Preview
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
-------------------------------------------------------------------X
NAQUAWN McINTOSH, Index No.: 526100/2020
Plaintiff, CPLR 3101(f)
DISCLOSURE
-against-
322 GATES LLC and AIRTAN MANAGEMENT
CORP.
Defendants.
-----------------------------------------------------------------------x
322 GATES LLC.,
Third Party-Plaintiff,
-against-
EXCELLENT INTERIORS, INC.
Third Party-Defendant.
-----------------------------------------------------------------------x
Responding Third-party defendant, Excellent Interiors, Inc., by and through their attorneys, the
Law Offices of Kevin P. Westerman, hereby provides the following, upon information and belief
pursuant to CPLR 3101(f):
INSURANCE AGREEMENTS
We have been advised that a primary policy of insurance, bearing policy number NCS0001208
has been issued to Excellent Interior Inc. Attached, as Exhibit “A” is a copy of that policy
provided to our office.
We have been advised that the current total available limits under policy number NCS0001208 is:
$1,000,000.00.
We have been further advised that the person currently responsible for adjusting the claim under
policy number NCS0001208 in connection with the above captioned matter is Robert Feeney and
their email address is feener3@nationwide.com.
We have been advised that an umbrella policy of insurance, bearing policy number A 4196322
issued by United Specialty Insurance Company has been issued to Excellent Interior Inc. Attached,
as Exhibit “B” is a copy of that policies provided to our office.
We have been advised that the current total available limits under policy number USA 4196322
1 of 94
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
is: $5,000,000.00.
We have been further advised that the person currently responsible for adjusting the claim under
policy number USA 4196322 in connection with the above captioned matter is Rachael Hummel
and their email address is Rachael.Hummel@ameritrustgroup.com.
Please note that Excess Carrier has disclaimed coverage as of August 29, 2021, annexed hereto as
Exhibit “C”.
Andrea E. Waisman, an attorney with the Law Offices of Kevin P. Westerman admitted to practice
in the Courts of the State of New York, hereby affirms under penalty of perjury:
1. We are attorneys of record for the responding Third-party Defendant.
2. The annexed insurance policies are the accurate and complete documents provided to us
by the carrier(s) for the responding Third-party Defendant.
3. Upon information and belief, reasonable efforts have been undertaken, and in accordance
with CPLR 3101(f)(2) will be undertaken, to ensure that this information remains accurate
and complete.
Dated: Garden City, New York
December 13, 2022
THE LAW OFFICES OF KEVIN WESTERMAN
___________________________
Andrea E. Waisman, Esq.
Attorneys for Third-party Defendant
EXCELLENT INTERIORS INC.
990 Stewart Avenue. Suite 400
Garden City, NY, 11530
Phone: (516) 493-4501
Matter No.: 22-008320
TO: Lisa M. Rolle, Esq.
TRAUB LIEBERMAN STRAUS & SHREWSBERRY, LLP.
Attorneys for Defendants/Third-Party Plaintiff, 322 GATES LLC.
Mid-Westchester Executive Park
Seven Skyline Drive
Hawthorne, New York 10532
914-347-2600
ASHER & ASSOCIATES, P.C.
Attorneys for Plaintiff
NAQUAWN McINTOSH
2 of 94
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
111 John Street, 14th Floor
New York, New York 10038
212-227-5000
MICHAEL P. BERKLEY, P.C.
Attorneys for Defendant
AIRITAN MANAGEMET CORP.
100 Garden City Plaza, Suite 518
Garden City, New York 11530
516-227-2121
3 of 94
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
AFFIDAVIT OF SERVICE
STATE OF NEW YORK, COUNTY OF NASSAU ss:
Lillian Rivera being duly sworn, deposes and says:
deponent is not a party to the action, is over 18 years of age and resides at Queens County, New
York On December 13, 2022, deponent served the within CPLR 3101(f) DISCLOSURE
To: TRAUB LIEBERMAN STRAUS & SHREWSBERRY, LLP.
Mid-Westchester Executive Park
Seven Skyline Drive
Hawthorne, New York 10532
ASHER & ASSOCIATES, P.C.
111 John Street, 14th Floor
New York, New York 10038
MICHAEL P. BERKLEY, P.C.
100 Garden City Plaza, Suite 518
Garden City, New York 11530
attorney in this action, at the address designated by said attorney(s) for that purpose of uploading
within the State of New York Courts Electronic Filing System (“NYSCEF”).
Lillian Rivera
Sworn to before me on this
13th day of December 2022
__________________
NOTARY PUBLIC
Cara R. DeMarco
Notary Public State of New York
No. 01DE6210721
Qualified in Nassau County
Commission Expires: 08/31/2025
4 of 94
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
Index No. 526100 Year: 2020
SUPREME COURT OF THE STATE NEW YORK
COUNTY OF KINGS__________________________________________________
NAQUAWN McINTOSH,
Plaintiff,
-against-
322 GATES LLC and AIRTAN MANAGEMENT CORP.
Defendants
AND THIRD-PARTY ACTION
___________________________________________________________________________
CPLR 3101(f) DISCLOSURE
___________________________________________________________________________
LAW OFFICES OF KEVIN P. WESTERMAN
Attorneys for Third-Party Defendant
EXCELLENT INTERIORS, INC.
990 Stewart Avenue Suite 400
Garden City, New York 11530
516-493-4501
_________________________________________________________________
NOTICE OF ENTRY
SIR: Please take notice that the within is a (certified) true copy of a
duly entered in the office of the Clerk of the within named Court on 20
Dated:
________________________________________________________________
NOTICE OF SETTLEMENT
SIR: Please take notice that an order of which the within is a true copy will be
presented for settlement to the Hon. one of the judges of the
within named Court, at on the day of
20 at .M.
Dated:
________________________________________________________________
Service of a Copy of the within is hereby admitted.
Dated: 20 _____________________________
5 of 94
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
-----____----------------------------------------------------------X
NAQUAWN McINTOSH, Index No.: 526100/2020
CERTIFICATION RE:
Plaintiff,
CPLR 3101(f)
DISCLOSURE
-against-
322 GATES LLC and AIRTAN MANAGEMENT
CORP.,
Defendants.
