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Home My WebLink About20143771.tiff RESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - POUDRE VALLEY HOSPITAL 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 the Poudre Valley Hospital Emergency Medical Services 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 Service 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 Poudre Valley Hospital Emergency Medical Services for a Tier I Emergency Medical Service 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 dj ATTEST: G. .JC,Lto; Jl tcaCfi !/� � '�:.�+ las Oc)51,Oc)51,O•3Oc)51,O•3ademache, Chair Weld County Clerk to the Board s +p• ice; ' ' tml t m•" c: /mac /%�eya.� 4•:x,,11, -� a Kirkme er, Pro-Tem /BY. �T ty Clerk to th- Board ir`gj \~•� v' an P. Conway APPROVED AS TO FORM: Mike Fre an County Attorney 12/13 Willia . Garcia Date of signature: \ '/ C&' ui nhIno.) (2 24 2014-3771 HL0047 1861 Memorandum % T 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 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 16`h Street Windsor, Colorado Greeley, Colorado 2014-3771 LI I 1 E� i cf?j L iiii-JoliDi Eli t-X C.:4113-Till [lb Li- j1 L il it l t? irdili fll LEJlittilii iii CI Eli U " z ro `�`, -.I roi a i o _ ill O ill- .17fill 71 ,� pp ? 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CI W 1^�1, �r w r Z v z7.1 Z m g v 0 m w uj VI 0 J (Fil1— .. aj U Q Z a cLi u1+ IX 0 Za co I Wi L1J �_ 7q m '":!1 W Fib _ v ? a, Fri , a.�vy a Q v o r o .J Y iii 3 ii o O 9 = a Q CI) Y ,..M r i_. ‘c,T, 1_, al z Immi en i Z ail in ,Q p F J Q filij Cr: ISI u CL m pr.,g c Q W O Iv W v t U CU Q O l7 W z - � I ImlJ 0 2 I- fu 6 } o x o o T 2 W M Z °' ni w z �ra �' la LA y u 0,-,I Y! m - W I I�-��t‘gii Q , E , 10 tom_ w rqt Q m N e_ J �/��/�� Z a L Y� z gi Fr, .74 N w rfil wu...-.,.� Ill 711 = f� _5a il N N VS .��ry� _ '4:*11.6.2.14%e DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17'^ Avenue Greeley, CO 80631 Public Health Web:h lwww..en.weld.ec_us/Departments/HealthEnvironment/intIYr,t,tlnI '�1 ` V+1 I Moallh AdministratlDit Pub1R resnn&0ilnicat 0nvlronrnentai Pi tali Ix eotnRNMullun, Emurponcy Propa»d4444 y V t.I RecO da Servh as Sarvlcn Cducati0n a Plannlnp 8 Reaponee S ` 6 0 1 N-I Y '" rele:9703n46410 Tree'970'!046420 T01e:9703046415 We.970.304.0470 Tole:970,504.612D tf ''t { F u:070.304 6412 Far. 6%0 304 64'.6 Fax: 970 304 0411 Fa,970.304 0452 r'ex 070.301 6469 0.4,44.en.7gyath&With Me commweii 1,u e suroe.w2:r.a talk np ID nail(.Wild Cowey Me neahhnrstDame to live.Wm.ttorp anti play. November 10, 2014 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: h:Bchie erdplatteva,lley,fireAr SUBJECT:201.5 Poudre Valley Hospital 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 Poudre Valley Hospital 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,7-2-100.B.5 The recommendation of the Weld County Emergency Medical/Trauma Service aimas) 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 F.M/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-BO below, The fee for said license shall be set by separate ordinance, The license shall issue unly 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: 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, 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 recointnendation 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, ; t Rachel Scanlan Environmental Health Specialist Environmental Health Services Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Poudre Valley Hospital As required in Section 7-2-1 OO.