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Home My WebLink About2006-215 License - Ambulance Operators (j 1-1- l' q ....... 0 (') (D ~ ::l ~ ~ [fJ (D (D ::::r' ::r p) lo0o-I r.:t [fJ ~ = ~. s ::s lo0o-I (') (D .p.. ~ (D r+ = :::t- . [fJe.. ~ l' ~ (D --- (D """l 1-1- ....... ~ 101 (') ~ (D (D '0...0 ~ ::l 0 ~.t=: [fJ """l ....... ~ (D ~ (D """l [fJ (D ::s ....... ~ ~S [fJ p.. [fJ 101 ~ (D ~ ~ ::l ::l ~ (D ,.... (D r+ 0.. [fJ 0 to Wo ~ r+ PJ 0-. \I'; 0 101 '""1 - 0"" ~ ~ \I'; PJ f\) = '""1 0 t"'4 PJ () 0 (J ~ 1-1- ::r' '-J (J ~ ~ '""1 ~ Ui. ::::r' r-t- p) ~ ::s (1) '0 ~ ::s r+ \I'; [fJ (D ~ ~ (1) """l ? 0\ ~ () ...j:::.. _. S ~ 0 :;0 ~ (1) ::s (J 0 ,.... '""1 P- (1) '""1 ----- ~ '""1 (1) PJ [fJ C '""1 (1) '""1 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 Telephone number: (541) 482-2770 Ambulance descriptions Manufacturer Vin # License # 1. 1992 FORD WHEELED 1 FDJS34M4NHA34394 EXEMPT COACH 2 1992 FORD LIFELINE 1 FDKE30M7PHA05945 EXEMPT 3. 1996 FORD LIFELINE 1 FDKE30F8THA48282 EXEMPT 4. 1999 FORD LIFELINE 1 FDXE40F2XHA00469 EXEMPT 5. 2002 FORD LIFELINE 1FDXF47F63EA10341 EXEMPT 6. 2006 FORD LIFELINE 1 FDXF47P06ED06467 EXEMPT o 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. o Enclose with the application, the initial license fee of $300 plus $100 per ambulance. o Enclose a performance bond in the amount of $500,000. o Enclose an insurance policy meeting the requirements of AMC 96.40.110.7. 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: 1!:;'t-{ f U rv-e(,lu.y- P~int name: //..Jh E ".../t/bld /.t'j U TItle: r'?- C4,l-r Date: / t; , r./ I '-tJ {- H:\ASA\City Licensing\2006Application for Lic..doc May 16, 2006 APPLICATION TO PROVIDE AMBULANCE SERVICE 08/2006 Vehicles/ EQuiument Level VEHICLES MILEAGE TYPE LEVEL Unit # Year Model License VIN# ALS/BLS Shop # 8831 2006 Ford 552 Lifeline ff 23J"I/;.'>- / FI)XF "., ft'f~€V~''I/; l 3,743 I ALS F - 450 4X4 Ford 8833 1998 Lifeline E211465 IFDXE40F2XHA00469 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 IFDKE30M7PHA05945 88084 3 ALS 133 E-350 4X4 Ford 8834 1996 Lifeline E 198560 1 FDKE30F8THA48282 110,905 3 ALS 283 E-350 4X4 Ford 8836 1992 Wheeled E195689 IFDJS34M4NHA3494 89,667 2 ALS 68 Coach E-350 ~ ~ tI1 tr:1 tJj $:: ~ -< tJj ~ t'I1 0 C tI1 ........ N' -..J Z ~ d 5: Q -..J to (t) N ~ O~ ,...,. ::r' 0 ;p ~ I 0 '" Z ::r:: 'TJ tJ t$' 0'\ () '" 0 ~. () t'I1 0"" "1 ~ ~>-3 g; ~ &2 ~ (lQ ! ~. ~. \lJ i ~ m C;;t""'~ p p.o tJj I ........en t- OC/l 'i::J I l110 >-< Z~~ i 0 Fl' U) ~ @ J ><: r\) >-d<~ \ 'Q.O ~ a m cn~. ::r:: ,.I ~?6 ~ r\) b:1tI1 0 ::r::PJ z ~ t""' en ....... <:/l r::n ""R'~ "0 (t) ,...,. ~ >-3 n t--; ...... "1 (t) ~ en ~"'":l"'" ,...,. ~. 'Tj \lJ - 0""' ~ :i ~g::s ........ ::l "1 p.j r\) () en 0 --l ,...,. Os ~ '-' t""' C i:\. ~ m ...... ..,~'" ? CL \J1 en ~ I:l... 0 0.- 0 '-' C/l \lJ 0'\ >-<: "1 ~ ~ 0.- W en <:/l ~ @ ~ 0 () N ~ '0 0 m en "1 0 "'d (t) -..J Z ~ <:/l (t) ::l U) c;J ,...,. g: \lJ m ,...,. ...... ~ <: (t) OREGON DEPARTMENT OF HUMAN SERVICES EMERGENCY MEDICAL SERVICE$& TRAVMA SYSTEM AUPtTNO. 2006 728 ao.oo PAYMENT RECeiVED EXPIRATION DATE MO/DAY YR. CERTIFfcPifIONNUMBER: (;233465 AMBULANCE TYPE: AMBULANCE LICENSE ....POST INAGEtIlCV (.)6/30/2007 .. ". ,,";, :..". ",'._, ,', .','" :., ';'.-, . ...-', '"".,,.. . .,.._._,_._,_..,....__..,-._,._._.....,._~~..,_...,._._.._._._,_._.--.-.-..,.....-.-.-..,.....-.-.-;,....-...,...-.""'";-....;,.;--.-.....::...:....,..-.... i . i i i i City of Ashland i i i i 455 Siskiyou Blvd i i i i Ashland OR 975202068 i i i i i: .i i ..._--~~._.-:,.;....'-._._._..;,..._._._-_._._._._......._._._._._._.-.---.-.-.-......_._,...;......._._._._._._._.....;._.;....1 MUST BE POSTED IN A CONSPICUOUS PLACE - NOT TRANSFERRABLE OREGQN [)EPARtMENT. OF HVI'lJ1ANS~~VICES IEMERGENCY MgDICAL SERVICES & TRAUMA SYSTEM AUP!TNO'l..{t"}l./ CERTIACATIoNOOMeER: . E:222273 80.00 i AMBUlANCE TYPE: 2002..Ford PA~NT RECEIVED EXPIRATION DATE "O:j)AY YR. 06/30/2007 AJ\IIB~LA"'Cl:. LtCE;N$E ...POST INA,$t;NqV f;..--~~~_._.~,;.:.,.._..."..:,."._._.-.~..-..:,...,':':"-,;.,-,.:,..._...:,..;._._'...._._._.,....._._....;...-;,..._......:,......,...,."":'._.""'._.....,...,.,._...;.....,.....;.._... : City of Ashland r : 455 Siskiyou Blvd i I i i Ashland OR i i 975202068 i i i ! i ....-..-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-._._._____._._._._._._._._._._._._..i I: f- _._. ,,~~~ ....~"""=~~'--'-'--'-~~"'-..,.-~...,.~..-.~.