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Agenda 11/13/2012 Item #16E 511/13/2012 Item 16.E.5. EXECUTIVE SUMMARY Recommendation to renew the annual Certificate of Public Convenience and Necessity (COPCN) for Ambitrans Medical Transport, Inc., to provide Class 2 inter - facility transport ambulance service for a period of one year. OBJECTIVE: Recommend the Board of County Commissioners grant a renewal Certificate of Public Convenience and Necessity to Ambitrans Medical Transport Inc., for a period of one year for Class 2 inter - facility transport services in Collier County. CONSIDERATIONS: Chapter 50 of the Collier County Code of Ordinances provides for the renewal of each certificate and allows for the renewal to be routinely approved by the Board upon the advise of the administrator or hold a hearing on same. Staff has approved the annual renewal application submitted by Ambitrans and deems the application as complete. Staff recommends that the annual certificate be renewed. It should be noted that Staff submitted an Executive Summary for the October 23, 2012 Board of County Commission meeting when it was discovered that the annual Certificate for Ambitrans was about to expire. Staff was in error by recording Ambitrans' start date (January 6, 2012) as opposed to its certificate granting date of October 24, 2012 which is the correct anniversary date of the renewal. Staff requested and received an extension by the Board for Ambitrans' certificate renewal date due to the calendar error. FISCAL IMPACT: A budget ammendment is necessary to recognize the $250.00 application fee for the Certificate of Public Convenience and Necessity renewal and appropriate expenditure of the same amount within the EMS Fund 490. GROWTH MANAGEMENT IMPACT: There is no Growth Management impact. LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is legally sufficient, and requires majority vote for approval. -JAK RECOMMENDATION: Recommendation to award a Class 2 Certificate of Public Convenience and Necessesity to Ambitrans Medical Transport Inc., for a period of one year. Prepared by: Dan Summers, Director, Bureau of Emergency Services Packet Page -2484- 11/13/2012 Item 16.E.5. COLLIER COUNTY Board of County Commissioners Item Number: 16.E.5. Item Summary: Recommendation to renew the annual Certificate of Public Convenience and Necessity (COPCN) for Ambitrans Medical Transport, Inc., to provide Class 2 inter - facility transport ambulance service for a period of one year. Meeting Date: 11/13/2012 Prepared By Name: BoniChristine Title: Administrative Assistant, Senior, 10/25/2012 2:22:30 PM Submitted by Title: Administrative Assistant, Senior, Name: BoniChristine 10/25/2012 2:22:31 PM Approved By Name: pochopinpat Title: Administrative Assistant,Facilities Management Date: 10/25/2012 2:54:22 PM Name: Pricel-en Title: Administrator, Administrative Services Date: 10/26/2012 3:40:27 PM Name: SummersDan Title: Director - Bureau of Emergency Services, Date: 10/26/2012 3:55:' )6 PM Name: KlatzkowJeff Title: County Attorney Date: 10/29/2012 9:46:00 AM Packet Page -2485- Name: KlatzkowJeff Title: County Attorney Date: 10/29/2012 10:49:48 AM Name: PryorCheryl Title: Management/ Budget Analyst, Senior;Office of Manag Date: 11/1/2012 10:06:30 AM Name: OchsLeo Title: County Manager Date: 11/4/2012 10:53:36 AM Packet Page -2486- 11/13/2012 Item 16.E.5. 11/13/2012 Item 16.E.5. c �reM Mi . i Packet Page -2487- 11/13/2012 Item 16.E.5. 4351 Pinnacle Street Charlotte Harbor, FL 33980 \'_MBITRANS (941) 743 -3665 - Fax: (941) 629 -7314 September 18, 2012 Walter Kopka Acting EMS Chief Collier County EMS 8075 Lely Cultural Parkway Suite 267 Naples, FL 34113 Re: COPCN Renewal Application Dear Chief Kopka: ^` Ambitrans Medical Transport, Inc. (Ambitrans) is pleased to submit the enclosed renewal application to Collier County for its consideration in the issuance of a Class 2 Certificate of Public Convenience and Necessity (COPCN) to provide ambulance transportation within Collier County. Since 1995, Ambitrans has specialized in the transportation of inter - facility transports by ambulance. With our vehicles licensed and permitted through the