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Home My WebLink About20143773.tiff1 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 of the Weld County Code, the Weld County pursuant to Section 7-2 100 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, 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 approval of the License is conditional upon execution of appropriate Mutual Aid Agreements. 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 8th day of December, A.D., 2014. BOARD OF COUNTY COMMISSIONERS E LD COUNTY, COLORADO ATTEST: dims,, Cl Gv/.d�W G' .e. .�•'�'� as ademac er Chair Weld County Clerk to the Board % •c ® y � ara Kirkme e , Pro-Tem Be--Y14A GUI--eft- ``.1 r ty Clerk to th Board Sean P. Conway APPROVED AS TO FORM: Mike Fre n County Attorney William F. Garcia Date of signature: '2�3 CC: {K-oUlivkina) 12/2i4 2014-3773 1861 Memorandum TO: Douglas Rademacher, Chair ✓t U coUNTY Board of County Commissioners 1 FROM: Mark E. Wallace, MD, MPH, Director Department of Public Health & Environment DATE: December 4, 2014 SUBJECT: 2015 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 19, 2014. The Council recommended that each service provider 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 server 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 2014-3773 E. z 4 ' 7 a Ill o u , _ 7 a ila ? C (C z 7 vt O L-- ,, a 01 91 m..... o 0 w . w o g ci-u �, Z Q � a� p v a IL WZ 5 Q 5L9 C IX v 0 N C o 0 1 , U w o ET c n o 41 c I—I U Z z a Z 8 �� ri d Z a �••� 1 Q cn 0 7 Ll ilJ a W r.i Q U ` m -I Z Q a �" z9 � � a } o 7 Y o W a CL rel 1-3 w c C dCO O O FQ- p L U Lu U N N in °' Q o z o Z 7 2 I- Il i W J Ur Z N W " Z u C� rQ ^ U M H u r LL w o a L1 rn mroc to do 8 u . .7 Wto 0 LIIa ~ J -, Z , l0 W v 7 W J 5 7' spoN rtra 0 1nnun1La1IGlannlame lonulz, lit,_lit, E_tor _18bL/' DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT '1555 N. 17(h Avenue r .IM Greeley, CO 80631 Public Health , \, Web:httn:ll w w.co.weld.co.us/Departments/Health Environmentinaex.htrni health Administration Public health 8 Clinical Environmental Health Communication, Emergency Pwp4re Qness COUAVile'Records Services Services Educelion 6 Penning d Rasponae �I -_j_ Tele:970 304 64 0 '1 ,a 6/ .40:6520 Fee: 6t0:i4 6415 Tee:070339 6170 Tett:970 304 6470 1 Far 970 304 6412 Far:970%4 6416 Fax: 078 30-fiat Far 570 334 6452 Fat:970 30.1 6469 Ow visioh 743`0.. .00,00 cc.000,,a,a;.e acv:a..e.v4* 'k.•.5 m maim Vic,44 c ..nb trrt rasic.earp,a.:e A We.ie.�a,,. Wk aadptl7 November 10, 2014 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: bschacfkr' 7Iattevtlleytire_org SUBJECT: 2015 Stadium Medical 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. Attached to this document are the Ambulance Service License Application,and Maps or 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 Departmenl 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-SO 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: Liecnsure 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, 1Y`^'— ilf" — Melissa Taylor Environmental Health Specialist Environmental Health Services Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Stadium Medical 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#l: FINDING #2: FINDING#3: FINDING#4: Recommended Level of Service: Tier I Tier 2 .Tier 3 Recommended Service Area: V [�.._ Lk.