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Home My WebLink About20153882.tiff RESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - FREDERICK-FIRESTONE 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 Frederick-Firestone 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 Frederick-Firestone 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. I 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, COLORADO ATTEST: CC '...42.44) • * ==�.� arbara Kirkme r, Chair Weld County Clerk to the, �,��I�IL/jl% / � � i, EXCUSED � ,, _�� ,,,. Mike Freeman, Pro-Tem BY: �, .�../!%i , 6:.� �t 1V_=►�' / ) . , Deputy CI; k to th`•-'�: "'�� a ; Sean P. Conway 6c y-- ..1_744 AP AS ORM mi-ii -��I 4-- ;/111 Julie . Cozad I ount orney EXCUSED Steve Moreno Date of signature: ///4/// ej_ : /4_, ',) 0 1 01-/- /6 2015-3882 HL0047 1$61 Memorandum IterE TO: Barbara Kirkmeyer, Chair v�1 N �• Board of County Commissioners 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 zummin mmo-no ninini intenomm o. w �, L 5 mg_U M cc , - ,t- M mg U V M < Z mg (u Z . mg L. t0 O . "§ [R' j"' t"' O �? o Ca 6 g ��" Z N 00 "' z o � W o o t Zo M 7 z2 Z ° Z o o z 0 D M , 0 °-:-) MOM a O oc w O `_ IX cn " O E~ "la N UJ CD w E z - me 0. W8 le a Fe 0. mjpi iiltz J i—i i oi ';O 5 :.13 a 6 igimg. _ 3_ I 1.2 W ,E ro w "" ' ill WE lip Z z • p ILz W Z w O � M 3 Z 4 O Z W Q V m 1.0_ rt_I O-2 ' N a WirA ol'ij L r T c WLijZ .E "g- in g 3 � : oi-i X o mg 'id v sl t' owl 1 N W U Z r r W r-i _ en' "2 `ru! �" W N8 oi W o a" ra ci3 Lii g U . 3.. �j, W cuoaon c mg J •N ^� 7 ., E 0 El 3._ ��;J� W vii 1$61 s DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue r Greeley, CO 80631 i '1 PublcHealth Web rttiw,ANnvw cc.weld co us/Departments!;4ealthEnvironrrentIndex.htrri -1, fr1,M r't +' , Health Administration Public Health&Clinical Environmental Health Communication. Emergency Preparedness Y l VINO Recorde. Services Services Education&Planning L Response Tee 9 ?CO WOTele 970 304 6420 Tele 970 304 6415 Tele 970 304 6470 Tale 970 304 6420 r^„ r—, F a. 9'r r 304 54 i 2 Fax 970 3046416 Fax 970 30d 641 t Far. 570 304 6452 Fax 970 304 6469 (u••netrr Together v dh the commu l,es we serve,a-n are workmq to make Weld County We neallhrest place to live learn.wo a and play October 30,2015 David Bressler Chair Weld County Emergency Medical/Trauma Service Council Via email: Dave.lir,- SUBJECT: 2016 Frederick-Firestone Fire Protection 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 Frederick-Firestone Fire Protection 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/Frauma 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,7-2-100.8.5 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 1 he lee for said license shall be set by separate ordinance. The license shall issue only in the following tiers of service: Tier I: i,icensure authorizing for Primary Care, as defined in Section 7-1-30 of this Chapter. Tier II: L.icensure 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. I ier III: Licensurc authorizing for Standby Service,as defined in Section 7-1-30 of this Chapter. A. The Board of Counts 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 Finns 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, A tQ b( LvUv\\\XXXhhh=== Rachel Scanlan Environmental Health Specialist Environmental Health Services ii 1 Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Frederick-Firestone Fire Protection District As required in Section 7-2-100.13.5., 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 received at the time of the review. FINDING #2: There have been no issues reported to the EMTS S 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 