HomeMy WebLinkAbout20163605.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 28th day of November, A.D., 2016.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: SS jdo sok.
Weld County Clerk to the Board
BY�
cz. ieti1/4,hded
eauty Cler
k Clerk to the Boar
AP"• SAS
ounty • ttorney
Date of signature: la /9311C9
Mike Freeman, Chair
C
Sean P. Conway, Pro-Tem
tie A. Cozad
XCUSED
arbara Kirkmeyer
Steve Moreno
CC HL CS "rrraw / K a)
I o3 I
2016-3605
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
2016-3605
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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 2017 application
Other EMTS Council recommendations or comments:
Recommendation 6y:
i
r —4/0
---1Date: !
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: I CA
Name of Ambulance Service: t '.-t p rn y so N EYS
Owner:
Name: i H o rfrP so N v ALL CV 5 EV-V t c -ES t ts1`R.-ltd
Address:- 4 o C-t._,`e e —s OALE rpk. w y t._.ova-LAN O 8053%
Phone Number: A r -4-O - 3 - LO O RS
Operations Manager:
Name:.f\tvt)'f LESk.AE1
Address:`*-k%o C.t-rY C'STALE k0.3y !moo v a IAN) CD SOS
Phone Number: -° - C0423 3 - Cp O a S
Email: Q s\mw o- ' R...rn S
Medical Director:
Name:�C. PrA • L\0.0Dt n
AddressTho,.•\ S#o eel.)3 alma ta4& e- iw'4' Are lett^CR-S? Eu oo S
Phone Number:4-4'a.o -- Co 9'�- -
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): Nf\
-TITLE 3Z SPaiAL bts-r-lt-tcc' - FA HAMtkiel AILb L14AtQ
What area of Weld County will be served by this company? Please attach a map indicating
the service area.
u fore t.J t T'N--i tv -114C cM GRAS) t+ t L -),o o o Aga cS
6F" v,k-S b tea >N sots cwtrivit 0 D -So Nsf'D wu F URA btt-ttc-T'S
Health Administration
Vital Records
Tele: 970-304-6410
Fax: 970-304-6412
Public Health &
Clinical Services
Tele: 970-304-6420
Fax: 970-304-6416
Environmental Health
Services
Tele: 970-304-6415
Fax: 970-304-6411
Communication,
Education & Planning
Tele: 970-304-6470
Fax: 970-304-6452
Emergency Preparedness
t Response
Tele: 970-304-6470
Fax: 970-304-6452
Public Health
Page 1
How many ambulances do you operate? \\ - Se. a P. T i fic4 -fl
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.
T ,ocation #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:
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:
kl 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: (Q Tier I ❑ Tier II ❑ Tier HI
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 )Kpplicant
SUBSCRIBED AND AFFIRMED
DAY OCT b QE1& , 20
(�-� car -'
MARVI S. DOLGENER
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID # 19914010442
MY COMMISSION EXPIRES JULY 31 2019
Title
1o\ik Alb
Date
BEFORE ME THIS 1L11.14
1kO , IN THE COUNTY OF
, STATE OF COLORADO.
Signature ovary
Signature otary
My Commission expires: '7 / 3 I / � q
*Please make additional copies as necessary.
Page 6
TH0MPSON
VALLEY
BIERGENcY MBDIGAL SERVICES
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.
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