(.1A `tc'a\- Other EMTS Council recommendations or comments: �'t�l• f`--r 4i, Lt r_Y? ta.t:-\- t_:.,a...ca Y0-1 T ci . At^.'•t;pi'.?)7, a., i... , lr r. 'a^4'• I.'•'c, A�' ,' i _ (v�-''ti�\ /:7 // Recommendation By: :--/:;e4 _r. .�. �!- - -- Date: /7/(1 f I'i . C) DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue • r lr' it}. Greeley, CO 80631 Public Health �� www.weldhealth.org �" Health Adminlstratlon Public Health& Environmental Health Communication, Emergency Preparedness Vital Records Clinical Services Services Education&Planning S.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 Fox: 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 RENEWAL APPLICATION Date of application: Name of Ambulance Service: Cl`? T OA\kA sr\ I YA9-,c. \ Owner: Name: _'\,-Cl go z a� Address: ( o t\S - ��3(1('+` .� � `�'-• N prod�t'r 4 Phone Number: .?J 5 L 1 r'1 Z� Operations Manat•er: Name: C _ ' r'` N_ E'_` Address:l 1� \ ,,�?. CA- . Lo fU.W,f' C© �C)Z_C.) q , Phone Number:30 " `mac -k, - 1 ( `1 Email: _ j[_lk-j.CT c� J l_\J v ' (NN-Q-c LCcD . C Pursuant to Section 7-2-150 of Weld County Code Ordinance,any change of ownership requires a new application for ambulance service license. (For Office Use Only) Date Received: / / Documents Checked: - Remarks: Date Referred to EMTC: / / Approved Recommended(YIN): Date Referred to B.O.C.C.: / / Licensing Agent Name and address of each stockholder of partner owning 10%or more of the outstanding stock of the company of having re than a 10%owle ship interest(if applicable): 'cn .G-- J=-.A_p(e .- ei,5 cAno:1 C7C1 Whatnjca-of Weld County will be served by this company?Please attach a map indicating the service area. _•:?__YLC.z ' C. .-t-C17'O^./tfrr e ._ CU-0 _i' n(It') C/,_ (o_ t,/ C-0/C.C1-2 2 How many ambulances do you operate?/0 ( O'K.(/ L 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: _ j oil'umber: C. ✓i os�� (C%IA/t'; Cit y:��p/t.U.�+--(e," �S—• State: CO Phone: • 'G1-JO�/ Location#2: Street Number:^f O'— - City: State: Phone: Medical Director:•-----) / Name: E'.AQ i- er'YiUI..� '' Mailing Address:/ 1 '5!.1 r`/r/1.6A-2.1l,�` r% t 1`• PD IT.rLr(n� rJ 0/cam Phone Number: =3 CJ 1,� 9 J,-;Z• 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 compliance with the minimum data collection and reporting of transportation and/or treatment of patients: es 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.Yesfio Level of Service Requested(circle one or more): Tier I Tier lI Tier III �--- Please read carefully: 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. 7-2-170 Annual Renewal All licenses and permits shall be renewed annually,shall expire on December 31 of the year issued,and shall not be renewed until the application has been approved by the Department.All applications for renewal of licenses and permits shall be made not later than sixty(60)days prior to the date of expiration. The Department shall notify,by certified mail,return receipt requested,each licensee of the renewal 1 y•Y • AMBULANCE VEHICLE PERMIT RENEWAL LIST Name of Ambulance Service: t,t rY> 1t Application Year: Ca v 5 Vehicle #n / : Year; QCC l Make: c-cj r r, Model: LA Sd 4 Wheel Drive (Y/NI): Manufacturers Identification Number(V.I.N.): �x� ��FIN 90 C Colorado State License Number (Registration No.): QC 3- -7-A Motor Vehicle Chassis Number: \ A1s_ Registered with the State of Colorado as an emergency vehicle(Y/N): JQA Date Ambulance placed in service: C-i3 / (-}SL / /� r C Normal Location of Ambulance: (i.