HomeMy WebLinkAboutC15-260 Eagle County Paramedic Services License and Vehicle PermitLICENSURE VALID FROM: July 1, 2015 to June 30, 2016 AMBULANCE SERVICE: Eagle County Paramedic Services ADDRESS: 1055 Edwards Village Blvd., PO Box 990 Edwards, CO 81632 PHONE: 970 - 926 -5270 FAX: 970 - 926 -5235 EAGLE COUNTY PARAPMEDIC MEDICAL ADVISOR: Diana Hearne, M.D. The inspection of the above named ambulance service was made on 5/26/15 by Jennie Wahrer, RN. This ambulance service has met licensing requirements for Eagle County as established in the resolution as approved by the Board of Commissioners May 2007, resolution number 2007 -052. INSPECTOR(s): (Signature)_ Li/ai.A-4Q Jennie Wahrer, RN PUBLIC HEALTH DIRECTOR APPROVAL TO ISSUE LICENSE: �lunp 2, 9015 nnifer dwig, Public He h Director Date BY AUTHORITYOF THE EAGLE COUNTY BOARD OF COUNTY ATTEST: Inn UL-4 Clerk to the Board of COUNTY OF EAGLE, STATE OF COLORADO, By and Through Its BOARD OF COUNTY COMMISSIONERS 4 t �t By: Kathy andler -Henry County Commissioners Chair EAGLE COUNTY PERMIT VALID FROM: July 1, 2015 to June 30, 2016 AMBULANCE SERVICE: Eagle County Parmedic Services ADDRESS: 1055 Edwards Village Blvd., PO Box 990 Edwards, CO 81631 PHONE: 970 - 926 -5270 FAX: 970 - 926 -5235 EAGLE COUNTY PARAPMEDIC MEDICAL ADVISOR: Diana Hearne, M.D. Asset ID Purpose Year — Make - Model VIN Plate 101 ALS / 911 Ambulance 2010 -Ford E -350 1FDWE3FP7ADA07695 31 -MQG 102 ALS/ 911 Ambulance 2014 — Chevrolet 3500 1GB3G2CL3E1162236 027 -MQG 103 ALS / 911 Ambulance 2014 — Chevrolet 3500 1GB3G2CL1E1163515 022 -MQG 104 ALS / 911 Ambulance 2015- Chevrolet 3500 1GB3G2CL1F1116373 021 -MQG 780 ALS / 911 Ambulance 2010 -Ford E -350 1FDWE3FP9ADA15264 011 -MQG 781 ALS / 911 Ambulance 2010 -Ford E -350 1FDWE3FPOADA15265 012 -MQG 782 ALS / 911 Ambulance 2007 -Ford E -350 1FDWE35P27DB07679 013 -MQG 783 ALS / 911 Ambulance 2007 -Ford E -350 1FDWE35P77DB00744 014 -MQG 784 ALS / 911 Ambulance 2007 -Ford E -350 1FDWE35P27DA96425 015 -MQG 785 ALS / 911 Ambulance 2010 -Ford E -350 1FDWE3FP5ADA07694 016 -MQG 787 ALS / 911 Ambulance 2009 -Ford E -350 1FDWE35P19DA71499 018 -MQG 801 ALS / 911 2008 -Ford E -450 1FDXE45P78DA77008 024 -MQG Ambulance 804 ALS / 911 2003 -Ford E -450 1FDXE45F73HA60864 023 -MQG Ambulance EAGLE COUNTY AMBULANCE VEHICLE PERMIT EAGLE COUNTY The inspection of the above named ambulances was made on May 26, 2015 by Jennie Wahrer, RN. These ambulances have met permit requirements for Eagle County as established in the resolution number 2007 -052 as approved by the Board of Commissioners May 2007. INSPECTOR(s): (Signature) Jennie Wahrer, RN PUBLIC HEALTH DIRECTOR APPROVAL TO ISSUE PERMIT: 4�� June 2, 2015 JerAfer Lud ig, Public Health Director Date BY AUTHORITYOF THE EAGLE COUNTY BOARD OF COUNTY COMMISSIONERS: ! OUNTY OF EAGLE, STATE OF LORADO, By and Through Its RD OF COUNTY COMMISSIONERS a ATTEST: t • r�[ORw� �l.{ML. �f . 51►� _ By: Clerk to the Board of by Chandler -Henry County Commissioners Chair EMERGENCY MEDICAL SERVICES APPLICATION: AMBULANCE SERVICE LICENSE Date of application: Ambulance Service (owner): �a /e `oun Ile-11017 Doing Business as: 61le eo, nj, tea, /nera� c ery�c�s Physical Address: Street: 10$-5- dctJary'Sll �ffir� City: u>a •,/ Zip: 02 Mailing Address (if different from physical): Street / PO Box: i�o City: d1uja --4 Zip: ?163.2 What area of the county will be served ?: (please include an attached map) The ambulances will be located at: (central and sub station addresses) /a i / - /g/ 4%. /ludo Dr. ✓G Avo» ' /790 6W "7 6..k Fa(W4r66 f 4k . 