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HomeMy WebLinkAboutbocc.con.085.1996 , c��- gs ���i .t, i,..-:t:':`:�. %. ;� ���i� .J ��:.1 .�'. 'L. '� '� � ���:��� - ;r..'�•: . T4 ' : � A5PEN AMBULANCE DISTRICT � � The undersigned,representing the$oard of County Commissioners of Pitkin County,Colorado,do hereby license the above named applicant to provide ambulance services within Pitkin County.This license shall have upon it any restrictions listed below,shall be granted any waivers listed below and shall be , valid for the dates listed below uniess revo[ced by the Board of Cotcnty Commissioners pursuant to the provisions of Pitkin County Resolution No.87-7 ��� and any applicable laws of the State of Colorado. AMBULANCES:Medic-4,Medic-5,Medic-6 RESTRICTIONS:None � " WAIVERS:None � This License is valid from January 1.1996 to December 31,1996. �r�-°--- � ' � airperson,Pitkin Counry Board of Counry Commissioners .. 1.�,�..� lr ,r��T�f o„ �-�i-;� -- �; i ; , ,��,� � t,� . . � . .,.; .� x. .....:������ ..... ' ' . ' 1 . M�,�-f �,��: �,. . ��,k � �:. .�;t.,�� . , ;;:g�� .< PITKIN COUNTY APPLICATTON FOR RMSULANCE LICENSE � . ?= • :i`..� . , ;' PLEASE TYPE ALL INFORMATTON ��� SERVICE NAME:����i�n�.'sa��.�vci;.-�]zr.-���•�- M�un�� P,:�=��4-{af.;�:q�_ I` �, � : _-,,.r_�,. �. ADDRESS: C'-�o! ���ri.—=. C r::��r iZ� ��-,3 t � ' OWNSRS OR OEFICERS: �'i r t�}�a� \,.J R i,G i_:;t --A;�n e�i��rt• -- t��r. +�c�.� �.. - . e PHONE NUMBERS: �'-}`-� 1 S P,o � 1' DESCRIPTION OF AMHULANCE: MAKE, MODEL, YEAR, LICENSE NO. �-p�M�L���7 � • F ��L3 4 44 t=JT L r �„)t 1�-.•_ .� .. �-l._.� C�:�,.� l�'�:,_- i' Mo�l.�+�a�z. �M»Jiilnfu� �3'�n3 a � . ADDRESS AND DESCRIPTION OF BASE OF OPERATIoNS: i cx-b��-d a,-�r-!e.ctr-a����j ���y";• AT /L�sT:�.l�-Ji�,v`3�+..vre_ T.��.:arcr_� ��.L 1l1�ItI,� I-�a�t1��rLC/a•,n��5 r'I,'�� . C� PHYSICIAN ADVTSOR: ]7�:,_ C.FA:z�� M/�-�r�NCz COLORADO CERTIFICATION NUMBER: 3 0�,y � y, 4 - PHONE NUMBERS: �Z�- 1 1 zo _ . i-,,. SIGNATURE: ��{ . ��_.,!.r-. � '� v, ., WAIVER REQUESTS: hloN� y. f; i; 3 y . i APPLICANT:_ �'�GW A 2� -i-f--. l,�r�t_tct�Z DATE: /_�/S�1 9 5 SIGNATUAE: � �/, /,�,�u�J � \ � 9 . +� , t , }I . �I t. i � ��' � � r a ;' �:� ' • � �'i'1 ' • �Y1E.�l c+S ' �4�?�,.•�Y,',��(�. . 2'��Xi�tr': ,`;::. �. 