HomeMy WebLinkAboutCC Resolution 8791 (Drug Testing Services)RESOLUTION NO. 8791
,RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL AUTHORIZING
CONTINUATION OF AN AGREEMENT WITH PHARMCHEM LABORATORIES, INC.,
TO PROVIDE LABORATORY DRUG TESTING SERVICES FOR THE CITY
WHEREAS, the City of San Rafael has need for a chemical
laboratory provider to provide laboratory drug testing services
for candidates applying for employment in the Police and Fire
Departments; and in special circumstances as part of a fitness for
duty medical examinations; and
WHEREAS, PHARMCHEM Laboratories, Inc., has provided this
service in satisfactory fashion for the past two years.
NOW, THEREFORE, BE IT RESOLVED by the San Rafael City
Council that the following action be taken:
The MAYOR and the CITY CLERK are authorized to execute,
on behalf of the City of San Rafael, a renewal of the Professional
Services Agreement between City and PHARMCHEM Laboratories, Inc.,
in accordance with Section 7 of the Agreement entered into between
the parties on November 19, 1990; and
BE IT FURTHER RESOLVED that said Renewal Agreement will
continue from year to year unless terminated by either party by
giving thirty (30) days written notice to the other party that the
Agreement will not be renewed.
I, JEANNE M. LEONCINI, Clerk of the City of San Rafael,
hereby certify that the forgoing Resolution was duly and regularly
introduced and adopted at a Regular meeting of the City Council of
the City of San Rafael on Mondav the 7th day of December, 1992,
by the following vote to -wit:
AYES:COUNCILMEMBERS: Breiner, Cohen, Shippey, Thayer & Mayor Boro
NOES:COUNCILMEMBERS: None
ABSENT:COUNCILMEMBERS: None
JE . LEONCINI; City Clerk
OR101NAL Q^„,
Z���1
RcC�EiVErD
Lel BORA TORIES INC
N 0 v -i i�yJ
PEk:;UNNEL
SERVICE AGREEMENT
Date: October -4-1990
Contractor: HiarntChcni Laboratories, Inc.
150.5A O'BrIen I)nVe
Alenlo fall:. Calilornja 9-1025
"l'Vlehhc 1lC: (.115) 328-6200
This Agreement is made or, the above date in Menlo Park,
California. by and between PharmChem Laboratories. Inc.. a
California corporation (" PharmCheni') and the client specified
above ("Client").
1. SCOPE OF SERVICES.
'File parties hereby agree that PharmChem will provide Client
with the drug detection and related services described below
and in the attached exhibits ("the Services"), subject to the terns
and conditions set forth in this Agreement -
2. FEES AND CHARGES.
Client agrees to pay PharmChem its fees and charges for the
Services as specified in Section 9 below and Exhibit A.
2.1 No -Charge Items. The fees and charges specified in
Exhibit A include, at no extra cost, the following: (a) consulta-
tion regarding the selection of drugs for analysis and appropriate
testing; procedures: (b) establishment of a secure chain-ol-
custody procedure; (c) assistance in interpreting test results (up
to one man-hour per specimen submitted); (d) supplies for col-
lecting and submitting specimens for testing, including; (as
agreed by the parties) unne vials and caps, labels, protective
seals, plastic bags, mailin,; materials, and chain -of -custody or
other transmittal forms, te) written reports on analyses per-
formed; (f) storage of samples and records for the periods
specified herein; (g) periodic newsletters and technical bulletins;
and (h) access to a telephone hotline for technical inquiries.
2.2 Travel Expenses. If any travel beyond a radius of twenty-
five (25) miles from PharmChem's offices is authorized by Client
under this Agreement. Client shall pay all reasonable, ordinary
and necessary expenses incurred by PharmChem, including,
without limitation, transportation, hotels, and the like.
Contract/Client No.:
Client: city of San Rafael
Name
0._-Ho15156n
Address
_SatL_$afaP1 , rA 194C)15-1 611
( _A15 -1 —4115--306-A
telephone
3. SUBMISSION OF SPECIMENS.
Client shall submit specimens for testing only in accordance
with the procedures prescribed by PharmChem as specified in
Exhibit B.
