HomeMy WebLinkAbout2-7-18 meeting packet items 1 - 12
NOTICE OF MEETING
City Council Meeting
Wednesday, February 7, 2018 7:00 P.M.
City of Lake Elmo | 3800 Laverne Avenue North
AGENDA
A. Call to Order/Pledge of Allegiance
B. Approval of Agenda
C. Accept Minutes
1. January 16, 2018
D. Public Comments/Inquires
E. Presentations
F. Consent Agenda
2. Approve Payment of Disbursements and Payroll
3. Approve Extension of Comcast Cable Franchise Agreement
4. Approve Drug Testing and Drug Free Workplace Policies
5. Approve Service Agreements with Industrial Health Services Network (IHSN)
6. Approve Chicken Ordinance-Ordinance No 08-196
7. Approve Consultant for Brookfield Building Fit Test/Analysis
8. Approve Old Village Ph3 Street & Utility Improvements – Change Order No. 4.
9. Approve Old Village Ph3 Street & Utility Improvements – Pay Request No. 6.
10. Approve Private Development Security Reductions – Easton Village 2nd and Easton Village 3rd.
11. Approve 5th Street North – Resolution Authorizing MnDOT to Perform Speed Zone Study
12. Approve Non Profit Donation Policy
G. Regular Agenda
13. Wyndham Village Subdivision Sketch Plan Review & Comprehensive Plan Amendment – Resolution 2018-
006
14. Legacy at North Star Preliminary Plat and PUD Plans-Resolution 2018-013
15. Short Term Rental Ordinance Amendment-Ordinance No 08-197 & 08-200, Resolution 2018-014
16. Fairfield Inn Final PUD and CUP-Resolution 2018-008, 2018-009
17. Solar Ordinance-Ordinance No 08-xx, Resolution 2018-010
18. Windpower Ordinance-Ordinance No 08-xx, Resolution 2018-011
19. CSAH15/CSAH14 Realignment – Resolution Approving Cooperative Agreements-Resolution 2018-012
20. Finance Director-Job Description and Posting
21. Personnel Policy Amendment for Substitute Firefighters
H. Council Reports
I. Staff Reports and Announcements
J. Adjourn
Our Mission is to Provide Quality Public Services in a Fiscally Responsible
Manner While Preserving the City’s Open Space Character
CITY OF LAKE ELMO
CITY COUNCIL MINUTES
JANUARY 16, 2018
CALL TO ORDER/PLEDGE OF ALLEGIANCE
Mayor Pearson called the meeting to order at 7:00 pm.
PRESENT: Mayor Mike Pearson and Councilmembers Justin Bloyer, Jill Lundgren and Christine
Nelson. ABSENT: Councilmember Julie Fliflet.
Staff present: Administrator Handt, City Attorney Sonsalla, City Engineer Griffin, Planning
Director Becker, Finance Director Swanson and City Clerk Johnson.
APPROVAL OF AGENDA
Item 3, “Approve Payment of Disbursements and Payroll” was moved to the Regular Agenda.
Councilmember Nelson seconded by Mayor Pearson, moved TO APPROVE THE AGENDA AS
AMENDED. Motion passed 5 – 0.
ACCEPT MINUTES
Minutes of the December 19, 2017 and January 2, 2018 Special Meetings and December 19, 2017
Regular Meeting were accepted at presented. Minutes of the January 2, 2018 Regular Meeting
were accepted as amended.
PUBLIC COMMENTS/INQUIRIES
None
PRESENTATIONS
Mayor Pearson read a proclamation regarding the 2018 Kindness Campaign promoting random
acts of kindness.
CONSENT AGENDA
4. Accept December 2017 Assessor’s Report
5. Accept December 2017 Public Works Department Report
6. Accept December 2017 Building Department Report
LAKE ELMO CITY COUNCIL MINUTES
JANUARY 16, 2018
Page 2 of 5
7. Accept December 2017 Fire Department Report
8. Approve Community Room Use Agreement for Lake Elmo Library
9. CSAH13 (Ideal Avenue/Olson Lake Trail) – Approve Cooperative Agreement Payment
No. 4.
10. Approve Private Development Security Reductions – Southwind; Easton Village 1st;
Savona 3rd & 4th.
11. Boulder Ponds 1st Addition – Accept Improvements.
12. Traffic Signal Maintenance Agreements – Approve Cooperative Maintenance
Agreements for Traffic Signal Systems at CSAH15 and CSAH10; and at CSAH15 and
CSAH14 –Resolution 2018-005
13. Approve Contract for Landscape Architecture Services
14. Approve Revised 2018 Regular Meetings Calendar
15. Approve Therapeutic Massage Premises Permit – Boon Massage and Wellness Center,
11200 Stillwater Blvd. Suite 102
16. Approve Fire Department Training Contract with Dakota County Technical College
Consent Agenda accepted by unanimous consensus.
ITEM 3: Approve Payment of Disbursements and Payroll
Brief discussion held regarding the purchase of bottled water. Payment of disbursements and
payroll approved by unanimous consensus.
ITEM 17: Wyndham Village Subdivision Sketch Plan Review & Comprehensive Plan
Amendment
Councilmember Bloyer, seconded by Councilmember Lundgren, moved TO TABLE ITEM 17.
Motion passed 4 – 0.
ITEM 18: Legacy at North Star Preliminary Plat and PUD Plans
Planning Director Becker presented details of the proposal for a new single family residential
development of 276 lots on 98.93 acres. The PUD and preliminary plat requests were also
reviewed along with recommended condition of approval.
Discussion was held concerning trails and a potential connection to the Hamlet on Sunfish Lake
neighborhood. Mark Skeie spoke on behalf of the Hamlet HOA, commenting on the trail to the
lake access area and buffers between Hamlet and the proposed development.
Neil Kruger, 4452 Lake Elmo Avenue, commented on affordable housing.
Tom Laier, 3899 Kindred Way, commented on public use of the dock in the Hamlet
neighborhood.
LAKE ELMO CITY COUNCIL MINUTES
JANUARY 16, 2018
Page 3 of 5
Craig Allen of GWSA commented on the proposed buffers.
Mayor Pearson, seconded by Councilmember Bloyer, moved TO APPROVE THE LEGACY
AT NORTH STAR PRELIMINARY PLAT AND PUD PLANS WITH 25 CONDITIONS OF
APPROVAL.
Councilmember Bloyer, seconded by Councilmember Nelson, moved TO AMEND THE
PRIMARY MOTION TO STRIKE LANGUAGE IN CONDITION 7 TO STATE THAT THE
APPLICANT WILL PROVIDE A TRAIL CONNECTION TO HAMLET ON SUNFISH
LAKE AND WILL NOT RECEIVE PARKLAND DEDICATION CREDIT FOR THE TRAIL.
Motion passed 3 – 1. (Pearson – nay)
Councilmember Nelson, seconded by Councilmember Bloyer, moved TO AMEND THE
PRIMARY MOTION TO REVISE CONDITION 10 TO STATE THAT THE APPLICANT
WILL PROVIDE A BUFFER DEEMED ADEQUATE BY THE CITY WITH SUFFICIENT
LANDSCAPING OR BERMING WITHIN RESIDENTIAL LOTS PROTECTED BY A
LANDSCAPE EASEMENT AND APPROVED BY THE CITY. Motion passed 3 – 1.
(Lundgren – nay) Council expressed consensus that portions of the buffer are anticipated to be
50 feet.
Councilmember Bloyer, seconded by Councilmember Nelson, moved TO AMEND THE
PRIMARY MOTION BY STRIKING CONDITION 13 REQUIRING DEVELOPER TO
DEDICATE PARKLAND WITHOUT RECEIVING PARKLAND DEDICATION CREDIT.
Motion passed 4 – 0.
Councilmember Bloyer, seconded by Councilmember Nelson, moved TO AMEND THE
PRIMARY MOTION BY STRIKING CONDITION 19 REQUIRING FENCING AROUND
STORMWATER PONDING. Motion failed 1 – 3. (Pearson, Lundgren, Nelson – nay)
Mayor Pearson, seconded by Councilmember Nelson, moved TO AMEND THE PRIMARY
MOTION TO AMEND CONDITION 25 TO STATE THAT THE DEVELOPER WILL
PROVIDE A TRAIL EASEMENT THE LENGTH OF THE STORMWATER PIPE ALONG
LAKE ELMO AVENUE AND GRADE THE AREA FOR A FUTURE BITUMINOUS
TRAIL. Motion passed 4 – 0.
Mayor Pearson, seconded by Councilmember Bloyer, moved TO DIRECT STAFF TO
PREPARE A RESOLUTION FOR APPROVAL OF PRELIMINARY PLAT AND PUD
WITH CONDITIONS STATED IN THE CURRENT COUNCIL PACKET AS AMENDED
BY THE CITY COUNCIL. Motion passed 4 – 0.
Primary motion as amended passed 4 – 0.
LAKE ELMO CITY COUNCIL MINUTES
JANUARY 16, 2018
Page 4 of 5
ITEM 19: Interim Ordinance for Comprehensive Plan Amendment Moratorium
Planning Director Becker provided an overview of the proposed ordinance.
Councilmember Lundgren, seconded by Councilmember Bloyer, moved TO OPEN THE
PUBLIC HEARING. Motion passed 4 – 0.
Craig Allen, GWSA, relayed concerns expressed by a landowner.
Councilmember Bloyer, seconded by Councilmember Lundgren, moved TO CLOSE THE
PUBLIC HEARING. Motion passed 4 – 0.
Councilmember Bloyer, seconded by Councilmember Nelson, moved TO ADOPT
ORDINANCE 08-195 DECLARING A MORATORIUM FOR A ONE YEAR PERIOD ON
2030 COMPREHENSIVE PLAN AMENDMENTS. Motion passed 4 – 0.
Mayor Pearson, seconded by Councilmember Bloyer, moved TO ADOPT RESOLUTION
2018-007 AUTHORIZING SUMMARY PUBLICATION OF ORDINANCE 08-195. Motion
passed 4 – 0.
ITEM 20: Assessor Services
Administrator Handt reviewed proposals for assessor services.
Councilmember Lundgren, seconded by Councilmember Bloyer, moved TO DIRECT STAFF
TO PREPARE A CONTRACT FOR ASSESSING SERVICES WITH CHASE PELOQUIN.
Motion passed 4 – 0.
ITEM 21: Purchase Agreement for 3880 Laverne Ave. N.
Administrator Handt provided an update on the potential offer to purchase 3880 Laverne Avenue
North and reviewed proposed terms of the draft purchase agreement prepared by the City
Attorney. Financing was discussed with Finance Director Swanson recommending that the City
use the EDA to issue bonds to finance the purchase.
Councilmember Bloyer, seconded by Councilmember Nelson, moved TO APPROVE THE
PURCHASE AGREEMENT FOR 3880 LAVERNE AVE. N., APPROVE $3,300 FOR CEG
TO COMPLETE A PROPERTY CONDITIONS ASSESSMENT AND PHASE 1
ENVIRONMENTAL ASSESSMENT, DIRECT STAFF TO BEGIN SECURING
FINANCING VIA THE EDA USING HRA POWERS AND AUTHORIZE THE CITY
ADMINISTRATOR TO CONTRACT A FIT ANALYSIS. Motion passed 4 – 0.
LAKE ELMO CITY COUNCIL MINUTES
JANUARY 16, 2018
Page 5 of 5
STAFF REPORTS AND ANNOUNCEMENTS
Administrator Handt: Announced an open house February 15th from 6:00 p.m. to 8:00 p.m. for
public input on the space needs study.
City Attorney Sonsalla: Working on the 3880 Laverne purchase agreement and other issues
City Engineer Griffin: Working on the CSAH 15 realignment and Hudson Blvd. project.
Meeting adjourned at 9:46 pm.
LAKE ELMO CITY COUNCIL
ATTEST:
______________________________
Mike Pearson, Mayor
_______________________________
Julie Johnson, City Clerk
STAFF REPORT
DATE: February 7, 2018
CONSENT #3
AGENDA ITEM: Cable Franchise Extension
SUBMITTED BY: Kristina Handt, City Administrator
BACKGROUND:
Included in your packet is a memo from Tim Finnerty, Cable Commission Executive Director. It
provides details on the background and proposal before the Council.
ISSUE BEFORE COUNCIL:
Should the Council extend the cable franchise agreement with Comcast?
PROPOSAL:
The cable commission is requesting an extension of the cable franchise agreement with Comcast until
November 1, 2018 to allow good faith negotiations to continue.
It is not all uncommon for franchise renewals to take extra time as they are a very complex matter.
RECOMMENDATION:
If removed from the consent agenda:
“Motion to approve the resolution to extend the cable franchise agreement until November 1, 2018.”
ATTACHMENTS:
• Memo from Tim Finnerty
• Resolution to extend cable franchise agreement
M E M O R A N D U M
TO :Kristina Handt, City Administrator
FROM :Tim Finnerty, Cable Commission Executive Director
DATE :January 18, 2018
SUBJECT :Recommendation to approve Franchise Extension Agreement
Attached please find a proposed Agreement for the extension of the Franchise with Comcast. The Cable
Commission is recommending that the City Council approve the Extension Agreement. The Agreement will extend
the expiration date of the current Franchise from July 1, 2018 to November 1, 2018. The purpose of the proposed
extension is to allow for continued informal negotiations between Comcast and the Cable Commission regarding the
longterm renewal of the Franchise.
Background
As you know, the Cable Commission has been working on the matter of franchise renewal with Comcast (the existing
franchise agreement is set to expire July 1, 2018). The Commission began direct negotiations with Comcast in
September 2017, and prior to that, developed and documented a comprehensive needs assessment to serve as the
negotiation objective on behalf of member cities. The needs assessment report is available at:
https://drive.google.com/file/d/0B1qh_NnmAEg2SHZtc0tKSnBNVlU/view
Renewal issues can be resolved through “informal” processes (negotiation), or through a “formal” hearing process.
Based on the time required to complete the formal process, the Commission adopted two schedules. In both, the
parties would start with negotiations, but move the formal process forward so that it would be completed by roughly
the date scheduled for franchise expiration if negotiations were not successful. One schedule assumed that the
expiration date stayed as is, and effectively required the parties to reach negotiated deal points by January. In the
other, the parties would extend the franchise to give themselves more time to engage in negotiations. Both were
presented to Comcast in the fall.
Recommendation to Approve Extension
The Cable Commission submitted proposed deal points for negotiation to Comcast in October, 2017, and Comcast
was to respond in December. It has not yet responded, and the Commission and Comcast agreed that extending the
franchise would allow Comcast to respond and negotiations to proceed informally.
The Cable Commission therefore is recommending that the City approve the extension per the attached Extension
Agreement. The Cable Commission believes this simple extension of the current franchise expiration will allow both
parties to continue informal negotiations for the next couple of months without being put at a disadvantage. The
extension preserves your right to use the INET, and preserves existing support and channels (including high
definition channels) for local cable programming. It does not harm the communities in any way.
Please feel free to contact me after you have had a chance to review this if you wish to discuss it or have any
questions. Thank you!
STAFF REPORT
DATE: February 7, 2018
REGULAR
ITEM #: 4
TO: Mayor and City Council
FROM: Jake Foster, Assistant City Administrator
AGENDA ITEM: Approve City Drug Testing/Drug-Free Workplace Policy
BACKGROUND:
Staff and the Human Resources Committee have determined that there is a need for a drug-free workplace
policy for City employees. As part of this policy, staff would also like to implement a drug testing
portion of the policy for both DOT and non-DOT employees.
Drug-free workplace and drug testing policies are common practices in cities throughout Minnesota. In
order to properly enforce, maintain, and monitor these policies, an outside vendor will be needed.
Included in your packet are drug testing policies for both DOT and non-DOT employees which were
updated for Lake Elmo using language from the League of Minnesota Cities.
ISSUE FOR DISCUSSION:
Should Council approve the recommendation of the Human Resources Committee to create a drug-free
workplace and drug testing policy?
PROPOSAL DETAILS/ANALYSIS:
The services the committee has recommended for non-DOT employees are pre-employment drug
screening, alcohol and drug screening based on suspicion, and alcohol and drug screening if an accident
occurs while an employee is on duty or City property is involved. Aside from the pre-employment drug
screening, non-DOT employees shall not be subject to further drug and alcohol testing without reasonable
suspicion or being involved in an accident while on-duty and/or one that involves City equipment.
The committee further recommends the DOT drug and alcohol testing which includes, pre-employment
drug screening, alcohol and drug screening based on suspicion, alcohol and drug screening if an accident
occurs while an employee is on duty or City property is involved, as well as random selection for testing,
and all other DOT requirements.
FISCAL IMPACT:
The vendor that has been identified, Industrial Health Solutions Network (IHSN), charges and annual
service fee of $229.00 for the DOT service program. The annual service fee for non-DOT employees will
be waived if a service agreement is in place with IHSN for DOT testing. There is an additional one time
account set-up fee of $50. Each drug test has an administration/currier fee of $44.90 plus a collection fee
from the clinic of $24 for a total of $68.90 each test. Alcohol/breath tests are also done at the Stillwater
Medical Group Clinic and carry a charge of $44.
Random drug testing needs to occur at a 25% rate annually for the City to be DOT compliant. Tests will
be performed quarterly. Currently there are eight employees who are subject to DOT regulations. This
means two employees will have to be tested randomly at an annual total cost of $137.80 for the drug tests.
Additionally, DOT employees need to be randomly tested for alcohol consumption at a rate of 10%
annually with a minimum of one employee needing to be tested each year. The analysis for random
testing requirements is performed quarterly, but the system may not require employees to be tested each
quarter if annual thresholds are being met.
The 2018 cost to implement the City proposed drug testing and drug-free workplace policies would be
approximately $470 plus any additional pre-employment, suspicion based, or accident based drug or
alcohol screens at $68.90 or $44 respectively. The cost to continue the program in subsequent years
would be approximately $420 annually, which is the total cost from 2018 less the one time account set-up
fee of $50.
Costs may differ with different vendors.
OPTIONS:
1) Adopt the drug testing policies for DOT and non-DOT employees
2) Amend and the adopt the drug testing policies for DOT and non-DOT employees
3) Adopt the drug testing policy for DOT employees only
4) Do not adopt any drug testing policies
RECOMMENDATION:
If removed from the consent agenda:
“Motion to Adopt the drug testing policies for DOT and non-DOT employees”
ATTACHMENTS:
1. DOT Drug and Alcohol Testing Policy for Commercial Drivers
2. Non-DOT Drug and Alcohol Testing and Drug-Free Workplace Policy
DOT Drug and Alcohol Testing Policy for Commercial Drivers
City of Lake Elmo, Minnesota
Drug and Alcohol Testing for Commercial Drivers Policy
Purpose and Objectives
The City of Lake Elmo (“City”) has a vital interest in maintaining safe, healthful, and efficient
working conditions for employees, and recognizes that individuals who are impaired because of
drugs and/or alcohol jeopardize the safety and health of other workers as well as themselves. The
City is concerned about providing a safe workplace for its employees, and while the City does
not intend to intrude into the private lives of its employees, it is the goal to provide a work
environment conducive to maximum safety and optimum work standards. Alcohol and drug
abuse can cause unsatisfactory job performance, increased tardiness and absenteeism, increased
accidents and workers’ compensation claims, higher insurance rates, and an increase in theft of
city property. The use, possession, manufacture, sale, transportation, or other distribution of
controlled substance or controlled substance paraphernalia and the unauthorized use, possession
transportation, sale, or other distribution of alcohol is contrary to this policy and jeopardizes
public safety.
In response to regulations issued by United States Department of Transportation (“DOT”), the
City has adopted this Policy on Alcohol and Controlled Substances for employees who hold a
commercial driver’s license (CDL) to perform their duties. The City also has a separate Policy on
Controlled Substance and Alcohol Testing for employees not covered by DOT regulations.
Given the significant dangers of alcohol and controlled substance use, each applicant and driver
must abide by this policy as a term and condition of hiring and continued employment.
Moreover, federal law requires the City to implement such a policy.
To ensure this policy is clearly communicated to all drivers and applicants, and in order to
comply with applicable federal law, drivers and applicants are required to review this policy and
sign the “Certificate of Receipt” portion.
Because changes in applicable law and the City’s practices and procedures may occur from time
to time, this policy may change in the future, and nothing in this policy is intended to be a
contract, promise, or guarantee the City will follow any particular course of action, disciplinary,
rehabilitative or otherwise, except as required by law. This policy does not in any way affect or
change the status of any at-will employee.
Any revisions to the Federal Omnibus Transportation Employee Testing Act will take precedent
over this policy to the extent the policy has not incorporated those revisions.
Persons Subject to Testing & Types of Tests
All employees are subject to testing who job duties include performing “safety-sensitive duties”
on City vehicles that:
1. Have a gross combination weight rating or gross combination weight of 26,001 pounds or
more, whichever is greater, inclusive of a towed unit(s) with a gross vehicle weight rating
or gross vehicle weight of more than 10,000 pounds, whichever is greater; or
2. Have a gross vehicle weight rating or gross vehicle weight of 26,0001 or more pounds
whichever is greater; or
3. Are designed to transport 16 or more passengers, including the driver; or
4. Are of any size and are used in the transportation of materials found to be hazardous for
the purposes of the Hazardous Materials Transportation Act (49 U.S.C. 5103(b)) and
which require the motor vehicle to be placarded under the Hazardous Materials
Regulations (49 CFR part 172, subpart F).
The following functions are considered safety-sensitive:
• all time waiting to be dispatched to drive a commercial motor vehicle
• all time inspecting, servicing, or conditioning a commercial motor vehicle
• all time driving at the controls of the commercial motor vehicle
• all other time in or upon a commercial motor vehicle (except time spent resting in a sleeper
berth)
• all time loading or unloading a commercial motor vehicle, attending the same, giving or
receiving receipts for shipments being loaded or unloaded, or remaining in readiness to
operate the vehicle
• all time repairing, obtaining assistance, or attending to a disable commercial motor vehicle.
The City may test any applicant to whom a conditional offer of employment has been made and
any driver for controlled substance and alcohol under any of the following circumstances:
Pre-Employment Testing.
All applicants, including current employees seeking a transfer, applying for a position where
duties include performing safety-sensitive duties described above, will be required to take a drug
test prior to the first time a driver performs a safety-sensitive function for the City. A driver may
not perform safety-sensitive functions unless the driver has received a controlled substance test
result from the Medical Review Officer (“MRO”) indicating a verified negative test result. In
addition to pre-employment controlled substance testing, applicants will be required to authorize
in writing former employers to release alcohol test results of .04 or greater, positive controlled
substance test results, refusals to test, other violations of drug and alcohol testing regulations,
and completion of return to duty requirements within the preceding three years.
The City will contact the candidate’s DOT regulated previous and current employers within the
last three years for drug and alcohol test results as referenced above, and review the testing
history if feasible before the employee first performs safety-sensitive functions for the city.
Post-Accident Testing.
