HomeMy WebLinkAbout20090421.tiffRESOLUTION
RE: APPROVE COLORADO EMS PROVIDER GRANT APPLICATION 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 a Colorado EMS Provider Grant Application
from the County of Weld, State of Colorado, by and through the Board of County Commissioners
of Weld County, on behalf of the Weld County Paramedic Service, to the Colorado Department of
Public Health and Environment, with 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 Colorado EMS Provider Grant Application from the County of Weld,
State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf
of the Weld County 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 11th day of February, A.D., 2009.
ATTEST:
Weld County Clerk to the Boar
BY.
De
APP
OARD OF COUN COMMISSIONERS
LD C! Y, s •• RADO
Sean P. Conway
er, Pro -Tern
C _
;ti 4. lwL tr�- 1 , ,
ara Kirkmeyer
unty °'�orney evi
Date of signature. aaq
l` C9
David E. Long
CC`i,QCr�
2009-0421
AM0020
03/0 9
EMS Provider Grant Application
Page 1 of 10
ATTACHMENT A
CDPHE Use Only - Fiscal Year 2010
Colorado EMS Provider Grant
Application
Colorado Department of Public Health and Environment
HFEMSD - A2
4300 Cherry Creek Drive South
Denver, CO 80246-1530
RETAC Eva! #
Legal Name: WELD COUNTY
Doing Business As: WELD COUNTY PARAMEDIC SERVICES
3.
Grant Contact Person: MR. DAVID BRESSLER
E-mail: dbressler@co.weld.co.us
2.
4
Federal Tax ID Number
846000813
Phone Numbers
Day: 970-353-5700 Mobile:970-302-1127
Fax: 970-304-6408
5.
Agency Mailing Address:
915 10TH STREET, GREELEY, CO 80631
7.
8.
Legal Status of Agency: City/County Government, City/County Government
Is this a RETAC or statewide grant? False
Note: Grants for RETAC or statewide projects will be reviewed by the SEMTAC only.
Do you have any current grant requests to other agencies for the current budget year?
True : NORTHEAST ALL HAZARDS REGION GRANT FUNDING FOR POSITIVE AIR PURIFYING
RESPIRATORS
Multi -Agency Application? False
Request Categories
Agency Match: 50%
PROJECT AREA SUMMARY
No More than 2 categories allowed per application
Ambulance, Other Vehicle
Grant Request Totals:
Total Category Cost
Agency Share
50%
$93,500.00
$93,500.00
State Share
50%
CDPHE Use Only
Amount Funded / SEMTAC
Eval #
$46,750.00
$46,750.00
$46,750.00
$46,750.00
1
Grant Application History For Agency
Grant Fiscal
Year
2009
2008
2008
2007
2007
2006
2006
2005
Category
Veh
Data
Veh
EMSEquip
Veh
EMSEquip
Veh
Defib
Status
Funded: $38,400.00
Spent: $17,000.00
Funded: $41,700.00
Spent: $40,500.00
Funded: $35,420.00
Spent: $31,200.00
Denied: Eval 1 Cat
Funded: $36,803.00
Spent: $36,803.00
Funded: $2,375.00
Spent: $2,198.67
Funded: $76,814.00
Spent: $74,829.85
Denied: Eval
https://www.hfemsd2.dphe.state.co.us/CEMSISWeb_Grants/frm 5102_PrintApp.aspx 2/11/2009
EMS Provider Grant Application
Page 2 of 10
2005
Veh
Funded: $75,000.00
Spent: $73,500.00
MATRIX Data Submission Requirement
Is this agency currently participating in the statewide data collection system? Yes
Balance Sheet for Entire Agency
Enter the date of your most current financials for
your entire agency:
Note: Use this same accounting period
throughout the financial information Category
❑2
3.
4.
Accounting Method:
Define accounting method for Depreciation and
Capital
List New Capital Items Purchased:
For 12 months ending:
12/31/2008
Accrual
Straightline
Zoll Cardiac Monitors, Stryker Power Cots, Auto Pulse CPR
device, Ambulance Purchase with matching Grants Funds
Assets
8.