3.1 Untestable Specimens. If PharmChem receives an
unidentified specimen, an improperly sealed or labeled
specimen, it specimen containing less urine than reasonably
required by PharmChem, or a specimen which for any other
reason cannot by tested in accordance with Exhibit C, which-
ever is applicable, PharmChem shall dispose of the specimen
without conducting any of the tests and shall promptly notify
Client of the action taken, subject to the handling charge
therefor specified in Exhibit A.
4. REPORTING.
PharmChem shall furnish to Client an analytical report of the
drug analysis performed on each specimen tested under this
Agreement as specified in Exhibit D.
4.1 Written Reports. Each report of an analysis performed
by PharmChem under this Agreement shall be subject to the
express technical definitions, qualifications, and comments set
lorth in the official written report furnished to Client for such
analysis.
4.2 Disclaimer. Upon Client's prior written request and
authorization, PharmChem shall be permitted to send Client
any test results by telephone, telecopier, or other facsimile
service. Client hereby acknowledges that, in such event, various
persons beyond PharmChem's employ or control (or the employ
or control of Client) may thereby participate in such result trans-
mission and gain access thereto. Accordingly, Client further
acknowledges that PharmChem cannot be responsible for any
consequential mistransmission, misunderstanding. or breach of
4.3 Testing Criteria. PharntCherns testi. , cedures require
initial screening of it specimen by one methodology and con-
firmation of any positive initial screening test by at least one
additional independent methodology. If the initial screening test
is negative, there is no confirmation test prrfurnu d, :1111[ the
report shill[ he negative. If they initial screening te;l is positive
but the confirmation test is negative. the report shall be nega-
tive. ['flat ntC'h0m shall generale it posiliye report if and only
if both the initial ;crvvl ing test and at Ieasl 0110 r011firma601!
test 1111 it specimen are positive. A "negative" test means
the test(s) applied did not find tl. particular drug; or drug
metabolites at or above the detecti, h't levels specified in Exhibit
C. and. conversely, it "positive" test means that the tests applied
(lid find the particular drug; or drug metabolites ;It or above the
dl'teclion levels specified in I•:xhil;it C. Neither it positive not-
a
ora negative test, unless expressly dated by PharmChem to the
contrary, is an indication of whetoer the person whose bodily
fluid was Iested Was ftlICltnlall% impaired at the time Itte
specimen was given, because of such variables as tolerance.
body nhaas. 111110 of consuoiplion cersua little of testing;, cxrrc-
tion rat". and the like.
5. STORAGE OF SPECIMEN.
5.1 Negative Specimen. tijW6lI lIS which arc detcr11rinc i to
be negative shall be retained by PharmChem at roam
temperature for two (2) weeks after the completion of testing.
5.2 Positive Specimen. Specimens which are determined to
Ile positive shall h(, retained by PharmChem for the time
specified in Exhibit D after the completion of testing. If frozen,
sorb sprcinu•ns shall he stilled at or hcloty-:i°l'. ['tient flrrrhy
acknowledges that freezing retards bacterial decomposition but
may not hall all chemical processes in it specimen. and freez-
ing may itself affect some metaholites found iu urine.
5.3 Additional Testing. ,Stored specimens %N ill h; subject to
further testing or retesling only on Clients v ritlen l-ekluest ;111(1
payment of the then prevailing fees and charges. Client hereby
acknowlt-dges that a frozen specimen retrieved from storage
mai" not produce 0xartly tfl0 siu11c lest r S1111S (1110 lu rflentical
or other changes which c.tuuht he stopped fly freezing.
5.4 Disposal of Specimens. Upon Client's writicn request and
payment of I'harniCheins then prevailing; storage charges.
PharmChem shall store ;1 specimen fill- periods beyond those
specified in Exhibit D. If no such request is received prior to the
termination of the specified periods. PharmChem shall be enti-
tled to dispose of any stored specinu•n without notice to Client.
6. RETENTION OF TEST RECORDS AND
REPORTS.
