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QPPT`M'yF"r INDIAN RIVER COUNTY <br />4i 5 T O <br />DEPARTMENT OF EMERGENCY SERVICES <br />rn <br />"CY S APPLICATION FOR <br />CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY (COPCN) <br />APPLICANT NAME: Positive Mobility, Inc. d/b/a Elite Medical Response DATE: 4-16-2024 <br />APPLICATION FEE: $100.00 APPLIES TO INITIAL APPLICATIONS ONLY. <br />If payment applicable, make check payable to INDIAN RIVER COUNTY FIRE RESCUE. <br />® This is a new application; fee is attached. <br />❑ This is a renewal of our present COPCN. <br />❑ This is a renewal of our present COPCN with ownership or classification changes. <br />CLASSIFICATION OF CERTIFICATE REQUESTED <br />Please check applicable boxes and options. <br />Class A ❑ _BLS _ALS <br />Governmental entities that use advanced life support vehicles to conduct a pre- <br />hospital EMS ALS/BLS service. <br />Class B 0 v BLS V ALS <br />Agencies that provide non -emergency ambulance inter -facility medical transport <br />at the ALS/BLS level. <br />Class C R "' BLS b ALS <br />Agencies that provide non -emergency ambulance inter -facility medical transports <br />which require special clinical capabilities and require a physician's order. <br />Class D © ✓ BLS &' ALS <br />Agencies that provide non -emergency ambulance medical transports limited to <br />out of county transfers. <br />WFIRE ADMIN ASSISTANTS\BethlBeth Casano EOCICOPCN\RENEWAL PACKETS\COPCN Application.doc <br />76 <br />