Preview
FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023
NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
HUSSEIN BADR, Index No. 515722/2023
Plaintiff, DEFENDANTS JEAN
BOULOUTE, ADT LLC, AND
-against- GELCO FLEET TRUST’S
RESPONSE TO PLAINTIFF’S
JEAN BOULOUTE, ADT SECURITY SERVICES DEMAND FOR CONTENTS OF
INC., and GELCO FLEET TRUST, INSURANCE AGREEMENTS
Defendants.
The Defendants JEAN BOULOUTE, ADT LLC (incorrectly named as ADT SECURITY
SERVICES INC.), and GELCO FLEET TRUST, (“Defendants”), by and through their attorneys
of record GOLDBERG SEGALLA LLP, make their response to Plaintiff’s Demand for Contents
of Insurance Agreements and state as follows:
GENERAL OBJECTIONS
1. Defendants object to Plaintiff’s Demands to the extent they seek disclosure of
information protected by the attorney-client privilege, by the attorney work product doctrine as
material prepared in anticipation of litigation, or by other statutory or common law privileges.
2. If such information and/or documents are produced inadvertently despite the
presence of a privilege, such production does not constitute a waiver of the aforementioned
privileges.
3. Defendants object to Plaintiff’s Demands to the extent they purport to impose
obligations beyond those required by the CPLR. Defendants will produce information and
documents in accordance with the CPLR.
4. Defendants object to Plaintiff’s Demands to the extent that such demands are vague,
onerous and burdensome.
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5. Defendants object to Plaintiff’s Demands to the extent they seek information not
related to the claims at issue in this litigation.
6. Defendants object to Plaintiff’s Demands to the extent that they seek documents
that are already in the Plaintiff’s possession or control or are as equally available to the Plaintiff
as they are to Defendants.
7. Neither Defendants’ indication that it will produce responsive documents, nor its
failure to object to a document request, constitutes an acknowledgment that any responsive
documents exist within Defendants’ regular business records.
DEMAND FOR CONTENTS OF INSURANCE POLICIES
Information and documentation, as evidenced in the form of a copy of the insurance policy in
place at the time of the loss, shall include:
1. All primary, excess, and umbrella policies, contracts or agreements issued by private or
publicly-traded stock companies, mutual insurance companies, captive insurance entities,
risk retention groups, reciprocal insurance exchanges, syndicates, including, but not limited
to, Lloyd’s Underwriters as defined in § 6116 of the Insurance Law, surplus lines insurers,
and self-insurance programs insofar as such documents relate to the claim being litigated.
RESPONSE: See copies of the applicable primary, excess and umbrella auto declaration
policy pages identified as follows:
Old Republic Insurance Company, Policy No. MWTB 314319 22,
dated October 1, 2022 – October 1, 2023, stamped ADT000001-
ADT00006;
Chubb, Policy No. G28166837 007, dated October 1, 2022 –
October 1, 2023, stamped ADT000007;
2
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Ascot Insurance Company, Excess Casualty Insurance Policy,
No. EXNA2210000109-02, dated October 1, 2022 - October 1, 2023,
stamped ADT000008;
Great American Insurance Group, Policy No. EXC4457774, dated
October 1, 2022 – October 1, 2023, stamped ADT000009-ADT000010;
Star Indemnity & Liability Company, Policy No. 1000041199221, dated
October 1, 2022 – October 1, 2023, stamped ADT000011-ADT000015;
Liberty Surplus Insurance Corporation, Policy No. RFE-621-095279-012,
dated October 1, 2022 – October 1, 2023, stamped ADT000016-ADT000017;
AIG Property Casualty, Policy No. 14572416, dated October 1, 2022 –
October 1, 2023, stamped ADT000018.
2. The insurance policy in place is provided, a complete copy of any policy, contract, or
agreement under which any person or entity may be liable to satisfy part or all of a judgment
that may be entered in this action or to indemnify or reimburse for payments made to satisfy
the entry of final judgment as referred to in this demand, including, but not limited to,
declarations, insuring agreements, conditions, exclusions, endorsements, and similar
provisions;
3. The contact information, including the name and e-mail address, of an assigned individual
RESPONSE: See Response No. 1.
4. The contact information, including the name and e-mail address, of an assigned individual
responsible for adjusting the claim at issue; and
RESPONSE: Defendants’ Third-Party Administrator, including the name
and email address of the assigned adjuster are as follows:
Third-Party Administrator:
Gallagher Bassett services, Inc.
P.O. Box 2934
Clinton, IA 52733-2934
3
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Assigned Adjuster:
Scott Pitchon
Senior Resolution Specialist
Scott_Pitchon@gbtpa.com
5. The total limits available under any policy, contract, or agreement, which shall mean the
actual funds, after taking into account erosion and any other offsets, that can be used to
satisfy a judgment described in this demand or to reimburse for payments made to satisfy the
judgment.
RESPONSE: See Response to Request No. 1.
Dated: New York, NY
October 30, 2023
Respectfully Submitted,
GOLDBERG SEGALLA LLP
By:_____________________________
Abraham D. Leybengrub, Esq.
Attorneys for Defendants
JEAN BOULOUTE, ADT LLC
(incorrectly named as ADT SECURITY
SERVICES INC.) and GELCO FLEET
TRUST
711 3rd Avenue, Suite 1900
New York, New York 10017-4013
T: (646) 292-8785
aleybengrub@goldbergsegalla.com
TO: Nicholas Elefterakis, Esq.