State of Florida's Bureau of EMS, our fleet of advanced life support and basic life support ambulances serve Southwest Florida on a daily basis. Transports from hospital to hospital, hospital to nursing homes and nursing homes to hospital' continues to represent our core business. While Ambitrans is proud to work in conjunction with EMS organizations in Sarasota and Charlotte counties to mitigate their response to non - emergent calls for assistance, our company focus remains committed to servicing the non -911 market. For the last eight (8) years, Ambitrans has been rendering Basic Life Support, Advanced Life Support and Critical Care Transport to patients of the Physicians Regional Healthcare System and the NCH ' Transports from nursing homes to hospitals are non -life threatening in nature Charlotte County - Lee County - Sarasota County www.ambitrans.com Packet Page -2488- 11/13/2012 Item 16.E.5. Page Two Chief Kopka Collier County COPCN Healthcare System who required service to facilities located outside of Collier County's limits. These out -of- county transports typically average over sixty (60) miles in distance. Since commencing operations within Collier County on January 9h of this year, Ambitrans has transported over 1,250 patients point -to -point within the county. Ambitrans operates twenty -four hours per day, seven days per week. Requests for transportation are received through our Communications Center housed in our corporate offices in Port Charlotte, with our personnel and vehicles deployed from our satellite locations in Naples, Cape Coral, Port Charlotte, Venice and Sarasota. In the absence of a formal COPCN application, items outlined in Section 50 -55 of the Collier County Ordinance have been addressed within this document as well as other materials we felt were of importance in your renewal process. We welcome the opportunity for staff to conduct an on -site review of our premises and meet the personnel who are responsible for making us the quality organization that we are. Upon reviewing the enclosed information, should you have any further questions, please do not hesitate to contact me at (941) 613 -6427. Sincerely, _4. J/�� Alan J. Skavroneck Chief Operating Officer AJS: kms Charlotte County - Lee County - Sarasota County www.ambitrans.com Packet Page -2489- n n 11/13/2012 Item 16.E.5. Packet Page -2490- r 11/13/2012 Item 16.E.5. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application Sec. 50-55 Procedure for obtaining certificate. An applicant for a certificate shall obtain forms from the department to be completed and returned to the division administrator. Each application shall contain: (1) The name, age and address of the owner of the ambulance or ALS provider, or if the owner is a corporation, then of the directors of the corporation and of all of the stockholders holding more than 25 percent of the outstanding shares. For governmental units, this information shall be supplied for members of the governing body. Corporate Officers/Directors Michael J. Grant, 4351 Pinnacle Street, Charlotte Harbor, FL 33980 50% Lorraine B. Grant, 4351 Pinnacle Street, Charlotte Harbor, FL 33980 50% Alan J. Skavroneck, 4351 Pinnacle Street, Charlotte Harbor, FL 33980 0% Packet Page -2491- 11/13/2012 Item 16.E.5. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application .(2) The boundaries of the territory desired to be served. Collier County Packet Page -2492- 11/13/2012 Item 16.E.5. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (3) The number and brief description of the ambulances or other vehicles the applicant will have available. Ambitrans currently has seventeen (17) vehicles available to its fleet. These units are permitted with the Bureau of EMS as Advanced Life Support and Basic Life Support vehicles. Through the use of the company's computer aided dispatch software, Zoll Data RescueNet Dispatch- BillingTm, management is able to staff according to anticipated demand. Staffing levels and patterns are determined using historical data and other internal statistics. Vehicles are posted in accordance with direction from our communications center personnel to specified areas to aid in proper deployment and call response. In the event of increased call volume, Ambitrans has the ability to schedule additional labor and resources to meet any unforeseen increase in market demand. Packet Page -2493- 11/13/2012 Item 16.E.5. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (4) The address of the intended headquarters and any substations. Ambitrans corporate office is located at: 4351 Pinnacle Street, Port Charlotte, FL 33980 Our Collier County substation is located at: 2220 Trade Center Way, Naples, FL 34109 Our auxiliary substation to backup the Collier County operation is located at: 935 N.E. 7th Terrace, Cape Coral, FL 33909 Packet Page -2494- i 11/13/2012 Item 16.E.5. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (5) The training and experience of the applicant. Ambitrans Medical Transport, Inc. was incorporated in 1983 to provide Para transit services to the residents of Charlotte Countg. In 1988, ownership of the company transferred to its current principals. In 1995, Ambitrans commenced its ambulance operations. Today, Ambitrans operates in Charlotte, Collier, Lee and Sarasota counties. Ambitrans is compliant with Florida Statute 401 and Florida Administrative Code 64J in accordance with standards set forth by the Bureau of EMS and Department of Health as evidenced by the recent site inspection conducted by the Bureau. Our state license is valid through August 2013. As noted on our enclosed organizational chart, the management team at Ambitrans collectively has over 200 years of experience in the EMS industry. We employ personnel who are specifically assigned to our Training and Quality Assurance Department. Patient care reports are reviewed for quality assurance and adherence to our medical protocols and standards of care. Our education team is also responsible for our in -house training, which includes CPR, Advanced Cardiac Life Support, Pediatric Advanced Life Support, Emergency Vehicles Operators Course and on -going continuing education units needed for bi- annual certification renewal. Ambitrans' experience is not limited to Southwest Florida; our Chief Operating Officer serves as the Vice - President for the Florida Ambulance Association as was recently reappointed by the State Surgeon General to another four (4) year term on the Emergency Medical Services Advisory Council. Dr. Daniel V. O'Leary serves as our medical director of record as mandated under Florida Statute 401.265. This is in addition to his normal day -to -day duties as an emergency room physician at Peace River Medical Center in Port Charlotte as well as serving as the Medical Director for Charlotte County Fire and EMS. Packet Page -2495- 11/13/2012 Item 16.E.5. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (6) The name and addresses of three Collier County residents who will act as references for the applicant. Patricia Davis 212 Napa Ridge Road East Naples, FL 34119 Representative Matt Hudson 3301 East Tamiami Trail Naples, FL 34112 Senator Garrett Richter 2320 Harrier Run Naples, FL 34105 A Packet Page -2496- 11/13/2012 Item 16.E.5. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (7) A schedule of rates which the service intends to charge, Description Service Basic Life Support Base Rate $395.00 Advanced Life Support Base Rate $395.00 Advanced Life Support Base Rate — Level 2 $625.00 Specialty Care Transport Base Rate $750.00 Per Loaded Mile $10.00 Oxygen $45.00 Drugs $10.00 - $25.00 IV Supplies $20.00 - $25.00 Packet Page -2497- 11/13/2012 Item 16.E.5. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (8) Such other pertinent information as the administrator may require. No additional information was requested by the administrator at the time of submission. Packet Page -2498- r 11113/2012 Item 16.E.5. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (9) An application or renewal fee of $250.00. (Exception Collier County EMS). See next page for copy of check. Packet Page -2499- -N, MWO Packet Page -2500- 11/13/2012 Item 16.E.5. Q r p O O UO * i w * * = i t Lo m' « t 41 d: ... a El cl �M^ J -m m q m CL * t * W- ; * Z « O ; 'C * qJ Co CD f" LL w O . t7 Ctr a H v L t0 � W'. U` f ¢ o� a. E-OO Packet Page -2500- 11/13/2012 Item 16.E.5. 