LICENSE AGREEMENT WITH DONOR NETWORK OF AZ.DOC

LICENSE No. P50119 AMENDMENT No. 03
C-18-08-018-1-03
AMENDMENT No. 3 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 are parties to that certain License and Fee Agreement No.
P50119 (“License”) dated and approved by the Maricopa County Board of
Supervisors on October 31, 2007 and subsequently amended October 27, 2009
and November 1, 2011. 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 on October 30, 2013.
C. Licensor and Licensee now mutually desire to amend the License to extend the
term.
AGREEMENT
NOW THEREFORE, in consideration of the foregoing and other valuable
considerations, Licensor and Licensee agree to amend License No. P50119 as
follows:
1. The term of the license is hereby extended through June 30, 2016. This License is
subject to termination pursuant to the provisions of A.R.S. 38-511. 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. Licensee shall reimburse Licensor for use of the Tissue Recovery Room at a rate
of Five Hundred Dollars ($500.00) per individual donor case regardless of the
outcome plus all applicable taxes.
3. The effective date of this Amendment No. 3 is the date of execution by the
Maricopa County Board of Supervisors.
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LICENSE No. P50119 AMENDMENT No. 03
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4. The foregoing paragraphs contain all the changes made to the License by this
Amendment No. 3. All other terms and conditions of the License and subsequent
amendments remain the same and in full force and effect.
5. Both parties are subject to the Operational Procedures – Shared Use of Premises
as described in Exhibit “A” attached hereto and by reference incorporated into the
License.
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LICENSE No. P50119 AMENDMENT No. 03
C-18-08-018-1-03
IN WITNESS WHEREOF, the parties have signed this Amendment No. 3:
LICENSEE: LICENSOR:
Donor Network of Arizona Maricopa County
By: ____________________________ By: ______________________________
Chairman of the Board
_______________________________ ATTEST:
Title
_______________________________ __________________________________
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.
________________________________________
Robert Swan Date
Deputy County Attorney
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LICENSE No. P50119 AMENDMENT No. 03
C-18-08-018-1-03
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
accreditation, and
Eye Bank Association of America, and provide documentation of such
accreditation as requested by Maricopa County.
2. Assure all DNA staff wears identification badges while on Maricopa Forensic
Science Center premises.
3. Provide recovery documents, including, but not limited to, evaluation forms
of donors, medical records, signed consent forms, policies and procedures for
donor evaluation and management, and recovery and transport procedures for
tissue and eye donation.
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LICENSE No. P50119 AMENDMENT No. 03
C-18-08-018-1-03
4. Adhere to Maricopa Forensic Science Center’s administrative, medical and
staff policies at all times and work cooperatively with all Maricopa Forensic
Science Center .
5. Designate a coordinator to be assigned to Maricopa Forensic Science Center
to serve as a liaison.
6. Conduct professional education programs for Maricopa Forensic Science
Center employees. At Maricopa Forensic Science Center’s request to the
DNA operations director, and subject to DNA availability, DNA staff will
participate in Maricopa Forensic Science Center’s community education
programs related to DNA activities.
7. Develop single point referral service through which Maricopa Forensic
Science Center will refer all deaths to DNA. DNA will maintain 24-hour
capability to promptly respond to all calls from Maricopa Forensic Science
Center to determine medical suitability for tissue and eye donation.
8. Assure trained personnel are available on a 24-hour basis to travel or
telephonically respond to Maricopa Forensic Science Center to provide donor
management and support when appropriate. Such support will include,
without limitation; explaining tissue and eye donation to families; obtaining
medical examiner consent as required by Arizona law; performing the
excision and preservation of tissues and eyes as appropriate; and distributing
tissues and eyes to recipients.
9. 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 Maricopa Forensic Science
Center tissue recovery room when available or alternate site so that
Maricopa Forensic Science Center 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;
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LICENSE No. P50119 AMENDMENT No. 03
C-18-08-018-1-03
f) Notify the designated Maricopa Forensic Science Center staff of the
completion of the tissue recovery; and,
g) Clean the recovery area, short of terminal cleaning. Dispose of waste
per Maricopa Forensic Science Center’s instructions.
10. Maintain and, upon Maricopa Forensic Science Center’s request, provide a
log of all referral calls either directly or indirectly received from Maricopa
Forensic Science Center.
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 Maricopa Forensic
Science Center with cardiac pathology reports complete with glass slide of
representative tissue(s) examined within 30 days of recovery.
14. Forward information on potential donors that have been ruled out for
transplant to eligible medical research and education organizations.
Maricopa Forensic Science Center 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 Maricopa Forensic Science Center with a written request to
do so.
3. Work cooperatively with DNA in reviewing Maricopa Forensic Science
Center records and providing education to Maricopa Forensic Science
Center’s staff on donation issues.
4. Grant DNA staff entry privileges to the premises of Maricopa Forensic
Science Center.
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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LICENSE No. P50119 AMENDMENT No. 03
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6. Allow DNA access to medical records of decedents allowed by law and as
necessary to provide compliance data for routine referral and to improve
identification of potential donor.
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