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2016-698 Emergency Svc - North State Medical Transport - Application for Services Franchise by Ordinance
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2016-698 Emergency Svc - North State Medical Transport - Application for Services Franchise by Ordinance
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Last modified
9/10/2019 9:26:00 AM
Creation date
12/15/2016 11:05:52 AM
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Template:
BOCC
Date
12/13/2016
Meeting Type
Regular Meeting
Document Type
Others
Agenda Item
6f
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5. El N/A —Financial statement pertaining to(proposed)operations in Orange County. <br /> 6. [Z See Attached—A list of radio frequencies the applicant is authorized to operate on, and a copy of the <br /> FCC license(s) in the name of the person providing the service. <br /> 7. El See Attached A description of the applicant's capability to provide twenty-four hour coverage, seven <br /> days per week for the district covered by the franchise applied for. <br /> 8. nX See Attached —An accurate estimate of the minimum and maximum times for a response to calls <br /> within the district covered by the franchise applied. <br /> 9. R See Attached A written plan detailing how the applicant will furnish credentialed personnel and a <br /> current roster of all credentialed personnel with a list of their credentials. <br /> 1 O.nX See Attached —A copy of the applicant's written standard operating procedures including but not <br /> limited to the management of equipment, supplies, and medications. <br /> 11.[:] N/A Copy of organization by-laws (if applicable). <br /> 12. [@ See Attached—Roster of all members and employees, including name, address, and NCDL number. <br /> 13. nX See Attached List all vehicles owned and operated by applicant. <br /> 14, nX See Attached Proposed fee schedule for service in Orange County. <br /> CERTIFICATIONS <br /> Provide initials in each certification blank to indicate agreement to each statement <br /> I certify on behalf of the named franchise applicant the following: <br /> That the information contained within and any attachments provided is true and correct and <br /> to the best of my knowledge; <br /> 27 2- That the franchise applicant is compliance with North Carolina General Statutes 131 E, Article <br /> 7; <br /> �3. That,the applicant shall provide notices to Orange County Emergency Services of any <br /> changes to the information provided in this Application within five (5) days of any changes <br /> and/or any relinquishment of the franchise; <br /> 4 Z4. That I am the duly authorized agent of the Board and have been authorized to submit this <br /> application and certification to the Orange County; and <br /> X25. That any information found to be false or misleading may be grounds for termination of the <br /> franchise and the franchise agreement. <br /> Authorizing Name/Title: Bryan Perry-Compliance Officer <br /> Authorizing Signature: Date: <br />
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