HomeMy WebLinkAbout20070423.tiff RESOLUTION
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 GrantApplication 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 21st day of February, A.D., 2007.
BOARD OF COUNTY COMMISSIONERS
WEL'Tó14UNTY, COQR O
ATTEST: ated, / III /E11,/,
` c �
` ( Jx avid E. Long, Chair
Weld County Clerk to the B-,�rd4
1561 'r>-' \ .,o l
1 ? u1`I'�lliam . ,1QrIPro-Tem
BY: Cr ���tt,�rL�"� , ,y (� 'z/l/
Deputy Clerk to the Boar. L-
_ '' Willi F. Garcia
APP AS M:
Robert D. Mdsde
unty Attorney
g as demacher
Date of signature: 3--S -c7
2007-0423
AM0019
0
riet
WELD COUNTY PARAMEDIC SERVICES
4 1121 M STREET
GREELEY, COLORADO 80631
PHONE (970) 353-5700 EXTENSION 3216
WI I E-MAIL: rosborrie@co.weld.co.us
FAX: (970) 304-6408
C
COLORADO
February 15, 2007
Subject: Colorado Department of Public Health State Provider Grant.
This grant presented today is the yearly State Provider grant offered by the Colorado
Department of Public Health and Environment. This grant has been very positive for Weld
County Paramedic Services over the last 5 years. We have received funding 4 out of the 5
years. In the past this grant has provided funds for 4 ambulance re-mounts and educational
equipment which was desperately needed. This year we are asking for funding on another
ambulance re-mount and data collection computers. The award for this grant will provide
$77,120.00 to Weld County Paramedic Services. The grant is a tiered process covering several
weeks and award announcements are expected by 6/30/2007. I have left a copy of this grant
for you to review. I appreciate your time and consideration on this grant. If you have any
questions please feel free to contact myself or Dave Bressler.
Thank you,
roy Osborne -
Medical Operations Supervisor
Weld County Paramedic Services
2007-0423
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9: 'ReDim' can only change the rightmost dimension.
ATTACHMENT A
Colorado EMS Provider Grant Fiscal Year 2008
Application
CDPHE Use Only
Colorado Department of Public Health and Environment
HFEMSD - A2
4300 Cherry Creek Drive South
Denver, CO 80246-1530 RETAC Eval #
SEMTAC Eval #
Date Printed: Wednesday, February 14, 2007 3:41 PM
Request Categories
Ambulance, Other Vehicle
Data Collection
Agency Information
1. Legal Name of Agency Weld County Paramedic Services
2 DBA (Doing Business As - If WCPS
Applicable)
3. Federal TaxID Number 84-6000813
4. Grant Contact Person Director Dave Bressler
Phone: 970-353-5700 Fax: 970-304-6408 Pager: Email: dbressler@co.weld.co.us
5. Agency Mailing Address 1121 M St, Greeley, CO, 80631
6. Agency Street Address 1121 M St, Greeley, CO, 80631
7. Legal Status of Agency / Organization City/County Government
8. Type of Service
ALS: Yes, BLS: No, Fire/Rescue: No, Training: No, Other: No,Describe:
9 This a RETAC or statewide grant No
project:
10. This is a multi Agency Application: No
11. List your RETAC: Northeast
12. List the county your agency is licensed Weld
m:
This agency has current grant requests
13. No
in to other agencies for the current
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budget year? If yes, describe them here.