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: T�ier I Tier 2 Tier 3 Recommended Service Area: Other EMTS Council recommendations or comments: 1 1 ' I. +1.++ ,t 1A +;tA11+t.. • • Recommendation By: ./rr ..,. 4 le l-- _ . Date: Itlj i�i�l r•;--- :-,-:-•---I DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT , ,, II( i; :t.4� 1555 North 17th Avenue ' I ' Greeley, CO 80631 t'r G i—.11Y I ' Y' _ Public Health ';F< 7.ti• i - www.weldhealth.org q Herrn Admtnlskatlon Public Health a Envlronmenial Neellh Communication. Emergency Preparedness 4IIpI Records Clinical Services Services Edueollon&Planning a Response Tele:970-304-6410 Tole:970-304.6420 Tele:970.304.641 S Tele:970-304-6470 Teks;970.304-6420 Fox; 970-304-6412 fax;970-W74-6416 Fox:970.304.6411 Fox:970-304-6452 fox:970.304-6469 Otl,.'u not Together with the communities Aso acne,we are working to make Weld County the healthiest place to live,learn wodc,and play. AMBULANCE SERVICE LICENSE RENEWAL APPLICATION Date ofapplicalion:,j_i_1 t j_I 1 l,( _ ' Naive of Ambulance Service: tC} Gl'�j' il!e�-U4 1"f 0a j?...� e,V r/k I f-4 e f 7 Owner: '.i 7 f Name: �f. 4 �/A.(L(t'• /f.%,(tftttO.%e '^�-v,-4 C+ Address: ..),_3 / �1. _—l'`'_�--/ie.A.rr•`i:'N'tj Atl S :..ct- I Phone Number: ( `!)<�� , ... .L1 ,).{- ' Operations Manager: f, t Name: J...:f' / 1 e-'t . �.})1tt k-v... • _. _. Address: '..r t__I,L,.._.iks ,C-r` L Phone Number: V_J e)) 3(.1/ • ‘I S-')- c Email: e..I�i .e.... ....e'hj 6):(t'-fj = l_i ' +...}f. r . .. e 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: i -_ / Documents Checked; Remarks: I Date Referred to EMTC: / _I_ Approved Recommended-(Y/Ni:.., Date Referred to B.O.C.C.:_ / iLicensing Agent 1 Name and address of each stockholder of partner owning 10%or Mora of the oulstnncling stock Ollie company of having more than r+ 0%o vnershi>interest(if applicable): _._....._...._.._ uC(2 e. _(in !Imo`,(_ .2.._ f-(c�rvtd.,�t/ C,_ �..�r�__.S��.. -��_.� ._._ _ �',_ _u -U 5 What penof wow County will be served by this om�iany? Please attach a map/}yJtrjdicating the sorvi•c area. S/L.. `•CR t___ ..11 FVi,.1 ..w:r A^-• / 4'(1..... Lett I-low many ambulances do you operate? . ..._l .._.....�.. _._.._-.... . Location and description oldie place(s)from which this ambulance service will operate. if there are more than Iwo locations,attach a separate sheet with the above information. Location 111: Street Number: _ °-r~ rt- r-a�.t'.c�r _ �.— - City; State: Phone:.._.___.. Locotiou 112: Street Number: --.- City: - ___ State: ____.__ Phone:.. Medical Director. Name: ! _I G It e.. ._ �rl ti. .i .N.._ -- — dS Mailing Address: _.. ►{ _ r_c Phone Number: l:j70)_��%.' i - _ J U As required in Section 7-3-30 of the Weld County Code Ordinance and Chapter 4 Section 6 oldie CDPH1 Emergency Medical told Trauma Core System regulations,as of the dale of the application,are you in compliance with the minimum data collection mid reporting of transportation and/or treatment ot'}>aticnls: (Tc� 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 regulations as of the dale 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): 'Pier 1 • Fier II Tier Ill Please read caretbIly: 74-f0 License for Antbulnoce Service No person shall provide or operate no 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: Pier l: Licensure nutioricing for Primary Care,as defined in Section 7-1-30 offing 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 liL: Licensure authorizing for Standby Service,as defined in Section 7-1-30 of this Chapter. 