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~1-302 (Rev.

10-6-95)

FEDERAL BUREAU ~: ~STIGATION
DATE 07-30-2010 EY UC60322LP/PLJ/CC ALL HJFOP1!ATIOIiI IS CmITAHIED EXCEPT

~~t~LE1
Date of transcription

CLASSIFIED

HEREIN

1:nJCLASSIFIED

REASOI,J: 1.4 c DECLASSIFY OIoJ: 07-30-2035

loJHEF:E SHm,rN

OTHERWISE

09/15/2001

SSN: I NJ, home telephone was interviewed at his buslness DEBELLIS INSURANCE INC. (DIA), 492 Franklin Avenue Nutle NJ 071r1~0~. __ ~A=l=s~o~,

durin the interview were

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After the identity of the intervlewlng agent and the nature of the interview was made known, I folunteered the following information: (u ~~-----------I company

L......."......,....._-_,_I.:=.i:::;.s-t.::;.:h:.:.;e:::..,L..1 ~ ..,....-_----Ilof The DIA. was started byl lin 1967·C~)
and
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I lis ~hel lof .... I-------.... ......... at D IA on occ as 1on . =--~ __ ----II a fr iend h~e-=l"""p:.=s h=_=i"'4m out is IL.......II and does not work for DIA. ( t4) MOVING In June of 2001, a telemarketer COMPANY fUMC) to solicit businesT.

I Iwas unable to meet in person so he spoke with LNU on ~ t~ telephone and wrote UMC a Commercial Auto Policy for elr vehicles. I Iconduqted all t~e busin~ss with UMC via telephone and facsimile. jnever went to the offices of ~~ UMC. UMe is a household furnishings moving company.(u)

a:Dointment for.

Ito meet with a.

from DIA contacted URBAN The telemarketer made an

ILNU on 0t:J01.

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recently received a check from UMC for their insurance. The check was drawn on account from CHASE MANHATTAN BANK. The check number was 8466 of $3,463.37. I I provided a copy of the check all the documents in their files relating to UMC.(k)

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as payment in the amount and a copy of
1036500845365,

I Iremembered one male from UMC coming to DIA to pick up some driver's licenses of drivers for UMC. I Idid not know the name of the individual. nor could he remember a physical description.~)

Investigation b7A

on

09/14/2001

at

Nutley,

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This document contains neither recommendations nor conclusions it and its contents are not to be distributed outside your agency.

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of the FBI.

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It is the property of the FBI and is loaned to your agency;

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FDi02a

(Rev. 10-6-95)

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Continuation ofFD-302 of

-~----------------------~~--~--~--

,On

09/14/2001

,Page

2

_

The writer showed I five males: ~------~

photo array of the following

I
1

Photograph number 1r----------, DOB: L..-I__ ----I

I

Photograph number 2 1 DOB: Photograph ~mber 3 _j DOB: ...... 1 __ Photograph number I I DOB: L..-

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----'

----I

did not recognize anyone from the photographs or their nam~e-s-.--~N~o~t~e: I Ipaused for quite some time while looking at photograph number 3.)C~) After looking at the photographs, 1 1 asked the interviewing agent if eViryone at UMC was Israeli. The intervie~ing agent asked I why he would ask such a question. I I responded that he.also carries the insurance policy for MOISHES MOVING COMPANY located near the entrance of the Hoboken Tunnel. DIA has had the insurance for MOISHES for approximately one year.(") ~ ~Iexplained that the movers at MOISHES are all subcontractors. There are approximately 6 to 12 at any given time. I I stated DIA carries separate insurance policies on each subcontractor's business. The subcontractors are all young individuals from Israel just out of the military. I I stated he knows this becallse the subcontractors talk openty about thelr experiences. also stated the subcontractors seemed to be all hard working nice individuals. (~)

I

I

I Ihas met all the subcontractors and employees of MOISHES and knows them by sight. The subcontractors regularly come into DIA's office to make payments and drop off any necessary insurance documents. C~)

FDy02a

(Rev. 10.6.95)

Continuation ofFD·302 of

!


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All documents provided by DIA will be maintained in a 1A with the case file. This report relates to NK1765.(~)

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URBAN MOVING SYSTEMS; INC• . ' ..:,
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DEBELLIS 492

INS

AGENCY, AVE. 07110 NJ

INC.

FRANKLIN 973-661-1500

NUTLEY, FAX

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973-661-9750
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FACSIMILE

TRANSMITTAL
FROM:

SH'EET b6

COMPANY:

DATE:

Urban Moving .
FAX NUMBER:

09/07/01
TOTAL NO. OF PAGES INCLUDING COVER:

JO 1- 55% - Ot;).IS
NUMBER:

02
SENDER'S REFERENCE NUMBER: YOUR REFERENCE NUMBER:

PHONE

RE:

NOTES/COMMENTS:

Please sign and return the enclosed form to my office naming me as your agent on the worker's compensation renewal. There will be no difference in premium. I will service this policy in coiljunction with your commercial auto.

If there are any questions please contact me.
Sincerely,

Rece~veo:

1/11/01

4:25PM;...

201 662 9434

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9434

, INSURANCE OFFICE .'DEBELLIS

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ACORD.. AGENT/BROKER OF RECORD CHANGE
PRODUCER

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DATE

INSURANCE

COMPANY NAME

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Pleasebe advised that we wish to name
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DATE

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for the lines of business shown above, currently in force or submitted . by application.
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This authorization replaces any other authorization that may have been previously completed for any other insurance representative for the stated lines of business. _rg(Pleaserescind the

o There will be no rescission letter
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IN5UAED'S.5IGNATURE

day waiting period

60

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DATE

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OF APPuCABLE)

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ACORD 36 (1I9a)

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DeBELLIS INSURANCE

AGENCY, INC.
",

492 FRANKLIN"AVENUE, NUILEY, NEW JERSEY 07110 • Tel: (973) 661-1500 • Fax. (973) 661-9750

July 09, 2001

Urban Moving 3 18th St. Weehawken, NJ

Attn:L-1 _----I Re: Insurance Proposal

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DearD We spoke several weeks ago and I advised you that my firm would like an opportunity to quote the insurance coverage for your moving company. I advised you at that time that my office presently works with other moving firms both small and large. The info"rmation I will need to obtain is as follows: of Policies (Auto, Cargo, Warehouseman Liability, Commercial Package, Worker's Compensation, Commercial Umbrella) 2. Schedule of Vehicles (to include - year, make, model, VIN number, cost new, GWV) . 3. Schedule of drivers (name & license number) 4. Three years of loss runs from your current/prior carriers If there are any questions please feel free to contact me.

1. Copies

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IFPf..· ~-REMI~_!JAY~eHT
have the right to receive ~ an itemlzallon of the Amount
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F:'LAN ._..
at this time ]. Financed.
llam~ion

_fREMl.UM_fJ~CE.AGREEMENI...AND...DISCLOSURS.SIAte.MeNL
Rolley Designation (Check One) ~ 2.."I'ype of Agreement (Check One) ~ 3. Preferred Billing Method (Check One)

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Inforce Monthly ~m.entJI

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LOAN AGREEMENT

QUOTE NO.

Cash Down Payment Required

$

Amount Financed

credll provided to me or on my behalf)

(The Amount of

'--"'-1-$_... 1980

_.t::_..

DEBELLIS AGENCY 492'FAANKUN A\JE NUTLEY, NJ 07110

Phone No:

Fax No:
: 16.00

ANNUAL PERCENTAGE RATE
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R
61 ....

%

PLAN
Pili 6' .... lI-I71. • .

~ Hut1ton CI\Y Cllntre • Corner of GrGOn & HUdson, NY 121134

st.t. St.

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~p~;t .... I mDy"pt'epay-lIuI full ~_tdU9 u~·~·Ag;;;;;.,nt.lf I uta Paymant A lale ci,-;g;"Will bo Impoaod ~~ anylnstanmentWnlch' de eo, Itlere i~ EInon-rofundable lIerviOO charge 01 $10 In CT. NY, PA: S12 in NJ:not made Within fiYIl (5) daytI of the eue daiPJ (10 days;NJ. IN, nt;'and MS). $1$11'1RI ond K't'i $20 in MD; A%. $16 maximum In TN; $30 non·",fundable fae 11Iis IAle chlll-ge Vlill be 5% 01 tho paymClnt. The lale elIB!'QtI will b!i.a· Inc;lu~d in tlnllnc$ elIllI'gll In IN. No lllfund of une~mad inlorost will be mllde if minimum or one dollar ($1.00) ($2 in TN). See back of (aim for maximum late \hlt 81noUnt refundable Is IlllIs than one dollar ($1 In NV, NJ, MD) and three charga by lltate. dollars ($3 III CT, PA, RI), or ma><imum IlIIQW8d by stst-o. 8oc;urif¥ IntArMt AI Illecurity for the paymenb to be made, I am auignlng Contract ~r.nclI RefoNlnce should be made to: the terms of this II) you all unellml'!CI prsmlume under the Policies. aI'od alllot& payments Agreement aa slated below and on the next page foi infonnetlon !.Ibolll wttlth raduce thll uneamed p[$mlumll, ThIll mellO.that thl& monay can be nonpayment, dar"ull, the right to accelerola, the matu~ty or th~ """1~""'''''. u~d to pay IImcunI$ due under this agraeme,!l. and rebates, and

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BINDER

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(CONTINUED ON REVeRSE SIDE) The innurod under&land$lInd agI'M9 !hilt Ihtl provisIons en the reve~ rNoTlce~. this Agreem&nibiifiiiiiYii'ii"ieadltorii' it TO . any _!!lank ~~. ,,~. . __ ."_.

in thl& Agreement, il meanl PREMIUM PAYMeNT PLAN (PPP). lM'lenever!be WOrd "I" (or) "me" Is used In this Aglreel:Jtett.;.;:;:;-;.::::::;;::;-:1---"c;;..--· It means lhe InBured undersigned. 36920 00 1. Payments. In conslderaUOfI of thf.l premium paymenbllo be made by you 10 the above Ir'll~U1ancecompany(les). I promi&e to pay you aa stated abolle In the "Payment Schedule." IF I do not mllke 3ny payments \Ioithll'l five (Ii) days of \he date the paY.ment Is due, 1"";11 a pey I:hwge a~ ata!ed ebcve. : 2. TaM. & FHS. , understand the fcllawing: . (a) If the", 10an amount In the "Tallli!l & Fee," c:olumn In thl! Schedule of PoUciel! listed above, Ihls fee Is clmrged under Section 21 1~ of Ihe New Yodc.lnsura Law (NY Slatl only) 0( the law, If !lny, of the slale in which IIiVIt. This rea 1&charged fat obtaining and !llIrvidng the Polley and !aXIIS r(liated lI1er&to. (b) A fee of S wtJlch II not being IInanced. hag been clI8rved under the p(OVfslal'l!l of 1t1es& laws. " none hall been charged.. Ihe word -notIe"ls sno

lhOSe IhlngSiiBt8ci tibOWT':'

the

S~;Qi"PojjCi;;-wr,enever

i5OiiOt:,1gn

contain,

.. : $Ide heNlOf are Ineorporated by roferanee and con~lilute CIpart:of this AQrBllmenl, Underiiiii law, ~~t y 10 pay oW in aciVanc;fh'a"fuii8~;OUiiiiU&~ .' _and u~c1er·ce~~itl~.~.!_n~~d:af the linsm:e charga ".

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DEBELLIS

INSURANCE . 492 FRANKLIN
NJ 973-661-1500 NUTLEY,

AGENCY, AVE.
07110

INC

.

FAX

973-661-9750

'.
FACSIMILE
TO:

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SHEET

TRANSMITTAL
FROM:

.----

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1---------. 08/01/01

b6

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COMPANY: DATE:

Urban Moving Systems
FAX NUMBER:

TOTAL NO. OF PAGES INCLUDING

COVER:

PHONE NUMBER:

SENDER'S

REFERENCE

NUMBER:

RE:

YOUR REFERENCE

NUMBER:

COMI'vfERCIALAUTO QUOTATION - REVISED

NOTES/COMMENTS:

Per our conversation today please be advised I have obtained the following quotation on your commercial autos: Liability Limit $1,000,000 Comprehensive & Collision Deductible $1,000. Total Annual Premium = $38,920 De.posit Required to Bind = $9,730 (the balance of the premium can be financed on 9 monthly installments). Please make check payable to DEBELLIS AGENCY. This indication is based on 6 units with total values of $237,995. If there are any questions please contact my office.

SincerelY.,.

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PPP - PREMIUM You have the right to receive at this time an itemization of the Amount Financed.

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I wantanitemization Idonotwantanitemization ~

Policy Designation (Check One) r&l Commercial 0 Personal 2. Type of Agreement (Check One) I]) New 0 APC 0 Renewal 3. Preferred Billing Method (Check One) K: Coupon Book

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Inforce Monthly Statement

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Total Premiums

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$

389201°0

,
INSURED/BORROWER (Name, Address and Telephone Number) URBAN MOVING SYSTEMS INC 3 18TH STREET " WEEHAWKEN, NJ 07087 IACCT. NO.

.~
B Cash Down Payment Required

$

9730

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Amount Financed (The Amount of credit provided to me or on my behalf)

$

29190 °0 1

Pm Phone No: AGENT

AM Phone No: (Name and Business

or BROKER

D

(Dollar amount credit will cost me)

FINANCE CHARGE

$

1980 133

DEBELLIS AGENCY 492 FRANKLIN AVE NUTLEY, NJ 07110

r.nt.. INFORMATION
~IS~S~.1...c.

