twelve (12) hours of m-service training annually in the areaof safety, aud records that verify/record. such training must be kept on file at the company's prixnary place ofbusiness within South Carolina.

Q No

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PUBLIC SERVICE COMMISSION QF SOUTB CAROLINAl01 EXECUI1VE CENTER DRIVE, SUITE 100

COLUMBIA, SOUTH CAROLINA 29210

Applicant is familiar with the provision of S.C. Code Ann. 1158-23-10, et seq,(1976), and amendments thereto,and R. 103-100 through R.103-241 of the Commission's Rules and Regulations for Motor Camera (S.C. CodeAnn. Regs., 1976)r and R.38-400 through R.38-503 of the Department ofPublic Safety*s Rules and Regulationsfor Motor Carriers (Volume 2, S.C. Code Ann., 1976) and amendments thereto, and hereby promises compliancetherewith.

S.C. CodeAnn. Section 58-3-250 states, in part, that every final oidcr 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:IApplicant AGREES to receive future Commission orders related tc the Applicant's authority iu South Carolina

ough the Ccnnnission's egervice System. The Appficsnt authorizes the Commission to scrveits orders by using the e-mail address as it appears on page cne ofthis Application, To sign up for eService notifications, please visit vwvv.psc.sc.gov tc create a Ivly DMS account.

, Thu Applicant DOES NOT AGREE ic receive future Commission ordem related to the Applicant's authority in SouthCsmfina through the Commission's eService System.

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

ant (e.g. President, Owner, etc.)

Sl'ATE OP SO T I.IN

COIINTY Oir

SWORN TO B 0Tins ~X daycf

etary Public

Commission Expires

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R. Wes Hayes, Jr.Chairman

Rusty L Monhollon, Ph.D.prWidenr iS Brecurive Director

July 23, 2021

South CaroNnaCornrnission on Hitcher Education

Ar~s wFa were &aanc

Mrs. Aiicia Thomas, OwnerJohnson-Thomas Medical Training Center700 5. Parker Driver, Suite 8Florence, SC 29501

Dear Mrs. Theinas:

Enclosed is the amended license for Johnson-Thomas Medical Training Center to offer the followingcertificate programs:Nursing Assistant (100 Clock Hours)Medical Assistant(96 Clock Hours)

Phlebotomy (80 Clock Hours)EKG Technician (50 Gock Hours)

The license period is December 1, 2020, through November 30, 2081. The license is issued underauthority of the Nonpublic Pascsecandary institution License Act, Titie 59, Chapter 58, Sections 10-140,South Caroiina Code ofLaws, 1976, as amendeck Chapter 62 Regulatians of the South CarolinaCommission on Higher Education; and the rules and policies of the Commission, You must prominentlydisplay'he license at the facifty of the scheol:

It is the institution's responsibility to immediately notify the Commission of significant changes in thecourse or program ofFerings, facilities, Bnances, ownership, or administration or of any other changes thatmay signihcantly affect the courses of instruction offered. You must apply ta the Commission for appravalbefore yau offer any additional pragrarris ai open additional locations

By applying for and accepting the license, you are agreeing to comply with the iequirements for licensureas prescribed by applicable statutes, regulations, rules, and conditioris.

Please ii.t me know if you have any questions.

Stacey Price, Program CoordinatorAcademic Affairs, Postsecondary Institution Licensing(803) 737-7781sprice@chetscgov

Enclosure: License No. 5720

Q II 803. 737 2260 1122 Lady 5t, Ste 400Columbia, SC 29201 www.che.sc.gov Q II

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South CarolinaCommission on Higher Education

Postseeond.~ Institution I.ieense

Issued under the authority of Chapter 5S ofTitle 59, I976 S.C. Code of Lawsas amended, and B.C. Commission on Higher Education Regulations,

Chapter 62.

Johnson-Thomas-.MecBeal TrainingCenter-,--::-:.

Aliaia Thomas, Otoner

Licensure is to ptte'r'programs leading to the following certificate:

Nursing AssistantMedical Assistant

PblebotontyEKQ Technician

"'cademic

AffairsPostsecondaxy Institution Licensing

Academic ABairsPostsecondary Idstitution Licensing

Licensure tndkertea only that minimum standards have been met; itis not anendorseotentor guarantee ofquaBty.