HomeMy WebLinkAbout20213318.tiffRESOLUTION
RE: APPROVE APPLICATION FOR TIER III AMBULANCE SERVICE LICENSE AND
AUTHORIZE CHAIR TO SIGN - STADIUM MEDICAL, INC.
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 Stadium Medical, Inc., for a Tier III Ambulance
Service License and recommend approval, and
WHEREAS, after review, the Board deems it advisable to approve said Application for a
Tier III 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 Stadium Medical, Inc., for a Tier III 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.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: dardfeiv XIID•tok,
Weld County Clerk to the Board
BY:
Deputy Clerk to the Board
APPR• ED
Count orney
Steve •reno, Chair
C C: HL(TG/6v), OEM(RR)
12/2O% I
Lori Sain
Date of signature:
2021-3318
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 I ;
Tier I
Tier II
Banner Health/NCMC
Paramedic Service
1801 16th St.
Greeley, CO
Platte Valley Ambulance Service
1750 E. Egbert St.
Brighton, CO
Ambulnz CO, LLC
7100 E. Belleview Ave., Ste. 112
Greenwood Village, CO
Frederick Firestone Fire
Protection District
8426 Kosmerl PI.
Frederick, CO
Platteville Gilcrest Fire
Protection District
202 Main St.
Platteville, CO
American Medical Response
of Colorado
3800 Pearl St.
Boulder, CO
Front Range Fire Rescue
101 S. Irene Ave.
Milliken, CO
Southeast Weld Fire
Protection District
95 W. Broadway Ave.
Keenesburg, CO
Tiler II!'
Greeley Fire Department
1155 10th Ave.
Greeley, CO
Thompson Valley EMS
4480 Clydesdale Pkwy.
Loveland, CO
Stadium Medical, Inc.
695 Canosa Ct.
Denver, CO
North Metro Fire
Rescue District
101 Spader Way
Broomfield, CO
UCHealth EMS
1024 S. Lemay Ave.
Fort Collins, CO
Mile High Ambulance Service
3251 N. Stagecoach Rd.
Englewood, CO
Mountain View Fire
Protection District
3561 Stagecoach Rd., Unit 200
Longmont, CO
Windsor Severance Fire
Protection District
100 N. 7th St.
Windsor, CO
17,/DU
H-LUU53
0
WELD COUNTY DEPARTMENT OF
PUBLIC HEALTH & ENVIRONMENT
License to Operate Ambulance Service
TIER III
STADIUM MEDICAL INC.
Name of Service
695 CANOSA COURT, DENVER, COLORADO 80204
Address
STADIUM MEDICAL 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.
C
CHAIR, BOARD OF WELD COUNTY COMMISSIONERS
DATF
NOT TRANSFERRABLE / PO5
IN A CONSPICUOUS PLACE
Tier Ill: Licensure authorizing for Standby Service, as defined in Section 7-1-30 of the Weld County Code.
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WELD 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: Stadium Medical Inc.
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: Stadium Medical provides standby services for events within Weld County. Stadium Medical's service
allows Weld County units to remain available within the county for a 911 response.
FINDING #2: Upon review of Stadium Medical's license application, we find that the service contributes to an efficient,
effective, and coordinated service for the citizens and guests of Weld County.
FINDING #3: Stadium Medical has 800 Mhz radio communications capabilities on the State Mutual Aid Channels.
Chapter 7 of the Weld County code does not explicitly call out communication requirements for standby
ambulance service.
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: nTier 1 Filler 2 nTier 3
Recommended Service Area: Stadium Medical has provided a service area map within the license application. Upon
review, there are no concerns with the service area.
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 Stadium Medical for a Tier III license.
Recommendation By:
Jeff "ra : pan EMTS Council Chair
Date:
11/17/2021
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: 0/13(11
Name of Ambulance Service: Si Pat LC
C
Owner:
Name: Q,O ci } Q r {k Nte,
Address: 6 9 5 Nilo( ( a, C-1 Denve, e, 1 c ,F-0 g o'(
Phone Number: 3 0 3" 5 `t j— 7 g i 4
Operations Manager:
Name: Me )1 AV\ A d t'
Address: C q S (,4-h o ,c A C l. D -enter, (0 10 204
Phone Number: 134 '" 3 `I '31 P1
Email: hlkA .S AiS��c� � •�wlly Q c k.l . Conn
Medical Director:
Name: Pe, fee Val rnc1/4,y1
Address: Ili C4 1 v` k I. / n
Or. is fIr -b n 1(0 S EL]
Phone Number: 3 z 3- `(7 2- k IS A
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):
see a t1'A.c,t. t, 1
What area of Weld County will be served by this company? Please attach a map indicating
the service area. !
