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Home My WebLink About20163599.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 28th day of November, A.D., 2016. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: SaitAd4) jdoegi Mike Freeman, Chair Weld County Clerk to the Board BY asi eputy Clerk to the Board APP'S DA ounty • ttorney Date of signature: tad t S9/1(0 C Sean PPConway, Pro-Tem c rbara Kirkmeyer Steve Moreno GGl-ILCear /TC,/MW/KGZ) Ot/o3/t"7 l 2016-3599 HL0048 -wz-C -. r. 0.0 N T Y t. Memorandum TO: Mike Freeman, Chair Board of County Commissioners FROM: DATE: Mark E. Wallace, MD, MPH Executive Director Department of Public Health & Environment 11/28/16 SUBJECT: 2017 Applications for Ambulance Service License Enclosed for the Board's review are eleven applications for ambulance service licenses pursuant to Chapter 7 of the Weld County Code (WCC) from the ambulance service providers listed below. Chapter 7 pertains to Emergency Medical Services. The Weld County Emergency Medical Trauma Service (EMTS) Council reviewed the application for each ambulance service on November 16, 2016. The Council approved 10 of the 11 applications. *Colorado Motocross is contingent on their attendance at BOCC hearing (11/28/16). *Stadium Medical was the only application not approved by EMTS council. Based on the scope 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, am recommending the following ambulance service providers listed 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 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 Windsor Severance Fire Protection District 100 North 7th Street Windsor, Colorado Tier I continued 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 2016-3599 �a O I ita u IIk° n, CD o U U [rulZ t=J Z a Z Z N U t� oCO o I I-, O U CD Q Um Lu vi OD 2 o Z 0th w 0 O O U) n Z RICK, COLORAC ?r IBULANCE SERVICE F ZULES AND REGULA1 Z N Z O 0 cu a -o I-� v Iii W I� v ¢U Q O 1 [rul 0 las U iii 1 • _O Et W E D sw W C° Q 30 uin!I W CL).17:21 ii z z z Jam F 'I ° Q D 0 O I'l CuIml O U 14 Lu m a r: �--i 0 Z I— U r!,Q z A O 0 CL 0 o5Qs I a)w I Fir O� z W c tinN �- Z ._I o _ J 0 CO E I imi Mo X "a O I W ix w U W N U CO 1 iE o z O m w w W o ›- Ra w H a N J _ ou- CO zfnulIXw a o o CC op mUrn J 1 N in _ -_L Z U 4-) ro mu s Laucan C cu ZI*11 _) w J J la5 V) 0 O L7LlL7�LI•� Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Frederick -Firestone FPD 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: 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 2017 application. Other EMTS Council recommendations or comments: Recommendation By: / I -Q �--�—--r /�7 '-- Date: / ( — — LI) (M1 WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue, Greeley, CO 80631 www.weldhealth.org Date of Application: AMBULANCE SERVICE LICENSE APPLICATION a4-06,rd.S', a.ai Name of Ambulance Service: Owner: Name: Adme.4- FAresion e PP() Free -Con -a- Evan< FM Address: 142 So kosw e*- PI , fecierisekt et) f 0nti Phone Number: 303 - $33 - «Z.7 qZ Operations Manager: +f Pit,, w c Address: 1424. Kos.., &lot Pie feeder. 9 Phone Number: 71-00-4q/ - a-1 q co Name: Email: d rrii„fr. i41, Its Medical Director: Name: Dr. be.,4 Address: 4 SCLL, ."4-4A Gra, ≤a-w>ta.€1L 1, I4sc;k.f, Le, P -A. to Phone Number: ?PJ - 273- 5 0 (24 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. Sena Wesc eAnevtair malt 4,41-4.1,14 Health Administration Vital Records Tele: 970-304-6410 Fax: 970.304-6412 Public Health & Clinical Services Tele: 970-304- 6420 Fax: 9/0-304-6416 Environmental Health Services Tele: 970-304-6415 Fax: 970-304-641 1 Communication, Education & Planning Tele: 970-304-6470 Fax: 970-304-6452 Emergency Preparedness IL Response Tele: 970-304-6470 Fax: 970-304-6452 Public Health Page 1 How many ambulances do you operate? 3 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: aM-Lei l"44 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: pg 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: IZJ Yes I 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:34 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 of Applicant t1v. eh:4 Io - Title I� ate SUBSCRIBED AND AFFIRMED BEFORE ME THIS 15 kh DAY October , 20 I(p , IN THE COUNTY OF wad , STATE OF COLORADO. DALE ROBIN INGRAHAM NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20044034067 My Commission Expires Sept. 23, 2020 Pak6241:10 Si _s, ature of Notary My Commission expires: O9 / 5 / &a2.D *Please make additional copies as necessary. Page 6 I C. Frederick Response Firestone Zones Fire Cr 11 is.— 1 -.N. .( I V Naamara ........C I j `. I , t` ate. / i T 1 , 1 1 / - - - -+ L Cr II ' - I- O r 73 4 ]0 — pis • r,. J--_ 43 2.13 '• a' - fe - i 1 13 .S. V •^ r Ives .s . � 1 • Y c ill a , 1 . 1 • rte . El < . • , ,if VS44 1° 4.. ' _.LR._ I 1 • I <� 1 1 1 dewy w...nw 1 r 1 J �rlr .♦ 1 II 1 22I G 1 . as - 1 1 !.AP_... / 1 / N "pis- -,. 4 g . _ .r��ira�ii •�, �� i ii M 1 EI; 1 1 1 i , _I CI III I -J Omn' IL. J 1 I f ( LL 1 o l ago u_a. ... 1 1 YwNRM.� I t-� t i li 1 1 a ' 4J ♦-.� S'P ray — • 1 , 1 _. ti 1 • 71 '1 6, i 1 1✓w FREDERICK -FIRESTONE FIRE PROTECTION DISTRICT OFFICIUM, VENERATIO, PIETAS Life Safety Division Office: (303) 833-2742 Fax: (303) 833-3736 E -Mail: dprunk@fffd.us October 25, 2015 The Frederick -Firestone Fire Protection District currently has EMS Mutual -Aid agreements with the following agencies: • Mountain View Fire Protection District Respectfully, Doug Prunk Division Chief Physical: 8426 Kosmerl Place, Frederick, CO 80504, Mailing: P. O. Box 129, Frederick, CO 80530; www.fffd.us Hello