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#11-5776 Amendment #12 (Marta U. Corbun) TWELFTH AMENDMENT TO AGREEMENT FOR MEDICAL EXAMINER SERVICES THIS TWELFTH AMENDMENT TO AGREEMENT FOR MEDICAL EXAMINER SERVICES ("Amendment") is entered into and is effective on this 1st day of October, 2022, by and between Marta U. Coburn, M.D., Florida District Twenty Medical Examiner for Collier County, Florida, doing business as District 20 Medical Examiner, Inc., a Florida for Profit Corporation (hereinafter called "Medical Examiner") and the Board of County Commissioners of Collier County, Florida(hereinafter called"County"), collectively referred to as the"parties." RECITALS: WHEREAS, the parties entered into an Agreement for Medical Examiner Services ("Agreement") dated September 27, 2011, a copy of which is attached hereto; and WHEREAS, the Eleventh Amendment to the Agreement was approved by the Board on September 28, 2021 (Agenda Item 16.H.1); and WHEREAS, the parties wish to extend the term of the Agreement and to clarify their respective responsibilities pertaining to compensation for the Medical Examiner's services and for certain costs relating to County-allocated charges consisting of Information Technology costs as well as General, Property, and Liability insurances pertaining to the Medical Examiner's Facility. WITNESSETH: NOW, THEREFORE, in consideration of Ten Dollars ($10.00) and other good and valuable consideration exchanged amongst the parties, and in consideration of the covenants contained herein,the parties agree as follows: 1. All of the above RECITALS are true and correct and are hereby expressly incorporated herein by reference as if set forth frilly below. 1 Amendment#12 to Contract 11-5776 2. Section I of the Agreement is hereby amended by extending the term of the Agreement from October 1, 2022 through September 30, 2023. 3. Section III, Paragraph A of the Agreement is replaced in its entirety to now read as follows: "The County hereby agrees to compensate the Medical Examiner for services to be performed for the term of this Agreement,beginning on October 1, 2022, in the amount of Two Million Seven Thousand Six Hundred Dollars ($2,007,600) by semimonthly payments ending September 30, 2023. In addition, the County will make payments on behalf of the Medical Examiner for County-allocated charges consisting of Information Technology costs,as well as General,Property,and Liability insurances in the total amount of Sixty One Thousand Five Hundred Dollars ($61,500). Any modifications to this Contract shall be in compliance with the County Procurement Ordinance and Procedures in effect at the time such modifications are authorized. 4. Except as further modified by this Amendment,the Agreement shall remain in full force and effect. If there is a conflict between the terms of this Amendment and the Agreement, the terms of this Amendment shall prevail. (Signature Page to Follow) 2 Amendment#12 to Contract 11-5776 C IN WITNESS WHEREOF, the executed have this Twelfth Amendment by authorized agents, as of the date first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS Crystal K. Kinzel, Comptroller and COLLIER COUNTY, FLORIDA Clerk of Colitis S. F ;l 0 By: ' r ,a# -W.� By: _ !`���• Attest aS O R�' 'm' deputy Clerk Wi am L. McDaniel, Jr., Chairman ci,_ St ature tm111' `5'tit i N 1,1 °'*. Approv Form and e ality: By: R. Te ch Deputy County Attorney MEDI L EXAMINER By: I I12 /2117/11/`-Q4 arta U. Coburn M.D. Medical Examiner Florida District Twenty 3 r Amendment#12 to Contract 11-5776 A� Client#: 711232 DISTR201 ACORD,,, CERTIFICATE OF LIABILITY INSURANCE 6/09 DATE(M/2022 WDD1M/DD/YYYY) 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Gabriela Kelley Marsh&McLennan Agency PHONE 727 447-6481 FAX (NC,No,Ext): (A/C,No): Bouchard Region E-MAIL abriela.kelle marshmma.com 101 N.Starcrest Drive ADDRESS: 9 y@marshmma.com AFFORDING COVERAGE NAIC# Clearwater, FL 33765 INSURER A:Employers Preferred Insurance Company 10346 INSURED INSURER B:Lloyds of London 555555 District 20 Medical Examiner INSURER C: 3838 Domestic Avenue INSURER D: Naples, FL 34104 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MOLIC/YEFF (MM/DDIVYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE T RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION EIG277943403 11/30/2021 11/30/2022 X IPER STATUTE I IOTH- ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? y N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 B Professional Liab LHM793384 12/16/2021 12/16/2022 $1,000,000/claim $3,000,000/aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) **Workers Comp Information** Other States Coverage Proprietors/Partners/Executive Officers/Members Excluded: Marta U Coburn, MD, Owner All states except ND, OH,WA,WY,self-insured states,those (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION COLLIER COUNTY BOARD OF COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COMMISSIONERS ACCORDANCE WITH THE POLICY PROVISIONS. 3327 TAMIAMI TRAIL EAST NAPLES, FL 34112 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S10925029/M10924997 RCGXK DESCRIPTIONS (Continued from Page 1) states insu **Supplemental Name** First Supplemental Name applies to all policies-District 20 Medical Examiner, Inc. SAGITTA 25.3(2016/03) 2 of 2 #S10925029/M10924997