COPCN Application - Polk County BoCC 2026

1. Click ‘Get Form’ to open the COPCN Application in the editor.
2. Select the type of application you are submitting: Initial or Renewal. Fill in your business name, address, and contact information accurately.
3. List all owners, partners, operators, and board members along with their daytime phone numbers in the designated section.
4. Indicate the level of service you wish to provide by checking the appropriate boxes for Basic Life Support or Advanced Life Support options.
5. Describe the geographical area where services will be provided and state the demand for these services in that area.
6. Detail the equipment you will utilize and complete any attached vehicle roster as required.
7. Ensure compliance documentation is attached, including necessary licenses and proof of insurance.
8. Review all sections for accuracy before signing and dating the application at the end.

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