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HomeMy WebLinkAboutbocc.con.012.1983 � .y . ., .,. . � '�� . �•.� / f r t ,}�d',r�+'�.F' '��1{�:�"���y,, 'w�j`rfs�<��t,� � „?+L �;��.0 � n } t �.�t,3'.�r���„iiFyy.' 1�.�{�3;,r�f,'y9it��''"�'h l �T'7 � yy�"fT"� ��,7\��,- - , l.�t��':.t'�aA�..s_^7L°Y!ff'3��7L.:��r���rtl-..�,�,��?r_Sr...;f ....�-....,�.�.x.�:*T{.zi��►���"`,x[�''y' . •, 5.;.<a�� �2�..�ryP�`�i.3'� 1�tld� �;: " �� APPLICATION FOR LIC�NS� �. . .. . �i,�1 TO OP�RATE Al�tt,U19IvCii SERVICE Ii� ��`L PZTKIN COUNTY, COLORADO "� :.. i;-::. � n CA 2(83) . '>r.;.;•" �?? 1. SERVIC� NAME �r lOUNT�s*� +�'�3��-�"��E Se.���c.G i: 2. ADDRESS ��;� !-}7� �5?�� l�o ;:i i,-kJ .t ,� 3. PHON� NUFIBER �'.�,S- I I ZO ���a V A�i 7 I�os�n:�A�- � 4. DESC^.IPTION OF EACI[ AML'ULA.7CE to be operated by applican� (include make, �' �� � �� model, year of manufacture, Colorado State license number, motor vehicle � cnassis number): �. �'� s�W.�� /'�� �-r�1C ���sv��•�� �l�-- 9zo2 %�.c 1�,=.�'o7,g9 � i� �� (1+GH�4U➢� i �7�- ��� V,✓ �G-���8 _r-i 5�-�s�-z���a E �' �,�, /a 7� �.e.v ��v ,ZC�--i'9�9 �� "> ��j 7v�3 7 ;� ' - �� B,r�;ec,...k .98� �/rlc sua�a,8��Z,— '.� _ � � � -- �. � 5, i3OCATION AND DESCRIPTIOD? of piace or places from which the applicant's ambulance service eperates: S J�nl3JLAx�cES o�eRAte, y-eom. As��� l�A«�.�wp;•�nc Y'o �s�°c..� �i p , ' � ' �'ll..� ��' �2EA B:�^re.Rm�IKy NSPeN�q��R.••D3 r cSn�o..s mrass 6 C; Fl2EP. (� � 6. The undersigned, representinr, the applicant herein, certifies, with respect ' to the ambulanca service for whidi this permit is sought (and vehicles ;� to be used hy the applicant in pr.oviding such service) th^t: � � (a) Each ambuiance listed in paragraph 4 abov assed the C o � : mo ve e ine� ' n wit��. *l:e precee date of thi ��` � application. U � �b) Each ambulance listed iii paragraph 4 above is c^vered by a complying p�licy as defined in Se�tiun 10-4-7C'3, C.R.S. 1973. S � (c) �.ch ambulance listed in paragraph 4 above wi�l oe staffed by at least two persons at every scene of a call for medical ascistance, and at � �. � :I1 times that a patient is being transportPd, a driver and an � attendant. Each ambulance driver possesses a valid Colorado Driver s Lic^_nse and currnnt certificarion in either rlmerican Red Crnss or �'`, .� Amerir.an lleart Associatiou CYF. Additionaily, each driver holds . � currenl' certification i.n, at minimum, eitlicr Micri.can Fed Cross � � Advanced Pirst Aid, Ctash Zn�ury Pianagement, or Trz�uma Pianagemer�t. '�> ' � i:ach ❑Ctendnnt is a curre::tly cer�iL"ied timcrgency Nedical ':'eclinician, cr t:':- ; , ar. R.^? ial:o is ::c:lici..na11'y t:aine.l and cerciEied in i.rash in�ury . Pl�aa�ement or Trauma itanage^��nt as descriUa: lbove. � (d) Each ambulance listed in paraf;r�ph 4 aUave contains equipment which i , meets or exceeds tl�e requirements set forth in the "Mibulance � Inspection Slieet." i (c) Lach ambul�rc� iisced in parari'a�;i 4 abovr shal� maintain two-way '� radio communicatlon ca�abiliep wil'li tli� receivin� medioal facilily. t���N,� k:-" - ::a �,. ���;� ' - -. �'>_ :.� " � ' a •��"'� �" x:i�i ;` '1��z `f7. C,� � ��r R',�•� . "��; ` . Y � '��, � c . k q �. 4'� s ��"` �jA.t�� k t"'� ��j"lya Y,�gta. E��'h� N����i� ��4i•�'`��o� S��j��, n �`� . 7 .�.��tt�.��N....�s �+�a,��.i), .. .. '�.4 �e r.i._ �i.vt*afa+R h�.ECGr �3'�.F.' .r�:.�i'b'�a��:r: ..+....�l.�-ir $'�/�:�.::,�k i ..# �' " ' E: NOTN: Ii. tLe evenl the .�i�rii�,�,c sceks a waivcr from r�..� of `.lw toregoin�; �� requlreme,:ts, please sCate the naturn. of tlie s�ecific waiver renuested, tl�e 3� � nced for L-hc wniver, ar.y �lternate p:oposals, any plan or commitment to mcet F� ��the requirec:ents, and a stntement as to wl�y, if: granCe�, th� waiv�r will not _ �,, advereely atfect the puulic wclfare: tu 4=n,�'; ��1�n �'' PE / � %E? � { ,• � 6 ir+r i,v ,,f �--�- ' �. �� . � `` � �.• � r � ��-' . 3�� � S � { R'C �- ����� �� // ` {.-:' Date 1 �Z � ��r.-,O 7'���Fe�J � �> Signature r; �; �� ��.2. ���.��.�� y°,T-� Title - �: F. � GRANT OF FEitPfIT �y. 5` The undersigned, repr^.senting t:�e Board of County Commissioners of Pitkin �; ;; ' -.�:� County, Colora3o, does herc-by grant a license to the above�named a.pplic�nt to '�: - yrovide ambulance service within Pitkin Cou�ity (and does further :.s�ue a permit { rY for each ac�bulanee listed in parag.aph 4 of this application Lo be used in (t � ' t rovidin such service), both of which license and ( p g permit(s) shall be valid through the date of December 31, 14oQ, fro�a the date hereof (unless earlier j �, revoked by the Board of CoUnty Commissioners pursuant to the pro isions oP u'; the Board's Resolution ?io. 79-129 or any amendment thereto). . �� • � ,�� �: 2a �e�t�c, 19s3 � . i ` Date of Issuance tE�c ��� � . / Signature ;V. � � �s CHAI2dNAN. BOARD OF COiAJTY CCNMISSIOI�RS s� - i Title � '• '; � ;�� GRANT OF 51AIVEP. �*- �. The undersi�ned, represencing the Board of County Commissioners of Pitkin '� County, Colorado, does hereUy grant a �oaivPr of license conditions to the above �"� pA• '.� , nawed applicant as stated b�low: � ;,-s:..:� : ' f- F q'� � •. �_ 1I f* �9�; • � "i Date of Issulnce ' j �t Signaturc ; �'' - st�f'' ti, ,� ' Tit�e ��^'F� �i� Z�'� �>;� i