LICENSE RE P-50119 AMD 5 DONOR NETWORK AZ.PDF

LICENSE No. P50119 AMENDMENT No. 05
C-18-08-018-1-05
AMENDMENT No. 5 TO LICENSE AND FEE AGREEMENT
FOR USE OF REAL PROPERTY
BETWEEN
DONOR NETWORK OF ARIZONA, LICENSEE
AND
MARICOPA COUNTY, LICENSOR
RECITALS
A. Licensor and Licensee (collectively, the “Parties”) are Parties to that certain License and
Fee Agreement No. P50119 dated October 31, 2007 and subsequently amended October
27, 2009, November 1, 2011, September 25, 2013 and April 26, 2016 (the “License”). The
License is for non-exclusive use of space located at 701 W. Jefferson Street, Phoenix, AZ
85007, consisting of a 400 square foot Tissue Recovery Room.
B. The term of the License expires June 30, 2019.
C. Licensor and Licensee now mutually desire to amend the License to extend the term and
update Exhibit “A” of the License.
AGREEMENT
NOW, THEREFORE, in consideration of the mutual covenants herein and other good
and valuable consideration, receipt and sufficiency of which is hereby acknowledged,
Licensor and Licensee agree to amend the License as follows:
1. The term of the License is hereby extended 3 (three) years and will commence July 1, 2019
and expire June 30, 2022. This License is subject to termination pursuant to the provisions
of A.R.S. 38-511, the provisions of which are incorporated herein by this reference.
Licensor may terminate the License without cause upon 90-days’ written notice. Licensee
and/or any of its employees, agents, officers, directors, members, successors or assigns
hereby waives any and all rights to bring any claim against Licensor or its employees,
agents, officers, directors, members, successors or assigns from or relating in any way to
Licensor’s termination of this License.
2. Exhibit “A” of the License is replaced in its entirety. Both Parties are subject to the
Operational Procedures – Shared Use of Premses as described in Exhibit “A” attached
hereto and by this reference incorporated herein.
3. Licensee shall reimburse Licensor for the use of the Tissue Recovery Room at a rate of
Five Hundred Dollars ($500.00) per individual donor case regardless of the outcome, plus
any applicable taxes.
4. The effective date of this Amendment No. 5 is the date of execution by Maricopa County.
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LICENSE No. P50119 AMENDMENT No. 05
C-18-08-018-1-05
5. The foregoing paragraphs contain all the changes made to the License by this Amendment
No. 5. All other terms and conditions of the License and subsequent amendments remain
the same and in full force and effect.
IN WITNESS WHEREOF, the Parties have signed this Amendment No. 5:
LICENSEE: LICENSOR:
Donor Network of Arizona Maricopa County
____________________________________ ____________________________________
Tim Brown, President & CEO Bill Gates, Chairman of the Board
ATTEST:
____________________________________
Date
____________________________________
Clerk of the Board Date
This Amendment has been reviewed by the undersigned Attorney, who has determined that it is
proper in form and is within the power and authority granted under the laws of the State of Arizona.
____________________________________
Deputy County Attorney Date
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LICENSE No. P50119 AMENDMENT No. 05
C-18-08-018-1-05
EXHIBIT “A”
Operational Procedures – Shared Use of Premise
1. On a monthly basis, Licensor will provide Licensee a listing of donor recovery
activity at the Facility, for both successful and unsuccessful cases, and include the
following information:
i. Licensee’s case number for donor
ii. Licensor’s case number
iii. Date the Tissue recovery was attempted or completed
iv. Time recovery team entered Tissue Recovery Room
v. Time recovery team exited Tissue Recovery Room
vi. List of Licensee’s recovery team members
vii. List of specific Tissues procured per case
viii. List of donor cases resulting in unsuccessful Tissue recovery
2. The Parties understand that tissue recovery will be performed by Licensee’s personnel.
Licensee’s personnel will prepare the decedent in the Tissue Recovery Room. Licensee
will provide supplies or equipment. Licensee may utilize Licensor’s bio-medical waste
disposal system only for the disposal of bio-medical waste that results from the
Licensee’s tissue recovery activity at the Facility.
