Page 271 - TRG AIA-305 Prequalification Statement

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Client#: 1515855 RINALGRO
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
ACORDTM 8/16/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT DJ Hardisty
NAME:
USI Insurance Services PHONE FAX
(A/C, No): 610 537-4220
(A/C, No, Ext): 914 459-6200
333 Westchester Ave, Suite 102 E-MAIL
ADDRESS: [email protected]
White Plains, NY 10604
INSURER(S) AFFORDING COVERAGE NAIC #
914 459-6200
INSURER A : United Specialty Insurance Company 12537
INSURED INSURER B : State National Insurance Company, Inc. 12831
BSD 685 New York PropCo LLC
INSURER C : Endurance American Insurance Co. 10641
c/o SHVO
INSURER D : Navigators Insurance Company 42307
745 Fifth Avenue
INSURER E : Argonaut Insurance Company 19801
New York, NY 10151
INSURER F : Westfield Specialty Insurance Company 24120
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY PSS2201516 01/27/2022 01/27/2025 EACH OCCURRENCE $2,000,000
CLAIMS-MADE X OCCUR DAMAGE TO RENTED $50,000
PREMISES (Ea occurrence)
MED EXP (Any one person) $5,000
PERSONAL & ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000
PRO-
X POLICY JECT LOC PRODUCTS - COMP/OP AGG $4,000,000
OTHER: $
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
(Ea accident) $
ANY AUTO BODILY INJURY (Per person) $
OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
$
B UMBRELLA LIAB X OCCUR AVM2200241 01/27/2022 01/27/2025 EACH OCCURRENCE $3,000,000
C X EXCESS LIAB CLAIMS-MADE EXC30015560800 01/27/2022 01/27/2025 AGGREGATE $3,000,000
D DED RETENTION $ NY18EXC941349IV 01/27/2022 01/27/2025 $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS' LIABILITY Y / N STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

** Excess Liability Information **

C EXC30015560800 Eff Date: 01/27/2022 Exp Date: 01/27/2025
Excess Liability Each Occ Limit: $5,000,000
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
New York City Department of
Buildings ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Licensing Unit
280 Broadway, 1st Floor AUTHORIZED REPRESENTATIVE
New York, NY 10007

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