HomeMy WebLinkAbout20100352 RESOLUTION
RE: APPROVE APPLICATION FOR COLORADO EMTS PROVIDER GRANT AND
AUTHORIZE CHAIR TO SIGN
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, the Board has been presented with an Application for the Colorado EMTS
Provider Grant from the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Paramedic Service,to the Colorado Department of
Public Health and Environment, commencing upon full execution, with further terms and conditions
being as stated in said application, and
WHEREAS, after review, the Board deems it advisable to approve said application, 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 for the Colorado EMTS Provider Grant from the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on
behalf of the Paramedic Service, to the Colorado Department of Public Health and Environment be,
and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 17th day of February, A.D., 2010.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: y
N 4 mfg Dougla$ Rademabher, Chair
Weld County Clerk to th o cf.
t .+3F --;,,,,,. .171 Barbara Kirkmey/err ro-Tem
BY: I+ C�
> yy �-
Deputy Clerk to the Bo ,r-7,;( P t��;
'C``- y:- Sean_ . Co y
•
APP `' E S T • / / 2j
7— R / William F. Garcia
o ty Attorney EXCUSED
7 David E. Long
:%
Date of signature: .3l/0
2010-0352
AM0020
,41,',/ ,77.4.3 ( /G,-Yr-) C�� /O
EMTS Provider Grant Application Page 1 of 9
ATTACHMENT A
CDPHE Use Only-Fiscal Year 2011
t: Colorado EMTS Provider Grant
'r Application
Colorado Department of Public Health and Environment
HFEMTSD-A2
4300 Cherry Creek Drive South
Denver,CO 80246-1530
RETAC Eval#
DRAFT
This application is in draft form until it is submitted to the state.
No
1. Legal Name: WELD COUNTY 2. Federal Tax ID Number
Doing Business As:WELD COUNTY PARAMEDIC SERVICES 846000813
3. 4 Phone Numbers
Grant Contact Person: Mr.David Bressler Day:970-353-5700 Mobile:970-302-
E-mail:dbressler@co.weld.co.us 1127
Fax:970-304-6408
5. Agency Mailing Address:
915 10TH STREET,GREELEY,CO 80631
Is this a RETAC or statewide grant? No
Note:Grants for RETAC or statewide projects will be reviewed by the SEMTAC only.
EThis is a multi-agency application:
8. If this is a regional,state-wide,RETAC or multi-agency grant,this project
impacts:
Request Categories
Agency Match: 50%
Agency Share State Share CDPHE Use Only
PROJECT AREA SUMMARY Total Category Cost 50% S Amount Funded / SEMTAC
5Eval#
I, IV Equipment $105,525.00 $26,381.25 $79,143.75
Grant Request Totals: $105,525.00 $26,381.25 $79,143.75
Grant Application History For Agency
Grant Fiscal Year Category Status
2010A EMSE quip Funded: $4,390.00
q p Spent:
2010A Veh Funded:$49,750.00
Spent:
2010 Veh Funded:$46,750.00
Spent:
2009 Veh Funded: $38,400.00
Spent:$38,400.00
2008 Data Funded: $41,700.00
Spent:$40,500.00
2008 Veh Funded: $35,420.00
Spent: $31,200.00
2007 EMSEquip Denied:Eval
2007 Veh Funded: $36,803.00
Spent: $36,803.00
tad/o —, 35c
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EMTS Provider Grant Application Page 2 of 9
MATRIX Data Submission Requirement
Is this agency currently participating in the statewide data collection system?Yes
Rates and Collection
1. This agency charges for EMTS services Yes
Agency:Yes
2. Who processes this agency's billing and accounting? Contract Service:No
No Billing/Accounting:No
Service Base Rate Medicare Allowable
3. BLS(Basic Life Support)non-emergent $1,200.00 $217.93
4. BLS—Emergent $1,300.00 $348.69
5 ALS1 (Advanced Life Support-Level 1) $1,400.00 $261.52
Non-emergent
6. ALSI —Emergent $1,500.00 $414.07
7. ALS2-non-emergent $1,900.00 $599.31
8. ALS2-emergent $0.00 $0.00
9 SCT(Specialty Care Transport) $0.00 $0.00
non-emergent
l0. SCT(Specialty Care Transport) $0.00 $0.00
emergent
L 1. PI(Paramedic ALS Intercept) $0.00 $0.00
non-emergent
12. FW(fixed Wing)—non-emergent $0.00 $0.00
13. FW(fixed Wing)—emergent $0.00 $0.00
14. RW(Rotary Wing)—non-emergent $0.00 $0.00
15. RW(Rotary Wing—emergent $0.00 $0.00
16. Treat and Release $150.00
17. Mileage Rate-Urban $18.00
17. Mileage Rate -Rural I to 17 miles $18.00
19. Mileage Rate-Rural 18 to 50 miles $18.00
20. Overall collection rate(Percentage): 30%
Financial Narrative(REQUIRED)
Weld County Paramedic Services(WCPS)is owned and operated by the Board of County Commissioners of Weld County.The agency being an
enterprise fund is solely responsible for its budget and financial well being within the County.The agency serves over 4,000 square miles of
North/Northeastern Colorado.Operating as an enterprise of Weld County Government since 1989,WCPS is required to bill and collect all of
their operational costs of providing advanced life support treatment and transportation.The service area and customer base include a population
that is over 50%Medicare,Medicaid,and medically indigent.With the required changes placed on ambulance services in the Medicare/
Medicaid fee schedules and forced
