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Item I02 1.2 County f � .�� ",�, 1 BOARD OF COUNTY COMMISSIONERS Mayor Craig Cates,District 1 Mayor Pro Tem Holly Merrill Raschein,District 5 The Florida Keys Michelle Lincoln,District 2 James K.Scholl,District 3 David Rice,District 4 County Commission Meeting April 19, 2023 Agenda Item Number: I.2 Agenda Item Summary #11882 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. 2022-33 in the amount of $77,933.00 for construction support services during the Automated Surface Observing System (ASOS) Relocation project at the Florida Keys Marathon International Airport. The project is funded by MTH FDOT Grant G1237 (80%) and MTH Airport Operating Fund 403 (20%). ITEM BACKGROUND: In accordance with the Florida Keys Marathon International Airport's approved Airport Layout Plan (ALP), the existing Automated Surface Observing Systems (ASOS) is scheduled to be relocated to allow for future infrastructure improvements which includes both drainage improvements and improved aircraft parking positions. The ASOS in its current location prohibits the implementation of these future improvements. PREVIOUS RELEVANT BOCC ACTION: Approval of Master Agreement for Professional Services with Jacobs Project Management Co. for General Consulting Services for both Monroe County Airports on February 16, 2022. Approval of original FDOT Grant G1237 on November 20, 2018 and Amendment 41 on April 15, 2020. CONTRACT/AGREEMENT CHANGES: New Task Order STAFF RECOMMENDATION: Approval DOCUMENTATION: Jacobs PSO 2022-33 MTH ASOS CA services FINANCIAL IMPACT: Effective Date: Upon Execution Packet Pg. 1522 1.2 Expiration Date: 730 days after execution Total Dollar Value of Contract: $77,933.00 Total Cost to County: 0 Current Year Portion: Budgeted: Yes Source of Funds: FDOT Grant G1237 (80%) and MTH Airport Operating Fund 403 (20%) CPI: Indirect Costs: Estimated Ongoing Costs Not Included in above dollar amounts: Revenue Producing: No If yes, amount: Grant: County Match: Insurance Required: Yes Additional Details: 04/19/23 403-63502 - MARATHON AIRPORT R & R $15,586.60 REVIEWED BY: Beth Leto Completed 04/03/2023 12:41 PM Richard Strickland Completed 04/03/2023 4:59 PM Pedro Mercado Completed 04/03/2023 5:01 PM Purchasing Completed 04/03/2023 5:10 PM Budget and Finance Completed 04/04/2023 8:44 AM Brian Bradley Completed 04/04/2023 8:58 AM Lindsey Ballard Completed 04/04/2023 9:24 AM Board of County Commissioners Pending 04/19/2023 9:00 AM Packet Pg. 1523 1.2.a MASTER AGREEMENT FOR PROFESSIONAL SERVICES TASK ORDER FORM Upon Execution Effective Date Task Order No. 2022 -33 403-635108-G1237 Engineer E173 Client Project No. g J d This Task Order is entered into on the effective date noted above pursuant to the "Master Agreement for Professional Services"between Monroe County, Florida("Client") and JACOBS PROJECT MANAGEMENT CO. ("Consultant"), dated February 16, 2022 (`Agreement'). The Agreement is incorporated herein and forms an integral part of this Task Order. N N Services Authorized — Relocate Automated Surface Observing System (ASOS) — Construction Support Services Client authorizes Consultant to perform the Services described in Exhibit A attached hereto and o incorporated herein, which Exhibit A is marked with the above noted Task Order No. and consists of 3 page(s). Pricing N/A Time and Expense per Agreement and Appendix B to the Agreement. Firm Fixed Price of$__77,933.00 N/A Other(Describe): `0 Ft E 41 1 0 PFORM U Schedule J.MERCAUO Services may commence on Exemitio 1 pa w / � W Services will cease by 730 days Other (SEAL) BOARD OF COUNTY COMMISSIONERS N ATTEST: KEVIN MADOK, CLERK OF MONROE COUNTY, FLORIDA N N en By By Deputy Clerk Mayor/Chairman 0 CONSULTANT: JACOBS PROJECT MANAGEMENT CO c� By_!E� Jacqueline x� s Res o u Director Witness Y. � � _� Title . File: MSTRAPS—Monroe County Page 1 of 1 Packet Pg. 1524 1.2.a Exhibit A—Scope of Work (2022 - 33) Monroe County The Florida Keys Marathon International Airport(MTH) Relocate Automated Surface Observing System (ASOS)—Construction Support Services SCOPE OF'4 ORI Jacobs will provide Construction Support Services for the relocation of the Automated Surface Observing System(ASOS).These improvements will be located at the Florida Keys Marathon International Airport in Marathon,Florida. N N N DESt.;UPTIO `Ol'^WO'R U) a Article D—Construction Administration The specific tasks Jacobs will perform are as follows: N • Prepare construction contract. • Prepare, stamp, sign and issue Conformed Drawings and Specifications. • Coordinate the issuance of the Notice to Proceed;Administrative and Construction. U) • Review contractors base line schedule and updated schedules. • Jacobs will provide responses for Requests for Information(RFIs)within 5 business days from receipt.A maximum of 12 RFIs will be reviewed. • Jacobs will complete the review of Submittals within 10 business days from receipt. A U maximum of 10 submittals will be reviewed. • Prepare for and attend Pre Construction Conference;PM and Electrical Engineer. • Jacobs will lead four (4) bi-monthly construction meetings and site visits by the PM. Meeting minutes will be produced. • Jacobs will lead eight (8) bi-monthly construction meetings to be held by Microsoft Teams. Meeting minutes will be produced. N • Jacobs electrical engineer will complete two site visits to review the construction and N equipment installation. • Electrical engineer will prepare for and attend the Final Inspection. • Prepare field sketches. • Jacobs will review change documentation, anticipate up to three(3)change orders. 