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Home My WebLink About20143774.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 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 OLORADO ATTEST: d. r 1 1.�/I i x npae wt lgla Rademac er, hair Weld County Clerk to the Boar d+• -�.�. �- i (iU-!t.�1<- ceLX4u�7tec IA61 ( ; <. h / • , �, .. r,-ra Kirkmeyer, ro-Tem BY: 1 l.. 1 .� 1 I s I a..� u=%uty Clerk to t e Board IP C. ♦ i ,`:can P. Conway APPROVED AS TO FORM: a a Mike Free n County Attorney ty/�G � William F. Garcia Date of signature: /3 ,I 2014-3774 CC1OLIK.amtun4 1212q HL0047 861 , Memorandum Ira- \tom TO: Douglas Rademacher, Chair Board of County Commissioners auN1Y 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 2014-3774 Eilli 3 iE�as Ca telini It 11 1j GT till ; Et' Vii' Lil :� i 7 57O. �l C 1 ray ' !w3 rifij ow a :4)1 �5 > o Ffd-C z 9' 7s El z rd L_-_-_ Cy)OQ z La D ALA MO N ff.J W ryp IC1I 0 1-1 Z 0 E2 gz Wo ,_ "'' H W re toa z ol'al O • U w w O Irk U LA W = o a �� 17 J w O a u 5 c z z a z rciii ,.'� 7 ~ ai N J J O U _ \zzial CCH Ltt ❑ °� v W a -� a o Q o _, QDL Z J o lug zz 2 = LLJ a o m d 2 cc o J g o L O•rniW a a o � W v � � _ I Ari I'M' � v W > O t7 z z U Z i- z o v :±1 J p O v) ola W m Ill a CNJ o w 3 z^O 0 I ,4 = v i u ru U x F. m o O 2 o -_ [ 0 l 21 CO o m tF rEd z T 5 o 0j C:,i. z W „.:,-i .. 1T-3if 9` I = ii, if-li. .„ , .....,-, o 51vI Ell LiEMI U Ei El � v ! ElL1LJILilvIEl ° %t N,„ I 1 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT �s- 1 Cr. C---. 1555 N. 17th AvenueV-e) ` { / f i �rt' \ Greeley, CO 80631 V l -� I PublkFiealth `,,' Web:13g2://www.co.weld_co.us/Departments/HealthEnvironmenUindex.html Ir;ttrr c J fill) Health Administration Public Health 4 Clinical Environmental Heat9 Communication, Emergency Preparedness IVl 1 "' Vital Records Services Services Education 4 Planning a Response f1 I' , Tele 970 304 6710 Tele.970 3114 6420 Tate'970 304 6415 Tate'970 304.6470 Tale 970.304 6.120 _-V.. - . — Fat 970344 641'r Far 970 304 0416 Fos 970 304 6411 Faa 070.304&152 Fax 970.3016169 Ch:•asV1 l;;yr•rne...,.. ice cc7.,T,:n.l x3 w3 s.'vF..r8 are wO.•A,.;3 to make weld CO VPry if neaNn4sl plow to wo,'eanr.Tore end plat October 15,2014 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: h chael•crlatte alleyfire,orl! SUBJECT: 2015 Thompson Valley 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 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 7.2-100.13.5. 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 (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. 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. Tier IL 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 111: 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 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, WA" Melissa Taylor Environmental Health Specialist Environmental Health Services Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Thompson Valley EMS As required in Section 7-2-100.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: (tier I Tier 2 Tier 3 Recommended Service Arca: Other EMTS Council recommendations or comments: • Recommendation By: 1'_ : . . j':,. t -1 :� __ Date: _ �+ i'. ►y DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 Nor'h 17th Avenue C:a) Greeley, CO 80631 Public Health r�r'Y Y Y rr..rrnr rwrt wlr ',Ono www.weldhealth.org Health Adminichr,Ilon Public Health& Environmental Health Communleailon. Emergency Preparedness Vital Records Clinical Services Services Education&Planning L Response Tele:970-304-6410 Tele:970.304-6420 Tele:970-304-6415 Tele 970-304-6470 Teie:970-304-6420 Fox: 970-304.6412 Fox: 970.304.6416 Fox: 9/0-304-641 I Fax: 970-304-6452 Fax: 970-304-6469 Our vision:Together will)the curntnrorities we serve,we arc wurkiny to make Weld Ccanty the healthiest place a I:ve,learn,wuik,and play. AMBULANCE SERVICE LICENSE RENEWAL APPLICATION it Date of application: Name of Ambulance ServiceT Ac.)c \ Setl'\) V kLL- Owner Nance: WN`+\V`.