acceptance of assignment,coupled with the changes in the Colorado"No Fault"automobile insurance
on collection rates,WCPS has experienced an average collection rate of approximately 30%over the last two years.WCPS has continued to
strictly monitor the budget along with decreasing certain items,and
continuing to electronically bill patients to address the revenue shortfall created by these changes.The
result is a negative impact on our scheduled replacement of ambulance units.WCPS has had to
lengthen the service life of our ambulances and continue to employ a re-chassis program for
maximum cost savings and timely replacement of vehicles.Uncollected debt still continues to be a
burden on WCPS;it is recorded as bad debt and reflects negatively on our budget numbers.When
providing services to the citizens and visitors of Weld County,WCPS maintains 100%compliance.
Bad debt reflects that portion of services that will never pay for themselves.This uncollected debt obviously affects our ability to maintain
equipment,purchase new equipment,and provide data collections to the State as requested.WCPS has maintained a solid budget but with
increasing bad dept and mandatory write offs;they will continue to strain the budgets for replacement of vehicles and the purchase of new
equipment.
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EMTS Provider Grant Application Page 3 of 9
Narrative Describing Your Agency's Structure and Service Area
Weld County Paramedic Services(WCPS)provides advanced life support response,evaluation,
treatment,and transport to the 300,000 citizens and numerous visitors throughout the 4,000 square
miles of Weld County Colorado.WCPS operates as an enterprise of Weld County Government,billing and collecting all costs of operations.In
cooperation with surrounding ALS providers via mutual aid agreements along with the tiered response of first responders from the fire
departments operating throughout Weld County,WCPS provides timely and quality advanced life support care.Of the 15,000 calls for service,
over 60%of the calls fall into the rural/frontier areas,county roads and highways of Weld County.Primary response of units to those calls
comes from fixed stations and system status placement of resources throughout Weld County.911 Advanced Life Support coverage is provided
through the fluid deployment of up to 11 ambulances throughout a 24 hour operational period.Primary ambulance staffing shifts includes 6 day
units,4 night units,and one 24 hour ambulance located out of the Ft.Lupton area.WCPS increases the number of units as needed for additional
requests for service based upon call demand,standbys,and other medical incidents.
Grant Request Categories
Category IV-Equipment(Request Details)
Qty Description Price Each Agency Share State Share Amount Funded
15 I Panasonic Arbritrator Arbtr-Kit-360 $7,035.00 $26,381.25 $79,143.75
15 Totals $26,381.25 $79,143.75
Category IV-Equipment (Narrative)
WCPS is requesting assitance with the State Provider Grants program to purchase 15 "Driver Monitoring" systems to add to its
fleet of emergency and patient transport vehicles at a cost of$6,368 each.In addition to the"Driver Monitoring"units,a server
dedicated to the secure upload and storage of data will be requested at a total cost of$10,005. This server will meet specifications
as outlined by CDPHE guidelines on server requirements.This will add an additional$667 dollars to each of the"Driver
Monitoring"units making our unit cost with server storage at$7,035.00
Agencies Financial Need
Weld County Paramedic Services(WCPS)is owned and operated by the Board of County Commissioners of Weld County.The
agency being an enterprise fund is solely responsible for its budget and financial well being within the County.The agency serves
over 4,000 square miles of North/Northeastern Colorado.
Operating as an enterprise of Weld County Government since 1989,WCPS is required to bill and collect all of their operational
costs of providing advanced life support treatment and transportation.The service area and customer base include a population that
is over 50%Medicare,Medicaid,and medically indigent. With the required changes placed on ambulance services in the
Medicare/Medicaid fee schedules and forced acceptance of assignment,coupled with the changes in the Colorado"No Fault"
automobile insurance on collection rates,WCPS has experienced an average collection rate of 27%over the last two years.
WCPS has continued to strictly monitor the budget along with decreasing certain items,and continuing to electronically bill
patients to address the revenue shortfall created by these changes.The result is a negative impact on our scheduled replacement of
ambulance units.WCPS has had to lengthen the service life of our ambulances and continue to employ a re-chassis program for
maximum cost savings and timely replacement of vehicles.
