2016-699 Emergency Svc - LifeStar Emergency Services -2023, LLC - Application for Services Franchise by Ordinance

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t. ORANGE COUNTY EMERGENCY SERVICES 32 APPLICATION FOR SERVICE FRANCHISE Franchise Application Category (A separate application must be completed for each general category of service.) Convalescent Transport Services Rescue Services ❑MS Transport n Confined Space (For OCES use only) ®'BLS Transport n Extrication Emergency Services ❑ Heavy Rescue Date Received: ❑ BLS Supplemental Transport ❑ High/Low Angle H BLS System Surge Transport ❑ Swift Water ❑ BLS Special Event Transport n Trench Collapse ❑ Medical Responder Non-transport [1 Underwater ❑ EMT Non-transport l—I Wilderness Search & Rescue Name of Applying Organization: LifeStar Emergency Services-2023, LLC Primary Local Business Address:TBD Local Address City/State/Zip: TBD Telephone number at local base of operations: TBD Name of Owner/Contact Person: Michael Lee Hoots Contact Email Address: MHoots@LifeStar911 .com Main Office/Owner/Contact Person Address: 3475 Myer Lee Drive Main Office City/State/Zip: Winston-Salem, NC 27101 Telephone number at main office: (336) 722-5433 Operating Business/Trade Name: LifeStar Emergency Services Application Attachments Required (See Orange County Franchise Ordinance for Additional Details) *Place a check mark in the check-box to indicate that the attachment has been included in the application. 1. [ Certified copy of an assumed name certificate if applicant does business under a trade de name AND trade name does not appear on the Articles of Incorporation or Charter. 2. L:0 Certified copy of Articles of Incorporation and/or Charter. 3. Applicant's resume' of training and experience for the applicable service. 4. A full description of the type and level of service to be provided including the location of the place or places from which it is intended to operate, the manner in which the public will be able to obtain assistance and how the vehicle will be dispatched.