9.
10.
12.
13.
14.
15.
Unreserved Cash Accounts
Reserved Cash Accounts
Unreserved Investments
Reserved Investments
Held in trust for Pension Benefits
Real Estate and Buildings
Equipment
Market Value: No
Depreciated Value: Yes
Accounts Receivable
Prepaid Expenses
Inventory
Other Assets
Total Assets
$707,600.00
$0.00
$0.00
$0.00
S0.00
$814,529.00
$261,596.00
$2,911,099.00
$0.00
$0.00
$197.00
$4,695,021.00
Liabilities
16.
17.
18.
19.
20.
21.
Acconts Payable
Short Term Notes and Loans
Long Term Notes and Loans
Taxes Payable
Payable Payroll Expenses
Prepaid and Deferred Revenue
Total Liabilities
Net Worth
$115,309.00
$85.00
$585,000.00
$0.00
$322,885.00
$0.00
$1,023,279.00
$3,671,742.00
Profit and Loss
I.
Enter the date of your most current financials for your
(agency)
For 12 months ending:
12/31/2008
Income / Revenues
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EMS Provider Grant Application
Page 3 of 10
2.
3.
4.
5.
6.
7.
8.
9.
10.
For this agency: The EMS Portion of our budget is
different from the Entire Agency(budget)
Government
Mil Levy = 0%
enter dollar revenues -->
Donations, Contributions, Bequests
EMS Fee for Service
Fund Raising
Interest and Dividends
Grants - List Sources: State Provider Grant
Subscription Program
Other Income, Define: Sale of Surplus
Equipment/Assests; Misc Fees
Total Income
No
L
Entire Agency
$0.0]
L
$0.00
$0.00
59,071,202.00
$0.00
$0.00
$31,200.00
50.00
$1,275.00
$9,103,677.00
EMS Portion
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
S0.00
$0.00
$0.00
Expenses
12.
13.
14.
15.
16.
17.
Operational Expense
Personnel Costs
Salaries, benefits, etc.
Depreciation Expense
Debt Service
Capital Expenditures
Other Expenses, Define: Bad Debt
Total Expenditures
Profit (or Loss)
Rates and Collection
2.
This agency charges for EMS services
Who processes this agency's billing and accounting?
Service
3.
4.
5.
6.
7.
8.
9.
10.
11.
BLS (Basic Life Support) non -emergent
BLS — Emergent
ALS1 (Advanced Life Support -Level I)
Non -emergent
$1,240,924.00
$4,232,634.00
$216,421.00
$0.00
ALS I — Emergent
ALS2 - non -emergent
ALS2 - emergent
SCT (Specialty Care Transport)
non -emergent
SCT (Specialty Care Transport)
emergent
PI (Paramedic ALS Intercept)
non -emergent
$310,530.00
$3,345,486.00
$9,345,995.00
($242,318.00)
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
Yes
Agency: Yes
Contract Service: No
No Billing / Accounting: No
Base Rate
$1,400.00
$1,400.00
SI,400.00
$1,400.00
$0.00
$1,700.00
50.00
$0.00
$0.00
Medicare Allowable
$209.32
$328.34
$251.18
$397.70
$0.00
$575.62
$0.00
$0.00
$0.00
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EMS Provider Grant Application
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12.IIFW (fixed Wing) — non -emergent
13.
14.
15.
16.
17.
17.
19.
{ 20.
FW (fixed Wing) — emergent
RW (Rotary Wing) — non -emergent
RW (Rotary Wing — emergent
Treat and Release
Mileage Rate — Urban
Mileage Rate — Rural 1 to 17 miles
Mileage Rate - Rural 18 to 50 miles
Overall collection rate (Percentage):
$0.0011 $0.00l
$0.00
$0.00
$0.001-
$0.00
$0.00
$0.00
$0.00
$18.00
$18.00
$18.00
27%
Financial Narrative (REQUIRED)
I. Please explain below
- Any information about your agency financials that will help evaluators understand your financial situation, such as
reserves or balances. If your board requires a specific balance or reserve for example, use this space to explain that.