As soon as practicable following an accident involving a commercial motor vehicle operating on
a public road, the City will test each surviving driver for controlled substances and alcohol when
the following occurs:
• The accident involves a fatality or
• The driver receives a citation for a moving traffic violation from the accident and an injury is
treated away from the accident scene or
• The driver receives a citation for a moving traffics violation from the accident and a vehicle
is required to be towed from the accident scene.
The following chart summarizes when DOT post-accident testing needs to be conducted:
Type of accident involved
Citation issued to
the DOT covered
CDL driver?
Test must be performed
by the City
i. Human fatality
YES YES
NO YES
ii. Bodily injury with
immediate
medical treatment away from
the scene
YES YES
NO NO
iii. Disabling damage to any YES YES
motor vehicle requiring tow NO NO
away
A driver subject to post-accident testing must remain readily available or the driver will be
deemed to have refused to submit to testing. This requirement to remain ready for testing does
not preclude a driver from leaving the scene of an accident for the period necessary to obtain
assistance in responding to the accident or to obtain necessary medical care.
Post – Accident Controlled Substance Testing
Drivers are required to submit a urine sample for post-accident controlled substance testing as
soon as possible. If the driver is not tested within thirty-two (32) hours after the accident, the
City will cease its attempts to test the driver and prepare and maintain on file a record stating
why the test was not promptly administered.
Post- Accident Alcohol Testing
Drivers are required to submit to post-accident alcohol testing as soon as possible. After an
accident, consuming alcohol is prohibited until the driver is tested. If the driver is not tested
within two (2) hours after the accident, the City will prepare and maintain on file a record stating
why the test was not administered within that time. If eight hours have elapsed since the accident
and the driver has not submitted to an alcohol test, the City will cease its attempts to test the
driver and prepare and maintain on file a record stating why the test was not administered.
The City may accept the results of a blood or breath test in place of an alcohol test and urine test
for the use of controlled substances if:
• The tests are conducted by federal, state, or local officials having independent authority for
the test, and
• The tests conform to applicable federal, state, or local testing requirements, and
• The test results can be obtained by the City.
Whenever such a test is conducted by a law enforcement officer, the driver must contact the City
and immediately report the existence of the test, providing the name, badge number, and
telephone number of the law enforcement officer who conducted the test.
Random Testing.
Every driver will be subject to unannounced alcohol and controlled substance testing on a
random selection basis. Drivers will be selected for testing by use of a scientifically valid method
under which each driver has an equal chance of being selected each time selections are made.
These random tests will be conducted throughout the calendar year. Each driver who is notified
of selection for random testing must cease performing safety-sensitive functions and report to the
designated test site immediately. It is mathematically possible drivers may be selected be picked
and tested more than once, and others not at all.
If a driver is selected for a random test while he or she is absent, on leave or away from work,
that driver may be required to undergo the test when he or she returns to work.
For 2014, federal law requires the City to test at a rate of at least twenty-five percent (25%) of its
average number of drivers for controlled substance each year, and to test at a rate of at least ten
percent (10%) of its average number of drivers for alcohol each year. These minimum testing
rates are subject to change by the DOT.
Reasonable Suspicion Testing.
When a supervisor has reasonable suspicion to believe a driver has engaged in conduct
prohibited by federal law or this policy, the City will require the driver to submit to an alcohol
and/or controlled substance test.
The City’s determination that reasonable suspicion exists to require the driver to undergo an
alcohol test will be based on “specific, contemporaneous, articulable observations concerning the
appearance, behavior, speech, or body odors of the driver.” In the case of controlled substance,
the observations may include indications of the chronic and withdrawal effects of a controlled
substance.
The required observations for reasonable suspicion testing will be made by a supervisor or other
person designated by the City who has received appropriate training in identification of actions,
appearance and conduct of a driver which are indicative of the use of alcohol or controlled
substance. These observations leading to an alcohol or controlled substance test, will be reflected
in writing and signed by the supervisor who made the observations. The record will be retained
by the City. The person who makes the determination that reasonable suspicion exists to conduct
testing, will not be the person conducting the testing, which shall instead be conducted by
another qualified person.
Alcohol testing is authorized only if the observations are made during, just before, or just after
the driver has ceased performing such functions. If a reasonable suspicion alcohol test is not
administered within two (2) hours following the determination of reasonable suspicion, the City
will prepare and maintain on file a record stating the reasons the alcohol test was not promptly
administered. If a reasonable suspicion alcohol test is not administered within eight (8) hours
following the determination of reasonable suspicion, the City will prepare and maintain on file a
record stating the reasons the alcohol test was not administered, and will cease attempts to
conduct the alcohol test.
Notwithstanding the absence of a reasonable suspicion test, no driver may report for duty or
remain on duty requiring the performance of safety-sensitive functions while the driver is under
the influence of or impaired by alcohol, as shown by the behavioral, speech, and performance
indicators of alcohol use, nor will the City permit the driver to perform or continue to perform
safety-sensitive functions until (1) an alcohol test is administered and the driver’s alcohol
concentration is less than .02; or (2) twenty-four (24) hours have elapsed following the
determination of reasonable suspicion.
Return-to-Duty Testing.
The City reserves the right to impose discipline against drivers who violate applicable FMCSA
or DOT rules or this policy, subject to applicable personnel policy and collective bargaining
agreements. Except as otherwise required by law, the City is not obligated to reinstate or
requalify such drivers for a first positive test result.
Should the City consider reinstatement of a DOT covered driver, the driver must undergo a
Substance Abuse Professional (“SAP”) evaluation and participate in any prescribed
education/treatment, and successfully complete return-to-duty alcohol test with a result
indicating an alcohol concentration of less than 0.02 and/or or a controlled substance test with a
verified negative result, before the driver returns to duty requiring the performance of a safety-
sensitive function. The SAP determines if the driver has completed the education/treatment as
prescribed.
The employee is responsible for paying for all costs associated with the return-to-duty test. The
controlled substance test will be conducted under direct observation.
Follow-Up Testing.
The City reserves the right to impose discipline against drivers who violate applicable FMCSA
or DOT rules or this policy, subject to applicable personnel policies and collective bargaining
agreements. Except as otherwise required by law, the City is not obligated to reinstate or
requalify such drivers.
Should the City reinstate a driver following a determination by a Substance Abuse Professional
(SAP) that the driver is in need of assistance in resolving problems associated with alcohol use
and/or use of controlled substance, the City will ensure that the driver is subject to unannounced
follow-up alcohol and/or controlled substance testing. The number and frequency of such follow-
up testing will be directed by the SAP and will consist of at least six (6) tests in the first twelve
(12) months following the driver’s return to duty. Follow-up testing will not exceed sixty (60)
months from the date of the driver’s return to duty. The SAP may terminate the requirement for
follow-up testing at any time after the first six tests have been administered, if the SAP
determines such test is no longer necessary. The employee is responsible for paying for all costs
associated with follow-up tests.
Follow-up alcohol testing will be conducted only when the driver is performing safety-sensitive
functions, or immediately prior to or after performing safety-sensitive functions.
Cost of Required Testing.
The City will pay for the cost of pre-employment, post-accident, random, and reasonable
suspicion controlled substance and alcohol testing requested or required of all job applicants and
employees. The driver must pay for the cost of all requested confirmatory re-tests, return-to-duty,
and follow-up testing.
Required Prior Controlled Substance and Alcohol Checks for Applicants
The City will conduct prior drug and alcohol checks of applicants for employment to drive a
commercial motor vehicle. Applicants must execute a consent form authorizing the City to
obtain the required information. The City will obtain (pursuant to the applicant’s written consent)
information on the applicant’s alcohol test with a concentration result of 0.04 or greater, positive
controlled substance test results, and refusals to be tested within the preceding three (3) years
which are maintained by the applicant’s previous employers. The City will obtain all information
concerning the applicant which is maintained by the applicant’s previous employers within the
preceding three (3) years pursuant to DOT and FMCSA controlled substance and alcohol testing
regulations. The City will review such records, if feasible, prior to the first time a driver
performs safety-sensitive functions.
Prohibited Conduct
The following conduct is explicitly prohibited by applicable DOT and FMCSA regulations and
therefore constitutes violation of City policy.
Under the influence of alcohol when reporting for duty or while on duty.
No driver may report for duty or remain on duty requiring the performance of safety-sensitive
functions while having an alcohol concentration of 0.04 or greater. Drivers reporting for duty or
remaining on duty to perform safety-sensitive functions while having an alcohol concentration of
0.02, but less than 0.04, will be removed from duty for 24 hours, escorted home and placed on
vacation leave for hours missed from work.
On-Duty Use of Alcohol.
No driver may use alcohol while performing safety-sensitive functions.
Pre-Duty Use of Alcohol.
No driver may perform safety-sensitive functions within four (4) hours after using alcohol. If an
employee has had alcohol within four hours they are to notify their supervisors before
performing any safety-sensitive functions.
Alcohol Use Following an Accident.
No driver required to take a post-accident alcohol test may use alcohol for eight (8) hours
following the accident, or until the driver undergoes a post-accident alcohol test, whichever
occurs first.
Refusal to Submit to a Required Alcohol or Controlled Substance Test.
No applicant or driver may refuse to submit to pre-employment, post-accident, random,
reasonable suspicion or follow-up alcohol or controlled substance testing.
In the event an applicant or driver does in fact refuse to submit to required alcohol or controlled
substance testing, no test will be conducted. Refusal by a driver to submit to controlled substance
or alcohol testing will be considered a positive test result, will cause disqualification from
performing safety-sensitive functions, and may appear on the driver’s permanent record. Drivers
who refuse to submit to testing will be subject to discipline, up to an including termination. If an
applicant refuses to submit to pre-employment controlled substance testing, any applicable
conditional offer will be withdrawn.
For purposes of this section, a driver is considered to have refused to submit to an alcohol or
controlled substance test when the driver:
• Fails to provide adequate breath for alcohol testing without a valid medical explanation after
he or she has received notice of the requirement for breath testing.
• Fails to provide adequate urine for controlled substance testing without a genuine inability to
provide a specimen (as determined by a medical evaluation), after he or she has received
notice of the requirement for urine testing.
• Fails to report for testing within a reasonable period of time, as determined by the City.
• Fails to remain at a testing site until testing is complete.
• In the case of directly observed or monitored collection, fails to permit observation or
monitoring.
• Fails or declines to take a second test as required by the City and/or collector.
• Fails to undergo a medical examination as directed by the City pursuant to federal law.
• Refuses to complete and sign the alcohol testing form, to provide a breath or saliva sample,
to provide an adequate amount of breath, or otherwise cooperate in any way that prevents the
completion of the testing process.
• Engages in conduct that clearly obstructs the test process.
Altering or attempting to alter a urine sample or breath test.
A driver altering or attempting to alter a urine sample or controlled substance test, or substituting
or attempting to substitute a urine sample, will be subject to providing a specimen under direct
observation. Both specimens will be subject to laboratory testing. In such case, the employee
may be subject to immediate termination of employment and any job offer made to an applicant
will be immediately withdrawn.
Controlled Substance Use.
No driver may report for duty or remain on duty requiring the performance of safety-sensitive
functions when the driver uses any controlled substance, except when the use is pursuant to the
instructions of a licensed medical practitioner who has advised the driver in writing the substance
does not adversely affect the driver’s ability to safely operate a commercial motor vehicle.
Drivers must forward this information regarding therapeutic controlled substance use to the City
immediately after receiving any such advice.
Having a medical marijuana card and/or a cannabis prescription from a physician does not allow
anyone to use or possess that drug in the city’s workplace. The federal government still classifies
cannabis as an illegal drug. There is no acceptable concentration of marijuana metabolites in the
urine or blood of an employee who performs safety-sensitive duties for the City. Employees are
still subject to being tested under our policies, as well as for being disciplined, suspended or
terminated after testing positive for cannabis while at work.
Controlled Substance Testing.
No driver may report for duty, remain on-duty or perform a safety-sensitive function if the driver
tests positive for controlled substance.
Collection and Testing Procedures
Drivers are required to report immediately upon notification to the collection site. For random
tests conducted off site, employees may use a City vehicle to drive to the collection site. Drivers
will be expected to provide a photo ID card for identification to the collection staff. All drivers
will be expected to cooperate with collection site personnel request to remove any unnecessary
outer garments such as coats, sweaters or jackets and will be required to empty their pockets.
Collection personnel will complete a Federal Custody and Control Form (“CCF”) which drivers
providing a sample will sign as well.
Alcohol Testing.
Employees will be tested for alcohol just before, during, or immediately following performance
of a safety-sensitive function. If a driver is also taking a DOT controlled substance test, generally
speaking, the alcohol test is completed before the urine collection process begins. Screening tests
for alcohol concentration will be performed utilizing a non-evidential screening device included
by the National Highway Traffic Safety Administration on its conforming products list (e.g., a
saliva screening device) or an evidential breath testing device (“EBT”) operated by a trained
breath alcohol technician (“BAT”) at a collection site. An alcohol test usually takes
approximately 15 minutes if the result is negative. If a driver’s first attempt is positive (with an
alcohol concentration of .02 or greater), the driver will be asked to wait at least 15 minutes and
then be tested again. The driver may not eat, drink or place anything in his/her mouth (e.g.,
cigarette, chewing gum) during this time. All confirmation tests will be conducted in a location
that affords privacy to the driver being tested, unless unusual circumstances (e.g., when it is
essential to conduct a test outdoors at the scene of an accident) make it impracticable to provide
such privacy. Any results less than 0.02 alcohol concentration is considered a “negative” test
result.
If the driver attempts and fails to provide an adequate amount of breath, he/she will be referred to
a physician to determine if the driver’s inability to provide a specimen is genuine or constitutes a
refusal to test. Alcohol test results are reported directly to the City by the collection site staff.
Controlled Substance Testing.
The City will use a “split urine specimen” collection procedure for controlled substance testing.
Collection of urine specimens for controlled substance testing will be conducted by an approved
collector and will be conducted in a setting and manner to ensure the driver’s privacy.
Controlled substance testing generally takes about 15 minutes. At the collection site, the driver
will be given a sealed container and must provide at least 45 ml of urine for testing. Once the
sample is provided the collection personnel will check the temperature and color and look for
signs of contamination. The urine is then split into two separate specimen containers (A, or
“primary,” and B, or “split”) with identifying labels and security seals affixed to both. The
collection facility will be responsible for maintaining a proper chain of custody for delivery of
the sample to a DHHS-certified laboratory for analysis. The laboratory will retain a sufficient
portion of any positive sample for testing and store that portion in a scientifically-acceptable
manner for a minimum 365-day period.
If an employee fails to provide a sufficient amount of urine to permit a controlled substance test
(45 milliliters of urine), the collector will discard the insufficient specimen, unless there is
evidence of tampering with that specimen. The collector will urge the driver to drink up to 40
ounces of fluid, distributed reasonably over a period of up to three hours, or until the driver has
provided a sufficient urine specimen, whichever occurs first. If the driver has not provided a
sufficient specimen within three hours of the first unsuccessful attempt, the collector will cease
efforts to attempt to obtain a specimen. The driver must then obtain, within five calendar days,
an evaluation from a licensed physician, acceptable to the MRO, who has expertise in the
medical issues raised by the employee’s failure to provide a sufficient specimen. If the licensed
physician concludes the driver has a medical condition, or with a high degree of probability
could have, precluded the driver from providing a sufficient amount of urine, the City will
consider the test to have been canceled. If a licensed physician cannot make such a
determination, the City will consider the driver to have engaged in a refusal to test, and will take
appropriate disciplinary action under this policy.
The primary specimen is used for the first test. If the test is negative, it is reported to the MRO
who then reports the result, following a review of the CCF Form for compliance, to the City. If
the initial result is positive or non-negative, a “confirmatory retest” will be conducted on the
primary specimen. If the confirmatory re-test is also positive, the result will be sent to the MRO.
The MRO will contact the driver to verify the positive result. If the MRO is unable to reach the
driver directly, the MRO must contact the City who will direct the driver to contact the MRO.
Review of Test Results
The MRO is a licensed physician with knowledge and clinical experience in substance abuse
disorders, and is responsible for receiving and reviewing laboratory results of the controlled
substances test as well as evaluating medical explanations for certain drug test results. Prior to
making a final decision to verify a positive test result, the MRO will give the driver or the job
applicant an opportunity to discuss the test result, typically through a phone call. The MRO, or a
staff person under the MRO’s supervision, will contact the individual directly, on a confidential
basis, to determine whether the individual wishes to discuss the test result. If the employee or job
applicant wishes to discuss the test result:
• The individual may be required to speak and/or meet with the MRO, who will review the
individual’s medical history, including any medical records provided.
• The individual will be afforded the opportunity to discuss the test results and to offer any
additional or clarifying information which may explain the positive test result. If the
employee or job applicant, believes a mistake was made at the collection site, at the labor, on
a chain-of-custody form, or that the drug test results are caused by lawful substance use, the
employee should tell the MRO.
• If there is some new information which may affect the original finding, the MRO may
request the laboratory to perform additional testing on the original specimen in order to
further clarify the results; and
• A final determination will be made by the MRO that the test is either positive or negative,
and the individual will be so advised.
If the MRO upholds the positive, adulterated or substituted drug determination, that test result
will be provided to the City. There is no opportunity to explain a positive alcohol test provided in
the DOT regulations.
The driver can request the MRO to have the split specimen (the second “B” container) tested at
the driver’s expense. This includes all costs that may be associated with the re-test. There is no
split specimen testing for an invalid result. The driver has 72 hours after they have been notified
of the positive result to make this request. If the employee requests an analysis of the split
specimen, the MRO will direct the laboratory to send the split specimen to another certified
laboratory for analysis.
If an employee has not contacted the MRO within 72 hours, the employee may present
information documenting that serious injury, illness, lack of actual notice of the verified test
result, inability to contact the MRO, or other circumstances unavoidably prevented the employee
from making timely contact. If the MRO concludes there is legitimate explanation for the
employee’s failure to contact within 72 hours, the MRO will direct the analysis of the split
specimen.
If the results of the split specimen are negative, the City may pay for all costs associated with the
rest and there will be no adverse action taken against the employee or job applicant.
Notification of Test Results
Employees.
The City will notify a driver of the results of random, reasonable suspicion, and post-accident
tests for controlled substance if the test results are verified positive, and will inform the driver
which controlled substance or substances were verified as positive. Results of alcohol tests will
be immediately available from the collection agent.
Right to Confirmatory Retest.
Within seventy-two (72) hours after receiving notice of a positive controlled substance test
result, an applicant or driver may request through the MRO a re-analysis (confirmatory retest) of
the driver’s split specimen. Action required by federal regulation as a result of a positive
controlled substance test (e.g., removal from safety-sensitive functions) will not be stayed during
retesting of the split specimen. If the result of the confirmatory retest fails to reconfirm the
presence of the controlled substance(s) or controlled substance metabolite(s) found in the
primary specimen, or if the split specimen is unavailable, inadequate for testing or untestable, the
MRO will cancel the test.
Dilute Specimens
Dilute Negatives Creatinine concentration of specimen is equal to or greater than 2 mg/dL, but
less than or equal to 5 mg/dL. If the City receives information that a driver has provided a dilute
negative specimen, the City will direct a recollection, pursuant to the MRO’s direction, under
direct observation.
Consequences for Drivers Engaging in Prohibited Conduct
Job Applicants.
Any applicable conditional offer of employment will be withdrawn from a job applicant or
employee seeking a transfer who refuses to be tested or tests positive for controlled substance
pursuant to this policy.
Employees.
Drivers who are known to have engaged in prohibited behavior with regard to alcohol misuse or
use of controlled substance, as defined earlier in this policy, are subject to the following
consequences:
• Removal from Safety-Sensitive Functions
No driver may perform safety-sensitive functions, including driving a commercial motor
vehicle, if the driver has engaged in conduct prohibited by federal law.
No driver who is found to have an alcohol concentration of 0.02 or greater but less than 0.04 may
perform or continue to perform safety-sensitive functions for the City, including driving a
commercial motor vehicle, until the start of the driver’s next regularly scheduled duty, but not
less than twenty-four (24) hours following administration of the test.
If a driver tests positive under this policy, or is found to have an alcohol concentration of .02 or
greater but less than .04, the driver will be removed from safety sensitive duties and escorted
home; the driver should not drive home, but be escorted to his or her home. The driver will then
be placed on vacation, for hours missed from work.
• Notification of Resources Available
The City will advise each driver who has engaged in conduct prohibited by federal law or
who has a positive alcohol or controlled substance test of the resources available to the
driver, in evaluating and resolving problems associated with the misuse of alcohol and
use of a controlled substance, including the names, addresses, and telephone numbers of
Substance Abuse Professionals and counseling and treatment programs. The City will
provide this SAP listing in writing at no cost to the driver.
• Discipline
The City reserves the right to impose whatever discipline the City deems appropriate in
its sole discretion, up to and including termination for a first occurrence, against drivers
who violate applicable FMCSA or DOT rules or this policy, subject to applicable
personnel policies and collective bargaining agreements. Except as otherwise required by
law, the City is not obligated to reinstate or requalify such drivers following a first
positive confirmed controlled substance or alcohol test result.
• Evaluation, and Return to Duty Testing
Should the City wish to consider reinstatement of a driver who engaged in conduct
prohibited by federal law and/or who had a positive alcohol or controlled substance test,
the driver must undergo a SAP evaluation, participate in any prescribed
education/treatment, and successfully complete return-to-duty alcohol test with a result
indicating an alcohol concentration of less than 0.02 and/or or a controlled substance test
with a verified negative result, before the driver returns to duty requiring the performance
of a safety-sensitive function. The SAP will determine what assistance, if any, the driver
needs in resolving problems associated with alcohol misuse and controlled substance use
and will ensure the driver properly follows any rehabilitation program and submits to
unannounced follow-up alcohol and controlled substance testing.
• Follow-Up Testing
If the driver passes the return-to-duty test, he/she will be subject to unannounced
follow-up alcohol and/or controlled substance testing. The number and frequency for
such follow-up testing will be as directed by the SAP and will consist of at least six tests
in the first twelve months. These tests will be conducted under direct observation.
• Refusal to test
All drivers and applicants have the right to refuse to take a required alcohol and/or
controlled substance test. If an employee refuses to undergo testing, the employee will be
considered to have tested positive and may be subject to disciplinary action, up to and
including termination. Refer to Refusing to Test provided earlier in this policy.
• Responsibility for Cost of Evaluation and Rehabilitation
Drivers will be responsible for paying the cost of evaluation and rehabilitation (including
services provided by a Substance Abuse Professional) recommended or required by the
City or FMCSA or DOT rules, except to the extent that such expense is covered by an
applicable employee benefit plan or imposed on the City pursuant to a collective
bargaining agreement.
Loss of CDL License for Traffic Violations in Commercial and Personal
Vehicles
Effective August 1, 2005, the FMCSA established strict rules impacting when CDL license
holders can lose their CDL for certain traffic offenses in a commercial or personal vehicle.
Employees are required to notify their supervisor immediately if the status of their CDL license
changes in anyway.
