HomeMy WebLinkAbout2007-078 License - Ambulance Operators
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CITY OF
ASHLAND
Memo
DATE: 04-09-2007
TO: Barbara Christensen, City Recorder
FROM: Greg 1. Case, Fire Dept - Division. Chief
RE: Renewal of City of Ashland Ambulance Operator License
Barbara,
With the deadline of May31 st approaching, I wanted to get this sent in a timely manner so here are the
documents to be included in the renewal Application for Ambulance Operators License. Included are the
required certifications and documentation required by the AMC 6.40. Keith will be sending the Memo to
Martha and a Council Communication requesting ambulance license renewal. As in the past the fees and
bond have just been charged to our budget - let me know if this is still correct.
Should you need any other information please let me know and I will get it to you as soon as possible.
Thank you!
'1
,-'1/
-':', "lJ'A
/ "-.:1 i.k
/'
Ashland Fire & Rescue
455 Siskiyou Blvd,
Ashland, Oregon 97520
www.ashland.or.us
Tel: 541-482-2770
Fax: 541-488-5318
TTY: 800-735-2900
rAl
CITY OF ASHLAND
APPLICATION FOR AMBULANCE OPERATOR LICENSE
AMC Ch. 6. 6.40
06/2007
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 1FDXE40F2XHA00469 EXEMPT
5. 2002 FORD LIFELINE 1 FDXF47F63EA1 0341 EXEMPT
6. 2006 FORD LIFELINE 1FDXF47P06ED06467 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 ~6.40.110.7. Attach
additional pages as necessary. Explain any box not checked.
Submit your application and required enclosures to Barbara Christensen, City Recorder,
City Hall, 20 East Main Street, Ashland, Oregon 97520.
I certify that each ambulance listed above is adequate and safe for the purposes for
which it is to be used and that it is equipped as required by Ashland Municipal Code
Chapter 6.40 and the laws of the State of Oregon.
Si~nature: /f'~'"'~~
Print name: /[tll-( e Lv'()fI~<..4
Title: ~. I
Date: << 'I'-r
Y-,7'-d '7
H:\ASA\City Lieensing\2007 lie app\2007Applieation for Lie..doe
APRIL 06, 2007
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CITY OF ASHLAND
APPLICATION FOR AMBULANCE OPERATOR LICENSE
2007
Vehiclesl Equivment Level
*as of 04-06-07
VEHICLES
MILEAGE TYPE LEVEL
Unit # Year Model License VIN# ALS/BLS
Shop #
Ford
8831 2006 Lifeline E233465 IFDXF47F06ED06467 16,952 1 ALS
552 F - 450
4X4
Ford
8832 2002 Lifeline E222273 IFDXF47F63EA10341 75,403 1 ALS
462 F - 450
4X4
Ford
8833 1998 Lifeline E211465 1FDXE40F2XHA00469 120,766 3 ALS
364 E-450
4X4
Ford
8834 1996 Lifeline E198560 1 FDKE30F8THA48282 112,011 3 ALS
283 E-350
4X4
Ford
8835 1992 Lifeline E195689 1 FDKE30M7PHA05945 88,272 3 ALS
133 E-350
4X4
Ford
8836 1992 Wheeled E195689 1FDJS34M4~3494 89,723 2 ALS
68 Coach
E-350
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I .. OREGON DEPARTMENT OF HUMAN SERVICES
f . EMERGENCY MEDICAL SERVICSS & TRAUMA SYSTEM
AUDiT NO.
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CERTIFICATION NUMBER:
728
80.00
E233465
AMBULANCE TYPE:
PAYMENT RECE:IVED
2006
AMBULANCE LICENSE - POST IN AGENCY
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AUDiT NO. l..{t><:J
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EXPIRATION
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06/30/2007
AMBULANCE TYPE: .
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~ EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEM
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AUDIT NO.3 eJ i
CERTIFICATION NUMBER:
. 1::211465 .
80.00
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',AMBULANCE TYPE:
~ 1999 Ford
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06/30/2007
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455 Siskiyou Blvd
Ashland OR
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EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEM
AUDIT NO. '. ~ t,t, ~f
'80.00
PAYMENT RECEIVED
EXPIRATION
DATE
1'110; DAY YR.
. AMBULANCE LICSNSE - POST IN AGENCY
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AUDIT NO. '302.:..
