Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0023 - Emergency Medical Services - General › Chapter 2 - AMBULANCE SERVICE BUSINESS LICENSE › Section 2-3 - Application

Current through July 13, 2024
(a) Unless the service operated is a type
				listed in Section
				2
				above, no person shall commence operation of an ambulance service in this state
				prior to receiving an ambulance service business license.
(b) A person planning to establish an
				ambulance service shall apply for an ambulance service business license at
				least thirty (30) says prior to the date when she anticipates commencing
				operations. The applicant shall complete an application form provided by the
				Division and shall submit the completed application form and a twenty dollar
				($20.00) application fee to the Division by certified mail, return receipt
				requested.
(c) The application form
				shall contain the following information:
(i)
				The applicant's name, physical address, and mailing address;
(ii) The type of business organization (for
				example, sole proprietorship, partnership or corporation) and a statement of
				whether the business organization is for profit or nonprofit;
(iii) If the business organization is a
				partnership, the names, business addresses and mailing addresses of each
				partner, including silent partners and limited partners;
(iv) If the business organization is a
				corporation or a limited liability company, the names, business addresses and
				mailing addresses of all corporate officers and the name, business address and
				mailing address of each shareholder who owns ten percent (10%) or more of the
				corporation's stock. If a parent corporation owns ten percent (10%) or more of
				the corporation's stock, the application shall list the names, business
				addresses and mailing addresses of all corporate officers of the parent
				corporation and of each shareholder in the parent corporation who owns ten
				percent (10%) or more of the parent corporation's stock;
(v) The trade name or business name of the
				applicant;
(vi) For each attendant
				whom the applicant anticipates using, the name, training history, and current
				certification status of the individual;
(vii) The name of the individual responsible
				for ensuring that each attendant working for the ambulance service meets all
				continuing medical education. If this individual is designated as an ambulance
				administrator, that title should be included on the application form;
(viii) A completed application for a permit
				for each ambulance to be used in the ambulance service business. Each such
				application shall comply with Chapter 3 of these rules;
(ix) The location from which the ambulance
				service shall operate, and the boundaries of its normal area of
				operation;
(x) A copy of a
				certificate of insurance, issued by an insurance carrier licensed to do
				business in Wyoming, which certificate shows that each ambulance owned or
				operated by the ambulance service company is covered by insurance providing for
				the payment of benefits and damages in at least the following amounts:
(A) Liability coverage in the amount of one
				million dollars ($1,000,000.00) for each individual claim and two million
				dollars ($2,000,000.00) for personal injury or death claims arising out of any
				one (1) motor vehicle accident, or the limits allowed to participants of the
				state's Local Government Liability Pool;
(B) Liability coverage in the amount of one
				hundred thousand dollars ($100,000.00) for property damage claims arising out
				of any one (1) transaction or occurrence, or the limits allowed to participants
				of the state's Local Government Liability Pool; and
(C) Liability coverage in the amount of two
				million dollars ($2,000,000.00) for personal injury, death or other claims
				arising out of any one (1) transaction or occurrence, or the limits allowed to
				participants of the state's Local Government Liability Pool.
(xi) A statement of affirmation
				that the ambulance service shall be operated in full compliance with all
				applicable federal and state requirements, including such rules as the Division
				may from time to time promulgate or amend;
(xi) The name of the physician medical
				director and, if an individual is so designated, of the ambulance
				administrator, with signatures indicating that those individuals have agreed to
				serve in their respective capacities; and
(xii) Such other information as the Division
				may require in order to accomplish full implementation of applicable federal
				and state requirements and of the Division's rules.