--:-- MUST BE POSTED IN A CONSPICUOUS PLACE - NOT TRANSFERRABLE r~~===7~=O-"-c-'5R~GON':5EPARrM-ENT-OF'-HuMAN.sr;RVIGES lilSMERGENCY MEDICAL SERVICES & TRAUMA SYSTEM ~ CERTIFir;ATIONNuMBER: il E211465 .j AMBULANCE TYPE: i 1999 Ford A,UPITNO. :g&l 80.00 PAYMENT RECEiVED EXPIRATION DATE MO. DAY YR. 06/30/2007 AMBULANCE LICENSE - POST IN AGENCY ,.- _. -.'"':'". -. --,..... -- -.....,. -'-' - --...,.., -.-. _. ---.--- ,_. _....,....- --. ,.....-.- .-.-"- --. -.- .-.,...,..-- ,...,..-.-.-.-.-,.-.-.-.., , . City of Ashland 455 Siskiyou Blvd Ashland OR 975202068 i... _. _ ._. _. _ __._ ._._._._. _._._._ __._. _'_'''''''_"_' _. _._. _._. _. _ __._ ,_,_.___._. _.___.___._._._._._._..; i !'l i CERTIFfCAfIONNUMBER: .i E186951 " " i --- '-.- ~-~ -- OREGON DEPARTMENT OF HUMAN SERVIGIES EMERGENCY MqDICAL SqR\lICES & TRAUMA SYSTEM . -:-:.---,'-..-,.-=---==----:..-:;::-=--:::::-.;:;-..::..:..::,.-..:...c..=-=:::;:o--==:....::...~-.,-.-~~;:_~~.;__::.._-_=::::::.~~_:::::::::..:.._=s_.::::=~.~..c-'-~.-->~~"'~-'~-n~~1 I j '1 11 ~ I II !l " AUDIT NO. 80.00 PAYMENT RECEIVED :1 AMBULANCE TYPE: , 1993 Ford EXPIRATION DATE !.'IO:OAY YR. 06/30/2007 I AI\iIBPLANCI:, LiCeNSE -POST INA~ENCY 1'.:-......,:._--._._-..;.;_......_."7.-:._._._,;-.:..__.'"':'.,,.,._~,..;...:-_._.:.,..._._._._.,.,.,:-._.___~._...._._._...,~......,...,._.~....,.,__....;;.,.:,....___... : City of Ashland I i 455 Siskiyou Blvd 1 I I ! Ashland OR ! I ! : 975202068 ! i i i i i..__._.___._._._._._._._._._._._._.___._._._._._._._._.-.-.-.---.-.-.-.-.-._......._._._._._._.___._...i J 1 L;.~~ .~~~~~="~-"=~'"'c~co-==wsTBE'posTED"iN~ACONsPICUOUS PLACE _ NOT TRANSFERRABLE tr=~~~="=x===OREGQN~~ePARrM-ENT'OF=HUMAN~\llCES I.. .. .e!>!~l;NC1{ I!.!1EPIC~ 8.1;R\ZICES & TRAUMA SYSTEM : cEfl:nFIGATfONNUMBER: t . E195689 I i AMBULANCE TYPE: 1992 Fprd A.U[j'ff\jO. 3tiL aD.OO PAYMENT RECEIVED EXPIRATION DATE !.'IO:OAY YR. II ~ ! tj :1 [I " t. ..',~~~,.~__,~~__._~~=="'~=~.:.,.==_=:,~~_. '--.:.- ' ,,__. "_~_'.~= ~- -~------- - MUST BE POSTED IN A CONSPICUOUS PLACE - NOT TRANSFERRABLE AMBULANCE LICENSE ....POST IN AGENCY Op/30/Z00? i..._._._._._._._._._._._._._._._._._._._._._._._._._._.-'-'-.-.-.-.-.-----.-.-.-._._._.___._.___...i j __.. u.~ _ ~...~~ OREGON C>EPARTMENT OF HUl\I1ANSERVIGES EMERGENCY MEOICAl. SERVICES & TRAUMA SYSTEM AUDIT NO. :st?;..~ CERTIFICATION NUMBER: E198560 80.00 AMBULANCE TYPE: 1996 Ford PAYMENT RECEIVED EXPIRATION DATE MO. DAY YR. !"_. ---' -. -. .,.,......._.~. ~. -.-. -.- '-. -..,., .,.... .,.,'-' -. - '---'-'-' ~. -. -.-.,.,., --. -. -.'-...... ,....-.,....,-....:. ,- '-. _....;..- '-''1 AMBULANCE LICENSE -POST IN AGENCY 06/30/2007 City of Ashland 455 Siskiyou Blvd Ashland OR 975202068 i..._._._._._._._._._._._._._._._._._._._._._._._._._._.-'-'-'-'-'-'-.-.-.-.-.-.-.-.-.-._._._._._...i MUST BE POSTED IN A CONSPICUOUS PLACE - NOT TRAN~FFRI=lARI F First Level Last Name Name MI Cert # Expires DL# Empl 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- Cockellll 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 ~ 800 NE Oregon Street Ste. 607 Portland, OR 97232 ~ (503) 731-4011 @ 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 Adi'1linistrative 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. \ - - - - - -STAT~OF OREGO; - - - - - -\- STAT~ OF OREGO;-- DEPARTMENT OF HUMAN SERVICE~ I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEMS I I IDENTIFICATION I CERT. # 112485 BASIC EXPIRES 06/30/2007 I", I Walt L Anders I ~ EMT - B CER T. # 112485 23 Wilson Road g Walt LAnders I Ashland, OR 97520-9102 I; I 1- 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 ~ and is certified as I ~ WT: 198 I an Emergency Medical Technician at the levei indicated I L IL', 1c::J' fA 0 j G cuLfV7- ~ HAlR: Blonde EYES: Hazel Signature of Certificate 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 Todd E Beck 21 Anna Laura Dr Jacksonville, OR 97530 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/publicheaIth/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. ,--- \ I CERT. # 124333 PAAAMEDIC EXPIRES 06/30/2007 I I I I I I I I Todd E Beck 21 Anna Laura Dr Jacksonville, OR 97530 - -STAT~~OREGO;- - - - - - -I-STAT-; OF OREGO;-- DEPARTMENT OF HUMAN SERVICE~ EMERGENCY MEDICAL TECHNICIAN \ EMERGENCY MEDICAL SSI'lVICES & TRAUMA SYSTEMS I IDENTIFICATION IOJ I ~ EMT-P CERT. # 124333 I ~ Todd E Beck 0) I.