Loading...
HomeMy WebLinkAboutJacobs_CA__1-2022_WW_Util_Tech_Serv_10-7-22I:\Engineering\2021 - 2030 Contracts\2022 CONTRACTS\Jacobs 2022 WW Util Tech Serv\Jacobs CA #1- 2022 WW Util Tech Serv_10-7-22.docx Page 1 of 2 AMENDMENT NO. 1 The CITY OF OSHKOSH, hereinafter referred to as CITY, and JACOBS ENGINEERING GROUP, INC., 1610 North 2nd Street, Suite 201, Milwaukee, WI 53212, hereinafter referred to as the CONSULTANT, entered into an agreement for 2022 WASTEWATER UTILITY TECHNICAL SERVICES on December 14, 2021. Paragraph C in ARTICLE XII. PAYMENT included the provision that costs for additional services shall be negotiated and set forth in a written amendment to this AGREEMENT executed by both parties prior to proceeding with the work covered under the subject amendment. THEREFORE, the CITY and the CONSULTANT agree to insert the following paragraph after the third paragraph in ARTICLE III. SCOPE OF WORK: The CONSULTANT shall provide the services described in the CONSULTANT’s Scope of Services dated August 20, 2022. The CITY and the CONSULTANT further agree to insert the following bullet point after the first bullet point in Paragraph A of ARTICLE XII. PAYMENT:  Payment for Amendment No. 1 shall be a Time and Materials Sum not to exceed $78,780 (Seventy Eight Thousand Seven Hundred Eighty Dollars). DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C I:\Engineering\2021 - 2030 Contracts\2022 CONTRACTS\Jacobs 2022 WW Util Tech Serv\Jacobs CA #1- 2022 WW Util Tech Serv_10-7-22.docx Page 2 of 2 All other terms contained within the December 14, 2021 agreement remain unchanged and in effect. In the Presence of: CONSULTANT ____________________________ By: _____________________________ ____________________________ Rajeev Srivastava, Ph.D. (Seal of Consultant Manager of Projects if a Corporation) By: _____________________________ _____________________________ (Specify Title) CITY OF OSHKOSH _____________________________ By: _____________________________ (Witness) Mark A. Rohloff, City Manager _____________________________ And: _____________________________ (Witness) Jessi L. Balcom, City Clerk APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which which will accrue under this Agreement. __________________________ City Attorney _______________________________ City Comptroller DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext): PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Attn: City Clerk 3,000,000 CONTRACTUAL LIABILITY Continental Shelf Lands Act Coverage. Designated Construction Project(s) General Aggregate Limit Endorsement applies to General Liability policy. Coverage includes U.S. Longshore and Harbor Workers Compensation Act Coverage and Outer 4,000,000 work. Coverage is primary and certificate holder's insurance is excess and non-contributory. XCU is covered under the 1-212-948-1306 CPM G21743793 020 the negligence of the insured in the performance of insured's services to cert holder under contract for captioned EON G21655065 013 volunteers are added as an additional insured for general liability, auto liability & pollution liability as respects BPG000FC.1. SECTOR: Public. City of Oshkosh, and its officers, council members, agents, employees and authorized PROJECT MGR: Linda Mohr. CONTRACT MGR: Leanne Andersen. RE: All Projects. CONTRACT END DATE: 8/30/2021. PROJECT NUMBER: USA N A 1-212-948-1306 Los Angeles, CA 90017 06/17/2022 HDO G72496176 07/01/23 2,500,000 Cert_Renewal 07/01/2307/01/22 2,100,000 Jacobs Engineering Group Inc. A A 2,100,000 ACE AMER INS CO A 3,000,000 07/01/22 07/01/22 07/01/22 1000 Wilshire Blvd., Suite 1140 C/O Global Risk Management X X PO Box 1130 215 Church Avenue 500,000 65828218 65828218 X 633 W. Fifth Street Los Angeles, CA 90071 1,000,000 LIC #0437153 1,000,000 ISA H25568230 3,000,000 X 07/01/23 07/01/23 07/01/23 07/01/23 07/01/23 07/01/22 07/01/22 Oshkosh, WI 54903-1130 5,000 CONTRACTORS POLLUTION PROFESSIONAL LIABILITY X WCU C68914577 (OH)* WLR C6891453A (AOS) SCF C68914619 (WI) City of Oshkosh A A A 07/01/22 X PER CLAIM/ PER AGG PER CLAIM/PER AGG 22667 4,000,000 CIRTS_Support@jacobs.com Marsh Risk & Insurance Services DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C SUPP (05/04) SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE NAME OF INSURED: Additional Description of Operations/Remarks from Page 1: Additional Information: 06/17/2022 *$2,000,000 SIR FOR STATE OF: OHIO WILL NOT EXCEED OR BROADEN IN ANY WAY THE TERMS, CONDITIONS, AND LIMITS AGREED TO UNDER THE APPLICABLE CONTRACT.* the General Liability coverage. *THE TERMS, CONDITIONS, AND LIMITS PROVIDED UNDER THIS CERTIFICATE OF INSURANCE Jacobs Engineering Group Inc. DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C NOTICE OF CANCELLATION TO OTHERS (Schedule – Email Only) ENDORSEMENT Named Insured Jacobs Engineering Group, Inc Endorsement Number 0 Policy Symbol CPM Policy Number G21743793 0 Policy Period 07/01/202 to 07/01/202 Effective Date of Endorsement 07/01/202 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. The “insured” and the Insurer hereby agree to the following changes to this Policy: Section IX. GENERAL CONDITIONS, Subsection A. Cancellation, of the Policy, is amended with the addition of the following: 1.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. 2.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. 3.The Schedule must be in an electronic format that is acceptable to us; and must be accurate. 4.Our delivery of the notification as described in Paragraph 3. 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. 5.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. 6.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. 7.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. 8.We may arrange with your representative to send such notice in the event of any such cancellation. MS-299542.11 (03/20) Page 1 of 2 DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C 9.You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. 10. This endorsement does not apply in the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. Authorized Representative MS-299542.11 (03/20)Page 2 of 2 DocuSign Envelope ID: 9C85C7DD-6DA1-433E-B03D-BCD3B43E952C