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Home My WebLink About20130927RESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - MILLIKEN 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 Milliken 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 Milliken 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 COSI{VTY COMMISSIONERS WELD COUN Y. COLORADO ATTEST: Weld County Clerk to the Board BY: 9C(A/I uty Cle APED ounty Attorney Date of signature APR 2 P 2013 PYi i cev�sv i HL ef/.30 William F. Garcia, Chair her, Pro-Tem n P. Conway e Freeman rbara KirkmeyOr c&: NL( Witt / �'1a-V14 2013-0927 HL0042 1-1(3o Memorandum TO: Board of County Commissioners FROM: Dr. Mark Wallace S c—Th DATE: April 10, 2013 SUBJECT: Milliken Fire Protection District 2013 Application for EMS Services Milliken Fire Protection District, located at 101 South Irene, Milliken, 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 Milliken Fire Protection District receive a Tier I license. 2013-0927 AAAAAAAAAA AA AAA A A A I A A A A A A111111111111111 H LL. Z OW H Z Z W O Io: < Z o. 0 ca H J W U U 0 — J -� W o] a a) U > v V1 al U C E Q al v a 0 0 a) tO C a) U J I- 0 I- m 0 z 0 H 0 W F a w re 4. z w J J 2 z M In 0 co 0 0 cc 0 J 0 0 z W J J ui z 2 F- 7 0 cn I- 0 I- U, 0 z 0 F 0 W F 0 cc a W U- z w J J Name of Owner z z 0 U 0 LL vi z Z 0 > w w N 0 Z a gin Q z Q Q OU cc 0 w O O Z IM N O 6w .4 2 m § w CO 111 wz a w 0 K J O U z 0 w dl z w U J N 0 N LID 0- 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. WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Permit to operate an Emergency Medical Vehicle (Ambulance) This Certifies: MILLIKEN FIRE PROTECTION DISTRICT Motor Number: 1FDWF36R68ED13130 p. ^ MEETS WELD COUNTY STANDARDS FOR us EMERGENCY MEDICAL VEHICLES (AMBULANCES). THIS PERMIT WILL EXPIRE DECEMBER 31, 2013. Director, Weld County Department of Public Health and Environment Date Must Be Pasted in Vehicle DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17t" Avenue Greeley, CO 80631 PublieBealth Web: htto://www.en.weld.co.us/Deoartments/HealthEnvironment/index html Heake Admimuaion Public Heall9 & Clinical Environmental Heath Communication, Emergency Preparedness Vital Records Services Services Education & Planning & Refporee Tele: 470304.6410 Tale: 970.304.6420 Tele: 970.904.5415 Tele: 970.304.6470 Tde: 970.304.6420 Fx 970.304.6412 Fax 970.3046416 Fax: 970904.6411 Fax: 970.304.6453 Fax: 9703046499 CurAsian: Together wet; Me communities we serve, we are wwMngm make Weld Couvy the healthiest place no live, learn. work and play. March 15, 2013 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: bsehaefera,nlattevallevfire.org SUBJECT: 2013 Milliken Fire Protection District EMS Application NOTICE OF EMERGENCY MEDICAL SERVICES LICENSE APPLICATION TO THE WELD COUNTY EMERGENCY MEDICALJTRAUMA 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 Milliken 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. 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 1: 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: Licensors authorizing for Standby Service, as defined in Section 7-1-30 of this Chapter. A. The Board of County Commissioners reserves the right to amend these rules and regulations and any other individual conditions of licensing as applied to any particular license, as needed in keeping with its legislative function and in order to implement the policy of the State of Colorado that the regulation and control of ambulance licenses is in the exclusive purview of the boards of county commissioners. Persons or firms seeking application and approval of any ambulance license under this Chapter acknowledge that Weld County may contract with specific ambulance service provider(s) which will serve the emergency ambulance need of Weld County and participating municipalities. Please forward the Councils recommendation to the Department. Please do not hesitate to call me should you have any questions. Sincerely, Shana Fassman Environmental Health Specialist Environmental Health Services Recommended Level of Service: Recommended Service Area: Tier 2 Tier 3 As listed In the application. The service area encompasses the Milliken 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 Colorado Health. No issues were identified. Other EMTS Council recommendations or comments: None Recommendation By: Recommendation Date: 3/k//3 MILLIKEN F/RE PROTECT/ON DISTR/CT 101 South Irene Avenue. Milliken CO, 80543 Phone: (970)587-4464 Fax: (970)587-0260 March 13.2013 Weld County Department of Public Health and Environment Attn: Environmental Health Services 1555 N. 17th Avenue Greeley, CO 80631 To whom it may concern, Greetings! Attached is the 2013 Milliken Fire Protection District (MFPD) application for a Tier One license in Weld County. Through a contractual arrangement with University of Colorado Health (UCH), the MFPD is "furnishing...the transportation of patients by ambulance" from its "primary base of operation" at 101 S. Irene Ave., Milliken, CO 80543 (WCC, pg. 7-4, 2013). Because the MFPD assets listed on page 6 of the application will be operated UCH sub -contractors a few points of clarification should be made: • Sub -contractor Medical Director is Dr. David Farstad. All ALS and BLS medications listed in the attachments are per his protocols. The MFPD, per our agreement with the Weld County Fire Chief's Association, will continue to use Dr. Benji Kitagawa as MFPD 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 MFPD assure "an efficient, effective, and coordinated emergency medical response to residents of the county" (WCC, pg. 7-10, 2013). We thank you for your consideration. Sincerely, Ron Bateman, Fire Chief Milliken Fire Protection District Page 2 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue Greeley, CO 80631 Web: www.weldhealth.orq Health Administration Vital Records Tee 97030465'0 Fax 970.304.64'2 Public Health & Clinical Services Tele 970.304 6420 Fax: 972.304 6416 Environmental Health Services Tele 970 304 64'5 Fax 970 304 64'1 Communication. Education 8 Planning Teie 970 304 6476 Fax. 970.304 6452 Ou' WS Of TOoerner Wile the foMMun:l:e5 We Serve. we are wcriong to make We'd .'.Our: y the hea::taexl p/ace Public Health Emergency Preparedness 2. Response Tee 970 304 6420 Fax 970 304 6469 to byelearn work and play AMBULANCE SERVICE LICENSE APPLICATION Date of application: 2-28-2013 Name of Ambulance Service: Milliken Fire Protection District Owner: Name: Milliken Fire Protection District Address: 101 South Irene, Milliken, CO 80543 Phone Number: 970-587-4464 Operations Manager: Name: Dean Prather, Fire Marshal Address: 101 South Irene, Milliken, CO 80543 Phone Number: Email: 970-587-4464 dgrather a millikenfirerescue.com 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: Remarks: (For Office Use Only) Documents Checked: Approved Recommended (YN): Date Referred to B.O.C.C.: Licensing Agent Page 3 Name and address of each stockholder of partner owning 10% or more of the outstanding stock of the company of having more than a 10% ownership interest (if applicable): N/A What area of Weld County will be sened by this company? Please attach a map indicating the service area. Map Attached How many ambulances do you operate? Milliken Fire Protection District will operate 1 ambulance. 