On May 24, 2018 a
Exhibit,Appendix
was filed
involving a dispute between
Atlantic Casualty Insurance Company,
and
Eastern Fruit & Vegetables Inc.,
for Commercial - Contract
in the District Court of Kings County.
Preview
FILED: KINGS COUNTY CLERK 09/25/2018 08:57 AM INDEX NO. 510798/2018
NYSCEF DOC. NO. 13 RECEIVED NYSCEF: 09/25/2018
EXHIBIT B
FILED: KINGS COUNTY CLERK 09/25/2018 08:57 AM INDEX NO. 510798/2018
NYSCEF DOC. NO. 13 RECEIVED NYSCEF: 09/25/2018
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY CHANGES -
Policy Change
Number PA1
POLICY NUMBER POLICY CHANGES COMPANY
L146001424-1 EFFECTIVE
4/17/2016 Atlantic Insurance
Casualty Cornpany
NAMED INSURED AUTHORIZED REPRESENTATIVE 310146
Eastern Fruit & Vegetable Inc.
MORSTAN GENERAL AGENCY, INC.
600 COMMUNITY DRIVE
MANHASSET, NY 11030
COVERAGE PARTS AFFECTED
Commercial General Liability
CHANGES
An audit was performed on the above referenced policy. The auditrevealedan increase in thepolicyexposure, resultingin an
additionalpremium which is reflected
in this
endorsement.
Classification
Code: 13673 State: NY Territory:
Classification
Description:Grocery Stores
Premium Basis: GS Total Exposure: 2,775,356
Prem/Ops Rate: 26.383 Prod/Compl. Ops Rate:0.393
Prem/Ops Prem: $73,222.00 Prod/Compl. Ops Prem: $1,091.00
Total Premium forClass:$74,313.00
______
ADDT'L PREMIUM: $67,357.00 RET PREMIUM: STATE TAX: $2,424.85 FEE: $121.24
Stamping Fee
oate 7/18/2017 initialsDLL
Authorized Representative Signature
IL 12 01 11 85 Copyright, Insurance Services Office, Inc.,1983
Copyright, ISO Cornrnercial Risk Services, Inc.,1983
Page 1 of 1
FILED: KINGS COUNTY CLERK 09/25/2018 08:57 AM INDEX NO. 510798/2018
NYSCEF DOC. NO. 13 RECEIVED NYSCEF: 09/25/2018
09-18-2017
Atlant c Casualty
Policy Number: L146001424-1 ru Insurance Conapany
A membeaof the StrkhlomJinsuranceurrnm, we.
Policy Effective Dates: 04-17-2016 to 04-17-2017
Eastern Fruit& Vegetable Inc.
1230-1236 Coney Island Avenue
Brooklyn, NY 11218
Dear Sir orMadam,
A premium audit for the above referenced policy was completed and resulted in an additional premium. Efforts to collect
thispremium liom you have been unsuccessful and the audit has been returned to us fordirect collection.
This payment isdue and payable directlyto Atlantic Casualty Insurance Company. This payment must be remitted within
(10) business days from the date of this letter.Remit payment to:
Atlantic Casualty Insurance Company
Attention: Premium Audit
400 Commerce Court
Goldshoro, NC 27533-8010
Any amount not received hy 10-02-2017 may be turned over to Brown & Joseph, our third-party collection agency, and/or
the current policy may be cancelled. We look forward to your prompt remittance. Please disregard thisifpayment has
already been rernitted.
Please detach thiscoupon and remit itwith payment toensure prompt and accurate record of your payment.
Policy Number: L146001424-1
..
Insured Name : Eastern Fruit & Vegetable Inc .
Amount Due: $69,903.09
Payment Reason: Additional premium due as a result of a premium audit .
Attention: Premium Audit ^"""f‰i"L""13
Document Filed Date
September 25, 2018
Case Filing Date
May 24, 2018
Category
Commercial - Contract
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FILED: KINGS COUNTY CLERK 09/25/2018 08:57 AM INDEX NO. 510798/2018 NYSCEF DOC. NO. 13 RECEIVED NYSCEF: 09/25/2018 EXHIBIT B FILED: KINGS COUNTY CLERK 09/25/2018 08:57 AM INDEX NO. 510798/2018 NYSCEF DOC. NO. 13 RECEIVED NYSCEF: 09/25/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES - Policy Change Number PA1 POLICY NUMBER POLICY CHANGES COMPANY L146001424-1 EFFECTIVE 4/17/2016 Atlantic Insurance Casualty Cornpany NAMED INSURED AUTHORIZED REPRESENTATIVE 310146 Eastern Fruit & Vegetable Inc. MORSTAN GENERAL AGENCY, INC. 600 COMMUNITY DRIVE MANHASSET, NY 11030 COVERAGE PARTS AFFECTED Commercial General Liability CHANGES An audit was performed on the above referenced policy. The auditrevealedan increase in thepolicyexposure, resultingin an additionalpremium which is reflected in this endorsement. Classification Code: 13673 State: NY Territory: Classification Description:Grocery Stores Premium Basis: GS Total Exposure: 2,775,356 Prem/Ops Rate: 26.383 Prod/Compl. Ops Rate:0.393 Prem/Ops Prem: $73,222.00 Prod/Compl. Ops Prem: $1,091.00 Total Premium forClass:$74,313.00 ______ ADDT'L PREMIUM: $67,357.00 RET PREMIUM: STATE TAX: $2,424.85 FEE: $121.24 Stamping Fee oate 7/18/2017 initialsDLL Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc.,1983 Copyright, ISO Cornrnercial Risk Services, Inc.,1983 Page 1 of 1 FILED: KINGS COUNTY CLERK 09/25/2018 08:57 AM INDEX NO. 510798/2018 NYSCEF DOC. NO. 13 RECEIVED NYSCEF: 09/25/2018 09-18-2017 Atlant c Casualty Policy Number: L146001424-1 ru Insurance Conapany A membeaof the StrkhlomJinsuranceurrnm, we. Policy Effective Dates: 04-17-2016 to 04-17-2017 Eastern Fruit& Vegetable Inc. 1230-1236 Coney Island Avenue Brooklyn, NY 11218 Dear Sir orMadam, A premium audit for the above referenced policy was completed and resulted in an additional premium. Efforts to collect thispremium liom you have been unsuccessful and the audit has been returned to us fordirect collection. This payment isdue and payable directlyto Atlantic Casualty Insurance Company. This payment must be remitted within (10) business days from the date of this letter.Remit payment to: Atlantic Casualty Insurance Company Attention: Premium Audit 400 Commerce Court Goldshoro, NC 27533-8010 Any amount not received hy 10-02-2017 may be turned over to Brown & Joseph, our third-party collection agency, and/or the current policy may be cancelled. We look forward to your prompt remittance. Please disregard thisifpayment has already been rernitted. Please detach thiscoupon and remit itwith payment toensure prompt and accurate record of your payment. Policy Number: L146001424-1 .. Insured Name : Eastern Fruit & Vegetable Inc . Amount Due: $69,903.09 Payment Reason: Additional premium due as a result of a premium audit . Attention: Premium Audit ^"""f‰i"L""13