ELEFTERAKIS, ELEFTERAKIS & PANEK
Attorneys for Plaintiff
HUSSEIN BADR
80 Pine Street, 38th Floor
New York, New York 10005
T: (212) 532-1116
nick@elfterakislaw.com
4
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Old Republic Insurance Company, Policy No. MWTB 314319
22, dated October 1, 2022 – October 1, 2023, stamped
ADT000001- ADT00006
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Mt. Pleasant, Pennsylvania
BUSINESS AUTO DECLARATIONS
POLICY NUMBER POLICYHOLDER SERVICE OFFICE: Producer: * 770
MWTB 314319 22 Old Republic Risk Management, Inc. Marsh
MWTB 314319 21 445 South Moorland Road Sunrise, FL
PREVIOUS POLICY NUMBER * Brookfield, WI 53005 (877) 797-3400
ITEM ONE
NAMED INSURED: ADT, Inc. (See Form PIL 040 01 16)
MAILING ADDRESS: * 1501 Yamato Road
Boca Raton, FL 33431
POLICY PERIOD: * From: 10/01/22 To: 10/01/23 at 12:01 A.M. Standard Time at your mailing address shown above.
FORM OF BUSINESS: *
CORPORATION INDIVIDUAL LIMITED LIABILITY COMPANY (LLC) PARTNERSHIP OTHER
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS
STATED IN THIS POLICY.
ITEM TWO
SCHEDULE OF COVERAGES AND COVERED AUTOS
This Policy provides only those coverages where a charge is shown in the premium column below. Eac h of these coverages will apply only to those "autos" shown as covered
"autos". "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the Covered Autos section of the Business
Auto Coverage Form next to the name of the coverage.
COVERAGES COVERED AUTOS LIMIT OR DEDUCTIBLE PREMIUM
***See Deductible Coverage Endorsement
COVERED AUTOS LIABILITY 1 $ 5,000,000 $
PERSONAL INJURY PROTECTION 5 SEPARATELY STATED IN EACH P.I.P. ENDORSEMENT $
(Or Equivalent No-fault Coverage) MINUS $ *** DEDUCTIBLE
ADDED PERSONAL INJURY PROTECTION SEPARATELY STATED IN EACH ADDED P.I.P. ENDORSEMENT. $
(Or Equivalent Added No-fault Coverage)
PROPERTY PROTECTION INSURANCE 5 SEPARATELY STATED IN THE P.P.I. ENDORSEMENT $
(Michigan Only) MINUS $ *** DEDUCTIBLE FOR EACH ACCIDENT.
AUTO MEDICAL PAYMENTS $ EACH INSURED $
MEDICAL EXPENSE AND INCOME LOSS SEPARATELY STATED IN THE MEDICAL EXPENSE AND INCOME LOSS $
BENEFITS (Virginia Only) BENEFITS ENDORSEMENT.
UNINSURED MOTORISTS 6 $ Minimum Statutory Limit(s) Except Where Rejected $
UNDERINSURED MOTORISTS 6 $ Minimum Statutory Limit(s) Except Where Rejected $
(When Not Included In Uninsured Motorists
Coverage)
PHYSICAL DAMAGE $ Deductible $
2,8
COMPREHENSIVE COVERAGE For Each Covered Auto For Loss Caused By Theft Or Mischief Or Vandalism
(A maximum deductible will also apply. Refer to Coverage Form for details.)
OR
$ *** Deductible
For All Perils For Each Covered Auto
(A maximum deductible will also apply. Refer to Coverage Form for details.)
See ITEM FOUR for Hired or Borrowed Autos.
YOUR POLICY PROVIDES COLLISION COVERAGE ON RENTAL VEHICLES. PLEASE REFER TO THE PORTION
OF YOUR POLICY PROVIDING “COLLISION” COVERAGE FOR ANY LIMITATIONS IN COVERAGE THAT MAY
APPLY.
COUNTERSIGNED * 11/03/22 BY *
(Date) (Authorized Representative)
* Entry optional if shown in the Common Policy Declarations.
THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER 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.
CA DEC GN 0003 04 22 Includes copyrighted material from Insurance Services Office, Inc. used with its permission. Page 1 of 6
6 of 30 ADT000001
FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023
NYSCEF DOC. AUTO
BUSINESS NO. DECLARATIONS
40 (Continued) RECEIVED NYSCEF: 10/30/2023
ITEM TWO
SCHEDULE OF COVERAGES AND COVERED AUTOS (Continued)
PHYSICAL DAMAGE $ Deductible $
SPECIFIED CAUSES OF LOSS COVERAGE For Each Covered Auto For Loss Caused By Theft Or Mischief Or Vandalism
(A maximum deductible will also apply. Refer to Coverage Form for details.)
OR
$ Deductible
For All Perils For Each Covered Auto
(A maximum deductible will also apply. Refer to Coverage Form for details.)
See ITEM FOUR for Hired or Borrowed Autos.
PHYSICAL DAMAGE $ *** Deductible $
COLLISION COVERAGE 2,8 For Each Covered Auto
See ITEM FOUR for Hired or Borrowed Autos.
PHYSICAL DAMAGE For Each Disablement Of A Private Passenger Auto,
TOWING AND LABOR $ Light or Medium Truck $
0B PREMIUM FOR ENDORSEMENTS $
MICHIGAN CCA SURCHARGE $
ASSESSMENTS, SURCHARGES AND FEES $
Not applicable in NC, NY, PR
**ESTIMATED TOTAL PAYABLE $
Total Shown Is Payable At Inception: $ 1,969,437 ** This Policy may be subject to final audit.
AUDIT PERIOD (if applicable) ANNUALLY SEMI-ANNUALLY QUARTERLY MONTHLY
ENDORSEMENTS ATTACHED TO THIS POLICY: = See Forms Index
= Forms and Endorsements applicable to this Coverage Part/Policy omitted if shown elsewhere in the Policy.
ITEM THREE
SCHEDULE OF COVERED AUTOS YOU OWN
Covered Auto Description
Covered Trade Body Serial Vehicle ID
Auto No. Year Model Name Type Number (S) Number (VIN)
1
ON FILE WITH THE COMPANY
2
3
4
5
Covered Town And State Where The Covered
Auto No. Original Cost New: Auto Will Be Principally Garaged:
1
2
3
4
5
Classification
Size GVWR,
Business Use GCW or Except For Towing And Labor, All Physical Damage
Radius s = service Vehicle Secondary Loss Is Payable To You And The Loss Payee
Covered Of r = retail Seating Age Rating Named Below According To Their Interests In The
Auto No. Operation c = commercial Capacity Group Classification Code Auto At The Time Of The Loss:
1
2
3
4
5
Coverages-Premiums, Limits And Deductibles
(Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TWO column applies instead.)