7-2-170 Arnrual Renewal All licenses and permits shall be renewed annually,shall expire on December 31 of the year issued,nod shall not be renewed until the application has been approved by the Department. MI applications for renewal of licenses and permits shall be mnde not later than sixty(60)days prior to the date of expiration. The Department shall notify,by certified'nail,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 Kevin, We do not have vehicles assigned to panicutar stations in Fort t or(treeIe .Our locutions and n potential number of ambulance located al each station arc as Billows: I-1'nudre Polley Hospital 1024 South Lenity Ave.:Fluspitat udnllnisUuLion,uathaliinec supplies,support set vices Fort Collins,Co.80524 I M1S Atln►inistrntivc Office and South FC:Stallon: 3509 S.Mason SI,tY I,3.4: 10 Ambulances.uinlxtlance administration and Iratiiing.ambulance supplies Fort Collins.CO 80525 3-West FC Station 415 S.Bryan SL: I Ambulance Fort Collins.CO 8(1521 4-East FC Station 913 E.Myrtle St.: 2 Ambulances nod I 'I I:MIS Antbulauce Fort Collins.CO 80524 5•Rartnouy FC Station: 2127 K.Harmony Rd.: I Ambulance Fort Collins,CO 80528 G-Accounling Offlee: 2315 E.Harmony Rd..Suite 200:No Ambulances Rm Collins,Cu,80528 7-The Greeley Emergency S Surgical Center Station: I Ambulance,nail ulunee Iraining.'unbalance supplies 6906 10a'St. Greeley,CO 80634 8-Windsor Fire Dept.,Sin. 1: 2 Ambulance(Mtds 12 15).umbulaneesupplies 100 N 7i°St. Windsor.CO 80550 9-A(llliken Fire Dept.,Stn. I: 1 Ambulance(,Mded la),ambulance supplies 101 S.Irene Ave Milliken,CO 80543 I0-Johnstown trirc Dept.: I AlMRdlunce(Medd 14 Used as a reserve unit)Supervisor vehicle-Dodge P.(1. 1 or)'I'clep Ave. Johnstown,CO 80534 Thanks and if yon need'nom information.please feel free to contact me. Page 5 I HEREBY CERTIFY THAT I AM AUTHORIZED TO SUBMIT THE FORGOING APPLICATION AND THE INFORMATION PROVIDED TN 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 CONSTITUTES GROUNDS FOR LICENSE REVOCATION AND POSSIBLE CRIMINAL PROSECUTION. .c1 q -4 hZ6-v1. Ali+1 /I,( . f _5- Signature of Applicant I itle < < l to suBscRippip 4.ND AFFIRMED BEFORE ME TI{IS 54> DAY ,20 I ,IN THE COUNTY OF t. ,2 n48- 7 ,S ATE OF COLO'- ==. KAREN h FRS I Signature of Notary NOTAR PURL STATE OF ADO STATE NOTARY ID p.199040032gfission expires: / / myCOMMISSION EXPIRE T�tAY y`_ S p I Milliken Fire Protection District Oecembet 2012 ---T' f il. K� '.•tk 1r ,l, .? 1'4 ►;f1S�vYi. C S C i yl tt _- — f tk•} �S '�� r5.h'a•,, ,I;AliltIN:y d 2 - `_i F�ifi y • \ 4•`•`r . •". 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Poudre Valley Hospital UNIVERSITY OF COLORADO HEAL-Ill 10/30/14 Mutual Aid Agreements 2014-2015 PVH EMS has current mutual aid agreement with the following agencies operating in Weld County: Windsor Fire Johnstown Fire Milliken Fire Thompson Valley EMS Poudre Fire ')/e7../14,1,,r," • ,_. udi Biatten PVII EMS Manager/Adntin Chief University Colorado Health 3509 S.Mason St #1 Fort Collins,CO 80525 judi.hratten(aluchealth.org (970)391-9826 1024 S.Lernay Ave. • Foi I Collins.CO 00524 • Phone:970.495.7000 • pvhs erg 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� r ' 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. 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