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Home My WebLink About20133450.tiffRESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - FREDERICK -FIRESTONE 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 Frederick -Firestone 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 Frederick -Firestone 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. ATTEST:o�ua�.�iUf.. Weld County Clerk to the Board BY. Deputy APP y Attorney DEC 31201 Date of signature: BOARD OF COUNTY COMMISSIONERS WELD ¢OfCO ADy�DO., William F. Garcia, Chair or �4S Douglas Rademach an P. Conway e Freeman Pro-Tem IL ,c� vL Barbara Kirkmeyer (0,0,IHI, UlAnh,Talau) 071 ILI 2013-3450 HL0042 Memorandum TO: FROM: DATE: SUBJECT: Dr. Mark Wallace December 4, 2013 Board of County Commissioners 1W Frederick — Firestone Fire Protection District 2014 Application for Ambulance Service License Frederick — Firestone Fire Protection District, located at 8426 Kosmerl Place, Frederick, 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 Frederick -Firestone Fire Protection District receive a Tier I license. 2013-3450 a, U a) U) a) U C n3 ma 7 aa) w a 0 O a1 U, C a, U J N to U) O co Cr 0 U U Cr w 0 w CC w a a w 0 O (NI CO F- U F• U, a 0 U w F• a CL Cr w z 0 U) w Cr U Cr w C w a LL W U z 0 cC 0 >- U Q Z_ H z D 0 U 0 J WV) 5z 0 z W U w w K LUo w Z Z Q gW mD 2 z a z z Q D QU U 0 w 0 oz H CD cI U] N W M C� W m 2 W U w a J H Z D a w U, Z w U J N NOT TRANSFERRABLE / POST IN A CONSPICUOUS PLACE Tier I: Licensure authorizing for Primary Care, as defined in Section 7-1-39 of the Weld County Code. DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue Greeley, CO 80631 Web: htto://www.co.weld.co.us/Deoartments/HealthEnvironmenthndex.html PublicHeakh Rcmt. P.emoty. rtoic,t. Health Administration Public Health &Clinical Environmental Health Communication, Emergency Preparedness Vital Records Services Services Education & Planning &Response Tele: 970.304.6410 Tele: 970.304.6420 Tele: 970.304.6415 Tele: 970.304.6470 Tele: 970.304.6420 Fac 970.304.6412 Fax: 970.304.6416 Fax: 970.304.6411 Fax: 970.304.6452 Far: 970.304.6469 Our vision: Together with the communities we serve, we are working to make Weld County:he healthiest place to Lye, learn, work and play. October 28, 2013 Barry Schaefer Chair Weld County Emergency MedicallTrauma Service Council Via email: bschaefer@plattevalleyfire.org SUBJECT: 2014 Frederick Firestone Fire Protection District EMS Application NOTICE OF EMERGENCY MEDICAL SERVICES LICENSE APPLICATION TO 1'HE WELD COUNTY EMERGENCY MEDICAL/TRAUMA SERVICE COUNCII, The Weld County Department of Public Health and Environment has received and is in process of reviewing an Emergency Medical Service License Application from Frederick Firestone Fire Protection District. Attached to this document are the Ambulance Service License Application, and Maps of its proposed Service Area. On behalf of the Board of County Commissioners, the Department is requesting the Emergency Medical/Trauma Service Council review the attached documents in accordance with Section 7-2-100.B.5. of the Weld County Code (enumerated below). The Department will forward your recommendation to the Commissioners. Below are the most applicable portions of the code: Weld County Code, 7-2-100.B.5 The recommendation of the Weld County Emergency Medical/Trauma Service (EM/TS) Council as to whether or not the issuance of the license will contribute to an efficient, effective, and coordinated emergency medical response to residents of the County. The EM/TS Council shall also provide: a. Recommended Service Area. b. Recommended Tier of License. Weld County Code, 7-2-10. No person shall provide or operate an ambulance service publicly or privately in the County unless that person holds a valid license to do so issued by the Board of County Commissioners, except as provided in Section 7-2-80 below. The fee for said license shall be set by separate ordinance. The license shall issue only in the following tiers of service: Tier I: Licensure authorizing for Primary Care, as defined in Section 7-1-30 of this Chapter. Tier IL Lie -ensure 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 74-30 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, b(u) Yvuav Rachel Scanlan Environmental Health Specialist Environmental Health Services Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Frederick Firestone Fire Protection District As required in Section 7-2-100.8.5., 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: F2¢deRAc) - t as -rot i ; e�,r - +s ..tc k hct5 -Vow +b C0tp Per 3 'J M ecru i Nip fav ctt tQS tc.. 1.3eiC �lr�"3fL,t T\g-e-2,i(AS FINDING #2: FINDING #3: FINDING #4: Recommended Level of Service: Tier 1 Tier 2 Tier 3 Recommended Service Area: PCS 1r15--t-e-n 6t.i .P,,p\. c..a nQm Other EMTS Council recommendations or comments: Recommendation By: Date: 403— DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue Greeley, CO 80631 Public Health Prevcnt Web: www.weldhealth.orq ' Health Administration Public Health 6 Clinical Environmental Health Communication, 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: JO -a%--13 Name of Ambulance Service: Fr 4i ritrFiv q,11TvA C hit fro kJ -At b Owner: Name: So.w,,e Address: V.12 (o Xo5vr a,r, Q1 r _fide". ite( j L:?? gocoy Phone Number: N3) g35- - A742 Operations Manager: Name: b T{{�� fta In IL Address: IAA. g.p4►H e. -r- j Pi Phone Number: 7?'G 1.41 -'2 to Email: 4rivt k Q .f-.p.