Mesquite Fire Rescue Mesquite Fire and Rescue

Mesquite Fire Rescue
3 John Deere Drive
Mesquite, NV 89027
Phone: (702) 346-2690
Fax: (702) 346-5242
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Mesquite Fire and Rescue

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Cost: $125.00
Notes: IMPORTANT CLAUSE: This ground ambulance subscription is for 911 Emergency Life Threatening use ONLY and does not apply to requests for personal health related responses or transports. Mesquite Fire Rescue reserves the right to discontinue this ambulance subscription when it is determined that such service is being abused or used improperly. This ambulance subscription only applies to Mesquite Fire Rescue ground ambulance services and is for Mesquite residents only. This ambulance subscription does not preclude the billing of your insurance companies. It is our policy to bill your primary and secondary insurance companies first. You will be requested to provide insurance information to the billing company upon usage of this emergency service. This coverage is valid for one year and can be renewed on a yearly basis thereafter. This ambulance subscription begins the date you enroll and continues for twelve months. Questions can be referred to 702-346-2690.

Registration Information
First Name:	*
Last Name:	*
Address:	*
City:	*
State:	*
Zip:	*
Phone:	*
Email:
Alternate Phone:
Home address if different from above:
Eligible Dependent:
Eligible Dependent:
Eligible Dependent:
Eligible Dependent:
Eligible Dependent:
I agree to terms and understand the dependent eligibilty as outlined:	*

GROUND AMBULANCE SUBSCRIPTION COVERAGE: This ground ambulance subscription is for Emergency 911 Life Threatening use only and does not apply to requests for personal health related responses or transports. Mesquite Fire Rescue reserves the right to discontinue this ambulance subscription when it is determined that such service is being abused or used improperly. This coverage is valid for one year and can be renewed on a yearly basis thereafter. This ambulance subscription does not preclude the billing of your insurance. It is our policy to bill your primary and secondary insurance companies. You will be requested to provide insurance information to the billing company upon usage of this emergency service. This ambulance subscription only applies to Mesquite Fire Rescue ground ambulance services and is for Mesquite residents only.

DEPENDENT ELIGIBILITY: If you are eligible for coverage, the family members listed below are included:

Your legal spouse;
Your unmarried children under age 19. Children include:

Your naturally born children;
Stepchildren;
Legally adopted children, or children placed with you for adoption, who are dependent upon you for support and maintenance;
Foster children, but only when the court has appointed you legal guardian;
Grandchildren, but only when the court has appointed you legal guardian, the grandchildren are principally dependent on you for support, and they live with you.

Your unmarried children ages 19 through 26 who are full-time students (at least 9 units of study) at an accredited post-secondary educational institution, such as a college or university, community or junior college, graduate school, or an accredited vocational, trade, or business school.
Elderly parent(s) or sibling(s) related by marriage or blood who live in your household and depend on you for support.