Looks like the digestive cycle dont you . [laughter] maybe these are kidneys. [laughter] i do want you are learning our language. Maybe its just conscious. Commissioners, youve been with greg now for probably almost an hour and so i do want to recognize that the depth of his knowledge of all of these areas and his leadership in this area and weve worked hard at ensuring the stabilization of the Department Around capital pieces its a sharing economy in the department where we really want to focus on our Service System so our patients and our staff will have Safe Building and weve also given up three times our ability to move this building to ensure that people here also have than opportunity so i think were the closest because one of my jobs was moving out of this building when i first started over 20 years ago and again its a volatile sometimes process and especially if the economy changes but i think were very, very close for having this solid plan for this and i am very hopeful that we can and to all this planning were doing but i want to acknowledge all the staff who behind us are doing some incredible lifting and right after two hospitals being built wore back right at doing more capitol projects and were Getting Better at the management of those and also really managing the financially so i just wanted to acknowledge greg s leadership our c. F. O. Regarding that relationship. It also does and i sit on the committee that reports out all of the city capitol projects and ace watch you know some of the departments were very highly regarded of our ability to operate all of our capitol projects and getting them out the door so we hope it continues that reputation so that well be seen as an project to move on and having people in Safe Buildings is a real goal we all have. Can i followup with one last question, first of all, no rest for the weary but thank you so much and i really appreciate all the work and answering our questions and youve been getting us to this point with so many projects like the a. H. R. So with regards to capitol projects , how much are we at risk with regards to the operational budget if there are building capitol over runs are we responsible for the whole projector just the operational aspects of decanting buildings and the staff or if the building costs 10 or 20 million more than most does it come out of our general Fund Allocation because i want to know how much risk we have around the building. Interview so the short answer is were not going to put ourselves in a scenario where we have to face that decision. Its a real issue and we learned that the regard way overtime over starting with the San FranciscoGeneral Hospital bonds and we put a lot of oversight in place to make sure that we dont end up in a situation where we go out and borrow money through a geo bond and run out of dollars to complete the scope that we said we were going to complete so our approach and our policy now is that we make an investment up front to do the planning and the estimating and we appropriately size the geo bond if our ambitions are higher than the dollars available and the bond we scale back our ambitions and so the other piece that we have in place is we have oversight process and structure that i think is barely strong and we have executive committees Barbara Garcia herself chairs the a Oversight Committee and we have controls in place if there are changes to scope or to costs for us to review those, we review those changes as they come in so we have a lot of controls around the process with the goal of not putting ourselves in a place where we hit that situation and where were over budget and we have to deal with it. The risk to volume our department because theres d. P. W. Involved and other divisions where they are the lead constituent or the lead interest. Yeah, we worked very closely with d. P. W. So d. P. W. Is our partner in delivering all the capital programs with us from beginning to end so we work with them very closely and in the event that we do get to a point where we have a challenge in the budget or we have an unforeseen cost that arises, ultimately the financial responsibility for that would be what the department of publichealth because d. P. W. Is our implement er and we are the lead sponsor or the lead constituent as you say of the project so it really is on us to manage the projects from the beginning and as we foresee or as we experience problems as we go along for us to take ownership and manage the solutions. Thank you, very much. Just to make sure just to let you know we are starting quarter ly meetings with d. P. W. To ensue were coordinated with them as well. Our. Saphia is but executive level we will meet shortly for our first quarterly meeting with the executive director of d. P. W. Yes, thats absolutely correct, i think weve gotten a lot of experience both on our side on the d. P. W. Side through this work with the vendors and how to hold the vendors to accountability so yeah its a good point. I do think there was an example back when we were building laguna and it was commission that needed to listen to what was happening and then the department the directors and finance people and so fourth working with the Mayors Office to workout what was going to happen and that day up with of the issues was steel of course and that drove the cost of the project far higher than project ed and there were a number of other controls that probably should have been in place but weve learned from that experience and did much better at the sfgh rebuild but we did have to work i mean working closely with the city so its not that you are responsible and cuts half the people off the clinics but how do we do this and the ultimate was to remove one time and it then butts it back within the budget and so its a collaboration because city cannot just have you also default on the project nor could it actually want to sustain taking away patients needs related to this but this is part of the i think the