Maintenance and Disclosure of Records
Except as required or authorized by law, the City will not release driver’s information that is
contained in records required to be maintained by this policy or FMCSA and DOT regulations.
In addition, a driver is entitled, upon written request, to obtain copies of any records pertaining to
the driver’s use of alcohol or a controlled substance, including any records pertaining to his or
her alcohol or controlled substance tests.
Policy Contact for Additional Information
If you have any questions about this policy or the City’s controlled substance and alcohol testing
procedures, you may contact the Assistant City Administrator, obtain additional information.
Definitions
Accident:
Means an occurrence involving a commercial motor vehicle operating on a public road which
results in a fatality; bodily injury to any person who, as a result of the injury, immediately
receives medical treatment away from the scene of the accident; or one or more motor vehicles
incurring disabling damage as a result of the accident, requiring the vehicle to be transported
away from the scene by a tow truck or other vehicle. The term “accident” does not include an
occurrence involving only boarding and alighting from a stationary motor vehicle; an occurrence
involving only the loading or unloading of cargo; or an occurrence in the course of the operation
of a passenger car or a multipurpose passenger vehicle unless the vehicle is transporting
passengers for hire or hazardous materials of a type and quantity that require the motor vehicle to
be marked or placarded in accordance with 49 C.F.R. § 177.823; 49 C.F.R. § 382.303(a); 49
C.F.R. § 382.303(f).
Alcohol Concentration (or Content):
Means the alcohol on a volume of breath expressed in terms of grams of alcohol per 210 liters of
breath as indicated by an evidential breath test. 49 C.F.R. § 382.107.
Alcohol Use:
Means the consumption of any beverage, mixture, or preparation, including any medication,
containing alcohol. 49 C.F.R. § 382.107.
Applicant:
Means a person applying to drive a commercial motor vehicle. 49 C.F.R. § 382.107.
Breath Alcohol Technician or BAT:
Means an individual who instructs and assists individuals in the alcohol testing process and
operates an evidential breath testing device (EBT). 49 C.F.R. § 40.3.
City:
Means City of Lake Elmo.
City Premises:
Means all job sites, facilities, offices, buildings, structures, equipment, vehicles and parking
areas, whether owned, leased, used or under the control of the City.
Collection Site:
Means a place designated by the City where drivers present themselves for the purpose of
providing a specimen of their urine or breath to be analyzed for the presence of alcohol or
controlled substances. 49 C.F.R. § 40.3.
Commercial Motor Vehicle:
Means a motor vehicle or combination of motor vehicles used in commerce to transport
passengers or property if the motor vehicle (1) has a gross combination weight rating or gross
combination weight of 26,001 or more pounds, whoever is greater, inclusive of a towed unit(s)
with a gross vehicle weight rating or gross vehicle weight of more than 10,000 pounds,
whichever is greater; or (2) has a gross vehicle weight rating or gross vehicle weight of 26,001 or
more pounds, whichever is greater; or (3) is designed to transport sixteen (16) or more
passengers, including the driver; or (4) is of any size and is used in the transportation of materials
found to be in the transportation of materials found to be hazardous for the purposes of the
Hazardous Materials Transportation Act (49 U.S.C. 5103(b)) and which require the motor
vehicle to be placarded under the Hazardous Materials Regulation. (49 C.F.R. part 172, subpart
F) § 382.107.
Confirmation (or Confirmatory) Test:
For alcohol testing means a second test, following a positive non-evidential test, following a
positive non-evidential (e.g., saliva) screening test or a breath alcohol screening test with the
result of 0.02 or greater, that provides quantitative data of alcohol concentration. For controlled
substance testing, “Confirmation (or Confirmatory) Test” means a second analytical procedure to
identify the presence of a specific controlled substance or metabolite which is independent of the
screen test and which uses a different technique and chemical principal from that of the screen
test in order to ensure reliability and accuracy. 49 C.F.R. § 382.107.
Controlled Substance:
Means those substances identified in 49 C.F.R. § 40.85(. Marijuana, amphetamines, opiates,
(including heroin), phencyclidine (PCP), cocaine, and any of their metabolites are included
within this definition. 49 (C.F.R. § 382.107; 49 C.F.R. § 40.85.
Department of Transportation or DOT:
Means the United States Department of Transportation.
DHHS:
Means the Department of Health & Human Services or any designee of the Secretary,
Department of Health & Human Services. 49 C.F.R. § 40.3.
Disabling Damage:
Means damage which precludes departure of a motor vehicle from the scene of the accident in its
usual manner in daylight after simple repairs, including damage to motor vehicles that could
have been driven, but would have been further damaged if so driven. Disabling damage does not
include damage which can be remedied temporarily at the scene of the accident without special
tools or parts, tire disablement without other damage even if no spare tire is available, headlight
or tail light damage or damage to turn signals, horn or windshield wipers which make them
inoperative. 49 C.F.R. § 382.107.
Driver:
Means any person who operates a commercial motor vehicle. This includes, but is not limited to
full-time, regularly employed drivers; casual, intermittent or occasional drivers; leased drivers
and independent owner-operator contractors who are either directly employed by or under lease
to the City or who operate a commercial motor vehicle at the direction of or with the consent of
the City. For purposes of pre-employment testing, the term driver includes a person applying to
drive a commercial motor vehicle. 49 C.F.R. § 382.107.
Drug:
Has the same meaning as “controlled substance.”
Employee seeking a transfer:
Refers to an employee who is not subject to DOT regulations seeking a transfer to a position that
will subject them to DOT regulations in the sought after position.
Evidential Breath Testing Device or EBT:
Means a device approved by the National Highway Traffic Safety Administration (“NHTSA”)
for the evidential testing of breath and placed on NHTSA’s “Conforming Products List of
Evidential Breath Measurement Devices.” 49 C.F.R. § 40.3.
Federal Motor Carrier Safety Administration or FMCSA:
Means the Federal Motor Carrier Safety Administration of the United States Department of
Transportation.
Medical Review Officer or MRO:
Means a licensed physician (medical doctor or doctor of osteopathy) responsible for receiving
laboratory results generated by a controlled substance testing program who has knowledge of
substance abuse disorders and has appropriate medical training to interpret and evaluate an
individual’s confirmed positive test result together with his or her medical history and any other
relevant biomedical information. 49 C.F.R. § 40.3
Performing (a Safety-Sensitive Function):
Means any period in which a driver is actually performing, ready to perform, or immediately
available to perform any safety-sensitive functions. 49 C.F.R. § 382.107.
Positive Test Result:
Means a finding of the presence of alcohol or controlled substance, or their metabolites, in the
sample tested in levels at or above the threshold detection levels established by applicable law.
Reasonable Suspicion:
Means a belief a driver has engaged in conduct prohibited by the FMCSA controlled substance
and alcohol testing regulations, except when related solely to the possession of alcohol, based on
specific contemporaneous, articulable observations made by a supervisor or City official who has
received appropriate training concerning the appearance, behavior, speech or body odors of the
driver. The determination of reasonable suspicion will be made in writing on a Reasonable
Suspicion Record Form during, just preceding, or just after the period of the work day that the
driver is required to be in compliance with this policy. In the case of a controlled substance, the
observations may include indications of the chronic and withdrawal effects of a controlled
substance.
Safety-Sensitive Function:
Means all time from the time a driver begins to work or is required to be in readiness to work
until the time he or she is relieved from work and all responsibility for performing work. Safety-
sensitive functions include:
• All time at a city plant, terminal, facility, or other property, or on any public property,
• waiting to be dispatched, unless the driver has been relieved from duty by the employer;
• All time inspecting equipment as required by 49 C.F.R. § 392.7 and 392.8 or otherwise
inspecting, servicing, or conditioning any commercial motor vehicle at any time;
• All time spent at the driving controls of a commercial motor vehicle in operation;
• All time, other than driving time, in or upon any commercial motor vehicle except time spent
resting in a sleeper berth (a berth conforming to the requirements of 49 C.F.R. § 393.76);
• All time loading or unloading a vehicle, supervising, or assisting in the loading or unloading,
attending a vehicle being loaded or unloaded, remaining in readiness to operate the vehicle,
or in giving or receiving receipts for shipments loaded or unloaded; and
• All time repairing, obtaining assistance, or remaining in attendance upon a disabled vehicle.
49 C.F.R. § 382.107.
Screening Test (also known as Initial Test):
In alcohol testing, mean an analytical procedure to determine whether a driver may have a
prohibited concentration of alcohol in her or her system. Screening tests may be conducted by
utilizing a non-evidential screening device included by the National Highway Traffic
Administration on its conforming products list (e.g., a saliva screening device) or an evidential
breath testing device (“EBT”) operated by a trained breath alcohol technician (“BAT”). In
controlled substance testing, “Screening Test” means an immunoassay screen to eliminate
“negative” urine specimens form further consideration. 49 C.F.R. § 382.107.
Substance Abuse Professional” or “SAP”:
Means a licensed physician (medical doctor or doctor of osteopathy), licensed or certified
psychologist, licensed or certified social worker, licensed or certified employee assistance
professional, or licensed or certified addiction counselor (certified by the National Association of
Alcoholism and Controlled Substance Abuse Counselors Certification Commission) with
knowledge of and clinical experience in the diagnosis and treatment of alcohol and controlled
substance-related disorders. 49 C.F.R. § 40.281.
Non-DOT Drug and Alcohol Testing and Drug-Free Workplace Policy
City of Lake Elmo, Minnesota
Drug and Alcohol Testing and Drug-Free Workplace Act Policy for
Non-Commercial Drivers (Non-DOT)
Purpose and Objectives
The City of Lake Elmo (“City”) has a vital interest in maintaining safe, healthful, and efficient
working conditions for employees, and recognizes that individuals who are impaired because of
drugs and/or alcohol jeopardize the safety and health of other workers as well as themselves. The
City of Lake Elmo does not intend to intrude into the private lives of its employees, but strongly
believes that a drug- and alcohol-free workplace is in the best interest of employees and the
public alike. Alcohol and drug abuse can cause unsatisfactory job performance, increased
tardiness and absenteeism, increased accidents and workers’ compensation claims, higher
insurance rates, and an increase in theft of city property. The City of Lake Elmo’s Drug and
Alcohol Testing Non-DOT policy has been established for the purpose of providing a safe
workplace for all.
City employees and applicants required to hold a commercial driver’s license by the United
States Department of Transportation (“DOT”) for their job will be tested under the City’s Policy
on Controlled Substance and Alcohol Testing for Commercial Drivers (the “DOT Policy”). All
other employees and job applicants offered employment with the city must undergo testing as
described by this policy.
To ensure the policy is clearly communicated to all employees and applicants to whom offers of
employment have been made, and to comply with state law, employees and applicants are
required to review this policy and sign the “policy acknowledgement.” A job applicant will also
acknowledge in this form that he/she understands that passing the drug test is a requirement of
the job.
Persons Subject to Testing and Circumstances Under Which Testing May Be
Required
Under this policy, the City may test any applicant to whom an offer of employment has been
made, and may test any employee for alcohol and/or controlled substance under any of the
following circumstances with a properly accredited or licensed testing laboratory, in accordance
with Minn. Stat. § 181.953, subd. 1.
(1) Pre-Employment Testing:
Every job applicant offered employment with the city receives the offer conditioned upon
successful completion of a drug test, among other conditions. If the job offer is withdrawn based
on drug test results, the city will inform the applicant of the reasons for the withdrawal. A failure
of the drug test, a refusal to take the test, or failure to meet other conditions of the offer will
result in a withdrawal of the offer of employment even if the applicant’s provisional employment
has begun. A negative or positive dilute test result (following a second collection), which has
been confirmed, will also result in immediate withdrawal of an offer of employment to an
applicant.
Temporary and seasonal employees are not subject to this policy with the exception of those
designated by the hiring department as safety-sensitive positions. OR Temporary and seasonal
employees are also subject to this policy. May want to address when testing will be conducted
for temporary and seasonal rehires.
(2) Reasonable Suspicion Testing:
Consistent with Minn. Stat. § 181.951, subd. 3, employees will be subject to alcohol and
controlled substance testing when reasonable suspicion exists to believe that the employee:
• Is under the influence of alcohol or a controlled substance; or
• Has violated written work rules prohibiting the use, possession, sale or transfer of drugs
or alcohol while working, while on city property, or while operating city vehicles,
machinery or any other type of equipment; or
• Has sustained a personal injury as defined in Minn. Stat. § 176.011, subd. 16 or has
caused another employee to sustain an injury or;
• Has caused a work-related accident or was operating or helping to operate machinery,
equipment, or vehicles involved in a work-related accident.
Reasonable suspicion may be based upon, but is not limited to, facts regarding appearance,
behavior, speech, breath, odor, possession, proximity to or use of alcohol or a controlled
substance or containers or paraphernalia, poor safety record, excessive absenteeism, impairment
of job performance, or any other circumstances that would cause a reasonable employer to
believe that a violation of the city’s policies concerning alcohol or drugs may have occurred.
These observations will be reflected in writing on a Reasonable Suspicion Record Form.
For off-site collection, employees will be driven to the employer-approved medical facility by
their supervisor or a designee. For an on-site collection service, the employee will remain on site
and be observed by the supervisor or designee. The medical facility or on-site collection service
will take the urine or blood sample, and will forward the sample to an approved laboratory for
testing.
Pursuant to the requirements of the Drug-Free Workplace Act of 1988, all City employees, as a
condition of continued employment, will agree to abide by the terms of this policy and must
notify [Human Resources/the City Administrator] of any criminal drug statute conviction for a
violation occurring in the workplace not later than five days after such conviction. If required by
law or government contract, the City will notify the appropriate federal agency of such
conviction within 10 days of receiving notice from the employee.
Right of Refusal:
Employees and job applicants have the right to refuse to submit to an alcohol or drug test under
this policy. However, such a refusal will subject an employee to immediate termination. If an
applicant refuses to submit to applicant testing, any conditional offer of employment will be
withdrawn.
Any intentional act or omission by the employee or applicant that prevents the completion of the
testing process constitutes a refusal to test.
An applicant or employee who substitutes, or attempts to substitute, or alters, or attempts to alter
a testing sample is considered to have refused to take a drug and/or alcohol test. In such a case,
the employee is subject to immediate termination of employment, and in the case of an applicant,
the job offer will be immediately withdrawn.
Refusal on Religious Grounds:
An employee or job applicant who, on religious grounds, refuses to undergo drug or alcohol
testing of a blood sample will not be considered to have refused testing, unless the employee or
job applicant also refuses to undergo drug or alcohol testing of a urine sample.
Cost of Required Testing:
The City will pay for the cost of all drug and alcohol testing requested or required of all job
applicants and employees, with the exception of confirmatory retests. Job applicants and
employees are responsible for paying for all costs associated with any requested confirmatory
retests.
Prohibition against Controlled Substance and Alcohol
Use and Possession of Alcohol or Drug(s):
Employees are prohibited from the use, possession, transfer, transportation, manufacture,
distribution, sale, purchase, solicitation to sell or purchase, or dispensation of alcohol, drugs, or
drug paraphernalia while on duty; is on City premises; while operating any City vehicle,
machinery, or equipment; or when performing any city business, except (1) pursuant to a valid
medical prescription used as properly instructed; (2) the use of over-the-counter controlled
substance used as intended by the manufacturer; or (3) when necessary for approved law
enforcement activity.
Besides having a zero-tolerance policy for the use or possession of alcohol, illegal drugs, or
misused prescription drugs on the worksite, we also prohibit the use, possession of, impairment
by any cannabis or medical cannabis products (e.g., hash oils or pills) on the worksite by a
person working as an employee at the City or while “on call” and subject to return to work.
Having a medical marijuana card, patient registry number, and/or cannabis prescription from a
physician does not allow anyone to use, possess, or be impaired by that drug here. The federal
government still classifies cannabis as an illegal drug, even though some states have
decriminalized its possession and use. There is no acceptable concentration of marijuana
metabolites in the blood or urine of an employee who operates our equipment or vehicles or who
is on one of our worksites. Applicants and employees are still subject to being tested under our
drug and alcohol testing policy. And employees are subject to being disciplined, suspended, or
terminated after testing positive for cannabis if the employee used, possessed, or was impaired
by cannabis, including medical cannabis, while on the premises of the place of employment or
during the hours of employment.
While Impaired of Alcohol or Drug(s):
Employees are prohibited from being under the influence of alcohol or drugs or having a
detectable amount of an illegal drug in the blood or urine when reporting for work; while on
duty; is on the City’s premises; while operating any city vehicle, machinery, or equipment; or
when performing any City business, except (1) pursuant to a valid medical prescription used as
properly instructed; or (2) the use of over-the-counter controlled substance used as intended by
the manufacturer.
Driving While Impaired:
A conviction of driving while impaired in a City-owned vehicle at any time during business or
non-business hours, or in an employee-owned vehicle while conducting city business, may result
in discipline, up to and including discharge.
Criminal Controlled Substance Convictions:
Any employee convicted of any criminal drug statute must notify his or her supervisor and the
City’s Human Resources Director in writing of such conviction no later than five days after such
conviction. Within 30 days after receiving notice from an employee of a controlled substance-
related conviction, the City will take appropriate personnel action against the employee up to and
including discharge, or require the employee to satisfactorily participate in a controlled substance
abuse assistance or rehabilitation program as an alternative to termination. In the event notice is
not provided to the supervisor and the employee is deemed to be incapable of working safely, the
employee will not be permitted to work and will be subject to disciplinary action, including
dismissal from employment. In accordance with the Federal Drug-Free Workplace Act of 1988,
if the City is receiving federal grants or contracts of over $25,000, the City will notify the
appropriate federal agency of such conviction within 10 days of receiving notice from the
employee.
Failure to Disclose Lawful Controlled Substance:
Employees taking a lawful controlled substance, including prescription and over-the-counter
controlled substances, which may impair their ability to perform their job responsibilities or pose
a safety risk to themselves or others, must advise their supervisor of this before beginning work.
It is the employee’s responsibility to seek out written information from his/her physician or
pharmacist regarding medication and any job performance impairment and relay that information
to his/her supervisor. In the event of such a disclosure, the employee will not be authorized to
perform safety-sensitive functions.
Review and Notification of Test Results
Notification of Negative Test Results:
In the case of job applicants and in accordance with Minn. Stat. § 181.953, Human Resources
will notify a job applicant of a negative drug result within three days of receipt of result by the
City, and the hiring process will resume. In accordance with Minn. Stat. § 181.953, subd. 3, a
laboratory must report results to the city within three working days of the confirmatory test
result. A “Negative Test Results Notification” form will be sent to the job applicant, and the job
applicant may request a copy of the test result report from Human Resources.
In the case of current employees and in accordance with Minn. Stat. § 181.953, Human
Resources will notify the employee of a negative drug and/or alcohol result within three days of
receipt of result by the city. A “Negative Test Results Notification” form will be sent to the
employee, and he or she may request a copy of the test result report from Human Resources or
the City Administrator.
Notification of Positive Test Results:
In the event of a confirmed positive blood or urine alcohol and/or drug test result, the city will
notify the employee of a positive drug and/or alcohol result within three days of receipt of the
result. Human Resources will send to the employee or job applicant a “Positive Test Results
Notification” letter containing further instructions. The employee or job applicant may contact
Human Resources to request a copy of the test result report if desired. In accordance with Minn.
Stat. § 181.953, subd. 3, a laboratory must report results to the City within three working days of
the confirmatory test result.
Right to Provide Information after Receiving Test Results:
Within three working days after notice of a positive controlled substance or alcohol test result on
a confirmatory test, the employee or job applicant may submit information to the City to explain
the positive result. In accordance with Minn. Stat. § 181.953, subd. 10, if an employee submits
information either before a test or within three working days after a positive test result that
explains the positive test result, (such as medications the employee is taking), the City will not
take an adverse employment action based on that information unless the employee has already
been under an affirmative duty to provide the information before, upon, or after hire.
Right to Confirmatory Retest:
A job applicant or employee may request a confirmatory retest of the original sample at the job
applicant’s or employee’s own expense after notice of a positive test result on a confirmatory
test. Within five working days after notice of the confirmatory test result, the job applicant or
employee must notify the City in writing of the job applicant’s or employee’s intention to obtain
a confirmatory retest. Within three working days after receipt of the notice, the City will notify
the original testing laboratory that the job applicant or employee has requested the laboratory to
conduct the confirmatory retest or transfer the sample to another qualified laboratory licensed to
conduct the confirmatory retest. The original testing laboratory will ensure the control and
custody procedures are followed during transfer of the sample to the other laboratory. In
accordance with Minn. Stat. § 181.953, subd. 3, the laboratory is required to maintain all samples
testing positive for a period of six months. The confirmatory retest will use the same controlled
substance and/or alcohol threshold detection levels as used in the original confirmatory test.
In the case of job applicants, if the confirmatory retest does not confirm the original positive test
result, the City’s job offer will be reinstated and the City will reimburse the job applicant for the
actual cost of the confirmatory retest. In the case of employees, if the confirmatory retest does
not confirm the original positive test result, no adverse personnel action based on the original
confirmatory test will be taken against the employee, the employee will be reinstated with any
lost wages or salary for time lost pending the outcome of the confirmatory retest result, and the
City will reimburse the employee for the actual cost of the confirmatory retest.
Access to Reports:
In accordance with Minn. Stat. § 181.953, subd. 10, an employee will have access to information
contained in his or her personnel file relating to positive test results and to the testing process,
including all information gathered as part of that process.
Dilute Specimens:
A negative or positive dilute test result (following a second collection) which has been confirmed
will subject an employee to immediate termination.
Consequences for Employees Engaging in Prohibited Conduct
Job Applicants:
The City’s conditional offer of employment will be withdrawn from any job applicant who
refuses to be tested or tests positive for illegal drugs as verified by a confirmatory test.
Employees:
• No Adverse Action without Confirmatory Test. The City will not discharge, discipline,
discriminate against, or request or require rehabilitation of an employee based on a
positive test result from an initial screening test that has not been verified by a
confirmatory test.
• Suspension Pending Test Result. The City may temporarily suspend a tested employee
with or without pay, or transfer that employee to another position at the same rate of pay
pending the outcome of the requested confirmatory retest, provided the City believes that
it is reasonably necessary to protect the health or safety of the employee, co-employees,
or the public. The employee will be asked to return home, and will be provided
appropriate arrangements for return transportation to his or her residence. In accordance
with Minn. Stat. § 181.953, subd. 10, an employee who has been suspended without pay
will be reinstated with back pay if the outcome of the requested confirmatory retest is
negative.
Discipline and Discharge:
Confirmatory Positive Test Result:
The City will not discharge an employee for a first confirmatory positive test unless the
following conditions have been met:
• The City has first given the employee an opportunity to participate in either a drug or
alcohol counseling or rehabilitation program, whichever is more appropriate, as
determined by the City after consultation with a certified chemical use counselor or
physician trained in the diagnosis and treatment of chemical dependency. Participation by
the employee in any recommended substance abuse treatment program will be at the
employee’s own expense or pursuant to the coverage under an employee benefit plan.
