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***TMMEDiATE ACTION REQUIRED*** <br /> 1)Read the attached Terms and Conditions along with the Waste Acceptance Policy. <br /> 2)Choose and circle your desired service level. <br /> "... .. ) g yc ( ) <br /> €. R"k5�.:: 3 Please Fax Agreement Stzric��le 366 422-3373. <br /> STERI SAFE(sm)Service Agreement <br /> Customer: Delta Pathology Associates Customer#• 6038100 <br /> Address: 3133 W March Ln Site ED#: 002. <br /> City/State/Zip: Stockton,CA 952192360 Phone#: (209)320-6118 <br /> E-Mail: a@a.com Fax#: (209)326-6136 <br /> Sales Rep: Amanda Frangos Generator iD#: <br /> Generated By: Amanda Frangos Contract Number: SRCL-00463733 <br /> STERI-SAFE PROGRAM BENEFITS Preferred <br /> NO FINE.NO FAIL.OSHA Guarantee:We Pay Your Fine As It Pertains to Bloodborne Pathogens and Waste <br /> Management Practices. <br /> Annual On-Site Bloodborne Pathogens Training:011-Site BBP Training Takes the Worry Out of Fulfilling This OSHA <br /> Requirement. <br /> Annual On-Site Mock OSHA Evaluation:Review Your Facility for Potential OSHA Violations. <br /> Online Safety Meeting Library:Critical and Timely Topics Added Quarterly. <br /> Online AISDS Svstem:Millions of MSDSs Available to Search,Store,Download,and Print. <br /> Product Discounts:Apply to Quality Infection Control and Safety Products. <br /> Online HIPAA Resources:Forms,Policies,and Training for Compliance with HIPAA Regulations. ° <br /> Safety Posters and Secondary Labels:Provide Essential Information to Staff Members. <br /> Award-Winning Online Bloodborne Pathogens Training.Helps to Fulfill Annual Requirement for BBP Training- <br /> Steri-Safe Safety Plan Builder:Complete Site-Specific Safety Plans Quickly and Easily. <br /> Online Medical Waste Training:Medical Waste Training with.State-Specific Information Provides Waste Segregation <br /> and Handling Information.Includes Waste Segregation Poster. <br /> DOT Training:Comply with DOT's Training Requirement. <br /> Medical Waste Services:Removal,Disposal,and Complete Documentation(Manifests). <br /> Custom Scheduled Service Frequencies:Choose 2,3,4,6,13,26,52 Stops Yearly,or Daily Stops. <br /> Flat Monthly Fee:Simplifies Budgeting. <br /> Monthly Service Fee$ $1,381.91 <br /> (PLEASE Cmct.F ONE) <br /> Estimated Stops per Year:52 Max Yearly $/Each additional <br /> (A charge of$161.00 will be added for each add].stop) Containers container <br /> Maximum Medical Waste Containers per Year:131 <br /> Steri-Safe RAM 131 current container rate <br /> Payment Schedule(Please Check One):1x1 Monthly 11 Quarterly 11 Annually plus 10% <br /> ContractEffective Date:3013-01-01 ................................................................................................................................................... <br /> Chemo/Path 240 100.00 <br /> Any additional services or products selected by Customer shalt be billed separately Disposal <br /> according to current Stericycle pricing. <br /> Customer certifies that they will properly classify and segregate their special waste <br /> streams and that they will not co-mingle those haste streams with any other. <br /> During the Original Term of the Agreement,Stericycle will not increase the Monthly Service Fee listed above by more than 6%annually. <br /> By signing below T acknowledge that T am Customer's author]red officer or agent and that T have the authority to bind Customer to this Agreement.Customer agrees to be <br /> bound by the terms and conditions that appear on the second page hereof and comply with Stericyde's Waste Acceptance Policy,both of which are integral parts of this <br /> Agreement.(Appendix A)- <br /> CUSTOMER:X Name Title Date <br /> STERTCYCLE:X Name Amanda Frangos Title Date <br /> 4010 Commercial Ave.,Northbrook,IL 60062•Phone:(847)943-6861•Fax:(866)422-3373 <br /> Offer Expiration Date:1-7-2013 <br /> Oftiro IIne f)nly:Gide#:RX-Lt1.PC I f10.0.FD-1.!).H2-1.(] <br /> Document Integrity Verified EchoSign Transaction Number.OSCVYA4USR2H3H <br />