--- type: court_doc id: "court_ctb_2032_30" court: "CTB" case_no: "22-50073" doc_number: 2032 doc_type: "EXHIBIT" filed_date: null lang: "en" machine_translated: false url: "https://mubeitech.com/en/court/court_ctb_2032_30" json_url: "https://mubeitech.com/api/court/court_ctb_2032_30" --- # Guo Wengui / Miles Guo — bankruptcy case · EXHIBIT · ECF #2032-30 Exhibit 30 Policy Notice (See Your Revised 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: Golden Spring (New York) Ltd. 162 E 64th St New York, NY 10065 At 12:01 A.M. standard time at your mailing address shown 04/01/2022 - 04/01/2023 Your Broker/Agent Is: Wolfson Insurance Brokerage, Inc. 358 Fifth Avenue, 8th Floor New York, NY 10001 Phone: (212) 683-2622 Broker number: 0051997 Name of Issuing Company: AIG Property Casualty Company Your Policy Has Been Changed Effective Date: 04/01/2022 Description of Change: Delete 2017 Lexus LX 570 #9861 Revised Annual Premium: Premium Charge for Endorsement: \$19,391.00 From: To: -\$3,628.00 04/01/2022 04/01/2023 This summary of coverage provides you with complete policy information, including the above change, and represents your coverage currently in effect. AUTO AUTO　YEAR　MODEL　vin　TYPE　GARAGE ZIP　AGREED VALUE 2018 MERCEDES S650x　WDDUX8AB4JA400527 REG　10022　\$144.878 2　2020　MERCEDES Airstream　WDAFF4CD5KT014771 MOT　10065　\$133.867 ന　2021　4JGFF8HB0MA399467 REG　10022　\$142.158 DRIVER　NAME　AGE　AUTHORIZED Cao Defeng　33　Covered 2　Gerald Scott Barnett　50　Covered COVERAGE LIMITS, PREMIUMS AND DEDUCTIBLES COVERAGE LIMITS, PREMIUMS AND DEDUCTIBLES Premium For… What we will pay　AUTO 1:　AUTO 2:　AUTO 3: Type of Coverage　2018 MERCEDES S650x　2019 MERCEDES Airstream　2021 MERCEDES GLS SECTION II – LIABILITY COVERAGES Combined Single Limits　\$1,000,000.00 Per Occurrence　\$911.00　\$609.00　\$1,336.00 SECTION III – COVERAGE FOR YOUR MEDICAL EXPENSES Medical Payments　\$50,000.00 Per Person　\$8.00　\$4.00　\$9.00 SECTION IV – UNINSURED MOTORISTS or SUM COVERAGE Supplementary UM/UIM*- Single　\$1,000,000.00 Per Occurrence　\$289.00 \$145.00 \$289.00 SECTION V – COVERAGE FOR DAMAGE TO YOUR AUTO Collision　Up to the Agreed Value　\$3,880.00　\$3,067.00　\$4,362.00 Other than Collision　Up to the Agreed Value　\$1,184.00　\$770.00　\$1,251.00 SECTION VI – PERSONAL INJURY PROTECTION Basic Personal Injury　\$50,000.00 Per Person　\$226.00　\$144.00　\$243.00 Protection Optional Basic Economic Loss　\$25,000.00 Per Person　\$7.00　\$7.00　\$7.00 Additional Personal Injury Protection　\$100,000.00 Per Person　\$21.00　\$21.00　\$21.00 Aggregate PIP Benefits　\$175,000.00 Per Person　\$254.00　\$172.00　\$271.00 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　\$2.00 ENDORSEMENTS Accidental Death Benefit　\$15,000.00 Per Policy　\$12.00　Included　Included Cash Settlement　Vehicle(s): 3　\$253.00　\$281.00 Motor Vehicle Law Enforcement Fee　\$10.00　\$10.00　\$10.00 Total Annual Premium Per Auto　\$6,803.00　\$4,777.00　\$7,811.00 Total Annual Premium for All Autos:　\$19,391.00 Deductibles SECTION V – COVERAGE FOR DAMAGE TO YOUR AUTO　Collision　\$1,000.00 (\$0 for Coll Glass Claims)　\$1,000.00 (\$0 for Coll Glass Claims)　\$1,000.00 (\$0 for Coll Glass Claims) Other than Collision　\$1,000.00 (\$0 for Comp Glass Claims)　\$1,000.00 (\$0 for Comp Glass Claims)　\$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 FORMS AND ENDORSEMENTS DESCRIPTION　TITLE Private Client Group Automobile Policy　PCA-PAP (01/19) Amendment of Policy Provisions - New York　PCA-AMDPP-NY (01/19) Mandatory Personal Injury Protection Coverage Endorsement - New York　PCA-MPIP-NY (01/19) Auto Accidental Death Benefit Endorsement　PCA-ACCD (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) 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) Cash Settlement Option Endorsement　PCA-CSO (01/19) Federal Employees Using Autos In Government Business Endorsement　PCA-FEDEMP (01/19) 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) Miscellaneous Type Vehicle Endorsement　PCA-MISCVEH (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　P33C1000N　3512　018　98　98　N/A　N/A Auto 2　943700　9500　018　N/A　N/A Auto 3　P50F1000N　9500　018　98　98　N/A　N/A Tier Designation: 4 Listed Below are the Premium Discounts and Surcharges that are Applied to Your Policy Premium – New York Policy Number: Policy Term: 04/01/2022 - 04/01/2023 DISCOUNTS: The Premium Discounts listed below are included in your total policy premium: DISCOUNT DESCRIPTION　APPLIES TO　POLICY SAVINGS Daytime Lights　Vehicle(s): 1,3　\$345.00 Antilock Brake　Vehicle(s): 1,3　\$345.00 Automatic Braking　Vehicle(s): 1　\$105.00 Blind Spot Monitoring　Vehicle(s): 1　\$105.00 Passive Restraint　Vehicle(s): 1,3　\$144.00 Anti-theft Device　Vehicle(s): 1,2,3　\$283.00 Total Savings:　\$1,327.00 SURCHARGES: A Surcharge amount of \$ 1,497.00 due to