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Home My WebLink About20133446.tiffRESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - POUDRE VALLEY HOSPITAL EMERGENCY MEDICAL SERVICES 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 Poudre Valley Hospital Emergency Medical Services 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 Poudre Valley Hospital Emergency Medical Services 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. ATTEST: Weld County Clerk to the Board BY APP Deputy unty Attorney arbara Kirkmeyer DEC 3 1 2013 Date of signature: BOARD OF COUNTY COMMISSIONERS WELD 7UNp*OLe¼DOI William F. Garcia, Chair �7 La-1I(p 2013-3446 HL0042 Memorandum TO: Board of County Commissioners FROM: Dr. Mark WallacehtLi DATE: December 4, 2013 SUBJECT: Poudre Valley EMS 2014 Application for Ambulance Service License Poudre Valley EMS, located at 3509 South Mason, Fort Collins, 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 Poudre Valley EMS receive a Tier I license. 2013-3446 9 N 0 co 0 a 0 J 0 U vi z J J 0 U a 0 LL 0 N w F_ J U) A 0 IX 2 a N rW W U Z a 0 cc 0 U U Q Z_ >- H Z D 0 U 0 W - U'1 5z O z a W U � CC w w Vo W z z Q a N J IT CCD D c` z z Q D Lt.! 0 H U K w w 0 0 C7 1-2 Nri o X N m L w LU w U w 0 J H Z D 0 w U z w U J TO NOT TRANSFERRABLE / POST IN A CONSPICUOUS PLACE Licensure authorizing for Primary Care, as defined in Section 7-1-39 of the Weld County Code. N F I DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue Greeley, CO 80631 Web: htto://www.co.wald.cosis/Denartments/HealthEnvironment/Index.html PublicHeatth T e G.n. Pmmme. Pmuo. Health Administration Public Health & Clinical Environmental Health Communication, Emergency Preparedness Vital Records Services Services Education & Planning & Response Tale: 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 dsion: Together wkh the commurxlies we serve, we am working to make Wela County the healthiest place to Ike, learn, work and play. October 25, 2013 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: bschaefer(a,plattevaileyfire.org SUBJECT: 2014 Poudre Valley EMS Application NOTICE OF EMERGENCY MEDICAL SERVICES LICENSE APPLICATION TO THE WELD COUNTY EMERGENCY MEDICAL/TRAUMA SERVICE COUNCIL The Weld County Department of Public Health and Environment has received and is in process of reviewing an Emergency Medical Service License Application from Poudre Valley EMS. Attached to this document are the Ambulance Service License Application, and Maps of its proposed Service Area. On behalf of the Board of County Commissioners, the Department is requesting the Emergency Medical/Trauma Service Council review the attached documents in accordance with Section 7-2-100.B.5. of the Weld County Code (enumerated below). The Department will forward your recommendation to the Commissioners. Below are the most applicable portions of the code: Weld County Code, 7-2-100.B.5 The recommendation of the Weld County Emergency Medical/Trauma Service (EM/TS) Council as to whether or not the issuance of the license will contribute to an efficient, effective, and coordinated emergency medical response to residents of the County. The 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, Shana Vogel Environmental Health Specialist Environmental Health Services Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Poudre Valley EMS As required in Section 7-2-100.B.5., the EMTS Council should review the application to assess as to whether the ambulance service will contribute to an efficient, effective, and coordinated emergency medical response to residents of the County? Please include any findings related to response time, coordination with other ambulance services, location, service area, etc. that is the basis for the Council's recommendation: FINDING #1: ^ Ureag U=4s a V.Qlc( et R2coit.)c Foy c3 P% \t it -A0 \l,t&... a .