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�tauet. fan++�b <br /> ORANGE COUNTY EMERGENCY SERVICES ` <br /> { APPLICATION FOR SERVICE FRANCHISE <br /> a <br /> Tar+b �a24tiir <br /> Franchise Application Category <br /> (A separate application must be completed for each general category of service.) <br /> Convalescent Transport Services Rescue Services _ <br /> ❑X ALS Transport ElConfined Space For OCES use_ <br /> a] BLS Transport ❑ Extrication ( y) <br /> Emergency Services ❑ Heavy Rescue <br /> Date Received: <br /> ❑ BLS Supplemental Transport ❑ High/Low Angle <br /> ❑ BLS System Surge Transport ❑ Swift Water <br /> ❑ BLS Special Event Transport ' ❑ Trench Collapse <br /> ❑ Medical Responder Non-transport ❑ Underwater <br /> ❑ EMT Non-transport ❑ Wilderness Search & Rescue <br /> Name of Applying Organization: North State Medical Transport LLC. <br /> Primary Local Business Address: 1240 Corporation Pkwy. <br /> Local Address City/State/Zip: Raleigh, NC 27610 <br /> Telephone number at local base of operations: 919- 1-8911 <br /> Name of Owner/Contact Person: Stuart Coward <br /> Contact Email Address: scoward@nsmt.biz <br /> Main Office/Owner/Contact Person Address: SAA <br /> Main Office City/State/Zip: SAA <br /> Telephone number at main office: SAA <br /> Operating Business/Trade Name: North State Investment Group. DBA, North State Medical Transport <br /> Application Attachments Required <br /> (See Orange County Franchise Ordinance for Additional Details) <br /> *Place a check mark in the check-box to indicate that the attachment has been included in the application. <br /> FX� See Attached Certified copy of an assumed name certificate if applicant does business under a trade <br /> name AND trade name does not appear on the Articles of Incorporation or Charter. <br /> 2. X❑ See Attached Certified copy of Articles of Incorporation and/or Charter. <br /> 3. 0 See Attached Applicant's resume' of training and experience for the applicable service. <br /> 4. © See Attached—A full description of the type and level of service to be provided including the location <br /> of the place or places from which it is intended to operate, the manner in which the public will be able to <br /> obtain assistance and how the vehicle will be dispatched. <br />