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Home My WebLink About20130929RESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - WINDSOR SEVERANCE 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 Windsor Severance 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 Windsor Severance 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 CC}L4NTADO ATTEST: �• 4.a .c\ -s xes. Weld County Clerk to the Board BY: William F. Garcia, C air 9 nr)ft _1,-r Douglas Rademacher, Pro-Tem uty ?WE erR to the B ounty Attorney can P. Conway Mike Freeman •PR 2 9 2013 ?Barbara Kirkmeyer Date of signature. L130to 2013-0929 HL0042 Memorandum TO: Board of County Commissioners , FROM: Dr. Mark Wallace l \ G� DATE: April 10, 2013 SUBJECT: Windsor Severance Fire Protection District 2013 Application for EMS Services Windsor Severance Fire Protection District, located at 100 N 7th Street, Windsor, 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 Windsor Severance Fire Protection District receive a Tier I license. 2013-0929 444444444444444 A A A A A A A I aJ U aJ a) u C CO 3 a a, CO a) a O O 4-I a, C a) V J Ui I I- 0 I - U) 0 Z 0 h 0 W 0 0. w Cr w 0 Z Q w w rn 0 U) 0 Z irca 0 U) IA 0 co 0 0 Q 0 0 0 0 rn 0 z 1- W w I -- co 2 I- n Z 0 0 I- 0 cc cn Z 0 h 0 W I.. 0 a w U- w 0 Z a W w N 0 ca z z z D 0 U 0 J W vi Z zO Q W J U cC W W cc N Q u Z Z a Q N J W D D 2 a z z Q D 3 W 0 a U z o Ww 0 O Z my o x CO II-- C� W CO U wZ a w 0 cC J O H z 0 w N Z w U J N O CC Q NOT TRANSFERRABLE / POST IN A CONSPICUOUS PLACE Tier I: Licensure authorizing for Primary, as defined in Section 7-1-30 of the Weld County Code. 1 1 , 1 1 , 11 1 111 1 11 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Permit to operate an Emergency Medical Vehicle (Ambulance) This Certifies: WINDSOR SEVERANCE FIRE PROTECTION DIST Motor Number: 1 FDW F36R38EB25617 MEETS WELD COUNTY STANDARDS FOR EMERGENCY MEDICAL VEHICLES (AMBULANCES). THIS PERMIT WILL EXPIRE DECEMBER 31, 2013. Director, Weld County Department of Public health and Environment LI. t, 13 Date Must Be Posted In Vehicle rggg7.�._ WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Permit to operate an Emergency Medical Vehicle (Ambulance) This Certifies: WINDSOR SEVERANCE FIRE PROTECTION DIST Motor Number: 1FDWF36R78EB25619 MEETS WELD COUNTY STANDARDS FOR EMERGENCY MEDICAL VEHICLES (AMBULANCES). THIS PERMIT WILL EXPIRE DECEMBER 31, 2013. Director, Weld County Department of Public Health and Environment fh H Date Must Be Posted In Vehicle DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue Greeley, CO 80631 Web: htte://www.co.weld.co.us/Deeartments/HealthEnvironmenVindex.html Pu6]icHeatth rn..w. ►new.. Preto.. Health Administration Pubic Health & Clinical Environmental Health Communication, Emergency Preparedness Vital Records Services Services Education & Planning & Response Tele:970.304.6410 Tele: 970.304.6420 Talc: 970 304.6415 Tele: 970.304.6470 Tele: 970.304.6420 Fax: 970.304.6412 Fax: 970.304.6416 Far 970.304.6411 Fax 970.304.6452 Fax 970.304.6469 Our Neion: Together weh the corrmxm*lea we atone, we are waxing to make Wald County the healthiest place to Me, learn, work end play. March 15, 2013 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: bschaefcrplattevallevfire.org SUBJECT: Windsor Severance Fire Protection District EMS Application 2013 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 Windsor Severance 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. 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 III: 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, ��— • Kevin Antuna Environmental Health Specialist Environmental Health Services Recommended Level of Service: Tier 2 Tier 3 Recommended Service Area: As listed in the application. The service area is the Windsor -Severance Fire Protection 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 of Colorado Health. No issues were identified, Other EMTS Council recommendations or comments: None r Recommendation By: Recommendation Date: .3./23/43 Windsor -Severance Fire Protection District March 13, 2013 Weld County Department of Public Health and Environment Attn: Environmental Health Services 1555 N. 17`h Avenue Greeley, CO 80631 To whom it may concern, Greetings! Attached is the Windsor -Severance Fire Protection District (WSFPD) application for a Tier One license in Weld County. Through a contractual arrangement with University of Colorado Health (UCH), the WSFPD is "furnishing...the transportation of patients by ambulance" from its "primary base of operation" at 100 7th St., Windsor, CO (WCC, pg. 7-4, 2013). Because the WSFPD assets listed on page 6 of the application will be operated by 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 WSFPD, per our agreement with the Weld County Fire Chief's Association, will continue to use Dr. Benji Kitagawa as WSFPD 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 WSFPD 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, Herb Brady, Fire Chief Windsor -Severance Fire Protection District ph 970.686.9596 • fx 970.686.9623 • 100 7th Street • Windsor, Colorado 80550 • www.windsor-severancefire,org Page 2 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue Greeley, CO 80631 Public Health Web: www.weldhealth.org 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. 970.3046470 Tele. 970 304 6420 Fax 970 304 6412 Fax. 970.3046416 Fax 970.304.6411 Fax 970.304.6452 Fax. 970 304 6469 Our vision Together with the communities we serve. we are working to make Weld County the healthiest place to live. learn. work and play AMBULANCE SERVICE LICENSE APPLICATION Date of application: ti /s', LA/3 Name of Ambulance Service: l/f/ fAP,9 w/ (/G4{ Owner: Name: /A/ofr e - i'lfizt./C F F,ea Pei>T6&T, o.-/ Des TX/ 4 -1 - Address: /0O 4/. lay fi FFT Gf//NOdaK. Co eotri Phone Number: 970 6 13.F 2624, Operations Manager: Name: _Lif/CIAEL etAe:E w iL L , GebeA, /o N1' C N/CF Address: les0 /V. �F� S'r,z FT k',sOfo%', Es 60rim Phone Number: 91a 686 26x6 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 Phone Number: Please read carefully : 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): Nor /4PP&/C(WL( What area of Weld County will be served by this company? Please attach a map indicating the service area. /NiNOJme 1 G� Fr rf,2A) it/ £t.