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Home My WebLink About20130928RESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - JOHNSTOWN FIRE PROTECTION DISTRICT 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 the Johnstown Fire Protection District for a Tier I Emergency Medical Services License and recommend approval, and WHEREAS, after review, the Board deems it advisable to approve said Application for a Tier I 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 the Johnstown Fire Protection District for a Tier I 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 15th day of April, A.D., 2013. BOARD OF COUNTY COMMISSIONERS WELD CQ '?OLORADO ATTEST: Weld County Clerk to the Board ttorney Date of signature:PR 2 9 2013 I Rio) Licesl.se. q/3, William F. Garcia Chair arbara Kirkmeyer CE 1-1'L ( dl'' 2013-0928 HL0042 Memorandum TO: Board of County Commissioners FROM: Dr. Mark Wallace y• l 6 DATE: April 10, 2013 SUBJECT: Johnstown Fire Protection District 2013 Application for EMS Services Johnstown Fire Protection District, located at 100 Tele Ave Johnstown, Johnstown, 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 (EMITS) Council reviewed this application on March 20, 2013. The Council recommended (see attached) that Johnstown Fire Protection District receive a Tier I license. 2013-0928 44.1444444444444 A A A A I I I A A A A A A A I- u. O w ZZ w O fr re W d Z o. W O ~ J Z ,Q O W U= U 0 - ▪ -I yW m ? D 0.1 U > al L/1 a) ro CO C 3 Q ar al a 0 0 4-4 a) U J la 1 F' U CC F- U) 0 z 0 F' U W F- 0 a W U- z 0 U) z 0 0 2 tu M It) 0 CO 0 0 a 0 J 0 U z 0 N z x 0 w 7 z w a 0. W J W F- 0 0 F' U F' U) 0 z 0 I - U W F 0 CC 0. W U- z 0 I- N z x 0 z 0 U 0 J w V) Z 0 Z g w cc w w cC N 0 w Z Z Q CtALIJ � J CO 7 2 cc a H a� w U Q 0 c w w = 0� o z m� I -IN o`x mE- C w CO w U Z a W 0 cc J 0 H U Z 0 w Ln w U In Cl 0 N In cc F 0 W 5 a u) 0 O U a N z 0 U Q z 0 N J re re W LL N Z I- 0 z Tier I: Licensure authorizing for Primary, as defined in Section 7-1-30 of the Weld County Code. 111111111111111 ► ► ► ► ► ► ► ► ► WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Permit to operate an Emergency Medical Vehicle (Ambulance) This Certifies: JOHNSTOWN FIRE PROTECTION DISTRICT Motor Number: 1 RDW F36R58EB25618 ^ MEETS WELD COUNTY STANDARDS FOR DPP 4 EMERGENCY MEDICAL VEHICLES (AMBULANCES). S I STHIS PERMIT WILL EXPIRE DECEMBER 31, 2013. Director, Weld County Department of Public Health and Environment 1 `I J 13 Date Must Be Posted In Vehicle DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue Greeley, CO 80631 Web: felo://www.co.weld.co.us/Deeertments/HealthEnvironment/Index.html Health Administration Public Heal & Clinical Environmental Health Communication, Emergency Preparedness l/Hall Records Services Services Education & Planning & Response Tele: B70.304.6410 Tele: 970.304.6420 Tele: 970.304.6415 Tele: 970.304 6470 Tate:9703066420 Fax' 970404.6412 Fex' 970.3046416 Fax: 970.3046411 Fee: 970.904.6452 Fax: 970,304.4499 Our Neen. TOE/0M with the communities we two, we are wwklnQ Iv the Weld Courtly the health! es le Ike, teem work end pleY March 15, 2013 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: bcchaefer(a>,plattevalleyfire.org SUBJECT: 2013 Johnstown Fire Protection District EMS Application NOTICE OF EMERGENCY MEDICAL SERVICES LICENSE APPLICATION TO THE. WELD COUNTY EMERGENCY MEDICAL/TRAUMA 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 Johnstown Fire Protection District. 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. 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: Licensurc 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 HI: 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. Please do not hesitate to call me should you have any questions. Sincerely, Shana Fassman Environmental Health Specialist Environmental Health Services Recommended Level of Service: Recommended Service Area: Tier 2 Tier 3 As listed in the application. The service area is the Johnstown Fire Protection District, with the small exclusion that lies within the Thompson Valley EMS District. Will the service contribute to an efficient, effective, and coordinated emergency medical response to residents of the County? Council's recommendation: Contractual metrics were reviewed in the contract between the Fire District and University Colorado Health. No issues were identified. A Tier 1 is recommended for this application. Other EMTS Council recommendations or comments: None Recommendation By: � 1�t / Recommendation Date: a_1/4 DA '3 March 13, 2013 Johnstown Fire Protection District 100 Telep Avenue Johnstown, CO 80534 970-587-4477 FAX 970.587.0324 Weld County Department of Public Health and Environment Attn: Environmental Health Services 1555 N. 17th Avenue Greeley, CO 80631 To whom it may concern, Greetings! Attached is the 2013 Johnstown Fire Protection District (JFPD) application for a Tier One license in Weld County. Through a contractual arrangement with University of Colorado Health (UCH), the JFPD is "furnishing...the transportation of patients by ambulance" from its "primary base of operation" at 100 Telep Ave., Johnstown, CO 80534 (WCC, pg. 7-4, 2013). Because the JFPD assets listed on page 6 of the application will be operated UCH sub -contractors a few points of clarification should be made: • Sub -contractor Medical Director is Dr. David Farstad. All ALS and BLS medications listed in the attachments are per his protocols. The JFPD, per our agreement with the Weld County Fire Chiefs Association, will continue to use Dr. Benji Kitagawa as JFPD Medical Director. • A letter from Brenda Harstad, dated March 8, 2013, attesting to the requirements set forth in Sections 7- 2-90 and 7-3-50 of Weld County Code has been included in the packet. • Two sub -contractor rosters have been included in the packet: o One roster with Driver's License numbers o One roster with EMT/Paramedic Certification numbers, driver's training verification and CPR/PALS/ACLS/etc. expiration dates — have been included in the packet. • Sub -contractor has also provided insurance proof of insurance that has been included in the packet. Furthermore, each party has agreed to indemnify the other for claims arising from that party's acts or omissions, subject to Colorado law. Contractual metrics insisted upon by the JFPD assure "an efficient, effective, and coordinated emergency medical response to residents of the county" (WCC, pg. 7-10, 2013). We thank you for your consideration. Sincerely, Ron Bateman, Fire Chief Johnstown Fire Protection District Page 2 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue Greeley, CO 80631 Web: www.weldhealth.ofg Health Administration Public Health & Clinical Environmental Health Vital Records Services Services Tele. 970 304 6410 Tel. 970 304 6420 Tele 970.304 6415 Fax' 970.304 6412 Fax. 970304.6416 Fax. 9703046411 Education & Pining Tel' 970 304 6470 Fax' 970.304 6452 Public Health Emergency Preparedness & Response Tele' 970 304.6420 Fax 970.304 6469 Our vision Together with the communities we serve, we are aorkrg to make Weld County the healthiest dace to kve. learn. work and pay AMBULANCE SERVICE LICENSE APPLICATION Date of application: 03/13O013 Name of Ambulance Service: Johnstown Fire Protection District Owner: Name: Johnstown Fire Protection District Address: 100 Telep Ave, Johnstown, CO 80534 Phone Number: 970-587-4477 Operations Manager: Name: OTC Bernie Covillo Address: _100 Telep Ave, Johnstown, CO 80534 Phone Number: _970-587-4477 Email: hco%illo'riiohnstuanfire.urg 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: Approved Recommended (Y/N): Date Referred to B.O.C.C.: / / Licensing Agent Page 3 Name and address of each stockholder of partner owning 10% or more of the outstanding stock of the company of having more than a 10% ownership interest (if applicable): N/A What area of Weld County will be served by this company? Please attach a map indicating the service area. JFPD-see attached map How many ambulances do you operate? 