7 //P) ) 105Y �%p�warCls t/ dial a &.Y Now many ambulances do you operate ?: 13 Manager Information (or individual responsible for the operation of services): Name: t-,re ( IYa- er,So/! Address: 10515, /Ca /tJdards (f. / /mac C3�+r�. Phone: Medical Director Information: Name: '0n. 0,ana Address: fyj. Phone ( —0- A 7 Names of stockholders or partners owning 10% or more of the outstanding stock of the company, or having more than 10% ownership interest: Name: i� Address: Phone: (� - Name: Address: Phone:( - Name: Address: Phone: U If more space is needed please attach additional pages with application. If this is an initial application (not a renewal application) please attach A SEPARATE permit request for each ambulance. Insurance: ce L5yv•�r (1%�� Agency: 7. 1104 n r Address: f ✓eeA -ss wy 5L.,/c 170 City: State: e7oZip: 9011a Agent: /, 6(�XX Q1 /'5. PLEASE ATTACH A CERTIFICATE OF INSURANCE - /971, ATTACHMENTS: C3 SERVICE AREA MAP C) ADDITIONAL STOCKHOLDER INFORMATION W14 ICJ INSURANCE CERTIFICATE IN I HEREBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF AND CONTAINS NO WILLFUL MISREPRESENTATION OR FALSIFICATION. DETERMINATION THAT AN AMBULANCE SERVICES LICENSE HAS BEEN ISSUED BASED ON FALSE INFORMATION CONSTITUTES GROUNDS FOR LICENSE REVOCATION AND POSSIBL RIMINA ROSECUTION. Signature of Applicant Date f� SUBSCRIBED AN AFF7jAED BEFORE ME THI DAY OF , 20�, IN THE COUNTY OF , STATE JOFORAtD. /I W A ),v ture of ... .................................................... . My commission expires: ol 12z/ ;9D / f} (for office use only) Date received: 5 / 26 / 2015 Documents checked: Yes Fee paid or excused: excused Receipt#: NA Comments: Approval Recommended (Y /N): Y Date referred to B.O.C.C.: 6 / 16/ 2015 Jennie Wahrer, 6/1/15 LICENSING AGENT 3 u z uj I z Cb L.1 I Nt 0 u U om U c) < ¢A o ft - _Tz f . FT, 4_1 EAGLCOU -02 VSULLIVAN A4- R CERTIFICATE OF LIABILITY INSURANCE DATE (M /201 I'YY) 5/28/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER T. Charles Wilson Insurance Service 384 Inverness Parkway Suite 170 Englewood, CO 80112 CONTACT NAME: PHONE 368 -5757 FAx AIC No Ext : ( 303 ) AIC, No : (303) 368 -5863 E-MAIL ESS: info @wilsonins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Arch Insurance Company 11150 INSURED INSURER B: $ 1,000,000 INSURER C: CLAIMS -MADE FX] OCCUR Eagle County Health Service District INSURER D: MEPK07362107 P O Box 990 Edwards, CO 81632 INSURER E DAMAGE TO RENTED PREMISES Ea occurrence INSURER F : MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF . MM/DO/YYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FX] OCCUR MEPK07362107 01101/2015 01/01/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 GEN'L POLICY ❑ PRO JECT [K LOC PRODUCTS - COMP /OPAGG $ 10,000,000 $ OTHER: AUTOMOBILE LIABILITY EO accident) SINGLE LIMIT $ 1,000,000 A X ANY AUTO MEPK07362107 01/01/2015 01/01/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE MEUM07170207 01/01/2015 01/01/2016 AGGREGATE $ 3,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A Emergency Ser E &O MEPK07362107 01/01/2015 01/01/2016 Included in GL DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) General Liability (Public Liability) Limit is $1,000,000 Per Occurrence (All persons for bodily injury and property damage in a single occurrence). In addition there is an additional $1,000,000 Per Occurrence (all persons in a single occurrence) on the Umbrella Policy. The General Liability policy has a $10,000,000 Annual Aggregate limit for all persons, all occurrences during the policy period plus and additional $3,000,000 annual aggregate limit on the Umbrella Policy for a total of $13,000,000 annual aggregate limit for all persons, all occurrences during the policy period. General Liability (Public Liability) is not written per person, each accident, the policy is written per occurrence. CERTIFICATE HOLDER CANCELLATION ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD — — -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Eagle County