-----------------------------------------------------------------------Ç
322 GATES LLC.,
Third Party-Plaintiff,
-against-
EXCELLENT INTERIORS, INC.
Third Party-Defendant.
------------------------.----------------------------------------------Ç
STATE OF NEW YORK )
COUNTY OF KINGS) SS.:
ISAAC HIRSCH, being duly sworn deposes and says:
1. I am the defendant in the action herein.
2. Upon information and belief, pursuant to CPLR 3122-b, the annexed CPLR
3101(f) disclosure is an accurate and contains complete copies of the insurance policy
information provided by the insurance carrier(s).
3. Upon information and belief, in accordance with CPLR 3101(f)(2), reasonable
efforts have been, and will be, undertaken, to ensure that this information remains accurate and
complete.
Dated: / * S , 2022
Isaac Hirsch
6 of 94
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
Sworn to before me this day
of / , 2022
DAVID KATZ
Stateof New York
NotaryPublit,
No.Q1RA80998%
Qualifiedin KingsCounty
otary Pub•ic Sept 29.20 )
Commission Expires
7 of 94
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
Ex hi bi t “A ”
8 of 94
(Page 1 of 29) INDEX NO. 526100/2020
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
I) I TTII)If It
PAGE
Producer No: 31729 SAN: 41092730000000
Pol Eff Dt: 12-12-2017 Office:
Date Printed: 12-21-2017
Time Printed: 14:17:42
Trans Eff Dt: 12-12-2017
Insured Name: EXCELLENT INTERIOR CORP
Policy No: NCS0001208
Trans Seq No: 001
Trans Type: New Business Issue
Oper Init: LAUTAC1
Company Abbr: SI
Release Version: 17.21
User-Selected Sets Copies Printer
INSURED COPY 01 PDF ONLY
HOME OFFICE COPY 01 PDF ONLY
CERTIFICATE COPY 01 No forms to include with this set
HOME OFFICE(FAX) COPY 01 No forms to include with this set
VEHICLE/DRIVER SCHEDU 01 No forms to include with this set
9 of 94
(Page 2 of 29) INDEX NO. 526100/2020
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
POLICYWRITING INDEX
SCOTTSDAT.EINSURANCEOCBIPANY
CUSTOMERID POLICYNUMBER PREVIOUSPOLICYNUMBER EFFECTIVEDATE EXPIRATIONDATE
103512070C NCS0001200 NEW 12-12-2017 12-12-2018
NAMED INSURED EXPN'T.TR'NT
INTERIOR CORP
MISCELLANEOUSINFORMATION TRANSACTIONINFORMATION
BILL TYPE AGENCY TRANS.TYPE NEWBUSINESS
DIRECTBILL TRANS.SEQ. # 001
BILL PLAN DATE PROCESSED 12-21-17
OPERATORl.D. IAUTAC1 TRANS.DATE 12-12-17
UNDERWRITER1.D. OCONNL2 ENDORSEMENT#
SUBMISSIONDATE CANC/REIN REASON
DUNN & BRADSTREET REINSURANCEIND: N
NY FREETRADEZONE XREFPOLICY#1
DEPARTMENTCODE C XREFPOLICY#2
PROG¯!AMCODE XREFPOLICY#3
SIC CODE 1542 XREFPOLICY#4
PROFITSHARING XREFPOLICY#5
POLICYPRICING - PROP/BOP- GLASS- IM - FEIN
CRIME - GL - AU -
LINE OF BUSINESS/ COMMISSIONS:
LINE OF BUSINESS COMMISSION %
GENERALLIABILITY
FULL ANNUAL PREMlUM
BILLED PREMIUM
NAMED INSURED MAILING ADDRESS AGENT INFORMATION CODE 31729
EXCELIENT INTERIOR CORP CRC INSURANCE SERVICES INC
140 BROADWAY36TH FL
199 IEE AVE #164
BROOKLYN NY 11211 NEW YORK NY 10005
RETAIL AGENT INFORMATION CODE
ASSEMBLY INFORMATION
STAMPS/ STICKERS
Taxes & Fees
SPECIAL INSTRUCTIONS
BRITTANEY JOHNSON12/20/17
GLORIA DROBBIN GDROBBIN@CRCINS.COM
TRIA REJ
DED-X
INSPECT-Y
AUDIT-Ž
COMPOSITERATED- PREM/OPS
HomeOffice
10 ofCopy
94
(Page 3 of 29) INDEX NO. 526100/2020
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
POLICYWRITING INDEX
ACCOUNT NUMBER POLICY NUMBER PREVIOUS POLICY NUMBER EFFECTIVE DATE- EXPIRATION DATE
103512070C NCSO001208 NEW 12-12-2017 12-12-2018
COMPUTER PRODUCED FORMS
UTS-COVPG 01-16 COVER PAGE
NOTX0178CW 03-16 CLAIM REPORTING INFORMATION
OPS-D-1 01-17 COMMON POLICY DECLARATIONS
UTS-126L 10-93 SCHEDULE OF TAXES, SURCHARGES OR FEES
UTS-SP-2L 12-95 SCHEDULE OF FORMS & ENDORSEMENTS
UTS-SP-3 08-96 SCHEDULE OF LOCATIONS
IL 00 17 11-98 COMMON POLICY CONDITIONS
IL 00 23 07-02 NUCLEAR ENERGY LIABILITY EXCLUSION ENDT
UTS-74G 08-95 PUNITIVE OR EXEMPLARY DAMAGE EXCLUSION
UTS-9G 05-96 SERVICE OF SUIT CLAUSE
GLS-516 08-17 SPECIFIED PROJECT EXCLUSION
CLS-SD-1L 08-01 COMMERCIAL LIABILITY COVERAGE PART DEC
CLS-SP-1L 10-93 GENERAL LIABILITY COVERAGE PART-EXT.