COVERED AUTOS LIABILITY PERSONAL INJURY PROTECTION ADDED PERSONAL INJURY PROPERTY PROTECTION
PROTECTION INSURANCE (Michigan Only)
Limit Limit Limit
Stated In Each Stated In Each Stated In P.P.I.
Covered P.I.P. Endorsement Added P.I.P. Endorsement
Minus Minus
Auto No. Limit Premium Deductible Premium Endorsement Premium Deductible Premium
1
STATED IN DECLARATIONS ITEM TWO
2
3
4
5
Total
Premium
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FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023
NYSCEF DOC. AUTO
BUSINESS NO. DECLARATIONS
40 (Continued) RECEIVED NYSCEF: 10/30/2023
ITEM THREE
SCHEDULE OF COVERED AUTOS YOU OWN (Continued)
AUTO MEDICAL PAYMENTS MEDICAL EXPENSE AND
Each Insured INCOME LOSS BENEFITS (Virginia Only) COMPREHENSIVE
Limit Stated In Deductible
The Medical Expense For Loss Caused
And Income Loss By Theft Or
Covered Benefits Endorsement Mischief Or Deductible
Auto No. Limit Premium For Each Person Premium Vandalism * OR For All Perils * Premium
1
STATED IN DECLARATIONS ITEM TWO
2
3
4
5
Total
Premium
SPECIFIED CAUSES OF LOSS COLLISION TOWING AND LABOR
Deductible
For Loss Caused
By Theft Or Limit
Covered Mischief Or Deductible Per
Auto No. Vandalism * OR For All Perils * Premium Deductible Premium Disablement Premium
1 ITEM TWO
STATED IN DECLARATIONS
2
3
4
5
Total
Premium
* (A maximum deductible will also apply. Refer to Coverage Form for details.)
ITEM FOUR
SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS
Covered Autos Liability Coverage - Cost Of Hire Rating Basis For Autos Used In Your Motor Carrier Operations (Other Than Mobile Or Farm Equipment)
Estimated Annual
Covered Autos Liability Coverage Cost Of Hire For All States Premium
Primary Coverage
Excess Coverage
Total Hired Auto Premium
For "autos" used in your motor carrier operations, cost of hire means:
1. The total dollar amount of costs you incurred for the hire of automobiles (includes "trailers" and semitrailers) and, if not included therein,
2. The total remunerations of all operators and drivers' helpers, of hired automobiles whether hired with a driver by lessor or an "employee" of the
lessee, or any other third party, and
3. The total dollar amount of any other costs (e.g., repair, maintenance, fuel, etc.) directly associated with operating the hired automobiles whether,
such costs are absorbed by the "insured", paid to the lessor or owner, or paid to others.
Covered Autos Liability Coverage - Cost Of Hire Rating Basis For Autos NOT Used In Your Motor Carrier Operations (Other Than Mobile Or Farm Equipment)
Covered Autos Estimated Annual
Liability Coverage State Cost Of Hire For Each State Premium
Primary Coverage
Excess Coverage
Total Hired Auto Premium
For "autos" NOT used in your motor carrier operations, cost of hire means the total amount you incur for the hire of "autos" you don't own (not including
"autos" you borrow or rent from your partners or "employees" or their family members). Cost of hire does not include charges for services performed by
motor carriers of property or passengers.
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FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023
NYSCEF DOC. AUTO
BUSINESS NO. DECLARATIONS
40 (Continued) RECEIVED NYSCEF: 10/30/2023
ITEM FOUR
SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS (Continued)
Physical Damage Coverages - Cost of Hire Rating Basis For All Autos (Other Than Mobile Or Farm Equipment)
Estimated Annual
Cost Of Hire For Each
State
(Excluding Autos
Coverage State Deductible Hired With A Driver) Premium
Comprehensive $ Deductible
For Each Covered Auto For Loss Caused By Theft Or Mischief Or
Vandalism
(A maximum deductible will also apply. Refer to Coverage Form for
details.)
Specified $ Deductible
Causes Of Loss For Each Covered Auto For Loss Caused By Theft Or Mischief Or
Vandalism
(A maximum deductible will also apply. Refer to Coverage Form for
details.)
Collision $ Deductible
For Each Covered Auto
Total Hired Auto Premium
For Physical Damage coverages, cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your
partners or "employees" or their family members). Cost of hire does not include charges for any "auto" that is leased, hired, rented or borrowed with a driver.
Cost Of Hire Rating Basis For Mobile Or Farm Equipment - Other Than Physical Damage Coverages
Estimated Annual
Cost Of Hire For Each State Premium
Coverage State Mobile Equipment Farm Equipment Mobile Equipment Farm Equipment
Covered Autos Liability -
Primary
Coverage
Covered Autos Liability -
Excess
Coverage
Personal Injury
Protection
Medical
Expense
VA
Benefits
(Virginia Only)
Income Loss
Benefits VA
(Virginia Only)
Auto Medical
Payments
Total Hired Auto Premiums
Cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your partners or "employees" or their family
members). Cost of hire does not include charges for services performed by motor carriers of property or passengers.
Cost Of Hire Rating Basis For Mobile Or Farm Equipment - Physical Damage Coverages
Estimated Annual
Cost Of Hire For Each State
(Excluding Autos Hired
With A Driver) Premium
Mobile Farm Mobile Farm
Coverage State Deductible Equipment Equipment Equipment Equipment
Comprehensive $ Ded.
For Each Covered Auto
For Loss Caused By Theft
Or Mischief Or Vandalism
(A maximum deductible
will also apply. Refer to
Coverage Form for details.)
Specified $ Ded.
