HomeMy WebLinkAboutCA Dept. of Health Services - 2005-09-06MEETING DATE: September 6, 2005 DEPA THEID NUMBER: FD05 005
Council/Agency Meeting Held: O
Deferred/Continued to:
Approved ❑ Conditionally Approved ❑ Denied
City Jerk' ignat
Council Meeting Date: September 6, 2005
Department ID Number: FD05 005
CITY OF HUNTINGTON BEACH
REQUEST FOR ACTION
SUBMITTED TO: HONORABLE M YGRAND CITY COUNCIL MEMBERS o
SUBMITTED BY: P EL�ULBRETH-GRAF Administrator cam== f:
ry o -<
PREPARED BY: DUANE OLSON, Fire Chi
o T.,
SUBJECT: ADOPT MEMORANDUM OF AGREEMENT BETWEEN THE STATE (IF
CALIFORNIA DEPARTMENT OF HEALTH SERVICES (CDHS) AID THE
CITY OF HUNTINGTON BEACH FOR CHEMPACK STORAGE CD
Statement of Issue, Funding Source, Recommended Action, Alternative Action(s), Analysis, Environmental Status, Attachment(s)
Statement of Issue: The City Council is being asked to adopt the attached Memorandum of
Agreement (MOA) between CDHS and the City of Huntington Beach for storage of two
CHEMPACK containers with pharmaceuticals to treat 2,000 chemically injured patients and
authorize the creation of a revenue/expenditure account for the necessary retrofitting of a
City fire station to facilitate acceptance of the containers. All related expenditures would be
reimbursed by CDHS.
Funding Source: If approved, funds, estimated up to $12,000, will be appropriated from the
unreserved, undesignated General Fund Balance, but will be fully reimbursed from the
CDHS. No other matching or in -kind City funds are required to accept the CHEMPACKS.
Recommended Actions:
1. Accept the Memorandum of Agreement between the CDHS and the City of Huntington
Beach for the acceptance of the CHEMPACKS,
2. Authorize the Fire Chief to expend funds to cover the retrofitting of a City fire station at a
cost not to exceed $12,000, and
3. Approve the appropriation of $12,000, from the unreserved, undesignated General Fund
Balance, to be reimbursed by the CDHS.
Alternative Action(s): Do not approve the Memorandum of Agreement and reject the
reimbursement funding from the CDHS and direct staff accordingly.
FD05 011 Adopt Memorandum of Agreement for CHEMPACK StorageUASI Agreement and Funding -2-
7/27/2005 2:47 PM Z S_
REQUEST FOR ACTION
MEETING DATE: September 6, 2005 DEPARTMENT ID NUMBER: FD05 005
Analysis: The CDHS, under its Memorandum of Agreement between the Centers for
Disease Control and Prevention (CDC), has agreed to distribute CHEMPACKS throughout
the state for use in the event of a Weapons of Mass Destruction (WMD) incident. The City of
Huntington Beach, as a Metropolitan Medical Response System (MMRS) Agency, was
selected to store two CHEMPACKS at a City fire station.
Each CHEMPACK container includes pharmaceuticals capable of treating 1,000 chemically
injured patients. In the event of a WMD chemical incident, Fire Department personnel are
authorized to deploy and use the pharmaceuticals. CHEMPACKs are secure storage
containers that extend the shelf -life of the pharmaceuticals from five to seven years. The
CHEMPACK containers and their pharmaceuticals are valued at approximately $60,000
each.
The attached Memorandum of Agreement identifies the storage requirements and the details
of usage for the pharmaceuticals. Adoption of the MOA significantly improves the City's
capability to respond to a WMD chemical incident.
COUNCIL POLICY REGARDING REQUESTS FOR AN APPROPRIATION OF GENERAL
FUNDS: - As adopted by the City Council in March 1998, all requests for appropriation of
general funds must meet one of the following criteria: 1) The request is for an unanticipated
emergency, 2) The request is required to implement labor negotiations, or 3) The request will
be offset by related new revenues. This appropriation meets the requirements set forth in #3.
Environmental Status: None
Attachment(s):
RCA Author: Olson/Reynolds/Justen
FD05 011 Adopt Memorandum of Agreement for CHEMPACK StorageUASI Agreement and Funding -3-
7/27/2005 2:47 PM
ATTACHMENT #1
MEMORANDUM'OF AGREEMENT
BETWEEN THE
THE STATE OF CALIFORNIA
DEPARTMENT OF HEALTH SERVICES
AND
City of Huntington Beach
(CHEMPACK STORAGE FACILITY)
1. Purpose
The purpose of this Memorandum of Agreement (MOA) is to coordinate the
implementation of the State of California Department of Health Services' (CDHS)
responsibilities under its "Memorandum of Agreement Between The Centers For
Disease Control And Prevention (CDC), U.S. Department Of Health And Human
Services And The State Of California Department of Health Services." (Attachment A)
11. , Parties
The parties to this MOA are the State of California Department of Health Services
(CDHS) and City of Huntington Beach
(CHEMPACK Storage Facility)
Ill. Incorporation by Reference
The CDHS MOA with CDC Strategic National Stockpile (SNS) Program (Attachment A)
is incorporated by reference and made part of this MOA.
IV. CDHS Responsibilities
1. Request that CDC SNS Program deliver to the CHEMPACK Storage Facility the
CHEMPACK Container and be present to assist during the delivery and installation.
2. Designate a single person to be the CDHS CHEMPACK point of contact (POC) and
designate an alternate CDHS CHEMPACK POC (APOC) to backup the CDHS
CHEMPACK POC. Provide contact information on the CDHS CHEMPACK POC and
APOC to the CHEMPACK Storage Facility prior to delivery of the CHEMPACK
Container to the CHEMPACK Storage Facility. (Attachment B)
3. Notify the CHEMPACK Storage Facility of any change of the CDHS CHEMPACK
POC or APOC within one business day of assignment.
4. Conduct on site inventories, security checks, and quality control checks as required
by the CDHS MOA with CDC SNS Program. Where reasonably practicable and in the
best interest of the CDC SNS Program, provide a minimum of 24 hours advance notice
to the CHEMPACK Storage Facility POC of the timing of such inspections and checks.
5. Provide a list of personnel with access to the CHEMPACK Containers at the
CHEMPACK Storage Facility to the CDC SNS Program at the time of delivery, and
update as changes occur.
6. Work with the CHEMPACK Storage Facility to correct any non -complying
environmental or security conditions identified by the CDC SNS Program or the CDHS
Within the timeframes specified in the CDHS MOA with CDC SNS:Program.
V. CHEMPACK Storage Facility Responsibilities
9. Ensure that a federal Drug Enforcement Administration registrant for controlled
substances is present during delivery of the CHEMPACK Container to the CHEAMPCK
Storage Facility to sign for custody.
