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Item I06 L6 County �� � .�� �y,4 ' �, "tr, BOARD OF COUNTY COMMISSIONERS Mayor Michelle Coldiron,District 2 �1 nff `ll Mayor Pro Tem David Rice,District 4 -Ile Florida.Keys Craig Cates,District 1 Eddie Martinez,District 3 w Mike Forster,District 5 County Commission Meeting August 18, 2021 Agenda Item Number: I.6 Agenda Item Summary #8541 BULK ITEM: No DEPARTMENT: Airports TIME APPROXIMATE: STAFF CONTACT: Richard Strickland(305) 809-5200 N/A AGENDA ITEM WORDING: Approval of Jacobs Project Management Task Order 12/15-Cl in the amount of $608,800.00 providing staff augmentation support services to the Airport during the anticipated 12 months of pre-construction (design) of the Concourse A and Terminal Improvements Program at the Key West International Airport; to be funded by FDOT Concourse A Design Grant GIP09 and Airport Operating Fund 404. ITEM BACKGROUND: The task order includes such services as attending project scoping meetings, attending the project kick-off meeting for the CMAR firm, attending project progress and design review meetings, attending stakeholder meetings,providing responses to questions and requests for clarification from the A&E design firm of Jacobs 15% design documents, and review of A&E and CMAR invoices. PREVIOUS RELEVANT BOCC ACTION: Approval of Master Agreement for Professional Services with Jacobs Project Management Company for General Consulting Services for both Monroe County Airports on February 15, 2017. Approval of FDOT Grant GIP09 on October 21, 2020. CONTRACT/AGREEMENT CHANGES: New Task Order STAFF RECOMMENDATION: Approval. DOCUMENTATION: Jacobs 1215-Cl Conc A staff aug FINANCIAL IMPACT: Effective Date: Upon Notice to Proceed(NTP) Expiration Date: 730 days after NTP Packet Pg. 1099 L6 Total Dollar Value of Contract: $606,800.00 Total Cost to County: $-0- Current Year Portion: Budgeted: Yes Source of Funds: Grant GlP09 (50%) and EYW Airport Operating Fund 404 (50%) CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: If yes, amount: Grant: County Match: Insurance Required: Yes Additional Details: REVIEWED BY: Beth Leto Completed 07/28/2021 11:10 AM Richard Strickland Completed 07/28/2021 12:00 PM Pedro Mercado Completed 07/30/2021 10:40 AM Purchasing Completed 07/30/2021 11:33 AM Budget and Finance Completed 08/02/2021 11:42 AM Maria Slavik Completed 08/02/2021 1:48 PM Liz Yongue Completed 08/02/2021 4:05 PM Board of County Commissioners Pending 08/18/2021 9:00 AM Packet Pg. 1100 1.6.a MASTER AGREEMENT FOR PROFESSIONAL SERVICES TASK ORDER FORM Effective Date Upon Execution Task Order No. 12/15-Cl Client Project No. 404-630205-GAKD149 Engineer Project No. E9Y379C1 This Task Order is entered into on the effective date noted above pursuant to the "Master Agreement for Professional Services" between Monroe County, Florida ("Client") and JACOBS PROJECT MANAGEMENT CO. ("Consultant"), dated February 15, 2017 ("Agreement"). The Agreement is incorporated herein and forms an integral part of this Task Order. Services Authorized—Concourse A and Terminal Improvements Program Staff Augmentation LO cv Client authorizes Consultant to perform the Services described in Exhibit A attached hereto and r incorporated herein, which Exhibit A is marked with the above noted Task Order No. and CL consists of 2 page(s). 0 Pricing N/A Time and Expense per Agreement and Appendix B to the Agreement. X Firm Fixed Price of$ 608,800.00 N/A Other(Describe): NROE COUNTY AT nNEY Schedule A FIT0VED FORM U7 Services may commence on Execution ASS[ST LINTY ATTORNEY Services will cease by 730 days 7/26/21 _ Other T- (SEAL) BOARD OF COUNTY COMMISSIONERS ATTEST: KEVIN MADOK,CLERK OF MONROE COUNTY, FLORIDA 0 BY BY .__.......... _ Deputy Clerk Mayor/Chairman CONSULTANT: JACOBBS PROJECT MANAGEMENT CO Dig Acton Jeffrey . DN:tcnll Jeffrey D.Acton,osigned by Jeffrey D.Jacobs UPMCo),ou, C} � email=JeffreyActon@Jacobs.com,c-US By _ Date:2021.07.16 12:04:39-04 00 Witness Title . Region PM/CM Services Group Leader File: 14STR MPS Monroe County Page 1 of 1 Packet Pg. 1101 1.6.a Exhibit A— Scope of Services (12/15-C1) Monroe County Key West International Airport Concourse A and Terminal Improvements Program Staff Augmentation The below staff augmentation assignment and pricing is provided based upon and shall be performed under base agreement "Master Agreement for Professional Services 12/15". The Master Agreement for Professional Services is between Monroe County Florida and Jacobs Project Management Co. with an execution date of January 27, 2017 (together the base agreement Master Agreement for Professional Services 12/15 and any amendments thereto are defined as the "Agreement"). Notwithstanding anything to the contrary contained or referenced in this Scope of Services, the terms and conditions of the Agreement shall govern all staff augmentation under this Scope of Services. 