Causes For Each Covered Auto
Of Loss For Loss Caused By Theft
Or Mischief Or Vandalism
(A maximum deductible
will also apply. Refer to
Coverage Form for details.)
Collision $ Ded.
For Each Covered Auto
Total Hired Auto Premiums
For Physical Damage Coverages, cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your
partners or "employees" or their family members). Cost of hire does not include charges for any auto that is leased, hired, rented or borrowed with a driver.
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FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023
NYSCEF DOC. AUTO
BUSINESS NO. DECLARATIONS
40 (Continued) RECEIVED NYSCEF: 10/30/2023
ITEM FOUR
SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS (Continued)
Rental Period Rating Basis For Mobile Or Farm Equipment
Estimated Number Of
Days Equipment Will
Be Rented Premium
Town And State
Where The Job Mobile Farm
Coverage Site Is Located Equipment Equipment Mobile Equipment Farm Equipment
Covered Autos Liability -
Primary Coverage
Covered Autos Liability -
Excess Coverage
Personal Injury
Protection
Medical Expense
Benefits VA
(Virginia Only)
Income Loss
Benefits VA
(Virginia Only)
Auto Medical
Payments
Total Hired Auto Premiums
ITEM FIVE
SCHEDULE FOR NON-OWNERSHIP COVERED AUTOS LIABILITY INCLUDED IN ITEM TWO, LIABILITY COVERAGE
Named Insured's Business Rating Basis Number Premium
Other Than Auto Service Operations, Number Of Employees INCLUDED
Partnerships Or LLCs Number Of Volunteers
Auto Service Operations Number Of Employees Whose Principal
Duty Involves The Operation Of Autos
Number Of Volunteers
Number Of Partners
(Active And Inactive) Or LLC Members
Partnerships Or LLCs Number Of Employees
Number Of Volunteers
Number of Partners
(Active And Inactive) Or LLC Members
Total Non-ownership Covered Autos Premium INCLUDED
ITEM SIX
SCHEDULE FOR GROSS RECEIPTS OR MILEAGE BASIS
Address of Business Headquarters Location:
Type Of Risk (Check one): Public Autos Leasing Or Rental Concerns
Rating Basis (Check one): Gross Receipts (Per $100) Mileage (Per Mile)
Estimated Yearly (Gross Receipts Or Mileage):
Premiums
Covered Autos Liability
Personal Injury Protection
Added Personal Injury Protection
Property Protection Insurance (Michigan Only)
Auto Medical Payments
Medical Expense And Income Loss Benefits (Virginia Only)
Comprehensive
Specified Causes Of Loss
Collision
Towing And Labor
When used as a premium basis:
FOR PUBLIC AUTOS
Gross receipts means the total amount earned by the named insured for transporting passengers, mail and merchandise.
Gross receipts does not include:
1. Amounts paid to air, sea or land carriers operating under their own permits.
2. Advertising revenue.
3. Taxes collected as a separate item and paid directly to the government.
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NYSCEF DOC. AUTO
BUSINESS NO. DECLARATIONS
40 (Continued) RECEIVED NYSCEF: 10/30/2023
ITEM SIX
SCHEDULE FOR GROSS RECEIPTS OR MILEAGE BASIS (Continued)
4. C.O.D. collections for cost of mail or merchandise including collection fees.
Mileage means the total live and dead mileage of all revenue producing "autos" during the policy period.
FOR RENTAL OR LEASING CONCERNS
Gross receipts means the total amount earned by the named insured for the leasing or renting of "autos" to others without drivers.
Mileage means the total live and dead mileage of all "autos" you leased or rented to others without drivers.
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NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023
Chubb, Policy No. G28166837 007, dated October 1, 2022 –
October 1, 2023, stamped ADT000007
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ADT000007
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NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023
Ascot Insurance Company, Excess Casualty Insurance Policy,
No. EXNA2210000109-02, dated October 1, 2022 - October 1,
2023, stamped ADT000008
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Commercial Excess Liability
Insurance Policy
Declarations
Policy Number: EXNA2210000109-02
Item 1. a) Named Insured: ADT Inc.
And as more fully set forth in the Lead Underlying Policy
b) Address of Named Insured: 1501 Yamato Road
Boca Raton, FL 33431
Item 2. a) Lead Underlying Policy No: XOO G28166837 007
b) All other Underlying Policy No(s): As per Schedule of Underlying Endorsement
c) Lead Underlying Insurer: ACE Property and Casualty Insurance Company
As per Schedule of Underlying Endorsement
d) All other Underlying Insurer(s):
Item 3. Limit of Liability: a) $15,000,000 each Occurrence
b) $15,000,000 Aggregate
Item 4. Underlying Limits: a) $10,000,000 each Occurrence
b) $10,000,000 Aggregate
which in turn is excess of various insurances and/or retentions as
more fully set forth in the Lead Underlying Policy
Item 5. Policy Period: From: 10/1/2022 to 10/1/2023
both at 12:01 a.m. Standard Time at the address of the Named
Insured.
Item 6. Notice to: a) Notice of Occurrence:
Attention: Claims Department
Email: USClaims@ascotgroup.com
b) All other Notices:
To Insured: See Item 1 above.
To the Company: Ascot US
55 W. 46th Street, 26th Floor
New York, NY 10036
T: + 646 356 8101
ascotgroup.com
Item 7. Ascot Premium: $ (100% Flat Annual)
Item 8. Policy Form: MXS
Endorsements:
See below Schedule
Date: 9/29/2022
CXN-D001-0221-00 Page 1 of 1 © 2020, Ascot U.S.
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NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023
Great American Insurance Group, Policy No. EXC4457774,
dated October 1, 2022 – October 1, 2023, stamped ADT000009-
ADT000010
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NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023
Star Indemnity & Liability Company, Policy No.
