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Home My WebLink About2012-163 License - Ambulance Operators f Yy7L .. YJ_u.. •~C ryyE /`, k ` Jam..- C .wSs1 . ` '•II ..' Iif.'If l Y, U) -h :3 � CD D c Fi 3 j = cD cn v fl' m � — 0 ! t. CD CD y ,( c- 3 CD CL cn - C: CD = CD :3 ;U (D > o rtcn CL v W p CD C) D cn o N III, ' cr o � 1 n CD r N CD a rn CD N ! ! l o c� I CD r CL CD i ' CD N CITY OF ASHLAND , Council Communication N15tZ0T 'Business Meeting Ambulance Operator's License Renewal FROM: John Karns, Fire Chief Ashland Fire &Rescue kamsi@ashland.onus SUMMARY Annual renewal by Council of the Fire Department's Ambulance Operator's License per AMC 6.40.110. BACKGROUND AND POLICY IMPLICATIONS: Ashland Municipal Code (AMC) Chapter 6.40.110 requires ambulance service providers operating within the City of Ashland to apply annually for an ambulance operator's license. The fire department has provided emergency services in Ashland since 1885. From 1926 to 1936, the fire department operated the ambulance service in Ashland, and in 1936 the ambulance service was sold to Litwiller Funeral Home. The fire department obtained its first medical response vehicle (Rescue 9) through community donations in 1973, and began providing first response emergency medical services to the community. In January 1996, the City of Ashland purchased the Ashland Life Support Ambulance Company and Ashland Fire & Rescue began providing ambulance services within a 650 sq mile ambulance service area in south Jackson County, known as ASA III. Ambulance services in Oregon are regulated by county governments, and within the City of Ashland they are required to obtain an ambulance operator's license. This license is renewed on an annual basis. FISCAL IMPLICATIONS: The license fee of$300 plus $100 per ambulance, for a total of$900. This is provided for by a line item in the department's emergency medical services budget (604160). STAFF RECOMMENDATION AND REQUESTED ACTION: Staff recommends renewal of the Ambulance Operator's License for Ashland Fire &Rescue. SUGGESTED MOTION: Does the Council wish to approve the Ambulance Operator's License renewal for Ashland Fire & Rescue? ATTACHMENTS: ' Ambulance license renewal application. Page 1 of 1 �r, CITY OF ASHLAND APPLICATION FOR AMBULANCE OPERATOR LICENSE AMC Ch. 6. 6.40 2012 Applicant's Name: CITY OF ASHLAND Trade Name, if any: ASHLAND FIRE & RESCUE Address: 455 Siskiyou Boulevard Ashland OR 97520 Telephone number: 541 482-2770 Ambulance descriptions Manufacturer Vin # License # 1. 1996 FORD LIFELINE 1FDKE30F8THA48282 EXEMPT 2. 1998 FORD LIFELINE 1FDXE40F2XHAO0469 EXEMPT 3. 2003 FORD LIFELINE 1FDXF47F63EA10341 EXEMPT 4. 2006 FORD LIFELINE 1FDXF47P06ED06467 EXEMPT 5. 2008 FORD LIFELINE 1FDXF47R48ED90832 EXEMPT 6. 2011 FORD LIFELINE 1FDUF4HTOBEC53861 EXEMPT • Attach information showing that every proposed driver, attendant and driver- attendant is qualified as required in Ashland Municipal Code Chapter 6.40 and as required by the laws of the State of Oregon. • Enclose with the application, the initial license fee of$300 plus $100 per ambulance. • Enclose a performance bond in the amount of$500,000. • Enclose an insurance policy meeting the requirements of AMC §6.40.110.7. Attach additional pages as necessary. Explain any box not checked. Submit your application and required enclosures to Barbara Christensen, City Recorder, City Hall, 20 East Main Street, Ashland, Oregon 97520. I certify that each ambulance listed above is adequate and safe for the purposes for which it is to be used and that it is equipped as required by Ashland Municipal Code Chapter 6.40 and the laws of the State of Oregon. Signature: / Print name: Greg I. Case Title: Division Chief Date: 04-03-2012 K: Ambulance lic\City Licensing\2012\2011 lic