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HomeMy WebLinkAboutApplications for First Responder Services for Caldwell, Cedar Grove, Eno, Mebane, New Hope, North Chatham, Orange Grove and White Cross fire departments in accordance with the provisions of the EMS Francise Regulating Ordinance 3 APPLICATION FOR AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE ORANGE COUNTY, NORTH CAROLINA Date of Application: March 1, 1994 I . APPLICANT: A. Name of Applicant: ,Caldwell Fire Department, B. Address :Street: 7020 Guess Road City/State: Rougemont, N. C . Zip 27572 C . Telephone No, at Base of Operations : 919-732-8445 D . Name of Owner/Contact Person: Bryant Walker E . Address :Street: 5108 Walker' s Farm Road City/State: Hillsborough, N. C . Zip 27278, F . Telephone No. : 919-732-4034, G. *Trade Name: N/A H. Category of Franchise Applied For (A separate application must be completed for each category of service applied for) : BLS : ALS : RESCUE SERVICES [x] First Responder [ ] D--Level [ ] Extrication [ ] Emergency Med Techn. [ ] I-Level [ ] High/Low Angle [ ] Convalescent Transport [ ] P-Level [ ] Confined Space [ ] Trench [ ] Water H. ATTACHMENTS REQUIRED 1 . Certified copy` of Articles of Incorporation Charter or *Assumed Name Certificate . 2 . Resume ' of training and experience of the applicant in rescue and transportation and care of patients . 3 . A financial statement as it pertains to operations in Orange County. 4 . A copy of Organization' s By-Laws ( if applicable) . 5 . A copy of Organization' s Standard Operating Procedures . 6 . A current roster of members to include name, address , and social security number. 4 APPLICATION FOR AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE ORANGE COUNTY, NORTH CAROLINA Date of Application: March 1 , 1994_ I . APPLICANT: A. Name of Applicant: Cedar Grove Fire Department B . Address :Street : Hawkins Road City/State: Cedar Grove, N. C . Zip 27231 C . Telephone No . at Base of Operations : 919-732-6899 D . Name of Owner/Contact Person: Frank Berry E . Address :Street: 6521 NC 86 North City/State : Hillsborough, N. C . , Zip 27278 F . Telephone No . : 919-732-0787 G. *Trade Name: NIA H. Category of Franchise Applied For (A separate application must be completed for each category of service applied for) : BLS : ALS: RESCUE SERVICES [X] First Responder [ ] D-Level [ ] Extrication [ ] Emergency Med Techn. [ ] I-Level [ ] High/Low Angle [ ] Convalescent Transport [ ] P-Level [ ] Confined Space [ ] Trench [ ] Water H. ATTACHMENTS REQUIRED: 1 . Certified copy' o f Articles of Incorporation Charter or *Assumed Name Certificate . 2 . Resume' of training and experience of the applicant in rescue and transportation and care of patients . 3 . A financial statement as it pertains to operations in Orange County. 4 . A copy of Organization' s By-Laws ( if applicable) . 5 . A copy of Organization' s Standard Operating Procedures . 6 . A current roster of members to include name, address , and social security number. A . 5 APPLICATION FOR AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE ORANGE COUNTY, NORTH CAROLINA Date of Application: March 1 , 1994 I . APPLICANT: A. Name of Applicant: Eno Fire Department, B. Address :Street: 5019 US 70 City/State: Durham, N. C . Zip 27705 C . Telephone No . at Base of Operations : 919-383-5967, D . Name of Owner/Contact Person: Johnny Riley, E . Address :Street: 6313 Mt . Herman Church Road City/State: Durham, N. C . Zi p 27705 F . Telephone No . : 919-383-277 . G. *Trade Name: NIA H. Category of Franchise Applied For (A separate application must be completed for each category of service applied for) : BLS: ALS : RESCUE SERVICES [X] First Responder [ ] D-Level [ ] Extrication [ ] Emergency Med Techn. [ ] I-Level [ ] High/Low Angle [ ] Convalescent Transport [ ] P-Level [ ] Confined Space [ ] Trench [ ] Water H. ATTACHMENTS REOUIRED: 1 . Certified copy' of Articles of Incorporation Charter or *Assumed Name Certificate , 2 . Resume ' of training and experience of the applicant in rescue and transportation and care of patients . 