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IV. ADDITIONAL INFORMATION REQUIRED TO BE SUBMITTED <br /> ® WITH THIS APPLICATION: <br /> 1. Factual Statement indicating the public need and services, including studies <br /> supporting the demonstrated demand and feasibility for the proposed <br /> service(s) and deficiencies in existing services, and any other pertinent data <br /> you wish to be considered. <br /> 2. Factual statement of the proposed services to be provided, including type of <br /> service, hours and days of operation, market to be served, geographic areas <br /> to be serviced, and any other pertinent data you wish to be considered. <br /> 3. Factual Statement indicating the ability of the applicant to manage and provide <br /> the proposed services, including the management plan, maintenance facilities, <br /> insurance program, accounting system, system for handling complaints, <br /> system for handling accidents and injuries, system for providing the county <br /> monthly operating reports and any other pertinent data you wish to be <br /> considered. <br /> 4. Copy of Standard Operating Procedures. <br /> 5. Copy of Medical Protocols. <br /> 6. Copy of your insurance policy — must show coverage limits — <br /> 7. Vehicle Information. For each vehicle provide the following: <br /> a. Make, Model, Year, Manufacturer <br /> b. Mileage <br /> c. VIN # <br /> d. Tag Number <br /> e. Passenger capacity (E/E1 classification) <br /> f. Indicate ALS/BLS (A-D classification) <br /> 8. Personnel Roster. For each employee provide the following: <br /> a. Name — Last, First and Middle Initial <br /> b. Driver's License # (if commercial, specify class) & Expiration Date <br /> ADDITIONAL INFO REQUIRED FOR A-D classifications <br /> c. Emergency Medical Service Certification and # (EMT or Paramedic) <br /> d. Expiration date of Certification <br /> e. Whether or not has an Emergency Vehicle Operation Certificate. <br /> 9. Fee Schedule Including: <br /> Service Type, Base Rate, Mileage, Waiting and Special Charges <br /> U:\Brianb\COPCN\COPCN Application rev.2013.doc 4 <br /> 45 <br />