ELECTRONIC SERVICES Gaming Device/Cashless Wagering System Approval Request (1) Request Reference#: (2) Manufacturer ID #: (3) Gaming Device Platform: (4) Gaming Device Platform Lab #: (5) System: (6) System Lab #: (7) Applied Date: (8) Emergency(Yes/No): (9) Outside Agency to Perform Testing: (10) Description of Platform and System Use (attach additional sheets if needed): I certify that: (a) The above information completely describes this request. (b) This gaming device system use is intended for the Nevada Market. (c) This gaming device platform for use on the listed system is in compliance with applicable Nevada Gaming Commission Regulations and Technical Standards. (d) Any copyrights over this gaming device platform are held by: (e) This platform was designed and developed by: (11) (Submitting Manufacturer) hereby agree to indemnify, hold harmless and defend, not excluding the State’s right to participate, the State of Nevada, the Nevada Gaming Commission, the State Gaming Control Board, the Nevada Attorney General and each of their members, agents, and employees in their individual and representative capacities from any and all claims against the agencies or persons named in this paragraph, arising out of the submission, application, investigation and deliberation concerning this application, and against all liabilities, expenses, damages, charges and costs, including court costs and attorney’s fees, which may be sustained by the person or agencies named in this paragraph as a result of said claims, suits and actions. (12) (Authorized Signature) Revised 5/02 American LegalNet, Inc. www.USCourtForms.com