HomeMy WebLinkAboutCAG2020-206 - Original - Stericycle - Drug Disposal Services - 07/01/2020ApprovalOriginator:Department:
Date Sent:Date Required:
Authorized to Sign:
o Director or Designee o Mayor
Date of Council Approval:
Budget Account Number:
Budget? o Yes o No
Grant? o Yes o No
Type:Review/Signatures/RoutingDate Received by City Attorney:Comments:
Date Routed to the Mayor’s Office:
Date Routed to the City Clerk’s Office:Agreement InformationVendor Name:Category:
Vendor Number:Sub-Category:
Project Name:
Project Details:
Agreement Amount:
Start Date:
Basis for Selection of Contractor:
Termination Date:
Local Business? o Yes o No*
*If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace.
Notice required prior to disclosure?
o Yes o No
Contract Number:
Agreement Routing Form
For Approvals, Signatures and Records Management
This form combines & replaces the Request for Mayor’s Signature and Contract Cover Sheet forms.
(Print on pink or cherry colored paper)
Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20
Docusign Envelope lDi 57 F C2917 -21 48-488Ç-91D4-6D60F00S1 9D2
{þ Stericycld Account/Site #6032076-00'1
Generator lÐ #,.
Service Agreement
Effective Dale 071o112020 between stericycle, Inc and city of Kent Police Dept
Service Address
Customer/Company Name: City of Kent Police Dept
--
Address 1: 220 4th Ave
Billing !nformation (if different):
Billing Contact/Company Name:
ç Address 1
Address 2:Address 2:
City / State / Zip; Kent, WA Õo^i t City/State/Zip:
Phone:253-856-5810_
Fax:Fax:
Email: cwarren@kentwa.gov Fm¡ il
E Biohazardous Regulated Medical Waste Disposal
lSenuice Ler,et Budget'Plan 0 $7s Current container rate plus
10ô/"$o
0 $o
0 $o
0 $o
E Stericycle Reusable Sharps Program
(Only available with purchase of "Biohazardous Regulated Medical Waste
D¡sposal" seruices)
0 $o
tr Fixer / Developer - Photo Processing Disposal Seruice 0 $7s $ 100 $o
E Pathological / Trace Chemotherapy Disposal Seryìce 0 $7s $ 100 $o
n Pharmaceutical Waste D¡sposal
lDruq DispogaI Service 0 0 $ 190
$7s $o
Ë CsRx Controlled Substance Waste Service
(Only ava¡lable w¡th purchase of "HDDS" serv¡ces)0 I (lâ1. LslÕ( Lontârnêr
every 16 weeks
$o
E lSteri-Safe Prefened FïP.AA Comdiarrce Solutiôn $o
E Biohazardous Regulated Medical Waste Disposal - Transactional
Additional Commenß:
:TYO4:$o $o 10 -13 slops:.$2oi $o
' Pr¡ce per Box: WA only = Based on WUTC Totíff pr¡cing Houts of opetotion S g-5 M g-5
+' Minimum Pickup Fee: WA only = Í10,00 minimum monthly fee. Truntqct¡onal = (min.
T9-5 W 9-S r9-5 F 9-5 5 9-5
f. box(es) agreed to by customet + stop charge)
Monthly Service Fee: $ o.oo
Minimum Pickup Fee: $ _-
Fuel Charge (per stop): $ 0
Energy Fee (per stop): $ 0
Envi ron menta I F ee'. 0o/o
Record Retention Fee (per stop): $ 0
Total Monthly Service Fees: $o.oo
Billingschedule: :MonthlY:
Includes All Fees (Additional Taxes May Apply)
Duringthel¡rra'12months' oftheAgreement,Stericyclewill notincreasetheabovefees.
Thereafter, fees will not increase by more than i5:ø annu"lly.
terminate this Agreement prov¡ded all equipment is paìd for at the then current replacement values or returned to Stericycle in good and usable condìtion.
lN wlTNESS WHEREOF, this Agreement hås been duly executed on the day, month and yearwr¡ten below.
Stericycle:
Contracting Entity:
Name:came'ron
1¡1¡". :CSS:
Date, 6/30/2020
Customer:
,lhe oflet wiL expire'OO. /00/p00ii
Kent - PoliceStericycle. lnc.
PAWI
Name: ,
,ct ty of
panytywa r ren
Title:
Date:
rt Services Man r
Signature:Signatu -kusbndby;re'.1 ¡t...t t,.-...
I W\^a v-øtqw
and conditions and comply with Ster¡cycle's Waste Acceptance Policy, both of which are integral parts of this Agreement.
Stericycle, lnc. o 4010 Commercial Ave., Northbrook,lL60062. P (000) 000:0000. F (000) 000-0000
DocuSign Envelope lD: 57FC2917-21 48-488C-91 D4-6D60F0051 9D2
Stericycle, lnc., a Delaware corporation, with offices al 28161 N. Keith Drive,
Lake Forest, lL 60045 (collectively, "stericycle"), and City of Kent Police Dept
with offices at220 4th Ave S, Kent WA 98032 ("Customer"), hereby enter into
and agree as provided in this Services Agreement (the "Agreement") dated as
of the 1st day of July, 20 20 (the "Effective Date).