2. Allow breaking of the CHEMPACK Container seal by pre -designated individuals
and use of the packaged products in accordance with the CDHS MOA with CDC SNS
Program and State Mutual Aid Regional and Operational Area plans.
3. Develop, in accordance with CDHS and State Mutual Aid Regional and Operational
Area plans, a plan for the apportionment of CHEMPACK materiel with neighboring
hospitals/agencies to facilitate rapid distribution of CHEMPACK materiel in an
emergency.
4. Designate a single person to be the CHEMPACK Storage Facility POC and
designate at least one CHEMPACK Storage Facility alternate (APOC). Provide contact
information to the CDHS prior to delivery of the CHEMPACK Container to the
CHEMPACK Storage Facility, and update as changes occur. (Attachment C)
5. Provide contact information to the CDHS CHEMPACK POC for the CHEMPACK
Storage Facility's head of security and an alternate security person prior to delivery of
the CHEMPACK Container to the CHEMPACK Storage Facility, and update as changes
occur. (Attachment D)
6. Notify the CDHS of any change of the CHEMPACK Storage Facility POC,
CHEMPACK Storage Facility APOC, CHEMPACK Storage Facility head of security or
alternate security person within one business day of assignment. The CHEMPACK
Storage Facility POC and the CHEMPACK Storage Facility head of security shall act as
joint custodians of the CHEMPACK Container and shall have responsibility for
overseeing CHEMPACK Storage Facility compliance with the terms of this MOA.
7. Ensure that the CHEMPACK Storage Facility meets the requirements set forth in
the CDHS MOA with CDC SNS Program regarding size, lighting, ventilation,
temperature control, sanitation, humidity, security conditions, etc.
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8. Ensure that requirements set forth from the California Department of_Health
Services Licensing and Certification Division and the California Office of Statewide
Health Planning and Development Facilities Development Division (OSHPD) are
adhered to where applicable. (Attachment E)
9. Not dispose of any CHEMPACK materiel, unless directed by the CDHS or CDC
SNS Program..
10. Allow CDC SNS Program personnel and CDHS CHEMPACK POC or designee
access to the CHEMPACK Container Storage Facility and cooperate fully with the
CDHS and the CDC SNS Program for all inventories, security checks and quality control
checks required under the CDHS MOA with CDC SNS Program. Full access must be
given upon demand. The CHEMPACK Storage Facility POC or CHEMPACK Storage
Facility APOC and the CHEMPACK Storage Facility head of security or alternate
security person shall be present at and facilitate all such inventories, inspections, and
checks. For quality control checks required under Section V, paragraph 12 of the
CDHS MOA with CDC SNS Program, the CHEMPACK Storage Facility shall complete
the CHEMPACK Monthly Quality Assurance Assessment Form and submit it to the
CDHS CHEMPACK POC by the end of each calendar month. (Attachment F)
11. Ensure the capability to rapidly move CHEMPACK materiel, including, but not
limited to, providing as necessary hydraulic lifts, forklifts, loading docks, or ramps.
12. Provide a list of personnel with access to the CHEMPACK Containers at the
CHEMPACK Storage Facility to the CDHS CHEMPACK POC at the time of delivery of
the CHEMPACK Container to the CHEMPACK Storage Facility, and -update as changes
occur.
13. Correct any non -complying environmental and security conditions at the
CHEMPACK Storage Facility that are identified by the CDC SN-S Program or the CDHS
within the timeframes specified in the CDHS MOA with CDC SNS Program. . The
CHEMPACK Storage Facility shall allow immediate access to and removal of the
CHEMPACK Container upon request by the CDC SNS Program or -the CDHS.
14. Notify the CDHS, CDC SNS Program and the Medical Health Operational Area
Coordinator (MHOAC) within two hours if the CHEMPACK Container Storage Facility
loses climate control:
15. Cooperate with the CDHS by allowing timely access and providing requested
personnel, if the CDHS directs the movement of the CHEMPACK Container on a
temporary basis. Coordinate with the CDHS and the CDC SNS Program to ensure the
maintenance of proper security and environmental conditions for CHEMPACK materiel
during any non -emergency movement (including pre -positioning assets for special
events). Movements of CHEMPACK materiel not specifically directed by the CDC SNS
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Program or CDHS shall be funded by the CHEMPACK Storage Facility's Operational
Area
16. Maintain a written record of any emergency deployment, identifying the amount of
CHEMPACK materiel expended and the amount of materiel returned to the container.
17. in the event of any use, compromise or loss of CHEMPACK materiel not
specifically authorized by the CDHS, report the use, compromise or loss to the CDHS
as soon as possible, but no later than 24 hours following discovery. In the event of an
accidental compromise to the CHEMPACK container, e.g., fire or accidental damage,
the Chempack Storage Facility will not be held responsible.
18. Allow the CDHS, at its discretion, to strategically move, either temporarily or
permanently, the CHEMPACK Container, or any part thereof, at any time to protect the
public. Assist the CDHS, at its request, in making any such movements.
19. Cooperate with and assist the CDHS, at its request, in implementing the CDHS
MOA with CDC SNS Program
VI. Costs
The CDHS will reimburse the CHEMPACK Storage Facility for costs associated with
modifying the CHEMPACK Storage Facility to meet requirements set forth in Part V,
paragraphs 7 and 8 above. Once agreement is reached on modification costs between
the CDHS and the CHEMPACK Storage Facility, the payment terms will be attached to
this MOA, as Attachment G.
VII. Liability
Each party to this agreement shall be responsible for its own acts and omissions and
those of its officers, employees and agents. No party to this agreement shall be
responsible for the acts or omissions of entities not a party to this agreement.
Neither party to this MOA agrees to release, hold harmless, or indemnify the other party
from any liability that may arise from or relate to this MOA.
Vlll. Effect on Procedures and Laws
The parties to this MOA agree to comply with all applicable federal and state laws and
regulations.
IX. No Private Right Created
This document is an internal agreement between the CDHS and the CHEMPACK
Storage Facility and does not create or confer any right or benefit on any other person
or party, private or public. Nothing in this agreement is intended to restrict the authority
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of either signatory to act as provided by law or regulation, or to restrict any agency from
enforcing any laws within its authority or jurisdiction.
X. Settlement of Disputes
The parties agree to consult with one another in good faith to resolve any
disagreements that may arise from or relate to this MOA, before referring the matter to
any other person or entity for settlement.