1 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: 100 Telep Ave City: Johnstown Location #2: Street Number: State: CO Phone: 970-587-4477 City: State: Phone: Medical Director: Name: M.D. Farstad, David Mailing Address: 1024 South Lemay Ave Ft. Collins, CO 80534 Phone Number: 970-495-8006 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 5 I HEREBY CERTIFY THAT I AM AUTHORIZED TO SUBMIT THE FORGOING APPLICATION AND 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. gnature of App cant Title raiv+� at�J/?J l �j Dae ' SCRIBED AND AFFIRMED BEFORE ME THIS 13 2to My ComNssico Wires 08(31/2889 (`CM , 20 1 3 , IN THE COUNTY OF , STATE OF COLORADO. Signature of Notary My Commission expires: 2 / 3 I / 20i 3 Page 6 AMBULANCE VEHICLE PERMIT LIST Name of Ambulance Service: _JFPD Application Year: 2013 Vehicle # Year: 2008 Make: Ford Model: F350 XLT 4 Wheel Drive (Y/N): _NManufacturers Identification Number (V.I.N.): I FDWF36R58EB25618 Colorado State License Number (Registration No.): 100UGR Motor Vehicle Chassis Number:_1 FDWF36R58EB25618 Registered with the State of Colorado as an emergency vehicle (Y/N): _Y 2672A Date Ambulance placed in service: 2008 Normal Location of Ambulance: _l00 Telep Ave. Johnstown, CO 80534 Vehicle # Year: Make: Model: 4 Wheel Drive (Y/N): Manufacturers Identification Number (V.I.N.): Colorado State License Number (Registration No.): Motor Vehicle Chassis Number: Registered with the State of Colorado as an emergency vehicle (Y/N): Date Ambulance placed in service: Normal Location of Ambulance: Vehicle # Year: Make: Model: 4 Wheel Drive (Y/N): Manufacturers Identification Number (V.I.N.): Colorado State License Number (Registration No.): Motor Vehicle Chassis Number: tegistered with the State of Colorado as an emergency vehicle (Y/N): Date Ambulance placed in service: Normal Location of Ambulance: verir Windsor -Severance Fire Rescue \ POIC.r , wtY FIIIU fxorrc7lon t V' lI rCr p Mill,... w'rr r � 1 • i N- i • .F. 1 \ ,r 5 �.• i r 4 SLly�f� '� • �`•} ailtill 1: i w '._. •'• ! • • ; _.. awns •wncno11e•srru• MI PRO Tacna. a:vac,' t . • LI ii iiii 'i �� i i! iiv fir►:—!•1i.� NUrilpi • Ji t ,IA t• i iffy i ' �..• o..ou4.rm • .urHM NeIRC7r0N II4I4 ; } i .r• _'girl\ �. ••y`'t. i I X41 t i 77.- • \1� 'FN. jiffs , I OP ID: SG A�'KU CERTIFICATE OF LIABILITY INSURANCE °"03/14/2013 03/14/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 970-686-7120 F&W Insurance 3005 Center Green Dr., Ste 120 Fax: 970-686-7131 Boulder, CO 80301 Dudley Locke N MEACT Sarejane R. Gomez, CIC FAX INC No. ExtL 970486-7120 ojc, yq: 970486-7131 E-MAIL ADDRESS: sgomez@vflsco.com PRODUCER JOHNSI5 CUSTOMER ID I INSURER(S) AFFORDING COVERAGE NAIC N INSURED Johnstown Fire Protection District 100 Telep Ave Johnstown, CO 80534 INSURER A : American Alternative Insurance - - WSURER B:Pinnacol Assurance 41190 INSURERC: INSURER D INSURER E: INSURER F : E NUM • THIS IS TO CERT. FY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO_ICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE .SSJED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH PO_ICIES LIMITS SHORAN MAY HAVE BEEN REDUCED BY PAID C_AIMS INSR LTR TYPE OF INSURANCE INSR SK DPOLICY NUMBER POLICY EFF POLICY IMMIDD/YYYYI IMM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE -PRrMSE5 S 1,000,000 A X Gov MERC AL 3ENERA_J4BLiY X VFIS-TR-2053280-05 05/01/2012 05/01/2013Ea FIT occurrence, 5 1,000,000 CLAIMS -MADE X CCC:.R MEDEXP;Any onepe'so^) S 10,000 PERSONAL &AD'✓ N.JRY $ 1,000,000 - GENERA_ AGGREGATE $ 3,000,000 GENL AGGREGATE _WI' APPLES PER PROD,,C'S- COMPIOP AGG 5 3,000,000 PO_ CY JEPROLOC S AUTOMOBILE LIABILITY COMB NED SINGLE _ M- A X AN'Y AL'O VFIS-TR-2053280-05 05101/2012 05/01/2013 !Ea accident) $ 1,000,000 BODI_Y INJLRY ,Pee person, A__ OWNED AJTOS 5 BOO -Y IN_ JRY Per a:acera) SCHEDJLEC PLTOS $ '— PROPERTY DAMAGE r REDAJTOS 'Pei acadenn 5 NON-0N'1EDAU-CS X UMBRELLA LIAB X OCGLP EACH OCCURRENCE 5 2,000,000 EXCESS LIAB CLAMS -MACE AGGREGATE A - - VFIS-TR-2053280-05 05101/2012 05/01/2013 5 4,000,000 • DEDJC' BLE $ X RE'EN•ION $ 5 WORKERSCOMPENSAnp! WCS'A- „B- AND EMPLOYERS LIABILITY YIN X TU TORY LIMITS �ER B ANY PROPRIETOR/PARTNER.EEEC..TIVE ^ 30155 01/01/2012 01/01/2013 E _ EACH ACC DEN OFF.CER/MEMBER EXCLUDED? NIA .. S 100,000 (Mandatory in NH) EL D.SEASE - EAEMPLO•EE If yes descnbe roe: 5 5 100,000 DESCRIPTION OF OPERA' ONS oe ow E L DISEASE - PG CY _ MIT 500,000 A Crime (Surety) X VFIS-TR-2053280-05 05/01/2012 05/01/2013 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule. if more space is required) 2008 Ford Ambulance VIN# 1FDWE36R58EB2561B, 2004 Dodge First Responder VIN# 1D7HU18D24S617775- The Certificate holder is named as an Additional Insured. Cancellation provision of (30) days. Professional Liability is included in the General Liability Coverage. CANCELLATION Weld County Board of County Commisioners 1400 17th Street Greeley, CO 80631 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1968-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD O N THIS CARD MUST BE KEPT IN THE INSURED VEHICLE AND PRESENTED UPON DEMAND C @ E o ui D U N 0 0 m c c W 0 3 0 0 ¢ U 15 c y m D o T W E OI J O C C 0 T U a C 0 CO O 0 a a o m - o E m c pco o c c •0 m 0co c @ a 0 3 al 0 o -o `o O 0 N 0 N 0 0 @ C Z = o` a� W - m M > o R D C O C C U@ 0 O D E E L W _ @ @ O co Z Z > O•N W a N N Q U c 0 Z m ACORD CORPORATION 2006-2007. ACORD 50 Co 120071031 COLORADO INSURANCE IDENTIFICATION CARD U CO to < y 0 0 w L. N i co L o o= W el y m ` LL� 0 aw !_ ° u O Z in >O p to c >' a i co m i, '" W _ C > ^ d C U Z .7 G O 2 c N u a > m W v C UO N c 2 0 y o m i of o N CL Ja° mw `Q m a °' y0 in in u 0 u > U O W E h a0 c a C OD €¢ w W �'o o .. 0 0 N D U O U W N c O zCY� O C.C F C p0 EIL ?@ 0 W�'' .C too= � 0to_i CU • n0 .--3 z F W - fn W S91n 6 ¢ p LL Co JpO O^N G > u N BLOC W? COMPANY NUMPFP THIS CARD MUST BE KEPT IN THE INSURED VEHICLE AND PRESENTED UPON DEMAND our Agent/Company as a ': c N co D E p 0 C C T N N p _ co 0 m p W - a a 0 m `o c @ c -O T @ 0) L c o a m E 0 3 ^ 0 o U Era co W W z t ° m c a > > W m N O _o c > 0 O @ p v ¢ a cu E E W n m @ O 1il Z Z > O - N an a co co) Q @ O c 0 Z w ACORD CORPORATION 2006-2007 ACORD 50 Co 12007/001 COLORADO INSURANCE IDENTIFICATION CARD K n a c b V V C0 cc a " N i i N 2 0 0 0 p .C. :CO -0 C u c w o XI o z 1 :0 zfri o L 0 c a t > Wa0 o m m to E > 0c U z a 4 c o it a 7. m � S z' ra o co o in ca W 1 W a m i `o, Q rc h W c O m N in N O it >V 0 0 W 5 00 ; a3 N- W mW on 0a Ira W O s in C 0 za7 0 Y�O a C c H 3 711 N 1.0 F❑ a�piU� .8 t.°17 fJ N 0'-0 0 K ONJy0 �O�� z F Y.C>OW o.. - 6 N 5 v ��''O�j �rc COMPANY NUMBI N UNIVERSITY of COLORADO HEALTH Weld County, Dept of Public Health and Environment 1555 North 17th Avenue Greeley, CO 80631 March 8, 2013 To Whom It May Concern: Pursuant to the requirements of Section 7-3-50 and 7-2-90 of the Weld County Ordinance, Poudre Valley Hospital Ambulance Service (owned and operated by Poudre Valley Hospital) attests to the following: • No employees of Poudre Valley Hospital Ambulance Service have had any criminal complaints or convictions, including Class I or II traffic violations within the past twelve (12) months. Each employee's criminal background check and motor vehicle records have occurred within 45 days of submittal of this app:ication. • Poudre Valley Hospital Ambulance Service has not had any judgments entered against us within the past twelve (12) months, including findings of fact, conclusions of law and order by any court or other tribunal. Sincerely, Brenda L Harstad, RN CHC Ethics/Compliance & Privacy Officer University of Colorado Health Susan Brown From: Sent: To: Subject: Susan Brown Tuesday, April 09, 2013 8:37 AM Susan Brown FW: Johnstown Fire Protection District From: Douglas Rademacher Sent: Monday, April 08, 2013 8:51 AM To: Monica Mika Subject: FW: Johnstown Fire Protection District Make this part of the record, thanks. Douglas Rademacher Commissioner 1150 O street PO Box 758 Greeley, CO 80632 970-356-4000x4207 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. From: Jimjfdeaol.com [mailto:Jimjfdeaol.com] Sent: Sunday, April 07, 2013 1:17 PM To: Mike Freeman; Douglas Rademacher; Barbara Kirkmeyer; Sean Conway; William Garcia Cc: ron bateman@icloud.com; Jimjfd@aol.com Subject: Johnstown Fire Protection