~ -;;; HT: 6' 1" WT: 215 HAIR: Dark Brown EYES: Blue The individual named above and described on the reverse of this card has 1_"0 completed the requirements set forth inORS 682 et sea, and is certified as '" EZ:::;;;:i." " >h, """J:d~ifl~ ! Signature of Certificate Holder This certificate is the property of the Department of Human ~, p (-; :i r;) [. June 23, 2005 Department of Hunlan 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 11edford,OR 97504 Congratulations on your recertification! Below is your new E11T-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 tbe 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 tra~ning unit, continuing education requirements for all levels of E11Ts, current E11S Update (newsletter), current articles of interest, EMS hot topics, Awards Banquet information, EMS for Children, and a list of staff yolican contact in our office for different programs. Thank you for your continual support and involvement in Oregon EMS. r------------------\-------- I STATE OF OREGON . STATE OF OREGON - DEPARTMENT OF HUMAN SERVIC~ I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEM~ I CERT. # 127032 PARAMEDIC EXPIRES 06/30/2007 I IDENTIFICATION I I w I Lars F Borosund I ~ EMT-P CERT. # 127032 I 1766 Serenity Drive I ~ Lars F Borosund Medford, OR 97504 I I_~ The individual named above and described on the reverse of this card has'" HT: 5' 7" HAIR: Light Brown I completed the requirements set forth in ORS 682 at seq. and is certified as I ~ WT: 157 EYES: Brown an Emergency Medical Technician at the level indicated I /' .' 4,r' /' ( (j ~ riA ..J. I Signature of Certificate Holder May 20, 2005 Department of Hun1an Services - Health Se~rvices EMERGENCY MEDICAL SERVICES ~ 800 ]\j'E Oregon Street Ste. 607 Portland, OR 97232 ~ (503) 731-4011 ~ Fax (503) 731~4077 Steven P Boyersmith 1110 La Lama Dr ~edford,OR 97504 Congratulations on your recertification! Below is your new EMT-P certification u_ _.__~~d:wbiclLexpires 06/30[2002'-___ - -... ---- .----------- -- --.- - ----- --- 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 tbat 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 ;S~qllet ll1fQ1plati()n, EMS fQr.Childt:.en.and aJisCQf..sta:fLYQu_can. - --contact in our office for different programs. Thank you for your continual support and involvement in Oregon EMS. \ ~ - - - --sTATE O~OREGON -~~ - - - -\- STATE OF OREGON - DEPARnAENT OF HUMAN SERVICES \ E~J\ERGENCY MEDICAL TECHNICIAN \ EMERGENCY MEDICAL SE.RVICES & TRAUMA SYSTEMS I I IDENTIFICATION CERT. # 120378 J?ARAMEDIC EXPIRES 06/30/2007 I I" I Steven P Boyersmith I ~ EMT -P CERT. # 120378 I 11 10 La Lorna Dr I g Steven P Boyersmith I Medford, OR 97504 If 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 I ~ i '" 'Z~O"h'~'"",J;'~~ HT: 5' I I" HAlR: Dark Brown ./ WT: 170 '-- :-:;:-;--5EYE..~~n/ / /- /~ t- ~ / /-./",- . - ,,/.. ~---- -- Signature of"Ce~l€tt.oroer , //_-- This C8rtifiq{,te is the property of the O~parfment of Human 8p.rv;ces and must b{i 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 0 (503) 731-4011 . Fax (503) 731-4077 Kelly W Bums 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/publichealthJems. 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 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 OREGON I EMERGENCY MEDICAL TECHNICIAN I CERT # 120248 PARAMEl)IC EXPIRES 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 completed the requirements set forth in ORS 682 e1 seq. and is certified as an Emergency Medical Technician at the level indicated /' -' /J /" .1' I () ~ _ ~ '^ _ _.-I..... \ STATE OF OREGON - DEPARTMENT OF HUMAN SERVICE I EMERGENCY MEDICAL SERVicES & TRAUMA SYSTEM~ I IDENTIFICATION I" I~ EMT-P CERT. # 1Z0248 I ~ Kelly W Burns 0> 1_::" '" HT: 6' 4" I~ WT: 200 HAIR: Dark Brown , . EYE2': B1ue,.,..~ , '.' -! ',' / ,.( e..', VI- . ];;. ,_. , Signat~~ of Certificate Holder ~..., I' r;-'-"J : STATE OF OREGON - DEPARTMENT OF HUMAN SERVICES EMERGENCY MEDICAL ES & TRAUMA SYSTEMS IDE ION I" c Ii j:g Cl I~ I] I I I I HT: 5' 10" WT: 175 This certificate is the property of the Department of Human Services and must be surrendered by the hofder on demand. 