Explanations of unreserved cash accounts and investments, as well as reserved cash accounts or investments.
Your cash match source
_ If applicable, the issues which have dictated your choice for filing a financial waiver. Your comments should
include explanations of extenuating circumstances that have rendered financial hardship or other reasons for
requesting a financial waiver
The numbers provided throughout section I are based on the fiscal year 2008. These facts have not
been audited and could be subject to correction. The 2008 financial records have been completed, but
have not been audited. 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
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EMS Provider Grant Application
Page 5 of 10
of vehicles and the purchase of new equipment.
Narrative Describing Your Agency's Structure and Service Area
Please use this area to describe your agency to someone from outside your area. Include a description of your district
I. proper, response area and the number of residents. Assume that the reader does not know the structure and staffing of
your agency, the terrain and roads of your area, and any special circumstances your agency contends with.
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. Primary response of units comes from fixed stations and system
status placement of resources throughout Weld County. 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 14,000 calls for service, over 60% of the calls fall into the rural / frontier areas,
county roads and highways of Weld County. The other 40% of calls occur within the city of Greeley.
Advanced Life Support coverage is provided through the fluid deployment of 11 ambulances
throughout a 24 hour operational period. Primary ambulance deployment includes a 24 hour ALS
unit, six(6) ALS units covering the daytime, and four (4) ALS units for the night time hours. WCPS
can also increase the number of units as needed for additional requests for service based upon call
demand, standbys, and other medical incidents. WCPS operates as an enterprise of Weld County
Government, billing and collecting all costs of operations.
Grant Request Categories
Category I - Ambulance, Other Vehicle
Category I - Ambulance, Other Vehicle (Request Details)
Qty
1
Description
III ; 2 wd
REMOUNT / RECHASSIS BRAUN AMBULANCE
Replacement
VMD Included in Request
Price Each
$93,500.00
Totals
Agency Share
$46,750.00
$46,750.00
State Share
$46,750.00
$46,750.00
Amount Funded
Category I - Ambulance, Other Vehicle (Equipment Request Details)
Qty
Description
Price Each
Agency Share
State Share
Amount Funded
0 Vehicle Equipment Requests
Category I - Ambulance, Other Vehicle (Additional Questions)
If the requested vehicle(s) is(are) replacement(s):
2.
What was the number of calls your agency was
unable to respond to due to mechanical
unavailablility of the emergency vehicle to be
replaced
What will be done with the unit that is replaced?
3
The ambulance module box will be recycled
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EMS Provider Grant Application
Page 6 of 10
u
3.
What is the average length of service, in miles and
or years, of vehicles operated by your agency?
and the Chassis is traded in on a new one.
5 Years
Category I - Ambulance, Other Vehicle (Narratives)
Please describe your
agency's vehicle
replacement program.
Weld County Paramedic Services (WCPS) has initiated a re -chassis
program in which chassis would be replaced and patient modules would be
re -mounted. The first re -chassis occurred in 2004 and was a great success at
an average savings of over $68,000 over the purchase of a new ambulance.
This project will continue until each of the 9 type III ambulances have been
re -mounted 3 times each. In 2007 we had to purchase a new ambulance to
add to the fleet with increasing call volume and with the addition of a 12
hour ambulance. WCPS continues to monitor its fleet and this year was able
to fund a Projects Coordinator position that is responsible for the daily
maintenance and vehicle readiness. This person works with the WCPS to
find solutions that will meet the needs and challenges of WCPS as its
demand for service increases.
Vehicle request
narrative - Please
explain if this vehicle
will be replacing any
previously owned
vehicles and how the
cost was determined, as
well as any other
information that would
help an outside person
understand the needs of
your vehicle request.
The management of WCPS continues to search for methods to operate more
efficiently and effectively. In 1998 a decision was made to establish a
program that would save an estimated $2.5 million over the following 12
years. A re -chassis program was undertaken in which ambulances chassis
would be replaced and patient modules would be re -mounted. The first re -
chassis occurred in 2004 at a savings of approximately $68,000 over the
purchase of a new ambulance. This project will continue until each of the 9
type III ambulances have been remounted 3 times. The cost of this rechassis
was based upon a purchase agreement with Life Star Rescue Inc. who has
provided our last rechassis on December 19, 2008 for a price of $90,000.