1. Services. (a) Stericycle will provide Customer the services set forth on
page 1 of this Agreement (the "Services") which are incorporated herein and
made a part of this Agreement. (b)Customershall beliableforandshall indemnifu,
defend and hold harmless Stericyde tom and against all demands, daims, ac.tions, losses,
damages, and expenses, including reasonable attomey fees resulting ftorn any Non-
Conforming Waste (defined below) or Customer's failure to properiy store, package, label,
or segregate Rl\/W. (c) All lab wastes or materials that contain or have the potential to
contain infectjors substances arising from any agenß listed under 42 CFR 723 are
prohibited ftom inclusion among RIVIW to be collected and must be preteated by Customer
priorto disposal. (d) The cunentversion of theSteriq¡cleWasteAcceptance Policy (WAP')
is attached. Stericycle may periodically update the WAP. (e) During ttre Term, Stericycle
shall be the exclusive provider of the SeMces to Customer at all of ib locations, and
Customer shall use no other RIVI¡V disposal service, method or seruice provider, whether
at tlìe service location(s) set forth herein or at any other cunent or future location(s) of
Customer. As used herein, "Non€onforminq Waste' means any substance, v\Este or
container that is excluded, not accepted or nonconforming under the WAP or othenrvise
cannot be accepted by Stericyde under any applicable law, rule or regulation. (f) Stericycle
may bill addltional chaçes for each noncompliant container (overweight under applícable
laws, rules or regulations; each container exceeding 50 lbs; containers holding non-
conforming waste; and containers where the waste is improperiy segregated or packaged)
provided by Customer.
2. Term of this Agrcement (a) The initial term of this Agreement (the "lnitial Term') will
begin on the Effective Date set forth above and continue for Sixtv(60) months. This
Agreement will automatically renew for successive terms of month to month (each, an
"Extension Term"), unÞss either party gives the ottrer party at least 60 days'written notice,
prìor to the renewal date, of ib request to terminate this Agreement. The lnitial Term and
each Extension Term, if any, are collec{ively refened to as the 'Term".(b) Upon the
erpiration or termination of tris Agreement, Custoner shall pay Stericþe all amounts due
for seMces and products provided prior to the expirat'ton or termination (and any other
amounts due to Stericycle, which may include a fnal pickup fee). (c) Stericycle shall have
the right to retieve ib Equipment (defined below)frorn Customerwtlerever located.
3. Pricing. Customer shall pay to Stericycle he seMce fees set forth on page 1
(Service Fees"). Stericycle may adjust the SeMce Fees to cover nonønfollable cosb,
induding but not limited to taxes, fuel and regulatory fees annually in accordance with llre
percentage listed on page 1.
4. Payment Terms, Customer shall pay in full each Stericycle invoice witirin 30 days of
he date of such invoice. Any invoiced amounß not received by Stericycle within hat
timeframe will be subject to an interest chaçe of 1 .5% per month (or the maximum amount
allowed by law). Customer shall rcimburse Stericycle for all cosb that it inalrs in collecting
ovedue amounß from Custo¡ner. Stericycle may, wih notice, suspend seMces until any
overdue amounb (plus interestcharyesand collec{ion fees, if any)are pairC. Customershall
also pay all taxes imposed by any govemmental auûrority w'tr respect to the purchase of
any services and prcducb hereunder, including all sales, use, excise, occupation, franchise
and similar taxes and taxlike fees and charges (but excluding all taxes on Steriq/cles net
income). Siericycle will cooperate with Customer to determine the applicability of exemption
certificates, if any, that Customer provides in a timely manner to Stericycle.
5. EarlyTermination, ln lhe eventthat Customerterminates this Agreement priortotire
e&iration of the Term other ttìan as set forb in Section 6 Customer shall promp{y pay
Stericyde (a) all unpaid invoices and any late chaçes thereon; and (b) an amount equalto
50% of Customer's average monthly charge multiplied by the number of months (including
any partial months) remaining until the expir:ation date of the Term.
6. Default and Early Termination for Cause. Either party may immediately
terminate this Agreement, in whole or in part, upon wr¡iten notice to the other
party if the other party breaches any material provision of this Agreement and
fails to cure such breach within thirty (30) days following receipt of written notice
of such breach. Documented service or performance deficiencies by Stericycle
or nonpayment by Customer of amounts dghtfully owed to Stericycle or
Customer's failure to comply with Stericycle polices related to the Services
shall constitute a material breach.
7. Limitation of Uability. ln no event shall either party be liable for any indirec[
exemplary, punitive, special, incidental or consequential damages, or lost profib, lost
revenue, lost business oppofunities or the cost of substjtr¡te items or seMces under or in
connection wih this Agreement.
8. Compliance Materials; Confidentiality. To the extent that Stericycle provÍdes
Customer with electronic or printed materials ('Comoliance Materials"), it provides these
subjec{ to a limited license to Customer to use Compliance Materials for its or¡vn, non-
commercial use. Stericycle may revoke this license at any time. Customer may not copy
TERMSAND CONDITIONS Account/Site*f6032076:00t
or distribúe Compliance Materials or use or republish Compliance Materials for or to any
third party or audience. Customer agrees to return all Compliance Materials to
Stericycle at Customer's expense at the expiration or termination of this
Agreement. Stericycle may charge Customer a fee for failure to return
Compliance Materials. Customer agrees to not disclose to any third parties
Stericycle pricing, policies and procedures.
9. Compliance with l-aws and Policies. Each pady shall comply with all la¡¡s, rules
and regulat¡ons applicable to its performance hereunder. Stericþe and Customer shall
keep adequate books, records and documentation as requhed by applicable lar¡¡s, rules,
regulations and guidelines peftaining to storage or handling of RttiW and he Services
hereunder. Customer shall comply with the WAP applicable to the Services.