Public Health and Environment THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. Box 660, 551 Broadway ACCORDANCE WITH THE POLICY PROVISIONS. Eagle, CO 81631 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD — — -- EAGLE COUNTY APPLICATION: AMBULANCE VEHICLE PERMIT Date of application: 6/ / Ambulance Service (owner): � � Coanr�y ` /14- i���y�ac Doing Business as: ,"-a, k 4o, S;/v.ecs Physician Medical Advisor: ____4jr, Physical Address: Address: /4��•c[s (/, City: ia�3 State: c/-/d Zip: 8/63 Phone: (91A 92& Sa70 Mailing Address (if different from physical): Street / PO Box: 77 O'no City: dc�.ro�s Zip; /6 3 a AMBULANCE DESCRIPTION: *6Ee '*ff / Cz) 'w" Year: Make: Model: V.I.N. Colorado Registration #: Colorado Emergency Vehicle #: Assigned agency vehicle number: Description of color scheme, insignia, lettering: Date placed in service: / / Ee A91.91clv*7E . Normal location(s) of this vehicle: 1140.43 INSURANCE COVERAGE: Please attach a copy of the insurance coverage for THIS vehicle that shows the Company, Agent, and coverages for Bodily Injury and Property Damage. I HERBY CERTIFY THAT THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF AND CONTAINS NO WILLFUL MISREPRESENTATIONS OR FALSIFICATION. SUBSEQUENT DETERMINATION THAT PERMIT HAS BEEN ISSUED BASED 1FSE I ORMATION CONSTITUTES GROUNDS FOR PERMIT REVOCATION. r' /% SIGNATURE OF APPLICANT: _ _,� i — DATE: 4 ............................................. ............................... a . Date received: 5 / 26/ 2015 Inspection satisfactory (Y /N): Y Comments: Approval Recommended (Y /N): Y (for office use only) Documents checked: Yes INSPECTED ON: 5 / 26 / 2015 Date referred to B.O.C.C.: 6 / 16/ 2015 Jennie Wahrer LICENSING AGENT EAGLE COUNV •� PARAMEDIC SERVICES Fleet Assets — Gov. Fleet Tag #6679 Asset ID Purpose Year — Make - Model VIN Plate 101 ALS / 911 Ambulance 2010 -Ford E -350 1FDWE3FP7ADA07695 31 -MQG 102 ALS / 911 Ambulance 2014 — Chevrolet 3500 IGB3G2CL3El 162236 027 -MQG 103 ALS / 911 Ambulance 2014— Chevrolet 3500 1GB3G2CL1E1163515 022 -MQG 104 ALS / 911 Ambulance 2015 -- Chevrolet 3500 1GB3G2CL1F1116373 021 -MQG 780 ALS / 911 Ambulance 2010 -Ford E -350 1FDWE3FP9ADA15264 011 -MQG 781 ALS / 911 Ambulance 2010 -Ford E -350 IFDWE3FPOADA15265 012 -MQG 782 ALS / 911 Ambulance 2007 -Ford E -350 1 FDWE35P27DB07679 013 -MQG 783 ALS 1911 Ambulance 2007 -Ford E -350 1FDWE35P77DB00744 014 -MQG 784 ALS / 911 Ambulance 2007 -Ford E -350 1FDWE35P27DA96425 015 -MQG 785 ALS / 911 Ambulance 2010 -Ford E -350 1FDWE3FP5ADA07694 016 -MQG 787 ALS / 911 Ambulance 2009 -Ford E -350 1FDWE35P19DA71499 018 -MQG 801 ALS / 911 2008 -Ford E-450 1 FDXE45P78DA77008 024 -MQG Ambulance 804 ALS / 911 2003 -Ford E-450 1FDXE45F73HA60864 023 -MQG Ambulance 805 Training / Community 2011 Mercedes Sprinter WD3PE7CD4B5533881 025 -MQG Events 201 Field Supervisor 2014 Ford Expedition IFMJUIG50EEF03856 028 -MQG EMS 20 202 Asst. C.E.O. 2014 Ford Explorer 1FM5K8D83EGC08270 019 -MQG EMS 775 C.E.O. 2011 -Ford Explorer 1FMHK8D82BGA84422 007 -MQG EMS 776 Staff Use 2007 -Ford Expedition IFMFUI6597LA79101 008 -MQG 777 Staff Use 2006 -Ford Explorer 1 FMEU73876UB 19732 653 -DQZ 778 Field Supervisor 2012 -Ford Expedition IFMJUIG56CEF39810 009 -MQG EMS 10 779 Operations Manager 2009 -Ford Explorer 1 FMEU73879UA07551 010 -MQG EMS 810 Community Paramedic 2007 - Chevrolet Tahoe 1GNFK13027J346200 026 -MQG 812 Staff Use 2004 -Ford Explorer 1 FMZU72K84ZB05532 020 -MQG Trailer MCI Use 2007 - PAC 4P2FB08127U077475 958 -BHG *Government Plates on all vehicles. Permanent expiration. Common Fleet Expiration Date of November. Each year we will receive a list of all vehicles in our fleet in November. We cross out any that are retired from the fleet and note if plates have been moved to another vehicle or