NAUTILUS INSURANCE GROUP.
Nautilus Insurance Company Great Divide Insurance Company
December 22, 2014
CERTIFIED RETURN RECEIPT REQUESTED & US MAIL - 10075944 New York Adjustment Bureau, Inc.
66-19 Woodhaven Blvd Rego Park NY 11374
RE: Company: Nautilus insurance Compan
Insured: New York Mart Avenue U 2 Inc.
Claim Number: 10075944
Policy Number: NN432443
Loss Location: 1721 Avenue U Brooklyn NY 11229
Date of Loss: 09/17/2014
Type of Loss: Water
Dear Lu Parello:
In accGidâñce with the provisions of the policy of insurance, we hereby place you upon formal notice that if you are contemplating making a claim against Nautilus Insurance Company in coññêctich with the above-referenced alleged loss you are required to sign and submit a swom proof of loss in accordance with the provisions of the policy of insurance issued to you and otherwise comply in all particulars with the policy provisions. This sworn proof of loss must be submitted within 60 days from the receipt of this Notice.
For your convenience I am enclosing herewith a blank Proof of Loss.
We again request your full cooperatian to produce the requested documents and access to the roof.
As you know, as time goes by, evidence can be lost, thus, we ccñsider the delays in complying with the policy conditions may be prejudicing Nautilus insurance Company's investigation.
1. Copy of your letter of representation
2. Copy of hard contents inventory and any business personal property 3. Copy of plumber's report
4. Copy of tax retums for 2013 to 2014 and current year
5. Copy of insured's incurred invoices and receipt for improvements & bettêrments 6. A complete list of all tenant improvements made by the insured since occupancy 7. Copy of the lease agreement
8. Building owners name and contact information
9. Name and contact information for the adjacent store owner's 10. Any and all building inspection report
11. Access to the roof, so that Mr. Monaco may inspect the roof with the independent adjuster, the insured, the landlord and yourself
We again remind you of your client's duties under the policy and also would like to point out that we will not pay for loss or damage to personal pisperty in the building mused by or resulting from rain unless the building or structure first sustain damage by a covered cause of loss.
7233 East Butherus Drive Scottsdale, Arizona 85260 Phone 800.842.8972 480.951.0905 Fax 480.951.9730 BERTREY COM PANYe
NAUTILUS INSURANCE CO MPANY
Scottsdale, Arizona
Transaction Type: New Policy No.
NN432443
Renewal of Policy # Inspection Ordered: 2014 03 4 5 2
Rewrite of Policy # Yes
O
No THEINSURER(S) NAMED HEREIN IS (ARE) NOT
Cross Ref. Policy # LICENSED BY THE STATE OF NEW YORK, NOT
NIC Quote # SUBJECT TO ITS SUPERVISION, AND IN THE
Named Insured and Ma!!!ng Address EVENT OF THE INSOLVENCY OF THE
(No., Street, Town or City, County, State, Zip Code) INSURER(S), NOT PROTECTED BY THE NEW
New York Mart Avenue U 2nd Inc . YORK STATE SECURITY FUNDS. THE POLICY
MAY NOT BE SUBJECT TO ALL OF THE
1721 Avenue U REGULATIONS OF THE INSURANCE
Brooklyn NY 11229- DEPARTMENT PERTAINING TO POLICY FORMS.
THIS INSURER IS NOT LICENSED IN THE STATE
OF NEW YORK AND IS NOT SUBJECT TO ITS
Agent and Me!!!ng Address Agency No. 03110-02 SUPERVISION.
(No., Street, Town or City, County, State, ZipCode) Jimcor Agency, Inc.
625 Maple Ave.-Route 9 Saratoga Springs, NY 12866
NO FLAT CANCELLATION
d: From 06/13/2014 to 06/13/ 2015 at 12:01 A.M. Standard Time at your mailing address shown above.
Business Description: Supermarket Tax State
A
Form of Business:
O
Individual Partnership Joint VentureO
TrustO
Limited Liability Company (LLC) Organization, including a Corporation (but not including a Partnership, Joint Venture or LLC) IN RETURN FOR THE PAYMENT OF THE PREMlUM, AND SUBJECTTO ALL THE TERMS OFTHIS POLICY,WE WILL PROVIDEYOU THE INSURANCE STATED IN THIS POLICY.
THIS POLICY CONSISTS OFTHE FOLLOWING COVERAGEPARTS FORWHICH A PREMIUM IS INDICATED.
THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT
Commercial Property Coverage Part $ 3,767 . 00
Tax & Fee Schedule TOTAL ADVANCE PREMlUM $ 3 , 76 7 . 00
Mbimum & Deposit
TOTAL TAXES & FEES $
TOTAL $ 3,767.00
Form(s) and Endorsement(s) made a part of this policy at time of issue:
Refer to Schedule of Forms and Endorsements.
United Aline Co. Ltd 103 Cuttermill Road Great Neck, NY 11021
Countersigned: Saratoga Springs, NY By Vl/†
06/19/2014 OJS Countersignature or Authorized R6pressñtative, whichever is applicable E C
THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS, COVERAGE PART COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETETHE ABOVE NUMBERED POLICY.
Includes copyrighted m aterial of !neumnce Services Office, Inc., with its permission.
E001 (O4/ 09) GENERAL AGENT
POLICY NUMBER: NN432443
Named Insured: New York Mart Avenue U 2nd Inc.
