HomeMy WebLinkAboutAgenda - 09-01-1998 - 8gOnvge Couvry
Board oPCommiuioven
Dafe: Sepmmber 1,1998
AMOn Agrotla
Item No
Suhjecn Csrrbon Foe Department lat Rmpooder@Reacue Exhieadoo Fnvchlu
AppDndov
Departmroc Emergro<y Manegemem-EMS PubBa Drorwg Vm~ No®
Alnehmrot(a): Ivformsdov Cromer Nick Warm
1)Fim Responder&]temue Exbinaw Extevairo Number: 3030
Fmvchiu Appliradov ielepbove Number.
Htllsborough 132-8181
Chapel Hill 9683501
Mebane 336-22]-2031
Duehem 688-]331
Purpou
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Background
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Office of Orange County Emergency Management
PO Bpx 8101, Hil6borougb, NC 2]2]8
Office (919) 968-2050 fix (919) 968-4066
APPLICATION FOR FRANCHISE
AMBULANCE * MEDICAL FIRST RESPONDER' RESCUE
Date of Applicariom. i-21-9g
Name of Applicant Town of Carr DO rp Fire Department
CirYJStare: 301 W. Hein St. Larrbpro. X.C. $ip: 2]510
Telephone # A[ Base o! Opendom: 919-968J i l5
Name of Owner/ConmaPerson: Rodney Nurr ay. Fi re Cbief
Address: ($PeeL) same az aDOVe
Oh/8rate: Lp:
THephom #:
Trade Name':
CATEGORY OF FRANCHISE APPLIED FOR:
(A seWnre appOratlon must be completed fm eaNt category of senke applkd for)
BLS ALS RESNESERVICES
Fbst Responder I 1 DLevN Ix 1 EMWOn
j ]Emergency MedlW TechNNan 17 I~LevN [ ] HIgWLpw Angle
[ ] ComNescent (NOmEmergexy) I 1 P-LevN I ] ConMed Spxe
Trampprt- [ ] TrenNl
[ ]Water
ATTACHMENTS REQUIRED:
I. Certlfled copy of Ardde of Incorporatlon Charter or'Assumed Name Cerdflcare
2. APPlionr's Rrsume' of mining/experience in rez ve, vansporradonr and Wtlent care
3. Finantial Statement pertaining ro operations in OranHe County
4. Copy of Organilation's BY-Laws (if aPPliable)
5. Copy of Otganiratlon's Standard Operating Procedures
6. Current Roster of Members induding names, addresses,'and social security numbers
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