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3rd Change Order 03/16/2022GVS COURTq c Kevin Madok, CPA Clerk of the Circuit Court & Comptroller — Monroe Count Florida o p Y, E cOVN DATE: March 21, 2022 TO: Breaime Erickson, Contract/Budget Adiiiiiiistrator Project Management Stan Thompson, Contract Adniiiiistrator Project Management FROM: Liz Yongue, Deputy Clerk SUBJECT: March 16' BOCC Meeting Attached is a copy of the following item which has been accepted into the record: D1 3rd Change Order with Pedro Falcon Contractors, Inc. iii the amount of $123,934.52 for the Long Key Transfer Station Builduig Repairs project. This change order is needed after an inspection was performed iii which unforeseen additional damage to the buildi ig was found. Should you have any questions please feel free to contact me at (305) 292-3550. cc: County Attorney_ Finance File KEY WEST 500 Whitehead Street Key West, Florida 33040 305-294-4641 MARATHON 3117 Overseas Highway Marathon, Florida 33050 305-289-6027 PLANTATION KEY 88820 Overseas Highway Plantation Key, Florida 33070 305-852-7145 PK/ROTH BUILDING 50 High Point Road Plantation Key, Florida 33070 305-852-7145 MONROE CouNTYIENGINEERINGI PROJECT MANAGEMENT CONTRACT CHANGE ORDER PROJECT TITLE: Long Key Transfer Station Building Repairs CHANGE ORDER NO: 03 BOCC APPROVAL DATE: 03/116/2022,711c-) CONTRACT DATE: 04/2112021 TO CONTRACTOR: Pedro Falcon Contractors, Inc. The Contract is,th'9666d as follows - The original (Contract Sum) (Guaranteed Maximum Price) $394,186.00 Net change by j:�evioq§ly, authorized Change Oed6(�i;ili-�-.T�.�i...,.-,,.....,...;.;..,..-."--.-�-z..;,;-V;I.,.,.,.-��-;,.,�.i..�.,;�4i-.�l.;; $29,541.16 The (Contract Surri) (Guaranteed Maximum Price) prior to this Change -order $423,727.18; The (Contract S�um (Guaranteed Maximum Price) will be (increased) (decreased) (unchanged) by this Change Order .............. $123,934.52 The new (Contract Sum (Guaranteed Maximum Price) including this Change Order is,., $547,661.70.; The Contract TiMeill-be (L6rbased)(decre-ased) (unchanged) by-k,;,;,;...',..,;,.;;:: .:.i�iiI 120 days The date of Substantial Completion- as of the date of this Cha6qe Order is '5/26/20-221 .additional work. Chance order 1s-11.4Vd or a�contracontract price: DATE: 2-94-9022. Change Order Attachment per Ordinance No. 024-2015 • Change Order was not included in the original contract specifications. Yes ® No ❑ If Yes, explanation: After execution of the contract and following removal of stored materials from the metal building, the condition of the structure was determined to be worse than anticipated and required further structural repairs not in the original contract specifications. • Change Order was included in the original specifications. Yes ❑ No If Yes, explanation of increase in price: • Change Order exceeds $50,000 or 5% of contract price (whichever is greater). Yes ® No ❑ If Yes, explanation as to why it is not subject for a calling for bids: The contractor is already on the jobsite performing other repairs and has been in constant contact/discussions with the Design Engineer about the various additional repairs needed. Re -bidding the project would delay the repairs and most likely would not result in any savings to the County due to escalating material costs. • Project architect approves the change order. Yes ® No ❑ If no, explanation of why: • Change Order is correcting an error or omission in design document. Yes ❑No Should a claim under the applicable professional liability policy be made? Yes ❑ No Explain: 32/16/2022 CHANGE ORDER SPREADSHEET Change Order p: Date Submitted: ASIS OF ESTIMATE (LEGAL RECOMMENDATIONS IMPLEMENTED): (Per C-- General Condltlons) 1 No ov had on Insurance erpenses(Sec 00750 J24) 6 NO Sales Tax Included In Markup Calculatlon(Sec. 00750,7.2.4) 2 If Sub;pbh mswork, GC CanoNy charge%5%for Manage-1(Sac00750,T24H2) ,IO kDb Is being aef pert rmed, IMcdrreett5 sulatlona, add[tEnaf m kLRDr,moued, ohly5%overhead a nl Erof't 0. 00750,7'ZAN2) 4 When be Ht Inc eas: /d� easebm rktlpslshell b-[allayed using neYWtal. Sec W750, 7.2,A) 5 DI,-C- re.nsdered ove head andLttl,d. N pe ntage-,kups(5ec 00750 ].24) ADDITIONAL WORK CALCULATED MARKUPS CONTRACTOR EXPENSES/DIRECT COSTS ITEM DESCRIPTION UOM Q, UNIT PRICE SUBTOTALS) 5%OVERHEAD' 5%PROFIT" 5%MANAGEMENT- TOTALS Tempos ry Toilets-2 Months Month 2 $250.00 $250.00 Temporary Phone-2 Months Month 2 :125.00 $125.00 :250.00 $250.00 SuperintendentTru d<-2Months Month 2 $600.00 $1,200.00 $1,200.00 SuperintendentFu el-8weeks Week 8 $200.00 $1,600.00 $1,600.00 SiteSuperintendent-320MHS@$52.00%35%Labor Burden MT 320 $70.20 $22414.00 $22,464.00 PermL-s LS 1 $4,500.00 $4,500.00 Disposal Fees LS 1 :4,500.00 $6,800.00 $6,800.00 $6,800.00 $0.00 $0.00 $0.00 $0.00 Subtotal $37,064.00 $0.00 $0.00 $37,064.00 I ITEM DESCRIPTION UOM Q, UNIT PRICE SUBTOTALS) ) 5%OVERHEAD' 5%PROFIT" 5%MANAGEMENT"' TOTALS) CREDIT: Demolltlon Metal Bullding CREDIT:New Wall Glrts CREDIT: New Stru tBadng CREDIT: Metal Skiing at Metal Bullding CREDIT: Metal Roof at Metal Bullding CREDIT: Pa IntMetel Bullding Palnt Prep at Columns Only 220 MHS @ $54.68 Paint at Columns Materials Only Paint at Columns Labor Only 110 MHS @ $54.68 Sdssor Llft for Palntlng (5 weeks) Sdssor Litt Deliver/Pld<up Fee LS 1 -$12,630.00 LS 1 -12,079.00 LS 1 -$499.00 LS 1 -126'661.00 LS 1 -158,783.00 LS 1 -155,442.00 LABOR EQUIPMENT MATERIALS/OTHER 2029.60 $7,650.00 $6,014.80 $1,500.00 $500.00 m UBCONTRACTED WORK ITEM DESCRIPTION UOM Q, UNIT PRI CE SUBTOTAUS) 5%OVERHEAD' 5%PROFIT" 5%MANAGEMENT"' TOTAL kyline Steel St -teal Steel Column Repairs LS 1 519,250.00 519,250.00 $19,250.0 SA Bui lding so_ Metal Bullding Repairs LS 1 5181,732.00 5181,732.00 $181,732.0 $0.00 $0.0 $0.00 0.0 $0.00 $0.0 Subtotal $200,982.00 i510048.14 $211,031.11 CONTRACTORS B OND CHANGE ORDER SUBTOTAL ITEM DESCRIPTION TOTALS P & P Bond @ 1.2% $333,464.94 $1,469.58 Subtotal $1,469.58 CHANGE