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We hereby request berthing for the above listed vessel and have provided the required information herein. We further agree, as the agent or authorized representative for the agent requesting berth, to accept responsibility for all charges assessed against the vessel and any additional charges resulting from requests for service from the Terminal or Terminals at which the vessel is either working or at layberth. I further certify that funds sufficient to cover anticipated Port expenses on the above named vessel have been received from the owner/operator of this vessel.