Request Categories
Agency Match: 50%
CATEGORIES Total Category Cost Agency Share State Share
No More than 2 categories allowed per application 50% 50%
1 I Ambulance, Other Vehicle $70,840.00 $35,420.00 $35,420.00
❑ II Communications $0.00 $0.00 $0.00
J] III Data Collection $83,400.00 $41,700.00 $41,700.00
IV Defibrillation/ Cardiac Monitor $0.00 $0.00 $0.00
V EMS Equipment $0.00 $0.00 $0.00
VI EMS Training $0.00 $0.00 $0.00
VII Extrication Equipment $0.00 $0.00 $0.00
VIII Injury Prevention $0.00 $0.00 $0.00
IX Other $0.00 $0.00 $0.00
X Recruitment/Retention •
$0.00 $0.00 $0.00
RR Cash Match= 0%
Grant Request Totals: $154,240.00 $77,120.00 $77,120.00
Balance Sheet for Entire Agency
Enter the date of your most current financials for
1 your entire agency: For 12 months ending:
Note: Use this same accounting period 12/31/2005
throughout the financial information Category
2. Accounting Method: Cash
3. Define accounting method for Depreciation and Straightline
Capital
3 Ambulance re-chassis, Medical Gator, and
4. List New Capital Items Purchased:
Computer equipment for ambulances.
Assets
5. Unreserved Cash Accounts $366,468.00
6. Reserved Cash Accounts $0.00
7. Unreserved Investments $0.00
8. Reserved Investments $0.00
9. Held in trust for Pension Benefits $0.00
10. Real Estate and Buildings $704,801.00
11. Equipment $104,841.00
Market Value: No
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IDepreciated Value: Yes
12. Accounts Receivable $2,159,037.00
13. Prepaid Expenses $0.00
14. Inventory $0.00
15. Other Assets $0.00
Total Assets $3,335,147.00
Liabilities
16. Acconts Payable $48,110.00
17. Short Term Notes and Loans $885,000.00
18. Long Term Notes and Loans $0.00
19. Taxes Payable $15,476.00
20. Payable Payroll Expenses $250,775.00
21. Prepaid and Deferred Revenue $9,897.00
Total Liabilities $1,209,258.00
NetWorth $2,125,889.00
Profit and Loss
Enter the date of your most current financials For 12 months ending:
1' for your(agency) 12/31/2005
Income/Revenues
For this agency: The EMS Portion of our
2. budget is different from the Entire Agency No
(budget)
Entire Agency EMS Portion
3. Government $0.00 $0.00
4 Mil Levy = 0% $0.00 $0.00
enter dollar revenues -->
5. Donations, Contributions, Bequests $2,100.00 $0.00
6. EMS Fee for Service $7,723,410.00 $0.00
7. Fund Raising $0.00 $0.00
8. Interest and Dividends $0.00 $0.00
Grants - List Sources: State Provider and
9 $85,576.00 $0.00
RETAC
10. Subscription Program $0.00 $0.00
11. Other Income, Define: Contracted billing $2,984.00 $0.00
for North Park ambulance district
Total Income $7,814,070.00 $0.00
Expenses
nl II II
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12. Operational Expense $3,110,452.00 $0.00
13. Personnel Costs $3,154,140.00 $0.00
Salaries, benefits, etc.
14. Depreciation Expense $182,419.00 $0.00
15. Debt Service $0.00 $0.00
16. Capital Expenditures $108,233.00 $0.00
17. Other Expenses, Define: $0.00 $0.00
Total Expenditures $6,555,244.00 $0.00
Profit (or Loss) $1,258,826.00 $0.00
Rates and Collection
1. This agency charges for EMS services Yes
Agency: Yes
Who processes this agency's billing and •
2. accounting? Contract Service: No
No Billing/ Accounting: No
Service Base Rate Medicare Allowable
3. BLS (Basic Life Support) non-emergent $1,220.00 $199.56
4. BLS—Emergent $1,220.00 $319.30
5 ALS1 (Advanced Life Support-Level 1) $1,220.00 $239.48
Non-emergent
6. ALS1 — Emergent $1,220.00 $548.00
7. ALS2 - non-emergent $0.00 $0.00
8. SCT (Specialty Care Transport) $0.00 $0.00
non-emergent
9 SCT (Specialty Care Transport) $0.00 $0.00
emergent
10. PI (Paramedic ALS Intercept) $0.00 $0.00
non-emergent
11. FW (fixed Wing)—non-emergent $0.00 $0.00
12. FW (fixed Wing)—emergent $0.00 $0.00
13. RW (Rotary Wing)—non-emergent $0.00 $0.00
14. RW (Rotary Wing—emergent $0.00 $0.00
15. Treat and Release $150.00
16. Mileage Rate— Urban $18.00
17. Mileage Rate — Rural 1 to 17 miles $18.00
18. Mileage Rate - Rural 18 to 50 miles $18.00
19. Overall collection rate (Percentage): 33 %
Financial Narrative (REQUIRED)
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1. 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 2005. These facts have been
audited and are accurate. The 2006 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 mile of
North /Northeastern Colorado. Operating as and 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
eh changes in the Colorado No Fault automobile insurance on collections rates, WCPS has
experienced an average collection rate of 33% over the last year. This year has been a transition year
for WCPS; the service has had to fill 4 FTE's due to increasing call volume and the need for better
system coverage. 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 being a negative impact on our scheduled replacement of ambulances, along with
the inability to purchase needed data collection laptops. 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. The fact is that this portion of uncollected
money affects the operation and administrative functions of WCPS. 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 33% explain that with 100%
services provided we are losing 67% of our budget to bad debt or write offs. This trend has continued
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 the strain the budgets for replacement 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 proper, response area and the number of residents. Assume that the
1' 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.
