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Home My WebLink About20213314.tiffEsther Gesick Subject: FW: Updated Ambulance Service - UCHealth Emergency Medical Services From: Gabri Vergara <gvergara@weldgov.com> Sent: Friday, July 1, 2022 11:15 AM To: Karla Ford <kford@weldgov.com> Subject: Updated Ambulance Service - UCHealth Emergency Medical Services As per my voice message, just checking best process for getting updated license (with address change) signed by Board Chair. I can either send a hard copy to you or email an electronic copy for you to print out. Thanks, Gabri Vergara Consumer Protection Manager Department of Public Health & Environment 1555 N. 17th Ave. I Greeley, CO 80631 970-400-2226 ( gvergara@weldgov.com - ® Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. COYI�� FkiC�- l 9�� fit�7G� XDa I - 3 9 NLU05� D WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT License to Operate Ambulance Service TIER I UCHEALTH EMERGENCY MEDICAL SERVICES Name of Service 3509 SOUTH MASON STREET, FORT COLLINS, COLORADO 80525 Address POUDRE VALLEY HEALTHCARE, INC. Name of Owner IS LICENSED UNTIL DECEMBER 31, 2022, TO OPERATE AN AMBULANCE SERVICE IN WELD COUNTY IN ACCORDANCE WITH EXISTING WELD COUNTY RULES AND REGULATIONS. JUL 1 3 2022ftN CHAIR, RD OF WELD COUNTY COMMISSIONERS DATE G NOT TRANSFERRABLE / POST IN A CONSPICUOUS PLACE Tier I: Licensure authorizing for Primary Care, as defined in Section 7-1-39 of the Weld County Code. RESOLUTION RE: APPROVE APPLICATION FOR TIER I AMBULANCE SERVICE LICENSE AND AUTHORIZE CHAIR TO SIGN - UCHEALTH EMERGENCY MEDICAL SERVICE WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, pursuant to Section 7-2-100 of the Weld County Code, the Weld County Department of Public Health and Environment and the Weld County Emergency Medical/Trauma Services Council have reviewed the application of UCHealth Emergency Medical Service for a Tier I Ambulance Service License and recommend approval, and WHEREAS, after review, the Board deems it advisable to approve said Application for a Tier I Ambulance Service License, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the application of UCHealth Emergency Medical Service for a Tier I Ambulance Service License, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said license. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 6th day of December, A.D., 2021. ATTEST: Weld County Clerk to the Board BY: G "r puty Clerk to the Board rney Date of signature: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO q Steve )Moreno, Chair , Pro -Tern Perry L. EXCUSED ike Freeman Lori Saine HL(T6/Gv), OEI-t(RRi 2021-3314 HL0053 Memorandum TO: Steve Moreno, Chair Board of County Commissioners FROM: Mark A. Lawley, Executive Director Department of Public Health & Environment DATE: November 29, 2021 SUBJECT: 2022 Applications for Ambulance Service Licenses Enclosed for the Board's review are sixteen applications for ambulance service licenses, pursuant to the Weld County Code, Chapter 7, Emergency Medical Services, from the ambulance service providers listed below. The Weld County Emergency Medical Trauma Service (EMTS) Council reviewed each application on November 17, 2021, and approved all sixteen applications. Based on the delegated responsibility of the Department, we have reviewed the applications and have deemed all ambulance services listed below to have met all applicable licensure application requirements as per Chapter 7. As such, I am recommending the following ambulance service providers for licensure: Tier 1 Tier I Tier II Banner Health/NCMC Paramedic Service Platte Valley Ambulance Service Ambulnz CO, LLC 1801 16th St. 1750 E. Egbert St. 7100 E. Belleview Ave., Ste. 112 Greeley, CO Brighton, CO Greenwood Village, CO Frederick Firestone Fire Platteville Gilcrest Fire American Medical Response Protection District Protection District of Colorado 8426 Kosmerl PI. 202 Main St. 3800 Pearl St. Frederick, CO Platteville, CO Boulder, CO Front Range Fire Rescue Southeast Weld Fire 101 S. Irene