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5. 31, Financial statement pertaining to (proposed) operations in Orange County. <br /> 6. 3111. 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. 1Mr 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. 11 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. re A written plan detailing how the applicant will furnish credentialed personnel and a <br /> curre ster of all credentialed personnel with a list of their credentials. <br /> 10. 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.[ Copy of organization by-laws (if applicable). <br /> 12. jle Roster of all members and employees, including name, address, and NCDL number. <br /> 13. d List all vehicles owned and operated by applicant. <br /> 14. 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 /> 1. That the information contained within and any attachments provided is true and correct and <br /> to the best of my knowledge; <br /> VSS 2. That the franchise applicant is compliance with North Carolina General Statutes 131E, 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. 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 /> 5. 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: ���—`� <br /> g Signature: �`,..• 77' ( ) '\(f <br /> Authorizin Si nature: '\. ,��► Date: <br />