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Home My WebLink About20143765.tiff RESOLUTION RE: APPROVE APPLICATION FOR TIER I EMERGENCY MEDICAL SERVICES LICENSE AND AUTHORIZE CHAIR TO SIGN - BANNER HEALTH/NORTH COLORADO MEDICAL CENTER PARAMEDICS 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, p ursuant 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 Banner Health/NCMC Paramedics 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 Banner Health/NCMC Paramedics 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 WELD COUNTY COLORADO ATTEST:demo) , $( 1. `'��a: ( Chair �- `� I- Rademacher, Ch it Weld County Clerk to the Boa tie #� ' / 1k? �:� � %LL& (.Lie_/AZ ciii f;iyu•-ra Kirkmeyer, Prb-Tem BY: / L i t — 1. zn. .,, �i, , .f y Clerk to th Board Sean P. Conway APPROVED AS TO FORM: a �.�`� Mike Fre n County Attorney Wiliam . Garcia Date of signature: Z" /A e: gilt \ 20HL0047 1861 Memorandum TO: Douglas Rademacher, Chair V I J \ Board of County Commissioners NT-,t 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 2014-3765 [Fi1 a a` wnl 111 O — o [C .-- G N z ra r 7 N z tul C o a m o W F U o L_, H 2 w p w 1--- M J wO Z acflU � z0 0 w pa J z o L�l i ZZ a co u g 5 C� aci _ L cn W a VIi It N p U 8 a ai U 0 o U z u �. Et C J 0 Z a Z - .� d Z — a o a Q F:, rug I E to - ce 0 0 ' Wco E 0v Dv mD Z v -43 v W 0 a � w v o W ' o Y t = Wa UE z z N LO 7 re x 7 Z J O a = en cc a p ¢ l� d o 0 (� 0 N W Z O IL o IL o �. Iliil!ita U v 0 cc I"' r Q w ZQ c l lii iJll I , U Uz •; ,7,0z J x ~i N F- c �i -i W J 0 w m oN w - o o � } a ? ro W r U (LJ (C ? la Z w 13 o xrp a m W P. �1�1 W p m13 7 w ~ O 1 W Z Y Z D 7Z a v "PE ,� m w Cy' 7 U aramg p ro- 7K11_9.1 lg lg LGinia"LGILG nlg LGIn l� [Big Mini lig la'la , J86l ' e DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1555 N. 17th Avenue Gree'ey, CO 80631 Public Health ., Wet,: httrO:/lwww.Coweld co t 4,DeoarlmertsIHeaILEnvironmentiindex.html �+' I Health Administration Public Health&Clinical ErviroMNMatHealth Communication, EIMrgancy Preparedness t�f� _ Y(lal Records Services Sanlces Education it Planning &Reeponoo /f u) OI .Aj V- Tvte.670.304 6410 Tole:970 304.8420 TWe.970.304.6415 Tele:970 304.6470 Tee:970.304 6420 U r64 970 304.6412 Fax:970.304£416 Fay:070 304 6411 Fo•. D70.304 6452 Fes:97O304 6469 Our lesion:Tocofl.a,Kali,me communities we serve,we are waking 10 make Weld County Ow IwolUiio51 p11)05 fo live.item wn/k a•,d'Way October 24,2014 Barry Schaefer Chair Weld County Emergency Medical/Trauma Service Council Via email: bschaeler(u,3plattevalleytire.ctrg SUBJECT:2015 Banner Health/NCMC Paramedics 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 Banner Health/NCMC Paramedics. 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 7-2-100.8.5. of the Weld County Code (enumerated below). The Department will forward your recommendation to the Commissioners. Below arc the most applicable portions of the code: Weld County Code,7-2-100.B.5 The recommendation of the Weld County Emergency MedicaUTrauma 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 Arca. 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 H: Licensure authorizing for transports of patient(s)to and from licensed medical facilities. This licensure dues 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 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: Banner Health/NCMC Paramedics 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 Area: (:.1. Other EMTS Council recommendations or comments: t{ Recommendation 13y.` , f.-c Daie: 1[1�� Banner Health/North Colorado Medical Center Paramedic Services 1121 M Street ,CO. 80631 u.r,ne.Notn Greeley, North Colorado Supervisor Cell: (970)302-2833 Medical Center' Banner Health/NCMC Paramedics Ambulance Service License Application Date of Application: 10/21/2014 Name of the Ambulance Service: Banner Health/North Colorado Medical Center Paramedic Services Owner: Name Banner Health/North Colorado Medical Center Address: 1801 16th Street. Greeley,CO. 80631 Phone Number: (970)392-2435 Operations Manager: Name Mitch Wagy Address: 1121 M Street. Greeley,CO. 80631 Phone Number: (970)392-2435 For Office Use Only: Date Received: / / Documents Checked(Y/N): Remarks: Approval Recommendation: Date Referred to B.O.C.C.: / / Licensing Agent: Application Submission Statement: iHvperlinkl See Hard Copy at End of Application Banner Health/NCMC Paramedics: County Licensing Application (2014 to 2015) Banner Health/North Colorado Medical Center Paramedic Services 1121 M Street Itannvr North CO. 80631 North Colorado Supervisor Cell: (970)302-2833 Medical Center. Pursuant to Section 7-2-40 of the Weld County Code: Any change of ownership requires a new application for ambulance service license. All vehicles are two axles. Name and address of each stockholder or partner owning 10%or more of the outstanding stock of the company or having more than a 10%ownership interest if applicable: Not Applicable. What area of your County will be served by this company? Please attach a map indicating the service area. • Map#1. • Map#2. All of the Weld County Service area with the exception of the following cities or towns: • Oacono. • Firestone. • Frederick. • Johnstown. • Lochbuie. • Milliken. • Severance. • Windsor, • Southeast Weld. ._ I - 'Weld — 4W , • WELD •T- 1 f • _ ,�.,..._ es COUNTY •�.r I I _ 1 1 M" �t IfEd[SSUO 't WOW . .. _. Banner Health/NCMC Paramedics: County Licensing Application (2014 to 2015) Banner Health/North Colorado Medical Center Paramedic Services 1121 M Street ',miner I lean h Greeley,CO. 80631 North Colorado Supervisor Cell: (970) 302-2833 Medical Center• Stations: How many stations do you have? Five indicate the location and description of the stations from which these ambulances will operate. If there are more than two locations,attach a separate sheet with the above information: Location#1 Address: 1121 M Street. Greeley,CO. 80631 Phone Number: (970)392.2438 Location#2 Address: 34015. 