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Home My WebLink About20143767.tiff RESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - FREDERICK-FIRESTONE 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 Frederick-Firestone 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 Frederick-Firestone 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 WELD COUNTY COLORADO eAr ATTEST: dotty gc ,,. • ��T`9 �crlar� �C,L�D E)Li3 ,'a" Rademache jChair Weld County Clerk to the Board • 61 ( '� Kirkmeyer Pro-Tern 7 De ty Clerk tot a Board / CIU p ! i'P. Conway APPROVE AS TO FORM: /La, ��Mi a Free n County Attorney 1 � William F. Garcia Date of signature: '/ /3 et' `-K' \ 2014-3767 77 Memorandum 3.\-TrE TO: Douglas Rademacher, Chair Board of County Commissioners 0 NTY ; 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 76 Street Denver, Colorado 1801 16th Street Windsor, Colorado Greeley, Colorado 2014-3767 . i 1 C ' i��1E La C11O1111-51A u za_' il ; C s:1 e ' � r ate ' ; �xa� � r} � a ' s tl ? i iii:; n.."b rEi: u , Ilk; It 2 Q L al ) CC 4044- rC 0 l r z te EriLnt...31(iti-E:L:t.imattilliit LG zi CD rr^ s �YII"' N 543 I I i O U 0 OD® a O Z w ° ; ! 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Z z -c rya traE [L a --A I- Q I" w W o W al 7i Z ° ui Z Q v m ri ral in -wss o U 0 m o a h ; Z �' C. oL.Thi ILI v -a IX LL I- z o < hi TA :II in J ~" 2 I- W m U o x o o ._ 4.1 ro i t0 u, 11 LL Fri Nti W W !cx: �_0 ro 14 444 Li w 1 :[...E., o m J ¢ r P 2 O �`i Z v �� D v l�a Rol Z v -.7,.. £ (�� lJ tij fM i4 = ii a N a Di LiI�iDiDIE-3iG, DiviD-iDIGlvrii Ki 5iDia LiiDIHEq1 °41 �y 1861 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N, 17t Avenue Greeley, CO 80631 T r .,., tblicHeatth Web:ttttpdiv,ww.co.welci.cu.usiDtip.atiments/HealthEnviren ill finuindex.html t HealthAdminieuatton Public Health ttClinical Environmental Health Commnmcation, Em ergennyPreparedtroas c I Vital Records Services Setvlcee Education&Planning l Response rain'973 506 6410 Tale:970 304.0423 TNe:010.304 64I 5 Tele:970.304 6470 Tele:970.304 6120 1� - Fax: 970.304.6412 Fax: 07D304.0116 ele 970.3046411 Fax 9703016452 Fax 973364.6449 Our v.var.:rugaclor ado too eceion+one..ec are save, e6!m.,king m make We'd Cnu+d y thy hcuNhrcwr/dace 16✓wa.Kern,work and play. October 31, 2014 Barry Schaefer Chair Weld County Emergency Medicall"frauma Service Council Via email: tIschfteterrwolattev l..evtirc,t'rg SUBJECT: 2015 Frederick-Firestone 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 from Frederick-Firestone Fire Protection District. Attached to this document are the Ainbuance Service License Application,and Maps of its proposed Service Area. On behalf ot'the Board ol'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-I00.1L5 The recommendation of the Weld County Emergency MedicaVl'rauma 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/IS 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 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 IIT: Licensure authorizing for Standby Service,as defined in Section 7-1-30 of this Chapter. Recommendation of the Weld County Emergency Medical/Trauma Service Council for: Frederick-Firestone 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: Tter I Tier 2 Tier 3 Recommended Service Area: / f .. '.l..