�oQ . us t-ruluf&rb, . o ro `1 Pursuant to Section 7-2450 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 FREDERICK -FIRESTONE FIRE PROTECTION DISTRICT Life Safety Division Office: (303) 833-2742 Fax: (303) 833-3736 E -Mail: dptunk@fffd.us J October 15, 2013 The Frederick -Firestone Fire Protection District currently has three Fire Stations. Each Fire Station houses one of the District's Ambulances. These Ambulances are located at: Station #1 - Ambulance 3421 31 Walnut Drive Frederick, CO 80530 Station #2 - Ambulance 3422 3991 Rowe Street Frederick, CO 80516 Station #3 - Ambulance 3423 6800 Tilbury Avenue Firestone, CO 80504 Respectfully, Douglas J. Prunk Division Chief Physical: 8426 Kosmerl Place, Frederick, CO 80504, Mailing: P. O. Box 129, Frederick, CO 80530; www.fffd.us FREDERICK -FIRESTONE FIRE PROTECTION DISTRICT Life Safety Division Office: (303) 833-2742 Fax: (303) 833-3736 E -Mail: dptunk@fffd.us October 29, 2013 Rachel Scanlan Weld County Environmental Health Services Dear Ms. Scanlan, Enclosed please find our paperwork for the year 2014 ambulance license for the Frederick - Firestone Fire Protection District. Fees: The check is included for the license and inspection of three vehicles Medical Director: Our Medical Director is Dr. Jeff Beckman; Exempla Good Samaritan Medical Center in Lafayette, CO; office phone: 303-425-2289. Insurance: I have enclosed our current insurance certificate. T Quality Control/Training Standards: I have enclosed copies of both standards. Protocols: I have included our current Exempla protocols and the current version of the Denver Metro protocols for July 1, 2013. Staff: I have attached an Excel spreadsheet detailing our staff. This spreadsheet is maintained only on our secure server and is edited only by our Training Lieutenant or the Fire Chief. Hard copies of all certifications are maintained and this spreadsheet is verified twice a year by audit. Vehicle maintenance and safety inspection protocol: The maintenance of our ambulances is coordinated between Interstate Ford, TransWest-Frederick and the vehicle manufacturer. The daily inspection for all units is included. The maintenance summary is tracked in our software program and will be available for review at the time of inspection. Please contact me if you need additional information. Thank you in advance for your time and we look forward to our inspection. Respectfully, Douglas J. Prunk Division Chief Physical: 8426 Kosmerl Place, Frederick, CO 80504, Mailing: P. O. Box 129, Frederick, CO 80530; www.fffd.us I p _ ! �l _. _ h yi II_- I rI I Ir Ii Li i 1, L n y� }yil a / r[�Y s �' fide I.1 I ,_ Ian �0 1 I yi.....Ial j�i' � I_ I • _ '. TF ( :d f^�''wt 0Mr use 5- ��j{{ l4kV _ 1.'1H { _.. w --m-- Yf4Y'_�JI�IYJI �v �f} C[7 YatN�S di I •' a`ds°i ^"":0+1 715Ee'e.. -_ r t iC .41,1)1 'ter � ....[E. ` —1_2:1 �, IL a • , � INNS { - / NI- �'� )�'f. fiY t 3 11 �- v I r j e �� ' I '� H cam. r -,— a Tari 1.1 W z G y r y N L Q Ls. -47, Y N 'n u u y SI d Q LL LL . 4 i.. � h .. ' ; to)w H H W 0 LL O - Y VO 2 i...° W W ei x LL Fell e A E i 6 (9 v a a o `�' m m m m ¢ x a rx o 3, 2 f ca a Cl �� •, Fr� e,9€agpi¢yEPap: FS€5CSp•33i Ifd� + §ak �c §}} E EIY1H {{ C�p Sf5 4Sq�fi ea F r i1 t §y {5II IY3t3dj5 a¢FF .asF€�1 ': 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 H 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. Nv.04,--F L;1 S44,L lQ zI-13 Signature ofApplicant Title Date J SUBSCRIBED AND AFFIRMED BEFORE ME THIS gtlkh DAY 0 r.-"6k7er , 20 ib IN THE COUNTY OF wgVQ , STATE OF COLORADO. DALE ROBIN INGRAHAM NOTARY PUBLIC STATE OF COLORADO My Commission Expires eei I'fie�}z # a0044034014 d )(aVN.,a 11140 Si ure of Notary My Commission expires: FREDERICK -FIRESTONE FIRE PROTECTION DISTRICT '1 OFFIC1OM, PcNsMilO, PrnTAs Life Safety Division Office: (303) 833-2742 Fax: (303) 833-3736 E -Mail: dprunk@fffd.us October 15, 2013 The Frederick -Firestone Fire Protection District currently has EMS Mutual -Aid agreements with the following agencies: • Mountain View Fire Protection District Respectfully, Douglas J. Prunk Division Chief Physical: 8426 Kosmerl Place, Frederick, CO 80504, Mailing: P. O. Box 129, Frederick, CO 80530; www.fffd.us Hello