65354 May 20, 2005 on Department of Hurnan Services - Health Services EI\1ERGENCY MEDICAL SERVICES ~ 800 NE Oregon Street Ste. 607 Portland, OR 97232 0 (503) 731-4011 @ 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$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. ---------------- I I EMERGENCYMEOICALTECHNICIAN I CERT. # 113788 PARAMEDIC EXPIRES 06/30/2007 I I I I I I STATE OF OREGON - -\- STAT~ OF OREGO-;. DEPARTMENT OF HUMAN SERVIC~ I EMERGENCY MEDICAL SERVIQES & TRAUMA SYSTEM~ I IDENTIFICATION I" J~ I~ 0> J~ The indiVidual named above and described on the reverse of this card has 1=0 completed the requirements set forth in ORS 682 ~ and is certified as ~ an Emergency Medical Technician af the level indicated. I /' -,. . () Q .,J . Greg I Case 816 Voris Avenue Ashland, OR 97520 EMT-P CERT. # 113788 Greg I Case HT: 5' 9" WT: 180 HAIR: Dark Brown EYES: Green Sionature of Certificate Holder May 20, 2005 Department of Hunlan Services - Health Services EMERGENCY MEDICAL SERVICES ~ 800 NE Oregon Street Ste. 607 Portland, OR 97232 @ (503) 731-4011 @ 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 $1 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 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. - - - - - - - - - - - - - -- -- I I EMERGENCY MEDICAL TECHNICIAN I CERT. # 123943 PARAMEDIC EXPIRES 06/30/2007 I I Robert C Cockell II I 2]0] Dead Indian Memorial Road Ashland, OR 97520 I I I I STATE OF OREGON --\----------- STATE OF OREGON - DEPARTMENT OF HUMAN SERVICE I EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEM~ I IDENTIFICATION 1m I ~ EMT-P CERT. # 123943 I ~ Robert C Cockell II '" I.~ ;; HT: 5' 10" WT: ]75 HAIR: Blonde EYES: Blue The individual named above and described on the reverse of this card has completed the requirements set forth in GRS 682 el seq. and is certified as I ~ an Emergency Medical Technician at the level indicated. I /' . ' ///' J' r () ~ _ IiL.-l. I Signature of Certificate Holder ~8~ m3lD ~ "_m 0.5" ~:: =E ~U't=: ~ ~[ ~ 2 ~ ~ ~~ ~ = :3 ~2~ s~;; e,~,~ .O~e; ~H ~ .~;. (o_@,- mi g..g:' , lJi. 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N 00 !II C "'" l"'1 ':~, .!;;;., fij (I) C Q\ (;J c t:l c ~. -..:J m == m :0 Ci) m(J) Z:-j Q~ s::m IThO 0,,11 (;"0 ,)>,,:0 rm '.-f G) ~O :::tZ Z o i> Z ~t:o:l :::a: :::~ Il> I a "'CI '"'~ ~~ 10> := ::!.'\'!il 'II: ~ ~. 00 !II C "'" Department of Human Services - Health Services EMERGENCY MEDICAL SERVICES ~ 800 NE Oregon Street Ste. 607 Portland, OR 97232 I!) (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. ,- - - - - ~TAT~F OREGO~ - - - - - -1- STAT~ o~ OREGO;-- DEPARTMENT OF HUMAN SERVICE I EMERGENCYMEOICALTECHNICIAN I EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEMS I \ iDENTIFICATION \ CERT. # 118901 P A:RAMEDICEXPlR~S 06/3012007 \ Q) I Curt JFonnolo I ~ EMT-P CERT. #118901 I 1883 Valley View I g Curt J Formolo Medford, OR 97504 I ~ I ~ HT..6'1" The individual named above and described on the reverse of this card has I.:!eo I completed the requirements set forth in ORS 682 et seq. and is certified as _ WT: 185 I an Emergency Medical Technician at the level indicated I b~ I I BAIR: Dark Brown ,/,f~7BrOW~~~? Signature of C7liC~te Hold'8/- This cet1;r;cate is the property of the Department of Human /~ 1~\ 7 r-) Services and must be surrendered by the holder on demand. '. :,. c. J May 20, 2005 ~on Department of Human Services - Health Services EMERGENCY MEDICAL SERVICES @ 800 NE Oregon Street Ste. 607 Portland, OR 97232. (503) 731-401111a 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 tbe 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~OFOREGO;- - - - - - -\- STAT~ 0-;- OREGO-;- DEPARTMENT OF HUMAN SERVICE I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SERViCES & TRAUMA SYSTEMS I CERT. # 121237PARAMltDIC EXPIRES 06/30/2007 I IDENTIFICATION I I w I Matthew E Freiheit I ~ EMT-P CERT. # 121237 I 492 Thimbleberry Lane I ~ Matthew E Freiheit Ashland, OR 97520 en 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 GRS 682 et seq. and is certified as WT: 180 I an Emergency Medical TechniCian at the level indicated I I/'_ /J..--.l"() ~ ,J , HAIR: Blonde EYES: Blue Signature of Certificate Holder May 20, 2005 Department of Human Services - Health Services EMERGENCY MEDICAL SERVICES @ 800 NE Oregon Street Ste. 607 Portland, OR 97232 it (503) 731-4011 9 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$1 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 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. \ - - - - - -STATE OF OREGO~ - - - - - -\- STAT~ 0-; OREGO-;- DEPARTMENT OF HUMAN SERVICE I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SsRV!GES & TRAUMA SYSTEMS I I IDENTIFICATION I CERT. # 124336 PARAMEDIC EXPIRES 06/30/2007 I" I Jennifer A Hadden . I ~ EMT-P CERT. # 124336 I 1313 Mill Pond Rd I ~ Jennifer A Hadden I Ashland, OR 97520-7321 If The individual named above and described on the reverse of this card has l:go I completed the requirements set forth in GRS 682 et seq. and is certified as _ I an Emergency Medical Technician af the level indicated. I 1/'., 4~ J' r 0 ~ ~ OIL -1. I ~ )e-[J2il~trrlerlt L _f-l11.rll,al~1 }~) c__n lL~[ e ,-tI tl] ~~:rVl (~e s '" >r""~ JIlt . '"--'~-'-'~'--'-~-'~=~-' .