“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs” OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY OSH-FD-700 (REV 12/16/15) Page 1 of 2 APPLICATION FOR OSHPD PREAPPROVAL OF MANUFACTURER’S CERTIFICATION (OPM) OFFICE USE ONLY APPLICATION #: OPM-0375-13 OSHPD Preapproval of Manufacturer’s Certification (OPM) Type: New Renewal Update to Pre-CBC 2013 OPA Number: Manufacturer Information Manufacturer: Plexus Manufacturer’s Technical Representative: Daniel Schraufnagel Mailing Address: 55 Jewelers Park Drive, Neenah, WI. 54956 Telephone: On File Email: On File Product Information Product Name: Cerner RX Station Product Type: Other Electrical & Mechanical Elements Product Model Number: N/A General Description: Automated Medication Dispensing Cabinet Applicant Information Applicant Company Name: EASE Co. Contact Person: Jonathan Roberson, S.E. Mailing Address: 5877 Pine Ave. Suite 210, Chino Hills, CA. 91709 Telephone: (909) 606-7622 Email: [email protected]I hereby agree to reimburse the Office of Statewide Health Planning and Development review fees in accordance with the California Administrative Code, 2016. Signature of Applicant: Date: 8/29/16 Title: Principal Engineer Company Name: EASE Co. d d i i c c c c h a a h a a a a a a t t n i n c c c c h a h a a d D l a d D n ic D E n c i E ca E a at e c ti e c m a m a m l e e E e D E D E n D l n i t e s e E s E m m m m m m e m m C e a a C e a C n i n l t : i s b s b s E i E m m C m O C m O C a t a a i b b : i t O O ical Elements nical Elements on Dispensing Cabinet ion Dispensing Cabinet nah, WI. 54956 Email: On File on & Mec ed Med M enah, WI. 54956 o & ed Email: On c d & M Me n O File e M William Staehlin OPM-0375-13 10/05/2017 // 10/05/2017 OPM-0375-13: Reviewed for Code Compliance by William Staehlin Page 1 of 14
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OSHPD PREAPPROVAL OF MANUFACTURER'S CERTIFICATION (OPM) · William StaehlinWWilli StWilliam StaWillliam Sla SStaehlinS aaeaehlaehhlhlliliinin OPM-0375-135 10/05/2017/ 200 10/05/2017
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“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYOSH-FD-700 (REV 12/16/15) Page 1 of 2
APPLICATION FOR OSHPD PREAPPROVAL OF MANUFACTURER’S CERTIFICATION (OPM)
OFFICE USE ONLY
APPLICATION #: OPM-0375-13
OSHPD Preapproval of Manufacturer’s Certification (OPM)
Type: New Renewal Update to Pre-CBC 2013 OPA Number:
Manufacturer Information
Manufacturer: Plexus
Manufacturer’s Technical Representative: Daniel Schraufnagel
Mailing Address: 55 Jewelers Park Drive, Neenah, WI. 54956
Telephone: On File Email: On File
Product Information
Product Name: Cerner RX Station
Product Type: Other Electrical & Mechanical Elements
Product Model Number: N/A
General Description: Automated Medication Dispensing Cabinet
Applicant Information
Applicant Company Name: EASE Co.
Contact Person: Jonathan Roberson, S.E.
Mailing Address: 5877 Pine Ave. Suite 210, Chino Hills, CA. 91709
I hereby agree to reimburse the Office of Statewide Health Planning and Development review fees in accordance with the California Administrative Code, 2016.
Signature of Applicant: Date: 8/29/16
Title: Principal Engineer Company Name: EASE Co.
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10/05/2017 OPM-0375-13: Reviewed for Code Compliance by William Staehlin Page 1 of 14
“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT DIVISION
STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCYOSH-FD-700 (REV 12/16/15) Page 2 of 2
Registered Design Professional Preparing Engineering Recommendations
Company Name: EASE Co.
Name: Jonathan Roberson, S.E. California License Number: S4197
Mailing Address: 5877 Pine Ave. Suite 210, Chino Hills, CA. 91709
OSHPD Special Seismic Certification Preapproval (OSP)
Special Seismic Certification is preapproved under OSP-(Separate application for OSP is required)
Special Seismic Certification is not preapproved
Certification Method(s)
Testing in accordance with: ICC-ES AC156 FM 1950-16
Other* (Please Specify):
*Use of criteria other than those adopted by the California Building Standards Code, 2016 (CBSC 2016) for component supports and attachments are not permitted. For distribution system, interior partition wall, and suspended ceiling seismic bracings, test criteria other than those adopted in the CBSC 2016 may be used when approved by OSHPD prior to testing.
Analysis
Experience Data
Combination of Testing, Analysis, and/or Experience Data (Please Specify):
List of Attachments Supporting the Manufacturer’s Certification
Test Report Drawings Calculations Manufacturer’s Catalog
Other(s) (Please Specify):
OFFICE USE ONLY – OSHPD APPROVAL VALID FOR CBC 2016 & ALL PRE-2016 CODE BASED PROJECTS
Signature: Date: 10-05-2017
Print Name: William Staehlin
Title: SSE
Condition of Approval (if applicable):
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