Get Fl Certificate Of Public Convenience And Necessity Or Nonemergency Medical Transportation Service 2012-2025

This guide provides clear, step-by-step instructions for completing the FL Certificate of Public Convenience and Necessity or Nonemergency Medical Transportation Service form online. Designed for users with varying levels of experience, it aims to simplify the process of filling out the necessary information.

Follow the steps to complete your application online.

1. Press the ‘Get Form’ button to access the FL Certificate Of Public Convenience And Necessity Or Nonemergency Medical Transportation Service form, making it available for filling out in your preferred online format.
2. Begin by selecting whether your application is for a new license or a renewal. Optionally, specify the class of service you will provide from the list, including ALS Rescue, ALS Transfer, BLS Transport, ALS Air Rescue, or Nonemergency Medical Transportation Service.
3. Input the name of the service or governmental entity you represent, along with the mailing address, city, state, zip code, and a telephone number to reach your organization.
4. Provide the owner's name, mailing address, date of birth, city, state, zip code, and if applicable, attach the names of elected officials if the organization is a governmental entity.
5. List the general manager or contact person, including their telephone number and email address for communication.
6. Enter the date of incorporation or formation of the business association and attach additional information on the type of corporation and names of shareholders if required.
7. Detail your five preceding years of business experience, including the services provided, locations served, and if licensed by another entity.
8. Specify the geographic area for the requested service, ensuring you provide ample detail to avoid confusion.
9. Describe your communication systems and ensure to attach the necessary documentation, such as the FCC License or communications contract.
10. Indicate the address of the main station and any substations involved in your operation, attaching additional information if you have more than three substations.
11. Complete the financial information section; non-governmental applicants must attach a financial statement as specified by the Broward County Administrative Code.
12. For non-governmental applicants, attach the Certificate of Insurance as required, ensuring Broward County Board of County Commissioners is listed as an additional insured party.
13. Provide vehicle information by completing the required forms based on your service type, ensuring to submit additional forms for each vehicle that requires a permit.
14. Include personnel information and attach any required training records and documentation for each employee involved.
15. Explain your staffing patterns and operational hours if applicable, ensuring to comply with the service type specified.
16. If applying as a COPC applicant, attach documentation of recent or proposed contact with a medical director as dictated by state law.
17. New applicants must submit three letters of reference and complete local and state criminal background checks as required.
18. Finally, return the signed and notarized application with the application fee of $556.00, making sure all attachments are included for review.

Start your application online today to ensure a smooth filing process.