The certified chemical use counselor or physician trained in the diagnoses and treatment
of chemical dependency will determine if the employee has followed the rehabilitation
program as prescribed; and
• The employee has either refused to participate in the counseling or rehabilitation program
or has failed to successfully complete the program, as evidenced by withdrawal from the
program before its completion or by a refusal to test or positive test result on a
confirmatory test after completion of the program.
Other Misconduct:
Nothing in this policy limits the right of the City to discipline or dismiss an employee on grounds
other than a positive confirmatory test result, including conviction of any criminal drug statute
for a violation occurring in the workplace or violation of other city personnel policies.
Emergency Call Back to Work Provisions:
If an employee is called out for a City emergency and he or she reports to work and is suspected
of being under the influence of drugs or alcohol, he or she will not be subject to the testing
procedures of this policy, but may be subject to discipline and will not be allowed to work.
Appropriate arrangements for return transportation to the employee’s residence will be made. It
is the sole responsibility of the employee who is under the influence of alcohol and/or drugs and
who is called out for a City emergency, to notify his or her supervisor of this information and
advise if he or she is unable to respond to the emergency call back.
Non-Discrimination
The City of Lake Elmo policy on work-related substance abuse is non-discriminatory in intent
and application; however, in accordance with Minn. Stat., ch. 363, disability does not include
conditions resulting from alcohol or other drug abuse which prevents an employee from
performing the essential functions of the job in question or constitutes a direct threat to property
of the safety of individuals.
Furthermore, the City will not retaliate against any employee for asserting his or her rights under
this policy.
Policy Contact for Additional Information
If you have any questions about this policy or the City’s drug and alcohol testing procedures, you
may contact your immediate supervisor, Human Resources, or the City Administrator to obtain
additional information.
By this policy, the City of Lake Elmo has established a drug-free awareness program to inform
employees about the dangers of drug abuse in the workplace and its policy of maintaining a
drug-free workplace. Each City employee will receive a copy of this policy and will be required
to read it.
Definitions
Alcohol: Means the intoxicating agent in beverage alcohol or any low molecular weight alcohols
such as ethyl, methyl, or isopropyl alcohol. The term includes but is not limited to beer, wine,
spirits, and medications such as cough syrup that contain alcohol.
Alcohol use or usage: Means the consumption of any beverage, mixture, or preparation,
including any medication, containing alcohol.
Applicant: Means a person applying for a job with the City.
City: Means the City of Lake Elmo.
City premises: Means, but is not limited to, all City job sites and work areas. For the purposes
of this policy, city premises also includes any other locations or modes of transportation to and
from those locations while in the course and scope of employment of the City.
City vehicle: Means any vehicle which employees are authorized to use solely for City business
when used at any time; or any vehicle owned or leased by the City when used for City business.
Collection site: Means a place designated by the City where job applicants and employees
present themselves for the purpose of providing a specimen of their breath, urine, and/or blood to
be analyzed for the presence of controlled substances and alcohol.
Confirmatory test: Means a controlled substance or alcohol test on a sample to substantiate the
results of a prior controlled substance or alcohol test on the same sample, and that uses a method
of analysis allowed under one of the programs listed in Minn. Stat. § 181.953, subd. 1.
Drug: Has the same meaning as “controlled substance” defined in Minn. Stat. § 152.01, subd. 4.
Drug and alcohol testing, drug or alcohol testing, and drug or alcohol test: Mean analysis of
a body component sample according to the standards established under one of the programs
listed in Minn. Stat. § 181.953, subd.1, for the purpose of measuring their presence or absence of
drugs, alcohol, or their metabolites in the sample tested.
Drug paraphernalia: Has the meaning set forth in Minn. Stat. § 152.01, subd. 18.
Employee: Means a person who performs services for compensation for the City and includes
independent contractors except where specifically noted in this policy.
Initial screening test: Means a drug or alcohol test that uses a method of analysis under one of
the programs listed in Minn. Stat. § 181.953, subd. 1.
Job applicant: Means a person who applies to become an employee of the City, and includes a
person who has received a job offer made contingent on the person passing drug testing.
Positive test result: Means a finding of the presence of alcohol, illegal drugs, or their
metabolites that exceeds the cutoff levels established by the City. Minimum threshold detection
levels are subject to change as determined in the City’s sole discretion.
Reasonable suspicion: Means a basis for forming a belief based on specific facts and rational
inferences drawn from those facts.
Safety-sensitive position: Means a job, including any supervisory or management position, in
which an impairment caused by drug or alcohol usage would threaten the health or safety of any
person.
Under the influence: Means (1) the employee tests positive for alcohol or drugs, or (2) the
employee’s actions, appearance, speech, and/or bodily odors reasonably cause the City to
conclude that the employee is impaired because of illegal drug use or alcohol use.
STAFF REPORT
DATE: February 7, 2018
CONSENT
ITEM #: 5
TO: Mayor and City Council
FROM: Jake Foster, Assistant City Administrator
AGENDA ITEM: Approve Service Agreements with Industrial Health Services Network (IHSN)
BACKGROUND:
Staff and the Human Resources Committee have determined that there is a need for vendor to help
administer the City’s proposed drug-free workplace and drug testing policies for City employees.
The vendor that has been identified is Industrial Health Services Network (IHSN) in Hudson, WI. IHSN
would provide a comprehensive service to City staff to ensure compliance with any state or federal
regulations, including those for DOT employees.
ISSUE FOR DISCUSSION:
Should Council approve the HR Committee’s recommendation to enter into service agreements with
Industrial Health Services Network (IHSN) to help administer the City’s proposed drug-free workplace
and drug testing policies?
PROPOSAL DETAILS/ANALYSIS:
IHSN provides a completely comprehensive drug testing offering for both DOT and non-DOT employees.
Both of these groups would require individual service agreements as the needs for each pools differ.
The services staff recommends for non-DOT employees as outlined by IHSN are pre-employment drug
screening, alcohol and drug screening based on suspicion, and alcohol and drug screening if an accident
occurs while an employee is on duty or City property is involved. IHSN also offers optional services and
support materials that could be purchased if the need arises.
Staff further recommends using IHSN for DOT drug testing which includes, pre-employment drug
screening, alcohol and drug screening based on suspicion, alcohol and drug screening if an accident
occurs while an employee is on duty or City property is involved, as well as random selection for testing,
and all other DOT requirements.
IHSN will provide result reporting and the arrangement of specimen collection at the Stillwater Medical
Group collection facility for both programs. Additionally IHSN will help with the policy development for
each of these programs to ensure compliance with state statute and federal regulations.
FISCAL IMPACT:
IHSN charges and annual service fee of $229.00 for the DOT service program. The annual service fee for
non-DOT employees will be waived if a service agreement is in place with IHSN for DOT testing. There
is an additional one time account set-up fee of $50. Each drug test has an administration/currier fee of
$44.90 plus a collection fee from the clinic of $24 for a total of $68.90 each test. Alcohol/breath tests are
also done at the Stillwater Medical Group Clinic and carry a charge of $44.
Random drug testing needs to occur at a 25% rate annually for the City to be DOT compliant. Tests will
be performed quarterly. Currently there are eight employees who are subject to DOT regulations. This
means two employees will have to be tested randomly at an annual total cost of $137.80 for the drug tests.
Additionally, DOT employees need to be randomly tested for alcohol consumption at a rate of 10%
annually with a minimum of one employee needing to be tested each year. The analysis for random
testing requirements is performed quarterly, but the system may not require employees to be tested each
quarter if annual thresholds are being met.
The 2018 cost to implement the City proposed drug testing and drug-free workplace policies would be
approximately $470 plus any additional pre-employment, suspicion based, or accident based drug or
alcohol screens at $68.90 or $44 respectively. The cost to continue the program in subsequent years
would be approximately $420 annually, which is the total cost from 2018 less the one time account set-up
fee of $50.
RECOMMENDATION:
If removed from the consent agenda:
“Motion to approve the service agreements with Industrial Health Services Network”
ATTACHMENTS:
1. Service agreement for the DOT (FMCSA) employee program
2. Service agreement for the non-DOT employee program
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Program - FMCSA
IHSN’s Premier Service Program is a high service model designed for employers who want a
comprehensive solution for their drug and alcohol testing program needs. This service package is
ideal for employers who want the assistance and experience of knowledgeable staff to coordinate
their testing services and assist with the administration of their program.
Clients who enroll in our Premier Service program receive the following Superior Quality and
Value Added Service Package:
IHSN Services Guide
Upon enrollment each IHSN client receives our valuable IHSN Services Guide. Our IHSN
Services Guide provides:
• An introduction to our service program,
• Answers to your common service questions,
• A listing of your designated service providers (Lab, MRO & collection sites),
• Program Management Resources,
• Sample Forms,
• Sample Company Policy Information, and
• Tabbed sections for you to store your service contracts and copies of our monthly
newsletter, IHSNews.
This handy ring-bound guidebook is divided into convenient tabbed sections for easy reference
and convenient storage of your important program documents.
Laboratory and MRO Services
IHSN makes using or changing to our services a snap by making all the arrangements for
establishing your laboratory testing and Medical Review Officer (MRO) accounts. IHSN will set-up
your account with one of our contracted top quality SAMHSA certified labs and establish your
MRO services account with our MRO Services Department. IHSN also takes care of ordering and
arranging for the laboratory to ship the initial supply of drug testing materials directly to you or to
each of your designated collection sites, making a change to IHSN services a breeze.
Test Panel
DOT clients who enroll in our Premier service program receive the DOT mandated 5-panel drug
screen. This panel tests for THC/Marijuana, Cocaine, Amphetamines/Methamphetamines,
Opiates and PCP.
Rapid Result Reporting
IHSN understands that drug test results cannot come too soon. Your company’s critical
personnel and operations decisions depend on them. Our MRO Services Department is
dedicated to providing the rapid, top quality service you need. Negative test results are generally
reported the afternoon following specimen collection (provided the collection facility ships the
sample the same day it is collected and faxes a copy of the MRO copy of the custody and control
form to our offices the day of collection). Positive laboratory test results are handled immediately
upon receipt from the laboratory ensuring minimal wait times for your MRO verified result.
Deluxe Result Reporting Options
IHSN recognizes that some companies may require test results to be reported to multiple
locations or require varying levels of access to test results. Our sophisticated result reporting
system has the ability to report test results to multiple locations and to accommodate varying
access levels to result data.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Program - FMCSA
Specimen Collection Supplies
IHSN provides all specimen collection supplies needed for drug testing including:
♦ Specimen collection and bottle containers
♦ Custody and Control Forms (CCF) pre-printed with your company’s account information;
and,
♦ Courier overnight shipping envelope and airbill for sending specimens to your designated
SAMHSA-certified lab
IHSN will order and ship the initial supply of testing materials to you or directly to your collection
site(s).
Collection Site Location and Account Set-Up
Our Premier service clients receive IHSN’s Collection Site Locator & Account Set-up Service.
Locating and establishing urine specimen collection and alcohol testing sites is critical to the
success of your Drug and Alcohol Testing Program. Using our vast collection site database and
collection site locator resources, we will locate collection sites in your designated testing areas
and help you determine which sites best meet your unique service needs. We will then coordinate
the set-up of your account at each chosen collection site by providing the site with detailed
instructions concerning the establishment of your account, including:
♦ Your company name, address, phone numbers and authorized contacts
♦ The names, addressees and phone numbers of your testing lab and MRO
♦ Specimen shipping instructions
♦ Instructions concerning how to order additional testing supplies,
♦ Instructions concerning the disbursement of testing paperwork, and
♦ Billing instructions
For DOT regulated employers IHSN will also obtain a certification form from the facility verifying
that the site agrees to provide services in compliance with all applicable DOT regulations and
agrees to provide copies of all required documentation including training records when requested
by the employer or DOT agency.*
Additionally, we will also order and ship the initial supply of specimen collection materials to each
collection site or if you prefer we will ship the supplies directly to you for distribution to your sites or
employees. IHSN will also act as a liaison between the employer and the collection site on an
ongoing basis.
* IHSN does not obtain copies of the training documentation for each collector or alcohol test technician.
IHSN obtains a certification form from the site stating that they agree to provide all services in compliance
with DOT regulations including ensuring that all of their staff are trained according to DOT requirements. If
a DOT auditor requests the training information for a specific collector or alcohol technician, the employer is
responsible for obtaining this documentation from each site location.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Program - FMCSA
Premier Random Selection Services
IHSN’s drug and alcohol random selection services are included at no extra charge for clients
enrolled in our Premier service program. IHSN’s sophisticated computerized random selection
service is designed to simplify the management and employee list maintenance duties of your
random selection program. IHSN creates an individual random selection pool for each client
enrolled in our Premier service program. To help you keep your employee list up to date, each
quarter IHSN sends you a reminder to submit changes to your employee list. Our easy to
complete update forms or electronic submission procedures make updating your employee list
quick and painless!
Our random computer system automatically calculates the number of random selections required
for the quarter and then selects the appropriate number of employees for random drug and/or
alcohol testing. We also automatically select a percentage of alternates in addition to the primary
selections. These alternates are provided for your convenience to be used in cases when the
original employees selected are not available for testing due to termination, medical leave, etc.
Premier service clients also receive the following additional random selection service and
reporting benefits.
• For Premier service clients, our computer system tracks your drug tests as they enter our test
results system and matches the selections made to the random tests you have completed. If
a test enters our test results system labeled as a random test, but does not match a selection
in our system, (i.e. the test was marked as a random, but is actually a different category of
test; or the SS# on the paperwork does not match the SS# in our data base; etc.) we
automatically contact you to determine the cause of the discrepancy and then submit any
necessary data changes to the testing laboratory. This process ensures that all of your
random testing is properly completed and labeled so that your IHSN random progress and
laboratory statistical reports will reflect the correct data.
• Premier service clients are sent a progress report just prior to the end of each selection period
detailing the status of the random drug testing for the current period. This report includes a
summary of the number of selections made, the number of drug tests completed to date and
the number of drug tests remaining to be completed for the selection period. This value
added report is a timely management tool providing either a confirmation that you have
completed all the required drug testing for the period or a friendly reminder that you still have
testing to complete before the period ends.
• Premier Service Clients who fail to complete their random testing by the end of the selection
period are issued a notice of non-compliance each month until the testing has been
completed. These friendly reminders are designed to assist you in maintaining compliance
with DOT regulations and/or company policy and serve as a gentle reminder that you still have
outstanding tests that need to be completed.
Our Premier random selection system makes managing your random selection program as easy
as 1-2-3!
Please Note: If a client does not complete all the required random selections for two successive selection
periods, IHSN reserves the right to cancel random selection services on the account.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Program - FMCSA
Split Sample Testing Services
DOT regulations require that all DOT drug screen collections be completed using the split sample
collection method. In short this collection method requires that the urine specimen be divided into
two separate specimen bottles at the time of collection. Both bottles are sealed and shipped to the
laboratory. However, only the primary bottle is originally tested. If an employee’s test result is
verified as positive or as a refusal to test by the Medical Review Officer (MRO), the employee has
the right to request that the second or “split” specimen bottle be shipped to a second certified
testing laboratory for reanalysis. IHSN’s MRO automatically informs the employee of this right
during the donor interview process. If the employee requests this specimen be re-tested, DOT
regulations require our MRO Services Department to process this request immediately. The fee
for this test is billed to the employer. The employer may choose to collect re-imbursement from
the employee if this is required by the employer’s company policy.
DOT Regulatory and Program Compliance Assistance
Premier service clients receive assistance with DOT regulatory and program compliance
questions and concerns for no additional charge. IHSN’s friendly, dedicated staff is extensively
trained to provide answers to your regulatory and program compliance questions. Wading
through and reading DOT regulations can be confusing and time consuming. Our highly
knowledgeable staff can quickly guide you through the rules to help you locate and understand the
appropriate regulations and procedures.
Access to IHSN’s 24 hour Emergency Testing Assistance
Because accidents do not occur just on weekdays or during regular office hours, IHSN has staff
on call 24 hours a day, 365 days a year to assist our Premier service Clients with post-accident or
other emergency testing situations. To utilize this service simply call our toll free number day or
night. Our on call representative will locate a test site and make all the arrangements with the
collection site for the required testing. When you are dealing with an accident or other emergency
testing situation the last thing you want to worry about is locating a competent site to perform drug
and alcohol testing. We make arranging for emergency testing worry free!*
*Note: Due to the urgent nature of this testing and the immediate need for the completion of the site set-up, IHSN will not
obtain a signed collection site certification statement prior to completing an emergency site set-up. If the employer
wishes to obtain this information, it is the employer’s responsibility to obtain this documentation from the test site after the
completion of services.
Access to IHSN’s Non-Emergency Over-The-Road Collection Site Set-up Services
For situations where is it not convenient to use your permanent collection sites for pre-
employment, random or other testing, IHSN offers our Premier service Clients our IHSN “Over-
the-Road” Collection Site Set-Up Service. To use this service simply call our toll free number
during regular office hours. We will locate a collection site in the requested area and make all the
arrangements for the required testing. We then call you back with the facility information so you
can direct your employee to the test site. This service is a great tool for completing random testing
on-the-road or pre-employment testing on applicants who live far distances from your place of
business, saving you travel and lodging expenses when qualifying applicants. *
*Note for DOT employers only: To ensure that all testing is completed in compliance with DOT regulations, IHSN’s
standard policy is to obtain a collection site certification form from each site prior to completing a site set-up for your
company. However, this can delay the site set-up. If the employer does not want the set-up delayed for this process, the
employer can request that IHSN not obtain the site certification. In these cases the employer will be required to sign a
release form.
Premier Specimen Status Tracking & Expedited Result Reporting
IHSN understands that drug test results cannot come too soon, your critical personnel decisions
depend on them. If you are particularly anxious about the status of a pending test result simply
call our offices. Our MRO staff will contact the lab to 1) verify that the lab has received the
specimen, 2) determine the testing status of the specimen and, 3) obtain an estimate of when the
lab is expected to release the result to the MRO for review.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Program - FMCSA
In addition to contacting the lab to verify the status of your test results, for Premier service clients,
our MRO staff will also contact your collection site to verify that the employee did complete the
test, we will verify when the sample was shipped, and track the specimen with the courier service
responsible for transporting the specimen to the testing laboratory. If you are particularly anxious
about a specific result our MRO staff can also enter a “flag” in our computer system that will
automatically notify the staff member the minute that specific result is received into our computer
system. The result can then be flagged for “priority or emergency” processing to further expedite
the MRO review and reporting process.
Expedited Correction of Custody and Control Form errors
Some MRO’s simply cancel specimens that are submitted to the lab with minor Custody and
Control Form Errors (i.e. missing date, missing collector signature, collector failed to mark test
type, etc.) rather than taking the time to correct them. Other MRO’s leave it up to the laboratory to
obtain the necessary documentation required to correct paperwork errors. These practices cost
the employer not only time and lost revenue, but also the cost and hassle of arranging for a
second collection if the sample must be re-collected. IHSN, however, takes an active role in the
correction process. When a correctable Custody and Control form error occurs, the laboratory
notifies our MRO of any errors for your account. Our MRO administrative staff then expedites the
correction process by coordinating with the collector to correct the error. Our MRO staff contacts
the collector to inform the collector of the error, review the proper procedures to ensure that the
error does not happen again, and obtain the necessary corrective paperwork. This involvement in
the correction process to expedite the correction of custody and control form errors is not
common practice for most MRO organizations. Our MRO Services Department is committed to
going the extra mile, ensuring that you receive your test results as rapidly as possible. This
commitment to excellence speeds up the processing time for Custody and Control form errors
saving you time and money.
Regular Customer Service Account Reviews
All Premier service clients receive regular account reviews. Our friendly, dedicated staff will
contact you to review your account history and point out any changes in testing activity that may
indicate a service or compliance concern. This personalized service helps you identify and
correct compliance issues before they become a problem.
Subscription to IHSNews
Our monthly newsletter, IHSNews keeps you up to date on changes in DOT regulations.
IHSNews also provides regulation reviews, DOT interpretive guidance, procedure reviews, and
articles on other drug and alcohol testing topics. One subscription to IHSNews is provided to
each IHSN client as part of their service program.
Drug and/or Alcohol Free Workplace Policies
Each DOT regulated employer is required to have a written drug and alcohol testing policy.
Industrial Health Services Network, Inc. provides each employer regulated by the Federal Motor
Carrier Safety Administration (FMCSA) Regulations with a sample drug free workplace policy at
no extra charge. This sample is designed to be used as a model for developing your drug and
alcohol testing policy. IHSN recommends that you have a competent attorney review any new
policy before adopting it as your company policy.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Program - FMCSA
IHSN’s on-line Regulation and Compliance Resource Center
Premier Service Clients have access to our on-line DOT Regulation and Compliance Resource
Center. This Resource Center located on IHSN’s web site (www.ihsn.com) provides access to:
♦ The 49 CFR Part 40 Drug and Alcohol Testing Regulations
♦ The Part 382 Federal Motor Carriers Safety Administration Drug & Alcohol Testing
Regulations
♦ DOT Interpretive Guidance
♦ Common Regulation Questions and Answers
♦ Guidance for Making Post-Accident Testing Decisions
♦ Program Management Tools
♦ Past issues of IHSNews, and
♦ Links to Variety of useful DOT, Government and Industry Drug and Alcohol Testing Web
Sites.
Optional Services
Employee Information and Supervisor Training Programs
Employee Information and Supervisor Training Programs are key to maintaining an effective drug
and alcohol testing program. DOT regulations require that you distribute materials to your drivers
explaining what is expected of them under the DOT drug and alcohol testing rules. Our driver
guide is packed with easy to read information and includes a certificate of receipt for your driver
testing files.
Supervisors play a crucial role in an effective drug and alcohol-testing program. More than
anyone else, they are in a position to recognize changes in an employee’s job performance.
FMCSA regulations require that each person in a supervisory role over drivers complete 60
minutes of training on drug abuse and 60 minutes of training on alcohol misuse. Our supervisor
training guide is designed to comply with this training requirement. This training manual is packed
with valuable information and includes sample forms and a certificate of completion.
Program Management & Resource Materials
Quality Program Management and Resource materials are essential to the maintenance of your
drug and alcohol-testing program. IHSN offers additional quality program materials to make it
easier for you to manage your testing program and maintain compliance with DOT regulations.
See the page in this proposal titled “IHSN Program Materials” for more information.
Substance Abuse Professional (SAP) Referral Services
When an employee violates an FMCSA drug or alcohol testing program prohibition, FMCSA
regulations require the employer to provide the employee with a referral to a qualified Substance
Abuse Professional (SAP). IHSN can assist you with this requirement by making a referral to a
qualified Substance Abuse Professional. IHSN’s SAP Referral service includes: 1) locating an
appropriate facility and certified individual to perform the SAP evaluation and 2) providing you with
documentation that the individual meets the criteria to act as an SAP per DOT regulations.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Drug Screen Collection & Alcohol Testing Services
IHSN will work with your existing provider location(s) or will establish drug screen collection and
alcohol testing sites for you. Below you will find our suggestion(s) for service providers in the
areas you requested. If you prefer to work with a different facility than the site(s) listed below,
please provide your representative with the name, address and phone number of the site of your
choice. Fees for drug screen collection and alcohol testing services will be the usual and
customary fees charged by the site. Unless otherwise noted below, all fees for services provided
by your collection site will be billed to you directly by the provider site. The collection site service
fees listed below are based on the collection site’s current fee schedule and are subject to change
without notice. Please note that collection and alcohol testing fees are in addition to IHSN’s
testing fees.