11/13/2012 Item 16.E.5. Ambitrans Medical Transport, Inc. - Collier County COPCN Renewal Application (10) Financial data including assets and liabilities of the operator. A schedule of all debts encumbering any equipment shall be included. See next page for financial information. Packet Page -2501- n .� 11/13/2012 Item 16.E.5. F M , ME • 3 Packet Page -2502- 11/13/2012 Item 16.E.5. BRIAN W. CROSLAND, CPA, PL CERTIFIED PUBLIC ACCOUNTING & CONSULTING KR1sTi L. RAM)OLPH Ar.Imc*-, INSn' UM, OF CrILTIFIEO PUBLIC ACCOL=Aws rLOR1i)A INSTITUTE OF CERTIFIED PuBuc AccouNam, M DEBORAI4 A. BRADLEY, CPA. CHFP HEsLLTHFNANCIALMANAMmEATAssomnoN SIiAwN M. CLnitx CPA. MmICAL GROur "AmNIHI.'7' ASSOCL MN Commuwry ssoc7Anom 1NSrffvm Y6..,....,. u,"'Cx..".:ssw'c+o"✓7s.'�.^.:.i �..:...,..� .... .........- ....... _.....�+.,..'�..L,... , ".�..».z'�'+..+.�...:. � .� .: . ».:::.ss.d'uyw - " IN:D.EPENDENT ACCOUNTANTS' COMPILATION REPORT To the Board of Directors Ambitrans Medical Transport, Inc. Charlotte Harbor, Florida We have compiled the accompanying statement of assets and liabilities of the ambulance transportation operations of Ambitrans Medical Transport, Inc. and subsidiaries as of June 30, 2012. This financial statement has been prepared on the income basis of accounting utilized by the Company for federal income tax reporting purposes. We have not audited or reviewed the accompanying financial statement and, accordingly, do not express an opinion or provide any assurance about whether the financial statement is in accordance with the income tax basis of accounting. Management is responsible for the preparation and fair presentation of the financial statement in accordance with the income tax basis of accounting and for designing, implementing, and maintaining internal control relevant to the preparation and fair presentation of the financial statement. Our responsibility is to conduct the compilation in accordance with Statements on Standards for Accounting and Review Services issued by the American Institute of Certified Public Accountants. The objective of a compilation is to assist management in presenting financial information in the form of a financial statement without undertaking to obtain or provide any assurance that there are no material modifications that should be made to the financial statement. The accompanying statement was prepared for the purpose of presenting the assets and liabilities of the ambulance transportation operations of Ambitrans Medical Transport, Inc. and subsidiaries, and is not intended to be a complete presentation of Ambitrans Medical Transport, Inc, and subsidiaries consolidated assets and liabilities. This report is intended solely for the information and use of the board of directors and management of Ambit -ans Medical "Transport, Inc. and the Collier County Board of County Commissioners and is not intended to and should not be used by anyone other than these specified parties. August 14, 2012 Punta Gorda, Florida rxe+ .wrcc�csv�*.:+Y ° <cr r^< �••�,, c+ .,-•• _.—._ _._ 201 W. MARION Av %lvr•, SUITE 1204 11UNTA GORDA, rL 33950 PHONE; (941) 629 -1197 t'Ax: (941) 629 -5274 Packet Page -2503- i 11/13/2012 Item 16.E.5. Ambitrans Medical Transport, Inc. and. Subsidiaries Statement of Assets and Liabilities of the Ambulance Transportation Operations r� Income Tax Basis of Accounting June 30, 2012 (Unaudited) Assets Current Assets: Cash available for $127,487 ambulance transportation operations Propedy Equipment: $500,000 and Office equipment.and computers 65,058 Machinery and equipment 169,317 Medical transportation vehicles 1,097,125 Less current portion above 1,331,500 Less accumulated depreciation (1,312,766) Property and Equipment, net 16,734 Total Assets $518,734 Liabilities Accrued profit sharing $127,487 Other liabilities 23,625 Notes payable to banks 138,169 Long Term Liabilities: 289,281 Notes payable to banks 302,382 Less current portion above (138,169) 164,213 Total liabilities 453,494 Net Assets Over Liabilities, income tax basis $65,240 Read Independent Accountants' Compilation Report Packet Page -2504- 11/13/2012 Item 16.E.5. Packet