XI. Effective Date, Modification, and Termination
This agreement shall become effective when the CHEMPACK Storage Facility
modification costs are agreed upon and both parties sign this MOA. This agreement
shall remain in effect unfit terminated by either party. The terms of this agreement may
be modified in writing upon the consent and signature agreement of both parties. This
agreement may be terminated immediately by the CDHS at any time by giving written
notice to the CHEMPACK Storage Facility. The CHEMPACK Storage Facility may
terminate this agreement by written notice to the CDHS at least six months in advance
of the effective date of termination. In the event of termination, all CDC SNS Program
equipment, related records, and/or other materiel generated by or for the CHEMPACK
Program in furtherance of this agreement are property of the CDC SNS Program and
shall be returned to the CDC SNS Program within six months of the termination date.
XIi. Capacity to Enter Into Agreement
The persons executing this MOA on behalf of their respective entities hereby represent
and warrant that they have the right, power, legal capacity, and appropriate authority to
enter into this agreement on behalf of the entity for which they sign.
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XIII. Attachments
A. CDHS MOA with CDC
B. CDHS CHEMPACK Point of Contact Information
C. CHEMPACK Storage Facility Point of Contact Information
D. CHEMPACK Storage Facility Security Point of Contact Information
E. CDHS Licensing & Certification and OSHPD Letters (To follow)
F. CHEMPACK Monthly Quality Assurance Assessment Form
G. Payment Terms (To follow)
Elisabeth H. Lyman
Deputy Director, igning on be of CHEMPACK
Public Health Emergency Preparedness Storage Facility
California Department of Health Services
/ / 7 -060 mynr
Date Signed Title of the Signatory
November 16, 2005
Date Signed
ATTACHMENT A
MEMORANDUM OF AGREEMENT
BETWEEN THE
CENTERS FOR DISEASE CONTROL AND PREVENTION,
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
AND THE STATE OF CALIFORNIA,
DEPARTMENT OF HEALTH SERVICES
I. Purpose
To effectively respond to acts of chemical terrorism and other public health
emergencies, the Centers for Disease Control and Prevention (CDC) agrees to pre-
position sustainable repositories of nerve agent antidotes in locations in the State of
California. This Memorandum of Agreement (MOA) establishes the terms, conditions,
and responsibilities between the parties for deployment, management, and
maintenance of this federally owned asset.
If. Parties
The Parties to this MOA are the Centers for Disease Control and Prevention (CDC), a
component of the United, States Department of Health and Human Services (HHS) and
the State of California Department of Health Services (CDHS) The CDC will carry out
the responsibilities in this MOA on behalf of the U.S. Department of Health and Human
(DHHS) Services. CDC will implement this MOA through its Strategic National
Stockpile (SNS) Program, CHEMPACK Project.
Ill. Definitions
For purposes of this MOA, these terms shall be defined as follows:
CHEMPACK means: the sustainable repository of nerve agent antidotes -and other
necessary and certain supporting equipment to care for individuals exposed to -nerve
agents, including but not limited to auto -injectors, bulk symptomatic treatment supplies,
and self -monitoring storage Containers. CHEMPACK is a component of the CDC SNS
Program. The CHEMPACK Project provides two types of Containers: 1) The
Emergency Medical Service (EMS) Container designed for use by emergency
responders (materiel packaged primarily in -auto -injectors) and 2) The Hospital
Container designed for hospital use (materiel packaged primarily in multi -dose vials for
precision dosing and long term care). See CHEMPACK Container contents, Appendix 1.
Shelf Life Extension Program (SLEP) means the Food and Drug Administration's
(FDA) shelf life extension program designed to maintain the readiness and
effectiveness of pharmaceuticals over extended periods of time. The SLEP defers costs
by extending the expiration date of stored pharmaceuticals rather than replacing stocks
that have reached a set expiration date. Through centrally located automated
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monitoring devices, the CDC. SNS Program staff is able to ensure that conditions of
CHEMPACK materiel comply with SLEP guidelines, thus enabling CHEMPACK to
provide the State a long-term capability.
IV. CDC Responsibilities
1. Determine the contents and recommended doses of standardized
CHEMPACK Container packages acid -a treatment formulary to treat patients
exposed -to nerve agents.
2. Allocate to the CDHS, $ 9,390,928 worth of CHEMPACK Containers and
contents. The CDHS will determine the number and type of Containers that it
wants to receive, up to the total dollar allocation of $9,390;928. This allocation
will not be received in actual funds, but as purchasing power only for the purpose
of acquiring CHEMPACK Containers and contents.
3. Procure and deliver the CHEMPACK materiel to CHEMPACK Container
Storage Facilities identified by the CDHS, subject to subsection 5 below once the
CDHS has identified the required number and type of EMS or Hospital
CHEMPACK Containers within the $9,390,928 allocation.
4. Provide SATCO® C Drug Enforcement Administration (DEA) Containers
for each type of CHEMPACK Container. Each CHEMPACK Container will be
equipped and installed with one padlock, a Sensaphone®, and a CDC SNS
Program serial numbered Container seal.
5. Determine in its sole discretion the suitability of CHEMPACK Container
Storage Facilities within the State of California based on the criteria outlined in
section V of this agreement.
6. Provide a CDC SNS Program Fielding Team to install the CHEMPACK
Containers at CDHS_designated CHEMPACK Container Storage Facilities,
conduct a joint inventory with designated- CHEMPACK Container Storage Facility
personnel, and validate the operational status of CHEMPACK environmental and
security monitoring equipment.
7. Ensure that Schedule IV substances are secured in a locked DEA
approved CHEMPACK Container and that a CDHS designated pharmacy or
medical professional with a DEA registration for that location has inventoried and
assumed custody of the materiel.
8. Provide resources and assets required to sample, restock, re -label, and
dispose of CHEMPACK materiel subject to the SLEP.
9. Provide resources and assets required to perform surveillance and quality
assurance/quality control of CHEMPACK assets.
N.
10. Conduct periodic audits, including quality assurance and quality control
inspections, to verify that the CDHS is implementing proper inventory, storage,
and security procedures for CHEMPACK assets.
11. Ensure proper disposal in accordance with applicable federal, state, and
local regulations of expired CHEMPACK medical materiel, except sterile water
for injection.
V. CDHS Responsibilities
1. Authorize breaking the CHEMPACK Container seal and use the contents, only
when designated state officers, employees. or agents determine that an
accidental or intentional nerve agent release: (1) threatens the medical security
of the community; and (2) places multiple lives at risk; and (3) is beyond local
emergency response capabilities; and (4) the material is medically necessary to
save human life.
2. Designate a single- person to be the statewide point of contact (State
CHEMPACK POC) for CHEMPACK. Provide that individual's coritact numbers
during normal business hours and after hours (office phone, cell phone, pager,
email and fax). Also, designate an alternate (APOC) to backup the State
CHEMPACK POC, and provide corresponding contact -information. This
information shall be provided to the CDC SNS Program within.30 days of the
State's Aecision to participate in the CHEMPACK Project.
3. Notify CDC SNS Program of any changes in contact personnel within one
business day of assignment of a new POC / APOC.
