HomeMy WebLinkAbout20072972.tiff CHAPTER 7
Emergency Medical Services
ARTICLE I
General Provisions
Sec. 7-1-10. Purpose.
The purpose of this Chapter is to set forth the requirements for high quality emergency medical
services to all citizens of the County. It is the intent of the Board of County Commissioners that
emergency medical service in the County will consist of, at least a minimum, timely response,
transportation, treatment, communication and documentation subsystems designed to prevent
premature mortality and to reduce the morbidity that arises from critical injuries, exposure to
poisonous substances and illnesses.
Sec. 7-1-20. Delegation
A. The Board of County Commissioners designates and delegates to the Director of the
Weld County Department of Public Health and Environment the authority to manage the
Emergency Medical Services Rules and Regulations as set out in this Chapter. Under the
direction of the Board, inspections, licenses, permits, applications and other functions necessary
to implement this Chapter shall be the responsibility of the Director.
Sec. 7-1-30. Definitions
The following definitions shall apply in the interpretation and enforcement of this Chapter.
Advanced life support personnel means a minimum of two individuals, including at least
(1) one state-licensed Registered Nurse, or one (1) state-certified EMT-Paramedic or EMT
Intermediate, and the second individual must be, at a minimum, a current state certified EMT
Basic. One(1) of the two individuals above named personnel may also serve as the emergency
vehicle operator of the n land ambulance.
Air ambulance means a fixed-wing or rotor-wing aircraft that is equipped to provide air
transportation and is specifically designed to accommodate the medical needs of individuals who
are ill, injured or otherwise mentally or physically incapacitated and who require in-flight
medical supervision.
Ambulance means any privately or publicly owned land or air vehicle especially
constructed or modified and equipped, intended to be used and maintained or operated by an
ambulance service for the transportation in the County of individuals who are sick, injured or
otherwise incapacitated or helpless. For the purposes of this Chapter, ambulance shall not
include air vehicles used in air medical transport, because,by state law, such air ambulances are
licensed by the Colorado Department of Public Health and Environment.
a. Basic life support ambulance means an land ambulance that meets the
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requirements for equipment as established by the Board of County Commissioners and is
staffed by at least one (1) Emergency Medical Technician-Basic/EMT-B currently
certified by the State, and a driver that as a minimum has a current American Red Cross
Advanced First Aid Card, an American Heart Association Health Care Provider
Cardiopulmonary Resuscitation Card or its equivalent, or the equivalent of both as
established by the State Advisory Council on Emergency Medical Services, and a valid
Colorado driver's license.
Applicant means that person or entity who is an initial applicant or an applicant for
renewal for an ambulance service license or ambulance vehicle permit.
Current E.MS. Act laws means the Emergency Medical Services Act, Section 25-3.5-101
et. seq., C.R.S., as amended; the Colorado Department of Public Health and Environment Rules
Pertaining to Emergency Medical Services, 6 CCR 1015-3, as amended; and Colorado Board of
Medical Examiners Rule 500, 3 CCR 713-6, as amended.
Department means the Weld County Department of Public Health and Environment.
Director means the Director of the Weld County Department of Public Health and
Environment.
Emergency vehicle operator means any person authorized to either drive an land
ambulance or pilot an air ambulance in the County as provided in this Chapter.
Medical director means a physician adviser who holds an active Colorado medical
license,who establishes protocols and standing orders for medical acts performed by First
Responders, Registered Nurses, or state of Colorado-certified EMTs of a prehospital EMS
service agency and who is specifically identified as being responsible to assure the competency
of the performance of those acts by such First Responders, Registered Nurses, or state of
Colorado-certified EMTs.
Physician advisor means a medical director. a physician who establishes protocols and
standing orders for medical acts performed by EMT Basics, EMT Intermediates, EMT
Paramedics, First Responders or Registered Nurses, of a pre hospital emergency medical care
service agency and who is specifically identified as being responsible to assure the competency
of the performance of those acts by such EMT Basics, EMT Intermediates, EMT Paramedics,
First Responders or Registered Nurses. Physician Advisor shall also mean a Colorado licensed
physician who is specifically designated and has accepted responsibility for directing the conduct
of pre hospital training courses conducted by a Division recognized training center or training
group, and for evaluating the performance of students in such training courses.