Stillwater Medical Group - Workwell
1500 Curve Crest Blvd.
Stillwater, MN 55082
Hours:M - F: 8am-4:15pm
Appt not required but a
call ahead is preferred
for any service.
Urine Specimen
Collection Fee:
$24.00
Phone:(651) 439-1234 DOT Physical Fee:$85.00
Fax:(651) 275-3395 Breath Alcohol Test
Fee:
$44.00
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
IHSN Program Materials
Cab Packs $5.90
A Cab Pack is a sealed collection kit that contains the specimen bottle kit, a custody and control form, an
airway bill, and courier shipping bag. The pack is designed be kept aboard a vehicle for post accident or
random on the road testing. We highly recommend having a cab pack for each of your vehicles to decrease
the possibility of errors during post accident testing.
DOT Program Materials
FMCSA Drug & Alcohol Testing Forms Packet Paper Version: $34.95
CD Version: $39.95
The IHSN Drug & Alcohol Testing Forms Packet is designed to aid employers in complying with the record
keeping requirements of the Federal Motor Carriers Safety Administration’s drug and alcohol testing
program. Each of these time saving forms includes a guide at the bottom of each form listing to whom, and
where copies of each form should be distributed. Additionally, each of the program checklists included
features not only a list of required documents, but also the time period the form must be retained by the
employer. Unlike the program forms sold by other companies, you do not need to buy our forms more than
once! IHSN provides you with a packet of master forms that can be photocopied for your internal company
use. This packet is also available on CD (Files are in pdf format).
DOT Drug and Alcohol Testing Regulations: Part 382 $14.95
This guidebook provides you with a complete copy of the current Part 382 drug and alcohol testing rules.
(A pdf version of this booklet is available to download for free in the “clients only” area of our web site.)
DOT Drug and Alcohol Testing Regulations: Part 40 $14.95
This guidebook provides you with a complete copy of the current Part 40 drug and alcohol testing rules.
(A pdf version of this booklet is available to download for free in the “clients only” area of our web site.)
FMCSA Supervisor's Reasonable Suspicion Training Guide $64.95
This guide is designed to meet the supervisor training requirements of 382.603. This manual provides your
supervisors with guidance concerning the physical, behavioral, speech and performance indicators of drug
and alcohol abuse. Additionally, this manual provides guidance concerning how to approach employees
when reasonable suspicion testing is required and how to document the request for testing (includes
sample forms)
Driver’s Guide to the FMCSA Drug & Alcohol Testing Rules $4.50
This booklet is designed to educate your employees about the dangers and health effects of the use and
abuse of drugs and alcohol. This booklet meets the requirements of part 382.601(b) and is designed to be
distributed to each of your drivers along with a copy of your company’s written drug and alcohol policy.
FMCSA Complete Materials Package $172.00
Save 5%! This cost saving package includes all the basic program materials you need to implement your
FMCSA testing program. This package includes 1 - Drug & Alcohol Testing Forms Packet (paper version),
1 - Supervisor’s Reasonable Suspicion Training Manual, 1 - DOT Drug and Alcohol Testing Regulations:
Part 382 book, 1 - DOT Drug and Alcohol Testing Regulations: Part 40 book, 5 – FMCSA Driver’s
Guidebooks, and 5 – Cab Pack Test Kits. (Don’t forget to order additional Driver’s Guides and cab packs for
each additional driver!)
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Service Fees - FMCSA
IHSN Premier Service Program
IHSN Services Guide
SAMHSA Laboratory Testing
DOT SAMHSA 5-panel Test
Certified Medical Review Officer Services
Automated Results Reporting
Deluxe Result Reporting Options
Next Day Reporting on Negative Test Results
Positive Test Results Confirmed by GC/MS
Specimen Collection Supplies
Collection Site Referral Services & Account Set-Up Services (First 2 sites free, fee for
each additional site)
Premier Random Selection Services
DOT Regulatory and Program Compliance Assistance
Access to IHSN’s 24 hour Emergency Testing Services
Access to IHSN’s Non-Emergency Over-The-Road Collection Site Set-Up Services
IHSN’s Premier Customer Service Package
Premier Specimen Status Tracking
Expedited Correction of Correctable Custody and Control Form Errors
Regular Customer Service Account Reviews
Subscription to IHSNews
Password Access to IHSN’s On-Line Regulation and Compliance Resource Center
One Monthly Billing Statement for all Lab, MRO and IHSN Services
Annual Service Fee:...............................................................................................................$229.00
Fee Per Drug Test:............................................................................................................... $44.90*
Optional Services
Collection Site Referral & Set-Up Services............First 2 sites free, $45 fee for each additional site
Urine Specimen Collection Combined Billing Service ........................................................$5.00/test
Non-Emergency Site Set-Up Services (regular office hours) .........................$45.00 per set-up plus
testing and collection fees
Emergency After Hours Site Set-Up Services ...............................................$75.00 per set-up plus
testing and collection fees
Split Specimen Re-test..........................................................................................$180.00 per test**
SAP Referral Services........................................................................................$150.00 per referral
Employee And Supervisor Training Programs.................................... See Program Materials Sheet
Program Management and Resource Materials................................. See Program Materials Sheet
*Test Fees are based upon a maximum positive rate of 5 % per year. Positive test results above the 5 %
maximum annual rate will be subject to an additional $45.00 fee per test. If translation services are
required for an MRO interview with a non-English speaking employee, the MRO will utilize the translation
services of AT & T Language Line. The employer will be charged a per minute translation fee based upon
the current rate charged by AT & T Language Line.
** Split Specimen re-test fees are billed to the employer and the employer is responsible for payment of all
split specimen re-test fees. The employer may choose to seek reimbursement from the employee
according to the employer’s company policy.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Service Agreement
DURATION OF OFFER: This offer is open for 30 days from the date of this proposal
DURATION OF PRICING: Annual fee and test fees are effective for term of this agreement. IHSN reserves the
right to increase client’s annual fee or test fees due to regulation changes or unforeseen increases in
laboratory, shipping or other costs. IHSN will provide Client a written notice of any mid term increase in the
annual fee or test fees 30 days in advance. Fees at renewal will be IHSN’s present market price at the time of
renewal. Fees for all other services are subject to change without notice.
PAYMENT TERMS: Invoices are issued monthly and payment is due within 15 days of the invoice date.
CUSTOMER SATISFACTION GUARANTEE: Subject to the conditions below, if customer is dissatisfied with
IHSN’s quality of service or support, IHSN will, at customer’s written request: (i) cancel service and close the
account, and (ii) cancel customer’s contract without liability for the termination fee. CONDITIONS TO
SATISFACTION GUARANTEE:
1. IHSN must receive written notice of the issue from the customer.
2. The issue must be attributable to facilities or causes within IHSN’s reasonable control; for example problems
caused by acts of God, natural disasters, inclement weather or third parties are not grounds to invoke the
guarantee.
3. If the issue is due to the performance of a subcontracted or coordinated third party service provider (i.e. lab,
MRO, collection site, etc.) IHSN must be reasonably given the opportunity to (i) resolve the problem with the
existing service provider, or (ii) change service providers and pass through any corresponding differences in
service provider fees. If there is no alternate service provider reasonably available or customer is unwilling to
accept an alternate service provider, then the issue shall not be covered by this satisfaction guarantee.
4. IHSN is unable to resolve a covered problem to customer’s reasonable satisfaction within 30 days after
receipt of written notice.
5. Customer’s account must be current (no balance older than 30 days).
TERM AND TERMINATION: Client agrees that IHSN will be its sole provider of the drug and alcohol testing
services covered by this agreement, unless those services are not available because of location, emergency or
necessitated by regulations or government authorities. This agreement shall be for an Initial Term of 1 year
from the date signed by the Customer. Upon expiration of the Initial Term, this agreement shall automatically
renew for successive 1-year periods at IHSN’s present market price at the time of renewal. Customer or IHSN
may terminate this Agreement at the end of any term by submitting a written notice to the other party at least
thirty (30) days prior to the end of such term. If service is terminated prior to expiration of the current term,
whether by IHSN for customer breach, or by Customer other than under the Customer Satisfaction Guarantee,
Customer shall forfeit all annual fees paid and upon demand by IHSN pay a termination fee equal to either 1)
the average monthly billing for all prior months of the current term multiplied by the number of months
remaining on the current term or 2) the average monthly billing for the last 12 months multiplied by the number
of months remaining on the current term, whichever is greater.
AMENDMENTS: Changes in federal or state regulations or standard testing practices may necessitate periodic
amendments to the terms of this agreement. In the event an amendment is necessary, IHSN will issue a written notice
to the client which shall include a deadline by which client must notify IHSN of its refusal to accept the amended terms.
Failure to provide notice by and/or continued use of IHSN services after the expiration of this deadline will constitute
acceptance of the amendment by client.
ACCEPTANCE: Acceptance may be made by email, mail or fax. Email and fax documents shall serve as originals.
ENTIRE AGREEMENT: This written Agreement and the accompanying Service Fees sheet constitute the entire
agreement between the parties and supersedes any prior or contemporaneous proposals, discussion or agreements,
whether verbal or written.
CHOICE OF LAW: This agreement shall be construed and controlled by the laws of the State of Wisconsin
and both parties further consent to the jurisdiction of the state and federal courts sitting in that state.
Customer hereby accepts and agrees to the terms, conditions and pricing as stated in this proposal.
For: ___________________________________________ For Industrial Health Services Network, Inc.
(Company Name)
By ____________________________________________A
(Name of Authorized Representative) Emily S. Battis, President VD010118
_______________________________________________ Date: _____________________________
(Signature of Authorized Representative)
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Enrollment Form - FMCSA
Our Testing Program Is: Mandated by U.S. DOT Regulations
Non-DOT/Company Policy (If you selected this option, please stop here and
contact your IHSN representative to request a Non-DOT enrollment form)
If your company is regulated by the US Department of Transportation, please indicate all DOT
Modal Agency Drug and Alcohol Testing Regulations your company must comply with:
Federal Motor Carrier Safety Administration (FMCSA)
Other DOT Agency (please list agency name) ________________________________
Result Reporting Preferences
Results should be directed to the following address:
Mailing Address: ________________________________________________________
City. State, Zip: _________________________________________________________
Phone: (_____________) __________________________________________
Please list the names of the individuals authorized to receive test results (please list phone # if
different than number listed above):
Primary person________________________________________________________
2nd person___________________________________________________________
3rd Person____________________________________________________________
Desired reporting method:
Auto Fax reporting is a computerized faxing system that immediately faxes test results to your
secure fax upon release by the MRO. If auto fax is selected, you must have a secure fax with
access to this fax limited to only those individuals authorized to receive test results.
Notify Fax reporting is designed for clients who do not have a secure fax or who want to control their
inbound faxes. A notice is faxed to you informing you when your tests are available for reporting. Then
you simply call IHSN to have your test result reports released to your fax while you monitor your fax
machine.
Phone reporting is designed for clients who do not have a secure fax. A representative will call you with
your test results and a written copy will be mailed to you the same day.
Mail reporting is designed for clients who do not have a secure fax. When the result is released by the
MRO for reporting, a written copy of the result is mailed to you. This is the least efficient way to
receive results and is not recommended for clients who are anxiously awaiting test results.
Select one: Auto Fax* Notify-Fax* Phone* Mail only
If Auto fax or notify-fax reporting is selected, enter the fax number to report results:
( )_________-_________
* If fax or phone reporting is selected, the client will receive a preliminary result report
via fax or phone. A final result report signed by the MRO is then sent via U.S. Mail.
Newsletter Subscription:
A copy of our newsletter publication, IHSNews, is provided to each client as part of their annual
program fee. The newsletter is sent out by email. Please list the email address that you would like
your newsletter sent to:
______________________________________@___________________________________
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Enrollment Form - FMCSA
Random Selections
I want IHSN to complete our company drug & alcohol random selections?Yes No
If yes, which quarter do you want IHSN to begin making these selections*?
immediately for the current quarter (clients just starting a program or clients who have not
completed random selections for the current quarter should check this option)
1st quarter(Jan.-March 31) 2nd Quarter(April 1-June 30)
3rd quarter(July 1-Sept. 30) 4th quarter(Oct. 1-Dec. 31)
*IHSN standardly performs random selections on a quarterly basis. If your company’s operations are
seasonal, please contact your representative to discuss the appropriate random selection schedule for your
company.
Selection Rate:
Random selections are drawn at a rate equal to the minimum annual selection rate set by the
applicable DOT agency. If you would like your selection rate set higher than the minimum annual
selection rate, please enter the desired selection rate below, otherwise leave this section blank.
Drug: ___________%/ calendar year Alcohol: _____________%/calendar year
All random correspondence should be directed to:
Random Selection Contact: _____________________________________________________
Phone: ____________________________ Fax: ________________________________
Email: _________________________________________________________________
Address: _______________________________________________________________
City, State, Zip: __________________________________________________________
All random correspondence should be sent by (please select one):
mail fax email
Billing Information
Accounts Payable Contact: _________________________________________________
Phone: ( )____________________________ Fax: ( ) _____________________
Billing Address: ___________________________________________________________
City, State, Zip: __________________________________________________________ _
Physical/Shipping Address
Street Address: ___________________________________________________________
City, State, Zip: __________________________________________________________ _
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Enrollment Form - FMCSA
Program Supplies
Item Description Quantity Unit Price Total
Annual Service Fee 1 $229.00 $229.00
Collection Site Referral & Set-Up Services (first 2 sites free) $45.00
Cab packs $5.90
FMCSA Drug & Alcohol Testing Forms Packet (printed)$34.95
FMCSA Drug & Alcohol Testing Forms Packet (CD) $39.95
DOT Drug and Alcohol Testing Regulations: Part 382 $14.95
DOT Drug and Alcohol Testing Regulations: Part 40 $14.95
FMCSA Supervisor’s Reasonable Suspicion Training Guide $64.95
Driver’s Guide to the FMCSA Drug & Alcohol Testing Rules $4.50
Complete FMCSA Training Package $172.00
Subtotal
Sales Tax (WI residents add 5.5% sales tax. SD residents
add 4% state sales tax plus the applicable city sales tax.)
Shipping & Handling: Introductory Materials 1 $14.95 $ 14.95
Shipping & Handling: Additional Program Materials:
(Based on weight. Please call for quote if paying by check.
IHSN will automatically calculate for credit card orders.)
Total
Please mail your check to IHSN (or complete the credit card authorization below) for this amount at the
time you mail your acceptance. If you are faxing your acceptance please complete the credit card
authorization form below.
Credit Card Payment Authorization
Please charge my credit card for the annual program fee and any supplies ordered above
Card: VISA MASTERCARD
Card Number: ______________________________________________
3-Digit Security Code (found on the backside of card): ______________
Card Expiration Date: ________________________________________
Cardholder Name: ___________________________________________
Card Billing Address: _________________________________________________________
City, State, Zip: ______________________________________________________________
Cardholder Phone Number: ___________________________________
Cardholder Signature: ________________________________________
To establish Your Account, Please submit the following by fax or mail to:
Industrial Health Services Network, Inc.
Attn: Account Setup
P.O. Box 490, Hudson, WI 54016
Fax: (715) 386-9308
1. Your signed Service Agreement
2. Your completed Enrollment Form
3. A List of your current collection facilities (please include the site name, complete address, phone
number, fax number and contact person) or a list of the locations where sites are needed,
4. If you have requested random selection services, a complete list of the names and social security numbers of your
employees for random selections. You must submit a computer file or use the form provided.
5. A check or completed credit card billing authorization for the annual program fee and any program supplies ordered.
(NOTE: Please do not send credit card information by email. Please mail, fax or call in your credit card information)
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Program – Non-DOT
IHSN’s Premier Service Program is a high service model designed for employers who want a
comprehensive solution for their drug and alcohol testing program needs. This service package is
ideal for employers who want the assistance and experience of knowledgeable staff to coordinate
their testing services and assist with the administration of their program. Clients who enroll in our
Premier Service program receive the following Superior Quality and Value Added Service
Package:
IHSN Services Guide
Upon enrollment each IHSN client receives our valuable IHSN Services Guide. Our IHSN
Services Guide provides:
• An introduction to our service program,
• Answers to your common service questions,
• A listing of your designated service providers (Lab, MRO & collection sites),
• Program Management Resources,
• Sample Forms,
• Sample Company Policy Information, and
• Tabbed sections for you to store your service contracts and copies of our monthly
newsletter, IHSNews.
This handy ring-bound guidebook is divided into convenient tabbed sections for easy reference
and convenient storage of your important program documents.
Laboratory and MRO Services
IHSN makes using or changing to our services a snap by making all the arrangements for
establishing your laboratory testing and Medical Review Officer (MRO) accounts. IHSN will set-up
your account with one of our contracted top quality SAMHSA certified labs and establish your
MRO services account with our MRO Services Department. IHSN also takes care of ordering and
arranging for the laboratory to ship the initial supply of drug testing materials directly to you or to
each of your designated collection sites, making a change to IHSN services a breeze!
Test Panel
Employers who enroll in our Premier service program receive their choice of testing panels.
Employers can select our standard 5-panel, 7-panel, 10-panel or a custom panel drug screen.
Our standard 5-panel drug screen tests for THC/Marijuana, Cocaine,
Amphetamines/Methamphetamines, Opiates and PCP. Our standard 7-panel drug screen tests
for all substances included on the 5-panel test plus benzodiazepines and barbiturates. Our
standard 10-panel drug screen tests for all substances included on the 7-panel test plus
methadone, methaqualone and propoxyphene.
Rapid Result Reporting
IHSN understands that drug test results cannot come too soon. Your company’s critical
personnel and operations decisions depend on them. Our MRO Services Department is
dedicated to providing the rapid, top quality service you need. Negative test results are generally
reported the afternoon following specimen collection (provided the collection facility ships the
sample the same day it is collected and faxes a copy of the MRO copy of the custody and control
form to our offices the day of collection). Positive laboratory test results are handled immediately
upon receipt from the laboratory ensuring minimal wait times for your MRO verified result.
Deluxe Result Reporting Options
IHSN recognizes that some companies may require test results to be reported to multiple
locations or require varying levels of access to test results. Our sophisticated result reporting
system has the ability to report test results to multiple locations and to accommodate varying
access levels to result data.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Program – Non-DOT
Specimen Collection Supplies
IHSN provides all specimen collection supplies needed for drug testing including:
♦ Specimen collection and bottle containers
♦ Custody and Control Forms (CCF) pre-printed with your company’s account information;
and,
♦ Courier overnight shipping envelope and airbill for sending specimens to your designated
SAMHSA-certified lab
IHSN will order and ship the initial supply of testing materials to you or directly to your collection
site(s).
Collection Site Location and Account Set-Up
Our Premier service clients receive IHSN’s Collection Site Locator & Account Set-up Service.
Locating and establishing urine specimen collection and alcohol testing sites is critical to the
success of your Drug and Alcohol Testing Program. Using our vast collection site database and
collection site locator resources, we will locate collection sites in your designated testing areas
and help you determine which sites best meet your unique service needs. We will then coordinate
the set-up of your account at each chosen collection site by providing the site with detailed
instructions concerning the establishment of your account, including:
♦ Your company name, address, phone numbers and authorized contacts
♦ The names, addressees and phone numbers of your testing lab and MRO
♦ Specimen shipping instructions
♦ Instructions concerning how to order additional testing supplies,
♦ Instructions concerning the disbursement of testing paperwork, and
♦ Billing instructions
Additionally we will also order and ship the initial supply of specimen collection materials to each
collection site or if you prefer we will ship the supplies directly to you for distribution to your sites or
employees. IHSN will also act as a liaison between the employer and the collection site on an
ongoing basis.
Premier Random Selection Services
IHSN’s drug and alcohol random selection services are included at no extra charge for clients
enrolled in our Premier service program. IHSN’s sophisticated computerized random selection
service is designed to simplify the management and employee list maintenance duties of your
random selection program. IHSN creates an individual random selection pool for each client
enrolled in our Premier service program. To help you keep your employee list up to date, each
quarter IHSN sends you a reminder to submit changes to your employee list. Our easy to
complete update forms or electronic submission procedures make updating your employee list
quick and painless!
Our random computer system automatically calculates the number of random selections required
for the quarter and then selects the appropriate number of employees for random drug and/or
alcohol testing. We also automatically select a percentage of alternates in addition to the primary
selections. These alternates are provided for your convenience to be used in cases when the
original employees selected are not available for testing due to termination, medical leave, etc.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Program – Non-DOT
Premier service clients also receive the following additional random selection service and
reporting benefits.
• For Premier service clients, our computer system tracks your drug tests as they enter our test
results system and matches the selections made to the random tests you have completed. If
a test enters our test results system labeled as a random test, but does not match a selection
in our system, (i.e. the test was marked as a random, but is actually a different category of
test; or the SS# on the paperwork does not match the SS# in our data base; etc.) we
automatically contact you to determine the cause of the discrepancy and then submit any
necessary data changes to the testing laboratory. This process ensures that all of your
random testing is properly completed and labeled so that your IHSN random progress and
laboratory statistical reports will reflect the correct data.
• Premier service clients are sent a progress report just prior to the end of each selection period
detailing the status of the random drug testing for the current period. This report includes a
summary of the number of selections made, the number of drug tests completed to date and
the number of drug tests remaining to be completed for the selection period. This value
added report is a timely management tool providing either a confirmation that you have
completed all the required drug testing for the period or a friendly reminder that you still have
testing to complete before the period ends.
• Premier Service Clients who fail to complete their random testing by the end of the selection
period are issued a notice of non-completion each month until the testing has been
completed. These friendly reminders are designed to assist you in maintaining compliance
with your company policy or vendor contracts and serve as a gentle reminder that you still
have outstanding tests that need to be completed.
Our Premier random selection system makes managing your random selection program as easy
as 1-2-3!
Please Note: If a client does not complete all the required random selections for two successive selection
periods, IHSN reserves the right to cancel random selection services on the account.
Access to IHSN’s 24 hour Emergency Testing Assistance
Because accidents do not occur just on weekdays or during regular office hours, IHSN has staff
on call 24 hours a day, 365 days a year to assist our Premier service Clients with post-accident or
other emergency testing situations. To utilize this service simply call our toll free number day or
night and we will locate a test site and make all the arrangements with the clinic for the required
testing. When you are dealing with an accident or other emergency testing situation the last thing
you want to worry about is locating a competent site to perform drug and alcohol testing. We
make arranging for emergency testing worry free!