10. Excuse of Perfurmance. Neiher party will be responsible if its performance of any
aci(s) required hereunder (other tlran üre payrnent of any amounb due) is intemrpted or
delayed due to any reason beyond its reasonable control.
11. Equipment, Customer shall have the care, custody and control of any
containers and other equipment owned by Stericycle and placed at Customer's
premises ("Equipment") and accepts responsibility and liability for the
Equipment and its contents. Any damage or loss to such Equipment, other than
normal wear and tear, will be charged to Customer at full replacement value.
12. Waste Brokes. Stericycle reserves the right to deal solely with the
Customer and not with any third party agents of the Customer for all purposes
relating to this Agreement. Customer represents and warrants to Stericycle
that it is the medical waste generator and is acting for its own account and not
through a broker or agent. Stericycle shall be entitled to terminate this
agreement and seek all available legal remedies, including but not limited to
liquidated damages, in the amount set forth herein for Customer's breach of
this representation and warranty.
'1 3. Miscellaneous. ( a )This Agreement constitutes tlre entire agreement between the
parties relating to the subjec{ mafter of this Agreement and supersedes any prior
agreemenb and anangements between the parties. (b) This Agreement may be modified
onlybyawrittenamendmentsignedbyanauürorizedrepresentativeofeachparty. (c)This
Agreement shall be binding upon and inure to the benefit of the parties hereto and üreir
respecfive successors and permitted assigns, legal representatives and heirs; provided,
horivever, that Customer may not assign iß righb or delegate its obligations under this
Agreement without he prior written consent of Stedcycle. (d) Stericyde's relalionship with
Customer is that of an independent contractor, and nodring in this Agreement shall be
construed to designate Stericyde as an employee, agentorpadnerof ora jointvenfurewiût
Customer. (e) Any dispute arising in connection with or relating to this Agreement or
between the parties ('Disputes") tlrat the parties are unable to resolve informally, such as
via discussion and negotiation between the parties, shallsolely and exclusively be resolved
by binding and final arbibation before the American Arbitration Association ('AM),
conducted pußuant to the Federal Arbitration Ad (as the pañÌes acknow'ledge that he
seMces provided involve interstate commerce). All DispLfes will be determined on an
indMdual basis (and not as a class member or in any purported class or representative
capacity, considered unique as to its facts, and shall not be consolidaied in any arbitnation
or other proceeding with any claim or contþversy of any other party, and the arbitator or
ûier of fact shall not preside over any form of representative or class proceeding. The
exclusive jurisdic,tion and forum for resolution of any D¡spute shall be by aóitration, whicfr
shall take place in the state where Customer is located at the closest AAA offce. (f) The
failure of either party to insist upon the performance of any provision hereof, or to exercise
any right granted under any provision hereof, will not be construed as uaiving that provision
or any other prcvision, and the provision will continue in fullforce and efiect. (g) No term or
condition contained in a Customer purchase oder or any other invoice acknorrvledgment
shall be binding upon Stericycle unless agreed to by Stericyde in witing. (h) Each provision
of this Agreement must be interpreted in a rrvay that is valid under applicable law. lf any
provision is held inval¡d, the rest of the Agreement will remain in full force and effect. (i) The
failurc of either party to insist upon the performance of any provision hereof, or to exercise
any right granted under any provision hereol will not be consfued as waiving that prcvision
or any oher provision, and tfe provision will continue in full force and efiect. All u¡aivers must
be in witing andsigned bytlre partywaiving ib righfs 0 Exceptas otherwisesetforth herein,
this Agreement shall be govemed by and construed ¡n accordance with the laws of the State
of lllinois, without regard to the conlid of law provsions.
DocuSign Envelope lD i 57 F C2917 -2 1 48-488C-9 1 D4-6D60F0051 902
Regulated Medical Waste Acceptânce Policy
Stericycle policy re quires compliance with all applicable regulatíons regarding the collection, transportätion and trealment of regulated medical waste.
Federal Department of Transportation (DOT) Regulations require the generator of regulated medical wäste to certify that the packaging and documentation
of transported rêgulated medical waste cornplies with DOT regulations regardÌng waste classi{¡cetion, packaging, labeling and shipping documentation. To
ensure that neither Stericycle nor the gên€rator of regulated medical waste violates applicable regulations, it is imperative that all parties understand the rules
regardìng proper identification, classification, sågrêgetion and packaging of regulated medicel wäste. The purpose of this policy îs to summarize the minimum
requirements for preparing your rnedical waste for collectiön, transportation and tréatment, Addïtìonal facìlity or state-specìfìc waste accêptancê policies may apply
based on permìt specifications, Please conlect your local rêpresêntatÌve forfurthsr informatlon or email customercare@stericycle.com,
REGULATED MEDICAL WASTE
Stericycle accepts medical waste generated in a broad range of medical, diagnostic, therapeutic.and research act¡v¡ties. The term "medical waste" includes
biohazardous, biomedical, infectious or regulated medical waste as defined underfederal, state or local laws, rules, regulations and guidolines. Except as defined
by specific state regu¡ations, this excludes RCRA hazardous waste pharmaceuticals, all DEA scheduled drugs including *controlled substances, bulk chemotherapy,
wâste containing mercury or other heavy metals, batterìes of anytype, cauter¡zers, non-inlectious dentãl waste, chemicals such as solvents, reãgents, corrosives oT
ignitable materials classified às hazardous waste under Federaland State EPA Regulations. ln addition, Stericycle cânnot accêpt bulk liquids, radioactive materials,
or complete human remains (including heads, full torsos and fetuses). Stericycle cannot äccept the6e excluded materials packaged as regulated medical waste. All lab
wastes Õr materials which contain or havethe potential to contaìn infectious substances arising from those agents listed under42 CFR Part 73 (HHS),7 CFR Part 331
(USDA-Plant Protection and Ouarantine), and 9 CFR Part 121 (USDA-Veterinary Services) are strictly prohibiled from medical waste byfederal law and must be pretreatod
prior to disposal. Separate protocol and packaging requirements apply for the disposal of non-hazardous plrarmaceuticals. Hazardous waste transportat¡on serv¡ces
may be offered in certðin geographical locations, under separate contract. Please contact your local representative for details and packaging specifications.