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: 101 South Irene City: Milliken Location #2: Street Number: City: State: CO Phone: 970-587-4464 Medical Director Name: David J. Farstad MD State: Phone: Mailing Address: 1024 South Lemay, Fort Collins, CO 80524 Phone Number: 970-495-8006 Please read carefully : 7-2-170 Annual renewal. All licenses and permits shall be renewed annually, shall expire on December 31 of the year issued, and shall not be renewed until the application has been approved by the Department. All applications for renewal of licenses and permits shall he 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 (901 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 I and II traffic violations, within the previous twelve (12) months. * H. As required in Section 7-2-90 of the Weld County Code Ordinance, Proof of insurance, as required in section 7-3-60 of this Chapter. (Worker's compensation insurance, Public liability and property damage bodily injury, Property damage, Professional liability, and Ambulance vehicles coverage.) I. As required is 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. K. As required in Section 7-2-90 (K) of the Weld County Code Ordinance, make available for review by the Department current records of compliance with the current EMS Laws. L. As required in Section 7-2-90 (L) of the Weld County Code Ordinance. copies of any judgments entered against the licensee or license applicant within the previous twelve (12) months. including findings of fact, conclusions of law and order by any court or other tribunal. M. As required in Section 7-2-90 (M) of the Weld County Code Ordinance, such other information as the Department may require to make a fair determination. As required in Section 7-3-I 10 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 HEREBY CERTIFY THAT I AM AUTHORIZED TO SUBMIT THE FORGOING APPLICATION AND THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF AND CONTAINS NO WILLFUL MISREPRESENTATION OR FALSIFICATION. IN ADDITION, I CERTIFY THAT I HAVE READ AND UNDERSTAND THE PROVISIONS AND REQUIREMENTS OF WELD COUNTY CODE CHAPTER 7, INCLUDING, BUT NOT LIMITED TO, SECTION 7-8-10, WHICH ENCOURAGES ALL LICENSED AGENCIES PROVIDING EMS RESPONSE IN WELD COUNTY TO MAKE A GOOD FAITH EFFORT TO EXECUTE WRITTEN MUTUAL AID AGREEMENTS WITH ALL OTHER EMS PROVIDERS LOCATED WITHIN OR BORDERING ON THEIR AREAS OF RESPONSE. DETERMINATION THAT AN AMBULANCE SERVICES LICENSE HAS BEEN ISSUED BASED ON FALSE INFORMATION CONSTITUTES GROUNDS FOR LICENSE REVOCATION AND POSSIBLE CRIMINAL PROSECUTION. tn. ol, r.haro CL;,i 3•1S-13 Signature ofApplicant Title rt- SLBSCRIBED�AND AFFIRMED BEFORE ME THIS -� DAY 4C- . 20 /3 . IN THE COUNTY OF 4(2-C- / . STATE OF COLORADO. 4eCfliol re ofNotary My Commission expires: 07. °�/ Date , OA Q r. •(- o Y.• :: a0// Page 6 AMBULANCE VEHICLE PERMIT LIST Name of Ambulance Service: Milliken Fire Protection District Application Year: 2013 Vehicle # Year: 2008 Make: Ford Model: F350 XLT Frazier Type 1 12" Gen Med 4 Wheel Drive (YES): N Manufacturers Identification Number (VAN.): 1FDWF36R68ED13130 Colorado State License Number (Registration No.): 093CGR (Title #: 06N662904) Motor Vehicle Chassis Number: 1FDWF36R68ED13130 Registered with the State of Colorado as an emergency vehicle (Y/N): 1' Date Ambulance placed in service: 01 / 01 / 2008 Normal Location of Ambulance: 101 South Irene, Milliken, CO 80543 Vehicle # Year: Make: Identification Number (V.I.N.): Model: 4 Wheel Drive (YIN): 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: Vehicle # Year: Make: Model: 4 Wheel Drive (Y/N): Manufacturers Identification Number (V.I.N.): Colorado State License Number (Registration No.): Motor Vehicle Chassis Number: Registered with the State of Colorado as an emergency vehicle (Y/N): Date Ambulance placed in service: Normal Location of Ambulance: Milliken Fire Protection District District Boundaries May 2010 _r. 40_7; ivy illi...,al.:.:.tiszlis;:a.....2.,.0, .1. v .1 -. 1 1",itiatilljr.41:11 etaF_Imo • a ..:...._ g != �. �.a,� ii: llile .. 1r WI. tarn g ti * . :. •d! .....glalillat Ai. I. ril lial I RiPili fijai rM I Art II . a 7 ...I': Pfgallnialr 111.. Illigalall I.:2:: . li -r Ihfl• lisp,t.. faill , tatf..4.52stattrai .,:.:�� Ear teark-qmmovitireal r AI i . lya laWnastairdallala IMr, isdal! tic lippliallti-m4,---4t-rm---/-1W-_. -- I saa'uimnnnr �i►�I._L aS$ 1 .tNigrairi,t i �1sfSO4 �� I ...��^111/ — .i/9rii . rl - . oiswIrsawrige--TA =MEE Mal .1 III Ifirtagin M1011111 7. - i ,rim IR . �E:' �s!� E1111EN�I M�=%jramib II?' teunnuralWIPEIMENIMISm_Pi illil iii.ass Mt. rigirmr4111111 111111151- Ph imir -- - ere )1MitakEi 11"1 y OM At Ilit�._mit. gn41111111lIra 11i�YYAUA_-iiiii Pm. Intm O , 1 .. a =Pm stra- PP-411111 ' ��i WtS!!S ��s,aat•am n U If • V C a n LL a�C C a C .c 1.01 C 0 CC U, C ance Response Map E Q C 0 a U, Ili cc cc TVEMS Response Area 4I t I 1 Likg C 0 a N N lr C L C N d CC f ° I 1 Windsor -Severance Fire Rescue .ouu- Nwsr.pt }II.i617Mr rwa —• r: r m_, il la. + • ., a a . — Maim '_ _-.. as. .. iMt)I?"" .—`-^ Pte. -- -I k r.� • e \ ; I 'I. `. 1 tom. 4_ 1 1. • la itYi !' ,1� lf� is , I+ I — _ • r .\ MILLI -2 OP ID: SG ,4��Ro CERTIFICATE OF LIABILITY INSURANCE °"03/1 /2013" 03114/2013 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 CNASIET CT Sarajane R. Gomez, CIC - rAPH°c.NNo. Ertl: 970-686-7120 „Uc, Nol 970-686-7131 E-MAIL ADDRESS: S90R1e2.�Vfi600.c0m INSURERS) AFFORDING COVERAGE NAIC a INSURER A : American Alternative Insurance INSURED Milliken Fire Protection District PO Box 130 Milliken, CO 80543 INSURER B: Pinnacol Assurance 41190 - INSURER C: INSURER 0 : INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: • 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. PISRLIP LTR ; TYPE OF INSURANCE INSR 1YW POLICY NUMBER POLICY EFF ! POLICY EXP (MOLIC YEFF POLICY LIMITS A GENERAL LIABILITY I X I , VFIS-TR-2053276-05 II 05/01/2013 85161/2614 I I EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY AMAGE IO RENTED pDREMI5E5 (Eaomrlerce) IS 1,000,000 ' ; I CLAIMS -MADE IV(OCCUR MED EXP (Any one person) I S 1,000,000 PERSONAL a ADV INJURY !$ 1,000,000 GENERAL AGGREGATE S 3,000,000 GENT AGGREGATE LIMIT APPLIES PER — P PRODUCTS - COMP/OP AGG S 3,000,000 POLICY j o •- � LOC f 1 I AUTOMOBILE LIABRJTY IVFIS-TR-2053276-05 05101/2012 05/01/2013 I COMBINED SINGLE LIMIT (EaacooenI) S 1,000,000 X , ANY AUTO ALL OWNED SCHEDULED AUTOS : AUTOS BODILY INJURY (Per person) I S BODILYNJURY(Perawdent) S I NON -OWNED HIRED AUTOS AUTOS mPROPERTY DAMAGE (Per adenU $ A UMBRELLA LIAR I X I OCCUR I I VFIS-TR-2053276-05 I . 