1000041199221, dated October 1, 2022 – October 1, 2023,
stamped ADT000011-ADT000015
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NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023
Dallas, TX 1-866-519-2522
Policy No.: 1000041199221
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FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS HUSSEIN BADR, Index No. 515722/2023 Plaintiff, DEFENDANTS JEAN BOULOUTE, ADT LLC, AND -against- GELCO FLEET TRUST’S RESPONSE TO PLAINTIFF’S JEAN BOULOUTE, ADT SECURITY SERVICES DEMAND FOR CONTENTS OF INC., and GELCO FLEET TRUST, INSURANCE AGREEMENTS Defendants. The Defendants JEAN BOULOUTE, ADT LLC (incorrectly named as ADT SECURITY SERVICES INC.), and GELCO FLEET TRUST, (“Defendants”), by and through their attorneys of record GOLDBERG SEGALLA LLP, make their response to Plaintiff’s Demand for Contents of Insurance Agreements and state as follows: GENERAL OBJECTIONS 1. Defendants object to Plaintiff’s Demands to the extent they seek disclosure of information protected by the attorney-client privilege, by the attorney work product doctrine as material prepared in anticipation of litigation, or by other statutory or common law privileges. 2. If such information and/or documents are produced inadvertently despite the presence of a privilege, such production does not constitute a waiver of the aforementioned privileges. 3. Defendants object to Plaintiff’s Demands to the extent they purport to impose obligations beyond those required by the CPLR. Defendants will produce information and documents in accordance with the CPLR. 4. Defendants object to Plaintiff’s Demands to the extent that such demands are vague, onerous and burdensome. 38187824.v1 1 of 30 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 5. Defendants object to Plaintiff’s Demands to the extent they seek information not related to the claims at issue in this litigation. 6. Defendants object to Plaintiff’s Demands to the extent that they seek documents that are already in the Plaintiff’s possession or control or are as equally available to the Plaintiff as they are to Defendants. 7. Neither Defendants’ indication that it will produce responsive documents, nor its failure to object to a document request, constitutes an acknowledgment that any responsive documents exist within Defendants’ regular business records. DEMAND FOR CONTENTS OF INSURANCE POLICIES Information and documentation, as evidenced in the form of a copy of the insurance policy in place at the time of the loss, shall include: 1. All primary, excess, and umbrella policies, contracts or agreements issued by private or publicly-traded stock companies, mutual insurance companies, captive insurance entities, risk retention groups, reciprocal insurance exchanges, syndicates, including, but not limited to, Lloyd’s Underwriters as defined in § 6116 of the Insurance Law, surplus lines insurers, and self-insurance programs insofar as such documents relate to the claim being litigated. RESPONSE: See copies of the applicable primary, excess and umbrella auto declaration policy pages identified as follows: Old Republic Insurance Company, Policy No. MWTB 314319 22, dated October 1, 2022 – October 1, 2023, stamped ADT000001- ADT00006; Chubb, Policy No. G28166837 007, dated October 1, 2022 – October 1, 2023, stamped ADT000007; 2 38187824.v1 2 of 30 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 Ascot Insurance Company, Excess Casualty Insurance Policy, No. EXNA2210000109-02, dated October 1, 2022 - October 1, 2023, stamped ADT000008; Great American Insurance Group, Policy No. EXC4457774, dated October 1, 2022 – October 1, 2023, stamped ADT000009-ADT000010; Star Indemnity & Liability Company, Policy No. 1000041199221, dated October 1, 2022 – October 1, 2023, stamped ADT000011-ADT000015; Liberty Surplus Insurance Corporation, Policy No. RFE-621-095279-012, dated October 1, 2022 – October 1, 2023, stamped ADT000016-ADT000017; AIG Property Casualty, Policy No. 14572416, dated October 1, 2022 – October 1, 2023, stamped ADT000018. 2. The insurance policy in place is provided, a complete copy of any policy, contract, or agreement under which any person or entity may be liable to satisfy part or all of a judgment that may be entered in this action or to indemnify or reimburse for payments made to satisfy the entry of final judgment as referred to in this demand, including, but not limited to, declarations, insuring agreements, conditions, exclusions, endorsements, and similar provisions; 3. The contact information, including the name and e-mail address, of an assigned individual RESPONSE: See Response No. 1. 4. The contact information, including the name and e-mail address, of an assigned individual responsible for adjusting the claim at issue; and RESPONSE: Defendants’ Third-Party Administrator, including the name and email address of the assigned adjuster are as follows: Third-Party Administrator: Gallagher Bassett services, Inc. P.O. Box 2934 Clinton, IA 52733-2934 3 38187824.v1 3 of 30 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 Assigned Adjuster: Scott Pitchon Senior Resolution Specialist Scott_Pitchon@gbtpa.com 5. The total limits available under any policy, contract, or agreement, which shall mean the actual funds, after taking into account erosion and any other offsets, that can be used to satisfy a judgment described in this demand or to reimburse for payments made to satisfy the judgment. RESPONSE: See Response to Request No. 1. Dated: New York, NY October 30, 2023 Respectfully Submitted, GOLDBERG SEGALLA LLP By:_____________________________ Abraham D. Leybengrub, Esq. Attorneys for Defendants JEAN BOULOUTE, ADT LLC (incorrectly named as ADT SECURITY SERVICES INC.) and GELCO