* Un-dlspensed from DEA Regi*rant
WASTE SEGREGATION AND PACKAGING
The generator is solely responsible for properly segregating, packaging and labeling of regulated medical waste. Proper segregôtion and packaging reduces the
potentialforaccidental releaseofthecontentsandexposuretoemployeesandthegeneral public.DOTregulationsrequire(49CFR173.197)thatall packagesof
regulated medicaì waste be prepared fortransport in containers meeting thefollowìng requirementsi 1)rigid; 2) leak resistant; 3) imperviousto moisture; 4) of
sufficient strength to prevent tearing or bursting under normal conditions of use and handling; 5) àealed to prevent leakage during transporU and ó) puncturê
resistant for sharps, All regulated medical wastê must be accompanied by a properly completed shipping document (See 49 CFR 172.202).
MANAGEMENT OF NON.CONFORMING WASTE
As required by regulation and company policy, Stericycle employees may ref use containers that are non-conforming because of their contents ÕT âre improperly
packaged, leaking, clarnaged or likely to create a risk of exposure to employees or the gerreral public. Any waste found to be non-conforming to this Wâste
Acceptance Policy identifiecl in roLrte to, or at a Stericycle location, may be returned to the generator for, proper packaging and disposal, or may be rerouted
for appropriate destruction; this rnay irrclude improperly marked regulated medícal waste which should have been iclentif ied for incineration (i.e. pathological,
chemotherapy or non-hazardoua pharmaceuticals). Proper segregation and packaging is essentiat lo ensure complìarrt and safe handling, collection, transportôtion
and treatment of regulated rnedical waste,
STERICYCLE REGULATED MEDICAL WASTE ACCEPTANCE POLICY CHECKLIST
*ionsu/t 5te¡ic.ye'le llâptesêntatiyê fo r specilic requirements
req0lrements cont act our $tericycle Custonrer Seryice Depå,tment ât custo mercare@stericycle,corn
. Shãrps - Means any object contâminated with a pathogen or that may become
contaminated with a pathogen through handling or during trânsportation and also
capable of cutting or penetrating skin or a packag¡ng material. Sharps includes needles,
syringes, scalpels,. brokèn glass, culture slides, culture dishes, broken capillary tubes,
broken rigid plastic, and exposed encls of dental wires.
. Regulated MedicalWoste or ClinicalWaste or (Bio) Medical Waste - Means a waste
or reusable mâtèrial derivecl from the medicãl treatment of an animal or human, which
includes diagnosis and immunization, or from biomedical research, which includes
the production and test¡ng of biological producß.
. Trâce Chemotherapy Contâm¡nâted Waste - RCRA Empty drug vials, syringes and
needles, spill kits, lVtubing and bags, contaminated glovesand gowns, and related
materials as defined in applicable laws, rules, regulations or guidelines.
o Pathological Waste - Human or animal body parts, organs, tissues and surgical
specimen (decanted of formaldehyde, formalin or other preservatives as required per
hazardous waste rules).
e Non-RCRA Pharmáceuticals - Must be characterized and certified as non-RCRA
hazardous material by the generator. Excludes all DEA scheduled drugs, including
controlled substancesl
r California Only - Solidified Suction Canisters - Suction canisters that have been
injectecl with solidifier materials to control liquids or suction canisters mâde of h¡gh
heât resistant plastics such âs polysulfone.
ACCEPTED REGULATEÞ MEDICAL WASTE
,ICCEPTED REGULATED MEDICAL WASTE WHICH MUST BE IDENTIFIED
AND 5ËGREGATED FOR INCINERATION
. Untreated Category A lnfectic¡us Substances
. Complete Human Remains (including heads,
full torsos, ând fetuses)
r Bulk Chemotlrerapy Waste
o Mercury-Containing Dental Waste - Non-contâct
ând contact amalgam and products. chairside traps.
amalgam sludge orvacuum pump filters, extracted
teeth with mercury fillings ând empty âmalgam capsules
. Any Mercury Containing Material or Devices - Any
mercury thermometers, S phyg moma nometers, lâ b or
medicâl devices
. RCRA Hazardous Pharmaceutical Waste and all DEA
Federal a nd.Stâte Controlled Substa nces*
. Chenricals - Formaldehyde, formalin, acids, alcohol,
waste oil, solvents, reâgents, fixer developer, fluorescein
r Compressed Gas Cylinders, Canisters, lnhalers and
Aerosol Çans
¡ Hazardous or Universal Waste - any other waste
determined by Federal or State EPA regulations including
but not limited to batteries, bulbs, heavy metals, etc.
