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03C <br /> 1 <br /> IV. List each ambulance and rescue vehicle owned and operated by the <br /> applicant(see attached) . <br /> V. Submit a financial statement indicating the net worth of the <br /> owner of applicant over and above all debts, judgments, claims <br /> and demands whatso ever. <br /> VI. List the title of all actions and unsatisfied judgments, of record <br /> • including the amount of judgments against such owner. <br /> VII. Submit the court record, if any, of applicant. If applicant is <br /> a corporation, partnership, association or other organization, <br /> a <br /> the court record of any of the officers , directors and supervising <br /> employees thereof, including the general manager or director. <br /> VIII . ' List liens, mortgages, or other encumbrances on such ambulances <br /> --the amount and character thereof. <br /> IX. Describe the Insurance coverage of the applicant, giving the <br /> name and address of insuror and the depth of such coverage. <br /> • i <br /> K. Type of Ambulance Service Proposed: <br /> Emergency Transportation <br /> 17 Convalescent and Nonemergency Transportation . <br /> L7 Rescue <br /> Z:17 Other (Specify) <br /> — <br /> 4 <br /> 1 <br />