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06/30/2007
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PAYMENT RECEIVED
EXPIRATION
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455 Siskiyou Blvd
Ashland OR
975202068
06/30/2007
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ASHLAND FIRE & RESCUE
APPLICATION TO PROVIDE AMBULANCE SERVICE
2007
last Name First Name MI level Cert # Expires Dl# Empl Stat
Anders, Walt L. EMT -Basic 112485 6/30/2007 1955034 PFT
Beck Todd E. EMT -Paramedic 124333 6/30/2007 5837326 PFT
Boyersmith Steven P. EMT -Paramedic 120378 6/30/2007 4545965 PFT
Burns Kelly W. EMT -Paramedic 120248 6/30/2007 5207865 PFT
Butterfield Derrek L. EMT -Paramedic 130423 6/30/2007 9322054 PFT
Case Greg I. EMT -Paramedic 113788 6/30/2007 3254941 PFT
Cocke II II Robert C. EMT -Paramedic 123943 6/30/2007 6109120 PFT
Earl William EMT -Paramedic 128504 6/30/2007 9057843 PFT
Formolo Curt J. EMT -Paramedic 118901 6/30/2007 3738940 PFT
Freiheit Matthew E. EMT -Paramedic 121237 6/30/2007 4927105 PFT
Hadden Jennifer A. EMT -Paramedic 124336 6/30/2007 3535298 PFT
Hanstein David C. EMT -Paramedic 111814 6/30/2007 2524064 PFT
Hickman Margueritte LR EMT -Basic 128889 6/30/2007 3676587 PFT
Hollingsworth Scott M. EMT -Paramedic 113607 6/30/2007 2830146 PFT
Knutson Brent EMT -Paramedic 130961 6/30/2007 5263705 PFT
LaCoste Rod T. EMT -Paramedic 127119 6/30/2007 4322818 PFT
Manning Donald EMT -Paramedic 129281 6/30/2007 9613555 PFT
Martin Richard F. EMT -Paramedic 130001 6/30/2007 8543648 PFT
Menold Lance W. EMT -Paramedic 125954 6/30/2007 6022755 PFT
Rasor Marshall G. EMT -Paramedic 126969 6/30/2007 5067632 PFT
Rosenlund Derek A. EMT -Paramedic 121067 6/30/2007 5541498 PFT
Sallee Dana S. EMT -Paramedic 116336 6/30/2007 3654752 PFT
Shepherd David G. EMT -Paramedic 123197 6/30/2007 3667291 PFT
Stephens Robert W. EMT -Paramedic 123787 6/30/2007 5856509 PFT
Stidham Ryan E. EMT -Paramedic 127950 6/30/2007 5182683 PFT
Stoy John Trent EMT -Paramedic 118911 6/30/2007 4856227 PFT
Stubbs Todd C. EMT -Paramedic 130277 6/30/2007 9309381 PFT
Turner Shannon EMT -Paramedic 126208 6/30/2007 3263694 PFT
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 @ 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 0613012007.
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 infonnation 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.
\- - - - - ~TATE QF08EGO~ - - - - - -\-STAT~ 0-; OREGO-;- DEPARTMENT OF HUMAN SERVICE~
I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL Sj';B\(iq;ES & TRAUMA SYSTEMS
I I IDENrlf=ICATION
I CERT. # 112485 BASlCExplRES 06/30/2007 I "
I Walt L Anders I ~ EMT - B CERT. # 11248S
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 et seq. and is certified as I] WT: 198
I an Emergency Medical Technician at the level indicated.
I /' A _ A. , () q ~A
HAlR: Blonde
EYES: IIazel
Q.inno:::llflll"'-'''''' h';"';.4t-&:,_~~_ 11_1~1
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 G 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: 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 9Fc9.BEGON STATE OF OREGON - DEPARTMENT OF HUMAN SERVICE~
\ EMERGENCYMEPi(;:ALTECHNICIAN 1 EMERGENCY MEDICAL Sl;R).{I!;)ES & TRAUMA SYSTEMS
I CERT. # 124333 pP iRAM'Ebl<~E~~~S 06/30/2007 : Ql IDENT:iF,iQA,TION
I Todd E Beck I ~ EMT-P CERT..f!1~43:33
21 Anna Laura Dr - Todd E Beck.
I I~
Jacksonville, OR 97530 C>
I /-;;;6
,~ HT: 6' I"
The individual named above and described on the reverse of this card has 1:"0
I completed the requirements set forth inORS 682 et seq. and is certified as _ WT: 215
I an Emergency Medical Technician.at the level indicated. I
I ~A-1"" ~'JJ} j,,~ ~~ I
.fIA;IR: DarkBrown
EYES: Blue
Signature a/Certificate Holder
/",p/,~,
May 20, 2005
Department of Human Services - Health Sel~vices
EIVlERGENCY MEDICAL SERVICES ~ 800 N'E Oregon Street Ste. 607
Portland, OR 97232 ~ (503) 731-4011 ~ Fax (503) 731-4077
Steven P Boyersmith
1110LaLomaDr
Medford, OR 97504
Congratulations on your recertification! Below is your new EMT-P certification
card which exoires 06/30l2002...___- ---- .---------- .-..-------. -- ---- -- ---- ---
--- ---.---.--.." '-"- .------.'-.. .-
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 tr~ining unit, continuing education requirements for all1evels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
topics, A ward~J3~ql:1etiJ:1fQ@ati9n,_ EMS fQ;r_~bjl(ke-n,~n4 alist..Qf.sta.fLyou_can-
-contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
----------------\-----------
\" - - - - - - STATE O-F- OREGON - -- -- - - - - - -- - sTATE-oF OREGON ~ OEPARTIAENT OF HUMAN SERVICES
\ EMERGENCY MEOICAL'TECHNICIAN \ EMERGENCY MEDICAL SsR,,!-lqES & TRAUMA SYSTEMS
I - I IDENTIFICATION
I CERT. # 120378 PARAMEDIC EXPJRES 06/30/2007 \..