0 • Jacobs will review four(4)pay applications. • Review closeout documentation. • Review quality assurance test results. • Jacobs will prepare Record Drawings from the contractor issued As-Builts drawings after construction is complete. Services for Article D will be provided under a lump sum basis. QUALIFICATIONS AND ASSUMPTIONS Page I of 3 Packet Pg. 1525 1.2.a For the purpose of providing a stipulated fee amount, this proposal has been based on the following qualifications and assumptions: • Inspection services for building / permitting inspections is not in our scope (no inspectors on staff),none are anticipated by the architect/engineer. • Attendance and/or presentation to public hearings and/or other meetings with municipal agencies are not included. • Municipal Agency and all associated permit fees are to be paid by the client or contractor. Jacobs is not responsible for obtaining any permits. Permits are to be obtained by the contractor. Jacobs will monitor the contractor's progress through the permit process for the client and provide follow up periodically with the permitting agency to verify the status,but it is ultimately the responsibility of the contractor to obtain all permits. • Contract Support Services does not include maintenance or preparation of As- N Built drawings which is the contractor's responsibility. N • Quality Control is the responsibility of the contractor. • Services not described in the scope of work are not included. U) 0 c� Construction Phase Services - If this Agreement includes the furnishing of any Services during the construction phase of the project, the following terms will apply: (a) If JACOBS is called N upon to observe the work of CLIENT's construction contractor(s) for the detection of defects or deficiencies in such work,JACOBS will not bear any responsibility or liability for such defects or deficiencies or for the failure to so detect. JACOBS shall not make inspections or reviews of the safety programs or procedures of the construction contractor(s) and shall not review their work for the purpose of ensuring their compliance with safety standards. (b) If JACOBS is called upon to review submittals from construction contractors, JACOBS shall review and approve or 0 take other appropriate action upon construction contractor(s)' submittals such as shop drawings, product data and samples, but only for the limited purpose of checking for conformance with U information given and the design concept expressed in the contract documents. JACOBS' action shall be taken with such reasonable promptness as to cause no delay in the work while allowing sufficient time in JACOBS' professional judgment to permit adequate review. Review of such submittals will not be conducted for the purpose of determining the accuracy and completeness of other details such as dimensions and quantities. (c) JACOBS shall not assume any responsibility or liability for performance of the construction services, or for the safety of persons and property N during construction, or for compliance with federal, state and local statutes, rules, regulations and codes applicable to the conduct of the construction services. JACOBS shall have no influence over the construction means, methods, techniques, sequences or procedures. Construction safety shall remain the sole responsibility of the construction contractor(s). (d) All contracts between U) CLIENT and its construction contractor(s) shall contain broad form indemnity and insurance clauses in favor of CLIENT and JACOBS, in a form satisfactory to JACOBS. On-Site Services During Construction - The presence or duties of Jacobs' personnel at a construction site, whether as onsite representatives or otherwise, do not make Jacobs or Jacobs' personnel in any way responsible for those duties that belong to Client and/or the construction contractor or other entities, and do not relieve the construction contractor or any other entity of < their obligations, duties, and responsibilities, including, but not limited to, all construction methods, means, techniques, sequences, and procedures necessary for coordinating and completing all portions of the construction work in accordance with the construction Contract Documents and any health or safety precautions required by such construction work. Page 2 of 3 Packet Pg. 1526 1.2.a Jacobs and Jacobs' personnel have no authority to exercise any control over any construction contractor or other entity or their employees in connection with their work or any health or safety precautions and have no duty for inspecting, noting, observing, correcting, or reporting on health or safety deficiencies of the construction