703.03 APPLICATION FOR LICENSE; RENEWAL.
   (a)   Each initial application for a license shall be accompanied by a five hundred dollar ($500.00) fee and shall be made on forms prescribed by the Service-Safety Director, such forms to provide at least the following information:
      (1)   Name and address of the applicant and if the applicant is a corporation or a partnership, an identification of the majority ownership interest and/or the identification of any person owning more than ten percent (10%) of the ownership interest of such corporation or partnership.
      (2)   Any trade or other fictitious name under which the applicant does business or proposes to do business.
      (3)   A detailed chronological history of the applicant with regard to the provision of emergency medical services and the transportation of patients within the State.
      (4)   A description of each ambulance to be used including the make, model, year of manufacture, motor and chassis number, the license registration number in the State, the color scheme, insignia and monogram, or other distinctive characteristics to be used to designate the applicant's ambulance.
      (5)   A list of each EMT including level of training currently utilized by the service or intended to be utilized at any time in the future, and an affidavit that each such person has a current and valid license issued by the Ohio Department of Public Safety.
      (6)   A list of each essential item of equipment including the communications and frequencies in each ambulance and each base station.
      (7)   The location and description of the place or places from which the ambulances are intended to be dispatched.
      (8)   The medical advisor of the EMS.
      (9)   A copy of the current Ohio Medical Transportation Board license and inspection report for each ambulance operating in the City of Mansfield.
      (10)   Any other information that the Service-Safety Director may deem reasonably necessary to a determination of compliance with this chapter.
   (b)   Any renewal of a license issued pursuant to this Chapter shall be accompanied by a one hundred fifty dollar ($150.00) fee and a copy of the current Ohio Medical Transportation Board license and inspection report for each ambulance operating in the City of Mansfield.
(Ord. 12-103. Passed 6-5-12.)