~~~~-_..~_.~.~.~~-~_..,~,,- - , --'---'1\ r -,'. , 1% ---~,.-, -,- -, 'I' '-~r-~I'I--r'~" '" '.n -(' r"~ -, n, n 'C('" EIVIERut~l-jL y JVl ~-iJJIL1-, j J ~"ij::.'J(, J,---,b~) ,,~ ?5UU _ "'d:.', tm:::.f;on :)rreet .:Jte. 0 } / J).()rrJarld) OR ~)~7232 &~ (5'03) '731..,l-!.C~Jl f~ F~a)( (<Sf)]) '7'.:-tl-itOr7Pl May 20, 2005 David C Hanstein 1516 Larkspur ~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 Rules are: Updates from the Director, a list of available classes from the mobile training unit, continuing education requirements for all1evels 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. \ - - - - - --S~ATEOFC)REGO;- - - - - - --i-STATE 0;;- OREGON - DE;:RTMENT OF HUMAN SERV\~E \ EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SERVIc:;ES & TRAUMA SYSTEM~ I ! IDENTIFICATION CERT. # 111814 PARAMEDIC EXPIRES 06/30/2007 , I !" I David C Hanstein I ~ 1516 Larks.pur I ~ Medford, OR 97504 co I~ m E1VIT-P CERT. # 111814 David C Hanstein The individual nC:Hned above and described on the reverso 01 ihis c:=trd has completed the requirements set forth in GRS 682 et sea, and is certified as I ~ an Emergency Medical Technician at the level indicated bflr1:~~Li. (4,\p~ 111\.~r[!j HT: 6'2" \NT: 245 " . " - ,'-'HAIR: DarkBf~>wn .", , . i !1YES: Hazel_C~--- /" --<' -----_.=_.~' ";'.~.~-'",-~- ~ SignaiurBof'(-;ertHicate Holder ._,;i'_<_" _~ -- Th;.~ ".,--+;I:~~.~ .~ H.._ _____.---'_ ..f" ,.... Department of Human Services - Health Services l\.~-on ElVIERGENCY MEDICAL SERVICES @ 800 NE Oregon Street Ste. 607 '-' I ~~ Portland, OR 97232 @ (503) 731-4011 Q Fax (503) 731-4077 May 20, 2005 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$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 trqining 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 OREGON STATE OF OREGON - DEPARTMENT OF HUMAN SERVICE~ I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SERVlc;ES & TRAUMA SYSTEMS I I IDENTIFICATION CERT. # 128889 BASIC EXPIRES 06/30/2007 I I g I Margueritte L Hickman I j EMT -B CERT. # 128889 I ~:;f~~~t~w;;~o~r I! Margueritte L Hickman I I_::;c '0 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 sea. and is certified as _ WT: 165 I an Emergency Medical Technician at the level indicated. I /'. /1 ~ J' I () ~ rlA HAIR: Light Brown EYES: Green Siqnature of Certifir.Rtp Hnlri", May 20, 2005 Department of Human Services - Health Services ElVIERGENCY l\1EDICAL SERVICES @ 800 NE Oregon Street Ste. 607 Portland, OR 97232 0 (503) 731-4011 0 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/publichealthJems. 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. I 1-- - - - STAT-; OF OREGO; ~ -- -- - -- rSTATE OF OREGON - DEPARTMENT OF HUMAN SERVICES MERGENCY MEDICAL TECHNiCIAN I EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEMS E . .. . I IDENTIFICATION CERT. # 113607 P ARAMElJlC EXPIRES 06/30/2007 I '" I ~ EMT-P CERT.# 113607 I ~ Scott M Hollingsworth '" 1_":; '" HT: 6'2" The Individual named above and described on the reverse 01 this card has I ~ WT: 195 completed the requirements set forth in GRS 682 et seo. and IS certified as an Emergency Medical Technician at the levell~dlcated. Scott M Hollingsworth 3077 E Main Ashland, OR 97520 I-lAIR: Black EYES: Brown - .,-' f. l"O"- I ! 0\ .\\ Ii U;I \,' " II ~I.."~ m (f) I ,~ iil I" ~ :il f 11 i <::!\ ::a SJ;1, " li:." 4). 1.. ... <( g., I 'It: 'Iii;... " . G~' "I ~ ~ - S2 I e ~~ I " \L Si; C> '"'" ,"I l [1 'j oJ .,i' ~;" ~; I ,t ~~.~~--~~.~~ _'~~~__~_~~_'~~f__ - -~~ -,~ ---b_H~"___~--. _~, Portland, OR 97232 @ (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 06/30/2007. 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. ---------------- I- I I CERT. # 127119PARA,1\1EDICEXPIRES 06/30/2007 I I \ I I I I I I STATE OfQ13EGON EMERGENCYM~1)iCAL TECHNICIAN -/----------- STATE OF OREGON - DEPARTMENT OF HUMAN SERV1C~ I EMERGENCY MEDICAL ~!=J;lY'QES & TRAUMA SYSTEMS I IDENl'''~I~.4\TION I" !~ EMT-P CERT.#1~7119 \ g Rod Lacoste C> t~ HT: 5' II" WT: 175 HAIR: Blonde EYES: Blue Rod Lacoste PO Box 146 Jacksonville, OR 97530 The individual named above and des9ribed on the reverse of this card has I~.Q completed the requirements set forth in ORS 682 et seq. and is certified as _ an Emergency Medical Technician at the level indicated. / , I I b' Signature of Certificate Holder This certificate is the property of the Department of Human Services and must be surrendered by the holder on demand ,~ r-' (- :1 ') 5 r -'-'-" '- - -'-~~ATE Or="OREGO;- - - - - - -i-STATE OF OREGON - DEPARTMEN~ OF HUMAN SERVICE~ I ...... . EMERGENPYM~[)jQA[TJ:CHNICIAN. '. I EMERGENCY MEDICAL ~,E;fl.YICES & TRAUMA SYSTEMS I . . '" . . . I IDENTIFICATION CERT. # 129281 '.PARAMEDICEXP~S 06130/2007 ';'" : pDOonBaOldXR44M~1ilg,;.:.;,~,:"~.. II ~S~ EMT-P CERl..j~~~~~1 .,t~"~; ." _ Donald R Maniti~~g~~',~' ;':..