Access to IHSN’s Non-Emergency Over-The-Road Collection Site Set-up Services
Because it is not always possible or convenient to use your permanent collection sites for pre-
employment, random or other testing, IHSN offers our Premier service Clients our IHSN “Over-
the-Road” Collection Site Set-Up Service. To use this service simply call our toll free number
during regular office hours. We will locate a collection site in the requested area and make all the
arrangements for the required testing. We then call you back with the facility information so you
can direct your employee to the test site. This service is a great tool for completing random testing
on-the-road or pre-employment testing on applicants who live far distances from your place of
business, saving you travel and lodging expenses when qualifying applicants.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Program – Non-DOT
Premier Specimen Status Tracking & Expedited Result Reporting
IHSN understands that drug test results cannot come too soon, your critical personnel decisions
depend on them. If you are particularly anxious about the status of a pending test result simply
call our offices. Our MRO staff will contact the lab to 1) verify that the lab has received the
specimen, 2) determine the testing status of the specimen and, 3) obtain an estimate of when the
lab is expected to release the result to the MRO for review.
In addition to contacting the lab to verify the status of your test results, for Premier service clients,
our MRO staff will also contact your collection site to verify that the employee did complete the
test, we will verify when the sample was shipped, and track the specimen with the courier service
responsible for transporting the specimen to the testing laboratory. If you are particularly anxious
about a specific result, for Premier service clients, our MRO staff can also enter a “flag” in our
computer system that will automatically notify the staff member the minute that specific result is
received into our computer system. The result can then be flagged for “priority or emergency”
processing to further expedite the MRO review and reporting process.
Expedited Correction of Custody and Control Form errors
Some MRO’s simply cancel specimens that are submitted to the lab with minor Custody and
Control Form Errors (i.e. missing date, missing collector signature, collector failed to mark test
type, etc.) rather than taking the time to correct them. Other MRO’s leave it up to the laboratory to
obtain the necessary documentation required to correct paperwork errors. These practices cost
the employer not only time and lost revenue, but also the cost and hassle of arranging for a
second collection if the sample must be re-collected. IHSN, however, takes an active role in the
correction process. When a correctable Custody and Control form error occurs, the laboratory
notifies our MRO of any errors for your account. Our MRO administrative staff then expedites the
correction process by coordinating with the collector to correct the error. Our MRO staff contacts
the collector to inform the collector of the error, review the proper procedures to ensure that the
error does not happen again, and obtain the necessary corrective paperwork. This involvement in
the correction process to expedite the correction of custody and control form errors is not
common practice for most MRO organizations. Our MRO Services Department is committed to
going the extra mile, ensuring that you receive your test results as rapidly as possible. This
commitment to excellence speeds up the processing time for Custody and Control form errors
saving you time and money.
Regular Customer Service Account Reviews
All Premier service clients receive regular account reviews. Our friendly, dedicated staff will
contact you to review your account history and point out any changes in testing activity that may
indicate a service or compliance concern. This personalized service helps you identify and
correct compliance issues before they become a problem.
Subscription to IHSNews
Our monthly newsletter, IHSNews provides articles on a variety of drug and alcohol testing topics.
One subscription to IHSNews is provided to each IHSN client as part of their service program.
IHSN’s on-line Resource Center
Premier service Clients have access to our on-line Resource Center. This Resource Center
located on IHSN’s web site (www.ihsn.com) provides access to:
♦ Program Management Tools
♦ Past issues of IHSNews, and
♦ Links to Variety of useful DOT, Government and Industry Drug and Alcohol Testing Web
Sites.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Program – Non-DOT
Drug and/or Alcohol Free Workplace Policies
IHSN recommends that any employer requiring employee drug and alcohol testing have a written
drug and/or alcohol testing policy for their company. Due to the fact that testing regulations vary
from state to state, it is not possible for IHSN to provide a model policy that would comply with the
laws of all 50 states. IHSN recommends that you engage the services of a competent attorney to
develop a testing policy specific to your state law and individual company needs. Listed below
are some sources for information concerning state drug testing laws that may assist you with the
development of your company policy.
• Your company legal counsel: Your company legal counsel should be able to assist you in
identifying any state drug testing laws that you must comply with as well as assist you in writing
your company policy.
• Your State Attorney General’s Office: Your State Attorney General’s Office should be able to
provide you with information regarding your state’s drug testing laws.
• U.S. Department of Labor: This web site features a variety of information and resources
concerning how to develop a drug free workplace policy, including a policy builder module.
http://www.dol.gov/elaws/drugfree.htm
• Substance Abuse and Mental Health Services Administration: This site provides information
and tools regarding drug-free workplace programs. You can access this web site at
http://www.samhsa.gov/workplace
• Drug Free Workplace – Office of National Drug Control Policy: This web site offers a variety
of information and resources regarding drug free workplace programs including links to state and
local drug offices and publications.
http://www.whitehousedrugpolicy.gov/prevent/workplace/index.html
• The National Clearinghouse for Alcohol and Drug Information: This web site features
publications for workplace drug testing programs. http://www.health.org/workplace
• DTState Laws: This is a multimedia subscription information service that offers subscribers access
to state statutes, court decisions, issues forums, state news, and employer notes concerning
workplace drug and alcohol testing. For more information visit http://www.dtstatelaws.com/
• Institute for a Drug Free Workplace: This organization provides a variety of publications to
assist employers in implementing and maintaining their drug free work place programs including a
guide to state and federal drug testing laws. http://store.drugfreeworkplace.org/publications.aspx
Optional Services
Employee Information and Supervisor Training Programs
Employee Information and Supervisor Training Programs are key to maintaining an effective drug
and alcohol testing program. It is essential that employees understand not only what is expected
of them, but also what to expect when they submit to drug and alcohol testing. Our employee
guide is packed with easy to read information and includes a certificate of receipt for your
personnel files.
Supervisors play a crucial role in an effective drug and alcohol-testing program. More than
anyone else, they are in a position to recognize changes in an employee’s job performance. Our
supervisor-training guide gives your supervisors the tools they need to make reasonable suspicion
determinations. This training guide is packed with valuable information and includes sample
forms and a certificate of completion.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Drug Screen Collection & Alcohol Testing Services
IHSN will work with your existing provider location(s) or will establish drug screen collection and
alcohol testing sites for you. Below you will find our suggestion(s) for service providers in the
areas you requested. If you prefer to work with a different facility than the site(s) listed below,
please provide your representative with the name, address and phone number of the site of your
choice. Fees for drug screen collection and alcohol testing services will be the usual and
customary fees charged by the site. Unless otherwise noted below, all fees for services provided
by your collection site will be billed to you directly by the provider site. The collection site service
fees listed below are based on the collection site’s current fee schedule and are subject to change
without notice. Please note that collection and alcohol testing fees are in addition to IHSN’s
testing fees.
Stillwater Medical Group - Workwell
1500 Curve Crest Blvd.
Stillwater, MN 55082
Hours:M - F: 8am-4:15pm
Appt not required but a
call ahead is preferred
for any service.
Urine Specimen
Collection Fee:
$24.00
Phone:(651) 439-1234 DOT Physical Fee:$85.00
Fax:(651) 275-3395 Breath Alcohol Test
Fee:
$44.00
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
IHSN Program Materials
Cab Packs $5.90
A Cab Pack is a sealed collection kit that contains the specimen bottle kit, a chain of custody form, an
airway bill, an MRO envelope and courier shipping bag. The pack is designed to be kept aboard a company
vehicle for post accident or random on the road testing.
Supervisor's Reasonable Suspicion Training Guide $64.95
This manual is designed to provide your supervisors with information concerning the physical, behavioral,
speech and performance indicators of drug and alcohol abuse. Additionally this manual offers guidance
concerning how to approach employees when reasonable suspicion testing is required and how to
document the request for testing (sample forms included).
Employee Drug & Alcohol Testing Information Guide $4.50
This booklet is designed to educate your employees about the dangers and health effects of the use and
abuse of drugs and alcohol as well as information regarding what to expect when they submit to drug
and alcohol testing.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Service Fees – Non-DOT
IHSN Premier Service Program
IHSN Services Guide
SAMHSA Laboratory Testing
Choice of Test Panel (5, 7, 10 Panel)
Certified Medical Review Officer Services
Automated Results Reporting
Deluxe Result Reporting Options
Next Day Reporting on Negative Test Results
Positive Test Results Confirmed by GC/MS
Specimen Collection Supplies
Premier Random Selection Services
Access to IHSN’s 24 hour Emergency Testing Services
Access to IHSN’s Non-Emergency Over-The-Road Collection Site Set-Up Services
IHSN’s Premier Customer Service Package
Premier Specimen Status Tracking
Expedited Correction of Correctable Custody and Control Form Errors
Regular Customer Service Account Reviews
Subscription to IHSNews
Password Access to IHSN’s On-Line Resource Center
One Monthly Billing Statement for all Lab, MRO and IHSN Services
Annual Service Fee:...............................................................................................$179.00*WAIVED
One Time Account Set-Up Fee ...............................................................................................$50.00
Fee Per Drug Test:..............................................................................................................$44.90**
*Annual fee is waived as long as the client has an active DOT account with IHSN. An annual fee will be
implemented for this non-DOT testing account if the client should close its DOT account or request that either
random selection services or separate billing statements be provided for the non-DOT account.
Optional Services
Collection Site Referral & Set-Up Services.................................................$45.00 per collection site
Urine Specimen Collection Combined Billing Service ........................................................$5.00/test
Non-Emergency Site Set-Up Services (regular office hours) .........................$45.00 per set-up plus
testing and collection fees
Emergency After Hours Site Set-Up Services ...............................................$75.00 per set-up plus
testing and collection fees
Split Specimen Re-test........................................................................................ $180.00 per test***
SAP Referral Services........................................................................................$150.00 per referral
Employee And Supervisor Training Programs.................................... See Program Materials Sheet
**Test Fees are based upon a maximum positive rate of 5 % per year. Positive test results above the 5 %
maximum annual rate will be subject to an additional $35.00 fee per test. If translation services are
required for an MRO interview with a non-English speaking employee, the MRO will utilize the translation
services of AT & T Language Line. The employer will be charged a per minute translation fee based upon
the current rate charged by AT & T Language Line.
** *Split Specimen re-test fees are billed to the employer and the employer is responsible for payment of all
split specimen re-test fees. The employer may choose to seek reimbursement from the employee
according to the employer’s company policy.
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Service Agreement
DURATION OF OFFER: This offer is open for 30 days from the date of this proposal
DURATION OF PRICING: Annual fee and test fees are effective for term of this agreement. IHSN reserves
the right to increase client’s annual fee or test fees due to regulation changes or unforeseen increases in
laboratory, shipping or other costs. IHSN will provide Client a written notice of any mid term increase in the
annual fee or test fees 30 days in advance. Fees at renewal will be IHSN’s present market price at the time of
renewal. Fees for all other services are subject to change without notice.
PAYMENT TERMS: Invoices are issued monthly and payment is due within 15 days of the invoice date.
CUSTOMER SATISFACTION GUARANTEE Subject to the conditions below, if customer is dissatisfied with
IHSN’s quality of service or support, IHSN will, at customer’s written request: (i) cancel service and close the
account, and (ii) cancel customer’s contract without liability for the termination fee. CONDITIONS TO
SATISFACTION GUARANTEE:
1. IHSN must receive written notice of the issue from the customer.
2. The issue must be attributable to facilities or causes within IHSN’s reasonable control; for example problems
caused by acts of God, natural disasters, inclement weather or third parties are not grounds to invoke the
guarantee.
3. If the issue is due to the performance of a subcontracted or coordinated third party service provider (i.e. lab,
MRO, collection site, etc.) IHSN must be reasonably given the opportunity to (i) resolve the problem with the
existing service provider, or (ii) change service providers and pass through any corresponding differences in
service provider fees. If there is no alternate service provider reasonably available or customer is unwilling to
accept an alternate service provider, then the issue shall not be covered by this satisfaction guarantee.
4. IHSN is unable to resolve a covered problem to customer’s reasonable satisfaction within 30 days after
receipt of written notice.
5. Customer’s account must be current (no balance older than 30 days).
TERM AND TERMINATION Client agrees that IHSN will be its sole provider of the drug and alcohol testing
services covered by this agreement, unless those services are not available because of location, emergency or
necessitated by regulations or government authorities. This agreement shall be for an Initial Term of 1 year
from the date signed by the Customer. Upon expiration of the Initial Term, this agreement shall automatically
renew for successive 1 year periods at IHSN’s present market price at the time of renewal. Customer or IHSN
may terminate this Agreement at the end of any term by submitting a written notice to the other party at least
thirty (30) days prior to the end of such term. If service is terminated prior to expiration of the current term,
whether by IHSN for customer breach, or by Customer other than under the Customer Satisfaction Guarantee,
Customer shall forfeit all annual fees paid and upon demand by IHSN pay a termination fee equal to either 1)
the average monthly billing for all prior months of the current term multiplied by the number of months
remaining on the current term or 2) the average monthly billing for the last 12 months multiplied by the number
of months remaining on the current term, whichever is greater.
AMENDMENTS Changes in federal or state regulations or standard testing practices may necessitate periodic
amendments to the terms of this agreement. In the event an amendment is necessary, IHSN will issue a written notice
to the client which shall include a deadline by which client must notify IHSN of its refusal to accept the amended terms.
Failure to provide notice by and/or continued use of IHSN services after the expiration of this deadline will constitute
acceptance of the amendment by client.
ACCEPTANCE Acceptance may be made by email, mail or fax. Email and fax documents shall serve as originals.
ENTIRE AGREEMENT This written Agreement and the accompanying Service Fees sheet constitute the entire
agreement between the parties and supersedes any prior or contemporaneous proposals, discussion or agreements,
whether verbal or written.
CHOICE OF LAW This agreement shall be construed and controlled by the laws of the State of Wisconsin and
both parties further consent to the jurisdiction of the state and federal courts sitting in that state.
Customer hereby accepts and agrees to the terms, conditions and pricing as stated in this proposal.
For: ___________________________________________ For Industrial Health Services Network, Inc.
(Company Name)
By ____________________________________________A
(Name of Authorized Representative) Emily S. Battis, President VND040116
_______________________________________________ Date: _____________________________
(Signature of Authorized Representative)
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Enrollment Form – Non-DOT
Our Testing Program Is: Non-DOT/Company Policy
Mandated by Government Regulations (If you selected this option, please stop
here and contact your IHSN representative to request the correct enrollment form)
Test panel choice: 5 panel(standard) 5 panel(DOT Look-A-Like) 7 panel 10 panel
Result Reporting Preferences
Results should be directed to the following address:
Mailing Address: ________________________________________________________
City. State, Zip: _________________________________________________________
Phone: (_____________) __________________________________________
Please list the names of the individuals authorized to receive test results (please list phone # if
different than number listed above):
Primary person________________________________________________________
2nd person___________________________________________________________
3rd Person____________________________________________________________
Desired reporting method:
Auto Fax reporting is a computerized faxing system that immediately faxes test results to your
secure fax upon release by the MRO. If auto fax is selected, you must have a secure fax with
access to this fax limited to only those individuals authorized to receive test results.
Notify Fax reporting is designed for clients who do not have a secure fax or who want to control their
inbound faxes. A notice is faxed to you informing you when your tests are available for reporting. Then
you simply call IHSN to have your test result reports released to your fax while you monitor your fax
machine.
Phone reporting is designed for clients who do not have a secure fax. A representative will call you with
your test results and a written copy will be mailed to you the same day.
Mail reporting is designed for clients who do not have a secure fax. When the result is released by the
MRO for reporting, a written copy of the result is mailed to you. This is the least efficient way to
receive results and is not recommended for clients who are anxiously awaiting test results.
Select one: Auto Fax Notify-Fax
Mail Only Phone followed by mailed copy
If fax or notify-fax reporting is selected, enter the fax number to report results:
( )_________-___________
Newsletter Subscription:
A copy of our newsletter publication, IHSNews, is provided to each client as part of their annual
program fee. The newsletter is sent out by email. Please list the email address that you would like
your newsletter sent to:
______________________________________@___________________________________
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Enrollment Form – Non-DOT
Random Selections
Does your company have a random testing program? Yes No
Billing Information
Accounts Payable Contact: _________________________________________________
Phone: ( )____________________________ Fax: ( ) _____________________
Billing Address: ___________________________________________________________
City, State, Zip: __________________________________________________________ _
Physical/Shipping Address
Street Address: ___________________________________________________________
City, State, Zip: __________________________________________________________ _
I N D U S T R I A L H E A L T H S E R V I C E S N E T W O R K , I N C .
Premier Service Enrollment Form – Non-DOT
Program Supplies
Item Description Quantity Unit Price Total
Annual Service Fee 1 $179.00 waived
One Time Account Set-Up Fee 1 $50.00 $50.00
Collection Site Referral & Set-Up Services 1 $45.00 $45.00
Cab packs $5.90
Supervisor’s Reasonable Suspicion Training Guide
(Non-DOT Version)
$64.95
Employee Drug & Alcohol Testing Information Guide
(Non-DOT Version)
$4.50
Subtotal
Sales Tax (WI residents add 5.5% sales tax. SD residents
add 4% state sales tax plus the applicable city sales tax.)
Shipping & Handling: Introductory Materials 1 $14.95 $ 14.95
Shipping & Handling: Additional Program Materials:
(Based on weight. Please call for quote if paying by check.
IHSN will automatically calculate for credit card orders.)
Total
Please mail your check to IHSN (or complete the credit card authorization below) for this amount at the
time you mail in your acceptance. If you are faxing your acceptance please complete the credit card
authorization form below.
Credit Card Payment Authorization
Please charge my credit card for the annual program fee and any supplies ordered above
Card: VISA MASTERCARD
Card Number: ______________________________________________
3-Digit Security Code (found on the backside of card): ______________
Card Expiration Date: ________________________________________
Cardholder Name: ___________________________________________
Card Billing Address: _________________________________________________________
City, State, Zip: ______________________________________________________________
Cardholder Phone Number: ___________________________________
Cardholder Signature: ________________________________________
To establish Your Account, Please submit the following by fax or mail to:
Industrial Health Services Network, Inc.
Attn: Account Setup
P.O. Box 490, Hudson, WI 54016
Fax: (715) 386-9308
1. Your signed Service Agreement
2. Your completed Enrollment Form
3. If you have requested random selection services, a complete list of the names and social security numbers of your
employees for random selections. You must submit a computer file or use the form provided.
4. A check or completed credit card billing authorization for the annual program fee and any program supplies ordered.
(NOTE: Please do not send credit card information by email. Please mail, fax or call in your credit card information)
1
STAFF REPORT
DATE: February 6, 2018
REGULAR
ITEM #: 6
MOTION
TO: City Council
FROM: Emily Becker, Planning Director
AGENDA ITEM: Review of the Chicken Ordinance
REVIEWED BY: Ben Prchal, City Planner
BACKGROUND:
Staff had been asked to prepare an analysis of surrounding communities and their rules relating to the
keeping of chickens. The Council reviewed the analysis at its workshop on January 9, 2018 and directed
Staff to increase the number of chickens allowed on properties within the City.
PROPOSAL DETAILS/ANALYSIS:
Current Ordinance. The current ordinance allows property owners to own more chickens based on the
number of acres they have. No property owner is allowed to keep chickens on property of .49 acres or
less. The table below outlines the number of chickens that are allowed on properties of 0.5-5 acres. A
permit must be obtained to keep chickens on properties of 5 acres or less. The permit application requires
that notices be mailed to all homes within 150 feet of the applicant’s property prior to issuance of the
permit, and the permit is valid for up to two years. Chickens kept on properties of 5 acres or more are
restricted to 0.02 animal units per 2 grazable acres (50 chickens per 2 grazable acres).
Lot Size (Acres) Chickens Allowed
0.00 - 0.49 0
0.50 - 0.99 4
1.00 - 1.49 6
1.50 - 1.99 8
2.00 - 2.49 10
2.50 - 2.99 12
3.00 - 3.49 14
3.50 - 3.99 16
4.00 - 4.49 18
4.50 - 4.99 22
Amended Ordinance. At the January 9, 2018 workshop, Council directed Staff to make the following
amendments to the Chicken Ordinance. The amended ordinance is attached for reference.
2
• Allow up to 4 chickens on lots of 0.49 acres in size or less.
• Increase the number of chickens allowed on lots of 0.5-4.49 acres in size by 2.
• Increase the number of chickens allowed on lots of 4.50-4.99 acres in size to 30.
• Remove the requirement that notice be sent out to property owners within 150 feet of the applicant’s
property prior to issuance of the chicken permit that is required to keep chickens on properties of
less than five acres.
• All permits are valid for up to two years.
ATTACHMENTS:
1. Ord. 08-196
STAFF REPORT
DATE: February 7, 2018
CONSENT #7
AGENDA ITEM: Consultant for Building Fit Test/Analysis
SUBMITTED BY: Kristina Handt, City Administrator
BACKGROUND:
At the January 16th meeting, Council directed staff to obtain quotes for a building fit test/analysis for the
Brookfield building with respect to using it as a fire hall and city hall in the future. The building fit
test/analysis is one of the contingencies in the purchase agreement for 3880 Laverne Ave N. The city has
90 days (April 18th) to complete their due diligence with respect to the contingencies.
ISSUE BEFORE COUNCIL:
Who would Council like to do the fit analysis of the Brookfield site?
PROPOSAL:
Staff was able to obtain quotes from two architecture firms-Leo A Daly and Buetow 2 Architects Inc.
Copies of their proposals are included in your packet.
The proposals are similar in scope of work, timeline (4-6 weeks) and price ($4,750 and $4,900 respectively).
Both firms have done work previously in Washington County on municipal fire stations and city halls.
Staff is recommending Leo A Daly for this project. Since the city has a limited time to complete the work
staff is further recommending Council authorize the Mayor and Clerk to execute a contract for the services
after it has been reviewed by the City Attorney.
RECOMMENDATION:
If removed from the consent agenda:
“Move to direct staff to prepare a contract with Leo A Daly for a building fit test/analysis and authorize
the Mayor and City Clerk to execute the contract after legal review.”
ATTACHMENTS:
• Leo Daly Proposal
• Buetow 2 Architects, Inc Proposal
730 SECOND AVENUE SOUTH
SUITE 1100
MINNEAPOLIS, MN 55402-2455
TEL 612.338.8741
FAX 612.338.4840
www.leoadaly.com
ABU DHABI
ATLANTA
AUSTIN
BEIJING
CHICAGO
COLLEGE STATION
CORPUS CHRISTI
DALLAS
DAMMAM
DOHA
FLINT
FORT WORTH
HONG KONG
HOUSTON
LANSING
LAS VEGAS
LOS ANGELES
MIAMI
MILPITAS
MINNEAPOLIS
OAKLAND
OMAHA
ORANGE
RIYADH
SAN ANTONIO
SAN MARCOS
TAMPA
WACO
WASHINGTON DC
WEST PALM BEACH
PLANNING
ARCHITECTURE
ENGINEERING
INTERIORS
EST. 1915
January 19, 2018
Kristina Handt
City Administrator
City of Lake Elmo
3800 Laverne Avenue North
Lake Elmo, MN 55042
Dear Kristina:
Thank you for inviting LEO A DALY to assist the City of Lake Elmo as you continue your plan to
improve the City’s services and facilities. We are pleased to present this proposal for
professional services based upon our recent and continued conversations.