GLS-230S 08-09 MIN & ADV PREM\MIN EARNED CANC ENDT
CG 21 06 05-14 EXCL-ACC/DISCL OF CONFI OR PERSONAL INFO
GLS-152S 08-16 AMENDMENT TO OTHER INSURANCE CONDITION
GLS-464S 03-15 SPECIAL CONDITIONS-CONTRACTORS
GLS-518 10-16 CONSOLIDATED (WRAP-UP) INS PROGRAM EXCL
CG 00 01 04-13 COMMERCIAL GENERAL LIABILITY COV FORM
CG 20 01 04-13 PRIMARY AND NONCONTRIBUTORY - OTHER INSD
CG 20 33 04-13 ADDL INSD-OWNERS, LESSEES OR CONTR'S
CG 20 37 04-13 ADDL INSD-OWNERS/LESSEES/CONTR-COMP OPS
CG 21 09 06-15 EXCLUSION - UNMANNED AIRCRAFT
CG 21 16 ADL 04-13 EXCL-DESIGNATED PROFESSIONAL SERVICES
CG 21 35 10-01 EXCL-COV C-MEDICAL PAYMENTS
CG 21 47 12-07 EMPLOYMENT-RELATED PRACTICES EXCLUSION
CG 21 49 09-99 TOTAL POLLUTION EXCLUSION ENDORSEMENT
CG 21 67 ADL 12-04 FUNGI OR BACTERIA EXCLUSION
CG 21 73 01-15 EXCLUSION OF CERTIFIED ACTS OF TERRORISM
CG 21 86 12-04 EXCL-EXTERIOR INSULATION & FINISH SYSTEM
CG 21 96 ADL 03-05 SILICA OR SILICA-RELATED DUST EXCLUSION
CG 24 04 ADL 05-09 WAIVER OF TRANSFER RIGHTS OF RECOVERY
GLS-148S 06-15 LIABILITY DEDUCTIBLE (PER OCC/OFF)
GLS-281s 09-07 CONTINUING OR ONGOING DAMAGE EXCLUSION
GLS-282s 07-16 MULTI-UNIT HABITATIONAL CONVERSION EXCL
HomeOfice
11 ofCopy
94
(Page 4 of 29) INDEX NO. 526100/2020
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
PAGE 3
POLICYWRITING INDEX
ACCOUNT NUMBER POLICY NUMBER PREVIOUS POLICY NUMBER EFFECTIVE DATE - EXPIRATION DATE
103512070C NCS0001208 NEW 12-12-2017 12-12-2018
GLS-289S 11-07 KNOWN INJURY/DAMAGE EXCL-PERS & ADV INJU
GLS-304S 07-08 CROSS LIABILITY EXCLUSION
GLS-74S 09-05 AMENDMENT OF CONDITIONS
UTS-266G 05-98 ASBESTOS EXCLUSION
UTS-267G ADL 05-98 LEAD CONTAMINATION EXCLUSION
HomeOfice
12 ofCopy
94
(Page 5 of 29) INDEX NO. 526100/2020
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
POLICYWRITING INDEX
ACCOUNT NUMBER POLICY NUMBER PREVIOUS POLICY NUMBER EFFECTIVE DATE - EXPIRATION DATE
NCS00012OB NEW 12-12-2017 12-12-2018
HorneOfice
13 ofCopy
94
(Page 6 of 29) INDEX NO. 526100/2020
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
PAGE 2
POLICYWRITING INDEX
ACCOUNT NUMBER POLICY NUMBER PREVIOUS POLICY NUMBER EFFECTIVE DATE - EXPIRATION DATE
NCSO001208 NEW 12-12-2017 12-12-2018
GENERAL COMMENTS:
BRITTANEY JOHNSON 12/20/17
GLORIA DROBBIN GDROBBIN@CRCINS.COM
TRIA REJ
DED-X
INSPECT-Y
AUDIT-Y ANNUAL
COMPOSITE RATED- PREM/OPS
Home
14Ofice
ofCopy
94
(Page 7 of 29) INDEX NO. 526100/2020
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
COMMON POL1CY DECI..ARATIONS
Underwritten by:Scottsdale Insurance Company
NEW PolicyNumber
Home Office:
Renewal ofNum ber NCS0001208
One Nationwide Plaza - Columbus, Ohio 43215
AdministrativeOffice:
8877 North Center Drive - Scottsdale,
Arizona 85258
Gainey
AMEND NI PER ENDT#2-EO 1-800-423-7675 - A StockCompany
ITEM 1. NAMED INSURED AND MAILING ADDRESS ON
ODEN DNOC SENT 1/31/18
EXCELLENT INTERIOR
199 LEE AVE #164 ODEN REINSTATEMENT SENT ON 2/9/18
BROOKLYN NY 11211
AGENT NAME AND ADDRESS
CRC INSURANCE SERVICES INC Agent No.: Program No.: NONE
140 BROADWAY 36TH FL
3172 9
NEW YORK NY 10 0 0 5
NOTICE OF NONRENEWAL SENT
ITEM 2. POLICY PERIOD From: 12 -12 -2 0 17 To:12 -12 -2 0 18 Term:1 Year
12:01 A.M., Standard
Time at the mailing
addæssshown In ITEM 1.
Business Description:GENERAL CONTRACTOR
In return forthe payment ofthe premium, and subject to allthe terms of this policy, we agree with you to provide the
insurance as stated in thispolicy. This policy consists of the following coverage parts for which a premium isindicated.
Where no premium is shown, there is no coverage. This premium may be subject to adjustrnent.
Coverage Part(s) Premium Summary
Commercial General LiabilityCoverage Part $
Commercial Property Coverage Part $ NOT COVERED
Commercial Crirne And FidelityCoverage Part $ NOT COVERED
Commercial Inland Marine Coverage Part $ NOT COVERED
Commercial Auto Coverage Part $ NOT COVERED
Professional LiabilityCoverage Part $ NOT COVERED
$
$
$
$
Total Policy Premium $
$
Total Taxes, Surcharges or Fees $
Policy Total $
Form(s) and Endorsement(s) made a part of thispolicy at time of issue:
See Schedule of Forms and Endorsements
THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATION ),TOGETHER WITH
THE COMMON POLICY CONDITIONS, COVERAGE PART S , COVERAGE FORM AND FORM(S)
AND ENDORSEMENT(S), IFANY, COMPLETE T ABOVE-NUMBERE LICY.
