Guo Wengui / Miles Guo — bankruptcy case · EXHIBIT · ECF #1805-36

Your New York Automobile Declarations Page

Your 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. Policy Number: Policy Period:

Name of Insured and Mailing Address:

Hudson Diamond NY LLC 162 E. 64th Street New York, NY,10065

At 12:01 A.M. standard time at your mailing address shown Your Broker/Agent Is:

Wolfson Insurance Brokerage, Inc. 358 Fifth Avenue, 8th Floor New York, NY, 10001

Name and Address of Issuing Company: AIG Property Casualty Company

175 Water St, 18th Floor New York, NY 10038

Phone: (212) 683-2622 Broker number: 0051997

AUTO YEAR MAKE MODEL VIN TYPE GARAGE

1 2019 ROLLS RO CULLINAN SLA689X56KU114001 REG 10065 \$283,712

COVERAGE LIMITS, PREMIUMS AND DEDUCTIBLES

AUTO 1:

Combined Single Limits \$1,000,000.00 Per Occurrence \$698.00 SECTION III – COVERAGE FOR YOUR MEDICAL EXPENSES Medical Payments \$50,000.00 Per Person \$10.00 SECTION IV – UNINSURED MOTORISTS or SUM COVERAGE

UM/UIM*- Single \$1,000,000.00 Per Occurrence \$234.00 SECTION V – COVERAGE FOR DAMAGE TO YOUR AUTO Collision Up to the Agreed Value \$3,697.00 Other than Collision Up to the Agreed Value \$735.00

Basic Personal Injury \$50,000.00 Per Person \$176.00

Protection \$100,000.00 Per Person \$25.00 Aggregate PIP Benefits \$175,000.00 Per Person \$209.00 Work Loss \$4,000.00 Per Month, Max of 3 Years

Additional Death Benefit \$3,000.00 Per Person \$2.00

Cash Settlement Vehicle(s):

Total Annual Premium Per Auto \$5,817.00 Total Annual Premium for All Autos: \$5,817.00

SECTION V – COVERAGE FOR DAMAGE TO YOUR AUTO Collision \$1,000.00

\*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.

New Vehicle Replacement Within the first three (3) years

Trip Interruption and Emergency Living Expenses Up to \$5,000

Vehicle and Home Alteration Up to \$10,000 Vehicle Identity Theft and Fraudulent Title

Custom Equipment Up to \$1,500 (Regular Vehicles Only)

Hudson Diamond NY, LLC 781 Fifth Ave 18th Floor, New York,NY,10022 Auto 1

Amendment of Policy Provisions - New York PCA-AMDPP-NY (01/19) Mandatory Personal Injury Protection Coverage Endorsement - New York PCA-MPIP-NY (01/19) Private Client Group Automobile Policy PCA-PAP (01/19) Cash Settlement Option Endorsement PCA-CSO (01/19) Rental Vehicle Coverage Endorsement - New York PCA-RVC-NY (01/19) Additional Personal Injury Protection Coverage Endorsement - New York PCA-APIP-NY (01/19) Uninsured Motorists Endorsement - New York PCA-UM-NY (01/19) Full Coverage Window Glass Endorsement PCA-FULLGL (01/19) Optional Basic Economic Loss Coverage Endorsement - New York PCA-OBEL-NY (12/19) Single Liability Limit Endorsement - New York PCA-SLL-NY (01/19) Federal Employees Using Autos In Government Business Endorsement PCA-FEDEMP (01/19) Change To Insurer's Address - Notice 141636 (05/21) Supplementary Uninsured/Underinsured Motorists Endorsement - New York PCA-SUPUMUIM-NY (01/19) Single Supplementary Uninsured/Underinsured Motorists Endorsement - New York PCA-SSUPUMUIM-NY (01/19) Additional Insured - Lessor Endorsement - New York PCA-ADIL-NY (01/19) OTHER INFORMATION USED TO RATE YOUR POLICY

Your Class Code Annual Miles Territory Symbols

Auto 1 945600 1629 018 98 98 N/A N/A

Listed Below are the Premium Discounts and Surcharges that are Applied to Your Policy Premium – New York

DISCOUNTS:

The Premium Discounts listed below are included in your total policy premium:

DISCOUNT DESCRIPTION APPLIES TO POLICY SAVINGS

Five Year Accident Free Policy \$278.00

Passive Restraint Vehicle(s): 1 \$87.00

Anti-theft Device Vehicle(s): 1 \$87.00

Personal excess liability policy discount Policy

SURCHARGES:

A Surcharge amount of \$ 0.00 due to accidents/violation and/or inexperienced operator(s) is included in your total policy premium.

Accident Date (s): NONE Violation Date (s): NONE

Your 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.