FILED: NEW YORK COUNTY CLERK 10/21/ :13 PM INDEX NO /2015 NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 10/21/2016. Exhibit A
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1 FILED: NEW YORK COUNTY CLERK 10/21/ :13 PM INDE NO /2015 NYSCEF DOC. NO. 18 RECEIVED NYSCEF: 10/21/2016 Exhibit
2 COMMERCIL GENERL LIBILITY CLIMS-MDE GEN'L GGREGTE LIMIT PPLIES PER: PRO- POLICY JECT LOC UTOMOBILE LIBILITY NY UTO LL OWNED UTOS SCHEDULED UTOS HIRED UTOS NON-OWNED UTOS UMBRELL LIB ECESS LIB DEDUCTIBLE CERTIFICTE OF LIBILITY INSURNCE OCCUR CLIMS-MDE RETENTION WORKERS COMPENSTION ND EMPLOYERS' LIBILITY Y / N NY PROPRIETOR/PRTNER/EECUTIVE OFFICER/MEMBER ECLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERTIONS below DESCRIPTION OF OPERTIONS / LOCTIONS / VEHICLES (ttach CORD 101, dditional Remarks Schedule, if more space is required) ECH OCCURRENCE DMGE TO RENTED PREMISES (Ea occurrence) MED EP (ny one person) PERSONL & DV INJURY GENERL GGREGTE PRODUCTS - COMP/OP GG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DMGE (Per accident) GGREGTE WC STTU- TORY LIMITS E.L. ECH CCIDENT OTH- ER E.L. DISESE - E EMPLOYEE E.L. DISESE - POLICY LIMIT DTE THIS CERTIFICTE IS ISSUED S MTTER OF INFORMTION ONLY ND CONFERS NO RIGHTS UPON THE CERTIFICTE HOLDER. THIS CERTIFICTE DOES NOT FFIRMTIVELY OR NEGTIVELY MEND, ETEND OR LTER THE COVERGE FFORDED BY THE POLICIES BELOW. THIS CERTIFICTE OF INSURNCE DOES NOT CONSTITUTE CONTRCT BETWEEN THE ISSUING INSURER(S), UTHORIZED REPRESENTTIVE OR PRODUCER, ND THE CERTIFICTE HOLDER. IMPORTNT: If the certificate holder is an DDITIONL INSURED, the policy(ies) must be endorsed. If SUBROGTION IS WIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTCT Caren Malthaner PRODUCER C&H GENCY 783 Riverview Drive P.O. Box 324 Totowa NJ INSURED Mistral rchitectural Metal & Glass Inc th Street Woodside NY COVERGES CERTIFICTE NUMBER: GL,U, WC REVISIONNUMBER: THIS IS TO CERTIFY THT THE POLICIES OF INSURNCE LISTED BELOW HVE BEEN ISSUED TO THE INSURED NMED BOVE FOR THE POLICY PERIOD INDICTED. NOTWITHSTNDING NY REQUIREMENT, TERM OR CONDITION OF NY CONTRCT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICTE MY BE ISSUED OR MY PERTIN, THE INSURNCE FFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO LL THE TERMS, ECLUSIONS ND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MY HVE BEEN REDUCED BY PID CLIMS. INSR DDL SUBR LTR TYPE OF INSURNCE INSR WVD POLICY NUMBER POLICY EFF POLICY EP LIMITS GENERL LIBILITY Contractual Liability N / NME: PHONE F (/C, No, Ext): (973) (/C, No): (973) E-MIL DDRESS: cmalthaner@chagency.com PRODUCER CUSTOMER ID #: INSURER : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : /20/2014 9/24/2015 INSURER(S) FFORDING COVERGE 2/9/2015 NIC # Starr Indemnity & Liability Co m. Guarantee & Liability Ins ,000, , ,000 2,000,000 4,000,000 4,000,000 OCCUR /20/2014 9/24/2015 ECH OCCURRENCE 4,000,000 4,000, /24/2014 9/24/2015 B Excess Liability EC /20/2014 9/24/2015 Each Occurrence: 4,000,000. 2nd Layer ggregate: 4,000,000. Re: 499 Park venue, New York, NY - Lobby Renovations. See attached for dditional Insureds.. CERTIFICTE HOLDER CNCELLTION SVF Park New York, LLC C/O Hines Interests Limited Partnership 499 Par venue New York, NY CORD 25 (2009/09) INS025 (200909) SHOULD NY OF THE BOVE DESCRIBED POLICIES BE CNCELLED BEFORE THE EPIRTION DTE THEREOF, NOTICE WILL BE DELIVERED IN CCORDNCE WITH THE POLICY PROVISIONS. UTHORIZED REPRESENTTIVE Robert Culnen/EDN CORD CORPORTION. ll rights reserved. The CORD name and logo are registeredmarks of CORD
3 COMMENTS/REMRKS The following are included as dditional Insureds with respect to this project, per dditional Insured Endorsements CG2010 and CG2037 attached, but only if required by written and signed contract:. Clune Construction Company LP. B. SVF Park New York, LLC. C. merican Realty dvisors. D. Hines Interests Limited partnership. E. Gardiner & Theobald, Inc. This insurance is Primary and Non-Contributory, per policy form. Waiver of Subrogation applies, per policy form. OFREMRK COPYRIGHT 2000, MS SERVICES INC.
