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Item J2 } J.2 `, County of Monroe �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 September 15, 2021 Agenda Item Number: J.2 Agenda Item Summary #9645 BULK ITEM: Yes DEPARTMENT: Airports TIME APPROXIMATE: STAFF CONTACT: Richard Strickland(305) 809-5200 N/A AGENDA ITEM WORDING: Approval of Jacobs Project Management Co.'s Task Order No. 12/15-C4 in the amount of $211,987.00 for additional construction inspection and construction administration services for the Taxiway A Rehab. and Lighting project at the Key West International Airport. The Task Order is being funded by FDOT Airfield Improvements Grant G1007 (50%) and Airport Operating Fund 404 (50%). ITEM BACKGROUND: Services include construction inspection, quality assurance testing, and construction administration for five additional weeks while the contractor removes and replaces certain areas of pavement that were found to be deficient. 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 RPR/CA PSO 12/15-60 on October 16, 2019 and PSO 12/15-97 on February 17, 2021. CONTRACT/AGREEMENT CHANGES: New PSO STAFF RECOMMENDATION: Approval. DOCUMENTATION: Jacobs 1215-C4 TWY A FINANCIAL IMPACT: Effective Date: Upon Execution Expiration Date: 365 days after execution Total Dollar Value of Contract: $211,987.00 Packet Pg. 1415 J.2 Total Cost to County: Current Year Portion: Budgeted: Source of Funds: FDOT Grant G1007 (50%) and Airport Operating Fund 404 (50%) CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: N/A If yes, amount: N/A Grant: County Match: Insurance Required: Yes Additional Details: REVIEWED BY: Beth Leto Completed 08/26/2021 5:23 PM Richard Strickland Completed 08/28/2021 2:21 PM Pedro Mercado Completed 08/28/2021 2:45 PM Purchasing Completed 08/30/2021 8:28 AM Budget and Finance Completed 08/30/2021 11:09 AM Maria Slavik Completed 08/30/2021 11:11 AM Liz Yongue Completed 08/30/2021 3:08 PM Board of County Commissioners Pending 09/15/2021 9:00 AM Packet Pg. 1416 J.2.a MASTER AGREEMENT FOR PROFESSIONAL SERVICES TASK ORDER FORM Effective Date Upon Execution Task Order No. 12/15-C4 Client Project No. 404-630196-GAKD142 Engineer Project No. E9Y37960 This Task Order is entered into on the effective date noted above pursuant to the "Master Agreement for Professional Services" between Monroe County, Florida ("Client") and JACOBS PROJECT MANAGEMENT CO. ("Consultant"), dated February 15, 2017 ("Agreement"). The Agreement is incorporated herein and forms an integral part of this Task Order. Services Authorized — Rehabilitate Taxiway A — Construction Support and RPR Services c, Amendment 2 I cv Client authorizes Consultant to perform the Services described in Exhibit A attached hereto and r incorporated herein, which Exhibit A is marked with the above noted Task Order No. and 0. consists of page(s). 0 Pricing N/A Time and Expense per Agreement and Appendix B to the Agreement. X Firm Fixed Price of$ 211,987.00 N/A Other(Describe): �'OE oou 11,41, Schedule t7VE7 PJEO b J. %FOPM F® Services may commence on Execution AS& UNTY A RNEY Services will cease by 365 da s Date 8/26/21 In cv Other N (SEAL) BOARD OF COUNTY COMMISSIONERS 0 ATTEST: KEVIN MADOK CLERK OF MONROE COUNTY, FLORIDA By Deputy Clerk By Mayor/Chairman CONSULTANT: JACOBS PROJECT MANAGEMENT CO Digtaly signed by Jeffrey D.Acton Jeffrey D. ON!cnl Jeffrey D.Acton,o=acobs (1PMCo),ou, 0egitaly sib®o I+Y Jacquatria Raas Acton email=leKrey.Acton@lacobs.com,c=US Jacqueline By Dale:202 L8625 11:2f:64-64'OQ' 6N cn=.lacqua6oa itosa a=US om.l—ba Eng.—e g, Ross1-12ia1ga111.—@A�.b. Witness_ Data 202108.25 11 3153 0 S. Region Title g Group S p C Services roU Leader ___ _ _ _ File: MSTR APS—Monroe County Page 1 of I Packet Pg. 1417 J.2.a Exhibit A—Scope of Work(12/15-C4) Monroe County Key West International Airport Rehabilitate Taxiway A—Amendment 2 Construction Support and RPR Services BACKGROUND CL Under PSO 12/15-60,Jacobs was contracted by Monroe County to provide construction support and RPR services for the Rehabilitation of Taxiway A.The services also included quality assurance testing, construction administration services, site visits from our pavement subject °— matter experts,and full-time construction inspection. LO In April of 2021,there were deficiencies noted in the paving work performed by the Contractor. o Testing and analysis of the newly constructed pavement was then performed to determine the extent of the problems with the newly placed pavement.The Contractor demobilized during the testing and analysis phase between April and August of 2021. During that time period Jacobs was required to continue to provide RPR services as there were other