05/01/2012 05/01/2013 I EACH OCCURRENCE S 1,000,000 , x ' EXCESSLIAB CLAIMS -MADE AGGREGATE S 2,000,000 I 1 DED X RETENTIONS B • IOFFICER/MEMBER WOS COMPENSATION AND REMPLOYERS' LIABILITY YIN NIA 30925 101/01/2013 01/01/28141 • X TORY LIMITS ' pER- I I ANY PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED', EL EACH ACCIDENT S 100,000 r , E L DISEASE ' EA EMPLOYEE S 100,000 (MandaMy In NH) If yes. desalbe under DESCRIPT1ON OF OPERATIONS bale., E L DISEASE - POLICY LIMIT 5 500,000 A Crime I VFIS-TR-2053276-05 05/01/2012' 05101/2013 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remark. Schedule, H more apace Is required) 2008 Ford Ambulance VIM 1FDWF36R68ED13130 $150,000 Value. The certificate holder is hereby named as an Additional insured. Cancellation provision of (30) days. CERTIFICATE HOLDER CANCELLATION Weld County Board of County Commisioners 1400 N 17th Street Greeley, CO 80631 SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 0 0) N J J_ THIS CARD MUST BE KEPT IN THE INSURED VEHICLE AND PRESENTED UPON DEMAND N m C C N a E O C m CO C > O N E C o m' a CO 0 `a C W 0. 0 mCC P- o Z W Ws O n U O Q0 LL n O w O W a (n N Q N U c 0 z w 1. Name and address of each driver, passenger and witness. co m 0 d CO C O T N a E O U U C .� m > N O c >0 o m E U co > z m ACORD CORPORATION 2005-2007. All rights reserved. ACORD 60 CO (2007/03) COLORADO INSURANCE IDENTIFICATION CARD COMMERCIAL x z 0O a w u pp a ai N La CD ta re u u g LL m w c c) w3 a m u 0 `-G > rc j w 0 w LL 2> so 0 0 0 > 0 q m w y 0 E > I 0 0 U ,z 4 0 a c O C O z u N 0 a o C a o f o N 2 C a OQ E < ' a m N H O w H UCH ! 0 O Ca - CI 8J 3 to LL riU •' < on M x° i20Q o u 0 m w in m LL <m o t° N Y m= w N 00'U O = a d' oeJii, c m 20 a.2 F jC>00 Oo o co c o yo 0 0 o a > >- N 7pO pni? COMPANY NUMBER COLORADO INSURANCE IDENTIFICATION CARD THIS CARD MUST BE KEPT IN THE INSURED VEHICLE AND PRESENTED UPON DEMAND E 0o L N U N N C CO CO :6Q a C y 0 (o a >. m E rn O c c I' 3i, Y . N C N .20 N O m'0 a a v - Eifs > a ( 0 i C CO a > C C CO o 30 m O m — `O U cc 4O co U ca d m a Z C a J > m N O C) m a 5 > a c c 0O m `o m < m a) U a L O N z z > O W a r N CO N N 0 0 c 0 z w O ACORD CORPORATION 2006-2007. Alghfe reserved. ACORD 60 CO (2007/031 0 O CO a COMMERCIAL a a 0 3- COMPANY NUMBER EXPIRATION DATE EFFECTIVE DATE POLICY NUMBER VEHICLE IDENTIFICATION NUMBER MAKE/MODEL ISSUING CARD AGENCY/COMPAN w a z O •I m ^! ty a o 7 m CO 0 mw m ir Uj O 0 U O a .1 Crc m Ei Cl 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, /%'2n �i9'%A Brenda L Harstad, RN CHC Ethics/Compliance & Privacy Officer University of Colorado Health M ill i'Cen Town Hall. 1101 brood Si.. Drawer 290 • FLAiken. CO 80.543 • r97 ) 587-'331.19701 587-267H fax YpgME0 Apri15, 2013 Weld County Commissioners 1150 O Street Greeley, CO 80631 Dear Commissioners: This letter is an endorsement of the Milliken Fire District's contract with Poudre Valley Health (PVHS)/University Health Systems for ambulance service. One of the responsibilities of an elected official is to make community safety and emergency services a high priority. The new provider will bring these added benefits: • An ambulance will be located at the Milliken Fire Station 24/7. • In the event that this ambulance is out on an emergency, a backup will be provided from Windsor. Also, there is a PVH ambulance located at the emergency facility at 10th St. and 71St Ave. in Greeley. • PVHS/UCH has guaranteed a substantial improvement in response times, perhaps as much as eight to ten minutes based on historical data. Citizens will have a choice of local emergency hospitals. In life threatening situations, transportation will be to the nearest facility. Other added benefits include: 1. Special Operations Response Team for medical teams if there is a SWAT call or water rescue issue, etc. 2. Volunteer EMTs who will help with community events, such as Beef and Bean Days 3. Community Paramedicine, using EMTs and paramedics to deliver community healthcare --- vaccination, blood pressure, etc. 4. Child car seat installation ---available monthly We are deeply appreciative of our fire district for keeping the best interests and care of the local citizens in mind. Respectfully, Milt Tokunaga Mayor of Milliken, Colorado Jennifer Fuller From: Milt Tokunaga [MTokunaga@town.milliken.co.usj Sent: Thursday, April 11, 2013 11:56 AM To: Jennifer Fuller Cc: ronald.e.bateman@gmail.com Subject: Upcoming Commissioner's meeting on April 15 Attachments: ambulance endorsement, commissioners.pdf Jennifer, As I have a conflict to attend the Commissioner's meeting on April IS, I wish to have the attached letter distributed to their packets. Please confirm receipt. Thank you for your time, Milt Tokunaga Mayor, Milliken, CO mtokunagaAtown.milliken.co.us 970.744.3007 direct 1 AMBULANCE SERVICES AGREEMENT THIS AMBULANCE SERVICES AGREEMENT is entered into on January 18 . 2013, to be effective as of 120 days from the entrance into the agreement (the "Effective Date") by and between POUDRE VALLEY HEALTH CARE, INC. D/B/A POUDRE VALLEY HOSPITAL, a Colorado non-profit corporation ("PVH") and MILLIKEN FIRE PROTECTION DISTRICT, a Colorado Title 32 special district ("Milliken"). 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. Milliken has the authority under Colorado Secs 32-1-103(7), C.R.S. and 32-1-1002(1)(e)(I), C.R.S. to provide for ambulance services to patients in its district. Pursuant to these statutes, Milliken 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 Milliken. 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 Milliken. ACCORDINGLY, PVH and Milliken agree to the following: 1. JOINT RESPONSIBILITIES 1.1 No Milliken employee shall be deemed to be an employee of PVH, nor shall any employee of PVH be deemed to be an employee of Milliken. 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 Milliken. 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 Milliken 2.1.1 Med 16 2008 Ford F-350 XLT with Frazer Type I Generator Powered Module VIN- 1FDWF36R68ED13130 Page 1 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. 7t' Street) ALS Primary Response Ambulance 2.2.1 (b) Windsor Station 1- Single Resource Captain Ambulance 2.2.1 (c) Milliken Station (located at 101 S. Irene Ave) 1- ALS Primary Response Ambulance 2.2.2 Single Response Level 2 call: 2.2.2 (a) Either primary Ambulance responds to 911 call 2.2.2 (b) Windsor ALS Primary Response Ambulance flexes to open district (if initial call was in Milliken/Milliken District). 2.2.3 Double Response Level 1 call: 2.2.3 (a) Remaining Ambulance will post in Iron Mountain Area 2.2.4 Triple Response 2.2.4 (a) Mutual Aid Agreement with PVH EMS (Fort Collins) or Thompson Valley EMS or Banner Northern Colorado Medical Center 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 Milliken district shall be divided into three areas, the "Urban Response Area", the "Suburban Response Area° and the "Rural Response Area". The Urban Response Area is defined as the area encompassed by North by WCR 52, East by WCR 27 and 77th Ave, South by WCR 42, and West by the border between Johnstown and Milliken Fire Protection District (approx. HWY 257),. The Suburban Response Area is defined as the Hill -N -Park /Dos Rios/Arrowhead Area and includes the area in the Milliken Fire Protection District encompassed by North by WCR 54, East by WCR 33, South by WCR 50, by West WCR East by 77th Ave. The Rural Response Area is considered all areas not defined by The Urban Response Area and The Suburban Response Area but in the Milliken 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 after arrival at a receiving facility if transported. Page 2 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 Milliken 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 tumover 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 Milliken. 