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t <br /> 2 , <br /> APPLICATION <br /> FOR <br /> AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE <br /> ORANGE COUNTY, NORTH CAROLINA <br /> azaaascsomsxssssxxaxcsx:asxssacaossssssssssssssmsaasaasos xmtresss=sx= <br /> Date of Applicationt 12- 12-93 <br /> I. APPLICANT: <br /> A. Name of Applicant: SOUTH ORANGE RESCUE SQUAD,INC. <br /> B. Address:Street: 202 ROBERSON STREET <br /> City/State: CARRBORO, N.C. Zip 27510 <br /> C. Telephone No. at Bass of Operations: 967-1515 <br /> D. Name of Owner/Contact Person: RAYMOND D. deFRIESS <br /> E. Address:Street: SAME <br /> City/State: SAME Zip <br /> F. Telephone No. : SAME PAGER# 216-0424 <br /> G. *Trade Name: SOUTH ORANGE RESCUE SQUAD <br /> H. Category of Franchise Applied For (A separate <br /> application must be completed for each category of <br /> service applied for) t <br /> BLS: ALS: RESCUE SERVICES <br /> [ ] First Responder [x] D-Level [ ] Extrication <br /> [x] Emergency Ned Techn. [x] I-Level [ ] High/Low Angle <br /> [y(] Convalescent Transport [x] P-Level [ ] Confined Space <br /> [ ] Trench <br /> [ ] Water <br /> H. ATTACHMENTS REQUIREDt <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 />