¡ Radioactive Waste - Any conta¡ner wlth a radioactivi!
levê'l that exceeds regulatory or permitted limits; leacl-
corìtaining materials
OTHER REGULATED MEÞICAL Vl'ASTEs NOT
ACCEPTED AS REGUTATED MEÞICAL WASTE
BY STERICYCTE
We orotect what måttêrs.êt 201 8 Sterìcvcle. lnc. All rio hts reqentecl.lkx.2\.:ll Stericvcle
DocuSign Envelope lDi 57 F C2917 -2 1 48-488C-9 1 D4-6D60F005 1 9D2
alllrtüû Stericycle'I STRTTCE ÐEsT R.XPTTTNS
3í s h aea rdou s Re g u lated fitl ed íca I lflta*te Þisposa I
r 5afe, cornpliant ctllectisn, tran:por? and tr**trnenl r:f regrtlateel rïedic"rl lv*ste.
* Âçce*t tô FOT ancl biohaa*rd*us tr*iniRg *n MySlericyele,e*rn, *ur cpnr¡*nient *¡'¡li*e ruslorn*l peirt*l
N[LATËD SËÊ.V}{Ë5:
S*cnre pitft-up qf Fixsry'üev*lap*r * Photo Proc*sx*ng tirposal Sqrvice
* TrEatrnent anrl disp*sæl of x-ray fix*r/devel*per rcntaining silv*r cr hydr*quinrn*,
r 1t'¡is c{,rviüË is av¿ilable ifl {Å and parts cf CT, MA, f,J H, AI, VT, þ¿J and l.iY.
$ccurs piefu-up af Faihøl*gicafïrace Chem*therapy tisposal fu¡"r¡ice
r Tr*almenl and díspos¡¡l q:f infecti**r !#acte nr eliseardsci itenrs thrt hæv* b*sn c*nt*nri**ted [:y
tra,ce anrçunts cf rl'tsmotherapeutic, rylatrcpic ar antin*oplaslic pharm*ceulicals.
R.egulated Madicel Wast¿ - Transaetisnal
* {*nt*iners, nranifests, enHerlicn, trrnrpnrt, treatmenl ":nr} dispcsail nf all regulxted ¡"¡redic¿lweste
{excepl non-eonf*rrning wøste¡ rn *il *:il-eåil bscig.
Stericycle ReusablE Sharps Progräm
r üur Sharps fuìaragement Seruice utili¿ss reus¿ble sharps r*ntainers t* slre¿nrline the ¿ollectirn ¡n¿l
disposal of sharps årr your facJlity. A Stericycle dríver wilì pick Llp y*Lrr pæckaqed, full shaçs conl¡inerç
*nd prcvide clean *¡lec for contirrued *çe,
r Ëacß'r r*usabte cunt¡in*r can be çtiliEed up tc 6üt timcs" üur ser,.,ice reduces plastic g*ing into landfil*s
anef helps avr:id utilízing n*turel rcs*N:reÊâ lo rreal* il*ur cünt¿iners.
r EaEy-tr-use rtntaånsr design allcws fur singte-handed clisp*sal nf rharps, The c*r"ltainen base is
lranspar'*nt rnakinç it eesy t* Ee* fire fitñ line and pr*ve*l cverfillÊn¡¡ t* r*clucr nereJlectirü{ injuries"
Ste¡"l"Saf,e* ÛSHA Compllance Solutíons
r s,werri-winning blcaclårornp patlr*g*ns lrainüng¿, availat¡le cnlin* in Ëriçlish and Spanirh. üurtnlir"¡e
Tr*inin'lç {enlar prcvides tracking *nd reportinu.
* Simple, *utanratecf Safety lllsn 8uí[der tc help y*u sräy cnmpliant ¡nd arceEç lo oyer 1û million
5*fety Þata Slre'*ts ta *axily ere,ste e ruct*mir*S rnlin* hind*r,
r Preferred ievel scrviceE inrlude annu¿l orl-síle tralning, mrck ûSþ{Å inspection and ¡ rJsciicated
l-tealtfrcare f*rnplåanee Ëqlucatclr" We elss pr*uùelc * N* Fine. Nn Fail,05HÅ Gl¡ðråntee.
r Ënj*y ¡ 1û*, disr*unt *n þÌealthc¿re Fr*ciucts.
Steri"Safe* þltPåA Compliance Sotrutions
r Criticai training i*c[uding f-llPÅA priv*cy, s*cnrity **d s¡ciai mçe]ia,
r $:asy-tt*uss l'liPAi{ priuacy and security risk ¿ssesçmer¡tç.
r Fref*rred level s*rvleeç inelu*e ann¡¡¿l nil-xitc fllPÀå, pri'.raey anrd xecurity gap an*lyris nnd trainings.
.âAX* Sl*.irlrle, ll1{. ,Eilriçht6 r¿ser,J¡{i We protest what matter$.
