{"id":"court_ctb_1805_36","court":"CTB","case_no":"22-50073","doc_number":1805,"sub_number":36,"doc_type":"EXHIBIT","filed_date":null,"title":"Exhibit J ![](_page_1_Picture_1.jpeg)","summary_zh":null,"summary_en":null,"body_en":"## **Exhibit J**\n\n![](_page_1_Picture_1.jpeg)\n\n# **Your New York Automobile Declarations Page**\n\nYour Declarations Page shows at a glance the coverage you have and your premium. Your Declarations Page is part of your policy. Please read your policy carefully, including your Declarations Page and any attached Endorsements, for a description of your coverage.\n\n### **Policy Number: Policy Period:**\n\n**Name of Insured and Mailing Address:**\n\nHudson Diamond NY LLC 162 E. 64th Street New York, NY,10065\n\n## PCG 0016847665 05/10/2022 - 05/10/2023\n\nAt 12:01 A.M. standard time at your mailing address shown\n\n### **Your Broker/Agent Is:**\n\nWolfson Insurance Brokerage, Inc. 358 Fifth Avenue, 8th Floor New York, NY, 10001\n\n**Name and Address of Issuing Company: AIG Property Casualty Company**\n\n175 Water St, 18th Floor New York, NY 10038\n\nPhone: (212) 683-2622 Broker number: 0051997\n\n# DESCRIPTION OF YOUR COVERED AUTO(S)\n\n| AUTO   | YEAR | MAKE                     | MODEL    | VIN               | TYPE | GARAGE<br>ZIP | AGREED<br>VALUE |\n|--------|------|--------------------------|----------|-------------------|------|---------------|-----------------|\n| 1      | 2019 | ROLLS RO                 | CULLINAN | SLA689X56KU114001 | REG  | 10065         | \\$283,712       |\n|        |      | DESCRIPTION OF DRIVER(S) |          |                   |      |               |                 |\n| DRIVER | NAME |                          |          | AGE               |      |               | AUTHORIZED      |\n| 1      |      | Dean M Rabideau          |          | 55                |      | Covered       |                 |\n| 2      |      | Cao Defeng               |          | 33                |      | Covered       |                 |\n\n![](_page_2_Picture_1.jpeg)\n\n# COVERAGE LIMITS, PREMIUMS AND DEDUCTIBLES\n\n|                                                            | Premium For…                                     |                               |                                              |            |  |  |\n|------------------------------------------------------------|--------------------------------------------------|-------------------------------|----------------------------------------------|------------|--|--|\n|                                                            |                                                  |                               | AUTO 1:                                      |            |  |  |\n| Type of Coverage                                           | What we will pay                                 |                               | 2019                                         |            |  |  |\n|                                                            |                                                  |                               | ROLLS RO                                     |            |  |  |\n|                                                            |                                                  |                               | CULLINAN                                     |            |  |  |\n| SECTION II – LIABILITY COVERAGES                           |                                                  |                               |                                              |            |  |  |\n| Combined Single Limits                                     | \\$1,000,000.00 Per Occurrence                    |                               | \\$698.00                                     |            |  |  |\n|                                                            | SECTION III – COVERAGE FOR YOUR MEDICAL EXPENSES |                               |                                              |            |  |  |\n| Medical Payments                                           | \\$50,000.00 Per Person                           |                               | \\$10.00                                      |            |  |  |\n|                                                            | SECTION IV – UNINSURED MOTORISTS or SUM COVERAGE |                               |                                              |            |  |  |\n| Supplementary<br>UM/UIM*- Single                           | \\$1,000,000.00 Per Occurrence                    |                               | \\$234.00                                     |            |  |  |\n|                                                            | SECTION V – COVERAGE FOR DAMAGE TO YOUR AUTO     |                               |                                              |            |  |  |\n| Collision                                                  | Up to the Agreed Value                           |                               | \\$3,697.00                                   |            |  |  |\n| Other than Collision                                       | Up to the Agreed Value                           |                               | \\$735.00                                     |            |  |  |\n| SECTION VI – PERSONAL INJURY PROTECTION                    |                                                  |                               |                                              |            |  |  |\n| Basic Personal Injury                                      | \\$50,000.00 Per Person                           |                               | \\$176.00                                     |            |  |  |\n| Protection<br>Optional Basic Economic<br>Loss              | \\$25,000.00 Per Person                           |                               |                                              | \\$8.00     |  |  |\n| Additional Personal Injury<br>Protection                   |                                                  | \\$100,000.00 Per Person       |                                              | \\$25.00    |  |  |\n| Aggregate PIP Benefits                                     |                                                  | \\$175,000.00 Per Person       |                                              | \\$209.00   |  |  |\n| Work Loss                                                  | \\$4,000.00 Per Month, Max of 3 Years             |                               |                                              |            |  |  |\n| Other Necessary Expenses<br>\\$50.00 Per Day, Max of 1 Year |                                                  |                               |                                              |            |  |  |\n| Death Benefit                                              | \\$2,000.00 Per Person                            |                               |                                              |            |  |  |\n| Additional Death Benefit                                   | \\$3,000.00 Per Person                            |                               | \\$2.00                                       |            |  |  |\n| ENDORSEMENTS                                               |                                                  |                               |                                              |            |  |  |\n| Cash Settlement                                            | Vehicle(s):<br>1                                 |                               | \\$222.00                                     |            |  |  |\n| Motor Vehicle Law<br>Enforcement Fee                       |                                                  |                               | \\$10.00                                      |            |  |  |\n|                                                            |                                                  | Total Annual Premium Per Auto | \\$5,817.00                                   |            |  |  |\n|                                                            |                                                  |                               | Total Annual Premium for All Autos:          | \\$5,817.00 |  |  |\n| Deductibles                                                |                                                  |                               |                                              |            |  |  |\n| SECTION V – COVERAGE FOR DAMAGE TO YOUR AUTO               |                                                  | Collision                     | \\$1,000.00                                   |            |  |  |\n|                                                            |                                                  |                               | (\\$0 for Coll<br>Glass Claims)               |            |  |  |\n|                                                            |                                                  | Other than<br>Collision       | \\$1,000.00<br>(\\$0 for Comp<br>Glass Claims) |            |  |  |\n\n\\*The maximum amount payable under SUM coverage shall be the policy's SUM limits, reduced and thus offset by motor vehicle bodily injury liability insurance policy or bond payments received from, or on behalf of, any negligent party involved in the accident, as specified in the SUM endorsement.\n\n![](_page_3_Picture_1.jpeg)\n\n# ADDITIONAL COVERAGES PROVIDED\n\n## For Regular and Miscellaneous Vehicles\n\n| COVERAGE                                                   | DESCRIPTION                           |\n|------------------------------------------------------------|---------------------------------------|\n| New Vehicle Replacement                                    | Within the first three (3) years      |\n| Transportation Expenses                                    | Up to \\$15,000                        |\n| Trip Interruption and Emergency Living Expenses            | Up to \\$5,000                         |\n| Roadside Assistance                                        | Up to \\$100 per day                   |\n| Personal Property                                          | Up to \\$5,000                         |\n| Pet Injury                                                 | Up to \\$2,500                         |\n| Vehicle and Home Alteration                                | Up to \\$10,000                        |\n| Vehicle Identity Theft and Fraudulent Title                |                                       |\n| Accidental Airbag Deployment                               |                                       |\n| Lock and Key Replacement                                   |                                       |\n| Towing                                                     | Within a 200-mile radius              |\n| Custom Equipment                                           | Up to \\$1,500 (Regular Vehicles Only) |\n| Original Equipment Manufacturer (OEM)<br>Replacement Parts |                                       |\n\n## ADDITIONAL INSURED(S)\n\n**NAME ADDRESS AUTOS**\n\nHudson Diamond NY, LLC 781 Fifth Ave 18th Floor, New York,NY,10022 Auto 1\n\n## FORMS AND ENDORSEMENTS\n\n| DESCRIPTION                                                                  | TITLE                    |\n|------------------------------------------------------------------------------|--------------------------|\n| Amendment