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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. This service is provided 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. Of the near 13,000 calls for service, over 60% of the
calls for service 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 five ambulances during the day and four ambulances from 2200 to
0600, via fixed stations and system status placement of resources throughout Weld County. Operating
with 38 full time field staff and an office and administrative staff of 8 Weld County operates as and
enterprise of Weld County Government, billing and collecting all costs of operation.
Grant Request Categories
Category I - Ambulance, Other Vehicle (Request Details)
1. Qty 1
2. Type Code III
3. Two or Four Wheel Drive 2 wd
4. Description Braun remount of exsisting ambulance
5. Price Each $70,840.00
6. Total Request $70,840.00
7. Agency Share $35,420.00
8. State Share $35,420.00
9. Is this a new vehicle or a replacement? Replacement
8a. Which unit does it replace?
1 Vehicle Requests. Total $70,840.00
Category I - Ambulance, Other Vehicle (Equipment Request
Details)
1. Qty
2. Description
3. Price Each $
4. Total Request $
5. Agency Share $
6. State Share $
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0 Vehicle Equipment Requests
Category I - Ambulance, Other Vehicle (Additional Questions)
If the requested vehicle(s) is(are) replacement(s):
What was the number of calls your agency was
unable to respond to due to mechanical
1' 0
unavailablility of the emergency vehicle to be
replaced
This unit will be remounted and
2. What will be done with the unit that is replaced?
placed back into service.
3 What is the average length of service, in miles and or years, 15000 Miles
of vehicles operated by your agency?
Category I - Ambulance, Other Vehicle (Narratives)
Weld County Paramedic Services (WCPS) has initiated a re-chassis
program in which chassis would be replaced and patient modules would be
remounted. 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
Please describe your
remounted 3 times each. The vehicles with one remount are as follows in
agency's vehicle
2004 vehicles 16 and 18 were remounted and in 2005 vehicles 17, 19, 20
replacement program.
were remounted. At the present time we had two vehicles being remounted
for 2006 and it was vehicles 21 and 22. We will need to remount vehicles
23and 24 to complete the first cycle of the three remounts. We will need to
complete these last two vehicles in 2007 due to mileage and increased cost
of operation due maintenance issues.
Weld County Paramedic Services (WCPS) is an agency of Weld County
government that operates as and enterprise fund. Funding is provided
through fees for service only. The economy, Medicare, and Medicaid cuts,
tort law auto insurance and increasing costs are some of the major factors
that have negatively affected WCPS. Significant mandatory budget cuts
Vehicle request have been met. The management of WCPS continues to search for methods
narrative - Please to operate more efficiently and effectively. In 1998 a decision was made to
explain if this vehicle establish a program that would save and estimated $2.5 million over the
will be replacing any next 12 years. A re-chassis program was undertaken in which ambulances
previously owned chassis would be replaced and patient modules would be remounted. The
vehicles and how the first re-chassis occurred in 2004 at a savings of approximately $68,000 over
cost was determined, as the purchase of a new ambulance. This project will continue until each of
well as any other the 9 type III ambulances have been remounted 3 times. This project will
information that would require the remounting of 1 unit this fiscal year. With considerations for
help an outside person inflation and variations in the requirements of each specific unit it is
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understand the needs of estimated that the cost of remounting I chassis this year will be $70,840.00.