CONTA' 'NED

D.ATE.1I-~«"

__13Y

J.=::':
Type of I nsurance BA BINDER

E

Total of Payments (Amount I will have. paid after making all schedule~ payments)

Phone

No:

Fax No:

'$

3117°133

ANNUAL PERCENTAGE

RATE

(Cost of my credit figured as a yearly rate) Amount of Each Payment 3463.37

16.00

0/0

~ Hudson City C~ntre " Corner of Green & State st. Hudson, NY 12534 R 518-822-1000· Fax 518-82B-5729 Prepayment I may prepay the full amount due under this Agreement If I Late Payment A late charge will be imposed on any installment which i do so, there is a non-refundable service charge'of $10 in CT, NY, PA; $12 in NJ; not made within five (5) days of the due date (10 days NJ, IN, TN, and MS). $15 in RI and KY; $20 in MD; 4% - $15 maximum in TN; $30 non-refundable fee This late charge will be 5% of the payment. The late charge will be a included in finance charge in IN. No refund of unearned interest will be made if minimum of one dollar ($1.00) ($2 in TN). See back of form for maximum late the amount refundable is less than one dollar ($1 in NY, NJ, MD) and three charge by state. dollars ($3 in CT, PA, RI), or maximum allowed~y state. Security Interest As a security for the payments to be made, I am aSSigning Contract Reference Reference should be made to the terms of this to you ali"uneamed premiums under the Policies, and all loss payments Agreement as stated below and on the next page for information about which reduce the uneamed premiums. This means that this money can be nonpayment, default, the right to accelerate, the maturity of this obligation, used to pay amounts due under this agreement. and prepayment, rebates, and penalties Full Name of Insurance Company and_. New (N) (N) ~eLf... Effective Date Name and address of General Agent or or Renewal (R) or COy. by Company Office to Which Premium is Paid Policy -> (R) Prem. Mo. Day Yr. EMPIREINSI

Payment Schedule Number of Payments Payable 1st Final Monthl Annual I Quarterl~ PavmentD e PavmentD 9 09/05/01 05/05/02 1 1

• SCHEDULE OFPOLtCIES: ersonal P Auto- BI (BodilyInjul}l)- PO(PropertyDamage)- HO<Homeowners)F (Fire)- ML (Multiline)- MC (Motorcycle) BOP(BusinessOwners) Policy Number .. and Prefix Policy Premiums 38920 00

N 12

08

06

01

Taxes 00 Wherever the word "Policy" is used, it means those things listed above in the Schedule of Policies. Whenever "you" is use Fees 0 00 in this Agreement, it means PREMIUM PAYMENT PLAN (PPP). Whenever the word "I" (or) "me" is used in this Agreemerlt-'[O-t-al-p-re-m-iu-m-s-l----=----!-=-.:.....j it means the insured undersigned. 38920 00 1. Payments. In consideration of the premium payments to be made by you to the above insurance company(ies). L<:_R_ec_o_rd_ln_'A:..:,1__, -'---' I promise to pay you as stated above in the "Payment Schedule." If I do not make any payments within five (5) days of the date the payment is due, I will pay a charge as stated above. 2. Taxes & Fees. I understand the following: (a) If there is an amount in the "Taxes & Fees" column in the Schedule of Policies listed above, this fee is charged under Section 2119 of the New York Insura Law (NY State only) or the law, if any, of the state in which I live. This fee is charged for obtaining and servicing the Policy and taxes related thereto. (b) A fee of $ , which is not being financed, has been charged under the provisions of these laws. If none has been charged, the word "none" is sho (CONTINUED ON REVERSE SIDE) . The insured understands and agrees that the provisions on the reverse side hereof are incorporated by reference and constitute a part of this Agreement. NOTICE 1. Do not sign this Agreement before you read it or if it bins 3. Under the law. you have a right to payoff in advance the full amount due TO any blank space. and under certain conditions to obtain a partial refund of the finance charge. INSURED 2. You are entitled to a completely filled in copy of this Agreement. 4. Keep your copy of this Agreement to protect your legal rights. All Insureds mustsignasnamedin policies.If corporation, uthorized a officersmustsign;if partnership, artnershouldsignas such;signatolY p actingIn representative's capacity represents thataUInsureds haveauthodzed thistransact_io_n_. ------,=-~_:__-:---;-~-:-_=-.-:_::_:_:=_-;-rt:'":-;;-:::_:_=:_;_::=:_::_::=:=-=~------, ~ The Undersignet""............. .w&:.III:::5IlI.I:=~=..!lI.Ii:~il::jnts onthe reverseside.
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&J "'nTI~'-F-tJ-E'X-T-P-A-G-E-F-O-R-IM-P-O-R-:::TA~N:-:-:T-:I-::N=FO-:R::MA::7: :::-:
~ (Slgnalure of Insur.d)

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From:

URBAN MOVING SYSTEMac 3 18TH STREET • WEEHAWKEN, NJ 07087


L

i
Place stamp here

Attn: Process Immediately' PREMIUM PAYMENT PLAN HUDSON CITY CENTRE CORNER OF STATE & GREEN STREETS P.O. BOX 668 HUDSON, NEW YORK 12534-0668

'.

(Fold with the above facing out for mailing)

Premium Payment Plan PO Box 668, Hudson, New York 12534-0668 Dear Insured: Welcome! It can take over a week to receive your payment coupon book. This is your first payment coupon. To avoid late charges, your payment must be received by PPP on or before the due date. Payment to your agent or broker does not eliminate the late charge. MAIL EARLY!! The easy way to get and keep your needed insurance coverage, finance your policies with Premium Payment Plan, easy and flexible payment schedules with low down payments to help you afford the best protection available. Why should you deal with multiple bills for each insurance company? Ftnance all your insurance and pay only one bill each month. PPP is here to serve you through the best professional independent insurance agents and brokers in the country.

Call us at PPP if you have any questions

(518)822-1000

(For mailing, fold-up the below section -place check in the fold - tape or staple all 4 sides)

FIRST PAYMENT COUPON:
Policies BINDER Insurance Co General Agent New/Renew Term Effective Date Premiums

B
B

08/06/01 08/06/01 08/06/01
Taxes Fees TOTAL Make check payable to Premium Payment Plan. Include check- fO.ld, staple, mall

3892000

38920 00

Insured's Name: Address:

URBAN MOVING SYSTEMS INC 318TH STREET WEEHAWKEN, NJ 07087
Agent/Code:

Due: Amt Due:

09105/01 3463.37

DEBELLIS AGENCYI

Premium Payment Plan * PO Box 668, Hudson, NY, 12534 "Tel. 518-822-1000

Sa-HI-in

bUG. 10. 200i

93-:!96

uv,

11./1

' • .J

"

---------------+--------------------+--------------------+ Vehicle Type ; !'ruck.:13 . : Truck
'l'errito.y
!'iab Factor Phy Oam Pactor

Vehicle

--------~------+----~---------------+--~----~------------+ ~ 2000 GMe "an
: l~99 Inc8rnaciona~ :
:

Class Code

Cost: New

Age Group Coverage

--------------~T-----------: Limits
Pay

03199 1.30+0.CO=l.30 1.lD~O.OO~l.lO 10 -\ $18.000 2

Not Ot:hen'1ise Clas

...

+

3

Not Otherwis~ ..Clas 33199 1.55+0.00=1.55 O.80TO.OO~O.80 10 $35,000
+ e ' premiUm :

-----------~---+--------------------~----~---------------~ ~--------------p~--------------------------------.------------~----------------~o~al~ual P~ernium :

~O.OD=Ncne $0.00: O.62:~edestri~n 0.62: UM !$L.OOO,OOO $216.00:$1.000,000 $216.00: Coverago Type :Cornprehensive :Comprehensive Other !t'han Col ;$2,000 ded 5141.00:$1,000 ded 5138.00: Collision :51.000 ded $345.00:51,QOO ded $401.00; Premium $3245.62: $3774.62: PIP ;Pedestrian

Medical

Liability

---------------.---------------~----?--------------------T :$1,000,000 $2543.00:$1,000,000 53019.00:
:None

: Premium:

Limits

S7.020.00

FROM:

PS3

AUG 10 2001 12:32PM


Urban Moving Systems, Inc.
't

p. 1

New Jersey Headquarters . 3, 18th Street
, -Weehawken, NJ 07087

(201) 558-0031

New York Headquarters 446 West so" Str,ee~ New York, NY 1[J019
(212) 336-9267

"

I

DebellisInsuran,
VIA FACSIMILE: 973--661·9750

l.J biC

way.

Dea~ The informalon you requested Is.below. Please call me to conlirm that y.0u received them and that the application is on It's

I

Thank

VO".

£I

Urban Moving Systems,

inc.

=

398463 :USDOT 923345

c=J r

8-1Q-O I

lease

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SODn

Co p ~e..S a.s

oot

a.ll vehk Ie

~eoal s+r-co,~lor,s

as

p0s.s/ble. -r~"k r":
I


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'

492 Frankljn Avenue Nutley, New Jersey 07110' Phone: (973)661-1500 Fax: (973)661-9750

... \

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Fax
" To: . Co.:

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From:

Ta+er

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~

Pages: Date:

13
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cc:
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[) Please Reply

Urgent'~,

PleltSe re.~'ew o..-pp;_
. ar-e.

los~ -rLtfl',s. n UN ~ ·of'cl~~J. Ac.ccltV\+ ·sold ~t·~38'1 q c;l6 ,
~ou"d

b~DS'+ 0-+ $ <il30 t-ec.ei \Jed. l0eed 8-5... or- ~-Co -(j\. IhQY)J<s . 0\
.ALL mFOBMATION CO~l

:mMc~~~t1~

sinr-cere_IY_,

--,

.. ..

...

..

DATE

08/03/2001
PRODUCER

DeBellis Insurance Agency, 492 Franklin Avenue Nutley, NJ 07110

GARAGE AND DEALERS VEHICLE SCHEDULE BOILER & MACHINERY WORKERS COMPENSATION

AGENCY CUSTOMER 10

00007675
QUOTE

UMBRELLA TRUCKERSiMOTOR CARRIER

STATUS OF SUBMISSION

7 BOUND (Give Date ancllor Attach Copy): I-08/06/2001
DATE

X

l.!J

ISSUE POWCY

I

ENTER THIS INFORMATION WHEN COMMON DATES AND TERMS APPLY TO SEVERAL UNES. OR FOR MONOUNE POLICIES.

12:01

TIME

APPLICANT INFORMATION

£lm
PM

PROPOSED EFF DATE

PROPOSED EXP DATE

08/06/2001

08/06/2002

M

BIWNGPLAN DIRECT BILL AGENCY BILL

PAYMENT PLAN

AUDIT

NAME (Firat Named Insured & Other Named Insureds)

URBAN MOVING SYSTEMS INC

SUBCHAPTER"S'CORPORATION UMITED CORPORATION

NOT FOR PROFIT ORGANIZATION

BUSINE~MARTED

1990

PREMISES INFORMATION
LOCt BLDt
',

STREET, CITY, COUNTY, STATE, ZIP+4

" 00001 00001

3 18TH STREET WEEHAWKEN

HUDSON

t=j

CITYUMITS INSIDE OUTSIDE

INTEREST OWNER

YRBUILT

PART OCCUPIED

~

NJ 07087
tllNSIDE OUTSIDE

IIIII-

TENANT

b6 b7C

OWNER TENANT

c·a • NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS BY PREMISE(S)

[jINSIDE OUTSIDE

OWNER TENANT

MOVING & STORAGE (HOUSEHOLD)

GENERAL INFORMATION
EXPLAIN ALL "YES" RESPONSES 1.ttIHli,ru'F,,I;I~~MIl~~~\AAY OF ANOTHER ENTITY OR DOES YES NO EXPLAIN ALL "YES" RESPONSES 7. tM( rt.w.figJllE~"q,~~~~s RELATING TIl. S~WAJ.,f,,~USE 0r'lURING? 8. DURING THE LAST TEN YEARs. HAS PJN APPUCANT BEEN CONVICTED OF PJN DEGREE OF THE CRIME OF ARSON? (In RI, thl. quasHen must be allSWl!red by any appllcanlfer r.ICPOrty Inswance. FailufO to dl.cle se the axistence of an arson cony etlan i~ a mlsdemeaner punishable by a senteilco of up te' one year of imprisenment). 9. ANY UNCORRECTED FIRE CODE VIOLATIONS? YES NO

2. IS A FORMAL SAFETY PROGRAM IN OPERATION? 3. ANY EXPOSURE TO FlAMMABLES, EXPLOSIVES, CHEMICALS? 4. ANY CATASTROPHE EXPOSURE? 5. ANY OTHER INSURANCE WITH THIS COMPANY OR BEING SUBMITTED? 6. ~X,f,9,U.,!G~~§,X~'!f~fDE.g~~,+Nf~8~~,E~ REMARKS \~~gR NON·RENEWED

X X X X X X

X X X

~

~,:.
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATIONrOR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL HERETO) COMMITS AlRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE PERSON TO CR MINAL AND NY: SUBSTANTIALl CIVIL PENALTIES. .
APPUCANT'S SIGNATURE

I

ACORD 125 (8/97)

PLEASE COMPLETE REVERSE SIDE

I

PRODUCER'S SIGNATURE

lAD
@ACORD CORPORATION 1993

PRIOR CARRIER INFORMATION
UNE CATEGORY CARRIER POLICY NUMBER

1998-2001

i ?OUCYTYPE
i

RETRO DATE EFF·EXP DATE GENERAL AGGREGATE ~~g~~~~UMP PERSONAt&AOVINJ EACH OCCURRENCE FIRE DAMAGE MEDICAL EXPENSE BODILY INJURY OCCURRENCE AGGREGATE OP

I

I ~;;:

.
!

I ccc ..

R:)~:C=

.
I

I ~;:~as I C:C::;R~e.c= ! 1 I I

::.>'''3
'J":CE

II

C::::!J~QE!'JCE

II

C:_.\I'-'S

,'.:o:e

I

<)c::~;n~~ICE

I ':;;~.~5I

':;.: ....:;:;:;:··::l I

G E N E C OR MA ML EL RI CA IB ~ AI LL T IS T Y

..

."

i

~

PROPERTY OCCURRENCE DAMAGE AGGREGATE COMBINED SINGLE UMIT MODIFICATION FACTOR TOTAL PREMIUM CARRIER POUCY NUMBER AI. UI TA °B MI 01. BI IT ~Y POUCYlYPE EFF-EXP DATE COMBINED SINGLE UMIT BODILY INJURY EAPERSON EAACCIDENT

VAN LINER INS CO

1,000,000
."

PROPERTY DAMAGE MODlFIC~TlON FACTOR TOTAl. PREMIUM CARRIER POUCY NUMBER

P R 0 P E R T Y

POUCYTYPE EFF·EXP DATE

.
MIlT MIlT
-,

I BUILDING

I PERSPROP
TOTAl. PREMIUM CARRIER POUCYNUMBER POUCYlYPE EFF-EXP DATE UMIT

MODIFICATION FACTOR

MODIFICATION FACTOR TOTAl. PREMIUM

UNE

TYPEIDESCRlPTlON OF OCCURRENCE OR CLAIM

REMARKS

NOTE: FlDEUTY REQUIRES A FlVEYEAR LOSS HISTORY

PERSONAL INFORMATION ABOUT YOU MAY BE COLLECTED FROM PERSONS OTHER THAN YOU. SUCH INFORMATION AS WELLAS OTHER PERSONAL AND PRIVILEGED INFORMATION COLLECTED BY US OR OUR AGENTS MAY IN CERTAIN CIRCUMSTANCES BE DISCLOSED TO THIRD PARTIES WITHOUT YOUR AUTHORIZATION. YOU HAVE THE RIGHT TO REVIEW YOUR PERSONAL INFORMATION IN OJJR FILES AND CAN REQUEST CORRECTION OF ANY INACCURACIES. A MORE DETAILED DESCRIPTION OF YOUR RIGHTS AND OUR PRACTICES REGARDING SUCH INFORMATION IS AVAILABLE UPON REQUEST. CONTACT YOUR AGENT OR BROKER FOR INSTRUCTION ON HOW TO SUBMrr A REQUEST TO US.

NOTICE OF INSURANCE INFORMATION PRACTICES

DATE (MMJDDIYY)

0~(03(2001

FAX

"xt): .

Deaellis Insurance Agency, Inc. 492 Franklin Avenue
Nutley, NJ 07110
1.. •..··••·••·•·•···••·•·••·•···•·••·••·•··••····••·•· ,
"""········1 COMPANY USE ONLY

. E.,(PIRATION DATE

DIRECT31LL AGENCY BILL

PAYMENT PLAN

AUDIT

08/06/2001 l 08/06/2002·· X FOR························~··

,

.

LlABIUTY PROPERlY DAMAGE PERSONAL INJURY PROTECTION
, •.••...•.•...•..•...•••.•..•.••.••.•• :••..•..., .•:

$ $

j •....••.••.•.••.•••••.••.••.•.•••.•..••••.••.••.•..•••••.•••••....•..•..••.

OR EQUIVALENT NO·FAULTCOVERAGE

s

ADDmONAL P.I.P. MEDICAL PAYMENTS

WIC MIE

s
$

PHYSICAL DAMAGE ·········1························ ·····T~·································r·········· ···,,····.·

..

.................................. ~.~ ~.······:··~···C:::T~-J-·$·· : ·····················································1
SPECIFIED CAUSES OF LOSS

UNINSURED MOTORIST ••.••. ·$::.·.·.· UNDERINSUREO MOTORIST
$

1 COLUSION

1,000, 000 1

<.•.••... :••: •....;.: ..:•• :•.••.••.••.••..•.••..

;

..