3. The Parties agree that, following the Licensee’s tissue recovery efforts, Licensee’s staff
shall be responsible for cleaning the Tissue Recovery Room and returning the Tissue
Recovery Room to ready status.
Donor Network of Arizona (DNA) Responsibilities - Shall:
1. Maintain accreditation with the American Association of Tissue Banks, and Eye
Bank Association of America, and provide documentation of such accreditation as
requested by Maricopa County.
2. Assure all DNA staff wear identification badges while on Forensic Science Center
(FSC) premises.
3. Provide recovery documents, including, but not limited to, evaluation forms of
donors, medical records, signed authorization forms, policies and procedures for
donor evaluation and management, and recovery and transport procedures for tissue
and eye donation.
4. Adhere to Maricopa County and Office of the Medical Examiner (OME)
administrative, medical and staff policies at all times and work cooperatively with all
OME staff.
5. Designate a coordinator to be assigned to OME to serve as a liaison.
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LICENSE No. P50119 AMENDMENT No. 05
C-18-08-018-1-05
6. Conduct professional education programs for OME employees. At OME’s request to
the DNA operations director, and subject to DNA availability, DNA staff will
participate in OME’s community education programs related to DNA activities.
7. Assure trained personnel are available on a 24-hour basis to travel or telephonically
respond to the FSC to provide donor management and support when appropriate.
Such support will include, without limitation explaining tissue and eye donation to
families; obtaining Medical Examiner authorization as required by Arizona law;
performing the excision and preservation of tissues and eyes as appropriate; and
distributing tissues and eyes to recipients.
8. Facilitate and coordinate the recovery of eyes and tissues (including musculoskeletal,
cardiovascular, and skin) by performing the following activities:
a) Arrange for tissue donation in a manner which ensures that the needs of the
family, Medical Examiner, Justice of the Peace, and funeral home are met;
b) Schedule the tissue recovery to occur in FSC tissue recovery room when
available or alternate site so that OME procedures can continue as scheduled
without disruption;
c) Provide staff, equipment and supplies needed for tissue recovery;
d) Provide complete documentation of the tissues recovered for filing in the
donor’s medical record;
e) Reconstruct the donor to restore anatomical configuration;
f) Notify the designated OME staff of the completion of the tissue recovery; and,
g) Clean the recovery area, short of terminal cleaning. Dispose of waste per
OME instructions.
10. Maintain and, upon OME’s request, provide a log of all referral calls either directly
or indirectly received from OME.
11. Maintain the confidentiality of all information obtained during the evaluation and
completion of the tissue donation. No medical information shall be released except
as authorized by the donor’s legal representative or by law.
12. Coordinate appropriate follow-up and support for donor’s families.
13. Ensure cardiovascular tissue processors provide the OME with cardiac pathology
reports complete with glass slides of representative tissue(s) examined within 30 days
of recovery.
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LICENSE No. P50119 AMENDMENT No. 05
C-18-08-018-1-05
14. Upon request, forward information on potential donors that have been ruled out for
transplant to eligible medical research and education organizations.
Maricopa CountyOffice of the Medical Examiner Responsibilities - Shall:
1. Directly or indirectly refer all potential eye and tissue donors to DNA. Grant
DNA the right of first refusal to procure all potential eye and tissue donors. The
parties to this agreement understand that DNA will comply with family requests
for referral of eyes and tissue donation to other procurement agencies.
2. Directly or indirectly notify DNA of potential eye and tissue donors if DNA
provides OME with a written request to do so.
3. Work cooperatively with DNA in reviewing OME records and providing
education to OME staff on donation issues.
4. Grant DNA staff entry privileges to the premises of FSC.
5. When appropriate and available, allow DNA access to an autopsy suite or
alternative location (e.g., special procedure room, x-ray suite) for the coordination
and recovery of eye(s) and tissue.
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