ORDER GRAND TOTAL $123,934.52 filk 16 February 202121 Project: Long Key Transfer Station Renovation and Addition PCO Number: 003 Description: Major Structural Revision to Metal Building Potential Change Order 003 — Major Structural Revisions to Metal Building addresses major revisions to the contracted work at the metal building. The original contract was for minor structural revisions, painting of existing steel. structural member and new siding and roof panels. After the space was vacated by the end user and vast quantities of materials having been moved a subsequent inspection by the Contractor revealed thol the conditions addressed in the contract drawing were significant enough that a structural revision was needed. The difference between the original approach and the revised approach as detailed in the revision plans does not allow for a side -by -side comparison for credits and adds. Credits are based upon the approved schedule of values provided based on the original scope of work which include overhead and profit at a bid rate with higher Overhead and Profit than the allowed change order rate. Work on the woodshed and the metal building should have proceeded simultaneously. PFC was directed to proceed with the wooden shed portion, and which used the general conditions and supervision slated to be used during the course of construction for both building sections. General conditions and supervision are therefore a part of the added work in this change order. PFC Original Work - Credits rIT-J of Is no NewWall Girts ................................................................................................. <$2,079.00> NewStrut Bracing .............................................................................................. <$499.00> Metal Siding at Metal Building ....................................................................... <$26,66i.00> Metal Roof at Metal Building ......................................................................... <$58,783.00> Established 1984 19MIMIUMM. V 1=101 �� 111 � TOTAL CREDITS INCLUSIVE OF ALL OVERHEAD AND PROFIT ...................... <$156,094.00> REVISED WORK ITEMS — ADDITIONS Skyline Steel — see attached proposal Structural Steel Column Repairs ......................................................................... $19,250-00 PFCProfit @ 5% ....................................................................................................... $962-50 subtotalPFC ........................................................................... o ........ $20,212-50 Metal Building Repairs including demolition of wall panels and roof panel and girts and purlins, new girts, new purlins, new wall sheathing, new roof sheathing, new trims .............. _. .. ........ ......... .............. ........................ $181,732.00 PFCProfit at 5%,, . ... ... ....... ........................................... ....... .............. $9,o86.6o SubtotalPFC ........................................................................................ $19o,818.6o PFC Self Performed Paint Prep at Columns Only 220 MHS @ $54.68 .............................................. $12,029.6o Paint at Columns Materials Only .......................................................................... $7,650-00 Paint at Columns Labor Only 110 MHS @ $54.68 ............................................... $6,014.8o Scissor Lift for Painting 5 Weeks .......................................................................... $1,500.00 Delivery/Pick-up Lift ............................................................................................... $500.00 Sub -total PFC Self -performed ............................................................................. $27,694-40 Overhead at 5% ...... ................... .— ...... ...................... $1,384.72 Profit@ 5% ............................................................................................................ $1.384-72 rll, 1� i � 1111111 1. oll mu''.. W, PFC Expenses Temporary Toilets 2 Months 125................................... ....... ...............$250.00 Temporary hone 2 Months 1 5.................................................................. 25 . 00 TruckMonths ........................................................................ $1,200.00 Supt.Fuel 8 Weeks ...........................................................................$1, oo.00 Site Superintendent 320 MHS @ $70.20........................................................... $ .0 DisposalFees........................................................................................................ $6,800.00 Permit e .....................................................................................---....--.... , . 00 Subtotal PFC Expenses ................................................................... $37,o64.00 SUBTOTAL PFC AND SUBCONTRACTORS ADDITIONS ............................ , 558-94 SUBTOTAL CREDITS ............................ ....................................... <156,094.00> TOTAL ADDITIONS AND CREDITS ................................................................ $12 2,464-94 ........................................................... $1,469.58 Amount:Total Requestfor Change Order ....................................