your vehicle request. WCPS respectfully requests matching funds from the state for our re-
chassis project. This program of remounting ambulances is a responsible
and effective utilization of funds that are increasingly difficult too obtain. It
is but one of many methods by which WCPS strive to maintain the highest
quality emergency service with less financial resources.
Category III - Data Collection (Request Details)
Total Agency State Share
Qty Description Price Each Request Share
10 Panasonic Tough Book Item $4,536.00 $45,360.00 $22,680.00 $22,680.00
number Cf-19CDBABVM
10 512 Memory upgrade $79.00 $790.00 $395.00 $395.00
10 Battery Charger $167.00 $1,670.00 $835.00 $835.00
10 _Batter for CF18B-D-F-K $149.00 $1,490.00 $745.00 $745.00
10 Protection Plus $840.00 $8,400.00 $4,200.00 $4,200.00
10 Two Year Extended Warranty $420.00 $4,200.00 $2,100.00 $2,100.00
Extension
10 Desktop port replicator $302.00 $3,020.00 $1,510.00 $1,510.00
10 Pentax pocketjet III printer engine $298.00 $2,980.00 $1,490.00 $1,490.00
10 Camber CF-18 Dock with $589.00 $5,890.00 $2,945.00 $2,945.00
wireless pass
10 Mounting Kit $545.00 $5,450.00 $2,725.00 $2,725.00
10 Wireless antenna $40.00 $400.00 $200.00 $200.00
10 Service work- Install $375.00 $3,750.00 $1,875.00 $1,875.00
12 Requests in Category. Total $83,400.00
Category III - Data Collection (Narrative)
Weld County Paramedic Services (WCPS) is an agency of Weld County government that operates as
and enterprise fund. Funding is provided through fees for service only. The economy, Medicare, and
Medicaid cuts, tort law auto insurance and increasing costs are some of the major factors that have
negatively affected WCPS. Significant mandatory budget cuts have been met. The management of
WCPS continues to search for methods to operate more efficiently and effectively. WCPS initiated a
data collection project approximately 2 years ago with the purchase of the Motorola 900 laptop
computers. The computers were installed with Healthware solutions and electronic data collection
was begun. WCPS eventually migrated to the use of Tiburon for its dispatch information. The goal of
installing Tiburon and Healthware on the same machine was to someday migrate the Tiburon
information into Healthware and decrease the need for repetitive data entry. The problem became
clear very shortly after both systems were installed on the ML 900. We began having data corruption
issues on Healthware and Tiburon rarely was reliable for crew utilization. The unfortunate result was
that Healthware and Tiburon would not run together on the same machine without causing conflicts
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with each other. WCPS has spent countless hours and dollars on finding a solution to the problem.
The last effort was utilizing VM software which failed to produce reliable results. The end decision
was to use the ML 900 for Tiburon and purchase a separate laptop for data collection. WCPS is
requesting funding for the purchase of 10 Panasonic tough books (item number CF-19CDBABVM
and required options). WCPS has always maintained its need and want to provide the highest quality
data to the State of Colorado. This move to separate computers will allow WCPS to provide this data
in a timely and consistent manner without fear of corrupted data due to software incompatibility. This
move will also provide a positive work environment for the crews of WCPS by providing them a
portable workstation to better fit their active jobs. Maintenance will also decrease due to the
separation of the conflicting software and keeping the machines up and running without taking them
down for one issue. These computers will keep the data collection stream clean and efficient by
allowing the employees to complete their trip sheets in a timely manner after the call with minimal
delays due to computer issues. With running nearly 13,000 calls in 2006 WCPS feels it has valuable
data to provide to the State of Colorado and maintains its dedication to provide this information.