District I have lived in Johnstown my entire life and am a 35 year member of Johnstown Fire Dept and JFPD Board of Directors. I have been involved several times over past asking for better and improved ambulance service to my community. Every time it has fallen on deaf ears. I had a personal occasion to use Weld County Ambulance in 2012, the staff that treated me was very good, however the wait seemed very long. I have herd several other stories of long waits and have worked to get better service for years. There for I urge all of you to work for the people of western Weld County and approve the EMS Council recommendation to approve UCH application for a tier 1 license. This needs to be accomplished in a very timely manner. Jim Young 1118 North 2nd Street Johnstown 1 Johnstown April 11, 2013 Weld County Board of Commissioners Commissioner William Garcia, Chairman Commissioner Doug Rademacher, Pro -Tern Commissioner Sean Conway Commissioner Mike Freeman Commissioner Barbara Kirkmeyer 1050 O Street Greeley, CO 80632 Re: Tier One Ambulance License Dear Board of Commissioners: RECEIVED APR 12 2013 WTY COMMISSIONERS I write this letter strongly encouraging you to vote in support of a Tier One Ambulance License for the Johnstown Fire Protection District. The rapidly growing population and the immense size of Weld County have stretched thin existing ambulance resources. The result has been lengthy response times for the citizens and guests of our community. In 2008, the Fitch and Associates Report identified the need to have an ambulance in the Johnstown/Milliken community. The JFPD has engaged in collaborative and responsible government with an innovative plan that will cut response times in half. Along with the recommendations of the EM/TS Council and the Medical Director, we ask that this letter be submitted as part of the official record (Weld County Code 7-2-100(B)(3)) to be considered by the Weld County Board of Commissioners. Thank you. Sincerely, "71'1/ Mark E. Romanowski, Mayor Town of Johnstown P.O. Box 609 101 Charlotte Johnstown, CO 80534 p: 970.587.4664 1: 970.587.0141 www.townofjohnstown.com Jennifer Fuller From: Diana Seele (dseele@townofjohnstown.com] Sent: Thursday, April 11, 2013 5:33 PM To: Jennifer Fuller Cc: Roy Lauricello Subject: Emailing: Letter from Mayor Mark Romanowski - Town of Johnstown Attachments: Letter from Mayor Mark Romanowski - Town of Johnstown.pdf Hello Jennifer, Attached please find a letter from Johnstown Mayor Mark Romanowski addressed to the Weld County Commissioners, Please forward this letter to Commissioners. Thank you for your time. Diana Seele, CMC Town Clerk 1 J ohnstown April 11, 2013 Weld County Board of Commissioners Commissioner William Garcia, Chairman Commissioner Doug Rademacher, Pro -Tern Commissioner Sean Conway Commissioner Mike Freeman Commissioner Barbara Kirlaneyer 1050 O Street Greeley, CO 80632 Re: Tier One Ambulance License Dear Board of Commissioners: I write this inter strongly encouraging you to vote in support of a Tier One Ambulance License for the Johnstown Fire Protection District. The rapidly growing population and the inmiense size of Weld County have stretched thin existing ambulance resources. The result has been lenuthy response nines for the citizens and Quests of our community. in 2008, the Fitch and Associates Report identified the need to have an ambulance in the Jo'nnstown/Milliken community. The JFPD has engaged in collaborative and responsible government with an innovative plat: that will out response times in half Along with the recommendations of the EM: 1. Council and the Medical Director, we ask that this letter be submitted as par: of the official record (Weld County Code 7-2-100(B)(3)) to be considered by the Weld County Board of Commissioners. Thank you. Mark E. Romanowskt, Mayor Town of Johnstown P.O. Box 609 101 Charlotte Johnstown, CO 80534 p: 970.587.4664 f: 970.587.0141 www.townofjah nstown. ca m Memorandum TO: Board of County Commission FROM: Dr. Mark Wallace DATE: April 10, 2013 SUBJECT: Johnstown Fire Protection District 2013 Application for EMS Services Johnstown Fire Protection District, located at 100 Isle Ave Johnstown, Johnstown, 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 March 20, 2013. The Council recommended (see attached) that. Johnstown Fire Protection District receive a Tier I license. EXHIBIT AMBULANCE SERVICES AGREEMENT / THIS AMBULANCE SERVICES AGREEMENT is entered into on January 26 2013, to be effective as of 120 days from the entrance into the agreement (the "Effective Date") by and between POUDRE VALLEY HEALTH CARE, INC. D/B/A POUDRE VALLEY HOSPITAL, a Colorado non-profit corporation ("PVH") and JOHNSTOWN FIRE PROTECTION DISTRICT, a Colorado Title 32 special district ("Johnstown"). A. PVHS is engaged in the business of operating Poudre Valley Hospital, an acute care hospital with its principal place of business at 1024 South Lemay Avenue, Fort Collins, Colorado (the "Hospital" or "PVH"). PVH provides emergency medical services at medical incidents to patients in Larimer and Weld Counties through its ambulance services. B. Johnstown has the authority under Colorado Secs 32-1-103(7), C.R.S. and 32-1- 1002(1)(e)(I), C.R.S. to provide for ambulance services to patients in its district. Pursuant to these statutes, Johnstown desires to contract with PVH for qualified personnel to provide emergency medical services as part of ambulance services ("Contract Services"). C. PVH has the staff and equipment to provide the requisite Contract Services to Johnstown. D. The parties desire to enter into this Agreement in order to provide a full statement of theft respective responsibilities in connection with the delivery of services from PVH to Johnstown. ACCORDINGLY, PVH and Johnstown agree to the following: 1. JOINT RESPONSIBILITIES 1.1 No Johnstown employee shall be deemed to be an employee of PVH, nor shall any employee of PVH be deemed to be an employee of Johnstown. 1.2. Both parties shall work collaboratively to ensure the most efficient use of the resources at the scenes of medical requests for services. Both agencies shall ensure that they work from a similar standard operating procedure with the goals of high quality and efficient patient care as well as safety of all responders. 1.3 Both parties shall work together to obtain and maintain current mutual aid agreements from surrounding agencies. 1.4 Both parties shall work in conjunction to ensure that customers receive the highest quality care and that patients are satisfied with such care. Both parties shall work towards quantifying levels of customer satisfaction. 2. PVH RESPONSIBILITIES 2.1 Vehicles: PVH agrees to transfer ownership of one ambulance and one command vehicle (see 2.1.1) to Johnstown. PVH agrees to pay for all maintenance on the vehicle for the remainder of the 2013 calendar year. As of January 1, 2014 all maintenance and any replacement costs for ambulances will be the sole responsibility of Johnstown. The balance of the extended warranty on the ambulance chassis will be transferred to Johnstown. In exchange for the transfer of Page 1 • ownership, PVH will receive crew quarters and bay space in the Johnstown fire station for the five year term of the agreement. 2.1.1 Med 14 2008 Ford F-350 XLT with Frazer Type I Generator Powered Module VIN- 1FDWF36R58EB25618, 2004 Dodge Ram 1500 Pick-up w/topper VIN- 1D7HU18D24S617775 2.2 Crew: PVH agrees to provide the following personnel to be deployed: 2.2.1 Standard Deployment Level 3 call: 2.2.1 (a) Windsor Station 1 (located at 100 N. 7'" Street) ALS Primary Response Ambulance 2.2.1 (b) Windsor Station 1- Single Resource Captain Ambulance 2.2.1 (c) Milliken Station (located at 101 S. Irene Ave) 1- ALS Primary Response Ambulance 2.2.2 Single Response Level 2 call: 2.2.2 (a) Either primary Ambulance responds to 911 call 2.2.2 (b) Windsor ALS Primary Response Ambulance flexes to open district (if initial call was in Milliken/Johnstown District). 2.2.3 Double Response Level 1 call: 2.2.3 (a) Remaining Ambulance will post in Iron Mountain Area 2.2.4 Triple Response 2.2.4 (a) Mutual Aid Agreement with PVH EMS (Fort Collins) or Thompson Valley EMS or Banner Northern Colorado Medical Center paramedic services. 