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 Milliken 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: Milliken 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. 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 Page 3 (i.e. spinal immobilization, pain management, etc.) These reviews will be used to ensure that care delivered to Milliken 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 Milliken 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 Milliken 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 2.16 2.16 Communications. PVH shall purchase and maintain 800mHz pack -sets for each ambulance. Fuel for Vehicles. PVH is responsible for all fuel necessary for all vehicles donated to Milliken. PVH shall provide a Certificate of Insurance to Milliken 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 Milliken. 2.17 PVH shall abide by the terms of the Business Associate Agreement as attached and incorporated herein as Exhibit B. 2.18 PVH personnel assigned to Milliken shall respond in Milliken's ambulance to the scene of a medical incident as directed by either Milliken or a dispatch center. If patient transport is warranted, PVH personnel shall operate Milliken's ambulance to effect such transport. Milliken personnel shall normally not be utilized as ambulance attendants or drivers except when unusual circumstances warrant such duties. 3. MILLIKEN RESPONSIBILITIES 3.1 Performance problems of PVH employees placed with Milliken will be documented and reported to PVH immediately. 3.2 Milliken 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 Page 4 other network connectivity. 3.3 Milliken 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 Milliken 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 Milliken under this Agreement. 4.2 PVH agrees to indemnify, defend, and hold harmless Milliken 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 Milliken 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 Milliken upon 30 (thirty) days written notice of termination to the other party. If termination occurs by Milliken within the first three hundred sixty-five days of PVH assuming provision of EMS in the district, Milliken will be liable for the start-up capital costs incurred by PVH. 6.3 Milliken may terminate this agreement immediately when quality of care or patient safety is deemed by Milliken 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 Page 5 financial obligations under Article X, Section 20 of the Colorado Constitution, such obligations shall be subject to annual appropriation of funds by the Milliken governing board. Notwithstanding anything herein to the contrary, in the event of non -appropriation, Milliken 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 Milliken 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 Milliken 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 Milliken 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, Milliken 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, Milliken 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 Milliken 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 With a copy to: Page 6 PVHS Legal Department 2315 E. Harmony Rd., Ste. 200 Fort Collins, CO 80528 Fort Collins, CO 80524 Fax: (970) 237-7094 FAX (970) 495-7663 If to Milliken: Fire District: Milliken Fire Protection District Attn: Fire Chief 101 S. Irene Ave Milliken, CO 80543 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 Page 7 party under this Agreement, including the terms of this Agreement, information obtained from corporate or personal records or documents; and neither party will permit inspection of any papers or documents related to this engagement without the other party's prior written consent. 16. Assignment Neither party may assign this Agreement without the prior written consent of the other party. 17. Entire Agreement This Agreement embodies the entire agreement and understanding between the parties with respect to the subject matter of this Agreement and supersedes all prior and contemporaneous oral and written agreements with respect hereto. Page 8 IN WITNESS HEREOF, the Parties have caused this Agreement to be executed by their authorized officers as evidenced by their signatures below. For "Milliken Date: �%i J )i'7 1 / '77- 2 , 2 ,r" TAX/SS ID Number: 8i—IIJ 83cp� (Please provide W-9; this document can be found at http://vww.irs.gov/pub/rs-pdf/fw9.odf) State of Colorado City of -3 r.: 1 r 5 t County of 6 The foregoing instrument was acknowledged before me on this alut of }^1f (name). (Notary '5igaat`ure) SI 31 fto3 (Commission Expiration Date) day of .Y:,r ucsv 2023 by (Notary Seal) FOR POUDRE VALLEY HEALTH CARE, INC. D/B/A POUDRE VALLEY HOSPITAL By: CHE, President/CEO 1Po V_ ey Hospital Date State of Colorado City of County of ` of c The foregoing instrument was acknowledged before me on this day of2013 by ( (name). 1 1 (.;,,,,,.4)(4--ct_4-,6c, (Notary Signature) v�.. (Commission Expiration Date) J (Notary Seal) Page 9 Z013 My Commission Expires 08/31/2009 EXHIBIT A Key Performance Indicators Key Performance Indicators (KPI) will be reported to an oversight board on a monthly basis and annual basis, KPIs to be reported shall include: Requests for Service: A report outlining requests for service, sorted by call type Response Times: see Section 2.4 and 2.5 for specific standards Destination Report: A report outlining Hospital Destinations Training: A report of all education and training provided to the Milliken staff. After Action Reports: A report of all after actions reports conducted by PVH crew and Milliken staff. Additional Activities: A report of additional activities to include; Fire Standbys, Community Paramedicine Activities, Special Event Coverage, etc Average Call Costs: A report of geographically adjusted call costs will be presented. Page 10 EXHIBIT B BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ("Agreement") is effective this 1st day of May 2013 ("Effective Date"), by and between MILLIKEN FIRE PROTECTION DISTRICT ("MILLIKEN") and POUDRE VALLEY HEALTH CARE, INC., D/B!A POUDRE VALLEY HOSPITAL a Colorado non- profit corporation ("Business Associate"). RECITALS WHEREAS, the parties have executed an agreement or agreements whereby Business Associate provides independent contractor services to MILLIKEN, and Business Associate receives, has access to or is subject to the federal regulations issued pursuant to the Health Insurance Portability and Accountability Act ("HIPAA") and codified at 45 C.F.R. parts 160 and 164 ("HIPAA Rules"); WHEREAS, the HIPAA Rules require MILLIKEN to enter into a contract with Business Associate in order to mandate certain protections for the privacy and security of Health Information, and those Regulations prohibit the disclosure to or use of Health Information by Business Associate if such a contract is not in place; WHEREAS, Business Associate acknowledges that effective January 1, 2010, as a business associate, it is responsible to comply with the HIPAA Security and Privacy regulations pursuant to Subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH), including Sections 164.308, 164.310, 164.312 and 164.316 of title 45 of the Code of Federal Regulations. NOW, THEREFORE, in consideration of the foregoing, and for other good and valuable consideration, the receipt and adequacy of which is hereby acknowledged, the parties agree as follows: DEFINITIONS 1.1 "Disclose" and "Disclosure" mean, with respect to Health Information, the release, transfer, provision of access to, or divulging in any other manner of Health Information outside Business Associate's internal operations or to other than its employees. 