Life Star has quoted a $93,500 replacement cost for a new unit. WCPS
respectfully requests matching funds from the state for our re -chassis
project. This program of re -mounting ambulances is a responsible and
effective utilization of funds that are increasingly difficult to obtain. It is but
one of many methods by which WCPS strive to maintain the highest quality
emergency medical service with less financial resources. WCPS wants to
acknowledge the support received from the State of Colorado, SEMTAC,
and RETAC through the funds released to EMS agencies through its State
EMS Provider Grant Program. This is the single request by WCPS this year
and we would like to thank everyone for their time and daunting task of
maintaining an excellent grant program.
Attestation
Special note for multi -agency applicants:
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EMS Provider Grant Application
Page 7 of 10
ALL agencies involved in a multi -agency grant application are required to complete, sign and submit
this attest form, in addition to providing financial information for each agency.
1.
2.
3.
4.
4a.
4b.
4c.
Legal Name of Agency:
DBA (Doing Business As - If
Applicable:
Federal Tax ID Number:
WELD COUNTY
WELD COUNTY PARAMEDIC SERVICES
846000813
Grant Contact Person:
Title:
First Name:
Last Name:
MR.
DAVID
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 EMS Grants Program concerning grant requests.
Financial Information
The Authorized Agent attests to the agency or organization's ability to provide the matching funds
5. (50%, 40%, 30%, 20% or 10%) to complete the purchase of the grant award, should the agency be
awarded state funds.
The Authorized Agent is aware that EMS vehicles and equipment purchased must be without any
6. 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
7. 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:
The agency(ies)/organization(s) affected by the possible outcome of this grant request, including
8. 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.
10. The grantee shall submit quarterly progress reports to the Colorado Department of Public Health
and Environment, EMS 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
A. be made in accordance with the then current state of Colorado reimbursement rates for travel
as specified in the Fiscal Rules of the state of Colorado.
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EMS Provider Grant Application Page 8 of 10
Written proof of the successful completion of any training or educational program shall be
B. 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 services account grant funds in all public service
D. 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
E utilize a course evaluation 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 listed on the State award then the grantee
B. 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 emergency
C. 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 competitive solicitation process before purchasing
D. 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 after the cancellation, termination, or expiration
E. 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.
The grantee shall keep inventory control records for all equipment it purchases. The grantee
F. 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
G. 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
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EMS Provider Grant Application Page 9 of 10
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
H. 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 public
J. 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.
14.
15.
16.
17.
18.
19.
First Name
Last Name
Title
Daytime Phone Number
Daytime Phone Number Extension
Date
Signature of Authorized Agent
William
Garcia
Chairman of the Board of Weld County
Commissioners
970-356-4000
X 4209
1 t 2009
Required Attachments
Mail One hard copy of you application with original signatures and any attachments to:
EMS Provider Grants Program
Health Facilities and Emergency Medical Services Division
4300 Cherry Creek Drive South
Denver, CO 80246
#
Description
1.
Hard copy of the agency profile. No signature required.
2.
Hard copy of the financial waiver. Signature required. (The financial waiver is only a part of
your application if your cash match is less than 50%.)
Only if agency cash match percent is less than 50%
3.
Hard copy of the grant application.
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.
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.
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EMS Provider Grant Application Page 10 of 10
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https://www.hfemsd2.dphe.state.co.us/CEMSISWeb_Grants/frm_5102_PrintApp.aspx 2/11/2009
Colorado EMS Agency Profile
Page 1 of 4
For Agency ID 322 - Weld County Paramedic
Services
Close
Submission Year:
Date Submitted to State:
2009
2/9/2009
Agency Information
1. Agency Name:
2. Agency DBA Name:
3a. Agency Mailing Address:
3b. Physical Address:
4. Main Phone Number:
5. Contact Person:
6. Fax Number:
7. Web Site:
8. E -Mail:
Weld County Paramedic Services
Weld County Paramedic Services
1121 M St
Greeley, CO 80631
1121 M St
Greeley, CO 80631
970-353-5700 ext. 3211
David W Bressler
970-304-6408
www.co.weld.co.us/departments/paramedic_services/ambulance.html
dbressler@co.weld.co.us
9. Emergency 24 Hour Phone 970-302-2833
Number:
10. Emergency 24 Hour Field Supervisor
Contact:
11. RETAC Affiliated With: Northeast Colorado
Licensing and Services
1. Is this agency a licensed ground ambulance Yes
service?
