To operate a ground ambulance service in Arizona, an application must be filed with the Department of Health Services, Bureau of Emergency Medical Services & Trauma System, and a Certificate of Necessity (CON) granted by the Director.  The CON describes the service area (including central operations station), level of service, type of service, hours of operation, response times, effective date, expiration date, legal name and address of the ambulance service, and any limiting or special provisions the Director prescribes.  The ground ambulance service must adhere to the restrictions of the CON and operate in accordance to the statutes and rules by which it is governed.  Click on these links for statutes and ground ambulance rules.
  
To apply for a Ground Ambulance Certificate of Necessity, the following must be submitted.  The forms below are available in PDF or Word format.  In order to download the PDF version, Acrobat Reader™ is required. 

Initial Ground Ambulance Service CON:
(For specific details on requirements see R9-25-902)

1. Application for Ground Ambulance Service Certificate of Necessity
   [PDF 197K]  [DOC 50K].

2. The following information:
   a. Where the ground ambulance vehicles are located within 
       the applicant's proposed service area.
   b. A statement of the proposed general public rates.
   c. A statement of the proposed charges.
   d. The applicant's proposed response times, response codes, and
       response-time tolerances for each scene locality in the proposed 
       service area. 
   e. A plan to provide temporary ground ambulance service to the proposed
       service area for a limited time when the applicant is unable to provide
       ground ambulance service to the proposed service area.
   f.  Whether a ground ambulance service currently operates in all or part
       of the proposed service area and if so, where.
   g. Whether an applicant or a designated manager:
       *  Has ever been convicted of a felony or a misdemeanor involving
           moral turpitude.
       *  Has ever had a license or certificate of necessity for a ground
           ambulance service suspended or revoked by any state or
           political subdivision.
       *  Has ever operated a ground ambulance service without the
           required certification or licensure in this or any other state.

3. A description of the proposed service area by any method specified in A.R.S. § 36-2233(E) and a map that illustrates the proposed service area.

4. A projected Ambulance Revenue and Cost Report [PDF 607K] [DOC 309K].

5. The financing agreement for all capital acquisitions exceeding $5,000.

6. The source and amount of funding for cash flow from the date the ground ambulance service commences operations until the date cash flow covers monthly expenses.

7. Any proposed ground ambulance service contract under A.R.S. §§ 36-2232(A)(1) and 36-2234(K).

8. The information and documents specified in R9-25-1101, if the applicant is requesting to establish general public rates.

9. Any subscription service contract under A.R.S. §§ 36-2232(A)(1) and 36-2237(B).

10. A certificate of insurance or documentation of self-insurance required in A.R.S. § 36-2237(A) and R9-25-909.

11. A surety bond if required under A.R.S. § 36-2237(B).

12. The applicant's and designated manager's resume or other description of experience and qualification to operate a ground ambulance service.

13. For provision of ALS:
    a.  A current written contract for ALS medical direction.
    b.  Proof of professional liability insurance for ALS personnel required in
         R9-25-909(A)(1)(b).

14. A NON-REFUNDABLE $100 application filing fee for an initial certificate of necessity (A.R.S. § 36-2240.1).

Renewal of Ground Ambulance Service CON:
(For specific details on requirements see R9-25-904)

1. Application for Ground Ambulance Service Certificate of Necessity Renewal
   [PDF 185K]  [DOC 45K];

2. Proof of continuous insurance coverage or a statement of continuing self-insurance, including a copy of the current certificate of insurance or current statement of self-insurance required in R9-25-909;

3. Proof of continued coverage by a surety bond if required under A.R.S. § 36-2237(B);

4. A copy of the list of current charges required in R9-25-1109;

5. An affirmation that the certificate holder has and is continuing to meet the conditions of the certificate of necessity, including assessing only those rates and charges approved and set by the Director; and

6. A NON-REFUNDABLE $50 application filing fee (A.R.S. § 36-2240.2).

The Bureau offers a packet which provides detailed application information for a Certificate of Necessity (CON) in the State of Arizona.  If can be obtained by writing to the Bureau of Emergency Medical Services, Ambulance and Regional Services Section, 150 North 18th Avenue, Suite 540, Phoenix, Arizona 85007.  Questions concerning CON can be answered by calling Harry Eth, CON Program Manager, at (602) 364-3166 or via email.  Information regarding current certificates in the state can also be obtained using the same address and phone number.