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4 <br /> APPLICATION <br /> FOR <br /> AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE <br /> ORANGE COUNTY, NORTH CAROLINA <br /> Date of Application: 8-16-96 <br /> I . APPLICANT: <br /> A. Name of Applicant: Mebane Fire Department <br /> B. Address :Street: 101-103 W. Washington Street PO Box 314 <br /> City/State: Mebane, NC Zip 27302 <br /> C. Telephone No. at Base of Operations:Non Emerg. 919-563-5718 <br /> D. Name of Owner/Contact Person: Chief Jimmy Jobe <br /> E. Address:Street: 106 E. Washington Street <br /> City/State: Mebane NC Zip 27302 <br /> F. Telephone No. : 919-563-5901 City Hall - 919-563-2051 Home <br /> G. *Trade Name: Mebane Fire - Rescue <br /> H. Category of Franchise Applied For (A separate <br /> application must be completed for each category of <br /> service applied for) : <br /> BLS: ALS: RESCUE SERVICES <br /> [ ] First Responder [ ] D-Level [x ] Extrication <br /> [ ] Emergency Med Techn. [ ] I-Level [ ] High/Low Angle <br /> [ ] Convalescent Transport [ ] P-Level [ ] Confined Space <br /> [ ] Trench <br /> [ ] water <br /> H. ATTACHMENTS REQUIRED: <br /> 1. Certified copy of Articles of Incorporation Charter <br /> or *Assumed Name Certificate. <br /> 2 . Resume' of training and experience of the applicant <br /> in rescue and transportation and care of patients . <br /> 3 . A financial statement as it pertains to operations <br /> in Orange County. <br /> 4 . A copy of Organization's By-Laws (if applicable) . <br /> 5 . A copy of Organization's Standard Operating <br /> Procedures . <br /> 6 . A current roster of members to include name, <br /> address, and social security number. <br />