Laserfiche WebLink
V. NOTARIZED STATEMENTS <br />I, _Ray Gonzalez the representative of <br />Applicant Name <br />RG Ambulance Service. Inc. dba All County Ambulance do hereby attest that <br />Business 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 all 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 CFl"W <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 Necessi _ III subject <br />this service and its authorized representatives to corrective ac ion and <br />penalty provided in the referenced authority 2r6d,lttat to the best of tt <br />knowledge, all statements on this application are true and correct. <br />APPLICANT SIGNA <br />f, <br />v <br />DAT <br />Before me personally appeared the said Ray Gonzalez f who says <br />that he/she executed the above instrument of his/her own free will and accord, with full <br />owledge of the purpose th f. worn and subscribed in my presence this N day of <br />lce'k(, 2024. <br />4 My commission expires: -"�knl Z <br />NOTARY PUBLIC <br />JORGE CURBELO <br />MY COMMISSION x HH 212472 <br />EXPIRES: January 8, 2028 <br />U 1FIRE ADMIN ASSISTANTS\Beth\Beth Casano EOCICOPCN\COPCN APPLICATION\COPCN Applicatron.dom <br />156 <br />