'l. PITKIN COUNTY APPLZCATION FOR AMBULANCE LICENSE ' . `.';. PLEASE TYPE ALL INFORMATION SERVICE NAME: :a - -'�^t� �t,..r= c'�?�.�r.a: - MAnlnc�a t�., ��c YAU�y K!�fp�n4i.:,` .1 :r' - ADDRESS: O�i-�f t n<_�1.� (�r��.« �Zo. ,��AR OWNERS OR OFPICERS: T���c�.t i.:t� �..�_ n i_t,t_r- - A->�-�1 nrn:..,��.n�:v_ .t�i 2�co rz, : PHONE NUMHERS: J'-1�1--1 S'e c , DESCRTPTION OF AMBULANCE: MAKE, MODEL, YEAR, LICENSE NO. ? _ P�nc�u Gvr1:^� �- p -,1 �1�1`-�-C i��J r a lr ��+.�rl c lk-r � n"r--f TY:+� '4i o"� '1i12y��-'�A J U in Hc r `t 8`t A S� . ADDRESS AND DESCRIPTION OF BASE OF OPERATIONS: �ttrl ; 1 rx�a��c.t-} NZ�z�Zi+�yyy 1�'-,p�,t �,. � t � .,r.� . �a - � � _ �,. -� r� � � Pfntszczt�rr Anvzsox: ,r�,� Cw�z,� r,n�._n�<<_z COLORADO CERTIFICATION NUMBER: 3 aci�3 � PHONE NUMBEAS: 1 �S - 1�z�c �, .�y t / , SIGNATURE• (.�c����L�� /�'t,•^i WAIVER REQUESTSc �QN� APPLICANT: IZ�cEt b,z� -�! . W P.�uE:t. DATE: j i�S�y ,, SIGNATURE: �- �/ G�Ji7u� T - i. : 1� � . ,. / r _ '_,e'V� . ' • t � -:�' y.c ' . . t � a�� � �,.: i J � - . .. -:.,., �..� ._�� . . :� ,�� �l . .:. r ... '-' ' (,. . ' . � . . . ' _ ;.. .. � ....� . ': . :.� ' . .: l .�� .i, . ... . .. � . . . ..l:i s. ._ . ..... ...�....i,. .,. .-.. � ` " + �' . - (Y4E�G�.a.. "Fj�i�f ;�. ' �:�.>.,9�. . ,,,.. l..�,,.�,;,,�i_' ,,: ; .< •t. PZTKIN COUNTY APPLICATION FOR AMBULANCE LiC$PISE Y • ,''i�� s . i.: PLEASE TYPE ALL INFORMATION �'', SERVICE NAME: flsa�nl A�n�,ts.��.,>rtc�. XS�srn�cc- Mn�1�a�.�ts�A�;���A�� ��u>��rq�.e.,�..�' �� ADDRESS: O`-f�1 f.�c r�� C rac_=i� 2•� -�}-S�-..i OWNERS OR OFFICERS: ��c�iAts-n 1�/�\4ti�Z J�'-z�al -liM� ��1n J•- ,���nu��,_, • PHONE NUMBERS: S`+•-3- t S c3 c� . _ ` �, DESCRIPTION OF AMBULANCE: MAKE, MODEL, YEAR, LICENSE NO. � . � ?iru4a �o..i�r-� � , +�,� i=�on� V'Ar1 MO�vJ��_E;3T AN(� 4-!40t'L.� �" y'8S'A,o j � � ADDRESS AND DESCRSPTION OF BASE OF OPERATIONS: . � AS"� i�.'>7ys3-Atv�c�v 1nNCr- J�,:�z_�TS_tl` .-.;�t -f4s�.�n1 VAi.I r?13-v.s�,�.r�L SLl^n j�S CJ � PHYSICIAN ADVISOR: �2. C_ii�.i M�rar iN �r = COLORADO CERTIFTCATION NUMBEA:_ 7j¢�9 5 �'•,� PHONE NUMBERS: t, - i 7 c, � � . SIGNATI7RE: „���_ � � /'� •- Y,'i, ,�--J'�" �t ; WAIVER REQUESTS: I�joNc �� —� APPLICANT: ri c,a c.wa +-0. ln����«"�, DATE: I L/sl5 S SIGNATURE: � �/ [�.�ia � i � i ,� � � ` . + a :i` . .:