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Home My WebLink About20133454.tiffRESOLUTION RE: APPROVE APPLICATION FOR TIER III EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - STADIUM MEDICAL, INC. WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, pursuant to Section 7-2-100 of the Weld County Code, the Weld County Department of Public Health and Environment and the Weld County Emergency Medical/Trauma Service Council have reviewed the application of Stadium Medical, Inc., for a Tier III Emergency Medical Services License and recommend approval, and WHEREAS, after review, the Board deems it advisable to approve said Application for a Tier III Emergency Medical Services License, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the application of Stadium Medical, Inc., for a Tier III Emergency Medical Services License be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that approval of the License is conditional upon execution of appropriate Mutual Aid Agreements. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said license. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 16th day of December, A.D., 2013. BOARD OF COUNTY COMMISSIONERS ATTEST: Weld County Clerk to the Board BY APP Deputy le k to the Boar Attorney DEC 3 1 2013 Date of signature: WELD G UNf O Chair William F. Garcia ouglas ademach n P. Conway Freeman arbara Kirkmeyer r, Pro-Tem U IA c e i-lly(etomitpdy) t1'61►L/ 2013-3454 HL0042 Memorandum TO: FROM: DATE: SUBJECT: Board of County Commissioner Dr. Mark Wallace l) December 4, 2013 Stadium Medical 2014 Application for Ambulance Service License Stadium Medical, located at 695 Canosa Ct., Denver, Colorado, has applied for an Ambulance Service license pursuant to Chapter 7, of the Weld County Code (WCC). Chapter 7 pertains to Emergency Medical Services. The Department has reviewed this application and has deemed the ambulance service to have met all applicable licensure application requirements found in Chapter 7. As such, I am recommending for licensure. The Weld County Emergency Medical/Trauma Service (EM/TS) Council reviewed this application on November 20, 2013. The Council recommended (see attached) that Stadium Medical receive a Tier III license, 2013-3454 W O Z H W Z � W Z 5 re 5 W W C]_ f- J Z d � W U W m (1) U .1 CJ a) U C - Qa vw03 v �.., 0 O C v U J N co 0 cc 0 U w z w Ca 7 U 0 Z Q T� W W U Z C cc O U U Q Z_ >- H Z D 0 U 0 WV) 5z z — a U J D CC W W[ (J V) Z U Z I -c VI Q JW U D D W 2 Q > Zz z Q D Qo o W� 0 oZ N O W CO I - W W U W 0 J H Z C W VI Z W U J V) U W g d N 0 U U d N Z 0 U z 0 N J W z Z H 0 Z Licensure authorizing for Standby Service, as defined in Section 7-1-30 of the Weld County Code. DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue Greeley, CO 80631 Public Health Web: http://www.co.weld.co.us/Deoadments/HealthEnvironment/index.html Health Administration Public Health & Clinical Environmental Health Communication, Emergency Preparedness Vital Records Services Services Education & Planning & Response Tele: 970.304.6410 Tele: 970.304.6420 Tele: 970.304.6415 Tele: 970.304.6470 Tele: 970.304.6420 Fax: 970204.6412 Fax: 970204.6416 Fax: 970.304.6411 Fax: 970.304.6452 Far 970.304.6469 Our vision: Together with the communities we serve, we are working to make Weld Countythe healthiest place to Iwo, roam, work endplay, November 13, 2013 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: bschaefer(a7plattevallevfrre.org SUBJECT: 2014 Stadium Medical EMS Application NOTICE OF EMERGENCY MEDICAL SERVICES LICENSE APPLICATION TO THE WELD COUNTY EMERGENCY MEDICALfI'RAUMA SERVICE COUNCIL The Weld County Department of Public Health and Environment has received and is in process of reviewing an Emergency Medical Service License Application from Stadium Medical. Attached to this document are the Ambulance Service License Application, and Maps of its proposed Service Area. On behalf of the Board of County Commissioners, the Department is requesting the Emergency Medical/Trauma Service Council review the attached documents in accordance with Section 7-2-100.B.5. of the Weld County Code (enumerated below). The Department will forward your recommendation to the Commissioners. Below are the most applicable portions of the code: Weld County Code, 7-2-100.B.5 The recommendation of the Weld County Emergency Medical/Trauma Service (EM/TS) Council as to whether or not the issuance of the license will contribute to an efficient, effective, and coordinated emergency medical response to residents of the County. The EM/TS Council shall also provide: a. Recommended Service Area. b. Recommended Tier of License. Weld County Code, 7-2-10. No person shall provide or operate an ambulance service publicly or privately in the County unless that person holds a valid license to do so issued by the Board of County Commissioners, except as provided in Section 7-2-80 below. The fee for said license shall be set by separate ordinance. The license shall issue only in the following tiers of service: Tier I: Licensure authorizing for Primary Care, as defined in Section 7-1-30 of this Chapter. Tier II: Licensure