OPS-D-1 (1-17)
HomeOfice
15 ofCopy
94
(Page 8 of 29) INDEX NO. 526100/2020
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
COMPANY®
SCOTTSDALE INSURANCE
SCHEDULE OF TAXES, SURCHARGES OR FEES
Policy No. NCS0001208 Effective Date: 12-12-17
12:01 A.M., Standard Time
Named Insured EXCELLENT INTERIOR CORP AgentNo. 31729
OPS-D-1 (cont.)
TAXES, SURCHARGES OR FEES BREAKDOWN :
INSPECTION FEE
TOTAL TAXES, SURCHARGES OR FEES $
UTS-126L (10-93)
Home
16Ofh ce Co94
of py
(Page 9 of 29) INDEX NO. 526100/2020
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
COMPANY®
SCOTTSDALE INSURANCE
SCHEDULE OF FORMSAND ENDORSEMENTS
Policy No. NCS0001208 Effective Date: 12-12-17
12:01 A.M., Standard Time
Narned Insured EXCELLENT INTERIOR CORP AgentNo. 31729
COMMON POLICY FORMS AND ENDORSEMENTS
UTS-COVPG 01-16 COVER PAGE
NOTX0178CW 03-16 CLAIM REPORTING INFORMATION
OPS-D-1 01-17 COMMON POLICY DECLARATIONS
UTS-126L 10-93 SCHEDULE OF TAXES, SURCHARGES OR FEES
UTS-SP-2L 12-95 SCHEDULE OF FORMS & ENDORSEMENTS
UTS-SP-3 08-96 SCHEDULE OF LOCATIONS
IL 00 17 11-98 COMMON POLICY CONDITIONS
IL 00 23 07-02 NUCLEAR ENERGY LIABILITY EXCLUSION ENDT
UTS-74G 08-95 PUNITIVE OR EXEMPLARY DAMAGE EXCLUSION
UTS-9G 05-96 SERVICE OF SUIT CLAUSE
GENERAL LIABILITY FORMS AND ENDORSEMENTS
GLS-516 08-17 SPECIFIED PROJECT EXCLUSION
CLS-SD-1L 08-01 COMMERCIAL LIABILITY COVERAGE PART DEC
CLS-SP-1L 10-93 GENERAL LIABILITY COVERAGE PART-EXT.
GLS-230S 08-09 MIN & ADV PREM\MIN EARNED CANC ENDT
CG 21 06 05-14 EXCL-ACC/DISCL OF CONFI OR PERSONAL INFO
GLS-152S 08-16 AMENDMENT TO OTHER INSURANCE CONDITION
GLS-464S 03-15 SPECIAL CONDITIONS-CONTRACTORS
GLS-518 10-16 CONSOLIDATED (WRAP-UP) INS PROGRAM EXCL
CG 00 01 04-13 COMMERCIAL GENERAL LIABILITY COV FORM
CG 20 01 04-13 PRIMARY AND NONCONTRIBUTORY - OTHER INSD
CG 20 33 04-13 ADDL INSD-OWNERS, LESSEES OR CONTR'S
CG 20 37 04-13 ADDL INSD-OWNERS/LESSEES/CONTR-COMP OPS
CG 21 09 06-15 EXCLUSION - UNMANNED AIRCRAFT
CG 21 16 04-13 EXCL-DESIGNATED PROFESSIONAL SERVICES
CG 21 35 10-01 EXCL-COV C-MEDICAL PAYMENTS
CG 21 47 12-07 EMPLOYMENT-RELATED PRACTICES EXCLUSION
CG 21 49 09-99 TOTAL POLLUTION EXCLUSION ENDORSEMENT
CG 21 67 12-04 FUNGI OR BACTERIA EXCLUSION
CG 21 73 01-15 EXCLUSION OF CERTIFIED ACTS OF TERRORISM
CG 21 86 12-04 EXCL-EXTERIOR INSULATION & FINISH SYSTEM
CG 21 96 03-05 SILICA OR SILICA-RELATED DUST EXCLUSION
CG 24 04 05-09 WAIVER OF TRANSFER RIGHTS OF RECOVERY
GLS-148S 06-15 LIABILITY DEDUCTIBLE (PER OCC/OFF)
GLS-281s 09-07 CONTINUING OR ONGOING DAMAGE EXCLUSION
GLS-282s 07-16 MULTI-UNIT HABITATIONAL CONVERSION EXCL
GLS-289S 11-07 KNOWN INJURY/DAMAGE EXCL-PERS & ADV INJU
GLS-304S 07-08 CROSS LIABILITY EXCLUSION
GLS-74S 09-05 AMENDMENT OF CONDITIONS
UTS-266G 05-98 ASBESTOS EXCLUSION
UTS-267G 05-98 LEAD CONTAMINATION EXCLUSION
ADD CG2026/CG2037 PER ENDT#1-EO
UTS-SP-2L (12-95) Homeomee
17 ofcopy
94
(Page 10 of 29) INDEX NO. 526100/2020
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
COMPANY®
SCOTTSDALE INSURANCE
SCHEDULE OF LOCATIONS
Policy No. NCS0001208 Effective Date: 12-12-17
12:01 A.M., Standard Time
Narned Insured EXCELLENT INTERIOR CORP AgentNo. 3172 9
Prem. Bidg. Designated Premises
No. No. (Address, City, State,Zip Code) Occupancy
001 001 199 LEE AVE #164
BROOKLYN, NY 11211
UTS-SP-3 (8-96) Homeomee
18 ofcopy
94
(Page 11 of 29) INDEX NO. 526100/2020
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM
NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022
ENDORSEMENT
COMPANYe No.
SCOTTSDALE INSURANCE
Attached to and forming a part of Endorsernent Effective Date 12-12-17
Policy No. NCS0001208 12:01 A.M., Standard Time
Named Insured EXCELLENT INTERIOR CORP Agent No. 317 2 9
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
PUNITIVE OR EXEMPLARY DAMAGE EXCLUSION
In consideration of the premium charged, it is
agreed thatthis does not to a claim of or indem-
policy apply
nification for punitive or exemplary damages.
Punitive orexemplary damages also include any damages awarded pursuant to statute inthe form of double,
treble or other multiple damages in excess of compensatory damages.
If suit
isbrought against any insured for a claim fallingwithin coverage provided under the policy,seeking
both compensatory and punitive or exemplary damages, then the Company willafford a defense to such
action; however, the Company will have no obligation to pay for any costs, interestor damages attributable
to punitive or exemplary damages.
