HomeMy WebLinkAboutAmbulance License
CITY OF ASHLAND
APPLICATION FOR AMBULANCE OPERATOR LICENSE
AMC Ch. 6. 6.40
Applicant's Name: CITY OF ASHLAND
Trade Name, if any: ASHLAND FIRE & RESCUE
Address: 455 Siskiyou Boulevard
Ashland OR 97520
. (541) 482-2770
Telephone number:
Ambulance descriptions Manufacturer Vin# License #
1. 1992 FORD WHEELED 1 FDJS34M4NHA34394 EXEMPT
COACH
2 1992 FORD LIFELINE 1 FDKE30M7PHA05945 EXEMPT
3. 1996 FORD LIFELINE 1FDKE30F8THA48282 EXEMPT
4. 1999 FORD LIFELINE 1FDXE40F2XHA00469 EXEMPT
5. 2002 FORD LIFELINE 1 FDXF4 7F63EA 10341 EXEMPT
6. 2006 FORD LIFELINE 1 FDXF47P06ED06467 EXEMPT
1:1 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.
1:1 Enclose with the application, the initial license fee of $300 plus $100 per ambulance.
1:1 Enclose a performance bond in the amount of $500,000.
1:1 Enclose an insurance policy meeting the requirements of AMC ~6.40.11 0.7. 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: ~?LJ~
P~int name: t /./-1, c: /;JtlP d /L j 0
Title: 14- (j4~f-r
Date: / P , J / ,-~{-
H:\ASA\City Lieensing\2006Applieation for Lie..doe
May 16, 2006
APPLICATION TO PROVIDE AMBULANCE SERVICE
08/2006
Vehicles/ Eauioment Level
VEmCLES
MILEAGE TYPE LEVEL
Unit # Year Model License VIN# ALS/BLS
Shop #
8831 2006 Ford
552 Lifeline C 131Vt~- IFI))(F '17 ~6'i>P€/167 3,743 1 ALS
F - 450
4X4
Ford
8833 1998 Lifeline E211465 IFDXE40F2~00469 119,105 3 ALS
364 E-450
4X4
Ford
8832 2002 Lifeline E222273 IFDXF47F63EA10341 63,379 1 ALS
462 F - 450
4X4
Ford
8835 1992 Lifeline E195689 IFD~30M7PFU\05945 88084 3 ALS
133 E-350
4X4
Ford
8834 1996 Lifeline E198560 1 FD~30F8TFU\48282 110,905 3 ALS
283 E-350
4X4
Ford
8836 1992 Wheeled E195689 IFDJS34M4NFU\3494 89,667 2 ALS
68 Coach
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. OREGON DEPARTMENT OF HUMAN:SERV1CES .. '.
EMERGENCY MEDICAL SERVICES '& TRAUMA SYSTEM
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AUDIT NO.
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I City of Ashland r
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EMERGENCY MEDICAL SERVICES & T@\LJMA sYSTEM
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CEflTIFlCA1'1ONNUMBER:
E211465
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. EXPIRATION
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" AMBULANCE TYPE:
~ 1999 Ford
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06/30/2007
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455 Siskiyou Blvd i
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OREGON DEPARTMENT OF HUMAN SERVICES .'
EMERGENCY MEDICALSERVICES & TRAUMA SYSTEM
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AUDiT NO. ,,~'::r~t .
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:1 CERTIFicATioN NUMBER: .'
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~ AMBULAN2E TYPE:
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. OREGON DEpARTMENT OF HUMANSERVICES'.
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Ashland OR !
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First Level
Last Name Name MI Cert # Expires DL# Emol Stat
Anders, Walt L. EMT -Basic 112485 6/30/2007 1955034 PFT
EMT-
Beck Todd E. Paramedic 124333 6/30/2007 5837326 PFT
EMT-
Borosund Lars F. Paramedic 127032 6/30/2007 8716517 PFT
EMT-
Boyersmith Steven P. Paramedic 120378 6/30/2007 4545965 PFT
EMT-
Burns Kelly W. Paramedic 120248 6/30/2007 5207865 PFT
EMT-
Butterfield Derrek L. Paramedic 130423 6/30/2007 9322054 PFT
EMT-
Case Greg I. Paramedic 113788 6/30/2007 3254941 PFT
EMT-
Earl William Paramedic 128504 6/30/2007 PFT
EMT-
Cockell " Robert C. Paramedic 123943 6/30/2007 6109120 PFT
EMT-
Formolo Curt J. Paramedic 118901 6/30/2007 3738940 PFT
EMT-
Freiheit Matthew E. Paramedic 121237 6/30/2007 4927105 PFT
EMT-
Hadden Jennifer A. Paramedic 124336 6/30/2007 3535298 PFT
EMT-
Hanstein David C. Paramedic 111814 6/30/2007 2524064 PFT
Hickman Margueritte LR EMT-Basic 128889 6/30/2007 3676587 PFT
EMT-
Hollingsworth Scott M. Paramedic 113607 6/30/2007 2830146 PFT
EMT
Knutson Brent Paramedic 130961 6/30/2007 PFT
EMT-
LaCoste Rod T. Paramedic 127119 6/30/2007 4322818 PFT
EMT-
Manning Donald Paramedic 129281 6/30/2007 PFT
EMT-
Martin Richard F. Paramedic 130001 6/30/2007 8543648 PFT
EMT-
Menold Lance W. Paramedic 125954 6/30/2007 6022755 PFT
EMT-
Rasor Marshall G. Paramedic 126969 6/30/2007 5067632 PFT
EMT-
Rosenlund Derek A. Paramedic 121067 6/30/2007 5541498 PFT
EMT-
Sallee Dana S. Paramedic 116336 6/30/2007 3654752 PFT
EMT-
Shepherd David G. Paramedic 123197 6/30/2007 3667291 PFT
EMT-
Stephens Robert W. Paramedic 123787 6/30/2007 5856509 PFT
EMT-
Stidham Ryan E. Paramedic 127950 6/30/2007 5182683 PFT