FLEET TRUST 711 3rd Avenue, Suite 1900 New York, New York 10017-4013 T: (646) 292-8785 aleybengrub@goldbergsegalla.com TO: Nicholas Elefterakis, Esq. ELEFTERAKIS, ELEFTERAKIS & PANEK Attorneys for Plaintiff HUSSEIN BADR 80 Pine Street, 38th Floor New York, New York 10005 T: (212) 532-1116 nick@elfterakislaw.com 4 38187824.v1 4 of 30 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 Old Republic Insurance Company, Policy No. MWTB 314319 22, dated October 1, 2022 – October 1, 2023, stamped ADT000001- ADT00006 5 of 30 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 Mt. Pleasant, Pennsylvania BUSINESS AUTO DECLARATIONS POLICY NUMBER POLICYHOLDER SERVICE OFFICE: Producer: * 770 MWTB 314319 22 Old Republic Risk Management, Inc. Marsh MWTB 314319 21 445 South Moorland Road Sunrise, FL PREVIOUS POLICY NUMBER * Brookfield, WI 53005 (877) 797-3400 ITEM ONE NAMED INSURED: ADT, Inc. (See Form PIL 040 01 16) MAILING ADDRESS: * 1501 Yamato Road Boca Raton, FL 33431 POLICY PERIOD: * From: 10/01/22 To: 10/01/23 at 12:01 A.M. Standard Time at your mailing address shown above. FORM OF BUSINESS: * CORPORATION INDIVIDUAL LIMITED LIABILITY COMPANY (LLC) PARTNERSHIP OTHER IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS This Policy provides only those coverages where a charge is shown in the premium column below. Eac h of these coverages will apply only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos" for a particular coverage by the entry of one or more of the symbols from the Covered Autos section of the Business Auto Coverage Form next to the name of the coverage. COVERAGES COVERED AUTOS LIMIT OR DEDUCTIBLE PREMIUM ***See Deductible Coverage Endorsement COVERED AUTOS LIABILITY 1 $ 5,000,000 $ PERSONAL INJURY PROTECTION 5 SEPARATELY STATED IN EACH P.I.P. ENDORSEMENT $ (Or Equivalent No-fault Coverage) MINUS $ *** DEDUCTIBLE ADDED PERSONAL INJURY PROTECTION SEPARATELY STATED IN EACH ADDED P.I.P. ENDORSEMENT. $ (Or Equivalent Added No-fault Coverage) PROPERTY PROTECTION INSURANCE 5 SEPARATELY STATED IN THE P.P.I. ENDORSEMENT $ (Michigan Only) MINUS $ *** DEDUCTIBLE FOR EACH ACCIDENT. AUTO MEDICAL PAYMENTS $ EACH INSURED $ MEDICAL EXPENSE AND INCOME LOSS SEPARATELY STATED IN THE MEDICAL EXPENSE AND INCOME LOSS $ BENEFITS (Virginia Only) BENEFITS ENDORSEMENT. UNINSURED MOTORISTS 6 $ Minimum Statutory Limit(s) Except Where Rejected $ UNDERINSURED MOTORISTS 6 $ Minimum Statutory Limit(s) Except Where Rejected $ (When Not Included In Uninsured Motorists Coverage) PHYSICAL DAMAGE $ Deductible $ 2,8 COMPREHENSIVE COVERAGE For Each Covered Auto For Loss Caused By Theft Or Mischief Or Vandalism (A maximum deductible will also apply. Refer to Coverage Form for details.) OR $ *** Deductible For All Perils For Each Covered Auto (A maximum deductible will also apply. Refer to Coverage Form for details.) See ITEM FOUR for Hired or Borrowed Autos. YOUR POLICY PROVIDES COLLISION COVERAGE ON RENTAL VEHICLES. PLEASE REFER TO THE PORTION OF YOUR POLICY PROVIDING “COLLISION” COVERAGE FOR ANY LIMITATIONS IN COVERAGE THAT MAY APPLY. COUNTERSIGNED * 11/03/22 BY * (Date) (Authorized Representative) * Entry optional if shown in the Common Policy Declarations. THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER 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. CA DEC GN 0003 04 22 Includes copyrighted material from Insurance Services Office, Inc. used with its permission. Page 1 of 6 6 of 30 ADT000001 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. AUTO BUSINESS NO. DECLARATIONS 40 (Continued) RECEIVED NYSCEF: 10/30/2023 ITEM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS (Continued) PHYSICAL DAMAGE $ Deductible $ SPECIFIED CAUSES OF LOSS COVERAGE For Each Covered Auto For Loss Caused By Theft Or Mischief Or Vandalism (A maximum deductible will also apply. Refer to Coverage Form for details.) OR $ Deductible For All Perils For Each Covered Auto (A maximum deductible will also apply. Refer to Coverage Form for details.) See ITEM FOUR for Hired or Borrowed Autos. PHYSICAL DAMAGE $ *** Deductible $ COLLISION COVERAGE 2,8 For Each Covered Auto See ITEM FOUR for Hired or Borrowed Autos. PHYSICAL DAMAGE For Each Disablement Of A Private Passenger Auto, TOWING AND LABOR $ Light or Medium Truck $ 0B PREMIUM FOR ENDORSEMENTS $ MICHIGAN CCA SURCHARGE $ ASSESSMENTS, SURCHARGES AND FEES $ Not applicable in NC, NY, PR **ESTIMATED TOTAL PAYABLE $ Total Shown Is Payable At Inception: $ 1,969,437 ** This Policy may be subject to final audit. AUDIT PERIOD (if applicable) ANNUALLY SEMI-ANNUALLY QUARTERLY MONTHLY ENDORSEMENTS ATTACHED TO THIS POLICY: = See Forms Index = Forms and Endorsements applicable to this Coverage Part/Policy omitted if shown elsewhere in the Policy. ITEM THREE SCHEDULE OF COVERED AUTOS YOU OWN Covered Auto Description Covered Trade Body Serial Vehicle ID Auto No. Year Model Name Type Number (S) Number (VIN) 1 ON FILE WITH THE COMPANY 2 3 4 5 Covered Town And State Where The Covered Auto No. Original Cost New: Auto Will Be Principally Garaged: 1 2 3 4 5 Classification Size GVWR, Business Use GCW or Except For Towing And Labor, All Physical Damage Radius s = service Vehicle Secondary Loss Is Payable To You And The Loss Payee Covered Of r = retail Seating Age Rating Named Below According To Their Interests In The Auto No. Operation c = commercial Capacity Group Classification Code Auto At The Time Of The Loss: 1 2 3 4 5 Coverages-Premiums, Limits And Deductibles (Absence of a deductible or limit entry in any column below means that the limit or deductible entry in the corresponding ITEM TWO column applies instead.) COVERED AUTOS LIABILITY PERSONAL INJURY PROTECTION ADDED PERSONAL INJURY PROPERTY PROTECTION PROTECTION INSURANCE (Michigan Only) Limit