I - Steven P Boyersmith . I ] EMT -P CER1".#120:?7a
I 1110 La LomaDr 10 Steven P Boyersmith
Medford, OR 97504 _ _' _ _ _ . Ii
I The individual named above -and descrrbed on the reverse of thiS card has ~
I completed the requirements setforth in ORS 682 et sec. and is certified as 12
I an Emergency Medical Technician at the level indicated_
Ib~ ~~
HT: 5' 11" I-IAJR: Dark Brown /-
WT: 170 C->::>,,,,EYE.~7~:vreen~ ..//
>,'f./ _-., - / ~.//
:>/c-/ (., --_ -.,/""
/ - Signature of'Ge~I€t1.plaer
This certifi~;e is the property of i;;~ De.~~; ~f ~uman
_ _ _~... _.._L....._ _..____;..I_._....Il.....h.... h..../..J.....,..~ ..I____.J
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 . 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/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 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.
\ STATE QF OREGON
I EMERGENCYI\l1~pJCAL T~CHNICIAN
I CERT. # 120248 PARAMEDIC EXPIRES 06/30/2007
I . .. .. .... ( ..
Kelly W Bums .
I 2691 Mickelson Way
I Ashland, OR 97520
I
I
I
r STATE OF OREGON - DEPARTMENT OF HUMAN SERV1Ci
I EMERGENCY MEDICAL SlfRYlqES & TRAUMA SYSTEM:
I IDENTiFiCATION
,,,
l~
l~
0>
I~
The individual named above and described on/he reverse of this card has 1_ ~o
completed the requirements set forth irt ORS 682 et seq. and is certified as
an Emergency Medical Technician at the level indicated. I
~ ~ ~
EMT-P CERT, #:1:20248
Kelly W Burns
HT: 6'4"
WT: 200
HAIR: DatkBtown
" I fYE~: Bltie12
,.,( .( t b....,. .1:;)..-- ..
...~ -' ci~,.......~+"l ~-~,:,.:..~~':'e~" U"I,..J,...w
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I
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STATE OF OREGON - DEPARTMENT OF HUMAN SERVICES
EMERGENCY MEDICAL ES & TRAUMA SYSTEMS
JOE JON
This certificate is the property of the Department of Human
Services and must be surrendered by the holder on demand.
65354
May 20, 2005
Department of Hurnan Services - Health Services
EMERGENCY MEDICAL SERVICES 8800 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 EMERGENCYMEPICAL TECHNICIAN
I CERT. # 113788 PARAMltOlCEXPIRES 06/30/2007
I
I
I
I
I
I
STATE Qf QREGON
-1- - - -- - - - - - - --
STATE OF OREGON - DEPARTMENT OF HUMAN SERVIC~
I EMERGENCY MEDICAL SEAVJqES & TRAUMA SYSTEMI
I IDENctipiCATION \
/"
I ~ EMT-P CERT~ #U3788
I g Greg I Case
Dl
I <05
HT: 5' 9"
I ~ WT: 180
I
HAIR: DatkBrown
EYES: Green
Greg I Case
816 Voris Avenue
Ashland, OR 97520
The individual named above and described on the reverse of this card has
completed the requirements set forth in ORS 682 et seQ. and is certified as
an Emergency Medical Technician at the level indicated.
tl
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES 11} 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$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 OFQRgGO;:;- - -- - - - -\- STAT~ 0-; OREGO-;:;- DEPARTMENT OF HUMAN SERVicE;
I EMERGEN,CYME;Ply~L TECHNICIAN I EMERGENCY MEDICAL SI~Jil\(J9ES & TRAUMA SYSTEM~
: CERT. # 123943 PAJ{AMEDJC~~pi){ES 06/30/2007 I" IDEN'TIf7JCATION
I Robert C CockellIl . I ~ EMT-P CER1\#123943
I 2101 Dead Indian Memorial Road I g Robert C CockeHU
Ashland, OR 97520 ~
I I g
The individual named above and described on the reverse of this card has '" HT: 5' 10"
I I :!2s>
completed the requirements set forfh in.ORS 68? ei seq. and is certified as ~ WT: 175
I an Emergency Medical Technician at theleyel indicated. I
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HAIR: Blonde
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Department of Human Services - Health Services
ElVlERGENCY lVlEDICAL SERVICES @ 800 NE Oregon Street Ste. 607
Portland, OR 97232 \9 (503) 731-4011 @ Fax (503) 731-4077
May 20, 2005
on
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/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.