$123,934-52 r ' its 8 �. BTE." S aKilli11f_107i]N February 14, 2022 SKYLINE STEEL, INC Project Location Ship to: Attn: Mike Davis 67901 Overseas Hwy 4987 NW 23d Ave Long Key, FL 33001 Fort Lauderdale, FL 33309 C _��In mw Email: Mike@SkylineSteel.net ID � y 0 Project: Layton Transfer Station — Long Key, FL — Renovation and Addition to Existing PEMB Building Systems of America (BSA) is pleased to quote your building needs for the referenced project. The material will be fabricated by Allied Steel Buildings to meet site visit take -off measurements for project location. Proposal details are as follows: Protect Location: Layton Transfer Station, 67901 Overseas Hwy, Long Key, FL 33001 Protect Description: Remove Damaged Pre-Eng Metal Building Components and Install New Components: • Work to be performed on (1) existing building at the project location Specifications: • Drawings by BEA Architects, Inc., dated 11/3/21 Includes but not limited to: 1. Demo of existing damaged wall panels/girts/purlins/trims 2. Installation of New wall panels/girts/purlins/trims per take -off list below 3. (61) 24 Gauge, PBR Roof Panels (w/Miami Dade Approval) (Galvalume) 4. (30) 24 ga, PBR Ridge Cap Die -Formed 1:12 pitch (Galvalume) 5. (20) low eave trim (color TBD) 6. (8) Rake Trim (color TBD) 7. (2) Peak Boxes 8. (10) Rake Angle 9. (140) Mastic Tape, 3/32" x 1/2 x 50'-0" 10. (115) 24 Gauge, PBR wall panels (w/Miami Dade Approval) (color TBD) er^�i�irti��r��.��rt►r��rrrr�z�,rtz�r�►[��ir�r��x�t�A�are�e�rir��e�.�s�re�.�s��e BTE." S 11. (5) Outside Corner Trim (color TBD) 12. (6) Jamb Trim (color TBD) 13. (108) 14 ga, 10" Purlins, standard punch (Galvanized) 14. (36) 14 ga, 10" Purlins, standard punch (Galvanized) 15. (36) 14 ga, 10" Girts, standard punch (Galvanized) 16. (6) 14 ga, 10" Eave Struts (Galvanized) 17. (3) 14 ga, 10" Eave Struts (Galvanized) 18. (1000) 1/2"x1.5", A325 Bolts w/nuts and washers 19. (4000) 12-14 x 1 1/4 w/washers. Structural Roof Screws (Galvalume) 20. (3000) 1/4-14 x 7/8" w/Washers. Stitch Screws (Galvalume) 21. (3000) 12-14 x 1 1/4 w/washers. Structural Wall Fasteners (color TBD) 22. (2000) 1/4-14 x 7/8" w/washers. Structural Stitch screws (color TBD) 23. All material, equipment, labor, safety requirements, and insurance for a complete scope of work Exclusions: 1. Demolition of existing Rigid Frame structures (includes removal/replacement of damaged existing wall panels, wall girts, roof purlins, and trims) 2. Interior Wall Liner panels and Interior Ceiling Liner panels 3. Wall and Roof Insulation (can provide for additional cost —just need to know R-Value owner wants to achieve) 4. Demo/replacement of existing wall framed openings (Windows, Doors, Louvers) 5. Roof Framed Openings- Curbs/Roof Top Equipment/Skylights 6. Field Welding (expect all members to have bolted and screwed connections) 7. Cleaning or Painting of newly installed steel members. Primer is to protect the steel during transport from factory to jobsite. Painting or cleaning steel is the responsibility of others. 8. Foundation/Footer/Slab-on-Grade Design and Install 9. Interior Architectural Build -out/ Life Safety/Landscaping/Civil/Mechanical/Electrical/Plumbing/Fire Sprinkler 10. Any work on existing wood structure (work is only on the existing PEMB) 11. Bond/Permit Fees/Impact Fees/Trash Dumpsters/Temp Toilets END OF SCOPE Pricing: TOTAL for (lea) of Buildings: $181,732.00[One Hundred Eighty -One Thousand Seven Hundred Thirty -Two Dollars] Price above Includes sales tax on materials only This price will be honored if the Order is Entered by (Entry Date): 2 25 2022 COST BREAKDOWN: • Nucor Building (lea) = $114,732 • Building Erection = $67,000 Deliverables: • Lead Times (based on building order being placed by 2/25/22) a) Material Fabrication and Delivery: 3 to 6 weeks from date order is placed b) Erection: 25 working days (remove old panels/trims and replace) Alternates: • None U141In01114i14WIN 011M M1111Irg.LY.lgo] ► IVil1r101m To-Mlisp-141Ln:mnsintst BTE." S Payment Breakdown: • 50% Deposit for Materials (this is to schedule and fabricate) • Balance on Materials due prior to shipment to jobsite (component materials must be paid prior to shipment) • Erection: 20% at Mobilization, balance due at completion AGREED TO BY: GENERAL CONTRACTOR: SKYLINE STEEL NUCOR BUILDER: BUILDING SYSTEMS OF AMERICA By: Name/Title: Date Signed: By: Name/Title: Ray Jackson / President Date Signed: H141In11AAAA WIN0i !MIKIL1IIwZ"PAalL IJi11[$]I11ITTg-MImr-141-nux"wLanus FEBRUARY 16, 2022 PEDRO FALCON CONTRACTORS 31160 AVENUE C BIG KEY, FL 33043 PH: 305-731-6978 ATTN: KEN BYGLER D E B ( P]EDROFAI_,CO�i COM QUOTATION: LONG KEY TRANSFER STATION PLANS: PER EMAIL DATED 2/16/2022 QUOTE 9022227 Page 1 of 1 We propose to furnish the following items for the above -mentioned project, F.O.B. jobsite and install items, which are noted with an asterisk (*): 1) * Revised Drawings S2.0 and S4.0 Added Repair of Columns and Base Plates LUMP SUM TOTAL FOR ITEM#1..................................................$19,250.00 NOTES: A) Galvanized Steel is to be Fabricated From Pre Galvanized Steel B) Price Includes Tax on Materials. C) Price is Subject to Review after Thirty (30) Days. D) Included Temporary Shoring of Existing Columns while Working on Repair. EXCLUSIONS: 1) Code Requirements 2) Any Item not Specifically Noted Herein 3) Signed and Sealed Engineered Drawings 4) Pulling of Permits 5) Embeds for Other Trades 6) All Stud and Gauge Metal 7) Weld Inspection by Others RESPECTFULLY SUBMITTED, MIKE DAVIS SENIOR ESTIMATOR SKYLINE STEEL, INC. 4987 NW 231d Avenue * Fort Lauderdale, Florida 33309 * (954) 968-1912 * Fax: (954) 968-7077 ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/15/2021 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 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). PRODUCER Bowen, Miclette & Britt of Florida, LLC 1020 N. Orlando Avenue, Suite 200 Maitland FL 32751 CONTACT NAME: Michelle Rushing PHONE FAX /C No Ext : 407 647-1616 A/C No): 407 628-1635 WC, ADDRESS: mrushing@bmbinc.