--- type: court_doc id: "court_ctb_1805_36" court: "CTB" case_no: "22-50073" doc_number: 1805 doc_type: "EXHIBIT" filed_date: null lang: "en" machine_translated: false url: "https://mubeitech.com/en/court/court_ctb_1805_36" json_url: "https://mubeitech.com/api/court/court_ctb_1805_36" --- # Guo Wengui / Miles Guo — bankruptcy case · EXHIBIT · ECF #1805-36 Exhibit J 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 PCG 0016847665 05/10/2022 - 05/10/2023 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 DESCRIPTION OF YOUR COVERED AUTO(S) AUTO　YEAR　MAKE　MODEL　VIN　TYPE　GARAGE ZIP　AGREED VALUE 1　2019　ROLLS RO　CULLINAN　SLA689X56KU114001　REG　10065　\$283,712 DESCRIPTION OF DRIVER(S) DRIVER　NAME　AGE　AUTHORIZED 1　Dean M Rabideau　55　Covered 2　Cao Defeng　33　Covered COVERAGE LIMITS, PREMIUMS AND DEDUCTIBLES Premium For… AUTO 1: Type of Coverage　What we will pay　2019 ROLLS RO CULLINAN SECTION II – LIABILITY COVERAGES 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 Supplementary 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 SECTION VI – PERSONAL INJURY PROTECTION Basic Personal Injury　\$50,000.00 Per Person　\$176.00 Protection Optional Basic Economic Loss　\$25,000.00 Per Person　\$8.00 Additional Personal Injury 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 Other Necessary Expenses \$50.00 Per Day, Max of 1 Year Death Benefit　\$2,000.00 Per Person Additional Death Benefit　\$3,000.00 Per Person　\$2.00 ENDORSEMENTS Cash Settlement　Vehicle(s): 1　\$222.00 Motor Vehicle Law Enforcement Fee　\$10.00 Total Annual Premium Per Auto　\$5,817.00 Total Annual Premium for All Autos:　\$5,817.00 Deductibles SECTION V – COVERAGE FOR DAMAGE TO YOUR AUTO　Collision　\$1,000.00 (\$0 for Coll Glass Claims) Other than Collision　\$1,000.00 (\$0 for Comp Glass Claims) \*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. ADDITIONAL COVERAGES PROVIDED For Regular and Miscellaneous Vehicles COVERAGE　DESCRIPTION New Vehicle Replacement　Within the first three (3) years Transportation Expenses　Up to \$15,000 Trip Interruption and Emergency Living Expenses　Up to \$5,000 Roadside Assistance　Up to \$100 per day Personal Property　Up to \$5,000 Pet Injury　Up to \$2,500 Vehicle and Home Alteration　Up to \$10,000 Vehicle Identity Theft and Fraudulent Title Accidental Airbag Deployment Lock and Key Replacement Towing　Within a 200-mile radius Custom Equipment　Up to \$1,500 (Regular Vehicles Only) Original Equipment Manufacturer (OEM) Replacement Parts ADDITIONAL INSURED(S) NAME ADDRESS AUTOS Hudson Diamond NY, LLC 781 Fifth Ave 18th Floor, New York,NY,10022 Auto 1 FORMS AND ENDORSEMENTS DESCRIPTION　TITLE 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 Covered Auto　COMP　COLL　LIB　MED / PIP Auto 1　945600　1629　018　98　98　N/A　N/A Tier Designation: 8 Listed Below are the Premium Discounts and Surcharges that are Applied to Your Policy Premium – New York Policy Number: PCG 0016847665 Policy Term: 05/10/2022 - 05/10/2023 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 Three Year Safe Driver　Policy　\$111.00 Passive Restraint　Vehicle(s): 1　\$87.00 Antilock Brake　Vehicle(s): 1　\$389.00 Anti-theft Device　Vehicle(s): 1　\$87.00 Supplemental Lines of Business　\$742.00 Personal excess liability policy discount　Policy Collections policy discount　Policy Home insurance policy discount　Policy Total Savings:　\$1,694.00 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.