HomeMy WebLinkAboutAgenda - 09-01-1998 - 8iorpge corny
Board pt Commimioven
Dace: September 1,1998
Acdov Agmdv
Item No ~L
Av Care Paramedic irewportetlov Frovchue AppDevtlov
Departmwc Emmgency Movegmem -EMS Public Hemivg Ym ~ No
Atla¢hmevt(a): Ivfprmetlpv Costae[: Nick Wmers
t)Pmamedic Trmsport Fmochise E:ceesiov NVmher. 3030
Appliceriov ielephove Number.
Hillsborough ]32-8181
Chopel Hill 968-0501
Mebme 336-22]-2031
Dwhem 688-]331
Purpose
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OHlce of Orange County Emergenty Management
PO Bax 81 8 1, Hillsborough, NC 2 ]2 ]8
Of/ICe (919) %8-2050 Fax (919) 966-4066
APPLICATION FOR FRANCHISE
AMBULANCE • MEDICAL FIRST RESPONDER' RESCUE
Oate o/ Application:
Name of Applicant CAROLINA AIR CARE
CitylSlate: CHAPEL HILL NC Zip: 2]514
Telephone # At Base of Operations: !9191 %6 3044
Name of Owner/COntraU Person: _ UNC HOSPITALS
Atltlress: (Street) 101 MANNING DRIVE
Ciry/State'. CHAPEL HILL Zip. 2]514
Telapho~eit: 191919663041-L 10f(
CATEGORY OF FRANCHISE APPLIED FOR:
(A separate application must be completed for each category of service applied for)
BLS ALS RESCUE SERVICES
(]First Respontler (] D-Level [ ] Extrication
[ ]Emergency Metliwl Technician [ ] I-level [ ] HigNLOw Angle
[ ] onvalescaM (NOn-Emergency) ~'P-Level [ 7 Confnetl Space
[ Transport [ ]Trench
[ ] Water
IX] Specialized Transport-Piedmont WomenS Health Center
ATTACHMENTS REpUIRED:
1. CeNfe0 copy of ANUes of Inwmoregon Charter or •Aaeumetl Neme Ceniflcate
2. Applicants Resume' of Veining/experience in reawe, tranaportatlon, antl pegent care
3. Finanual Btalement pertaining ro operagons in Orange County
4. Copy of Organizagon's By-Laws (6 applicable)
5. Copy of Orgenizafon's Standard Operating Prdwdures
fi. Cunant RosNr of Members inclutling names, addresses, and soaal zewdty numbers