$

··················~::~:TiF:;.t:jy·BAsis············· ..t··················· ·sTi\i'Es······;··'·iij;_vs·r······iiVJer..·.. ii·ci:iiiER:Ai:;Eiiii'E·tiiuc'iiiii::e··············, ......
NUMBER OF NON·OWNED LIABIUTY .................................. HIRED PHYSICAL DAMAGE

s

ENt;.oii5EiiiiiN;rs:i~o~iMS; ..;:r;M;;;~;;;.;;;

:

,~.p RTN~ .. A ..

~ ...•...............

L

..................................
I

~~
~

L

:

: ,:
; ;.:.;:.:·::::.:;.:

7.:~.:;;:.:.::~;;.::::

!. \..~.~~.?.~.~~:; .

.

VEH' YEAR 00002 1999

MAKE:

INTERNATIONAL .. " ..

":,

.
TERR

" .. " ..
CITY, STATE, ZIP WHERE GARAGED

~D.~~TR~q~...

l VJ.N.: "iHTSCAAM'SX6750'si'" ··l ..·..·..·..Gvwicicyi .. .. ...... CLASS l 23000
F

.
: SIC FACTOR SEAT CP RADIUS lSP DEDUCTIBL::S • ACV

COST NEW :$

42,259
FARTHEST TERM COM?

DRIVE TO WORK/SCHOOL UNDER 15 MILES

USE

X
:S

~b~::;L 1,000

X

COMP COLl

1$

;

i AA

:

X ; STAMT

:·$·......·..·i.... · ..

REMARKS

I UNDERSTAND THAT THE COVERAGE SELECTION AND LIMIT CHOICES INDICATED HERE WIll APPLY TO All FUTURE POLICY RENEWALS, CONTINUATIONS AND CHANGES UNLESS I NOTIFY YOU OTHERWISE IN WRITING.

DATE (MM'DDIYY)

..~.~!.~3/~,O,0~.

DeBellis Insurance Agency. Inc, 492 Franklin Avenue Nutley, NJ 07110

EFFECTIVE DATE

08.(_?~!.~_~_?._~ .. 08/06/2002
••• _ •• _ ••••• -

1

EXPIRATION DATE

DIRECT

eiu,
__ •••••••••• _ •• _ •••••••••••

PAYMENT PUN

At.:CIT

X
_ •••••

AGENCY BILL
__ ••••••••••• _ ••••••••••••• " •• _ •••••••••••••• •••• •• 0

'.

" '1".--

PlEASURE
FARM

PlEASURE
FARM

PLEASURE FARM

COMM'L PLEASURE FARM

RETAIL

PLEASURE FARM

PAcE

DAtE 01/31/00

6~

ll.(O

o
o

I§I

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I

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orEI
CI.O!ID

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ij !00'l1'

oi EN

rorA

atSEP.\lEs
~-"-

PAVI'tHTS ~

tl\OUR~ED LOSS

- -.~-.- -.-.- ..-.0.00 0,00
OIOD

POTEHTIAL OEOUCTlOLE

rOTAL k(COVEhED

- -..
1060D,00
e
g

I

C'

pOl.IC~ YEAR: 99 ToTAl.S FoR LOIS.; 0) tlADILIlY1AL ~U10 covlfJ&! mE' 911" COHHEflC
.

",-=",,",C_"'-~-----""'_'-"""''''0.00

DtIIClIllE

. '.

I'

i RESEll!!

0.00 ' • 10600.00 10600.00 0;00 0.00 1116.11

'9\!,n

~~IC'I YEM' 91 . TOTAlS ,QR Llo,D.: 03 ~DHMtRtIAL

.'

coVEMot, fI~E:coLLISIOHom'

~iIiO
.

. OEOucnaL£ Q RESERVES' 2 R~st~VES

M~ ,
0.00

IOOMO

0,00 0.00

1610,2~

CLOSED ""''''"'''-'''''''__..".."~--

"~Q

5 cL~IHS

10600.00,

1;27.02 1~127.0%

..

-..-_.,,..---.0.00

. O.OD

0.00

0.00

" "
0'
a:I

,.(,

,0

0.00

1610.2$

0.00

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VAlILIHEli IIfSURAKCE COHPAKY. Ci1JSToM£A QPEH/Cl.05ED RE~ORT BIllI lESS m[, K ,RGK(R "',: til ItIHI iii!: 00&00000 FOR POLICY II~D£R: BAO~,51Hao , poll GV O~TES 09/0$/99 TO 06/05/00 GUSTQH~ft NUMBER AhD KAME:' ' PROOllC[II KUI!B£!\ Aif& HAHn ooooomtd URBAN ,~OVIKC SYSTEI4S. INC, 135 ~,E, CO£f~UlAKN & cO., IflC. HA"HASS~Tr NY 11030 ~~oa 312 ~AVONIA AVEHU~NI P.o. &~ 4305

om o7/11/~

p~G&

61

ell!r. m[: p

J£R5EV Cl TV

MJ 01302 IMO, PAID

,

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C

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COMPAlt~ 01 V~LIHEn INSURANCE COMPANY CUlM STATUS ft£PO~T DAlE OPEN 1ft!), L,U. 01 GIl~~CIA1. AUTO ~CCIDEHT LDcmO!l OPEN EXP. tlA III ~UHb~ 11~I!IA"T TorAl R~SERvr LOSS £~PLOV(R/DR IVrA NAME DESC. OF CUlM ,H2181l! tt05l1l 01/ I0/00 0.00 "101m Rlllllfitu RJ 01000 0,00

TllrAL IH. tHO.

om .~==~::su~.• ~ ~ ..•....... - --.ib ACTIO!!OlIIER(nE lO~

~

,..•.....••.. . -

EX~. IAIO

TOTAL Id, (XV I

R£COVERV

TOTAL PAID

rOl'~L IUCIJ~~ED HEi INOunnED

CL~TN11-~
cLHT

__,J

0,00

2511.11 1,00 2S1Z.76

-..-~
i51! .16

-

0.00 2S12.11

0,00 2512, 1~

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c po LOSS• 91jPD WBILlTV
,

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VOIIlI E! I N ilSlII!II<f "",AllY' IIIsTlli9 "'OII"!lSm RlPIIII tusT. TWE' I IIIlIIts' Til E: M !!OIIER 1111I 115 AOINT !IBR' 00lI00000 FOR fOLler HUJf8tR: ~AO~~51BOD
POLle~ DATES 08/~5/99 TO 08/05/00

VAGE Oh TE

07/31/00

6Z

ClISrOllER UUMIIO AIID KA~E: l12P.VONIHVENUE
JER$EV

OG8~21518 lilliAN !'Dill" III tEll, ,"II.

II

I,

PRQOUC[R "UHB£~ AIlD HAlE:

115

I. Eo IJQETIIIJIAIN t 110" IIle.
NV 1l0jD ~l08

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jcm

KJ

07302 '01AI. IN. 11Il. IECOI9' TOTII. IN. EXI. TOTAl. IIICIJ!II[1I 1111 I N!lIIM 120.111

eOMPAHV 01 . V~HWE~IKSUUNG[ COKPAKY • elI IH IIN~r.~ CIAI!WII (1.1IN !!Ali! !EPOI! OIIE onN INI, 1111. PI I" tOtD, 01 COI4llEnCIM. AUTO LOSS!!IE , DES', ~ 1011 vmllAliE E~l!l'llR ~ II H ICGlDEiIT LOGATlO! OPENEXI• Tfill. IEltlYE IIIP. PIPI ID !DTII. 10

I

~;~~~};~~9'···-:·····-··~~·--·~ijff·--::r-··-~~f..:i:ii·.... ....;:;a ·· · ",,
CTIIIifOIHiS mE LOI ' 0.01 120.11 120,II
C\.tlT ClHi

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)

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011 VI!.

fYI! UIlS
,0

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10lOb.Ob 601.01

lIMO lUll

11210.50 GI!.DO

I 113MO

o ~.

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(\J (!) ~ ~

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rLHf Kl CLHT I~ eLMT 65

D 91 LOSS" BI/PD lIABIUTV

Ph LOSS• 81/'0 LIA8ILITV

~

olJlT 66 ~

~

99. tzS193

0,00 0,00 0,00

2411.41

40,00 ~~53.~1

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CL~TNZ

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9H26!b5

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Cl"£11

K&!IIMEII

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10/21/91

0.110
b,GO 0,00

1610.11

t!lo.~ 1,01

1610,11 1&lD.21 0.10

1110.11

0.00

ClMT Nt URBAN MaVII~ &YSTEHS, IdC,

G COlLISION

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.-4

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T1180TA2 T1~ 20:1?!21 VAHl.lftm I~SURAIlCE tnMMIIV· CUSTOMER ~PEK/CLO$EO RE~ORT cusr. TYPE: " 8USlllESS mE: M aaOk£R liaR: 135 AGEHlllBR: OOODOooO fOR ,QUC'i HUHa£II: BA022SIl00 POL 1GY ~ATEB o81a5/9~ TO 08}0'/99 c~rOMER HUIomER~"D HAIlE: PRGDUCER"IJI1BER AND NA"E! OOObOl2519 URBA",~VIIfO sVSTCMS, IflC, 135 com£LHANII k CO" 1Il0. )12 mOIHA £V£IIIJE If ,,0, aox ~30& ' HAHIIASSETT NV 11ol0 ~30a

61 DAT£.01/31/00

u.

JEmV Cl'[V
f

.

HJ 013O~ O,[~ REStR~E$ tOTAL
,PAVMENTS

, C'\
"

...................... ~
rot \GY ~£M:
9& TolALS FOIl L.O,B,! 03 co~CIAL AUTO CDV(RAGE 'I'Y,E: COLLISIOM
DPEN

_
2 REstftVES

_
0,00

"ICURREO lQSS

_

POTENTIAL BEDUCll8Lr

rml

REcnVEkED

HET

IRCU~RED

-_0.'~_ un
0,00

~
0,00
O.OD

.
0.00 76.50 o e

.

DEDUCTIBL£ o RESERVES

1000.00 0.00

ClOS£D

0,00 16,SO

0.00

76,;0

I
"

I
I

I

roLlOV YEM: 93 ToTALS FO~ l.O.B.: 03 COMMEMIAL AUTO
co~E1tAG[ mE: QI/~D lIMtlllV
l'

I
J j

.
l

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o
M

.
L

ot£~·

OEOUCTISLt l ~£SERVES ' I RESEmS

0.00 61~~,20

96~,40
0,00

0,00

OrOD

7068.60
O.OD

... ,..c o ... co

e

ClOSEO

D,no
61211.20

1068.60 0,00

D,oa
0.110

0,00

'C'II:I::lCno;:IJ=.,."".ralln"fIel:!l~zr=~~=:ua::;:=U_'=::SllhlllleltliSA=:::nJIIII:;~lIl11U1'11Ul::l~PII.r:::Il".~:r,a:p upa:r.:ua:.:::'::J ...

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'TOT~L FOR¥OLlCY ftUHllER&A022~1800

? ClAIMS

,o~o.90

0,00

1165,10

Jl65,IO,

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VAIU.IMEil INSU~AHCI:

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Tilt 2<)13': 21

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fOR P9LIGY NUMBER; 6402251800 PO~ICVDAm 08/~/9& TO O!/osm cusrOKtR KUMm ~ND HANE: PRODUGER HUHFIER h~: ~11J OODOOZ2519 URS~N HOVING SystEMS, IRC, 135 AlE, roUTtLMAliK l: C(I" IIIG, 0 MAAKMSETt NY 11OlO 430& S12 p~vON AVENUE 61 IA P , , BOX ~las Jt~S£ ~ CITY HJ OW:!.
IIiSURANCE COH'ARY

ClSI. I'm: H

81151"[$$ m~I

cOllPm·

~USToMtaOPEK/CLOSED ft£,ont JMllEil lilli' til -

DAn: D11 JI/OO IIIl' 00010010

6D

ClAIM HUMBER CLAIMANT"

lOSS 'DATE

...

I

". C A1111111 ACTI 011 o1llA ll1E . (ltfT II UK9A1I mVIKG SYSTEMS, IHC, l cUlT N~
ctHT
CLNT

91-1222l1 05/11'" '

-.- I om. -..-.-..~.--- -•....- o~/!D/" •

i COllPAHY 01 VAlU.III£R t,o.a. OJ cOIi.HERClftI. AUTO

CtAlM sTATUS RE~ORT DATE OPEN 11101

ACCIOElff LOOATIOlI CLDIEII II.IZOEli

EMMYEA/DRIVEII hAHE URI
OF CUlM

SliMS. I !It.

--.•.....__ .._ .._
OPEUKP,ft£GtRVi EX', rAID lOlAL TOTAL PAID 0.00 0.00 0.00
"

IND. tAlb

ToTAL IU. IIID.

TOTAL IN. EXP, Hcr INCURRED TOTAl. INCUftP,£O

RECOVERY

KJ 01000

LOS
C COLLiSION

16.SO 16.50

o.on

_

o. OIl 11.!O 16.50

_.-_._ _

O.DO 76,50

N~ cLIfT N~ elHT ,6

6J

"

e a

99-12299' O~/14199

EliZABETH

OPEN

01/16/99

HJ 070CB '

a

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(\j (Il ~
)

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,;UIT ,5 .,.~="'~-"""'=-=....... =~ ClHT 16

CU~TII elM\' IZ----....I cUlT Nl ClKl' 611

ofHtR TIP E LOS o PD LIlS~ • BI/PD liABiliTY

6000.00 124.£0 612~,20

D,OO 96~.40
96UO

6000.00 1086.60 7Q8B,6~

0,00
70SUfl

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PhGt j11~OTA2 TIME 20:39:21 VAIILIIIER IHSUMHC, cOllPAHV· ClISTOM~R OPEN/CLOSED REPORT eUST, TYPE: " BUSINESS TYPE: K BROKER HaR: 115 ACENt DaR: 00000000 FOR fOl.ICV NUMBERl D~022'laoo . POLICV DATF;S 04/05/97 11) 'o8/~~/% PRonvC~~ HIJIIBE~AIID NAM£! 13S U, GOETTELHAHK& co" INC. CUSTOIltA HUMB£R AIKI MmE I P.O. B~ l130e • ooooo~~u u~AJI MOVltIC svsr~RS INO, "A"H~~tT1 N~ 11030 U08 312 ,AVONIA AVENUE Nt
I

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TOTAL

-.--.--~--.-- --.~-0,00 0.11 0.00 0 ,op O.Q~ liIII. "
Q

"tOOVERED

HET
IIICURRED '

POLlCV ~£Ah: 97 TotALS FOIl L.U.; 03 _~CIAL coVEMOE mE: Ol/PD wmlTY

. a,~

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=,....:- __ i
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VAlLI HER INSURAHC£COKP~IIV - ~TOII£R OttN/CLOSED REPeaT eUST. typE: .: 1I BUSIHFSS m,£: M BROI(E~IIB~: AGtlIT NbS: 00000000 1ijij01A2 rOR POL1CY II\IMIER: SA0225180n TIME 20:l9:27 PCl.ICV oms oefQlj/91TO o&/OSI98 'p~OOI.lC~RHlI!lBO AIID NAME: 135 U. ua£lmNAlI~ 1co•• lIIe. CUSTrulEa HUliER AIID NAME: 0000022516 URBAN MOVIHG SVSTEllS, IKC. P.O, sox q30e NY 11030 4l0& MAIIIlAS$ETT 112 PAVON I A hVENUE 11

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PAGE 5& DAlE 01/11/00

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JUL 12 2001 3:22PM

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1

Urban Moving Systems, Inc.
• New Jersey Headquarters 3, 18t~Street Weehawken, NJ 070W ·.(201) 558-0031 ....