1.2 "Health Information" means information that (i) relates to the past, present or future physical or mental health or condition of an individual; the provision of health care to an individual, or the past, present or future payment for the provision of health care to an individual; (ii) identifies the individual (or for which there is a reasonable basis for believing that the information can be used to identify the individual); and (iii) is received by Business Associate from or on behalf of MILLIKEN, or is created by Business Associate, or is made accessible to Business Associate by MILLIKEN. 1.3 "Individually Identifiable Health Information" shall mean information that can be used to identify the individual, such as a name or social security number. 1.4 "Protected Health Information" shall mean Health Information and Individually Identifiable Health Information in any medium whether electronic or otherwise. Page 11 1.5 "Security Incident" shall mean the attempted or successful unauthorized access, use disclosure, modification, or destruction of information or interference with system operations in an information system. 1.6 "Security Rules" shall mean the security standards for the protection of electronic protected health information at 45 CFR Part 164, Subpart C and amendments thereto. 1.7 "Services" has the same meaning as in the Services Agreement 1.8 "Use" or "Uses" mean, with respect to Health Information, the sharing, employment, application, utilization, examination or analysis of such Information within Business Associates internal operations. 1.9 All capitalized terms not defined in this section shall have the meanings ascribed to them in 45 C.F.R. Part 160 and Part 164, subparts A and E pursuant to the Health Insurance Portability and Accountability Act of 1996. OBLIGATIONS OF BUSINESS ASSOCIATE 2.1 Permitted Uses and Disclosures of Health Information. Unless otherwise specifically provided in this Agreement or authorized in writing by MILLIKEN, and except as required or permitted by law, Business Associate hereby agrees (a) to keep all PHI confidential and in its possession except as necessary to provide the services under the Services Agreement; (b) to restrict access to PHI to those employees of Business Associate or other workforce members under the control of Business Associate who are actively and directly participating in providing the Services and who need to know such information in order to fulfill such responsibilities ("Business Associate Representatives"); (c) not to copy or duplicate any PHI except as necessary to provide the services under the Services Agreement; (d) to treat any and all copies of, and notes, memoranda, analyses, compilations, abstracts, synopses, studies of other material produced from PHI as PHI; (e) to communicate only with the authorized representatives of PVHS conceming PHI; (f) not to use any PHI for any purpose other than the purpose for which such PHI was provided in connection with providing the services under the Services Agreement; and (g) not to use PHI in any manner that would violate the HIPAA Rules if MILLIKEN were providing the services under the Services Agreement or in any other manner that may be detrimental to MILLIKEN. 2.2 Uses and Disclosures of PHI for Business Associate Operations. Business Associate may use PHI, if necessary, for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate. Business Associate may disclose PHI for its proper management and administration or to carry out its legal responsibilities if the disclosure is required by law, or if Business Associate obtains reasonable written assurances from the Person to whom PHI will be disclosed that: (a) PHI will be held confidentially and used or further disclosed only for the purpose for which it was disclosed to such Person or only as required by law; and (b) such Person will notify Business Associate of any instances of which it becomes aware in which the confidentiality of PHI was breached. 2.3 Adequate Safeguards for Health Information. Business Associate warrants that it shall implement and maintain appropriate administrative, physical and technical safeguards in compliance with the HIPAA Rules and any other relevant laws or regulations to prevent the Use or Page 12 Disclosure of Health Information in electronic or any other form that it creates, receives, maintains or transmits under this Agreement, in any manner other than as permitted by this Agreement. 2.4 Reporting Non -Permitted Use or Disclosure. Business Associate shall report to MILLIKEN each Use or Disclosure that is made by Business Associate, its employees, representatives, agents or subcontractors that is not specifically permitted by this Agreement, including any Security Incident involving Health Information as required by the Security Rules. The initial report shall be made by telephone call to the appropriate representative at MILLIKEN within forty-eight (48) hours from the time the Business Associate becomes aware of the non -permitted Use or Disclosure, followed by a full written report to the Privacy Officer no later than ten (10) business days from the date the Business Associate becomes aware of the non -permitted Use or Disclosure. Business Associate shall take (i) prompt corrective action to cure any such deficiencies and (ii) any action pertaining to such unauthorized disclosure required by applicable federal and state laws and regulations. 2.5 Business Associate's Notification. Business Associate's notification to MILLIKEN pursuant to Section 2.4 of this Agreement shall include the following: • Identification of the nature of the non -permitted use or disclosure of other breach; Identification of the PHI used, accessed or disclosed; Identification of who made the non -permitted use or received the non -permitted disclosure; Identification of what corrective action Business Associate took or will take to prevent further non -permitted uses or disclosures; Identification of what Business Associate did or will do to mitigate any negative effect of the non -permitted use or disclosure; and Provide such other information, including a written report, as MILLIKEN may reasonably request. 2.6 Sub -Contractors and Agents. Business Associate will ensure that any and all Persons who have access to PHI by or through Business Associate, including (without limitation) the Business Associate Representatives, agrees to the same restrictions and conditions that apply to Business Associate hereunder. 