SCHEDULE OF FORMS AND ENDORSEMENTS
IL0017 (11/98) Common Policy Conditions
E001J (11/06) Nautilus Policy Jacket
E906 (06/07) Service of Suit
5013 (07/09) Minimum Earned Premium Endt
E915 (07/13) OFAC Adv Notice to Policyholder
F001 (03/12) Comm1 Property Coverage Part Dec
CP0010 (04/02) Building & Personal Prop Cvg Frm
CP0030 (04/02) Bus Income & Extra Exp Cyg Form
CP0090 (07/88) Commercial Property Conditions
CP0133 (05/02) New York Changes
CP1030 (04/02) Cause of Loss - Special Form
CP1211 (10/00) Burg-Robbery Protect Safeguards
ILO935 (07/02) Excl-Certain Comp-Related Losses
ILO953 (01/08) Excl of Certified Acts of Terror
E600 (09/12) Actual Cash Value
E909 (03/08) Disclosure-SFP & Decl of Terror
F201 (11/05) Exclusion - Property Pollution
F202 (11/05) Excl-Micro/Bio Organisms/Contam
F210 (11/05) Amendment of Coverage - Collapse
F400 (05/09) Equip Breakdown Enhancement Endt
F605 (11/05) Total Loss Endorsement
The forms and endürsérñênts shown on this Schedule constitute the entire policy at the time of issuance.
S902 (07/09) Page 1 of 2
SCHEDULE OF FORMS AND ENDORSEMENTS
(continued)ADDITIONAL FORMS APPLICABLE:
The forms and endc::omonts shown on this Schedule constitute the entire policy at the time of issuance.
S902 (07/ 09) Page 2 of 2
POLICY NUMBER: NN432443
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
MINIMUM EARNED PREMIUM ENDORSEMENT
If this policy is cancõ||õd at your request, there will be a minimum earned premium retained by us of
$
_
orJ
% of the premium for this insurance, vvhichever is greater.Non-payment of premium is considered a request by the first Named Insured for cancellation of this policy.
If a policy fee, inspection fee or expense constant is applicable to this policy, they will be fully earned and no refund will be made.
AII other terms and conditions of this policy remain unchanged.
S013 (O7/ 09) Includes copyrighted material of Insurance Services Office, Inc., with its pe !ee!en.
COMMERCIAL PROPERTY COVERAGE PART DECLARATIONS
POLICY NUMBER: N N432443
O
Supp'smêñte! Declarations is attached (Applies only if box is checked) Effective Date: 06/ 13 / 2 0 14 12:01 A.M. Standard Time BUSINESS DESCRIPTION SupermarketDESCRIPTION OF PREMISES
PREM BLDG LOCATION ADDRESS CLASS CONST PROT YEAR NO. OF
NO. NO. CODE CLASS BUILT STORIES
1 1 1721 Avenue U 0532 JM 4 1930 3
Brooklyn NY 11229-
BLDG DESC/ OCCUPANCY: Grocery Stor e BLOG DESC/ OCCUPANCY:
BLDG DESC/ OCCUPANCY:
ERAGES PROVIDED CNSL""-MCEAT THE DESCRIBEDPREMISESAPPLlESONLYFORCOVERAGESFORWHICHA LIMITOF !NSUPM!cE ISSHOWN)
PREM BLDG COVERAGE LIMIT OF COVERED CAUSES OF LOSS * COINS % RATES PREMlUM
NO. NO. INSURANCE
1 1Business Pers Prop 300,000 Special-Incl Theft 80% .6190 $ 1,857
1 1Bus Inc wo/Rent w/EE 300,000 Special-Incl Theft .6000 1,800
1 1Equipment Breakdown SEE F400 110
* IF EXTRAEXPENSECOVERAGE,LIMITSON LOSSPAYMENT
DEDUCTIBLE $ 2 , 50 0 Exceptions: $
OPTIONAL COVERAGES (APPLICABLEONLYWHENENTRIESAREMADEIN THESCHEDULEBELOW)
AGREED VALUE REPLACEMENT COST (APPLIES ONLY IF "X" IS SHOWN BELOW)
PREM BLDG EXPIRATION COVERAGE AMOUNT BUILDING PERSONAL INCLUDING
NO. NO. DATE PROPERTY "STOCK"
1 1 X
PREM BLDG . INFLATION GUARD PERCENTAGE ** MONTHLY LIMIT OF ** M^7.'MUM PERIOD ** EXTENDED PERIOD NO. NO. BUILDING PERSONAL PROPERTY INDEMNITY (Fraction) OF NDEMNITY *** OF INDEMNITY (Days)
1 1 1/4
" APPLIESTOBUSINESSINCOMEONLY
* * APPLIESONLYIF
T
IS SHOWNBELOW MO RTGAGE HOLDER(S)PREM BLDG M ORTGAGE HOLDER NAME AND MAILING ADDRESS
LOAN NUMBER:
LOAN NUMBER:
- LOAN NUMBER:
PREMIUM FOR THIS COVERAGE PART $ 3 , 76 7
FORMS AND ENDORSEMENTS (other than epp!!ceb!e Forms and CñdcrssiTiants shown elsewhere in the policy) Forms and Endorsements app:y|iig to this Coverage Part and made part of this policy at time of issue:
APPLICABLE TO ALL COVERAGES:
Refer to Schedule of Forms and Endorsements
APPLICABLE TO SPECIFIC PREM ISES/ COVERAGES:
PREM NO. BLDG NO. COVERAGES FORM NUMBERS
THESE DECLARATIONS ARE PART OFTHE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD.