Attestation
Special note for multi-agency applicants:
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. Legal Name of Agency: Weld County Paramedic Services
DBA (Doing Business As -If WCPS
2' Applicable:
3. Federal Tax ID Number: 84-6000813
4. Grant Contact Person:
4a. Title: Director
4b. First Name: Dave
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 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:
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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.
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.
If the grantee provides a training or educational program, then the grantee shall acknowledge
C the use of emergency 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
D 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
C. process before purchasing that equipment. The 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
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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
tear excepted. The grantee shall perform all necessary maintenance services for all equipment
H. 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,
I. 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. First Name _David E.
14. Last Name Long
15. Title Chairman of Board of County Commissioners
16. Daytime Phone Number 970-336-7204
17. Daytime Phone Number Extension X4200
18. Date : F [B 21 LUU7
r-
19. Signature of Authorized Agent c
Once you have all of the answers you need, use this work eet to fill out your
application online.
https://www.hfemsd2.dphe.state.co.us/CEMSISWeb_Grants/frm_5102_PrintApp.aspx 2/14/2007
- frm_ 5102a_PrintAppBlank Page 12 of 12
Go Back I
•
https://www.hfemsd2.dphe.state.co.us/CEMSISWeb_Grants/frm_5102_PrintApp.aspx 2/14/2007
4:t tele
1 r
R ESGU E NG_
CUSTOMIZE ID SERVICE, REMOUNT ANA REPAIR
1171 Production Drive. Van Wert,O11 45891
Phone: 419-238-1459 or 877-519-1459 *Fax: 419-238-1479
www.lifestarrescue.com •
May 15, 2006
2007
Weld Co. Paramedics (amTSSI C
Greeley,CO
REMOUNT QUOTATI N
1 2006 Ford E-450XL Super Duty Ambulance Prep Chassis 158"WB $31,950.00
(Fleet discount NOT included)
1 Remount of your Braun modular ambulance $32,890.00
E,
Transportation(as of 5/9/06—subject to change) $3,000.00 p�k�`}
1,,000.00
1 Trade ip of old chassis ($TBD 1
FINAL PRICE - $67,840.00
3,000.00
1171 Q.ou -t-u-t qL
ITEMS THAT WHERE DELETED IN STANDARD REMOUNT
A
Delete new Federal Little light(map light)
Delete standard 10"beltline
Delete sandblast and repaint module
Delete new door seal
Delete new attendant seat
Delete new upholstery
Delete new electrical system install existing console and switches (update as
needed)
Leave existing shoreline
**Lettering not included
OPTIONAL ITEMS THAT ARE INCLUDED IN ABOVE PRICE
Weldon LED grille lights
Grip strut in running boards
Wig wags
Cat eye fog lights
Reinstall existing air horns,new fittings, lines and solenoid
Install new Impact suction unit(recess into streetside wall)
Weldon LED brake/tail/turn/backup lights (ILOS)
(5) amber or red—Weldon 9x7 LED module lights
(3) blue—Weldon 9x7 LED module lights
LED rear intersection lights
Install customer supplied computer stand
Delivery: 75-90 days after signed contract.
Terms: Final payment due upon completion, after inspection and
acceptance.
Warranty: 1 year written warranty on workmanship.
Call me if you have any questions.
Sincerely,
Jamie Ramos
Remount Sales Manager
Quote 002203
portable systems
Corporate Headquarters Print Date 12108/06
12851 West 43rd Drive Quote Valid Date 01/07107
Un8112 Prices are valid arid Me dale shown stews
Golden.CO 80403
Inside Sales Rep Amy Hale
arnyhePodabkwntpurasyslems.tout
Remit payments to: Customer: Phone:8881219-8699
Portable Computer Systems,Inc. Weld CountyPO Box 75BGreeley,CO Far 940583-4314
PO Box 17127 80632
Denver,CO 80217 Salesperson Angela Konigsbauer
Phone:303/346-2487
Quotation
Customer Requested By F.O.B. Tema
WEL002 Julie Jordan Origination Net 30 Days
Item Number Desaiptlon y Comments Quantify Unit Price Extended Price
WORK-INSTALL SERVICE WORK-INSTALL 1.000 375.00 37500
•
Notes
Terms
Payment Terms shal be as stated on this quote.A service charge of 1-'A%per month will be charged on all past the balances.