PharinChenr shall retain the relevant laboratory records for each
tested sperimen for seven 1 ) Ve;us from the dale thereof. Upon
Client's written request and pa'vnionl of PharmChem's then
prevailing records retention tees. PharmChem shall store such
records for an additional time. If no such request is rcceived
prior to the end of such seven (71 -year period, PharmChem shall
be cnliticd to dispose of such records without notice til Client
7. TERM
7.1 Term. This Agreement shall commence on the date first
written above and shall continue until terminated by either party
(a) for c•onvenienc arty (30) days' written notice to'
party or (b) as specified in Section 7.2 or 7.3 bolo,
7.2 Termination by Client. Client shall, without .
notice, have ►he immediate right to terminate this Agreemet(,
if am' of the following events or conditions occur: (a) Pharm-
Chem petitions for reorganization under the Bankruptcy Code
or is adjudged a bankrupt; (b) PharmChem becomes insolvent,
ora receiver is appointed due to the insolvency of PharmChem;
(c) PliarnlChem makes a general assignment of the assets and
business of PharmChem for the benefit of PharmChem's
creditors: (d) PharmChem defaults in the performance of any
of its material obligations under the terms of this Agreement
and has riot cured such default within thirty (30) days of written
notice of such default by Client; or (e) without limiting the
foregoing. PharmChem, its employees, agents, or representa-
tives violate the confidentiality and nondisclosure provisions
of this Agreement.
7.3 Termination by PharmChem. PharmChem shall, without
further notice, have the immediate right to terminate this
Agreement if any of the following events occur: (a) Client
petitions for reorganization under the Bankruptcy Code or is
adjudged a bankrupt; (b) Client becomes insolvent, or a receiver
is appointed due to the insolvency of Client; Ic) Client makes
it general assignment of the assets and business of Client for
the benefit of Client's creditors; or (d) Client defaults in the
performance of any of its material obligations or payments of
any indebtedness under this Agreement and has not cured such
default within thirty (30) days of written notice of such default
by PharmChem.
8. CONFIDENTIALITY.
8.1 Reasonable Efforts. PharmChem shall take all reasonable
steps to preserve the confidentiality of test reports and any
related laboratory records within the custody, control or pos-
session of PharmChem.
8.2 Reliance on Designated Representative. PharmChem
shall he entitled to rely on Client's designation of authorized
representative(s) set forth in Exhibit E or anv written amend-
ment thereofand the oral assurance of any person who identifies
himself or herself as such authorized representative and gives
the above identification number assigned to Client in furnishing
reports, assistance or other information under this Agreement.
9. BILLING AND PAYMENT.
9.1 Monthly Invoices. PharmChem shall send itemized
monthh• invoices to Client at the above address or such other
address(es) as Client may designate for Services rendered during
the preceding month. Ilems of reimbursement shall be separate-
ly described and itemized, and copies of expense reports or
receipts shall be included.
9.2 Payment. All invoices shall be due and payable in full
within thirty (30) days after the date thereof. Client agrees to
pity interest on amounts past due at the prime rate of Sanwa
Bank, San Jose, California, in effect on the date such amounts
first become past due. Payment shall be made in Menlo Park,
California, in U.S. currency.
9.3 PharmChem's Remedies. Notwithstanding anything to
the contrary elsewhere in this Agreement, if Client breaches
its obligations under this Section 9, PharmChem shall be
entil•led to withhold test reports until all w...,unts owing are
paid in full and, in addition, to terminate this Agreement.
9.4 Audit Rights. PharmChem shall maintain, preserve, and
make ;tvailtrhlr for inspection, audit and reproduction. tip to
twenty-four (24) months foll the submission of the final
invoice under this .-\green 'ie books. records, a4reenrents
and other documents used in determining any fees or charges
to Client during the performance of this Contract. In addition.
PharmChem shall. to the maxinnurt extent feasible', includr
.similar rutdit right provisions for PharmChem and Client in
all 1'barnlCltenl iontracts with subcontrac•tut•s. if uny.
10. WARRANTIES AND COVENANTS.
10.1 License. PharmChem warrants to Client that it is dniv
licensed by all California and federal agencies as required tw
laic to perform the• services.
10.2 Performance of Services. PharmChem warrants to
Client that the Services shall be performed with the degree
of skill and care that is required by c urrent, Ruud and sound
professional procedures and practices and in conformity with
generally accepted professional standards pre=vailing in the
field of forensic toxicology at the time the Scrvirrs arr
performed.
10.3 Law. PharmChem warrants to Client that, in perform-
ing the Services. it will comply with all applicable'ocal. slate
and federal laws. regulations. and rules. including. with()ctt
limitation. those pertaining to equal employment oppor-
tunity and the cunfidentality of medical information (if
applicable).
10.4 General Disclaimers. EXCEPT AS SPECIFICALLY
PR( )\'1111F1) IN SECTIONS I11.1, 10.2 AND M3 Alit )\ E:.