F001 (03/ 12) |iidüdes copy;ighted material of !nsumnce Services Office, Inc., with its permission.
POLICY NUMBER: NN432443 C OM M ERCIAL PROPERTY CP 12 11 10 00
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BURGLARY AND ROBBERY PROTECTIVE SAFEGUARDS
This endorsement modifies insurance provided under the following:
COMMERCIAL PROPERTY COVERAGE PART
SCHEDULE*
Premises Building Propsity Safeguards
No. No. Symbols Applicable
1 1 BR-1
Describe any "BR-4"-
*Information required to complete this Schedule, if not shown on this endarserñêiit, will be shown in the Declarations.
A. The fü||Giving is added to the Commercial Property c. "BR-3"
Security Service, with a recording
Conditions: system or watch clock, making hourly rounds
BURGLARY AND ROBBERY PROTECTIVE covering the entire building, when the
SAFEGUARDS Premises are not in actual operation.
1. As a condition of this insurance, you are required d. "BR-4" The protective safeguard described in to maintain the protective devices and/ or services the Schedule.
listed in the Schedule above. B. The following is added to the Exclusions section of the 2. The protective safeguard(s) to which this Causes Of Loss - Special Form:
endorsement applies are identified by the following BURGLARY AND ROBBERY PROTECTIVE
symbols: SAFEGUARDS
a. "BR-1"
Automatic Burglary Alarm, protecting We will not pay for loss or demege caused by or the entire building, that signalsto: resulting from theft if, prior to the theft, you:
(1) An outside central station; or 1. Knew of any suspension or impairment in any
(2) A police station. protective safeguard listed in the Schedule above
b. "BR-2"
Automatic Burglary Alarm, protecting and failed to notify us of that fact; or
the entire building, that has a loud sounding 2. Failed to maintain any protective safeguard listed gong or siren on the outside of the building. in the Schedule above, and over which you had
control, in complete working order
CP 12 11 1000 Copyright, !nsumnce Services Office, Inc., 1999
POLICY NUMBER: NN432443 IL 09 53 01 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUSION OF
CERTIFIEDACTS OF TERRORISM
This endorsement modifies insurance provided under the following:
BOILER AND MACHINERY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
CRIME AND FIDELITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGEPART FARM COVERAGE PART
STANDARD PROPERTY POLICY
SCHEDULE
The Exception Covering Certain Fire Losses (Paragraph C) applies to property !ocated in the fal|Gwing state(s), if covered under the indicated Coverage Form, Coverage Part or Policy
State(s) Coverage Form, Coverage Part Or Policy
New York
Information rec¡üired to complete this Schedule, if not shown above, will be shown in the Dec|âratiüns.
A. The fc:|cwing definition is added with respect to B. The fa||cwiñg exclusion is added:
the provisions of this endorsement: CERTIFIED ACT OF TERRORISM EXCLUSION
"Certified act of terrorism" means an act that is We will not pay for loss or damage caused directly certified by the Secretary of the Treasury, in or indirectly by a "certified act of terrorism". Such concurrence with the Secretary of State and the loss or damage is excluded regardless of any other Attorney General of the United States, to be an act cause or event that contributes concurrently or in of terrorism pursuant to the federal Terrorism Risk
any sequence to the loss.
Insurance Act. The criteria contained in the
Terrorism Risk Insurance Act for a "certified act of C. Exception CGvariñg Certain Fire Losses
terrorism" include the following: The following exception to the exclusion in
1. The act resulted in insured losses in excess of Paragraph B. applies only if indicated and as
$5 million in the aggregate, attributable to all indicated in the Schedule of this endorsement.
types of insurance subject to the Terrorism If a "certified act of terrorism" results in fire, we will
Risk Insurance Act; and pay for the loss or damage caused by that fire.
2. The act is a violent act or an act that is Such coverage for fire applies only to direct loss or dangerous to human life, property or damage by fire to Covered Property. Therefore, for infrastructure and is corninitted by an example, the coverage does not apply to individual or individuals as part of an effort to insurance prGvidêd under B=iness Income coerce the civilian population of the United and/ or Extra Expense coverage forms or States or to influence the policy or affect the endorsements which apply to those forms, or to conduct of the United States Government by the Legal Liability Coverage Form or the Leasehold
coercion. Interest Coverage Form.
IL 09 5301 08 Copyright ISO Properties, Inc., 2007 Page 1 of 2
If aggregate insured losses attributable to terrorist D. Application Of Other Exciüsiviis
acts certified under the Terrorism Risk Insurance The terms and limitations of any terrorism Act exceed $100 billion in a Program Year (January exclusion, or the inapplicability or omission of a 1 through December 31) and we have met our terrorism exclusion, do not serve to create insurer deductible under the Terrorism Risk coverage for any loss which would otherwisc be Insurance Act, we shall not be liable for the excluded under this Coverage Part or Policy, such payment of any portion of the amount of such as losses excluded by the Nuclear Hazard losses that exceeds $100 billion, and in such case Exclusion or the War And Military Action Exclusion.
insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury
IL 0953 01 08 Copyright ISO PrGp6ities, Inc., 2007 Page 2 of 2
POLICYHOLDER DISCLOSURE FOR STANDARD
FIREPOLICY STATES AND
DECLINATION
OF TERRORISM INSURANCE COVERAGE
THIS ACKNOWLEDGES THAT YOU HAVE CHOSEN TO DECLINE COVERAGE FOR ACTS OF TERRORISM, AS
DEFINED IN THE TERRORISM RISK INSURANCE ACT, AS AMENDED (THE "ACT"),
YOU SHOULD NOTE HOWEVER, IF YOUR POLICY PROVIDES COVERAGE FOR COMMERCIAL PROPERTY
AND/ OR COMMERCIAL INLAND MARINE, THERE ARE STATE STATUTORY EXCEPTIONS COVERING CERTAIN FIRE LOSSES AS IT RELATES TO COVERED PROPERTY LOCATED IN THE STATES LISTED IN THE SCHEDULE BELOW. IF AN "ACT OF TERRORISM" CERTIFIED UNDER THE ACT RESULTS IN FIRE, WE WILL PAY FOR THE LOSS OR DAMAGE CAUSED BY THAT FIRE. SUCH COVERAGE FOR FIRE APPLIES ONLY TO DIRECT LOSS OR DAMAGE BY FIRE TO COVERED PROPERTY AND IS SUBJECT TO ANY LIMITATIONS OF ANY TERRORISM EXCLUSION, OR INAPPLICABILITY OR OMISSION OF A TERRORISM EXCLUSION. THIS NOTICE DOES NOT
SERVE TO CREATE COVERAGE FOR ANY LOSS WHICH WOULD OTHERWISE BE EXCLUDED UNDER YOUR
POLICY.
State(s) New York
You are hereby notified that under the Act the dsfiñiticñ of act of terrorism has changed. As defined in Sêcticñ 102(1) of the Act: The term "act of terrorism" means any act that is certified by the Secretary of the Treasury - in cóñGürrence with the Secretary of State, and the Attorney General of the United States - to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Govemment by coercion. Under your coverage, any losses resulting from certified acts of terrorism may be partially rê|mbürsed by the United States Government under a formula established by the Act. However, your policy may contain other exclusions which might affect your coverage, such as an exclusion for nuclear events. Under the formula, the United States Government generally reimburses 85% of covered terrorism losses exceeding the statutorily established deductible paid by the insurance company providing the coverage.
The Act contains a $100 billion cap that limits U.S. Government reimbursement as well as insurers' liability for losses resulting from certified acts of terrorism when the amount of such losses exceeds $100 billion in any one calendar year. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced.
THE PORTION OF YOUR PREMlUM THAT IS ATTRIBUTABLE TO COVERAGE FOR DIRECT LOSS OR DAMAGE THAT IS CAUSED BY AN "ACT OF TERRORISM" CERTIFIED UNDER THE ACT AND WHERE FIRE ENSUES IS
$ 25 , 00 , and does not include any charges for the portion of losses covered by the United States gaverrirrierit under the Act.
Name of Insurer: NAU T I LUS TNSURANCE COliPANY
Policy Number: _NN 4 324 43
E909 (O3/08) Includes copyr|p.td material of National Association of Insurance Commissioners, with itsp-leeion.
COMMERCIAL LINES POLICY -COMMON POLICY DECLARATIONS
NAUTILUS INSURAN CE COM PANY
Scottsdale, Arizona
Transacticr. Type: New Policy No.
NN432443
Renewal of Policy #
_
inspection Ordered: 2014 03 4 5 2Rewrite of Policy # Yes
O
No THEINSURER(S) NAMED HEREIN IS (ARE) NOT
Cross Ref. Policy # LICENSED BY THE STATE OF NEW YORK, NOT
NIC Quote# SUBJECT TO ITS SUPERVISION, AND IN THE
Nam ed Insured and Mailing Address EVENT OF THE INSOLVENCY OF THE
(No., Street, Town or City, County, State, Zip Code) INSURER(S), NO T PROTECTED BY THE NEW
New York Mart Avenue U 2nd Inc . YORK STATE SECURITY FUNDS. THE POLICY
MAY NOT BE SUBJECT TO ALL OF THE
1721 Avenue U REGULATIONS OF THE INSURANCE
Brooklyn NY 11229- DEPARTMENT PERTAINING TO POLICY FORMS.
THIS INSURER IS NOT LICENSED IN THE STATE
OF NEW YORK AND IS NOT SUBJECT TO ITS
Agent and Mailing Address Agency No. 03110- 02 SUPERVISION.
(No., Street, Town or City, County, State,ZipCode) Jimcor Agency, Inc.
625 Maple Ave.-Route 9
Saratoga Springs, NY 12866
NO FLAT CANCELLATION
d: From 06/ 13/2014 to 06/13 / 2 015 at 12:01 A.M. Standard Time at your mailing address shown above.
Business Dsacription: Supermarket Tax State
A
Form of Business:
O
IndividualO
Pã it ñ õiship Joint VentureO
Trust Limited Liability Company (LLC) Organization, including a Corporation (but not including a Partnership, Joint Venture or LLC) IN RETURN FOR THE PAYMENT OF THE PREMlUM, AND SUBJECTTO ALL THE TERMS OF THIS POLICY,WEWILL PROVIDE YOU THE INSURANCE STATED IN THIS POLICY.
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FORWHICH A PREMlUM IS INDICATED.
THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT
Commercial Property Coverage Part $ 3, 767 . 00
Tax & Fee Schedule TOTAL ADVANCE PREMlUM $ 3,767 . 0 0
Miñimum & Deposit
TOTAL TAXES & FEES $
TOTAL $ 3,767.00
Form(s) and Endorsement(s) made a part of this policy at time of issue:
Refer to Schedule of Forms and Endorsements.
United Aline Co. Ltd 103 Cuttermill Road Great Neck, NY 11021
Countersigned: Saratoga Springs, NY By iftst. *
{
_
06/19/2014 OJS Countersig Åature or Authorized Representative, whichever is applicable E C
TH ESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS, COVERAGE PART COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY
Includes copyrighted m aterial of Insurance Services Office, Inc., with its perm ission.
EO01 (O4/ 09) GENERAL AGENT
POLICY NUMBER: NN432443
Named Insured: New York Mart Avenue U 2nd Inc .
SCHEDULE OF FORMS AND ENDORSEMENTS
IL0017 (11/98) Common Policy Conditions
E001J (11/06) Nautilus Policy Jacket
E906 (06/07) Service of Suit
S013 (07/09) Minimum Earned Premium Endt
E915 (07/13) OFAC Adv Notice to Policyholder
F001 (03/12) Comml Property Coverage Part Dec
CP0010 (04/02) Building & Personal Prop Cvg Frm
CP0030 (04/02) Bus Income & Extra Exp Cvg Form
CP009O (07/88) Commercial Property Conditions
CP0133 (05/02) New York Changes
CP1030 (04/02) Cause of Loss - Special Form
CP1211 (10/00) Burg-Robbery Protect Safeguards
ILO935 (07/02) Excl-Certain Comp-Related Losses
ILO953 (01/08) Excl of Certified Acts of Terror
E600 (O9/12) Actual Cash Value
E909 (03/08) Disclosure-SFP & Decl of Terror
F201 (11/05) Exclusion - Property Pollution
F202 (11/05) Excl-Micro/Bio Organisms/Contam
F210 (11/05) Amendment of Coverage - Collapse
F400 (05/09) Equip Breakdown Enhancement Endt
F605 (11/05) Total Loss Endorsement
The forms and endorsements shown on this Schedule constitute the entire policy at the time of issuance.
SQO2(O7/09) Page 1 of 2
SCHEDULE OF FORMS AND ENDORSEMENTS
(continued)ADDITIONAL FORMS APPLICABLE:
The forms and endorsements shown on this Schedule constitute the entire policy at the time of issuance.
S902 (O7/09) Page 2 of 2
POLICY NUMBER: NN432443
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
MINIMUM EARNED PREMIUM ENDORSEMENT
If this policy is cance!!ed at your request, there will be a minimum earned premium retained by us of
$ or
J%
of the prêmism for this insurance, whichever is greater.Non-payment of premium is considêred a request by the first Named Insured for cancellation of this policy.
If a policy fee, inspection fee or expense constant is applicable to this policy, they will be fully earned and no refund will be made.
All other terms and conditions of this policy remain unchanged.
S013 (07/09) Includes copyiightsd m aterial of Insurance Services Office, Inc., with its permission.
COM MERCIAL PROPERTY COVERAGE PART DECLARATIONS
POLICY NUMBER: NN432443
O
Supp|õiiiõñtal Declarations is attached (Applies only if box is checked) Effective Date: 06/13 / 2 014 12:01 A.M. Standard Time BUSINESS DESCRIPTION SupermarketDESCRIPTION OF PREMISES
PREM BLDG LOCATION ADDRESS CLASS CONST PROT YEAR NO. OF
NO. NO. CODE CLASS BUILT STORIES
1 1 1721 Avenue U 0532 JM 4 1930 3
Brooklyn NY 11229-
BLDG DESC/ OCCUPANCY: Grocery Stor e
BLDG DESC/ OCCUPANCY:
BLDG DESC/OCCUPANCY:
COVERAGES PROVIDED ONSURANCEAT THEDESCRIBEDPREMISESAPPLlESONLYFORCOVERAGESFORWHICHA LIMITOF INSURANCEISSHOWN)
PREM BLDG COVERAGE LIMIT OF COVERED CAUSES OF LOSS * COINS % RATES PREMlUM
NO. NO. INSURANCE
1 1 Business Pers Prop 300, 000 Special-Incl Theft 80% . 6190 $ 1, 857
1 1Bus Inc wo/Rent w/EE 300,000 Special-InCl Theft .6000 1,800
1 1Equipment Breakdown SEE F400 110
*IF EXTRAEXPENSECOVERAGE,LIMITSON LOSSPAYMENT
I . .
DEDUCTIBLE $ 2 , 500 Exceptions: $
OPTIONAL COVERAGES (APPLICABLEONLYWHENENTRIESAREMADEIN THESCHEDULEBELOW)
AGREED VALUE REPLACEMENT COST (APPLIES ONLY IF "X" IS SHOWN BELOW)
PREM BLDG EXPIRATION COVERAGE AMOUNT BUILDING PERSONAL INCLUDING
No. NO. DATE PROPERTY "STOCK"
1 1 X
PREM BLDG INFLATION GUARD PERCENTAGE ** MONTHLY LIMff OF ** MAXIMUM PERIOD ** EXTENDED PERIOD NO. NO. BUILDING PERSONAL PROPERTY INDEMNITY (Fraction) OF INDEMNITY*** OF !NDEMNITY (Days)
1 1 1/4
" APPLIESTOBUSINESSINCOMEONLY
" * APPLIESONLYIF"X"ISSHOWNBELOW MORTGAGE HOLDER(S)
PREM BLDG MORTGAGE HOLDER NAME AND MAILING ADDRESS
LOAN NUMBER:
LOAN NUMBER:
LOAN NUMBER:
PREMIUM FOR THIS COVERAGE PART $ 3 , 767
FORMS AND ENDORSEMENTS (other than app!keb!e Forms and Endorsements shown s|sawhere in the policy) Forms and Endor::emsats applying to this Coverage Part and made part of this policy at time of issue:
APPLICABLE TO ALL COVERAGES:
Referto Schedule of Forms and Endorsements
APPLICABLE TO SPECIFIC PREMISES/ COVERAGES:
PREM No. BLDG NO. COVERAGES FORM NUMBERS
THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAM E OF THE INSURED AND THE POLICY PERIOD.