Limit Limit Stated In Each Stated In Each Stated In P.P.I. Covered P.I.P. Endorsement Added P.I.P. Endorsement Minus Minus Auto No. Limit Premium Deductible Premium Endorsement Premium Deductible Premium 1 STATED IN DECLARATIONS ITEM TWO 2 3 4 5 Total Premium CA DEC GN 0003 04 22 Includes copyrighted material from Insurance Services Office, Inc. used with its permission. Page 2 of 6 7 of 30 ADT000002 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. AUTO BUSINESS NO. DECLARATIONS 40 (Continued) RECEIVED NYSCEF: 10/30/2023 ITEM THREE SCHEDULE OF COVERED AUTOS YOU OWN (Continued) AUTO MEDICAL PAYMENTS MEDICAL EXPENSE AND Each Insured INCOME LOSS BENEFITS (Virginia Only) COMPREHENSIVE Limit Stated In Deductible The Medical Expense For Loss Caused And Income Loss By Theft Or Covered Benefits Endorsement Mischief Or Deductible Auto No. Limit Premium For Each Person Premium Vandalism * OR For All Perils * Premium 1 STATED IN DECLARATIONS ITEM TWO 2 3 4 5 Total Premium SPECIFIED CAUSES OF LOSS COLLISION TOWING AND LABOR Deductible For Loss Caused By Theft Or Limit Covered Mischief Or Deductible Per Auto No. Vandalism * OR For All Perils * Premium Deductible Premium Disablement Premium 1 ITEM TWO STATED IN DECLARATIONS 2 3 4 5 Total Premium * (A maximum deductible will also apply. Refer to Coverage Form for details.) ITEM FOUR SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS Covered Autos Liability Coverage - Cost Of Hire Rating Basis For Autos Used In Your Motor Carrier Operations (Other Than Mobile Or Farm Equipment) Estimated Annual Covered Autos Liability Coverage Cost Of Hire For All States Premium Primary Coverage Excess Coverage Total Hired Auto Premium For "autos" used in your motor carrier operations, cost of hire means: 1. The total dollar amount of costs you incurred for the hire of automobiles (includes "trailers" and semitrailers) and, if not included therein, 2. The total remunerations of all operators and drivers' helpers, of hired automobiles whether hired with a driver by lessor or an "employee" of the lessee, or any other third party, and 3. The total dollar amount of any other costs (e.g., repair, maintenance, fuel, etc.) directly associated with operating the hired automobiles whether, such costs are absorbed by the "insured", paid to the lessor or owner, or paid to others. Covered Autos Liability Coverage - Cost Of Hire Rating Basis For Autos NOT Used In Your Motor Carrier Operations (Other Than Mobile Or Farm Equipment) Covered Autos Estimated Annual Liability Coverage State Cost Of Hire For Each State Premium Primary Coverage Excess Coverage Total Hired Auto Premium For "autos" NOT used in your motor carrier operations, cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your partners or "employees" or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. CA DEC GN 0003 04 22 Includes copyrighted material from Insurance Services Office, Inc. used with its permission. Page 3 of 6 8 of 30 ADT000003 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. AUTO BUSINESS NO. DECLARATIONS 40 (Continued) RECEIVED NYSCEF: 10/30/2023 ITEM FOUR SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS (Continued) Physical Damage Coverages - Cost of Hire Rating Basis For All Autos (Other Than Mobile Or Farm Equipment) Estimated Annual Cost Of Hire For Each State (Excluding Autos Coverage State Deductible Hired With A Driver) Premium Comprehensive $ Deductible For Each Covered Auto For Loss Caused By Theft Or Mischief Or Vandalism (A maximum deductible will also apply. Refer to Coverage Form for details.) Specified $ Deductible Causes Of Loss For Each Covered Auto For Loss Caused By Theft Or Mischief Or Vandalism (A maximum deductible will also apply. Refer to Coverage Form for details.) Collision $ Deductible For Each Covered Auto Total Hired Auto Premium For Physical Damage coverages, cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your partners or "employees" or their family members). Cost of hire does not include charges for any "auto" that is leased, hired, rented or borrowed with a driver. Cost Of Hire Rating Basis For Mobile Or Farm Equipment - Other Than Physical Damage Coverages Estimated Annual Cost Of Hire For Each State Premium Coverage State Mobile Equipment Farm Equipment Mobile Equipment Farm Equipment Covered Autos Liability - Primary Coverage Covered Autos Liability - Excess Coverage Personal Injury Protection Medical Expense VA Benefits (Virginia Only) Income Loss Benefits VA (Virginia Only) Auto Medical Payments Total Hired Auto Premiums Cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your partners or "employees" or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. Cost Of Hire Rating Basis For Mobile Or Farm Equipment - Physical Damage Coverages Estimated Annual Cost Of Hire For Each State (Excluding Autos Hired With A Driver) Premium Mobile Farm Mobile Farm Coverage State Deductible Equipment Equipment Equipment Equipment Comprehensive $ Ded. For Each Covered Auto For Loss Caused By Theft Or Mischief Or Vandalism (A maximum deductible will also apply. Refer to Coverage Form for details.) Specified $ Ded. Causes For Each Covered Auto Of Loss For Loss Caused By Theft Or Mischief Or Vandalism (A maximum deductible will also apply. Refer to Coverage Form for details.) Collision $ Ded. For Each Covered Auto Total Hired Auto Premiums For Physical Damage Coverages, cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your partners or "employees" or their family members). Cost of hire does not include charges for any auto that is leased, hired, rented or borrowed with a driver. CA DEC GN 0003 04 22 Includes copyrighted material from Insurance Services Office, Inc. used with its permission. Page 4 of 6 9 of 30 