Orange County NC Website
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~„ <br />s`'pa~ Cam' <br />ORANGE COUNTY EMERGENCY SERVlGES ~`'~~~ ~ `~`~ <br />~~ APPLICATi4N FOR SERVICE FRANCHISE <br />~~:. <br />Franchise Application Category <br />{Q separate application mus# be completed for each general category of service.) <br />Convalescent Transport Services Rescue Services <br />^ ALS Transport <br />© BLS Transport ^ Confined Space (For OCES use only) <br />^ Extrication <br />Emergency Services <br />® ALS Transport ^ Heavy Rescue <br />^ High/Low Angle Date Received: <br />© BLS Transport ®Swift Water <br />^ Medical Responder Non-transport ^ Trench Collapse <br />^ EMT Non-transport ^ Underyvater <br /> ^ Wilderness Search ill Rescue <br />Name of Applying Organization: Johnston Ambulance Service, tnc. <br />Primary Local Business Address: 4916 Hillsborough Road <br />Local Address City/State/Zip: Durham, NC 27703 <br />919-384-9100 <br />Telephone number at local base of operations: <br />( Name of Owner/Contact Person: Jeffrey D. White, Vice-President <br />!' <br />Main Office/Owner/Contact Person Address: 2803 Highway 70 West <br />Main Office City/State2ip: Goldsboro, NC 27530 <br />Telephone number at main office: 800-625-3500 <br />-' Operating 13usiness/Trade Name: <br />~,' <br />Application Attachments Required <br />(See Orange County Franchise Ordinance for Additional Details) <br />7. Certified copy of an assumed name certificate if applicant does business under a trade name AND trade <br />name does. not appear on the Articles of Incorporation or Charter. [ ] <br />~" 2. Certified copy of Articles of Incorporation and/or Charter. ~ Section Itt <br />3. Applicant's resume' of training and experience for the applicable service. pJ Section IV <br />~_ <br />4. A full description of the type and level of service to be provided including the location of the place or <br />places from which it is intended to operate, the manner in which the public will be able to obtain assistance <br />~:. and how the vehicle will be dispatched. ~ Section V <br />_ 5. Financial statement pertaining to (proposed) operations in Orange County. ~ Section yt <br />~, <br />6 <br />