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V. NCM--'� JZED STATEMENTS <br />I Alred Ai Belothe representative of <br />Applicant Name <br />Positive Mobility, Inc. d/b/a Elite Medical Response <br />do hereby attest that <br />B Mness Name of Service <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 ail the <br />requirements for operation of an ambulance service in the State of Florida as <br />provided in Chapter 401, Part III, 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 authority and that to the best of my <br />knovvledge, all statements on this aplication are true and correct, <br />APPLICANT 9 DATE <br />Before me personally appeared the said Alfred Angelo <br />17Dss <br />that he/she executed the above instrument of his/her own free will and accord, with full <br />knowledge of the purpose thereof. Sworn and subscribed in my presence this 171h 40Y of <br />April 2024 <br />NIST'A&YkAX <br />Ki <br />TONYAJ. WiNGFIELD <br />1AY COMMISSION # HH 314201 <br />EXPIRES: SeP temper 26, 2026 <br />.y <br />U:\FIRE ADMIN ASSISTANTS\Beth\Beth Casano EOC1COPCN,\RJENEW a4GKETSICOPCN Application.doc 5 <br />80 <br />