~ 1 Bonanza, OR 97623\ I ~., . II The Individual named ~Qo~e'anil de~ri~' oh.i~e r;verse of this card haS,' '-_!o completed the requiremelit" seHorthm' ()'RS68Z~ and is certified as I M '- --, T~"""~"i""'''''''~' I ]10___ ~ 1,1 State Public Health Officer This certificate is the property of the Depattment of Human Services and must be sUrre1Jf!.e~ep by the holder on demand. 7'322L , .A --}. .~ ') ,." (~ \ "V f"- \ 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 '..\'-~ l) " ,~ ) {"~.- ....... ,~..) . . \ \ 1'-' , ~........., \_ /.,..'> '" .~. +.. /.~)Y~-'\ .........'{ I....~ '" /! \, t.. \..A ,'" Richard F Martin 2701 N Keene Way Drive Medford, OR 97504 cv\~.... ..,.,.!.'..... /' 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 a111evels 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~O-;; OREGO~ - - - - - -\- STAT~ OF OREGO-;- DEPARTMENT OF HUMAN SERVICE I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SERVIQES & TRAUMA SYSTEMS I CERT. # 130001 PARAMEDIC EXPIRES 06/30/2007 I IDENTIFICATION I IOJ I Richard F Martin I ~ EMT -P CERT. # 130001 270] N Keene Way Drive '" Richard F Martin , l.g Medford, OR 97504 I Ii The individual named above and described on the reverse of this card has '" HT: 6' 0" HAIR: Blonde I completed the requirements set forth In ORS682 et seq. and is certified as I ~ WT: 200 EYES: Blue I an Emergency Medical Technician at the level indicated I/"', /1 -" i' I () ~ "A Sianature afCertificCltp Hn/rlM May 20, 2005 Department of Human Services - Health Services E!v1ERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607 Portland, OR 97232. (503) 731-4011 9 Fax (503) 731-4077 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 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. -----------------~-------- 1- STATE OF OREGON STATE OF OREGON - DEPARTMENT OF HUMAN SERVIC~ I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SERVIQES & TRAUMA SYSTEM~ I CERT. # 125954 PARAMEDIC EXPIRES 06/30/20071 I IDENTIF'ICATION I ru I LarJce W Menold I ~ EMT-P CERT. # 125954 I 7138 Hwy 66 I ~ Lance W Menold Ashland, OR 97520 I II The individual named above and described on the reverse of this card has '" HT: 5' 9" I completed the requirements set forth in ORS 682 et sell and is certified as I ~ WT: 165 I an Emergency Medical Technician at the level indicated I/'. /I ~ J. , () ~,.,A HAIR: Blonde EYES: Blue Sion::lt\ IrA nf r;~rtifi(,:::ltp !--l"Jrlny May 20, 2005 Department of Human Services - Health Services EMERGENCy!vrnDICAL SERv1CES @ 800 I'lli 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 all1evels 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- - - - - -STAT~~OREGO;- - - - - - -I-STAT~ O~-OREGO;-- DEPARTMENT OF HUMAN SERVICES \ EMERGENCY MEDICAL TEc;HNIClAN \ EMERGENCY MEDICAL S~RVICES & TRAUMA SYSTEMS : CERT. # 126969 PARAMEDIC ExPIRES 06/30/2007 I" IDENTIFICATION I Marshall G Rasor I ~ EMT-P CERT. # 126969 I 2500 Lindley Way I ~ Marshall G Rasor Klamath Falls, OR 97601-4237 I I~ The individual named above and described on the reverse of this card has <" HT: 5' 9" I completed the requirements set forth in GRS 682 et seq. and is certified as Il! WT: 220 ! ~o ~;:;;;;::i,O " ,", ''']:'n~r(~ HAIR: Dark Brown EYES: Brown Signature of Certificate Holder r= ., ,) - I'" (:, /. r"- ~-J' :~, "-'1 '-.~ ThiS certificate is the property of the Department of Human Jun 21 05 12:01 p Ashland Fire & 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 ~crr9.Fhi.9-~~xpires._Q6i3f)L2llil7___ _ _ 'u __'.