2.7. Availability of Internal Practices, Books and Records to Government Agencies. Business Associate agrees to make its internal practices, books and records relating to the Use and Disclosure of Health Information available to the Secretary of the federal Department of Health and Human Services (the "Secretary") for purposes of determining MILLIKEN's compliance with the HIPAA Rules. Business Associate shall immediately notify MILLIKEN of any requests made by the Secretary and provide MILLIKEN with copies of any documents produced in response to such request. 2.8. Access to and Amendment of Health Information. Business Associate shall, to the extent MILLIKEN determines that any Health Information constitutes a "designated record set" under the HIPAA Rules, (a) make the Health Information specified by MILLIKEN available to the individual(s) identified by MILLIKEN as being entitled to access and copy that Health Information, and (b) make any amendments to Health Information that are requested by MILLIKEN. Business Associate shall provide such access and make such amendments within the time and in the manner specified by MILLIKEN. Page 13 2.9 Accounting of Disclosures. Upon MILLIKEN's request, Business Associate shall provide to MILLIKEN an accounting of each Disclosure of Health Information made by Business Associate or its employees, agents, representatives or subcontractors ("Disclosure"). Any accounting provided by Business Associate under this Section 2.9 shall include: (a) the date of the Disclosure; (b) the name, and address if known, of the entity or person who received the Health Information; (c) a brief description of the Health Information disclosed; and (d) a brief statement of the purpose of the Disclosure. For each Disclosure that could require an accounting under this Section 2.9, Business Associate shall document the information specified in (a) through (d), above, and shall securely maintain that documentation for six (6) years from the date of the Disclosure. 2.10 Availability for Audit. Business Associate shall make its internal practices, books, and records relating to the Use and Disclosure of PHI received from MILLIKEN, or created or received by Business Associate on behalf of MILLIKEN available to the Secretary for purposes of the Secretary determining MILLIKEN's compliance with the Privacy Rule. In the event that Business Associate is requested by the Secretary to make available its books, records and documents relating to MILLIKEN compliance with the Privacy Rule, Business Associate will, to the extent not prohibited by law, notify MILLIKEN within 2 business days. 2.11 Obligation of MILLIKEN. MILLIKEN shall notify Business Associate of any current or future restrictions or limitations on the use of Health Information that would affect Business Associate's performance of the Services, and Business Associate shall thereafter restrict or limit its own uses and disclosures accordingly. 2.12. Security Standards. Business Associate will: (a) Implement administrative, physical and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of electronic PHI that it creates, receives, maintains, or transmits on behalf of MILLIKEN. (b) Ensure that any agent, including a subcontractor, to whom Business Associate provides such electronic PHI agrees to implement reasonable and appropriate safeguards to protect it; and (c) Report to MILLIKEN any security incident affecting MILLIKEN of which Business Associate becomes aware in accordance with the Security Rules. 2.13. Notification of Breach of Unsecured Protected Health Information. Business Associate will: (a) Except as provided in 45 C.F.R. § 164.412, report immediately to PVHS after it becomes aware of any Breach cf Unsecured Protected Health Information and promptly provide to MILLIKEN (i) a list of all Individuals whose Unsecured Protected Health Information has been, or is reasonably believed by the Business Associate to have been, accessed, acquired, used, or disclosed during the Breach, and (ii) any other available information that MILLIKEN is required to include in notifications to such Individuals pursuant to 45 C.F.R. § 164.404(c); and (b) Cooperate with MILLIKEN in making any requisite notifications to Individuals and the Secretary as a result of any Breach of Unsecured Protected Health Information, including paying for the cost of notification to Individuals, and of media notification if the legal requirements for media notification are triggered by the circumstances of such breach, provided that Business Associate shall not initiate any such notifications without approval of MILLIKEN. Page 14 2.14 Term and Termination. The term of this Agreement shall be the same as the term of the Services Agreement. In addition to and notwithstanding the termination provisions set forth in the Services Agreement, both this Agreement and the Services Agreement may be terminated immediately upon written notice by MILLIKEN to Business Associate if MILLIKEN determines, in its sole discretion, that Business Associate has violated any material term of this Agreement or any provision of the Privacy Standards or Security Standards or applicable federal or state privacy law relating to the obligations of Business Associate under this Agreement. Business Associate's obligations under Sections 2.1 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.10, 2.12, and 2.13 shall survive the termination or expiration of this Agreement. 2.15. Disposition of Health Information Upon Termination or Expiration. Upon termination or expiration of this Agreement and the Services Agreement, Business Associate shall either return or destroy, in MILLIKEN's sole discretion and in accordance with any instructions by MILLIKEN, all Health Information in the possession or control of Business Associate or its agents and subcontractors. However, if Business Associate determines that neither retum nor destruction of Health Information is feasible and notifies MILLIKEN in writing of that determination, Business Associate may retain Health Information provided that Business Associate (a) continues to comply with the provisions of this Agreement for as long as it retains Health Information, and (b) further limits Uses and Disclosures of Health Information to those purposes that make its return or destruction unfeasible. Upon termination or expiration of this Agreement, Business Associate will give to MILLIKEN copies of all documents in Business Associate's possession or control that are required to be maintained by or on behalf of MILLIKEN by the HIPAA Rules or the Security Rules other than what Business Associate is permitted or required by law to retain. 2.16. No Third Party Beneficiaries. There are no third party beneficiaries to this Agreement. 2.17. Use of Subcontractors and Agents. Business Associate shall require each of its agents and subcontractors that receive Health Information from Business Associate to execute a written agreement obligating the agent or subcontractor to comply with all the terms of this Agreement, including appropriate and comparable safeguards, as defined in Section 2, above. 2.18. Relationship to Services Agreement Provisions, In the event that a provision of this Agreement is contrary to a provision of the Services Agreement, the provision of this Agreement shall control. Otherwise, this Agreement shall be construed under, and in accordance with, the terms of the Services Agreement. 