renewal.doc April 10, 2009 _ CERTIFICATE OF COVERAGE Agent This w-runcata is issued as a matter of infcrmawn Direct only and n those confers no rides upon the era e:ate holder - aher and Inose provided in u the coverage ate holder This certificate does not amend,Emend of alter tha coverage afforded by the coverage eoeumems listed herein, cilycouniy insurance services 'Named Member or Participant Companies Affording Coverage City of Ashland COMPANY A-Citycounty insurance Services(CIS) 20 East Main Street COMPANY B-National Union Fire Insurance Company of Pitts,PA Ashland,OR 97520 COMPANY C-RSUI Indemnity LINES OF COVERAGE This Is to cerwy that coverage documents listed herein have been issued to the Named Member herein far the Coverage period indicated. Not wihstanding any requirement term or condition of any contract or other document with respect to which the cen,fica a may be issued or may pertain,the coverage afforded by the coverage documents listed herein Is subject to all the terms,condihons and exclusions of such coverage documents. Type of Coverage Company Certificate Effective Termination Letter Number Date Date Coverage Limit General Liability A 11LASH 771!2011 7712012 General Aggregate: 515,000.000 X Commercial General Liability Each Occurrence: 55,000.000 X Public Officials Liability X Employment Practices X Occurrence Auto Liability A ti LASH 7/1/2011 7112012 General Aggregate: None X Scheduled Autos Each Occurrence: $5.000,000 X Hired Autos _ X Non-Owned Autos Auto Physical Damage A 11APDASH 7!112011 7!12012 X Scheduled Autos X Hired Autos X Non-Owned Autos X Property A 11 PASH 7112011 7/112012 Per Filed Values X Boller and Machinery A 11BASH 7/1/2011 7/12012 Per Filed Values X Excess Crime B 11 ECASH 7/112011 7/1/2012 Per Loss; $250,000 Excess Earthquake Excess Flood Workers'Compensation Description: Jackson County Is named as additional Insured per the agreement made between Jackson County and the City of Ashland giving Ashland Fire&Rescue the ekefusive right to provide ambulance service in ASA#3, Cishilicate Holder: CANCELLATION:Should any of the coverage documents herein be cancelled before the explrab'an date thereof.CIS will Provide 30 days wn3en notice to me certi0caie holder named herein,but WVre to mail Jackson County such nolica shidl hnpos,no obligation or liability of any kind upon COS.its agents or mpmsenl4rves,or 1005 East Main Street the issuer of this cerhfcato. Medford.OR 97504 ' �K�• "-�"- --'rI °"- Date: June 21,2011 '' OREGON DEPARTMENT OF HUMAN"SERVICES,.., AuDRNO, EMERGENCY MEDICAL SERVICES& TRAUMA SYSTEM 34418 ., CERTIFICATION NUMSER:' - .. 80.00 ' . E19 8560 _. PAYMENT RECETVEO AMBULANCE TYPE: .. EXPIRATON-.r "•'1996`; DATE Ford VD. DAY YR. AMBULANCE LICENSE POST IN AGENCY 06130/2012; ; City of Ashland#1501 455 $ISk1y0U Blvd ADMINISTRATOR Ashland OR 97520 :STATE HEALTiI DIVISION MUST BE POSTED IN A CONSPICUOUS PLACE-NOT TRANSFERRABLE AUDIT NO. OREGON DEPARTMENT OF HUMAN SERVICES EMERGENCY MEDICAL SERVICES',&TRAUMA SYSTEM 34424 to CERTIFICATION NUMBER $0,00 '. E211465 '.: PAYMENT RECEIYEO . ,'•: r .. - EXPIRATION:. AMBULAlICE TYPE: DATE ;. 1998 Ford Ma.-uAJ YR. F. AMBULANCE LICENSE POST IN AGENCY . 08/3012012 —_ - ; City of Ashland#1501 I ,; 455 Siskiyou Blvd ADMINISTRATOR Ashland OR 97520. <- STATEHEAU VDmsION I i .............._. _._. .. -. . MUST BE POSTED IN A CONSPICUOUS PLACE-NOT TRANSFERRABLE OREGON DEPARTMENT OF:HUMAN'S.ERVICES . AuDNNO. EMERGENCY MEDICAL SERVICES $c TRAUMA SYSTEM 34439, OERTiF"TION NWBER: :. `$0.00 E222273 PAYMENT RECENO AMEVLANCE TYPE: ` EXPIRATION DATE -:2002.:Ford M. DAY YR. AMBULANCE LICENSE-POST,IN AGENCY, 0613012012' ;.' City of Ashland#1501 455 Siskiyou Blvd ADMINMTRATOR Ashland OR 97520 STATE HEALTHDNISION ! I OREGON DEPARTMENT OF HUMAN SERVICES,". NO. PUBLIC HEALTH DIVISION EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEMS PROGRAM 34377, AGENCY NUMBER: • :. 