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V. NOTARIZED STATEMENTS <br />I, Ray Gonzalez , the representative of <br />Applicant Name <br />FU Ambulance Service.Inc- dba Amwican Ambulance Service do hereby attest that <br />— 1 <br />Business Name of Service s <br />the above named service will provide continuous service on a 24-hour, 714ky <br />week basis. I do hereby attest that the above named service meets all": <br />requirements for operation of an ambulance service in the State of Floridalf <br />provided in Chapter 401, Part 111, Florida Statutes, Chapter 64E-2,#lorida I <br />Administrative Code, and that I agree to comply with all the provisions of Chapter <br />I <br />304, Life Support Services. G <br />ALL APPLICANTS <br />I further acknowledge that discrepancies discovered d the effective <br />period of the Certificate of Public Convenience and Necess will subject <br />this service and its authorized representatives to correct' e1action and <br />penalty provided in the referenced autho4ty ant at tht�best of my <br />knowledge, all statements on this appli tion are tr a correct: <br />APPLICAN SIG TURE { <br />Before me personally appeared the said Ray Gonzalez <br />that he/sty executed the above instrument of his/her.ow n Free vA ash ac.cid, <br />#til <br />knowledge of the <br />purpose . sworn, mWsubscrlitied M mypresence I of <br />_ <br />r <br />i <br />E <br />{ <br />Jort� alio <br />My COMMISSION N HH 212472 <br />kJ' EXPIRES: January 8, 2426 .. {{ <br />I .. <br />i <br />WFIFtE ADMIN ASSISTANTS1Beth\Beth Casano EOC\COPCN\COPCN APPLICATIONICOPCN Application.dou <br />