2.19 Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning that permits MILLIKEN to comply with the HIPAA Rules. 2.20 Amendment. The parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for MILLIKEN to comply with the requirements of the HIPAA Rules. 2.21 Waivers. No delay or omission by MILLIKEN in exercising any rights or remedies under this Agreement or applicable law shall impair such right or remedy or be construed as a waiver of any such right or remedy. Any single or partial exercise of a right or remedy shall not preclude further exercise of that right or remedy or the exercise of any other right or remedy. No waiver shall be valid unless in writing signed by the party to be bound. Page 15 Form th e (Rev. December 2011) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Name (as snown o your income tax return) Milliken Fire Protection District Give Form to the requester. Do not send to the IRS. of Business name/dis egarded entity name, if different from above a m N 0. 0 r o o = C a`O Address (number, street, and apt. or suite no.) o. 101 S. Irene co m Crty, state, and ZIP code m m Milliken, CO 80543 Check appropriate box for federal tax classification: IndividuaVsole proprietor ❑ C Corporation E S Corporation TI Partnership 11 Trusttestate ❑ Limited liability company Enter the tax classification (C=C corporation. S=S corporation, P=partnership) ❑� Other (see instructions) , List account numbers) here (optional) Part Fire Protection District 1 QExempt payee Requester's name and address (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. i Social security number Employer identi ication number 8 4 1 1 5 8 3 6 6 Leal Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S. person General Instructions gotta / (' e,iJLf. -F Date" A /15-- Z-0/ 3 Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Note. If a requester gives you form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No. 10231X Form W-9 (Rev. 12-2011) a oNE: !:. +lam . To wr. t;rii( il??: 21.0 3::: 4; `.hnta7.• air^ • E-1:5iitvt: ) is::F•.:? • iF•^7!)• Ci[.i:-i3i April 5, 2013 Weld County Commissioners 1150 O Street Greeley, CO 80631 Dear Commissioners: This letter is an endorsement of the Milliken Fire District's contract with Poudre Valley Health (P\THS)/University Health Systems for ambulance service. One of the responsibilities of an elected official is to make community safety and emergency services a high priority. The new provider will bring these added benefits: • An ambulance will be located at the Milliken Fire Station 24/7. • In the event that this ambulance is out on an emergency, a backup will be provided from Windsor. Also, there is a PATH ambulance located at the emergency facility at 10th St and 71 sC Ave. in Greeley. ▪ PVHS/UCH has guaranteed a substantial improvement in response times, perhaps as much. as eight to ten minutes based on historical data. Citizens will have a choice of local emergency hospitals. In life threatening situations, transportation will be to the nearest facility. • Other added benefits include: 1. Special Operations Response Team for medical teams if there is a SWAT call or water rescue issue, etc. 2. Volunteer EMTs who will help with community events, such as Beef and Bean Days ;. Community Para medicine, using EMTs and paramedics to deliver community healthcare --- vaccination, blood pressure, etc. 4. Child car seat installation ---available monthly We are deeply appreciative of our fire district for keeping the best interests and care of the local citizens in mind. Respectfully, Milt Tokunaga Mayor of Milliken, Colorado Memorandum TO: Board of County Commissioners FROM: Dr. Mark Wallace DATE: April 10, 2013 SUBJECT: Milliken Fire Protection District 2013 Application for EMS Services Milliken Fire Protection District, located at 101 South Irene, Milliken, 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 Milliken Fire Protection District receive a Tier I license. Mark mentioned that there was going to be another meeting about getting Ambulance service in Milliken. I can't be there because of work, but I thought this letter might help. My name is Jeremiah Wheeler. My family has lived in Milliken for about three years and during that time we have had the need three different times for medical assistance. During this time, my wife and I have questioned why we don't have a ambulance in Milliken to help. Our son Logan had a seizure in December of 2009. The fire department was great in helping us get the situation under control and allowing us as parents to feel like everything was being taken care of. We didn't realize just how bad he was until the fireman didn't wait for the paramedics to come in to the house. They wrapped him in a blanket and carried him into the ambulance to help get to the hospital faster. A few months later my wife called me while I was working in Denver to report that my son was having another seizure and that she had called 911 and the fire truck had just arrived. I left work immediately to come home and was told on the way home that he was being sent to the hospital. I got to the hospital in Loveland before the ambulance did. We were frustrated again about what took so long and found out we were waiting for the ambulance to show up. This last December our son had another seizure and while the firemen were working on helping Logan, we called our friend to help watch our daughter while we went to the hospital with our son. While our friend was at our house helping us she asked where the ambulance was and if we were planning on going to the hospital. Of course we were going, but we were waiting for the ambulance to arrive. A few days later we brought some cookies to say thank you to the fire department. We were given a tour around the station and found an ambulance parked in the garage. The ambulance was parked there but had no paramedics assigned to use it. I am thankful for the care and service the firemen gave. I know we are fortunate that our situation did not end up worse than it did. My concern is that I know if there had been someone to drive and work from that ambulance our son could have been to the hospital sooner. I hope we won't have the need for an ambulance again, but I have to be realistic and understand that it is very possible that we will need it again. My wife and I ask that something be done to ensure that someone will be there so we don't have to wait any longer. Thank you for your time to hear our concern. We hope this will help to find a solution for our town in bringing staff to use the ambulance. If there are any questions, please feel free to contact us. 