4. Determine the quantity and type of CHEMPACK Containers (EMS / Hospital),
required to meet the needs of state and local first responders to respond to a
nerve agent event, (within the allocation of $9,390,928) and provide this
information to the CDC SNS Program at least 60 days prior to the mutually
agreed upon expected state delivery dates.
5. Develop a CHEMPACK Operational Plan for use, surveillance, and maintenance
operations as an addendum to the State Emergency Response Plan. The plan
should address: asset placement; distribution; coverage areas; security;
procedures for control, authorization and use of CHEMPACK assets. This plan
shall be provided to the CDC SNS Program at least 30 days prior to the initial
expected state delivery date.
6. Provide the address of each CHEMPACK Container Storage Facility to the CDC
SNS Program at least 45 days prior to the expected CHEMPACK Storage Facility
delivery date.
Z
7. Assist the CDC SNS Program in.pre-coordinated access to CHEMPACK
Container Storage Facilities as needed to monitor CHEMPACK materiel.
8. Ensure that CHEMPACK Container Storage Facilities are of a suitable size;
designed to -provide adequate lighting, ventilation, temperature control; provide
sanitation, humidity, and space and security conditions for storage of
pharmaceuticals. See CDHS Responsibility for Container Storage Standards for
Schedule IV Controlled substances and Pharmaceuticals are based upon the
following DEA, FDA, and CDC SNS Program Storage Criteria as included in
Appendix If.
9. Ensure proper disposal of expired sterile water for injection in accordance with
applicable federal, state, and local regulations.
10.Conduct joint inventories with the CDC SNS Program. Fielding Team upon
delivery and approximately every 18 months thereafter.
I I. Designate a DEA Registrant in accordance with applicable federal and state
regulations to sign for custody of the CHEMPACK Containers during delivery.
12. Conduct quality control checks at each CHEMPACK Container Storage Facility to
ensure that the facility's climate is within acceptable environmental limits and that
the security system is in place and operational. The CDHS will submit to CDC
SNS Program a monthly CHEMPACK Project Quality Control (QC) checklist to
document security and environmental storage conditions at each CHEMPACK
Container Storage Facility.
13. Provide adequate transportation of CHEMPACK materiel in an emergency.,
including coordinating with state and local officials and emergency planning
members for use of vehicles, freeway routes, and airfields.
14. Ensure CHEMPACK Container Storage Facilities have the capability to rapidly
move CHEMPACK materiel as required. This may include, but is not limited to,
hydraulic lifts, forklifts, loading docks, or ramps.
15. Provide a list of personnel with access to the CHEMPACK Containers at each
CHEMPACK Container Storage Facility to the CDC SNS Program POC at the
time of delivery, and update as changes occur.
16. Ensure CHEMPACK Container Storage Facilities correct non -complying
environmental and security conditions identified by CDC SNS Program POC in a
timely manner (usually within one hour). When conditions cannot be corrected
within 12 hours, the CDC SNS Program Logistics Team will coordinate with the
State CHEMPACK POC to move CHEMPACK Containers) to an acceptable
location to safeguard the quality or security of the materiel.
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17.Notify the CDC-SNS PROGRAM Logistics Team within two hours after being
notified by a CHEMPACK Container Storage Facility of a loss in climate control.
18.Coordinate with CDC SNS Program personnel to ensure the maintenance of- -
proper security and environmental conditions for CHEMPACK materiel during
any non -emergency movement. See Section IX of the Agreement. Movements
of CHEMPACK materiel not specifically directed -by the -CDC SNS Program shall
be the responsibility of the CDHS.
19. Notify the CDC SNS Program within 24 hours of an emergency usage. The
usage report should identify the amount and type of CHEMPACK expended and
the amount of materiel returned to the CHEMPACK Container.
20. Report the non -emergency use, compromise or loss of CHEMPACK materiel to
the CDC SNS Program as soon as possible following discovery.. The CDHS
must submit a follow-up report within 48 hours of the discovery detailing the
circumstances and inventory of the non -emergency use, compromise or loss of
CHEMPACK materiel.
21.In separate MOAs, the CDHS will assign specific responsibilities to the
participating CHEMPACK Container Storage Facilities to assure the objective -of
this MOA is met.
VI. Costs
Except where otherwise detailed in the MOA, each party is responsible for its own
costs. Any assistance provided by CDC SNS Program under this MOA is subject to the
availability of appropriations. The CDC SNS Program is not currently funded to replace
any CHEMPACK material used in response to an actual nerve agent incident or
damaged, destroyed or lost due to any other reason, such as an accident or natural
disaster. If such an event occurs, however, the CDC _SNS Program Will cooperate with
the CDHS to identify mechanisms to replace the CHEMPACK materiel and will
negotiate with the CDHS for replacement of the CHEMPACK materiel on a case -by -
case basis.
VII. Ownership
The CDC SNS Program shall at all times retain ownership of all CHEMPACK materials.
Subject to the terms of this MOA, CDC SNS Program grants the CDHS permission to
use CHEMPACK materials in the event of an accidental or intentional nerve agent
release that: (1) threatens the medical security of the community; and 2) places multiple
lives at risk; and (3) is beyond local emergency response capabilities; and (4) the
materiel is medically necessary to save human life.
I
VIII. Storage
State and local agencies may only store the materiel provided as part of the
CHEMPACK Project in the CDC SNS-provided CHEMPACK Containers. The CDHS
may, however, allow storage of state or local agency owned materiel in the same
location as the CHEMPACK Containers. -
IX. Movement for Special Events
The CDC SNS Program authorizes the CDHS to move CHEMPACK for State -
designated special events (e. g., National Special Security Events, Super Bowls, World
Series, major political conventions, state fairs, major concerts, and key summits) on a
temporary basis. The temporary movement of CHEMPACK Containers is subject to the
following -conditions: (1) the CDHS CHEMPACK POC or APOC must notify the CDC
SNS Program at least 48 hours prior to such movement of CHEMPACK Containers; (2)
the notification must be made telephonically or in writing (electronic or paper) to the
designated CDC SNS Program POC, the CDC SNS Program Regional Coordinator; or
'CDC SNS Program Project Manager; (3) the CDHS shall ensure that environmental and
security requirements outlined in Section V are maintained throughout transport and
placement; and (4) any movement of CHEMPACK materiel not specifically directed by
the CDC SNS Program shall be the responsibility of the CDHS.
X. Compliance with U.S. Drug Enforcement Administration Requirements
The CDHS agrees to comply with all applicable federal, state, and local requirements
regarding storage, use, and handling of controlled substances. A non exclusive list of
federal requirements regarding the storage, use, and handling of these substances may
be found in Title 21 Code of Federal Regulations Part 1301. In addition, the CDHS
agrees to designate a pharmaceutical or medical professional with a DEA registration
who will sign for and accept custody for controlled substances and other
pharmaceuticals in CHEMPACK Containers at each Container Storage Facility. The
CDHS designee will be responsible for the storage and safeguarding of controlled
substances within the CHEMPACK Container and ensure compliance. with federal,.
state, and local requirements. The CDHS POC must provide the custodian's name,
license number and contact information two weeks prior to the scheduled delivery of a
CHEMPACK Container.