PROJECT BACKGROUND / UNDERSTANDING
LEO A DALY understands the City of Lake Elmo has nearly completed a municipal facilities
space needs assessment for its City Hall, Fire Station No. 1, and Fire Station No. 2. This study
investigated each building’s physical condition, assessed the space requirement needs for City
Hall and the Fire Department, as well as proposed several conceptual master plan options
which address the growing capital improvements required and solve the shortage of space for
each department. In doing so, creating a civic presence and improving or maintaining the Fire
Department response times were also examined.
Concurrent to the assessment, the City began negotiations for the purchase of the Brookfield
Office Building and its 2.5 acres adjacent to City Hall. An agreed purchase price is in place,
and they City has contracted with SEG to conduct a due diligence review of the building and
property prior to closing on the agreement.
PROJECT OBJECTIVE
Upon purchase, the City will be the landlord until the last of the existing leases expire in June of
2022. In the meantime, the City will move City Hall functions, less the Council Chambers, into
this building. The scope of our proposal is to synthesize all the programming and asset
evaluations completed to date, as it pertains to the Brookfield building and site, into a concept /
fit design and implementation plan. LEO A DALY proposes utilizing a client driven design
charrette process to create and develop up to three options for the site.
We have organized our proposal based upon assessing the results of the future open house,
affirming the space needs report, reviewing the site and building due diligence report,
developing concept alternatives, and presenting creative options to provide a road map for
funding and project delivery. Our approach is as follows:
PROJECT APPROACH
PART A – UNDERSTANDING OF THE EXISTING PHYSICAL CON DITIONS
· Collect and review previous studies from CEG and BKV.
· Analyze the site and its surrounding context in relation to parking, ingress, egress,
separation of user groups, and the civic presence of the site within the city.
· Conduct kick-off meeting to identify goals, schedules, and participants.
LEO A DALY
January 19, 2018
Kristina Handt
Page 2
PART B – FACILITY NEEDS CONFIRMATION (SPACE PROGRA M CONFIRMATION)
· Review and refine the existing program as it relates to possible city department
and staff located at the Brookfield building and site with key leadership.
PART C – CONCEPTS, COSTS, AND FUNDING (SYNTHESIS)
· Host design workshop / charrette with key staff which vets:
o Re-purposing the Brookfield building,
o Site concepts addressing proper site access for various users (general
public, city hall staff, fire department staff, etc.)
o Friendly parking strategies for users and neighbors alike.
o Complementary programmatic relationships inter-departmentally,
between the Brookfield building and any addition, and externally to
the site.
· Develop preliminary costs and implementation schedules.
· Package all information into a clear report for implementation.
· Present to key leadership and city council.
COMPENSATION
Lump Sum Fee: $4,750 (including reimbursable)
SCHEDULE
Part A: Start: February 12 (or upon notice to proceed)
Duration: One week after notice to proceed and receipt
of currant studies
Part B: Start: March 5, or upon completion of Part A
Duration: One to two weeks
Part C: Start: March 12 or March 19
Duration: Two to three weeks
If this meets with your approval, please contact Todd LaVold at LEO A DALY via mail or email
for contract development. We appreciate this opportunity and look forward to working with you.
Sincerely,
LEO A DALY
Todd LaVold
Associate, Senior Architect
tblavold@leoadaly.com
STAFF REPORT
DATE: February 7, 2018
CONSENT #8
AGENDA ITEM: Old Village Phase 3 Street, Drainage, and Utility Improvements - Change
Order No. 4
SUBMITTED BY: Jack Griffin, City Engineer
REVIEWED BY: Kristina Handt, City Administrator
Rob Weldon, Public Works Director
Chad Isakson, Project Engineer
ISSUE BEFORE COUNCIL: Should the City Council approve Change Order No. 4 for the Old Village
Phase 3 Street, Drainage, and Utility Improvements?
BACKGROUND: Douglas-Kerr Underground, LLC was awarded a construction contract to complete the
Old Village Phase 3 Street, Drainage, and Utility Improvements on May 16, 2017.
PROPOSAL DETAILS/ANALYSIS: Douglas-Kerr Underground, LLC has submitted a change order to
address additional work completed for the following items:
1. Revise storm sewer pipe size on 31st Street. Increased pipe capacity is required as part of the
stormwater treatment basin elimination, per the Valley Branch Watershed District permit.
2. Remove and dispose of a concrete pillar monument from 3200 Lake Elmo Avenue as ordered by
Washington County for work related to the Old Village Phase 2 project. Washington County will
reimburse Lake Elmo for the work through a credit on the Phase 2 project invoice.
3. Raise a City owned sanitary sewer manhole on Lake Elmo Elementary School property by adding
a barrel section to match the elevation with the final grading in the playground area.
FISCAL IMPACT: This change order will increase the contract in the amount of $5,386.40 bringing the
revised construction contract to $1,583,940.42. With this change order the project remains within the
authorized project budget and contingencies.
RECOMMENDATION: Staff is recommending that the City Council approve, as part of the Consent
Agenda, Change Order No. 4 for the Old Village Phase 3 Street, Drainage, and Utility Improvements. If
removed from the consent agenda, the recommended motion for the action is as follows:
“Move to approve Change Order No. 4 for the Old Village Phase 3 Street, Drainage, and Utility
Improvements, thereby increasing the contract amount by $5,386.40”.
ATTACHMENTS:
1. Change Order No. 4.
CHANGE ORDER NO. 4
OLD VILLAGE PHASE 3 IMPROVEMENTS
CITY OF LAKE ELMO, MINNESOTA
PROJECT NO. 2016.133
QUANTITY UNIT PRICE AMOUNT
CO4‐1 LF 112.0 $43.35 $4,855.20
CO4‐2 EACH 1.0 $1,740.05 $1,740.05
CO4‐3 LF ‐61.0 $37.85 ‐$2,308.85
CO4‐4 EACH ‐1.0 $1,470.00 ‐$1,470.00
CO4‐5 EACH 1.0 $450.00 $450.00
CO4‐6 LS 1.0 $2,120.00 $2,120.00
TOTALS ‐ CHANGE ORDER NO. 4 $5,386.40
THE CITY SANITARY SEWER MANHOLE ON LAKE ELMO ELEMENTARY
SCHOOL NEEDED TO BE RAISED AFTER FINAL GRADING WAS
COMPLETED.
ITEM DESCRIPTION OF PAY ITEM UNIT
CHANGE ORDER
24" RC PIPE
DESCRIPTION / JUSTIFICATION
24" RC PIPE APRON W/ TRASH GUARD
DISPOSE OF CONCRETE PILLAR MONUMENT
ADD BARREL SECTION TO SANITARY SEWER MANHOLE
REMOVE 21" RC PIPE SEWER, DES, 3006 CL III
REMOVE 21" RC PIPE APRON W/TRASH GUARD
ELIMATION OF THE STORMWATER TREATMENT BASIN ON 31ST STREET
RESULTED PIPE SIZE CHANGES TO BE IN COMPLIANCE WITH VALLEY
BRANCH WATERSHED DISTRICT PERMIT REQUIREMENTS.
REMOVE EXISTING PILLAR AT REQUEST OF WASHINGTON COUNTY.
COUNTY COMPENSATED FOR WORK ON OLD VILLAGE PHASE 2
INVOICING
STAFF REPORT
DATE: February 7, 2018
CONSENT #9
AGENDA ITEM: Old Village Phase 3: Street, Drainage and Utility Improvements – Pay
Request No. 6
SUBMITTED BY: Chad Isakson, Project Engineer
REVIEWED BY: Kristina Handt, City Administrator
Jack Griffin, City Engineer
ISSUE BEFORE COUNCIL: Should the City Council approve Pay Request No. 6 for the Old Village
Phase 3: Street, Drainage and Utility Improvements?
BACKGROUND: Douglas-Kerr Underground, LLC was awarded a construction contract on May 16,
2017 to complete the Old Village Phase 3: Street, Drainage and Utility Improvements.
PROPOSAL DETAILS/ANALYSIS: Douglas-Kerr Underground, LLC, has submitted Partial Pay
Request No. 6 in the amount of $84,294.63. The request has been reviewed and payment is recommended
in the amount requested. In accordance with the contract documents, the City has retained 5% of the total
work completed. The amount retained is $73,382.98.
FISCAL IMPACT: None. Partial payment is proposed in accordance with the Contract for the project.
Payment remains within the authorized scope and budget.
RECOMMENDATION: Staff is recommending that the City Council approve, as part of the Consent
Agenda, Pay Request No. 6 for the Old Village Phase 3: Street, Drainage and Utility Improvements project.
If removed from the consent agenda, the recommended motion for the action is as follows:
“Move to approve Pay Request No. 6 to Douglas-Kerr Underground, LLC in the amount of $84,294.63
for the Old Village Phase 3: Street, Drainage and Utility Improvements project”.
ATTACHMENTS:
1. Partial Pay Estimate No. 6.
PARTIAL PAY ESTIMATE NO. 6
OLD VILLAGE PHASE 3 IMPROVEMENTS
CITY OF LAKE ELMO, MINNESOTA
PROJECT NO. 2016.133
QUANTITY UNIT PRICE AMOUNT QUANTITY AMOUNT QUANTITY AMOUNT
1 LS 1
$58,045.95 $58,045.95 0.00 $0.00 0.75 $43,534.46
2 ACRE 1.15
$6,000.00 $6,900.00 0.00 $0.00 1.20 $7,200.00
3 TREE 42
$200.00 $8,400.00 0.00 $0.00 43.00 $8,600.00
4 LF 2884
$1.20 $3,460.80 228.00 $273.60 2,780.00 $3,336.00
5 LF 144
$11.45 $1,648.80 0.00 $0.00 101.00 $1,156.45
6 LF 440
$3.00 $1,320.00 33.00 $99.00 378.00 $1,134.00
7 EACH 1
$450.00 $450.00 0.00 $0.00 1.00 $450.00
8 SY 10246
$1.10 $11,270.60 0.00 $0.00 10,246.00 $11,270.60
9 SY 765
$3.75 $2,868.75 ‐269.00 ‐$1,008.75 744.80 $2,793.00
10 SY 300
$6.25 $1,875.00 86.00 $537.50 491.44 $3,071.50
11 EACH 3
$260.00 $780.00 0.00 $0.00 3.00 $780.00
12 EACH 14
$90.00 $1,260.00 3.00 $270.00 7.00 $630.00
13 EACH 6
$450.00 $2,700.00 0.00 $0.00 6.00 $2,700.00
14 LF 240
$3.50 $840.00 ‐91.00 ‐$318.50 157.50 $551.25
15 LF 610
$2.75 $1,677.50 452.00 $1,243.00 470.00 $1,292.50
16 LF 200
$27.00 $5,400.00 0.00 $0.00 165.00 $4,455.00
17 LF 100
$24.00 $2,400.00 0.00 $0.00 90.00 $2,160.00
18 EACH 8
$35.00 $280.00 5.00 $175.00 8.00 $280.00
19 EACH 5
$160.00 $800.00 0.00 $0.00 5.00 $800.00
20 EACH 26
$90.00 $2,340.00 14.00 $1,260.00 27.50 $2,475.00
21 SF 200
$23.00 $4,600.00 97.00 $2,231.00 132.00 $3,036.00
22 CY 12605
$10.85 $136,764.25 0.00 $0.00 12,605.00 $136,764.25
23 CY 467
$32.50 $15,177.50 0.00 $0.00 0.00 $0.00
24 CY 400
$29.85 $11,940.00 56.00 $1,671.60 77.60 $2,316.36
25 CY 7764
$19.00 $147,516.00 0.00 $0.00 7,764.00 $147,516.00
26 SY 1000
$1.50 $1,500.00 0.00 $0.00 4,791.30 $7,186.95
27 CY 2288
$31.95 $73,101.60 54.00 $1,725.30 2,342.00 $74,826.90
28 HOUR 40
$150.00 $6,000.00 31.50 $4,725.00 52.75 $7,912.50
29 GAL 501
$1.40 $701.40 80.00 $112.00 110.00 $154.00
30 TON 230
$101.00 $23,230.00 103.54 $10,457.54 253.26 $25,579.26
31 TON 590
$54.50 $32,155.00 0.00 $0.00 0.00 $0.00
32 TON 315
$63.00 $19,845.00 0.00 $0.00 0.00 $0.00
33 TON 790
$48.75 $38,512.50 789.11 $38,469.11 789.11 $38,469.11
34 TON 420
$56.25 $23,625.00 0.00 $0.00 420.85 $23,672.81
35 TON 170
$0.01 $1.70 121.54 $1.22 203.91 $2.04
36 LF 1400
$3.25 $4,550.00 0.00 $0.00 0.00 $0.00
37 LF 1600
$0.01 $16.00 0.00 $0.00 0.00 $0.00
38 EACH 1
$1,024.05 $1,024.05 0.00 $0.00 1.00 $1,024.05
39 EACH 1
$1,095.10 $1,095.10 0.00 $0.00 0.00 $0.00
40 EACH 2
$1,470.00 $2,940.00 0.00 $0.00 0.00 $0.00
41 EACH 2
$2,466.45 $4,932.90 0.00 $0.00 2.00 $4,932.90
42 LF 410
$0.01 $4.10 0.00 $0.00 0.00 $0.00
43 LF 1300
$10.50 $13,650.00 140.00 $1,470.00 1,100.00 $11,550.00
44 EACH 20
$175.00 $3,500.00 0.00 $0.00 0.00 $0.00
45 LF 3236
$35.10 $113,583.60 6.00 $210.60 3,236.00 $113,583.60
46 LF 125
$36.55 $4,568.75 0.00 $0.00 125.00 $4,568.75
47 LF 741
$32.60 $24,156.60 0.00 $0.00 678.00 $22,102.80
48 LF 350
$30.35 $10,622.50 3.00 $91.05 282.00 $8,558.70
49 LF 178
$37.85 $6,737.30 1.00 $37.85 117.00 $4,428.45
50 LF 101
$100.90 $10,190.90 0.00 $0.00 109.00 $10,998.10
51 EACH 2
$2,939.55 $5,879.10 0.00 $0.00 2.00 $5,879.10
52 EACH 7
$1,580.75 $11,065.25 0.00 $0.00 6.00 $9,484.50
53 EACH 8
$2,432.30 $19,458.40 0.00 $0.00 10.00 $24,323.00
54 EACH 2
$3,484.05 $6,968.10 0.00 $0.00 1.00 $3,484.05
55 EACH 1
$3,940.80 $3,940.80 0.00 $0.00 0.00 $0.00
56 EACH 1
$4,945.05 $4,945.05 0.00 $0.00 1.00 $4,945.05
57 EACH 21
$500.75 $10,515.75 0.00 $0.00 21.00 $10,515.75
58 EACH 9
$1,004.55 $9,040.95 0.00 $0.00 6.00 $6,027.30
59 EACH 4
$324.60 $1,298.40 0.00 $0.00 0.00 $0.00
60 EACH 1
$986.40 $986.40 0.00 $0.00 1.00 $986.40
61 EACH 4
$254.20 $1,016.80 0.00 $0.00 4.00 $1,016.80
62 EACH 5
$429.50 $2,147.50 0.00 $0.00 5.00 $2,147.50
63 LF 815
$11.05 $9,005.75 0.00 $0.00 869.00 $9,602.45
64 LF 760
$20.45 $15,542.00 0.00 $0.00 340.00 $6,953.00
65 LF 250
$9.70 $2,425.00 0.00 $0.00 254.00 $2,463.80
66 LF 290
$14.15 $4,103.50 7.00 $99.05 470.00 $6,650.50
67 EACH 36
$167.60 $6,033.60 0.00 $0.00 0.00 $0.00
68 EACH 14
$3,175.50 $44,457.00 0.00 $0.00 15.00 $47,632.50
69 LF 48
$137.15 $6,583.20 0.00 $0.00 49.18 $6,745.04
70 LF 3236
$1.25 $4,045.00 3,236.00 $4,045.00 3,236.00 $4,045.00
71 SY 120
$14.30 $1,716.00 0.00 $0.00 147.09 $2,103.39
72 LS 1
$25,028.00 $25,028.00 0.00 $0.00 1.00 $25,028.00
73 EACH 27
$279.20 $7,538.40 0.00 $0.00 27.00 $7,538.40
74 EACH 3
$726.45 $2,179.35 0.00 $0.00 2.00 $1,452.90
75 EACH 27
$362.85 $9,796.95 0.00 $0.00 27.00 $9,796.95
76 EACH 3
$839.00 $2,517.00 0.00 $0.00 3.00 $2,517.00
77 EACH 1
$390.95 $390.95 0.00 $0.00 1.00 $390.95
78 EACH 3
$1,025.40 $3,076.20 0.00 $0.00 3.00 $3,076.20
Clearing & Grubbing
Clearing & Grubbing
Salvage & Install Mailbox Assembly
Salvage & Install Pavers (Incl. Flagstone Steps & Wall)
Common Excavation (P)
Infiltration Basin Excavation (EV)
Subgrade Correction (EV)(Includes Select Granular Borrow ‐ Mod 5%)
Select Granular Borrow ‐ Mod. 5% (CV)(P)
Geotextile Fabric, Type V
Remove Water Main Pipe
Remove Sewer Pipe (Storm)
Remove Backstop Fence
Remove Concrete Curb & Gutter
Type SP 9.5 Wearing Course Mix (3,B)
1‐1/4" Curb Stop & Box
Pulverize Bituminous Pavement (P)
Remove Bituminous Driveway & Parking Lot Pavement
Remove Concrete Driveway Pavement
Remove Catch Basin or Manhole (Storm)
Salvage and Install Fence
Salvage Sign (Type C or Street Name Sign)
Remove Gate Valve & Box
Sawing Concrete Pavement (Full Depth)
ITEM DESCRIPTION OF PAY ITEM UNIT
CONTRACT THIS PERIOD TOTAL TO DATE
DIVISION 1
Mobilization
Sawing Bit Pavement (Full Depth)
Salvage Retaining Wall
Agg. Base, Cl. 6 (CV) (P)
Street Sweeping
Bit. Material for Tack Coat
Type SP 9.5 Wearing Course Mix (2,C) (Parking Lots, Driveways & Bike Trails
Remove Hydrant
Type SP 9.5 Wearing Course Mix (3,C)
Salvage & Install Sign Type C
Type SP 12.5 Wearing Course Mix (3,B)
Type SP 12.5 Wearing Course Mix (3,.C)
Bituminous Wedge Paving
Saw & Seal Joint (40' Intervals)
Pipe Foundation Rock
1‐1/4" HDPE Service Pipe
Sewer Televising
Construct Drainage Structure 2'x3' (w/ CasƟng)
4" PVC Perf. Edge Drain w/ Backfill & Wrap
Draintile Cleanout
8" PVC Pipe Sewer (SDR 26)
12" RC Pipe Sewer, Des 3006 CL V
15" RC Pipe Sewer, Des 3006 CL V
8"X6" PVC Wye, SDR 26
6" Clean‐Out Assembly (SCH 40)
2" Pressure Cleanout & CurbstopAssembly
Construct Drainage Structure Des. CC ‐ 48" (w/ CasƟng)
Construct Drainage Structure Des. CC ‐ 60" (w/ CasƟng)
Construct Drainage Structure Des. CC ‐ 72" (w/ CasƟng)
Construct Drainage Structure Des. CC ‐ 84" (w/ CasƟng)
8"X4" PVC Wye, SDR 26
6" PVC Sanitary Service Pipe ‐ Sch40
4" PVC Sanitary Service Pipe ‐ Sch40
2" HDPE Pressure Pipe
Tracer Wire Box ‐ (at property line)
Sanitary Sewer Manhole (10' Deep)
Sanitary Sewer Manhole Extra Depth
2"x1‐1/4" Fused Tee
15" RC Pipe Apron w/Trash Guard
18" RC Pipe Apron w/Trash Guard
21" RC Pipe Apron w/Trash Guard
36" Span RC Pipe‐Arch Apron w/Trash Guard
Infiltration Basin Underdrain System
18" RC Pipe Sewer, Des 3006 CL V
21" RC Pipe Sewer, Des 3006 CL III
36" Span RC Pipe‐Arch Sewer CL IIA
Connect to Existing Sanitary Sewer
2" Rigid Insulation
Temporary Water Service
1" Corporation Stop
2" Corporation Stop
1" Curb Stop & Box
2" Curb Stop & Box
8" x 1 ‐1/4" Saddle Tap
Connect to Existing Water Main
QUANTITY UNIT PRICE AMOUNT QUANTITY AMOUNT QUANTITY AMOUNT
ITEM DESCRIPTION OF PAY ITEM UNIT
CONTRACT THIS PERIOD TOTAL TO DATE
79 EACH 34
$382.35 $12,999.90 0.00 $0.00 32.00 $12,235.20
80 EACH 8
$4,199.10 $33,592.80 0.00 $0.00 11.00 $46,190.10
81 EACH 14
$1,586.10 $22,205.40 0.00 $0.00 15.00 $23,791.50
82 EACH 8
$2,036.45 $16,291.60 0.00 $0.00 8.00 $16,291.60
83 EACH 4
$3,023.65 $12,094.60 0.00 $0.00 4.00 $12,094.60
84 LF 1095
$9.20 $10,074.00 0.00 $0.00 1,181.00 $10,865.20
85 LF 90
$22.95 $2,065.50 0.00 $0.00 60.00 $1,377.00
86 LF 394
$24.45 $9,633.30 0.00 $0.00 267.00 $6,528.15
87 LF 2424
$32.30 $78,295.20 0.00 $0.00 2,441.00 $78,844.30
88 LF 892
$60.95 $54,367.40 0.00 $0.00 892.00 $54,367.40
89 LB 3606
$3.25 $11,719.50 0.00 $0.00 3,726.00 $12,109.50
90 CY 40
$115.00 $4,600.00 0.00 $0.00 33.00 $3,795.00
91 SF 5100
$4.90 $24,990.00 0.00 $0.00 5,083.00 $24,906.70
92 SF 480
$6.10 $2,928.00 0.00 $0.00 709.90 $4,330.39
93 LF 365
$19.00 $6,935.00 6.00 $114.00 165.50 $3,144.50
94 LF 5525
$12.25 $67,681.25 0.00 $0.00 5,518.00 $67,595.50
95 SY 300
$47.75 $14,325.00 2.00 $95.50 423.30 $20,212.58
96 SY 125
$55.75 $6,968.75 10.00 $557.50 118.80 $6,623.10
97 SF 72
$30.00 $2,160.00 0.00 $0.00 92.50 $2,775.00
98 LS 1
$2,300.00 $2,300.00 0.75 $1,725.00 0.75 $1,725.00
99 SF 21
$43.50 $913.50 0.00 $0.00 21.00 $913.50
100 EACH 3
$495.00 $1,485.00 0.00 $0.00 1.00 $495.00
101 LF 2400
$1.25 $3,000.00 0.00 $0.00 715.00 $893.75
102 EACH 23
$125.00 $2,875.00 0.00 $0.00 30.00 $3,750.00
103 CY 125
$39.50 $4,937.50 0.00 $0.00 0.00 $0.00
104 CY 1500
$24.75 $37,125.00 741.90 $18,362.03 920.23 $22,775.69
105 SY 6300
$5.25 $33,075.00 0.00 $0.00 5,190.00 $27,247.50
106 ACRE 2
$1,108.00 $2,216.00 0.00 $0.00 0.00 $0.00
107 ACRE 0.2
$777.00 $155.40 0.00 $0.00 0.00 $0.00
108 SY 2400
$1.35 $3,240.00 0.00 $0.00 2,200.00 $2,970.00
109 LF 800
$2.10 $1,680.00 0.00 $0.00 160.00 $336.00
110 LF 700
$15.50 $10,850.00 0.00 $0.00 630.00 $9,765.00
111 EACH 4
$1,400.00 $5,600.00 0.00 $0.00 0.00 $0.00
$1,576,039.15 $88,731.19 $1,431,607.58
TOTALS ‐ BASE CONTRACT $1,576,039.15 $88,731.19 $1,431,607.58
CHANGE ORDER NO. 1
CO1‐1 CY ‐467.0 $32.50 ‐$15,177.50 0.00 $0.00 0.0 $0.00
CO1‐2 EACH ‐1.0 $1,024.05 ‐$1,024.05 0.00 $0.00 0.0 $0.00
CO1‐3 EACH ‐1.0 $1,470.00 ‐$1,470.00 0.00 $0.00 0.0 $0.00
CO1‐4 LF ‐410.0 $0.01 ‐$4.10 0.00 $0.00 0.0 $0.00
CO1‐5 CY ‐125.0 $39.50 ‐$4,937.50 0.00 $0.00 0.0 $0.00
CO1‐6 LF 230.0 $68.90 $15,847.00 0.00 $0.00 236.0 $16,260.40
CO1‐7 EACH 3.0 $1,299.50 $3,898.50 0.00 $0.00 3.0 $3,898.50
CO1‐8 EACH ‐3.0 $1,004.55 ‐$3,013.65 0.00 $0.00 0.0 $0.00
CO1‐9 EACH ‐4.0 $324.60 ‐$1,298.40 0.00 $0.00 0.0 $0.00
CO1‐10 LF ‐460.0 $20.45 ‐$9,407.00 0.00 $0.00 0.0 $0.00
TOTALS ‐ CHANGE ORDER NO. 1 ‐$16,586.70 $0.00 $20,158.90
CHANGE ORDER NO. 2
CO2‐1 AC 2.0 $3,450.00 $6,900.00 0.00 $0.00 1.07 $3,691.50
CO2‐2 LS 1.0 $650.00 $650.00 0.00 $0.00 1.0 $650.00
CO2‐3 CY 20.0 $88.00 $1,760.00 0.00 $0.00 20.0 $1,760.00
CO2‐4 LF 15.0 $51.70 $775.50 0.00 $0.00 15.0 $775.50
TOTALS ‐ CHANGE ORDER NO. 2 $10,085.50 $0.00 $6,877.00
CHANGE ORDER NO. 3
CO3‐1 HR 9.0 $900.00 $8,100.00 0.00 $0.00 9.00 $8,100.00
CO3‐2 LS 1.0 $391.15 $391.15 0.00 $0.00 1.0 $391.15
CO3‐3 EA 1.0 $524.92 $524.92 0.00 $0.00 1.0 $524.92
TOTALS ‐ CHANGE ORDER NO. 3 $9,016.07 $0.00 $9,016.07
TOTALS ‐ REVISED CONTRACT $1,578,554.02 $88,731.19 $1,467,659.55
CONTRACTOR CREW TIME
SERVICE PIPE MATERIALS
HYDRANT EXTENSION
MULCH
BLACK VINYL COATED FENCE
B618 Concrete Curb & Gutter
6" Concrete Driveway Pavement
8" Concrete Driveway Pavement
Seeding (Seed Mixture Type 25‐131)
Seeding (Seed Mixture Type Basin)
Erosion Control Blanket Category 3N
Sediment Control Log
6' Wide Agg. Lime Walking Trail
Temporary Rock Construction Entrance
Truncated Domes
Traffic Control
Sign Panels, Type C
Sign, Type Special (Street Name)
Silt Fence, Preassembled
Storm Drain Inlet Protection
Filter Topsoil Borrow (Pulverized) (LV)
Common Topsoil Borrow (Pulverized) (LV)
Sodding, Type Mineral
8" C900 PIPE SEWER
REMOVE 8"X6" PVC WYE, SDR 26
8" Water Main DIP ‐ CL 52 (Poly Encased)
16" Water Main DIP ‐ CL 52 (Poly Encased)
Water Main Fittings
Random Rip‐Rap, Class III (includes Geotextile Fabric)
5" Concrete Walk
6" Concrete Walk ‐ Pedestrian Ramp
B612 Concrete Curb & Gutter
BONDED FIBER MATRIX MULCH
REMOVE INFILTRATION BASIN UNDERDRAIN SYSTEM
REMOVE FILTER TOPSOIL BORROW (PULVERIZED) (LV)
REMOVE 6" PVC SANITARY SERVICE PIPE ‐ SCH 40
8"X6" C900 WYE
REMOVE INFILTRATION BASIN EXCAVATION (EV)
REMOVE SHED
REMOVE 15" RC PIPE APRON W/TRASH GUARD
SUBTOTAL ‐ DIVISION 1
REMOVE 6" CLEAN‐OUT ASSEMBLY (SCH 40)
REMOVE 21" RC PIPE APRON W/TRASH GUARD
Hydrant
6" Gate Valve & Box
8" Gate Valve & Box
16" Butterfly Valve & Box
1" Type K Copper Pipe
2" Type K Copper Pipe
6" Water Main DIP ‐ CL 52 (Poly Encased)
Connect to Existing Water Service
STAFF REPORT
DATE: February 7, 2018
CONSENT
ITEM #: 10
AGENDA ITEM: Private Development Projects – Approve Security Reductions for Easton
Village 2nd Addition and Easton Village 3rd Addition
SUBMITTED BY: Jack Griffin, City Engineer
REVIEWED BY: Kristina Handt, City Administrator
Emily Becker, Planning Director
Chad Isakson, Assistance City Engineer
ISSUE BEFORE COUNCIL: Should the City Council approve security reductions for the Easton Village
2nd Addition and Easton Village 3rd Addition?