3 . A financial statement as it pertains to operations in Orange County. 4 . A copy of Organization' s By-Laws ( if applicable) . 5 . A copy of Organization' s Standard Operating Procedures . 6 . A current roster of members to include name, address , and social security number. ti 6 r APPLICATION FOR AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE ORANGE COUNTY, NORTH CAROLINA Date of Application: March 1, 1994 I . APPLICANT: A. Name of Applicant : Mebane Fire Department, B. Address :Street: 101-103 West Washington Street, City/State: Mebane, N. C . Zip 2?302, C . Telephone No . at Base of Operations : 919-563-7000, D. Name of Owner/Contact Person: James Jobe E . Address :Street: 109 West McKinley Street City/State: Mebane, N. C . Zip 27302, F . Telephone No . : 919-563-6569 G. *Trade Name: N/A H. Category of Franchise Applied For (A separate application must be completed for each category of service applied for) : BLS : ALS : RESCUE SERVICES [x] First Responder [ ] D-Level [ ] Extrication [ ] Emergency Med Techn. [ ] I-Level [ ] High/Low Angle [ ] Convalescent Transport [ ] P-Level [ ] Confined Space [ ] Trench [ ] Water H. ATTACHMENTS REQUIRED: 1 . Certified copy` of Articles of Incorporation Charter or *Assumed Name Certificate . 2 . Resume ' of training and experience of the applicant in rescue and transportation and care of patients . 3 . A financial statement as it pertains to operations in Orange County. 4 . A copy of Organization' s By-Laws ( if applicable) . 5 . A copy of Organization' s Standard Operating Procedures . 6 . A current roster of members to include name, address , and social security number . 7 APPLICATION FOR AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE ORANGE COUNTY, NORTH CAROLINA Date of Application: March 1 , 1994, I . APPLICANT: A. Name of Applicant : New„_Ho ^Fire De^tment B. Address :Street: Hwy 86 North, City/State: Chapel Hill, N . C . Zip 27516 C . Telephone No . at Base of Operations : 919-929-3473, D. Name of Owner/Contact Person: Michael Bordeaux E . Address :Street: 3414 University Station Road City/State: Chapel Hill , N . C . Zip 27514 F . Telephone No . : 919-383-3477 G. *Trade Name: N A H. Category of Franchise Applied For (A separate application must be completed for each category of service applied for) : BLS : ALS: RESCUE SERVICES [X] First Responder [ ] D-Level [ ] Extrication [ ] Emergency Med Techn. [ ] I-Level [ ] High/Low Angle [ ] Convalescent Transport [ ] P-Level [ ] Confined Space [ ] Trench [ ) Water H. ATTACHMENTS REQUIRED: 1 , Certified copy` of Articles of Incorporation Charter or *Assumed Name Certificate . 2 . Resume ' of training and experience of the applicant in rescue and transportation and care of patients . 3 . A financial statement as it pertains to operations in Orange County. 4 . A copy of Organization' s By-Laws ( if applicable) . 5 . A copy of Organization' s Standard Operating Procedures . 6 . A current roster of members to include name, address , and social security number. 