1501 OPERAM14 DATES NO. DAY YR.THRU MO. DAY YR. AMBULANCE AGENCY LICENSE— POST IN AGENCY 65/.12/2'611 'Ofil30/2012 'i C11y of Ashland 41501 455 SiskiyoU Blvd PAYMENT DATE Ashland, OR 97520 Mo• DAY rA' 05112!2077 MUST BE POSTED IN A CONSPICUOUS PLACE-NOTTRANSFERRABLE CITY OF TALENT No. (541) 482-2770 /j m e J The person, firm or corporation below named is hereby granted license to engage in, carry on or conduct, in said city, the business, trade calling, profession, exhibition or occupation described below; for the period indicated. ASHLAND FIRE & RESCUE NAME OF BUSINESS City of Ashland Licensee: 455 Siskiyou Blvd Ashland OR Address: 455 Siskiyou Blvd Ashland OR 97520 Date of Issue . Jan. 1, 2012 �E/Y/ Dec. 31, 2012 Authorized by //j/�� - qTV RECD POST OFFICE BOX 445 TALENT,OREGON 97540 TELEPHONE(541)535-1566 ASHLAND FIRE DEPARTMENT, PAUL S MD ROSTYKUS, PAUL S MD 455 SISKIYOU BLVD ASHLAND, OR 97520.0000-000 Ilrlrr llrrlllllrrrlrlllrrlllrlrllrrrllrrrlllrrllrrrlllrrllrl�l BEA REGISTRATION THIS REGISTRATION FEE ) CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE Nu1.teER EXPIRES Palo I UNITED STATES DEPARTMENT OF JUSTICE JBA3050692 .06-30-2012 FEE EXEMPT I DRUG ENFORCEMENT ADMINISTRATION I WASHINGTON D.C.20537 SCHEDULES BUSINESSACTNITY" ISSUE DATE i This registration is only for use at Federal or State Institutions. 2,2N, PRACTITIONER. ' 05-11-2009 1 3,3N 4,5 1 1 Sections 304 and 1008(21 USC 824 and 958)of the Controlled ASHLAND FIRE DEPARTMENT,PAUL S MD I Substances Act of 1970, as amended, provide that the Attorney ROSTYKUS,PAUL S.MD I General may revoke or suspend a registration to manufacture, 455 SISKIYOU BLVD distribute,dispense.Import or export a controlled substance. ASHLAND,OR 97520-0000 I THIS CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF 1 OWNERSHIP,CONTROL,LOCATION,OR BUSINESS ACTIVITY, 1 AND IT IS NOT VALID AFTER THE EXPIRATION DATE. I CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE UNITED STATES DEPARTMENT OF JUSTICE - DRUG ENFORCEMENT ADMINISTRATION , WASHINGTON D.C.20537 - BEA REGISTRATION THIS REGISTRATION FEE NUMEER EXPIRES PAID BA3050692 06-30-2012 FEE EXEMPT This registration is only 1 . for use at Federal or State institutions. SCHEDULES BUSINESS ACTATIY .ISSUE DATE 2j2N, PRACTITIONER 05-11-2009 3,3N,4,5, ASHLAND FIRE DEPARTMENT, PAUL'S MD Sections 304 and 1008(21 USC.824 and 958)of the ROSTYKUS, PAUL S MD Controlled Substances Act of 1970, as amended, N 455 SISKIYOU BLVD -provide that the Attorney General may revoke or ASHLAND, OR 97520-0000 suspend a registration to manufacture, distribute, o dispense,Import or export a controlled substance. i LLTHIS,CERTIFICATE IS NOT TRANSFERABLE ON CHANGE OF OWNERSHIP,CONTROL,LOCATION,OR BUSINESS ACTIVITY, AND IT IS NOT VALID AFTER THE EXPIRATION DATE. i CITY OF ASHLAND APPLICATION FOR AMBULANCE OPERATOR LICENSE 2012 First Employee Last Name Name MI Level Status Anders, Brian W. EMT-Paramedic PFT Beck Todd E. EMT-Paramedic PFT Boyersmith Steven P. EMT-Paramedic PFT Burns Kelly W. EMT-Paramedic PFT Case Greg I. EMT-Paramedic PFT Formolo Curt J. EMT-Paramedic PFT Foss Justin EMT-Paramedic PFT Freiheit Matthew E. EMT-Paramedic PFT Hadden Jennifer A. EMT-Paramedic PFT Hanstein David C. EMT-Paramedic PFT Hegdahl Tim R. EMT-Paramedic PFT Hickman Margueritte LR EMT-Basic PFT Hollingsworth Scott M. EMT-Paramedic PFT Knutson Brent A. EMT-Paramedic PFT Garfas-Knowles Ronald W EMT Paramedic PFT LaCoste Rod T. EMT-Paramedic PFT Manning Ashley EMT Paramedic PFT Menold Lance W. EMT-Paramedic PFT Rasor Marshall G. EMT-Paramedic PFT Roselip David EMT-Paramedic PFT Rosenlund Derek A. EMT-Paramedic PFT Sallee Dana S. EMT-Paramedic PFT Shepherd David