\ o -an.) �v ,MPLW 4- Stse.a tea. FINDING #2: i2At...tpotTt MAT- al.rF W&r6r 2 _ aerc PC c.c.PWAtLM%IC f _ *AamI,AZ 4 i 13 FINDING #3: FINDING #4: Recommended Level of Service: Tier 2 Tier 3 Recommended Service Area: LA S'tn Oti,tyritt.A-'neta Other EMTS Council recommendations or comments: Recommendation Name of Ambulance Service: Owner: "9 g� (� Name: A4-604 Va, /-1 &a 17�a v Address: a 3 13' /+ / Q Phone Number: C�(70) _2,32. -/ 2 S0 Operations Manager: �t Judith 4-. i31Cvu-v, Name: Page 2 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue Greeley, CO 80631 Public Health Web: www.weldhealth.orq Health Administration Public Health a Clinical Environmental Health Communication, Emergency Preparedness Vital Records Services Services Education & Planning 6 Response Tele: 970.304.6410 Tele 970304.6420 Tele: 970304.6115 Tele: 970.304.6470 Tele: 970.304.6420 Fax: 970.304.8412 Fax: 970.304.6416 Fax: 970.304.6411 Fae 970.304.6452 Fax: 970304.6469 Our vision: Together with the communities we serve, we are working to make Weld Countythe heallNest place to live, learn. wort and play AMBULANCE SERVICE LICENSE RENEWAL APPLICATION Date of application: / o/ S/a 0 /2 PDveix, V H*; /U ft ems gea S Address: 3 50 i S . /rrl aSo-n & t r±- i Ft() ce S50 s .1 S' Phone Number: (970) 3 91 - 9sa Pursuant to Section 7-2-150 of Weld County Code Ordinance, any change of ownership requires a new application for ambulance service license. Date Received: / / (For Office Use Only) Documents Checked: Remarks: Approved Recommended (Y/N): Date Referred to B.O.C.C.: / / Licensing Agent Page 3 Name and address of each stockholder of partner owning 10% or more of the outstanding stock of the company of having more than a 10% ownership interest (if applic a /0 /O ��K/1 e /! W rn� 11 , What area of Weld County will be served by this company? Please attach a map indicating the service area. How many ambulances do you operate? O1,0 (06 en,,, F c) welcPcri rosJ 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: City: P/C Qs C e-Gtt-c1e1 Location #2: Street Number: City: State: Phone: Medical Director: Name: State: Phone: petLJ flokgto4, M D_ Mailing Address: j b S • Phone Number: (97 CO 41 95 - too Please read carefully : Ave re) (ago 512 7-2-170 Annual renewal. Ail 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) Signature of Applicant P�` itle Page 4 ii - r. 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 for Class H traffic offense, f 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. G ai ggs aMr /a/2- rte Date SUBSCRIBED AND AFFIRMED BEFORE ME THIS aril l DAY OGbbe% , 20 13 , IN THE COUNTY OF LQ.r 1 non , STATE OF COLORADO. Signature of Notary My C/ mmis on expires: 03 / Oy / O16/5 Poudre Valley Hospital 10/22/2013 UNIVERSITY OF COLORADO HEALTH Weld County Dept. Of Public Health & Environment 1555 North 17th Ave. Greeley, CO 80631 Dear Sir/Madame, We do not have assigned vehicles (numbers) to any particular station in FC. Our "station locations" and the "potential number" of ambulances located at each are as follows: Our main office/station: 3509 S. Mason St. #9 Fort Collins, CO 80525 10 ambulances 415 S. Bryan St.: 