446 West 501ll Street
(
.(

New York Headquarters New York, NY 10019 (212) 338-9267

...

O;},I5"

DeBellis Insurance Agency, Inc. VIA FACSIMILE: 973-661-9750 Re: Insurance proposal Dead Please review the following and call me to let me know if you need anything else.

I

b7

Thank you,

L.'lt\:' :::
'-P.l)

.$1{,

'BOO

1(-,
t.t1~
:- ~ G,,~O()
1-

( $/7,;; .....

::. !15'l.~f:,~"

+ 3% •
:$ 100

Cc..r3h

-"Bo~

(."P1\& - 8~K

ALL INFORMATION

REREIN C SIFIED DATE~YII.14t~~

COW
.

'Ne..

-~R

JUL 12 2001 3:22PM
06/25/01

H.ASERJET
2 9200

3200
»SC

p.2

HON 14:38 FAX 1 61

III 001

Baldwin Sadler Corporation

dba-CAt-Baldwin Sadler Insurance Services National Managing Speciality Underwriters CA license 0801356 "" June

PO Box 70111 ". Royersford, PA 19468·0841 (6"111)792·9100 (81)0) 2-2-7·9040

(610) 792·9200

25, 2001

IUrban

3 18TH STREET WEEHAWKEN, NJ 07087

Moving Systems,

I

do/ - 55'1- 00'/.)
Inc.

Re: Urban Moving svstems, Inc. !lHZ5623720; 16-AUG·OO to 16·AUG-01)
L b7C
....I

DearL.1

Baldwin Sadler Corporation is a national managing specialty cargo Insurance for The Hanover Insurance Company. We have had no reported claims on the above captioned of June 25, 2001. c

underwriter

for

policy as

Sinoerely.

. ...
COpy

~.

JUL 12 2001 3:22PM

1ItLASERJET

3200

p.3

Transmit. txt 1 PAGE 1

LOSSES AS OF: 09(30/2001 ACROSS ACCOUNTS - BY ACCOUNT -. RUN DATE:07/05/2001 RMD DETAIL LOSS RUN INSURED:URBAN 4J MOVING SYSTEMS INC PRODUCER:0004J REPORTING OFFICE:O

POLICY NUMBER: UB 688X6573 01 CLAIMANT INJURY CLASS

ACCIDENT

PERIOD FROM: 01011990 TO 070520 MEDICAL AMOUNT

CLAIM ACCIDENT 01 FILE NUMBER AMOUNT C DA~E -.. ~---.-cotes CODE ADJ PRE- CLAIM ~ POLICY EFF.DATE:09/18/2000 NO CLAIMS FOR THIS POLICY PERIOD STATE:

o
AGE

o

* TOTAL

STATE

NO. CLAIMS OPEN CLOSED NO. CLAIMS

0 0 0 0

0 0
0

0
0 0

1

*TOTAL POLICY

0

0

LOSSES AS OF:06/30/2001 RUN DATE:07/05/2001 Injury of tfie--Code: .... ~""" -

ACROSS ACCOUNTS - BY ACCOUNT RMD DETAIL LOSS RUN Class Code:The manual code numbe u for

" r"

---:--

D-Death nder which the P-Permanent Disability compensation M-Major Permanent Disability N-Minor Permanent Disability T-Temporary Total or Temporary Partial ave 0000 until X-Medical Claims '. " Eff Date 7-Contract Medical or Hospital 8-Closed Death Cases in CA Page 1

classification is covered

employee

Prefix CM claims will h

18 months after Po~icy

-jUL 1~: ?qp;l;

,'

.3:

22PM

~LASERJET

3200

p.4

Transmit. txt 9-Permanent Partial not in CAr TX, or N~ O-Hospital Reimbursement in CA 1 PAGE
OIC - Op~n 9r Closed Indi~~tor

1

Selection Criteria for: 01-RMD DTL LOSS RUN Member Name:Q6360Q01. Run-Time:15.57.36 Parm Name: Parm Dese: IF ACC DATE FROM 01011990 TO 07052001 IF POL-NBR EQ 688X6573 Format: 0 Current or History Selection was: C -.... ~-The ---~. Typ-e; Reported was: Claim Size Option: Report Title ==>

--------------------------------------------------------------

of·-Dollars
==>

"

_

1_-

-

C'-

__

..

,_"

_

Sort Field1: Sort Field2: Sort Field3:

Heading:~ Heading: Heading:

Variable Selection statements:

> >

~

> >

>

>

>

> >
>

> ~. >.
>

> >
>

>

Page 2

DEBELLIS

INSURANCE 492 FRANKLIN
NJ 973-661-1500

AGENCY, AVE.
07110

INC.

NUTLEY, FAX -..

973-661-9750
" "

.,

FACSIMILE TRANSMITTAL
TO,i--_---, FRO;:;:M;:,_'

SHEET
......

I

COMPANY,

DATE:

Urban Moving Systems
FAXNU1mER:

08/01/01
TOTAL NO. OF PAGES INCLUDING COVER:

01
PHONE NU1mER: SENDER'S REFERENCE NU1mER:

RE:

YOUR REFERENCE

NU1mER:

COMMERCIAL AUTO QUOTATION

NOTES/COMMENTS:

Per our conversation today please be advised I have obtained the following quotation on your commercial autos: Liability Limit $1,000,000 Comprehensive & Collision Deductible $1,000. Total Annual Premium = $40,292 Deposit Required to Bind = $10,073 (the balance of the premium can be financed on 9 monthly installments) This indication is based on 7 units with total values of$159,662. The quotes for the Cargo, Warehouseman's Liability, and WC will be obtained shortly.

If there are any questions please contact my office.

Sincerelv.

c:"2

AUG 10 2001 12:32PM

H__ ASERJET 3200

p.1

Urban Moving Systems~Inc.
. 3, 18 Street
th

New Jersey Headquarters

. -Weehawken, NJ 07087 {201} 558-0031

New York Headquarters 446 West 50lh Street New York, NY 10019 (212) 33B-92Q7.,~

"

I

Debellis Ins,.rance

VIA FACSIMILE: 973-661-9750

I

b6 b7C

The tnfonnaion you requested Is below. Please call me to confirm that y.0u received them and that the application is on irs way.
Thank YOII.

Dea~

I

'.

/!

Urban Moving Systems, Inc.

Dott-33739 Dot 691256

JUL 12 2001 3:23PM

1ItLASE~JET

3200

p.12

2

Drivers

b

biC

- ....

~--.

",~ -,:.;:-...:

,:"T":'

,,"-::- ~''''l :.:~ , :.• :0,....

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....... ~;::::.'.. _ .....:
•'

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.:.:
, •••

. -s R''';
-,...0:.11:

... .'_.:~ .; ~~

AUG 02 2001

UfZQ,ErJ\

10:23AM

LASERJET

3200

p. 1

3, 1 SIll Street

New Jersey Headquarters

Urban Moving Systems,lnc.

Weehawken, NJ 07087 (201) 558!OD31 .
.

;Wi-

SSt-I)~1 ~ F"-,X

C:).l 0

ol..><'~ \00

...

New York Headquarters 446 West 5·01h Street New York, NY 10019 (212) 338-9267

I

DeBellis Insurance Agency, Inc. VIA FACSIMILE: 973-661-9750

I

De~

Here IS a revised list of trucks tIlatwe lieed covered by our polICY. I apologize for the mix-up. Please give me a call so we can go over the details. . . •

I

.

.

Revised Vehicle Schedule
(,VW /

./
j

J
<'lS.50D

d5.500

r:

JUL 12 2001 3:27PM
06/15/01

H~ASERJET

3200

FRf 09: ~3 FAX 516 6.45~r


Policy Number: Company: Effective Date: Expiration Date: Carriers Ins 08/05/2001 08/05/2002, Jersey City. NJ Jersey City, NJ Jersey City, NJ . Jersey City, NJ $45,259. $37,466 .. $26,000. $15;00'0. $15.000 .' $1,000. $1,000. $20,935. $1,000.

p.22
@002

Urban Moving Systems Inc . 3 18th Street W~e.hawk.en,NJ 07087

<

1

2000 1984 1999· 1998'

GMC International InternaHonat International

Van
Tmck

1GCEG15W4Y1142815 "1 HTLDUP8EHA33628 1 HTSCAAM5X575087 1HTSlAAM7WH574499 1HSDPPN9RH559152 ·1FDNK72CXP.VA20054 1FONK72C2PVA 19948

$1,000.

2
3

Tmck
Truck.

$1,000. :~ 1,-000; $1,000 .. $1.000; $1,000.

45 6 7

1994
1993 1993

International
Ford' Ford

TnJCk
TOlck Truck

Jersey City, NJ
Jersey City. NJ Jersey City. NJ

s t.oen
$1,000.
$1,000 ..

,<

JUL 12 2001 3:28PM

~LASERJET

3200

p.23

Annual Receipts: $1,168,970.00
.., ,4

"

\

<,

...

',,_ "t)

. Radius: • 90% 300 miles • 8% 120 miles • 2% 2500 miles

AL L IloJFOP1!.ATID~I cotrr AI NED m-rCLASSIFIED

b7C

JUL 12 2001 3:28PM

~LASERJET

3200

p.24

ALL nJFOP1!ATID~1 COJoITAlNED

IS UNCLASSIFIED
DATE 07-~;O-2010 BY UC60322LP/PL,J/CC

Warehouse Insurance
"

..

.'... ()A_

11:d/l(_ 0-<> will r=--I ~I

Square footage: 16,000

b6 b7C

Construction:

concrete cinder blocks

Total value of items stored: $250,000

Security: closed circuit t.v. system and audio recording

Who has access: warehouse personnel, storag~'manager

$prinklers:

yes
(~

.

·Alarm System: ADT security linked to loc.al police station 1 block . from premises

JUL

12 2001

3:29PM

e.
481-0837 (09/99)

p.25

'INFORI!ATION CONTAnJED HEP1:Hr IS TJ1JCLASSIFIED DATE 07<;0-2010 BY UC60322LP/f'~J/CC

•..

".HANOVER INSURANCE COMPANY
Worcester, Massachusetts
. .

.,

MOTOR TRUCK CARGO COvERAGE PART
This endorsement, effective .. 8/16/00 part of Policy No. IHZ5623720 issued to Urban Moving Systens
s

(l~:Ol A.M., standard time), forms a Ihc ...

by Hanover Insurance Company.

J~~~

b6 b7C

Authorized Representative

Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and what is or is not covered.

Part!

Applies to All Insureds

Parts II ibrough XI Apply Only if Checked Below:
0 .0 0 0 0 0 0

PartIl Part ill
Part IV Part V PartY! Part VII Part VITI Part IX Part X Part XI

Spoilage or Free~g Owner's Goods Extension - Insured' Specified Perils Including Theft Specified Perils Excluding Theft Theft From Locked Vehicle (Only). Reduced Theft Limit On Target Commodities Theft of An Entire Load (Only) Theft From "Unattended" Vehicle Exclusion Vehicle Alarm Warranty
B

Merchandise

Owner's Goods Extension - Extended Coverage Period

0
0 '0

481-0837 (09/99) .-:.~ Page 1 of 8

1ItLASERJET

3200

p.26

we 00 00 00

(A)

CONTINENTAL CASUALTV COMPANY

.6 ALL IIJFDP.lIATIml CmlTAHJED
IS mrCLASSIFIED

DATE 07-30-2010 BY WORKERS COMPENSATiON AND EMPLOYERS LIABILITY INSURANCE POLICY you as follows: 't ...

In return for the payment of the premium and :Ubject to all terms of this policy, we agree'@ GENERAL SECTION A. The Policy This policy includes at its effective date the Information Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Information Page) and us (the insurer named on the Information Page). The only agreements relating to . this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who Is Insured You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured. but only in your capacity as an employer of the partnership's employees. C.. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational dis-

ease law of each state or territory named in Item 3.A. of the .Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, any federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits . D. State State means any state of the United' States of America, and the District of Columbia. E. Locations This policy covers all of your workplaces listed in Items 1 or 4 of the Information Pagej.and it covers all other workplaces in Item 3.A. states unless you have other insurance or are self-insured for such workplaces,

PART ONE- WORKERS COMPENSATION
A.

INSURANcE

HowThis Insurance Applies
~This workers com:pensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting deatli.. 1. Bodily injury by accident must occur during the Pdlicy period. 2. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee'S last day of last exposure to the conditions causing or ·aggravating such bodily injury by disease must occur during the policy period.

-= = ..-=-

= -

B. WeWillPay
We will pay promptly when due the benefits required of you by the workers compensation law. C. We Will Defend We have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to investigate and settle these claims, proceedings or suits. .We have du~ to defend a claim, proceeding or suit that is' not covered by this insurance. D. We Will Also Pay.· . We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit defend: . 1. reasonable expenses incurred at our request,

no

'e

but not loss of earnings; .

2. .premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this insurance; and . 5.. expenses we incur. E. Other Insurance We will not pay more than our share of benefits and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that may apply, all shares will be equal until the loss is. paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid. F. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required because: 1. of your serious and willful misconduct: 2. you knowingly employ an. employee in violation of law; 3. you !ail to.comply with a health or safety law or regulation; or 4. you discharge, coerce or otherwise discriminate against any:employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. Page 10f5

013011

JUL 12 2001 3:31PM

p. 1

-.

481-0837 -(09/99)

.~i"
PART I. GENERAL TERi,\1SAND CONDITIONS .g. "Throughoutthis policy, the words "you" and "your" refer to the Named Insured shown in the Declarations. The words ''we,'' "us" and "our" refer to the Company providing this insurance. . This coverage part, Pari. I, replaces the "Canditi\i.#J~;· reverse of the Declarations Page (irany). <'.
carrying the property, if'these causes cf "loss" would be covered under this Coverage Form;

contraband, or property in. the course of illegal transportation or trade; .
pads, tarpaulins, handtrucks, !ihallts. tiedowns , . and similar equipment used on OI in .
" Oil

en the
3.

connection with. vehicles you ownOr operate.

otherwords and pmases that appear in quotation marks have special meaning. Refer to Section G-DEFrnITIONS. A COVERAGE We will pay for "loss" to Covered Property from any of the Covered Causes of Loss. 1. Covered Property, as used in this Coverage'Form, means property of others that you have accepted for transportation as a common or contract motor carrier under your tariff and bill of lading or , shipping receipt U!sue)i by you, or as a. coIrtrIlci carrier under contract. . We cover property only while:
3.

Covered Causes of Loss Covered Causes of Loss means your legal liability

Physical "Less" to Covered Property except those Causes of "Loss" listed In. the Exclusions.
4.

imposed by law or assumed by contract, for Direct

as a common or ·contract motor carrier, either a~

Coverage E.rlensions
II.

Earned Freight Charges

contained in or on any land vehicle while in "transit" .and/or during "loading" or
"unloading;" or

We cover your earned freight chargesthaty.ou are unable to collect as a result of a '-'1083" covered by thls Coverage Form, The most we will pay in anyone occurrence is $3,000. This limit is separate from the Limits of Insurance shown in. the Declarations. b.
Debris Removal (1) We wJ1 pay your -expense to 'remove debris of Co\:ered Properly caused by or

h.

at premises,

But, we cover property only at premises shown in the Declarations; coverage does not apply to property for which a storage charge is made,
2. PropertY Not Covered. Covered Property does not include:
8.

resulting from a Coveted Cause of Loss that occurs during the policy period. The expenses will be paid only if they are reported to us within 180 days of the earlier-of
(0) the date of direct physical. "loss;" or

accounts, bills. blueprints, currency, deeds, evidences of debt, money, notes, securities, commercial paper or other documents of value; bullion. precious precious valuable furs; pain.tings, statuary and other works of art; "intennodal." containers, trailers or other carrying conveyance; live animals, birds or full except as follows: . We only cover your liability for theft or death or destruction directly resulting from or made necessary by fire, smoke, explosion, rioters, strikers, civil commotion, flood, or by collision upset or overturn of the vehicle
c.

