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r <br /> i A <br /> 9 <br /> APPLICATION <br /> FOR <br /> AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE <br /> ORANGE COUNTY, NORTH CAROLINA <br /> Date of Application: June 16, 1997 <br /> I. APPLICANT: <br /> A. Name of Applicant: Efland Fire Department <br /> B. Address:Street: Highway 70 East <br /> City/State: Efland. NC Zip: 27243 <br /> C. Telephone No. at Base of Operations: <br /> D. Name of Owner/Contact Person: Raymond Wilson, Chief <br /> E. Address:Street: 503 Mt. Willing Road <br /> City/State: Efland. NC Zip: 27243 <br /> F. Telephone No.: 919-732-7959 <br /> G. *Trade Name: <br /> H. Category of Franchise Applied For (A separate application must be completed <br /> for each category of service applied for): <br /> BLS: ALS: RESCUE SERVICES <br /> [ ] First Responder [ ] D-Level [xx ] Extrication <br /> [ ] Emergency Med Techn. [ ] I-Level [ ] High/Low Angle <br /> [ ] Convalescent Transport [ ] P-Level [ ] Confined Space <br /> [ ] Trench <br /> [ ] Water <br /> I. ATTACHMENTS REQUIRED: <br /> 1. Certified copy of Articles of Incorporation Charter or *Assumed Name <br /> Certificate. <br /> 2. Resume' of training and experience of the applicant in rescue and <br /> transportation and care of patients. <br /> 3. A financial statement as it pertains to operations in Orange County. <br /> 4. A copy of Organization's By-Laws (if applicable). <br /> 5. A copy of Organization's Standard Operating Procedures. <br /> 6. A current roster of members to include name, address, and <br /> social security number. <br />