Get Certificate Of Public Convenience And Necessity Polk County Florida Application

This guide provides clear instructions for completing the Certificate Of Public Convenience And Necessity application for Polk County, Florida, online. It is designed to assist users in navigating each section of the application effectively.

Follow the steps to complete your application successfully.

1. Click ‘Get Form’ button to obtain the application form and open it for completion.
2. Choose the application type by selecting either 'Initial' or 'Renewal' at the beginning of the form.
3. Enter the name of your business, complete with the full address including city, state, and zip code. If applicable, provide a P.O. Box as well.
4. Fill in your contact numbers, ensuring to include area codes. List a business office number, pager number, and cell phone number.
5. Provide the names, addresses, and daytime phone numbers of all owners, partners, operators, and/or board of directors of the corporation.
6. State the relevant experience of each individual listed in the previous step to demonstrate qualifications.
7. Indicate the level of service you wish to provide by checking the appropriate box. Review Polk County Ordinance 12-029 for service definitions.
8. Describe the geographical area where services will be offered. Specify if it covers an entire county or a portion of it.
9. Provide supporting evidence that illustrates the demand or need for your proposed level of service in the designated geographical area.
10. Detail the equipment you will be using to provide the service. You may attach additional sheets if necessary and complete the vehicle roster.
11. Indicate the number of personnel required to staff each service unit, and complete the personnel roster that accompanies the application.
12. Attach proof of compliance with all applicable federal, state, and local requirements, including necessary licenses.
13. State the addresses and descriptions of each operational location, including hours of operation, staffing details, and contact numbers.
14. Answer the question regarding backup availability in case of unit failure, and if applicable, explain your procedure.
15. Provide written documentation that may assist Polk County Fire Rescue or other emergency services during a disaster.
16. Indicate whether your service will transport patients out of Polk County and if it will pick up from other counties before returning.
17. Specify the type of service being provided (land, water, or air) by checking the appropriate box.
18. If applicable, provide evidence for any replacement of an existing Certificate of Public Convenience and Necessity.
19. Include a fee of $300 with your application submission.
20. Provide a detailed rate schedule listing all fees and charges associated with your service.
21. Read and agree to the terms required if the Certificate of Public Convenience and Necessity is issued, then sign and date the application.
22. Scan and email the notarized form along with any necessary supporting documents to the designated official, or mail them to the provided address.

Begin the process of applying for your Certificate Of Public Convenience And Necessity online today!