EMT-
Stoy John Trent Paramedic 118911 6/30/2007 4856227 PFT
EMT-
Stubbs Todd C. Paramedic 130277 6/30/2007 9309381 PFT
EMT-
Turner Shannon Paramedic 126208 6/30/2007 PFT
ASHLAND FIRE & RESCUE
APPLICATION TO PROVIDE AMBULANCE SERVICE
2006
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES e 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 E!) Fax (503) 731-4077
Walt LAnders
23 Wilson Road
Ashland, OR 97520-9102
Congratulations on your recertification! Below is your new EMT-B certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit; continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
\- - - - - -STATEoF OR~Go;:; - - - - - -\- STAT-; OF OREGO-;- DEPARTMENT OF HUMAN SERVICH
I EMERGENCY Mi:OIGAL TECHNICIAN I EMERGENCY MEDICAL S~R\lIc;.:ES & TRAUMA SYSTEMS
I I IDENTIFiCATION
I CERT. # 112485 BASIC EXPIRES 06/30/2007 I <l>
I Walt L Anders I ~ EMT -B CERT. # H2485
23 Wilson Road I ~ Walt LAnders
I Ashland, OR 97520-9102. . I_i
I HT:6'2"
The individual named above and described on the reverse of this card has ~
I completed the requirements set forth in ORS 682 et seq. and is certified as 12 WI: 198
I an Emergency Medical Technician at the level indicated.
I L 11-'. /cJ' r.P _~ ~. ctiL~ ~
H.A1R: Blonde
EYES: Hazel
Signature of Certificate Holder
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232,. (503) 731-4011 G Fax (503) 731-4077
May 20, 2005
Todd E Beck
21 Anna Laura Dr
Jacksonville, OR 97530 .
on
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Em~rgency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
. rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems..
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquetinformation, EMS for Children, and a list of staff you can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
1- - - - - STAT;-QEOf\EGO;- - - - - - -\- STAT~ OF OREGON - DEPARTMENT OF HUMAN SERV\CE~
\ EMERGENCYM~pit:~tTI?C;:HNICIAN \ EMERGENCY MEDICAL Sl.\t\~ES & TRAUMA SYSTEMS
: CERT. # 124333P ;(tt#~~~19 ~~~s 06/30/2007 I ~. IDEN ION
I Todd E Beck ... .. I ~ EMT-P CER't.t!,124333
21 Anna Laura'Dr ~ Todd E Beck
I Jacksonville, OR 97530 I ~
I 1_0",<=
HT: 6' 1"
The individual named above and described on the reverse of this card has I ~
I completed the requirements set forth inORS 682 et seq. and is certified as _ WT: 215
! "E~~"" '""ow :t:d~ ! ",. ","'"". '" ,.,:::::: ::~:=:~,'o:'~:~:' (; i) r. ? r
.~: DatkBrown
EYES: Blue
June 23, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 . Fax (503) 731-4077
Lars F Borosund
1766 Serenity Drive
~edford,OR 97504
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name ,return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of $10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rilles are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements f9r all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
------------------\--------
I STATE qJ=()REGON - STATE OF OREGON - DEPARTMENT OF HUMAN SERV1C~
I EMERGENCYMEPICAL TECHNICIAN I EMERGENCY MEDICAL S~f1c'14IqES & TRAUMA SYSTEM~
I CERT. # 127032 PARAMEDIC EXPIRES 06/30/2007 I' IDEN1"~'rqATloN
I . ....... I"
I Lars F Borosund I ~ EMT-P CER1'.#J27032
I 1766 Serenity Drive I ~ Lars F Borosund .
Medford, OR 97504
I 1.2~
'" HT: 5'7"
The individual named above and described on the reverse of this card has
I /32.9 WT] -7
completed the requirements set forth in ORS 682 et seq. and is certified as _ : :>
an Emergency Medical Techniciqn at the level indicated, I
/' .' /1....-. J' , () ~. riA....J. I
HAlR: Light BrOWn
EYES; Brown
Signature of Certificate Holder
Department of Human Services - Health Services C>regon
EMERGENCY MEDICAL SERVICES ~ 800 NE Oregon Street Ste. 607
Portland, OR 97232 ~ (503) 731-4011 . Fax (503) 731-4077
May 20, 2005
Steven P Boyersmith
1110 La Lama Dr
~edford,OR 97504
Congratulations on your recertification! Below is your new EMT - P certification
__~~<:l.which_expires 06/JOL2_Q01~_-_________-___-____-___-___________- -- - ---- -----
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate ina secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealtb/emS.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile-tniining unit, continuing education requirements for a11levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics,Awar~ J3~_q~et_i_T.'fq~8:tiQn,EMS t:QrJ;bil9T-eu:aan4aJisLQfstafLyou_c.an-
-'contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
r ~ ~ ----~STATE QF- OREGON -~~ ~ ~ - ~l~ sTATE-oF OREGON~- DEPARTMENT OF HUMAN SERVICES'
1 EMERGENCY MEPICAL TJ:,CHNICIAN \ EMERGENCY MEDICAL qlS~\flGES & l"RAUMA SYSTEMS
I .. .. I IDEN'1]FICP;T10N
I CERT. # 126378 PARAMEDIC ExPIRES 66/36/2667 I .. . .