,- - - - - ~TATE QF9FtEGO;:; - - - - - -I-STAT~ o~ OREGO~ DEPARTMENT OF HUMAN SERVIC~
I EMERGENCVN[E,oicAL 'f~CHNICIAN I EMERGENCY MEDICAL SSflVI(i1ES & TRAUMA SYSTEM~
\ . ...' ........ .'<" \ iDEN'rl~re}\rION
\ CERT. # 118901 :e~~M~~1.9E~P!-R~S 06/30/2007 \ Q) ;;',.'.;;
I Curt J Fonuolo .' I ~ EMT-P CER'l\U~;J;l~~,Ol
I 1883 Valley Vie~ I i Curt J Formolo'
Medford, OR 97504 I g>
I g
The individual named above and de. sc..ribed. on the reverse of this card has '" HT: 6' 1"
I completed the requirements set forth in ORS 682 et seg. and is certified as I ~ WT: 185
I an Emergency Medical Technic.ian a.t the leVel indicated.
I
I
I
b'
kIAIR: Darlc Bro\Vu
/~AtYES:Btbw~ /'
/<,~ 7.. / /
Signature of CerJilii;-;;te Holdfu
This certificate is Ihe property of the oep::ment of Human I~ .~\ 7 0
Services and must be surrendered by the holder on demand.
May 20, 2005
on
Department of Human Services - Health Services
El\.1ERGENCY l\1EDICAL 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, 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 9fQREGO;:;- - - - - - -\- STAT~ O~ OREGO-;- DEPARTMENT OF HUMAN SERVICE
I EMERGENCYMEPICAL TECHNICIAN I EMERGENCY MEDICAL SsF\YIO,ES & TRAUMA SYSTEMC:
I CERT. # 121237 PARAMEDIC EXPIRES 06/30/2007 I IDEN1'lFIC;ATION '--
I I ~
I Matthew E Freiheit I ~ EMT-P CERT~#i~J~37
I 492 ThimbleberryLane I ~ Matthew E Freiheit
Ashland, OR 97520 0>
I I ~
The individual named above and described on the reverse of this card has 1_:5lo HT: 6' 0" H.A1R: Blonde
I completed the requirements set forth inQRS 682 ei seq. and is certified as WT: 180 EYE.S: Blue
I an Emergency Medical Technician ai the level indicated. I
~ 1\' n , ,.",. .;,..
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 @J 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$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.
\- - - - - -STATE Of; .OFjEGO;:;- - - - - - -1- STAT-; OF OREGO-;- DEPARTMENT OF HUMAN SERVICE
I EMERGENCYMEOIt:ALTi::CHNICIAN I EMERGENCY MEDICAL $~IJYJqES & TRAUMA SYSTEMS
I . .', . .'... c' I IDENTIFicAtnoN
I CERT. # 124336 PARAMEIJICEXPJRES 06/30/2007 I:!!
I Jennifer A Hadden I ~ EMT-P CERT. #1~4~36
I 1313 Mill Pond Rd . I ~ Jennifer A Haddett
I Ashland, OR 97520-732] If
The individual named above and described on the reverse of this card has 1:2..<>
I completed the requirements set forth lliOBS 682 et seq. and is certified as ~
I an Emergency Medical Techliiciangt th~level indicated. I
I/'. ... Il Q.J I
"~-~~""._..._._.~...'--",,_~~ """'-~-"._.-.~~-,"-... -~.-.._~.~,-_.- '_"_'_-_"~~_""""'_'~"_'~~"-,,-. ...~-~~..~-._.~--...~_.~~"'~~._.._-~--..'.__~_r..~~,.
---...(..t....'"y
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'w"$.r. -)f!r,Ii<-"'''I'']
a=-~ jV~ I!r 5
~-"'5"''''"'p~ ""
Departrnent of J-Iurrlan Servic:i~S --.. JIealth Services
EIvIERGENCY' lVrEDICAL SERVICES ;':41 800 l\IE Oregon Street Ste. 607
- . - 'r'T, ""~re,'-,-, (<- '-'or" "~r) 1 .'r-' -, T' ft::;,r,rl' '-1--11 -'0"7~7
f>ny'r'I'l"flO l}'-l L) j .I -).I.;~ -';/ i -) 1 I ; i ..-LJ., l i i ,;~ t-<8X '.~I\..i -11 ji. -4. . /
..a ',J1..'~... '.') ,_1.'- ~ . ~~~- ~ \.... v._;" .../.... ; '-' -'_ _ .. .,. _ \" _~ J _;t . j
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/pubIicheaIth/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.
\---
I
: CERT. # 111814
I
I
I
- - ~TAT~ OF OREGO;- - - - - - -i- STAT~ O~~ OREGON ~ DEPP-.RTMENT OF HUMAN SERVICE
EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SER\{If(ES & TRAUMA SYSTEM~
! IDENTiHCATION
/"
I~
I~
If
The individual named above and described on the f€\/erse of ihis card has rc
completed the requirements set forth in QRS 682 ef seq. and is certified as I ~
an Emergency Medical Technician at the level indicated.