AUTH ORIZED REPRESENTATIVE DATE
UTS-74g(8-95)
HomeOftee
19 ofCopy
94
(Page 12 of 29) INDEX NO
Preview
FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020 NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS -------------------------------------------------------------------X NAQUAWN McINTOSH, Index No.: 526100/2020 Plaintiff, CPLR 3101(f) DISCLOSURE -against- 322 GATES LLC and AIRTAN MANAGEMENT CORP. Defendants. -----------------------------------------------------------------------x 322 GATES LLC., Third Party-Plaintiff, -against- EXCELLENT INTERIORS, INC. Third Party-Defendant. -----------------------------------------------------------------------x Responding Third-party defendant, Excellent Interiors, Inc., by and through their attorneys, the Law Offices of Kevin P. Westerman, hereby provides the following, upon information and belief pursuant to CPLR 3101(f): INSURANCE AGREEMENTS We have been advised that a primary policy of insurance, bearing policy number NCS0001208 has been issued to Excellent Interior Inc. Attached, as Exhibit “A” is a copy of that policy provided to our office. We have been advised that the current total available limits under policy number NCS0001208 is: $1,000,000.00. We have been further advised that the person currently responsible for adjusting the claim under policy number NCS0001208 in connection with the above captioned matter is Robert Feeney and their email address is feener3@nationwide.com. We have been advised that an umbrella policy of insurance, bearing policy number A 4196322 issued by United Specialty Insurance Company has been issued to Excellent Interior Inc. Attached, as Exhibit “B” is a copy of that policies provided to our office. We have been advised that the current total available limits under policy number USA 4196322 1 of 94 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020 NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 is: $5,000,000.00. We have been further advised that the person currently responsible for adjusting the claim under policy number USA 4196322 in connection with the above captioned matter is Rachael Hummel and their email address is Rachael.Hummel@ameritrustgroup.com. Please note that Excess Carrier has disclaimed coverage as of August 29, 2021, annexed hereto as Exhibit “C”. Andrea E. Waisman, an attorney with the Law Offices of Kevin P. Westerman admitted to practice in the Courts of the State of New York, hereby affirms under penalty of perjury: 1. We are attorneys of record for the responding Third-party Defendant. 2. The annexed insurance policies are the accurate and complete documents provided to us by the carrier(s) for the responding Third-party Defendant. 3. Upon information and belief, reasonable efforts have been undertaken, and in accordance with CPLR 3101(f)(2) will be undertaken, to ensure that this information remains accurate and complete. Dated: Garden City, New York December 13, 2022 THE LAW OFFICES OF KEVIN WESTERMAN ___________________________ Andrea E. Waisman, Esq. Attorneys for Third-party Defendant EXCELLENT INTERIORS INC. 990 Stewart Avenue. Suite 400 Garden City, NY, 11530 Phone: (516) 493-4501 Matter No.: 22-008320 TO: Lisa M. Rolle, Esq. TRAUB LIEBERMAN STRAUS & SHREWSBERRY, LLP. Attorneys for Defendants/Third-Party Plaintiff, 322 GATES LLC. Mid-Westchester Executive Park Seven Skyline Drive Hawthorne, New York 10532 914-347-2600 ASHER & ASSOCIATES, P.C. Attorneys for Plaintiff NAQUAWN McINTOSH 2 of 94 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020 NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 111 John Street, 14th Floor New York, New York 10038 212-227-5000 MICHAEL P. BERKLEY, P.C. Attorneys for Defendant AIRITAN MANAGEMET CORP. 100 Garden City Plaza, Suite 518 Garden City, New York 11530 516-227-2121 3 of 94 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020 NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 AFFIDAVIT OF SERVICE STATE OF NEW YORK, COUNTY OF NASSAU ss: Lillian Rivera being duly sworn, deposes and says: deponent is not a party to the action, is over 18 years of age and resides at Queens County, New York On December 13, 2022, deponent served the within CPLR 3101(f) DISCLOSURE To: TRAUB LIEBERMAN STRAUS & SHREWSBERRY, LLP. Mid-Westchester Executive Park Seven Skyline Drive Hawthorne, New York 10532 ASHER & ASSOCIATES, P.C. 111 John Street, 14th Floor New York, New York 10038 MICHAEL P. BERKLEY, P.C. 100 Garden City Plaza, Suite 518 Garden City, New York 11530 attorney in this action, at the address designated by said attorney(s) for that purpose of uploading within the State of New York Courts Electronic Filing System (“NYSCEF”). Lillian Rivera Sworn to before me on this 13th day of December 2022 __________________ NOTARY PUBLIC Cara R. DeMarco Notary Public State of New York No. 01DE6210721 Qualified in Nassau County Commission Expires: 