I - Steven P Boyersrnith . I ~ EMT -P CERT;# 12Q378
I III 0 La Lorna rpr I g Steven P Boyersmith
Medford, OR 97504 . . . ... I i
I The individual named above -and- desc;ribed onlhe reverse of this card has ~
I completed the requirements selforth in GRS 682 et seq. and is certified as 1:2
I an Emergency Medical Technician a.t thelEwel indicated. I
i b~ ^__,~~ i
HT: 5' II" HAJR: Dark Brown
WT: 170 C:,;--::","E'Ya;~n~
"/;::;5 ~.. ". ' ~/
_ . -- Signature of/Ge. .:- t€-ttp1aer
,. . .' /.-" -~_.-...,..
This certiiiq{,te is the prCiperty of the Deparrriie~i of Human
Sp.rvicp.s af1d-m!Jst be surrendered bv the holder on demand.
//
/
,-,/'
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 .. Fax (503) 731-4077
KeIIy W Burns
2691 Mickelson Way
Ashland, OR 97520
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems. .
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will fmd there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list. of staff you .can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
j STATE QFQBEGON
I EMERGENCYM;.OiCALTECHNICIAN
I CERT. # 120248 PARAMEI)ICEX~IRES 06/30/2007
I . .. .... .... . .. ...
I Kelly W Bums .
2691 Mickelson Way
I Ashland, OR 97520
I
I
I
I
The individual named above and described. on the reverse of this card has I ~
completed the requirements set forth in ORS 682 et seq. and is certified as _
an Emergency Medical Technician at the level indicated. I
~ _ ~ .~ _ _--I.- I
\ STATE OF OREGON - DEPARTMENT OF HUMAN SERVICE
I EMERGENCY MEDICAL Se;RMIQES & TRAUMA SYSTEM~
I IDENTriFJCATION
I"
I ~ EMT -p CERT.#,itZ024$
I ~ Kelly W Burns
0>
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.. HT: 6' 4"
WT: 200
~. P:' ('".:::;> "'r~
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I This certificate is the property of the Department of Human
Services and must be surrendered by the holder on demand
I
STATE OF OREGON - DEPARTMENT OF HUMAN SERVICES
EMERGENCY MEDICAL S & TRAUMA SYSTEMS
JDEJON
HT: 5' 10"
WT: 175
65354
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 e Fax (503) 731-4077
Greg I Case
816 Voris Avenue
Ashland, OR 97520
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$l 0.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealthlems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
j- - - - - -STAT~Of OREGO;:; - - - - - -\- STAT7 o~ OR EG 0-;- DEPARTMENT OF HUMAN SERVlC-;;
I EMERGENCYMEPICALTECHNICIAN I EMERGENCY MEDICAL SP:'1Y'IQES & TRAUMA SYSTEM~
: CERT. # 113788 J>AAAMtl)fCEXPIRES 06/30/2007 : <D IDENTIFICATION
I Greg I Case . I ~ EMT-P CERT;.#113188
I 816 Voris Avenue I~ Greg I Case
Ashland, OR 97520 ~
I 1.,,"0
'u HT: 5' 9"
The individual named above and described on the reverse of this card has I!!E
I completed the requirements set forth i~. ORS 682 et sea. and is certified as WT: 180
I an Emergency Medical Technician at the level indicated. I
. /' ". . 11 . Q ..A . I
Hi\.IR: Dat~ Brown
EYES: Green
Sianature df Certificate Holder
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232 e (503) 731-4011 e Fax (503) 731-4077
Robert C Cockell II
2101 Dead Indian Memorial Road
Ashland, OR 97520
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We.
encourage you to use this tool frequently. Some items you will find there other than
the Adrpinistrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all. levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you. can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
\- - - - - -STATE OFQR_EGO~ - -- - - - -j- STATE OF OREGO;-. DEPARTMENT OF HUMAN SERVICE
I EMERGENGYMEDI<;Al T~CHNICIAN I EMERGENCY MEDICAL ~~RYIPES & TRAUMA SYSTEM~
: CERT. # 123943 PARAMEDIC Ex~tllES 06/3012007 I Ql IDEN11;I17i~ATION
I Robert C CockellU ... .. I ~ EMT-P CERT.#JZ39f3
I 2101 Dead Indian Memorial Road I ~ Robert C CockeHll .
Ashland, OR 97520 ~
I 1_6",
HT: 5' 10"
I ~~~~~e~~~d~~ ~:~~~~~~~e s~~~o~t~S~~I~~sO~;~ee{~~~.s:n~ i~hi~e~~f;~dh:: I ~ WT: 175
I an Emergency Medical Technician at the level indicated. I
I/'. , //,-. J' ( () ~ _ rtA .~ -'- I
HAIR: Blonde
EYES: Blue
Signature of Certificate Holder
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Department of Human Services - Health Services lJreg'on
EMERGENCY.MEDICAL SERVICES ~ 800 NE Oregon Street Ste. 607
Portland, OR 97232 4} (503) 731-4011 .. Fax (503) 731-4077
May 20, 2005
Curt J Formolo
1883 Valley View
Medford, OR 97504
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealtb/ems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
,- - - - - STATEQEQREGO;- - - - - - -'-STATE O~ OREGO-;:;- DEPARTMENT OF HUMAN SERVICE
I EMERGENCvMepicAL TECHNICIAN I EMERGENCY MEDICAL SpRYlqES & TRAUMA SYSTEMS
I ...... .... \ IDEN'rIFI$ATION
\ CERT. # 118901 ,~~RAI"~l\\~!9l?;'~.-e~~s 06/3012007 \ <0';::0"