DocuSign Envelope lDi 57FC2917-2148-488C-91 D4-6D60F00519D2
qþ Stericycle'SüKVICH üËSCRIPfiûf\üS
@ Fharrnac*utiml lltfaste Þispnxal
Ilnug Dirper*lSen¡ice
r Treatn¡ent and disposal *f n*n"ha¿ardouç pllarmaceutiealwasts, Tþís incll¡der pharmaccuticat xnd
¡ver*the-cçunter drug praducts th*t dc not fall under tl"¡* dsfinitinn of ha¡ardnus pharnr,rceutical vc¿çte,
r [nvircnmenta{{y-fri*ndly *elutínn: ta prrtect Trur rornrr¡ilt"¡ities and !,våtsrwñys,
Hazsrdous Drug ilnspnral Service
r ïreatment and disptsal erf pharra*rceulirals tha{ either sxhibil cliar*cteristics that nrake thcrn n
h;¿ardr:L¡ç w*Ete çr tlr¡t arc specifically lirted aE ¿ ha¡ardnus lvaste by IFÅ nr state authcrities,
* We pr*vide y.*u onith * Pharr*rareutic*l lVarTo ldentilicatinn Chçcklicr,
5eal8¿$end$ tontrollad 3uâstanc* Env*loper
- Seal&5enej ccnlrnlled s¿¡bstan*e rnailt¡ack envelopex are fsr u*e only hy patientr/rnci-l,¡rers;
5$ envelupes pør locatian annrually.
ËsRx* ücntrollsd Suhrtancs tJllasts Seruics
* This saluli*n is d*siEned t* h*lp srualf hrspituls and nûr'i-äcllt€ rare facilitÍes prsvsnt rJiv*rçlan
when disp*ring *f cantrolled sl¡bstsnces in ths f*r¡n af tablets. eapsuâe:, lk¡uid: ànd Fãt{hÊs.
- Mifigates the ïisk *f dåversicn wi"len disposinç nf r*ratr*lled :ubstancr vr*ste in yn*r facilities.
- Tfiis *elutisn pr*videe pë*c* af rninei that ycun *cntrnll*d subEl*nce w¿cte will be
prmeer**d with t*ta[ ççcuritl¡ and *ornpliane*.
:*t* Slùr'(!¿!e, 1ûù ål¡ t,lçhts rpçeryert.We protect what mãtters"
DocuSign Envelope lD: 57FC2917 -21 48-488C-91 D4-6D60F0051 9D2
cusromerrD#. 6032076 siærD# oo1
Material Code Check if dispensed
Vy'a¡farin >0.37o P001
Epinephrine P042
Pl.rysotigmir:e
Salicylate
Pl88
Physotigmine P204
Mitonycin u010
Acetaldehyde,
trichloro
u034
Cyclophosphamide u058
Daunomycin u059
Cyclohexane vt29
Melphalan ul50
ottoo.o Stericycle*Washington, Oregon, Idaho and Alaska Rider
a
I understand that RCRA hazardous rvaste can not be accepted as meclical waste by Stericycle and may not be placed in sharps
containers or in rnedical waste containers (i.e. recl bags) at site location(s) listed on agreen'ìent. I acknowledge that the following
information is accurate and complete regarding RCRA hazardous waste and I have presented this information to the necessary
individuals on the staff. In addition, in Washington state only dangerous waste may not be disposed of in regulated medical waste
containers. Please refer to the Stericycle Vy'aste Acceptance Protocol to know what is acceptable for RMW containers,
RCRA hazardous waste generated by the healthcare industry commonly includes, but is not limited to, the medicatìons listed
below. For medications with a "P" code on the table below, ernpty syringes, ampules, or other containers are considered RCRA
waste. For medications with a "U" code on the table below, ernpty (less than 3o/o by volume) syringes, ampules, or other containers
are not considered RCRA waste.
Please chcck only the statements that are applicable to the location(s) in agreement lisfed above
Ø No RCRA hazardous wastes are generated.
tr This facility dispenses the following
medications that, when disposed of,
may be considered RCRA waste
(check all applicable medications):
I A1l RCRA hazardous wastes generated at this location(s) are properly segregated and disposed of
with a licensed waste recycling or disposal service and not included in the medical waste stream.
christy warren 6/30/2020
Print Narne: ' Date:
Facility
^un,..
City of Kent Políce Dept
Material Code CASRN Use Trade Namels)
Warla¡in >0.3%P00l 8l-81-2 Blood thinner Conmadin. Jantoven
Epinephrine P042 5t-43-4 Etnergency allergy kits, cerain types ofglaucoma, eye
srûgery, cardiac arest
Epipen, Epinephrine
Physotigmine Salicylate Pl88 57-64-7 Acholinergenics (liberates/acts like acefylcholine)Eserine, Physostigrnine
Physotigmine P204 57-47-6 Acholinergenics (liberates/acts like acefylcholine)Eserine, Physostigrnine
Mitonlycin u010 1404-00-8 Chemotherapy Mitornvcin. Mutalnvcin. Mitosol
Acetaldehvde. trichloro u034 302-17-0 Sedative Chloral Hydrate. Somnote. Chloralum. Aquachloral
Cvclonhosohamide u058 6055-19-2 Chemotherapy Cvtoxan. Neosar. Cvclophosphamide
Daunolnvcin u059 20830-8 r -3 Chelnotherapy Cerubidine, Daunorubicin HCL, Daunoxome
Cyclohexane u129 1t0-82-7 Scabies Lindane, Kwell
Melphalan u150 148-82-3 Chemotheranv Alkeran. Melohalan
Signature:fr19"i;,',,-
Support Services Manager
Title:
Phone Numbe rt ç253 ,
Cornments:
856-5810 Bn,ui1, cwârren @kentwa. gov
Steticycle respect,t ),otú privaqt q,xd will ttot di,ttrìhule your personal information without pennissbn.
