(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.
(d) Inspection of records. The Division, at its sole discretion, may at any time inspect the records of any person holding an ambulance service business license to verify information contained in the ambulance business license application.