HomeMy WebLinkAbout20153892.tiff RESOLUTION
RE: APPROVE APPLICATION FOR TIER III EMERGENCY MEDICAL SERVICES LICENSE
AND AUTHORIZE CHAIR TO SIGN -STADIUM MEDICAL, INC.
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 Stadium Medical, Inc., for a Tier III Emergency
Medical Services License and recommend approval, and
WHEREAS, after review on December 14, 2015, which was continued to December 16,
2015„ 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 Stadium Medical, Inc., 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 16th day of December, A.D., 2015.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, CO ORADO
ATTEST: diordsoti V .; .►:, a.( Q. - G�-
'"-"-cur* iN arbara Kirkmeyer Chair
Weld C•unty Clerk to the -`�. •'-v- s.
so vi.!,.. 't X.CUSED
AAAI ,��= �` X.
Freeman, Pro-Tem
MPLIP.'Ai it 1
Deputy Cl rk to t e B\\ it I --wow ,
�'•1;1 '�I Sean P. Conwa
APPRO S TO F : // a eP
Julie . Cozad frmy Attorney w.. ter
g / /�//� Steve Moreno
Date of signature:
ee,1 kit //0249//1°.
2015-3892
HL0047
1861, . Memorandum
I Tr
y i
TO: Barbara Kirkmeyer, Chair
v Board of County Commissioners
GpU_NTY-
z-
FROM: Mark E. Wallace, MD, MPH,
Executive Director
Department of Public Health & Environment
DATE: November 23, 2015
SUBJECT: 2016 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 (EM/TS) Council reviewed the application
for each ambulance service on November 18, 2015. The Council recommended that each service
receive a license based on their tier level.
The Department has reviewed the applications and has deemed all ambulance services listed
below to have met all applicable licensure application requirements found in Chapter 7. As such,
I am recommending licensure for the following ambulance service providers.
Tier I Tier I continued Tier I continued
Frederick— Firestone Fire Poudre Valley EMS Platte Valley Ambulance
Protection District 3509 South Mason Service EMS
8426 Kosmerl Place Fort Collins, Colorado 1600 Prairie Center Parkway
Frederick, Colorado Brighton, Colorado
Front Range Fire Rescue Southeast Weld Fire
101 South Irene Avenue Protection District
Milliken, Colorado 65 East Gandy Avenue
Keenesburg, Colorado Tier III
Mountain View Fire Thompson Valley EMS Colorado Motocross Medics
Protection District 4480 Clydesdale Parkway 729 Remington Street
3561 Stagecoach Road, Unit 200 Loveland, Colorado Fort Collins, Colorado
Longmont, Colorado
Banner Health/Northern Windsor Severance Fire Stadium Medical
Colorado Medical Center Protection District 695 Canosa Court
Paramedic Service 100 North 7th Street Denver, Colorado
1801 16th Street Windsor, Colorado
Greeley, Colorado
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14).\ 861 y� DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT dais
�` ais
1555 N. 17 Avenue
II y r ' 1+ Greeley, CO 80631
Public Health
rptAreb; hop g,'„ww.co.weld co usiDepartments;He.althEnvironmenilindeit.html
Health Administration Public Health IL Clinical Environmental Health Communication, Emergency Preparedness
N 1 Y Vital Records Services Services Education I Planning &Response
C O 1 1 9 p;O`54!; Tee 970 304 6420 l e!e 870 577 6415 Tele 970 304 ti4i 0 Tele 970 304 6420
�J •
--.� 9i:i30454i7 Far 970 Fax 97G's0464ii Fax 970 Far 9773046469
U r v toggen:e.'yetn the cornmun4res we serve,we are work 49 to make Weld County Mie'leanest place to we.learn work and play
October 23. 2015
Dave Bressler
Chair
Weld County Emergency Medicallfrauma Service Council
Via email: 1.);vc_i3resslci'ii'1>a_ir,cr!ieiii,: _cone
SUBJECT: 2016 Stadium Medical. Inc
NOTICE OF EMERGENCY MEDICAL SERVICES LICENSE APPLICATION TO THE
WELD COUNTY EMERGENCY MEDICAL/TRAUMA SERVICE COUNCIL
The Weld County Department of Public Health and Environment has received and is in process of reviewing an
Emergency Medical Service License Application from Stadium Medical, Inc.. Attached to this document are the
Ambulance Service License Application, and Maps of its proposed Service Area.
On behalf of the Board of County Commissioners, the Department is requesting the Emergency Medical/Trauma Service
Council review the attached documents in accordance with Section 7-2-100.B.5. of the Weld County Code (enumerated
below). The Department will forward your recommendation to the Commissioners.