Quick response team means any organized group of individuals trained, at a minimum, as
First Responders,that provides initial care to a patient prior to the arrival of an ambulance.
Registered nurse (R.N.) Means a person duly licensed under the provisions of the
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Professional Nurse Practice Act of the State of Colorado.
Standby service means a service provided by contract or on a voluntary basis to provide
emergency medical services at special events, including athletic and competitive events, which
may pose a potential hazard for injury or death and require immediate emergency medical care.
Standby service providers must comply with all requirements, including,but not limited to,
insurance requirements for emergency medical service providers set forth in this Chapter.
ARTICLE II
Licenses and Permits
Sec. 7-2-20. Vehicle permit for each ambulance.
In addition to the license required by Section 6 7-2-10, above, for an ambulance service, the
Department shall issue a permit for each ambulance used. Said ambulance vehicle permit shall
be issued upon a finding that the applicant's vehicle and equipment comply with the
requirements of this Chapter and the applicable requirements set forth in the current E.M.S. Act
Laws. The permit issued for each vehicle will describe the maximum level of service that can be
provided by that vehicle (e.g., "Ambulance basic life support"or"Ambulance advanced life
support"). The ambulance vehicle permit fee shall be set by separate ordinance.
Sec. 7-2-30. Expiration of licenses and permits.
The All ambulance service licenses and ambulance vehicle permits issued by the County shall
expire on December 31 of the year issued.
Sec. 7-2-40. Medical director required.
Each ambulance service licensed in the County shall have a Medical Director,who shall comply
with all of the appropriate requirements of the current EMS Laws. The Medical Director shall be
notified in writing by the Department of any violation of this Chapter by any ambulance service
or individual licensee for which the Medical Director provides services and oversight.
Sec. 7-2-50. Advanced life support ambulance.
When an ambulance service operates or charges as a paramedic or advanced life support
ambulance service, the staffing and equipment must comply with the definition of advanced life
support ambulance.
Sec. 7-2-70. Reciprocal agreements with other jurisdictions.
The County may enter into reciprocal licensing and permitting agreements with other counties
and neighboring states.
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Sec. 7-2480. Exclusions.
The provisions of this Article Chapter shall not apply to the following:
A. The exceptional emergency use of a privately or publicly owned vehicle, including
search and rescue unit and quick response vehicles that do not routinely transport patients or
vehicles used to transport patients for extrication from areas inaccessible to a permitted
ambulance. Vehicles used in this capacity may only transport patients to the closest practical
point for access to a permitted ambulance or hospital. or aircraft not ordinarily used in the formal
act of transporting patients.
D. Vehicles used or designated for the scheduled transportation of convalescent patients,
handicapped individuals with disabilities or persons who would not be expected to require
skilled treatment or care while in the vehicle.
Sec. 7-2-890. Application Requirements.
Every applicant for an ambulance service license or an ambulance vehicle permit shall complete
and submit to the Department an application and supporting documents for approval. Said
application for approval shall contain, but not be limited to the following information:
C. Land . hicles+The description of the ambulance, including the make, model, year of
manufacture, current Colorado state license number, motor vehicle chassis number and length of
time the vehicle has been in service.
D. Air vehicles: The description of the ambulance, including the make, model, tail
number and identifying colors, as well as a current Part 135 Certificate.
ED. The location and description of the place or places from which the ambulance
service will operate.
FE. The name, address and telephone number of the required medical director to the
ambulance service, and an attestation by the Medical Director of willingness to provide medical
oversight and a medical continuous quality improvement program for the ambulance service.
GF. The area to be served by the ambulance service.
HG. A list of all emergency medical service providers who may be called upon to
respond to an emergency with the ambulance service. This list shall include the following
information on each person:
TH. Proof of insurance, as required in Section 7-3-50, below.
3I. A current copy of EMT or Paramedic protocols adopted by the ambulance service in
accordance with standards approved by the ambulance service's medical director.
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1O. A current copy of the ambulance service's training standards in accordance with the
requirements approved by the ambulance service's rnMedical dDirector. All training must be
through a state-certified emergency medical services training center.
LAC. Make available for review by the Department current records of compliance with
the current EMS Laws.
L. Copies of any judgments entered against the licensee or license applicant within the
previous twelve(12)months including findings of fact, conclusions of law and order by any
court or other tribunal.