I Curt J Fonnol~. "" I ~ EMT-P CER'J\At;~~a!JQl
1883 Valley View I ~ Curt J Formolo .'
" Medford, OR 97504 IE",
The individual named above and de'sc.rib.ed. on. the reverse of this card has 1=0 HT: 6' 1"
I completed the requirements set forth in ORS 58? et seq. and is certified as _ WT: 185
I an Emergency Medical Technician at the level indicated. I
I b' I
I I
I I
f:iA:IR: D~tk13tQwn
,-;?A!YES: Brb~~/
/ 7' ,"
}", - .,,-...... ...-..:....,- ./
" .-. .'_:' , ,--' ',' ,. , ~--....-
Signature of C~tit:ate Holder r C? FO) ,',
This certificate is the property 01 the Department 01 Human i) .> (.I 0
Services and must be surrendered by the holder on demand " < ,
May 20, 2005
Department of Human Services - Health Services
El\1ERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 G Fax (503) 731-4077
Matthew E Freiheit
492 Thimbleberry Lane
Ashland, OR 97520 .
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, A wards Banquet information, EMS for Children, and a list of staff you. can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
\- - - - - -STATE 9f9REGO;; - - - - - -\- STATE OF OREGO-;:;- DEPARTMENT OF HUMAN SERVICE
I EMERGENCvlIIIEOICAL TeCHNICIAN I EMERGENCY MEDICAL SI?RYlqES & TRAUMA SYSTEMS
I . . .. . ..' . .,... . I IDENmj~jI;':A'rrON
I CERT. # 121237PARAMBDICEXPIRES 06/30/2007 I" '. . .
I Matthew E Freiheit I ~ EMT-P CERT~.#ftt~r37
I 492 ThimblebenyLane I i Matthew E Freiheit
Ashland, OR 97520 01
I I ~
-;;; HT: 6'0"
The individual named above and described on the reverse of this card has 1_:20
I completed the requirements set forth in ORS 682 et seq. and is certified as WT: 180
I an Emergency Medical Technician at the level indicated. I
I/', /1___1" () ~ riA' I
HAtR: Blonde
EYES: BlUe
Signature older-Micate Holder
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 . Fax (503) 731-4077
Jennifer A Hadden
1313 Mill Pond Rd
Ashland, OR 97520-7321
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealthlems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of inter~st, EMS hot
topics, Awards Banquet information, EMS for Children;. and a list of staff you. can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
\ - - - - - -STATEOE.QI?EGO~ - - - - - -\- STAT~ OF OREGO-;- DEPARTMENT OF HUMAN SERVICE
I EMERGENCYME.DICALTEcHNICIAN I EMERGENCY MEDICAL Sc~IiJ~l@.ES & TRAUMA SYSTEMS
I I IDENrll;:tie~rION
I CERT. # 124336 PARAMErflCEXPJRES 06/30/2007 I ~
I Jennifer A Hadden I ~ EMT -P CERT'# t24q~6
I 1313 Mill Pond Red ... ...... I ~ Jennifer A Hadden
I Ashland, OR 97520-7321 II
The individual named above anq described on the reverse of this card has 1-_""0
I completed the requirements set forth in ()8Sf382 et seq. and is certified as
I an Emergency Medical Technician 91 the'lilvel indicated. I
1/'., /1r-' J' , 0 ~ ~ rilL -1. I
.,' TI r\.' 'LiT"" p..., .
D' ;pp\n-t'trna1l1J 01: }--'rnrlT'='>ln '.oaPI"\\nCf";; _. h ge'.a'-lfl'l '....:~.llr-V.l.c...es
~... !lJl i}..' .-.. \/J!. ~,._ _'!o. __~......-. C~.!.J.t }.J ~/. ,,)1........, t-IL ...l!...1.l \y .1lI. u_,
EIvlERGENCY lVIEDICAL SERVICES (j 800 NE Oregon Street Sie. 607
Portland, OR 97232 ~ (503) 731.-40n I~Fax (503) 73 I -4077
May 20, 2005
David C Hanstein
1516 Larkspur
Medford, OR 97504
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates .from the Director, a list of available classes
.from the mobile training unit, continuing education requirements for aU levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
\ - - - - - -STATEOF OREGON - - - - - -\- STATE OF OREGON- DEPARTMENT OF HUMAN SERV\~t
\ EMERGENCY MEDICAL teCHNICIAN I EMERGENCY MEDICAL SEiFlYIPES & TRAUMA SYSTEM~
I CERT. # 111814 PARAMEDIC EXPIRES 06/30/2007 I IDENTiFlc:ATION
: David C Hanstein I ~ ElVIT-P CERT. ~N;1814
I 1516 Larks.pur I ~ David C Hanstein ....
I Medford, OR 97504 0>
I~ HT: 6' 2"
WT: 245
.......___,-;c.....
The individual named above and described on the reverse of this card has
completed the requirements set iorth in ORS 682 ~ and is certified as I ~
an Emergency Medical Technician at the level indicated. I
b~~ Jb'tT ~*ti~ !
//BAIR: IJarkBrowl1
!/~::~.:~~::~~':.HazeIS;:~:~;.~_..
; . ,;...........~:".,.,:,.,.:"'".
-".' SignaturecOn,;~.rmrcate Holder
I Th;.~ ..........+;I;~~~~ :~ .L._ ____........ _.f'L. '""'
May 20, 2005
Department of Human Services - Health Services
ElVIERGENCY MEDICAL SERVICES 0 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 e Fax (503) 731-4077
Margueritte L Hickman
1891 Orangewood Dr
Medford, OR 97504
Congratulations on your recertification! Below is your new EMT-B certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate .will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$l 0.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always fmd the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot .
topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs. .
Thank you for your continual support and involvement in Oregon EMS.