CYGvI- 1kstd vhI d (ovr. t!y
Health Administration
Vital Records
Tele:970-304-6410
Fax: 970-304-6412
Public Health 8
Clinical Services
Tele:970-304-6420
Fax: 970-304-6416
Environmental Health Communication,
Services Education & Planning
Tele: 470-304-64 15 Tele: 970-304-6470
Fax: 970-304-6411 Fax: 970-304-6452
Emergency Preparedness
& Response
Tele: 970-304-6470
Fax: 970-304-6452
PublicHealth
Page 1
How many ambulances do you operate? 10
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.
Sec0 H-z-ci4t-
Location #1:
Street Number:
City: State: Phone:
Location #2:
Street Number:
City: State: 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:
Yes ❑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:
L2Yes ❑ 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: ❑ Tier I ❑ Tier II DfTier III
Page 2
OWNER & MANAGER INFORMATION You must list all officers, directors, general partners, managing members,stockholders,_partners. and members. If a holding company has
an ownership interest in the licensed business, list that company and its ownership percentage as well. Please attach additional pages if necessary.
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FIRST AND LAST
v
AD e, c t:.~: STATIC^
Rodger Ames
5363 Parfet St. Arvada, CO 80002
08/21/1959
EMAIL ADDRESS
pOSl7'tON
contact@stadiummedical.com
303-549-7914
CEO
70%
2ND
CONTACT
HOMI�ADp[?EStfi
CODE
DA rOF BIRTH
FIRST AND LAST
STREET ADDRESS CITY STATE
tmmJddfyy)
Meghan Adas
3262 Elm St. Denver, CO 80207
04/28/2090
EMAIL ADDRESS
PHONE d
POSITION
COO
% OWNERSHIP
4.72%
mada@stdiummedical.com
(720) 384-3189
3RD
CONTACT
NAME
}tOJilEADDRE
A
ZIP CODE
.. DATE -OF BIRTH.__.
FIRST AND LAST
S ADDIS STATE
dd/
William Vellman
12654 Buckhorn DriveLittleton, CO 80127
01/30/2054
EMAIL ADDRESS
PHONE#
PosmON
% OWNERSHIP
303-809-5347
Partner
8%
4TH
CONTACT
J4OME ADORE
s
1AfE
+ CHIDE .
�4
FIRST AN
$ ,x CITY
(mmlddhfy}
Andrew W. Parker
5000 E. Oxford AvenueCherry Hills Village, CO 80113
_
EMAIL ADDRESS
PHONES
POSITION
% OWNERSHIP
Partner
4.72%
57 H
CONTACT
>
CODE
PA
T AND LAST
sTR ADD S CITY STATE
$ ddlyy$
Miriam McCarty
419 Majestic View DriveBoulder, CO 80303
%liWNERSHIIP
EMAIL ADDRESS
PHONES
POSITION
Partner
4.72%
,� ��. .
AND T
SIAlE
tmrlltddtyY)
Charles Rupert
6888 Otis CourtArvada, CO 80003
12/6/60
EMAIL ADDRESS
Partner
8.9%
STADIUM
*MEDICAL*
Locations of Operations
Main Headquarters: 695 Canosa Ct. Denver, CO
80204
Substations:
Fairmount Fire Station: 12901 W 43rd Dr,
Golden, CO 80403
Pleasant View Fire Station: 955 Moss St,
Golden, CO 80401
Golden Fire Station #1: 911 10th St, Golden, CO
80401
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
REVOCATION AND POSSIBLE CRIMINAL PROSECUTION.
Signature of Applicant
C r° /oh 9/Z
Title Dale
SUBSCRIBED AND AFFIRMED BEFORE ME THIS 1? ft'
DAY OF OC Ij , 20 Z ) , IN THE COUNTY OF
D envy✓
ignature of Notary
, STATE OF COLORADO.
My Commission expires: / 1 / Zu 2'L
WarlIAilladdlkdaralhabilmomalre
MIKAYLA D PASSMANTE
Notary Pubic - State of Coiorado
Notary ID 20144000113
1 My Commission Expires Jan 2.2022
Page 7
STADIUM
*MEDICAL*
Mutual Aid Agreements
Date: 10/13/21
Stadium Medical currently has Mutual Aid Agreements
with:
Northglenn Ambulance
Action Care Ambulance
Denver Health
Summit County
Rodger Ames
President, Stadium Medical
Map of Service Area: Denver Metro Area and
Surrounding Counties
Hello