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.
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FILED: KINGS COUNTY CLERK 05/04/2020 10:41 AM INDEX NO. 510798/2018
NYSCEF DOC. NO. 97 RECEIVED NYSCEF: 05/04/2020
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY CHANGES
Number 01
POLICY NUMBER POLICY CHANGES COMPANY
EFFECTIVE
L146001424-2 04/17/2017 Atlantic Casualty Insurance Company
NAMED INSURED AUTHORIZED REPRESENTATIVE 310146
MGi-stai-
Eastern Fruit & Vegetable Inc. General Agency of NY, Inc. a division of Hull
600 Community Drive
Manhasset NY 11030
COVERAGEPARTSAFFECTED
COMMERCIAL GENERAL LIABILITY
CHANGES
IT IS HEREBY UNDERSTOOD AND AGREED THAT THE POLICY IS AMENDED
AS FOLLOWS:
PER THE EXPIRING AUDIT THE SALES EXPOSURE IS AMENDED PER FORM ACD-GL1
(O8/11) PER THE ATTACHED.
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.
BRK: RICHARD D. ANDREOLI
ADDT'L PREMlUM: $58830.00 RET PREMlUM: STATE TAX: FEE:
Date 08/O2/2017 InitialsSU
Authoriz Representative Signature
IL 12 01 11 85 Copyright, Insurance Services Office, Inc.,1983
Copyright, lSO Commercial Risk Services, Inc.,1983
ACIC 0144
FILED: KINGS COUNTY CLERK 05/04/2020 10:41 AM INDEX NO. 510798/2018
NYSCEF DOC. NO. 97 RECEIVED NYSCEF: 05/04/2020
InSHranCC
COMMERCIAL GENERAL LIABILITY COVERAGE
Company
PART DECLARATIONS
Reñéwal of Number L146001424-1 Policy No. L146001424-2
Named Insured and Mailing Address (No., Street,Townor City,County, State, Zip Code)*
Eastem Fruit & Vegetable Inc.
1230-1236 Coney Island Avenue
Brooklyn NY 11218
Period * : From to at 12:01 A.M. Standard Time at your
Policy 04/17/2017 04/17/2018 mailing
address shown above.
IN RETURN FOR THE PAYMENT OF THE PREM lUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE
WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
LIMITS OF INSURANCE
Each Occurrence Limit $ 2,000,000
Damages To Premises
Rented To You Limit $ 100,000 Any one premises
Medical Expense Limit $ 5,000 Any one person
Personal and Advertising Injury Limit $ 2,000,000 Any one person or organization
General Aggregate Limit $ 4,000,000
Products / Comipleted Operations Aggregate Limit $ 2,000,000
RETROACTIVE DATE (CG 00 02 ONLY)
Coverage A of this
Insurance does not applyto injury"
or "propertydamage" which occurs before theRetroactive
"bodily Date,
if any,shown here:
(EnterDateor "None"if no RetmactiveDateapplies)
DESCRIPTION OF BUSINESS AND LOCATION OF PREM!SES
Form of Business:
individual ¤ Joint Venture C Partnership Organization (Other than Partñérship or Joint Venture)
Business Description*:
GROCERY
Location of AII premises You Own, Rent or Occupy:
1230-1236 Coney Island Avenue Brooklyn NY 11218
PREMlUM
Rate Advance Premium
Claccificatian Code No. Premium Basis Territory Pr/Co All Other Pr/Co AllOther
Stores 13673 S 2775356 001 .320 23.559 $889 $65391
Grocery
GS
Extension Subtotal $
Total or Minimum Premium $ 66,280.00
**(a) area (c) total cost (m) admissiün (p) payroll (s) gross sales (u) units (t)other
FORMS AND ENDORSEMENTS applying to this Coverage part and made part of this policy at time of issue +:
SEESCHEDULEOFFORMSANDENDORSEMENTS
Countersigned:*
. . *
By
if shown inCommon Declarations. A presentative
*Entry optional Policy
+Forms and Endorsements applicable to thisCoverage Part omitted if shown elsewhere in e policy.
THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHE WITH THE COMMON POLICY CONDITIONS,
COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED
POLICY.
ncludescopyrightedmaterialof InsuranceServicesOffice,Inc.,with its permission.
