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12/15-C2 New Beacon 4` °° "1r Kevin Madok, CPA a; J.C. Clerk of the Circuit Court& Comptroller—Monroe County, Florida ? ; ?= DATE: August 26, 2021 TO: Beth Fcto Airports FROM: Sally NI. Abrams, D.C. SUBJECT: August 18, 2021 BOCC Meeting Attached, for your handling, is item 17, Jacobs Project Management Task Order 12/15-C2 in the amount of$72,613.00 for design, permitting and bidding support for a new Airport Beacon at the Key West International Airport; to be funded with Passenger Facility Charge Fund 406 (PFC #18) and FDOT Essential Airport Equipment Grants G0E47 and/or Grant GI V31. Should you have any questions, please feel free to contact me at ext. 3550. Thank you. cc: County Attorney Finance File KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING 500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road Key West,Florida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plantation Key,Florida 33070 305-294-4641 305-289-6027 305-852-7145 305-852-7145 MASTER AGREEMENT FOR PROFESSIONAL SERVICES TASK ORDER FORM Effective Date Upon Execution Task Order No. 12/15-C2 . Client Project No, 404-630188-GAKD136 Engineer Project No. E9Y379C2 . This Task Order is entered into on the effective date noted above pursuant to the "Master Agreement for Professional Services" between Monroe County, Florida ("Client") and JACOBS PROJECT MANAGEMENT CO. ("Consultant"), dated February 15, 2017 ("Agreement"). The Agreement is incorporated herein and forms an integral part of this Task Order. Services Authorized—Key West International Airport(EYW)New Beacon Client authorizes Consultant to perform the Services described in Exhibit A attached hereto and incorporated herein, which Exhibit A is marked with the above noted Task Order No. and consists of 6 page(s). Pricing N/A Time and Expense per Agreement and Appendix B to the Agreement. X Firm Fixed Price of$ 72,613.00 N/A Other(Describe): n'' ATTOF1NEY •.#0u,;.. , ule `rl FORM At r. ��may commence on Execution ASS FED fY ATTORNEY s° ill cease by 547 days • Date 7/26121 \ "1 Ai BOARD OF COUNTY COMMISSIONERS '' -'.w -''.1 . T: KEVIN MADOK,CLERK OF MONROE COUNTY,FLORIDA By Cak Art /�{/ a cif By a As"Deputy Clerk 0ni V nt Z4 ayor airman CONSULTANT: JACOBS PROJECT MANAGEMENT Co Jeffrey D. OlgiDN:n:;:n .o Mieel oa;.D �" VPKK&,rn, By Acton `mar.. . Witness Title S. Region El4/SM;SrirVlces Group Leader File: MSTR APS-Monroe County tll I `!' '..' Page l ofl - Exhibit A —(12/15—C2) Scope of Services Monroe County Airports Key West International Airport (EYW) New Beacon SCOPE OF WORK Jacobs will provide project management, coordination services, design,permitting, and bidding support services for the installation of new airport beacon at Key West International Airport (EYW). EXISTING CONDITIONS EYW New Beacon The existing beacon at Key West International airport is reaching the end of its' serviceable life and is ready for replacement. The replacement of the beacon for the design and construction was approved in a PFC application. Under a previously awarded purchase order,the survey and geotechnical investigation services were completed. This scope of services will include the design and bidding support services for a new airport beacon. DESCRIPTION OF WORK This project comprised of the following elements. 1. Installation of new high mast pole and airport beacon. 2. Demolition of existing beacon and high mast pole. General Scope One construction package will be developed for this project. For this construction package, Jacobs will provide the following services: 1. Management of the project from data collection,bid opening and award of the construction contract. 2. Preparation of minutes of meetings and phone conversations. 3. Preparation of the construction documents and incorporation of Monroe County's front- end contract documents. 4. Preparation of the engineering report, construction cost estimate, and construction schedule. 5. Bidding and award assistance. Assumptions/Design Parameters 1. The project will not require a new backup generator. 2. The new beacon will be mounted to a lowering ring on the high mast pole to allow for equipment to maintained without the use of a bucket truck/manlift. 3. It is assumed the project will not require an EA, CATEX,nor a Section 163 review. 4. An alternative siting study is not required for this project. The new beacon will be installed adjacent to the existing beacon and at the same height. Page 1 of 6 5. It is assumed a CSPP is not required. 6. Jacobs will develop plans, an outline of specifications,an engineering report, and a construction cost estimate at the 30%design level for review. 7. Jacobs will develop plans,technical specifications, an engineering report, and a construction cost estimate at the 90%design level for review. Jacobs will develop the 7460 to be submitted to the Airport and FAA for review. 8. Jacobs will produce a final contract set of plans, specifications, engineering report, construction schedule,and construction cost estimate for bidding purposes. 9. DEP and ACOE permits are not required based on the current scope of the project. 