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The Port Authority of New York and New Jersey Tunnels, Bridges and Terminals Department E-Zpass Programs Division 2 Montgomery Street Jersey City, NJ 07302

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The Port Authority of New York and New Jersey Tunnels, Bridges and Terminals Department E-Zpass Programs Division 2 Montgomery Street Jersey City, NJ 07302 Date: _____________________ The Port Authority of New York and New Jersey Tunnels, Bridges and Terminals Department E-ZPass Programs Division 2 Montgomery Street Jersey City, NJ 07302 RE: Authorization to release E-ZPass transaction information for E-ZPass Account #____________. I am writing to authorize The Port Authority of New York and New Jersey (“Port Authority”) to release to New York Container Terminal (NYCT) certain E-ZPass transaction information to facilitate [Trucking Company]’s participation in NYCT’s Reimbursement Program (Program), and to specifically consent to such release. I have provided NYCT with evidence of ownership of the E-ZPass account controlling the participating tags by supplying either an E-ZPass Account Statement or an E-ZPass Transaction View summary downloaded in pdf format from my E-ZPass agency website. A copy of that statement/summary is attached for your use. I certify that I am authorized to grant this release on behalf of [Trucking Company]. Specifically, for the referenced E-ZPass account and all related tags that have been registered with the NYCT Program, I consent to the Port Authority releasing the following information for transactions at the Goethals Bridge, Bayonne Bridge, and Outerbridge Crossing: (1) transaction date and time, (2) toll plaza of use, (3) class of vehicle, (4) number of axles, and (5) amount of toll collected. Consent to this data exchange will be in effect from the date of this letter to December 31, 2016 unless revoked in writing by myself or a duly authorized representative of [Trucking Company]. I further certify that each registered tag is or will be assigned to a truck having commercial license plates and properly classified as one of Classes 2 – 6 according to the Port Authority toll rate schedule. I understand that it is my responsibility to update this Program account information whenever there is a change in the status of any tags previously registered or whenever new tags are to be added. In the case of new tags being added, the “Principal Email Address on Record” established for this account will be used to transmit to NYCT and the Port Authority additional E-ZPass statements/summaries that include the tags to be added. This will be done using the “Program Account Modification Email” template 1 found on the Program website. The transmittal email will expressly authorize the Port Authority to release to NYCT E-ZPass transaction data associated with the added tags. I further understand that in the event the Port Authority for any reason determines that an account or tag is not in good standing, E-ZPass transactions associated with such account or tag will not be eligible for reimbursement until the matter has been resolved. I further agree (on behalf of [Trucking Company] for company-owned tags) to indemnify and hold the Port Authority, its Commissioners, officers, employees, agents and representatives harmless from and against any and all claims that may arise out of or may be connected to the release of this information. All other E-ZPass terms and conditions remain in full force and effect. This consent will continue in effect for the time period specified above, unless and until written notice is provided to the Port Authority and NYCT to end it at an earlier date. It is agreed that all rules governing the Reimbursement Program as provided by NYCT, including any amendments that may be made to such rules from time to time, will be adhered to. Sincerely, Trucking Company OR E-ZPass Account Owner Name: ________________________ Name: _______________________ Title: _________________________ Title (if any): __________________ Address: ______________________ Address: ______________________ ______________________ ______________________ Phone: ________________________ Phone: _______________________ Email: ________________________ Email: _______________________ cc: New York Container Terminal, LLC– Alfred Tung ([email protected]); Applicant 2 NYCT Reimbursement Program Program Account Modification Email Tag Additions From: [E-ZPass Account Owner/Trucking Company] To: NYCT Special Administrative Tolls Unit; PANYNJ E-ZPass Programs Division Date: Subject: NYCT Reimbursement Program – Tag Additions E-ZPass Account #: __________ The E-ZPass tags included in the attached E-ZPass Account Statement or E-ZPass Transaction View summary, which has been downloaded in pdf format from my E-ZPass agency website, are to be added to my or, in the case of company-owned tags, [Trucking Company]’s NYCT Reimbursement Program account. Authorization is expressly granted to The Port Authority of NY & NJ (Port Authority) to release E-ZPass transaction data associated with the added tags in accordance with the permissions granted to the Port Authority by me, or in the case of company-owned tags, [Trucking Company] during creation of the original Program account. 3 .
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