ADT000004 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. AUTO BUSINESS NO. DECLARATIONS 40 (Continued) RECEIVED NYSCEF: 10/30/2023 ITEM FOUR SCHEDULE OF HIRED OR BORROWED COVERED AUTO COVERAGE AND PREMIUMS (Continued) Rental Period Rating Basis For Mobile Or Farm Equipment Estimated Number Of Days Equipment Will Be Rented Premium Town And State Where The Job Mobile Farm Coverage Site Is Located Equipment Equipment Mobile Equipment Farm Equipment Covered Autos Liability - Primary Coverage Covered Autos Liability - Excess Coverage Personal Injury Protection Medical Expense Benefits VA (Virginia Only) Income Loss Benefits VA (Virginia Only) Auto Medical Payments Total Hired Auto Premiums ITEM FIVE SCHEDULE FOR NON-OWNERSHIP COVERED AUTOS LIABILITY INCLUDED IN ITEM TWO, LIABILITY COVERAGE Named Insured's Business Rating Basis Number Premium Other Than Auto Service Operations, Number Of Employees INCLUDED Partnerships Or LLCs Number Of Volunteers Auto Service Operations Number Of Employees Whose Principal Duty Involves The Operation Of Autos Number Of Volunteers Number Of Partners (Active And Inactive) Or LLC Members Partnerships Or LLCs Number Of Employees Number Of Volunteers Number of Partners (Active And Inactive) Or LLC Members Total Non-ownership Covered Autos Premium INCLUDED ITEM SIX SCHEDULE FOR GROSS RECEIPTS OR MILEAGE BASIS Address of Business Headquarters Location: Type Of Risk (Check one): Public Autos Leasing Or Rental Concerns Rating Basis (Check one): Gross Receipts (Per $100) Mileage (Per Mile) Estimated Yearly (Gross Receipts Or Mileage): Premiums Covered Autos Liability Personal Injury Protection Added Personal Injury Protection Property Protection Insurance (Michigan Only) Auto Medical Payments Medical Expense And Income Loss Benefits (Virginia Only) Comprehensive Specified Causes Of Loss Collision Towing And Labor When used as a premium basis: FOR PUBLIC AUTOS Gross receipts means the total amount earned by the named insured for transporting passengers, mail and merchandise. Gross receipts does not include: 1. Amounts paid to air, sea or land carriers operating under their own permits. 2. Advertising revenue. 3. Taxes collected as a separate item and paid directly to the government. CA DEC GN 0003 04 22 Includes copyrighted material from Insurance Services Office, Inc. used with its permission. Page 5 of 6 10 of 30 ADT000005 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. AUTO BUSINESS NO. DECLARATIONS 40 (Continued) RECEIVED NYSCEF: 10/30/2023 ITEM SIX SCHEDULE FOR GROSS RECEIPTS OR MILEAGE BASIS (Continued) 4. C.O.D. collections for cost of mail or merchandise including collection fees. Mileage means the total live and dead mileage of all revenue producing "autos" during the policy period. FOR RENTAL OR LEASING CONCERNS Gross receipts means the total amount earned by the named insured for the leasing or renting of "autos" to others without drivers. Mileage means the total live and dead mileage of all "autos" you leased or rented to others without drivers. CA DEC GN 0003 04 22 Includes copyrighted material from Insurance Services Office, Inc. used with its permission. Page 6 of 6 11 of 30 ADT000006 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 Chubb, Policy No. G28166837 007, dated October 1, 2022 – October 1, 2023, stamped ADT000007 12 of 30 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 ADT000007 13 of 30 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 Ascot Insurance Company, Excess Casualty Insurance Policy, No. EXNA2210000109-02, dated October 1, 2022 - October 1, 2023, stamped ADT000008 14 of 30 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 Commercial Excess Liability Insurance Policy Declarations Policy Number: EXNA2210000109-02 Item 1. a) Named Insured: ADT Inc. And as more fully set forth in the Lead Underlying Policy b) Address of Named Insured: 1501 Yamato Road Boca Raton, FL 33431 Item 2. a) Lead Underlying Policy No: XOO G28166837 007 b) All other Underlying Policy No(s): As per Schedule of Underlying Endorsement c) Lead Underlying Insurer: ACE Property and Casualty Insurance Company As per Schedule of Underlying Endorsement d) All other Underlying Insurer(s): Item 3. Limit of Liability: a) $15,000,000 each Occurrence b) $15,000,000 Aggregate Item 4. Underlying Limits: a) $10,000,000 each Occurrence b) $10,000,000 Aggregate which in turn is excess of various insurances and/or retentions as more fully set forth in the Lead Underlying Policy Item 5. Policy Period: From: 10/1/2022 to 10/1/2023 both at 12:01 a.m. Standard Time at the address of the Named Insured. Item 6. Notice to: a) Notice of Occurrence: Attention: Claims Department Email: USClaims@ascotgroup.com b) All other Notices: To Insured: See Item 1 above. To the Company: Ascot US 55 W. 46th Street, 26th Floor New York, NY 10036 T: + 646 356 8101 ascotgroup.com Item 7. Ascot Premium: $ (100% Flat Annual) Item 8. Policy Form: MXS Endorsements: See below Schedule Date: 9/29/2022 CXN-D001-0221-00 Page 1 of 1 © 2020, Ascot U.S. 15 of 30 ADT000008 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 Great American Insurance Group, Policy No. EXC4457774, dated October 1, 2022 – October 1, 2023, stamped ADT000009- ADT000010 16 of 30 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 17 of 30 ADT000009 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 18 of 30 ADT000010 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 Star Indemnity & Liability Company, Policy No. 1000041199221, dated October 1, 2022 – October 1, 2023, stamped ADT000011-ADT000015 19 of 30 FILED: KINGS COUNTY CLERK 10/30/2023 07:23 PM INDEX NO. 515722/2023 NYSCEF DOC. NO. 40 RECEIVED NYSCEF: 10/30/2023 Dallas, TX 1-866-519-2522 Policy No.: 1000041199221