/' -, ,1__" f () (I CiA . :.
(.-,;Jl-,'i.~ f~4.-1~ J._~ Akr.~ r-1~
PARAMEDIC EXPIRES 06/30/2007
David C Hanstein
1516 Larkspur
Medford, OR 97504
EMT -P CERT. it 111814
David C Hansteili
..,"' ')
HT: 6' 2"
WT: 245
"" .~
,f"llAIR: Da:rkBrown
._<:~,::;:::,~:::~'~:~:~j~~;;~;'--
SignaiumotCe'fiiiic;t;}.iolder-
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
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
tbe Administrative Rules are: Updates from the Director, a list of available classes
from the mobile trClining 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.
Tbank you for your continual support and involvement in Oregon EMS.
1- - - - - -STAT~F OREGO;:;- - - - - - -\-STAT~ OF OREGO-;. DEPARTMENT OF HUMAN SERVIC~
I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL Sl;RVI9ES & TRAUMA SYSTEMS"
I CERT. # 128889 BASIC EXPIRES 06/30/2007 ,I IDENTIFICATION
I ~
I Margueritte L Hickman Ii EMT -B CERT. # 12$889
I 1891 Orangewood Dr I! Margueritte L Hick~afj
Medford, OR 97504 u'
I I~
The individual named above and described on the reverse of this card has '" HT: 5' 5/1 HAIR: Light Brown
I completed the requirements set forth inQRS 682 et seq. and is certified as I ~ WT: 165 EYES: Green
I an Emergency Medical Technician at the level Indicated.
I /'" A _ A' I (J a...J~ Qi..,,.........,,....... .....& ,.......;;.+:,,:__.1_ " . .
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232 e (503) 731-4011 . Fax (503) 731-4077
Scott M Hollingsworth
3077 E Main
Ashland, OR 97520
Congratulations on your recertification! Below is your new EMT-P certification
card which expires 06/30/2007.
Please review your certificate carefully. If there is an error in your name return
your certificate immediately to our office with the corrections. Send the certificate
to: Emergency Medical Services, PO Box 14450, Portland, OR 97293-0450 and a
corrected certificate will be issued to you. Keep your certificate in a secure place.
Duplicates can be issued for a fee of$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.
. I - - - - -STAT~ OF OREGON - --- -- - -- r~;TATE OF OREGON - DEPARTMENT OF HUMAN SERVICES
i EMERGENCYMEOICALTEGHNICIAN : EMERGENCY MED1~~~~~~~X~~~ TRAUMA SYSTEMS
I CERT. # 113607 PARAMEDIC EXPIRES 06/30/2007
I . .. I Q)
I Scott M Hollingsworth I ~ EMT-P CERT.#.IJ~q07
3077 E Main I ~ Scott M Hollingsworth
I Ashland, OR 97520 If HT: 6' 2" BAIR: Black
I The individual named above and described on the reverse 01 this ca~d. has I ~ WT 195 EYES: Brown
I completed the requirem~ts set. forth ip. O,RS_~?L,':.t^~~~. and IS certified as - :
,
,r_"' .." 'f,'
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~~.-~---~.- ~ ~.~-~-- - --~_. ~--- - -~~ ~.~ ~~-b~u _u___ ___. ~_,
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 $1 0.00.
Please be aware that you are required to be familiar with the Oregon administrative
rules pertaining to your certification. These rules are available on our web site
under rules and statutes at: www.dhs.state.or.us/publichealth/ems.
You will always find the latest information from this office on tbe web site. We
encourage you to use this tool frequently. Some items you will find there other than
the Administrative Rules are: Updates from the Director, a list of available classes
from the mobile training unit, continuing education requirements for all levels of
EMTs, current EMS Update (newsletter), current articles of interest, EMS hot
. topics, Awards Banquet information, EMS for Children, and a list of staff you can
contact in our office for different programs. .
Thank you for your continual support and involvement in Oregon EMS.
-------------
/- - STATE QfJ2JJl=GON
I EMERGE~9Y' M~J;!IC-"~~t~(:HN'C'AN
: CERT. # 1271l9PARArvftD!C~~~S 06/30/2007
I Rod Lacoste
PO Box 146
\ Jacksonville, OR 97530
I
I
I
I
I
I
The individual named above and described orl,tlie reverse 01 this card has 1"0
completed the requirements set lortl) in. ORS 682 et seq. and is certilied as _
an Emergency Medical Technician at ilielevel indicated. I
I
I
I
---,-----------
STATE OF OREGON - DEPARTMENT OF HUMAN SERV/C~
I EMERGENCY MEDICAL ~~~M!QES & TRAUMA SYSTEM$
r " ;,,~DEN~!~L~~TION
~~ EMT-P CER~;'#!Z1~1~ "
\ ~ Rod Lacoste
'"
~~
HT: 5'11"
WT: 175
HAIl'{: Sihhdt
. EYJi;S: ~lue .
b'
Signature a/Certificate Holder
This certificate is the property of the Department of Human
Services and must be surrendered by the hotder on demand.