0 SCOPE OF SERVICES LO CJ Jacobs Project Management Co. (Jacobs) has been requested to provide staff augmentation services to support Monroe County in delivering their design of Concourse A and Terminal o Improvements Program. The staff provided will perform services as requested by Monroe County, such assignments shall include items outlined under Article A. Such Services shall be performed on CL a lump sum basis. ASSUMPTIONS I 1. Jacobs will not be providing any cost estimating services. It is assumed the A/E and CMAR W firms will be performing the cost estimating services. 2. Jacobs will not be providing project controls for this project. 3. This proposal only includes staffing through the preconstruction phase of the program. 4. The preconstruction phase includes services the selected architectural and engineering (A/E) firm will perform which includes data collection, design validation, design, design reviews, scheduling, construction phasing and maintenance of traffic, estimating, outreach, and stake LO holder coordination. 5. The preconstruction phase includes services the selected construction manager at risk (CMAR) will perform which includes participation in design reviews, constructability reviews, construction 0 phasing and maintenance of traffic, scheduling, estimating, outreach, and stake holder coordination. 6. It is assumed the preconstruction phase will consist of a twelve (12) month duration. Bidding and construction phase services is not included in this task order and will be included in a future task order as directed by Monroe County. 7. Proposal is based upon the assumption of up to six (6) design packages: a. Demolition b. Site Work and Utilities c. Foundations d. Steel e. Building Envelope f. Building Interiors and Systems Page 1 of 2 Packet Pg. 1102 1.6.a ARTICLE A —STAFF AUGMENTATION SERVICES 8. Jacobs will provide a Project Director and Senior Architect. 9. Such staff may be used to: g. Attend the project scoping meetings for the CMAR firm. h. Assist the County in reviewing proposals submitted by the CMAR firm. i. Attend the project kick-off meeting for the CMAR firm. j. Attend project progress and design review meetings. k. Attend stake holder meetings. I. Provide responses to questions and clarifications from the A/E and design firms. m. Coordinate between CMAR and A/E with airport operations and maintenance staff. n. Review A/E and CMAR invoices on behalf of the County. o. Coordinate with the FAA and FDOT on behalf of the County. p. Review submitted A/E and CMAR schedules and provide the County with comments. q. Attend stake holder meetings to identify project impacts and outline corresponding supporting strategies. r. Perform peer reviews of the design development and final design documents on behalf of the County, based on our development and understanding of the 15% preliminary design LO documents. s. Perform peer reviews of the anticipated bid packages. o c i c LO cv N c Page 2 of 2 Packet Pg. 1103 1.6.a JACOBS ENGINEERING GROUP JOB HOUR AND FEE ESTIMATE Monroe County Airport: Key West International Airport Project: Concourse A and Terminal Improvements Program Staff Augmentation FEE SUMMARY BASIC SERVICES _ Hours Fee DBE AMOUNT Article A: Staff Augmentation-Preconstruction Phase 2,988 $ 608,800 0 CJ Total Basic Services Lump Sum Fee 2,988 $ 608,800 $ uO r TOTAL LUMP SUM PROJECT FEE 2,988 $ 608,800 $ r o DBE Percentage 0.00CL N 0 I 0 tJ r tJ u7 r N r N 0 Page 1 of 2 Packet Pg. 1104 AC 06%ol7/zoz6.a - CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI: CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE! BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[ REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement of this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LIC #0437153 1-212-948-1306 CONTACT NAME: Marsh Risk & Insurance Services PHONE FAX CIRTS Support@jacobs.com A/C No Ext: A/C,No: 1-212-948-130 E-MAIL 633 W. Fifth Street ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Los Angeles, CA 90071 INSURERA: ACE AMER INS CO 22667 INSURED INSURER B: Jacobs Project Management Co. INSURER C: C/O Global Risk Management 1000 Wilshire Blvd., Suite 2100 INSURER D7 INSURER E Los Angeles, CA 90017 INSURERF: COVERAGES CERTIFICATE NUMBER: 62390167 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOI O INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI; CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM r EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. U® INSR ADDL SUBR POLICY EFF POLICY EXP LO LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS r A X COMMERCIAL GENERAL LIABILITY HDO G72493503 07/01/21 07/01/22 EACH OCCURRENCE $ 1,000,000 r � OCCUR DAMAGE TO CLAIMS-MADE PREMISES(Ea occurrence) ccurrence) $ 500,000 X CONTRACTUAL LIABILITY MED EXP(Any one person) $ 5,000 CL PERSONAL&ADV INJURY $ 1,000,000 N GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 1,000,000 O U X POLICY PEA LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ I A AUTOMOBILE LIABILITY ISA H25545631 07/01/21 07/01/22 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO �, AUTOS ONLY AUTOS BODILY INJURY(Per person) $ OWNED SCHEDULED ,: BODILY INJURY(Per accident) $ `l t8 HIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY _ � .. I •-- Per accident) $ 7 . 