§ 111.004. Application for registration.

A.

The application for registration pursuant to this chapter shall be submitted to the Licensing Agent.

B.

The application shall include the following required information:

1.

The complete business name including corporate ownership names and any name under which the company conducts business;

2.

The business address of the ambulance service including phone number, facsimile number and e-mail address of the business and primary contact person including all emergency telephone numbers to reach the primary contact;

3.

The name, address and telephone number of the statutory agent;

4.

The name and address of the principal corporate office;

5.

The name and address of the parent corporation, if applicable;

6.

The federal identification number;

7.

A description of the form of ownership;

8.

The identity of the state in which the ambulance service or corporate owner is incorporated and the state identification number;

9.

A description of all insurance coverage and a copy of the certificate of insurance as required by Ohio Revised Code Section 4766.06, which includes a provision for notice to the Licensing Agent for the City of Akron thirty days prior to cancellation of the insurance coverage;

10.

A description of the services the emergency medical services organization or ambulance service intends to perform within the City of Akron;

11.

A copy of the current license granted to the ambulance service by the state of Ohio;

12.

A copy of the application for a license submitted to the state of Ohio and all subsequent changes or amendments to the application and any application for renewals submitted to the state after initial licensure by the state;

13.

Any other application requirements that may be adopted by the City of Akron Emergency Medical Services Advisory Board;

14.

A notarized statement that the emergency medical services organization or ambulance service registering will cooperate with the Akron Fire Division and Emergency Medical Services Advisory Board in any investigation of a complaint rendered against it that affects the health, safety or welfare of any patient in Akron, Ohio; and

15.

A notarized statement that the emergency medical services organization or ambulance service will promptly provide a copy of all correspondence to or from the state of Ohio that involves the licensing of the company, its vehicles or its personnel or any complaint involving a patient transport in Akron.

C.

The Licensing Agent shall notify the applicant that the application is incomplete and will not be processed until all of the information required in subsection B of this section has been provided.

(Ord. 178-2004)