HomeMy WebLinkAbout20203760.tiffRESOLUTION
RE: APPROVE APPLICATION FOR TIER I AMBULANCE SERVICE LICENSE AND
AUTHORIZE CHAIR TO SIGN - FREDERICK -FIRESTONE FIRE PROTECTION
DISTRICT
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 the Frederick -Firestone Fire Protection District
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 the Frederick -Firestone Fire Protection District fora 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 16th day of December, A.D., 2020.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: ditIL) aC.iD;c1
Weld County Clerk to the Board
BY:
ounty torney
Date of signature: )2/2.3
Mike Freeman, Chair
Stevg►Moreno, Pro-Tem
cbtt K. James
LIVIA
arbara Kir
Kevin D. Ross
C c C. UT, /GANA IA (RR.
O11°S fa 1
2020-3760
HL0052
Memorandum
TO: Mike Freeman, Chair
Board of County Commissioners
FROM: Mark A. Lawley, Executive Director
Department of Public Health & Environment
DATE: December 11, 2020
SUBJECT: 2021 Applications for Ambulance Service Licenses
Enclosed for the Board's review are fifteen 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 18,
2020, and approved all fifteen applications.
Changes from 2020 include the addition of Ambulnz CO, LLC as a new Tier II ambulance service. Mile High
Ambulance Service was previously approved in September 2020 for licensure through 2021.
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
Banner Health/NCMC
Paramedic Service
1801 16th Street
Greeley, CO
Frederick Firestone Fire
Protection District
8426 Kosmerl Place
Frederick, CO
Front Range Fire Rescue
101 South Irene Avenue
Milliken, CO
Greeley Fire Department
1155 10th Avenue
Greeley, CO
Mountain View Fire
Protection District
3561 Stagecoach Road, Unit 200
Longmont, CO
Tier I (continued)
North Metro Fire
Rescue District
101 Spader Way
Broomfield, CO
Platte Valley Ambulance Service
1750 East Egbert Street
Brighton, CO
Platteville Gilcrest Fire
Protection District
202 Main Street
Platteville, CO
Poudre Valley Hospital EMS
3509 South Mason
Fort Collins, CO
Southeast Weld Fire
Protection District
65 East Gandy Avenue
Keenesburg, CO
Tier I (continued)
Thompson Valley EMS
4480 Clydesdale Parkway
Loveland, CO
Windsor Severance Fire
Protection District
100 North 7th Street
Windsor, CO
Tier II
Ambulnz CO, LLC
7100 East Belleview Ave., Ste. 112
Greenwood Village, CO
American Medical Response
of Colorado
3800 Pearl Street
Boulder, CO
Tier III
Stadium Medical, Inc.
695 Canosa Court
Denver, CO
2020-3760
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WELD COUNTY DEPARTMENT OF
PUBLIC HEALTH & ENVIRONMENT
License to Operate Ambulance Service
I RI
FREDERICKMFIRESTO :::.E FIRE P ' N TECTION DISTRICT
Name of Service
8426 KOSMERL PLACE, FREDERICK, COLORADO 80516
Address
FREDERICK FIRESTONE FIRE PROTECTION DISTRICT
Name of Owner
IS LICENSED UNTIL DECEMBER 31, 2021, TO OPERATE AN AMBULANCE SERVICE IN WELD COUNTY IN ACCORDANCE
WITH EXISTING WELD COUNTY RULES AND REGULATIONS.
a
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Lir1 `LY/
CHAIR, BOARD OF WELD COUNTY COMMISSIONERS
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.
DATE
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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: Frederick Firestone Fire Protection District
As required in Section 7-2-100.6.5., 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 is the basis for the Council's recommendation:
FINDING #1: Federick Firestone FPD services the towns of Federick, Firestone, and unincorporated areas of
Weld County, and responds to emergencies on Interstate 25. FFFPD works well with its neighbors and
provides mutual aid when requested. FFFPD has mutual aid agreements with its neighbors.
FINDING #2: FFFPD provides timely Fire Based EMS to the citizens and guests of their response area. The
EMTS Council has not been made aware of any deficiencies with service delivery.
FINDING #3: The EMTS Council believes that FFFPD contributes to an efficient, effective, and coordinated
response to the citizens and guests of its service location.
