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DocuSign Envelope ID: D7EF525D-DBF6-4AO6-BOA8-1570CBCFE8C4 <br />DS <br />Contract Agreement Routing/Review Checklist Dept <br />DS <br />FIN <br />Routing Sequence <br />o (IT/CAO/Finance) -> Department -> Finance -> City Attorney's Office -> City Manager's Office -> City Clerk's Office <br />1 <br />Contractor/Vendor Name: Axis Community Health <br />If no Munis Contract Entry, briefly explain why <br />Department Staff Contact: ZR &.lay Ingram <br />2. Funding Source <br />a. What is the funding source(s) for this contract? <br />Org: 1745020017550200 Object: 433165 <br />Munis Contract Number: 2024390 <br />Business License Info: <br />Project: <br />3. Contract Agreement/Amendment <br />a. Is the finalized Contract Agreement or Amendment Agreement (Signed b vendor) attached? <br />b. Has the CAO been consulted to review and finalize the contract?' Y❑✓ NLJ If not, why not?' <br />c. If a contract involves a purchase or subscription of software/hardware, has IT reviewed? Y N N/A ✓ If not, <br />why not? <br />d. Has it been signed by a vendor/contractor already? YUNll If not, why not? <br />4. Supporting Documentation <br />a. Is a current Certificate of Insurance included in this review packet? Y❑✓ N❑ If not, why not? <br />b. If a contract or purchase order amount is greater than $10,000, is bid quote summary/documentation, showing <br />bids from at least three vendors/contractors, included? If not, is <br />i. The completed Sole Source Justification form included? Y N❑ <br />ii. This utilizing the cooperative purchasing program? Y[:]NLJ If so, include relevant documentation(s). <br />c. Has the council already approved this contract or purchase?' If so, include a copy of the final city council agenda <br />report in the packet. <br />d. Is Surety/Performance Bond(s) required? Y❑N❑ If yes, include document(s). <br />E-mail Information <br />• Finance: FINContracts@cityofpleasantonca.gov <br />Shsieh@cityofpleasantonca.gov (if Sole Source Justification form is included) <br />• City Attorney's Office: Contracts@cityofpleasantonca.gov <br />• City Manager's Office: CMContracts@cityofpleasantonca.gov (Use the name "Gerry Beaudin" in DocuSign) <br />• City Clerk's Office: ClerkContracts@cityofpleasantonca.gov <br />1 If using contractor's or vendor's contract agreement form, CAO must review first before finalizing. <br />2 If there are no changes to terms & conditions of the current city's contract agreement template and the overall contract amount is <br />under $10,000, CAO review is optional. <br />3 For any contract over $100,000, council approval is required. <br />