° COVN T Y (Cri9f ,irri f ent r.o ) Flow many ambulances do you operate? /!.t/ 0 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: /60 /l/ 7"LEJe-eEr City: ktli/1/12,1092 State: Co Phone: 920 Geg 26Z{o Location #2: Street Number: City: State: Phone: Medical Director: Name: D,4 V I p f c es -7-4 , 174.9.. Mailing Address: /O Z V ✓o'Ty Lcntev At•6,t,ve, ,r. COzi..,1ns C ) 9 74 1'5_8 alit 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 4 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, address 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 Colorado driver's license. 5. A statement of criminal complaint or convictions, including Class 1 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 (J) 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. 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. 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 7-3-110 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) O. 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. * 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. Page 5 I I IEREBY 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 MAT 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 FO LICENSE REVOCATION AND POSSIBLE CRIMINAL PROSECUTION. Signature of Applicant Fititf 110 Title 7 -17/SUBSCRIBED AND AFFIRMED BEFORE ME THIS ) „ wio( •ri� /6, �- j, f ) , 20J , IN THE COUNTY OF 'Ctr,, C / (Y , MATE OF COLORADO. Signature of Notary My Commission expires: 241 /7l / 7 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 application. • 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, Prnec Brenda L Harstad, RN CHC Ethics/Compliance & Privacy Officer University of Colorado Health dINIIIIIWIIIINIINMI'Il11X IIINCIIINUIIInhNONINInYNIIUAInhIIIIh IIYWmIIYIII IIIIIINIIOIIIItl IlI It MI III 4!S16..»rt .vw 33 mwnmwwmmmwmummmnnmmmw"mmmIwmwmwwm immmmmemmnmmiwmwnwwwmmniimmmmmmmmmmmommn nixwErwwmiu 3 S Page 6 AMBULANCE VEHICLE PERMIT RENEWAL LIST Name of Ambulance Service: /'%'w Jag ✓Flifi ANC6 ice 9ir_0 7 6cnoN Application Year: ZO l 3 Vehicle# i Mfo it �+ST2/C'I Year: u o S Make:FO.pp Model: F3$ O XLT 4 Wheel Drive (Y/N): A/ Manufacturers Identification Number (V.I.N.): 2 rb w F3 (o R- 38E E B L 5 b 17 Colorado State License Number (Registration No.): ,er9 9 - v C7 it Motor Vehicle Chassis Number: 2Fp G✓f3 6 i. 7 g f e Z 5611 Registered with the State of Colorado as an emergency vehicle( Date Ambulance placed in service: / / Normal Location of Ambulance: __/op Al 7 /4 YT �iI4MP (J 8 ds^b N): U7/ A Vehicle # a- : two 15 Year: zoo e Make: Ed 0 Model: n'5d %'f' 4 Wheel Drive (Y/N): "/ Manufacturers Identification Number (V.I.N.): a FD tn1F36 R 78 C6 2 5 b t Colorado State License Number (Registration No.): 1_0,2. - Motor Vehicle Chassis Number: IF/7 /N t? 6 x 2 .' £ e256( 5 6( 5 Registered with the State of Colorado as an emergency vehicle 6/N): Z-6 %,� Date Ambulance placed in service: / / Normal Location of Ambulance: /oe /✓ I >' S'% bv,rvDf , W • 9 c rrd Vehicle # N1/4 Year: Make: Model: Identification Number (V.I.N.): 4 Wheel Drive (Y/N): Manufacturers 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: 0 to N co a z COLORADO INSURANCE IDENTIFICATION CARD COMPANY NUMBER a a w 2 CC Q 2 N W ? o w z p H H Z H a w w CO cn a U V) S H z O CC COMMERCIAL X a w H Z w U1 w a_ a a Z Q w U S w N Co ID 0. E O U C U) Q T O co) C c o v m no E m _c To rn a o m o LC c Z w ...(13 a U d O Q d u_ O to w N < Q U c Z y in a O Zr, o a a rc m m w o b z zn IS)- N w a w a LL r 0 z N N r o 3O g LL C r R LL O w p w g i 0 C > r C d to E w a m N > Z u n ` - 2 v o E 0 in 0 < J ¢ _ x a in O O O win z Cr O r) IA', Y 10O coO Ca D �C co in > LL <RY�O N E O 0 N EJJ CU 0 ow y ZH' r≤d .O mo U M co N� D w D LL w c. vs,,,... Av0i a % > N Oo)m an z ui t N 0 m C m m 3 `O aM- C N m a E C c c m T o . o O. d• c ≥ m t O m CL m OE O N y N U c • m -01:' w , m N D C O c c m `o d o E EE m m > Z Z > ®ACORD CORPORATION 2006-2007. All rights r ACORD 50 CO (2007/03) e re B COLORADO INSURANCE IDENTIFICATION CARD COMPANY NUMBER co co \) \} c{ ;f (( Como LU CO \ \ w as 2 Et 0 co 0 - co 0 \a CO§kk) _I (3074] 3* »BEEz j)§§ Oco 0 re o a La re C ill IV le ~Ow CI Z to \\0 0< w LLD CO In 0 EC 0 CSI E&/R UING CARD Li it to . CD ]) CO will 0 on |§ { k cm L.« p L))k) W .0 /) §iz § 06-2007. All rights reserved. O ACORD CORPORAT1O ACCRD 60 CO (2007/03) 13 9 CL co 0 WINDS -2 OP ID: CH �.� -" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 01/31/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY HOLDER. THIS 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 F8W Insurance CONTACT NAME: Sarajane R. Gomez, CIC 3005 Center Green Dr., Ste 120 Fax: 970-686-7131 Boulder, CO 80301 Dudley Locke PHONE E,1):970-686-7120FAX(A/C, No): 970.686-7131 E-MAIL ADDRESS: sgomez@fwprograms.com INSURER(S) AFFORDING COVERAGE NAIC r INSURED Windsor INSURER A: American Alternative Insurance -Severance Fire Protection District INSURERS Pinnacol Assurance - 41190 100 7th Street INSURER C: Windsor, CO 80550 INSURER D: INSURER E : INSURER F : COVERAGES fpPTIctrArc Altu.oce. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREREVISION D NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADDL SUBR M/ _ LTR TYPE OF INSURANCE POLICY INSR 'END POLICY NUMBER (MDP(YYFYYI IMM/UWYYYYI LIMITS GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR GENII AGGREGATE LIMIT APPLIES PER'. POLICY PRO- JECT LOC VFIS-TR-2057895-05 EACH OCCURRENCE 09/10/2012 09/10/2013 PREMISDAMAGE TORENT ante) MEDEXP(Any one person) PERSONAL B ACV INJURY GENERAL AGGREGATE PRODUCTS - CGMP/OP AGG S $ $ ,$ $ $ S 1,000,000 1,000,000 10,000 1,000,000 3,000,000 3,000,000 AUTOMOBILE LIABILITY A X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS NON -OWNED HIRED AUTOS AUTOS VFIS-TR-2057895.05 COMBINED SINGLE LIMIT (Ea accident) 09/10/2012'09/10/2013 BODILY INJURY Per person) _ BODILY INJURY (Per accident) - PROPERTY DAMAGE (Per accident) $ $ $ $ 1,000,000 X UMBRELLA LIAB X OCCUR A EXCESS LIAB CLAIMS -MADE DEO X RETENTION $ WORKERS VFIS-TR-2057895-05 EACH OCCURRENCE 09/10/2012 09/10/2013 AGGREGATE $ $ 1,000,000 2,000,000 COMPENSATION AND EMPLOYERS' LIABILITY Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below 26155 N/A X WRY LIMITS OER 01/01/2013 01/01/2014 E L. EACH ACCIDENT E. L. DISEASE - EA EMPLOYEE i EL DISEASE -POLICY LIMIT $ $ $ 100,000 100,000 500,000 A Crime VFIS-TR-2057895-05 09/10/2012 09/10/2013 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) PEBB-$50,000 4 DIRECTORS EACH @ $2,000 1 TREASURER @ $5,000 1 FIRE CHIEF @ $25,000 1 OFFICE MANAGER @ $125,000 District Accountant 1 @ $125,00 ALL WITH Faithful Performance CERTIFICATE HOLDER ,...."