Uncollected debt still continues to be a burden on WCPS;it is recorded as bad debt and reflects negatively on our budget numbers.
When providing services to the citizens and visitors of Weld County,WCPS maintains 100%compliance.Bad debt reflects that
portion of services that will never pay for themselves.Collection rates of 27%explain that with 100%services provided we are
losing 73%of our budget to bad debt or write offs.
This trend has continued to be consistent over the last few years and will continue to be in our future.This uncollected debt
obviously affects our ability to maintain equipment,purchase new equipment,and provide data collections to the State as
requested.WCPS has maintained a solid budget but with increasing bad dept and mandatory write offs;they will continue to strain
the budgets for replacement of vehicles and the purchase of new equipment.
Cost Effective Project Budget
Weld County works has fostered great working relationships with area vendors to secure competitive pricing on all of our capital
equipment purchases.Review and approval of purchases by the Weld County Commissioners are outlined by general County
policies and procedures.WCPS is held to strict and tight standards in providing cost effective solutions to our operational and
administrative needs.WCPS solicits bids through vendors for all capital equipment purchased,looking for ways to reduce costs by
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EMTS Provider Grant Application Page 4 of 9
maximizing quantity discounts.
Applicant's Qualifications
WCPS was established in 1974 as an enterprise fund in Weld County.As a Weld County department,the Paramedic Services has
access to County resources to assist and in daily ambulance operations.Resources most valuable to this grant include fleet support
and informational technology resources that will enable us to complete this project.Through fiscal management overseen by the
Weld County Commissioners,WCPS will remain a sound emergency medical services provider for our citizens we serve in the
years to come.
Systems Integration
This project as proposed meets the recommendations of a driver monitoring system outlined by the CDPHE-EMTS standards.A
driver system has not been established within our response area and WCPS would be looking to establish the driver monitoring
system within our agency.
Priority to Underdeveloped or Aged Systems
WCPS does not currently monitor ambulance driving through an objective recordable process.Driver monitoring is a passive
system where WCPS Supervisors maintain SOPP(Standard Operations Policies&Procedures)compliance through observations,
incident reporting,and outside feedback of accidents and occurrences. This system would enhance our driver monitoring our
system to identify areas that would reduce liability,increase safety,provide education&training,and objectively monitor our
employees driving. In addition to driver monitoring,the right monitoring system would also provide feedback to managers on the
direct patient care being given to patients by our employees.With the ability to visually and audibly record calls from start to
finish,this type of system would provide objective information that would enhance the quality assurance and improvement of the
services being provided.
Attestation
MI Legal Name of Agency: WELD COUNTY
DBA(Doing Business As-If Applicable: WELD COUNTY PARAMEDIC SERVICES
3. Federal Tax ID Number: 846000813
4. Grant Contact Person:
4a. Title: Mr.
4b. First Name: David
4c. Last Name: Bressler
Authorized Agent
The individual whose name and signature appear below,has been designated by the agency/organization listed above as the Authorized Agent to
complete and submit this grant application on its behalf.The agency/organization agrees to comply with the rules and regulations governing the
State of Colorado EMTS Grants Program concerning grant requests.
Financial Information
The Authorized Agent attests to the agency or organization's ability to provide the matching funds(50%,40%,30%,20%or 10%)to complete
5' the purchase of the grant award,should the agency be awarded state funds.
6 The Authorized Agent is aware that vehicles and equipment purchased must be without any financial liens and without the item being used as
collateral to secure a loan of any kind.
7 The Authorized Agent attests that,to the best of his/her knowledge,the information contained herein,with regard to the Agency's financial
condition,is true,accurate and correctly reflects the financial condition of the agency/organization.
Notification of Affected Entities
By signing below,the Authorized Agent also attests to the fact that:
8 The agency(ies)/organization(s)affected by the possible outcome of this grant request,including but not limited to agencies/organizations listed
in this application if it is a multi-agency application,has(have)been notified and has(have)agreed to its submission.
Applicant Duties and Obligations Should Funding be Awarded
Should the agency/organization listed in this application receive funding under this grant application,the agency/organization(hereinafter referred
to as'grantee')shall,and affirmatively promises to,comply with all of the provisions set forth below.
9 The grantee shall use grant funds received under this grant to complete all aspects of its grant application,and shall not use such funds for
purposes other than this.
