Laserfiche WebLink
II. COMPANY DETAILS <br />1. NAME OF AMBULANCE SERVICE: American Ambulance Service <br />MAILING ADDRESS: 4227 Saint 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, FI 34946 <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 />Charles Maymon 6605 NW 74th Ave Miami, FI 33166 President/ VP/ Treasure <br />Brian Richmond 6605 NW 74th Ave Miami, FI 33166 Secretary <br />5. PROVIDE NAMES AND ADDRESSES OF AT LEAST THREE (3) LOCAL <br />REFERENCES <br />NAME ADDRESS <br />John Skalko 1000.37th Street Vero Beach, 32960 <br />PHONE # <br />772-567-2552 <br />Will Talbert 131037 th Street Vero Beach, 32960 772-569-5107 <br />Darleen Silverstein 100037 th Street Vero Beach, 32960 772-567-4311 <br />C:\Users\jsalvesen\Desktop\Indian River COPCN 2018\American Ambulance Service COPCN 2018.doc 55 <br />