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Home My WebLink About20173976.tiffRESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - THOMPSON VALLEY 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 Service Council have reviewed the application of Thompson Valley Emergency Medical Service 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 Thompson Valley Emergency Medical Service 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 27th day of November, A.D., 2017. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: Cam(a/tAtio (' _; e1 Weld County Clerk to the Board puty Clerk to the Board AP /'DASTO orney Date of signature: i all I I 1 c.c. MLCTG) CI /(' I - ulie A. Cozad, Chair EXCUSED Steve Moreno, Pro-Tem 2017-3976 HL0049 Memorandum TO: Julie A. Cozad, Chair Board of County Commissioners FROM: Mark E. Wallace, MD, MPH Executive Director Department of Public Health & Environment DATE: November 20, 2017 SUBJECT: 2018 Applications for Ambulance Service License 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 16, 2016, and approved all 11 applications. Please note: Front Range Fire Rescue is asking the BOCC for a waiver per county code for an employee convicted of a Class I driving offense. Front Range Fire Rescue has included a letter with further detail in their application. Weld County Code, Section 7-3-50. Criminal record of ambulance crew member; "Unless waived by the Board of County Commissioners, no person shall be employed by an ambulance service as an ambulance crew member who has been convicted of any of the following offenses within the previous twelve (12) months from the date of application: felony, misdemeanor or Class I or Class II traffic offense. (Weld County Code Ordinance 2007-8; Weld County Code Ordinance 2013-7)." 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 �t1a7 Tier I continued Tier I continued Poudre Valley EMS 3509 South Mason Fort Collins, Colorado Southeast Weld Fire Protection District 65 East Gandy Avenue Keenesburg, Colorado A' Thompson Valley EMS 4480 Clydesdale Parkway Loveland, Colorado Windsor Severance Fire Protection District 100 North 7th Street Windsor, Colorado Platte Valley Ambulance Service EMS 1600 Prairie Center Parkway Brighton, Colorado Tier III Colorado Motocross Medics 729 Remington Street Fort Collins, Colorado Stadium Medical 695 Canosa Court Denver, Colorado 2017-3976 (-1 L o o c-19 L�L�L�IL�IL��1L�LGL�IL�IL�LGL, ,�1oLGL�IL�IL�L�L�L�L�L7 -5 7 7 N Name of Service 4480 CLYDESDALE PARKWAY, LOVELAND, COLORADO 80537 Address THOMPSON VALLEY HEALTH SERVICES DISTRICT _ 7 7 M -g_ 7 7 M 7 7 7 7 7 M 7 7 7 TE 7 7 5_ -5 7 7 U_ 7 5_ 7 7 7 7 TE 7 -2 7 V a 7 7 -g_ 7 3 7 7 -7 - 7 g ---g 7 ""leLGuLummenLe mLGLe-mon.GaLGmGr Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Thompson Valley 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 is the basis for the Council's recommendation: FINDING #1: Thompson Valley EMS (TV EMS) services approximately 100 square miles of western Weld County, 150 calls for service. TVEMS runs 6 ambulances. FINDING #2: TV EMS is in good standings with the Weld County Department of Public Health & Environment. FINDING #3: Per neighboring agencies, TV EMS provides mutual and auto aid in an efficient, effective and coordinated manner. FINDING #4: Recommended Level of Service: XX Tier 1 Tier 2 Tier 3 Recommended Service Area: As listed in the TV EMS 2018 application Other EMTS Council recommendations or comments: Recommendation By: Date: 11/20/2017 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: to r 4 Name of Ambulance Service. ��' ( Mc)931\,.. A LL E,. S (`(S Owner: NareTHO r c. c.--E-2V ICES Dm -viz -lc] Address�}�{ () �L� S ( (�L� 1� I` W {_ vau\t3O G o Phone Number:C\ 4-C - (o (o J - (r 0S Operations Manager: Name: N,JC) L S Address:(41SO (=l.y lal'S®fall 1?WY LOVE -1_1\00 6 Phone Number:°1 - Co Co ? — CQ 0 a Email: P.,l_E S! -\- (Z_ * V2,im6, C trY> Medical Director: Name: bR . Pry\ C N Z. _-- 0e) 1 Address: to 55 LE' r) -E. S I c`,.N 11Qxj c O aaD Phone Number: 30 j —�, Q, - 3 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 T1TR. 3 FAIIINN(\m( c**oc,N AI What area of Weld County will be served by this company? Please attach a map indicating the service area. WEST ILjS WGL.1) C.©UNTj c),1"11-k.i TNC G,ED6-I1V'M1C— fGu3flRQlE5 C "ry N -SO L- i rV t OSt G1--T1-1OVQ IST21G� Health Administration Vital Records lele: 970.304-6410 Fax: 970-304-6412 Public Health & Clinical Services Trle: 970 304-6420 Fax: 970-304-6416 Environmental Health Services Te:e: 970-304-6115 Fax: 970-304,6411 Communication, Education & Planning Tele 970-304-6470 Fax: 970-3046452 Emergency Preparedness & Response T ele: 970-304-6470 Fax: 970-304-6452 Public Health Page 1 How many ambulances do you operate? l - S E £✓V C L S E D 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: 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: RI 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: EgYes ❑ 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 Thompson Valley EMS Location #1: 2100 N. Boise Ave. Loveland, CO 80538 970-669-7256 Location #2: 380 N. Wilson Ave Loveland, CO 80537 970-776-8474 Location #3: 740 N. 2nd St. Berthoud, CO 80513 970-344-7158 Location #4: 2750 N. Taft Ave. Loveland, CO 80537 970-775-7351 Location #5 (Headquarters): 4480 Clydesdale Parkway Loveland, CO 80538 970-663-6025 Location #6: 4645 Sunview Dr. Loveland, CO 80538 970-685-4808 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. Signatulof Applicant Title Date SUBSCRIBED AND AFFIRMED BEFORE ME THIS a 3RD DAY OC_T" b_ER , 20\ , IN THE COUNTY OF LS --A1, cc -1 E R , STATE OF COLORADO. My Commission expires: OR— i 8 I i O1 Signature of Not *Please make additional copies as necessary. Page 6 MARVI S. DOLGENER NOTARY PUBLIC STATE OF COLORADO NOTARY ID * 19914010442 MY COMMISSION EXPIRES JULY 31, 2019 S X X I a. 0 4 41 . 0 )\r' F a4 sir ,6� a s- lir V* ES TESPARC �T1G� j .f r( 2 vs- a mini, I I aSSOMP 36 s kaix sr- • 4 I p 0 3 Lte I 36 \ral 'flirt 1 • ♦10ase iwINDSOR STOWN THOMPS0N VALLEY AGENCY MEDICAL SE1tVIOLS 4480 Clydesdale Pkwy., Loveland, CO Main 970-663-6025 Fax 970-667-0172 Mutual Aid Agreements Since we are licensed in both Weld County and Larimer County we don't have any official mutual aid agreements in place. We are dispatched as needed and respond when surrounding EMS agencies are in need of EMS support services. Hello