The grantee shall submit quarterly progress reports to the Colorado Department of Public Health and Environment,EMTS Category
10. (hereinafter referred to as'the State')
11. Requirements for Training and Education Grants
For any training or education requests funded from this application the grantee shall comply with the following terms and conditions:
Reimbursement for all travel expenses associated with the training or education program shall be made in accordance with the then
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EMTS Provider Grant Application Page 5 of 9
A. current state of Colorado reimbursement rates for travel as specified in the Fiscal Rules of the state of Colorado.
B Written proof of the successful completion of any training or educational program shall be submitted at the same time as the invoice
requesting reimbursement for that training or educational program.
C. Prompt billing at the end of each quarter or semester is expected.
If the grantee provides a training or educational program,then the grantee shall acknowledge the use of emergency medical and trauma
D. services account grant funds in all public service announcements,program announcements,or any other printed material used for the
purpose of promoting or advertising the training or educational program.
If the grantee provides a training or educational program,then the grantee shall develop and utilize a course evaluation tool to measure
E. the effectiveness of that training or educational program.The grantee shall submit a copy of all evaluation reports to the State upon
completion of the training or educational program.
12. Requirements for Equipment Grants
For any equipment purchases funded from this application,the grantee shall comply with the following requirements.
A. The grantee shall provide the state with written documentation of the purchase of the specified equipment.
All communications equipment shall be purchased from the State award for communications equipment,or from another vendor for a
comparable price and quality.If the grantee desires to purchase communications equipment which is not listed on the State award then
B. the grantee must complete,with the State's assistance if needed,an informal competitive solicitation process before purchasing that
equipment.If a competitive solicitation process is used,then the grantee shall purchase the communications equipment from the lowest
bidder whose bid meets the bid specifications.
If the grantee desires to purchase emergency vehicles other than ambulances,then the grantee must complete,with the State's assistance
if needed,an informal competitive solicitation process before purchasing that equipment.The proposed specifications for these
C. emergency vehicles must be approved by the State prior to the initiation of the informal competitive solicitation process.If a
competitive solicitation process is used,then the grantee shall purchase the emergency vehicles from the lowest bidder whose bid meets
the bid specifications.
If the grantee desires to purchase medical equipment,then the grantee must complete,with the State's assistance if needed,an informal
D. competitive solicitation process before purchasing that equipment.If a competitive solicitation process is used,then the grantee shall
purchase the medical equipment from the lowest bidder whose bid meets the bid specifications.
During the initial term and any renewal or extension term of the contract or purchase order issued to convey funding to the grantee,and
E after the cancellation,termination,or expiration date of said contract or purchase order,the grantee shall acquire and maintain personal
property casualty insurance for the replacement value of all equipment it purchases under this grant for the useful life of that purchased
equipment.
F The grantee shall keep inventory control records for all equipment it purchases.The grantee shall obtain the prior,express,written
consent of the State before relocating or reallocating any equipment it purchases.
G The grantee shall provide the State with a picture of each piece of equipment it purchases.The grantee may submit a picture of a piece
of purchased equipment at any time,but in no event no later than the date the grantee's final progress report is due to the State.
The grantee shall maintain all equipment it purchases in good working order,normal wear and tear excepted.The grantee shall perform
all necessary maintenance services for all equipment it purchases in a timely manner and in accordance with all manufacturer's
specifications and all manufacturer's warranty requirements.The grantee shall keep detailed and accurate records of all maintenance
services it performs on all equipment it purchases.
The grantee shall repair or replace all purchased equipment which is damaged,destroyed,lost,stolen,or involved in any other form of
casualty.
If the grantee ceases to provide emergency medical and trauma services in the state of Colorado,then all equipment purchased under
this grant shall either be placed with another operating emergency medical services provider in the state of Colorado,or be sold at
J. public auction for its then fair market value.That portion of the sale proceeds which equals the State's initial financial contribution
towards the purchase of that equipment shall be refunded to the State by the grantee.The grantee shall obtain the prior,express written
consent of the State prior to any relocation or sale of any purchased equipment.
Authorized Agent
13. First Name Douglas
14. Last Name Rademacher
15. Title Chairman of the Board of Weld County Commissioners
16. Daytime Phone Number 970-336-7204
17. Daytime Phone Number Extension X
18. Date
19. Signature of Authorized Agent
Required Attachments
Mail One hard copy of your application with original signatures and any attachments to:
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EMTS Provider Grant Application Page 6 of 9
Jeanne-Marie Bakehouse,
EMTS Provider Grants Program
HFEMTSD-A2
4300 Cherry Creek Drive South
Denver,CO 80246
# Description
1. Hard copy of the agency profile.No signature required.
Hard copy of the financial waiver.Signature required.(The financial waiver is only a part of your application if your cash match is less
2. than 50%.)
Only if agency cash match percent is less than 50%
Hard copy of the grant application.
3. Signature of the authorized agent required.Signature of the medical director is required only if you are requesting the
defibrillation/cardiac monitor category.
4. W-9.Signature required.
5. ]Vendor Disclosure Statement,signature required.
