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2000-372
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2000-372
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Last modified
8/20/2024 12:54:07 PM
Creation date
8/20/2024 12:54:05 PM
Metadata
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Template:
Official Documents
Official Document Type
Application
Approved Date
12/12/2000
Control Number
2000-372
Agenda Item Number
11.B.2.
Entity Name
Indian River Memorial Hospital
Subject
Renewal of Class B EMS Certificate of Public Comvenience & Necessity
Transport Service Non-Emergency Interfacility Advanced Life Support
Transport Service
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• <br />• <br />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 />17-71n <br />Class AClass B <br />U X <br />Clajs C ❑ Class D <br />II. TYPE OF APPLICATION: <br />NEW <br />RENEWAL 19 <br />LEVEL OF SERVICE <br />III. DATE OF APPLICATION: 11/6/00 <br />X <br />APPLICATION FEE ATTACHED: YES NO <br />BLS ❑X <br />ALS ❑X <br />APPLICATION FEE OF $100.00 APPLIES TO INITIAL APPLICATIONS ONLY. THE APPLICATION FEE IS <br />WAIVED FOR CERTAIN APPLICANTS - REFER TO THE ATTACHMENT FOR INFORMATION. <br />If payment is applicable, the check must be made payable to INDIAN RIVER COUNTY FLORIDA <br />
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