“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”

OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENTFACILITIES 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-0346-13

OSHPD Preapproval of Manufacturer’s Certification (OPM)

Type: New Renewal Update to Pre-CBC 2013 OPA Number:

Manufacturer Information

Manufacturer: Omnicell, Inc.

Manufacturer’s Technical Representative: Chris Muir

Mailing Address: 590 E. Middlefield Road, Mountain View, CA 94043

Telephone: (650) 251-6329 Email: chrism@omnicell.com

Product Information

Product Name: Tall Frame

Product Type: Automated Medication Dispensing Cabinets

Product Model Number: One-cell, two-cell and three-cell cabinets

General Description: Medication storage and dispensing cabinets.

Applicant Information

Applicant Company Name: Omnicell, Inc.

Contact Person: Chris Muir

Mailing Address: 590 E. Middlefield Road, Mountain View, CA 94043

Telephone: (650) 251-6329 Email: chrism@omnicell.com

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: 5/22/2017

Title: Engineer Company Name: Omnicell, Inc.

08/08/2017 OPM-0346-13: Reviewed for Code Compliance by William Staehlin Page 1 of 10

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“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”

OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENTFACILITIES 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: Degenkolb Engineers

Name: Adrian M. Nacamuli California License Number: S 4857

Mailing Address: 1300 Clay Street, Suite 900, Oakland, CA 94612

Telephone: (510) 250-1216 Email: nacamuli@degenkolb.com

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 1950-15

Other* (Please Specify):

*Use of criteria other than those adopted by the California Building Standards Code, 2016 (CBSC 2016) for componentsupports 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: 08-08-2017

Print Name: William Staehlin

Title: SSE

Condition of Approval (if applicable):

08/08/2017 OPM-0346-13: Reviewed for Code Compliance by William Staehlin Page 2 of 10

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