6 Any other attachments you wish to include.These should be documents useful to the reviewers,and can include letters of support,maps
of your service area,maintenance records,quotes or pictures of equipment you wish to replace.
Documents Received via Electronic Submission:
File Name Date Created File Size(kb) Click to Delete
No uploaded files found
Agency Profile
Submission Year 2010
Date Submitted to State 2/11/2010
Agency/Facility Information
1. Agency/Facility Name: Weld County Paramedic Services
2. Agency/Facility DBA Name: Weld County Paramedic Services
3a. Agency/Facility Mailing Address: 1121 M St
Greeley,CO 80631
3b. Physical Address: 1121 M St
Greeley,CO 80631
4. Main Phone Number: 970-353-5700 ext.3211
5. Contact Person: David W Bressler
6. Fax Number: 970-353-5700 ext.3211
7. Web Site: www.co.weld.co.us/departments/paramedic_services/ambulance.html
8. E-Mail: dbressler@co.weld.co.us
9. Emergency 24 Hour Phone Number: 970-302-2833
10. Emergency 24 Hour Contact: Field Supervisor
11. RETAC Affiliated With: Northeast Colorado
Licensing and Services
N/A
For EMS Agencies:
I. Is this agency a licensed ground ambulance service? Yes
2. Is this agency a licensed air ambulance service? No
3. If not licensed,does this agency occasionally transport patients? No
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EMTS Provider Grant Application Page 7 of 9
4. License levels: ALS
For Trauma Facilities:
5. Is this facility a designated trauma center? No
6. Designation level:
For All Agencies and Facilities:
7. Services: Ground Transport
Person Filling Out this Form
I. Name: LONNIE L KNUDSEN
2. Work Phone: 970-353-5700 ext.3218<
3. E-Mail: lknudsen@co.weld.co.us
EMS Agency Director
1. Agency Director's Name: David W Bressler
2. Mailing Address: 1121 M St
Greeley,CO 80631
3. Work Phone Number: 970-353-5700 ext.3211
4. E-Mail: dbressler@co.weld.co.us
EMS Deputy Director
1. Deputy Director's Name: Rod Deroo
2. E-Mail: rderoo@co.weld.co.us
EMS Medical Director
I. Medical Director's Name: Tyler James
2. Mailing Address: 1121 M St
Greeley,CO 80631
3. Office Phone Number: 970-353-5700 ext.3211
4. E-Mail: tjames@co.weld.co.us
5. Colorado License Number: 37443
Organizational/Financial Structure
1. Organizational Type: County government
2. Legal Status: City/county government
3. Funding Type: Patient fees,State grant,Federal grant,Taxes/mill levy
4. Billing Method: Agency
Personnel
For each level of responding personnel,please Employed Employed
indicate how many are employed Full Time Part Time Volunteer Total
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I. EMT-Basic: 12 28 40
2. EMT-Intermediate:
3. EMT-Paramedic: 36 23 59
4. First Responder:
5. Nurse:
6. Medical Director or Other Physicians: 1 1
7. Other: 3 2 5
8. Total: 51 54 105
Requests for Service for Calendar Year 2009
Total Number of Calls Number of Calls Reported in
Response Type Matrix
1. Emergency with Transport: 4,870 8,286
2. Emergency without Transport: 3,463 4,170
3. Non-Emergency: 4,304 420
4. Standbys: 51 70
5. Canceld Calls: 1,884 2,011
6. Other:
7. Total Requests for Service: 14,572 14,957
EMS Billing Rates
I. BLS 1,378.00
2. ALS 1,590.00
3. ALS-2 2,014.00
4. Specialty Transport 0.00
5. Mileage Rate 18.000
EMS Financial Resources
1. Total annual EMS expenses $9,299,528.00
2. Total annual EMS charges billed $13,787,038.00
3. Total annual EMS charges collected $4,837,755.50
4. Total annual EMS revenue(subsidy)from taxes or governmental $0.00
sources
Demographics of Service Area
1. Number of years that this agency has provided EMS services: 36
2. Population Density Category: Suburban
3. Employment Type: Paid
4. Number of stations for this agency: 4
5. Most Frequent mode of patient transport: Ground
6. Average Call Time: 27 minutes
7. Average mileage to nearest hospital: 8.00 miles
8. Average round trip mileage per call: 16.00 miles
Data Collection/System Participation
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I. What Data Collection System are you using at your Agency Zoll Data Systems-RescueNet TabletPCR
Now?
2. Are you currently submitting data to the Colorado EMS data No
system?
3. Ross Agency ID: 322
4. Is your agency National Incident Management System(NIMS) Yes
compliant?