>Q 4, , wV ELRIJt', CiO (-61)531=1 Address � O �-Y � 5 GALE 1)K Phone Numbcr:C\ "1.2(03 - C.r' 0 as-- ---.• U�perations Manager: Name: 9J\ teLE to I 14- —. c 3� v - c.OV Uj ten) CL $U� Address:Li C1--Y C*3 Ira Le -7)Y_w t Phone Number:kA -� • - (i) (1,- O 'L Rmail: r �5� _C' P_) r?.MS• ( t-Y1h 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 1 MTC:___/ /__ Approved Recommended(YIN):- Date Referred to B.O.C.C.• / / Licensing Agent Name and address of each stockholder of partner owning 10%Aor�mare of the outstanding stock of the company of having more than a 10%ownership interest(if applicable): 4� I- v:'_jet._ L=r_''�f E1� ';'^ t��i_ -1i�r—i_ -4, . _ C.tAl.- 1-7-Wl'.7)\4.-11-2,1CT.` �;•!..? �{.1-\k. —r`f ..N l:fA L_!-..1-\ C L.�1 C G `a 1�{.�-..l c 1(- r •p t&_D TV i-11711) cc\+r-rVt-\F1c, --c 4sLcLr',rV') What area of Weld County will be served by this company? Please attach_a map indicating the service area. (� L..��_r:Y� �?Tttil \•�li'•l.t� LC)\).-YV' _t . ) 1-1-k IN) 114 E \T7 C3 CDIZ.I\�I��L ��)0I'i ft l t,`.; V 1-V:..1O1 l I.x11\Y l-)cnC1t?.+ C7. 3 ( 'CO AL?`-,"Lt1 t•.3 \f How many ambulances do you operate? \\ _�---- 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 ft I: O- -"" Street Number:_.........................-- — `� City: State: Phone: _.__...... Location 02: Street Number: -- _........................... --__-- City: __�_------------- _ _ State: _—_ Phone: Medical Director: Name: -Mailing Address: Phone Number: 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: (YCsr 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,arc you in compliance with the reporting requirements of the agency profile: i Yes No Level of Service Requested(circle one or more): Tier I Tier H 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 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. 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 Page 4 1 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 LIC tNSE REVOCATION AND POSSIBLE CRIMINAL PROSECUTION. -'� SignatureEe. Applicant Title //,)) Date SUBSCRIBED)AND AFFIRMED BEFORE ME THIS I _ DAY C.)L(ti L•,#`Y`? ?0\ ,IN THE COUNTY OF .STATE OF COLORADO. Q. Signature orNa ary My Commission expires: O" /8 I / J : ) 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: 4645 Sunview Dr Loveland, CO 80538 970-461-8799 Location #5 (Headquarters): 4480 Clydesdale Parkway Loveland, CO 80538 970-663-6025 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.Jobin(a7ucdenver.edu : Ttaimmal,,,,: * li 1 ' •_! 3 0 § I9- 00. ..".°1-11 ol `M ' w T �. rfri O �• F Z Z (y - . t A J ti `4"C.10111C.IICIIII0111011" Mal h u"I.IS Fs . M. . i `r s -wirlit'ii s IS f:Ws.IN:s:l:s Li t Orr tat VIM IS .71 flit g-R / r. II li ii w Y M Q VI Ili O. - W' lit Mat ` - . THOMPSON VALLEY EMERGENCY MEDICAL SERVICES 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, 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 .. . . .. ...... '861 g t r r 1 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