F001 (03/ 12) Includes ccpy;ighted m aterial of Insurance Services Office, Inc., with its permission.
POLICY NUMBER: NN432443 COM M ERCIAL PROPERTY CP 12 11 10 00
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BU RGLARY AND ROBBERY PROTECTIVE SAFEGUARDS
This endorsement modifies insurance provided under the following:
COMMERCIAL PROPERTY COVERAGE PART
SCHEDULE*
Premises Büildliig Property Safeguards
No. No. Symbols Applicable
1 1 BR-1
Describe any "BR-4":
*Information required to camplete this Schedule, if not shown on this endorsement, will be shown in the DecIârations.
A. The fe"Gesh:g is added to the Commercial Property c. "BR-3"
Security Service, with a recording
Conditions: system or watch clock, making hourly rounds
BURGLARY AND ROBBERY PROTECTIVE covering the entire bu!!ding, when the
SAFEGUARDS Premises are not in actual operation.
1. As a condition of this insurance, you are required d. "BR-4" The protêctive safeguard described in to maintain the protective devices and/ or services the Schedule.
listed in the Schedule above· B. The following is added to the Exclusions section of the 2. The protective safeguard(s) to which this Causes Of Loss - Special Form:
endorsement applies are identified by the following BURGLARY AND ROBBERY PROTECTIVE
eymbais: SAFEGUARDS
a. "BR-1" Automatic Burglary Alarm, protecting We will not pay for loss or damage caused by or the entire building, that signals to: resulting from theft if, prior to the theft, you:
(1) An outside central station; or 1. Knew of any suspension or impairment in any
(2) A police station. protective safeguard listed in the Schedule above
b. "BR-2" Automatic Burglary Alarm, protecting and failed to notify us of that fact; or
the entire building, that has a loud sounding 2. Failed to maintain any protective safeguard listed gong or siren on the outside of the building· in the Schedule above, and over which you had
control, in complete working order
CP 12 11 1000 Copyright, Insurance Services Office, Inc., 1999
POLICY NUMBER: NN432443 IL 09 53 01 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
EXCLUSION OF
CERTIFIEDACTS OF TERRORISM
This endorsement modifies insurance provided under the following:
BOILER AND MACHINERY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART
EQUIPMENT BREAKDOWN COVERAGE PART
FARM COVERAGE PART STANDARD PROPERTY POLICY
SCHEDULE
The Exception Cavedñÿ Certain Fire Losses (Paragraph C) applies to property located in the fG||Gveing state(s), if covered under the indicated Coverage Form, Coverage Part or Policy
State(s) Coverage Form, COvêrags Part Or Policy
New York
InfGrmation required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. The following definitism is added with respect to B. The following exclusion is added:
the provisions of this endorsement: CERTIFIED ACT OF TERRORISM EXCLUSION
"Certified act of terrorism" means an act that is We will not pay for loss or damage caused directly certified by the Secretary of the Treasury, in or indirectly by a "certified act of terrorism". Such concurrence with the Secretary of State and the loss or damage is excluded regardless of any other Attorney General of the United States, to be an act cause or event that contributes ocacurisat|y or in of terrorism pursuant to the federal Terrorism Risk
any sequence to the loss.
Insurance Act. The criteria contained in the
Terrorism Risk Insurance Act for a "certified act of C. Exception Covering Certain Fire Losses
terrorism" include the following: The following exception to the exclusion in
1. The act resulted in insured losses in excess of Paragraph B. applies only if indicated and as
$5 million in the aggregate, attributable to all indicated in the Schedüie of this endorsement.
types of insurance subject to the Terrorism If a "certified act of terrorism" results in fire, we will
Risk Insurance Act; and pay for the loss or damage caused by that fire.
2. The act is a violent act or an act that is Such coverage for fire applies only to direct loss or dangerous to human life, property or damage by fire to Covered Property. Therefore, for
infrastructure and is committed by an example, the coverage does not apply to
individual or individuals as part of an effort to insurance provided under Business Income coerce the civilian population of the United and/ or Extra Expense coverage forms or States or to influence the policy or affect the endorsements which apply to those forms, or to conduct of the United States Government by the Legal Liability Coverage Form or the Leasehold
coercion. Interest Coverage Form.