(; 5 :~5 5
r-~-"-"~ ---' -=--~TATEQE:O,REGON - - - - - -I-STATE OF OREGO;:' DEPARTMENT OF HUMAN SERVIC~::'
I. ',' '- ',EMERGE~CY'MEa)jCAtIJ:CHNICIAN "" f EMERGENCY MEDICAL .. ES & TRAUMA SYSTEMS
: CERT:#l29281 tt~~~~~r 0<13012007 j, 10E ION
J Donald R Man.nmg+..;. ..' ;.;\ ~ \'. : r '
I ~~::~46Rk~'~iJ::~;,,; ,;~~)~;VoJ~::\i,) I!'
I, The individual named ~bo~~:ana'~ej~~d oh:ihei~verse of this card has 1,'_ :!2~oC
completed the requireme);t~, set'f~.rifj:~p'AS~~\~ and is certified as
i M E~",,:",M_'T_~~"'"'J;~ i ___..._",,,.._,,,,- [ 3 2 ;2 :;
I' . Grant HigginSOn /'. SelVices and must be surre1Ji!ti~e,d. by the holder on demand.
Slate Public Health Officer
,
.-^.
-,~.
-'-
Oregon
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
,~
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to;.
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May 20, 2005
. "Y ()
.,,1'- --
Richard F Martin
2701 N Keene Way Drive
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 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 staffyou'can
contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
,- - - - - -STATE9F OREGO;- - - - - - -\- STAT~ OF OREGO-;- DEPARTMENT OF HUMAN SERVICE
I EMERGENpYM;OI9JU_TECHNICIAN I EMERGENCY MEDICAL '~~@-I:!@ES & TRAUMA SYSTEM3
I CERT, # 130001PARAMEfnCEXPln:ES 06/30/2007 I IDENTI!;Jl;;ATION
I I w
I Richard F Martin I ~ EMT-P CERT.#J30001
I 2701 N Keene Way Drive I ~ Richard F Martin
Medford, OR 97504
I 1","001
'0 HT: 6' 0"
The individual named above and described on the reverse of this card has I:Q.Q
I compieted the requirements set fortQ in bRS 682 ~ and is certified as ~ WT: 200
I an Emergency Medical Technician at thelev~1 indicated. ,
- ^ ~
HAIR.: BIOi1de
EYE~: eJue
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES 0800 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 exoires 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 lat~st information from this office on the web site. We
encourage you to use this tdot 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.
\- - - - - -;'TATE 9F OREGO;; - - - - - -\-STAT7 o~ OREGO-;- DE~-:;RTMENT OF HUMAN SERVICE
I EMERGENCY Mi:QICALTECHNICIAN I EMERGENCY MEDICAL SIZBYIG,ES & TRAUMA SYSTEM~
I CERT. # 125954 PARAMEDrCEXPiRES 06/30/2007 I IDENTIFICATION
I ,~
I Lance W Menard I ~ EMT -P CERT. # 125954
I 7138 Hwy 66 I ~ Lance W Menold
Ashland, OR 97520
I Ii
The individual named above and desQribed on the reverse of this card has 'v HT: 5' 9"
I. I:2E
completed the requiremehts set forth in ORS 682 ~ and is certified as WT: 165
I an Emergency Medical Technician at the level indicated.
r . n n
HAIR: Blonde
EYES: Blue
May 20, 2005
Department of Human Services - Health Services
El\1ERGENCY 11EDICAL SERVICES. 800 NE Oregon Street Ste. 607
Portland, OR 97232 0 (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/publicheaItb/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 OE-QBEGO~ - - - - - -\- STAT~ OF OREGO-;:J- DEPARTMENT OF HUMAN SERV\CE~
\ EMERGENCVMl;r::iI~ALT~<;:HN1CIAN \ EMERGENCY MEDICAL SJsRYICES& TRAUMA SYSTEMS
: CERT. # 126969 PAril\'l*P!C.~iP1~~S 06/30/2007 ! " IDENTWi0~rlON
I Marshall G Ras.of. . I ~ EMT-P CERT.#t~6969
2500 Lindley Way ~ Marshall G Rasor
I Klamath Falls, OR 97601"4:437 I ~
I The individual named above and described on the reverse of this card has I ~ HT: 5' 9"
I 1=0
completed the requirements set forth in ORS 682 ~ and is certified as _ WT: 220
! eo ~:;;;:t.. <h, "",!:d~~
HAIR: Dark Brown
EYES: Brown
Signature of Certificate Holder
(::,' ~ c:: /1 c:
Thi", ,..",~;~;,..,...~", .,.. ~I.._ _ ~__ _...... _I" ,....,
Jun 21 05 12:01p
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 recertificationr Below is your new EMT-P certification
~C!rd. whig~~~pires..Q6f3DL.2illl7_h __ '. _ 'H._.__.' . _ ___ . _ n.,_ '__ ___
Please review your certificate carefully. If there is an error in your nameretum
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 all1evels of
EMTs, current EMS Update (newsletter), current articles ofintereS4 EMS hot
topi~~J Award~ 13anquet infoJJl1.ation, EMSJoLChildre~ andaJist of staffyou~,. _
-._-- contact in our office for different programs.