._.. -_._.. Windsor Renewal I, LLC 252 Clayton Streeet, 4th Floor Denver, CO 80026 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 ACORD 25 (2010/05) © 1988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WINDS -2 OP ID: CH `'1�"" CERTIFICATE OF LIABILITY INSURANCE DA01/31/2013YI 01/31/2013 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 INSURED Windsor -Severance Fire Protection District 100 7th Street Windsor, CO 80550 NAMEACT Sarajane R. Gomez, CIC PHE FAX (wc,NNo, Exu:970.686-7120 (A/c, No): 970-686-7131 E-MAIL ADDRESS: sgomez@fwprograms.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: American Alternative Insurance • INSURERS : Pinnacol Assurance 41190 INSURER C : INSURER D: INSURER E : INSURER F : • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR : POLICY EFF - POLICY EXP LTR INSR MD POLICY NUMBER IIMM/DDNYYY) MIMIDD/YYTY) LIMITS GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY • VFIS-TR-2057895-05 • CLAIMS -MADE X OCCUR GENII AGGREGATE LIMIT APPLIES PER PRO - POLICY JEO 09/10/2012 09/10/2013 EACH OCCURRENCE pREM SES a000CEDnce) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ $ $ $ $ S S 1,000,000 1,000,000 10,000 1,000,000 3,000,000 3,000,000 AUTOMOBILE LIABILITY A X ANY AUTO VFIS-TR-2057895-05 ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS 09/10/2012 09/10/2013 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ $ $ $ $ 1,000,000 X UMBRELLA LIAR X OCCUR A EXCESSLIAB CLAIMS -MADE VFIS-TR-2057895-05 DED X RETENTION $ IEACH 09/10/2012 09/10/2013 OCCURRENCE AGGREGATE $ $ $ 1,000,000 2,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE 1 26155 OFFICER/MEMBER EXCLUDED, N/A (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below 01/01/2013 01/01/2014 WC STATU- OTH- v TORY LIMITS ER EL. EACH ACCIDENT $ E DISEASE- EA EMPLOYEE $ E DISEASE- POLICY LIMIT $ 100,000 100,000 500,000 A Crime VFIS-TR-2057895-05 09/10/2012 09/10/2013 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) PEBB-$50,000 4 DIRECTORS EACH @ $2,000 1 TREASURER @ $5,000 1 FIRE CHIEF @ $25,000 1 OFFICE MANAGER @ $125,000 District Accountant 1 @ $125,00 ALL WITH Faithful Performance Windsor Renewal I, LLC 252 Clayton Streeet, 4th Floor Denver, CO 80026 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 ACORD 25 (2010/05) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Donald R. Brookshire, Mayor 231 W 4th Ave P.O. Box 339 Severance, Colorado 80546 March 11, 2013 Windsor/Severance Fire Protection District Ms. Stephanie Buchholtz, President 100 7th Street Windsor, CO 80550 Dear Ms. Buchholtz Telephone 970-686-1218 Fax 970-686-6250 I wanted to commend you and the Windsor Severance Fire Protection Board, as well as Chief Brady for all your vision and hard work to add a dedicated Ambulance Service to our Fire Protection District. On behalf of myself and The Town of Severance Board of Trustees, we want express our gratitude, and pledge our full support for the partnership with University Health Care to provide Ambulance Services within our district. We feel very strongly that the citizens in our community and within the Fire District have the best services available to them. The presentation You and Chief Brady gave to the town board at our regular meeting of January 7t°, 2013 we recognize that a partnership with UHC will dramatically improve the response times in our area, provide outstanding equipment and personnel, and additional services that will benefit our citizens. As elected officials we have the responsibility to strive for the highest level of services, protection, and quality of life for our community. The addition of an ambulance service in our area is an excellent example of how we can achieve this goal. We believe that as independent tax district you have the right and responsibility to provide the services and meet the needs of the citizens whom you serve. We also recognize that you have also worked closely with Johnstown and Milliken, establishing the search criteria for level of service, dispatch, response times, equipment and additional expectations that you considered when reviewing the potential Ambulance Service providers during your search process. It appears that UHC meets and exceeds the high expectations that our District holds itself accountable for. Thank you again for all the effort and hard work Chief Brady and the Windsor Severance Fire District Board has dedicated to this search process. We are excited to welcome UHC into the district and our community. I will be happy to offer any support you may need for final approvals, and intend to show my support before the County Commissioners Hearing on Ambulance Service License Applications. Please feel free to contact me I can offer any further assistance. Donald Brookshire 99 ,9Jz„a0rxiLe, Mayor, Town of Severance Esther Gesick Subject: Attachments: FW: Buchholtz letter 4-9-13 final.docx From: William Garcia Sent: Thursday, April 11, 2013 4:21 PM To: Commissioners; Esther Gesick Subject: FW: Bill Garcia Weld County Commissioner at -Large 1150 O St. Greeley, CO 80631 970-336-7204 I84I 7011 ��, -trt,.