10. It is assumed that a SFWMD permit will not be required for this project. 11. This scope of work does not include construction administration, resident project representative nor quality assurance testing. These services along with a construction management plan will be provided under a separate purchase order. 12. This scope of work will not require an AGIS project. 13. This scope of services 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. 14. Jacobs will reasonably rely upon the accuracy, and completeness of the information/data provided by the Client or other third parties. 15. In providing opinions of cost, financial analyses, economic feasibility projections, for the project, Jacobs has no control over cost or price of labor and materials; unknown or latent conditions of existing equipment or structures that may affect operation or maintenance costs; competitive bidding procedures and market conditions;time or quality of performance by operating personnel or third parties; and other economic and operational factors that may materially affect the ultimate project cost or schedule. Therefore, Jacobs makes no warranty that Client's actual project costs,financial aspects,economic feasibility,will not vary from Jacobs' opinions,analyses,projections, or estimates. 16. In soils, foundation,groundwater, and other subsurface investigations,the actual characteristics may vary significantly between successive test points and sample intervals and at locations other than where observations, exploration, and investigations have been made. Because of the inherent uncertainties in subsurface evaluations, changed or unanticipated underground conditions may occur that could affect total project cost and/or execution. These conditions and cost/execution effects are not the responsibility of Jacobs. 17. Jacobs shall at no time take title, risk of loss or ownership of the hazardous materials or wastes. Client recognizes that Jacobs assumes no risk and/or liability for hazardous materials encountered while performing any services associated with such hazardous waste. Page 2 of 6 ARTICLE A—DATA COLLECTION AND PRELIMINARY DESIGN Data Collection: 1. Prepare for and attend project design kick off meeting. 2. Research record drawings for underground utilities. (i.e. sewer,water,electric,gas, communication, etc.). 3. Perform site walk through survey to locate and note any special site conditions that would affect construction techniques or materials. Take photographs of the site and provide written documentation, sketches,notes, or reports to confirm and record the general conditions of the existing site. Field verify that all existing features in the field were picked up during the topographic survey. This task will be performed in conjunction with the onsite kick off meeting. Services for Article A will be provided under a lump sum basis. ARTICLE B—DESIGN Based on the information collected under Article A,the 30%, 90%, and final contract documents for the construction package will be developed for all elements identified in this scope of work. 1. Develop technical specifications utilizing FAA's standard specifications for construction. (i.e.FAA Specifications:P-101, P-152, T-904, T-901, T-905, P-620, ,etc.). Submit an outline of technical specifications at 30%. Submit complete technical specifications at 90%and Final. 2. Coordinate and incorporate Monroe County provided contract document/front-end specifications into the final contract bid documents. (i.e. Notice to Bidders, Invitation to Bidders, Instruction to Bidders, Bid Proposal, Contract, Contract Articles, General Specifications). 3. Develop a construction schedule for use in determining duration. 4. Prepare for and attend two (2) design review meetings(30%and 90%)with the Airport to discuss project progress and review the design submittals. The 30%meeting will be onsite. The 90%will be a virtual Microsoft Teams meeting. 5. Develop structural foundation design for the beacon's new high mast pole. 6. Develop detailed construction quantities and cost estimate at the 30%, 90%, and at final contract document design levels. 7. Develop Electrical and Control Design Page 3 of 6 8. Develop the following anticipated plans: Title Sheet(1) Index of Drawings,Notes, and Quantities (1) General Plan (1) Haul Route and Part 77 Surfaces (1) Existing Conditions and Soil Boring Plan (1) Demolition Plan(1) New Beacon Site Plan (1) Foundation Details (1) Beacon and High Mast Pole Details (2) Miscellaneous Electrical and Structural Details (1) Total: 11 Sheets 9. Develop Engineer's report. 10. Coordinate, distribute and print the following copies of the preliminary construction documents for the construction package (plans, specifications, design report, and construction cost estimate) for review by the Airport, FAA, and FDOT: Preliminary Submission (30%, 90%, Final Contract Documents for each construction package) FAA and Airport: 2 half size copies of plans and a CD containing the drawings specifications, engineering report, and engineer's estimate for each submission. 