Thank you for your continual support and involvement in Oregon EMS.
---------------,-----------
i- - - STATE OF OREGON STATE OF OREGON, DEPARTMENT OF HUMAN SERVIC\:i
\ EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEM~
\ CERT. # 121067 PARAMEDIC EXPIRES 06/3012007 I IDENTIFICATION
I 0
I Derek A Rosenlund I ~ EMT-P CERT. # 121067
I 642 Wilson Road 1.8 Derek A Rosenlund
AsWand, OR 97520-9324 0>
I I~
~ HT: 6' 1"
T'1e ir.diviclual named abcve and described on lhe reverse of this card has I ~
I completed the r&quirements set forth in ORS 682 ~ ana is ce,1ifiecl as.2 WT: 202
I an Emergency \>ledical Technician al the leval indicated. I
I G ~ I
I Gail R. Shi~ey. Adminislralor I ~:~i=~~~':ni~SI::~'::e%Z::;~~~::~:r~':r ~~ ~~::~d.
I OOice 01 Pub"c Heal1h Systems
Department of Human Services - Health Services ~on
EMERGENCY MEDICAL SERVICES (!) 800 NE Oregon Street Ste. 607 b
Portland, OR 97232 @ (503) 731-4011 ~ Fax (503) 731-4077
May 20, 2005
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$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/pubIichealth/ems.
You wil1 always find the latest information from this office on the web site. We
encourage you to use this tool frequent1y~ Some items you wil1 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 QREGON STATE OF OREGON - DEPARTMENT OF HUMAN SERVIC~
I EMERGENCYMEH)ICAL TECHNICIAN I EMERGENCY MEDICAL S~!1Y!yES & TRAUMA SYSTEM:
I .. . ... . .'. I . IDENtIFICATION
I CERT. # 116336 PARAMEl)lC EXPIRES 06/30/2007 , :g
I Dana S Sallee I ~ EMT-P CERT. #116336
I 170 Brierwood Dr . I 13 Dana S Sallee
I Talent, OR 97540"8618 I i
The individual named above and described on the reverse of this card has 1:29 HT: 6' 0"
I completed the requirements set forth in ORS 682 et seq. and is certified as - WT: 200
I an Emergency Medical Techniciahat the level ihdicated. I
, /'. /I_I.,f) q oJ I
HAIR: Dark Brown
EYES: Blue
Siqnature of GEJi1iJicate Holder
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL SERVICES @ 800 NE Oregon Street Ste. 607
Portland, OR 97232 9 (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 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 ClCPfjEGO; - - - - - -1-STAT~ O~ OREGO;-- DE~RTMENT OF HUMAN SERVICB
\ EMERGENCY MEHJICALT~CHN1C!AN I EMERGENCY MEDICAL S,~RYIQES & TRAUMA SYSTEMS
: CERT. # 123197 PARAM~:pJ.G EXPIRES 06/30/2007 : OJ IDENl'lfIG~TION
I David G Shepherd . j~ EMT-P CERT.#1z3197
I 3775 Coleman Creek Rd I g David G Shepherd
Medford, OR 97501 ;:,
I I~
The individual named above and descr. ibed on the reverse of this card has '" HT: 6' 0"
I /=0
completed the requirements set forthin..ORS 68? et seq. and is certified as _ WT: 175
I an Emergency Medical Technician at ihel~ve.1 indicated,
- ^ n
HA1R: Dark Brown
OdEYE~U
./'~:. Z~;.~\;;>~:" .. . .
May 20, 2005
Department of Human Services - Health Services
EMERGENCY MEDICAL 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 toour 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/oublichealth/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 SERVIC8
I EMERGENCYMEOICAL TECHNICIAN I EMERGENCY MEDICAL ~~~'6lpES & TRAUMA SYSTEMS
I . I IDENTIFICATION
CERT. # 123787 P ARAJ\1:EDIC EXPIRES 06/30/2007
I . .....
I Robert W Stephens
100 Alder Street
I Phoenix, OR 97535-7721
I
I
I
I
Iv
I~
I~
Ol
I~
The individual named above and described on the reverse of this card has 1:90
completed the requirements set forth in GRS 682 et sea. and is certified as _
an Emergency Medical Technician at the. level indicated. I
/' A _ .. , () a ~A. I
EMT-P CERt.# 12~787
Robert W Stephens
HT: 6' 0"
HAIR: LightBrown
EYES: BrowIl
WT: 219
~inn!:ltt Ira "if. rartifi:""~tl"\ U....I.....J......