Counties Served
Counties Served: Weld
Vehicle Inventory
Vehicle Unit Make/Model Chassis/Box Mileage Equipped 4WD Type KICK.1822/ Bought with EMS Date Replacing this
Number Year For Ross Funds Vehicle
28 Ford/E-450 2005/2000 154,527 ALS No III/II No 12/1/2010
29 Ford/E-450 2006/2001 150,459 ALS No III/II Yes 1/27/2010
31 Ford/E-350 2006/2006 119,862 ALS No III/11 No 12/1/2010
33 Ford/E450 2007/2002 92,868 ALS No III/II No 12/1/2010
34 Ford/E450 2007/2007 116,506 ALS No III/II No 12/1/2011
36 Ford/E450 2008/2003 85,268 ALS No III/II Yes 12/1/2011
37 Chevy/G4500 2009/ 1999 38,488 ALS No III/II Yes 12/1/2013
38 Chevy/G4500 2009/2002 9,067 ALS No III/II No 12/1/2013
39 Chevy/G4500 2009/2009 199 ALS No III/II No 12/1/2014
40 Chevy/G4500 2009/2009 695 ALS No III/II No 12/1/2014
41 Chevy/G4500 2009/2009 200 ALS No III/II No 12/1/2014
42 Chevy/G4500 2009/2009 200 ALS No III/II No 12/1/2015
222-EMSCom FORD/ 2005/ 121,804 Yes Other/V No 12/1/2012
Expedition
32-EMSI Va Ford/E350 2006/ 113,709 No Other/V No 12/1/2012
11-MiniBus Ford/E350 2004/ 3,808 No Other/V No 12/1/2015
Go Back
Colorado Department of Public Health and Environment
https://www.hfemsd2.dphe.state.co.us/CEMSISWeb_Grants/frm 5102_PrintApp.aspx 2/11/2010
EMTS Provider Grant - Attestation Page 1 of 3
EMTS Provider Grant Application-FY 2011
Weld County Paramedic Services(322)
ni Please be advised that the information you are providing is a matter of public record. Failure
to provide complete and accurate information may adversely impact your opportunity to
obtain funding under this grant process.
Thursday,February 11,2010 3:29 PM
Grant Application
Attestation
1. Legal Name of Agency: WELD COUNTY
2. DBA(Doing Business As-If Applicable: WELD COUNTY PARAMEDIC SERVICES
3. Federal Tax ID Number: 846000813
4. Grant Contact Person:
4a. Title: Mr.
4b. First Name: David
4c. Last Name: Bressler
Authorized Agent
The individual whose name and signature appear below, has been designated by the agency/organization listed above as the
Authorized Agent to complete and submit this grant application on its behalf.The agency/organization agrees to comply with the
rules and regulations governing the State of Colorado EMTS Grants Program concerning grant requests.
Financial Information
5 The Authorized Agent attests to the agency or organization's ability to provide the matching funds(50%,40%,30%,20%or
10%)to complete the purchase of the grant award,should the agency be awarded state funds.
6 The Authorized Agent is aware that EMTS vehicles and equipment purchased must be without any financial liens and without
the item being used as collateral to secure a loan of any kind.
The Authorized Agent attests that,to the best of his/her knowledge,the information contained herein,with regard to the
7.
Agency's financial condition,is true,accurate and correctly reflects the financial condition of the agency/organization.
Notification of Affected Entities
By signing below,the Authorized Agent also attests to the fact that:
The agency(ies)/organization(s)affected by the possible outcome of this grant request, including but not limited to
8. agencies/organizations listed in this application if it is a multi-agency application,has(have)been notified and has(have)agreed
to its submission.
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EMTS Provider Grant- Attestation Page 2 of 3
Applicant Duties and Obligations Should Funding be Awarded
Should the agency/organization listed in this application receive funding under this grant application,the agency/organization
(hereinafter referred to as"grantee")shall,and affirmatively promises to, comply with all of the provisions set forth below.
g The grantee shall use grant funds received under this grant to complete all aspects of its grant application,and shall not use
such funds for purposes other than this.
10 The grantee shall submit quarterly progress reports to the Colorado Department of Public Health and Environment, EMTS
Category(hereinafter referred to as'the State').
11. Requirements for Training and Education Grants
For any training or education requests funded from this application the grantee shall comply with the following terms and conditions:
Reimbursement for all travel expenses associated with the training or education program shall be made in accordance
A. with the then current state of Colorado reimbursement rates for travel as specified in the Fiscal Rules of the state of
Colorado.
B Written proof of the successful completion of any training or educational program shall be submitted at the same time as
the invoice requesting reimbursement for that training or educational program.
C. Prompt billing at the end of each quarter or semester is expected.
If the grantee provides a training or educational program,then the grantee shall acknowledge the use of emergency
D. medical and trauma services account grant funds in all public service announcements,program announcements,or any
other printed material used for the purpose of promoting or advertising the training or educational program.
