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{ <br />IV. ADDITIONAL INFORMATIM114WIRE0 TONSOU401" E <br />WITH THIS APPLICATION: i <br />t <br />RENEWAL APPLICANTS NEED ONLY Vs 4........ <br />-1. Factual Statement indicating the public need and services, including studies <br />supporting the demonstrated demand and feasibility for the proposed <br />service(s) and deficiencies in existing services, and any other pertinent data <br />you wish to be Considered. . i.: : <br />2. Factual statement of the proposed services to be provided, including type of ; <br />service, hours and days of operation, market to be served, geographic areas <br />to be serviced, and any other pertinent data you wish to be considered, i <br />3. Factual Statement indicating the ability of the applicant to manage and <br />provide the proposed services, including the management plan, maintenance <br />facilities, 'insuraince program, accounting system, system kir handling <br />complaints, system isrhandling accidents and injuries, system for provio►ng_ <br />the county monthly grating reports and any other pertinent dStb.y <br />be considered. <br />4. Copy Of Slarfdatd-£?perating Procedures. . <br />.5. Copy of Medical Protocols. <br />i3.: Copy ofyour Irstaftce policy >•- show cbvws:.. <br />2. VWc* ftdWfr**W. For each vehlele provide the following: <br />a. Make, Mods <br />14 Manufacturer <br />.... b. Mileage <br />- c. VIN # <br />& Tag Number <br />O, Passenger capaciiyFAI classifica*h) <br />C Indicate ALS/BLS (A -D classification <br />8; P.r 4nf111%,�r: FOreach employeoproVW the following: <br />.... r N --tit, First andMiddle. , <br />.......... . <br />q. <br />b. Ddver's License # (dgommercial, specify class) & Expiration Date <br />ADDITIONAL INFO REQUIRED FOR A -D classifications <br />� .: Emergency Medical Service Certification and # (EMT or Paramedic), i <br />d. :Expiration date of Certification <br />e. Whetheror not Im anErner <br />9. Fee Schedule incl: Service Type, Base Rate, Mileage, Waiting & Special Charges <br />U AFIRE ADMIN ASSISTANTS18ethOeth Casano EOCICOPCMCOPCN APPLICATIONICOPCN A.Whcation.docx 4 , <br />14? <br />i <br />I <br />