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
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. 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
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 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.
,- - - - - ~TAT~ 9fPAEGO;:;- - - - - - -\- STAT~ o~ OREGO;- DE~-RTMENT OF HUMAN SERVIC~
I EMERGENGYMEiPICAL TF;:CHNICIAN I EMERGENCY MEDICAL sE,I1YleEs & TRAUMA SYSTEMS
! CERT. # 127950 P AkAMEnICEX~lRES 06/30/2007 ! 11 IDENjJFICA,'T10N
I Ryan E Stidham Ii EMT -P CER1\# .1279501
I 1931 Parkwood Ave I! Ryan E Stidham
Central Point, OR 97502 ~,
I I~
The individual named above anq described on the reverse of this card has I~.
I completed the requirements set forth in ORS 682 et seq. and is certified as _
I an Emergency Medical Technician .a.t the level indicated. I
~ ~ n
HT: 6' 0" IiAlB.: LightI3town
WT: 1~d. J~ZI__
~"""---""-~"",,,,.,,,,,,,,,",,,,,_,,,,,_,,,,,,_,~,,-"",-,-"......_.....,,..,,,~;,_..........__......~"-'V"___'~'''''''''''''''''''<''''''"'''''''.-..,____.._._",u..._~~_",......,...-<...,.,;.~...."..____,.,_,......,.............-.....,.-y-..,.,~..-..........,.. __.,__._.._,...........,-"--~......,'~_
June 29, 2005
.Departrnent of Jlurnan Serv~ices -.- IIealth Services
EIV1ERGENCY IVIEDICAL SER\lICES ~ 800 NE Oregon Street Ste. 607
Portland, OR 97232 '& (503) 731-4011 @ 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$IO.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.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.
~ - - - - - -STAT~OFOREGON- - - - - - -I-STATE OF OREGON - DEPA-~EN;~F H~~AN SE~;tC~-s
I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL SERVICES & TRAUMA SYSTEMS
I CERT. # 118911 PARAMEDIC EXPIRES 06/30/2007 I IDENTIFiCATION
I 1;1!
, John I Stoy J = EMT-P CERT. # 118911
I i_1l
I 955 Grandview Dr 10 John T Stoy
I Ashland, OR 97520 b
I I~
Ttle individual named above and described on 'Ihe reverse of Ihls card has
I completed the requiroments set forth in ORB 682 !1.t~ and is certified as I.~
I an Emergency Medical Technician al the leve' indicated,
/' A' ..Ic J' r f} ~ ,_ riA ,~ -1.
I-IT: 6' j" I-lAIR: Dark Brown
WI: ! 95 EYES: Blue
/::l,^ -2,~Jf ,i:;;'~::'-"" . ....
I' SlgnalL're ot ceitiiiifai!fHc;!,;;;---
June 1,2005
Department of I-Iuman Services - Health Services
ElVIERGENCY MEDICAL SERVICES 0800 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 theDirector, 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.
\ - - - - - -STATEQF 08EGON - -- - - - -i-STATE OF OREGO;-. DE;RTMENT OF HUMAN SERV\C~
I EMERGENc;YMEPlc.ALTECHNICIAN I EMERGENCY MEDICAL SqR\(!PES & TRAUMA SYSTEM~
I .. . I IDENJ'If'J(;i.l\TION
[I CERTOTd'd#C13S0t2u7b7bS. PAMM~~J9kih~ES 06/30/20071 I ~ I
~ EMT -p CERr~'#;):jo@n
I 74 Freshwater Drive I ~ Todd C Stubbs.
Phoenix, OR 97535 OJ
I I_~
'. HI: 6' 2"
I The individual named abQve and describi;!d on the reverse of this card has 1=0
completed the requirements set fort.h in QRS 682 el seq. and is certified as _ WI: 200
I an Emergency Medical Technicianal the level indicated. I
1/'., ..1".-. J' ( 0 . ~ _ riA ~ _I. I
February 2, 2007
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
Shannon W Turner
PO Box 4
Phoenix OR 97535-0000
4
Below is your new Oregon-certified EMT-Paramedic certification card which
expires 06/30/2009.
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: http://www.oregon.gov/DHS/ph/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.
Again, welcome to the team.
CERT # 126208 EMT-Param~dit EXpir~s: 06/30/2009
Shannon W Turner .
PO Box 4
Phoenix OR 97535-0000
EMT -Param~di~CERT # 1~~~08
Shannon WTurJi~r
HT:73
WT: 200
HAIR: Lt. Brown Hair
EYES: Blue Eyes
b'
~.7 ~'; ~~~~~ r~ i~
1372~
This certificate is the property of the Department of Human
Services and must be surrendered by the holder on demand.
Agent
DIRECT
>'-..../,/
. "
u
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 b~en 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
05LASH
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
05APDASH
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
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 a(jents or representatives, or the
issuer of this certificate
By:
~V'1. -
u
Date:
7/21/06