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Amerisure Mutual Insurance Company 23396 INSURED PEDROFALCO INSURER B : James River Insurance Co. 12604 Pedro Falcon Electrical Contractors, Inc. 31160 Avenue C INSURER c :National Union Fire Ins Co of Pittsburg19445 INSURERD: Amerisure Insurance Company 19488 Big Pine Key FL 33043-4516 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 544508670 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y 00123482-0 11/2/2021 11/2/2022 EACH OCCURRENCE $ 1,000,000 Flvl CLAIMS -MADE X OCCUR Approved Risk Management with attachments DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑X PRO ❑ LOC JECT GENERAL AGGREGATE $ 2,000,000 11-15-2021 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: D AUTOMOBILE LIABILITY Y Y CA209293906 11/2/2021 11/2/2022 COMBINED SINGLE LIMIT Ea accident $ 1,000000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS C UMBRELLA LIAB X OCCUR Y Y EBU020773781 11/2/2021 11/2/2022 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N Y WC209452607 11/2/2021 11/2/2022 )( PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N N / A E.L. EACH ACCIDENT $ 1,000,000 (Mandatory ,, NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The following policy provisions and/or endorsements form part of the policies of insurance represented by this certificate of insurance. The terms contained in the policies and/or endorsements supersede the representations made herein. Electronic copies of the policy provisions and/or endorsements listed below are available by emailing: certificates@bmbinc.com When required by written contract, those parties listed in said contract, including the Certificate Holder, are added as additional insureds with respect to the General Liability including ongoing and completed operations, Auto Liability, and Umbrella Liability as afforded by the policy and/or endorsements. When required by written contract, waiver of Subrogation is granted with respect to the General Liability, Auto Liability, Workers Compensation, and Umbrella See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Monroe County Board of County Commissioners 1100 Simonton Street AUTHORIZED REPRESENTATIVE Key West FL 33040 @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: PEDROFALCO LOC #: AGENCY Bowen, Miclette & Britt of Florida, LLC POLICY NUMBER CARRIER 4DDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE NAIC CODE NAMEDINSURED Pedro Falcon Electrical Contractors, Inc. 31160 Avenue C Big Pine Key FL 33043-4516 EFFECTIVE DATE: Page 1 of 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Liability to those parties listed in said contract, including the Certificate Holder. The General Liability and Umbrella Liability certified herein are primary and non-contributory to other insurance available, but only to the extent required by written contract. Project: Florida Keys Marathon International Airport - Security Site Lighting Rehabilitation ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Poicy#OD1234Q2'0 Effective Dates: 1112/2021-11/2/2022 This endorsement modifies insurance provided under the following: Rlji�� Name Of Additional Insured Person(s) Or Organ ization(s): Location(s) Of Covered Operations Where required by written contract or written agreement All operations of the Named Insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section |A—VVhn Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Sohedu|e, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, inwhole orinpart, by: 1. Your acts oromissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your oioperations for the additional insured(s) at the location(s) desig- B.Withmepeo to the insurance afforded to these additional inauredm, the following additional exclu- sions apply: This insurance does not apply ho"bodily injury" or "property damage" occurring after: 1. All work, including mo1eha|m, poUa or equip- ment furnished in connection with such wmrk, onthe project (other than service, maintenance or repairs) to be performed byoron behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use byany person ororganization other than another contractor or subcontractor en- gaged in performing operations for a principal aaapart cfthe same project. Poicy#0O123482'0 Effective Dates: 11/2/2021 11/2/2O22 This endorsement modifies insurance provided under the following: Name Of Additional Insured Person(s) Or Organization (s): Location And Description Of Completed Operations Where required by written contract orwritten agreement All operations of the Named Insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at insured and included in the "prod ucts-com pleted operations hazard". Policy #DD123482-0 Effective Dates: 11/2/2021-11/2/2022 91Q24111111M COMMERCIAL GENERAL LIABILITY CG 24040509 Name Of Person Or Organization: Where required bywritten contract orwritten agreement Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following to Paragraph Of Rights Of Recovery Against OVhuma To Us of SentimnAV—Comditimms: VVewaive any right cfrecovery wmmay have against the person or organization shown in the Schedule above because ofpayments we make for injury or damage arising out of your ongoing operations or "your work" done under contract with that person or organization and included in the "products - completed operations hazavd"This waiver applies only to the pennon or organization shown in the Schedule above. CG 24 04 05 09 @ Insurance Services Office, |nc,2008 Page 1of1 Policy #00 123482-0 Effective Dates: 11/2/2021-11/2/2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. mwm;k i 1 %01.-1* 1 %Now I Name Of Additional Insured Person(s) Or Oraanization(s): I Where required by written contract or written agreement If no entry appears above, this endorsement applies to all Additional Insureds covered under this policy. Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis. AP5031 US 04-10 Page 1 of 1 Policy Effective Dates: 11/2/3O21 11/2/3022 FLORIDA ADVANTAGE COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT With respect $mcoverage provided bythis endorsement, the provisions o/the Coverage Form apply unless modified bythe endorsement. The premium for this endorsement is $ COMMON POLICY CONDITIONS - CANCELLATION, Paragraph A.2. is replaced by the following" 2. We may cancel this policy by mailing or delivering to the first Named Insured written notice of cancellatil, a. 1Udays before the effective date ofcancellation Uwecancel for nonpayment ofpremium; cn b. 60days before the effective date ofcancellation ifwmcancel for any other reason. d. Any organization you newly acquire or form, other than a partnership, joint venture or limited liab Ifity company, and over which you maintain ownership or a majority interest, will qualify as a Named Insuredl (1) Coverage under this provision is afforded only until the end of the policy period; (2) Coverage does not apply to "accidents" or "loss" that occurred before you acquired or formed the organization: and (3) Coverage does not apply Vzanorganization that isan1nsured'under any other policy orwould bean 1nsued^but for its termination orthe exhausting ofits limit cfinsurance, e. Any ^emp|eyec~nfyours using: (1) A covered "auto" you do not own, hire or borrow, or a covered "auto" not owned by the "employee" or a member of his or her household, while performing duties related to the conduct of your business or your personal affairs: o, (2) Am^auto`hired nrrented under acontract uragreement inthat ~emp| 's''name.vwthyour permission, while performing duties related to the conduct of your business. However, your "employce"does not qualify as an insured under this paragraph (2) while using a covered "auto" rented from you orfrom any member mfthe ''emp|uyce^s''household, t Your members, ifyou are alimited liability company, while using acovered ''auk/''you donot own, hire, ur borrow, while performing duties related to the conduct of your business or your personal affairs. g. Any person or organization with whom you agree in a written contract, written agreement or permit, to provide insurance such as is afforded under this policy, but only with respect to your covered "autos". This provision does not apply: (1) Un|ess1hewnttoncontoc1q/agreementisexecutedorthepennitisissuedpriortothe^hndi|yinjug/' or "property damage": includes copyrighted material ofInsurance Services Office, Inc. CA 71710508 Page 1uf6 Policy #CA209293906 Effective Dates: 11/2/2021-11/2/2022 8. AIRBAG COVERAGE SECTION III - PHYSICAL DAMAGE, B. EXCLUSIONS, Paragraph 3. is deleted and replaced by the following: We will not pay for "loss" caused by or resulting from any of the following unless caused by other "loss" that is covered by this insurance: a. Wear and tear, freezing, mechanical or electrical breakdown. However, this exclusion does not include the discharge of an airbag, b. Blowouts, punctures or other road damage to tires. 9. GLASS REPAIR • • DEDUCTIBLE No deductible applies to glass •. SECTION III - PHYSICAL • COVERAGE, • DEDUCTIBLE is amended to add the following: When there is a "loss" to your covered "auto" insured for Collision Coverage, no deductible will apply "loss" was caused • a collision with another "auto" insured by us. • IV - BUSINESS AUTO CONDITIONS, A. LOSS CONDITIONS, 2. • IN THE EVENT • • CLAIM, SUIT OR LOSS, paragraph a. is deleted and replaced by the following: a. You must see • it that we are notified as soon as practicable • an "accident", claim, "suit" or "loss", Knowledge of an "accident", claim, "suit" or"loss" by your "employees" shall not, in itself, constitute • to you unless • of your partners, executive officers, directors, managers, or members (if you are a • liability company) has knowledge • the "accidenfclaim, "suit" or "loss". Notice should include: (1) How, when and where the "accident" or "loss" occurred: (2) The "insured's" name and address; and (3) To the extent possible, the names and addresses of any injured persons and witnesses. 12. TRANSFER OF RIGHTS (BLANKET WAIVER OF SUBROGATION) SECTION IV - BUSINESS AUTO CONDITIONS A.S. TRANSFER OF • • RECOVERY AGAINST • TO US is deleted and replaced by the following: If any person • organization to or for whom we make a ment under this Covera•e F•rm 010.1 SECTION IV - BUSINESS AUTO CONDITIONS, B. GENERAL CONDITIONS, 2. • MISREPRESENTATION OR FRAUD is amended by the addition of the following: We will not deny coverage under this as of the • date • this policy. You must report to us any knowledge • an error • omission in • representations as soon as practicable after its discovery, This provision does not affect our right to collect additional premium or exercise • right of cancellation or non -renewal, Page 4 of 6 CA 71 7105 08 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy, We will not enforce our right against the person or organization named in the Schedule, (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. "Any person or organization required by written contract or certificate of insurance." "This endorsement is not applicable in California, Kentucky, New Hampshire, New Jersey, Texas and Utah." "This endorsernerit does not apply to policies in Missouri where the employer is in the construction group of code classifications. According to Section 287,150(6) of the Missouri Statues, a contractual provision Purporting to waive subrogation rights is against public policy and void where one party to the contract is an employer in the construction group at code classifications." This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 11/2/2021 Policy No WC209452607 Endorsement No, Insured Pedro Falcon Electrical Contractors, Inc. Premium $ Insurance Company Amerisure Insurance Co. Countersigned by WC 00 03 13 Hart Forms & 8ervi'res (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance. Reorder No 144988 Rolicy#E8UD2O773781 Effaubvo Dates: 11/2/2021 11/2/2O22 mmo' �� Commercial Excess Liability Policy With CriaisRmspomme' Various provisions in this policy restrict coverage, Read the entire policy carefully to determine rights, duties and what is and is not covered. Throughout this policy the words "you" and "your" vuh*r to the Named Insured shown in the Declarations and any other person or organization qualifying as a Named Insured under this policy. The words ^mm.