(b) the end of'the policy period. (2) 'The most we will pay under this coverage is 10% of 'the applicable Limit of Insurance for direct physical "loss" to Covered Property, up to a maximum of $6,000 for the sum of all such expenses for each occurrence. The Debris Removal Limit is separate from the Limit of Insurance stated elsewhere in the . policy. . Reloading Expense· If Covered Property is spilled as a result of an accident to the conveying vehicle. we will.pay your expense to reload the Covered Property. This coV&"ageapplies when there is no Gloss" to the Covered Property. The most we will: . ]lay in any one occurrence is $6,000. This limit is eeparate from the Limits cf Ineuranee . shown inthe Declaration.

b.

gold, silvcr, platinum or other alloys or metals, jewelry, watches, or semiprecious stones or similar property,

c. d.
e. f.

481-083.7 (09/99) Page 2 of 8

JUL 12 2001 3:31PM

LASER JET 3200
t;.

p.2 _ 481-083 7 '(O~/99)

The additional coverages for Debris Removal . and Reloading Expenses do not apply to the cost to: (a) extract
»:

...~, \.' (h) remove,
:B. EXCLUSIONS
1.

water; or

"pollutants" .

from lend or
1:.
'''',,-

This exclusion applies whether or not such persons are acting alone or in collusion with other persons or such acts occur during the hours of employment ..

restore or replace polluted land arwater.

freezlng, rus'ting, extremes of temperature,
shrinkage, evaporation, loss -of weight, change in flavor, finish or texture. or

spoilage,

deterioration,

contamination,

We will not pay YOJll" liability for. a "loss" caused directly or indirectly by any of the foHowing. Such. "loss" is excluded regardless of any other cause or event that contributes concurrently or in lII1y sequence to the "loss." a. Governmental Action

But we will pay your liability for direct "loss" caused by fire, explosion, smoke, riot or civil commotion, vandalism or malicious mischief, theft, collision, flood, upset or overturn of'the transporting conveyance. 3. fur a "loss" caused Em if "loss" by a. Covered Cause of'Lcss results, we will. pay for the resulting "loss." We will not pay your liability

by or resulting from !in.y of the following.

Seizure or destruction of property .by order of

governmental authority,

for acts of destruction ordered by governmental anthority and taken at the time of a fire to prevent its spread if the fire would be covered under this Coverage Part.
b. Nudear Hazard ~1) any weapon employing atomic flssion or fusion; or (2) nuclear reaction of radiation, or radioactive contamination from any. other. cause. But we wiU pay for direct "loss" caused by resulting rue if the fire VI'O~ld be covered under this Coverage Forni. 4.

Eut we v.ill

pay

a.

Weather condltions, But this exclusion only applies ifweather condltions contribute in any way with a cause in event excluded in paragraph 1 above to produce the "1095.»

11. Wear and tear, arJ:j quality in the property that causes it to damage or destroy itself, insects, vermin and rodents. We will not pay-for any cosh! or penalties you. incur for violation of any la.w 0):" regulation that applies to your delay inpayments, denial or settlement of Ij.UY claim made against you by others for "loss" lo Covered Property,

C. LIMITS OF INSURANCE
1. The most we will pay for "loss" in anyone occurrence .is the applicable Limits of ·lnsjlrance shown in the Declarations. The most we will pay for "loss" in anyone occurrence to Race Horses, Show AniID.als," or High Valued Breeding Animals is 150% of the commodity meat price per pound au the day of the "loss" on the Chicago Mercantile Exchange.

c.

War and Mllitury Action
(1) war, including undeclared or civil war; (2) warlike action by a military force, including action in hindering or. defending against an actual or expected attack, by any government, sovereign or other authority using military personnel Dr other agents; or

2.

(3) insurrection,

rebellion, revolution, usurped power or action taken by governmental authority in hindering or defending against any of these.

D. DEDUCT[BLE
We will pay only the amount of the adjusted "loss" in an.y one occurrence in excess of the Deductible !IIIIJluut shown in the Declarations, up to the applicable Limit of

2.

We will nat pay your liability for a "loss" caused
by or resulting from any of the following: a. . delay, loss of use, loss of market or any other consequential loss.
b.

Insurance.

.

Eo

GENERAL CONDITIONS The following conditions apply Common Policy Conditions: 1. Coverage TeITitory

in addition

to the

dishonest

acts by you, your employees or authorized representatives (including operators

under contract to you).

We cover property within;

481-0837 (09/99)

Page 3 of 8

JUL 12 2001 3:31PM

p.3

481-08~7 (09/99)
a. h. the states of the United States (excluding Alaska); Canada "1.

shall retain these records for three years after the policy ends,
Reimbursement to Us

but 'we do nOI cover any Pt"operf.yin transit to or
.fi;~ll:~;Hawtili, 2. Valuation

We may endorse this policy at your request to' 'comply with the requirements of the Interstate CommerceCommission or any other governmental
authority. ,

The value of property will be the least of the follawing ,amounts: .
ft.

1. the amount for which. you are liable;

z.
b. c.

If pay any "loss" solely because" of' any such' endorsement, you will promptly reimburse us for· that payment and aay other expense we have in connection v.ith. iltat payment. 8.
Adjustment payto:
II,

we

the amount of invoice, or in the absence

of an invoice, 'the actual cash value of that property as of the time of"108s;"

and Payment of Loss

At our option, we..may adjust the "loss" whh and you, for the account of whom it-may concern; or your customer, or the owners of the Covered Property.

the cost of reasonably restoring thai. property to its con.ditionJmmediately before "loss;" or the, cost of replacing that property 'With substantially identical property.

b.

In 1he event of "loss," the value of properly will be determined as of the time of"1058."
3. Labels In !he event

of "loss" only at the identi~.ing labels or wrappera containing the Covered. Properly, we will pay 1he cost to replace those labels or wrappers if the "loss" is caused by or results from a Covered Cause of Loss.
Concealment, MlsreprC$entation or Fraud This Coverage Part is voici':lli any case of fraud, mtentional concealment or misrepresentation of a material fact, by you or any ow Insured, at an}' time, concerning:
11.

If legal actions are taken {a enforce a claim against you, we reserve the right, at our option, without expense to you, to conduct and control your defense. This action will not increase our Iiability under your policy, nor increase the Limits of Insurance specified. 9. No Benefit to Bailee No person or organization, other than you, having custody of Covered Property, will benefit from this insurance.
10. Pulicy Period

4.

this Coverage Pari; the Covered Property; your interest in the Covered Property; or
a claim under t1~ Coverage Part. F.

We' cover "loss" commencing during the policy period shown in the Declarations,
11. Exccs~.Jruurance the Limits of Insurance of this policy shall I>~ provided by any other policy. LOSS CONDITIONS 1. ' AbandOlllD.ent There can ~e no abandonment of any property to

b.

c.
d.

You agree that no excess insurance over and above

5.

Legal Action Against Us No one may bring a legal action against us under this Coverage Part unless:
a,

there has been :fuiJ. compliance with all the terms of this Coverage Part, a.n4 the action is,brought within ~ years after you flrst have Icnowledge of the "loss,"

us.

2.

Appraisnl .

b. 6.

Records You shall keep accurate records of your trucking business and all' "gross receipts" from transpo~ '. the property covered by this Coverage Fonn. You ,.

Ifwe and you disagree onthe value ofth.e property or the amount of "loss," either may make written demand for an appraisal of the "loss," In this eVCJ,1t;;each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If ttey cannot agree, either may Icqu.est that selection be made by a judge of a court havmg

481-0837 (09/99) Page 4 of 8

JUL 12 2001 3:32PM

I

~AS~RJET 3200

_.
481-0837 (Q9/99)
4. Insnrance Under Two or More Coverages
1f two or more of this policy's coverages apply to the same "loss," we will not pay more than the actual amount of the '~OS8." 5. Loss Paymenr
"

p.4

jurisdiction. The appraisers will state separately the value of the property and amount of "1055." If they fail to agree, they will submit their difference to the umpire. A decision agreed to by ruzy two will be binding. EBclJ. part will; a. b. pay its chosen' appraiser, and bear the. other expenses of the: appraisal and umpire equally.

We will payor make good under this Coverage Part within

any "loss"
30

covered days after:

If there is an appraisal, we will sruiretain our right to dellYthe claim.

a. b.
Co

we reach agreement with you;
the entry offinal judgment; or
• the

3.' Duties in the Event of Loss You must see that the following are done in the event of "loss" to Covered Property: a.
b.'

fi1ing of an appraisal award.

We will not be liable for any part of a "loss" that has been paid or made good by others. 6. Other Insurance: If you have other insurance covering the same ."loss" as the insurance under this Coverage Part, we will pay only "the excess over what you should have received from the other insurance. We will pay the excess whether you can collect on the other insurance or nat 7.
Pllir. Sets or Parts

Notify the police if a Jaw JIIlI.y have been broken. Give us prompt notice of the "loss." Include a description of tIle property involved.
As soan as possible, give us a description of how, when and where the "loss" occurred,

Co

II. Take all reasonable steps to protect the Covered P.roperty from further damage. If feasible, set the damaged property aside and in the best possible order for examination. Also keep a record of your expenses, for consideration in the settlement of the claim.
e.

.n,

Pair or Set. In case of "loss" to any part of pair or set we may: 1.

Q

Make no statement that will assume any obligation or admit any liability, for any "loss" Jar which we be liable, without our consent.

may

repair or replace any part to restore the pair or set to its value before the "loss," or pay the difference between. the value of the Fa4" or set before and after the "10&1."

2. b.

f.

Permit us to :inspect the p.(operty and 'records proving "loss." permit us to question you under oath, at such times as lllllY be reasonably required, about any matter relating to this insurance or your claim. including your books end records. In such. event. your answers must be signed.
II. signed, sworn statement of "loss" containing the infonnation we request to settle the claim. You must do this within 60 days after our request. We will supply you with the necessary fonns.

g.

[f requested,

Parts. In case of"105s" to any part of Covered Property consisting of several parts when complete, we will only pay for tile value offhe lost or damaged part,

8.

Privilege to Adjust "WithOwner In the event of "loss" involving property of others in your care, custody or control, we have the right to: a. Settle the "loss" with ~ owners of the property. A receipt for paymeut from the owners of that property will satisfy any cla.i:m of yours. Provide a defense for legal proceedings brought against you. Ifprovided, the expenSe of this defense will be at our cast and will not reduce the applicable Limit of Insurance under this insurance.

h.

Send us

I.
j.
k,

Promptly send us any legal papers or notices received concerning the "loss." Cooperate with us in the investigation
settlement of the claim.

h.

or

You must promptly make claim in writing' against any' other :patti who may be liable for the "loss."

481-0837 (09J99)

Page 5 of 8

H~ASERJET

3200

p.S

PART FOUR-YOUR

DUTIES IF INJURY OCCURS Cooperate with tis and' assist us, as we may request, in the investigation, settlement or defense or any claim, proceeding or suit. 5. Do nothing after an injury occurs that would interfere with our right to recover from others. 4.

Tell us at once if injury occurs that ma?be covered by this policy. YOUI other duties are listed here. 1. Provide for immediate medical and other services required by the workers compensation Jaw. 2. Give us or our agent the names and addresses of the injured persons and of witnesses, and other information we may need. ""' 3. Promptly give us all notices, demands and legal papers related to the injury, claim, proceeding or suit. A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifications. We may change our manuals and apply the changes to this policy if authorized by law or a governmental agency regulating this insurance. B. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classifications. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual exposures are not properly described by those classifications, we will assign. proper classifications, rates and premium basis by endorsement to this policy. . C. Remuneration -Premium for each.work classification is determined by multiplying a rate times II premium basis. Remuneranon is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy period for the services of: . 1. All your officers and employees engaged in work covered by this policy; and 2. All other persons engaged in work that could make "!IS liable under Part One (\Vorkers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract. price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers 'of these persons lawfully secured their workers compensation obligations. D~ Premium Payments You will J!ay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. E. Final Premium The premium shown .on the Information Page, schedules, and' endorsements is an estimate. The final premium ",111 determined after this policy be

6. Do not yoluntarily

m@ payments, assume %b1lganons or incur expenses, except at your own cost.

PART FIVE-PREMIDM ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered. by this policy. If the final premium is more than the premium you paid to us, you must pay us the- balance. If it is less, we will refund the balance to you. The final premium will not be less th-an the highest minimum premium for the classifications covered by this policy. If this policy is canceled, final premium will be determined in the following way unless our manuals provide otherwise: 1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short-rate cancellation table and procedure. Final premium will not be less than the minimum pre- . miwn. F. Records You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit Will be used to determine final premium. Insurance rate service organizations have the same rights we have under 'this provision. 2.

PART SIX -COJ\llITIONS A. InspectiDn We have the right, but are not obliged to. inspect your workplaces at any time. ~r inspections are na~ ~afety inspections. They relate only t~ ~e insurability of the workplaces and the prenuums to be charged. We may give you reports on the conditions we find. We may also recommend changes: While

....

they may help reduce losses, do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insurance rate service organizations have the same rights we have under this provision. .

we

Page 4 ofS

JUL 12 2001 3:33PM

~LASE~JET

3200 481-0837 (09/99)'

10.6

9.

Recoveries Any recovery or salvage on a "lass" will accrue entirely to our benefit until the sum paid by us bas ·been. made up. .

ground, or a leading platform inunediatcly the transporting conveyance.
H. Canc~1l3tiop

adjacent to

10. ReiJutatemcnf of Limit After Loss The Limit Insurance 'will n~t b~ reduced by the payment of any claim, except for total "loss" of II

of

unearned premium on that item. To Us

scheduled item, in Which event we will. refund the .

11. Trllllsfer of Rights of Reco~e!1''Against Others
If any person or .orgenization to or for whom we make payment under this. insurance has rights to recover damages from another, those rights are . tr1llll3fem:d to us. That person or organization must do evety!lting neces~ary to secure' our rights and must do nothing after "loss" to bnpair them. Issued by ather carriers that limit their liability to

This policy may be cancelled by the Insured by surrender thereof to the Company or any .pf its ffilthorized agents or by mailing to the Company Written notice sta1ing when thereafter such cancellation shall be ~.ffective. • This policy may be cancelled by the .Company by mailing to the Insured at the address shown in this policy or Iast known address written notice stating when, not less than five (5) days thereafter, such cancellation shall be effective. The mailing of notice as aforesaid shall be sufficient proof of notice. The time of surrender or the effective date of the cancellation: stated .in the notice shall become the end of the pclicy period. Delivery of such written notice either by the Insured or by the. Company shall be equivalent to mailing.
If the Insured cancels, earned preIlli.lltas shall be computed in accordance with the customaxy short rate. table and procednre. ]f the Company cancels, earned' premiums .shall be computed pro 'rata. Premium adjllStment may be made at the time cancellation is effected and, if not then made, shall be made as SOOIl as practicable after cancellation becomes -effective, The Company's check or tIie check of its representative mailed or delivered as aforesaid shall be a sufficient ten~er of any refun.d of premium due to the Insured.

""-~

You may accept bills of'lading or shipping receipts

less than the actual value of the property.

G. DefinitionS "Loss" means accidental loss or d~e. "Gross receipt3" means the total amount of receipts to which you are entitled for the packing, leading,

unloading and transporting of Covered Property, regardless of whether you or another ewer originated
the tmnBpartatian.