1-----~~~FOREGO~------\~~~FOREG;DE~mMENTOFHUMANSE~1CE~
I EMERGENCY MeOICAL TECHNICIAN I EMERGENCY MEDICAL s~F'lvI9ES & TRAUMA SYSTEMS
I CERT. # 128889 BASIC EXPIRES 06/30/2007, I IDENTIFICATION
I ~
I Margueritte L Hickman I] EMT-B CER'f. # lZgSS9
I 1891 Orangewood Dr I! Margueritte L IIick~a.n
Medford, OR 97504 v'
I I_c~
'" HT: 5' 5"
The individual named above and described on the reverse of this card has 1=0
I completed the requirements set forth in ORS 682 et seq. and is certified as ~ WT: 165
I an Emergency Medical Technician at the level indicated. I
I/'. d __ j' , () q rlA I
HAIR: Light Brown
EYES: Green
Sianature of Certific~t" Hnlrlc,
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 . Fax (503) 731-4077
Scott M Hollingsworth
3077 E Main
Ashland, OR 97520
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully.. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. . Some items you will fmd there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all.Jevels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot ..
topics, Awards Banquet informa1ion. EMS for Children, and a list of staff you can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
I - - - - -STATE OF OREGON ~ --- -- - -- r. .STATE OF OREGON - DEPARTMENT OF HUMAN SERVICES
i EMERGENCY~E[)ICAL TSCHNICIAN : EMERGENCY MEDI~~~~.fi~~~~I~~ TRAUMA SYSTEMS
I CERT. # 113607 .PARAM'EU.ICE~Pl~S 06/30/2007 I
I Scott M Hollingswort~. . . I ~ EMT -P CERT.#H3(i07
I 3077 E Main I ~ Scott M HollingsworU.
II Ashland, OR 9752,0 Ii HT: 6' 2" HAIR: Black
The individual named above and described on the reverse of this card has I ~ WT 195 EYES: Brown
I completed the requirements set forth in ORS 68? ~t seq. and IS certified as :
I an Emergency Medical Technician at theJevell~dlcated. I
"""
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Portland, OR 97232 wa (503) 731-4011 @ Fax (503) 731-4077
May 20, 2005
Rod Lacoste
PO Box 146
Jacksonville, OR 97530
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/3012007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of $10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We .
encourage you to use this tool frequently. Some items you will :fmd there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interost, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you can . .
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
1-----~~~~~EGO~-----/S~~OFOREGON-DE~Rm~TOFHu~NSERV'~
I EMERGEfIIPY'M,!JjiC~~q:~CHNICIAN I EMERGENCY MEDICAL . S & TRAUMA SYSTEMS
r CERT. # 127119 ~A~~~l~:~~~s 06/30/2007 1 ~ IDE ION
I Rod Lacoste ~~ EMT-P CER':t'.'fU41~1~
\ ~~~:~:i~l~, OR 97530 \ ~ Rod Lacoste . ..... .
1 The individual named above and desc;:ribed' on the r~verse of this card has I ~ HT: 5' II" . HAIR; BfQt1de
I completed the requiremerits set forth iriOr:tS682et sea. and is certified as I ~ WT: 175 EY!tS: ~}~e
I an Emergency Medical Technici"n ai the ievel indicated. I
I/'I Signature of Certificate Holder
I b' I This certificate is the property of the Department of Human (S 5 1-5 5
Services and must be surrendered by the holder on demand.
I I
f"~~"-'- ---' -=-."=STATE~~~~E~O;-- - - - - -I-STATE OF OREGON - DEPARTMENT OF HUMAN SERVICE~
I. .,,'''' , 'EMERGE,.Cy'jEi)fcAtn;cHNlCIAN .' . . I EMERGENCY MEDICAL ES & TRAUMA SYSTEMS
I CERT. # ~2928i /,{~~bi&~~ 0613012007 j. IDE ON
i . =;jf~Z~~~;~,~ Ii
I The IndMdual named ~~~:iriii~d~~ ~~e~lSe of this card has ,~
I completed the requlremeii~ setcfO.tih'irt;Q'Rs '6agii1.aQ.. and Is certified as I ~
I an Emergency Medical Techni(:lan'tithEf~l'lhdicated. I'
I b' ."'~. : ..-.....-"..-"..... n 22 L
J. GaD R. Shibley, Adminlsllator , Grant Higginson ~ I' SeIVices BIId must be ~ by /he holder on demand.
. 0IIice of PublIc HeaIlh Systems Stale PublIc HeaIIh Officer
,
..'>"
'7-.
'---"
. >v.
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 . Fax (503) 731-4077
Richard F Martin
2701 N Keene Way Drive
Medford, OR 97504
'l,n'>
t';,.
\~\"
,L l..- _.' j~' \
\,...... ,j'" ...
.., ~:'"o. ....' I "t,....-... >-'
.-'i...r ,y"""'"
..r-- i .,. /~(\~J .
/] \ t.._,,-A
\""
May 20, 2005
f..~>S L' ,:
.1 i"'I.,..J....;~ ~-t..,.
\
/'"
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293;,.0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rilles are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will fmd there other than
the Administrative Rilles are: Updates from the Director, a list of available classes
from the mobile tr~ining unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you' can .
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
\- - - - - -STATE Of.QREGO;- - - - - - -\- STAT~ OF OREGO;-- DEPARTMENT OF HUMAN SERVICE
I EMERGENCYM~J11(:;ALTE:CHNICIAN I EMERGENCY MEDICAL ~F~Y!9ES & TRAUMA SYSTEMS
I CERT. # 130001J>ARAME:blC~.kpiRES 06/30/2007 / IDENmirl~ATION
'I Richard F Martin i i EMT-P CERt~#13(j(lOl
2701 N Keene Way Dtive " Richard F Martin
I /.g
Medford, OR 97504
I If
The individual named above and described on the reverse of this card has '. HT: 6' 0"
I I_:go
completed the requirements set fortl1 in ORS 682 et seq. and is certified as WT: 200
I an Emergency Medical Techhicianat the level indicated.