•t • 'PI L7t_ .oily) Orr .l It i. -Other EMTS Council recommendations or comments: Recommendation By /4 /_ !'� •� <___ --- ---------- Date:iL4 /i'( DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 North 17th Avenue 10, r 1' Greeley, CO 80631 Public Health '.;Y ,1;;. ' . . www.weldhealth,org Health Administration Public Health I Environmental Health Communication, Emergency Preparedness Vital Records Clinical Services Services Education It Planning L Response Tele:970-304-6410 Tele:970-304-6420 Teie:970-304-6415 Tele:970-304.6470 Tele:970-304-6420 Fax: 970-304-6412 Fax: 970-304-6416 Fox: 970-304-6411 Fax: 970-304-6452 Fax: 970-304-6469 Our vision:Together with the communities we sere,we are working to make Weld County the healthiest place to live,learn,work,and play. AMBULANCE SERVICE LICENSE RENEWAL APPLICATION Date of application: /0 41-1 i Name of Ambulance Service: rC pritef t —Rresfiric. hoc ProICLkP 01S.44' Owner: Name:_„1" Address:__LIg.(o Kosm,rj 'L Fidrr:_,CA sorb q Phone Number:3.03--g33-2742 Operations Manager: Name: btu u , Prsivik Address: 54,0,1 4? Phone Number: fyy4 /t Email:_4pr"h kt 4.V , !,[S Pursuant to Section 7-2-150 off Weld County Code Ordinance,any change of ownership requires a new application for ambulance service license. f (For Office Use Only) I Date Received: / / Documents Checked: Remarks: Date Referred to EMTC: / / •Approved Recommended(Y/N): 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 more than a 10%ownership interest(if applicable): N/f) What area of Weld County will b served by this company? Please attach a map indicating the service area. So Wad How many ambulances do you operate? 3 Ce.,,A tt. gr_1. / 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 41: Street Number: 32 W r+►LL I. City: Ff eAsitt ——.. State. ez Phone:_363- `a33 - 3 7.27 Location#2: Street Number: 31Q( vue City: State: Phone:3O3 (.51---31 0 L{ Medical Director: �� p , Name: Qf. .Z.1R .8J2- ,!4 - t Mailing Address: Phone Number:-303- 426 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: 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: No Level of Service Requested(circle one or more): 'Pier Tier I1 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 fcc 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 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 requirements of this section within ninety(90)days prior to the date of expiration(Weld County Code Ordinance 2007-8 1 GOV I TY'- AMBULANCE VEHICLE PERMIT RENEWAL LIST Name of Ambulance Service: f'rari. 'F'resiw+e I" ire Qrifte4wr, Application Year: a.a)S Vehicle #342(: Year: X001 Make: Me._ Model: £/SOO 4 Wheel Drive (YIN): /K1 Manufacturers Identification Number(V.I.N.): 1 6 8g qv' 78 F4l 115 7i( Colorado State License Number(Registration No.): WA Motor Vehicle Chassis Number: /V ft Registered with the State of Colorado as an emergency vehicle(Y&: N0 Date Ambulance placed in service: 0 7 / 0 1 / ;Aril Normal Location of Ambulance: 31 W {r►0-Y De. t'r' P.r;e4..I CA Vehicle#3q2.1— Year: 010(1 Make: Model: i/S"d'0 4 Wheel Drive(Y/N): / i Numb r V.I.N. (� C.,LB.1151 k Manufacturers Identification u ( ). 16Q le S ? 