Dickinson, TX · Galveston County
Ambulance Services Permit Application
Private ambulance providers use this application to request an initial or renewal permit for ambulance services operated within Dickinson city limits.
What this form is
Private ambulance providers must complete this application to operate an ambulance service within Dickinson city limits. It requests business and applicant contact information, plus rosters of ambulances and EMTs. Applicants must also provide proof of vehicle and commercial general liability insurance, required licensing and certification records, and the applicable application and per-vehicle and per-EMT fees. The city reviews the materials and inspects proposed equipment.
Who needs it
Private ambulance providers conducting or operating an ambulance service within Dickinson city limits must submit this application.
How to submit it
Return the completed forms and required documents to the Dickinson EMS Director’s Office, Attn: Derek Hunt, 4403 Highway 3, Dickinson, TX 77539. The application lists a $100 application fee plus applicable ambulance and EMT permit fees.
About notarization
This application is signed and dated without a notary; it requests no notarized or sworn attachment, so the applicant just signs and dates it.
How to submit this form
- 1
Download The Application
Download the Ambulance Services Permit Application.
- 2
Complete The Application
Complete all sections legibly and sign and date the applicant fields.
- 3
Gather Required Attachments
Include ambulance and EMT rosters, required licensing and certification proof, insurance proof, and applicable fees.
- 4
Submit To The City
Return the completed forms and required documents to the Dickinson EMS Director’s Office at the address listed on the application.
Frequently asked questions
- Who must complete the Ambulance Services Permit Application?
- Private ambulance providers conducting or operating an ambulance service within Dickinson city limits must submit the application for an initial or renewal permit.
- What documents and fees are required with the application?
- The application calls for ambulance and EMT rosters, proof of vehicle and commercial general liability insurance, licensing and certification records, and the $100 application fee plus applicable vehicle and EMT fees.
- Do I need a notary for the Ambulance Services Permit Application?
- No. The application is signed and dated without a notary and requests no notarized or sworn attachment.
- How do I submit the Ambulance Services Permit Application?
- Return the completed forms and required documents to the Dickinson EMS Director’s Office, Attn: Derek Hunt, at 4403 Highway 3, Dickinson, TX 77539.
Need something notarized?
This Ambulance Services Permit Application doesn’t need a notary — but Texas residents can notarize other documents online with a commissioned online notary.