An applicant for
an initial or renewal certificate of registration for an air ambulance shall
submit an application packet to the Department, including:
1. The following information in a
Department-provided format:
a. The
applicant's name; mailing address; e-mail address; fax number, if any; and
telephone number;
b. The names of
all other business organizations operated by the applicant related to the use
of an air ambulance;
c. The
physical address of the applicant, if different from the mailing
address;
d. If applicable, the
number of the applicant's air ambulance service license;
e. The name, title, address, e-mail address,
and telephone number of the individual acting on behalf of the applicant
according to
R9-25-102;
f. The
name, address, telephone number, and e-mail address of the owner of the air
ambulance, if different from the applicant;
g. Whether the air ambulance is a fixed-wing
or rotor-wing aircraft;
h. The
number of engines on the air ambulance;
i. The manufacturer's name;
j. The model name of the air
ambulance;
k. The year the air
ambulance was manufactured;
l. The
serial number of the air ambulance;
m. The tail number of the air
ambulance;
n. The aircraft colors,
including fuselage, stripe, and lettering;
o. A description of any insignia, monogram,
or other distinguishing characteristics of the aircraft's appearance;
p. The address at which the air ambulance is
usually based;
q. The address in
Arizona at which the air ambulance will be available for inspection;
r. The name and telephone number of the
individual to contact to arrange for inspection, if the inspection is
preannounced;
s. Whether the
applicant agrees to allow the Department to submit supplemental requests for
information under
R9-25-1201(C)(3);
t. Attestation that the information provided
in the application packet, including the information in the accompanying
documents, is accurate and complete; and
u. The dated signature of the applicant;
2. A copy of the following for
the air ambulance, issued by the Federal Aviation
Administration:
a. A current and valid
Certificate of Registration, and
b. A current and valid
Airworthiness Certificate;
3.2. A copy of a current
and valid registration for the air ambulance, issued by the Arizona Department
of Transportation under A.R.S. Title 28, Chapter 25, Article 4;
4. If a document required under
subsection (B)(2) or (3) is not issued in the name of the applicant,
documentation showing the applicant can legally possess and operate the
aircraft covered by the document, signed by the owner of the aircraft;
and
5.3. Unless the applicant
uses or intends to use the aircraft as an air ambulance only as a volunteer
not-for-profit service, the following fees:
a.
A $50 registration fee, as required under A.R.S. §
36-2212(D);
and
b. A $200 annual regulatory
fee, as required under A.R.S. §
36-2240(4).