HomeMy WebLinkAboutambulanceTEMPORARY SNOWMASS /WILDCAT FIRE PROTECTION DISTRICT TEMPORARY
MEDIC 9 AMBULANCE LICENSING
STAFF: JIM RICHARDSON
AGENDA ITEM SUMMARY
WORK SESSION DATE: December 16, 2009
AGENDA ITEM TITLE: Temporary Ambulance
STAFF RESPONSIBLE: Jim Richardson
ISSUE STATEMENT:
Jim Richardson, Chairman of the Emergency Medical Trauma Advisory Council, is
requesting approval by the BOCC for temporary licensure for 2010 of the following entity:
Advanced Life Support Ambulance
1. Snowmass/Wildcat Fire Protection District: Temporary Medic 9
The original Medic 9 ambulance was supposed to arrive December 18, but was totaled due to
a rollover accident enroute. It is being replaced by a temporary ambulance that will be put in
service from December 18 and for at least the following four months.
Paperwark for the license is on file with the Clerk's Office.
RECOMMENDED BOCC ACTION: Staff recommends approval of license.
Appli~ ion or A~ b~ nl ce Permit
Service Information
Service Name: Snowmass-Wildcat Fire Protection
Aaaress: PO Box 6436 Snowmass Village CO 81615
Street/P.O. City Sta~e Zip
Communication:970-923-2212 970-923-2224 sarthur(c~swfpd.com
Voice Fax E-MAiI
Vehicle Information
Radio Call Sign: M9
vIN: 1 FDXF47P77EA3 5778
Year: 2007
License Plate: Unavailable
4X4 Yes ( X ) No ( )
Make: Ford Type:
Where will Vehicle be Stationed: 5275 Owl Creek Road, Snowmass Villa~e CO
Waiver Request (Include Reason for Request)
Steve Sowles
----------------------- g -^----- --- ------~~_,_~
Scrvice Director's Name Si nature Datc
(Ambulance Inspector Use Only)
Valid Insurance Card Yes O No O
Valid Registration Card Yes O No O
Inspection Fee $50.00 O Mechanical Condition Certi~cate Attached ( j
Required BLS Equipment List Attached O
Required ALS Equipment List Attached ()
Pass Inspection () Fail () Reason for Failure
-nspector's Name Signature Date
12i 15:'2009 10: 56 9 r 69232224 SNO~nR1:;SS FIRE DEPT PGGE 62i ~i2
A.ppli~ ion or A~ b~ ~ce erz-aat
Service Informatiot~
Servicc Namc: 5nowmass-Wildcat Fire Protcction
Address: PO .Box 6436 Snowmass Villa~e CO S 1615
StrcetlP.O. Clty Slnfc Zip
Comznu~nicahion:970-923-2212 970-923-2224 sarthur(a~swfpd.com
volcc Fn~ F,.Mnll
Vehicle Infor~at'ron
~~dio CA11 Si~n: M9
vtN: 1 PDXF47P77~A35778
Liccnse Plate: Unava.ilablc
4X4 Xes ( X ) No ( )
Xea~-: 2007 Makc: Ford T'ype: I
where will vehac~e be Stationed: 5275 Owl Crcck Road. Sz~owmass Vzlla~e CO
WaAVer Requect (Include Rcason for Request)
Steve Sowles
(Ambulnncc Inspector Use Only)
Valid Insurance Card Yes (} No ()
Valid Registrntion C~~rd Vcs () No ()
inspection Fee $50.00 () Mechanical Condition CertificAte A,ttached ()
Required BLS Equipmcnt List A.ttached (}
Rcqnired ALS Eqvipment LRst Attachcd O
Pass 1'nspection O Fai1( ) Renson for ~ailurc
Iq,spatmr's iVamc
Signnturc
Dnlc
X