HomeMy WebLinkAbout20163604.tiffRESOLUTION
RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE
AND AUTHORIZE CHAIR TO SIGN - SOUTHEAST WELD 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 Southeast Weld 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 Southeast Weld 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: ddritvt) jdo:oseA�
Weld County Clerk to the Board
BY: a • Board
eputy Clerk to the
AP " s AS TO F
ounty Attorney
Date of signature:l31 a / t Co
Mike Freeman, Chair
Sean P. Conway, Pro-Te
XCUSED
arbara Kirkmeyer
Steve Moreno
GG' HC.CMcc) IST/TG/ KA)
Qt /0 3 / 1 7
2016-3604
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
2016-3604
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Recommendation of the Weld County Emergency Medical/Trauma Service Council
for: Southeast Weld Fire Rescue
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: Southeast Weld Fire Rescue (SE Weld) services approximately 405 square miles of Weld
County, including the Town of Keencsburg running 1,000 calls for service. SE Weld runs 3 ambulances.
FINDING #2: SE Weld meets the Standard of Cover Response times adopted by the Board of Directors.
FINDING #3: SE Weld is in good standings with the Weld County Department of Public Health &
Environment.
FINDING #4: Per neighboring agencies, SE Weld 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 SE Weld 2017 application.
Other EMTS Council recommendations or comments:
Recommendation By:
/— /2 /J0
Date: /
�ri� 21 2 Z
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 North 17th Avenue, Greeley, CO 80631 www.weldheaith.org
AMBULANCE SERVICE LICENSE APPLICATION
Date of Application: 9/4R 9 /;05 /4
Name of Ambulance Service: c -K QS# 'AMC/ -f';("c
Owner:
Name:
Address:
50 u eta S T i/de4/ [cc 4 se et
t'es E. 6 ct,tr1 �-u e ,P0301/
y
Phone Number: 303-- 7 3 a r Y203
Operations Manager:
Name:
Address:
low SeacA
b 7 es, rp sin + Alvr . ng. SOX l ��C,f14e 5 Airy , %a n
Phone Number: Q2o — 9- Q 5 7 Y
Email: sf wkcA & Se kit// i C °re • Deg
Medical Director:
Name:
Address:
&.kiieur.e Air od
geticlC 44/cf /X'cy' �l It Ur 6 SWee
Phone Number: 303- 5 ~ /loco
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.
so u'i1nea sf Wile/
Health Administration
Vital Records
fele: 9/0 304-6410
Fa,c: 970-31)4-6412
Public Health &
Clinical Services
Tele: 970-304-6420
Fax 9/0-304-6416
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
Tele: 970-304-6470
Fox: 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: leS E,
a c e
City: ettrAa56cAcIS State: C -D Phone: :365-73 9ii203
Location #2:
Street Number: /D #uiy/ 77
City: frss tau State: Co
Phone: __SoS - 7 3 'tip
As required in Section 7-3-30 of the Weld County Code Ordinance and Chapter 4 Section 6 of
the CDPI-IE 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:
rgYes ❑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:
NAYcs ❑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 ❑ Pier II
Her III
Page 2
I HEREBY CERTIFY THAT I AM AUTHORIZED TO SUBMIT TIIE 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.
naturtof Applicant
iCet i)(4e; Q
9_ --10/4.
Title Date
SUBSCRIBED ND A -FIRMED BEFORE ME THIS
DAY �2 I co , IN THE COUNTY OF
7p�� , STATE OF COLORADO.
STACY SARGENT
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID #20054047684
MY COMMISSION EXPIRES 12/13/2017
SQA
Si ure of Not
My Commission expires: Z / E 3 / 1
•
*Please make additional copies as necessary.
Page 6
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EMS Dispatch Am.
Zone C•nk
IPA
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SOUTHEAST WELD AMBULANCE
EMS DISPATCH ZONES
100 ljSO)
14.000
•EKs)
Southeast Weld Fire Protection District
P.O. Box 1.
Keenesburg_ CO 80643
9/27/2016
To Whom It May Concern:
Southeast Weld Fire District has mutual aid agreements with Platte Valley Ambulance Service, Frederick -
Firestone Fire District, Bennett Fire District, Strasburg Fire District and Morgan County Ambulance. In
addition, we have a mutual aid agreement "verbally" with Banner Paramedic Service and Weld County
Regional Communications Center.
Sincerely,
9ffi Beac
/Fire Chief
Southeast Weld Fire District
303-732-1028
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