Drone Use Request Unmanned Aircraft Systems (UAS) Use Application and Permit BEFORE LAUNCHING THE UAS PURSUANT TO AN APPROVED PERMIT, THE OPERATOR MUST CONTACT CAPITOL PROTECTIVE SERVICES AT (605) 773-3154. Bureau of Administration, Buildings & Grounds Room B01, 500 E. Capitol Ave., Pierre, SD 57501 Phone: 605-773-3344 Fax: 605-773-6333 NOTE: do not enter more text than can fit within each field... extra text will not show when printed. Operator Name: Business Name: Street Address: Mailing Address: Phone Number: E-mail: Purpose of Activity: Commercial Recreational FAA Registration #: Pilot License #: Location of Activity: Date of Activity: - Only the person listed on this permit may operate a UAS on the Capitol Complex, and must be eighteen years of age or older. Operator affirms that s/he will comply with all applicable FAA regulations, including but not limited to notification to the Pierre Regional Airport operator/air traffic control tower about Operator’s operation of a UAS, and Code of Federal Regulations (CFR) Title 14, Part 107, Small Unmanned Aircraft Systems, and Part 48, Registration and Marking Requirements for Small Unmanned Aircraft. The UAS must be within eyesight at all times, flown at least 25 feet away from people and not flown over an unprotected crowd, not flown inside buildings, and must not fly, photograph or video people in places where there is an expectation of privacy without the individual’s permission. Operator agrees to be fully responsible for any and all damages or injury which may result to any person or property by reason of or in conjunction with Operator’s activities. Operator agrees to pay the State for any and all damages to the Capitol Complex buildings or grounds resulting from Operator’s activities which will billed to Operator at cost plus 15%. In certain cases the Bureau of Administration may require a certificate of insurance for UAS operation. Operator agrees to defend, indemnify, and hold harmless the State and its elected and appointed officers, agents, and employees from and against any and all liability, damages, actions, claims, demands, losses, expenses, judgments, fees and costs of any kind or character, including the cost of legal defense, arising or resulting from or in connection with Operator’s acts or omissions or alleged acts or omissions and those Operator brings onto the premises. These defense and indemnity obligations survive termination of this permit. Operator is aware of, appreciates the character of and voluntarily assumes the risks involved in participating in use of the UAS. By signature below, Operator, on behalf of himself, heirs, next of kin, successors in interest, assigns, personal representatives, and agents hereby waives any claim or cause of action against and releases from liability the State of South Dakota, its officers, employees, and agents for any liability for injuries to person or property resulting from Operator’s activities. Signature of Operator Date The application form must be completed and returned to the South Dakota Bureau of Administration Buildings and Grounds office 10 days prior to the activity. If approval is granted, this completed form must be in the possession of the operator at all times during the activity. The permit may be revoked/operation of the UAS may be terminated at any time. BOA/B&G Use Only Revised: April 2017 Approved Disapproved Signed Date