8 APPLICATION FOR AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE ORANGE COUNTY, NORTH CAROLINA Date of Application: March 1 , 1994 I . APPLICANT: A. Name of Applicant : North Chatham Fire Department B. Address :Street: 45 Morris Road City/State: Pittsboro, N . C . Zip 27312 C . Telephone No . at Base of Operations : 919-542- 3380 D. Name of Owner/Contact Person: John Strowd E . Address :Street: 4089 Mt . Gilead Church Road City/State: Pittsboro N . C . , Zip 27312 F . Telephone No . : 919-542-3398 O. *Trade Name: N/A H. Category of Franchise Applied For (A separate application must be completed for each category of service applied for) : BLS : ALS: RESCUE SERVICES [X] First Responder [ ] D--Level [ ] Extrication [ ] Emergency Died Techn. [ ] I-Level [ ] High/Low Angle [ ] Convalescent Transport [ ] P-Level [ ] Confined Space f ] Trench [ ] Water H. ATTACHMENTS REQUIRED: 1 . Certified copy` of Articles of Incorporation Charter or *Assumed Name Certificate . 2 . Resume ' of training and experience of the applicant in rescue and transportation and care of patients . 3 . A financial statement as it pertains to operations in Orange County. 4 . A copy of Organization' s By-Laws ( if applicable) . 5 . A copy of Organisation' s Standard Operating Procedures . 6 . A current roster of members to include name, address , and social security number. • 9 APPLICATION FOR AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE ORANGE COUNTY, NORTH CAROLINA Date of Application: March 1, 1994 I . APPLICANT: A. Name of Applicant: Orange Grove Fire Department, B. Address :Street: 6800 Orange Grove Road City/State: Hillsborough, N . C . Zip 27278 C . Telephone No . at Base of Operations : 919-967-5858 D. Name of Owner/Contact Person: Tommy Holmes, E . Address :Street: 4311 Bradshaw Ouarry Road City/State: Efland, N. C . Zip ,27243, F . Telephone No . : 919-563-6505, G. *Trade Name: NIA H. ' Category of Franchise Applied For (A separate application must be completed for each category of service applied for) : BLS : ALS : RESCUE SERVICES [X] First Responder [ ] D-Level [ ] Extrication [ ] Emergency Med Techn. [ ] I-Level [ ] High/Low Angle [ ] Convalescent Transport [ ] P-Level [ ] Confined Space [ ] Trench [ ] Water H. ATTACHMENTS REQUIRED: 1 . Certified copy' of Articles of Incorporation Charter or *Assumed Name Certificate. 2 . Resume ' of training and experience of the applicant in rescue and transportation and care of patients . 3 . A financial statement as it pertains to operations in Orange County. 4 , A copy of Organization' s By-Laws ( if applicable) . 5 . A copy of Organization's Standard Operating Procedures , 6 . A current roster of members to include name, address , and social security number. 10 APPLICATION FOR AMBULANCE RESCUE OR MEDICAL FIRST RESPONDER FRANCHISE ORANGE COUNTY, NORTH CAROLINA Date of Application: March 1 . 1994 I . APPLICANT: A. Name of Applicant: White Cross Fire Department, B. Address :Street: 5722 Old Greensboro Highway, City/State: Chapel Hill . N. C . Zip 27516 C . Telephone No . at Base of Operations : 919-942--1194 D . Name of Owner/Contact Person: Jerry Lloyd E . Address :Street : 1514 White Cross Road City/State: Chapel Hint N. C . Zip 27516, F . Telephone No . : .919--967--1370, G. *Trade Name: NIA H. Category of Franchise Applied For (A separate application must be completed for each category of service applied for) : BLS : ALS : RESCUE SERVICES [X] First Responder [ ] D-Level [ ] Extrication [ ] Emergency Med Techn. [ ] I-Level [ ] High/Low Angle [ ] Convalescent Transport [ ] P-Level [ ] Confined Space [ ] Trench [ ] Water H. ATTACHMENTS REQUIRED: 1 . Certified copy` of Articles of Incorporation Charter or *Assumed Name Certificate . 2 . Resume ' of training and experience of the applicant in rescue and transportation and care of patients . 3 . A financial statement as it pertains to operations in Orange County. 4 . A copy of Organization' s By-Laws ( if applicable) . 5 . A copy of Organization' s Standard Operating Procedures . 6 . A current roster of members to include name, address , and social security number.