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Home My WebLink About20163607.tiffRESOLUTION RE: APPROVE APPLICATION FOR TIER III EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - COLORADO MOTOCROSS MEDICS, 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 Service Council have reviewed the application of Colorado Motocross Medics, LLC, for a Tier III Emergency Medical Services License and recommend approval, and WHEREAS, after review, the Board deems it advisable to approve said Application for a Tier III 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 Colorado Motocross Medics, LLC, for a Tier III 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: Warttai „Sso;c.k- Weld County Clerk to the Board BY: f uty Clerk to the Boar APP o D AS ttorney Date of signature: R a /99/1C9 MLICe-r3\e" Mike Freeman, Chair cromP Sean P. Conway, Pro-Tem /11O Julie A. Cozad XCUSED arbara Kirkmeyer Steve Moreno cc NLC 317 TaGinlwi Ka) or /O3i1-7 2016-3607 HL0048 Memorandum TO: Mike Freeman, Chair Board of County Commissioners FROM: Mark E. Wallace, MD, MPH Executive Director Department of Public Health & Environment DATE: 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, I 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 2016-3607 o G� G��L7�LJ�JL7L7 O, - -- st I Lu oYlt� 1• tSf 0 A. U U Z z H _ Z co O " U ooIL t No N I—m W L.1.1 CACD O Oz o — MS z _H U v z d — D V w .L 0 w ai p ° w lJ cn ..I W A 0 U v w u Z Z Q Y. U latt Z n Q U) W aw z o ��lu m� W — D c O J d 3 o Ca Q 0 0.02 IX sul cl)o� a ILl U ? U mo Q o r,.... . Q�z LLI lii ..I O Q Z Ow < O o Qon zH. o - rz o v W W cn �. o O z - o o x ° w[rul U a) o O� w U i"' F- Z 0 U ° J N co C] _L < ? C� i� R� O X o x Cli We.O cv w v w ..1 _ w L, o = L t� Z f- CU Z m D U — o M CC >. o n w 1- N O C m W w o 8 o z o 0 w o o CO�] rrr N J i I -7O = a Z U D 03 D 0 '5i L�J w c U 7 7 =v) w * [nJl tfi - o 0 �I�C�LJl� Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Colorado Motorcross 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: FINDING #1: Colorado Motorcross EMS functions as a standby medical service with one ambulance in service. FINDING #2: Colorado Motorcross EMS is in good standings with the Weld County Department of Public Health & Environment. FINDING #3: Per Weld County agencies that have worked directly with Colorado Motorcross EMS, they provide medical services in an efficient, effective and coordinated manner. FINDING #4: No Colorado Motorcross EMS representative was in attendance for EMTS review. Recommended Level of Service: Tier 1 Tier 2 'XX Tier 3 Recommended Service Area: Standby events Other EMTS Council recommendations or comments: *Conditional recommendation to approve Colorado Motorcross EMS based on a representative attending the BOCC meeting on November 28, 2016. Recommendation By: Date:// r 12'/tin - • WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMEN 1555 North 17th Avenue, Greeley, CO 80631 www.weldhealth. AMBULANCE SERVICE LICENSE APPLICATION Date of Application: t 044"'1'0 Name of Ambulance Service: ect lo/crh Owner: Name: Address: Phone Number: Ta6-'c, e, Gar ifc/srs' $(IOCtfe. cc c 4uir'c 97,. r8V er1t.7 ref Operations Manager: Name: Ion de it/A)Pre- Address: Phone Number: Email: Medical Director: Name: Address: Phone Number: 9®7 zr 7? -9 eieft-etece tote 51. tit ert‘n Cb- tr- 're - fy� `,- joe(t jacobconi/. 