Ave. Protection District Tier Ili Milliken, CO 95 W. Broadway Ave. Keenesburg, CO Greeley Fire Department Thompson Valley EMS Stadium Medical, Inc. 1155 10th Ave. 4480 Clydesdale Pkwy. 695 Canosa Ct. Greeley, CO Loveland, CO Denver, CO North Metro Fire UCHealth EMS Mile High Ambulance Service Rescue District 1024 S. Lemay Ave. 3251 N. Stagecoach Rd. 101 Spader Way Fort Collins, CO Englewood, CO Broomfield, CO Mountain View Fire Windsor Severance Fire Protection District Protection District 3561 Stagecoach Rd., Unit 200 100 N. 7th St. Longmont, CO Windsor, CO �Z/cam �I1.c�53 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT License to Operate Ambulance Service TIER I UCHEALTH EMERGENCY MEDICAL SERVICES Name of Service 1024 SOUTH LEMAY AVENUE, FORT COLLINS, COLORADO 80524 Address POUDRE VALLEY HEALTHCARE, INC. Name of Owner IS LICENSED UNTIL DECEMBER 31, 2022, TO OPERATE AN AMBULANCE SERVICE IN WELD COUNTY IN ACCORDANCE WITH EXISTING WELD COUNTY RULES AND REGULATIONS. 9 ~ r R(i- - DEC 0 �;2Q21 CHAIR, BOARD OF WELD COUNTY COMMISSIONERS DATE co UN Y NOT TRANSFERRABLE / POST IN A CONSPICUOUS PLACE Tier I: Licensure authorizing for Primary Care, as defined in Section 7-1-39 of the Weld County Code. -�s I1wWELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue, Greeley, CO 80631 www.weldhealth.org Recommendation of the Weld County Emergency Medical/Trauma Service Council for: UCHealth EMS As required in Section 7-2-100.B.5., the EMTS Council should review the application to assess as to whether the ambulance service will contribute to an efficient, effective, and coordinated emergency medical response to residents of the County. Please include any findings related to response time, coordination with other ambulance services, location, service area, etc. that are the basis for the Council's recommendation: FINDING #1: UCHealth EMS( UCH -EMS) provides Advanced Life Support treatment and transport ambulances primarily to the citizens and guests of Weld County. UCH -EMS provides service within GFD, FRFR, LSFPD, PVFPD, EFPD, and WSFPD. They have a strong working relationship with neighboring agencies and will provide service to them when requested. FINDING #2: UCH -EMS ensures that the service contributes to an efficient, effective, and coordinated emergency medical response to the citizens and guests of the response areas. UCH -EMS will provide support to the neighboring agencies when called upon to do so. FINDING #3: UCH -EMS does formally have mutual aid agreements in place with FRFR, and WSFPD although they will provide assistance to agencies outside of their district when called upon to do so. UCH -EMS works well with other agencies outside of their primary response area. FINDING #4: The Weld County EMTS Council has not been made aware of any negative or problematic concerns with service delivery to the citizens and guests of Weld County. Recommended Level of Service: Tier 1 Tier 2 Tier 3 Recommended Service Area: In reviewing the service area map submitted by UCH -EMS, the EMTS Council has no concerns and supports the service area indicated. Other EMTS Council recommendations or comments: The EMTS Council voting members recommend that the Weld County Department of Health and Environment and the Board of County Commissioner approve UCHealth-EMS for a Tier I license. Recommendation By: Date: 11/17/2021 Jef Str han EMTS Council Chair WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue, Greeley, CO 80631 www.weldhealth.org AMBULANCE SERVICE LICENSE APPLICATION Date of Application: 09/17/2021 Name of Ambulance Service: DBA - UCHealth EMS Owner: Name: Poudre Valley Healthcare Inc. Address: 1024 South Lemay Ave, Fort Collins, CO 80524 Phone Number: 970-495-7000 Operations Manager: Name: Kevin Waters Address: 3509 South Mason, Fort Collins, CO 80524 Phone Number: 970-237-7902 Email: Kevin.Waters@uchealth.org Medical Director: Name: Darren Tremblay, D.O. Address: 1024 South Lemay, Fort Collins, CO 80525 Phone Number: 970-495-8006 Name and address of each stockholder of