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Home My WebLink About20153888.tiff RESOLUTION 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 14th day of December, A.D., 2015. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, C LORADO ATTEST: draytipv ��--+..,4 arbara Kirkme er, Chair Weld County Clerk to the :-�� 1E Lz� EXCUSED Mike Freeman, Pro-Tem • BY: Deputy C1 rk to th o Conway 7P1R---ED• A • RM: '`r...r` %Gruel/' �'l Julie A. ozad (j Cou y A torney EXCUSED 1 / Steve Moreno Date of signature: O.7- /— /( 2015-3888 HL0047 U 1$61 Memorandum Tr TO: Barbara Kirkmeyer, Chair _ N T �, 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 4.811_011MINIIMILMILMINE1INNIMININIEWIM110 - •. S. w r..i (U Z , . r ({J, '.f:' IN ".2 0 , 13... me Qy V t'_' `u, Z I Z "E e N r w ci) o , , 0O OU r lu i IL I"� it p U LU Z W o 5-, Ime OW 0 zO 0 5 me �' � Ce N W ~ III Z Z '� o o `U ,.. "g_. W O ; o N W O I ;G a`' 0 V W w °Co ing I," cn W G U W C) U u° la 4'a, 5_ E. re >ii a) wz ra MIMI w w cn a L� co Z u C W N rd, W � 3_ 0 a W ON Jn ao a r MX o — W E W Z Z o. o 3- ril I"o L z = = Q = w M Z ..� o i W Q O m N- 3 'Q o W � o "ffi, O W °' W itta.. `' 0 3 N I NN r � �t'�) V r' .c�.� � W.I, a z Z o 4 v V J N "§.. 3, x.1.1 ""l (A a o O X F- 7 Z Z W N w 8 Ti1 a 0 M D , "5._ to 3_, , 0. a X E6 w ra g M. 0O 3 �{ r�r 'cL i L� it CO w O e wmg_. I- V' ct a m 0 c ime -N J"li l_ E. Z ' 3.. imme V1 w. F..) 3_ . Z o 3- w 3--, U N H 3_ 75ammummtemmennomoommemonlefcr `4 1861 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue '� �. , Greeley. CO 80631 l public Health Web t417,_/.44.1•O1 co. lci o_us/Departrn pl iHealthEnvironmeni'index.html Wean',Adm,n ,,tion Public Health&Clinical Environmental Health Communication. Emergency Preparedness --. Vital Records Services Services Education i Planning &Response G.0 N T Y 374' Tee 970 304 6420 isle 970 304 6415 Tale 970 304 6470 Tale 970 304 6420 • Fax 970 364 6416 Fax 970 304 64t 1 Fax; 970 304 6452 Fax 970 304 6469 Togeftxr with the cummun,hes we serve we are working to make Weld County the healthiest pace to live learn.work ano play October 23. 2015 Dave Bressler Chair Weld County Emergency Medical/Trauma Service Council Via email: Dave.Ri..essler;iihannerhealtl .coin SUBJECT: 2016 Thompson Valley EMS 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 Thompson Valley EMS. 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-t00.B.5 The recommendation of the Weld County Emergency Medical/Trauma Service (EMITS) Council as to whether or not the issuance cif 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 7-2-8(1 below. The fee for said license shall be set by separate ordinance. The license shall issue only in the following tiers of service: Tier 1: Licensure authorizing for Primary Care, as defined in Section 7-1-30 of this Chapter. "l'ier 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 Ill: 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 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 )‘ill 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, Melissa Taylor, MPH Environmental Health Specialist Environmental Health Services Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Thompson Valley EMS As required in Section 7-2-1Utl.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 received at the time of the review. There was no one in attendance at the meeting. FINDING #2: There have been no issues r portcdl to the EM IS Council concerning the service provided to the citizens and visitors to the Weld Counts' 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. r!