2.2.5 Additional Resources to be Concerned: 2.2.5 (a) 40 hour supervisor (single response capability in a non -transport capable vehicle) 2.3 Response Area: The Response Areas for the Johnstown district shall be divided into three areas, the "Urban Response Area", the "Suburban Response Area" and the "Rural Response Area". The Urban Response Area is defined as the area encompassed by North by WCR 52, East by the border between Johnstown and Milliken Fire Protection District (approx. HWY 257), South by WCR 42, and West by WCR 13 and 1-25. The Suburban Response Area is defined as Northmoor Area and includes the area encompassed by North by WCR 44, East by WCR 13, South by WCR 42, by West WCR 11 and the area West of 1-25 within the Johnstown Fire Protection District, including the Gateway Industrial Development. The Rural Response Area is considered all areas not defined by The Urban Response Area and The Suburban Response Area but in the Johnstown district. Areas within the Johnstown FPD that lie within the Thompson Valley EMS district shall not be included in the defined response area. 2.4 Response Time Expectations: Response Time is defined as the time period between when the ambulance first gained enough information to respond (i.e. dispatch time) and the time a properly equipped and staffed unit arrives at the scene defined as "wheels stopped". PVH agrees that the Response Time for the Urban Response Area shall be eight minutes and fifty-nine seconds (8:59) or less in ninety percent (90%) of Emergent Calls. Emergent calls are defined as calls as defined by Emergency Medical Dispatch Protocols; i.e. Echo, Delta, Charlie or Emergency Medical Dispatch Designation. PVH agrees that the Response Time for the Suburban Response Area shall be eleven minute and fifty-nine seconds (11:59) Page 2 a or less in ninety percent (90%) of Emergent Calls. PVH agrees that the Response Time for the Rural Response Area shall be nineteen minutes and fifty-nine seconds or less in ninety percent (90%) of Emergent Calls. In the event of a Concurrent Response, defined as any additional call for service while the primary ALS ambulance is assigned to a request for service or released up till 15 minutes after arrival at a receiving facility if transported. 2.5 Exemption to Response Times: If the Response Times exceed the defined Response Times in Section 2.4, PVH may apply for a Concurrent or Surge Exemption and it will be granted if PVH can demonstrate: 2.5.1 It meets the definition of a Concurrent Request 2.5.2 There are no lost unit hours during the timed period 2.5.3 Time on Task at receiving facility does not exceed agreed terms. Time on task includes all time from dispatch up to 15 minutes after arrival at a receiving facility if trasported as defined in section 2.7. 2.5.4 The Deployment Plan was followed. Deployment plan shall adjusted by representatives of Johnstown and PVH as necessary. 2.5.5 There were no routing delays 2.5.6 PVH can demonstrate a continuing effort to mitigate late responses. 2.6 Weather and other exemptions to Response Times: A blanket exemption may be granted by the Fire Chief or his/her delegate for the following: 2.6.1 Individual Weather Exemption: May be requested by the crews responding on the basis of road/weather conditions (i.e. poor visibility or icy roads, etc.). This request must be made by the crew to the dispatch services. 2.6.2 Train or other unexpected road closure. 2.6.3 Bad address or other inaccurate dispatch information out of the control of the responding crew. 2.7 Time on Task: PVH shall complete patient turnover and ambulance clean/restock within fifteen (15) minutes and be en -route back to its assigned district. This time on task may be extended depending on extenuating circumstances (i.e. Full Trauma Teams, Cardiac Arrest, etc...) Crew will detail this information. 2.8 Education: PVH agrees to provide continuing medical education (CME) to the staff at Johnstown. Topics will include all CME required to complete the National Registry recertification. PVH agrees to provide the following courses; Pre -Hospital Trauma Life Support, Pediatric Education for Pre -Hospital Professionals, and Advanced Medical Life Support thru UCH clinical Education Department; course tuition for all classes will be covered by the Northeast RETAC provided funds are available. 2.8.1 All PVH EMS Personnel assigned to Johnstown will maintain Colorado Department of Public Health and Environment Certification, National Registry Certification as well as Pre -Hospital Trauma Life Support, Advanced Medical Life Support and Pediatric Advanced Life Support or equivalent course within 1 year. 2.9 Make available PVH Ambulance Driver Training to Fire Personnel. 2.10 National Registry Affiliation: Johnstown employees who maintain National Registry certification will be encouraged to affiliate with PVH EMS to ease the process of recertification. Page 3 • 2.11 Key Performance Indicators: PVH agrees to comply with the Key Performance Indicators as described on Exhibit A attached and incorporated into this Agreement. 2.12 Quality Assurance and Quality Indicators: PVH shall conduct regular Quality Assurance of EMS Patient Care Reports. PVH will also conduct frequent After Action Reports to improve continuity of patient care. PVH shall conduct targeted reviews of certain call types across the service areas based on services provided (i.e. spinal immobilization, pain management, etc.) These reviews will be used to ensure that care delivered to Johnstown meets and exceeds nationally accepted benchmarks. 2.13 Medical Supplies: PVH shall provide durable medical equipment for each ambulance under this Agreement. The durable medical equipment to be Examples of equipment provided includes: (I) cot, (ii) monitor/defibrillator, (Hi) stair chair, (iv) suction, (v) split boards, (vi) road safety driver monitoring system, (vii) laptop to be used for Computer Aided Dispatch (CAD) purposes and any other durable medical equipment required by state, county or local statutes. PVH shall provide disposable medical supplies used by Johnstown on calls for service to include any disposable supply, which is currently stocked on the ambulance. PVH shall provide medical oxygen used on calls for service. PVH shall insure oxygen cylinders will be delivered to stations where PVH crews are quartered and PVH crews shall trade out empty cylinders with Johnstown crews. 2.14 Crew Station Duties: PVH agrees to insure that the crew performs the station duties as a member of the team and as a resident of the station. The PVH EMS Captain shall insure that the EMS crew completes all duties. 2.15 Communications. PVH shall purchase and maintain 800mHz pack -sets for each ambulance. Serious communications issues shall be identified by the oversight committee and addressed. 2.16 Fuel for Vehicles. PVH is responsible for fuel necessary to operate vehicles deeded by PVH to Johnstown for the duration of the agreement. 2.17 PVH shall provide a Certificate of Insurance to Johnstown upon request. The Certificate of Insurance shall provide proof of: a. general liability; General liability coverage shall be for not less than $1,000,000 (one million dollars) per occurrence and $3,000,000 (three million dollars) per aggregate. PVH employees are not entitled to Worker's Compensation benefits from Johnstown. 2.18 PVH shall abide by the terms of the Business Associate Agreement as attached and incorporated herein as Exhibit B. 2.19 PVH personnel assigned to Johnstown shall respond in Johnstown's ambulance to the scene of a medical incident as directed by either Johnstown or a dispatch center. If patient transport is warranted, PVH personnel shall operate Johnstown's ambulance to effect such transport. Johnstown personnel shall normally not be utilized as ambulance attendants or drivers except when unusual circumstances warrant such duties. Page 4 3. JOHNSTOWN RESPONSIBILITIES 3.1 Performance problems of PVH employees placed with Johnstown will be documented and reported to PVH immediately. 