contractor(s) or other entity or any other persons at the site except Jacobs' own personnel. t3 LO The presence of Jacobs' personnel at a construction site is for the purpose of providing to Client a LO greater degree of confidence that the completed construction work will conform generally to the construction documents and that the integrity of the design concept as reflected in the construction documents has been implemented and preserved by the construction contractor(s). Jacobs neither -guarantees the performance of the construction contractor(s) nor assumes responsibility for construction contractor's failure to perform work in accordance with the N construction documents. N Items identified as not included or limited in the scope of services can be provided or expanded upon as additional services under a separate agreement or supplemental to this agreement. 0 c� REFERENCES The contractor will need to provide the following documentation to Jacobs before commencing with our scope of work regards Record Drawings. U) 0 2 • As-built documentation from the contractor. U) t3 COMPENSATION See attached spreadsheet. SCHEDULE N N We anticipate completion of the deliverables in accordance with the following schedule: The overall duration of this effort will be as noted below: U) Item Duration (Business Days' 0 c� A. Construction Support Services 60 calendar days c� Page 3 of 3 Packet Pg. 1527 1.2.a JACOBS ENGINEERING GROUP JOB HOUR AND FEE ESTIMATE Monroe County Airport: Florida Keys Marathon International Airport Project: Relocate Automated Surface Observing System(ASOS) U FEE SUMMARY BASIC SERVICES Hours Fee DBE AMOUNT M Article A:Data Collection M Article B:Design Services Article C:Advertising and Bidding Article D.Construction Administration 371 $ 71,703 Total Services Cost Plus Fee 371 71,703CL U) SPECIAL SERVICES O Hours Fee Article D:Construction Support Services-Subconsultant;Tierra South rioridia $ 6,230 N Ttatai Special Services Fee 0 $ 6, 30 $ 371 77,633 $ 0 2 DBEPercentage 0.00% U) U M M CN cN cN U) O c5 c5 Packet Pg. 1528 AC - 09/14/2 22.a CERTIFICATE OF LIABILITY INSURANCE DATE(I 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 INSURERD: 1000 Wilshire Blvd., Suite 1140 INSURERE: Los Angeles, CA 90017 Cn INSURERE: Cn a COVERAGES CERTIFICATE NUMBER: 66569759 REVISION NUMBER: CN 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; N 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY HDO G72496176 07/01/22 07/01/23 EACH OCCURRENCE $ 1,000,000 U DAMAGES( RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ 500,000 X CONTRACTUAL LIABILITY MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 N GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 1,000,000 X POLICY❑ PRO JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 1,000,000 OTHER: $ A AUTOMOBILE LIABILITY ISA H25568230 07/01/22 07/01/23 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 U X ANY AUTO APPROVED BY RISK MANAGEMENT BODILY INJURY(Per person) $ , OWNED SCHEDULED ", ,. '' BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS BY--"`-= —' /�rn"^' " —; HIRED NON-OWNED DATE 9 �2n22 PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident WAIVER N/A_YES_ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION SCF C68914619 (WI) 07/01/22 07/01/23 X STATUTE OERH AND EMPLOYERS'LIABILITY A ANYPROPRIETOR/PARTNER/EXECUTIVE N/A WLR C6891453A (AOS) 07/01/22 07/01/23 E.L.EACH ACCIDENT $ 1,000,000 t% OFFICER/MEMBER EXCLUDED? IN I A (Mandatory in NH) WCU C68914577 (OH)* 07/01/22 07/01/23 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If t'J describe under DES 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ CN A PROFESSIONAL LIABILITY EON G21655065 013 07/01/22 07/01/23 PER CLAIM/PER AGG 2,000,000 OL U) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) U 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 9= International Airport. SECTOR: Public. The Monroe County Board of County Commissioners, its employees and official; are added as an additional insured for general liability & auto liability as respects the negligence of the insured 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 EXCEED OR BROADEN IN ANY WAY THE TERMS, CONDITIONS, ANDA 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 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 Packet P . 1529 nyumdo_newgalexy g 66569759 1.2.a DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 0 9/14/2022 NAME OF INSURED: Jacobs Project Management Co. Additional Description of Operations/Remarks from Page 1: LIMITS AGREED TO UNDER THE APPLICABLE CONTRACT.