Tie' I License as requested for the service area listed on application. Recommendation By: `""' ~= Date: 11-18-2015 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT p ' 1555 North 17th Avenue Greeley, CO 80631 Public Health www.weidhealth.org Health Administration Public Health& Environmental Communication, Emergency Preparedness Vital Records Clinical Services Health Services Education S.Planning &Response Tele:970-304-6410 Tele:970-304-6420 Tele:970-304-641.5 Tele:970-304-6470 Tele:970-304-6420 Fax: 970-304-6412 Fox: 970-304-6416 Fax: 970-304-6411 Fox: 970-304-6452 Fox: 97O304-6469 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: AO -,51(0-4,2Qlf( Name of Ambulance Service: Free/44.'4'01Z—/"ic Liable 1w Prot-4,4)71, D es irr`tsf Owner: Name: Sa.wt Address: 1112(9 X os e 4 1, Frederije�� kacoq Phone Number: [3j g 33- Z Operations Manager: Name: ov Pr v►�k Address: 54.....1f Phone Number: Sft,r..e Email: 4uik Q c 'rot. t.t 5 Medical Director: ( Name: r- J�Gtt' &P, Address: (,ocx.Q 5 04,144 4,, P1J,eti Phone Number: (3o)) Lac-..2281 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): $)ONL What area of Weld County will be served by this company? Please attach a map indicating the service area. Sov4 wi ettettee 4 Wdd How many ambulances do you operate? 3 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: foeAk - 51162.-1- 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: rgrYes ❑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:IXT Tier I ❑ Tier II O Tier III Page 2 FREDERICK-FIRESTONE ! Life Safety Division FIRE PROTECTION DISTRICT / !` Office: (303) 833-2742 ` ` ( Fax: (303) 833-3736 E-Mail: dprunk@fffd.us eccu. OFFlcII'M,vCNEMATIo,PIETAS October 1, 2015 The Frederick-Firestone Fire Protection District currently has three fire stations. Each fire station houses one of the District's Ambulances. These ambulances are located at: Station#1 - Ambulance 3421 31 Walnut Drive Frederick, CO 80530 Station#2 - Ambulance 3422 3991 Rowe Street Frederick, CO 80516 Station#3 - Ambulance 3423 6800 Tilbury Avenue Firestone, CO 80504 Respectfully, Douglas J. Pru Division Chief Physical:8426 Kosmerl Place,Frederick,CO 80504,Mailing:P.O.Box 129,Frederick,CO 80530;www.fffd.us 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 1N 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. nn� c L 1 /o/a-�//s� Signature of Applicant Title D to SUBSCRIBED AND AFFIRMED BEFORE ME THIS ,A$ DAY Oe.4ober ,20 15 ,IN THE COUNTY OF aci ,STATE OF COLORADO. Cerk; o0 40.34O -1 Oct Lank)ROBIN INGRAHAM si cure of Notary NOTARY PUBLIC STATE OF COLORADO My Commission expires: O9 / a3 /aO/(D My Commission Expires oq ,2 3 a o I in Page 6 . Frederick Firestone Fire i as ; 68V\ 67W Protection District -41 ` t _ } 18 17 16 15 14 13 18 1r . ` N 68 " 7W I 1 Cr 32 AdamsAv _ — 4113 r 1irrivisittt. •• . 1 21 22 23 24 19 2 iv 19 • 20 68vA 67W , 1 • . 1 it ilassi I ,w sessassallsawassis JD as I 1 1 • - 1 1 I I j 1 I I I , 1 • 1 30 29 28 27 28 1 25 30 29 28 I , I , I • , I , I . / 1 1 a 1 1 � . . . i% ' 1 1 1 % 1 , 4.11 Ora 1 CI a ,T, - - � _ - 1 • AP ON 41. MO rie IS 1 Gs. 1 1 . 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FREDERICK-FIRESTONE Life Safety Division �FIRB FIRE PROTECTION DISTRICT , Office: (303) 833-2742 Fax: (303) 833-3736 E-Mail: dprunk@fffd.us escu h�OFP(CwM,VENERATIO,PIETAS October 1, 2015 The Frederick-Firestone Fire Protection District currently has EMS Mutual-Aid agreements with the following agencies: • Mountain View Fire Protection District Respectfully, Doug Prunk Division Chief Physical:8426 Kosmerl Place,Frederick,CO 80504,Mailing:P.O.Box 129,Frederick,CO 80530;www.fffd.us Hello