LM. Such other information as the Department may require to make a fair determination.
Sec. 7-2-9100. Approval of application.
Sec. 7-2-1010. Fraud or misrepresentation.
Sec. 7-2-1120. Additional or replacement vehicles.
If an ambulance is added to a service's fleet, an application for an ambulance vehicle permit
shall be filed with the Department prior to the new ambulance being placed in service,but in no
event later than within thirty(30) days of receipt of the new ambulance. The completed
application shall include a description of the ambulance replaced. Upon receipt of a new
ambulance vehicle permit application, the Department shall inspect the new ambulance and issue
the new ambulance vehicle permit, if appropriate.
Sec. 7-2-1230. Additional inspections.
Sec. 7-2-1340. Appeal of application denial.
Any person or entity having been denied a license by the Director may appeal such denial to the
Board of County Commissioners. The request for a hearing on such denial must be in writing
and shall be filed with the Clerk to the Board no later than thirty(30) days after the date of
notification by the Director to the applicant of such denial. The request for a hearing shall
specify the grounds of the appeal. A hearing based upon the specific grounds stated in the appeal
shall be scheduled and conducted in accordance with Sec. 7-7-30 of this Chapter. The decision
of the Board of County Commissioners shall be based solely on the grounds of the appeal set
forth in the applicant's request for hearing.
Sec. 7-2-1450. Change of ownership.
Sec. 7-2-1560. Licenses and permits not transferable.
Sec. 7-2-1670. Annual renewal.
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Sec. 7-2-180. Change of medical director.
An ambulance service must report any change of medical director, including name, address and
telephone number to the Director within fifteen(15) calendar days of such change.
ARTICLE III
Ambulance Operation
Sec. 7-3-10. Emergency vehicle operator.
For land vehicles, the ambulance driver shall meet the requirements of Section 25-3.5-202,
C.R.S. This requirement may be waived in unusual emergency conditions when no driver
meeting these requirements is available. For air vehicles, the pilot of the aircraft must have a
current pilot's license issued by the FAA, which permits the pilot to operate the relevant aircraft.
Sec. 7-3-30. Documentation.
Each ambulance service shall prepare, maintain and submit upon request copies of uniform and
standardized records concerning the transportation and/or treatment of patients as required by the
Director and/or the State of Colorado Department of Public Health and Environment. Such
records shall include all information determined to be essential by the Colorado Department of
Public Health and Environment and set forth in the EMS Laws, for maintenance of adequate
minimum records on the patient's medical condition and medical care provided by the
ambulance service. All licensed ambulance services are required to utilize the statewide
emergency medical and trauma services uniform prehospital care reporting system operated by
the State of Colorado Department of Public Health and Environment.
Sec. 7-3-40. Agency Profile to be submitted to State.
Each licensed ambulance service shall complete and submit to the State of Colorado Department
of Public Health and Environment an agency profile as defined by Colorado Emergency Medical
and Trauma Services Advisory Council and approved by the State to provide information on
resources available for planning and coordination of statewide emergency medical and trauma
services on an annual basis.
Sec. 7-3-450. Criminal record of ambulance crew member.
Unless waived by the Board of County Commissioners, no person shall be employed by an
ambulance service as an ambulance crew member who has been convicted of any of the
following offenses within the previous twelve(12)months from the date of application: felony,
misdemeanor, Class I or Class II traffic offense within the previous twelve(12)months from the
date of application.
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Sec. 7-3-560. Insurance.
A. Coverage. No emergency medical service provider shall operate in the County unless
it is covered by insurance as set forth in this paragraph. Each ambulance service shall maintain
insurance coverage for each and every ambulance owned, operated or leased by the ambulance
service, providing coverage for injury to or death of persons in accidents resulting from any
cause for which the owner of said vehicle should be liable for any liability imposed on him or her
by law, regardless of whether the ambulance was being operated by the owner,his-er-her the
owner's agent, of lessee, or any other person, and coverage as against damage to the property of
another, including personal property, under like circumstances, in the following amounts:
Al. Worker's Compensation Insurance: Each ambulance service shall maintain at
least the statutorily required amount of worker's compensation insurance.
B2. Public liability and property damage, bodily injury:
a. Each person, five six hundred thousand dollars ($5600,000).
b. Each accident, five six hundred thousand dollars ($5600,000).
