77-3. Franchise Application.

Application for a franchise to operate ambulances in the County of Henderson shall be made upon such forms as may be prepared or prescribed by the County and shall contain:

  1. The name and address of the applicant and of the owner of the ambulance.
  2. The trade or other fictitious names, if any, under which the applicant does business along with a certified copy of an assumed name certificate stating such name or articles of incorporation stating such name.
  3. A transcript of the training and experience of the applicant in the transportation and care of patients including references from every location in which the applicant has been franchised for the past 15 years, if any.
  4. A description and copy of state certification for each ambulance owned and operated by the applicant.
  5. A description and copy of the ambulance provider license issued by NCOEMS.
  6. The location and description of the place from which it is intended to operate.
  7. An audited financial statement of the applicant as the same pertains to the operations in the County of Henderson, said financial statement to be in such form and in such detail as may be required by the County.
  8. A description of the applicant's capability to provide 24 hour coverage, 7 days per week, for the district covered by the franchise applied for and an accurate estimate of the minimum and maximum time for a response call within such districts demonstrating that minimum and maximum response times within the district covered by the franchise applied for would meet the requirements for the level of service for which application is made.
  9. A description of:
    1. Proposed service area
    2. Arrangements for medical direction and oversight.
    3. Agency medical certification level for NCOEMS.
    4. Compliance plan for EMS system continuing education training requirements.
  10. Any information the County shall deem reasonably necessary for a fair determination of the capability of the applicant to provide ambulance service in the County of Henderson in accordance with the requirements of state laws and the provisions of this regulation.
  11. The County reserves the right to deny any application if the Board of Commissioners finds the grant of such application is contrary to the interest of the citizens of the County.