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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: March 1 , 1994_ <br /> I . APPLICANT: <br /> A. Name of Applicant: Cedar Grove Fire Department <br /> B . Address :Street : Hawkins Road <br /> City/State: Cedar Grove, N. C . Zip 27231 <br /> C . Telephone No . at Base of Operations : 919-732-6899 <br /> D . Name of Owner/Contact Person: Frank Berry <br /> E . Address :Street: 6521 NC 86 North <br /> City/State : Hillsborough, N. C . , Zip 27278 <br /> F . Telephone No . : 919-732-0787 <br /> G. *Trade Name: NIA <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 /> [X] First Responder [ ] D-Level [ ] 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' o f 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 />