11. Conduct an in-house QA/QC prior to each submission. The in-house QA/QC check will involve an experienced independent individual,depending on each discipline,to conduct a comprehensive check on all documents to be submitted (e.g. plans, specifications, estimates, reports). Time will be required for engineers and CADD technicians/designers to correct items listed under the in-house QA/QC checks. 12. Address comments from 30%and 90%design submissions. 13. Prepare and submit electronically FAA form 7460-1 Notice of Proposed Construction or Alteration. Services for Article B will be provided under a lump sum basis. Article C—Bid Phase Services Upon completion of the construction documents and at the request of the Airport, Jacobs will prepare the project documents for bidding. Jacobs will perform bidding support services,the following terms will apply: A. The County appoints Jacobs as its Agent, and Jacobs accepts such appointment to perform bid/procurement services on the County's behalf in connection with the project. Page 4 of 6 B. Such services shall be performed under the County's direction and in accordance to such forms, terms and conditions, or modifications or revisions to same as the County may in its sole discretion at any time instruct Jacobs to use. All services shall be carried out in accordance with the procedures mutually agreed upon by the County and Jacobs. C. Jacobs shall not have authority to accept or bind the County in any way to changes, modifications, revisions, alterations, amendments, or supplemental, additional, or different terms and conditions (hereinafter referred to as "deviations") which may be submitted or requested by a vendor or contractor. Jacobs shall immediately submit any deviations from the County's standard terms and conditions to the County for review by the County's Purchasing Manager or their representative and such deviations shall not be accepted by Jacobs unless Jacobs receives express written approval thereof from the County's Project and/or Purchasing Manager or their representative. D. All documents issued by Jacobs hereunder shall be signed by Jacobs for the County if so directed. The ownership and title of all items purchased hereunder shall pass directly from the selling party to the County, and Jacobs shall at no time be a party to such transaction other than as agent of the County. The County shall have the unilateral right to have the commitment authority of Jacobs, its employee or this limited agency authorization in its entirety revoked and cancelled at any time, with or without cause. The County shall be obligated directly to the selling parry for all payments for materials, equipment, supplies and services procured hereunder. E. The County shall hold Jacobs and its employees harmless from any claims, suits or liabilities arising out of any breach or other failure of performance by any contractor,vendor or supplier under any contract or purchase order issued by Jacobs hereunder. The following task will be performed as part of the bid phase services: 1. Coordinate with the County Purchasing Department and the Airport to advertise for bids. 2. Coordinate with the County to provide electronic copies of the bid documents to prospective bidders 3. Prepare for and attend a project pre-bid conference 4. Prepare responses to address requests for information from prospective bidders 5. Prepare and coordinate the issuing of two (2) addenda with the County purchasing department. 6. Revise bid documents as necessary for the addendum 7. Review bids for responsiveness 8. Prepare a bid tabulation 9. Make a recommendation for award based on review of the bid information submitted. 10. Generate conformed construction documents and prepare and send out construction contract. Services for Article C will be provided under a lump sum basis. Page 5 of 6 PROJECT SCHEDULE: The tentative project schedule from the Notice to Proceed date will be as follows: Article A- 30%Design 60 days Article B—90%Design 30 days from Receipt of Comments Article D—Final Design 14 days from Receipt of Comments Page 6 of 6 JOB HOUR AND FEE ESTIMATE as Monroe County Airport: Key West International Airport Project: Key West International Airport(EYW)New Beacon FEE SUMMARY BASIC SERVICES Hours Fee DBE AMOUNT Article A Data Collection 24 $ 7,063 Article B-Design 400 $ 51,445 Article C-Bidding 98 $ 14,105 TOTAL LUMP SUM FEE 522 $ 72,613 $ - DBE Percentage 0.00% CERTIFICATE OF LIABILITY INSURANCE 06/07/20121 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 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 on 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: 1-212-948-1306 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 INSURERD: 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 PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD/YWY MM/DD/YWY A X COMMERCIAL GENERAL LIABILITY HDO G72493503 07/01/21 07/01/22 EACH OCCURRENCE $ 1,000,000 � OCCUR DAMAGE TO RENTED CLAIMS-MADE PREMISES Ea occurrence $ 500,000 X CONTRACTUAL LIABILITY MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 1,000,000 X POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 1,000,000 JECT OTHER: $ A AUTOMOBILE LIABILITY ISA H25545631 07/01/21 07/01/22 COMBINED SINGLE LIMIT $ 1,000,000 Ea accdent X ANY AUTO 1 T BODILY INJURY(Per person) $ OWNED SCHEDULED !' �' a BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS " r^" HIRED NON-OWNED -. PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY - """'"""'�"' Per accident $ may, 5 . 