partner owning 10% or more of the outstanding stock of the company of having more than a 10% ownership interest (if applicable): Not applicable What area of Weld County will be served by this company? Please attach a map indicating the service area. Windsor, Severance, Johnstown, Milliken, Hill -n -Park, Evans, Kersey, LaSalle, and Greeley Health Administration Public Health & Environmental Health Communication, Emergency Preparedness Vital Records Clinical Services Services Education i Planning & Response Tele: 970-304-6410 Tele: 970-304-6420 Tele: 970-304-6415 Tele: 970-304-6470 1ele:970-304-6470 Fax: 970-304-6412 Fax: 970-304-6416 Fax: 970-304-6411 Fax: 970-304-6452 Fax: 970-304-6452 Public Health Page 1 How many ambulances do you operate? 27 Location and description of the place(s) from which this ambulance service will operate. If there are more than two locations, attach a separate sheet with the above information. Location #1: Street Number: City: Location #2: Street Number: City: See Attached Form State: State: Phone: Phone: As required in Section 7-3-30 of the Weld County Code Ordinance and Chapter 4 Section 6 of the CDPHE Emergency Medical and Trauma Care System regulations, as of the date of the application, are you in compliance with the minimum data collection and reporting of transportation and/or treatment of patients: Ekes ❑No As required in Section 7-3-40 of the Weld County Code and Chapter 3 Section 3 of the CDPHE Emergency Medical Services regulations, as of the date of the application, are you in compliance with the reporting requirements of the agency profile: Ekes ❑No Please read carefully: Sec. 7-2-10 License for Ambulance Service. No person shall provide or operate an ambulance service publicly or privately in the County unless that person holds a valid license to do so issued by the Board of County Commissioners, except as provided in Section 7-2-80 below. The fee for said license shall be set by separate ordinance. The license shall issue only in the following tiers of service: Tier I: Licensure authorizing for Primary Care, as defined in Section 7-1-30 of this Chapter. Tier II: Licensure authorizing for transports of patients that originate in Weld County from licensed medical facilities. This licensure does not provide for primary care, as defined in Section 7-1-30 of this Chapter. Tier III: Licensure authorizing for Standby Service, as defined in Section 7-1-30 of this Chapter. Level of Service Requested: 0 Tier I ❑ Tier II ❑ Tier III Page 2 Location #1 3509 S. Mason, Fort Collins, CO 80525 Location #2 181 Timber Ridge Pkway, Severance, CO 80550 Location #3 2100 37th St, Evans, CO 80620 Location #4 27128 Co Rd 53, Kersey, CO 80644 Location #5 118 Main St, La Salle, CO 80645 Location #6 Front Range Fire Rescue Station 3/ UCHealth 4225 Yosemite Dr, Greeley CO 80634 Location #7 Western Hills Fire Station 1731 Cedar Ave, Greeley CO 80631 I HEREBY CERTIFY THAT I AM AUTHORIZED TO SUBMIT THE FORGOING APPLICATION AND THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF AND CONTAINS NO WILLFUL MISREPRESENTATION OR FALSIFICATION. IN ADDITION, I CERTIFY THAT I HAVE READ AND UNDERSTAND THE PROVISIONS AND REQUIREMENTS OF WELD COUNTY CODE CHAPTER 7, INCLUDING, BUT NOT LIMITED TO, SECTION 7-8-10, WHICH ENCOURAGES ALL LICENSED AGENCIES PROVIDING EMS RESPONSE IN WELD COUNTY TO MAKE A GOOD FAITH EFFORT TO EXECUTE WRITTEN MUTUAL AID AGREEMENTS WITH ALL OTHER EMS PROVIDERS LOCATED WITHIN OR BORDERING ON THEIR AREAS OF RESPONSE. DETERMINATION THAT AN AMBULANCE SERVICES LICENSE HAS BEEN ISSUED BASED ON FALSE INFORMATION CONSTITUTES GROUNDS FOR LICENSE REVOCAT N A DII�SSIBLE CRIMINAL PROSECUTION. : (c. R d� ) ,� Fi2C / 2�`z Srg pp icant Title Date SUBSCRIBED AND AFFIRMED BEFORE ME THIS DAY OF ____________,202/, IN THE COUNTY OF AMS RAJ DHAKAL-- LcM ru.// , STATE OF COLORADO. NOTARY PUBLIC ATE OF COLORADO rARY ID 20194040714 �` MISSION EXPIRES 10124/2023 i t re of Notary My Commission expires: /U / 2 q1 2c2? 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