PROPOSAL DETAILS/ANALYSIS: Staff has received and processed requests to reduce the
development security in accordance with the various development projects. These requests have been
reviewed and the following reductions are being recommended for approval:
Current Security Amount Proposed Security Amount
1. Easton Village 2nd Addition: $ 702,776 $371,223
2. Easton Village 3rd Addition: $1,104,400 $627,894
Work within each of these developments have progressed in accordance with the respective development
agreement and to the extent necessary to support a reduction in the security as detailed in the attached
Security Reduction Worksheets.
FISCAL IMPACT: It is the City’s goal to retain at all times during the subdivision improvements a
security amount that is adequate to ensure completion of all elements of the improvements as protection to
the City tax payers against the potential of developer default. With this reduction, the remaining security
amount held by the City remains sufficient to complete the remaining improvements.
RECOMMENDATION: Staff is recommending that the City Council approve, as part of the Consent
Agenda, the security reductions for the Easton Village 2nd Addition and Easton Village 3rd Addition as
detailed in this report and supporting documentation. If removed from the consent agenda, the
recommended motion for the action is as follows:
“Move to approve security reductions for the Easton Village 2nd Addition and Easton Village 3rd
Addition as detailed in the attached Security Reduction Worksheets.”
ATTACHMENTS:
1. Security Reduction Worksheet – Easton Village 2dn Addition.
2. Security Reduction Worksheet – Easton Village 3rd Addition.
EASTON VILLAGE 2ND ADDITION October 31, 2017
DEVELOPMENT AGREEMENT AMOUNTS
CATEGORY CONSTRUCTION 125% REMARKS #1 #2 #3 #4 #5 #6
Grading $238,969 $298,711.25 $298,711
Grading $38,286 $47,858 $47,858
Sanitary Sewer $54,276 $67,845 $50,884
Watermain $60,848 $76,059 $57,045
Storm Sewer $54,920 $68,650 $34,325
Streets and Sidewalks $226,308 $282,885 $141,443
Trails $12,570 $15,713
Surface Water Facilities $0 $0 included in Grading Agreement
Street Lighting $48,000 $60,000 By Xcel Energy
Street Signs and Traffic Control Signs $700 $875
Private Utilities (electricity, natural gas, telephone, and cable)
Landscaping $46,008 $57,510
Tree Preservation and Restoration NA NA included in Grading Agreement
Wetland Mitigation and Buffers NA NA LOC Through VBWD
Monuments $1,900 $2,375
Erosion Control $15,406 $19,257 included in Grading Agreement
Misc. $0 $0 None
Record Drawings $3,000 $3,750
TOTALS $562,221 $702,776 RELEASED AMOUNTS:$0 $331,553 $0 $0 $0 $0
CUMMULATIVE AMOUNTS:$0 $331,553
SECURITY AMOUNT REMAINING:$702,776 $371,223
DATE:10/17/2017 2/7/2018
Time of Performance:
REDUCTIONS
EASTON VILLAGE 3RD ADDITION October 31, 2017
DEVELOPMENT AGREEMENT AMOUNTS
CATEGORY CONSTRUCTION 125% REMARKS #1 #2 #3 #4 #5 #6
Grading $196,245 $245,306 $245,306
Sanitary Sewer $118,179 $147,724 $110,793
Watermain $128,435 $160,544 $120,408
Storm Sewer $118,267 $147,834
Streets and Sidewalks $157,590 $196,988
Trails $14,600 $18,250
Surface Water Facilities $0 $0 included in Grading Agreement
Street Lighting $12,000 $15,000 By Xcel Energy
Street Signs and Traffic Control Signs $1,850 $2,313
Private Utilities (electricity, natural gas, telephone, and cable)
Landscaping $98,573 $123,216
Tree Preservation and Restoration NA NA included in Grading Agreement
Wetland Mitigation and Buffers NA NA LOC Through VBWD
Monuments $2,800 $3,500
Erosion Control $29,982 $37,477 included in Grading Agreement
Misc. $0 $0 None
Record Drawings $5,000 $6,250
TOTALS $883,520 $1,104,400 RELEASED AMOUNTS:$476,507 $0 $0 $0 $0 $0
CUMMULATIVE AMOUNTS:$476,507
SECURITY AMOUNT REMAINING:$627,894
DATE:2/7/2018
Time of Performance:
REDUCTIONS
STAFF REPORT
DATE: February 6, 2018
CONSENT
ITEM #: 11
AGENDA ITEM: 5th Street North – Resolution Authorizing MnDOT to Perform Speed Zone Study
SUBMITTED BY: Jack Griffin, City Engineer
REVIEWED BY: Kristina Handt, City Administrator
Rob Weldon, Public Works Director
Chad Isakson, Assistant City Engineer
ISSUE BEFORE COUNCIL: Should the City Council request a speed zone study to determine the
reasonable and safe speed limit on 5th Street North from Inwood Avenue North (CSAH13) to Keats Avenue
North (CSAH19)?
BACKGROUND, PROPOSAL DETAILS/ANALYSIS: 5th Street North from Inwood Avenue
(CSAH13) to Manning Avenue (CSAH15), along with Hudson Boulevard, will be the backbone to support
the development along the I94 corridor, essentially becoming the primary access in and out of the residential
neighborhoods and commercial properties. As such, the construction of 5th Street has adhered to specific
design standards established by the City, including Municipal State Aid standards.
The portion of 5th Street North from Inwood Avenue (CSAH13) and Keats Avenue (CSAH19) has been
constructed through the various development projects and vehicles may now travel the full length of the
road segment. The street was constructed using a 40 mph “design” speed. However, in order to place speed
limit signs along this segment of 5th Street, the City must request an engineering and traffic investigation
to determine the “posted” speed limit.
Under Minnesota Statue Section 169.14, the authority to determine the safe and reasonable speed (posted
speed limit) on a roadway resides with the Commissioner of the Minnesota Department of Transportation
(MnDOT). As the local roadway authority, the City must pass a resolution requesting MnDOT to perform
this investigation. Once the investigation is complete, the City must post the speed limit based on the study’s
conclusions.
FISCAL IMPACT: None. There is no cost to have MnDOT perform the engineering and traffic
investigation.
RECOMMENDATION: Staff is recommending that the City Council approve, as part of the consent
agenda, a request to have the Minnesota Commissioner of Transportation perform an engineering and
traffic investigation to determine the reasonable and safe speed limit on 5th Street North. If removed from
the consent agenda, the recommended motion for the action is as follows:
“Move to approve Resolution No. 2018-015 authorizing the Minnesota Commissioner of
Transportation to perform an engineering and traffic investigation to determine the reasonable and
safe speed limit on 5th Street North from Inwood Avenue (CSAH13) to Keats Avenue (CSAH19).
ATTACHMENTS:
1. Resolution Authorizing MnDOT to perform Speed Zone Study.
CITY OF LAKE ELMO
WASHINGTON COUNTY
STATE OF MINNESOTA
RESOLUTION NO. 2018-015
A RESOLUTION AUTHORIZING THE MINNESOTA COMMISSIONER
OF TRANSPORTATION TO PERFORM AN ENGINEERING AND
TRAFFIC INVESTIGATION TO DETERMINE THE REASONABLE AND
SAFE SPEED LIMIT ON 5TH STREET NORTH BETWEEN INWOOD
AVENUE NORTH (CSAH13) AND KEATS AVENUE NORTH (CSAH19)
WHEREAS, 5th Street North, from Inwood Avenue North to Keats Avenue North, is a newly
constructed neighborhood collector street to serve new development, and
WHEREAS, it is in the best interest of all parties to establish a reasonable and safe speed to be
posted along this road segment, and
WHEREAS, under Minnesota Statue Section 169.14, the authority to determine the safe and
reasonable speed on a roadway resides with the Commissioner of the Minnesota Department of
Transportation (MnDOT), and
WHEREAS, the local authority having jurisdiction of the roadway may request such an
investigation to be performed.
NOW, THEREFORE, BE IT RESOLVED,
1. That the City Council of the City of Lake Elmo hereby requests the Minnesota Commissioner of
Transportation to perform an engineering and traffic investigation to determine the reasonable and
safe speed limit on 5th Street North from Inwood Avenue North (CSAH13) to Keats Avenue North
(CSAH19).
2. That the City of Lake Elmo agrees to support the conclusions of the study and the implementation
of such conclusion.
ADOPTED BY THE LAKE ELMO CITY COUNCIL ON THE SIXTH DAY OF FEBRUARY 2018.
CITY OF LAKE ELMO
By: __________________________
Mike Pearson
Mayor
(Seal)
ATTEST:
________________________________
Julie Johnson
City Clerk
STAFF REPORT
DATE: February 7, 2018
CONSENT
ITEM #: 12
TO: City Council
FROM: Greg Malmquist, Fire Chief
AGENDA ITEM: DONATION POLICY FOR THE CITY of LAKE ELMO
REVIEWED BY: Kristina Handt, City Administrator
BACKGROUND:
In 2016 a new law went into effect that allows cities to donate surplus property to non-profits. To date the
City of Lake Elmo has not had a Donation Policy. The proposed Policy and Donation Form are from an
approved template from the League of MN Cities.
ISSUE BEFORE COUNCIL:
Should the Council approve the “City of Lake Elmo, Minnesota, Policy for Donation of Surplus
Equipment to a Nonprofit Organization”?
PROPOSAL DETAILS/ANALYSIS:
Before surplus equipment can be donated, a city must adopt a policy on how it will determine what
equipment is surplus eligible for donation and how it will determine which nonprofit organizations may
receive donations. In addition, the policy must address the obligations of the local government to disclose
to the nonprofit that the surplus equipment may be defective and cannot be relied upon for safety purposes.
The policy lays out the procedure for donating and the form to be signed by the non-profit includes a
disclaimer so that these provisions of the law are met.
FISCAL IMPACT:
None
OPTIONS:
1) Approval Policy
2) Do not approve the policy
RECOMMENDATION:
If removed from the consent agenda:
“Motion to approve the City of Lake Elmo, Minnesota, Policy for Donation of Surplus Equipment to a
Nonprofit Organization.”
ATTACHMENTS:
• City Lake Elmo, Minnesota, Policy for Donation of Surplus Equipment to a Nonprofit
Organization
2/1/2018 1
City of Lake Elmo, Minnesota
Policy for Donation of Surplus Equipment to a Nonprofit Organization
Purpose
The purpose of this Policy is to establish procedures for the Donation of Surplus Equipment by
the City to a Nonprofit Organization as required by Minnesota Statue § 471.3459.
Scope
This policy applies to all City departments that generate Surplus Equipment and governs the
actions of all City employees and officials.
Definitions
“City” means the City of Lake Elmo, Minnesota.
“City Council” means the governing body of the City.
“Donation” means to contribute, donate or give Surplus Equipment at no cost to a Nonprofit
Organization that serves a public purpose and benefits its community as a whole.
“Eligible Organization” means a Nonprofit Organization serving one or more of the following
functions: cultural, historical, educational, safety, social services, environmental or economic.
“Fair Market Value” means the price at which property would change hands between a willing
buyer and a willing seller, neither being under any compulsion to buy or to sell and both having
reasonable knowledge of all relevant facts.
“Nonprofit Organization” means an organization formed under Section 501(c)(3) of the Internal
Revenue Code.
“Policy” means this Policy adopted by the City Council.
“Surplus Equipment” means equipment used by the City’s public works department, and cellular
phones and emergency medical and firefighting equipment that is no longer needed by the City
because it does not meet industry standards for emergency medical services, police, or fire
departments or has minimal or no resale value.
“Surplus Equipment Form” means the form attached as Exhibit I to this Policy that must be filled
out by a Nonprofit Organization requesting a Donation of Surplus Equipment.
2/1/2018 2
Procedure
The City shall determine all Surplus Equipment and may offer it for Donation in conformance
with the following guidelines:
1. Identify Surplus Equipment. Department supervisors are responsible for monitoring their
equipment and shall identify and report all Surplus Equipment to the City Administrator on at
least an annual basis.
2. Determine the Fair Market Value of Surplus Equipment. The City Administrator shall work
with City staff to determine the Fair Market Value of the Surplus Equipment.
3. City Council Declaration. The City Administrator will forward a list of the Surplus Equipment
with each item’s Fair Market Value to the City Council who shall approve or deny the Surplus
Equipment as eligible for Donation. The City has no obligation to make a Donation of Surplus
Equipment. Surplus Equipment that is not donated may be sold, recycled or discarded in the
discretion of the City Administrator.
4. Donation. After the City Council has determined the Surplus Equipment is eligible for
Donation, the City Administrator is responsible for coordinating the Donation of the Surplus
Equipment in accordance with the terms of this Policy.
5. Transfer between Departments. All Surplus Equipment must first be considered for transfer
between departments for the benefit of the City.
6. Advertisement. Surplus Equipment shall be posted as eligible for Donation on the City’s
website. The City may also use other reasonable means to notify Eligible Organizations about
the availability of Surplus Equipment. The City shall wait at least 30 days after advertising
Surplus Equipment before approving any Donation.
7. Surplus Equipment Form. Eligible Organizations interested in Surplus Equipment shall fill out
a Surplus Equipment Form and submit the form to the City Administrator.
8. Approval of Donation. If the Surplus Equipment has a Fair Market Value less than $500.00,
the City Administrator shall approve the Donation to an Eligible Organization, subject to review
by the City Council. If the Surplus Equipment has a Fair Market Value greater than $500.00, the
City Council must approve the donation by a majority vote of the City Council.
9. Prioritization of Donations. If more than one Eligible Organizations requests a Donation for
the same Surplus Equipment, the City shall consider factors it deems relevant including how the
Surplus Equipment will be used, the benefit to the Eligible Organization, the impact on the City,
how the Donation will accomplish goals of the City Council, and any previous Donation to the
Eligible Organization.
10. Conflict of Interest. All City employees and officials are prohibited from taking possession of
any Surplus Equipment on behalf of an Eligible Organization.
2/1/2018 3
11. As Is. A Donation of Surplus Equipment is made “as is” with no warranty, guarantee or
representation of any kind, express or implied, as to the condition, utility, or usability of the
Surplus Equipment offered. The Surplus Equipment may be defective and cannot be relied upon
for safety purposes.
12. Title. The City Administrator shall cause any title or other ownership documents to be
transferred to the Eligible Organization at the time of transfer. Any fees required to transfer the
Surplus Equipment are the responsibility of the Eligible Organization.
13. Transportation. In the Surplus Equipment Form, the Eligible Organization must provide a
detailed plan for transporting the Surplus Equipment from the City to the Eligible Organization.
The Eligible Organization must pay all expenses associated with the transportation of the Surplus
Equipment.
14. Delegation. The City Administrator may delegate specific responsibilities for implementing
this Policy.
15. Documentation. The City Clerk shall document the Donation of all Surplus Equipment and
shall keep such records in accordance with the City’s Records Retention Schedule.
16. Review of Policy. The City Administrator is responsible for maintaining and reviewing this
Policy. Any changes to this Policy must be approved by the City Council.
2/1/2018 4
Exhibit I
Surplus Equipment Form
Organization Name: _______
Organization Address:
_______
_______
Organization Website: _______
(Attach proof of status as a nonprofit corporation under Section 501(c)(3) of the Internal
Revenue Code.)
Organization Purpose: _______
Point of Contact
Name: _______
Address: _______
_______
Email: _______
Phone: _______
City Surplus Equipment of Interest: _______
How will the requested Surplus Equipment benefit your organization?
_______
How do you plan to transport the surplus property from the City to your location?
_______
DISCLAIMER OF WARRANTIES. The City makes no agreement, warranty or representation,
either express or implied, as to the value, design, condition, merchantability or fitness for any
particular purpose or use of the Surplus Equipment by the recipient or any other user.
The recipient acknowledges the Surplus Equipment may be defective and that it cannot be relied
upon for safety purposes. The recipient has a duty to inspect the Surplus Equipment before it is
used for any purpose.
The recipient acknowledges that the City is not a manufacturer of the Surplus Equipment or a
dealer therein; that the Surplus Equipment is being provided “as-is” and “with all faults,” it being
2/1/2018 5
agreed and understood that all of the aforementioned risks are to be borne by the recipient or user
of the Surplus Equipment.
In no event shall the City be liable for any damages in connection with or arising out of the
recipient’s or any other person’s or entity’s use of the Surplus Equipment.
I acknowledge that the Donation of any Surplus Equipment to my organization is subject to the
City’s Policy for Donation of Surplus Equipment to a Nonprofit Organization.
I have authority to request a Donation from the City and to bind my organization to the terms of
this form.
Signature of Applicant _____________________________________
Date _______