3.2 Johnstown shall be responsible for providing suitable living and workspaces at their station as well as bay space for parking the ambulance. These include, equipment, furniture, connectivity, phone, etc. The parties agree to work together to provide connectivity to the PVH Intranet or other network connectivity. 3.3 Johnstown shall ensure PVH has an 800mHz letter of permission to operate on their channel as well as appropriate dispatch software installed on each ambulance laptop. 4. INDEMNIFICATION 4.1 Johnstown agrees to indemnify, defend, and hold harmless PVH from and against any and all claims, judgments, costs, liabilities, damages, and expenses, including attorney fees whatsoever arising from any acts or omissions in the provision of services by Johnstown under this Agreement. 4.2 PVH agrees to indemnify, defend, and hold harmless Johnstown from and against any and all claims, judgments, costs, liabilities, damages, and expenses, including attorney fees whatsoever arising from any acts or omissions in the provision of services by PVH's employees under this Agreement. 5. PAYMENT AND BILLING. Beginning on the Effective Date, PVH agrees to pay Johnstown twenty four cents ($0.24) per mile, payable annually. 6. TERM AND TERMINATION 6.1 The term of this Agreement shall be from the Effective Date through December 31, 2018. 6.2 This Agreement may be terminated without cause by PVH or Johnstown upon 30 (thirty) days written notice of termination to the other party. 6.3 Johnstown may terminate this agreement immediately when quality of care or patient safety is deemed by Johnstown to be at unreasonable risk due to acts or omissions by PVH. 6.4 This Agreement may not be assigned, delegated or transferred by either party without the written consent of the other. 6.5 This Agreement may not be modified, except by written agreement executed by the Parties, provided if PVH deems modification necessary to comply with IRS requirements, 42 U.S.C. 1320a -7b or 42 U.S.C. 1395nn or other applicable laws, Page 5 w PVH may modify this Agreement to the extent necessary to comply with the applicable law. 7. REGULATORY COMPLIANCE 7.1 OBLIGATION SUBJECT TO ANNUAL APPROPRIATION. In so far as the financial obligations of the District as contained herein may be deemed to be multi -year financial obligations under Article X, Section 20 of the Colorado Constitution, such obligations shall be subject to annual appropriation of funds by the Johnstown governing board. Notwithstanding anything herein to the contrary, in the event of non -appropriation, Johnstown shall have the right to terminate this Agreement at the end of its then current fiscal year without penalty or other legal consequence. Notice of such intended non -appropriation shall be given by Johnstown at the earliest possible point in time during the preparation of its annual budget for the ensuing fiscal year, but in no event less than December 1 of the then current fiscal year. 7.2 In performing this Agreement, the parties agree to comply with all applicable state and federal laws. This Agreement shall be construed in accordance with the laws of the State of Colorado. 8. Independent Contractor Relationship 8.1 In performance of this Agreement, it is mutually understood and agreed that the PVH is at all times acting and performing as an independent contractor for the contract services. PVH will determine the method, and means of performing the Contract Services. The sole interest and responsibility of Johnstown is to ensure that the Contract Services shall be in accordance with applicable law, recognized standards of professional practice and the terms of this Agreement. 8.2 PVH shall have the right to perform the Contract Services for individuals or entities other than Johnstown during the term of this Agreement. 9. Access to Documentation For the purpose of implementing Section 1861 (v)(1)(I) of the Social Security Act, as amended, and any written regulations thereto, Johnstown agrees to comply with statutory requirements governing the maintenance of documents to verify the cost of services rendered under this Agreement as follows: 9.1 Until the expiration of four years after the furnishing of such services pursuant to this Agreement, Johnstown shall make available, upon written request to PVH and/or the Secretary of Health and Human Services, or upon request to the Comptroller General, or any of their duly authorized representatives, the contracts, books, documents and records of such Johnstown that are necessary to certify the nature and extent of such costs, and; 10. Notice All notices and other communications that either party may desire or may be required to deliver to the other party may be delivered in person or by depositing the same in the Page 6 United States mail, postage prepaid, certified or registered mail, or by electronic facsimile, addressed or delivered as follows: If to PVHS: Attention: President/CEO Poudre Valley Hospital 1024 South Lemay Avenue Fort Collins, CO 80524 FAX (970) 495-7663 If to Johnstown: Fire District: Johnstown Fire Protection District Attn: Fire Chief 100 Telep Johnstown, CO 80534 With a copy to: PVHS Legal Department 2315 E. Harmony Rd., Ste. 200 Fort Collins, CO 80528 Fax: (970) 237-7094 Either party may change the address to which notices are to be delivered by giving notice herein provided. Any notice shall be deemed to have been given if hand delivered or sent by electronic facsimile, as of the date delivered or transmitted, or if mailed as provided herein, on the third day after mailing. 11. Governing Law This Agreement shall be governed by and construed under the laws of the State of Colorado. 12. Modification and Waiver This Agreement can be amended only with a written agreement executed by the parties at the time of the modification. No breach of any provision hereof can be waived unless in writing. Waiver of any one breach of any provision hereof shall not be deemed a waiver of any other breach of the same or any other provision hereof. 13. Severability If any one or more of the terms, provisions, promises, covenants or conditions of the Agreement or the application thereof to any person or circumstance shall be adjudged to any extent invalid, unenforceable, void or voidable for any reason whatsoever, by a court of competent jurisdiction, or shall be determined by the ruling or interpretations of a Governmental agency or new legislation, to cause either party to perform an act which threatens its governmental provider or tax status, then such terms shall be deemed stricken from this agreement, and each and all of the remaining terms, provisions, promises, covenants and conditions of this Agreement or their application to other persons or circumstances shall not be affected thereby and shall be valid and enforceable to the fullest extent permitted by law. Notwithstanding the aforesaid, should the severance have the effect of materially altering the meaning of this Agreement, this Agreement shall be void. 14. Interpretation Page 7 No provision in this Agreement is to be interpreted for or against any party because that party or that party's legal representative drafted such provision. 15. Disclosure Neither party to this Agreement will disclose to anyone, without the other party's prior written permission, the nature or content of any oral or written communication, or any information gained from the inspection of any record(s) or document(s) submitted to each party under this Agreement, including the terms of this Agreement, information obtained from corporate or personal records or documents; and neither party will permit inspection of any papers or documents related to this engagement without the other party's prior written consent. 16. Assignment Neither party may assign this Agreement without the prior written consent of the other party. 