PHARMCHEt11 DISCLAIMS ALI. OTHER WARRANTIFS.
EXPRESSED OR IMPLIED. INC'LUDING'I HE I.MPLIEI) \1'.AIV
RANTIFti OF 1\1I:1:C'HANT'ABILITI' ANI ) FI-1'NFtiS FORA MR-
I'ICL'l_AR PURPOSF. IN NO EVENTSHALL PHARMCI II•:M BF.
L1:11;1.1: I'OR :\til' lNDIRI .t_'t'. SPECIAL OR ('OiNSI :Ol'I'.\TIAI
DAMAGES IN CONNECTION WITH OR :ARISING OUT OF
C'LIENT'S RELIANCE ON SERVICES Ia:NDERI:I) L'NDER
THIS AGREEN',ENT. EVEN IF PHARMCHEM HAS BEEN IN-
FORMED OF THE POSSIBILITY OF SUCH DAMAGES.
\1'1TI10i'T LIMITING THI: 1:0KIa;OING, HIARNIC'III'Al
ASSUMES No LIABILITY FOR ANY LOSS. COSTS, DAi\IAGES.
.ATTORNEYS' FEES OR OTHER EXPENSES WHICH CLIENT
MAY SUSTAIN OR INCUR BECAUSE. CLIENT I IAS ACTED OR
FAILED TO ACT BASED SOLELY ()N ANY 'TELEPHONE:
RUORTS PROVIDED BY PHARMCHEN.
10.5 Insurance. PharmChem covenants to maintain
appropriate insurance policies with suitable insurance coni-
panies authorized to do business in California covering
worker's compensation. professional liability, comprehensive
(general liability and comprehensive automobile liability risks.
PharmChem shall provide Client with certificates of insurance
for each of the foregoing policies and any renewals thereof.
10.6 No Representations by Client. Client covenants that
it shall not make any representation, warranty, or claim with
respect to any of the Services which is not expressly set forth
in the specifications, documentation, other technical literature
or written reports prepared and distributed by PharmChem.
10.7 Notice ari— ..)operation. Client covenants to give
prompt written notice of any legal proceeding, including,
without limitation, any civil action, administrative hearing,
or arbitration, in which the Services or any portion thereof
are to be ,t material issue in dispute, and Client further
covenants that, in regard to any such legal proceeding, it shall
use its best efforts to follow the technical and scientific advice
of PharrnChent with regard to the presentation and defense
of such Services or portion thereof, including, without
limitation. the use of such expert testimony or legal arguments
as PliarmC'hem may reasonably recommend.
11. INDEMNIFICATION.
11.1 By PharmChem. PharmChem shall defend, indemnify
and hold harmless Client from and against anv and all liabil-
ity, loss, costs, damages. attorneys' fees, and other expenses
Which Client nrty sustain or incur by reason of or in conse-
quence of PharmChem's sole negligence in performing its
Obligations under this Agreement, including. but not limited
to, sums paid or liabilities incurred in settlement of, and ex-
penses paid or incurred in connection with claims, suits, or
Judgments arising from I''harmChem's sole negligence jm-
c•luding expert witness fees paid by Client to PharmChem in
defense of tiuch action against Client).
11.2 By Client. Client shall defend. indemnify and hold
harmless I'harmChem front and against any and all liability.
loss, costs, damages. attorneys' fees. and other expenses which
PharmChem nmty sustain or incur by reason of or in conse-
quence of C'lient's sole negligence
, including. but not lb
limited to. sums paid or liabilities incurred in settlement of,
and expenses paid or incurred in connection with claims.
suits. or ju(Igntenls arising from Client's sole negligence or
am such breaches.
11.3 Survival. The indeninific•ation under Sections 11.1 and
11.2 alcove shall survive termination of this :Agreement.
12. INDEPENDENT CONTRACTOR.
I'harmChem is an independent contractor and shall not be
deemed an employee. agent, partner. or co -venturer of Client.
Neither parl'v shall have the authority to make amp binding
representation or agreement on behalf of the other.
13. MISCELLANEOUS.
13.1 Entire Agreement; Amendment. This instrument (in.
eluding the exhibits) contains the entire contract between the
parties• and anv agreement or representation respecting the
services or the duties of either party in relation thereto not
expressh' set forth in this instrument is null and void. Any
amendment or modification of this instrument shall be in
writing and duly executed by the parties.