ACD-GL1 08-11 °°Pyright, InsuranceServicesOffice.Inc.
ACIC 0145
Document Filed Date
May 04, 2020
Case Filing Date
May 24, 2018
Category
Commercial - Contract
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FILED: KINGS COUNTY CLERK 05/04/2020 10:41 AM INDEX NO. 510798/2018 NYSCEF DOC. NO. 97 RECEIVED NYSCEF: 05/04/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Number 01 POLICY NUMBER POLICY CHANGES COMPANY EFFECTIVE L146001424-2 04/17/2017 Atlantic Casualty Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE 310146 MGi-stai- Eastern Fruit & Vegetable Inc. General Agency of NY, Inc. a division of Hull 600 Community Drive Manhasset NY 11030 COVERAGEPARTSAFFECTED COMMERCIAL GENERAL LIABILITY CHANGES IT IS HEREBY UNDERSTOOD AND AGREED THAT THE POLICY IS AMENDED AS FOLLOWS: PER THE EXPIRING AUDIT THE SALES EXPOSURE IS AMENDED PER FORM ACD-GL1 (O8/11) PER THE ATTACHED. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. BRK: RICHARD D. ANDREOLI ADDT'L PREMlUM: $58830.00 RET PREMlUM: STATE TAX: FEE: Date 08/O2/2017 InitialsSU Authoriz Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc.,1983 Copyright, lSO Commercial Risk Services, Inc.,1983 ACIC 0144 FILED: KINGS COUNTY CLERK 05/04/2020 10:41 AM INDEX NO. 510798/2018 NYSCEF DOC. NO. 97 RECEIVED NYSCEF: 05/04/2020 InSHranCC COMMERCIAL GENERAL LIABILITY COVERAGE Company PART DECLARATIONS Reñéwal of Number L146001424-1 Policy No. L146001424-2 Named Insured and Mailing Address (No., Street,Townor City,County, State, Zip Code)* Eastem Fruit & Vegetable Inc. 1230-1236 Coney Island Avenue Brooklyn NY 11218 Period * : From to at 12:01 A.M. Standard Time at your Policy 04/17/2017 04/17/2018 mailing address shown above. IN RETURN FOR THE PAYMENT OF THE PREM lUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. LIMITS OF INSURANCE Each Occurrence Limit $ 2,000,000 Damages To Premises Rented To You Limit $ 100,000 Any one premises Medical Expense Limit $ 5,000 Any one person Personal and Advertising Injury Limit $ 2,000,000 Any one person or organization General Aggregate Limit $ 4,000,000 Products / Comipleted Operations Aggregate Limit $ 2,000,000 RETROACTIVE DATE (CG 00 02 ONLY) Coverage A of this Insurance does not applyto injury" or "propertydamage" which occurs before theRetroactive "bodily Date, if any,shown here: (EnterDateor "None"if no RetmactiveDateapplies) DESCRIPTION OF BUSINESS AND LOCATION OF PREM!SES Form of Business: individual ¤ Joint Venture C Partnership Organization (Other than Partñérship or Joint Venture) Business Description*: GROCERY Location of AII premises You Own, Rent or Occupy: 1230-1236 Coney Island Avenue Brooklyn NY 11218 PREMlUM Rate Advance Premium Claccificatian Code No. Premium Basis Territory Pr/Co All Other Pr/Co AllOther Stores 13673 S 2775356 001 .320 23.559 $889 $65391 Grocery GS Extension Subtotal $ Total or Minimum Premium $ 66,280.00 **(a) area (c) total cost (m) admissiün (p) payroll (s) gross sales (u) units (t)other FORMS AND ENDORSEMENTS applying to this Coverage part and made part of this policy at time of issue +: SEESCHEDULEOFFORMSANDENDORSEMENTS Countersigned:* . . * By if shown inCommon Declarations. A presentative *Entry optional Policy +Forms and Endorsements applicable to thisCoverage Part omitted if shown elsewhere in e policy. THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHE WITH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. ncludescopyrightedmaterialof InsuranceServicesOffice,Inc.,with its permission. ACD-GL1 08-11 °°Pyright, InsuranceServicesOffice.Inc. ACIC 0145