In conformity with the City Ordinance concerning the Licensing of Ambulances Services, the EMS Provider listed below request
permission from the Texas City Fire Department to staff its ambulances with the following employees:
Employee Name
Last, First
EMT
Level
Texas Drivers
Licence No.
Daytime Telephone
Number
Drivers Permit
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
EMS Provider Name Date
Texas City Fire Department
1725-25
th
Street North
Texas City, TX 77590
(409) 643-5705
Received Date:
Amount Paid:
Issue Date:
Expired Date:
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