IL 09 53 01 08 Copyright ISO Properties, Inc., 2007 Page 1 of 2
If aggregate insured losses attributab|é to terrorist D. Application Of Other Exclusions
acts certified under the Terrorism Risk Insurance The terms and limitations of any terrorism Act exceed $100 billion in a Program Year (January exclusion, or the inapplicability or omission of a 1 through December 31) and we have met our terrorism exclusion, do not serve to create insurer deductible under the Terrorism Risk coverage for any loss which would otherwise be Insurance Act, we shall not be liable for the excluded under this Coverage Part or Policy, such payment of any portion of the amount of such as losses excluded by the Nuclear Hazard losses that exceeds $100 billion, and in such case Exclusion or the War And Military Action Exclusion.
insured losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of the Treasury
IL 09 53 01 08 Copyright ISO Properties, Inc., 2007 Page 2 of 2
POLICYHOLDER DISCLOSURE FOR STANDARD
FIREPOLICY STATES AND
DECLINATION
OF TERRORISM INSURANCE COVERAGE
THIS ACKNOWLEDGES THAT YOU HAVE CHOSEN TO DECLINE COVERAGE FOR ACTS OF TERRORISM, AS
DEFINED IN THE TERRORISM RISK INSURANCE ACT, AS AMENDED (THE "ACT"),
YOU SHOULD NOTE HOWEVER, IF YOUR POLICY PROVIDES COVERAGE FOR COMMERCIAL PROPERTY
AND/ OR COMMERCIAL INLAND MARINE, THERE ARE STATE STATUTORY EXCEPTIONS COVERING CERTAIN FIRE LOSSES AS IT RELATES TO COVERED PROPERTY LOCATED IN THE STATES LISTED IN THE SCHEDULE BELOW. IF AN "ACT OF TERRORISM" CERTIFIED UNDER THE ACT RESULTS IN FIRE, WE WILL PAY FOR THE LOSS OR DAMAGE CAUSED BY THAT FIRE. SUCH COVERAGE FOR FIRE APPLIES ONLY TO DIRECT LOSS OR DAMAGE BY FIRE TO COVERED PROPERTY AND IS SUBJECT TO ANY LIMITATIONS OF ANY TERRORISM EXCLUSION, OR INAPPLICABILITY OR OMISSION OF A TERRORISM EXCLUSION. THIS NOTICE DOES NOT
SERVE TO CREATE COVERAGE FOR ANY LOSS WHICH WOULD OTHERWISE BE EXCLUDED UNDER YOUR
POLICY.
State(s) New York
You are hereby notified that under the Act the definitisñ of act of terrorism has changed. As defined in Section 102(1) of the Act: The term "act of terrorism" means any act that is certified by the Secretary of the Treasury - in concurrence with the Secretary of State, and the Attorney General of the United States - to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been cGrarñitted by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. Under your coverage, any losses resulting from certified acts of terrorism may be partia:|y reimbursed by the United States Government under a formula established by the Act. However, your policy may contain other exclusions which might affect your coverage, such as an exclusion for nuclear events. Under the formula, the United States Gaverarñêñt generally reimburses 85% of covered terrorism losses exceeding the statutarily established deductible paid by the insurance company providing the coverage.
The Act contains a $100 billion cap that limits U.S. Government reimbursement as well as insurers' liability for losses resulting from certified acts of terrorism when the amount of such losses exceeds $100 billion in any one ce!endar year. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced.
THE PORTION OF YOUR PREMIUM THAT IS ATTRIBUTABLE TO COVERAGE FOR DIRECT LOSS OR DAMAGE THAT IS CAUSED BY AN "ACT OF TERRORISM" CERTlFIED UNDER THE ACT AND WHERE FIRE ENSUES IS
$ 25 , 00 , and does not include any charges for the portion of losses covered by the United States government under the Act.
Name of Insurer: NAUTILUS IN
Policy Number: NN4 324 43
E909 (O3/ 08) Includes sub,;,:.kd material of National Association of Insurance Commissioners, with its permission.
NAUTILUS INSURANCE GROUP,
Nautitus Insurance Company Great Divide Insurance Company
November 12, 2014
CERTIFIED RETURN RECEfPT REQUESTED & US MAIL -10075944
New York Adjustment Bureau, inc.
66-19 Woodhaven Blvd Rego Park NY 11374
RE: Company: Nautilus insurance Compan
Insured: New York Mart Avenue U 2 Inc.
Claim Number: 10075944
Policy Number: NN432443
Loss Location: 1721 Avenue U Brooklyn NY 11229
Date of Loss: 09/17/2014
Type of Loss: Water
Dear Lu Parello:
As per our previous letter dated October 9, 2014 our investigation regarding this loss continues. As you are aware we have retained Professional Engineer, Robert Monaco with Peter Vallas Associates, Inc., to investigate the cause of loss. Based on Mr. Monaco's initial report, it is our undêrstâñding that the water damages suffered to the interior and subsequent damages to the business personal property appear to be the result of problems with roof drainage that have allowed water to enter from the roof drains and leak into the building. There is no evidence to suggest a pipe break since no repairs were said to be made by a plumber, At this time we request your client's full cooperation to produce the following items so that we may complete our Investigation.
1. Copy of your letter of representation
2. Copy of hard contents inventory and any business personal property 3. Copy of plumber's report
4. Copy of tax returns for 2013 to 2014 and current year
5. Copy of insured's incurred invoices and receipt for improvements & betterments 6. A complete list of all tenant improvements made by the insured since occupancy 7. Copy of the lease agreement
8. Building owners name and contact information
9. Name and contact information for the adjacent store owner's 10. Any and all building inspection report
11. Access to the roof, so that Mr. Monaco may inspect the roof with the indepeñdent adjuster, the insured, the landlord and yourself
We again remind you of your client's duties under the policy and also would like to point out that we will not pay for foss or damage to personal property in the building caused by or resulting from rain unless the building or structure first sustain damage by a covered cause of loss.
