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Home My WebLink About20133449.tiffRESOLUTION 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 16th day of December, A.D., 2013. Weld County Clerk to the Board orney DEC 3 1 2013 Date of signature: BOARD OF COUNTY COMMISSIONERS �� WELD CrOUN�/1COLQ$AD'�4-04^- William F. G as � i� 0,(, : ('i (vex", TO 1yk ) 2013-3449 HL0042 Memorandum TO: FROM: DATE: SUBJECT: Board of County Commissioners Dr. Mark Wallace December 4, 2013 Windsor Severance Fire Protection District 2014 Application for Ambulance Service License Windsor Severance Fire Protection District, located at 100 North 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/Trawna Service (EMITS) Council reviewed this application on November 20, 2013, The Council recommended (see attached) that Windsor Severance Fire Protection District receive a Tier I license. 2013-3449 iffmli _71i W 1" O Z H W • Z O i Z IL La 1:• 15 J Z D O= U W Ca L L� IU 0 Lf) 0 CO 0 r4 0 0 0 tn 0 z UI w n x O 0 Z 9, FIG F U) a 0 U UI O MUM La. U U z UI U O rn 0 0 z w U Z a 0 K 0 >- U a H Z D 0 U 0 w vi Z Z 0 a U J cc w w m w • 0 w Z Z a J w D D 2 cc Z Z a D HU cc0 w w o � H• Z �N O w m I=_- LU w U w 0 J H Z D 0 w N Z w U J N 0 NOT TRANSFERRABLE / POST IN A CONSPICUOUS PLACE Tier I: Licensure authorizing for Primary Care, as defined in Section 7-1-39 of the Weld County Code. L9 LaThEl DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue Greeley, CO 80631 Public Health Pn xn.. vmmau. Pnttet. Web: http://www.co.weld.co.usiDeoartments/HealthEnvironment/index.html Health Administration Public Health & Clinical Environmental Health Communication, Emergency Preparedness Vital Records Services Services Education & Planning & Response Tele: 970.304.6410 Tele: 970.304.6420 Tele: 970.304.6415 Tele: 970.304.6470 Tale: 971.304.6420 Far 970304.6412 Far 970.304.6116 Fax 970.304.6411 Fait 970.304.6452 Fax 970.304.6469 Our vision: Together with the commundies we serve, we am working to make Weld County the healthkst place to live, learn, wort and play. October 31, 2013 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: bschaeferaplattevallevfire.olg SUBJECT: 2014 Windsor Severance Fire Protection District EMS Application NOTICE OF EMERGENCY MEDICAL SERVICES LICENSE APPLICATION TO THt 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 7-2-1003.5. 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, 7-2-1003.5 The recommendation of the Weld County Emergency Medical/Trauma Service (EMITS) 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 including minutes of the EMS Council meeting pertaining to this application. Please do not hesitate to call me should you have any questions. Sincerely, Kevin Antuna Environmental Health Specialist Environmental Health Services Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Windsor Severance Fire Protection District As required in Section 7-2-100.B.5., the EMTS Council should review the application to assess as to whether the ambulance service will contribute to an efficient, effective, and coordinated emergency medical response to residents of the County? Please include any findings related to response time, coordination with other ambulance services, location, service area, etc. that is the basis for the Council's recommendation: FINDING #1: aJ ill r. IN FINDING #2: FINDING #3: FINDING #4: Recommended Level of Service: Recommended Service Area: Tier 2 Tier 3 Other EMTS Council recommendations or comments: Recommendation By: Date: pig, t. DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue Greeley, CO 80631 Web: www.weldhealth.orq Health Administration