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Home My WebLink About20143775.tiff RESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - WINDSOR SEVERANCE 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 Windsor Severance 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 Windsor Severance Fire Protection District for a Tier I 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 ELD COUNTY COLORADO ATTEST: do/4v Cd �� n ta5 ae'�i'a ' 1 L ♦ YYYouglas Rademachh r, C air Weld County Clerk to the B• BY. I ibcp arbara Kirkmeyer, P o-Tem t f /A .S � ��:,,:; �e-- ty Clerk tot eBs uNot Sean P. Conway APPROVED AS TO FORM: Mike Free n 1�/� County Attorney (/ � 2//3 William F. Garcia Date of signature: 2014-3775 MI. It (K. Qn-lunar24 HL0047 8 tiei Memorandum TO: Douglas Rademacher, Chair Board of County Commissioners !—� 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 Ill 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 2014-3775 aM 0 r ' ' t -�t tales-- J 3 C,r'1 L L it t�� [ i.' ri r 1' �i [x.5-1, 061 1 _1 =1 _.� _ _, ; � L_..__1 1__ I I _ i � 'nay __, W 0 Wi Ilkv FP Z at z ,,A , QC {�7 � ISM"" 0 a UP Q 51 Z !' r pil 1{A,�, _ O CD OZ W 2 Z O D Av.... 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CCo in w KA [ J V V U1 H Z Sr a J N �, r J J x x o x 2 I- o o r� . m I- 0 NW C z v, ro 'Di W D a o � _ v 1/4171 m ,� irq a z z w o U ° o m limiti M rjPrealrni -I c RI S m..E W 3 W474444 ii -t Egi cn frEl , A.° UNNICGUMbin l hIM�1TIINalla�LG1LaTn cn1 186l .i DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17'r Avenue 13 �( Greeley, CO 80631 J � Public Health �../ Web:t7 :llwww.co.weld.ce.4rslDenartmeI tslHealthEnvironment/index.fitm{ Health Administration Public Health&Clinical Environmental Ne.Nn Communlcstlon, En" ryeney P atednelts Mimi Records Records Sarvie Services Edueallon ti Planning &Response G O U Y Tele:970.303.6410 Tole:970.301&420 Tele 070,304 8476 Tale.970 304 6470 Tele 970.104.5420 — Fax: 9/0.304.6412 Film:9703040416 Fau:970 304.6411 rak:970.3041492 Fox: 970.304,6400 • Our visun:rcgrawr wTh the cnmmun ies we servo.*9 aro mvks:g to make WWJ Comity me I:oaNrwsI piece to rota,loam,week am'May October 31,2014 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: bschacf Tplattevalleyl rg SUBJECT: 2015 Windsor Severance 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 train Windsor Severance 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 MedicallTrauma 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!1'rattma 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 EMITS 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 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 Cate,as defined in Section 7-1-30 of this Chapter. Tier II: Licensure authorizing for transports of patient(s)to and from licensed medical facilities. This licensure does not provide for Primary Care,as defined in Section 7-1-30 of this Chapter. Tier III: 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, Kevin Antuna Environmental Health Specialist Environmental Health Services Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Windsor Severance Fire Protection 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: FINDING#2: FINDING#3: FINDING#4: Recommended Level of Service: . 'I'ierJ.,,. Tier 2 Tier 3 Recommended Service Area: _ ,•.,, ;; `. t . Other EMTS Council recommendations or comments: Recommendation By:_ br, . , �! -t' Date: ,I(t t I' \ N DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT '\`t"t'I"' - 1555 North 17th Avenue Greeley, CO 80631 Public Health ��♦ Y la L i www.weldHealth.org• Administration Public Health& Environmental Health Communication, Emergency Preparedness Vital Records Clinical Services Services Education&Planning &Response Tele:970-301-6410 1ele:970-304-6420 Tele;970-304-6415 Tele:970-304-6470 Tele;970.304.6420 Fox: 970.304.6412 Fox: 970-3046416 Fox: 970-304-6411 Fox: 970-304.6452 Fax; 970-304-6469 Out vision:'rogc.lter with the Coin nt.nities we servo,wo are working le take Weld County the healthiest place to live,team,work,and lility. AMBULANCE SERVICE LICENSE RENEWAL APPLICATION ` Date of application:_i �/ �l Name of Ambulance Service: w=Nn16e, , 'uc-fi,/?