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Home My WebLink About20203771.tiffRESOLUTION RE: APPROVE APPLICATION FOR TIER II AMBULANCE SERVICE LICENSE AND AUTHORIZE CHAIR TO SIGN - AMBULNZ CO, LLC 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 Ambulnz CO, LLC, for a Tier II Ambulance Service License and recommend approval, and WHEREAS, after review, the Board deems it advisable to approve said Application for a Tier II 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 Ambulnz CO, LLC, for a Tier II 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: dj.,ix, JGCdo•eA Mike Freeman, Chair Weld County Clerk to the Board BY: Deputy Clerk to the Board APP AST y ° torney Date of signature: 19.-%23/ Steve Moreno, Plo-Tem Sc6ft K. James Kevin D. Ross k CC: HL(T&fcw), OEht(RR) OI /og/2, I 2020-3771 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 2020-3771 H LOOSa PlararaPFa WELD COUNTY DEPARTMENT PUBLIC Hi; .kL,TH 8c E N1/I ® :y C License to Operate Ambulance Service AMBULNZ CO, LLC Name of Service 7100 E. BELLEVIEW AVENUE, STE 112, GREENWOOD VILLAGE, COLORADO 8O111 AMBULNZ U Address Gs, LLC / UC 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. CHAIR, BOARD OF WELD COUNTY COMMISSIONERS NOT TRANSFERRABLE / POST IN A CONSPICUOUS PLACE Tier II: Licensure authorizing for transports of patient(s) to and from licensed medical facilities. This licensure does not provide for Primary Care, as defined in Section 7-1-30 of the Weld County Code. 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: Ambulnz 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 is the basis for the Council's recommendation: FINDING #1: Ambulnz is new to the Weld County system. As a Tier II applicant, the organization will provide interfacility transfers, which will allow 911 response units to be available for responses to incidents within their service area. FINDING #2: Freeing up 911 response units will improve response times for 911 units and contribute to efficient, effective, and coordinated emergency response. FINDING #3: Ambulnz will service much of the Front Range of Colorado, and the units within Northern Colorado will perform interfacility transfers to facilities as recommended by the Physicians. The service will better serve Weld County residents to transport them to specialized facilities for the required care. Recommended Level of Service: Tier 1 Tier 3 Recommended Service Area: The EMTS Council has reviewed the service area for Ambulnz 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 II Ambulance to Ambulnz. Recommendation By: Jeff Stranahan EMTS Council Chair Date: _11/18/2020_ Page 1 of 1 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: October 12, 2020 Name of Ambulance Service: Ambulnz CO LLC Owner: 50% Ambulnz Holdings LLC, 50% University of Colorado Health Name: Address: vwelcome@ambulnz.com35 West 35th St. 5th Floor New York, NY 10001 University of Colorado Health 12401 E. 17th Ave Mail Stop F415 Aurora, CO 80045 Phone Number: Ambulnz: 212-273-9774 UCHealth: 720-848-0000 Operations Manager: Name: Candice L Moncayo Address: 7100 E. Belleview Ave Ste 112 Greenwood Village, CO 80111 Phone Number: 720-354-6833 Email: cmoncayo@ambulnz.com Medical Director: Name: Dr. Daniel Willner, MD Address: 7100 E. Belleview Ave Ste 112 Greenwood Village, CO 80111 Phone Number: 720-354-6833 Page I 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. Please see attached map. Health Administration Vital Records Tele: 970-304-6410 Fax: 970-304-6412 Public Health & Clinical Services Tele: 970-304-6420 Fax: 970-304-6416 Environmental Health Services Tele: 970-304-6415 Fax: 970-304-6411 Communication, Education i Planning Tele: 970-304-6470 Fax: 970-304-6452 Emergency Preparedness & Response Tele: 970-304-6470 Fax: 970-304-6452 PutbikHoelth Page 2 Company Information & Ownership Company Name: Ambulnz CO, LLC 2420 E. Pikes Peak Avenue, Suite 1001 Colorado Springs, CO 80909 866-255-7671 Ownership 50% Ambulnz Holdings, LLC 50% University of Colorado Health Owner Information: Ambulnz Holdings, LLC 35 West 35th Street, 5th Floor New York, NY 10001 212-273-9774 Owner Information: University of Colorado Health 12401 E. 17th Avenue Mail Stop F415, Aurora, CO 80045 720-848-0000 National Responsible Individual: Stan Vashovsky 35 West 35th Street, 5th Floor New York, NY 10001 212-273-9774 Authorized Contact Personnel: Candice Moncayo, CO Director of Operations 7100 E. Belleview Ave Suite 112, Greenwood Village, CO 80111 720-354-6833 Management: Ambulnz Holdings, LLC How many ambulances do you operate? 18 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: Please see attached. 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: 1E 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: E 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: ❑ Tier I Tier II O Tier III Page 3 Locations: Business Office / Main Location: 2420 East Pikes Peak Ave. Suite 1001 Colorado Spring, CO 80909 Business Office/ Secondary Location: 7100 E. Belleview Ave. Greenwood Village, CO 80111 Vehicle Locations: 2420 East Pikes Peak Ave. Suite 1001 Colorado Spring, CO 80909 16990 Village Center Dr. East, Parker, CO 80134 9475 S. University Blvd. Highlands Ranch, CO 80126 7100 E. Belleview Ave. Suite 112, Greenwood Village, CO 80111 11820 Destination Dr. Broomfield, CO 80021 913 E. Myrtle St. Fort Collins, CO 80524 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 REVOC I AND POSSIBLE CRIMINAL PROSECUTION. Signature of Applicant Director of Operations 10/8/2020 Title Date SUBSCRIBED AND AFFIRMED BEFORE ME THIS /t DAY OF lktn2.. , 20 Zo , IN THE COUNTY OF Amegilkt Signature of Notary , STATE OF COLORADO. STEVEN ZAUGG NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20034009024 MY COMMISSION f:XPIRI:+s 03/14/2023 My Commission expires: p 3 / l ' / Zot3 Page 8 Operations, Locations, Service area, Personnel & Ambulances Service Area: Moffat Routt Rio Blanco Garfield 1-, '1 arimer Jackson Grand Eagle Mesa Delta Montrose G San Miguel Dolores O e. Pitkin Gunnison 9 co ou»r Chia' creek Park San Juan Montezuma La Plata 3 Nf (o Weld Morgan a Adams e r. r Logan Nashington Elbert Fremont Saguache Custer Rio Grande Archuleta Conejos El Paso t incoin Pueblo Huerfano Costilla CroMoy Otero Phillips Yuma Kit Carson Cheyenne Kiowa Bent Las Animas Prowers Baca Ambulnz currently operates in the following counties: • Adams • Arapahoe • Broomfield • Denver • Douglas • Elbert • El Paso • Jefferson • Larimer Hello