of Policy Provisions - New York                                    | PCA-AMDPP-NY (01/19)     |\n| Mandatory Personal Injury Protection Coverage Endorsement - New York         | PCA-MPIP-NY (01/19)      |\n| Private Client Group Automobile Policy                                       | PCA-PAP (01/19)          |\n| Cash Settlement Option Endorsement                                           | PCA-CSO (01/19)          |\n| Rental Vehicle Coverage Endorsement - New York                               | PCA-RVC-NY (01/19)       |\n| Additional Personal Injury Protection Coverage Endorsement - New York        | PCA-APIP-NY (01/19)      |\n| Uninsured Motorists Endorsement - New York                                   | PCA-UM-NY (01/19)        |\n| Full Coverage Window Glass Endorsement                                       | PCA-FULLGL (01/19)       |\n| Optional Basic Economic Loss Coverage Endorsement - New York                 | PCA-OBEL-NY (12/19)      |\n| Single Liability Limit Endorsement - New York                                | PCA-SLL-NY (01/19)       |\n| Federal Employees Using Autos In Government Business Endorsement             | PCA-FEDEMP (01/19)       |\n| Change To Insurer's Address - Notice                                         | 141636 (05/21)           |\n| Supplementary Uninsured/Underinsured Motorists Endorsement - New York        | PCA-SUPUMUIM-NY (01/19)  |\n| Single Supplementary Uninsured/Underinsured Motorists Endorsement - New York | PCA-SSUPUMUIM-NY (01/19) |\n| Additional Insured - Lessor Endorsement - New York                           | PCA-ADIL-NY (01/19)      |\n\n## OTHER INFORMATION USED TO RATE YOUR POLICY\n\n| Your         | Class Code | Annual Miles | Territory |      | Symbols |     |           |  |\n|--------------|------------|--------------|-----------|------|---------|-----|-----------|--|\n| Covered Auto |            |              |           | COMP | COLL    | LIB | MED / PIP |  |\n| Auto 1       | 945600     | 1629         | 018       | 98   | 98      | N/A | N/A       |  |\n\n**Tier Designation:** 8\n\n![](_page_4_Picture_1.jpeg)\n\nListed Below are the Premium Discounts and Surcharges that are Applied to Your Policy Premium – New York\n\nPolicy Number: PCG 0016847665\n\nPolicy Term: 05/10/2022 - 05/10/2023\n\n#### **DISCOUNTS:**\n\nThe Premium Discounts listed below are included in your total policy premium:\n\n| DISCOUNT DESCRIPTION                      | APPLIES TO    |                | POLICY SAVINGS |\n|-------------------------------------------|---------------|----------------|----------------|\n| Five Year Accident Free                   | Policy        |                | \\$278.00       |\n| Three Year Safe Driver                    | Policy        |                | \\$111.00       |\n| Passive Restraint                         | Vehicle(s): 1 |                | \\$87.00        |\n| Antilock Brake                            | Vehicle(s): 1 |                | \\$389.00       |\n| Anti-theft Device                         | Vehicle(s): 1 |                | \\$87.00        |\n| Supplemental Lines of Business            |               |                | \\$742.00       |\n| Personal excess liability policy discount | Policy        |                |                |\n| Collections policy discount               | Policy        |                |                |\n| Home insurance policy discount            | Policy        |                |                |\n|                                           |               | Total Savings: | \\$1,694.00     |\n\n#### **SURCHARGES:**\n\nA Surcharge amount of \\$ 0.00 due to accidents/violation and/or inexperienced operator(s) is included in your total policy premium.