Vital Records Tele: 970.304.6410 Fax 970.304.6412 Public Health & Clinical Services Tele: 970.304.6420 Far 970.304.6416 Environmental Health Services Tele: 970.304 .6416 Fax 970.304.6411 Communication, Education & Planning Tele: 970.304.6470 Fax 970.304.6452 Emergency Prepared, & Response Tele: 970.304.6420 Fax: 970.304,6469 O,r viton: TogeVrcv with the wmmunib'es we serve, We are working to make Wad Countythe healthiest piece to eve, learn, work andp AMBULANCE SERVICE LICENSE RENEWAL APPLICATION Date of application: Name of Ambulance Service: a/awning J"SY ow, Owner: ((�� Name: l(//Np_jet livee/1g/Lf / n Address: /Q if /1/. 7/N Phone Number: 9 PO . 8 6 Zit 74P /o z3/LI Act /toner, ry D.rrie/ c7 Marto -mu 0/ evele," Ain) , CO 96 rib Onerations Manager: Name: ei/4W �L.9rre1A9L(, , d/tici,min chigtr Address: /06 Al.9ila f rec/ frInN?',gje, a ,96:',r6 Phone Number: 7*' 6$6 Z6Z6� Email: /yl bail r j // e w _fir . u s Pursuant to Section 7-2-150 of Weld County Code Ordinance, any change of ownership requires a new application for ambulance service license. Date Received: / / (For Office Use Only) Documents Checked: Remarks: Date Referred to EMTC: / / Date Referred to B.O.C.C.: / / Approved Recommended (Y/N): Licensing Agent Page 2 Name and address of each stockholder of partner owning 10% or more of the outstanding stock of the company of having more than a 10% ownership interest (if applicable): Nor /OPPGlc�gb'GC- What area of Weld County will be served by this company? Please attach a map indicating the service area. W 1hrwfdt, vF✓-' i' fc + VsESTE,LN W at.O rj,-u N 7 L How many ambulances do you operate? Location and description of the place(s) from which this ambulance service will operate. If there are more than two locations, attach a separate sheet with the above information. Location #1: Street Number: /O6 N. 714fj City: it/Miak12 State: 60 Phone: $0gg' 26 2,6 Location #2: Street Number: Ala 7 ifreeie.Ba e City: State: Phone: Medical Director: Name: b AV lb Fn QS T4 D , )fl'Lb. Mailing Address: /Q,S'onil LSM14`( Phone Number: ?D V9 S- 500 fa Please read carefully : re, fr CoLt pcf 9o5tY 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 -ISO 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) Windsor Severance Fire Rescue 100 7th Street, Windsor, Colorado, 80550 970-686-2626 www.wsfr.us October 22, 2013 Mutual Aid Agencies that Windsor Severance Fire Rescue operates with: Fire Departments: • Loveland Fire Rescue • Poudre Fire Authority • Ault -Pierce Fire Protecton District • Eaton Fire Protection District • Greeley Fire Department • Johnstown Fire Protection District EMS Transport Agencies: • Poudre Valley Hospital EMS • Thompson Valley EMS VALLEY fRE PRUTE Windsor -Severance Fire Rescue ON Divi¢cT inter AULT MEPOTECON DISTRICT GTernon ormuR S ; Page 4 * Please note Section 7-3-50 Criminal record of ambulance crew member. Unless waived by the Board of County Commissioners, no person shall be employed by an ambulance service as an ambulance crew member who has been convicted of any of the following offenses within the previous twelve (12) months from the date of application: felony, misdemeanor or Class I or Class II traffic offense. I HEREBY CERTIFY THAT I AM AUTHORIZED TO SUBMIT THE FORGOING APPLICATION 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 G OUNDS FOR e')NSE REVOCATION AND POSSIBLE C • b t AL PROSECUTION. Signature of Applicant Title ` il.tttttftfft` SCR1EE AFFIRMED BEFORE ME THIS N{t M. 44y'! 20 3 , IN THE C TY OF �e I , STATE OF COLORADO. • A = UB ?7T:, IIC • OFCOLO....... ignature of No 4°OUufnminin ' MYCommission expires: /0 / Hello