2. Is this agency a licensed air ambulance No
service?
3. If not licensed, does this agency occasionally No
transport patients?
4. License levels: ALS
5. Services: Ground Transport
Agency Director
1. Agency Director's Name:
2. Mailing Address:
David W Bressler
1121 M St
Greeley, CO 80631
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Colorado EMS Agency Profile
Page 2 of 4
3. Work Phone Number:
4. E -Mail:
970-353-5700 ext. 3211
dbressler@co.weld.co.us
Deputy Director
1. Deputy Director's Name:
2. E -Mail:
Medical Director
1. Medical Director's Name:
2. Mailing Address:
3. Office Phone Number:
4. E -Mail:
5. Colorado License Number:
Tyler James
1121 M St
WMailingCity], CO 80631
970-353-5700 ext. 3211
tjames@co.weld.co.us
37443
Person Filling Out this Form
1. Name:
2. Work Phone:
3. E -Mail:
LONNIE L KNUDSEN
970-353-5700 ext. 3218
Iknudsen@co.weld.co.us
Demographics of Service Area
1. Number of years that this agency has
provided EMS services:
2. Population Density Category:
3. Employment Type:
4. Number of stations for this agency:
5. Most Frequent mode of patient transport:
6. Average Call Time:
7. Average mileage to nearest hospital:
8. Average round trip mileage per call:
35 years
Rural
Paid
4
Ground
27 minutes
8.00 miles
16.00 miles
Personnel
For each level of responding
personnel, please indicate how Employed
many are employed Full Time
Employed
Part Time
Volunteer
Total
https://www.hfemsd2.dphe.state.co.us/CEMSIS Web_AgencyProfiles/page 1000AgencyProfi... 2/9/2009
Colorado EMS Agency Profile
Page 3 of 4
1. EMT -Basic:
2. EMT -Intermediate:
3. EMT -Paramedic:
4. First Responder:
5. Nurse:
6. Other:
7. Total:
12
36
3
51
22
2
26
2
52
34
2
62
5
103
Requests for Service for Calendar Year 2008
Response Type
1. Emergency with Transport:
2. Emergency without Transport:
3. Non -Emergency:
4. Standbys:
5. Canceld Calls:
6. Other:
7. Total Requests for Service:
Total Number of Calls
5,060
1,127
4,360
58
3,580
14,185
Number of Calls
Reported in Matrix
3,934
333
34
897
5,198
Data Collection / System Participation
1. What Data Collection System are you using Zoll Data Systems - RescueNet TabletPCR
at your Agency Now:
2. Ross Agency ID: 322
3. Is your agency National Incident Yes
Management System (NIMS) compliant?