€3. Property Damage: Each accident, five six hundred thousand dollars
($5600,000).
D4. Professional Liability Coverage:
a. Each person, five six hundred thousand dollars ($5600,000).
5. Ambulance Vehicle coverage: The ambulance vehicle insurance shall be a
complying policy for motor vehicles as defined in Sections 10-4-609 and 42-7-103,
C.R.S.
EB. Proof of Insurance. Proof of insurance shall be filed with the Department, along
with the application for an ambulance service license as required in this Chapter. Every
insurance policy required shall contain a provision for continuing liability thereunder to the full
amount thereof, notwithstanding any recovery thereon, that the liability of the insured shall not
be affected by the insolvency or bankruptcy of the insured, and that until a policy is revoked, the
insurance company will not be relieved from liability on account of nonpayment of premiums,
failure to renew license at the end of the year or any act or omission of the named insured. At
any time said insurance is required to be renewed, proof of renewal shall be provided to the
Department. The land vehicle insurance shall be a complying policy for motor vehicles as
defined in Section 10 4 703, C.R.S.
EC. Certificate of insurance requirements.
GD. Changes in the status of vehicles.
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HE. Changes in insurance.
Sec. 7-3470. Safety belts.
Safety belts shall be utilized by all persons in the forward compartment. Attending personnel
shall utilize seat belts when feasible. Safety belts or other safety restraining devices shall be
available for patients being transported, regardless of age or size. Such devices shall be utilized
when feasible.
Sec. 7-3480. Transport to medical facility.
Sec. 7-3-890. Approved locations; abandonment.
Sec. 7-34100. Compliance with zoning and other regulations all applicable laws and
regulations.
An Ambulance services operating in the County must comply with all applicable federal, state
and local laws and regulations, including, but not limited to, EMS Laws, HIPAA laws and
regulations, and relevant County and municipal zoning and-ether regulations.
Sec. 7-3-110. Medical continuous quality improvement program required.
Each licensed ambulance service operating within Weld County must have an ongoing medical
continuous quality improvement program consistent with the requirements defined in the
Colorado Board of Medical Examiners rules, 3 CCR 713-6, Rule 500, 3.2,b.
ARTICLE IV
Ambulance Vehicle Requirements
Sec. 7-4-10. Specifications.
Land vehicles obtained, licensed and placed in use as ambulances shall, at the minimum, meet
the guidelines as established by the State EMS Advisor the provisions in the EMS laws
applicable to ambulances. Variances of the above-mentioned specifications may be granted at
the discretion of the Director. Air vehicles obtained, licensed and placed in use as ambulances
shall, at the minimum,be in compliance with all state and federal regulations, including Federal
Aviation Regulations (FARs) specific to the operations of the air medical service. All
ambulances shall have the name and level of service of the ambulance service clearly visible on
said vehicles.
Sec. 7-4-20. Ambulance equipment.
Each ambulance shall contain the following equipment which shall be maintained in good
working order:
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A. Land vehicles.1. Emergency lighting and audible warning equipment which complies
with state law for emergency vehicles.
2B. Safe tires, and, in addition, adequate snow tires or chains when weather conditions
demand.
;C. In the case of ambulances providing primary care in the County, or otherwise
qualified pursuant to Section 7-2-80, above, a capability of two-way radio communication with
the following: the ambulance dispatcher, the Weld County Regional Communication Center and
on-line medical control.
4D. Safety belts for both the ambulance driver and other attending personnel.
SE. The minimal required equipment shall be that listed in the list established by the
Colorado Department of Public Health and Environment, Emergency Medical Services Division
set forth as required, either for Advanced Life Support or Basic Life Support, as applicable, in
the EMS Laws. The Director may add to this list at his or her discretion as other needs or new
methodology becomes known.
B. Air vehicles.
1.- All air ambulances must comply with the requirements set forth in Section 2.0,
Aircraft Equipment and Configuration, of the Colorado Air Medical Service Guidelines,
April 1995, or its successor.
2. All air ambulance services must comply with the relevant safety standards for
rotor wing or fixed wind aircraft, or both, a set for thin Sections 17.0, 18.0 and 19.0 of the
Colorado air Medical Service Guidelines, April 1995, or its successor.