retired. Revised: 3/20/2015 Printed: 5/26/15 CERTIFICATE OF AMBULANCE MECHANICAL CONDITION DATE: -1' / The undersigned, professing to be motor vehicle mechanic, has of this date, evaluated the mechanical condition of the identified ambulance and determined that this vehicle is in safe operating condition. Said evaluation does NOT warrantee future status of the ambulance due to conditions beyond my control. )(54,e fJ 1, 4,-/ffr (r57— AMBULANCE DESCRIPTION: Year: Make: Model: V.I.N. 74 �St�E GZs i 4, Assigned agency vehicle number:i�1?9C'Y/£U Ambulance Service (owner): ,' C'oanM y el>`d ryicc ��s��C Doing Business as: EVALUATION CHECKLIST Wheels & Tires Steering Alignment Suspension �,.-- Brakes Emergency Brake Lights Electrical System Glass Exhaust System Fuel System Body & Sheet Metal MECHANIC: / 'l ones / (PRINTED N ME/) AGENCY �//� /�'� , ADDR S: 613_ %+��, (97a) 6 Eagle County Ambulance Inspection List Public Health Department 4/11 EAGLE COUNTY AMBULANCE INSPECTION District: 9"LIP5 Date of inspection: J— a�✓3'- Ambulance: t411 ;e7el 6tokk;Oes VENTILATION EQUIPMENT Basic: ✓� Portable suction unit /adult & pediatric and a house (fixed system) or back -up suction unit ✓ Bulb syringe ✓ Portaple oxygen each with Variable flow regulator ✓✓ OZ bottles �c «house OZ Transparent, non - re breather fixed oxygen (vehicle) ,02 mask, cannula for adult ✓ 02 mask, pediatric Hand operated, self inflating bag -valve masks resuscitators with 02 reservoirs and standard 15mm/21 mm fittings in the following sizes: _e!f'5000 cc bag with newborn and infant -1"'7'50 cc bag for children ✓ 1000 cc bag with adult mask tf-:Tiransparent masks for infants, neonate patients, children and adults ✓� Nasopharyngeal airways in adult sizes 24 fr. through 32.fr Oropharyngeal airways in adult & pediatric sizes to include: infant, child, small adult, adult, and large adult Intermdi-atte /Advanced: w" Adult & pediatric endotracheal intubation equipment to include stylets and an endotracheal tube stabilization device and endotracheal tubes uncuffed, ranging from 2.5 -5.5, and cuffed size ranging from 6.0 -8.0 per medical director protocol. ,✓ Laryngoscope blades, straight & curved, sizes 0-4 !/. ,leo loe,/nJCAe`jsj. 45 1 Adult and pediatric magill forceps End tidal CO2 detector or alternative device, approved by the FDA, for determining end tube placement Eagle County Ambulance Inspection List Public Health Department 4/11 PATIENT ASSESSMENT EQUIPMENT Basic: ✓'' Blood pressure cuffs to include large adult, regular adult, child, and infant ✓"� Stethoscope +� Penlight Intermediate/Advanced: Portable, battery operated cardiac monitor - defibrillator with strip chart recorder and adult and pediatric EKG electrodes and defibrillation capabilities ✓� Pulse oximeter with adult and pediatric probes. ---'Electronic blood glucose measuring device SPLINTING EQUIPMENT Basic/Intermediate/Advanced: ✓Lower extremity traction splint ,,"'--Upper and lower extremity splints Long board, scoop, vacuum mattress or equivalent to immobilize patient head to pelvis ,--'Short board K.E.D. or equivalent, with the ability to immobilize the patient from head to pelvis ✓ Pediatric spine board or adult spine board that can be adapted to pediatric use _,,,'Adult & pediatric head immobilization equipment _ Adult & pediatric cervical spine equipment immobilization equipment per medical director Protocol DRESSING MATERIALS Basiclintermediate /Advanced: Bandages, various types & sizes ,Dressings, various sizes ✓ Sterile burn sheets Adhesive tape IN Eagle County Ambulance Inspection List Public Health Depaitment 4/11 OBSTETRICAL SUPPLIES Intermediate /Advanced: Sterile OB kit to include _Z, towels, ,---"4'x4 dressing, umbilical tape or cord clamps ✓ scissors u-"'-bulb syringe ✓'''^sterile gloves ✓thermal absorbent blanket -11-1—�Neo natal stocking cap MISCELLANEOUS EQUIPMENT Heavy bandage scissors /shears -,,-'Two working flashlights Thermal absorbent blankets /blanket and appropriate heat source COMMUNICATIONS EQUIPMENT e, _, All communications equipment shall be maintained in good working order. The communications equipment must be capable of transmitting and receivin /g lear voice communications. goo /ywe �Sa�e�ios �t r- v�� /.