11`h Avenue. Evans,CO. 80620 Phone Number: (970)392-2452 Location #3 Address: 2000 70`h Avenue Phone Number: (970)395-2690 Location#4 Address: Gilcrest Fire Department: 14679 WCR 42. Gilcrest,CO. 80651 Phone Number: (970)737-2966 Location#5 Address: Fort Lupton Fire Department: 2999 9`h Street. Fort Lupton,CO. 80621 Phone Number: (970)392-2446 Banner Health/NCMC Paramedics: County Licensing Application (2014 to 2015) Banner Health/North Colorado Medical Center Paramedic Services 1121 M Street minn� health Greeley,CO. 80631 North Colorado Supervisor Cell: (970)302-2833 Medical Center Banner Health /NCMC Paramedics Ground Vehicle List Date of Application: 10/21/2014 Name of the Ambulance Service: Banner Health/North Colorado Medical Center Paramedic Services Owner: Name Banner Health/North Colorado Medical Center Address: 1801 16th Street, Greeley,CO. 80631 Phone Number: (970)392-2435 Assistant Chief: Name Mitch Wagy Address: 1121 M Street. Greeley,CO. 80631 Phone Number: (970)392-2435 Medical Director: Name Dr. Rob Lowe Address: 1121 M Street. Greeley,CO. 80631 Phone Number: (720)317-9964 Section 7.2-110 of the Weld County Code: If an ambulance is replaced or an additional ambulance is added to a service's fleet, an application for an ambulance permit shall be filed with the Department within 30 days of receipt of the new ambulance. The completed application shall include a description of the ambulance replaced. Upon receipt of a new ambulance vehicle permit application,the Department shall inspect the new ambulance and issue the new ambulance vehicle permit,if applicable i3 A,„bµloIu.S Banner Health/ NCMC Paramedics: County Licensing Application (2014 to 2015) Page 2 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): What area of Weld County will be served by this company? Please attach a map indicating the service area. 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#1: Street Number: City: State: Phone: Location#2: 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 yo pliance 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 regulation of the date of the application,are you in compliance with the reporting requirements of the agency profile: es No Level of Service Requested(circle one or more): Tier 1 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 H: 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 lll: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) Kevin Antuna From: Bressler, Dave[Dave.Bressler@bannerhealth,com] Sent: Thursday, October 23, 2014 2:42 PM To: Kevin Antuna Cc: Wagy, Mitch E; Fain, Marilyn G Subject: Mutual Aid Agreements- Banner Health North Colorado Medical Center Paramedic Services Kevin: Banner Health North Colorado Medical Center Paramedic Services does no currently have written mutual aid agreements, Agency(s) needing assistance are instructed to follow standard dispatch protocol/standard operating procedures and contact Weld County Regional Communications and request the resources they need from Banner Health North Colorado Medical Center Paramedic Services. To date this has worked without issue on daily operations and the recent events where mutual aid has been provided throughout our service area. Please contact me if you have any questions. Thank you, rr Dave Bressler, Chief Banner/NCMC Paramedic Services (970) 392-2431 W (970) 302-1127 C Banner Health' NoC0 CONNECTED "PRI VII,CG X CON El DEN TIAI,a" Unless expressly stared otherwise,this message(and any attachment(s)thereto)is confidential and may be privileged. It is intended for the addressee(s)only.If you are not an addressee,any disclosure or copying of the contents of this e-mail or any action taken(or not taken)in reliance on it is strictly prohibited.If you are not an addressee,please inform sender immediately and delete this message from your system 1 • 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 THA AN AMBULANCE SERVICES L ENSE HAS BEEN ISSUED BASED ON FALSE INFORMATION CONS TES GR N FOR LICEN REVOCATION AND POSSIBLE CRIMINAL PROSECUTION. rcy 14 1 Signature of Applicant Title fate S4- SUBSCRIBED AND AFFIRMED BEFORE ME THIS DA, Y OCVC5 R ,20 ,IN THE COUNTY OF w"L,t�J ,STATE OF COLORADO. CHARLENE E SWAIN C NOTARY PUBLIC " ' Signature of Notary STATE OF COLORADO n �}, NOTARY ID 20024010397 My Commission expires: /p Jd�ci C� MY COMMISSION EXPIRES MARCH 29, 2018 P J 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@pvhsorg; 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@tvemscom; mlawley@mvfpd.org; rlesher@tvems.com; Christopher L. Mulberry Cc: bschaefer@plattevalleyfireorg; 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 Itor : - a ₹ punt,;, 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