L

Changes Kolice to IIIIYagent or knowledge possessed by any agent or by any other person shall not effect a waiver or a change in any part of'thia policy or estop the Company from asserting any right under the terms of this policy, nor sh.a11 the terms of this policy be waived or changed, except by endorsement is:rued 10 form !l part of this . policy. .

reelalmed,

"Pollutants" means any solid, liquid, gaseous or thennal initnnt or contaminant including smoke, vapor, soot. fumes, acids, alkalis, chemicals and waste. Waste' includes material to be reCYCled,reconditioned or .

reasonable and necessary stops, intecruptiorul, delays or tronsfers incidental to the route and method of shipment, including rest periods taken by the driver( s). Transit ends upon acceptance ofth.e goods by or on behalf of the consignee at destination, but shall not extend beyond 168 hours following anival at destination. "Intcrmod.a]" containers are containers used in combinatian with. another mode oftranBportation, such as trailer on flatcar. . "Loading" means the lifting or moving of Covered Property from the ground, or a loading platform immediately adjacent to the transporting conveyance, onto the transporting conveyance. "Unloading" means the lowering or moving of Covered Property from the tran~Orting conveyance to ihe

from the point of shipment bound for a specific destination. It remains in trllnsit during the Orclinllry,

"Transit" begins with the actuulmovemen:t of the goods

.

J.

Confonaity to Statute Terms of this policy which are in conflict \"lith the statutes of the state wherein this policy is issued. are hereby amended to conform to such statutes.

481-0837 (09/99)

Page 6 of 8

JUL 12 2001 3:34PM

e
to

LASE~.JET 3200

F·? . 481-0837 (09/99)

PART II

SPOILAGE OR FREEZING

OWNER'S

GOODS

EXTEL"{SION -

We will pay for "loss"

additional conditiOhs: •
We will not pay 1.

spoilage freezing due to mechanical or electrical breakdown of refrigeretio» or heating equipment, while on vehicles you 01iYn or(Operate, subject to the following

or

-Covered Properly caused by

EXTENDED

COVERAGE

PERIOD and
" -

. Coverage on your property attached upon "loading" ceases when "unloaded."
""' .._

.

for spoilage or freezing due to:

the 'lifi1ng or moving of the Covered Propcrt;y from the ground or loading platform .iIn,mediately adjacent to the transporting vehicle onto the transporting
"Loading" means

"t

... ':

heating equipment;
disconnecting

lack of fuel required to operate refrigeration, or

vehicle.

0

2.

or unplugging refrigeration or heating equipment, or termination of power by turning off switches or similar devices;

3.· failure to perform proper "maintenance" of the cooling. or heating equipment according to manufacturer's recommended schedule.

loading platfoon.

"Unloading" means the lowering onnoving of the Covered Property from the transpofting Vehicleto a loading platform or the ground immediately adjacent to the transporting vehicle. It is "unloaded" and coverage ceases' when property has been lowered to or placed upon the ground or

'

We will not cover property while it is being installed, erected or dismantled.

"Maintenance" means;
1.

to inspect cooling and heating cquiptru:n.t by you or your qualified representative at least once every 30 duys; repair or replace equipment as necessary;
record maintenance activities. Theserecordswill be available to us request.

PART V

SPECIFIED

THEJIT by the following:
Clause A3.

PERILS INCLUDING

COVERED CAUSES OF LOSS is replaced

2. ~.

upon

PARTm

. . Covered Causes of Less means your legal liability as a. common or contract motor carrier, either as imposed by law or assumed by contract for "loss" to Covered Property caused by or resulting from:
1. 2.

OWNER'S GOODS EXTENSION INSURED'S MERCHANDISE

fire, explosion, windstorm;
collision of a cargo vehicle 'With any . ather vehicle or object, excluding contact with any po.rti.on of the roadbed, or curbing, and excluding the coming- together of railroad cars during wiling or coupling; ovc:rluming of the cargo cru:ry.ing ";ehicl~

We provide coverage for loss or damage to your la.wful goods and merchandise. The property must be in your custody and actually in "transit," in or an vehicles operated by you. . We do not cover your property while:
1I' 2.

can:yilig

3.

in or all your premises; in any garage or other building where yoUr verucle(s) are usually kept

4.
5.

collapse of bridges and culverts; stranding, sinking, burning or collision of any regular fe.try or railroad carfloat (including general average and salvage .charges for which. yon.may be liable); "flood" meuns "loss" to property, but only while such. property is in transit, caused by any of the
following: a.

Such merchandise shall be valued at amount of invoice, or in the absence of invoice, at market value on date and at place of shipment.
Our liability shall. not exceed the limits specified in the po~cy declarations for:

G.

l,
2.

the property of others for which,you are legally liable;
the value of your own goods; or

the overflow of lilly body of water;
the release of water impounded by a dam; or any rapid accumulation

b.
c. 7.

3.

both combined.

water.

or runoff of surface

theft of an entire shipping package.

481-0837 (09/99)

Page 7 of 8

JUL

12

2001

3:34PM

LASER/ET

3200

p.8 , 481-0837 (09/99)'

PARTY!

SPECIFmD PERILS EXCLl:'"l>ING

THEFT

PARTL"{

TBffiFTOFru~ENTnmLQ~
(ONLY)

Clause A3. COVERED CAUSES OF LOSS is replaced by the following: .

C!'vered Causes of 1.05$ means your legal liability as a. carnn{on'orcontract.motorcarner. eithcras imposed by law or assumed by contract for "loss" to Covered Property caused by or r~ng from: '
L 2. fire. explosion, w.in~torm;

Theft coverage provided by your policy for Covered Property in or on vehicles is limited to "loss" caused by theft of an. entire carload, truckload, trailerload or. container, exciuflmg theft by your em.ploy~ or authorized representative (whether or not such.persons are acting alone or in colluaion-v,ith other persons or such acts occur during the hours of employment).
PART X

excluding the coming together of railroad cars during shifting or coupling;
3.

collision of a cargo canying vehicle With any other vehicle or object" excluding contact with any portion of the roadbed, or curbing. and

THEFT FROM "UNATTENDED" VEHICLE EXCLUSION

We will not Pil-Y for "Ioss" 'by theft of Covered Property :from an. "unattended" veHicle whlch you own or operate.
"Unattended" means (a vehicle) wijhout a person on or in the vehicle, Whose duty is to' safeguard the vehicle and its cargo.

overturning of the cargo carrying vehicle;

collapse of bridges and culverts; . S. stranding, sinking, burning or collision of any regular· ferry or railroad carfloat (including general average and salvage charges for which youmay'be liable); . (,. "flood" means "loss" to propertY, but only while such property is in transit, caused by any of the ' following: a. the overflow of any body of water; b. ~ the release of water impounded by a dam; or

4.

PARTn

VEHICLE ALARM WARRANTY

We will not pay for any "loss" caused by theft of Covered Property from vehicles owned or operated by you. unless:
1. 2.

the vehicle(s) are equipped with a Theft A1ann System; , is maintained in good working order ~t all times and inspected and approYj:d at least 'once each 60 days by the . IruUlll.facturer, or any of its authorized representatives. and proper inspection certificates
this alarm equipment

water.

any rapid accum.ulation or runoff of surface

issued;

PAR.TVII

THEFT FROM LOCKED VEHICLE (ONLY)

. 3.

We will not pay far "loss" caused by theft of Covered Property from "unattended" vehicles whicll you own or operate. unless: 1.
at the time of "loss" the doors, windows and cOllJ:Partments of the vehicle(s) were closed and, 4.

unloaded;

the alarm equipment protecting the cargo compartment of each vehicle is in the "ON" position. while rnerchanqise is in the compartment, except while being loaded or

locked;
2.

guard the contents.

during loading and unlOading, at least one employee will attend the cargo ~ompartment to,

there are visible signs on the exterior of the vehicle that the theft was a result of forced entry. REDUCED THEFT LIMIT ON .

PARTVID

TARGETCO~ODnaES

The most we will pay for "loss" caused by theft of , alcoholic bevera~ (other than. beer and wine). dru;9and pharmaceuticals. electronics equipment mannfa;1ured' tobacco produgts. and precious metals and allo'i§ is 10% of the applicable Limit of Insurance, up to a maximum of . $25,000 in anyone "loss." , ~",

481-9837'. (09/99) -

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JUL 12 2001 3:35PM

~LASERJET

3200

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B. Long Term Policy If the policy period is longer than one year and sixteen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. C. Transfer of Your Rights and 'Duties Your rights or duties under this policy may not be ·transferred without our written consent. If you die and we receive notice within thirty days after your death, we will cover your legal representative as insured. D. Cancelation 1. You may cancel this policy, You must mail or deliver advance written notice to us stating when the cancelation is 'to take effect.

We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancelation is :0 take effect. Mailing that notice (0 you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancelation, notice. ' 4. Any of these provisions that conflict with a law that controls the cancelation of the insurance in this policy is changed by this statement to comply with the law. E. Sole Representative The insured fast named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancelation, 2.

In witness whereof, the company has caused this policy to be signed by its President and Secretary at Hartford Connecticut, and countersig~ed on the information page by a duly authorized agent of the company. '

b biC

ALL nrFORMATlmr COIITAlNED HEP.Enr I:~ UnCLASSIFIED DATE 07-:30-2010. BY· UC60:322LP/PL,J/CC

CP·3349Bdieion2-92 Printed in U.S.A.Jl2-94) .
013013

."Includes copyright material or the National Council on Compen,sation Insurance, used with. its permission. @1991 National Council on Compcnsatiol) Insurance."

Page·S ofS

I
I I

I

I.

I I

LASERJET

3200
CmrrAHJED BY /PLJ/CC

p.10

ALL HJFOruiATIOl~

CNA

HEREHJ DATE

IS

TJ1~CLAS:'iIFIED

WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY
~, Q-

TYPEAR

INFORMAt!.1

PAGE

we 00

OO\Ot ( A)

POLICY NUMBER:

(6S59UB-67 4X65i -5-00 )

N~ TAX IDENTIFICATION INSURER: CONTINENTAL
1. INSURED:

NO.: 223511891000 CASUALTY COMPANY

NEW-aD

NCCI CO CODE: 10243 PRODUCER: A E GOETTELMANN & CO INC 120B NORTHERN BLVD

URBAN MOVING SYSTEMS INC 18TH STREET WEEHAWKIN Nu 07087
3

PO

BOX 120B

MANHASSET NV 11030-4308

Insured Is A CORPORATION Other work places and Identiijcatio.n numbers.are shown in the schedule(s) attached.

.
2.
3.

The policy period I~ frorn
A.

09-18-00

to

. 09-18-01 .12:01 A.M. at the insured's mailing address,
Part One

WORKERS 'COMPENSATION INSURANCE: satlon Law of the state(s) listed here:' Nu

'ofthe policy

applies to the Workei~s Campen.

~.

EMPLOVERS lIABllITY'INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of Qurllabillty under P.art Two are: .

.Bodily Injury by Accident: $ Bodily Injury by Disease: s Bodily Injury by Disease: . $
C. OTHER STATES INSURANCE:

100000 Each AccIdent . . 500000 Policy Limit

100000 Each Employee

Part Three o~the policy applies to the states, if any, listed here:

COVERAGE'EXCLUDED.
"

D.

This policy Includes these endorsements and sohsdues:

SEE LISTING OF ENDORSEMENTS - E~NSION
The premium

OF INFO PAGE

for this policy will be determined by our Manuals of Plans. All required Information is' subl~ct to verification and change

Aures, Classifications,
by

Rates and Rating audit to be made ANNl!ALi. • V

,! I

DA T!;
013014

10-20-00 HS' OFFICE: CNA . _. 041.1 PRODUCER: A E GOETTELMANN &-CO INC

OF ISSUE:

I I , ! r: ,
ST ASSIGN: Nu 725LW,
.I

I

!
!

'1
i

I'

JUL

12

2001

3: 36PM

._LA.SERJET

3200

p. 11

CNA
••

2
WORKERS COMPENSATION AND

EMPLOYERS LIABILITY POLICY EXTENSION
j'
I

OF INFO 'PAGE-SCHEDULE~'WC

00 00 01 ( A)

i' i !
!

I

. POLICY NUMB~R: (6S59UB-674X651-5-00)

INSURER: CONTINENTAL

CASUALTY

CPMPANY 10243-Nu RATE BUREAU ID: 317266 PREMIUM BASIS ESTIMATED TOTAL ANNUAL REMUNERATION

INSURED'S. NAME: URBAN MOVING SYSTEMS INC EXP. MOD. EFFECTIVE DATE: 09-18-00

CLASSIFICATION LOCATION 001 01

. CODE

RATES PER $100 OF REMUNERATION

ESTIMATED. ANNUAL PREMIUM

ENTITY CD 001 NO.: 223511891000 URBAN MOVING SYSTEMS INC

NJ ~X IDENTIFICATION
3 .18TH STREET . WEEHAWKIN. 'NJ 07087

FEIN 223511891

FURNITURE MOVING & STORAGE, DRIVERS .. CLERICAL OFFICE EMPLOYEES NDC

8293 8810

:2:36620

9 :11

2155.6

IF ANY

.25

----------------------------------------------------~------------------------------- . .
TOTAL PREMIUM SUBuECT TO EXPERIENCE MODIFICAT-IDN $ CONTINGENT EXP MOD: 1.356 MODIFIED PREMIUM TOTAL ESTIMATED ANNUAL STANDARD PREMIUM '6.00% PLAN PREMIUM ADJUSTMENT PROGRAM (0942) 2.90% PREMIUM DISCOUNT (0064) . EXPENSE CONSTANT(0900) 8.80% 0935 NJ SECOND INJURY FUND SURCHARGE . ..TOTAL ESTIMATED PREMIUM DEPOSIT AMOUNT DUE
2923.0

29230

21556

32868 32868

2572

1154 848 160

I I·

.:DATE ISSUE: 10-20-00 OF
013015

HB

ST ASSIGN: Nu

SCHEDULE NO: 01

OF LAST

JUL

12 2001

3:36PM

~RSERJET

3200

3

p.12

CNA

WORKER$ COMPENSATION EMPLOYERS LIABILITY POLICY Ef;J~9RSEMENT POLICY NU~BER:

AND

we

000412 (00).

~'-'

(6S59UB-674X651-5-00)

EXPERIENCE RATING MODIFICATION FACTOR ENDORSEMENT
The premium for this policy will be adjusted by an experience rating modification factor. The factor shown In the scbeduels a Contingent Experience Rating Modification factor based on the appropriate experience data available and supersedes any prior experience modification factor. We will Issue an endorsement to show a revised factor " If appropriate additional experience data becomes available. The Contingent factor will "apply unless a revised factor is subsequently issued. " SCHEDULE STATE Nt.! MODIFICATION 1 .3560

"CONTINGENT

DATE OF ISSUE: '10-20-00
013018

ST ASSIGN:

NJ

JUL

12

2001

3: 3SPM

tit

LASERJET

3200

4

F·13

CNA
...._. "

WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 29 04 07 (00) POLICY NUMBER: (GS59UB-G7 4X651 -5-00 )

NEW JERSEY PREMIUM .DISCOUNT ENDORSEMENT (SCHEDULE X)
The New Jersey premium for this policy and the pollclss, If any, listed in Item 2 of the Schedule may be eligible for a discount. This endorsement shows the discount rates In item 1 of the Schedule. The final calculation of premium discount will be determined by our Manual and your New Jersey standard premium as determined by audit. In certain cases where New Jersey retrospective spective rating. In such cases rating applies, all of the premium may not be subject to retro.

