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II. COMPANY DETAILS <br />1. NAME OF AGENCY: Falck Southeast II Corp d/b/a All County Ambulance <br />MAILING ADDRESS: 4227 St. Lucie Blvd <br />CITY Ft. Pierce COUNTY St. Lucie, FI <br />ZIP CODE: 34946 BUSINESS PHONE: 772-465-1111 <br />2. TYPE OF OWNERSHIP(i.e. Private, Government, Volunteer, Partnership, <br />etc.): <br />3. MANAGER'S NAME: Michael DeSouza <br />ADDRESS: 4227 St. Lucie Blvd, Ft. Pierce, F134946 <br />PHONE #: 772-465-1111 <br />4. PROVIDE NAME OF OWNER(s) OR LIST ALL OFFICERS, PARTNERS, <br />DIRECTORS, AND SHAREHOLDERS, IF A CORPORATION (attach a <br />separate sheet if necessary): <br />NAME ADDRESS POSITION <br />Robert F. Heffner 6605 NW 74h Ave Miami, FI 33166 President <br />5. PROVIDE NAMES AND ADDRESSES OF AT LEAST THREE (3) LOCAL <br />REFERENCES <br />NAME ADDRESS PHONE # <br />Edwin Rojas 901 37"' Street Vero Beach, FI 32960 772-567-2552 <br />John Skalko 1000 37th Street Vero Beach, FI 32960 772- 5674311 <br />Will Tarbet 1310 37th Street Vero Beach, FI 32960 772-569-5107 <br />C:1Usersysa1vesen\DesktopURFD COPCN 2016WCA IR COPCN 2016.doc 1) 108 <br />