If the grantee provides a training or educational program,then the grantee shall develop and utilize a course evaluation
E. tool to measure the effectiveness of that training or educational program.The grantee shall submit a copy of all
evaluation reports to the State upon completion of the training or educational program.
12. Requirements for Equipment Grants
For any equipment purchases funded from this application,the grantee shall comply with the following requirements.
A. The grantee shall provide the state with written documentation of the purchase of the specified equipment.
All communications equipment shall be purchased from the State award for communications equipment,or from another
vendor for a comparable price and quality. If the grantee desires to purchase communications equipment which is not
B. listed on the State award then the grantee must complete,with the State's assistance if needed,an informal competitive
solicitation process before purchasing that equipment. If a competitive solicitation process is used,then the grantee
shall purchase the communications equipment from the lowest bidder whose bid meets the bid specifications.
If the grantee desires to purchase emergency vehicles other than ambulances,then the grantee must complete,with the
State's assistance if needed,an informal competitive solicitation process before purchasing that equipment.The
C. proposed specifications for these emergency vehicles must be approved by the State prior to the initiation of the
informal competitive solicitation process. If a competitive solicitation process is used,then the grantee shall purchase
the emergency vehicles from the lowest bidder whose bid meets the bid specifications.
If the grantee desires to purchase medical equipment,then the grantee must complete,with the State's assistance if
D needed,an informal competitive solicitation process before purchasing that equipment. If a competitive solicitation
process is used,then the grantee shall purchase the medical equipment from the lowest bidder whose bid meets the bid
specifications.
During the initial term and any renewal or extension term of the contract or purchase order issued to convey funding to
E the grantee,and after the cancellation,termination,or expiration date of said contract or purchase order,the grantee
shall acquire and maintain personal property casualty insurance for the replacement value of all equipment it purchases
under this grant for the useful life of that purchased equipment.
F The grantee shall keep inventory control records for all equipment it purchases.The grantee shall obtain the prior,
express,written consent of the State before relocating or reallocating any equipment it purchases.
The grantee shall provide the State with a picture of each piece of equipment it purchases.The grantee may submit a
G. picture of a piece of purchased equipment at any time, but in no event no later than the date the grantee's final progress
report is due to the State.
The grantee shall maintain all equipment it purchases in good working order,normal wear and tear excepted.The
H grantee shall perform all necessary maintenance services for all equipment it purchases in a timely manner and in
accordance with all manufacturer's specifications and all manufacturer's warranty requirements.The grantee shall keep
detailed and accurate records of all maintenance services it performs on all equipment it purchases.
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EMTS Provider Grant-Attestation Page 3 of 3
The grantee shall repair or replace all purchased equipment which is damaged,destroyed,lost,stolen,or involved in
any other form of casualty.
If the grantee ceases to provide emergency medical and trauma services in the state of Colorado,then all equipment
purchased under this grant shall either be placed with another operating emergency medical services provider in the
state of Colorado,or be sold at public auction for its then fair market value.That portion of the sale proceeds which
equals the State's initial financial contribution towards the purchase of that equipment shall be refunded to the State by
the grantee.The grantee shall obtain the prior,express written consent of the State prior to any relocation or sale of any
purchased equipment.
Authorized Agent
13. First Name Douglas
14. Last Name Rademacher
15. Title Chairman of the Board of Weld County Commissioners
16. Daytime Phone Number 970-336-7204
17. Daytime Phone Number Extension
18. Date (02/17/2010
19. Signature of Authorized Agent
Go Back
Colorado Department of Public Health and Environment
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VENDOR DISCLOSER STATEMENT
Contract Performance Outside the United States or Colorado
Colorado Revised Statute 24-102-206
Contract or Purchase Order Routing Number:
(this line will be completed by the department)
Vendor Name: WELD COUNTY PARAMEDIC SERVICES
The person completing this form should be the business' President,Board Chairperson,Contract's
Authorized Signatory or the Purchase Order's Statement of Work Signatory.
This form shall be completed and returned to the contracting agency. This applies to all state contracts and
purchase orders for services executed after August 3,2007.
1. Are any services under the contract or any subcontracts or purchase order anticipated to be performed
outside the United States or Colorado?
Yes El No n
If"Yes",please complete the following two questions and then sign the form.
If"No",please sign the form.
2. Where will the services be performed under the contract,including any subcontracts or purchase order?
(List country(ies)and/or state(s).
3. Explain why it is necessary or advantageous to go outside of the United States or the State of Colorado to
perform the services under the contract or any subcontracts or purchase order.