13.2 Governing Law. This Agreement shall be governed by
and construed in accordance with the laws of the State of
California (excluding its choice of law rules).
13.3 Section Headings. The section headings contained in
this Agreement are for reference purposes only and shall not
affect in any way the meaning or interpretation of this
Agreement.
13.4 Attorney's Fees. Should any litik.., ., be commenced
brt„ern the parties hrrrto concerning this Agreenu nl or the•
rights and duties in relation thereto, in addition to such other
reliel as may be granted the party prevailing in such litigation
shall he entitled In ik reasonahle allrn-ney:s fee'; and rusts
therein. Such fees and e•osts shall be determined by the court in
such litigatiole rn in it separate acliun brought for that purpose.
13.5 Notice•s.:1m• and all nntices rnr other conenuneiralions
required or permitted by this Agreement or by law to be served
on or given to either party hereto by the other party shall be
Ill Writing and shall he ch•cneed duh served and given when
personally delivered to either of the parties to whom it is
directed. or in lieu of such personal service three (a) clays after
being deposited in the I'nited SUile s mail. first class postage
im-paid. addressed to the to „hone it es directed at the
adche•s" ,rt forth above unless notice of anolhe r addn•ss is
duly given
13.6 Binding on Successors. This Agreement shall be
binding upon and shat! inure to the benefit of the• parties
hereto and their respective representatives, heirs. admini-
stralms. successors and assi.;ns except as otherwise provided
herein
13.7 Publicity. Except as mar be required bv applicable law
M, regulation. neither party shell use in advertising, publicity.
or otherwise, any intorniation concerning this Agreement or
disclose• the terms and conditions of this Agreement without
the pli'lr ronu•nl of the olhct holy
Phiu-mChem Laboratories. lite.
BY
Reith W. Patten
Title: Vice President Marketing
13.8 Savings. a provision or part is severable from
the Agreement, and if one or more provisions or parts are c
declared invalid by a court of competent jurisdiction, the
remaining provisions shall nevertheless remain in full force
and effect.
13.9 Non -Waiver. The waiver by either party of any breach
of any term, covenant or condition contained in this Agree-
ment, or of any default in the performance of any obligations
under this Agreement, shall not be deemed to be a waiver
of any other breach or default of the same or any other
term, covenant or condition, nor shall any waiver of any inci-
dent of breach or default constitute a continuing waiver of
the same.
13.10 Force Majeure. 'Neither Client nor PharmChem shall
he c•nnsidered in default in the performance of its obligations
under this Agreement. except obligations to make payments
hereunder for work previously performed, to the extent that
the performance of any such obligation is prevented or
delayed by any cause, existing or future, which is beyond the
reasonable control of the affected party. In the event either
party claims that performance of its obligations are prevented
ur delayed by any such cause, that party shall promptly notify
the other party of such fact and of the circumstances pre-
venting or delaying performance.
IN WITNESS WHEREOF, the parties hereto have executed this
Agreement the day and year first above written.
Client
IS=
id of San Rafael
1. ; 1
Name: LAWRENCE E. MULRYAN
Title: Mayor
ATTEST: �Zn
J nne 1�1. Leon1('7,F1 ty e
EXHIBIT A Fetes and Charges
EXHIBIT B Specimen Submission Procedures
EXHIBIT B-1 Chain -of -Custody Form
EXHIBIT C Drug Panel and Analytical Methods
EXHIBIT D Reporting and Storage Requirements
EXHIBIT E Client's Authorized Representatives
Approved ast farm;
�
ASST. CITY ATTORNEY--
LABORATORIES. INC.
City of San Rafael
P.O. Box 151560
San Rafael, CA 94915-1560
Revised November 3, 1992
EXHIBIT A
FEES AND CHARGES
ROUTINE CHARGES
ITEM
Laboratory Analysis
EMIT Screen and GC/MS Confirmation
(Includes specimen transportation
and collection supplies)
No Test Charge
PRICE
$ 25.00 per specimen
ADDITIONAL CHARGES
Reanalysis Charge
EMIT Screen and GC/MS Confirmation
(no charge if drug presence
not confirmed)
Litigation Package & Explanation
Expert Witness Testimony
(plus travel and living expenses
at cost)
$ 12.50 per no test
$ 35.00 per reanalysis
$150.00 per package
$ 75.00 per hour
1505A O'Brien Drive ❑ Menlo Park, California 94025 D (415) 328-6200 --'Fax. (415) 688-1122
City of San Rafael
P.O. Box 151560
San Rafael, CA 94915-1560
EXHIBIT B
SPECIMEN SUBMISSION PROCEDURES
The following criteria must be satisfied before
laboratory analysis will be undertaken.