^ "us" and "our" refer to the company providing this insurance. In consideration of the payment ofthe premium and in reliance upon the statements in the Decbraiionm, we agree to provide coverage as follows: 11. INSURING AGREEMENT - COMMERCIAL EXCESS LIABILITY A. We will pay on behalf ofthe Insured those sums in excess of the Retained Limit that the Insured becomes legally obligated to pay as damages by reason of liability imposed by law because of Bodily Injury, property Damage or Personal Injury and Advertising Injury to Mich this insurance applies o/ because of Bodily Injury or Property Damage to Mich this insurance applies assumed by the Insured under an Insured Contract. Coverage under this policy will foUovvtha termo, dohnibona, conditions and exclusions of Scheduled Underlying Insurance, subject to the Policy Period, Limits of |naurance, premium and all other terms, definitions, conditions and exclusions of this policy. Provided, hnmmvmr, that coverage provided by this policy will not be broader than the coverage provided by the policy listed in Scheduled Underlying Insurance. The amount we will pay for damages is limited as described in Section IV. Limits of Insurance. 1. the Bodily Injury or Property Damage is caused by an Occurrence that takes place anywhere, and the Bodily Injury or Property Damage occurs during the Policy Period; and 2 the Personal Injury and Advertising Injury is caused by an Occurrence that takes place anyv�hoe arising out of your business, but only if the Occurrence was committed during the Policy Period. C. 1. This policy applies to Bodily Injury or Property DmnnoAe. only Kprior tothe Policy Period, no Insured listed under subparagraphs 2u, 2b.' 2c. or 2e. of Paragraph N.. of Section V1|' no executive officer or director listed under subparagraph 2d. of Paragraph N. of Section VYi and no employee authorized by you to give or receive notice of an Occurrence, c|einn or Suit, knew that the Bodily Injury or Property Damage had occurred, in whole or in port. If such an Insu,ed, or authorized employee knew, prior to the Policy Period, that the Bodily Injury or Property Damage had occurred, then any continuation, change or resumption of such Bodily Injury or Property Damage during or after the Policy Period will be deemed to have been known prior to the Policy Period. 2. Bodily injury or Property Damage which occurs during the Policy Period and was not, prior tothe Policy Period, known to have occurred byany Insured |imK*d under subparagraphs 2o, 2b, 2o. or 2e. of Paragraph N. of Section lq|, any executive officer or director listed under subparagraph 2d. of Paragraph N. of Section \4i or any employee authorized by you to give or mooiva notice of an Occurrence or o|aim, includes any continuation, change or resumption of that Bodily Injury or Property Damage after the end of the Policy Period. 30268(11/}8) Page 1 of26 AH2711 02001 Includes copyrighted material of Insurance Smnvinao Office, Inc. with its permission. L. Maintenance of Scheduled Underlying Insurance You agree that during the Policy Period: 1. you will keep Scheduled Underlying Insurance infull force and effect; 2. the terms, definitiona, conditions and exclusions of Scheduled Underlying Vnoummnon will not materially change; 3. the total applicable limits of Scheduled Underlying Insurance will not decrease, except for any reduction or exhaustion of aggregate limits by payment nfLoss to which this policy applies; and 4. any renewals or replacements of Scheduled Underlying Insurance will provide equivalent coverage to and afford limits ofinsurance equal toorgreater than the policy being renewed orreplaced. If you fail to comply with these requirements, wm will be liable only to the same extent that we would have, had you fully complied with these requirements. M. Other Insurance K other valid and collectible insurance applies to damages that are also covered by this policy, this policy will apply excess ofthe Other Insurance. However, this provision will not apply if the Other Insurance is specifically mitten to be oxnema of this policy. N. Premium The first Named|noureddesignatedinhom1ofdheDeclaodonow0|bemepomiNefmpaymnt of all premiums Men due. The premium for this policy will be computed on the basis set forth in Item 0of the Declarations. At the beginning of the Policy Period, you must pay us the Advance Premium shown in Item 6 of the Declarations. When this policy expires orKhis cancelled, wowill compute the earned premium for the time this policy was in force. If this policy is subject to audit adjustment, the eotuo| exposure base will be used to compute the earned premium. If the earned premium is greater than the Advance Pvomium, you will promptly pay um the difference. If the earned premium is |eam than the Advance Premium, we will return the difference to you. But in any event, wm wi|| retain the Minimum Premium as shown in Item G of the Declarations for each twelve months of the Policy Period. O. Separation ofInsureds Except with respect to the Limits of Insurance of this policy and rights or duties specifically assigned to the firsi Named Insured designated in Item 1 of the Declarations, this insurance applies: 1. as if each Named Insured were the only Named Insured; and 2 separately to each Insured against whom dahn is made or Suit is brought. P. Transfer of Rights of Recovery 1. If any Insured has rights to recover all mpart of any payment we have made under this policy, those rights are transferred to us. The Insured must do nothing after kaa to impair these rights and must help us enforce them. 90269(11/09) Page 17of26 /UH2711 02001 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 2. any person or organization, including the Insured, that has paid an amount in excess of the applicable Limits of Insurance of this policy will be reimbursed first; o. lastly, any person morganization, including the Insured that has paid anamount over which this policy is excess is entitled to claim the remainder. Expenses incurred in the exercise of rights ofrecovery will be apportioned among the persons or organizations, including the Insured, in the ratio of their respective recoveries as finally settled. 