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V. NOTARIZED STATEMENTS <br />I, Rishi Singh M.D., Vice President/CMO <br />Applicant Name <br />Coastal Care Corporation DBA Cleveland Clinic Advanced Medical Transport <br />Business Name of Service <br />, the representative of <br />do hereby attest that <br />the above named service will provide continuous service on a 24-hour, 7 -day <br />week basis. I do hereby attest that the above named service meets all the <br />requirements for operation of an ambulance service in the State of Florida as <br />provided in Chapter 401, Part 111, Florida Statutes, Chapter 64E-2, Florida <br />Administrative Code, and that I agree to comply with all the provisions of Chapter <br />304, Life Support Services. <br />ALL APPLICANTS <br />I further acknowledge that discrepancies discovered during the effective <br />period of the Certificate of Public Convenience and Necessity will subject <br />this service and its authorized representatives to corrective action and <br />penalty provided in the referenced authoM and that to the best of my <br />knowledge, all statements on this app ' ati are true and correct. <br />APPLICPT SIGNATURE DATE <br />Before me personally appeared the said I i l in C I'll 01 who:says <br />that he/she executed the above instrument of his/her own free wil and accord, with full <br />knowledge of the purpose thereof. Sworn and subscribed in my presence this � day of <br />2024 j <br />My commission expires:I�I z�J <br />NOVARY PUBLI <br />JENNIFERA. MACK <br />b7Y COMMISSION # HH 444125 <br />EXPIRES: 0dobar 18, 2027 <br />UAFIRE ADMIN ASSISTANTS1Beth\Beth Casana EOCICOPCNIRENEWAL PACKETSICOPCN Application.doc 5 <br />47 <br />