2 0 2..1 W, � $ 7 UMBRELLALIAB OCCUR " EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE WANW - " ", AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WLR C67817540 (AOS) 07/01/21 07/01/22 X STATUTE ER H AND EMPLOYERS'LIABILITY YIN 1,000,000 A ANYPROPRIETORIPARTNERIEXECUTIVE � N/A SCF C6781762A (WI) 07/01/21 07/01/22 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? A (Mandatory in NH) WCU C67817588 (OH)* 07/01/21 07/01/22 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A PROFESSIONAL LIABILITY EON G21655065 012 07/01/21 07/01/22 PER CLAIM/PER AGG 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) OFFICE LOCATION: Jacksonville, FL 32202. PROJECT MGR: Ryan Forney. CONTRACT MGR: Jack Renton. SENIOR CONTRACT MGR: 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 International Airport. CONTRACT END DATE: 02/14/2022. PROJECT NUMBER: E9Y16700. SECTOR: Public. The Monroe County Board 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 NOT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Monroe County Board of County Commissioners THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West, FL 33040 USA <5r-���'� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Cert_Renewal 62390167 DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 06/07/2021 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.* Additional Information: *$2,000,000 SIR FOR STATE OF: OHIO SUPP(06/04) NOTICE TO OTHERS ENDORSEMENT - SCHEDULE - EMAIL ONLY Named Insured Jacobs Engineering Group Inc. Endorsement Number 74 Policy Symbol 02493503 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: 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. 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 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 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 us 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 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 All other terms and conditions of the Policy remain unchanged. Authorized Representative ALL-32685 (01/11) Page 2 of 2 NOTICE TO OTHERS ENDORSEMENT- SCHEDULE - EMAIL ONLY Named Insured Jacobs Engineering Group Inc. Endorsement Number 44 Policy Symbol Policy Number Policy Period Effective Date of Endorsement SA IH25545631 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: 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. 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 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 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 us 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 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 All other terms and conditions of the Policy remain unchanged. r Authorized Representative ALL-32685(01/11) Page 2 of 2 Workers'Compensation and Employers' Liability Policy Named Insured Endorsement Number JACOBS ENGINEEMNG GROUP INC. 1000 VVILSFfl tE 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) AGE AMEMCAN MU" NCE COMPANY Insert the policy number.The remainder of the information is to be oompleted only when this endorsement is issued subsequent to the preparation of the policy. NOTICEL EMAIL ONLY A. If we cancel this Policy prior to its expiration date by notice to you or the ffirst Named insured foe"any reason other than nonpayment of premium, we will endeavor, as set out below,to send written notice of cancellation, vie 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: I. The beginning of the Policy period, if this endorsement is effective as of such date; or IIa This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. 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 Schedule in our records as of the date the notice of cancellation is mailed or delivered to the ffirst Named Insured. 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 organ ization(s). Our ffailure 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 foe" verifying any in-formation provided to us in any Schedule, nor are we responsible foe" any incorrect in-formation that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility foe"taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail address in-formation 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. 1® 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 and W1. Authorized Representative WC 99 03 68(01/11) Wage 1 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: 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. C. The Schedule must be in a 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 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 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 organization(s). Our failure to provide advance notification of cancellation or non-renewal 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 or non-renewal date 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 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) 5�;JOHN J. LUPICA> Pr,,idercnt Authorized Representative