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Home My WebLink About20133451.tiffRESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - MOUNTAIN VIEW 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 Mountain View 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 Mountain View 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. BOARD OF COUNTY COMMISSIONERS WELD COUNT)%IAOLDO ��"'�r illiam F. Garcia, Ch • Douglas Rademacher, ro-Tem ATTEST: Weld County Clerk to the Board BY Deputy APP a o' D ttorney DEC 3 1 2013 Date of signature: P. Conway arbara Kirkmeye (Kevin Tray N� 4 2013-3451 HL0042 Memorandum TO: Board of County Commissiorfei FROM: Dr. Mark Wallace DATE: December 4, 2013 SUBJECT: Mountain View Fire Protection District 2014 Application for Ambulance Service License Mountain View Fire Protection District, located at 3561 Stagecoach Road, Unit 200, Longmont, Colorado, has applied for an Ambulance Service license pursuant to Chapter 7, of the Weld County Code (WCC). Chapter 7 pertains to Emergency Medical Services. The Department has reviewed this application and has deemed the ambulance service to have met all applicable licensure application requirements found in Chapter 7. As such, I am recommending for licensure. The Weld County Emergency Medical/Trauma Service (EM/TS) Council reviewed this application on November 20, 2013. The Council recommended (see attached) that Mountain View Fire Protection District receive a Tier I license. 2013-3451 Z foa a 0 oil U U z O O H o to O W °a El F F. Laz 0 z Q U LOW U �_, W _ g ` z E" D Z CC� W K o 7 ai g�� N W O I., .++ U z 0 E. W O U z a o N �N %' z U Ill [" Z a cn m LU Z Y a O U U W W a 0 .� J 0 v tL v o a} vri N .... '�y j�1f�� I!@7! co w a ‘4.• ,• r ~ in a a z Q O p a y ly zu.., 0 ri JI Z Z H z oI o Z O X ..0 _ Z z < CCO H w CO W n w E 2 i nj `o l" U W Q v OD m ,_ z U n 0co v m W W1u ryr ��CU cn C DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue Greeley, CO 80631 PublicxeattL Web: http://www.co.weld.co.us/Departments/HealthEnvironment/index.html Health Administration Public Ream & Clinical Environmental Health Communication, Emergency Preparedness Vital Records Services Services Education 8 Planning 8 Response Tele: 970.304.6410 Tele: 970.304.6420 Tele: 970.304.6415 Tele: 970.304.6470 Tele: 970.304.6420 Fax: 970.304.6412 Fax 970.304.6416 Fax: 970.304.6411 Fax 970.304.6452 Fax: 970.304.8469 Our ttslon: Together ugh the communities we serve, we are waking to make Weld County the healthiest place to live, learn, work endplay. October 28, 2013 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: bschaeferP,plattevalleyfire.org SUBJECT: 2014 Mountain View Fire Protection District EMS Application NOTICE OF EMERGENCY MEDICAL SERVICES LICENSE APPLICATION TO [Hit 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 Mountain View 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 (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 EMITS 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, bcol Rachel Scanlan Environmental Health Specialist Environmental Health Services Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Mountain View Fire Protection District As required in Section 7-2-100.B.5., the EMTS Council should review the application whether the ambulance service will contribute to an efficient, effective, and coordinated response to residents of the County? Please include any findings related to response other ambulance services, location, service area, etc. that is the basis for the Council's FINDING #1: ctttM k U ttWM v�. 12414-/Fia to assess as to emergency medical time, coordination with recommendation: c a6�e-> 'M�. rt'-;r 7l FINDING #2: t '"i' +_ P¢._ ve �9u..lP�co S {t��' (veal -0 Le_ FINDING #3: FINDING #4: Recommended Level of Service: Tier 1 Tier 2 Tier 3 Recommended Service Area: M IASt-1pp � � ,c1 — Other EMTS Council recommendations or comments: Recommendation By:� Date: .47.44. DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue Greeley, CO 80631 Web: www.weldhealth.orq Public Health P.no.l. Nom. Pi.a.c0 Health Administration Public Health a, Clinical Environmental Health Communlcalion, Emergency Prepared] Vital Records Services Services Education & Planning & Response Tele:970.304.6410 Tele:970.304.6420 Tele:970.304.6415 Tele:970.304.6470 Tele: 970.304.6420 Fax: 970.304.6412 Fax 970.304.6416 Fax 970.304.6411 Fax: 970.304.6452 Fax: 970.304.6469 Our vision: Together with the communities we serve, we are working to make Weld County the healthiest place to live, learn, work and p AMBULANCE SERVICE LICENSE RENEWAL APPLICATION Date of application: Name of Ambulance Service: Ploi,l<.NT-ivrio F:r.cE Plzp Grsoa.i ► �silt�t�T Owner: Name: P*40 Lt N Address: 3 6 / is . S1 x ECc, fa Gi. R O uav raCYa 1-c,vaC,NCa l rt- E° Phone Number: 303 - N77.2 -0710 Operations Manager: Name: 1"44-2K ALA Lo LE / - Address: 25 61 N. ST P.6ECc f-C.