construction activities being performed. As a result of the demobilization of the paving crew the contract time elapsed and Jacobs expended our previously budget on inspecting other construction activities,which were originally planned to be performed concurrently with the paving activities. �- A plan for resolution of the issues was developed and agreed to in mid-August.The plan involves removal and replacement of some areas of the newly placed pavement.The Contractor anticipates re-mobilization on August 22, 2021 to complete the repair/replacement. This °— amendment is for the extension of our services for five additional weeks of construction starting. LO This amendment is to extend Jacobs services to continue to provide RPR services, construction administration services, site visits by Subject Matter Experts, and quality assurance testing. N 0 SCOPE OF WORK The scope of services for Amendment 2 will provide RPR services, construction administration services, site visits by Subject Matter Experts, and quality assurance testing for an additional five weeks of paving for the"Rehabilitate Taxiway A"project at Key West International Airport(EYW). In August and September, it is anticipated that General Asphalt will complete the paving of Taxiway A and the associated stub taxiways. General Asphalt will complete the second coat of pavement marking applications and address miscellaneous punch list items in October. The scope will also include services for the RPR to re-mobilize in October for the final pavement marking and punch list items as described above.This component of the project must be accomplished after the new pavement has fully cured. Page 1 of 4 Packet Pg. 1418 J.2.a These construction services will provide the following: ASSUMPTIONS ■ Construction phase services are based on continuing services for an additional 35 calendar days with an anticipate start date of August 22, 2021. It also includes work associated with the final pavement marking and punch list items which is to be accomplished in October. In the event the construction duration exceeds the calendar days listed above,Jacobs reserves the right to revise our proposal. ■ Jacobs will invoice on a percent complete, including expenses, to compensate the levelCL of effort required for each assignment. ARTICLE D—CONSTRUCTION ADMINISTRATION SERVICES LO 1. Review the Contractor's construction schedule. CL 2. Respond to Contractor's RFI's. 0 3. Attend weekly progress meetings. Observe work in progress and provide reports to Owner. Assume 5 progress meetings throughout the course of the extended construction project. i 4. Prepare Field Sketches, as necessary. �- 5. Provide general supervision and administrative support for resident project representative (RPR). 6. Site Visits to observe to assist in laying out repair areas and observing the work. LO N 7. Prepare and negotiate change orders,as necessary. Assume two change orders. 0 Services for Article D will be provided under a lump sum basis. AMENDMENT TO ARTICLE E-RESIDENT PROJECT REPRESENTATIVE(RPR) 1. Continue to coordinate and attend progress meetings with the contractor,Airport, and any other interested parties, as required prior to construction(e.g. Staging area coordination, setting up Contractor's trailer). 2. Continue to provide full-time RPR services for the work associated with the project. The RPR's for the project shall have field experience in the type of work to be performed, be fully qualified to make interpretations, decisions,field computations, and have knowledge of testing requirements and procedures. Page 2 of 4 Packet Pg. 1419 J.2.a The RPR's shall be responsible for the following: • Checking of construction activities to ensure compliance with the plans and specifications. Inform the contractor and County of any work,which is in non- compliance. • Coordinate quality assurance tests and verify they have been performed at the frequency stated in the specifications. • Review certifications for conformance with the specifications. CL • Document quantities of materials used on the project by actual measurements and computations in a field notebook or computer printout retained in a folder. LO • Maintain a set of working drawings on the job site,which can be used to prepare"As- Built"drawings. o CL • Review the test reports and certifications for conformance with the specifications and v, maintain a file for all reports and certifications. • Inform the County of deficiencies so corrections can be made and retesting performed. i N • Jacobs does not have control over or charge of and shall not be responsible for >- construction means, methods,techniques, sequences or procedures of