I/', /I --' I' , () ~ riA,
FlAIR: glonde
EYES: Blue
Sianature ofCEiriili""jp Hnlrlpr
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 . Fax (503) 731-4077
May 20, 2005
Lance W Menold
7138 Hwy 66
Ashland, OR 97520
Congratulations on your recertification! Below is your new EMT -P certification
card which exnires 06/30/2007.
..
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www~dhs.state.or;us/publichealth/ems.
You will always fmd the laY~st information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available ciasses
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot .
topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
------------------\----------
I STATEgF OREGON STATE OF OREGON - DEPARTMENT OF HUMAN SERVIC~
I EMERGENCY MeOICALTeCHNICIAN I EMERGENCY MEDICAL S~Fty!gES & TRAUMA SYSTEM~
: CERT. # 125954 PARAMltDICEXPIRES 06/30/2007 :" IDENTIFIc::ATION
I Lance W Menold I ~ EMT -P CERT.#12$9S4
I 7138 Hwy 66 I ~ Lance W Menold
Ashland, OR 97520
I I-g>:;
'U HT: 5' 9"
The individual named above and described on the reverse of this card has l:go
I compieted the requirements set forth in ORS 682 ~ and is certified as _ WT: 165
I an Emergency Medical Technician at the level indicated. I
I/'. /1 ~ ,. , () Q ",A' I
HAIR: Blonde
EYES: Blue
SinnFltllrp. ()f (;Art1fi('~tp I-Inlrlor'
May 20, 2005
Department of Human Services - Health Services
E.MERGENCY.MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 . Fax (503) 731-4077
Marshall G Rasor
2500 Lindley Way
Klamath Falls, OR 97601-4237
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for a11'levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
1- - - - - -STATE Of,~::lI:'EGO;:; - - - - - -,- STAT~ OF OREGO-;- DEPARTMENT OF HUMAN SERVICES
\ EMERGENC'VM~t)iC~LT~9HNICIAN \ EMERGENC'V MEDICAL ~~~YI,9ES & TRAUMA SYSTEMS
I ... ..... .. .": I IDENTIFiCATION
I CERT. # 126969 l'ARAM,EDIG.,ExPIllES 06/30/2007 I,,"he!
I Marshall G Rasor I ~ EMT-P CERT. #126969
I 2500 Lindley Way I ~ Marshall G Rasor
Klartlath Falls, OR 97601-4437
I I <ilco'"
HT: 5'9"
The individual named above and described. on the reverse of this card has 1_ "'-0
I completed the requirements set forth in QRS 682 et sea. and is certified as WT: 220
II a~n E,~m /,e~r,g~,e,n:Y.M,_edlc.alT. :chnlc,an at the ievel..'n Qdicaled~.1 I' Signature a/Certificate Holder ~. h. '" 'I C
b ~ ~ _~ This certificate is the property of the Department of Human (;. .) 6 tt (]
C'__.:___ __..1 _. _,,__
HAiR: Dark13rown
EYES:. Brown
Jun 21 05 12:01 p
Ashland Fit-e & Rescue
5414886017
p.1
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 . Fax (503) 731-4077
Derek A Rosenlund
642 Wilson Road
Ashland, OR 97520-9324
Congratulations on your recertification! Below is your new EMT -P certification
- _~arg.whiQILexpires._O_6f3f)L.2OD7____ - _u _u.____.._ h _._ _ __. _. _____ _ . ___ __H___U
Please review your certificate carefully. If there is an error in your name. return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems..
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for a111evels of
EMTs, current EMS Update (newsletter), current articles ofintere~ EMS hot
topiq~J._ Award~ Ilanquet infoxmation, EMS-.for..Children, ancLaJist of staffyou--can--- _ ._
----- contact in our office fOT different programs.
Thank you for your continual support and involvement in Oregon EMS.
i - - - - - STATE O;-OREGO;- - - - - --'-STAT-;- 0-; OREGON - DEPARTMENT OF HUMAN SERVIC~
I EMERGENCY MEDICAL TECHNICIAN \ EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEM~
\ CERT. # 121067 PARAMEDIC EXPIRES 06/3012007 I IDENTIFICATION
, .~
I Derek A Rosenlund I ~ EMT-P CERT. # ]21067
I 64-2 Wilson Road I ~ Derek A Rosenlund
I AsWand, OR 97520-9324 1_8"
HT: 6' 1"
T'le i~dividual named abcve and described on the reverse of this card has I:Q
I completed the requirements set forth in ORS 6B2 ~ ana is ce,1ified as.2 WT: 202
I an Emergency Medical Technician at the level indicated_ I
I I
I I This certificate is e property of rhe Oepar/mr;mJ of Human
Se",'ices and must be surrendered by the harder on demand_
I I
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232.. (503) 731-4011 G Fax (503) 731-4077
Dana S Sallee
170 Brierwood Dr
Talent, OR 97540-8618
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 arid a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently~ Some items youwiH find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles' of interest, EMS hot..
topics, Awards Banquet information, EMS for Children, and a list of staff YOU' can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
\ - - - - - -STATEQFQHEGO;; - - - - - -\- STATE OF OREGO-;:';-- DEPARTMENT OF HUMAN SERVICE
I EMERGENCYMEOICALTECHNICIAN I EMERGENCY MEDICAL S9FW1QES & TRAUMA SYSTEM~
I . . I' IDENTlfioATION
I CERT. # 116336 PARAMEDIC EXPIRES 06/30/2007 I" . .