o Specimen bottle must contain sufficient urine for
testing.
o Specimen and the Chain -of -Custody Form (Exhibit
B-1) must arrive at the laboratory in the same shipping
container.
o Barcode must be affixed to the specimen bottle.
o Specimen must have an intact security seal affixed to
the specimen bottle such that bottle cannot be opened
without breaking the seal.
o Specimen ID numbers on the Chain -of -Custody Form, on the
security seal and on the barcode on the specimen bottle
must match.
o Donor's initials and/or signature must appear on the
Chain -of -custody Form.
EXHIBIT B-1
CHAIN -OF -CUSTODY FORM
CHAIN OF CUSTODY FOR DRUG ANALYSIS
1505-A O'Brien Drive. Menlo Park. CA 94025-1435 Specimen No. 0002848363
I Results i0 Name and Aaaress Employer s Name and Aaaress
Collection bile and Address
Location Code
Reason Tar lest tunec, unel "rst
❑ 01 Preemployment _ 02 Random _ 03 Accident
Specimen Type
❑ Urine ❑ Blood J Urine and Blood
Specimen Identification IThis information will appear omv on too copy;
Specimen Iaentlllcetlon ITms information will appear on all contest
Remains concerning Couection
Account No
Special Tests Reauested
–erlaalc �easonaaie Other
04 Medical _ 05 Cause 06 Specify
Split Sample (Collect omv It reoulred by Chenti
❑ Yes
':1
No
Date collectec
Sadat Secunly
emoerature
COLLECTOR CERTIFICATION cenlly, trial the specimen
laentlfied
nr fh•s form is !ne
specimen oresentea to me ov the
donor orovlamg me certification below mat • bears
the same
•aenuticaaan number
as set forth above dna mat it
has Dean f:otlectea. fabewal and seated in accordance win roll instructions provided
SPLIT SAMPLE
C-CLLEC'?'3 S:D?IATU=E PharmChem LaBorarones. Inc.
Conarcidr s Name -Print tLasi First M I I
Collector s bianature
Shipma By Alrbnl • Dale Snlooea
Ship
PharmChem Laboratories. Inc
TT\,
COLLECTOR'S SIGNATURE SPECIMEN DONOR'S SiuhATURE OR INITIALS
Specimen,
1505-A O'Brien Drive
• Complete all unshaded areas of form.
To
Menlo Park. CA 94025-1435
DONOR CERTIFICATION AND CONSENT I cemry that
the specimen accomanninng this form is my own and that I
provided ll to Ina collector Further I cemw that
the sommen container was
searso -in a winger proof seal
In rry presence ana mat Ins Information brewaad
on this
form and 2n the
label is correct. Also. columl
to me snaring of me specimen ac-mbanpng this
form by
me Iaocratpry and
to the release by the laboratory
of the results of Ine analysts as wed as the
information
recorded on In's
form to the organization angor
Individual fWed on lints form.
Donor s Slonature or Initials
!11'111, loll
USE SECOND
t
0002848363 0 001328483t63so
SEAL AND
\ SPECIMEN No eee2B48363
BAR CODE SET
LACE OVER\
FOR BLOOD OR
CAP OF f DONOR'S SIGNATURE OR INITIALS
(SPECIMEN
SPLIT SAMPLE
C-CLLEC'?'3 S:D?IATU=E PharmChem LaBorarones. Inc.
PLACE NO. eee2848363 S
)/SPECIMEN
CAP
(OVEORFF
TT\,
COLLECTOR'S SIGNATURE SPECIMEN DONOR'S SiuhATURE OR INITIALS
INSTRUCTIONS TO COLLECTOR
• Complete all unshaded areas of form.
• Affix tamper proof seal and barcode as Illustrated.
�' !
• Ask donor to sign Donor Certification and Consent and initial/sign tamper proof seal.
.
• Place specimen and laooratory copy of Chain of Custoov form In shipping container
Q
• Keep specimen to secured storage until sniopec.