__._ ,. ". . _ ',._. _ __. .... Please review your certificate carefully. If there is an error in your namereturn 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 a111evels of EMTs, current EMS Update (newsletter), current articles of interest, EMS hot topi~~.1 Award~ 13anquet info1.1J..1.fIDon, EMS.1'oLChildren, andaJist of staffYOU-eaa_. ._ -._- coiltact in our office for different programs. Thank you for your continual support and involvement in Oregon EMS. :- - - - - ~TAT~O;-OREGO;- - - - - - -'~TAT~ 0-; OREGO;:' DEPARTMENT OF HUMAN SERV\C~ I EMERGENCY MEDICAL TECHNICfAN \ EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEM~ \ CERT. # 121067 PARAME.DIC EXPIRES 06/30/2007 I IDENTIFICATION , I" I Derek A Rosenlund I ~ EMT~P CERT. # 121067 642 Wilson Road 1-8 Derek A Rosenlund I AsWand, OR 97520-9324 OJ I 1_6", HT: 6' 1" I ~:~~~~~~~d~ha~ ~:;~~~~~~es:~~o~~Sf~i~~so~i~~s:n~f i~i~e~~f;~dh:: I ~ WT: 202 I an Emergency vledical Technician al the leval indicated. I I b ~ I I I ~~~i::~~~;':ni~sr :':~o::e%~::;eb~~t:~;~':r ~~ ~~r;:,:~d. I I May 20, 2005 Department of Human Services - Health Services A EMERGENCY MEDICAL SERVICES ~ 800 NE Oregon Street Ste. 607 Portland, OR 97232 @l (503) 731-4011 ~ Fax (503) 731-4077 Dana S Sallee 1 70 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 and a corrected certificate will be issued to you. Keep your certificate in a secure place. Duplicates can be issued for a fee of$1 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 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 staffyou.can contact in our office for different programs. Thank you for your continual support and involvement in Oregon EMS. \ - - - - - -STATEOF OREGO;:; - - - - - -\- STAT~ OF OREGO;- DEPARTMENT OF HUMAN SERVICE I EMERGENCY MEQICAL TECHNICIAN I EMERGENCY MEDICAL SERVIQES & TRAUMA SYSTEM~ I I IDENtiFICATION I CERT. # 116336 PARAMEDIC EXPIRES 06/30/2007 11! I Dana S Sallee I ~ EMT-P CERT. # 116336 I 170 Brierwood Dr I ~ Dana S Sallee I Talent, OR 97540-8618 I ~ b h f h' ,0 HT'. 6' 0" The individual named above and descri ed on t e reverse 0 t IS card has 1:2,2 I completed the requirements set forth in QRS 682 et seg., and is certified as ~ WT: 200 I an Emergency Medical Technician at the level indicated. I I LI1-'. IcJ.' Lfl j,.~ cuiVXrr~ I HAIR: Dark Brown EYES: Blue Signature of Certificate Holder ~ r :- Il 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 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 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. 1- - - - - -STAT~O~OREGO;- - - - - - -I-STAT~ o~ OREGO-;- DEPARTMENT OF HUMAN SERVICE~ \ EMERGENCY MEDiCAL TECHNICIAN I EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEMS I CERT. # 123197 PARAMEDIC EXPIRES 06/30/2007 I IDENTIFICATION I 11' I David G Shepherd Ii EMT-P CERT. # 123197 I 3775 Coleman Creek Rd I! David G Shepherd Medford, OR 9750 I v' I I~ 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 _ I an Emergency Medical Technician at the level indicated. I /' . ...f) d,~ HT: 6' 0" HAIR: Dark Brown /)~ EYE~ yr9=n / / ".,-/7a.x;r-/../t.r;{ ./' " ~/ .?Y_'-.-~__ _/,.-'~"7-:/_~/, /- .C::1(1n~h Ir,o.' ()f C:pttiflr"::ltCl t-J~,.....,.. WT: 175 May 20, 2005 Department of Human Services - Health Services EMERGENCY lVIEDICAL SERVICES @ 800 NE Oregon Street Ste. 607 Portland, OR 97232 ~ (503) 731-4011 0 Fax (503) 731-4077 Robert W Stephens 1 00 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$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 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. \ - - - - - -STAT~-OF OREGO~ - - - - - -1- STAT~ OF OR5GO-;- ~EPARTMENT OF HUMAN SERVICE~ I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SE;RVICES & TRAUMA SYSTEMS I I IDENTIFICATION I CERT. # 123787 PARAMEDIC EXPIRES 06/30/2007 11l I Robert W Stephens I~ EMT-P CERT.# 123787 100 Alder Street g Robert W Stephens I Phoenix, OR 97535-7721 I~ I ,-~ '" HT.. 6' 0" HAIR L. h B The individual named above and described on the reverse of this card has l!2o : 19 t rOwn I completed the requirements set forth in ORS 682 ~ and is certified as _ WT: 219 EYES: Brown I an Emergency Medical Technician at the level indicated. I I /' A J' f () n A I Signature of Certificate Holder / .' ///" ~ Oll._ ~ May 20, 2005 Department of Human Services - Health Services EMERGENCY MEDICAL SERVICES ~ 800 NE Oregon Street Ste. 607 Portland, OR 97232 @ (503) 731-4011l!l 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 carefuIly. 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 wiIl 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 wiII rmd there other than the Administrative Rules are: Updates from the Director, a list of available classes from the mobile training unit, continuing education requireme~ts 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~~OREGO;- - - - - - -1- STAT~ 0-; OREGO;- DEPARTMENT OF HUMAN SERVICE I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEMS I CERT. # 127950 P ARAMEDICEXPIRES 06/30/2007 ,I IDENTIFICATION I ~ Ryan E Stidham 1- EMT-P CERT. #127950 I 1931 Parkwood Ave i1 Ryan E Stidham I I! Central Point, OR 97502 ~, I I~ The individual named above and described on the reverse of this card has 1320 I completed Ihe requirements set forth in ORS 682 ~ and is certified as _ I an Emergency Medical Technician at the level indicated 1 r .. . ~ n HT: 6' 0" HAIR: Light Brown WT: 190 "-_ J~~ ~~. .