Due Diligence that we have to have to work with the department and with the administration to be sure that things do stay on budget and when they dont, then earlier rather than later the answers need to come a lot more transparency which i believe the department has really come up with now over the years in order to give us the information and so thats why im looking forward to being able to do that and i think we need something similar on our capitol projects right because that is another bond issue were following in terms of the seismic renovation at five and our other clinic buildings so were model it similarly although not as complex as the e. H. R. , right. Its interesting because when you look at what is under that building 5 program, there are the team here knows it from experience but there are dozens and dozens and dozens of moving parts different clinics relocate to go different areas so there is the bit of complexity to this but we will continue to report to you with the kind of summarized version much like we did with the bond. Ok. Thank you. Other questions commissioners on this particular part . Sorry to make you keep going. The last slide on the marathon. [laughter] Financial Data nightmare. [laughter] so risks and uncertain tease this is the last subject that the commission requested that we touch on. So the two biggest as no surprise they have been for quite some time is the federal environment, the policy environment and state and the economic changes possibility so recognizing of course that anything that happens there could be big enough it really changes the numbers that we projected out here in fundamentally changes the environment weve been looking at so weve been conscious of that and weve been talking about at this commission for most essentially the entire time ive been here and before but also at this city level trying to put ourselves in a position where when something happens we probably wont be able to mitigate it entirely but we can at least buy ourselves some room to deal with it so were not kind of thrown in to react mode immediately when something happens so a couple of the initiatives that are core to that strategies the reserves on the d. P. H. The management reserve that we created we have 92. 2 million thats built up from zero not so long ago so thats a lot of progress and that is i think a big deal helping us sleep a little bit better at night and in addition in the budget that was adopted over the summer, theres a 50 milliondollar place that is in a central city reserve to mitigate impacts of changing to the a. C. A. Or other federal cuts so that is helpful reserve if theres action again it wouldnt be enough to just make those a nonissue but it would be enough to help us mitigate the impacts and have time to develop a response to whatever may come. On the e. H. R. Project i showed you that large project budget over ten years. We have been funding that in pieces overtime and we have in the 1819 budget the the the last lump sum appropriation for the first three years of implementation so we have those funds set aside in a project budget and this is a question that has come up here and in other settings on the e. H. R. As how are we going to make sure that we have the funds in place to deliver it this is been our approach in our strategy and to make sure that we actually can execute and we have those funds that are segregated and a project they dont close out at the end of the year and its a project that continues overtime so the funds will remain available and they have the ability to manage that project so we through the work of the last several budgets pre funded that project with we had good news and its a Good Practice of saying when we have good news lets put an end to investment that is Capital Investment that will payoff over the long run and lastly the general fund we talked about there is the citys general fund reserve and this has been the work of the city and the controller and the mayor s office and over the last many years the city and the board of supervisors adopted the policy to increase the size of the citys general fund reserve it used to be 25 million total for the general fund and that reserve has grown overtime to about 8 of general Fund Revenues from a fraction of 1 that puts us in more of a Standard Range where we have re serves that are more proportion at to the size of the citys revenues so that should provide some question with one of these big changes. And then lets see of course Revenue Generation is our other strategy for mitigateing any of these issues and the more self reliant we have on our revenues and the less we rely on general fund dollars or were reliant on good news from the state or federals, the less susceptible to those changes so that thats got to be our policy for in sul eighting ourselves from the swings of the financial world so that is all ive got. [laughter] well, that was really very commendable. [laughter] recognize aside from having to stand. By itself its difficult. Its good for my back. I mean obviously the work behind it in the way that you and jury staff has recognized it as assisted the commission to understand where were moving forward and ask the commission if you have thoughts now commissioner gardner. Good. You have done a good job and he is at this point that this is a lot of money and its going and you reached also and. Thank you, very much and i just want to save the ive seen a change in culture and ownership of the financial situation that has been pretty profound and we have if you look at our financial steward ship is an element and integrated in to the planning in the other areas so all of the leaders in the network and on the Population Health division and i think the leadership is really coming from the divisions to drive the changes that end up on my spread sheet so focus on Financial Management in the department outside of the finance division is really strong. I would ask add to the chair that the rights of