6 3 Colorado State License Number(Registration No.): 0/4— Motor Vehicle Chassis Number: Ai/4- Registered with the State of Colorado as an emergency vehicle(Ye: A)0 Date Ambulance placed in service: /O / 0( / 0)2- Normal Location of Ambulance: 3 qa 1 g,0 44 G 5f, FlYo{te. j e Vehicle#3103 Year: (9-D)3 Make: _IVA I Model: 44.5-Zip 4 Wheel Drive(YIN): PO Manufacturers Identification Number(V.I.N.): ( [,6(o t,5(t. &a I ( 3 0.2.(v� Colorado State License Number(Registration No.): /V/A Motor Vehicle Chassis Number: lJ/f Registered with the State of Colorado as an emergency vehicle(Ye: A) 0 Date Ambulance placed in service: 0 3 /31 /,9-013 Normal Location of Ambulance: 1V/D ?r;/bury hue, Page 4 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 CONSTITUTES GROUNDS FOR LICENSE REVOCATION AND POSSIBLE CRIMINAL PROSECUTION. / 6-4 S'gnaturc of Applicant "Title ate SUBSCRIBED AND AFFIRMED BEFORE ME THIS A DAY Oufobe ,20 )`} , IN THE COUNTY OF W p id ,STATE OF COLORADO. DALE ROBIN II GRAHAM Signaitire of Notary NOTARY PUBLIC STATE OF COLORADO My Commission expires: _ / /010/6 My Commission Expires° �_ FREDERICK-FIRESTONE g: �f Life Safety Division FIRE PROTECTION DISTRICT ) Office: (303) 833-2742 % ( • ! �i Fax: (303) 833-3736 '\! E-Mail: dprunk@fffd.us Escue>. October 28, 2014 The Frederick-Firestone Fire Protection District currently has EMS Mutual-Aid agreements with the following agencies: • Mountain View Fire Protection District Respectfully, Doug Prunk Division Chief Physical:8426 Kosmcrl Place,Frederick,CO 80504,Mailing:P.O.Box 129,Frederick,CO 80530;www.ffTd.as ;LOH 10/144y Frederick Firestone Fire' Protection District 18 17 16 15 14 13 18 17 6 II i b-rWdl Y ___ Qo . Y fir t Jr -, 19 20 a 21 22 1 24 19 t 0I' i $ r. 30 29 28 27 I 25 30 29 28 .... Y T YY----- ----. Nt 31 32 33 34 36 31 32 33 wail- t v,, ---.-. \Hil/ n C, a 16 �, .mod It•l � f 7 b 111'11O11 g 9 11 Li 7 9 IL) 10 IT"' 16 15 14 13 18 17 16 d r • 19 ,/j20 22 • 23 24 19 20 21 _4 I _f YD.• 1 1 30 29 28 -30— - -- 3`0" —De [ 27 26 25 s 'IN 3 •34.x1 _ rve_^, .__ YJ .. .. i 5 l3 1 1 4_1 31 32 1 33 _- 34 j I 35 1 36 31 1 32 33 C / s 6 ' 5 4 3 2 i 6 ; 5 II'IV4 1 1 7""' 8 I 9 5 10 11 i 12 7 8 9 18 ; 17 16 15 14 13 I 18 I 17 5 16 / I is—, Ii� u 4 .4..._ VI N Highway ---- Major Road(Gravel) Parcel Gity Limit as a •` rd�-a �TF Major Road(Paved)I I Fire District ,,;Township • - '=_ --' - -' FREDERICK-FIRESTONE F;R≥ ` Life Safety Division FIRE PROTECTION DISTRICT �� i Office: (303) 833-2742 ' (� ( lax: (303)833-3736 - E-Mail: dprunk@fffd.us RESCUE OFFICIUM,VENC{AT1O,IIQTN October 28,2014 The Frederick-Firestone Fire Protection District currently has three fire stations. Each fire station houses one of the District's Ambulances. These ambulances arc located at: Station#1 - Ambulance 3421 31 Walnut Drive Frederick, CO 80530 Station #2 - Ambulance 3422 3991 Rowe Street Frederick, CO 80516 Station#3 - Ambulance 3423 6800 Tilbury Avenue Firestone, CO 80504 Resp fully, ci11.7 . Douglas J. Prunk Division Chief Physical:8426 Kosmcrl Place,Frederick,CO 80504,Mailing:P.O.Box 129,Frederick,CO 80530;www.fflaus 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 # ' f Lf ;Et 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