* u t% t% a CN CN CN U) O U M a CN U) U U) Additional Information: t3 *$2,000,000 SIR FOR STATE OF: OHIO t% t% a CN CN CN U) O U M E U SUPP(05/04) Packet Pg. 1530 1.2.a NOTICE TO OTHERS ENDORSEMENT- SCHEDULE - EMAIL ONLY Named Insured Jacobs Engineering Group Endorsement Number Inc. 78 Policy Symbol Policy Number Policy Period Effective Date of Endorsement HDO �G72496176 07/01/2022 To 07/01/2023 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. W 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 N of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. N LO B. The Schedule must be initially provided to us within 15 days after: CL t) i. The beginning of the Policy period, if this endorsement is effective as of such date; or 0 U ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. cat 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. c� 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 CCN4 with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you cat 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. c� ALL-32685(01/11) Page 1 of 2 Packet Pg. 1531 1.2.a All other terms and conditions of the Policy remain unchanged. U Authorized Representative LO CN CN CD CN LO CL U) 0 CN U) 0 2 U) U LO M CN CN CD CN LO CL U) 0 E ALL-32685(01/11) Page 2 of 2 Packet Pg. 1532 1.2.a NOTICE TO OTHERS ENDORSEMENT- SCHEDULE - EMAIL ONLY Named Insured ,Jacobs Engineering Group Inc. Endorsement Number 23 Policy Symbol P5568230 icy Number Policy Period Effective Date of Endorsement ISA 07/01/2022 To 07/01/2023 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. W 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 N of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. N LO B. The Schedule must be initially provided to us within 15 days after: CL t) i. The beginning of the Policy period, if this endorsement is effective as of such date; or 0 U ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. cat 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. c� 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 CCN4 with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you cat 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. c� ALL-32685(01/11) Page 1 of 2 Packet Pg. 1533 1.2.a All other terms and conditions of the Policy remain unchanged. U Authorized Representative LO M M CN CN CD CN LO CL U) 0 CN U) 0 2 U) U LO M CN CN CD CN LO CL U) 0 E ALL-32685(01/11) Page 2 of 2 Packet Pg. 1534 1.2.a Workers'Compensation and Employers' Liability Policy Named Insured Endorsement Number JACOBS ENGINEERING GROUP INC. 1000 WILSHIRE BLVD, STE 1140 Policy Number LOS ANGELES CA 90017 Symbol: WLR Number:C6891453A Policy Period Effective Date of Endorsement 07-01-2022 TO 07-01-2023 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 to which it is attached and is effective on the date issued unless otherwise stated. U en LO 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 cN provide or have provided to us (the "Schedule"). You or your representative must provide us with the e-mail address a of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. LO CL B. The Schedule must be initially provided to us within 15 days after: 0 L 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. �?L_ E. We will endeavor to send such notice to the e-mail address corresponding to each person or organization indicated in 0 the Schedule at least 30 days prior to the cancellation date applicable to the Policy. U 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 CCNN incorrect information that you or your representative provide to us. If you or your representative does not provide us 'CON 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. 0 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. WC 99 03 68(01/11) Page 1 Packet Pg. 1535 1.2.a Authorized Representative U LO M CN CN CD CN LO CL U) 0 U CN U) 0 2 U) U LO M CN CN CD CN LO CL U) 0 U c� WC 99 03 68(01/11) Page 2 Packet Pg. 1536 1.2.a THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured Endorsement Number Jacobs Engineering Group, Inc. 23 Policy Symbol Policy Number Policy Period Effective Date of Endorsement EON G21655065 013 07/01/2022 to 07/01/2023 07/01/2022 Issued By(Name of Insurance Company) - ACE American Insurance Company LO 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 theCq persons or organizations listed in the schedule that You or Your representative provide or have `N provided to Us (the Schedule). You or Your representative must provide Us with both the physical cN 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 cN Period commences. C. The Schedule must be in a 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 0 most recent Schedule in Our records as of the date the notice of cancellation or non-renewal is mailed or delivered to You. U) E. We will endeavor to send or deliver such notice to the e-mail address or physical address U corresponding to each person or organization indicated in the Schedule at least 30 days prior to the LO 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 CN person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind cN upon Us, Our agents or representatives, will not extend any Policy cancellation or non-renewal date cN and will not negate any cancellation or non-renewal of the Policy. LO CL G. We are not responsible for verifying any information provided to Us in any Schedule, nor are We U) responsible for any incorrect information that You or Your representative provide to Us. If You or 0 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 E 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) 9XOHN J.�LUPICA. President Authorized Representativ Packet Pg. 1537