08/31/2025 4 of 94 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020 NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 Index No. 526100 Year: 2020 SUPREME COURT OF THE STATE NEW YORK COUNTY OF KINGS__________________________________________________ NAQUAWN McINTOSH, Plaintiff, -against- 322 GATES LLC and AIRTAN MANAGEMENT CORP. Defendants AND THIRD-PARTY ACTION ___________________________________________________________________________ CPLR 3101(f) DISCLOSURE ___________________________________________________________________________ LAW OFFICES OF KEVIN P. WESTERMAN Attorneys for Third-Party Defendant EXCELLENT INTERIORS, INC. 990 Stewart Avenue Suite 400 Garden City, New York 11530 516-493-4501 _________________________________________________________________ NOTICE OF ENTRY SIR: Please take notice that the within is a (certified) true copy of a duly entered in the office of the Clerk of the within named Court on 20 Dated: ________________________________________________________________ NOTICE OF SETTLEMENT SIR: Please take notice that an order of which the within is a true copy will be presented for settlement to the Hon. one of the judges of the within named Court, at on the day of 20 at .M. Dated: ________________________________________________________________ Service of a Copy of the within is hereby admitted. Dated: 20 _____________________________ 5 of 94 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020 NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS -----____----------------------------------------------------------X NAQUAWN McINTOSH, Index No.: 526100/2020 CERTIFICATION RE: Plaintiff, CPLR 3101(f) DISCLOSURE -against- 322 GATES LLC and AIRTAN MANAGEMENT CORP., Defendants. -----------------------------------------------------------------------Ç 322 GATES LLC., Third Party-Plaintiff, -against- EXCELLENT INTERIORS, INC. Third Party-Defendant. ------------------------.----------------------------------------------Ç STATE OF NEW YORK ) COUNTY OF KINGS) SS.: ISAAC HIRSCH, being duly sworn deposes and says: 1. I am the defendant in the action herein. 2. Upon information and belief, pursuant to CPLR 3122-b, the annexed CPLR 3101(f) disclosure is an accurate and contains complete copies of the insurance policy information provided by the insurance carrier(s). 3. Upon information and belief, in accordance with CPLR 3101(f)(2), reasonable efforts have been, and will be, undertaken, to ensure that this information remains accurate and complete. Dated: / * S , 2022 Isaac Hirsch 6 of 94 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020 NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 Sworn to before me this day of / , 2022 DAVID KATZ Stateof New York NotaryPublit, No.Q1RA80998% Qualifiedin KingsCounty otary Pub•ic Sept 29.20 ) Commission Expires 7 of 94 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM INDEX NO. 526100/2020 NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 Ex hi bi t “A ” 8 of 94 (Page 1 of 29) INDEX NO. 526100/2020 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 I) I TTII)If It PAGE Producer No: 31729 SAN: 41092730000000 Pol Eff Dt: 12-12-2017 Office: Date Printed: 12-21-2017 Time Printed: 14:17:42 Trans Eff Dt: 12-12-2017 Insured Name: EXCELLENT INTERIOR CORP Policy No: NCS0001208 Trans Seq No: 001 Trans Type: New Business Issue Oper Init: LAUTAC1 Company Abbr: SI Release Version: 17.21 User-Selected Sets Copies Printer INSURED COPY 01 PDF ONLY HOME OFFICE COPY 01 PDF ONLY CERTIFICATE COPY 01 No forms to include with this set HOME OFFICE(FAX) COPY 01 No forms to include with this set VEHICLE/DRIVER SCHEDU 01 No forms to include with this set 9 of 94 (Page 2 of 29) INDEX NO. 526100/2020 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 POLICYWRITING INDEX SCOTTSDAT.EINSURANCEOCBIPANY CUSTOMERID POLICYNUMBER PREVIOUSPOLICYNUMBER EFFECTIVEDATE EXPIRATIONDATE 103512070C NCS0001200 NEW 12-12-2017 12-12-2018 NAMED INSURED EXPN'T.TR'NT INTERIOR CORP MISCELLANEOUSINFORMATION TRANSACTIONINFORMATION BILL TYPE AGENCY TRANS.TYPE NEWBUSINESS DIRECTBILL TRANS.SEQ. # 001 BILL PLAN DATE PROCESSED 12-21-17 OPERATORl.D. IAUTAC1 TRANS.DATE 12-12-17 UNDERWRITER1.D. OCONNL2 ENDORSEMENT# SUBMISSIONDATE CANC/REIN REASON DUNN & BRADSTREET REINSURANCEIND: N NY FREETRADEZONE XREFPOLICY#1 DEPARTMENTCODE C XREFPOLICY#2 PROG¯!AMCODE XREFPOLICY#3 SIC CODE 1542 XREFPOLICY#4 PROFITSHARING XREFPOLICY#5 POLICYPRICING - PROP/BOP- GLASS- IM - FEIN CRIME - GL - AU - LINE OF BUSINESS/ COMMISSIONS: LINE OF BUSINESS COMMISSION % GENERALLIABILITY FULL ANNUAL PREMlUM BILLED PREMIUM NAMED INSURED MAILING ADDRESS AGENT INFORMATION CODE 31729 EXCELIENT INTERIOR CORP CRC INSURANCE SERVICES INC 140 BROADWAY36TH FL 199 IEE AVE #164 BROOKLYN NY 11211 NEW YORK NY 10005 RETAIL AGENT INFORMATION CODE ASSEMBLY INFORMATION STAMPS/ STICKERS Taxes & Fees SPECIAL INSTRUCTIONS