authorizing for transports of patient(s) to and from licensed medical facilities. This licensure does not provide for Primary Care, as defined in Section 7-1-30 of this Chapter. Tier Ill: Licensure authorizing for Standby Service, as defined in Section 7-1-30 of this Chapter. A. The Board of County Commissioners reserves the right to amend these rules and regulations and any other individual conditions of licensing as applied to any particular license, as needed in keeping with its legislative function and in order to implement the policy of the State of Colorado that the regulation and control of ambulance licenses is in the exclusive purview of the boards of county commissioners. Persons or firms seeking application and approval of any ambulance license under this Chapter acknowledge that Weld County may contract with specific ambulance service provider(s) which will serve the emergency ambulance need of Weld County and participating municipalities. Please forward the Councils recommendation to the Department including minutes of the EMS Council meeting pertaining to this application. Please do not hesitate to call me should you have any questions. Sincerely, 030-4uLliebrit- Shana Vogel Environmental Health Specialist Environmental Health Services Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Stadium Medical As required in Section 7-2-100.B.5., the EMTS Council should review the application to assess as to whether the ambulance service will contribute to an efficient, effective, and coordinated emergency medical response to residents of the County? Please include any findings related to response time, coordination with other ambulance services, location, service area, etc. that is the basis for the Council's recommendation: FINDING #1: - *kit &P_ W1tc04D DC "VAN iparli.3AN. eaenits FINDING #2: -' W U0 ID "DiSCU.SS Lt M IS O(— S l.a C.an.as2 Kn air ti��-• �ecc u �` 4 c ou cc� -�-, 3 Ljcata�e Les FINDING #3: FINDING #4: Recommended Level of Service: Tier 1 Tier 2 Tier 3 Recommended Service Area: ... AS Ll s4-e_ei 6Y\ �IIGA'n pcu " Other EMTS Council recommendations or comments: Recommendation By:,e_Z - Date: hizoh 3— I DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue Greeley, CO 80631 Web: www.weldhealth.orq Health Administration Public Health&Clinical Environmental Health Communication, Emergency Prepared Vital Records Services Services Education & Planning & Response Tele: 970.3046410 Tele: 970.3046420 Tele: 970,304.6415 Tele: 970.304.6470 Tele: 970.304.6420 Far 970.304.6412 Fax: 970.3046416 Fax: 970.3046411 Fax: 970.304.6452 Fax 970.304.6469 Our vision: Together with the wmmunmes we serve, we are working to make Weld Courdyt le healthiest place to Ova, lean, work and p PublicRealtl AMBULANCE SERVICE LICENSE RENEWAL APPLICATION — Date of application: Name of Ambulance Service: SkCCtltl U m ' r\e4 Owner: Name: '\\pc'I.C7pr Address: p 9'S Cana sa eat 00/1 VP(' C o 8Ga0z/ Phone Number: 36 3- Se/ 9- 7 2/ V Operations Manager: AA Name: ! cd7er Ames Address: 9s do n O.S c2- /`/ nn en vs r' Phone Number:, 303- , S y 9- 7 9/ V Email/76n 'fc$tat �� /YAcid/req,C Co (to Pursuant to Section 7-2-150 of Weld County Code Ordinance, any change of ownership requires a new application for ambulance service license. . Date Received: / / (For Office Use Only) Documents Checked: Remarks: Date Referred to EMTC: / / Date Referred to B.O.C.C.: / Approved Recommended (Y/N): Licensing Agent Page 2 Name and address of each stockholder of partner owning 10% or more of the outstanding stock of the company of }}w�ing more than a 10% ownership�interest (if applicable): SYr*€)Vc�r l�rv�e S - ear, Sa C 4 . o.(` le 6T CC) goad!. What area of Weld County will be served by this company? Please attach a map indicating the service area. tic tm fle 0k--ei oiAo„{ _ QUI(Y C (kivtci (. How many ambulances do you operate? Location and description of the place(s) from which this ambulance service will operate. If there are more than two locations, attach a separate sheet with the above information. Location #1: Street Number: (n°1 /o S l a nos a CA - City: f\.} o r State: C_.(2) Phone: Location #2: Street Number: City: State: Phone: Medical Director: Name: elt-err- V E5\Mores Mailing Address: 'aCaJt-i gurvir.arN or k l -t Co &3i? 7 Phone Number:..0 . — el 7 a-' (!S,4 S3 Please read carefully : 7-2-170 Annual renewal. All licenses and permits shall be renewed annually, shall expire on December 31 of the year issued, and shall not be renewed until the application has been approved by the Department. All applications for renewal of licenses and permits shall be made not later than sixty (60) days prior to the date of expiration. The Department shall notify, by certified mail, return receipt requested, each licensee of the renewal requirements of this section within ninety (90) days prior to the date of expiration (Weld County Code Ordinance 2007-8) 7-2-180 Change of Medical Director An ambulance service must report any change of medical director, including name, address and telephone number, to the Director within fifteen (15) calendar days of such change. (Weld County Code Ordinance 2007-8) Page 3 Please read carefully and provide the following: G. As required in Section 7-2-90 (G) of the Weld County Code Ordinance, a list of all emergency medical service providers who may be called upon to respond to an emergency with the ambulance service. This list shall include the following information on each person: 1. Complete name and date of birth 2. The highest level of certification, licensure or training attained. 