So much of the New Jersey Standard Premium as is SUbject to retrospective ~atlng shall not be subject to discount. The remainder Is subject to discount and the discount Is calculated as follows: (a) Determine the discount as though none of the Standard prernlurn is SUbject to retrospective (b) Determine the·dlsoouDt as though only the premium subject to retrospective (e) The difference between (a) and (b) Is the applicable premium discount. SCHEDULE PREMIUM DISCOUNT. The first $5,000 of the Standard Premium shall be charged In full without discount, the next $95,000 shall be subject to a discount of 3.5%, the next $400,000 shall be subject to a discount of 5.0%, and the remainder shall be subject to a discount of 7.0%. . 2. OiHER POLICIES: rating. rating is disoounted.

i..
013017

I I

. DATE OF ISSUE: 10-20-00

. ST ASSIGN:

NI.l

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i

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12

2001

3: 36PM

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p.14

WORKSHEET~R
THINGS TO REMEMBER'WHEN
DO NOT DElAY IN CALLING

WORKERS' COMPENSATION TELEPHONE REPORTING
THE
INFORMATION BELOW:

COMPLETING

Call the Telephone Reponing Center to quickly and easily report all Workers' Compensation injuries. VVe ... II be asking you the 'following questions, so please ~ have the information hand)'. We will produce and submit the necessary state forms.
IF YOU DO NOT HAVE ANSWERS TO ALL OF THE QUESTIONS

ACCOUNT
CALLER'S PHONE NUMBERreXTEN510N CALLER'S NAME (FIRST, 1A1 LASt) ..

INFORMATION
BENEFIT Sf ATE

(

)
EMPLOYEK'S ADDRESS (STREEr, CITY. STATE & ZIP) EMPLOYER'S MAlUNC>ADDRESS (STREET. CllY, STATE &.211')

EMFLOVER'S NM.IC

OSA~E
PAR:NT COMPANYnNSURED S NAA1E POUcYFDRM POUCY NUMBER

(6SS9UB-674X651-5-00)

CAUSE 0; ACCIDENT (EG" SUP/FALl.., LlFnNC>, CHEMICAL)

IF MOTOR VEHICLE ACCIDENT, DRIVER'S LICENSE NUMBER

STATE WHERE ISSUED

= .,== =
0:::::;;
0;;::::
_

· -

CONTRIBUTINGFACTORS

EQUIP-MENT, MATERIAL OR SUBSTANCE I'NOL ¥ED

IF

OTHER PARilESWERE NAME (ARST, MI,lA51)

INVC\.VED

ADORESS

~HONe NUMBER

~= b=

WERE SAFEGUARDS PROVIDEO?

DESCRIPTION OF SAFEGUARDS

WERE SAFEGUARDS USED?

DYES

oNO
ADDReSS

DYES

DNO

WiTNESS INFORlrlATION NAME (FIRST, M1, lASl)

PHONE NUMBER

INJURY INFORMATION
PART OF BODY INJURED (e.G. H:AD, NECK. ARM, LEG; NATURE OF INJURY [EG, FRACTURE, SPRAI~I, LACERATION) _IIPREVOUSRELATED CONOmON? PRE,EXI5nNG MEDICAL CONDITION(S)

O~s

DNO LENGTH OF TIME DOING ACTIVllY 1ST DAY OF 'TREATMENT

CUMULATIVE INJURY? IF YES, LEN:>.H OF EXPOSURE

NATURE OF DlmES

DYES

ONO

NAME (A~ST, MI, LASl) TREATMENT ('X" AU 'THATJIPPLy)

-

WHAT TYPE OF FIRST AID WAS ADMINISTERED?

o FIRST AID-

-

NAME AND ADDRESS (STREET, CITY,STATE & Zip)

TREATMENT

.1
i
TREATMeNT

LEN(:TH CF STAY

1ST DAY OF TREATMENT

o HOSPITAU CLINICNAME ANO ADDRESS (STREET, c~, STATE & ZIp) PHONE NUMBER

SPECIALTY

lSTDA,( OFrnEATh1ENT

o, , PHYS.ICIAN . 013018

(

)..

WUNTCG98

CONTINUED

ON REVERSE SIDF=

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3200

e.

p.1,5

6
QUESTIONS

WORKERS'

COMPENSATION .,6

- FIRST REPORT OF INJURY - STATE SPECIFIC

Alabama Employee's county Employe(s 10 (U.C. Account) ·Specific product (e.g., tires)

Number

Alaska Side of body affected (left or right) Employer's Alaska address (if different from mailing address) Date and time employee left work Scheduled days off Time mrkday began Was accident caused by failure of a. machine or product? If Inpry was caused by a mechanical part. specify part If the accident was caused by anyone besides employee, gr~e name and address If fatal, name and address of dependents If you doubtvaJldityof claIm, state reason Alaska Unemployment Insurance Account Number (U.I. Ace!. No.) Arizona last date of work after Injury Number of days per week company usuaRy works Department number If validity of claim is doubled, state reason . If another perso)'l not employed by company caused accident, give name and address Was worker in your employ when Injured? . Hours per day employee worked the day of injury Will work loss exceed 7 days? Was injJred paid for the day of Injury? (If yes, specify amount) Was employee' hired for permanent employment? Number or monl11s employment available during the year Is employee fumished lodgin"g or board? (If yes, specify value) Does employee claim dependents~ Actual gross earnings of employee for the 30 calendar days preceding Injury Is employee paid olher than filled weekly or monthly sala ry7 Coes employee earn extra pay for overtime? (If yes, basis of paymenUhourlyamount) Number of hours overtime considered normal per week Has injured been employed for more than 12 months? Gross wages of employee during 12 months preceding injury (fromthrough/amount) GroSs wages of employee from date of hire through date of accident Has employee received a wage increase within 12 months pnorto injury? (If yes, specify date, wage/per before i!nd wage/per after Increase) . ' Gross earnings rrom dale of Increase through day prior to Inpry Was employee in overtime iniJred?

Connecticut Reason fe.--report (lost lime/medical·health careloccupational disease/correct prior report) Time employee's workday began Extent of accidenl'health and life coverage for employee For Occupational Disease.c;;'\I 'i,. .. Date of last exposure ~~ Date of diagnosis as occupationally related Employer's Registration Number (CRN) Was employee treated in an emergency room? Delaware Employer's UC Reporting Number Employee's county If employee has retumed to.work, at same wage?

District

of Columbia If employee has retumed to work, at Wbat time? Was injured hired in DC? Was injured given Form #7 DCWC? Piece or time 'MIrker

Florida TIme injury was reported Rate of pay I per Was physlcl.m/hospital authorized by employer? Does Ihe employer agree With the descriplion of accident? Did the employee knowingly refuse to use safety equlpment proVided byyou, the employer? . . Old the employee request medical care? (If yes, did the employer provide medical care?) . Georgia . SpecifIC products (e.g., tires) Hawaii Was employee furnished meals or lodging? Monthly salary . Department of Labor Number Medical deductible Idaho I~ gratuities (tip~; etc.) were received in the course of el)1ployment, estimate weekly value . lengih of lime employed by you at this OCCUpatJolI If mechanical apparalus or vehicle caused iniJrY, what part of it caused in~ry? Type of treatment Qnpatlentloutpatient) If fatal, name and address of nearest..relative What was employee doing when the accident occurred? Illinois !Dinois Unemployment Compensation Number SIC Number Total number of employees at the location where Illness or In~ry occurred . Was employee given Industrial Commission Handbook? Did incident resull in occupational injury or occupational disease? What unsafe act by a person caused or contributed 10 the In}lry or illness? Indiana Number of lost workdays to date Iowa Number of employees Was injury caused by failure to use safely equipment or observe regulations? If employee has not returned to work. probable length of disabiliw Is the injury expected to produce permanent disability?

vmen

California State Unemployment Insurance Account Number Type of emplC?yer (privat~state/clty/county/schaol district/other government) . Was employee unable to work for at least one fttll day alteJ: the dale of injury? . Date employee was provi~ed c;;lalm form Colorado . How long has emplqyee worked Tor this employer? Employee's length of experience at this assignment Years of education completed (6 to 20) Number of employees • If employee has not returned to work, estimate dale of return Did injury occur because of intoxication, failure to use safety deVices, failure to obey rules? _ Will benefits continue during disability? If employee's heaUh fnsuranc~ benefits disconllnue, what WII the 'weekly cost be for continuing such benefits? If fatal, give name, relationship and address of closest dependent of deceased Is employee receiving overtime, ccmrnissions or piecework?
01:1019

WUNTDG98

Page 1 of 4

7
JUL 12 2001 3:38PM ~,LASERJET 3200

p.16

WORKERS' COMPENSATION - FiRST REPORT OF INJURY ~ STATE SPECIFIC QUESTIONS
Does the employee receive either plecewerk Dr commission? Does the employe: declare tips as Income? Employe(s Account Number New Hampshire IfUllderage 18, is there a Child Labor Employment Certificate on file'? • Was injUred hired In New Hampshire? Piece or time werker Time disability began Has injured flied a Form aa WCA? Part of machine on which accident occurred? Kind of power (e.g., hand, fool, electrical, steam, etc.) Was accident caused by Injured's failUle to use or observe sarety equipment or regulation? Probable length of disability If employee has retUmed to work, al what time? Federal '-D. Number, Has employee returned to full or light duty? Initial tr~ment '(none, employer, emergency, hospitalized, culpallent, clinic or office visit) If employee Is a leased or temporary worker, cfient's business name Is there a managed care program? (II yes, name of provider) Is there a 'Mitten safety pro~ram in force? Is there an active safety committee? Number of employees, full time and part lime SIC Code Nel'lJersey Number of employees Was employee unable to work on 'any day after the injury? SIC Number Employer's Registration Number New Mel!:ico Federal 10 Number NM Unemployment Insurance Number . Does your business have a safety program? (If yes, specify aam!nislered period. weekly/monthlyl annually/other - if other, specify) Highest educationalle~el attained Totallost work days If occupational Illness, date diagnosed and description of diagnosis Was employee under the influence of drugs/alcohol? (Yes/no! unknown) . . New York ' code Number NYS U.L Employer Registration Number , Total earnings paid during 52 weeks prior 10 date of accident (include bonuses, overtime, value of lodging, etc.) Ofcl employer provide medical care? (If yes, \..nen?) Has the inj:.uylillness been previously reported on Form C-2.1? Indicate days of week that employee regularly works If fatal, name, address and relations~ip of nearest relative Narth Caronna Employer Cocle Number . TIme disability began KInd of power (hand, fool, electrical, steam, efo.) Part of machIne on which fn~ry occurred Was accident caused by injureel's failure to use or observe safety . eqUipmentorregulat!on7 Probable length of dislIbJnty If ~plcye9 has returned to work, at wIlal time? North Dakota WDI emplovee be off the job for fjYe or more consecutive days? - Time emplovee left work due to thislnjJry Time ~~rkday began on the day of in}lry If employee has not returned to IMlrk, estimate date of return Employee's gross tatal.earnings for the past 52 weeks List each dependent under age 18, or under age Z2 if attending school, or incapable 01 self support (name, birth date and relationship) Exacllocation of injury (e.g., plant, d!lpartrnent, building, etc.) Workers Compensation Account Number Season length (in months) Oh!iJ Time accident reported to employer Has employee ever filed a previous appJJcation for this inj~ry? Has employee filed any other claims with the Bureau or Industrial Commission? (If yes, specify claim number and body parts) Employee's county Employe~s Risk Number If under your employ for less than 12 months prior to injulY, Ust former employers, dates if employment, wages and number of weeKs Oklahoma SIC Number Oregon Education (number of yeats completed, or GED) Side of body affected (left Dr right) Department regularly employed Type of employer Qndlviduallcorporanonlpartnershiplother) Is worker an owner or corporate officer? Did injury occur during the course of employment? Was accident caused by failure of machinery or product? Did someone (not worker) cause a'coident? Time worker left wort< Explain if number of hours per shift or week varies Scheduled days off Pennsylvania . Employer's Unemployment Compensation Reporting Number If employee has returned to work, at what wage? employee's county If employee is under age 18, Certificate Number and occupation for Which issued Did injury occur because of mechanical defect or unsafe acl? Was employee amputated? South 'Oakota . Federal 10 Number Unemployment Number SIC ccide NUf!1ber Number of employees Is the employee an officer or partner? Time wolkday began Exemption information (empJoyeefspousefover €51b1lndlolher dependents) . Does employee receive pay in kind? (IF yes, explain) Type of treatment (outpatient, emergency room or in house) Inpry Cades: Body part injured (2 digits) Cause of injury (2digits) Nature of injury (2dlg1ts) Tennessee Federal 10 Number If paid on other than a lima basis, such as pieCe work or commissIons, indicate method and actual average weekly earnings IF board, lodging or other advantages were furnIshed in add'ltion 10' wages, state nature and estimated weekly value If employee has retumed 10 work, at what wage? If fatal, name and address of nearest relative Texas Federal Tax ID Number Doe~ the employee speak English? Qf no; specify language) Employee's mailing county If marriecl, spouse's name Page30f 4

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013020

WUNTDG98

JUL 12 2001 3:38PM
POLICY NUMBER

9,ASERJET
POLICY PERIOD

3200

8
COVERAGE IS PROVIDED IN THE

p.17

.

FROM

TO

, PROVIDENCE

~XlOS68264

08/0S/00\08/0S/0l

WASEINGTON

INSURANCE

COMP_llliY

UW0032 04/96

.

JUL

12 2001

3:42PM

4Ir
FROM

LASERJET

3200

9
COVERAGE IS PROVIDED IN THE

F·18

soucv NUMBER

POLICY PERIOD
TO

08/05/00

08/05/0l

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JUL

12 2001
~OUCY NUMBER

3:47PM

4It

LASERJET

3200

10
COVERAGE IS PROVIDED IN THE

p.1S

POLICY PERIOD TO FROM

CX10568264

08/05/00

I 08/05/01

I

PROVIDENCE

WASHINGTON

INSURANCE

CO[VIP]I.NY

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p.20

11
. POLICY NUMBER POLICY PERIOO FROM TO ,

CX1.0368264 .

08/05/00

I o:~/05/Ql

,

COVERAGE IS PROVIDED IN THE

PROVID3NCE

WASHINGTON

I:N'StJR..2WCE COMPA..1\lY

JUL 12 2001 3:55PM

LASERJET

3200

p.21

PROVIDENCE

LOCATIONS SCHEDULE

WASHINGTON

INSURlU~CE CO

URBAN MOVING SYSTEMS, JERSEY CITY,
Prems No. Bldg No.

POLICY #

CX10568264

312 PROVONIA AVENUE

NJ

07302

INC. #1

",

"

AGENT:

# 31001540

A.E GOETTELMANN. ~ CO.