• . woS cN1a u 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: John Holdrenjmailto:manaoer@townofseverance.org) Sent: Thursday, April 11, 2013 3:39 PM To: William Garcia Subject: FW: Sorry I forgot the attachment, old timers disease. John From: John Holdren jmailto:manager@townofseverance.org) Sent: Thursday, April 11, 2013 3:36 PM To: Bill Garcia (wgarcia@co.weld.co.us) Cc: Douglas Rademacher; Herb Brady; Sean Conway; Don Brookshire (dbrooks©frii.com) Subject: Mr. Garcia: Here is a copy of a letter of support from Severance to the Windsor/Severance Fire Protection District in reference to the ambulance service they are trying to get approval for from Weld County, coming before the Commissioners on Monday morning. I don't have Barb and Mike's e-mail address so would you please forward this to them for me? Thank you, rpara e. weicales, 4,4s aCmraa %aam 4 Saaavaea P.O. en 339 Svawaa, eO s0546 1 Office: (970)686-1218 Email: manager townofseverance.orq ova. 2 Esther Gesick From: Sent: To: Subject: William Garcia Tuesday, April 09, 2013 9:04 AM Esther Gesick; Commissioners FW: Ambulance Service Bill Garcia Weld County Commissioner at -Large 1150 O St. Greeley, CO 80631 970-336-7204 • I 101 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: DRB jmailto:dbrooks©frii.com] Sent: Tuesday, April 09, 2013 6:29 AM To: William Garcia Subject: Ambulance Service Dear Mr. Garcia, I am writing you this letter on behalf of myself and the Severance Town Board of Trustees. We respectfully request that you to vote to approve the Windsor Severance Fire district to contract with the Ambulance service of their choice. We feel very strongly that the citizens in our community and within the Fire District have the best services available to them. The Windsor Severance Fire district has done an in-depth review and search of multiple Ambulance Providers, and would like to contract with a provider that has the shortest response time, quality equipment and employees, and willing to have a strong working relationship with the district, in addition to providing ancillary services that will be beneficial to our community. I believe we can all agree that as elected officials we should strive to provide the highest quality services to our citizens. In the matter of health and safety, emergency care and response time can be the difference between life and death. I think it would be a failure on our part not to allow the Fire District the ability to choose a partner who can provide these services, and denying our citizens the best care available. Thank you very much for your consideration on this matter. Our citizens rely on us and our Fire District for their protection, safety, and wellbeing. Donald Brookshire Mayor, Town of Severance 1 Esther Gesick From: Sent: To: Subject: Please add to file. William Garcia Sunday, April 07, 2013 3:37 PM Esther Gesick FW: Bill Garcia Weld County Commissioner at -Large 1150 O St. Greeley, CO 80631 970-336-7204 u 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: John Holdren[mailto:manacieretownofseverance.orq] Sent: Monday, April 01, 2013 2:26 PM To: William Garcia Subject: Bill: How are you doing. I have heard a rumor that the approval for the Windsor/Severance ambulance issue may be coming up soon. I wanted ask you to vote for the approval on behalf of Severance. I don't know why the Commissioners would want to deny a better service, better response times and not allow the Fire district the opportunity to make this choice. If you would vote for the approval it would be greatly appreciated by the citizens of Severance. Any questions or if you would like to meet and visit about this issue please feel free to contact me at any time. Thank you, fala e 'Xel fne.. ,a wtae.aas, leas e6 Stator -4 P.O. 'Sax 339 Sentasee, e0 10546 Office: (970)686-1218 Email: manaoer(a)townofseverance.orq 1 \0'N%1 Of Wi lP5Ok COLCeRALO a April 12, 2013 Mr. William Garcia Chairman Weld Board County of Commissioners 1150 O Street Greeley, CO 80632 Dear Chairman Garcia, RECEIVED APR 12 2013 WELD COUNTY COMMISSIONERS On behalf of the Windsor Town Board, I want to thank the Weld County Commissioners for your continuing support of public safety for all citizens in Weld County. Certainly the ambulance service provided to the citizens of Windsor is one of the most essential public safety services. We have been fortunate that the Windsor/Severance Fire District, as the primary overseer of this service, shares the importance of this service. This has been displayed in the past and we believe it will continue into the future. As a result, the Town has entrusted the Fire District to recommend and provide a service that is best for the community. We believe that the Commissioners and the Fire District can reach a mutually agreeable direction that will benefit Windsor citizens. That direction is to approve the Windsor -Severance Fire District and UHC license agreements. Again, thank you for your service to the citizens of Windsor and Weld County. Sincerely, / ohn Vazquez, Mayo 301 Walnut Street • Windsor, Colorado • 80550 • phone 970-674-2400 • fax 970-674-2456 www.windsorgov.com Jennifer Fuller From: Sent: To: Cc: Subject: Attachments: Jennifer — Patti Garcia [pgarcia@windsorgov.com] Friday, April 12, 2013 3:55 PM Jennifer Fuller Kelly Arnold Letter to Weld County Commissioners Weld County BOC - ambulance service.pdf As we discussed, attached is the letter to the Weld County Commissioners that I requested be included in the Monday meeting information. Thanks, Patti Garcia Town Clerk Administrative & Customer Services Town of Windsor 301 Walnut Street Windsor CO 80550 Office 970-674-2400 Direct 970-674-2404 Fax 970-674-2456 pgarcia@windsorgov.com www.windsorgov.com 1 -oilOfWINDSOR April 12, 2013 Mr. William Garcia Chairman Weld Board County of Commissioners 1 150 O Street Greeley, CO 80632 Dear Chairman Garcia, On behalf of the Windsor Town Board, I want to thank the Weld County Commissioners for your continuing support of public safety for all citizens in Weld County. Certainly the ambulance service provided to the citizens of Windsor is one of the most essential public safety services. We have been fortunate that the Windsor/Severance Fire District, as the primary overseer of this service, shares the importance of this service. This has been displayed in the past and we believe it will continue into the future. As a result, the Town has entrusted the Fire District to recommend and provide a service that is best for the community. We believe that the Commissioners and the Fire District can reach a mutually agreeable direction that will benefit Windsor citizens. That direction is to approve the Windsor -Severance Fire District and UHC license agreements. Again, thank you for your service to the citizens of Windsor and Weld County. Sincerely, � r 2/ ..