4 POLICY NUMBER: COMMERCIL GENERL LIBILITY CG THIS ENDORSEMENT CHNGES THE POLICY. PLESE RED IT CREFULLY. DDITIONL INSURED OWNERS, LESSEES OR CONTRCTORS SCHEDULED PERSON OR ORGNIZTION This endorsement modifies insurance provided under the following: COMMERCIL GENERL LIBILITY COVERGE PRT SCHEDULE Name Of dditional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations.. Section II Who Is n Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. ll work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG ISO Properties, Inc., 2004 Page 1 of 1
5 POLICY NUMBER: COMMERCIL GENERL LIBILITY CG THIS ENDORSEMENT CHNGES THE POLICY. PLESE RED IT CREFULLY. DDITIONL INSURED OWNERS, LESSEES OR CONTRCTORS COMPLETED OPERTIONS This endorsement modifies insurance provided under the following: COMMERCIL GENERL LIBILITY COVERGE PRT SCHEDULE Name Of dditional Insured Person(s) Or Organization(s): Location nd Description Of Completed Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II Who Is n Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "productscompleted operations hazard". CG ISO Properties, Inc., 2004 Page 1 of 1
6 CLIMS-MDE GEN'L GGREGTE LIMIT PPLIES PER: PRO- POLICY JECT LOC UTOMOBILE LIBILITY UMBRELL LIB ECESS LIB CERTIFICTE OF LIBILITY INSURNCE OCCUR OCCUR CLIMS-MDE MED EP (ny one person) PERSONL & DV INJURY GENERL GGREGTE PRODUCTS - COMP/OP GG ECH OCCURRENCE GGREGTE DTE THIS CERTIFICTE IS ISSUED S MTTER OF INFORMTION ONLY ND CONFERS NO RIGHTS UPON THE CERTIFICTE HOLDER. THIS CERTIFICTE DOES NOT FFIRMTIVELY OR NEGTIVELY MEND, ETEND OR LTER THE COVERGE FFORDED BY THE POLICIES BELOW. THIS CERTIFICTE OF INSURNCE DOES NOT CONSTITUTE CONTRCT BETWEEN THE ISSUING INSURER(S), UTHORIZED REPRESENTTIVE OR PRODUCER, ND THE CERTIFICTE HOLDER. IMPORTNT: If the certificate holder is an DDITIONL INSURED, the policy(ies) must be endorsed. If SUBROGTION IS WIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ljay Insurance Brokerage Ltd 5 Shaker Ridge Lane P.O. Box 644 Commack NY INSURED MISTRL RCHITECTURL METL TH STREET WOODSIDE NY INSURER F : COVERGES CERTIFICTE NUMBER: CL REVISIONNUMBER: THIS IS TO CERTIFY THT THE POLICIES OF INSURNCE LISTED BELOW HVE BEEN ISSUED TO THE INSURED NMED BOVE FOR THE POLICY PERIOD INDICTED. NOTWITHSTNDING NY REQUIREMENT, TERM OR CONDITION OF NY CONTRCT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICTE MY BE ISSUED OR MY PERTIN, THE INSURNCE FFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO LL THE TERMS, ECLUSIONS ND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MY HVE BEEN REDUCED BY PID CLIMS. INSR DDL SUBR LTR TYPE OF INSURNCE INSR WVD POLICY NUMBER POLICY EFF POLICY EP LIMITS GENERL LIBILITY ECH OCCURRENCE DMGE TO RENTED COMMERCIL GENERL LIBILITY PREMISES (Ea occurrence) NY UTO LL OWNED UTOS HIRED UTOS SCHEDULED UTOS NON-OWNED UTOS Y DED RETENTION WORKERS COMPENSTION ND EMPLOYERS' LIBILITY Y / N NY PROPRIETOR/PRTNER/EECUTIVE OFFICER/MEMBER ECLUDED? N / (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERTIONS below CONTCT NME: PHONE F (/C, No, Ext): (631) (/C, No): (631) E-MIL DDRESS: greer@aljayinsurance.com INSURER : INSURER B : INSURER C : INSURER D : INSURER E : Greer Florea 12UECPM7756 9/11/2014 9/11/2015 INSURER(S) FFORDING COVERGE COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DMGE (Per accident) WC STTU- TORY LIMITS E.L. ECH CCIDENT OTH- ER E.L. DISESE - E EMPLOYEE E.L. DISESE - POLICY LIMIT 2/9/2015 NIC # Sentinel TERR DESCRIPTION OF OPERTIONS / LOCTIONS / VEHICLES (ttach CORD 101, dditional Remarks Schedule, if more space is required) The following shall be listed as additional insureds. Clune Construction Company LP. B. SVF Park New York, LLC. C. merican Realty dvisors. D. Hines Interests Limited partnership. E. Gardiner & Theobald, Inc. CERTIFICTE HOLDER CNCELLTION SVF Park New York, LLC C/o Hines Interests Limited Partnership 499 Park venue New York, NY CORD 25 (2010/05) INS025 (201005).01 SHOULD NY OF THE BOVE DESCRIBED POLICIES BE CNCELLED BEFORE THE EPIRTION DTE THEREOF, NOTICE WILL BE DELIVERED IN CCORDNCE WITH THE POLICY PROVISIONS. UTHORIZED REPRESENTTIVE Greer Florea/GFLORE CORD CORPORTION. ll rights reserved. The CORD name and logo are registeredmarks of CORD
7 DDITIONL COVERGES Medical payments MEDPM 5,000 PIP-Basic PIP 200 Uninsured motorist combined single limit UMCSL OFDTLCV Copyright 2001, MS Services, Inc.
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