XI. Requests for Information
Under 42 USC § 247d-6b, no federal agency shall disclose less than 5 USC § 552,
United States Code, any information identifying the location at which CDC SNS
Program materials are stored. To the extent permitted by law, the parties agree that
neither will disclose the nature of this effort and the temps of this agreement to any
person or entity, except as may be necessary to fulfill its mission and statutory and
regulatory responsibilities. The parties agree to notify one another before releasing
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3
materials or information relating to CHEMPACK or this MOA pursuant to federal or state
freedom of information act statutes or similar provisions in law.
X111. Liability
Each party to this agreement shall be responsible for its own acts and omissions and
those of its officers, employees and agents. No party to this agreement shall be
responsible for the acts or omissions of entities not a party to this agreement. Neither
party to this MOA agrees to release, hold harmless, or indemnify the other party from
liability that may arise or related to this MOA.
X111. Effect on Procedures and Laws
All assistance provided under this MOA must comply with applicable state and federal
laws, regulations, and CDC agency policies.
X1V. No Private Right Created
This document is an internal agreement between CDC and the CDHS and does not
create or confer any right or benefit on any other person or party, private or public.
Nothing in this agreement Is intended to restrict the authority of either signatory to act as
provided by law or regulation, or to restrict any agency from enforcing any laws within its
authority or jurisdiction.
XV. Settlement of Disputes
The parties agree to good faith consultation with one another to resolve disagreements
that may arise under or relating to this MOA before referring the matter to any other
person or entity for settlement.
.XVI. Authority
...............
This agreement is made under the authority of section 311 of the Public Health Service
Act (42 U.S.C. §243) and 42 U.S.C. §247d-6b.
XVII. Effective Date, Modification, and Termination
This agreement shall become effective upon the signature of both parties and shall
remain in effect until otherwise agreed to by EITHER party. The terms of this
agreement may be modified IN WRITING upon the consent and signature agreement of
both parties. Either party may terminate this agreement at any time; however, the
terminating party shall .provide written notice to the other party at least six months in
advance of the effective date of termination unless there is a critical failure to perform.
In the event of termination, all CDC SNS Program equipment, related records, and/or
other materiel generated by or for the CHEMPACK Project in furtherance of this'
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agreement are _property of the CDC SNS Program and shall be returned'to the CDC
SNS Program within six months of the termination date.
XVNt. Capacity to Enter into Agreement
The persons executing this Memorandum of Agreement on behalf of their respective
entities hereby represent and warrant that they have the right, power, legal capacity,
and appropriate authority to enter into this agreement on behalf of the entity for which
they sign.
v► lw• Ow► L� i+
Julie Gerb di , M.D.
Director,
Centers for Disease Control
and Prevention ,
Elisabeth H. Lyman
Deputy Director,
Public Health Emergency Preparedness
California Department of Health Services
FED 9 2005 % ' ! T-`C'
Date Signed Date Signed
14
Appendix I — CHEMPACK Container Contents
Unit Pack Cases
QTY
Mark 1 auto -injector
- 240
11
2640
Atropine Sulfate 0.4m /ml 20ml
100
1
100
Pralidoxime 1 m in 20m1
288
1
288
Atroen 0.6 mg
144
2
288
Atro en 1.0_mg
144
2
288
Diaze am 5m /ml auto -injector
150
4
600
Diazepam 5m /mi vial, 10ml
25
4
100
Sterile water for Injection SWFf 20cc Vials
100
3
300
Sensa hone® 2050
1
1
1
Satco C DEA Container
1
1.
1
Container Cost $551170.97
Unit Pack Cases CITY
Mark 1 auto -injector
240
2
480
Atropine Sulfate 044mqjml20m1
100
9
900
Pralidoxime 1 m Inj 20ml
288
10
2880
Atro en 0.5 mg
144
1
144
Atro en 1.0 mg
144
1
144
Diazepam 5qg1ml auto -injector
150
1
150
Diazepam 5 /ml vial, 10rd
25
26
650
sterile water for injection SWFI 20cc Vials
100
23
2300
Sensa hone® 2050
1
I
1
1
1
Satco C DEA Container
1
1
1
Container Cost $63,201.57
Appendix It— CDHS Responsibility for CHEMPACK Container Storage
Standards for Schedule IV Substances and Pharmaceuticals are based upon the
following DEA and FDA and CDC SNS PROGRAM STORAGE CRITERIA
1. Provide a locked room or cage. The CHEMPACK Container is constructed of
Lexan® mesh and is approved by the Drug Enforcement Administration (i.e.,
double locked standard, 24/7 security monitoring, and controlled designated
entry) for storage of Class IV controlled substances. The purpose of the
enclosed room or cage is to control access and ensure compliance with
applicable federal, state and local pharmaceutical regulations.
2. Install an intrusion detection device directed towards the CHEMPACK Containers
to alert CHEMPACK Container Storage Facility security or pharmacy personnel
of possible intrusion into the storage area. The sensor must be physically
monitored on a 24-hour basis by security or pharmacy personnel. CHEMPACK
15
Container Storage Facility security managers will test the interior devices
according to manufacturer specifications to ensure proper operation.
3. Ensure each CHEMPACK Containeris locked with a padlock and access to the
key is limited; key control shall be the responsibility of the DEA registrant and/or
the CHEMPACK Container Storage Facility pharmacy director.
4. Ensure a minimum clearance of 72" aisles and 34" doorways to maneuver
CHEMPACK Containers in and out of the storage location.
5. Provide a minimum of 40 sq. ft. of floor space per CHEMPACK Container at each
CHEMPACK Container location.
6. Ensure accessibility to CHEMPACK Containers. CHEMPACK Container
dimensions are 60.5" long X 32.5" wide X 60.5" high. The EMS Container has an
approximate.weight of 800 pounds and the Hospital Container has an
approximate weight of 1100 pounds.
7. Ensure CHEMPACK Containers are stored in a climate -controlled environment
With room temperature maintained between 59 and 86 degrees Fahrenheit (15
and 30 degrees Celsius). Humidity levels must be maintained below 60% in
accordance with Title 21, Code of Federal Regulations, Parts 205 and 211.
8. Provide one dedicated data quality analog phone line per Sensaphone0. The
telephone line must be a Plain Old Telephone Service (POTS) type line (this line
may not be a shared line). Digital lines on private branch exchanges (PBX) or
private telephone switchboards will not work with the Sensaphone@).