BRITTANEY JOHNSON12/20/17 GLORIA DROBBIN GDROBBIN@CRCINS.COM TRIA REJ DED-X INSPECT-Y AUDIT-Ž COMPOSITERATED- PREM/OPS HomeOffice 10 ofCopy 94 (Page 3 of 29) INDEX NO. 526100/2020 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 POLICYWRITING INDEX ACCOUNT NUMBER POLICY NUMBER PREVIOUS POLICY NUMBER EFFECTIVE DATE- EXPIRATION DATE 103512070C NCSO001208 NEW 12-12-2017 12-12-2018 COMPUTER PRODUCED FORMS UTS-COVPG 01-16 COVER PAGE NOTX0178CW 03-16 CLAIM REPORTING INFORMATION OPS-D-1 01-17 COMMON POLICY DECLARATIONS UTS-126L 10-93 SCHEDULE OF TAXES, SURCHARGES OR FEES UTS-SP-2L 12-95 SCHEDULE OF FORMS & ENDORSEMENTS UTS-SP-3 08-96 SCHEDULE OF LOCATIONS IL 00 17 11-98 COMMON POLICY CONDITIONS IL 00 23 07-02 NUCLEAR ENERGY LIABILITY EXCLUSION ENDT UTS-74G 08-95 PUNITIVE OR EXEMPLARY DAMAGE EXCLUSION UTS-9G 05-96 SERVICE OF SUIT CLAUSE GLS-516 08-17 SPECIFIED PROJECT EXCLUSION CLS-SD-1L 08-01 COMMERCIAL LIABILITY COVERAGE PART DEC CLS-SP-1L 10-93 GENERAL LIABILITY COVERAGE PART-EXT. GLS-230S 08-09 MIN & ADV PREM\MIN EARNED CANC ENDT CG 21 06 05-14 EXCL-ACC/DISCL OF CONFI OR PERSONAL INFO GLS-152S 08-16 AMENDMENT TO OTHER INSURANCE CONDITION GLS-464S 03-15 SPECIAL CONDITIONS-CONTRACTORS GLS-518 10-16 CONSOLIDATED (WRAP-UP) INS PROGRAM EXCL CG 00 01 04-13 COMMERCIAL GENERAL LIABILITY COV FORM CG 20 01 04-13 PRIMARY AND NONCONTRIBUTORY - OTHER INSD CG 20 33 04-13 ADDL INSD-OWNERS, LESSEES OR CONTR'S CG 20 37 04-13 ADDL INSD-OWNERS/LESSEES/CONTR-COMP OPS CG 21 09 06-15 EXCLUSION - UNMANNED AIRCRAFT CG 21 16 ADL 04-13 EXCL-DESIGNATED PROFESSIONAL SERVICES CG 21 35 10-01 EXCL-COV C-MEDICAL PAYMENTS CG 21 47 12-07 EMPLOYMENT-RELATED PRACTICES EXCLUSION CG 21 49 09-99 TOTAL POLLUTION EXCLUSION ENDORSEMENT CG 21 67 ADL 12-04 FUNGI OR BACTERIA EXCLUSION CG 21 73 01-15 EXCLUSION OF CERTIFIED ACTS OF TERRORISM CG 21 86 12-04 EXCL-EXTERIOR INSULATION & FINISH SYSTEM CG 21 96 ADL 03-05 SILICA OR SILICA-RELATED DUST EXCLUSION CG 24 04 ADL 05-09 WAIVER OF TRANSFER RIGHTS OF RECOVERY GLS-148S 06-15 LIABILITY DEDUCTIBLE (PER OCC/OFF) GLS-281s 09-07 CONTINUING OR ONGOING DAMAGE EXCLUSION GLS-282s 07-16 MULTI-UNIT HABITATIONAL CONVERSION EXCL HomeOfice 11 ofCopy 94 (Page 4 of 29) INDEX NO. 526100/2020 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 PAGE 3 POLICYWRITING INDEX ACCOUNT NUMBER POLICY NUMBER PREVIOUS POLICY NUMBER EFFECTIVE DATE - EXPIRATION DATE 103512070C NCS0001208 NEW 12-12-2017 12-12-2018 GLS-289S 11-07 KNOWN INJURY/DAMAGE EXCL-PERS & ADV INJU GLS-304S 07-08 CROSS LIABILITY EXCLUSION GLS-74S 09-05 AMENDMENT OF CONDITIONS UTS-266G 05-98 ASBESTOS EXCLUSION UTS-267G ADL 05-98 LEAD CONTAMINATION EXCLUSION HomeOfice 12 ofCopy 94 (Page 5 of 29) INDEX NO. 526100/2020 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 POLICYWRITING INDEX ACCOUNT NUMBER POLICY NUMBER PREVIOUS POLICY NUMBER EFFECTIVE DATE - EXPIRATION DATE NCS00012OB NEW 12-12-2017 12-12-2018 HorneOfice 13 ofCopy 94 (Page 6 of 29) INDEX NO. 526100/2020 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 PAGE 2 POLICYWRITING INDEX ACCOUNT NUMBER POLICY NUMBER PREVIOUS POLICY NUMBER EFFECTIVE DATE - EXPIRATION DATE NCSO001208 NEW 12-12-2017 12-12-2018 GENERAL COMMENTS: BRITTANEY JOHNSON 12/20/17 GLORIA DROBBIN GDROBBIN@CRCINS.COM TRIA REJ DED-X INSPECT-Y AUDIT-Y ANNUAL COMPOSITE RATED- PREM/OPS Home 14Ofice ofCopy 94 (Page 7 of 29) INDEX NO. 526100/2020 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 COMMON POL1CY DECI..ARATIONS Underwritten by:Scottsdale Insurance Company NEW PolicyNumber Home Office: Renewal ofNum ber NCS0001208 One Nationwide Plaza - Columbus, Ohio 43215 AdministrativeOffice: 8877 North Center Drive - Scottsdale, Arizona 85258 Gainey AMEND NI PER ENDT#2-EO 1-800-423-7675 - A StockCompany ITEM 1. NAMED INSURED AND MAILING ADDRESS ON ODEN DNOC SENT 1/31/18 EXCELLENT INTERIOR 199 LEE AVE #164 ODEN REINSTATEMENT SENT ON 2/9/18 BROOKLYN NY 11211 AGENT NAME AND ADDRESS CRC INSURANCE SERVICES INC Agent No.: Program No.: NONE 140 BROADWAY 36TH FL 3172 9 NEW YORK NY 10 0 0 5 NOTICE OF NONRENEWAL SENT ITEM 2. POLICY PERIOD From: 12 -12 -2 0 17 To:12 -12 -2 0 18 Term:1 Year 12:01 A.M., Standard Time at the mailing addæssshown In ITEM 1. Business Description:GENERAL CONTRACTOR In return forthe payment ofthe premium, and subject to allthe terms of this policy, we agree with you to provide the insurance as stated in thispolicy. This policy consists of the following coverage parts for which a premium isindicated. Where no premium is shown, there is no coverage. This premium may be subject to adjustrnent. Coverage Part(s) Premium Summary Commercial General LiabilityCoverage Part $ Commercial Property Coverage Part $ NOT COVERED Commercial Crirne And FidelityCoverage Part $ NOT COVERED Commercial Inland Marine Coverage Part $ NOT COVERED Commercial Auto Coverage Part $ NOT COVERED Professional LiabilityCoverage Part $ NOT COVERED $ $ $ $ Total Policy Premium $ $ Total Taxes, Surcharges or Fees $ Policy Total $ Form(s) and Endorsement(s) made a part of thispolicy at time of issue: See Schedule of Forms and Endorsements THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATION ),TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART S , COVERAGE FORM AND FORM(S) AND ENDORSEMENT(S), IFANY, COMPLETE T ABOVE-NUMBERE LICY. OPS-D-1 (1-17) HomeOfice 15 ofCopy 94 (Page 8 of 29) INDEX NO. 526100/2020 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 COMPANY® SCOTTSDALE INSURANCE SCHEDULE OF TAXES, SURCHARGES OR FEES Policy No. NCS0001208 Effective Date: 12-12-17 12:01 A.M., Standard Time Named Insured EXCELLENT INTERIOR CORP AgentNo. 