17. Entire Agreement This Agreement embodies the entire agreement and understanding between the parties with respect to the subject matter of this Agreement and supersedes all prior and contemporaneous oral and written agreements with respect hereto. Page 8 IN WITNESS HEREOF, the Parties have caused this Agreement to be executed by their authorized officers as evidenced by their signatures below. For "Johnstown": By: Date: TAX/SS ID Number: (Please provide W-9; this document can be found at http://www.irs.gov/Dub/irs-pdf/fw9.pdf) State of Colorado City of id-) nn County of COO., C\ The foregoing instrument was acknowledged before me on this day of, 1 ____ r (name). (Notary Seal) (Commission Expiration Date) FOR POUDRE VALLEY HEALTH CARE, INC. D/B/P POLJ.QREVALLEY HOSPITAL By:f,flc 1_L(�� vin Un , F' ACHE, President/CEO u V Iley Hospital Date State of Col ado Cityof ' COlhi) S County of „C. Y; S ;✓ The foregoing instrument was acknowledged before me on this °`! D day of S X201)ty Cv L) c ( (name). 2013 by (Commission Expiration Date) ;1+0 K' (Notary Seal) My Commission Expires 08/31 Page 9 EXHIBIT A Key Performance Indicators Key Performance Indicators (KPI) will be reported to an oversight board on a monthly basis and annual basis, KPIs to be reported shall include: Requests for Service: A report outlining requests for service, sorted by call type Response Times: see Section 2.4 and 2.5 for specific standards Destination Report: A report outlining Hospital Destinations Training: A report of ali education and training provided to the Johnstown staff. After Action Reports: A report of all after actions reports conducted by PVH crew and Johnstown staff. Additional Activities: A report of additional activities to include; Fire Standbys, Community Paramedicine Activities, Special Event Coverage, etc Average Call Costs: A report of geographically adjusted call costs will be presented. Communications: Communication issues Page 10 EXHIBIT B BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ("Agreement") is effective this 15th day of May 2013 ("Effective Date"), by and between JOHNSTOWN FIRE PROTECTION DISTRICT ("JOHNSTOWN") and POUDRE VALLEY HEALTH CARE, INC., D/B/A POUDRE VALLEY HOSPITAL a Colorado non-profit corporation ("Business Associate"). RECITALS WHEREAS, the parties have executed an agreement or agreements whereby Business Associate provides independent contractor services to JOHNSTOWN, and Business Associate receives, has access to or is subject to the federal regulations issued pursuant to the Health Insurance Portability and Accountability Act ("HIPAA") and codified at 45 C.F.R. parts 160 and 164 ("HIPAA Rules"); WHEREAS, the HIPAA Rules require JOHNSTOWN to enter into a contract with Business Associate in order to mandate certain protections for the privacy and security of Health Information, and those Regulations prohibit the disclosure to or use of Health Information by Business Associate if such a contract is not in place; WHEREAS, Business Associate acknowledges that effective January 1, 2010, as a business associate, it is responsible to comply with the HIPAA Security and Privacy regulations pursuant to Subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH), including Sections 164.308, 164.310, 164.312 and 164.316 of title 45 of the Code of Federal Regulations. NOW, THEREFORE, in consideration of the foregoing, and for other good and valuable consideration, the receipt and adequacy of which is hereby acknowledged, the parties agree as follows: DEFINITIONS 1.1 "Disclose" and "Disclosure" mean, with respect to Health Information, the release, transfer, provision of access to, or divulging in any other manner of Health Information outside Business Associate's internal operations or to other than its employees. 1.2 "Health Information" means information that (i) relates to the past, present or future physical or mental health or condition of an individual; the provision of health care to an individual, or the past, present or future payment for the provision of health care to an individual; (ii) identifies the individual (or for which there is a reasonable basis for believing that the information can be used to identify the individual); and (iii) is received by Business Associate from or on behalf of JOHNSTOWN, or is created by Business Associate, or is made accessible to Business Associate by JOHNSTOWN. 1.3 "Individually Identifiable Health Information" shall mean information that can be used to identify the individual, such as a name or social security number. 1.4 "Protected Health Information" shall mean Health Information and Individually Identifiable Health Information in any medium whether electronic or otherwise. Page 11 1.5 "Security Incident" shall mean the attempted or successful unauthorized access, use disclosure, modification, or destruction of information or interference with system operations in an information system. 1.6 "Security Rules" shall mean the security standards for the protection of electronic protected health information at 45 CFR Part 164, Subpart C and amendments thereto. 1.7 "Services' has the same meaning as in the Services Agreement. 1.8 "Use" or "Uses" mean, with respect to Health Information, the sharing, employment, application, utilization, examination or analysis of such Information within Business Associate's internal operations. 1.9 All capitalized terms not defined in this section shall have the meanings ascribed to them in 45 C.F.R. Part 160 and Part 164, subparts A and E pursuant to the Health Insurance Portability and Accountability Act of 1996. OBLIGATIONS OF BUSINESS ASSOCIATE 2.1 Permitted Uses and Disclosures of Health Information. Unless otherwise specifically provided in this Agreement or authorized in writing by JOHNSTOWN, and except as required or permitted by law, Business Associate hereby agrees (a) to keep all PHI confidential and in its possession except as necessary to provide the services under the Services Agreement; (b) to restrict access to PHI to those employees of Business Associate or other workforce members under the control of Business Associate who are actively and directly participating in providing the Services and who need to know such information in order to fulfill such responsibilities ("Business Associate Representatives"); (c) not to copy or duplicate any PHI except as necessary to provide the services under the Services Agreement; (d) to treat any and all copies of, and notes, memoranda, analyses, compilations, abstracts, synopses, studies of other material produced from PHI as PHI; (e) to communicate only with the authorized representatives of PVHS concerning PHI; (f) not to use any PHI for any purpose other than the purpose for which such PHI was provided in connection with providing the services under the Services Agreement; and (g) not to use PHI in any manner that would violate the HIPAA Rules if JOHNSTOWN were providing the services under the Services Agreement or in any other manner that may be detrimental to JOHNSTOWN. 2.2 Uses and Disclosures of PHI for Business Associate Operations. Business Associate may use PHI, if necessary, for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate. Business Associate may disclose PHI for its proper management and administration or to carry out its legal responsibilities if the disclosure is required by law, or if Business Associate obtains reasonable written assurances from the Person to whom PHI will be disclosed that: (a) PHI will be held confidentially and used or further disclosed only for the purpose for which it was disclosed to such Person or only as required by law; and (b) such Person will notify Business Associate of any instances of which it becomes aware in which the confidentiality of PHI was breached. 2.3 Adequate Safeguards for Health Information. Business Associate warrants that it shall implement and maintain appropriate administrative, physical and technical safeguards in compliance with the HIPAA Rules and any other relevant laws or regulations to prevent the Use or Page 12 Disclosure of Health Information in electronic or any other form that it creates, receives, maintains or transmits under this Agreement, in any manner other than as permitted by this Agreement. 