� Recommendation By: Date: 11-18-2015 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT ;/ 1 555 North 17th Avenue Greeley, CO 80631 Public Health www.weldhealth,org Health Administration Public Health& Environmental Communication, Emergency Preparedness Vital Records Clinical Services Health Services Education&Planning &Response 970-304-6411) Tele:970-304-6420 rele:970 304-64:5 Tele:970-304-6470 rei9:970-304-6420 Fax: 970-304-6412 Fc:<: F•70-304-6=-16 Fax: 970-304-6.1;' Fox: 97C-304-6452 FoA: 970-3t)a-6469 Our vision:Together with the communities we serve.we are woAcing to make Weld County the healthiest place to live,learn,work.and play. AMBULANCE SERVICE LICENSE APPLICATION Date of Application:lb C> AD - O 15 Name of Ambulance Service: 1 E\C re-,Pt-501\1 V R L L E- `' (7--) Owner: NameT\At IN-NP SON VPLLE'{ 1-1ERLT -1 RA/ tC--eS ►STR-Ic1 Address:448 C-L-4'DES1- ALE -1C)k<1 , "v�L-P4\ CO c-6°531) Phone Number:(21 to LP 3 - d 5-- Operations Manager: Name 7.12-P, i s Y L..,E S S E --- Address:t--4c-4$C) C L Y t E 7 Lt --1K LA-1Y i ELAND, at, '605'3(6 Phone Number:g -(v la 3 Email:'ke,.f.:4 cc +Y'Q.t.T1S Medical Director: Name: Q(>\ , REL. Ti'0 Address:I-c'c ‘1.- ST-OP \S \aL-101 , 4 Ave• fl—4 5� .(LO% ct, .1 po S Phone Number: -4a(;) 4;4:1-4 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):{V P1 LOC-AL O-,b Y e-RNm a NT-Tl"MC 3r1 Er.-1 AL_-riv,Lb SllLIc-T -jldtas`rs`a©ty YA-t..L VI, W t'1-"14 S€9zI tci? S 1STRlO-'r` 1NQf -c) T'V Sb) What area of Weld County will be served by this company? Please attach a map indicating the service area. CJESi Q.SL�1 t� e-t OKY'r"e t:i`')i'r4I NylrD6-RA\PI41C. I�AUhZ CLl `� Of:-TV S1'' 'Zo .>;rblrvt) cLc-E Tat_sTiz-te-TS How many ambulances do you operate?\\ (Se-E ©F RTTALt-4 el-3) Page I r Location and description of the placc(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: — City: State: Phone: Location#2: Street Number: City: - Statc: 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: J Yes ❑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: 21 Tier I ❑ Tier II ❑ Tier III Page 2 Medical Director Information Michael J. Jobin, M.D., FACEP Assistant Professor University of Colorado School of Medicine Department of Emergency Medicine University Hospital Anschutz Medical Campus Mail Stop B215 12401 East 17th Ave, Room 753 Aurora, CO 80045 Office 720-848-6777 Home 303-388-2500 Mobile 303-882-3222 Michael.Jobine.ucdenver.edu 2 Thompson Valley EMS Location #1: 2100 N. Boise Ave. Loveland, CO 80538 970-669-7256 Location #2: 380 N. Wilson Ave Loveland, CO 80537 970-776-8474 Location #3: 740 N. 2nd St. Berthoud, CO 80513 970-344-7158 Location #4: 2750 N. Taft Ave. Loveland, CO 80537 970-775-7351 Location #5 (Headquarters). 4480 Clydesdale Parkway Loveland, CO 80538 970-663-6025 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 CONSTITUTE OUNDS FOR ENS EVOCATION AND POSSIBLE CRIMINAL PROSECUTION. ` Signature of Ap cant Title Date SUBSCRIBED AND AFFIRMED BEFORE ME THIS V:\ a DAY ONTO Q E (Z ,20_\S , IN THE COUNTY OF Lq(Z.kre\_E . ,STATE OF COLORADO. MARVI S. DOLGENER Signature of N tary NOTARY PUBLIC STATE OF COLORADO ^^� /�1J / �q NOTARY ID X 19914010442 My Commission expires: Vim- f MY COMMISSION EXPIRES JULY 31.2019 • Page 6 z } ai1.11.r . . `l M i a • m ` { 1) rn X / u"„fzeirt 1= r. arm isr-E; .. . el ,, si 4.41 1 d , M usO-11 r — r xp .... I._1 1`j a I ■/ . • I. , b .i al s 481 " glit....,R �► g 1 r, ■..,--f , E� § ,....46..._, THOMPSON VALLEY h03DICAL SERVICffi 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.J......."...6//ek ,='...-}/ `',' :/\ Hello