G. EMT-Paramedic PFT Stephens Robert W. EMT-Paramedic PFT Stoy John Trent EMT-Paramedic PFT Stubbs Todd C. EMT-Paramedic PFT Trask Robert EMT-Paramedic PFT Turner Shannon W. EMT-Paramedic PFT ASHLAND FIRE & RESCUE APPLICATION TO PROVIDE AMBULANCE SERVICE 2012 Vehicles/ Equipment Level *as of 01-01-12 VEHICLES MILEAGE TYPE LEVEL Unit# Year Model License VIN# ALS/BLS Shop# Ford 8831 2011 Lifeline E244394 IFDUF4HTOBEC53861 8381 1 ALS 845 F-450 4X4 Ford 8833 2006 Lifeline E233465 1FDXF47F06ED06467 103,305 I ALS 552 F-450 4X4 Ford 8832 2008 Lifeline E244368 IFDXF47R48ED90832 41,852 1 ALS 615 F-450 4X4 Ford 8834 2003 Lifeline E222273 1FDXF47F63EA10341 112,116 1 ALS 462 F-450 4X4 Ford 8835 1998 Lifeline E211465 1FDXE40F2XHAO0469 127,748 3 ALS 364 E-450 4X4 Ford 8836 1996 Lifeline E198560 1FDKE30178THA48282 115,887 3 ALS 283 E-350 4X4 Barbara Christensen From: Cindy Hanks [hanksc @ash land.or.us] Sent: Tuesday, April 03, 2012 11:10 AM To: 'Greg Case' Cc: 'Barbara Christensen' Subject: RE: G reg, Thank you for your information. We will issue the JE for the transfer. Thanks Cindy From: Greg Case [mailto:caseg @ashland.or.us] Sent: Monday, April 02, 2012 2:17 PM To: 'Cindy Hanks' Cc: 'Barbara Christensen' Subject: CITY OF -ASHLAND Memo DATE: 4-03-2012 TO: Cindy Hanks CC: Barbara Christensen, City Recorder FROM: Greg I. Case, Fire Dept- Division. Chief RE: Renewal of City of Ashland Ambulance Operator License Fee Cindy, It is time once again for our ambulance renewal and a check must accompany our Ambulance license renewal. Could you do an inter-departmental transfer or Check for the Ambulance Licensing Fees From the EMS account# 110.07.13.00.604160 to the City of Ashland accounts receivable. It needs to be included in the renewal Application for Ambulance Operators License that includes the required certifications and documentation required by the AMC 6.40. the Chief has sent the Memo to Dave and a Council Communication requesting ambulance license renewal and is not yet scheduled for a council meeting. As in the past the fees and bond have just been charged to our budget—let me know if this is still correct. Should you need any other information please let me know and I will get it to you as soon as possible. t • Thank you! Greg Case, EMS Division Chief City of Ashland / Ashland Fire& Rescue 455 Siskiyou Boulevard Ashland, OR 97520 caseg(@ashiand.or.us Phone: 541-482-2770 TTY: 1-800-735-2900 Fax: 541-488-5318 This email is official business of the City of Ashland, and is subject to Oregon public records law for disclosure and retention. If you have received this message in error, please notify me. 2 CITY OF ASHLAND- Memo DATE: 4-03-2012 TO: Cindy Hanks CC: Barbara Christensen, City Recorder FROM: Greg I. Case, Fire Dept- Division. Chief RE: Renewal of City of Ashland Ambulance Operator License Fee Cindy, It is time once again for our ambulance renewal and a check must accompany our Ambulance license renewal. Could you do an inter-departmental transfer or Check for the Ambulance Licensing Fees From the EMS account# 110.07.13.00.604160 to the City of Ashland accounts receivable. It needs to be included in the renewal Application for Ambulance Operators License that includes the required certifications and documentation required by the AMC 6.40. the Chief has sent the Memo to Dave and a Council Communication requesting ambulance license renewal and is not yet scheduled for a council meeting. As in the past the fees and bond have just been charged to our budget—let me know if this is still correct. Should you need any other information please let me know and I will get it to you as soon as possible. Thank you! Ashland Fire&Rescue Tel:541482-2770 455 Sisklyou Blvd. Fax:541488-5318 =, Ashland,Oregon 97520 TTY: 800-735-2900 vmv.ashland.or.us