���'�/Ya.K±il�lJ�. ee� /ac �Q. �,da�s • �, Two -way communications that will enable the ambulance personnel to communicate with: Dispatch _,edical control facility or a physicians ✓RReeceiving facilities ,/ Mutual aid agencies EXTRICATION TION EQUIPMENT Appropriate for the level of extrication service the agency provides. Eagle County Ambulance Inspection List Public Health Department 4/11 BODY SUBSTANCE ISOLATION (BSI) EQUIPMENT (Properly Sized To Fit All Personnel) ✓� Non - sterile disposable gloves, to include a minimum 1 box of latex free gloves. Protective eye wear ✓Non- sterile surgical masks .✓ Safety protection gear for extrication �' Sharps containers for appropriate disposal and storage of medical waste and biohazards. HEPA masks, which can be of universal size SAFETY EQUIPMENT ✓�A set of 3 warning devices (reflectors, fussee) Itf-5- One ten pound (10 lb.) or two five pound (5 lb.) ABC fire extinguishers, with a minimum on one extinguisher accessible from the patient compartment and vehicle exterior. Child safety seat or appropriate protective restraints for patients, crew, accompanying family members or other vehicle occupants. _Properly secured patient transport system (i.e., wheeled stretcher) ✓ / Triage tags INTRAVENOUS EQUIPMENT ,--"Adult and pediatric intravenous solutions and administration equipment per medical director protocol ✓Adult and pediatric intravenous arm boards PHARMACOLOGICAL AGENTS _Pharmacological agents and delivery devices per medical director protocol (Attach protocol) ✓ Pediatric "length based" device for sizing drug dosage calculations and sizing equipment 4 Eagle County Ambulance Inspection List Public Health Department 4/11 OTHER REGULATIONS DISPLAYS /IDENTIFICATION ✓Each ambulance shall clearly display permanent markings on both sides showing the name of the ambulance service under which they are licensed. --�Audible and visible warning devices and special markings are present to designate the vehicle as an ambulance MAINTENANCE At the time of application for permit, the ambulance services shall submit to the County certificate prepared by a qualified mechanic certifying the ambulance is in safe operating condition. ✓ Tires are safe and approved snow tires or chains are available when weather conditions demand. INSURANCE: _.v�No ambulance shall operate in the county unless it is covered by workman's compensation insurance, commercial or general liability insurance, motor vehicle liability insurance, medical malpractice and other insurance polices as required by law. Check Minimum Coverage: �Public Liability and Bodily Injury:+ Each Person $1,000,000 Each Accident (Aggregate) $2,000,000 �operty Damage: Each Accident $1,000,000 �rofessionai Liability: (medical malpractice) Each Person $1,000,000 Aggregate: $2,000,000 evr .9�', 0 /,� /• @'D 5 Eagle County Ambulance Inspection List Public Health Department 4111 EAGLE COUNTY AMBULANCE INSPECTION GENERAL INFORMATION District Date: V6 MUTUAL AID AGREEMENT ✓ A written, contractual agreement between two licensees to supplement services in each other's response districts. DESTINATION GUIDELINES The Medical Director of the ambulance service shall establish destination guidelines that conform to state and regional requirements, accepted standards of medical care, or as otherwise mandated. 3/1512011:AR 6