3. If, prior to the time of anOccurrence, you waive any right of recovery against ospecific person morganization for injury ordamage as required under an Insured Contract, we will also waive any rights we may have against such person or organization Q. Transfer of Your Rights and Duties Your rights and duties under this policy may not be transferred without our mitten consent. If you die or are legally declared bankrupt your rights and duties will be transferred to your legal representative, but only Mile acting within the scope of duties as your k*Qa| representative. Hovwever, notice of oanoeUudom sent to the first Named Insured designated in Item 1 of the Declarations and mailed to the address shown in this policy will be sufficient notice to effect cancellation of this policy. R. Unintentional Failure toDisclose Your failure to diuokma all hazards existing as of the inception data of the policy will not prejudice you with respect to the coverage afforded by this policy, provided that any such failure or omission is not intentional. A. Advertisement means a notice that is broadcast or published to the general public or specific market segmen about your goods, products or services for the purpose of attracting customers or supporters. For the purposes this definition: I 1. notices that are published include material placed on the Internet or on similar electronic means of communication; and 2. regarding web -sites, only that part ofo web -site that is about your goods, products or services for the purposes of attracting customers or supporters is considered an advertisement. W. Auto means a land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment. Auto does not include Mobile Equipment. C. Bodily Injury means bodily injury, sickness or disease sustained byany person, including deaUh, mental anguish, mental injury, shock or humiliation resulting from any of these at any time. O. Crisis Management Event moans an Occurrence that in the good faith opinion of a Key Executive of the Named Insured, in the absence of Crisis Management Services, has or may result in: 1. damages covered by this policy that are in excess of the total applicable Unnha of Scheduled Underlying Insurance; and 90269(11/09) Page 18of26 /UH2711 02001 Includes copyrighted material of Insurance Services Office, Inc. with its permission. 1. it incorporates Your Product or Your Work that is known or thought to be defective, deficient, inadequate or dangerous; or 2. you have failed to fulfill the terms of contract or agreement; if such property can be restored to use by: 1. the repair, replacement, adjustment or removal of Your Product or Your Work; or 2. your fulfilling the terms ofthe contract oragreement. N. Insured means: 1. the Named Insured; 2 if you are designated in the declarations as: a. an individual, you and your spouse are insureds, but only with respect to the conduct of a business of Mich you are the sole owner; b. a partnership orjoint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct nfyour business. c. o limited liability compony, you are an insured. Your members are also insureds, but only with respect to the conduct of your business. Your managers are inaureda, but only with respect to their duties as your managers; d. an organization other than a partnership, joint venture or limited liability uompany, you are an insured. Your executive officers and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, but only with respect to their liability as stockholders; e. m trust, you are an insured. Your trustees are also insureds, but only with respect to their dudes as trustees; 3. your employees other than your executive officers (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct ofyour business; 4. your volunteer workers only whi|m performing duties related to the conduct of your business; 5. any person (other than your employee or volunteer worker) or organization while acting as your real emtoLo manager; G. your legal representative if you dia, but only with respect to duties as such. That representative will have all your rights and duties under this policy; 7. any person ororganization, other than the Named Insured, included msmnadditional insured under Scheduled Underlying Insurance, but not for broader coverage than would be afforded by such Scheduled Underlying Insurance. a. no person or organization is an Insured with respect to the conduct of any ounnmt past or newly formed partnership, joint venture or limited liability company that is not designated as e Named Insured in Item 1 of the Declarations; and 90269(11/09) Page 3Oof2G /UH2711 02001 Includes copyrighted material of Insurance Services Office, Inc. with its permission. b. no person or organization is an Insured under this policy who is not an Insured under applicable ScheduleV Underlying Insurance. This provision shall not apply to any organization set forth in the definition of NameV Insured in Paragraph T. 2 and 3. O. Insured Contract means that part of any contract or agreement pertaining to you/ business under Mich any Insured assumes the tort liability of another party to pay for Bodily Injury or Property Damage to w third person or organization. Tort liability mmema e liability that would be imposed by law in the absence of any contract or agreement. Insured Contract does not include that part ofany contract oragreement: 1. that indemnifies a railroad for Bodily Injury or Property Damage arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road -beds, tunnel, underpass or crossing; 2 that indemnifies an architect, engineer orsurveyor for injury or damage arising out of: a. preparing' approving, or failing to prepare or approve, maps' shop