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Home My WebLink About20173970.tiffRESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES 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 Service Council have reviewed the application of the Frederick -Firestone 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 Frederick -Firestone 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 27th day of November, A.D., 2017. BOARD OF COUNTY COMMISSIONERS WELD COU TY, COLORADO ATTEST: jC"1; e, Weld County Clerk to the Board BY. uty Clerk to the Board APPROV Ju ie _ g Cozad, Chair / / EXCUSED Steve Moreno, Pro-Tem Sean P. Conway ke Freeman my Attorney 'y ? 1 CUSED Date of signature: I a l 111'1 Cc 1-4 L. CTc,J l/call$ arbara Kirkmeyer 2017-3970 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 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 Thompson Valley EMS 4480 Clydesdale Parkway Loveland, Colorado Platte Valley Ambulance Service EMS 1600 Prairie Center Parkway Brighton, Colorado Tier III Colorado Motocross Medics 729 Remington Street Fort Collins, Colorado Banner Health/Northern Colorado Windsor Severance Fire Stadium Medical Medical Center Protection District 695 Canosa Court Paramedic Service 100 North 7th Street Denver, Colorado 1801 16th Street Windsor, Colorado Greeley, Colorado Il/a7 Hu..OOH9 2017-3970 51�' fin' uGlulE1E-1E15-101E-IE-IIVI010-1 i" r.. L la "g_ r3 7 7 Name of Service 8426 KOSMERL PLACE, FREDERICK, COLORADO 80516 Address FREDERICK FIRESTONE FIRE PROTECTION DISTRICT E_ 7 E 7 7 7 M 7 M M 7 7 7 7 7 3_ mg_ M 7 7 M 7 7 5_ M 7 M 7 -I,. M L U_ 7 "a "a M ral 3_ 7 -g_ M a I�r7 IsIImIoItubiIowebbbIIagIIalgiloltglr. .gIlgllgII Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Frederick -Firestone FPD As required in Section 7-2-100.1.5., 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: Frederick -Firestone Fire Protection District (FFFPD) services approximately 32 square miles of Weld County, including the Towns of Frederick and Firestone running 2,000 calls for service. FFFPD runs 3 ambulances. FINDING #2: FFFPD meets the Standard of Cover Response times adopted by the Board of Directors. FINDING #3: FFFPD is in good standings with the Weld County Department of Public Health & Environment. FINDING #4: Per neighboring agencies, FFFPD provides mutual and auto aid in an efficient, effective and coordinated manner. Recommended Level of Service: XX Tier 1 Tier 2 Tier 3 Recommended Service Area: As listed in the FFFPD 2018 application. Other EMTS Council recommendations or comments: Recommendation B 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: Ott , 6,1.--0-S; 0 Z Name of Ambulance Service: Owner: Name: 5/ ► l g Address: 1 tr o yst4Dr( P1 # 1 Fr i�X-� l.'V gtso�( Phone Number: 3O — 333 -- Operations Manager: Name: t Dv5, PrvrA,k.- Address: Phone Number: Email: Medical Director: Name: . to . S E Address: SLR... - 4.r'44'.,,,, ilfilecaLf&444 . e4fr W Phone Number: 303 — £42 t:Lgq 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. Health Administration Vital Records Tele: 9/0-304-6410 Fax: 9/0-304-6412 Public Health & Clinical Services Tele: 970 304-6420 Fax: 970-304-6416 Environmental Health Services Teie: 970-.304.64) 5 Fax: 970-304- 6411 Communication, Education & Planning I ele: 970-304-6470 Fax: 970-304-6452 Emergency Preparedness & Response Tele: 970-304-6470 Fax: 970-304-6452 Public Health Page 1 How many ambulances do you operate? 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: 1- 44- av gra4v4 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: KYes ❑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: cyrYes El 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 El Tier III Page 2 FREDERICK -FIRESTONE FIRE PROTECTION DISTRICT Life Safety Division Office: (303) 833-2742 Fax: (303) 833-3736 E -Mail: dprunk@fffd.us October 25, 2017 The Frederick -Firestone Fire Protection District currently has three fire stations. Each fire station houses one 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 3525 Hwy 119 Firestone, 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. 466 L•_al*" Signature of Applicant Title /0-2 441 SUBSCRIBED AND AFFIRMED BEFORE ME THIS Date DAY 00',02)4 20 tl , IN THE COUNTY OF , STATE OF COLORADO. DALE ROBIN INGRAHAM NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20044034067 My Commission Expires Sept. 23, 2020 Sig ture of Notary My Commission expires: 09 I 2 a / aO Q *Please make additional copies as necessary. Page 6 Frederick Firestone Fire Response Zones - .. oftittrolt. 6 Eon ten *Kat w;¢eWifOraw- 4ywe Summit Blvd FREDERICK -FIRESTONE FIRE PROTECTION DISTRICT Life Safety Division Office: (303) 833-2742 Fax: (303) 833-3736 E -Mail: dprunk@fffd.us October 25, 2017 The Frederick -Firestone Fire Protection District currently has EMS Mutual -Aid agreements with the following agencies: • Mountain View Fire Protection District Respectfully, Doug Prank Assistant Chief Physical: 8426 Kosmerl Place, Frederick, CO 80504, Mailing: P. O. Box 129, Frederick, CO 80530; www.fffd.us Hello