Orange County NC Website
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Office of Orange County Emergency Management <br />PO Bpx 8101, Hil6borougb, NC 2]2]8 <br />Office (919) 968-2050 fix (919) 968-4066 <br />APPLICATION FOR FRANCHISE <br />AMBULANCE * MEDICAL FIRST RESPONDER' RESCUE <br />Date of Applicariom. i-21-9g <br />Name of Applicant Town of Carr DO rp Fire Department <br />CirYJStare: 301 W. Hein St. Larrbpro. X.C. $ip: 2]510 <br />Telephone # A[ Base o! Opendom: 919-968J i l5 <br />Name of Owner/ConmaPerson: Rodney Nurr ay. Fi re Cbief <br />Address: ($PeeL) same az aDOVe <br />Oh/8rate: Lp: <br />THephom #: <br />Trade Name': <br />CATEGORY OF FRANCHISE APPLIED FOR: <br />(A seWnre appOratlon must be completed fm eaNt category of senke applkd for) <br />BLS ALS RESNESERVICES <br />Fbst Responder I 1 DLevN Ix 1 EMWOn <br />j ]Emergency MedlW TechNNan 17 I~LevN [ ] HIgWLpw Angle <br />[ ] ComNescent (NOmEmergexy) I 1 P-LevN I ] ConMed Spxe <br />Trampprt- [ ] TrenNl <br />[ ]Water <br />ATTACHMENTS REQUIRED: <br />I. Certlfled copy of Ardde of Incorporatlon Charter or'Assumed Name Cerdflcare <br />2. APPlionr's Rrsume' of mining/experience in rez ve, vansporradonr and Wtlent care <br />3. Finantial Statement pertaining ro operations in OranHe County <br />4. Copy of Organilation's BY-Laws (if aPPliable) <br />5. Copy of Otganiratlon's Standard Operating Procedures <br />6. Current Roster of Members induding names, addresses,'and social security numbers <br />~_ <br />\: <br />