F,acuËig¡*u
ItEruttÞ
Certificate Of Gompletion
Envelope ld: 57F C29 1 7 21 48488Cg 1 D46D60FOOS 1 9D2
Subject: Stericycle Document(s) for your Signature on City of Kent police Dept
Source Envelope:
Document Pages: 6 Signatures: 3
Certificate Pages: 5 lnitials: 0
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
Record Tracking
Status: Original
613012020 3:54:18 PM
Holder: Cameron Pawl
cameron.pawl@stericycle.com
Signature
ki,,,*tr-
Signature Adoption: Pre-selected Style
Using lP Address: 146.125.252.126
úi#::y'
Signature Adoption: Pre-selected Style
Using lP Address: 73.211.114.235
Signature
Status
Status
Status
Status
Status
Signature
Signature
Status
Hashed/Encrypted
Security Checked
Signer Events
Christy Warren
cwarren@kentwa.gov
Support Services Manager
City of Kent - Police
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 613012020 4:02:58 PM
lD'. cc7'f 1 545-2dee47cc-9065 -5a6527 3126f0
Cameron Pawl
cameron. pawl@stericycle.com
CSS
Stericycle lnc.- HCS
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ln Person Signer Events
Editor Delivery Events
Agent Delivery Events
lntermediary Delivery Events
Certified Delivery Events
Carbon Copy Events
Witness Events
Notary Events
Envelope Summary Events
Envelope Sent
Certified Delivered
Status: Completed
Envelope Originator:
Cameron Pawl
2355 Waukegan Road
Bannockburn, IL 60062
cameron. pawl@stericycle.com
lP Address: 13.108.254.8
Location: DocuSign
Timestamp
Sent: 6/30/2020 3:55:30 PM
Viewed: 613012020 4:02:58 PM
Signed: 613012020 4:lB:05 PM
Sent: 6/30/2020 4:18:09 PM
Viewed: 613012020 4:19:04 PM
Signed: 613012020 4:19:07 PM
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Timestamps
613012020 4:18:09 PM
613012020 4:19:05 PM
r$ignfulg.gsrilplda
&nüÉirtãd
üäÉû¡iuchêffii
,$e-G-ii.ilþ0hqskãd
6&0Þûcq*:,lw PM
SÅÐffiå04trt$;û7F'lli:
Electronic Record and Signature Disclosure created on'. 111212017 9:0'l:51 AM
Parties agreed to: Christy Warren
CONSUMER DISCLOSURE
From time to time, Stericycle Inc. (we, us or Company) may be required by law to provide to
you certain written notices or disclosures. Described below are the terms and conditions for
providing to you such notices and disclosures electronically through the DocuSign, Inc.
(DocuSign) electronic signing system. Please read the information below carefully and
thoroughly, and if you can access this information electronically to your satisfaction and agree to
these terms and conditions, please confirm your agreement by clicking the 'I agree' button at the
bottom of this document.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after signing session and, if you
elect to create a DocuSign signer account, you may access them for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.00 per-page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign 'Withdraw Consent' form on the signing page of a
DocuSign envelope instead of signing it. This will indicate to us that you have withdrawn your
consent to receive required notices and disclosures electronically from us and you will no longer
be able to use the DocuSign system to receive required notices and consents electronically from
us or to sign electronically documents from us.
All notices and dÍsclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
made available to you during the course of our relationship with you. To reduce the chance of
you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences ofyour electing not to receive delivery ofthe notices and disclosures
electronically from us.
How to contact Stericycle Inc.:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: customercare@stericycle.com
To advise Stericycle Inc. of your ne\ry e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at customercare@stericycle.com and
in the body of such request you must state: your previous e-mail address, your new e-mail
address. 'We do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc. to affaîge for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in the DocuSign system.
To request paper copies from Stericycle Inc.
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to customercare@stericycle.com and in
the body of such request you must state your e-mail address, full name, US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with Stericycle Inc.
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign session, and on the subsequent
page, select the check-box indicating you wish to withdraw your consent, or you may;
ii. send us an e-mail to customercare@stericycle.com and in the body of such request you
must state your e-mail, full name, US Postal Address, and telephone number. We do not
need any other information from you to withdraw consent.. The consequences of your
withdrawing consent for online documents will be that transactions may take a longer time
to process..
hardware and software
** These minimum requirements are subject to change. If these requirements change, you will be
asked to re-accept the disclosure. Pre-release (e.g. beta) versions of operating systems and
browsers are not supported.
Acknowledging your access and consent to receive materials electronically
Operating Systems:Windows@ 2000,'Windows@ XP, V/indows
Vista@; Mac OS@ X
Browsers Final release versions of Internet Explorer@ 6.0
or above (Windows only); Mozilla Firefox 2.0
or above (V/indows and Mac); Safari'" 3.0 or
above (Mac only)
PDF Reader:Acrobat@ or similar software may be required
to view and print PDF files
Screen Resolution:800 x 600 minimum
Enabled Security Settings:Allow per session cookies
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you were
able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to e-mail
this disclosure and consent to an address where you will be able to print on paper or save it for
your future reference and access. Further, ifyou consent to receiving notices and disclosures
exclusively in electronic format on the terms and conditions described above, please let us know
by clicking the 'I agree' button below.
By checking the 'I agree' box, I confirm that:
I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF
ELECTRONIC CONSUMER DISCLOSURES document; and
I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, for future reference and access; and
Until or unless I notify Stericycle Inc. as described above, I consent to receive from
exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available [o me by Stericycle Inc. during the course of my relationship with you.
a
a
a
onruk.."
