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Home My WebLink About20153887.tiff f � RESOLUTION 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 14th day of December, A.D., 2015 BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COL RADO ATTEST: daddy%) arbara Kirkmeyer Chair Weld County Clerk to the ,- •; EXCUSED Mike Freeman, Pro-Tern w ' r BY: Deputy C -rk to the SI , Sean P. Conway c � APP S TO F • %l,(0 e',1- C1� Cozad un t ey EXCUSED Steve Moreno Date of signature: y/L76//�i 2015-3887 HL0047 S61 Memorandum �' �" ►� TO: Barbara Kirkmeyer, Chair N TY . ,� Board of County Commissioners =-�S 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 ' iintRIE IEWINL7LMMINIEIMMI NIEM a El Ei IN u., I- -I w 'F, M f X71 Q w .-, 5- lle U B 3 z- 3 M Cf) Le-) I 3.- Cr rd li•O 00 0 LU Ili 3 Z ° � Z GI 1.1 Iiii OCI Z 0 U E INZ z > 0 t g o 0 m ,r) 3... 1a N N � c� ci � �E. re >ii CU 1 it ti 1" a gW 0 .., ug, 0 C aW W m W Q U 5 � � � z E. _ 3... "ra 8 035 w W o . 2 ri, Z a. r3- 13 z ii . r. W W Lu o o 3- n W H W N W • E. cc e U C2 W O Ill�j vN. ,U Q = o z Z U H Z o g v "fa A J J I. Z 0 ° �~' o CZ DE 3. W m 0 d u) o W Z E5' 1§.. MI- g. a O IR w 'Q m W i ' ig. E LW w o a 3.. i0ig. 0 w a w p oc' 3- IM i _ I L�� g- 0 mi N3, u.., "S_ ,, ,...., 2 ow = 15. 3. N t 3-, 13- i- Lu o'�1LG1LG1LG11-NRILG1LG1LG1ISMIlG11-MLG1LG1I-KO LG1 MI-Er *.l`* 1861 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 171h Avenue �. I I Greeley. CO 80631 c+.1 11 H 'P Web ! .I tir+vco weld co us/Departments/HeatthEnvironment/)ndex.htrTil .rea)v,w n.nis7.non Public Health 1 Clinical Environmental Health Communication. Emergency Preparedness Vital Records Services Services Education i Planning &Response c-- G O U N I Y I cc ?i0 304 W t,. Tale 970 304 6120 Tate 970 3046475 Tale 970 304 6470 Tale 97C 304 6420 I"a• 970 304 o41? Fax 970 304 6416 Fax 9i 0 304 6417 Fax 970 304 6452 Fax 970 304 6469 Our y.;irn roge'ie,wr3h the commutates we serve we are working to make Weld County Me healthiest place to Eve leam,work and play. October 7. 2015 Dave Bressler Chair Weld County Emergency Medical/Trauma Service Council Via email: Uavc.Rrccsslcr`u ba1 ;1�, . Iii SUBJECT: 2016 Southeast Weld Fire District EMS Application 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 Southeast Weld Fire District. 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 7-2-100.13.5. 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.B.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. h. Recommended 'Pier 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. -I-he fee for said license shall he 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 11: Licensurc 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 Ill: Licensurc 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 provider(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, MLVTO+ Melissa Taylor, MPH Environmental Health Specialist Environmental Health Services 1 Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Southeast \Veld Fire District 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: No findings were presented or r eceiN ed at the time of the review. FINDING #2: There have been n no issues reported to the [ MTS 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 1 License as requested for the service area listed on application. Recommendation By: Date: 11-18-2015 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1 ',I '' ' --- :.li VP ,i r 1 1;5`: r , rth i 7tI, Avenue `, blic Health Greeley.eley. COC� l tJ631 www.weldhealth.org Health Admr•.idration Public Health L Environmental Ceinmvnicatlon, Emergency Preparednec: Vital Records Clinical Service: Health Service; Education&Planning &Response Tee: 7.t3Qa-eat, lele. _' '' 'c e:S'70-;,C4-c_3i 2 %N.:?7'1.3('.1-: 70 res:973-3G.:-ea3.) 'il,: '•70.3O.-O:l: ;a.,: ',7C-...f..-4.:,«''r ra; 9'Gs,:S-tl' se c: 70-304-,^.-R`,, Ft-o: 9:Ct3GC-640; Crk v15rnn TpQe1ler wm1 the conlPunile5 we serve VW are wnrtang to make Weir,Ccunry the hedih.eet place it live learn work.and Nay AMBULANCE SERVICE LICENSE APPLICATIONDate of Application: l/,gr9'/9,1,45-- Name of Ambulance Service: 56 4,4*Sts s /* ! >°// -.•OF 41; 7ri ' 7 Owner: Name: 5b 4Y11•625.71—' 51 Weld As-R. 'S ';r/ Address: te S E, _Sass%o [f Abe e- ib Rag Phone Number: 5.0'3— ?Sal— 9'02.0 3 Operations Manager: Name: / U/�? &AC-4 KfareSilites/ Address: 5$_ 4. 6 A.h,l7 19t'' ', D g'D d f 3 Phone Number: %7i1� _ Se—?1.--- ® g? ' Email: `-•, P___ ye_kif ki 4 're • /, rr Medical Director: Name: Cfr'J*Ce -71/fic ro cl r., Address: I ( eft A.14- L. Crlrr T r t4i g:' 44n to g4 ) Phone Number: 3 — 149 8 lip, 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. 30 ItY4 a.S / lide /1 How many ambulances do you operate? P. 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: (95- C p► AtI 2 City: Kibtfte.510,,,r, State: no Phone: 503-73 .- G 3 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: s ❑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: ►= es ❑No Please read carefully: See_ 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:Fier 1 ❑ Tier II © Tier III Page • 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 BFI.iEl' 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-S-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 AMBUI:ANCE SERVICES LICENSE HAS BEEN ISSUED BASED ON FALSE INFORMATION CONSTITUTES GROUNDS FOR LICENSE REVOCATION AND POSSIBLE CRIMINAL PROSECUTION. 4' //4 /s- igna c of Applicant Title Date SUBSCRIB A I)AFFIRMED BEFORE ME THIS .24 DAY ,20/ . IN THE COUNTY OF p ,STATE OF COLORADO. Signature of Notary KELLY K. 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WCR . WCR 47 WCR 49 WeClij WCR 35 WCR 53 I WCR 5 -WCR-38 WCR-38—WCR-38 WCR-39 WCR 38 WCR 38 WCR . WCR 39 WCR 43 WCR 49 = 4 I WCR 47 WCR 35 WCR 39 STONELEIGH RD S I ANSEA . : --., I .______ _...„, WCR 47 _ -WCR-36 FAIRBANKS NORTH CT BEEBE DRAW PKWY I WCR-36 WCR 5 r 1 CR 4 7 1 /2 WCR 53 WCR 35 L IW I WCR 5 BADMINTON;RD N WC R-34-112 WCR 53 WCR 49 MGR 53 LEDYARD,RD S WCR 47 I WCR 34 WCR 34 WCR 49 . • I BURGHLEY CT WCR 47 1 /2 �n��R �� WCR 37 I F A Southeast Weld Fire Protection District r P.O. Box 1 • T Keenesburg. CO 80643 eOL�$,o 9/25/2015 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, Beac ire Chief Southeast Weld Fire District 303-732-1028 Hello