9. Ensure one dedicated standard 120VAC, 60HZ, 10W, UL-listed power outlet
power source per Sensaphone®. The outlet should be connected to an existing
facility emergency_ generator or the location must provide an uninterruptible
power supply (UPS) device.
10. Provide a fire detection and alarm device and, adequate fire suppression in
accordance with applicable federal, state and local pharmaceutical regulations
and fire codes.
11. Provide standard lighting to ensure CHEMPACK personnel can clearly see lot
numbers and product expiration dates as required by applicable federal, state and
local pharmaceutical regulations.
E.
ATTACHMENT B
California Department of Health Services
Emergency Preparedness Office
CDHS CHEMPACK Point of Contact Information
CDHS CHEMPACK PrimarO Point of Contact
Tom Ahrens SNS Coordinator.
Now We
Office Phone: (916) 650-6438 Cell Phone:(916)208-7061
f Home Phone:-(916) 933-5879 Pager:
E-Mail Address:
CDHS CHEMPACK Alternate Point of Contact #1 1
Louis Lallo Sr. Consulting Pharmacist -
Name
Office Phone: (916) 319-0999 Cell Phone: (916) 204-7941
Home Phone: (916) 482-0647 Pager:
E-Mail Address:
CDHS CREMPACK Alternate Point of Contact 112
Dana Grau Sr. Consulting Pharmacist
Name Title
Office Phone: (916) 319-8187 Cell-Phone:l (916) 208-7058
Home Phone:_(209) 466-9308 Pager:
E-Mail.
17
ATTACHMENT C
California Department of Health Services
Emergency Preparedness Office
CHEMPACK Storage Facility Point of Contact Information
CHEMPACK Storage Facility, 18591 Edwards Street
Main Phone Number: 714/375-8400
State of California Mutual Aid and Administrative Region: 1
DEA Registration Number:
Controlled Substance Schedules per DEA Registration:
CHEMPACK Storage Facility Primary Point of Contact
Charles ReynoldsProgram Manager
Office Phone: 714/375-5008 Cell Phone: 7141357-2237
j Home Phone: 760/731-3965
� E-Mail Address:
Pager: DNA
HB.
CHEMPACK Storage Facility Alternate Point of Contact #1 1
Jacques Pelletier Division Chief
- NAM girt
--
Office Phone: 714/536-5563 Cell Phone: 7141345-011 t
Home Phone: 949/716-8774
E-Mail
Pager: 714/433-4930
Surf
CHEMPACK Storage Facility Alternate Point of Contact #2
John Rees mum -talion Chief
Office Phone: 714/536-5406 Cell Phone: 714/337-7794
Home Phone:949/361-3992 Pager: 714 j4-33-4073
E-Mail Address: JRees@Surf city—HB.org
18
ATTACHMENT D
California Department of Health Services
Emergency Preparedness Office
CHEMPACK Storage Facility Security Point of Contact Information
CHEMPACK Storage Facility 18591 Edwards Street
Main Phone Number: 714/375-8400
State of California Mutual Aid and Administrative Region: 1
Department DEA Registration Number:
Controlled Substance Schedules per DEA Registration:
CHEMPACK Storage Facility Securitv Primary Point of Contact
Charles Reynolds WMD Program Manager
Office Phone: 714/375-5008 Cell Phone: 714/357-2237
Home Phone: 760'/731-3965 Pager: DNA
E-Mail Address' CReynolds@Surfcity-HB.org
CHEMPACK Storage Facility Security Alternate Point of Contact #1
MetroNet Dispatch Fire Dispatch Center
,rim
Office Phone: 714/765-4078 Cell Phone: DNA
Home Phone: DNA Pager: DNA
E-Mail Address: DNA
CHEMPACK Storage Facility Security Alternate Point of Contact #2
Huntington Beach Police Dis atch Center
Nun
Office Phone: 714/960-8825 Cell Phone: DNA
Home Phone: DNA
E-Mail Address:
Pager: DNA
owe
CaUfo►n(a
D::.. nt or IN
Health 4t*.f.
SANDRASHEWRY
Director
State of C fornia—Health and Human_Service-- ency
Department of Health Services
ATTACHMENT E
REQUIREMENTS FOR CHEMPACK LOCATION
ARNOLD SCHWARZENEGGER
Governor
Thank you for your interest in participating in the CHEMPACK Project as a location site. The
CHEMPACK Project as part of the national Strategic National Stockpile (SNS) program is
designed to quickly mobilize resources to minimize and neutralize the effect of an attack (or
large scale exposure) involving chemical nerve agents. To accomplish this goal CHEMPACK
containers are being strategically positioned throughout the country. The location of each
CHEMPACK is a decision made by each County Operational Area. Your community has
determined that a CHEMPACK should be placed in your institution and your institution's
willingness to accept a CHEMPACK is critical to the success of this extremely important
project.
CHEMPACK containers are available in two variations of pharmaceutical kits or containers.
Each type of CHEMPACK container will serve approximately 1000 patients.
• Hospital containers are designed for hospital use. The nerve agent antidotes are primarily
packaged in multiuse vials to allow medical professionals to better control the dosage for
follow-up and long term care and will assist with precise dosing.
• EMS containers are designed for initial use by emergency responders. The antidotes are
packaged primarily in single -use auto -injectors. A percentage of the doses are designed
for pediatric patients.
Containers must be located in an area of suitable size, designed to provide adequate lighting,
ventilation, temperature, sanitation, humidity, space and security conditions for storage of
pharmaceuticals.
Specifically, container locations must meet the following federal requirements:.
1. Accessibility: The location must be accessible to 20 foot or.iarger trucks and emergency
response vehicles. Each location should have a method for unloading the containers:
loading docks, ramps, or forklifts are appropriate. The containers are on wheels; however
they are very heavy and can weigh.over 700 pounds. A freight elevator may be necessary
if the location is upstairs.
Emergency Preparedness Office, MS 7002, P.O. Box 997413, Sacramento, CA 95899-7413
(916) 650-6416
Internet Address: www.dhs.ca_gov/epo
20
j
2. Space: Each container location must have a minimum of 40 square feet per container.
The dimensions are 60.5" H, 32.5"W, and 60.5%.
3. Temperature/Environmental requirements: Room temperature must be continuously
maintained between 59 and 86 degrees Fahrenheit. CHEMPACK staff recommends a
thermostat lock or other system to prevent tampering. The containers come with a
Sensaphone@ that will automatically alert the Centers for Disease Control and Prevention
(CDC) of noncompliance with temperature, humidity or security requirements. The room
must be designed to prevent the entry of rodents and/or vermin into the container storage
area. Humidity must be maintained below 60% to prevent visible mold growth. Storage
locations should be away from employee break areas where eating, drinking and smoking
may create unsanitary conditions.