// Jf 6--� ohn Vazquez, Mayor 301 Walnut Street • Windsor, Colorado • 80550 • phone 970-674-2400 • fax 970-674-2456 www.windsorgov.com Donald R. Brookshire, Mayo; 231 W 4th Ave P.O. Box 339 Severance, Colorado 80546 March 11, 2013 Windsor/Severance Fire Protection District Ms. Stephanie Buchholtz, President 100 71h Street Windsor, CO 80550 Telephone 970-686-1218 Fax 970-686-6250 Dear Ms. Buchholtz I wanted to commend you and the Windsor Severance Fire Protection Board, as well as Chief Brady for all your vision and hard work to add a dedicated Amoulance Service to our Fire Protection District. On behalf of myself and The Town of Severance Board of Trustees, we want express our gratitude, and pledge our full support for the partnership with University Health Care to provide Ambulance Services within our district. We feel very strongly that the citizens in our community and within the Fire District have the best services available to them. The presentation You and Chief Brady gave to the town board at our regular meeting of January 7t", 2013 we recognize that a partnership with UHC will dramatically improve the response times in our area, provide outstanding equipment and personnel. and additional services that will benefit our citizens. As elected officials we have the responsibility to strive for the highest level of services, protection, and quality of life for our community. The addition of an ambulance service in our area is an excellent example of how we can achieve this goal. We believe that as independent tax district you have the right and responsibility to provide the services and meet the needs of the citizens whom you serve. We also recognize that you have also worked closely with Johnstown and Milliken, establishing the search criteria for level of service, dispatch, response times, equipment and additional expectations that you considered when reviewing the potential Ambulance Service providers during your search process. It appears that UHC meets and exceeds the high expectations that our District holds itself accountable for. Thank you again for all the effort and hard work Chief Brady and the Windsor Severance Fire District Board has dedicated to this search process. We are excited to welcome UHC into the district and our community. I will be happy to offer any support you may need for final approvals, and intend to show my support before the County Commissioners Hearing on Ambulance Service License Applications. Please feel free to contact me I can offer any further assistance. Donald Brookshire Mayor, Town of Severance Memorandum TO: Board of County Commissioners FROM: Dr. Mark Wallace DATE: April 10, 2013 SUBJECT: Windsor Severance Fire Protection District 2013 Application for EMS Services Windsor Severance Fire Protection District, located at 100 N 7th Street, Windsor, 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 (E1v1/TS) Council reviewed this application on March 20, 2013. The Council recommended (see attached) that Windsor Severance Fire Protection District receive a Tier I license. n Donald R. Brookshire, Mayor 231 W 4th Ave P.O. Box 339 Severance, Colorado 80546 March 11, 2013 Windsor/Severance Fire Protection District Ms. Stephanie Buchholtz, President 100 71h Street Windsor, CO 80550 Dear Ms. Buchholtz Telephone 970-686-1218 Fax 970-686-6250 I wanted to commend you and the Windsor Severance Fire Protection Board, as well as Chief Brady for all your vision and hard work to add a dedicated Ambulance Service to our Fire Protection District. On behalf of myself and The Town of Severance Board of Trustees, we want express our gratitude, and pledge our full support for the partnership with University Health Care to provide Ambulance Services within our district. We feel very strongly that the citizens in our community and within the Fire District have the best services available to them. The presentation You and Chief Brady gave to the town board at our regular meeting of January 7th, 2013 we recognize that a partnership with UHC will dramatically improve the response times in our area, provide outstanding equipment and personnel, and additional services that will benefit our citizens. As elected officials we have the responsibility to strive for the highest level of services, protection, and quality of life for our community. The addition of an ambulance service in our area is an excellent example of how we can achieve this goal. We believe that as independent tax district you have the right and responsibility to provide the services and meet the needs of the citizens whom you serve. We also recognize that you have also worked closely with Johnstown and Milliken, establishing the search criteria for level of service, dispatch, response times, equipment and additional expectations that you considered when reviewing the potential Ambulance Service providers during your search process. It appears that UHC meets and exceeds the high expectations that our District holds itself accountable for. Thank you again for all the effort and hard work Chief Brady and the Windsor Severance Fire District Board has dedicated to this search process. We are excited to welcome UHC into the district and our community. I will be happy to offer any support you may need for final approvals, and intend to show my support before the County Commissioners Hearing on Ambulance Service License Applications. Please feel free to contact me I can offer any further assistance. Donald Brookshire ,%iarefa_l>,,,,{14..4Le Mayor, Town of Severance r, , Memorandum TO: Board of County Commissioners FROM: Dr. Mark Wallace N DATE: April 10, 2013 SUBJECT: Windsor Severance Fire Protection District 2013 Application for EMS Services Windsor Severance Fire Protection District, located at 100 N 7th Street, Windsor, 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 Windsor Severance Fire Protection District receive a Tier I license. J AMBULANCE SERVICES AGREEMENT THIS AMBULANCE SERVICES AGREEMENT is entered into on January _ 2013, to be effective as of May 1, 2013 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 WINDSOR -SEVERANCE FIRE PROTECTION DISTRICT, a Colorado Title 32 special district ("Windsor -Severance"). 