\n\nAccident Date (s): NONE Violation Date (s): NONE\n\nYour premium reflects a surcharge and is higher because, during the experience period, you had occurrences as outlined above under our rating plan. The Rating Information Disclosure Notice attached describes the rating plan that includes a list of events for which we may surcharge you and the circumstances under which surcharges may be removed. Please contact the Agent or Broker listed on the first page of your Declarations if you have any questions.","body_zh":"证物 J\n您的纽约州汽车保险申报页\n\n您的申报页让您对所享有的保险责任范围和保险费一目了然。您的申报页是保单的一部分。请仔细阅读保单，包括申报页和任何附带的批单，以了解您的保险责任范围说明。\n保单号： 保单期限：\n\n被保险人姓名及邮寄地址：\n\nHudson Diamond NY LLC（哈德逊钻石纽约有限责任公司） 162 E. 64th Street New York, NY,10065\nPCG 0016847665 05/10/2022 - 05/10/2023\n\n自所示邮寄地址当地标准时间凌晨 12:01 起\n您的保险经纪人/代理人为：\n\nWolfson Insurance Brokerage, Inc.（沃尔夫森保险经纪公司） 358 Fifth Avenue, 8th Floor New York, NY, 10001\n\n出单公司名称及地址：AIG Property Casualty Company（美亚财产保险公司）\n\n175 Water St, 18th Floor New York, NY 10038\n\n电话：(212) 683-2622 经纪人编号：0051997\n承保车辆描述\n\n车辆　年份　品牌　车型　车辆识别码（VIN）　类型　停放地邮编　约定价值\n\n1　2019　劳斯莱斯（ROLLS RO）　库里南（CULLINAN）　SLA689X56KU114001　常规（REG）　10065　\\$283,712\n驾驶人描述\n驾驶人　姓名　年龄　授权状态\n1　Dean M Rabideau（迪恩·M·拉比多）　55　承保\n2　Cao Defeng（曹德丰）　33　承保\n保额限额、保险费及免赔额\n\n保险费适用对象…\n\n车辆 1：\n险种　赔付金额　2019款劳斯莱斯库里南\n第二部分 – 责任保险\n综合单一限额　每次事故 \\$1,000,000.00　\\$698.00\n第三部分 – 医疗费用保险\n医疗费用赔偿　每人 \\$50,000.00　\\$10.00\n第四部分 – 无保险机动车或补充无保险机动车（SUM）保险\n补充无保险/保险不足机动车（UM/UIM）* - 单一限额　每次事故 \\$1,000,000.00　\\$234.00\n第五部分 – 车辆损失保险\n碰撞险　最高至约定价值　\\$3,697.00\n非碰撞综合险　最高至约定价值　\\$735.00\n第六部分 – 人身伤害保护\n基本人身伤害保护　每人 \\$50,000.00　\\$176.00\n自选基本经济损失　每人 \\$25,000.00　\\$8.00\n额外人身伤害保护　每人 \\$100,000.00　\\$25.00\n人身伤害保护（PIP）累计赔偿总额　每人 \\$175,000.00　\\$209.00\n误工损失　每月 \\$4,000.00，最长 3 年\n其他必要费用　每天 \\$50.00，最长 1 年\n身故赔偿金　每人 \\$2,000.00\n额外身故赔偿金　每人 \\$3,000.00　\\$2.00\n批单\n现金理赔　适用车辆：\n1　\\$222.00\n机动车执法费　\\$10.00\n每辆车年总保费　\\$5,817.00\n所有车辆年总保费：　\\$5,817.00\n免赔额\n第五部分 – 车辆损失保险　碰撞险　\\$1,000.00（碰撞车窗玻璃理赔为 \\$0）\n非碰撞综合险　\\$1,000.00（综合车窗玻璃理赔为 \\$0）\n\n*根据补充无保险机动车（SUM）保险条款，最高应付赔偿金额应为保单约定的 SUM 限额，并按照 SUM 批单中的规定，扣减并抵消从事故中涉及的任何过错方处收到的或代表其支付的机动车人身伤害责任保险保单赔付款或担保赔付款。\n提供的额外保险责任\n适用于常规车辆和杂项车辆\n\n保险责任　说明\n\n新车置换　前三（3）年内\n交通费用　最高 \\$15,000\n行程中断和紧急生活费用　最高 \\$5,000\n道路救援　每天最高 \\$100\n个人财产　最高 \\$5,000\n宠物伤害　最高 \\$2,500\n车辆及住宅改装　最高 \\$10,000\n车辆身份盗窃和产权欺诈\n安全气囊意外弹出\n门锁和钥匙更换\n拖车服务　200英里半径范围内\n定制设备　最高 \\$1,500（仅限常规车辆）\n原厂（OEM）更换零部件\n附加被保险人\n\n姓名 地址 车辆\n\nHudson Diamond NY, LLC 781 Fifth Ave 18th Floor, New York,NY,10022 车辆 1\n表格和批单\n\n说明　标题\n\n保单条款修订 - 纽约州　PCA-AMDPP-NY (01/19)\n强制性人身伤害保护保险批单 - 纽约州　PCA-MPIP-NY (01/19)\n私人客户群汽车保单　PCA-PAP (01/19)\n现金理赔选择权批单　PCA-CSO (01/19)\n租赁车辆保险批单 - 纽约州　PCA-RVC-NY (01/19)\n额外人身伤害保护保险批单 - 纽约州　PCA-APIP-NY (01/19)\n无保险机动车批单 - 纽约州　PCA-UM-NY (01/19)\n车窗玻璃全保批单　PCA-FULLGL (01/19)\n自选基本经济损失保险批单 - 纽约州　PCA-OBEL-NY (12/19)\n单一责任限额批单 - 纽约州　PCA-SLL-NY (01/19)\n联邦雇员在政府业务中使用汽车批单　PCA-FEDEMP (01/19)\n保险人地址变更通知　141636 (05/21)\n补充无保险/保险不足机动车批单 - 纽约州　PCA-SUPUMUIM-NY (01/19)\n单一补充无保险/保险不足机动车批单 - 纽约州　PCA-SSUPUMUIM-NY (01/19)\n附加被保险人 - 出租人批单 - 纽约州　PCA-ADIL-NY (01/19)\n用于厘定您保单费率的其他信息\n\n您的承保车辆　类别代码　年行驶里程　区域代码　代码符号\n\n承保车辆　综合险　碰撞险　责任险　医疗/人身伤害保护\n车辆 1　945600　1629　018　98　98　不适用（N/A）　不适用（N/A）\n\n层级指定：8\n\n以下列出适用于您的保单保险费的费率折扣和附加费 – 纽约州\n\n保单号：PCG 0016847665\n\n保单期限：05/10/2022 - 05/10/2023\n折扣：\n\n以下列出的保费折扣已计入您的保单总保费中：\n\n折扣说明　适用于　保单节省金额\n\n五年无事故　整单　\\$278.00\n三年安全驾驶人　整单　\\$111.00\n被动约束装置　车辆：1　\\$87.00\n防抱死制动系统　车辆：1　\\$389.00\n防盗装置　车辆：1　\\$87.00\n补充险种业务　\\$742.00\n个人超额责任保单折扣　整单\n收藏品保单折扣　整单\n房屋保险保单折扣　整单\n总节省金额：　\\$1,694.00\n附加费：\n\n因事故/违章和/或无经验驾驶人而产生的 \\$0.00 附加费金额已计入您的保单总保费中。\n\n事故日期：无 违章日期：无\n\n您的保费体现了附加费且金额较高，是因为在经验期内，根据我们的费率计划，您发生了如上所述的事件。随附的《费率信息披露通知》详细描述了该费率计划，其中包括我们可能向您收取附加费的事件清单以及可以取消附加费的情形。如有任何疑问，请联系申报页第一页上列出的代理人或经纪人。","key_entities":[],"ecf_references":[],"word_count":1393,"status":"published","published_at":null,"created_at":null,"updated_at":"2026-08-23 13:14:15"}