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Home My WebLink About20183839.tiffRESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - MOUNTAIN VIEW 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 Service Council have reviewed the application of the Mountain View Fire Protection District for a Tier I Emergency Medical Services License and recommend approval, and WHEREAS, after review, the Board deems it advisable to approve said Application for a Tier I Emergency Medical Services 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 Mountain View Fire Protection District for a Tier I Emergency Medical Services 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 3rd day of December, A.D., 2018. BOARD OF COUNTY COMMISSIONERS WELD OUNTY, COLORADO ATTEST: ditit,i)Jo;e,k,�-""� Steve Moreno, Chair Weld County Clerk to the Board BY: Deputy CI r -to the Bo APP, AS ount torney can P. Conwaye,,aa,/ lie A. Cozad Date of signature: t icl iiol -Tem 7 GC• HLCMWI TA pa,M II 31 IA 2018-3839 H L0050 Memorandum TO: Steve Moreno, Chair Board of County Commissioners FROM: Mark E. Wallace, MD, MPH Executive Director Department of Public Health & Environment DATE: November 27, 2018 SUBJECT: 2019 Applications for Ambulance Service Licenses Enclosed for the Board's review are eleven 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 the application for each ambulance service provider on November 15, 2018, and approved all 11 applications. Changes from last year include adding American Medical Response of Colorado as a new ambulance service and removing Colorado Motocross Medics because they have stopped operating in Weld County. 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 found in Chapter 7. As such, I am recommending the following ambulance service providers for licensure: TIER I Frederick -Firestone Fire Protection District 8426 Kosmerl Place Frederick, Colorado Front Range Fire Rescue 101 South Irene Avenue Milliken, Colorado Mountain View Fire Protection District 3561 Stagecoach Road, Unit 200 Longmont, Colorado Banner Health/Northern Colorado Medical Center Paramedic Service 1801 - 16th Street Greeley, Colorado TIER I — Cont'd Poudre Valley EMS 3509 South Mason Fort Collins, Colorado Southeast Weld Fire Protection District 65 East Gandy Avenue Keenesburg, Colorado Thompson Valley EMS 4480 Clydesdale Parkway Loveland, Colorado Windsor Severance Fire Protection District 100 North 7th Street Windsor, Colorado TIER I — Cont'd Platte Valley Ambulance Service EMS 1600 Prairie Center Parkway Brighton, Colorado TIER II American Medical Response of Colorado 3800 Pearl Street Boulder, Colorado TIER III Stadium Medical 695 Canosa Court Denver, Colorado 2018-3839 I 'off / 3 H L005O EIMEDESIMM-O1O11O1O1EMPIPMEMP WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT License to Operate Ambulance Service TIER I MOUNTAIN VIEW FIRE PROTECTION DISTRICT Name of Service 3561 NORTH STAGECOACH ROAD, LONGMONT, COLORADO 80504 Address MOUNTAIN VIEW FIRE PROTECTION DISTRICT Name of Owner IS LICENSED UNTIL DECEMBER 31, 2019, TO OPERATE AN AMBULANCE SERVICE IN WELD COUNTY IN ACCORDANCE WITH EXISTING WELD COUNTY RULES AND REGULATIONS. DEC 218 CHAIR. BOARD OF WELD COUNTY COMMISSIONERS DATE NOT TRANSFERRABLE / POST IN A CONSPICUOUS PLACE i ier I: Licensure authorizing for Primary Care, as defined in Section 7-1-39 of the Weld County Code. IBMialonirdigIMMIBMIR .t t- # Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Mountain View Fire Protection District efficient, As required in Section 7-2-100.8.5., 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: Findings Mountain View fire continues to provide a quality, and timely response to their area. Mountain View Fire provides a fire -based EMS system. I have heard no EMS related complaints directed toward the service currently being provided. Several mutual aid agreements are in place. Mountain View provides excellent service. Daily interaction with Mt. View, no issues and they provide an effective and efficient service In review of MVFPD application we find that their service meets the necessary requirements. They have a service that provides an efficient, and effective, and coordinate response to the resident of their response area. Additionally, they are willing to assist neighboring agencies when requested. Mountain View Fire continues to provide timely response to their response area and works collaboratively to provide mutual aid resources when they are requested by neighboring districts. Meets the efficient, effective, and coordinated expectation. Vehicle permits included in this application but not with others? Recommended Level of Service:411!) Recommended Service Area: The EMTS Council recommends the service area as noted in Mountain View Fire Protection Districts license application. Other EMTS Council recommendations or comments: The EMTS Council finds that Mountain View Fire Protection District's application meets all requirements and believe that their service deliver meets effective and coordinated service delivery. Recommendation By: Lance Homann 4- P 0 ---- Date: it- ic _ Ici EMTS Council Chair WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue, Greeley, CO 8C631 www.weldhealth.org AMBULANCE SERVICE LICENSE APPLICATION Date of Application: /U/Jr/g Name of Ambulance Service: Owner: Name: /tide/A/ 777 -in) Vi 6 .) /; rt,e Address: Phone Number: Operations Manager: Name: Address: ,3S -z / ti. s'.