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26 <br />Such written acceptance may be upon or at the end of a copy of this Franchise Ordinance <br />and it shall state and express the acceptance of said Franchise and its terms, conditions <br />and provisions; and Grantee shall agree in said written acceptance to abide by, to observe <br />and to perform the same according to all of its terms and provisions, subject to applicable <br />state and federal law and shall declare that statements and recitals contained on said <br />Franchise are correct and that it has made and does make the agreements and statements <br />set forth in this Franchise. Acceptance herein referred to shall be in the following form: <br />The undersigned, in his/her capacity as <br />of the Johnston Ambulance Service, Inc. and on behalf of that <br />agency, does hereby accept and approve the foregoing and attached Franchise and all of <br />its terms and conditions; and in consideration of the benefits and privileges granted to it <br />does hereby agree to abide by, carry out, observe and perform all of the obligations and <br />things provided to be carved out and performed by it in said Franchise approved by the <br />Grantor Commissioners, subject to applicable state and federal law. <br />This the day of , 2010 <br />FOR GRANTEE: <br />Printed Name and Title <br />STATE OF NORTH CAROLINA <br />COUNTY OF ORANGE ) <br />On the _ day of , 2010 before me a Notary Public for the County and <br />State aforesaid, personally appeared before me on <br />behalf of said agency, acknowledges the signing and execution of the foregoing <br />instrument. <br />IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed by <br />notarial seal on the day and year above written. <br />Notary Public <br />My Commission Expires: <br />Johnston Ambulance Services, Inc. <br />EMS Franchise Agreement <br />Page 19 of 23 <br />