-.. :;:. -..''''''." .,,-~._-.-._-' --"'-':'~~~_..-~,^'-"--'-'""~~-:'. - -_._--:._-_._,..~ _...,._-;----::---. --~:-.' __~.__.:_"_,._' ._._.'......(, H~"\~ 4 ](:'>.'n:H'trnput of ~-~Hrf(VFl "')f~Arv~cec. -'" I-I,l,",~-,'th~",r:hTv;('PS (S -;;L""'\'W"r.....~. ';i.-l. ~. ~/..Il .tt.~ :'~J, ;;l..........lO k,.. VS . .'l.. -<'''J , " ~-'-a.~.,i.Llt~ i>-Jv.A.. . Jl'/~' "....... EIvJERGENCY IvIEDICAL SERVICES ,~ SOONE OretJ:on Street Ste, 607 <...' Pordmld. OR 97232;Jl (503) 731-4011 0 Fax (503) 731-4077 June 29, 2005 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 $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. \ - - - - - -STATE OFOREGON"- - - - - - --\- STATE OF OREGON - DEPAmMEN;O;~~~AN ~~~~~~~ \ EMERGENCY MEDICAL TeCHNICIAN I EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEMS I CERT. # 118911 PARAMEDIC EXPIRES 06/30/2007 I IDENTIFICATION I~ I ~ EMT -P CERT. # 118911 I ~ John T Stoy 0: I~ l'g 1- John T Stoy 955 Grandview Dr Ashland, OR 97520 The individual named above and desciibed un Ihe reverse of Ihis card lias completed the requirements set forth il1 ORS fAl2 f1.L~ and is celtiiied RS an Er;g:~:: M;;I ::c;n.~ ician at the lev,,: iadicatedc0 . l--:::f'rlrl./r-~ ~o'fij- i tW~f-g HT: 6' J II HAIR: Dark Brown WT: 195 EYES: B!ue /1";':' J -;. r)t~~J..,f _..t:?';~~-"'~"uu . SignatL're 01 ceiilfilfaief:!r;!f":;;'--- June 1,2005 Department of I-Iuman Services - Health Services EfVlERGENCY MEDICAL SERVICES @ 800 NE Oregon Street Ste. 607 Portland, OR 97232 @ (503) 731-4011 @ Fax (503) 731-4077 Todd C Stubbs 74 Freshwater Drive Phoenix, OR 97535 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, 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. r------------------~-------__ I STATE OF OR~GON \ STATE OF OREGON - DEPARTMENT OF HUMAN SE~~C~ I EMERGENCYMEplCAL TeCHNICIAN I EMERGENCY MEDICAL SE;RVlCES & TRAUMA SYSTEM~ I . .. .. ... . . I IDENTIFICATION I CERT. # 130277 PARAMEDIC EXPlRES 06/30/2007 I <D . I Todd C Stubbs I ~ EMT-P CER'f. # 130277 I 74 Freshwater Drive I g Todd C Stubbs Phoenix, OR 97535 ~ I I~ The individual named above and described on the reverse of this card has I 1=0 completed the requirements set forth in GRS 682 et seQ and is certified as _ I an Emergency Medical Technician at the level indicated. I I LA-'.Ie.)' r.j) j G. L ~ I --....... -.,,; _/ ,- - - - - - STATE OF OREGO;; - - - -~ -'-''-STATE OF OREGON - DE~~TMENT OF-HUMAN SERVICES- ! EMERGENCY.I\IJEDICAi. TECHNICIAN ag I ~;~ERGENCY MEDICAL $!3RVICES & TRAUMA SYSTEMS ICERT. # 126208PARAMEDlC'EXPW.]!:S Ol/04/~OE I ::~:~~j IDENTIFICATION I ~ I.L;'S;, . I Shll1.U)oil W Turner a I ~~J~EMT-P CERT. # 126208 PO B~x 4 ~ I ~(i.:~~~bannon W Turner I Phoemx, OR 97535 ~ ~":3 I F""'" I ~~=:1rr: 6' }" I The individual named ebove anddes<:ribed on the reverse'of ihis I:!1G"~;1.'~, 200 completed the requirements set forth in ORS 682 ~ and is ce s.E t',,~';.:'i:rv 1 . : '" E;'~ ."'''' ':'",""O'''''''''''!:~d~', ~~: f:;,:;;; I (:;p ~ I ~:~. the propeftyof the Departmen/ of Human 7 3 1 5 0 Gail R. Shibley, Administrator Grant Higginson > ~~s and must be surrendered by the holder on demand. I OIflce of Public HeaUh Systems Stale Public Health Officer ~ , ......, . ==8 ~ '~saEl'iIP1.r#;l(iJ;i~i,~(4MlE'~A'<SI3" 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. " I ti 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 - RSUJ 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 # General Liability X Commercial General Liability X Public Officials Liability X Employment Practices X Occurrence o5LASH Effective Date 7/1/2006 Expiration Date 7/1/2007 Limits General Aggregate Each Occurrence $3,000,000.00 $1,000,000.00 A Auto Liability X Scheduled Autos X Hired Autos X Non-Owned Autos A Auto Physical Damage X Scheduled Autos X Hired Autos X Non-Owned Autos 05LASH 7/1/2006 7/1/2007 General Aggregate Each Occurrence None $1,000,000.00 o5APDASH 7/1/2006 7/1/2007 A Property A Boiler and Machinery B Excess Crime C Excess Earthquake C Excess Flood A Workers' Compensation 05PASH 05BASH 7/1/2006 7/1/2006 7/1/2007 Per Filed Values 7/1/2007 Per Filed Values escription: 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 CANCEL LA TION: 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 ~~~- 42 Date 7/21/06