Below are the most applicable portions of the code:
Weld County Code,7-2-100.13.5
The recommendation of the Weld County Emergency Medical/Trauma Service (EM/TS) Council as to
whether or not the issuance of the license will contribute to an efficient, effective, and coordinated
emergency medical response to residents of the County.The EM/TS Council shall also provide:
a. Recommended Service Area.
b. Recommended Tier of License.
Weld County Code,7-2-10.
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 tee 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: l.icensuie authorizing for Standby Service,as defined in Section 7-1-30 of this Chapter.
A. The Board of County Commissioners reserves the right to amend these rules and regulations and any
other individual conditions of'licensing as applied to any particular license, as needed in keeping with
its legislative function and in order to implement the policy of the State of Colorado that the
regulation and control of' ambulance licenses is in the exclusive purview of the boards of county
commissioners. Persons or firms seeking application and approval of any ambulance license under
this Chapter acknowledge that Weld County may contract with specific ambulance service
pros ider(s) which will serve the emergency ambulance need of Weld County and participating
municipalities.
Please forward the Councils recommendation to the Department including minutes of the EMS Council meeting
pertaining to this application. Please do not hesitate to call me should you have any questions.
Sincerely,
li
Melissa Taylor, MPH
Environmental Health Specialist
Environmental Health Services
}
1
Recommendation of the Weld County Emergency Medical/Trauma Service
Council for: Stadium Medical. Inc.
As required in Section 7-2-100.B.5., the F,MTS 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:
No findings were presented or received at the time of the review. There :v4./as no one in attendance at the
meeting.
FINDING#2:
There have been no issues reported to the [MIS Council concerning the service provided to the citizens
and visitors to the Weld County Service area.
FINDING #3:
FINDING #4:
Recommended Level of Service: Tier 1 Tier 2 Tier 3
Recommended Service Area:
As listed on the application,
Other EMTS Council recommendations or comments: Recommend approval of a Tier 3 License as
requested for the service area listed on application.
Recommendation By: '-..,...es�., Date: 11-18-20i 5
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
«�1,�l r � 1555 North 17th AvenueY.
c Public Health
Greeley, CO 80631
www.weldhealth.org
Health Administration Public Health& Environmental Communication, Emergency Preparedness
Vital Records Clinical Services Health Services Education&Planning &Response
Tele:970-304-6410 Tele:970-304-6420 Tele:970-304-6415 Tele:970-304-6470 Tele:970-304-6420
Fox: 970-304-6412 Fox: 970-304-6416 Fax: 970-304-6411 Fox: 970-304-6452 Fax: 970-304-6469
Our vision:Together with the communities we serve,we are working to make Weld County the healthiest place to live,learn,work,and play.
AMBULANCE SERVICE LICENSE APPLICATION
Date of Application: — (Q0 IS.
Name of Ambulance Service: S-1-0,A t tav�, i'1•e c c.O--.
Owner:
Name:/-----
O C. e - nn>b.S
Address: I,DCIS sc\OSa. - . q.e.c Co O ≤D1
Phone Number: SO3— 54q_
Operations Manager:
Name: P--Pe r- Aryyve S
(17 0(-/
Address: L i q ,�,(\cn .o.. o A(lJo-Qir.
Phone Number: ?)O.2)- >✓(q - "7 9 t
Email: -' � �t r, W.CyJ Cc-6 C'C/rYN
Medical Director:
Name: -c)e.-k-e r P 1k t,„o..r1
Address:k
alu {Jc-, L e ce�n Co 2°1/4-7
Phone Number:30 3— a. S 9.5,
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):
�oaE C PS .
What area of Weld County will be served by this company? Please attach a map indicating
the s ice area.
How many ambulances do you operate? /(7)
Page 1
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: ((As C . ,a()O S a
City: et.\„1.,e r State: Phone: $D a.O tf
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:
)2tYes ❑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:
YYes ❑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: 0 Tier I 0 Tier II Tier III
Page 2
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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.
�C
jr.N
Signature o f Applicant tn4f.Akit
Title ate
SUBSCRIBED AND AFFIRMED BEFORE ME THIS g/v
DAY Al f e.A,6•c�2 ,20 /S ,IN THE COUNTY OF
-Tf=f FG;;Rso/." ,STATE OF COLORADO.
I CAROL ABBATE I
4 Notary Public n/ 4
I State of Colorado Signature of Notary
Notary _o 20054041307 f
My Commission Expires Oct 26,2017 'dlommuswirmormiruierwmPqmpipswei r�/
My Commission expires: /0 /c /.."16/7
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STA CID IuM
C M E D I C A L *QC
"The People the Pros Trust"
695 Canosa Ct,Unit B,Denver CO 80204
www.Stadiurnmedical.com
Phone—720-235-3500
Billing-720-630-2020
Fax—720-235-3507
11/01/2015
Stadium Medical currently has Mutual Aid Agreements
with
Rural Metro Ambulance and
Northglenn Ambulance
C_______
Rodger Ames
I Owner/Stadium Medical
Hello