Signature: , Printed Name: Douglas Rademacher
Title: Chairman, Board of Weld County CommissioneBste: 02/17/2010
CDPHE VDS Form Page 1 of 1
Two Locations:
WIRELESS ADVANCED
bk °mum%uNiCA f10NS SALES QUOTE 3901 West Service Rd.
Confidential and Proprietary Evans, CO 80620
Prices Valid for 30 Days from Quotation Date -and -
x 1240 West Collins Drive
(800)456-0247 Casper,WY 82604
Fax(970)330.3632 Panasonic Arbitrator February 9,2010
( Customer Name: Weld County Paramedics
Contact: Del Maxfield
Address:
City,State Zip: Greeley,CO
Phone Number: (970)304.6570
Fax Number:
Email: dmaxfield@co.weld.co.us Page 1 of 1
item Qty Model Description Unit Extended
1 15 ARBTR-KIT-36O Panasonic Arbitrator Kit MK2.0 $5,585.00 $83,775.00
2 15 CN2581R-P Rear IR Camera $149.00 $2,235.00
3 15 TGS-30P G-Face Sensor $299.00 $4,485.00
4 15 WACINSTALL Installation of Arbitrator kit G-Force Sensor and Rear Camera $335.00 $5,025.00
SUB TOTAL $95,520.00
Salesperson: Todd Lawrence Sales Tax
Installation
Programming
Customer Signature: Shipping
Customer P.O.#&Date: GRAND TOTAL $95,520.00
Vour signature indicates that Wireless Advanced Communications has your approval to order the equipmentlservices listed above.
Elizabeth Strong
From: Bruce Barker
Sent: Friday, February 12, 2010 2:47 PM
To: CTB
Subject: FW: 2010 -2011 State EMS Grant Approval
Attachments: dbressler@co.weld.co.us.vcf; 2010 Draft Copy- CDPHE EMS Provider Grant FY2011 Grant
Attestation.pdf; 2010 Draft Copy- CDPHE EMS Provider Grant FY2011.pdf; 2010 Vendor
Disclosure Statement.pdf; 2010 Weld County Paramedics Arbitrator Quote (List Price)
02-09-2010.pdf; image002.png
Please place the item that is called, "2010 Draft Copy -- CDPHE EMS Provider Grant FY2011
Grant Attestation" on the agenda for Wednesday.
Thanks!
Original Message
From: Douglas Rademacher
Sent: Friday, February 12, 2010 11:35 AM
To: Bruce Barker
Subject: FW: 2010 - 2011 State EMS Grant Approval
Original Message
From: Dave Bressler
Sent: Thursday, February 11, 2010 4:53 PM
To: Barb Connolly; Commissioners; Don Warden; Monica Mika; Vicky Sprague
Cc: Jennifer VanEgdom
Subject: 2010 - 2011 State EMS Grant Approval
Commissioner Conway:
I have attached the information for the State EMS Grant for fiscal year 2011. I am
requesting the Board of County Commissioners support to apply for a grant to reduce the cost
of the Driver Monitoring Systems previously approved in the 2010 Budget for Weld County
Paramedic Services. In discussion with Chairman Rademacher, he requested the electronic
files be sent to the BOCC for the commissioner's review. If supported by the Board, the
required signatures of the Chairman will be completed and the grant delivered to the State of
Colorado by the required time of 5:00 pm on Tuesday. (Due to State furlough days along with
the holiday weekend it has complicated the process slightly) .
We have the opportunity to reduce the cost of this system to our capital budget by 75%
($79,143.75) if this grant application is successful. Weld County would provide matching
funds at 25% ($26,381.25) of total cost of the project, $105,525.00. This is consistent with
our discussions on this topic from weekly briefing and the approved 2010 Budget, while
acquiring this technology for the Weld County Paramedic Services Fleet.
The system provides driver monitoring for increased safety and situational awareness for the
not only the driver of the ambulance, but the attendant and patient(s) as well. Our hope is
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to reduce our fleet maintenance expenses and our limit our liability while responding to and
from calls for service. Best practices, both operationally and medically will then be
available through the review of the collected data. This system is manufactured by the same
company whose computer systems are installed in the ambulances currently and is serviced by
the same local company.
I have attached the required paperwork for the Chairman's signature, and have spoken with
Monica Mika and Barb Connolly who are aware of the potential savings to Weld County
Government and the Paramedic Services. Please contact me with any questions you may have
concerning the grant. I will pick up the grant on Tuesday and be in attendance at the
February 17th Board meeting.
Thank you,
Dave Bressler, Director
Weld County Paramedic Services
This message and all attachments are considered confidential to Weld County Paramedic
Services and disclosure, use, or distribution to anyone other than the designated recipient
without prior written permission of Weld County Paramedic Services is prohibited. If you
think you have received this message in error, please notify the sender via the reply feature
and delete this message without disclosure.
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