2.4 Reporting Non -Permitted Use or Disclosure. Business Associate shall report to JOHNSTOWN each Use or Disclosure that is made by Business Associate, its employees, representatives, agents or subcontractors that is not specifically permitted by this Agreement, including any Security Incident involving Health Information as required by the Security Rules. The initial report shall be made by telephone call to the appropriate representative at JOHNSTOWN within forty-eight (48) hours from the time the Business Associate becomes aware of the non -permitted Use or Disclosure, followed by a full written report to the Privacy Officer no later than ten (10) business days from the date the Business Associate becomes aware of the non -permitted Use or Disclosure. Business Associate shall take (i) prompt corrective action to cure any such deficiencies and (ii) any action pertaining to such unauthorized disclosure required by applicable federal and state laws and regulations. 2.5 Business Associate's Notification. Business Associate's notification to JOHNSTOWN pursuant to Section 2.4 of this Agreement shall include the following: • Identification of the nature of the non -permitted use or disclosure of other breach; • Identification of the PHI used, accessed or disclosed; • Identification of who made the non -permitted use or received the non -permitted disclosure; • Identification of what corrective action Business Associate took or will take to prevent further non -permitted uses or disclosures; • Identification of what Business Associate did or will do to mitigate any negative effect of the non -permitted use or disclosure; and • Provide such other information, including a written report, as JOHNSTOWN may reasonably request. 2.6 Sub -Contractors and Agents. Business Associate will ensure that any and all Persons who have access to PHI by or through Business Associate, including (without limitation) the Business Associate Representatives, agrees to the same restrictions and conditions that apply to Business Associate hereunder. 2.7. Availability of Internal Practices, Books and Records to Government Agencies. Business Associate agrees to make its internal practices, books and records relating to the Use and Disclosure of Health Information available to the Secretary of the federal Department of Health and Human Services (the "Secretary") for purposes of determining JOHNSTOWN's compliance with the HIPAA Rules. Business Associate shall immediately notify JOHNSTOWN of any requests made by the Secretary and provide JOHNSTOWN with copies of any documents produced in response to such request. 2.8. Access to and Amendment of Health Information. Business Associate shall, to the extent JOHNSTOWN determines that any Health Information constitutes a "designated record set" under the HIPAA Rules, (a) make the Health information specified by JOHNSTOWN available to the individual(s) identified by JOHNSTOWN as being entitled to access and copy that Health Information, and (b) make any amendments to Health Information that are requested by JOHNSTOWN. Business Associate shall provide such access and make such amendments within the time and in the manner specified by JOHNSTOWN. Page 13 2.9 Accounting of Disclosures. Upon JOHNSTOWN's request, Business Associate shall provide to JOHNSTOWN an accounting of each Disclosure of Health Information made by Business Associate or its employees, agents, representatives or subcontractors ("Disclosure"). Any accounting provided by Business Associate under this Section 2.9 shall include: (a) the date of the Disclosure; (b) the name, and address if known, of the entity or person who received the Health Information; (c) a brief description of the Health Information disclosed; and (d) a brief statement of the purpose of the Disclosure. For each Disclosure that could require an accounting under this Section 2.9, Business Associate shall document the information specified in (a) through (d), above, and shall securely maintain that documentation for six (6) years from the date of the Disclosure. 2.10 Availability for Audit. Business Associate shall make its internal practices, books, and records relating to the Use and Disclosure of PHI received from JOHNSTOWN, or created or received by Business Associate on behalf of JOHNSTOWN available to the Secretary for purposes of the Secretary determining JOHNSTOWN's compliance with the Privacy Rule. In the event that Business Associate is requested by the Secretary to make available its books, records and documents relating to JOHNSTOWN compliance with the Privacy Rule, Business Associate will, to the extent not prohibited by law, notify JOHNSTOWN within 2 business days. 2.11 Obligation of JOHNSTOWN. JOHNSTOWN shall notify Business Associate of any current or future restrictions or limitations on the use of Health Information that would affect Business Associate's performance of the Services, and Business Associate shall thereafter restrict or limit its own uses and disclosures accordingly. 2.12. Security Standards. Business Associate will: (a) Implement administrative, physical and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of electronic PHI that it creates, receives, maintains, or transmits on behalf of JOHNSTOWN. (b) Ensure that any agent, including a subcontractor, to whom Business Associate provides such electronic PHI agrees to implement reasonable and appropriate safeguards to protect it; and (c) Report to JOHNSTOWN any security incident affecting JOHNSTOWN of which Business Associate becomes aware in accordance with the Security Rules. 2.13. Notification of Breach of Unsecured Protected Health Information. Business Associate will: (a) Except as provided in 45 C.F.P,. § 164.412, report immediately to PVHS after it becomes aware of any Breach of Unsecured Protected Health Information and promptly provide to JOHNSTOWN (i) a list of all Individuals whose Unsecured Protected Health Information has been, or is reasonably believed by the Business Associate to have been, accessed, acquired, used, or disclosed during the Breach, and (ii) any other available information that JOHNSTOWN is required to include in notifications to such Individuals pursuant to 45 C.F.R. § 164.404(c); and (b) Cooperate with JOHNSTOWN in making any requisite notifications to Individuals and the Secretary as a result of any Breach of Unsecured Protected Health Information, including paying for the cost of notification to Individuals, and of media notification if the legal requirements for media notification are triggered by the circumstances of such breach, provided that Business Associate shall not initiate any such notifications without approval of JOHNSTOWN. Page 14 2.14 Term and Termination. The term of this Agreement shall be the same as the term of the Services Agreement. In addition to and notwithstanding the termination provisions set forth in the Services Agreement, both this Agreement and the Services Agreement may be terminated immediately upon written notice by JOHNSTOWN to Business Associate if JOHNSTOWN determines, in its sole discretion, that Business Associate has violated any material term of this Agreement or any provision of the Privacy Standards or Security Standards or applicable federal or state privacy law relating to the obligations of Business Associate under this Agreement. Business Associate's obligations under Sections 2.1 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.10, 2.12, and 2.13 shall survive the termination or expiration of this Agreement. 2.15. Disposition of Health Information Upon Termination or Expiration. Upon termination or expiration of this Agreement and the Services Agreement, Business Associate shall either return or destroy, in JOHNSTOWN's sole discretion and in accordance with any instructions by JOHNSTOWN, all Health Information in the possession or control of Business Associate or its agents and subcontractors. However, if Business Associate determines that neither return nor destruction of Health Information is feasible and notifies JOHNSTOWN in writing of that determination, Business Associate may retain Health Information provided that Business Associate (a) continues to comply with the provisions of this Agreement for as long as it retains Health Information, and (b) further limits Uses and Disclosures of Health Information to those purposes that make its return or destruction unfeasible. Upon termination or expiration of this Agreement, Business Associate will give to JOHNSTOWN copies of all documents in Business Associate's possession or control that are required to be maintained by or on behalf of JOHNSTOWN by the HIPAA Rules or the Security Rules other than what Business Associate is permitted or required by law to retain. 