/) C 4OO&/7 -'''C'1' 10-41/410tf7,iGT Owner: Name: ,Sf vt=:pJilwGz kE !i °7 c7-IaN O iS T,ZcC1 Address: JO p_ V/h J�'At t;4_,_ Yv i N o s 4 ,, Go e o> s'� Phone Number: ^ ? a -6 e Li " '.(_,,..L E? _ _- — Operations Manager; Name: IAA,1 G liP_f t.. ei...4 C.k.w>,,....t_ s of t tR-4-71 0 s (.Vi I e F' Address: f o (› 14i" C're oc'f,�tN I NN t� 4)• - 3�_e{ i) Phone Number:-_a 77O 6r 5 6-,C?. ''- x -i 3 0- --___ L'inail: __Vvt e.7 -a -L w t II .. w5-...f..-. ,..)5__ -- - _ 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:_ /___./..— Date Referred to D.O.C.C.: / / Approved Recommended(Y/N): ____,_ Licensing Agent Name and address of each stockholder of partner owning l0%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. tN: `+,.. ¢?t. x..vi .-.A6/C3__._2 A,L') !N f�5T,-G�.N tii`" (,a'mow 7'Y f low many ambulances do you operate? a 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#I: '7 Street Number:� _L�) D 7 /4 I,�r,*,e City:I/ ;4 eiti G! State: -C2? Phone: {0? ? 6 & it, Location#2: Street Number: ti/t#7 City:-- — ........�.-_. — State:— __-_ Phone: Medical Director: Name: tY1 416.961- 4P"rLc" Mailing Address: f J fG �!L.�_1.04.4 61 477- t_( i LL ° 0-Z y Phone Number: 9 77D ----- ----- As required in Section 7-3-30 of the Weld County Code Ordinance and Chapter 4 Section 6 of the CDl'1-1E 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 CDPI-IE Emergency Medical Services regulatio s of the date of the application, are you in compliance with the reporting requirements of the agency profile: .Yes No Level of Service Requested (circle one or more): Tier I Tier II 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 iiL 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 requirements of this section within ninety(90)days prior to the date of expiration (Weld County Code Ordinance 2007-8 •I 4 l • i. Anil eCTIDN DISTRICT / : - y,i I .•IR II , V.u,,.u..1,u Y.,ma 41 1 N yYMN .,. i +• .. .. —t t —YW^../ I --` ^'• \ 1 "' fiiili :,,may, r.ii i 1.72.::........ `ti 1 a, .• .. 1 .._._,.. 1111 '' i 7,Y� 'N..-- S; \ %.;,, 1 ;:rev:: / , 3 i rs. T 0.\1l„ .1 • <.'•9.. .„ ;,� •V ;� , ' ; \ :i- !I=o ;1 j ) •�1,,,,. • ! f I �' _... g i Ji;ii1 j`,�� f l i t. .3»-. —.•.,d,.,•Y_ --� -- iti . i....., \ ,.n...,F( j y j i) i 1 / _ } .1111 + j, s w ' 1 r.., Y l� � ....is / ,,,,:,....-.//1 ,•.. clad v.w.+....•.+...w+ • y,W.Rt V1 ..: r.N.v1..1...1. 1101.•.•Y,2 •• -• y '�YMl..a1WY11W i 1 i { t 1 + 4� 7 .. ' .,,.?,,, .uluaiM wok...mum UV. 4•u..I. ,,V' , 1 % 4.1.311". 1 I \...U.dill e l 1..ql 4; IV ^ �•• «la.•..w „'[ Iu1l11YiY{111N.NIUWUII ` ` \, t 1 1 :; Windsor Severance Fire Rescue ` @ ,,N 100 7th Street, Windsor, Colorado, 80550 970-686-2626 www.wsfr.us October 22, 2014 Mutual Aid Agencies that Windsor Severance Fire Rescue operates with: Fire Departments: • Loveland Fire Rescue • Poudre Fire Authority • Ault-Pierce Fire Protecton District • Eaton Fire Protection District • Greeley Fire Department • Johnstown Fire Protection District (Front Range Fire Rescue) EMS Transport Agencies: • Poudre Valley Hospital EMS • Thompson Valley EMS Page 4 I I LEREBY CERTIFY THAT I AM AUTHORIZED TO SUBMIT THE FORGOING APPLICATION AND THE INFORMATION PROVIDED IN THIS APPLIA'FION 1S 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•RESPONSF,. f DETERMINATION THAT N ORMAT ON CONSTITUAN S GROUNDS AMBULANCE Se/ICESUED BASED ON FALSE LICENSE REVOCATION AND POSSIBLE CRIMINAL PROSECUTION. �� ,'. (^`' 9A il' f2 s/Y Signature of Applicant Title ,,ot ttuntgtr,o, SUBSCRIBED AND AFFIRMED BEFORE ME TIIlS _� .•>'' ,ANli 2,i°,.:. .. DAY QC__ --• Y 20_� _,IN TI I1;COUNTY a ',;, .N , ', la, _. __,S'I'A I E OF COLORADO. ' .}.'.' C?, • 1in?. 1 - / �/} Signature of Notary'',,/ �.;.*ADO`�,,% My ommission expires:_/�1__//._/.1. 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 t ' 1 rl -- 7nrre 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