Sec. 158.204. - Application; contents; fee.

The fees listed below can be found electronically on the following City of Jacksonville webpage: www.coj.net/fees . (a) Every person owning or acting as an agent for the owner of any emergency medical transportation service shall submit a written application to the Director along with a filing fee to obtain a certificate. If the certificate is not issued the applicant shall receive a refund as noted in refund of fees. (b) The application shall include all information required by this Chapter and shall be on such forms as are prescribed by the Director. Upon receipt of the application the Director shall determine by investigation and review the accuracy and completeness of all information requested. The information on the application shall include: (1) The name of the applicant; (2) The date of the application; (3) Certification that applicant has applied or will apply to the Florida Department of Health for all licenses required by F.S. Ch. 401; (4) A list of violations of any federal, State or local statutes, ordinances, rules and regulations, during the past ten years (regardless of whether such violations are being appealed) including those described and defined in Sections 158.207 , 158.215 , and 158.216 that may cause denial of certificate; (5) A list of all principals, owner, agents, officers and current employees of the applicant and if the applicant is: (i) An individual, then his or her name, social security number, business and home addresses and business and home telephone numbers; or (ii) A partnership, then the full name of the partnership and the names, social security numbers, and business and home addresses and business and home telephone numbers of all partners, whether general or limited, accompanied by the partnership instrument or a certified copy thereof, and the business address and telephone number of the partnership; or (iii) A corporation, then the exact corporate name and state of incorporation and the names of all the officers and directors and all stockholders owning five percent or more of the outstanding voting stock with a notation of percentage of ownership, accompanied by articles of incorporation, or certified copies thereof, and the business address of the corporation that may be amended from time to time; (6) A statement of intent that the emergency medical transportation service is to be conducted under a name other than that of the applicant. If that is the case, the business name, the County of registration, under the Florida Statutes, and a copy of any registration of a fictitious name shall be provided; (7) A list of all vehicles (as required by Section 158.208 ) to be operated as an emergency medical transportation vehicle under the certificate, giving for each the make, type, year of manufacture, passenger accommodations, ownership and a copy of the vehicle registration issued by the State of Florida, Division of Highway Safety and Motor Vehicles and designating which vehicles are to be operated as ALS vehicles and which are to be operated as BLS vehicles; (8) A list of all personnel who are to be used as ambulance drivers, EMTs and paramedics, certified by the applicant that all such persons meet the requirements specified in Section 158.210 ; (9) A certificate of insurance as required by Section 158.212 ; (10) The name, business address, telephone number, license number as well as the DEA number of the medical director; (11) A Duval County occupational license; and (12) If the emergency medical transportation service is already operating in another County in the State of Florida, that fact shall be stated and the name of the County or Counties, along with the business address in the other counties, and the DEA number of the service shall be provided. (Ord. 97-450-E, § 1; Ord. 2017-665-E , § 10)