Counties Served
Counties Served:
Weld
Organizational / Financial Structure
1. Organizational Type:
2. Legal Status:
3. Funding Type:
4. Billing Method:
County government
City / county government
Patient fees, Taxes / mill levy
Agency
Vehicle Inventory
https://www.hfemsd2.dphe. state.co.us/CEMSIS W eb_AgencyProfiles/page 1000AgencyProfi... 2/9/2009
Colorado EMS Agency Profile
Page 4 of 4
Vehicle Make / Chassis / Mileage Equipped 4WD Type Bought Date
Unit Model Box Year For KKK.1822 / with EMS Replacing this
Number Ross Funds Vehicle
25 Ford / E- 2003 / 173,468 ALS No III / II Yes 8/1/2008
450 1999
27 Ford / E- 2006 / 122,006 ALS
450 1999
28 Ford / E- 2006 / 121,431 ALS
450 1999
29 Ford / E 2006 / 120,189 ALS
450 2000
30 Ford / E- 2006 / 105,518 ALS
450 2002
31 Ford / E- 2006 / 91,643 ALS
350 2006
33 Ford / 2007 / 65,018 ALS
E450 2002
34 Ford / 2007 / 75,745 ALS
E450 2007
35 Ford / 2008 / 39,927 ALS
E450 2003
36 Ford / 2008 / 46,464 ALS
E450 2003
37 Chev / 2009 / 693 ALS
G4500 1999
No III / II Yes 6/1/2011
No III / II Yes 6/1/2011
No III / II No 6/1/2011
No III / II Yes 8/1/2006
No III / II No 6/1/2011
No III / II No 6/1/2012
No III / II No 6/1/2012
No I / II Yes 6/1/2013
No III / II Yes 6/1/2013
No III / II Yes 6/1/2014
Ambulance Operation Safety
1. Total number of requests for service: 14,185
2. Total estimated vehicle miles: 384,000
3. Total number of reportable crashes in 2007: 4
4. Total number of persons injured: 3
5. Number of injured persons treated and released 3
on scene:
6. Number of injured persons treated and released
from the emergency department:
7. Number of persons admitted to the hospital:
8. Total number of persons killed:
9. Total estimated dollar value of property damage: $9,317
Close
Please be advised that the information you are providing is a matter of public record.
Colorado Department of Public Health and Environment
https://www.hfemsd2.dphe. state.co.us/CEMSIS Web_AgencyProfiles/page 1000AgencyProfi... 2/9/2009
LifE
STAR
RESCUE INC.
1171 Production Dr. Van Wert, OH 45891
Phone: 419-238-1459 or 877-519-1459 * Fax: 419-238-1479
www.LifeStarRescue.com
February 10, 2009
Weld County Colorado
915 10th Street
Greeley, CO 80631
Attention: Mitch Wagy
REMOUNT & REFURBISH QUOTE
Life Star Rescue Inc. is pleased to submit the following proposal for your consideration.
1 2009 Chevy G4500 utaway 159" WB chassis
(includes all applicable rebates)
1 Remount of Your Braun Modular Ambulance
(includes optional equipment listed below)
1 Trade-in of Old Chassis
FINAL PRICE
Includes all Standard and Optional Equipment per Attached List Below:
Lettering, Paint design and color to match your existing unit
New stainless wheel liners
New Star of Life decals
Whelen LED grille lights
New Whelen 4500 Series LED flush mount front lightbar
Six (6) new Whelen halogen scene lights
New Buell dual air horn system
New Hella clear fog lights
Wig -wag headlights and hide -a -strobe wig -wags
Reinstall two (2) communication radios
New front console with cup holders & map storage
MasterTech III electrical system upgrade with color Vista screens
Two new Motorola radio speakers
New Varner 1050CUL inverter/charger
$ 35,500.00
$ 60,500.00
$ (2,500.00)
$ 93,500.00
New MDT computer stand
New backup & patient cameras
Chevron striping on rear wall
New dome lights
New shoreline to match existing inlet
Install customer -supplied IV warmer
New Weldon halogen dome lights
New HVAC system
New upholstery
New EVS child safety seat on swivel base
New stainless kickplates on all three entry doors
Scorpion line hvac cabinet
Custom front radio console
New rear step bumper and fenderettes
Grip strut running boards
Velvac heated/remote rear-view minors
Delivery: Ninety (90) days from Production start date
Pickup & delivery included in price
Terms: $35,500.00 due for chassis payment at signing. Final Payment due
upon completion, after inspection and acceptance
Warranty: 1 Year written warranty on Workmanship
5 Year written warranty on Electrical System
3 Year written warranty on Paint System
Extended Lifetime Structural Warranty on Braun Module
Please contact me if you have any questions or concerns, or to secure a Production start date.
Respectfully,
Brian Murphy
Sales Representative
bmurphy(a),lifestarrescuc.com or cell: 419-605-7352
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