ARTICLE V
Qualifications of Emergency Medical Technicians
Sec. 7-5-10. Valid EMT certificate required.
No person shall practice as an Emergency Medical Technician for any ambulance service subject
to the licensing requirements of this Chapter unless that person holds a current valid Emergency
Medical Technician certificate from the State of Colorado.
Sec. 7-5-20. List of EMS providers required.
Each Emergency Medical Ambulance Service subject to the licensing requirements of this
Chapter shall provide the Department with a list of its Emergency Medical Service providers as
stated in Section 7-2-8014 G, above, and shall notify the Department of any changes in that list
within thirty(30) days of the change in the list.
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ARTICLE VI
EMS Providers Not Lieensed-With Employed or Utilized By a County Licensed Ambulance
Service
Sec. 7-6-10. Compliance by contract with ambulance services.
Emergency Medical Services contracting with, or employed by, groups and organizations for
public events and not affiliated employed or utilized by with a licensed ambulance service
licensed by the County shall, upon request,be able to demonstrate compliance with rules and
regulations as promulgated by the County, the State and the State Board of Medical Examiners
and through the EMS Laws
ARTICLE VII
Complaints and/or Suspension or Revocation of License or Permit
Sec. 7-7-10. Unlawful Practices.
The following practices shall be unlawful and shall be grounds for a suspension or revocation of
a license:
A. Willful and deliberate failure to respond to any emergency call.
B. Willful and deliberate failure to transport a patient when required in the event of an
emergency.
I. Noncompliance with any rule or regulation promulgated by the Colorado State Board
o f M di l nc set forth in the EMS Laws concerning the duties and responsibilities of
emergency medical technicians or medical directors.
Sec. 7-7-20. Complaints Concerning Ambulance Services.
Complaints against an ambulance service in the County, whether or not such ambulance service
currently holds a license pursuant to this Chapter,must be filed in writing with the Director. The
written Complaint must contain the name, address and telephone number where the Complaining
Party may be reached, and as detailed information as possible concerning the Complaint. The
Director or his designee will investigate such incidents. Upon completion of the investigation,
the Director shall report the resolution of the investigation to the Complaining Party and any
other entity as appropriate or required pursuant to the provisions of 6 CCR 1015-3, Section
12.4.2. A report of all complaints and the resolutions of such complaints shall be provided to the
medical director that oversees the relevant ambulance service.
Sec. 7-7430. Temporary suspension.
Sec. 7-7-340. Hearings to be public.
Sec. 7-7-450. Hearing in two phases.
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Sec. 7-7-560. Notification of revocation or suspension.
ARTICLE VIII
Countywide Emergency Service
Sec. 7-8-20. County ambulance service.
The Weld County Ambulance Paramedic Service is the ambulance service organized and
furnished by the County, pursuant to the provisions of state statutes. So long as the Weld County
Ambulance Paramedic Service is in existence and is duly licensed pursuant to this Chapter, the
Weld County Ambulance Paramedic Service may provide emergency service to all areas of the
County and to those other areas specifically set forth in the Weld County Ambulance Paramedic
Service application and license. Weld County Regional Communications Center may dispatch
Weld County Ambulance Paramedic Service to respond to a call within another ambulance
service's service area under the terms and conditions set forth in Section 7-3-20, above.
Sec. 7-8-30. Triage authority.
Incident Command shall appoint triage authority at an active incident. Weld County Ambulance
Paramedic Service shall be appointed medical triage authority in the County when Weld County
Ambulance Paramedic Service and any other ambulance service have responded to calls for
emergency assistance where medical triage authority has not yet been established, and/or a
dispute concerning medical triage exists.
ARTICLE XI
Enforcement
Sec. 7-9-10. Violations and penalties.
The County, through the Director of Weld County Department of Public Health and
Environment, may enforce this Chapter through methods included in this Chapter or through
other methods adopted by the Board of County Commissioners.
Sec. 7-9-20. Criminal penalties.
A. Any person, firm, corporation, or ambulance service violating any provision of this
Chapter is guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of
not more than one hundred dollars ($100.00), or by imprisonment in the County Jail for not more
than ten (10) days, or by such fine and imprisonment for each offense or violation. Each day
during which such violation continues shall be deemed a separate offense.