-) �7_S ( ��r1Q; C L_ �<'�S et" ( G G Vehicle #0'-) : r VS—C1 year:(2O " Make: -�, cl Model: L - 4 Wheel Drive (Y/N): /V Manufacturers Identification Number(V.I.N.): i F I X F `/ 5 F s Colorado State License Number(Registration No.): 6 y'7- / C Motor Vehicle Chassis Number: Registered with the State of Colorado as an emergency vehicle (YIN): (_/i)2O Date Ambulance placed in service: // / / R C cY Normal Location of Ambulance:6.. CI !t s 5.3 (' �f 077 u�'/ ? c:--)56,-Roy- Vehicle #a7: Year: a6 53 Make: 1 U rd Model: - ;?L.-7d 4 Wheel Drive(Y/N): Manufacturers Identification Number(V,I,N.): F `.f i-9-3f! 8 393 Vci. Colorado State License Number(Registration No.): (7,P-7— ise7 ? Motor Vehicle Chassis Number: / 94/1.0 sue. Registered with the State of Colorado as an emergency vehicle(Y/N): g.t'!0 Date Ambulance placed in service: 7 / /4 6(LS' ` Normal Location of Ambulance: � �,S C�c�/7O C� (� � Ao4...tr7- -� G Page 4 1 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, WIIICII ENCOURAGES ALL LICENSED AGENCIES PROVIDING EMS RESPONSE IN WELD COUNTY TO MAKE A GOOD FAITII 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. ignore of Applicant Title Date 6� SUBSC RIl3 D AN,):)AFFIRMED BEFORE ME THIS- _ DV�L. rC' f� ,20 /4�, IN THE COUNTY OF � ,STATE OF COLORA b. 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I.. •'rr• U'Il•n••i) • i 1• - ..- : II . II - :'x :. • t;, 711 � ; ,411 A• , 1 :.11, :1 .1•I: •1 • , • ': ^ vI • •t.' .� � •it •1 ` • •. ' ; • ILl 7h+V .t t •• I t ' • 1 .y •. .1 LS • • _..• l';1!$UIi• .... Cc•I \1 'S-i �• .''` E-• r• .t i• _ t i�qr / i� 1 i I.-.a:AlPaflk4 _ •.fir • / i c T = a, k�.:�, I•I :j it CH; jff ,f•' /,'.- :r,? -tI 1.4 ft. • • tare{ttpa//mapagoogle,com/meps?hl=en&fab=wl 111 Y{]6 M ED DI CAL -„- A L 3Ot "The People the Pro's Trust" 695 B Canosa Ct. Denver,Co. 80204 Phone-720.630-2000 Fax 720-235-3507 Date: 11/05/2014 There are no Mutual Aid Agreements with Stadium Medical, Sincerely, Rodger Ames Owner Stadium Medical 303-549-7914 Esther Gesick From: Kevin Antuna Sent: Wednesday, December 03, 2014 3:35 PM To: Herb Brady; Erik Morse; Ron Bateman; Mike Blackwill; Kate Jennings; Judi Bratten; scm@pvhs.org; Dave Bressler; Wagy, Mitch E; Joel D. Painter; Tom Beach; contact@stadiummedical.com; tdalton@mvfpd.org; ccraigle@pvmc.org; dprunk@fffd.us; jlum@stadiummedical.com; mdolgener@tvems.com; mlawley@mvfpd.org; rlesher@tvems.com; Christopher L. Mulberry Cc: bschaefer@plattevalleyfire.org; Rachel Scanlan; Deb Adamson; Mark Wallace; Melissa Taylor; bschaefer3761@gmail.com; Trevor Jiricek; Esther Gesick; Skye Turchado; Tanya Geiser Subject: Ambulance BOCC Hearing Hi All, The Board of County Commissioners (BOCC) will review your Ambulance Service License applications on Monday, December 8, 2014 at 9:00 am at 1150 O Street in Greeley(Weld County Administration Building). You may want to be present in case the Commissioners have questions. Thank you, Kevin Antuna Environmental Health Specialist Weld County Department of Public Health and Environment 1555 North 17th Avenue Greeley, CO 80631 Phone: 970.304.6415 x 2222 Fax: 970.304.6411 # r * 0 Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. 1 Hello