construction or for safety precautions and programs in connection with the work, since these are solely the Contractor's responsibility under the contract for construction. • Jacobs shall make every reasonable effort to ensure that the Contractor completes the LO work in accordance with the current approved schedule and carries out the work in accordance with the contract documents. N 0 • Review close out documentation. • Review payment requests and certified payrolls from the contractor. • Maintain a diary,which will contain entries made and signed by the resident engineer. Each entry should include the following, plus any additional pertinent data: a. Date and weather conditions. b. Names of important visitors. C. Construction work in progress and location. d. Size of contractor's work force and equipment in use. Page 3 of 4 Packet Pg. 1420 J.2.a e. Number of hours worked per day for contractor and subcontractors. • Record drawings will be prepared, in part, on the basis of information compiled and furnished by others, and may not always represent the exact location,type of various components, or exact manner in which the project was finally constructed. Consultant is not responsible for any errors or omissions in the information from others that is incorporated into the record drawings. 3. Provide full-time RPR services for the placement of final pavement markings and verification of punch list completion. 0. 4. Quality Assurance Testing of Construction Materials will be provided by our subconsultant, Tierra South Florida. Inspectors will be provided for both the production and placement of P- 401. An amendment to Tierra South Florida's original fee to extend their Quality Assurance LO Testing is included with this scope. T- o 5. RDM will serve as additional inspector and subject matter expert. An amendment to RDM's original fee to continue their services is included with this scope. 0 Services for Article E will be provided under a lump sum basis. i LO T- N N 0 U U Page 4 of 4 Packet Pg. 1421 J.2.a JACOBS ENGINEERING GROUP JOB HOUR AND FEE ESTIMATE Monroe County Airport: Key West International Airport Project: Rehabilitate Taxiway A-Amendment 2 FEE SUMMARY BASIC SERVICES Hours Fee DBE AMOUNT CL Article A:Data Collection 0 $ $ Article B:Design,Specifications and Meetings 0 $ $ Article C:Bidding Phase Services 0 $ $ Article D:Construction Phase Services 240 $ 40,062 $ Article E:RPR Services 250 $ 46,400 $ u3 Total Basic Services Lump Sum Fee 490 $ 86,462 $ - r SPECIAL SERVICES Hours Fee DBE AMOUNT CL Article D: Construction Phase Services y Tierra-Geotechnical $ 47,150 $ 47,150 C RDM-Asphalt Placement CIA $ 78,375 $ 78,375 ns I Total Special Services Lump Sum Fee 0 125,525 $ 125,525 SUBTOTAL LUMP SUM PROJECT FEE 490 $ 211,987 $ 125,525 TOTAL LUMP SUM PROJECT FEE 211,987 CJ u3 r N r N C Page 1 of 3 Packet Pg. 1422 J.2.a r pu , G t August 4,2021 Jacobs Project Management Co. 200 W.Forsyth Street, Suite 1520 Jacksonville,FL 32216 Attn: Mr.Doug Alger,Aviation/Utilities email: dco ,,, lSLe.r b s.c om Re: Geotechnical Services Proposal -Testing CL EYW Rehabilitate Taxiway A Key West, Florida TSF Proposal No.2108-545 LO N Dear Doug: o TIERRA SOUTH FLORIDA,Inc.(TSF)is pleased to transmit our Geotechnical Services Proposal for the above referenced project. Based on information provided to TSF,services to include field and plant inspection for the project noted above, with a start date anticipated for August 15, 2021, and a duration of 5-weeks,with work at night. I cv Based on the information provided,TSF estimates the fees for the project to be as noted below. >- UNIT QTY RATE FEES ASPHALT FIELD INSPECTOR NIGHT 25 $910.00 $22,750.00 ASPHALT PLANT INSPECTOR NIGHT 25 $910.00 $22,750.00 SENIOR ENGINEER HOUR 10 $165.00 $1,650.00 $47,150.00 T- cv We appreciate the opportunity to provide this estimate and look forward to continued participation in this project. If you have any questions pertaining to this estimate or if we may be of further service, 0 please contact our office. Respectfully submitted, TIERRA SOUTH FLORIDA,INC. s h �arm6 C-fl nnett, P.E. Principal Engineer Page 2 of 3 2765 Vista Parkway,Suite 10•west Palm Beach,Florida 33411 561-67-8536• °` ' State of Florida Professional Engineers License#28073 Packet Pg. 1423 / ( #O-§QzL s er-z * ) #D-§�z� s er :Wam Q,q! \ \ y Ci \ 2 « 2 \ a.2 �\ �\ ! ■ ■ } E oo Go Aq ! §6m r � \ co00 V 04 ® - %$ % 8 _ kk u � k 2 mLO & p 2 w $ --- kcr ° a wLLJ ; � � � - - co § / . o ■ § 2a x = C - 2 °z � 2 � ) m ®o ■ � ( �/ aj ` a E q \f §f 2{ a § � Ir � k o o $ �0 acl z ■ « R R ■ � 2 i / \ f ] 2 � w � ~ - 1 $ to co La $ W)\ co CL■ ■_ 44 Ri E o § ( E \\ � k U. £ A! \ \ \ q P < w _ \\\ § }CL } 333 � o 0 AC o%0l7/zoz.2.