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J a m Cl) J Q m U) J Q CO C!) J a¢¢¢ m (n J m co J w (n J m co J a¢ m U) J m co J Q CO CO J Q¢ m CO J CO CO J Q m INCIDENT # 2013-22 (� ' r a N N r co r O N 2013-103 2013-82 co �` Co r O N 2013-51 2013-57 N- co CO r Co r O N (C) r M r O N a) N CO r M r O N Co r a N 2013-26 2013-30 It) r M r O N N (O Co Co r O N CO (D M `• Co r O N U) CO r O N CO Co r O N V' Co r Co r M r O N N U) r M r M r O N 2013-27 r Co r O N 2013-32 2013-97 U') r r co r O N N N r M `� M r O N r Oi CO r a N 2013-58 2013-29 el r r M r a N r N Co r O N 2013-93 In (O r M r co r O N r co r a N 01/16/2013 2013-20 W F. Q O Co r O N N r O M r O N O O I03/02/2013 02/28/2013 02/17/2013 02/12/2013 Co r O N r O (-1-ci O 02/04/2013 03/16/2013 M r O N M O C-75 O 03/12/2013 01/01/2013 01/20/2013 CO r O N N N r O 02/28/2013 03/26/2013 03/28/2013 01/04/2013 01/06/2013 03/15/2013 03/22/2013 01/22/2013 02/07/2013 Cr) r O N Co N _ O 02/26/2013 03/03/2013 03/07/2013 02/17/2013 02/06/2013 01/22/2013 03/02/2013 02/12/2013 02/25/2013 03/27/2013 01/01/2013 O) T— 0 r N 0 N N 0 N N 0 N N 0 CO N 0 d- N 0 ID cO 0 0 C NO EMD C 0 0 C C 2/14/2013 11 22 00 2/27/2013 09 5400 1/19/2013 21 50 00 2/26/2013 21 24 00 3/12/2013 06 19 32 1/1/2013 17 03 00 1/14/2013 20 47 00 1/26/2013 06 31 00 2/14/2013 10 28'00 2/27/2013 09.01:00 1/19/2013 21 09 00 2/26/2013 20 20 00 3/12/2013 06 10 00 1/1/2013 16 43 00 1/14/2013 20'22 00 1/26/2013 0630 00 2/14/2013 10 09 00 2/27/2013 08 40:00 1/19/2013 20 47 00 2/26/2013 19 58.00 3/12/2013 05.47.17 1/1/2013 16 20.00 1/14/2013 19 58'00 1/26/2013 05 55 00 2/14/2013 10 09 00 2/27/2013 08 40 00 1/19/2013 20 47 00 2/26/2013 19.58 00 3/12/2013 05.47 00 1/1/2013 16 20 00 1/14/2013 19 58 00 1/26/2013 05 55 00 BALS B ALS B ALS B ALS J Q m B ALS ci) J Q CO CI) J Q CO 2013-76 O 1 CO O N 2013-25 2013-99 O N CO r C7 O N 2013-2 M O N 2013-39 02/14/2013 02/27/2013 CO ,-- a r 02/26/2013 03/12/2013 01/01/2013 01/14/2013 01/26/2013 �N E H 0 C O N d a) L ii d S Johnstown and Mi Johnstown Fire District Response Times, 2012 4th Quarter Weld Response Time Min. 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Irene Ave. Yli1fiken Co 80543 970-587-4464 April 12, 2013 Weld County Commissioners 1150 O Street Greeley, CO 80631 Dear Commissioners, The Milliken Fire Protection District dedicated the last ten years to providing 911 emergency response 24/7 to the citizens of the district. This process evolved from volunteer firefighters responding from home to professionally trained, state certified firefighters and officers responding as an engine company within 1 minute of being paged by dispatch. As citizens of Weld County, and of the Milliken Fire Protection District, we are encouraged that we would have full time staffing from Poudre Valley Heath Systems for Advance Life Support (ALS) ambulance service in our community, as well as the communities of Johnstown and Windsor. The goal of this collaboration is to reduce the average on scene time for ALS ambulance in our communities, and to give our citizens comparable or more rapid emergency medical care than is being provided to the communities of Fort Collins and Greeley. This effort will also add 3 ALS ambulance crews to be available as mutual aid assistance for calls outside the district boundaries of Milliken, Johnstown and Windsor for both Weld County and Larimer County. We appreciate the hard work and approval of the County EMITS Council, Medical Director, as well as elected officials in Milliken, Johnstown, and Windsor. As representatives of the constituents in our district, we feel that we would be derelict in our responsibilities if we did not work to provide our citizens and visitors to our district the best ALS service that we can obtain. We ask for your support to approve this service within the context of a shared fiduciary responsibility that we owe to our citizens as elected officials. Respectfully, The Milliken Fire Protection District Board of Directors Blair Howe, President Bill Elder, Vice President Jayna McCauley, Treasurer Roger Ainsworth, Secretary Roger Link, Director My son was six years old the first time he almost died. We hadn't known that he was asthmatic until we nearly lost him. It was a race against time when his lips started turning blue and he couldn't catch a breath. Fortunately when we called 911 an ambulance arrived less than 5 minutes later and immediately recognized that he was having serious respiratory problems. A few short minutes later and we were on our way to the hospital in the very capable hands of the EMTs and Paramedics who cared for him the entire time. Although it seemed like quite a long amount of time passed from when I called 911 until we arrived at the hospital in reality it was probably less than 20 minutes total. In this case, every single second counted and thanks to the fast response by our local EMS my son arrived at the hospital in time. In January of 2012 my family and I relocated to Johnstown, Colorado. We love our community, our neighborhood and the benefits of living in a semi -rural area. The only aspect we never took into consideration prior to moving was local ambulance response times. We live around a mile away from the Johnstown Fire Protection District Station and my son attends Milliken Middle School which is less than a block away from the Milliken Fire Protection District Station 1. We feel certain that when an emergency arises both districts would be there within a couple of minutes. We are not as certain in the case of an ambulance being needed. My son's asthma has not improved as he has gotten older and he is hospitalized a couple times every year. The middle school has had to contact me multiple times to pick him up because his asthma was inflamed. Since we have moved to Johnstown he has been admitted to the ER twice and both times we brought him to the hospital ourselves. Perhaps the only thing scarier than an ambulance ride is driving your sick child to a hospital and telling him over and over again that you are hurrying as fast as you can and knowing that there isn't anything you can do for him until you arrive. We live in the Carlson Farms subdivision in Johnstown and it takes us less than 10 minutes to drive to Medical Center of the Rockies, it can take over 20 minutes for the ambulance to arrive in our neighborhood. To a parent watching their child struggle for every breath, those 10 extra minutes are torture and that is why we have risked driving him ourselves rather than waiting for an ambulance to arrive. Now there is hope for us and our son with the opportunity being presented for new ambulance coverage with the University of Colorado. My heart literally soared the first time I learned about the proposed changes and the difference it would make in our community and specifically in our lives. A person should never hesitate to call 911 but that has been the case in our household since we moved here. We trust our local fire department and the wonderful care that they provide but we need reliable, fast response from an ambulance service as well. That option may finally be available for residents of Johnstown, Milliken and Windsor if these fire districts are granted a tier one license to serve our communities. I would no longer hesitate to call 911 because I would feel more secure in the knowledge that an ambulance would arrive within minutes and provide the necessary care while transporting my children to the hospital and instead of having to be the one responsible for transporting them, I would be able to just be their mother and give them the love and assurance they need. Please allow our districts the ability to better serve the residents by granting them a tier one license. Thank you. Rebecca Clark EXHIBIT Hello