I Dana S Sallee I ~ EMT-P CERt: #116336
I 170BrierwoodDr 1'5 Dana S Sallee
I Talent, OR 97540.8618 I j
The individual named above and described on the reverse of this card has'. HT: 6' 0"
I completed the requirements set forth in QRS 682.€it seq. and is certified as I ~ WT: 200
I an Emergency Medical Technician at the level indicated.
I LL'. ~cJ' fj) J..~ ~~
HAIR: Dark Brown
EYES: Blue
Signature of Certificate Haider
r G 7 11
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232 e (503) 731-4011 . Fax (503) 731-4077
David G Shepherd
3775 Coleman Creek Rd
Medford, OR 97501
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rides are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest info!lllation from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot.
topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs. . .
Thank you for your continual support and involvement in Oregon EMS;
\ - - - - - -STATE ()F9REGO;; - - - - - -\- STAT~ ~ OR EG 0;-- DEPARTMENT OF HUMAN SERVICE~
\ EMERGENCYM!:plcAL TECHNICIAN \ EMERGENCY MEDICAL ~J~RV1~ES & TRAUMA SYSTEMS
: CERT. # 123197 rNRAMEDICEXPfuEs 06/30/2007 : Q) IDENliIFIC.M'ION
I David G Shepherd ... . I~ EMT-P CERt.#iZ$1~7
I 3775 Coleman Creek Rct I~ David G Shepherd
Medford, OR 97501 OJ
I I HT: 6'0"
The individual named above and described on the reverse of this card has !
I completed the requirements set forth ir OflS 682 et seq. and is certified as 1:8 WT: 175
I an Emergency Medical Technician at theleve.1 indicated. I
, r ... . 11 a.A . I
BAIR: Da,rkBrown
2~EY~~
/t<<?~),~";~}J ,.. -
~Inn;qh rrp. ()f'r'ortifi,..~to I-ln rln..
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232. (503) 731-4011 . Fax (503) 731-4077
Robert W Stephens
100 Alder Street
Phoenix, OR 97535-7721
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00. .
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealthlems.
You.will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for al11evels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
\ - - - - - -STAT;OF 08EGO~ - - - - - -1- STAT-; OF OR5GO-;- DEPARTMENT OF HUMAN SERV\CE~
I EMERGENpVMEPICAL TECHNICIAN I EMERGENCY MEDICAL SI;j8y!9ES & TRAUMA SYSTEMS
I .... . I IDENT.~icATION
I CERT. # 123787 PARAiVtEDICEXPIR;ES 06/30/2007 1<1> .. .
I Robert W Stephens I ~ EMT -p CERl'.# lZ378.7'
100 Alder Street ~ Robert W Stephens
I Phoenix, OR 97535-7721 I~
I I ~ HT: 6' 0"
The individual named above and described on the reverse of this card has
I completed the requirements set forth in ORS 682 et sec. and is certified as I ~ WT: 219
I an Emergency Medical Technician at the level indicated.
1/'., 4.--. J' f () ~. rIA.: -1.
HAIR: LightBrown
EYES: Brown
Signature of Certificate Holder
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES 0800 NE Oregon Street Ste. 607
Portland, OR 97232 @ (503) 731-4011 11} Fax (503) 731-4077
Ryan E Stidham
1931 Parkwood Ave
Central Point, OR 97502
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. S~nd the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in.a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rul~s pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
\- - - - - -STATE9r:.0I3EGO~ - - - - - -\- STAT~ OF OREGO-;- DEPARTMENT OF HUMAN SERVICE:
I EMERGENCY M~I)I(:;AL TJ;;CHNICIAN I EMERGENCY MEDICAL SpJ.\WIQES & TRAUMA SYSTEMS
I CERT. # 127950 PARAMEDIC EXPIRES 06/30/2007 I IDENtiFIC;:ATION
I .... . .... .., 11!
II ~~;~ ;a;~~~~~ Ave II Jrn- :~~ -; ~~~::t27950'
Central Point, OR 97502
I I~
The individual named above anq described Oh the reverse of this card has 1=0
I completed the requirements set forth in.OHS 682 et seQ. and is certified as _
I an Emergency Medical Techniciah.at thelev~1 indicated. I
/" . ../1 ~ A.
HT: 6' 0" HiV.R: LightBrown
WT: ]~_ s:~
~.
June 29, 2005
..,....:__....'"'".~...~.;.....,_"""".....__._,___...,..""~__.....~_".,........._.-."",..-"',..."-_.....'.....-.--.........__.....-......"'-.:""'..~-,..._-_,.._.,.....,....___.........l'~...-__.._<'___''''_''''''N''''~''
Department of lIurnan Services -.- flealth Services
EIVIERGENCY MEDICAL SERVICES" 800 NE Oregon Street Ste. 607
Portland. OR 97232 @ (503) 731-40118 Fax (503) 731-4077
John T Stoy
955 Grandview Dr
Ashland, OR 97520
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. . Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$,lO.OO.