4. Electrical Power: A standard 120 VAC, 60Hz, 10 W, UL-listed power supply is required
for each Sensaphone®. Each Sensaphone® can monitor three CHEMPACK containers.
Each location must have automatic, 12-hour minimum back up or emergency electrical
power for the Sensaphone®. The Sensaphone® itself is equipped with 12-hour battery
backup. An uninterrupted power source (UPS) is minimally acceptable as a backup
power source. Locations equipped with back-up generators capable of maintaining
temperature in the event of a power outage are preferred as container sites.
5. Analog Phone Line: Container locations must have one (1) analog phone line for each
SensaphoneOD. Digital simulated analog fax lines or any digital line are not acceptable.
6. Fire Suppression: Each container location must have a fire suppression system.
Automatic sprinklers are recommended but not required.
7. Monitoring: Container locations must be physically checked monthly for continued
compliance with all the above requirements. A monthly Quality Assurance Assessment
Form will be provided that will need to be sent to the CHEMPACK Project at the
Emergency Preparedness Office of the California Department of Health. Services
(CDHSIEPO) by fax or email. The monthly compliance checks should take only minutes
to perform.
8. Environmental Response: Institution personnel must be available to respond to
emergency environmental alarms or conditions within one hour from notification.
9. Security: Security is a critical issue; pilferage and unauthorized access to
pharmaceuticals is illegal and may substantially increase the cost of the CHEMPACK
program and potentially negate its utility. Diazepam, a schedule IV controlled substance,
particularly presents a security concern. CHEMPACK containers have LEXAN®
Plexiglas walls lined with a hardened wire mesh to conform to FDA and DEA storage
requirements for schedule IV controlled substances. However, the facility, or at least the
CHEMPACK storage room, must have controlled access. Additionally, container
locations must have:
21
v V`
Alarms and Monitoring: Container locations without physical monitoring on a
continuous basis (24 hours a day, 7 days a week) must have a security system.
Motion detectors, contact sensors or other types of security systems may be used,
but the system must be monitored at all times (24 hours a day, 7 days a week) and
have notification abilities to contact designated responders should there be an
attempted break in to a container location.
• Security Response: Container locations must have staff members designated to
respond to any security alarm. The CHEMPACK Project at CDHS/EPO must
have current security contact information for all container locations.
• SNS Notification: The containers have a Sensaphone® attached that directly go
to the SNS program at the Centers for Disease Control and Prevention (CDC).
Therefore, they should receive an alarm when a container is opened; however, if
the phone line is disconnected, the SNS Program will not be automatically
notified. Container locations must contact CHEMPACK Project personnel at
CDHS/EPO as soon as possible when a container has been opened or
compromised.
10. Technical Assistance: The CHEMPACK Project at CDHS/EPO is committed to
facilitating the implementation of this program in participating hospitals. A minimal
amount of funding has been dedicated to cover reasonable retrofit expenses and
assistance in site planning is readily available from the CHEMPACK Project staff of the
CDHS/EPO.
Please contact Louis Lallo, Pharm.D., (916) 319-0999, llallo@dhs.ca.gov. if you have questions
on the CHEMPACK Project.
22
C]5�_f rx _ _ "Equitable Healthcare Accessibility for
Office of Statewide Health Planning and Development
Facilities Development Division
1600 91^ Street, Room 420
Sacramento. California 95814
(9)6) 654-3362
Fax (916) 654-2973
www.oshpd.co.gov/fdd
OSHPD REQUIREMENTS FOR CHEMPACK LOCATIONS
WITHIN HOSPITAL BUILDINGS
The Office of Statewide Health Planning and Development, Facilities Development
Division (OSHPD) regulates the construction and alteration of health facilities: When
construction work is proposed to accommodate a CHEMPACK container, plans showing
the work shall be submitted to OSHPD for review and approval prior to the beginning of
construction. Most CHEMPACK container installation projects in hospital buildings will
require only minor construction work.
Due to the limited -scope of the modifications needed to accommodate a CHEMPACK
location, it -is anticipated that most, if not all, projects can be field reviewed. For field
review, the plans, along with an Application for Plan Review (OSH-FD-1 2 1), may be
submitted to the OSHPD Area Compliance Officer (ACO). Contact the OSHPD ACO for
plan review submittal requirements, or with questions regarding the applicability of
OSHPD regulations. In order to expedite the review, projects for modifications to
accommodate CHEMPACK containers should not be combined with other alterations.
While OSHPD has no specific requirements regarding the location of CHEMPACK
containers within health facilities, any construction work or modification of the hospital
building needed to accommodate a CHEMPACK- location must be reviewed and
approved by OSHPD before construction begins. This work may include, but is not
limited to, constructing rooms or enclosures for the containers, installing seismic
restraints for the container, adding or relocating electrical or telephone outlets, installing
security devices, modifying HVAC systems, or replacing door hardware.
Because of the size of the CHEMPACK container, the California Building Code requires
that the container be restrained to prevent excess movement during a seismic event
(CBC Section 1632A.1, Table A-O, footnote 24). A suggested detail for restraining the
container is attached. This detail may be used for most typical installations; however,
restraint for atypical installations may need to be designed by an engineer.
OSHPD has no authority to verify that any requirements other than those found in the
California Building Standards Code have been met regarding the location or physical
requirements for a CHEMPACK container. OSHPD will not review for compliance with
CDC or other requirements.
For more information on construction or review requirements pertaining to the
location of CHEMPACK containers in health facilities, contact the OSHPD Area M
Compliance Officer for the facility, or Don Harris at (916) 654-2003. '
/0 N.
tccwd 10= 04
State of California - Health and Human Services Agency
23 Arnold Schwarzenegger, Governor
See dE
below
CHEIVIII
contair
1" Nyloi
Slot for strap (debut;
L2x2x16gax4"wl
3414 screws to wal.
1" wide nylon strap
(E)-Stud
(E) Gypsum board
L2x2 x 16 ga x 4"
#14 Screws (3 per angle)
Scale: Not to Scale Office of Statewide Health Planning and Development Restraint of
Facilities Development Division
1600 9th St, Room 420, Sacramento, CA 95814, 916-654-3362 C H E M PAC K
Checked: DWH 1831 9th St, Sacramento, CA 95814, 916-324-9090
311 South Spring St, Suite 1001, Los Angeles, CA 90013, 213-897-0166 Date: 10/26/2004 www.oshpd.c6.gov/tdd Containers
24
State of -fornia—Health and Human Services: ,ency
Department of Health Services
C.d6rOr11�/
HQattll S81Vk1K '
SANDRA SHEWRY
Director
kF,
ARNOLD SCHWARZENEGGER
Governor
DEPARTMENT OF HEALTH SERVICES LICENSING AND CERTIFICATION
REVIEW 'OF CHEMPACK LOCATIONS WITHIN HOSPITAL BUILDINGS.
