Except as otherwise set forth within this chapter, all applicants applying to the Board for an ambulance franchise to operate one or more ambulances, shall file a sworn application on a form provided by Surry County stating the following:
(A) The name and address of the owner. In the case where the owner is a corporation, a certificate of good standing from the Office of the Secretary of State must be provided. Out of state applicants must first domesticate with the North Carolina Secretary of State;
(B) The number of vehicles actually owned and the number of vehicles actually operated by such owner on the date of said application, if any;
(C) The net worth applicant;
(D) Whether there are any unsatisfied judgements of record against the owner and, if so, the captions of all actions and the amount of all judgements unsatisfied;
(E) The make, type, year of manufacture, serial number and equipment therein for each ambulance owned or operated or proposed to be operated by the applicant for a franchise within the county;
(F) Criminal record, if any, of applicant must be provided. This includes a corporation and any court records of its officers, directors, management and supervisors;
(G) Other reasonable information as the Board may require at its discretion;
(H) The level of service applicant seeks to provide, to wit: convalescent, emergency, critical care or other; and
(I) Hospitals (including Forsyth/Novant and/or WFU BMC) desiring an ambulance franchise for point-to-point service may make application for the specific level of franchise desired by making a written request to the Board of Commissioners and the proposed method and manner for offering such service. The standard application form need not be used for hospitals and/or major medical center applicants.
(Ord. passed 9-7-2004)