Please refer to the policy form CP0010 (04/02) entitled "BUILDING AND PERSONAL PROPERTY COVERAGE FORM"
7233 East Butherus Drive ScMsd ale, Arizona 85260 Phone 800.842.8972 480.951.0905 Fax 480.951.9730 A BERKLEY COMPANYë
NEW YORK INC.
10075944
November 12, 2014 Page 2 of 4
E. Loss Conditions
The following conditions apply in addition to the Common Policy Conditions and the Commercial Property Conditions.
3. Duties In The Event Of Loss Or Damage
a. You must see that the foi|üwiñÿ are done in the event of loss or damage to Covered Property:
(1) Notify the police if a law may have been broken.
(2) Give us prompt notice of the loss or damage. include a description of the property involved.
(3) As soon as possible, give us a description of how, when and where the toss or damage occurred, (4) Take all reasonable steps to protect the Covered Property from further damage, and keep a record
of your expenses necessary to protect the Covered Property, for consideration in the sett|êmsat of the claim. This will not increase the Limit of Insurance. However, we will not pay for any subsequent loss or damage resulting from a cause of loss that is not a Covered Cause of Loss.
Also, if feasible, set the damaged property aside and in the best possible order for examination.
(5) At our request, give us complete inventories of the damaged and undamaged property. Include quantities, costs, values and amount of loss claimed.
(6) As often as may be reasonably required, permit us to inspect the property proving the loss or damage and examine your books and records.
Also permit us to take samples of damaged and undamaged property for inspection, testing and analysis, and permit us to make copies from your books and records.
(7) Send us a signed, sworn proof of loss containing the information we request to investigate the claim. You must do this within 60 days after our request. We will supply you with the necessary forms.
(8) Cooperate with us in the investigation or settlement of the claim.
b. We may examine any insured under oath, while not in the presence of any other insured and at such times as may be reasonably required, about any matter relating to this insurance or the claim, including an insured's book and records. in the event of an examination, an insured's answers must be singed.
We also refer you to the policy form CP1030 (04/02) entitled CAUSES OF LOSS - SPECIAL FORM, which reads in part as follows:
CAUSES OF LOSS - SPECIAL FORM
A. Covered Causes Of Loss
When Special is shown in the Declaraticñs, Covered Causes of Loss means Risks Of Direct Physical Loss unless the loss is:
1. Excluded in Section B., Exclusions; or 2. Limited in Section C., Limitations;
that follow.
B. Exclusions
2. We will not pay for loss or damage caused by or resulting from any of the following:
d.(1) Wear and tear;
NEW YORK MART AVENUE U 2ND INC.
10075944
November 12, 2014 Page3 of 4
(2) Rust or other corrosion, decay, deterioration, hidden or latent defect or any quality in property that causes it to damage or destroy itself;
f. Continuous or repeated seepage or leakage of water, or the presence or ccñdeñsation of humidity, moisture or vapor, that occurs over a period of 14 days or more.
3. We will not pay for loss or damage caused by or resulting from any of the following, 3.a. through 3.c. But if an avcluded cause of loss that is listed in 3-a. through 3.e. results in a Covered Cause of Loss, we will pay for the loss or damage caused by that Covered Cause of Loss.
c. Faulty, inadequate or defective:
(1) Planning, zoning, development, surveying, siting;
(2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, compaction; .
(3) Matêrials used in repair, construction, renovation or remodeling; or (4) Maintenance;
of part or all of any property on or off the described premis .
C. Limitations
The following limitations apply to all policy forms and endorseraéñts, unless otherwise stated.
1. We will not pay for loss of or damage to prõperty, as described and limited in this section. In addition, we will not pay for any loss that is a consequence of loss or damage as described and limited in this section.
c. The interior of any building or structure, or to personal property in the building or structure, caused by or resulting from rain, snow, sleet, ice, sand or dust, whether driven by wind or not, unless:
(1) The building or structure first sustains damage by a Covered Cause of Loss to its roof or walls through which the rain, snow, sleet, ice, sand or dust enters; or
(2) The loss or damage is caused by or results from thawing of snow, sleet or ice on the building or structure.
Neut!!us Insurance Company, by this letter and by its initial notice and iñvastigation, does not waive nor invalidate any of the other terms, conditions or exclusions of this policy. We specifically reserve the right to exercise any of the other terms, conditions or exclusions of this policy that now exist or may later become apparent. Nautilus Insurance Corñpany also sp=3!fice!ly reserves the right to bring an action to declare the ob!igations and respGñé|bi|?ües of the parties hereto under the contract of insurance in question, at any time after the date of this letter.
If you have questions rEgarding this matter, please call me at 1-800-842-8972 ext. 4096. Thank you.
Sincerely,
Nautilus Insurance Company
Bryant Wilcox Litigation Specialist Direct Fax: 480-281-0808 Email: bwilcox@nautilus-ins.com
10075944
November 12, 2014 Page 4 of 4
cc: 3110 - 2 JIMCOR AGENCY, INC.
NEW YORK MART AVENUE U 2ND INC.
1721 AVENUE U
BROOKLYN NY 11229-0000
United Aline Co 103 Cuttermill Rd Great Neck NY 11021