3. A copy of current EMT -B, EMT -I or EMT -P certificate issued by the Colorado Department of Public Health and Environment; nurse licensure or an Advanced First Aid card from the American Red Cross; or a First Responder course completion certificate issued by a Division -recognized training center or training group. 4. Proof of valid driver's license. 5. A statement of criminal complaint or convictions, including Class I and II traffic violations, within the previous twelve (12) months. * H. As required in Section 7-2-90 of the Weld County Code Ordinance, Proof of insurance, as required in section 7-3-60 of this Chapter. (Worker's compensation insurance, Public liability and property damage bodily injury, Property damage, Professional liability, and Ambulance vehicles coverage.) As required in Section 7-2-90 (I) of the Weld County Code Ordinance, provide a current copy of EMT or Paramedic protocols adopted by the ambulance service in accordance with standards approved by the ambulance service's medical director. J. As required in Section 7-2-90 (5) of the Weld County Code Ordinance, provide a current copy of the ambulance service's training standards in accordance with the requirements approved by the ambulance service's medical director. All training must be through a state -certified emergency medical services training center. K. As required in Section 7-2-90 (K) of the Weld County Code Ordinance, make available for review by the Department current records of compliance with the current EMS Laws. L. As required in Section 7-2-90 (L) of the Weld County Code Ordinance, copies of any judgments entered against the licensee or license applicant within the previous twelve (12) months, including findings of fact, conclusions of law and order by any court or other tribunal. M. As required in Section 7-2-90 (M) of the Weld County Code Ordinance, such other information as the Department may require to make a fair determination. N. As required in Section 7-2-90 (N) of the Weld County Code Ordinance, a list of ambulance agencies, fire departments, special districts and other EMS providers with which the applicant has mutual aid agreements O. As required in Section 7-3-110 of the Weld County Code Ordinance, make available for review by the Department evidence of a medical continuous quality improvement program consistent with the requirements defined in the Colorado Board of Medical Examiners rules, 3 C.C.R § 713-6, Rule 500, 3.2, b. (Weld County Code Ordinance 2007-8) P. As required in Section 12.9.2 E lof the Colorado Rules Pertaining to Emergency Medical Services, provide a current copy of the ambulance service's pharmacological agents and delivery devices per medical director protocol. Page 4 * Please note Section 7-3-50 Criminal record of ambulance crew member. Unless waived by the Board of County Commissioners, no person shall be employed by an ambulance service as an ambulance crew member who has been convicted of any of the following offenses within the previous twelve (12) months from the date of application: felony, misdemeanor or Class I or Class II traffic offense. I HEREBY CERTIFY THAT I AM AUTHORIZED TO SUBMIT THE FORGOING APPLICATION ANT) THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF AND CONTAINS NO WILLFUL MISREPRESENTATION OR FALSIFICATION. IN ADDITION, I CERTIFY THAT I HAVE READ AND UNDERSTAND THE PROVISIONS AND REQUIREMENTS OF WELD COUNTY CODE CHAPTER 7, INCLUDING, BUT NOT LIMITED TO, SECTION 7-8-10, WHICH ENCOURAGES ALL LICENSED AGENCIES PROVIDING EMS RESPONSE IN WELD COUNTY TO MAKE A GOOD FAITH EFFORT TO EXECUTE WRITTEN MUTUAL AID AGREEMENTS WITH ALL OTHER EMS PROVIDERS LOCATED WITHIN OR BORDERING ON THEIR AREAS OF RESPONSE. DETERMINATION THAT AN AMBULANCE SERVICES LICENSE HAS BEEN ISSUED BASED ON FALSE INFORMATION CONSTITUTES GROUNDS FOR LICENSE REVOCATION AND POSSIBLE CRIMINAL PROSECUTION. Signature of Applicant „..SUBSCRIBE ZDAY J BOJAN LJUBENKO Notary Public State of Colorado 10_ O5 --- itle Date FIRMED BEFORE ME THIS 20 O , IN THE COUNTY OF , STATE OF COLORADO. Signature of Notary 0G My Commission expires: / v'� / 2 Ut`1 695 Oanosa CI, Denver, CO - Google Maps n Uua.lf • ''yyV�l alit Ave ``Iy, f.: 41l i A i�wwetkm , firurrrAfill gat' ��lllulr iil111/mtur0 !Stt\SS ttt\ %..\t+\ttSt\S SS{IIf(fffa :''t Bill Ave 1/27/12 Googie cleaver metro amp - Google Maps To see all the details that are \Asible on the screen, use the "Print" link next to the map. ' urLn¢.r:n Ikmcrf n:.:$1 Gunn. ' H:do�r�I-a J1 w l f;td6us mapf iunl• - 'ddesln iin•!<•f • mat • t;r•vth,. • D'Crrif/t'(. 1. I:::Ira • - Cok r'ado' Spring s Na itlps//mapago ogle. ca m/meps?hl=ealab=wl 1/1 Hello