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. Windsor -Severance has the authority under Colorado Secs 32-1-103(7), C.R.S. and 32-1- 1002(1)(e)(l), C.R.S. to provide for ambulance services to patients in its district. Pursuant to these statutes, Windsor -Severance 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 Windsor - Severance. D. The parties desire to enter into this Agreement in order to provide a full statement of their respective responsibilities in connection with the delivery of services from PVH to Windsor - Severance. ACCORDINGLY, PVH and Windsor -Severance agree to the following: 1. JOINT RESPONSIBILITIES 11 No Windsor -Severance employee shall be deemed to be an employee of PVH, nor shall any employee of PVH be deemed to be an employee of Windsor -Severance. 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 Vehicle Donation: PVH agrees to transfer ownership of two ambulances and one command vehicle (see 2.1.1) to Windsor -Severance. PVH agrees to pay for all maintenance on the vehicles 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 Windsor -Severance Page 1 2.1.1 Med 12 2008 Ford F-350 XLT with Frazer Type I Generator Powered Module VIN- 1FDWF36R38EB25617, Med 15 2008 Ford F-350 XLT with Frazer Type I Generator Powered Module VIN - 1 FDWF36R78E825619, 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 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 or Thompson Valley EMS or Banner Northern Colorado Medical Center EMS 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 Windsor -Severance 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 72, East by WCR 21, South by WCR 62, and West by WCR 13. The Suburban Response Area is defined as Ptarmigan Area and includes the area encompassed by North of Highway 392 and West of WCR 13/LCR 1, and North by WCR 78, East by WCR 25, South by Highway 34, by West WCR 25. The Rural Response Area is considered all areas not defined by The Urban Response Area and The Suburban Response Area but in the Windsor - Severance district. 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) 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 Page 2 • 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 as defined in section 2.7. 2.5.4 The Deployment Plan was followed. Deployment plan shall adjusted by representatives of Windsor -Severance 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 Windsor -Severance. 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 Windsor -Severance 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: Windsor -Severance employees who maintain National Registry certification will be encouraged to affiliate with PVH EMS to ease the process of recertification. 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. Page 3 4 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 Windsor -Severance 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, (iii) 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 Windsor -Severance 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 Windsor -Severance 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. 2.16 Fuel for Vehicles. PVH is responsible for all fuel necessary for all vehicles donated to Windsor -Severance. 2.16 PVH shall provide a Certificate of Insurance to Windsor -Severance 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 Windsor - Severance. 2.17 PVH shall abide by the terms of the Business Associate Agreement as attached and incorporated herein as Exhibit B. WINDSOR -SEVERANCE RESPONSIBILITIES 3.1 Performance problems of PVH employees placed with Windsor -Severance will be documented and reported to PVH immediately. 3.2 Windsor -Severance shall be responsible for providing suitable living and workspaces at all ambulance stations. These include, equipment, furniture, connectivity, phone, etc. The parties agree to work together to provide connectivity to the PVH Intranet or other network connectivity. Page 4 • 3.3 Windsor -Severance 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 Windsor -Severance 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 Windsor -Severance under this Agreement. 4.2 PVH agrees to indemnify, defend, and hold harmless Windsor -Severance 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 Windsor -Severance one dollar ($1.00) per loaded mile, payable quarterly. 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 Windsor -Severance upon 30 (thirty) days written notice of termination to the other party. If termination occurs within the first three hundred sixty-five days of PVH assuming provision of EMS in the district, Windsor -Severance will be liable for the start-up capital costs incurred by PVH. 6.3 Windsor -Severance may terminate this agreement immediately when quality of care or patient safety is deemed by Windsor -Severance 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, 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 Windsor - Page 5 Severance governing board. Notwithstanding anything herein to the contrary, in the event of non -appropriation, Windsor -Severance 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 Windsor -Severance 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 Windsor -Severance 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 Windsor -Severance 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, Windsor -Severance 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, Windsor -Severance 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 Windsor -Severance 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 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 With a copy to: PVHS Legal Department 2315 E. Harmony Rd., Ste. 200 Fort Collins, CO 80528 Fax: (970) 237-7094 Page 6 D FAX (970) 495-7663 If to Windsor -Severance: Fire District: Windsor Severance Fire Rescue Attn: Fire Chief 100 7th Street Windsor, CO 80550 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 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 Page 7 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 "Win sor-Severance": aO13 TAX/SS ID Number. 