31729 OPS-D-1 (cont.) TAXES, SURCHARGES OR FEES BREAKDOWN : INSPECTION FEE TOTAL TAXES, SURCHARGES OR FEES $ UTS-126L (10-93) Home 16Ofh ce Co94 of py (Page 9 of 29) INDEX NO. 526100/2020 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 COMPANY® SCOTTSDALE INSURANCE SCHEDULE OF FORMSAND ENDORSEMENTS Policy No. NCS0001208 Effective Date: 12-12-17 12:01 A.M., Standard Time Narned Insured EXCELLENT INTERIOR CORP AgentNo. 31729 COMMON POLICY FORMS AND ENDORSEMENTS UTS-COVPG 01-16 COVER PAGE NOTX0178CW 03-16 CLAIM REPORTING INFORMATION OPS-D-1 01-17 COMMON POLICY DECLARATIONS UTS-126L 10-93 SCHEDULE OF TAXES, SURCHARGES OR FEES UTS-SP-2L 12-95 SCHEDULE OF FORMS & ENDORSEMENTS UTS-SP-3 08-96 SCHEDULE OF LOCATIONS IL 00 17 11-98 COMMON POLICY CONDITIONS IL 00 23 07-02 NUCLEAR ENERGY LIABILITY EXCLUSION ENDT UTS-74G 08-95 PUNITIVE OR EXEMPLARY DAMAGE EXCLUSION UTS-9G 05-96 SERVICE OF SUIT CLAUSE GENERAL LIABILITY FORMS AND ENDORSEMENTS GLS-516 08-17 SPECIFIED PROJECT EXCLUSION CLS-SD-1L 08-01 COMMERCIAL LIABILITY COVERAGE PART DEC CLS-SP-1L 10-93 GENERAL LIABILITY COVERAGE PART-EXT. GLS-230S 08-09 MIN & ADV PREM\MIN EARNED CANC ENDT CG 21 06 05-14 EXCL-ACC/DISCL OF CONFI OR PERSONAL INFO GLS-152S 08-16 AMENDMENT TO OTHER INSURANCE CONDITION GLS-464S 03-15 SPECIAL CONDITIONS-CONTRACTORS GLS-518 10-16 CONSOLIDATED (WRAP-UP) INS PROGRAM EXCL CG 00 01 04-13 COMMERCIAL GENERAL LIABILITY COV FORM CG 20 01 04-13 PRIMARY AND NONCONTRIBUTORY - OTHER INSD CG 20 33 04-13 ADDL INSD-OWNERS, LESSEES OR CONTR'S CG 20 37 04-13 ADDL INSD-OWNERS/LESSEES/CONTR-COMP OPS CG 21 09 06-15 EXCLUSION - UNMANNED AIRCRAFT CG 21 16 04-13 EXCL-DESIGNATED PROFESSIONAL SERVICES CG 21 35 10-01 EXCL-COV C-MEDICAL PAYMENTS CG 21 47 12-07 EMPLOYMENT-RELATED PRACTICES EXCLUSION CG 21 49 09-99 TOTAL POLLUTION EXCLUSION ENDORSEMENT CG 21 67 12-04 FUNGI OR BACTERIA EXCLUSION CG 21 73 01-15 EXCLUSION OF CERTIFIED ACTS OF TERRORISM CG 21 86 12-04 EXCL-EXTERIOR INSULATION & FINISH SYSTEM CG 21 96 03-05 SILICA OR SILICA-RELATED DUST EXCLUSION CG 24 04 05-09 WAIVER OF TRANSFER RIGHTS OF RECOVERY GLS-148S 06-15 LIABILITY DEDUCTIBLE (PER OCC/OFF) GLS-281s 09-07 CONTINUING OR ONGOING DAMAGE EXCLUSION GLS-282s 07-16 MULTI-UNIT HABITATIONAL CONVERSION EXCL GLS-289S 11-07 KNOWN INJURY/DAMAGE EXCL-PERS & ADV INJU GLS-304S 07-08 CROSS LIABILITY EXCLUSION GLS-74S 09-05 AMENDMENT OF CONDITIONS UTS-266G 05-98 ASBESTOS EXCLUSION UTS-267G 05-98 LEAD CONTAMINATION EXCLUSION ADD CG2026/CG2037 PER ENDT#1-EO UTS-SP-2L (12-95) Homeomee 17 ofcopy 94 (Page 10 of 29) INDEX NO. 526100/2020 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 COMPANY® SCOTTSDALE INSURANCE SCHEDULE OF LOCATIONS Policy No. NCS0001208 Effective Date: 12-12-17 12:01 A.M., Standard Time Narned Insured EXCELLENT INTERIOR CORP AgentNo. 3172 9 Prem. Bidg. Designated Premises No. No. (Address, City, State,Zip Code) Occupancy 001 001 199 LEE AVE #164 BROOKLYN, NY 11211 UTS-SP-3 (8-96) Homeomee 18 ofcopy 94 (Page 11 of 29) INDEX NO. 526100/2020 FILED: KINGS COUNTY CLERK 12/13/2022 04:55 PM NYSCEF DOC. NO. 75 RECEIVED NYSCEF: 12/13/2022 ENDORSEMENT COMPANYe No. SCOTTSDALE INSURANCE Attached to and forming a part of Endorsernent Effective Date 12-12-17 Policy No. NCS0001208 12:01 A.M., Standard Time Named Insured EXCELLENT INTERIOR CORP Agent No. 317 2 9 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. PUNITIVE OR EXEMPLARY DAMAGE EXCLUSION In consideration of the premium charged, it is agreed thatthis does not to a claim of or indem- policy apply nification for punitive or exemplary damages. Punitive orexemplary damages also include any damages awarded pursuant to statute inthe form of double, treble or other multiple damages in excess of compensatory damages. If suit isbrought against any insured for a claim fallingwithin coverage provided under the policy,seeking both compensatory and punitive or exemplary damages, then the Company willafford a defense to such action; however, the Company will have no obligation to pay for any costs, interestor damages attributable to punitive or exemplary damages. AUTH ORIZED REPRESENTATIVE DATE UTS-74g(8-95) HomeOftee 19 ofCopy 94 (Page 12 of 29) INDEX NO