Any person desiring an ambulance service provider license shall file with the Health Director an application upon a form provided by the Health Director. Such application shall be accompanied by an application fee in the amount set from time to time by resolution of the Board of Supervisors to defray the expenses of processing the application and shall be verified under penalty of perjury. The application shall include the following information:
(a)
The name and address of the applicant and all owners and officers of the business and their percentage of ownership.
(b)
The business address and, if different, any and all addresses where any ambulance, operating equipment and supplies are located or will be kept.
(c)
The fictitious name, if any, under which the applicant does business or proposes to do business.
(d)
The training and experience of the applicant in the transportation and care of patients.
(e)
A complete description of each vehicle the applicant proposes to operate. Such description should include make, year of manufacture (and in the case of type I and type III, the year of manufacture of patient compartment), motor and chassis numbers, California state license number for the current year, and the color scheme, insignia, name, monogram, or other distinguishing characteristics used to identify such vehicle.
(f)
A statement of financial status and responsibility in a form acceptable to the Health Director.
(Added by Ord. No. 3390, effective 8-20-09; amended by Ord. No. 3490, effective 2-25-16)