§ 18-52. Application—Information and fee required.

No person, firm, governmental entity, agency, corporation, partnership or association shall operate any of the services as described in the classification of service in section 18-51 unless it has first obtained a certificate of public convenience and necessity issued by the board. Each application for a certificate of public convenience and necessity shall be accompanied by a non-refundable filing fee to be approved by resolution of the board and payable to the county at the time the application is submitted to the county to cover the costs and expenses incurred by the county in processing the application. An applicant for an initial certificate of public convenience and necessity shall apply to the board in writing and complete a form provided by the public safety director which shall contain the following information:

(1)

The name and address of the applicant; the business name of the partnership and the name and address of each partner, if applicable; the names and addresses of all officers and directors if the applicant is a corporation.

(2)

The name and address of the applicant's medical director, unless applying for a Class F certificate.

(3)

The service area which the applicant desires to serve.

(4)

A personnel roster which includes the names of all employees, positions held and their relevant licenses required by the state, license numbers and license expiration dates.

(5)

Written documentation of a background check performed by the state department of law enforcement on each of the applicant's personnel.

(6)

A vehicle roster which describes all transport vehicles which the applicant proposes to use in the county as well as their license and registration numbers.

(7)

A current financial statement, including any public funds other than Medicaid or Medicare funds received by the applicant. If the applicant is a governmental unit, a statement of funds budgeted for this service shall be provided.

(8)

A current certificate of insurance indicating the applicant's amount of liability insurance covering the applicant's operations.

(9)

The location and description of the place from which the applicant will operate.

(10)

A proposed rate schedule and a statement regarding the applicant's willingness to provide indigent transport services.

(11)

The names and addresses of at least three local references.

(12)

The need for the proposed service in the requested service area.

(13)

A description of proposed service.

(14)

Address of base of operations from which the proposed areas are intended to be served.

(15)

Such other reasonable information as may be requested by the public safety director.

(16)

The maximum number of transport vehicles which the applicant intends to operate in the county, including those identified in the vehicle roster as well as any planned expansion.

(17)

If the applicant is in classes A—D or F, has more than two transport vehicles, and as long as the county is the administrator of the Medicaid program, proof of the applicant's approved Medicaid provider status. In lieu of such proof, the applicant may submit a copy of a pending application filed with the Agency for Health Care Administration to become an approved Medicaid transportation provider.

(Code 1982, § 1-12.5-5; Ord. No. 96-04, pt. A, 2-20-1996; Ord. No. 08-011, pt. C, 3-15-2008)