{"id":"court_ctb_2292_54","court":"CTB","case_no":"22-50073","doc_number":2292,"sub_number":54,"doc_type":"EXHIBIT","filed_date":null,"title":"Exhibit 54 ![](_page_1_Picture_1.jpeg)","summary_zh":null,"summary_en":null,"body_en":"### **Exhibit 54**\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\n5\n\n![](_page_2_Picture_3.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                      | \\$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 54\n您的纽约州汽车保险声明页\n\n您的声明页让您的承保范围及保费一目了然。您的声明页是您保单的一部分。有关您承保范围的说明，请仔细阅读您的保单，包括您的声明页及任何附加的批单。\n保单号码： 保险期间：\n\n被保险人姓名/名称及邮寄地址：\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自所示邮寄地址标准时间凌晨 12:01 起\n您的经纪人/代理人是：\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签发公司名称及地址：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受保汽车说明\n\n汽车 年份 制造厂 车型 车辆识别代号（VIN） 类别 停放地\n邮编 约定\n价值\n\n1 2019 ROLLS RO（劳斯莱斯） CULLINAN（库里南） SLA689X56KU114001 常规 10065 $283,712\n驾驶员说明\n驾驶员 姓名 年龄 授权情况\n1 Dean M Rabideau 55 承保\n2 Cao Defeng 33 承保\n\n承保限额、保费及免赔额\n\n保费适用…\n\n汽车 1：\n承保类别 我们将赔付的金额 2019\nROLLS RO\nCULLINAN\n第二部分 – 责任保险\n综合单项限额 每次事故 $1,000,000.00 $698.00\n第三部分 – 医疗费用保险\n医疗给付 每人 $50,000.00 $10.00\n第四部分 – 无保险驾驶人或补充无保险驾驶人（SUM）保险\n补充\nUM/UIM*- 单项 每次事故 $1,000,000.00 $234.00\n第五部分 – 车辆损失保险\n碰撞 达到约定价值 $3,697.00\n碰撞以外损失 达到约定价值 $735.00\n第六部分 – 人身伤害保护\n基本人身伤害 每人 $50,000.00 $176.00\n保护\n可选基本经济\n损失 每人 $25,000.00 $8.00\n额外人身伤害\n保护 每人 $100,000.00 $25.00\n累计 PIP（人身伤害保护）保险金 每人 $175,000.00 $209.00\n误工损失 每月 $4,000.00，最多 3 年\n其他必要支出 每天 $50.00，最多 1 年\n身故保险金 每人 $2,000.00\n额外身故保险金 每人 $3,000.00 $2.00\n批单\n现金结算 车辆：\n1 $222.00\n机动车法律\n执行费 $10.00\n每辆汽车年度总保费 $5,817.00\n所有汽车年度总保费：$5,817.00\n免赔额\n第五部分 – 车辆损失保险 碰撞 $1,000.00\n（碰撞\n玻璃索赔为 $0）\n碰撞以外\n损失 $1,000.00\n（综合\n玻璃索赔为 $0）\n\n*根据 SUM 承保范围可支付的最高金额应为保单的 SUM 限额，并按照 SUM 批单中的规定，扣减并因而抵销从事故中任何过错方处收到或由其代表支付的机动车人身伤害责任保险保单或保函赔付款项。\n提供的附加承保项目\n适用于常规及杂项车辆\n\n承保项目 说明\n\n新车置换 在前三（3）年内\n交通费用 最高 $15,000\n行程中断及紧急生活费用 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车辆身份盗用及产权欺诈\n安全气囊意外弹出\n车锁与钥匙更换\n拖车 200 英里半径范围内\n定制设备 最高 $1,500（仅限常规车辆）\n原厂设备制造商（OEM）\n更换零件\n附加被保险人\n\n姓名/名称 地址 车辆\n\nHudson Diamond NY, LLC 781 Fifth Ave 18th Floor, New York,NY,10022 汽车 1\n格式条款与批单\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承保批单 - 纽约州 PCA-MPIP-NY (01/19)\n私人客户集团汽车保单 PCA-PAP (01/19)\n现金结算选项批单 PCA-CSO (01/19)\n租用车辆承保批单 - 纽约州 PCA-RVC-NY (01/19)\n额外人身伤害保护承保批单 - 纽约州 PCA-APIP-NY (01/19)\n无保险驾驶人批单 - 纽约州 PCA-UM-NY (01/19)\n车窗玻璃全额承保批单 PCA-FULLGL (01/19)\n可选基本经济损失承保批单 - 纽约州 PCA-OBEL-NY (12/19)\n单项责任限额批单 - 纽约州 PCA-SLL-NY (01/19)\n联邦雇员在政府公务中使用汽车批单 PCA-FEDEMP (01/19)\n保险人地址变更通知 141636 (05/21)\n补充无保险/保额不足驾驶人批单 - 纽约州 PCA-SUPUMUIM-NY (01/19)\n单项补充无保险/保额不足驾驶人批单 - 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用于厘定保单费率的其他信息\n\n您的 分类代码 年里程数 地区 标识符号\n\n受保汽车 综合 碰撞 责任 医疗 / PIP\n汽车 1 945600 1629 018 98 98 不适用 不适用\n\n层级指定：8\n\n以下列出适用于您保单保费的保费折扣与附加费 – 纽约州\n\n保单号码：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 保单节省额\n\n五年无事故 保单 $278.00\n三年安全驾驶员 保单 $111.00\n被动约束系统 车辆：1 $87.00\n防抱死制动 车辆：1 $389.00\n防盗装置 车辆：1 $87.00\n补充业务险种 $742.00\n个人超额责任保单折扣 保单\n收藏品保单折扣 保单\n房屋保险保单折扣 保单\n总节省额：$1,694.00\n附加费：\n\n因事故/违章及/或无经验驾驶员产生的附加费金额 $ 0.00 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您的保费体现了一项附加费并且金额较高，系因为在经验期内，您根据我们的费率计划发生了如上所述的事件。随附的费率信息披露通知说明了费率计划，其中包含我们可能向您收取附加费的事件清单，以及附加费可能被取消的情形。如有任何疑问，请联系声明页第一页所列的代理人或经纪人。","key_entities":[],"ecf_references":[],"word_count":1424,"status":"published","published_at":null,"created_at":null,"updated_at":"2026-08-23 13:13:36"}