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 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 (, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LO ' INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY HDO G72493503 07/01/21 07/01/22 EACH OCCURRENCE $ 1,000,000 r � OCCUR DAMAGE CLAIMS-MADE RENTED PREMISES(Ea occurrence) ccurrence $ 500,000 X CONTRACTUAL LIABILITY MED EXP(Any one person) $ 5,000 L Ch PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 1,000,000 X cu POLICY❑ PRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ I N A AUTOMOBILE LIABILITY ISA H25545631 07/01/21 07/01/22 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO T BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS ,: BODILY INJURY(Per accident) $ ` HIRED NON-OWNED l PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY _ � I •-- Per accident $ 7 . 15 . 2021 WV a UMBRELLA LAB lA —. _. ` OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE Kwxy ' -_--`" AGGREGATE $ (J DED RETENTION$ $ LO P' A WORKERS COMPENSATION WLR C67817540 (AOS) 07/01/21 07/01/22 X STATUTE EERH AND EMPLOYERS'LIABILITY Y/N T A ANYPROPRIETOR/PARTNER/EXECUTIVE � N/A SCF C6781762A (WI) 07/01/21 07/01/22 E.L.EACH ACCIDENT $ 1,000,000 VJ OFFICER/MEMBER EXCLUDED? * 07/O1/22 1,000,000 Ct A (Mandatory in NH) WCU C67817588 (OH) 07/01/21 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under U 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 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: 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 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. 1425 62390167 J.2.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.* CL V3 r N r CL o O U I tV Additional Information: *$2,000,000 SIR FOR STATE OF: OHIO V3 r N r N O U M U SUPP(05/04) Packet Pg. 1426 J.2.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 CL 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. CJ 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 o 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. 0 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. cv 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. W 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 I® 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 anyLO 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 0 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 Packet Pg. 1427 J.2.a All other terms and conditions of the Policy remain unchanged. Authorized Representative CL CJ LO r cv r CL o I N tJ LO r N r N 0 U U ALL-32685 (01/11) Page 2 of 2 Packet Pg. 1428 J.2.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 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 o 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. 0 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. cv 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. W 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 I® 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 anyLO 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 0 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 Packet Pg. 1429 J.2.a All other terms and conditions of the Policy remain unchanged. Authorized Representative CL CJ LO r- cv r CL o I N tJ LO r- N r N 0 U U ALL-32685(01/11) Page 2 of 2 Packet Pg. 1430 J.2.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 CL 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 c, L The beginning of the Policy period, if this endorsement is effective as of such date; or cv ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period 0 commences. CL C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. 0 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. I E. We will endeavor to send such notice to the e-mail address corresponding to each person or organization indicated in CN 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 I® kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. LO T_ 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 Ou 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 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. 1431 J.2.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 CL 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. T_ cv B. The Schedule must be initially provided to Us within 30 days after: 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. o 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 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 LO 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 0 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) 9ZJOZHN J.�LUPICA. President Authorized Representativ Packet Pg. 1432