'I 072 Sg0""/ (Please provide W-9; this document can be ound at http://www.irs.gov/pub/irs-pdf/fw9.pdf) State of Colorado City of County of The foregoing instrument was acknowledged before me on this 1 i day of -4 kt 20J jby IA -0-11- (Notary Seal) FOR POUDRE VALLEY HEALTH CARE, INC. D/B/A POUDRE VALLEY HOSPITAL HE, President/CEO oudr Valley Hospital Da/Rah State of Colorado City of c:= + 0 Jli v, County of La. c rn e The foregoing instrument was acknowledged before me on this I lC day of 3611 k 20 1 -.by rfc c (name). 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N O N M IA VI VI N O N N M C CO N N M N M C 00 O H N M t0 H H O en N C Cr; .-i N CO N N O Co m C O el N N Al N e•1 el e -I ei ei ei ei N N e-1 N .-I el el ei Ot to M MO N el 0 CO N N C 00 00 N N N C N en N el el VI 01 0 el N M Cr M to M to In C C M 1f1 N ci O M N C N In C ci ci N N M M M M C In M N Ln N to N 01 01 In a1 a1 to e-1 C Cr; N N 01 N CO 00 OD a1 0 N In lO .-i lD M a-i a-i C 00 O M en N N M a -I 0 Cr In el In M N el 0 C In M ci V1 ci N V1 N M .-I O el If1 el el C tD N N en N M C Co O O N en tD ci ei M a1 N en V1 .-I ROA N O tD N C O e -I N N N N e -I a -I ei a --I a --I el el N N N - el el e-1 ei el Al 1771 Delores River Drive 437 Pelican Cove 610 Hemlock Drive C 0 cri E O U In O co 35 Rochester Drive N > C > v ID 0 '— > s m 0 c (0 0 N m m O 01 i.+ C 00 m -0M y o CO tn 2 Ili N N C U L Q N i/ a u ID = N C O en ci W I — O O 00 O O N cael i 701 6th Street #B2 11 Cottonwood Court 328 North Shores Circle L d > J U J a+ 0 a) N rl It N 0 a) v U 0 0) m > .- m v w% v1 70 O a 3 v a) o an t . •m v E c •e ti aCi Co c_ N vI p- yO w m fo rn a In azNu2eM o >- Ou0 00 N n >0 Oel Lf1 el In el N eei c-i C I N 710 3rd Street 353 Amber Drive a) J C y C O > o ,. •N h N to v 0) a d a c ft ca "1 O O .C 0 E U U U M M Ln O1 In O O O O O ci ci CO N CO N N a)- N M tD O ci M to toN O ei N M 01 O- N M C tD N a-i C t0 m o ei N "Cr N m a) 00 CO 01 01 01 Cr) a1 01 0 0 0 O O el el el el el el a -I N N N N M M M M el e -I el ei el el el el el ci el Al N N N N N N N N N N NNNN N N N N N X X X X X X M 01 N V N. 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V N N el Cl 01 an .-I M In CO Al N. 03 V 0 00 N lD l0 03 el 01 Al In el ei N a -I el el Al 0 In In en 0 In N In N 0 N en el In M V en Al O V Al ri ei en 0 In M I� M 66 N V N N lO lD N O N 00 V1 N V M O 1p Cr; N O V In N Cr; M O o o 0 e -1 O ei 0 0 ei O O O ri 0 0 N 0 e-1 O .-1 0 0 0 0 0 0 ri ri .-1 .-1 O N e -a ti O O O O O O O r -1 O O O O O O O O O O O O O O O O O O O O O O O O O O ▪ V V el M el ri el el el el M N ei N en el V el N ei el el N el el en ei N N ei N r-1 U 0 m< 0 00 m<< m< O< 0 0 0< 0 0 0 0 0 U< D U< 0< 0<<< Q M O ey en el t0 Cl tO lO 01 ri enl0 tD en lD ei tD 01 lD - M O a-1 O en Nei MU) NONM in ri N en en O NN N N O rl N M O M 0 a'i N M en el O ri ei e 1 en M 0 ri M el in Al N. 00 N V Cl Cl In V Cl 0 Cl en CO N N en a-1 M N 00 lO ID O a-i V M a-i en Cl en O In V V MN O V ei O V O O In O N mom O O In enen- In In e'en AIN en N V 0 A N O O V Cr; M N N Cl a-i N O V V ID lD N LD In lO ci N N In M Cl M N 00 M Cl V N V N a-i In en en V N V en V In M In O V Al en a -I V N In O In O O el en el In N Ill en N Al en N M IC 00 lD 00 Cl O N N Cl a-i In O V 00 O ei M O M tr1 00 Cl N N N a-i O O N N N a-i Al el e-1 el el ri el a-1 el el el N N a-i el el ri N a -I Cl 00 el en N N 01 LO 0 Cl en In VD lO O en 00 Cl N 00 CO V lD Cl 03 LO ei LO lD In N e-1 N ri N V en N In In N in V Cr 0 el el 0 en 0 0 0 0 en el el et en 0 el Vl N M In el ci el In N en M N In N 00 Cl N N V in 00 V l0 00 O Cr; N ei IO In Cl VI O t0 00 O N M M N ID M N V ei in V N M O V N M en en V V V el en O V N V Ill In In In O en In In O V N N M ei M N In 00 07 O N N 01 ei V O V 00 O ei to O N rn N 00 N N ID ei O O N N N e -I N ei ei ei ei e -I e -I el el e -I e -I N a --I a--1 e -I a --I e -I N ri N e -I ei 0 0) N O > N ci 0 cu '65 N Y ≥ t v O1 > N N 16 7 Y CU M co In C> Y O d Y O VI > 2 Y l0 VI VI Y CU y al CU Y= 1 3i3 v> i a z 0) Y O C Y ry Y O 3 O. 0) Y C +"' 2 'O N VI en 2 u m m u cc Low c 0 0 0 Cl I._ O O a 0 ID Cl 00 V To In el 01 en O el ei l -I ei C ei V N e O lD el0e - lN lO In N c-1 lO > ei 00 CO3 fn lO ei N 805 Compassion 1130 Main Street 105 Locust Street 9 Orchid Court 1100 Main Street 0) U U 0) b0 0 O v w n K v CO N O E m U N en 0 N el el 0 N I, co 619 Chestnut Street #27 941 Durum Court 21 Ash Street 372 Buffalo Drive 36687 Roth Place 710 3rd Street 9400 WCR 78 C j. C O C O in ▪ OD U' Cu Cu a • m o r U M m ri c - co 1455 Main Street #100 In O ei M N V N eH en et l0 03 Cl el en V In N. 00 01 ri 01 01 el N N 03 el en V VD 03 V In en V V V In In In LID lO lO lO lO lO N N N N N N N CO 03 Cl C O O 0 el ri ci el ei N N N N N N N N N N N N Al N N N N Al Al N N N N N Al en M en en en en en en M M en I i X X X Ln N. CO In O N c -I LID N. N. N. M V el Al el Ifl N c -I M N V N • ON O N O O O O c -I O O 0 0 0 0 0 0 0 0 0 N l0 e V Al el N V N c -I 0 0 0 0 0 0 0 0 0 0 < 0300000000 n u1 M O1 N O t0 O .-I O N N c-1 el O c -I O c -I In a -I N Vl l0 in a N c -I N co d' N O c -I O In V u1 e+1 N C N O) M M rt1 (CIn V V O1 O IA M c -I I!1 O 71:N N N lO N CO Ol 00 lO o c -I O) n el el el V O ID en m to V M In LA In O c-1 MO O O R 00 00 c -I c -I M en O1 Ol V1 On M N 1/1 Le) Ln ct c -I O N Cr; N CO 00 00 )A O c -I O1 n 903 Scotch Pine Drive ai > a) o a) ≥ > Y .L Y CU L Y L a) O > N CL N ❑ a) 00 U a Y C >❑ >, Y V1 O > Y Y N E U C N ▪ N J -O G.) O E r n c E v E LE p 'La f° u a) U V N Q = el Ol O Al CO CO O vl Cl ei V n 1D lD 610 Hemlock Drive 619 Chestnut #27 N O1 O M In CO O1 N M l0 N N en en en en en V V en enr1 re1 m ec1 en ref en en I airsiSSIS U, CO ct Urban < 12 min. Urban < 9 min. N M O COOO 00 V el LV1 00 V LO at 00 Ol el 01 Lil O elt.0ei m N M O1 N N M .-I '-I C N O O O ei ei ei N M At N M 0 M LA e-1 el Q eA LA O M el M LA V O O Ln Ln .OJ ---i l0 O en 00 LO N .-1 01 O- N N N LA N M L% O 1 N O en N LO O 00 N V N Lfl LO y U ei en UI V O N N e1 VI LA el V O el COM M V C 0 N V N LA Ln M N en el Ln en M M Ln N m N N LA LO Cl ei V 00 LA 00 N Cl 4LA .-I Ln LO CO el O N t7 Ln LO 01 iii N i • CO N N L--1 L--1 L--1 N e-1 el el e-1 N el el el N elei U - C y co J d N LA M N N M ei LO LO M 01 ei CO O LO to N co N N N Ol N N N co M M M LO LO E y N V m H M O N M ei N O V) o O V ei m in N O N m el VI N N N Ln o ry N M ID L in 0l N 00 .-1 O 00 N e-1 Ln LO LO e-1 M 00 Vl O 01 N V N LO Ln N M N N V LO al O • y 0 ei M M O N O O LA V O M O LA Ai N M N O N m N tf ei N N O V N M C co M LA N M N N LA LO 01 .