Please be aware that you are required to be familiar with the Oregon administrative
rules .pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.uslpublichealth/ems~
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director,. a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet infonnation, EMS for Children, and a list of staff YOU' can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
~ - - - - - -STATE OF'C>REGON - - - - - -\- STATE OF OREGON - DEPARfMENTOF H~MAt.l SER;\CE-S
I EMERGENCY MEDiCAL TECHNICIAN I EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEMS
I I IDENTIFICATION
, CERT. # 118911 PARAMEDIC EXPIRES 06/30/2007 I
i 1&
John T Stoy 1= EMT -P CERT. # 11891 I
ial
955 Gmndview Dr I ~ John T Stoy
Ashland, OR 97520
I~ HT: 6' j"
The individual named above and described onlhe reverse ot this card has I;~
compleled the requirements setlarth in ORS 682 ~L~ and is l'eliiiied as ,2 \\iT: 195
an Emergency Medical Technician at the level indicated.
b~~ ~o~ ~tw:ri'>1
HAIR: Dark grown
EYES: Blue
;'):~ './Ii~ f2~~:_;tf /l~~;".'_."'-"'''' "
/.. Signature 01 CertJikfa-r:tfo!f;;---
June 1, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES @ 800 NE Oregon Street Ste. 607
Portland, OR 972320 (503) 731-4011e Fax (503) 731-4077
Todd C Stubbs
74 Freshwater Drive
Phoenix,O~ 97535
Congratulations on your recertificatiori! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$10.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on the web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative ~ules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, Awards Banquet information, EMS for Children, and a list of staff you. can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
\ - - - - - -STAT~9f9~I;~o;:; - - - - - -i-STATE OF OREGO-;';- DEPARTMENT OF HUMAN SERVIC~
I EMERGEN9Y'Me"'J<;,~LTtCHNICIAN I EMERGENCY MEDICAL 9 '{!!\JES & TRAUMA SYSTEM'-
I ..... . ......... > .' .. I IDE .... '-
I CERT. # 130277~AnAMli?~~fE~~tRES 06/30/2007 I " .~~TION
I Todd C Stubbs . I ~ EMT-P CER't;i#1~Q~77
I 74 Freshwater IDnve I ~ Todd C Stubbs ...
Phoenix, OR 97535 Ol
I I~
I The individual named above and described on the reverse of this card has I =0
completed the requirements set forth inQRS68;;' at seg. and is certified as _
I an Emergency Medical Technician <'it Hia'lavelindicated.
ILL'. /cJ'CP .1"" L~
'-../
,- - - - - - STATE OF_OREGO;- - - - -~..,Ji -1----~SrATE 'oF OREGON - DEPARTMENT O;-HUMAN SERVICES-
I EMERGE~CV:~JEDICA~ ?;CHNICIAN ag I ~i"ERGENCY MEDICAL S!2RVI9ES & TRAUMA SYSTEMS
ICERT. # 126208 ~PARA~DIC'EXPel~S 01~OCS I ~~&tj . IDENTIFICATION
I . ,,' ..' - 00 I ~:;';:i .' i
I Shll11901l, W TUI11~~- ' 'e:= I i::fft;EMT -P CE~T.~.J~6~OS
PO B~x 4 , ....' '. 2 ;&':~~baDDoD W TDra,er
I Phoentx, OR 91535 :Ilr/JII 1-lSt;::;;!'iSi
I ",.' ":, ,_.F- Ifir~:6'1"
The IndMdual named abov8and'de8cribed or"'he reverse of this s: ~';';<'>:::'J".....
I completed the requlrementssel:f.9~h in (lR, S, ~:l!llL.D.lI. and ill ce 12'F-"/fr 1.,200
I an Emergency Medlcel TechniCIan allhe 1ll1lellndlcated. I ~:.::.;:~
I 0" · "," q ~......f I ~;ifiii Ignature elf-certificate Holder
I ~ I ~:,' /hepropettyoflhe CJepIu1mBnI of Human 7 31 5 0
GaD R. Shibley, Admlnlstllltor Grant Higginson ~~s and must be surrendeted by /he holder on demand.
I 0IIIce of Public Health Systems Stale Public Health 0fIIcer ~ I ~~~-6
~ :;~~~~~~1l
,
.</. I
\ '.'
\ f
LJ
This certificate is issued as a matter of information only and confers no rights upon the
certificate holder other than those provided in the coverage document. This certificate
does not amend, extend or alter the coverage afforded by the coverage documents listed
herein.
Named Member or Participant
City of Ashland
20 East Main Street
Ashland, OR 97520
Companies Affording Coverage
COMPANY A - City County Insurance Services (CIS)
COMPANY B - Westchester Fire Ins. Co.
COMPANY C - RSUI Indemnity
This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Not withstanding any requirement, term or
condition of any contract or other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the coverage documents listed herein is subject
to all the terms, conditions and exclusions of such coverage documents.
Type of Coverage Certificate # Effective Expiration Limits
Date Date
General Liability 05LASH 7/1/2006 7/1/2007 General Aggregate $3,000,000.00
X Commercial General Liability Each Occurrence $1,000,000.00
X Public Officials Liability
X Employment Practices
X Occurrence
05LASH 7/1/2006 7/1/2007 General Aggregate None
Each Occurrence $1,000,000.00
Auto Physical Damage
X Scheduled Autos
X Hired Autos
X Non-Owned Autos
05APDASH
7/1/2006
7/1/2007
Property
05PASH
05BASH
7/1/2006
7/1 /2006
7/1/2007 Per Filed Values
7/1/2007 Per Filed Values
Boiler and Machinery
Excess Crime
Excess Earthquake
Excess Flood
Workers' Compensation
AMBULANCE SERVICE AREA #3 AGREEMENT FOR THE PERIOD 7-1-06 THROUGH 6-30-07.
ertificate Holder
JACKSON COUNTY
1005 EAST MAIN ST
MEDFORD, OR 97504
CANCELLATION: Should any of the coverage documents herein be cancelled before the expiration date
thereof, CIS will provide 30 days written notice to the certificate holder named herein, but failure to mail
such notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the
issuer of this certificate.
By:
~vt.~ - ___4
Date:
7/21/06