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Backup Documents 09/27/2022 Item #16F4 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 1 F 4 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Risk Risk Management �! q/27/22- 2. County Attorney Office County Attorney Office SZT �5 ''2 /4) /2- 4. BCC Office Board of County Commissioners ( 4 /0 !0 Y LZ 4. Minutes and Records Clerk of Court's Office 5. Procurement Services Procurement Services PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Ryan Nelson/Procurement Contact Information 239-252-8407 Contact/ Department Agenda Date Item was SEPTEMBER 27,2022 Agenda Item Number 16.F.4 Approved by the BCC Type of Document AMENDMENT Number of Original 1 Attached Documents Attached PO number or account N/A 11-5776-NS MARTA U. number if document is MEDICAL COBURN, M.D. to be recorded EXAMINER FLORIDA AMENDMENT DISTRICT #12 TWENTY MEDICAL EXAMINER INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature STAMP OK N/A 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be RMN signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the RMN document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's RMN signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A should be provided to the County Attorney Office at the time the item is input into SIRE. RECEIVED Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! SEP 27 2022 8. The document was approved by the BCC on 9/27/2022 and all changes made during N/A is not the meeting have been incorporated in the attached document. The CountyQption for Attorney's Office has reviewed the changes,if applicable. Risk ManagemTiis line. 9. Initials of attorney verifying that the attached document is the version approved by the N/A is not BCC,all changes directed by the BCC have been made,and the document is ready for the an option for Chairman's signature. this line. 16F4 . Ann P. Jennejohn From: Ann P.Jennejohn Sent: Thursday, October 6, 2022 12:48 PM To: 'Ryan.Nelson@colliercountyfl.gov' Subject: Contract Amendment#12 to #11-5776-NS (Item #16F4 9-27-22 BCC Meeting) Attachments: #11-5776 Amendment#12 (Marta U. Corbun).pdf For your records. Thank you! Ann Jenne,john 13MR Senior Deputy Clerk II Clerk to the value Adjustment Board Office: 239-252-8406 Fax: 239-252-8408 (if applicable) Ann.Jennejohn@CollierClerk.com Office of the Clerk of the Circuit Court & Comptroller of Collier County 3299 Tawuaw.i Trail, Suite #401 Naples, FL 34112-5324 www.CollierClerk.covv, i TWELFTH AMENDMENT TO 1 b F 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. WITNES SETH: 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 filly below. 1 Amendment#12 to Contract 11-5776 C 16F4 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 16F4 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 Courts ABy: r / � �"dad '"a' _ fi- �'1111 ." 411111. :Attest:at! +tYl; t7.i eputy Clerk Wi am L. McDaniel, Jr., Chairman v r sip ature t 1� ,'• Approv Form and e ality: By: R. Te ch Deputy County Attorney MEDIL EXAMINER arta U. Coburn M.D. Medical Examiner Florida District Twenty 3 r Amendment#12 to Contract 11-5776 .A9 Client#: 711232 DISTR201 4DATE M/ ) ACORD. CERTIFICATE OF LIABILITY INSURANCE 6/09/2022 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 A/C {A/C,No,Ext): (A/C,No): Bouchard Region E-MAIL marshmma.com 101 N.Starcrest Drive ADDRESS: 9abriela.kelle 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 INSRL SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMIDD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 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/OP AGG $ 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 PER OTH- AND EMPLOYERS'LIABILITY STATUTE FR ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 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) 1 6 F 4 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