Page -2505- LO �1- M V z H a O H� a U, a' H 4 U O y .0 H v o a� S c U O „fl s COO � eO a+ 0 v CL Cn U ix o z O z oZ v � � Z3 U z 15 o a z N < o '? H U o a 4 E C O 1 U b � Q Packet Page -2506- 11/13/2012 Item 16.E.5. v U v; U w C qqyqq to E 4 N O A R U w ki 8 �o A iw Co W W U) w 0 ��„ J Z -�av W 0 J LL = W LL D X. O a >- W W ti a �o w W W Q W W Q 1-; o0 =a u� m V z H a O H� a U, a' H 4 U O y .0 H v o a� S c U O „fl s COO � eO a+ 0 v CL Cn U ix o z O z oZ v � � Z3 U z 15 o a z N < o '? H U o a 4 E C O 1 U b � Q Packet Page -2506- 11/13/2012 Item 16.E.5. v U v; U w C qqyqq to E 4 N O A R U w ki 8 �o A iw Z 0 LU 11/13/2012 Item 16.E.5. Packet Page -2507- 0. Co 5 - 0 Z U L cvv z C) 0 LCO, :3 0 C> 0 9 D " MO :D -J UJ a. CO x !E�! CL 0 w I-- z 0 C-'J) 0 z Ul LL .Co C> (r) ul _j Lu W C) R o lu ce) z Z Z 0 P Co C-1 W W Co US Mo 0 LLI Lu < < _j = COC4 Z =. 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If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 941- 922 -0245 Bouchard - Sarasota 941 - 923 -4126 5310 Clark Road Suite 1 Sarasota, FL 34233 Brian Wyles NA CT ME: PHONE No A/C, No. Extl' IAIC. ADDRESS: PRODUCER GRANT -6 C S%MER ID N: INSURERS AFFORDING COVERAGE NAIC N CL318073 CL318073 INSURED Grant Medical Transportation INSURER A: Empire Fire & Marine Ins Co. 21326 INSURER 8: Zurich American Insurance Co 16535 Ambulance Mgmt Services, LLC INSURER C: American Guarantee & Liabili 26247 Ambitrans Medical Transport, l Venice Ambulance Service, Inc. 4351 Pinnacle Street INSURER D GENERAL AGGREGATE $ 3,000,00 Charlotte Harbor, FL 33980 INSURER E $ 3,000,00 $ ' INSURER F, UA131LITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS rnvcoer_GC CFRTIFICATF NIIMRFR- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I�TR TYPE OF INSURANCE POLICY NUMBER MM/DDlYYYY MMIODIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERALLIABILITY X CLAIMS•NADE 7 OCCUR X Professional Liab CL318073 CL318073 07/01/12 07/01/12 07101/13 07/01/13 EACH OCCURRENCE $ 1,000,00 PREMISES (Ea occurrence) $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL BADVINJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC IECT PRODUCTS - COMP/OP AGG $ 3,000,00 $ ' AUTOMOBILE X X X UA131LITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS PRA947670400 07/01/12 07/01/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) b PROPERTY DAMAGE (Per accident) $ $ $ C UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UC548002101 07/01/12 07/01/13 I EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 HXX DEDUCTIBLE RE TENTION $ None $ $ WORKERS COMPENSATION IA AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICER/MEMBER EXCLUDED (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS below N/A WCSTIMIT 0TH- Y E.L. EACH ACCIDENT is E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) EVIDEN1 EVIDENCE OF INSURANCE XXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXX SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Packet Page -2509- 11/13/2012 Item 16.E.5. W Packet Page -2510- 1"11,4 1 C O O CL N U) t� i ■ va, al- o ° � E a .. rte} F— = N Q N yy 1 11/13/2012 Item 16.E.5. C N ;a o N d ro U N Q N w yU} A U fn LL N 01 M Q CL m '0 a) c a C O d%0 Eu'>� 0) 4. a� � O H U o ° � E a .. rte} F— = N Q N yy L L 's H C N O X N C U 0 (D mUv Q N w yU} A U w E N@ N a LD O N M m H N c a C O d%0 Eu'>� 0) 4. > � o � O H U 0 U 1 c r i �i v� O X N C M N Q N a� A U > -• CD N M V W C O 2 1) Eu'>� M N �U U �i C 8 C a m N m �2 7 N m LL Packet Page -2511- - o X N C N LMMM!�? A U U aD Eu'>� Eo H U U 1 c r i yy ycyi Y 4) n us`i E m I 0 �T �a N tmOU � I rn BOW I I i O I I � I U I f0 Q CD I J I O i C a) 0 � i ( I i I N O I cc la C y m p d } O :5U to W = U C 8 C a m N m �2 7 N m LL Packet Page -2511- - n n 11/13/2012 Item 16.E.5. Packet Page -2512- Healthcare Practitioner License Printer Friendly Detail Information Display License Verification Data As Of 9/21/2012 DANIEL VINCENT O'LEARY. LICENSE NUMBER: ME77926 Profession MEDICAL DOCTOR License /Activity Status CLEARIACTIVE License Expiration Date 1/31/2013 Discipline on File NO Address of Record PEACE RIVER REGIONAL MED CTR 2500 HARBOR BLVD. PORT CHARLOTTE, FL 33952 License Original Issue Date 05/06/1999 Public Complaint NO The information on this page is a secure, primary source for license verification provided by The Florida Department of Health, Division of Medical Quality Assurance. This website is maintained by Division staff �..