accidents/violation and/or inexperienced operator(s) is included in your total policy premium. Accident Date (s): 01/13/2021 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. Notice of Information Practices State law requires us to notify you of our information gathering practices and your rights relating to those practices. While we rely heavily on the information applicants and insureds supply to us, we may also collect personal information from other sources. For instance, as part of our normal underwriting procedure, we will review motor vehicle records obtained from the Department of Motor Vehicles on all operators in your household and, we will review the claims history that you have had with any prior insurance company or companies, which we will obtain from a nationally recognized consumer investigative firm. We will not disclose any personal information which we have collected or received in connection with any insurance transaction unless you (or any other affected person) approves that disclosure except as permitted by law in the following circumstances: - 1. to persons or organizations, where necessary, to allow performance of a business, professional or insurance function for us; or, to allow the person or organization to assist us in determining your eligibility for insurance or in detecting insurance fraud; - 2. to other insurers, agents or insurance support organizations, where necessary, to complete an insurance transaction or to help detect fraud or other illegal activities; - 3. to a medical care institution or medical professional to verify insurance coverage or benefits or to alert an individual to a medical problem, or to conduct a service audit; - 4. to an insurance regulatory authority; - 5. to a law enforcement or other governmental authority, where necessary, to protect insurer interests or to assist in the investigation of fraud or other criminal activities; - 6. to facilitate actuarial or research studies; - 7. to permit marketing of selected products or services to insureds, although you have the right to tell us that you do not wish to have personal information released for marketing purposes; - 8. to any of our affiliated companies whose use of personal information will be for auditing or marketing purposes; - 9. (where relevant) to a group policyholder for the purpose of reporting claims experience or conducting an audit of insurance transactions. You can obtain access to any personal information we have about you if you properly identify yourself and submit a written request to us describing the information you want to review. Once we have received your request, and if the information is reasonably locatable and retrievable, we will, within 30 business days, take the following actions: - 1. inform you of the nature and substance of the recorded information; - 2. allow you to see and copy, in person, such recorded personal information; or - 3. send you a copy of the recorded personal information by mail. (We may charge you a reasonable fee to cover the cost of this service.) We will also tell you at this time the identity, if recorded, of persons to whom we have disclosed the personal information within the preceding two years. If you ask us to correct, amend or delete any information about you, we will within 30 days, either correct, amend or delete the personal information in dispute or notify you of our refusal to take such action along with the reasons for our decision. If we make the correction, amendment or deletion you've requested, we will also notify you along with any person you designate who has received the information about you within the preceding two years, any insurance support organization(s) which provided us with the disputed information. If we refuse to make the requested correction, amendment or deletion, you are permitted to file a concise statement setting forth what you think is the correct, relevant or fair information along with a statement of the reasons why you disagree with our refusal to correct, amend or delete the information subject to dispute. We will file your statement with the disputed personal information and make any person who reviews your file aware of your statement. We will also furnish your statement to any person who has received personal information from us with the two preceding years and any insurance support organization whose primary source of personal information is an insurer. You should know that personal information obtained from a report prepared by any insurance support organization may be retained and disclosed to other persons in the future. Please submit your request for additional information to: AIG Property Casualty Company Private Client Group 175 Water St, 18th Floor New York, NY 10038