The California Code of Regulations Title 22 (CCR, T22), Section 70805 requires that
hospitals obtain written approval from the Licensing and Certification (L&C) Program
when converting hospital space that was identified for a specific use at the time of
licensure. This regulation applies to hospitals that choose to accommodate a
CHEMPACK container.
In order to meet this requirement, L&C requests that the hospitals inform us, in writing,
of their intention to become a location site for CHEMPACK, and include in the letter a
brief description of the planned location of the kit, and the projected modifications of
their physical plant. The hospital should also include a copy of the "Application for Plan
Review" (OSH — FD-121) required by the Office of Statewide Health Planning and
Development (OSHPD) from hospitals that are participating in this project. Additionally,
once the plan and work has been reviewed by OSHPD, the hospital should provide L&C
with a copy of the approval notice. These documents will be stored in the facility's
confidential file.
Because the modifications required to become a CHEMPACK location are likely to be
limited in their scope, and in -light of the need to facilitate this process in order to comply
with. CDC deadlines, L&C will make every effort to expedite the request for approval
from hospitals that Chooseto participate in this program.
L&C also expects that hospitals who participate in the CHEMPACK program will
address the safe. and effective management of this pharmacy resource in their policies
and procedures as required by CCR, T 22 Section 70263 (c) (1). L&C may choose to
review these policies and procedures during the hospitals' next survey. Since CDC
maintains ownership of the CHEMPACK stockpile, and monitors the security of the
cache, L&C will not require hospitals to maintain pharmaceutical record keeping beyond
the requirements of the CDC
For more information regarding the L&C requirements of hospitals participating in the
CHEMPACK Project, please contact the local L&C district office, or
Jocelyn Montgomery at (916) 552-9365.
Licensing & Certification Program, 1501 Capitol Avenue, MS 3000
P.O. Box 997413, Sacramento, CA 95899-7413/Phone (916) 440-7360 FAX (916) 440-7369
Intemet Address: www.dhs.ca.gov
25
ATTACHMENT F
STRATEGIC NATIONAL STOCKPILE PROGRAM
CHEMPACK Monthly Quality Assurance Assessment
Site Name Evaluator Name
Date Time
The CDCSNS CHEMPACK Program will use this survey to evaluate CHEMPACK Storage Facilities for ongoing
maintenance of medical materiel.
The CHEMPACK Storage Facility's designated site representative will conduct monthly assessments at each
CHEMPACK Storage Facility. CHEMPACK Monthly Quality Assurance Assessment will be forwarded to the CDHS
CHEMPACK POC by the end of each month.
All sections within this document cover those areas the CDC SNS Program deems essential for maintaining a high
level of quality standards.
Note: any'No' responses recorded below must be explained (for the last question; explain for a yes
response). Attach additional sheets as required.
QUALITY ASSURANCE/ QUALtTY CONTROL ASSESSMENT
REQUIREMENT
COMMENTS
Temperature maintained continuously between 59' to 86' F
F1YES
with monitoring or verification being conducted on a routine
❑ NO
basis?
Are sanitary conditions being maintained to prevent the
from being Entry
❑ YES
product adulterated or compromised? (i.e.
points protected from vermin and humidity controlled to
Fj NO
prevent visible moldgrowth)
Power/electrical outlet(s) maintained operational with
❑ YES
adequate capabilities.
No
YES
Analog phone lines) maintained, and operational?
❑ NO
Storage area being maintained dear and accessible to allow
El YES
for ease.of inventorying, stock replenishment, and rapid
❑ No
mobilization?
Is security access limited to designated staff?
YES
❑ NO
There are no other products being stored in Container room
Q YES
or other processes taking place at the facility that could
❑
contaminate the medical materialT
NO
Does the facility have adequate lighting, ventilation and
❑ YES
protection from water damage?
No
Are eating, drinking and smoking prohibited in the
❑ YES
Immediate product storage area?
❑ NO
Are security systems_ in place, operational, and tested on a
YES
routine basis?
No
Are fire suppression systems and alarms maintained and
YES
26
operational? _
NO
The CHEMPACK containers remain sealed (the SNS
❑ YES
Program seal intact) with no indication of tampering?
NO
Are all the forms, Cube I.Q., and Loan Agreements in the
❑ YES
document pouch attached to the Chempack containers?
NO
Have the containers been moved or forward deployed?
❑ YES
Please explain if yes
NO
27
ATTACHMENT #2
CITY OF HUNTINGTON BEACH
INTERDEPARTMENTAL COMMUNICATION
TO: PENELOPE CULBRETH-GRAFT, DPA, CITY ADMINISTRATOR
FROM: DAN T.VILLELLA, CPA, FINANCE OFFICER
SUBJECT: FIS 2005 — 27 Adopt Memorandum of Agreement Between the State off
California Department of Health Services (Cdhs) and the City of
Huntington Beach for Chempack Storage
DATE: JULY 27, 2005
As required by Resolution 4832, this Fiscal Impact Statement has been prepared for
"Adopt Memorandum of Agreement Between the State off California Department of
Health Services (Cdhs) and the City of Huntington Beach for Chempack Storage."
If the City Council approves this action (total appropriation $12,000), the estimated fund,
there will be no effect on any fund balance since the amount is 100% reimbursable by the
State of California.
Dan Villella,
Finance Officer
RCA ROUTING SHEET
I INITIATING DEPARTMENT: I Fire Department I
SUBJECT: Adopt Memorandum of Agreement Between the State of
California. Department of Health Services and the City of
Huntinaton Beach for CHEMPACK Storaae
I COUNCIL MEETING DATE: ( September 6, 2005 1
RCA ATTACHMENTS -
STATUS
Ordinance (w/exhibits & legislative draft if applicable)
Not Applicable
Resolution (w/exhibits & legislative draft if applicable)
Not Applicable
Tract Map, Location Map and/or other Exhibits
Not Applicable
Contract/Agreement (w/exhibits if applicable)
Signed in full by the City Attorney)
Attached
Subleases, Third Party Agreements, etc.
Approved as to form by City Attorney)
Not Applicable
Certificates of Insurance (Approved by the City Attorney)
Not Applicable
Financial Impact Statement (Unbudget, over $5,000)
Attached
Bonds (If applicable)
Not Applicable
Staff Report (if applicable)
Not Applicable
Commission, Board or Committee Report (If applicable)
Not Applicable
Findings/Conditions for Approval and/or Denial
Not Applicable
EXPLANATION FOR MISSING ATTACHMENTS
REVIEWED
RETURNED
FORW ED
Administrative Staff
Assistant City Administrator Initial
( )
( )
City Administrator initial
City Clerk
( )
EXPLANATION FOR RETURN OF ITEM:
RCA Author: Olson/Reynolds/Justen