2.16. No Third Party Beneficiaries. There are no third party beneficiaries to this Agreement. 2.17. Use of Subcontractors and Agents. Business Associate shall require each of its agents and subcontractors that receive Health Information from Business Associate to execute a written agreement obligating the agent or subcontractor to comply with all the terms of this Agreement, including appropriate and comparable safeguards, as defined in Section 2, above. 2.18. Relationship to Services Agreement Provisions. In the event that a provision of this Agreement is contrary to a provision of the Services Agreement, the provision of this Agreement shall control. Otherwise, this Agreement shall be construed under, and in accordance with, the terms of the Services Agreement. 2.19 Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning that permits JOHNSTOWN to comply with the HIPAA Rules. 2.20 Amendment. The parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for JOHNSTOWN to comply with the requirements of the HIPAA Rules. 2.21 Waivers. No delay or omission by JOHNSTOWN in exercising any rights or remedies under this Agreement or applicable law shall impair such right or remedy or be construed as a waiver of any such right or remedy. Any single or partial exercise of a right or remedy shall not preclude further exercise of that right or remedy or the exercise of any other right or remedy. No waiver shall be valid unless in writing signed by the party to be bound. Page 15 Forth W-9 (Rev. December2011) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. Name as shown on your income tax return) Johnstown Fire Protection District Business name/disregarded entity name, ii different from above Check appropriate box for federal tax classification: f Exempt payee II IndividuaVsole proprietor ❑ C Corporation si S Corporation E Partnership ❑ Trust/estale ❑ Limited liability company. Enter the tax classification(C-C corporation, S=5 corporation,:J po P=Pannership)� IF Fire Protection District O Other (see instructions) Address (number, street, and apt. or suite no.) 100 Telep Ave. Requester's name and address (optional) City. state, and ZIP code Johnstown, CO 80534 List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line to avoid backup withholding. For individuals, this is your social security number (SSW). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Social security number Employer identification number 8 4 0 8 9 8 6 5 2 Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S. person,. General Instructio Date S. 6 - o/5 Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Note. It a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form it it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person it you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presuntCtat a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No. 10231X Form W-9 (Rev. 12-2011) Johnstown Fire Protection District P.O. Box 979 • 100 Telep Street • Johnstown, Colorado 80534 Telephone: (970) 587-4477 • Emergency 911 TO THE WELD COUNTY COMMISSIONERS: I HAVE BEEN A VOLUNTEER FIREFIGHTER AND BOARD MEMBER WITH THE JOHNSTOWN FIRE DISTRICT FROM 1971 TO PRESENT. I WOULD LIKE THE COMMISSIONERS TO KNOW THAT FIRE DEPARTMENTS WERE ASKED IN THE LATE 7O'S OR EARLY 80'S IF WE COULD HELP WITH WELD COUNTY HOSPITAL/ AMBULANCE SERVICE WITH ACCIDENT AND MEDICAL CALLS IN THE RURAL AREAS. THE FIRE BOARD APPROVED BUYING A TRUCK WITH AN AMBULANCE TYPE BODY TO SERVE THE JOHNSTOWN AND MILLIKEN AREA. IN THOSE DAYS WE WERE ASKED TO DRIVE OR HELP SUPPORT LIFE WHILE THE AMBULANCE WENT TO THE HOSPITAL. THIS CHANGED OUR FIRE DEPARMENT'S CHARTER FROM FIRE FIGHTING TO ALSO PROVIDING EMERGENCY MEDICAL NEEDS. IN ORDER TO SUPPORT THE NEEDS OF THE GROWING COMMUNITIES WE HAVE ADVANCED FROM FIRST AID OF THE 70'S AND 80'S TO TODAY'S EMT'S AND PARAMEDIC'S. IN 1998 JOHNSTOWN FIRE DISTRICT BUILT A NEW FIRE STATION WITH A SPECIAL TRUCK BAY WITH ELECTRICAL SHORE LINE FOR WELD AMBULANCE. IN 2010, JOHNSTOWN AND MILLIKEN FIRE BOARDS MET WITH COUNTY COMMISSIONER KIRKMEYER AND THE SUPERVISOR OF WELD COUNTY AMBULANCE TO DISCUSS THE NEED FOR BETTER AMBULANCE RESPONSE IN OUR FIRE DISTRICTS WITH NO RESOLUTION . IN 2009 I HAD WHAT IS CALLED A- FIBULATION FROM PREVIOUS HEART SURGERY. MY PULSE WAS 150 BEATS A MINUTE; I HAVE A MECHANICAL HEART VALVE AND AM CONSIDERED A VERY HIGH RISK. IT TOOK 45 MINUTES TO GET AN AMBULANCE WHILE FIREFIGHTERS MONITORED MY CONDITION. I AM ASKING YOU TO VOTE YES ON THE NEEDS OF OUR FIRE DISTRICTS AND SURROUNDING AREAS. THANK YOU FOR YOUR CONSIDERATION. LARRY WEBER JOHNSTOWN FIRE PROTECTION TREASURER re for 1st Quarter 2013 VCAS C/D/E Response Times in Johnstown Fi RESPONSE TIME 00 @99gPR222m2mmm�2�mm2Rmm��m2mm�mm�22mm OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO co 00c=o,-1-nn#Tr�#n-mnIr@@oocorrrrrr0000 2 0 ° 0 0 0 0 0 0: O e w= O 0 O=(/ z Lij o O o= o o O O c O o O o O o O o o= . BACK IN SERVICE en CV N. 1/412013 21:33:00 3/2/2013 19:48:00 1 O N § 2/17/2013 14:59:11 1 c § 2/1/2013 09:44:23 1 3 3/16/2013 20:21:00 3/3/2013 10:51:00 3/12/2013 05:04:00 I = CV y 1122/2013 21:09:00 1 2/28/2013 22:09:54 \ g §o 2 I 1/4/2013 05:52:00 O 2 3/15/2013 21:44:00 1 3/22/2013 19:40:00 2 2/7/2013 11:06:00 1 1/23/2013 17:25:00 CO 2 CI ,,,,-..F.' 3/7/2013 16:28:14 2/17/2013 12:47:00 2/6/2013 01:51:00 1/22/2013 14:06:00 3/212013 22:37:00 2/12/2013 10:54:00 2/25/2013 17:02:00 3/27/2013 09:13:00 1/1/2013 01:42:00 0 CD S 1 2/14/2013 11:22:00 ARRIVE 1/17/2013 20:39:00 1/4/2013 20:51:00 { 3/2/2013 18:42:00 2/28/2013 13:09:441 2/17/2013 14:49:03 2/12/2013 14:21:001 2/1/2013 09:28:541 3/16/2013 20:10:461 3/3/2013 10:18:001 3/12/2013 04-39:001 1/1/2013 20:33:00 1/20/2013 13:02:001 1/22/2013 20:58:001 2/28/2013 21:49:55 § § 1/4/2013 05:32:00 1/6/2013 12:09:001 3/15/2013 21:32:00 3/22/2013 19:27:00 1122/2013 01:00:00 2/7/2013 10:51:00 1/23/2013 17:09:00 2/26/2013 08:32:00 3/3/2013 08:27:00 3/7/2013 16:13:18 2/17/2013 12:36:00 5.0 1/22/2013 13:15:00 3/2/2013 22:18:00 2/12/2013 10:00:00 § N. 1 1/1/2013 01:26:00 CD 1 2/14/2013 10:28.00 DISPATCH 1/17/2013 20.35.00 1/4/2013 20:44:00 3/2/2013 18:34:00 § 2/17/2013 14:40:08 1 . 2/4/2013 15:40:04 3/16/2013 19:59:00 3/3/2013 10:05:00 3/12/2013 04:25:59 1/1/2013 20:19:00 I 1/22/2013 20:44:00 2/28/2013 21:35:44 3/26/2013 10:33:00 3/28/201312:05:00 1/4/2013 05:17:00 1/6/2013 11:54:00 3/15/2013 21:17:00 3/22/2013 19:12:00 1/22/2013 00:44:00 2/7/2013 10:35:00 1/23/2013 16:53:00 2/26/2013 08:16:00 3/3/2013 08:11.00 3/7/2013 15:58:55 N. 2/6/2013 01:15:54 1/22/2013 12:57:00 3/2/2013 22:00:00 2/12/2013 09:42:00 2/25/2013 18:34:00 3/27/2013 08:43:00 - 1/16/2013 07:39:00 1 2/14/2013 10:09:00 CL / 1/17/2013 20:35.00 1/4/2013 20:44:001 j 2/28/2013 13:01:17 2/17/2013 14:40:081 & j 2/4/2013 15:40:041 CV _j C 3/3/2013 10:05:00 3/12/2013 04:25:001 NI 1/2012013 12:48:001 CV .- CV N 3/26/2013 10:33:001 3/28/2013 12:05:00 1/4/2013 05:17:00 1/6/2013 11:54:00 3/15/2013 21:17:00 3/22/2013 19:12:00 1/22/2013 00:44:00 1/23/2013 16:53:00 2/26/2013 08:16:00 3/3/2013 08:11:00 2/17/2013 12:19:00 1_ 2/6/2013 01:15:54 o IN 2 3/2/2013 22:00:00 { 2/12/2013 09'42'00 E IN (N L3/27/2013 08:43:00 1/1/2013 01:07:00 1/16/2013 07:39:00 2/14/2013 10:09:00 APPARATUS BALS l CO < CD B ALS B ALS B ALS Cl) < m B ALS B ALS B ALS _I® < 0 < 0 B ALS B ALS g§ < 0:1 < CL) B ALS BALS B ALS J BALS B ALS B ALS B ALS r B ALS B ALS B ALS B ALS B ALS -4 < _ B ALS B ALS § < CO B ALS 1 B ALS co < _ B ALS 1 B ALS q < al INCIDENT # \ C csi m 2013-103 1 \ \ \ 2013-57 N. § CD a§~ co j \ \ / R 1 2013-13162 co 0 CD 2013-8 \ m \ eCV N- \ CV \ N N. 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