AXIS COMMUNITY HEALTH - THRID AMENDMENT (#2020405)

Docusign Envelope ID: FC72E12A-E2DD-42C4-BD36-C422ACOA54D2 Routing order. Finance ❑ CONTRACT/AGREEMENT TRANSMITTAL FORM City Attorney ❑ City Manager ❑ City Clerk Contractor: Axis Community Health New ❑ Amendment ❑✓ Contract # 2020405 Sole Source: Yes ❑ No ❑✓ (If yes, explain below) Approved by Council: Yes ❑✓ No ❑ Meeting Date: May 19, 2020 (If no, explain below) Subject/Summary: Behavioral health program for Pleasanton middle and high school students. Initiating Department. Library and Recreation Staff Member: Jay Ingram ext.: 5346 Funding Source: 00199200-433165-20802 Budgeted: Yes ✓❑ NO ❑ (If no, explain below) Surety/Performance Bond(s) Yes ❑ No ❑ (If required, attach to the contract) Certificates of Insurance: GI ❑ Auto ❑ Excess ❑ W/C ❑ (Attach to the contract) Business License No.: 1001098 Expiration Date: 12/31/23 Prof. ❑ Other ❑ (do not attach) Consultant requires filing a Statement of Economic Interest: Yes ❑ No ❑ (If no, explain below) Executed agreement will be mailed to name & address on contract unless otherwise indicated: Attorney consulted: Daniel ❑ Julie ❑ Larissa ❑ Wes ❑ Document to be recorded by: City ❑ Other ❑ Explanation(s): Agreement is renewable annually up to five years. Annual amount is NTE $35,000, not exceeding a total agreement amount of $175,000.