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FOURTH AMENDMENT TO AGREEMENT THIS FOURTH AMENDMENT TO AGREEMENT is made and entered into this I" day of July, 2011, by and between the City of Santa Ana, a charter city and municipal corporation of the State of California ( "City ") and Pulmonary Consultants & Primary Care Physicians Medical Group, Inc. ( "Consultant'). RECITALS: City and Consultant entered into Agreement N- 2007 -192, dated August 20, 2007, (hereinafter "said Agreement "), by which Consultant has provided SWAT physicals and annual hazardous materials medical examinations for Police and/or Fire Department personnel who handle hazardous materials, pursuant to Title 8, Section 5144 of the CALOSHA Respiratory Protection Regulation. 2. In accordance with the terms and conditions of said Agreement, the parties now wish to extend the term of said Agreement for an additional one -year period and increase compensation to pay for services during the extended term. WIIEREFORE, in consideration of the mutual and respective covenants hereinafter contained and made, and subject to all the terms and conditions of said Agreement as hereby amended, the parties do hereby agree as follows: Section 2.a., COMPENSATION, shall be amended to add $30,000 to pay for medical examination services during the 2011 -12 fiscal year, Section 3, TERM, shall be amended to extend the term of said Agreement for an additional one -year period, through June 30, 2012. 3. Except as hereinabove modified, the terms and conditions of said Agreement and any amendments thereto remain unchanged and in .full force and effect. IN WITNESS WHEREOF, City and Consultant have executed this Fourth Amendment to Consultant Agreement on the day and year first set forth above. ATTEST: CITY OF SANTA ANA MARIA D. HUIZAR DAVID N. REAM Clerk of the Council City Manager Additional signatures on next page 25C -3