� and is updated immediately upon a change to our licensing and enforcement database. 11/13/2012 Item 16.E.5. https: / /ww2. doh .state.fl.us /irm00praes /prasi: Packet Page - 2513- ?LicId= 74291 &ProfNl3R =... 9/21/2012 n n 11/13/2012 Item 16.E.5. =WUMN or c ax t�rWMD - s Packet Page -2514- www.sunbiz.org - Department of State Home Contact Us _ .. _ . __..... -------- _ E Filing Services Previous on List - - - ---_ Next on List Return To List Document Searches No Events No Name History Detail by Officer /Re ister Florida Profit Cor or g ed Agent Name AMBITRgNS ati'on MEDICAL TRANSPORT, INC. Filin information Document Number F'I /"N Number P9 5000024839 Date Filed 650571130 State 03/27/1995 Status FL Effective Date ACTIVE 03/21/1995 Pr'�� al Address 4351 PINNACLE I� CHARLOTTE HARBREET Changed 04/15/2008 Chan OR FL 33980 US Ihailin 43 n Address CHARLOTTI LE STREET Changed Oq /E HARBOR FL 33980 US istered A e GRANT �---__ nt Name & Address 4351 PINMICHAEL CHARLO NACLE STREET �'' Address OR FL 33 S Changed: U ged; 04/15/2008 O� '/l lrector pe Narne $ Address to // Title D pT 351 PT MICHAEL J CHARLOTTE HARBOR FL Title DS 33,980 351 PIINNAC AINE B CHARLOTTE L BAR F� Title Vp 33980 351 NP CF SL,gN NAL RE ET lrtp: // Ww :sulzbiz.org /scripts /cor det exe?act�on_DET Packet Page -2515 - `�In9 dnn __ 11/13/2012 Item 16.E.5. rage 1 oft Forms Help Officer /RA Name Search I Submt;j www.sunbiz.org - Department of State CHARLOTTE HARBOR FL 33980 Annual Reports Report Year Filed Date 2010 03/31/2010 2011 03/23/2011 2012 02/21/2012 Document Images 02/21/2012 — ANNUAL REPORT j View image in PDF format 03/23/2011 —ANNUAL REPORT View image in PDF format j 03/31/2010 —ANNUAL REPORT j View image in PDF format 04/08/2009 — ANNUAL REPORT j View image in PDF format .( 04/15/2008 — ANNUAL REPORT j View image in PDF format j 04/24/2007 — ANNUAL REPORT j View image in PDF format j 04/2012006 — ANNUAL REPORT I View image in PDF format_. j 04/16/2005 — ANNUAL REPORT j View image in PDF format j 02/02/2004 — ANNUAL REPORT j View image in PDF format 02/27/2003 —ANNUAL REPORT r View image in PDF format 04/22/2002 — ANNUAL REPORT j View image in PDF format j 05/14/2001 --ANNUAL REPORT j View image in PDF format j 05/24/2000 — ANNUAL REPORT E .View image in PDF format.. j 04105/1999 — ANNUAL REPORT View image in PDF format 04/22/1998 —ANNUAL REPORT I View image in PDF format j 02/17/1997 — ANNUAL REPORT j View image in PDF format j 03/05/1996 --.ANNUAL REPORT View image in PDF format j 03127/1995 — DOCUMENTS PRIOR TO 1997 ( View image in PDF format Note: This is not official record. See documents if question or conflict. 11/13/2012 Item 16.E.5. Previous on List Next on List Return To List _._.........___.....__...._. __...__..._.._._._.._...__..... Officer /RA Name Search No Events No Name History j Submit.,[ i Home i Contact us I Document Searches i E- i -ilinq Services I Forms I Help Copyright C:, and Privacy Policies State of Florida, Department of State hq: / /Www.sunbiz.org /scripts /cordet.exe ?a Packet Page -2516--doe—number--P950000248... 9/21/2012 11/13/2012 Item 16.E.5. ATTACHMENT 'A" Ambitrans Medical Transport Vehicle- Listing 1FDSS34P09DA59420 Vehicle Permits (BLS) 4477 1FDSS34P78DA64922 Vehicle Permits (BLS) 4476 1FDSS3ES1BDB27801 Vehicle Permit (ALS) 17027 1FDSS3ES3BDA26145 Vehicle Permits (BLS) 4355 1FDSS3ES3CDA18371 Vehicle Permit (ALS) 17149 1FDSS3ES4BDA26137 Vehicle Permit (ALS) 16462 1FDSS3ES5ADA25626 Vehicle Permit (ALS) 17151 1FDSS3ES5CDA18372 Vehicle Permit (ALS) 17150 1FDSS3ES6ADA31208 Vehicle Permit (ALS) 15923 -1FDSS3ES6BDA26138 Vehicle Permits (BLS) 4475 1FDSS3ES6BDB36820 Vehicle Permit (ALS) 17356 1FDSS3ES7BDB27799 Vehicle Permit (ALS) 17025 1FDSS3ES7BDB27804 Vehicle Permit (ALS) 17026 1FDWE35F92HA44797 Vehicle Permits (BLS) 4133 1FDXE45F23HB15317 Vehicle Permit (ALS) 15452 1FDXE45F2YHB54092 Vehicle Permits (BLS) 4228 1FDXE45F73HB48975 Vehicle Permits (BLS) 4470 Packet Page -2517-