15 . 2021 W a $ n UMBRELLA LAB lA .- � C OCCUR ""'�` - EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE -_--`" AGGREGATE $ U DED RETENTION$ $ O A WORKERS COMPENSATION WLR C67817540 (AOS) 07/01/21 07/01/22 X STATUTE OERH r" AND EMPLOYERS'LIABILITY A ANYPROPRIETORPARTNEPIEXECUTIVE � N/A SCF C6781762A (WI) 07/01/21 07/01/22 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? LO A (Mandatory in NH) WCU C67817588 (OH)* 07/01/21 07/01/22 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 LO If yes,describe under C4 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A PROFESSIONAL LIABILITY EON G21655065 012 07/01/21 07/01/22 PER CLAIM/PER AGG 2,000,000 0 U DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) ¢' OFFICE LOCATION: Jacksonville, FL 32202. PROJECT MGR: Ryan Forney. CONTRACT MGR: Jack Renton. SENIOR CONTRACT MGR: 0) Christopher Bowker. RE: Monroe County Airports - General Consulting Services Master Agreement with Jacobs Project Management Company for Professional Services at Key West International Airport and The Florida Keys Marathon U International Airport. CONTRACT END DATE: 02/14/2022. PROJECT NUMBER: E9Y16700. SECTOR: Public. The Monroe County Boi of County Commissioners, its employees and officials are added as an additional insured for general liability & auto liability as respects the negligence of the insured in the performance of insured's services to cert holder under contract for captioned work. *THE TERMS, CONDITIONS, AND LIMITS PROVIDED UNDER THIS CERTIFICATE OF INSURANCE WILL NO'. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORI Monroe County Board of County Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED II ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE r..r Key West, FL 33040 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Cert_Renewal Packet P+g. 1105 62390167 1.6.a DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 06�07�2022 NAME OF INSURED: Jacobs Project Management Co. Additional Description of Operations/Remarks from Page 1: EXCEED OR BROADEN IN ANY WAY THE TERMS, CONDITIONS, AND LIMITS AGREED TO UNDER THE APPLICABLE CONTRACT.* U O r V3 r CN o CL 0) O U I Additional Information: *$2,000,000 SIR FOR STATE OF: OHIO N U O r V3 r N r 0) O U M U SUPP(05/04) Packet Pg. 1106 1.6.a NOTICE TO OTHERS ENDORSEMENT — SCHEDULE — EMAIL ONLY Named Insured Jacobs Engineering Group Inc. Endorsement Number 74 Policy Symbol P2493503 cy Number Policy Period Effective Date of Endorsement HDO 07/01/2021 To 07/01/2022 Issued By(Name of Insurance Company) ACE American Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to its expiration date by notice to you or the first Named Insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule"). You or your representative must provide us with the e-mail address of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after: LO i. The beginning of the Policy period, if this endorsement is effective as of such date; or ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. CL N C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. U D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. E. We will endeavor to send such notice to the e-mail address corresponding to each person or organization indicated in W the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal y obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you N nor your representative provides us with e-mail address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. ALL-32685 (01/11) Page 1 of 2 Packet Pg. 1107 1.6.a All other terms and conditions of the Policy remain unchanged. Authorized Representative 0 r U LO r cv r CL o 0 I 0 U r U LO r N r N 0 U U ALL-32685 (01/11) Page 2 of 2 Packet Pg. 1108 1.6.a NOTICE TO OTHERS ENDORSEMENT— SCHEDULE — EMAIL ONLY Named Insured Jacobs Engineering Group Inc. Endorsement Number 44 Policy Symbol P5545631 icy Number Policy Period Effective Date of Endorsement ISA 07/01/2021 To 07/01/2022 Issued By(Name of Insurance Company) ACE American Insurance Company Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to its expiration date by notice to you or the first Named Insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic M notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule"). You or your representative must provide us with the e-mail address of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after: LO i. The beginning of the Policy period, if this endorsement is effective as of such date; or ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. N C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. U D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. E. We will endeavor to send such notice to the e-mail address corresponding to each person or organization indicated in W the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal y obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you N nor your representative provides us with e-mail address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. ALL-32685(01/11) Page 1 of 2 Packet Pg. 1109 1.6.a All other terms and conditions of the Policy remain unchanged. Authorized Representative 0 CJ r CJ LO r- cv r- CL o 0 I 0 tJ r tJ LO r- N r- N 0 U U ALL-32685(01/11) Page 2 of 2 Packet Pg. 1110 1.6.a Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number JACOBS ENGINEERING GROUP INC. 1000 WILSHIRE BOULEVARD SUITE 2100 Policy Number LOS ANGELES CA 90017 Symbol: WLR Number:C67817540 Policy Period Effective Date of Endorsement 07-01-2021 TO 07-01-2022 07-01-2021 Issued By(Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number.The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. NOTICE TO OTHERS ENDORSEMENT - SCHEDULE - EMAIL ONLY A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule"). You or your representative must provide us with the e-mail address of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after: L The beginning of the Policy period, if this endorsement is effective as of such date; or u3 cv ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period — commences. CL C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent ou Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. I E. We will endeavor to send such notice to the e-mail address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide usLO with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail address information with respect to a particular person or N organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. This Endorsement is not applicable in the states of AZ, FL, ID, ME, NC, NJ, NM,TX and WI. <5:�_ Authorized Representative WC 99 03 68(01/11) Page 1 Packet Pg. 1111 1.6.a THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number Jacobs Engineering Group, Inc. 36 Policy Symbol Policy Number Policy Period Effective Date of Endorsement EON G21655065 012 07/01/2021 to 07/01/2022 07/01/2021 Issued By(Name of Insurance Company) ACE American Insurance Company NOTICE TO OTHERS ENDORSEMENT—SCHEDULE A. If We cancel or non-renew the Policy prior to its expiration date by notice to You for any reason other than nonpayment of premium, We will endeavor, as set out below, to send written notice of cancellation or non-renewal via such electronic or other form of notification as We determine, to the persons or organizations listed in the schedule that You or Your representative provide or have provided to Us (the Schedule). You or Your representative must provide Us with both the physical and e-mail address of such persons or organizations, and We will utilize such e-mail address and/or physical address that You or Your representative provided to Us on such Schedule. , B. The Schedule must be initially provided to Us within 30 days after: T_ o i. The beginning of the Policy Period, if this endorsement is effective as of such date; or CL ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy �+ Period commences. 0 C. The Schedule must be in a format that is acceptable to Us and must be accurate. I D. Our delivery of the notification as described in Paragraph A of this endorsement will be based on the most recent Schedule in Our records as of the date the notice of cancellation or non-renewal is mailed or delivered to You. E. We will endeavor to send or deliver such notice to the e-mail address or physical address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the v, cancellation or non-renewal date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation or non- renewal of coverage. We have no legal obligation of any kind to any such person(s) or j organization(s). Our failure to provide advance notification of cancellation or non-renewal to the 'A person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon Us, Our agents or representatives, will not extend any Policy cancellation or non-renewal date N and will not negate any cancellation or non-renewal of the Policy. G. We are not responsible for verifying any information provided to Us in any Schedule, nor are We responsible for any incorrect information that You or Your representative provide to Us. If You or Your representative does not provide Us with a Schedule, We have no responsibility for taking any m action under this endorsement. In addition, if neither You nor Your representative provides Us with e-mail address and/or physical address information with respect to a particular person or organization, then We shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. With respect to this endorsement Our, Us or We means the stock insurance company listed in the Declarations, and You or Your means the insured person or entity listed in Item 1 of the Declarations page. All other terms and conditions of this Policy remain unchanged. MS-36362(04/19) 9ZJOZHN J.�LUPICA. President Authorized Representativ Packet Pg. 1112