drawings, opiniony, vepoUo, surveys, ha|d orders, change orders or drawings and specifications; or b. giving directions or instructions, or failing to give dhom, if that is the primary cause of the injury or damage; or 3. under Mich the Unmunyd' if an architect, engineer or surveyor, assumes liability for an injury or damage arising out ofthe |nournd'o rendering or failure to render professional morvicoa, including those shown in subparagraph 2 above and supervisory, inspection, architectural or engineering activities P. Key Exnoudwo means the Chief Executive Offioor, Chief Operating Offiuor' Chief Financial Officer, President, General Counsel or general partner (if the Named Insured is a partnership) of the Named Insured or ouka proprietor (if the Named Insured is m sole proprietorship). A Key Executive also means any other person holding u title designated by you and approved by us' which ddm is shown in Schedule B' Additional Key Executives attached to and forming part ofthis policy. O. Loma means those sums actually paid as judgments or maNemeNa' pruxidod, however, that if expenses incurred to defend a Suit or to investigate a claim reduce the applicable limits of Scheduled Underlying Insurance, then Loss shall include such expenses. R. Mobile Equipment means any of the following types of land vehicles' including any attached machinery or 1. bulldozers, farm machinery, forklifts and other vehicles designed for use principally off public roads; 2. veNokaa maintained for use solely mnornext topremises you own mrrent; 3. xmhio|oe that travel on cravAor treads; 4. vehicles, whether self-propelled or not, maintained primarily to provide mobility to permanently mounted: v.. power cranes, shovels, loaders, diggers or drills; M 5. vehicles not described in Paragraph 1, 2. 3or4above that are not self-propelled and are maintained primarily to provide mobility to permanently attached equipment of the following types: 90269(11/09) Puge31 of2G /UH2711 02001 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Is= TIT717MET-M. M F*kn _614 IM411 M MAPTIM Prime Expresssm .1 .1 . of - . A & I # 1 0 6 Any person or organization for whom you are performing operations when you and such person *rganization have agreed in writing in a contract or agreement that such person or organization is additional insured on your policy, but only if such person or organization is included under the covera provided by Scheduled Underlying Insurance. Such person or organization is an additional insured o 11 with respect to liability arising out of Your Work at the location(s) designated in such contract or agreeme This provision does not apply to liability arising out of the sole negligence of such person or organization for its own acts or omissions or those of its employees or anyone else acting on its behalf. Coverage afforded to these additional insured parties will be primary to, and non-contributory with, any other insurance available to that person or organization. Authorized Representative or I'll, tt Policy Effective Dates: 11/2/2021 11/2/2D22 NOTICE OF CANCELLATION, NONRENEWAL OR MATERIAL CHANGE -THIRD PARTY This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL UMBRELLA LIABILITY COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM Subject to the cancellation and/or nomeoewa|provisions ofthe Coverage Form 0owhich this endorsement is attached, wewill not: l. Cancel; 2. monmenew;oc 3, Materially change (reduce orrestrict) this Coverage Form, except for nonpayment of premium, until we provide at least days written notice of such cancellation, nonrenewal or material change. Written notice will be to the person or organization named in the Schedule. MR Schedule is intended as a courtesy only. If the p rson or organization named i t e Schedule does not rece i such notification within the time frame stated in this endorsement, this will not: 1 . Extend any Coverage Form cancellation date� 2. Negate the cancellation as to any insured or any certificate holder: 3. Provide any additional insurance that would not have been provided in the absence of this enclorseme or 4. Impose liability of any kind upon us. This endorsement does not entitle the person o/ organization named in the Schedule to any benefits rights or protection under this Coverage Form, SCHEDULE Name Of Person Or Organization Mailing Address Any person urorganization holding acertificate ofinsurance issued The address shown for that person ororganization |n for you, provided the certificate: that certificate ofinsurance 2. States that noticeof: a, Cancellation; b. Nonrenewal; or c. Material change reducing nrrestricting coverage; will be provided to that person or organization; 3, Is in effect at the time of the: a. Cancellation; bNonrenewa or Policy #WC209452607 Effective Dates: 11/2/2021-11/2/2022 EARLIER NOTICE OF CANCELLATION PROVIDED BY US Number of Days Notice 60 For any statutorily permitted reasonother than nonpayment of premium, the number of days required for notice of cancellation is increased to the number of days shown in the Schedule above. If this policy is cancelled by us we will send the Named Insured and any party listed in the following schedule notice of cancellation based on the number of days notice shown above. • Name of Person or Organization The Name of Person or Organization is any person or organization holding a certificate of insurance issued for you, provided the certificate: 1 , Refers to this policy; 2. States that notice of: a. Cancellation; b, Nonrenewal; or c. Material change reducing or restricting coverage; will be provided to that person or organization; 3, Is in effect at the time of the: a. Cancellation; b. Nonrenewal; or c. Material change reducing or restricting coverage; and 4. Is on file at your agent or broker's office for this policy. Mailing Address The Mailing Address is the address shown for that person or organization in that certificate of insurance,