FINDING #4: This year has had unique challenges. The EMTS Council has only met once in person, and other
meetings have been conducted virtually. FFFPD has attended the EMTS Council meeting and has been very
active in the Council throughout the year.
Recommended Level of Service:
Tier 2 Tier 3
Recommended Service Area:
The EMTS Council has reviewed the service area for Frederick Firestone FPD and foresees no concerns.
Other EMTS Council recommendations or comments:
The EMTS Council recommends that the Weld County Board of County Commissioner grant a Tier I
Ambulance License to Frederick Firestone Fire Protection District.
Recommendation By: Date: _11/18/2020_
Jeff Stranahan EMTS Council Chair
Page 1 of 1
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 North 17th Avenue, Greeley, CO 80631 www.weldhealth.org
71k. boo
AMBULANCE SERVICE LICENSE APPLICATION
Date of Application: a_,4062 --r ISM o'Z
Name of Ambulance Service: Fr f YeS 4. P
Owner:
Name:
Address: $ua (4) kQs e,r-
i
Phone Number: 703- g33 -,27Y 2.
Operations Manager: 444. OA i G �i T Govt Ronk-
Address:5 _
Name:
Phone Number:
Email: Ap r`q, U k CA.5
Medical Director:
Name: Dc, in, CIAtek-
Freder,' , CO * o≤ O-4
Address: SCL (icrock Saw-vLri Mter,4
Phone Number: 3O _ 112g-- 22Iq
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):
N �A
What area of Weld County will be served by this company? Please attach a map indicating
the service area.
Health Administration
Vital Records
Tele: 970-304-6410
Fox: 970-304-6412
Public Health &
Clinical Services
Tele: 970-304-6420
Fax: 970-304-6416
Environmental Health Communication,
Services Education & Planning
Tele: 970-304-6415 Tele: 970-304-6470
Fax: 970-304-6411 Fax: 970-304-6452
Emergency Preparedness
& Response
Tele: 970-304-6470
Fax: 970-304-6452
PabllcHealth
Page 1
How many ambulances do you operate? L.
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:
4.4 ..-tteteieJ
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:
Yes ❑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: 31 Tier I ❑ Tier II ❑ Tier III
Page 2
FREDERICK -FIRESTONE
FIRE PROTECTION DISTRICT
Operations Section
Office: (303) 833-2742
Fax: (303) 833-3736
E -Mail: dprunk@fffd.us
October, 2020
The Frederick -Firestone Fire Protection District currently has three fire stations. Each fire
station houses one or two of the District's Ambulances. These ambulances are located at:
Station #1 - Ambulance 3421
31 Walnut Drive
Frederick, CO 80530
303-833-3727
Station #3 - Ambulance 3423
6800 Tilbury Avenue
Firestone, CO 80504
303-833-4458
Station #4 - Ambulance 3424, Reserve Ambulance 3428
10706 WCR 7
Frederick, CO 80504
303-710-1720
Respectfully,
Douglas J. Prunk
Assistant Chief
Physical: 8426 Kosmerl Place, Frederick, CO 80504, Mailing: P. O. Box 129, Frederick, CO 80530; www.fffd.us
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.
ir) /5 7.a Z�
dire of Applicant Tit!e Dal
EF1KA L. VASQUEZ
NOTARY PUBLIC
STAIE OF COLORADO
NOTARY ID 20174031773
My Comeission Expires July 28, 2021
SUBSCRIBED AND AFFIRMED BEFORE ME THIS 15'4`''
DAY OF Ot Tobelr , 20 40 , IN THE COUNTY OF
UIJe .4 , STATE OF COLORADO.
Signature of Nota
My Commission expires: `j' / 28 /o)d3I
Page 7
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FREDERICK -FIRESTONE
FIRE PROTECTION DISTRICT
Operations Section
Office: (303) 833-2742
Fax: (303) 833-3736
E -Mail: dprunk@fffd.us
October, 2020
The Frederick -Firestone Fire Protection District currently has EMS Mutual -Aid agreements with
the following agencies:
• Mountain View Fire Protection District
• Platteville-Gilcrest Fire Protection District
Respectfully,
Doug Prunk
Assistant Chief
Physical: 8426 Kosmerl Place, Frederick, CO 80504, Mailing: P. O. Box 129, Frederick, CO 80530; www.fffd.us
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