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INDIAN RIVER COUNTY <br />DEPARTMENT OF EMERGENCY SERVICES <br />APPLICATION FOR <br />CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY <br />I. CLASSIFICATION OF CERTIFICATE REQUESTED <br />(See attachment for certificate classifications) <br />Class A X <br />Class C ❑ <br />Class B ❑ <br />Class D El <br />II. TYPE OF APPLICATION: LEVEL OF SERVICE: <br />NEW ❑ BLS ❑ <br />RENEWAL X ALS X <br />III. DATE OF APPLICATION: July 10, 2014 <br />APPLICATION FEE ATTACHED: YES ❑ NO X <br />APPLICATION FEE OF $100.00 APPLIES TO INITIAL APPLICATIONS ONLY. THE <br />APPLICATION FEE IS WAIVED FOR CERTAIN APPLICANTS - REFER TO THE <br />ATTACHMENT FOR INFORMATION. If payment is applicable, the check must be made <br />payable to INDIAN RIVER COUNTY, FLORIDA. <br />1. NAME OF AMBULANCE SERVICE: Indian River County Department of Emergency <br />Services <br />168 <br />