Certificate Of Completion
Envelope ld: 57FC29172148488C91 046D60F00519D2
Subject: Stericycle Document(s) for your Signature on City of Kent Police Dept
Source Envelope:
Document Pages: 6 Signatures: 3
Certifìcate Pages: 5 lnitials: 0
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC-06:00) Central Time (US & Canada)
Record Tracking
Status: Original
613012020 3:54:18 PM
Signer Events
Christy Wanen
cwarren@kentwa.gov
Support Services Manager
City of Kent - Police
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 613012020 4:02:58 PM
I D: ccTf 1 545-2dee-47cc-g06 5-5a6527 3f26t0
Cameron Pawl
cameron. pawl@stericycle.com
css
Stericycle lnc.- HCS
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
ln Person Signer Events
Editor Delivery Ëvents
Agent Delivery Events
lntermediary Delivery Events
Certified Delivery Events
Carbon Copy Events
Witness Events
Notary Events
Envelope Summary Events
Envelope Sent
Certified Delivered
Holder: Cameron Pawl
cameron.pawl@stericycle.com
Signature
[ftäfrtr
Signature Adoption: Pre-selected Style
Using lP Address: 146j29.252.126
h::{,:,v'
Signature Adoption: Pre-selected Style
Using lP Address: 73.211.114.235
Status: Completed
Envelope Originator:
Cameron Pawl
2355 Waukegan Road
Bannockburn, lL 60062
cameron. pawl@stericycle.com
lP Address: 1 3.1 08.254.8
Location: DocuSign
Timestamp
Sent: 6/30/2020 3:55:30 PM
Viewed: 613012020 4:02:58 PM
Signed: 6/30/2020 4:18:05 PM
Sent: 6/30/2020 4:18:09 PM
Viewed: 613012020 4:19:04 PM
Signed: 6/30/2020 4:19:07 PM
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
ïimestamp
Timestamp
Timestamp
Timestamps
613012020 4:18:09 PM
613012020 4:19:05 PM
Signature
Status
Status
Status
Status
Status
Signature
Signature
Status
Hashed/Encrypted
Security Checked
Si$iing Õm',Êlëte
e.ff¡plåtêd
,Sêd¡¡ity çhs,eked
,$eouS¡ly,çrtê&d
6&0&sâb*{g$r F},1
6ß0&0Ê0.4:.f,û:07 PM
Electronic Record and Signature Disclosure created on: 111212017 9:01:51 AM
Parties agreed to: Christy Warren
CONSUMER DISCLOSURE
From time to time, Stericycle Inc. (we, us or Company) may be required by law to provide to
you certain written notices or disclosures. Described below are the terms and conditions for
providing to you such notices and disclosures electronically through the DocuSign, Inc.
(DocuSign) electronic signing system. Please read the infbrmation below caref'ully and
thoroughly, and if you can access this information electronically to your satisfaction and agree to
these terms and conditions, please confirm your agreement by clicking the 'I agree' button at the
bottom of this document.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after signing session and, if you
elect to create a DocuSign signer account, you may access them for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.00 per-page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper f-ormat. How you must inform us of your decision to receive fïture notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign 'Withdraw Consent' f'orm on the signing page of a
DocuSign envelope instead of signing it. This will indicate to us that you have withdrawn your
consent to receive required notices and disclosures electronically from us and you will no longer
be able to use the DocuSign system to receive required notices and consents electronically from
us or to sign electronically documents from us.
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
made available to you during the course of our relationship with you. To reduce the chance of
you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences ofyour electing not to receive delivery ofthe notices and disclosures
electronically from us.
How to contact Stericycle Inc.:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: customercare@stericycle.com
To advise Stericycle Inc. of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at customercare@stericycle.com and
in the body of such request you must state: your previous e-mail address, your new e-mail
address. We do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc. to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in the DocuSign system.
To request pâper copies from Stericycle Inc.
To request delivery from us ofpaper copies ofthe notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to customercare@stericycle.com and in
the body of such request you must state your e-mail address, full name, US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with Stericycle Inc.
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign session, and on the subsequent
page, select the check-box indicating you wish to withdraw your consent, or you may;
ii. send us an e-mail to customercare@stericycle.com and in the body of such request you
must state your e-mail, full name, US Postal Address, and telephone number. We do not
need any other information from you to withdraw consent.. The consequences of your
withdrawing consent for online documents will be that transactions may take a longer time
to process..
hardware and software
** These minimum requirements are subject to change. If these requirements change, you will be
asked to re-accept the disclosure. Pre-release (e.g. beta) versions of operating systems and
browsers are not supported.
Acknowledging your access and consent to receive materials electronically
Operating Systems;Windows@ 2000, Windows@ XP, Windows
Vista@:Mac OS@ X
efs Final release versions of Internet Explorer@ 6.0
or above (Windows only); Mozilla Firefox 2.0
or above ('Windows and Mac); Safari* 3.0 or
above (Mac onlv)
PDF Reader:Acrobat@ or similar software may be required
to view and print PDF files
Screen Resolution:800 x 600 minimum
Enabled Security Settings Allow per session cookies
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you were
able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to e-mail
this disclosure and consent to an address where you will be able to print on paper or save it for
your future reference and access. Further, ifyou consent to receiving notices and disclosures
exclusively in electronic format on the terms and conditions described above, please let us know
by clicking the 'I agree' button below.
By checking the 'I agree' box, I confirm that:
I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF
ELECTRONIC CONSUMER DISCLOSURES document; and
I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, fbr future reference and access; and
Until or unless I notify Stericycle Inc. as described above, I consent to receive from
exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to me by Stericycle Inc. during the course of my relationship with you.
a
a
a