Al costs of collections,including reasonable attorneys fees shall be paid by the customer.
Returned merdtandse we not be accepted without authorization and be subied to a 20%restodcng fee.Reims mast be made within
30 days of invcice date Custom-math equpcem may not be retuned for any credit
Wananlies:PCS sells the products as set forth it the invoice without any express or implied warranties.In the event of any product defect
of nonconformmy,the Buyer's remedies shall be the warranties provided by the Manufacturer_Buyer shall not be entitled to any incidental.
consequential or special damages of any kind Subtotal 8340.00
stadal m include
es not taxes.stepping or inci
dental mal charges uNess dhevrne includedFinished '
Page 2
na Quote 002203
portable systems
Corporate Headquarters Print Date 12/08/06
12851 West 43rd Drive Quote Valid Date 01/07107
Unit 82
Gowan,CO 80403 Prices are raid uti the dale shown above
Inside Sales Rep Amy Hale
ertylnQpartableconput rsystems.com
Remit payments to: Customer: Phone 8882198699
Portable.Computer systems,Inc. Weld CountyPO Box 758Greeiey,CO Fa 9401683-4314
PO Box 17127 80632
Denver,CO 80217 Salesperson Angela Konigsbauer
Phone 3031346-2487
•
Quotation
Customer Requested By F.O.& Terms
INEL002 Julie Jordan Origination Net 30 Days
Item Number Description I Comments Quantity US Price Erferded Price
CF-19CDBABVM 1.06Ghz10.4"XGADgt80G8.512MB.802.11.Dualpass.V-EVDO 1.000 4536.00 4536.00
CF-W1BA5512-GR 512AB MEMORY UPGRADE-THRD PARTY 1.000 79.00 79.00
CF-VCBTBIU BATTERY CHARGER t000 167.00 167.00
CF-VZSU308U Battery forCF188-0-F-K 1.000 149.00 149.00
CF-SVCLTNF5Y PANASONIC TOUGHBOOK PROTECTION PLUS(5 YEARS) 1.000 840.00 840.00
CF-SVCLTEXT2Y PANASONIC TOUGHBOOK TWO YEAR WARRANTY EXTENSION(YRS 485) 1.000 420.00 420.00
CF-VEB181U DESKTOP PORT REPLICATOR 1.000 302.00 302.00
205537 PENTAX POCKET I8 PRINTER ENGINE 1.000 298.00 298.00
NP-CF18-W GAMIER CF-18 DOCK WITH WIRELESS PASS 1.000 589.00 589.00
KIT-MOUNT MOUNTING KIT: Includes base.pedestal.motion attachment printer mount and paper housing 1.000 545.00 545.00
laptop aid printer power srppty.shuWown timer.and all necessary cabing.
ANTENNA Wireless access Antenna 1.000 40.00 40.00
Notes
Terms
Payment Teens shall be as stated on Ills gine A service charge of 1-'F_%per MINIMA be charged anapest die balances.
Al costs of collegians.including reasonable attorney's fees shall be paid by the customer.
Retuned merchandse will not be accepted without authorization and we be sttOd Ica 20%restocking fee.Returns must be made within
30 days of irwaice date. Ctrsbmniade equipment may not be remand for any aerie
Wana,ies:PCS sells the products as set fort in the invoice without any express or spied warranties.In the event of any mood defect
of nonconformity.the Buyefs renades stall be the warranties provided by the Manufacturer.Buyer shall no be edited to any incidental.
consequential or special damages of any kind
(Continued) Subtotal dies not include taxes.shppmg or other incidentaldo dentalcharges unless otherwise irritated
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