}-ri, a 1rin>�r�oo Lew(' rile/T goS o / Phone Number: -3 03-.'7 72 `c 7 / 0 Email: 1)1 LAe MUFr1DsO1e.L Pursuant to Section 7-2-I50 of Weld County Code Ordinance, any change of ownership requires a new application for ambulance service license. (For Office Use Only) Date Received: / / Documents Checked: Remarks: Date Referred to EMTC: / / Approved Recommended (Y/N): Date Referred to B.O.C.C.: / / 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): Ni What area of Weld County will be served by this company? Please attach a map indicating the service area. 5, i-U, LA)' <C�17 ' nag- q -h ft-cs»tmyn o En 7>..c_C+3c, Al n RL, r.At_ R -tans How many ambulances do you operate? wr-r 14 3 Srrl# tSEk'U. 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: A r1 ic(+LAp Street Number: City: State: Phone: Location #2: Street Number: City: State: Phone: Medical Director: Name: _ Mailing Address: Phone Number: Please read carefully : Ann Ci+ -O 7-2-170 Annual renewal. All licenses and permits shall be renewed annually, shall expire on December 31 of the year issued, and shall not be renewed until the application has been approved by the Department. All applications for renewal of licenses and permits shall be made not later than sixty (60) days prior to the date of expiration. The Department shall notify, by certified mail, return receipt requested, each licensee of the renewal requirements of this section within ninety (90) days prior to the date of expiration (Weld County Code Ordinance 2007-8) 7-2-180 Change of Medical Director An ambulance service must report any change of medical director, including name, address and telephone number, to the Director within fifteen (15) calendar days of such change. (Weld County Code Ordinance 2007-8) Page 4 * Please 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 GROUNDS FOR LICENSE REVOCATION AND POSSIBLE CRIMINAL PROSECUTION. /0 Si y attire of Applicant Title ate SUBSCRIBED AN AFFIRMED BEFORE ME THIS =91 DAY ,Cf%#,- , 20 AS IN THE COUNTY OF (e-( , STATE OF COLORADO. J3 My Commission expires: 4' i 6 / ---9-e)/5/ MOUNTAIN VIEW gE sljj)cu E I w L'OKAV Medical Director: Adam Rush, MD Longmont United Hospital 1950 Mountain View Ave. Longmont, CO 80501 Phone: 303.651.5000 Cell: 720.684.6193 MOUNTAIN VIEW FIRE RESCUE 3561 N. Stagecoach Road • Longmont, CO 80504 (303) 772-0710 • FAX (303) 651-7702 www.mvfpd.org MOUNTAIN VIEW FIRE PROTECTION DISTRICT Location/Description of Ambulance Location Oct 2013 Station 1- Hwy 119 Engine 2201 10939 WCR 5 Longmont, CO 80504 303-772-0710 Station 3 — Mead Paramedic Engine 2203 441 Third Street Mead, CO 80542 970-535-4330 Station 4 — Niwot Ambulance 2224 Engine 2204 8500 Niwot Road Niwot, CO 80544 303-652-2984 Station 6 — Erie Ambulance 2226 Engine 2206 50 Bonanza Drive Erie, CO 80516 303-828-3152 Station 7 — Dacono Ambulance 2227 Engine 2207 161 Perry Lane Dacono, CO 80514 303-833-3896 Station 5 Brownsville Reserve Ambulance 10911 Dobbins Run Lafayette, CO 80026 Maintenance Dacono Reserve Ambulance Reserve Ambulance 100 Forest Dacono, CO 80514 0 m e • 0 as a • r i+ o 2 4+ Q a CO • • .� t iia , f , 1,` , 1 -.• 7 t , ,. 1 7 I ' IV. .. �i& Y-\ 77-;.., r. ,. 7 � :/ •• ' . k 1 L.' ; : 4, ' t 1 j • ei 1 t e ( r f 1�� - c)As-- ProV MOUNTAIN VIEW FIRE RESCUE 3561 N. Stagecoach Road, Unit 200 • Longmont, CO 80504 (303) 772-0710 • FAX (303) 651-7702 To Whom It May Concern: Below is a listing of the mutual aid agreements Mountain View Fire Protection District has with surrounding agencies. Mutual Aid Agencies Frederick/Firestone Fire — Fire/Ambulance - Longmont Fire- Fire - Berthoud Fire - Fire - Johnstown Fire - Fire - Platteville Fire - Fire - Fort Lupton Fire - Fire - North Metro Fire — Fire/Ambulance Lafayette Fire — Fire/Ambulance - Boulder Rural Fire - Fire Louisville Fire — Fire/Ambulance Mountain View Fire Protection District has mutual aid with all fire agencies in both Weld and Boulder County. We are in the process of getting mutual aid agreements with Banner Health, PVH Ambulance, AMR Ambulance and Thompson Valley Ambulance. Roger Rademacher Assistant Chief Mountain View Fire Protection District. www.mvfpd.org Hello