-I a 00 LA N N 01 V LA !Li LA CO 00 - O N V Cr; Co 01 Ln N = a el N N N el .-1 N el e1 el el N el el ti N el el =L O v V -0 01 0.1 3 3 X X X x >c X X i X E lA N m ▪ rn rn CO LA Cr N IN CPI INv-I N en O 01 M at LV N 00 O .M -I V N C N a 01 Ln V N el el I71 CFI o Ln ti E.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ln N v m m oo a Ln o Lo ao N m a M M ei in N Lb rn rn Ln el el r -I a, ea C v o > N 0.1 E V1 E > p -O m C N C • N en N � M 5 -DO RV 3 emi Q LO S ei V ei 2 lL0 Cm1 0 w o ry Z el N L.0 M Cr u CC U 3 814 Storm Mtn Ct 353 04B01 718 2nd St 354 No emd 864 Amber Ct 355 12D02 208 Ruth Ave 356 02A01 N Ln N N 0 3 N o 01 N cc C 2 > C CC O >. r 3U .- m Lno c -c 2 .-. 71 X - c vl 00 3 0) "' m Y U 4 — VI ▪ Ll Vl L re c a Vf Vl 4 Ol .C C N V C 0 h C O N cc • C c E L U c^ C 0 in- cc CO 2 2 a V C N U i N 0 a U LO w N cc m 0 M en co LA O m r.9 el w JO 2 U V LA el CO O U LA LA O O ei O O LA O LA >' O LO 01 O O m N 00 O el O el el vr el el R ei el3 N LO el 0 e1 O L0 CO N M U 7. ei co N N re co ei ei N el I V N co N LO 01 el el O O0 ei N CO el N 01 N Vl M M 360 17B03 364 06D01 365 29B01 368 29B01 370 21B02 374 26D01 375 33A01 el N N el N O O oU < O CO 01 m M LO O N M M O LO 00 al O M V N N N 00 00 CO M M M M M en 386 29D02 387 17D03 388 26A01 235 Cattail Bay M .-i el M ei m LO N m O N Ln N N N el N N N M 01 ei N LA N CO Q1 01 01 01 M M M M M r• x X X X X N O N 01 N N N M V O 0 in O O N co N N V N O M Ln to V CFI CO tO O V1 co CO co V1 O N O el V en N N N N M V M N ci M V O el Vl M a -I N O c-1 M O el V a f` 01 tD W 01 W tO O M tD tO O tO N M O tO M M V1 M N W of Ot n N O N N N e --I N .--I e --I e --I r -I N N N co co a) N co co C_ C_ N el V 01 e-i V tO in M Cr, V1 N N VI W M N 01 N CO O N 01 N it; M in Al O 01 01 N n e'i O LO O V V el LA O V1 N N V LO N M VI N Al O V Al O V LA O el en e-1 V1 O V V Vf tO M c -I 07 O V Ai tO V N N t0 tO N O W 01 O M N N N O1 64 M V1 tO N N N tO N ✓ M t -I V1 O N V1 V Ln M M M V Ln M a --I e-i O N O M M e'J M N N O en en N el N el N O O M M M Cr; N eb Ai N 01 Ol Ai M N V 01 01 N W N 01 O 66 N Ai M V 01 N 01 V ti Al N _ ci ci N e-i N ci e -I ci Al .-I .-I N ci ci el .-I N ci N U C CO :.1 V1 ri N O 01 N V N N 01 01 01 N. N V1 ci Vl V1 N CO V O V V el N V co V1 0 Cr el V 01 ci V1 V Vl M M M M N M M V1 in e-i Al V1 O en Vl M O M M M M M Vl V1 V1 e -I V N ON N tO N Al O N N c -I Ai N 00 O 63 O V M N N Ai eT N V CO Ai tO N V V) tO N O tO O W M N V1 V O O M O N V1 N M N M V N O If) 0 e -I V1 M N O M NH V1 N N N VI ci O N O 01 M M in CA t0 ri CO e-i N of 01 e-i en N th 01 Si O 00 N 01 O tO N o ni V 01 ei 01 V e -I r -I N .-I ci N e -I N ci e -I c -I N e -I .-I N e -I r -I e -I ci N e -I _ a M C C N v i) K N O0 0 a U y V1 • N U Y (0 '� CO c a U C C C yt# o 7cN C N (C N N N K C O Q K `^ ti ea•1 U O V >• > Nr-I o - o CO > _ N 398 No emd 399 19D01 402 10D02 403 No emd 404 No emd 405 17A03 406 29D02 407 29D02 408 01A01 1021 Grand Ave 410 06D02 U 0 CO ci e-i 411 29806 610 Hemlock 415 17A03 1455 Main St V O U M M to ci v I- C O a ci C cC c U 0 v a) C C > O i Y (C • Q U 0 VI O O. N C M O U - co O rnC Z U M W 12 i o "� V1 V E ✓ i o> • co N u 2 N e-1 CO r M ci 419 No emd 420 17B01 421 31A01 422 17A03 425 29804 426 13A01 429 31D03 242 Mallard Ct 430 31D03 6- /5 0 C C C O • O O n N u INl 0 Y to 1 h OL Cu C E V1 r v u E n E -o toC e» ° U x U ¢¢ N N 0 Vl V1 tO V1 0 V O ci O O N O O Cl V N M 00 N CON N 431 17A01 434 33CO2 435 25803 436 32B02 437 26A03 438 31D02 439 25803 440 No emd 619 Chestnut St 441 10001 15 U Y (CO 0 0 0 E o I el 0 N el in tO 442 11A01 443 17A03 WCR 25 and WCR 74 444 25603 518 Chestnut St 445 01CO3 4 14:13:49 cancelled X x x r -I 01 N CO in Ln M Ln .-I N VI m 63 C N N N l0 X x x x x x x C Ln C co N N C .-4 C N M O N co 01 O N a-1 N tD M o CO m 0 ci .-1 o a o Ln m m U N o m N ry C C v m ci .-1 O t0 00 r1 C C N iD 00 O CI N N m M C CA N tD m N U) N ci ri fi r 1 N - t0 m to c _ ci 01 Cr O 00 ci ci r-- to 01 N 01 c0 tD O M LD O N Ln Ln 03 N C co N VD t0 M N m m N O M Al M .-i el N V .-I M N In .-1 O M M M m M O N M 'Cl' Cr N N 0 tD C N 00 CO N N 01 M M OI 0 CO c1 Ct O O 00 N W CO C Ln N W ci O U) 01 N M N c -I c-1 O N .-i 'Cr .-i v M .-I C O in .-i m m ci C N in in O O m 0 ci re e-1 N tD O ci N tD -o N 'C 01 c -I 00 00 01 Ln t0 tD C.6 id t N C O in O tD CO Ol C M US m t.1 ci N c -I N W N al rl N N N N al N N N .-I N .--I N N N N Tv() v u c c m m u u O 0 Al N M tD N Ln C M m Ln 01 N LO N 01 01 01 00 N N co N 01 N N N 01 o m M C O C re M ct'e N en en en C N N en N N 0 0 0 n'I ci O M 0 N e m- Ln 0 C Ln C rn O el el el O O Ln N� a el N 0 en en el V 'Cr C 0 N O N 0 N N Ln Lf1 Ln 0 N Ln e1 0 0 . .. .. .. CO CO.. .. .. .. ...... .. .. .. .. .. .. .. .. .. .. .. Cr;.. .. CO.. .. A .. .. N tD N ,Li el lD O el 01 01 el 00 00 01 Ln CA el tD tD N N C N .--I LO Ln O 01 M N m lD N N N el el a-1 el N N N N N N N N N N r-1 el H N N H U CO Y U Y u N C ▪ C 0 IA o m a _ co v o o u m CO 0 N 0 N ci O c -I el el CO N 446 17803 447 29D02 449 06C01 451 26O28 342 Telluride Dr 454 31D01 36667 Pauline PI 457 17A01 610 Hemlock Dr 458 10D02 s 0- a.) m 4- x N p 0 Ci a L Ln m w O 66 6 O CO c 3 - Y u roc c c b c 0 c Y m in _ = J m o O o a o N U N VI 4..r in rn C a m Y QI -a " T V1 VI IA O VI Y (/L O to ` a V1 �, c U Y c c vt c a a a p m c c v 'o Y a— u E c 6 3 m c E= `n to 'm -0 ..= m In Dot in u m m m v— a v L E E E E.n:1E c p p x v o= N a m m` o 0 0 0o w p U 0i o 1 R m U 0 M 0 U U u F u m U w d m N LL H Ln 01 0 u all 0 LSI Ln 0 U 0 el 0 Lfl Ln Ln Ln Ln N Ln DI i el 0 0 t o CNN N N Cl" N O N M .--1 O O O O O O C CC 0 01 N 00 C CO3 > m tD Mel N Ln N > N el CO CO CO CO Ln CO c -I el 1\ n n N K 01 459 32802 460 06D01 N U M N Al M 'Cr CI" 465 29804 468 31A03 472 26A03 475 12D02 477 19D04 -0 -0 a a to Z O O Z CO 01 a -I N V Ln N N 00 00 00 00 Cr v C 'Cr v C 486 11A01 M el el Al M el O 0 0 O 0 0 0 0 0 O 0 en C m O U m U m m n Ln N LO MN CO 0 O 01 ." el 0 1 N m r1 0 m r1 N el 00 01 .-i m Ln CO 0 .-1 en Ln tD 00 00 01 01 01 01 O O O O O ct a Tr a Ln Ln Ln VI Ln N m(1 .i m N � m m N N O1 O1 N N N M m m N n LO N x 00 00 N m m 426 Crystal Beach Dr . i ,y ❑ U LID tD O N CT O O ti L O O '-1 O4 O4 Ui Ui an Ui LE) Ln ❑ < ❑ < ❑ < O m LO m W m N m N m N m IA J CG J a Suburban < 13 min. Suburban < 16 min. Hello