• Distribute copies or chain of custoav form as indicated on each copy.
=.ciAIN THiS CCPY FOR YOUR ricCCriDS
EXHIBIT C
DRUG
TESTING PANEL
Screening
Screening Confirmation
Confirmation
Drug or Drug Class
Method
Level*
Method
Level**
Alcohol
EA
0.05%
GC
0.05
Ethanol
Amphetamines
EMIT
1000 ng/ml
GC/MS
250
ng/ml
Amphetamine
Methamphetamine
Barbiturates
EMIT
300 ng/ml
GC/MS
250
ng/ml
Amobarbital
Butalbital
Pentobarbital
Phenobarbital
Secobarbital
Benzodiazepines
EMIT
300 ng/ml
GC/MS
250
ng/ml _
ACB
MACH
Cocaine Metabolite
EMIT
300 ng/ml
GC/MS
150
ng/ml
Benzoylecgonine
Cannabinoids
EMIT
100 ng/ml
GC/MS
10
ng/ml
THC
Opiates
EMIT
300 ng/ml
GC/MS
150
ng/ml
Codeine
Hydromorphone
Morphine
Methaqualone
EMIT
300 ng/ml
GC/MS
100
ng/ml '
Phencyclidine
EMIT
25 ng/ml
GC/MS
25
ng/ml
EKIT = Enzyme Immunoassay
cc = Gas Chromatography/Mass Spectrometry
ng/ml = nanograms/milliliter
* The screening level refers
to the concentration
of the specific member of the drug class
used to
calibrate and define the minimum positive screening test.
*• The confirmation level is the minimum level of drug that will be reported as
positive.
City of San Rafael
P.O. Box 151560
San Rafael, CA 94915-1560
EXHIBIT D
REPORTING AND STORAGE REQUIRM4EN'T'S
Reporting Requirements
o PharmChem will report results for specimens which test
negative by initial screen and do not require
confirmation testing within 24-48 hours of receipt at
the laboratory.
o PharmChem will report results for specimens which test
positive by initial screen and require confirmation
testing within 48-72 hours of receipt at the laboratory
excluding Saturdays, Sundays and holidays.
Normally, PharmChem will report results for all specimens
within 48 hours of receipt at the laboratory, excluding
Saturdays, Sundays, and holidays. However, in some
cases, additional testing is required to satisfy quality
assurance requirements.
Storage Requirements
o PharmChem will retain all negative specimens for two
weeks.
o PharmChem will retain all positive specimens, in a frozen
state, for 12 months.
o PharmChem will retain all laboratory records for seven
years.
EXHIBIT E
CLIENT'S AUTHORIZED REPRESENTATIVES
City of San Rafael
P.O. Box 151560
San Rafael, CA 94915-1560
AUTHORIZATION FOR RELEASE OF
ANALYSIS RESULTS
City of San Rafael hereby authorizes PharmChem
(Name of Company)
Laboratories, Inc. to disclose drug analysis results for specimens
submitted by City of San Rafael to the following
personnel: (Name of Company)
(Name) ' (Title)
(Name) ' (Title)
(Name) , (Title)
I understand that PharmChem will not release test results or other
confidential information to anyone other than the representatives
listed above. I agree to contact PharmChem immediately if there
are any changes regarding this authorization.
Dated:
Signature of Company Officer
Title
EXHIBIT E
CLIENT'S AUTHORIZED REPRESENTATIVES
City of San Rafael
P.O. Box 151560
San Rafael, CA 94915-1560
AUTHORIZATION FOR RELEASE OF
ANALYSIS RESULTS
City of San Rafael hereby authorizes PharmChem
(Name of Company)
Laboratories, Inc. to disclose drug analysis results for specimens
submitted by City of San Rafael to the following
personnel: (Name of Company)
G. C��IlkErL- .1 ?Ce&cnrLJ 6(�IcLfy-
n n (Name)(Title)
I_ ,t---,rL- . r ?6 [ 1
(Name) (Title)
(Name) ' (Title)
I understand that PharmChem will not release test results or other
confidential information to anyone other than the representatives
listed above. I agree to cont t P armChem immediately if there
are any changes regarding this ut iz on.
Dated: /(/1/10 50 GUS
gatureof Coojmpan Officer
euo), jU/I C L
Title
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