1 ambulance FC, CO 80521 913 E. Myrtle St.: 2 Ambulances and 1 TEMS Ambulance FC, CO 80524 PVH Harmony Campus: 1 Ambulance 2127 E. Harmony Rd. FC, CO 80528 The Greeley Emergency & Surgical Center station: 1 ambulance 690610th St. Greeley, CO 80634 Windsor Fire Dept 2 ambulances (Meds 12 & 15) ev K 100 N 7th St. Windsor, CO 80550 Milliken Fire Dept: 1 ambulance (Med 16) 101 S. Irene Ave Milliken, CO 80543 2 Johnstown Fire Dept: 1 ambulance (Med 14 used as a Reserve/backup ambulance) Supervisor Truck Ram 100 Telep Ave. Johnstown, CO 80534 Thanks and if more info is needed please contact me. Judith A. Bratten, Manager/Admin Chief EMS Operations PVH/UC Health EMS (970)391-9826 3509 S. Mason St #1 Ft Collins, CO 80525 1024 S. Lemay Ave. • Fon Collins, CO 80524 • Phone. 970.495 7000 • pvhs.org Johnstown Fire Protection District December 2012 Milliken. Fire Protection District E- Vii- -,.� Windsor -Severance Fire Rescue w r VA Ili! flat YMUUIE`TWS4 DISTX1CF smenamensery w.n.v.. , ,.1,13,. • • wnn i..nu.n..n.... 4 nF..o.rm• 4, �t�. /• nr u1uar+ni vr6erno�.:�A ci N. • E .nnuuunu.'hlnu uu:u.r2 Lcosai • aNN470.Yd FIFE ik[A C laN F1.ttH7[7 \ ;.nnnwww..on- Ally FIRE .5)01W1:l11: OLSIR[CT n:.ut1 [43,4•11...&12 .inn....: b..Y .1 � a 2A7yn nat FAQ74CTICN om W[', i . a nn....n...„n.,,..rn.In.n,. :...n:,:11n::nwIt..,:1u,nlmmE. ��\\;k. 1"n `\"I t a ad- v.�vin.af ..uunauu.unll,.0 cp o 03 C 15) cc E P O 3 CO 0o S C- w Map of: 6906 W 10th St Greeley, CO 80634-9726 �10tSt. t- a rnao quest 12y, .w .• 1500ft 1200m J I:; r-� Notes 6906 10th St Greeley Emergency and Surgery Center SUS __?N_10th ©2013 MapQuest - Portions O2013 NAYMEQ J Terms I Privacy C20t3 MapQuest, Inc. Use of directions and maps is subject to the MapQuest Terms of Use. We make no guarantee of the accuracy of their content, road con5tions or route usability. You assume all risk of use. rleyr.T,eirtls ct.„4'sg n Rd 54 :n RA Pv Cp. Rd 82 Co Rd 8: rEu n Ce•Ed Bu Rom VoddC73 Se He :a La Ro 54 We:GORa80 V2 _e Rd :: Oahocd aaaervdi. fames Lau✓ 0 r C B/10 E0ks Reservoir Co Rd SO Co Re 78 Poudre Are Amkoriy Response Areas in We a County Am -Aid whB PVH EMS Pandre Are Autkorfy Boundary Line DL,H ?inS /-r_a,- Air marques₹ - 0L6VEIdhd. .©2012 AiapQtnst Poitlons02012 VAYTE.O Poudre Valley Hospital UNIVERSITY OF COLORADO HEALTH 10/22/2013 Poudre Valley Hospital/UC Health EMS Mutual Aid Agreements with the following agencies: Legal Name Of Agency Level of Care ALS/BLS/CCT 1. Poudre Fire Authority 2. Glacierview Fire Protection District (GLV QRT) 3. Larimer County Search and Rescue (LCSAR) 4. Livermore Fire Protection District (LVQRT) 5. Poudre Canyon Fire Protection District (LPCQRT & UPCQRT) 6. Platte River Power Authority (PRPA) 7. Red Feather Lakes Fire Protection District (RFLQRT) 8. Wellington Fire Protection District (WELLQRT) 9. Rist Canyon Fire Protection District (RCQRT) 10. Poudre Valley EMT Reserves (PVH volunteer EMTs) 11. Thompson Valley EMS (WAS) 12. Cheyenne American Medical Response (AMR) 13. Medevac Greeley (helicopter) 14. Laramie Fire Dept 15. Estes Park EMS 16. Mountain View Fire 17. Jackson County EMS ** agency has a certified Paramedic responds when available MOUs with the following agencies: Fort Collins Police Services SWAT Larimer County Sherriffs Office Larimer County Dive Team Northern Colorado Bomb Squad Larimer County Sherriffs SWAT Team BLS BLS** BLS BLS** BLS BLS BLS BLS BLS BLS ALS ALS ALS/CCT ALS ALS ALS ALS 1024 S. Lemay Ave. • Fon Collins. CO 30524 • Non e:9704957000 • pvhs.org Hello