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tQttat �ohh Yu-°`"E <br /> ® is coUh!lY <br /> ORANGE COUNTY EMERGENCY SERVICES <br /> k . , APPLICATION FOR SERVICE FRANCHISE <br /> •�. �0 ®E�ER6EN��� <br /> tin coo` sERvicos <br /> Franchise Application Category <br /> (A separate application must be completed for each general category of service.) <br /> Convalescent Transport Services Rescue Services <br /> ❑ALS Transport C Confined Space <br /> n BLS Transport n Extrication (For OCES use only) <br /> Emergency Services E Heavy Rescue Date Received: <br /> ❑ BLS Supplemental Transport ❑ High/Low Angle <br /> C BLS System Surge Transport E Swift Water <br /> ❑ BLS Special Event Transport C Trench Collapse <br /> n Medical Responder Non-transport ❑ Underwater <br /> ❑ EMT Non-transport C Wilderness Search & Rescue <br /> Name of Applying Organization: South Orange Rescue Squad <br /> 202 Roberson Street <br /> Primary Local Business Address: <br /> Carrboro, NC 27510 <br /> Local Address City/State/Zip: <br /> 919-967-1515 <br /> Telephone number at local base of operations: <br /> Matthew Mauzy, Chief <br /> Name of Owner/Contact Person: <br /> admin @ sors.us / mauzy @sors.us <br /> Contact Email Address: <br /> PO Box 128 <br /> Main Office/Owner/Contact Person Address: <br /> Carrboro, NC 27510-0128 <br /> Main Office City/State/Zip: <br /> 919-967-1515 <br /> Telephone number at main office: <br /> South Orange Rescue Squad <br /> Operating Business/Trade Name: <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 /> 1. le 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. 400. Certified copy of Articles of Incorporation and/or Charter. <br /> 3. Ne Applicant's resume' of training and experience for the applicable service. <br /> 4. 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 />