§ 7.3-5. Application for certificate.

Each application for a certificate shall be accompanied by a nonrefundable fee in the amount of one hundred fifty dollars ($150.00) per classification desired, payable to the board to cover costs and expenses incurred by the board in processing the application. The fee is waived for Clay County Fire Rescue and any municipality application.

Any applicant for an initial certificate from the board shall apply to the fire chief in writing and provide the following information:

(1)

The name and address of the applicant; if the applicant is a partnership, the business name of the partnership and name and address of each partner; if the applicant is a corporation, the names and addresses of all officers, directors, and stockholders of the applicant and a statement that the corporate applicant is in good standing in the State of Florida; if the applicant is a municipality, the name of the municipality and the name and addresses of all senior administrative officials to include but not limited to mayor, manager, council members, senior administrative fire chiefs and any management personnel to be contacted in the event of emergencies;

(2)

The service area which the applicant desires to serve to include the approximate population of the area and documentation of the need for the service and benefits of such service. For municipality applicants, the following additional documentation shall be provided:

a.

The approximate number of monthly emergency calls within the area applied for;

b.

The current average total response time of each emergency medical service provider that previously provided, or is currently providing, in the areas applied for, and whether the total response time is adequate to serve the public health and safety;

c.

How many ambulances or rescue units, if any, would have to be left in operation in order to support the area that would be covered under the approved COPCN;

d.

A fractile total response time for the immediate area effected by the COPCN, the surrounding areas, and the second due response provided into the effected COPCN from an agency outside of the applicant's; and

e.

To your knowledge, would there be any financial implications to the County if the COPCN application is approved? If so, what?

(3)

The financial ability of the applicant to render safe and quality services to include the following information:

a.

The ability to maintain or place the equipment required by the state and by this chapter, specifically including operation of two (2) fully staffed operating ambulances with at least one (1) spare ambulance, and whether for a municipality any circumstances justify an exception to these requirements;

b.

The ability to maintain insurance for the payment of personal injury, death and property damage claims; and

c.

The financial completeness and stability of the applicant's EMS administrative and operational plan.

(4)

The location and description of the place or places from which the applicant will operate to include any proposed locations or substations as well as the maximum number of units the applicant proposes to place at the locations and whether the locations will provide additional coverage or improved total response times;

(5)

Copy of applicant's application for State of Florida EMS license including the names and certification numbers of all EMTs and paramedics utilized by the applicant to provide emergency medical services and the record of compliance with vehicle inspection standards under the applicable Florida Administrative Code for Chapter 401, Florida Statutes.

a.

If applicable, the past performance or service record of the applicant, obtained from sources such as, but not limited to, hospitals, local public safety agencies and Clay County Fire Rescue.

(6)

The name and address of medical director along with a copy of the proposed contract, an executed copy of which shall be provided prior to the certificate issuance date;

(7)

A description, type and condition of the applicant's telephone and radio communication system, including its assigned frequency, call number, mobiles, portables, range and hospital communications ability to determine if such systems are adequate or compatible with other systems that may interact with the applicant;

(8)

A description of the geographical area including the name of any municipalities that the applicant has previously been authorized to serve within the county as well as all other counties and municipalities within Florida or any area outside the State of Florida;

(9)

An agreement by the applicant to file, in the event that a certificate shall be granted and prior to the certificate issuance date, copies of policies of public liability, property damage and malpractice insurance as required by the applicable Florida Administrative Code for Chapter 401, Florida Statutes and this chapter, naming the board as an additional named insured;

a.

A private applicant shall additionally provide a willingness to hold harmless and indemnify the board and county for the service provided under any certificate approved.

(10)

A copy of the applicant's EMS standard operating policies and procedures and medical treatment protocols, which all shall include all general and/or specific instructions to personnel as to the exact nature of their duties and responsibilities, when applicable, and under what conditions, as well as a copy of the applicant's equipment list;

(11)

An agreement that should a temporary situation arise or a declaration of emergency be declared due to a serious or imminent threat to the public health, safety, welfare, or public need and convenience, the applicant shall offer assistance and abide by the orders of the fire chief;

(12)

If the applicant or any officer, principal or owner thereof has been convicted of a felony, information regarding nature and seriousness of the offense and the circumstances under which the felony occurred;

(13)

Proof that the applicant possesses all required federal and/or State of Florida licenses and permits;

(14)

A schedule of proposed rates for transportation or treatment of patients;

(15)

A sworn statement signed by the applicant stating that all the information provided by the applicant in the application is true and correct; and

(16)

Such other reasonable information as may be required by the fire chief and/or standing committee.

(Ord. No. 99-25, § 2, 5-25-99; Ord. No. 07-14, § 1(Exh. A), 3-13-07; Ord. No. 2018-23, § 1, 5-22-18)