B. Whenever the Department of Public Health and Environment,through one of its
employees, has personal knowledge of any violation of this Chapter, it shall give written notice
to the violator to correct such violation within fifteen(15)days after the date of the notice.
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Should the violator fail to correct the violation within such fifteen-day-period, the Director may
request that the Sheriff's office issue a summons and complaint to the violator, stating the nature
of the violation with sufficient particularity to give notice of said charge to the violator. The
summons and complaint shall require that the violator appear in court at a definite rime and place
stated therein to answer and defend the charge. One (1) copy of the summons and complaint
shall be served upon the violator by the Sheriff's office in the manner provided by law for the
service of a criminal summons. One(1) copy each shall be retained by the Sheriff's office and
the Director, and one (1) copy shall be transmitted to the Clerk of the Court.
C. It is the responsibility of the County Attorney to enforce the provisions of this
Section. In the event the Board of County Commissioners deems it appropriate, the Board of
County Commissioners may appoint the District Attorney to perform such enforcement duties in
lieu of the County Attorney.
Sec. 7-9-30. Equitable relief in civil action.
In the event that any ambulance service is being operated within Weld County in violation of any
provision of this Chapter, the County Attorney, or where the Board of County Commissioners
deems it appropriate, the District Attorney, in addition to the other remedies provided by law,
ordinance or resolution, may institute an injunction, mandamus, or other appropriate action or
proceeding to prevent, or enjoin such violation.
Sec. 7-9-40. Civil Penalties.
A. In addition to any penalties imposed pursuant to Section 7-9-20 above, any person,
firm, corporation or ambulance service violating any regulation or provision contained in this
Chapter may be subject to the imposition,by order of the County Court, of a civil penalty in an
amount of not less than two hundred fifty dollars ($250.00), nor more than five hundred dollars
($500.00). It is within the discretion of the County Attorney to determine whether to pursue the
civil penalties set forth in this Article. Each day after the issuance of the order of the County
Court during which such violation continues shall be deemed a separate violation and shall, in
accordance with the subsequent provisions of this Section,be the subject of a continuing penalty
in an amount not to exceed fifty dollars ($50.00) for each such day.
B. The Department of Public Health and Environment, through one(1) of its employees,
shall, upon personal information and belief that a violation of any regulation or provision of this
Chapter, give written notice to the violator to correct such violation within fifteen(15) days after
the date of such notice. If the violator fails to correct the violation within such fifteen-day period
or within any extension period granted by the Director, the Director may request the County
Sheriff or the County Attorney issue a summons and complaint to the violator, stating the nature
of the violation with sufficient particularity to give notice of such charge to the violator.
C. One(1) copy of the summons and complaint issued pursuant to Subsection B above
shall be served upon the violator in the manner provided by law for the service of a County Court
civil summons and complaint in accordance wit the Colorado Rules of County Court Civil
Procedure. The summons and complaint shall also be filed with the Clerk of the County Court
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and thereafter the action shall proceed in accordance with the Colorado Rules of County Court
Civil Procedure.
D. If the County Court finds,by a preponderance of the evidence, that a violation of any
provision of this Chapter as enacted and adopted by the Board of County Commissioners has
occurred,the Court shall order the violator to pay a civil penalty in an amount allowed pursuant
to Subsection A, above. Such penalty shall be payable immediately by the violator to the County
Treasurer. In the event that the alleged violation has been cured or otherwise removed at least
five(5) days prior to the appearance date in the summons, then the County Attorney shall so
inform the Court and request that the action be dismissed without fine or appearance of the
defendant.
E. Upon the filing with the Court of a receipt issued by the County Treasurer showing
payment in full of a civil penalty assessed pursuant to this Section and upon the filing of an
affidavit of the Weld County Department of Public Health and Environment that the violation
has been cured,removed or corrected, the Court shall dismiss the action and issue a satisfaction
in full of the judgment.
F. If a receipt showing full payment of the civil penalty or the affidavit required by
Subsection E, above, is not filed, the action shall continue and the Court shall retain jurisdiction
to impose an additional penalty against the violator in the amount specified in Subsection A of
this Section. Such additional penalty shall be imposed by the Court upon motion filed by the
County and proof that the violation has not been corrected. Thereafter, the action shall continue
until the penalty and any additional penalties so assessed and the filing of an affidavit of the
Department of Public Health and Environment that the violation has been corrected.
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