07 Kil6y Ettikeve4 imp _� 7t t! nt,�� if i cr. ter &(//405, C, , 5o s--' 97A- Yf(- CYZ7 Name and address of each stockholder of partner owning 10% or more of the outstanding stock of the company of h ving more than a 10% ownership interest (if applicable): JOEL e, fniivrae't e t) 711 e 44.4, ct . �A- 41 ! r ar• (arty What area of Weld County will be served by this company? Please attach a map indicating the service area. /, tot z C -N eC 4/a> 8-11$41140110 CI- �. ,v••ik. Atli • III Ce Health Administration Vital Records lele: 970-304 64 i0 Fax: 970-304-6412 Public Health & Clinical Services lele: 970 304.6420 Fox: 970-304-6416 Environmental Health Services Tele: 970-304-6415 Fox: 970-304-6411 Communication, Education & Planning Tele: 970-304-6470 Fax: 970-304-6452 Emergency Preparedness & Response fele: 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: 7 49 ?e.ftf p 1 c /r . City: pfr dyekt State: C�f , Phone: as t• t'9Z 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: >41 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: bJ 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 services Tier I: Licensure authorizing for Primary Care, as defined in Section 7-1-30 of this Chapter. Tier I1: 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 2S. 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 S INFORMATION CONSTITUTES GRO PROSECUTION. Si a Lire of Applicant VICES LICENSE HAS BEEN ISSUED BASED ON FALSE ENSE REVOCATION AND POSSIBLE CRIMINAL Title /40 i tit e Date SUBSCRIBED AND AFFIRMED BEFORE ME THIS //'`' ♦.• • ' �lr•` L o •• ey! . • • . , 20 /6. IN THE COUNTY OF STATE OF COLORADO. gnature otary y Commission expires: ea / O21 / 620/f1 *Please make additional copies as necessary. Page 6 Map of Island Grove Park, N 14th Ave Greeley, CO by MapQuest Page 2 of 2 MAP011EST. r 9 o n Q 5th St S O 2009 Mapouest Inc. d C 13 St eL a Q L r A;t O 5th St D : 3rd St WC - 4th St - e''' tilt N N 7 0 ct a. C C C 5 1200 m I QM ft z J Q t Map Data ©2009 SAVTEQ or TeleAtlas All rights reserved. Use subject to License/Copyright Map Legend Directions and maps are informational only. We make no warranties on the accuracy of their content, road conditions or route usability or expeditiousness. You assume all risk of use. MapQuest and Its suppliers shall not be liable to you for any loss or delay resulting from your use of MapQuest. Your use of MapQuest means you agree to our Terms of Use Map of 20125 W Frontage Rd # I-25 Berthoud, CO by MapQuest Page 2 of 2 MAPQNEST. / 250 0 42'. O 2009 folapOuest Inc. 441 'I' E 1400 m I 1200 ft a Map Data ©2009NAVTEQ or TeleAtias All rights reserved. Use subject to License/Copyright Map Legend Directions and maps are informational only. We make no warranties on the accuracy of their content, road conditions or route usability or expeditiousness. You assume all risk of use. MapQuest and its suppliers shall not be liable to you for any loss or delay resulting from your use of MapQuest. Your use of MapQuest means you agree to our Terms of Use I have attached the following documents to this application: A list of all emergency medical service providers who may be called upon to respond to an emergency with the ambulance service. This list shall include the following information on each person: 1. Complete name and date of birth 2. The highest level of certification, licensure or training attained. 3. A copy of current EMT -B, EMT -I or EMT -P certificate issued by the Colorado Department of Public Health and Environment; nurse licensure or an Advanced First Aid card from the American Red Cross; or a First Responder course completion certificate issued by a Division -recognized training center or training group. A current copy of EMT or Paramedic protocols adopted by the ambulance service in accordance with standards approved by the ambulance service's medical director. LI A current copy of the ambulance service's training standards in accordance with the requirements approved by the ambulance service's medical director. All training must be through a state -certified emergency medical services training center. ❑ A list of ambulance agencies, fire departments, special districts and other EMS providers with which the applicant has mutual aid agreements, or: ® At this time our agency does not have mutual aid agreements with other ambulance agencies, fire departments, special districts or EMS providers. A current copy of the ambulance service's pharmacological agents and delivery devices per medical director protocol. Page 3 Hello