�,4e cd/I-c// ,tL' Phone Number: 3,9 3 - 7 7,l D?1� Email: 06,eide ,v',Po. v26 - Medical Director: Name: /)fZ, AID4-7 Address: 35-6/ /✓• J C-cv4t;// O Phone Number: 3 0 3- 77,2 -07/0 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): What area of Weld County will be served by this company? Please attach a map indicating the service area. SeE Health Administration Vital Records Tel°. 3/0 304-6410 Fox: 9.-4J-304.64 i 2 Public Health & Clinical Services lelc-: 970-304 6470 Fax: 1'0-304-6415 Environmental Health Services T':e 910-304-641.5 Fox: 970-304 641 '. Communication, Education & Planning Tele:270-304-6470 Fun, 9703046452 Emergency Preparedness & Response Tele: 970-304-6470 Fax: 9/0-304-6452 Public Health Page I How many ambulances do you operate? 6 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: Set Pti. #� 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: E'Ycs ❑ 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: ElYes 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 ❑ Tier III Page 2 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 c Applicant Title Date SUBSCRIBED AND AFFIRMED BEF RE ME THIS _ I DAY _ , 20 1 O, IN TI IE COUNTY OF V\i ti , STATE OF COLORADO. CHERYL S LARSON NOTARY PUBLIC STATE OF COLORADO NOTARY ID # 19914017547 MY COMMISSION EXPIRES 01-14-2020 0% My Commission expires: nature of Notary I , /4, aoab *Please make additional copies as necessary. Page 6 Mountain View Fire Protection District (Fire Response Zones) IRO • a,. Zone Coda +. Kran UV IA •&/30 lPAi 7yemaw ledfi CN laM Ifl'G wJf 10/1470 MVI£ wlO WNE W.F irtaa , ! Wit Witt": elw: 4.1°.; ww 'Vvni y IMIC MOUNTAIN VIEW FIRE RESCUE 3561 Stagecoach Road, Unit 200 • Longmont, CO 80501 (303) 772-0710 • FAX (303) 651-7702 October 10, 2018 To Whom It May Concern: The following is a of all Mutual /Auto Aid agreements: • AMR Boulder and Longmont • Frederick Firestone Fire Protection District • North Metro Fire • Layfette Fire • Longmont Fire • Platteville/Gilcrest Fire • Berthold Fire Keith Long Assistant Chief Mountain View Fire Protection District www.mvfpd.org AMBULANCE VEHICLE PERMIT LIST Name of Ambulance Service: /Ylov", "/ leer✓ ),5 1c/--- Application Year: 010 I 9 Vehicle # I Year: 2-018 > Make: Model: (3.57' 4 Wheel Drive (YO: !� Vehicle Identification Number (V.I.N.): FOt I f 1 c SJ AG i1/yy Colorado State License Number (Registration No.): O3-3 38'8 Motor Vehicle Chassis Number: Registered with the State of Colorado as an emergency vehicle (Y/N): V Date Ambulance placed in service: Normal Location of Ambulance: Vehicle # L 5J74 r l 1 - /cq.'Y 40/4, M T CO grO 5-0 l Year: .2arS Make: ," Model: E3S& 4 Wheel Drive (YO: Vehicle Identification Number (V.I.N.): /FZA'q LIJOto G 9fi Colorado State license Number (Registration No.): OTI33e12 Motor Vehicle Chassis Number: Registered with the State of Colorado as an emergency vehicle 69/N): Date Ambulance placed in service: b / ZS / If Normal Location of Ambulance: ..5-7-4-7740,) 3 qq' yL f '1/2_ Vehicle # Year: 2a/6 Make: 0°4D - Model: /lam 4 Wheel Drive ( Vehicle Identification Number (V.I.N.): 3 C7 4//1AJCL 7.SC .'3271 o Colorado State License Number (Registration No.): UL Motor Vehicle Chassis Number: Registered with the State of Colorado as an emergency vehicle a/N): V Date Ambulance placed in service: / /‘ Normal Location of Ambulance: ,t o ion/ / (moo Ni A.)0 i , Ali if, i , re r/y Page 5 AMBULANCE VEHICLE PERMIT LIST Name of Ambulance Service: /let°✓^1v'W7v,) ✓)ErJ /Ort,05 . Dor, Application Year: ,0/9 Vehicle # Y Year: 2°'6 Make: 01;06L Model: 11-4--•%1\ 4 Wheel Drive (Y/10: 'J Vehicle Identification Number (V.I.N.): 3C 7 W n^J Ce- a GC 33270 Colorado State License Number (Registration No.): 4/VIP ' 7g Motor Vehicle Chassis Number: Registered with the State of Colorado as an emergency vehicle ): V Date Ambulance placed in service: / / 11 / /7 Normal Location of Ambulance: 0 d 6 5) z4 v� ��^'? rrc'c, CO Ses--/C Vehicle # Year: 20/y Make: 6/14 Model: ►24'1 4 Wheel Drive (Y� Vehicle Identification Number (V.I.N.): ) /-' Ox `t S `I 03 Og' 7g 7 Colorado State License Number (Registration No.): 66 54 F' Motor Vehicle Chassis Number: Registered with the State of Colorado as an emergency vehiclea/N): y Date Ambulance placed in service: /0 / 2/ / Normal Location of Ambulance: 5rit-770-►.J 7 IL ( e60 -2y Vehicle # 6 : Year: � Dvs Make: Ft'4)) Model: E 35-6 4 Wheel Drive Vehicle Identification Number (V.I.N.): .JOY F Y7 /315-46 74 'ft i' Colorado State License Number (Registration No.): X✓Qi'il3 Motor Vehicle Chassis Number: ):/ Registered with the State of Colorado as an emergency vehicleN): Y Date Ambulance placed in service: / 22' / OG Normal Location of Ambulance: 5s /J thvi t( Page 5 Hello