001

Street

001

445 ~~ST 50TH STREET

City

(LIABILITY ONLY)

NEW YORK

County

St

NY 10019

Zip

002 ,001

3 18TH STREET

WEEHAWKEN ffiIDSON

NJ 07087

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JUL 12 2001 3:55PM

lIt,LASERJET 3200

POL+CY NUMBER: CX10568264 -FORM SCHEDULE Forms and Endorsements applying to this Coverage policy at time of issue:
FORMS APPtICABLE

.'

p.22

COMMERCIAL

POLICY

Part and made a part of this

TO ALL PREMISES Description

AND COvERAGES'·"

Form
FORM FORM

Edition SCHP SCHL
12 12 11 04 04 04

1L0017 1L0183 IL0208

IL0023

IL0268 IL0935

85 98 98 98 07 00 08 98

96 96

PROPERTY FORMS SCHEDULE LIABILITY FORMS SCHEDULE COMMON POLICY CONDITIONS NUCLEAR ENERGY LIABILITY EXCLUSION ENDT NEW YORK CF~GES-FRAUD NEW JERSEY CHANGES-CANCELLATION & NO~NEWAL NEW YORK CHANGES - CANCELLATION & NONRENEWAL EXCLUSION OF CERTAIN COMPUTER RELATED LOSSES

AL L IloJFOP.MATID~I

cotrr AI NED

mICLASSIFIED DATE D7-:3D-2D10 BY UC6D:322LP/PLJ/CC

:

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12 2001 3:55PM

4If

LASERJET 3200

POLICY NUMBER: CXI0568264 .FORM SCHEPULE Forms and Endorsements applying policy at time of issue: to this Coverage

p.23

COMMERCIAL

PROPERTY

Part and made a part of this

FORMS APPLICABLE TO ALL PREMISES AND COVERAGES Form CPOOIO CP0090 IL0003 Edition
06 9S
07 88 04 98

,

Description BUILDING AND PERSONAL PROPERTY COMMERCIAL PROPERTY CONDITIONS CALCULATION OF PREMIUM COV FORM

FORMS APPLICABLE Form CPI030
PREMS

TO SPECIFIC

PREMISES AND COVERAGES

.Edition

Description

06 95 CAUSES OF LOSS-SPECIAL ~ORM 002 BLDG 001 YOUR PERSONAL PROPERTY

AL L IloJFOP.MATID~I .IS DATE CI7-:30-2010

cotrr AI NED
BY UC60:322LP/PLJ/CC

mICLASSIFIED

.1

I

Page 1 of 1

1ItLASERJET

3200

POLICY NUMBER: CXI0568264 .FORl."\1 SCHEDULE ~


Part.and

p.24

COMMERCIAL

LIABILITY

Forms and Endorsements applying policy at time of issue:
,

FORMS APPLICABLE" TO ALL PREMISES Form CGOOOI CGOOOI CG0163 Edition
01 96 07 98 07 1.0 07 09 10 08 06 04
07 04 97 07 98

.

to this Coverag~

made a part of this

AND COVERAGES

Description COMML GENERAL LIABILITy COV FM (OCCURRENCE) COMM GEN LIAB COV FORM-OCCUR VERSION NEW YORK CHANGES -PREMIUM AUDIT NY CHGES COI~L GENL LIM COVERAGE FORM. EMPLOYMENT-RELATED PRACTICES EXCLUSION EMPLOYMENT-RELATED PRACTICES EXCLUSION TOTAL POLLUTION EXCLUSION ENDORSEMENT _ EXCL-YR 2000 COMPUTER-RELATED/ELECTRONIC PROB NJ CHANGES - LOSS INFORMATION NY CHANGES - TRANSFOER OF DUTIES WHEN A LIMIT NY CHANGES - LEGAL ACTION AGAINST US NJ CHGES-COV FO LIABILITY FOR HAZARDS OF LEAD CALCULATION OF PREMIUM NUCLEAR ENERGY LIABILITY EXCL ENDT NUCLEAR ENERGY LIABILITY EXCL ENDT COMMERCIAL GENERAL LIABILITY

CG0104 CG2147 CG2147 CG2149 CG2160 CG2620 'CG2621 CG2624 CG2649 IL0021 U9935

10.93

98 93 98 98

91.

92

1L0003 IL0021

04 98

99 98

11. 85
91.

AL L IloJFOP1!.ATID~I cotrr AI NED mICLASSIFIED

DATE D7-:3D-2D10 BY UC6D:322LP/PLJ/CC

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p.25

9488N1069 NJ01 310

Audit Type: AS Revision Type: 0 Prorate: Yes

.:

/

$

44,404
153,195

s
$

$

86.574 184.331

URBANMOVING!$E$34 URBANMOVINGI$D$34

AL L IloJFOP1!.ATID~I

cotrr AI NED

mICLASSIFIED DATE D7-:3D-2D10 BY UC6D:322LP/PLJ/CC

·JUL 12 2001
_r

3:56PM

. . .. ~ ..
•.r

LASER.JET

3200


SAl:

p.26

Insured Name: URBAN MOVING SYSTEMS INC Policy Number: 6S59 US 688X6573 Policy Tenn: 09/18/2000 - 09/18/2Q01 Audit Term:

Loe:

Aud ID:

i i
i
1

NJ

0911812000 001 01

8293 8810

01 02

ANNUALIZED PAYROLL EXPOSURES FOR YEAR ENDED 12131/00 FURNITURE MOVING & STORAGE. DRIVERS CLERICAL OFFICE EMPLOYEES NOC

mICLASSIFIED 07-30-2010 BY UC60322LP/PLJ/CC

David MacGregor Co.
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DATE (Rev. 08-28-2000)

07-:::0-20.
BY '. 22LP/~LJ/CC 07-30-2035

ALL

CONTAINED

CLASSIFIED

PEASON: 1 4
DECT,.A.5SIFY

C
ON:

M
SErT

FEDERAL BUREAU OF INVESTIGATION

Precedence: To: From: Newark

ROUTINE Attn: lMA

Date:

09/17/2001

(Rotor), Squad C-9

Newark C-9

Approved Drafted By:

b7C

(S)

Case ID Title: ~)

r--D
(~~) Deriv~From: DeCl~\ifY On: G-3 Xl

1

Synopsis:

I9(J~~equest sub-files for to captioned investigation.

\

Details: ~V\n 09/14/2001, Newark Division, with the assistance~~t!e New York Office (NYO), initiated an investigation predicated upon the detention of five (5) Israeli Na~ionals who may have possessed information about the terrorist incident targeting the "Twin Towers" of New York City's World Trade Center (WTC). , ~~)he follo~ing s~b-f~les.are req~ested to serve as repos~torJ.es for the ~nvestJ..gat~ve ~nformatJ.on developed on the five (5) Israeli Nationals described herein:

'"\
\
I

Sub-file

A: B: C: D:
E:

p~)Investigation

at Newark continues.

\

••
1

(Rev. 08-28.2000)

DATE: 07-30-201C! CLASSIFIED BY TJC60322LP/PL,J/CC REASON: 1. 4 (C) DECLASSIF":r ON: 07-3D-20~:5

S~

FEDERAL BUREAU OF INVESTIGATION

Precedence: To: Newark

ROUTINE Attn:

Date: Squad C-9

09/17/2001

From:

Newark C-9 Con

Approved By Drafted'By:

f~

b

b7C

(S)
Title:

bl

Synopsis:

(~~1eport I.... (~) DerivedVrom: DeClaS~y On:

....I1

obtained. G-3 Xl

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Administrative: ,Q(atThe

attached~~~~r-

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~w~e=r==e-=o~b~t~a~i~n~e~d~-,
b3

Details: (~"'~on 09/14/2001, Newark Division, with the assistance o~the New York Office (NYO), initiated an investigation predicated upon the detention of five (5) Israeli Nationals who may have possessed information about the terrorist incident targeting the "Twin Towers" of New York City's World Trade Center (WTC). (~~The attached to a criminal sub oena serve~d~~o~n'-----U~~~~~~~~~

(~~)According to the display windows of the telephones, the following telephone numbers correspond to the following individuals:

b::.

SE¥
(S)
To: Re: .~... e. .... .~~ w a...fk FroID. l\T<=>"r:::arit ~r09/17/2001 (~)~ Investigation at Newark

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(presumably I (presumably. (NFI) ~----------~ continues .

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2

FD-302 (Rev. 10-6-95)

,

ALL

I1~FOpnATIO]oJ

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F~STIGATION'

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Date of transcription 09/11/2001

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Special Agents (SA) and of the Federal Bureau of Investigation (FBI) interviewed Police OfficerJ I East Rutherford Police Department, East Rutherfor , New JerseYI who provided the following information: t#)
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On 09/11/01

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stated that while assigned to a traffic detail, diverting traffic from Route 3 East to Route 120 North and Route 3 West/l lobserved a white Gheyroler van traveling slower than other vehicle on Route 3 East. t _~ecalled a message transmitted by dispatch of a national broadcast to be on the lookout for a white Chevrolet van bearing NJ registration JYJ13Y related to the terrorist attack earlier in the day. I I immediately informed of the possibility that he has observed the white CHEVROLET van wanted in connection of the terrorists attack.lk)
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advised that prior to the State Troopers tranSDortlna the occupants to their facility/l was told by \) 6 1 1 "We are Israeli. We are not your problem. Your ?,problems are our problems. The Palestinians are the problem. II l:= I I then told [ IIIWe were on the west side highway during the incident.

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Chief of Police John R. LaGreca CSRR 014157

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~ ST RUTHERFORD POLIC~ DEPARTMENT 312 Grove Street East Rutherford, New Jersey 07073

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DATE 09/11/01

[X] PRELIMINARY POLICE REPORT [ ] SUPPLEMENTAL REPORT TIME DAY LOCATION 1556 Tue Rt-3 East Service Rd. Mile 7.9 Nature of Report Police Information
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This officer was on special detail at the above location diverting traffic from further travel on Rt 3 east re-routing the traffic north on Rt120 and 3 west. While diverting traffic, this officer was informed by dispatch of a national broadcast related to the terrorist attack earlier in the day. The information relayed was to be on the look out for a 200-0 chev-y van color white NJ registration JYJ13Y occupied with approximately 3 or more individuals (unclear as to male or female). A short time later this officer observed a van traveling quite slower than the rest of traffic east towards me on the service road that appeared to be a newer model chevy with at least two occupants. I immediately informed I I(The OIC at the scene)of the possibility of a match on the vehicle. As this officer approached the vehicle I did not observe a front license plate. I went to the rear of the vehicle and observed the license plate (NJ JRJ13Y) I felt that the one letter difference in the plate could have been a mistake and requested a confirmation. The return transmission revealed the plate on the van matched the broadcast so at this time I returned to the driver door and requested the driver to stop the vehicle and exit. The Driver did not immediately exit the vehicle and was asked several more times but he appeared to be fumbling with a black leather fanny pouch type of bag. This officer then physically removed him. I Iremoved the passenger and one other passenger from the passenger side of the van and with minor assista~ce from I Ithe other two occupants were removed place~ on the grass off to the sho).11der nd this officer read all five a individuals their miranda rights. The van was secured and headquarters was requested to immediately notify the County Bomb Squad and FBI of the situation. All occupants were transported to the state police facilities inside the Meadowlands sports complex b State Troo ers to await the arrival of the FBI. The occupants were ,Driver) w/m dobl laddressess given: I rBrooklyn NY and Israel wearin blue 'eans torn knees and a gray and black shirt. w/m dob I IMiami Beach Fl 33139 Wearing jean overalls~ address qiven/ wearing a pink shirt and blue jeans.L~w/m dob I JNo addres~ given and uncertain of clothing description but individual was holding an ~erican Exprefs Card~ I w/m dobl lofL _ Manhatten Nyl Ionly personal belongings were a pack of Cigarettes and black sunglasses. I am not sure to the position of the other passengers. [U!A.TlON COlrr,AlNlIDl~, .JU_;L ~IS JJNCLPJ3S~/tiI3It~ ~~(_J3y"

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Report of Po-~I

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Officer in Charge

* Chief of Police John R. LaGreca CSRR 014157

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Telephone 201-438-0165
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DATE 09/11/01

PRELIMINARY POLICE REPORT [ ] SUPPLEMENTAL REPORT TIME DAY LOCATION 1556 Tue Rt 3 East Service Rd #7.9 Nature of Report Police Information
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COMPLAINANT Address

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Prior to the transportation to the State Police facilities this officer was told without question by the driver "We are Israeli, We are not your problem. Your problems are our problems( The Palestinians are the problem. I was also told by were on the west side highway during the incident. The black bag that the driver was fumbling with contained all of his belongings (see attached Receipt from the FBI for its c9ntents) . Jwas in possession of a white sock like sack filled with $4(70 in cash ( see attached receipt from FBI) . This officer did not speak to the Special Agent in charge Kevin Donovan and there were many other agents involved in the investigation. Two of which were and~ ~

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EAST RUTHERFORD POLICE.DEPARTMENT 312 Grove Street East Rutherford, New Jersey 07073

DATE 09/11/01

] PRELIMINARY POLICE REPORT [X] SUPPLEMENTAL REPORT TIME DAY LOCATION 1556 Tue Rt-3 South-Service-Rd Nature of Report Police-Information FN Ph.

Telephone 201-438-0165

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While on a traffic detail diverting traffic to Rt. 120 as Rt. 3 east was closed, we were informed by our desk officer PO I that there was a broadcast looking for a 2000 white Chevy van, NJ reg. Jyj-13Y, occupied by at least 3 people. After a short period of time, pol I who was on the traffic detail with me, advised me that a van which was stowly approaching us matches that description of the broadcast. Pol lapproached the driver1s side of the vehicle and I approached the passenger slde. I was able to see at I people in the van, two in the front and two in the back. Officer read the ~]ate nurber and I cqntacted the desk for confirmation on the p e number. PO! .advised me that the plate #, NJ reg. JRJ-13Y is one number off. He then contacted Hq and then it was confirmed that the plate on the vehicle was in fact the plate that the FBI had stated in the broadcast. While pol Iwas removing the driver from the vehicle, I removed the front seat passenger and one of the rear seat passengers. As I was removing the front seat passen he stated "we1re Isrealill• He was identified, via Isreal passport as W'M Dob of Isreal. He advised me that they were on their way to in Brooklyn where they are staying with a . roommate. He did not ave t e exact address. I I and I I I larrived at the scene. All five males were handcuffed and PO~ __~~ read them their miranda warnings. All five spoke and understood English and they acknowledged their understanding of miranda. : Bergen Count Bomb S uad, State P FBI notified. The driver .of vehicle was W M Dob of B ookl n ~=-:......, The rear passengers were: W1M Dob Miami Beach, FL (he was wearing blue Jean overall~s~)--iT---~~~======~W~/~M~ r~n~oaddress given - wearing a pink shirt and ue Jeans i W/M Dobl lof I I Manhatten, NY. FBI agents responded and took over the scene. All five were seperately transported to the State Police facilities in the Meadowlands Sports Complex by State Troopers, Further investigation by the FBI.

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FEDERAL BUREAU OF INVESTIGATION

Date of transcription

09/14/2001

In connection with a canvass conducted by the belowreferenced Special Agent at the apartment building located ate==] I lunion CitYI NJ to identify individuals reporting any unusual activ~ty around the apartment building over the prior few days, the following interview was conducted: ~ )
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~------~~------------------~I~d~ate of birth~== __~~-r __ ~~~~ r~~~~~~~~~~--~~~~IUnion City, NJ, was ~nterv~ewed. After'being advised of officia ~~~d~e-n~t~~~t~y~ interviewing agent and the purpose of the interview of the she provided the following information:~)

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The morning of the interview, a white van was parked in rear parking lot of the apartment complex. The van was white had no windows on the sides. It appeared to be a utility van an electric company. The name of the company, since forgotten, in red letters on the van. l14)

Usually, utility or service vehicles at the complex building parked in the front. This vehicle was parked in the back which is why it came to the interviewee's attention. It seemed out of place. No further information was available.~")

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ALL INFDPllATIOII CDIITAHIED HEREn! IS UNCLASSIFIED EXCEPT ~JHEEE SHOWIJ DTHEPJ,JISE

DATE: 07-30-2010 CLASSIFIED BY UC60322LP/PLJ/CC PEAS OIl: 1. 4 C DECLASSIFY Ol,r:07-3D-2035
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- 1FEDERAL BUREAU OF INVESTIGATION

Date of transcription

09/14/2001

Pursuant to a Federal Grand Jur District of New Jerse

These records were placed in a I-A envelope.~)

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09/14/01
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This document contains neither recommendations nor conclusions of the m:r-----------------it and its conten.ts are not to be distributed outside your agency.

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