passage if we can give you triple honors, again, its really been a fascinating just watching you and listening to everyone working and come in with the qualitative data in a way you can understand and review and see its astounding so really honor is ours, thank you. Commissioner. This might be a Monkey Wrench question, when i look at this has been a really clear and education at presentation and the question in my mind is when we talk about Contingency Planning why arent earthquake part of it because a lot of the work that we are going inform move forward with with the seismic retro fit and you know and moving like the departments, its really contingency important that no other natural disasters happen at this period of time. The last big earthquake is 1989 and theres no predictions when the next one is. Like has the department actually talked about having a contingency plan if like in three years theres a earthquake and that was before we actually moved any of the departments, you know, what would happen . Well, we consistently have drills in terms of how were going to respond to any kind of disaster and continuity of operations is part of our planning and we do practice what would happen if we did have any disaster of any kind and its hard to predict but continuity is a Core Foundation of prepared ness and so we have a plan and we consistently look at that plan and that means also success is of who is in charge if something happens if our own city recently so we are pretty prepared and they cant prepare for everything and everything but you have a operation of Operations Plans and they would look at services and how we responded so as an example if our Community Clinics wentz down we would probably open up the types of facilities and were getting pretty good at pop um clinics and so we have contin duty plan and the doctor is in charge of that and as part of the preparedness response. So i appreciate reminder in terms of Emergency Response and you have done a great job in like organizing and planning and im really curious not concerned yet but this gives me a lot of concerns and all the natural disasters and how it hit and in the east coast and how some of the really Emergency Services its paralyzed and it happened in puerto rico so that actually thought that i have in the questions that i have its kind of fiscal impact with that have and for us and its not so much ho how we respond to if and that is for us and how how we sort those impact. We should add on this list of federal and state or economic we should add that and you are right because that could happen Significant Impact that i dont think theres anyway to answer that question because etch type of event is its own type of event and for seen and theyre a whole a lot of potential risks that could come with that and as part of our disaster prepared ness exercising and working with the and on our process for the extent theres a disaster that allows us to recoup funds and federal or state governments and our structure and process ready to respond that so that is a financial upkeep initiative and that would be part of it and the seismic safety of our buildings is probably the most obvious mitigateing event if we did have a big seismic event that disabled one of our buildings and we had to move staff or services out that would be a financial cost and it would be productivity cost and it would also be really problematic if those people are supposed to be responding to other peoples emergencies so i dont know how to answer that question but she think about it as we plan for financial contingencys thats one of them. Out of the contingency plans that would be one that is still manageable for us you know, that is compared to some other possible scenario because of this years Political Climate and which includes relationships with north korea so i think that to really be able to plan some of these or have these discussions ahead of time like maybe im just like negative nancy, i dont know. Not at all. You know the city wide we do this process all the time several times a year we are doing different kinds of scenarios and so city wide we practice as well because the department is not going to be able to do this on their own the department of Emergency Management is the conveneer and coordinator of our responses city wide but what we can do shortly and one of our next meetings coming for the new year we can kind of go over some of the disaster trainings that we have had city wide and to be able to discuss that as you can remember fleet week is one of those areas that we do real major Disaster Response in terms of doing training and activation s around drills and so we can share the network city wide and the work on the department so just recently with our heat, we did have our hospitals being greatly impacted by that so there were conversations and some of us sitting and talking about what would happen if one one of our hospitals due to heat and the machinery going down what it terms in terms of evacuations in terms of the the hospital and so we can all practice, practice, practice, practice, you cant always predict but you can always be prepared so i think we can bring that forward to you and show you the work weve been doing in the last couple of years. And mr. Wagner said well add to that the risk and uncertain tease is a good point. Thank you. Yes, Commission Commissioner bern. Just with regard to the disaster planning, does that take in to account mutual aid from surrounding counties and are they in place . Yes, they have been in place and weve actually used them not so long ago and at times to bring on ambulances and a lot of times it goes the opposite direction so for north base buyers and weve sent hundreds of police over 100 individuals from our department so we have several more layers of mutual aid and everything from ambulance to we have one non profits that responded to the earthquake but never really got funded and is the Nonprofit Sector and how important the