text: Fip02 (Rev. 10-6-95) -1- FEDERAL BUREAU OF INVESTIGATION •£$ DATE: 07-30-2010 CLASSIFIED BY UC60322LP/PLJ/CC REASON: 1.4 (c) DECLASSIFY OH: 07-30-2035 ALL INFORMATION C OBTAINED HEPEII IS MCLASSIFIED EXCEPT liHERE SHOW OTHERWISE Date of transcription 09/15/2001 address \ DOB: [ , SSN: I Ihom e J NJ, home telephone I I was interviewed at his business DEBELLIS INSURANCE INC. (DIA) , 492 Franklin Avenue, Nutley, N J 07 110. Also pres ent during the interview were I ~ no ? - I " J AGENCY, ggN;f land I DOB: SSN:|_ 1' n NJ i J - After the identity of the interviewing agen t and the nature of the interview was made known, information: £,m ^ volunteered the following company was started by is the of DIA. The is the in 1961. C u ) I^F helps him out at DIA on occasion. ( and does not work for DIA.£t*} and is a friend of In June of 2001, a telemarketer from DIA contacted URBAN MOVING COMPANY (UMC) to s olicit busines s. The telemarketer made an appointme nt for | j to meet with a LNU on ng/nfi/2 >00 1. LNU was unable to meet in person so he spoke with the telep hone and w rote UMC a Commercial Auto Policy for tneir nnnHn r.fpH all f.h fi business with UMC via I never went to the offices of on vehicles t e 1 ephone ana tacsimi 1 e UMC. UMC is a household furnishings moving company. £u) ( | recently received a check from UMC as payment for their insurance. The check was drawn on account 1036500845365, from CHASE MAN HATTAN BAN K. The check number was 8466 in the amount of $3,463.37. I I provided a copy of the check and a copy of all the documents in their files relating to UMC.^^ remembered one male from UMC com ing to DIA to did pick up some driver ' s licenses of drivers for UMC. not know the name of the individual, nor could he remember a physical description. fu\ he hlC hi A b6 b7C Investigation on 09/14/2001 at Nutley, NJ Filefl by £3A jm frt Date dictated S^> b:i This document contains neither recommendations nor conclusions of the FBI. It is the property of the FBI and is loaned to your agency; it and its contents are not to be distributed outside your agency. FD-302a (Rev. 10-6-95) b7A Continuation of FD-302 of The writer showed five males : a photo array of the following Photograph nu mber 1 DOB: Photograph numb er 2 DOB: Photograph me mber 3 DOB:" Photograph qumhfir £ DOB: Photograph numb er 5 DOB their names di d not reco gnize anyone from the photographs or (Note : | | paused for quite some time while looking at photograph number 3.)£u) After looking at the photographs, interviewing agent if ev eryone at UMC was Israeli interview ing agent asked _ asked the The why he would ask such a question. [ | 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.£cO subcontractors time. explained that the movers at MOISHES are all There are approximately 6 to 12 at any given stated DIA carries separate insurance policies on each subcontractor's business. The subcontractors are all y oung individuals from Israel just out of the military. | stated he knows this benan.gfi i -.hp subcontractors talk openly aooun their experiences. | | also stated the subcontractors seemed to be all hard working nice individuals. Cu) t | has 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. r^J w )Cn Si FD-302a (Rev. 10-6-95) b7A r m he hlC Continuation of FD-302 of ' l ^^K®ftT n 09/14/2001 _ 3 >^^U'fljj\r( t , On ' ' , Page All documents provided by DIA will be maintained in a 1A with the case file. This report relates to NK1765.£t4\ ->, . ,: . *,?.***&}*.'$<&&&•*•* -. . . URBAN MOVING SYSTEIWSi INC. V- fe ^'v* THE CHASE MANHATTAN BANK, N.% ,y *." " /#'£'& 770 Lexington Avenue # iJi /r ' : '' "" ■■""* : s «New York, NY 10021, ' : ' '■ 'if '$#£# ''.&>• 8466 Vv »# ":;:■■' ^ Sf DeBellis Insurant **3,463.37 Three Thousand Four Hundred Sixty-Thr,eeanpj37/100' i***************************************************** DeBellis Insurance >f T 'f ;■ •, ft-'.: '.:', ■5 MEMO , ft i- 4 *?■<& aYv^ $ :? insurance installment ffc;;V DOLLARS V!" ■oaauEEtii- i:o a idoo l aaizioa&BQQaiiSaEiSii 1 ■ :» ;■ .' S f ;■;;, ft 2: *-& ^ : ."' W 3? fr?- '1 f v; ;',.^;§f ''>;;"■,';'''!;,.' I ':, ' f ," ' / , ' \'< •;>. '.1 $ ' DEBELLIS INS AGENCY, INC 492 FRANKLIN AVE. NUTLEY, NJ 07110 973-661-1500 FAX 973-661-9750 FACSIMILE TRANSMITTAL SHEET TO FROM: .b6 b7C COMPANY: Urban Moving . FAX NUMBER: DATE: 09/07/01 TOTAL NO. OF PAGES INCLUDING COVER: 02 PHONE NUMBER: SENDER'S REFERENCE NUMBER: RE: WORKER'S COMP - RENEWAL YOUR REFERENCE NUMBER: NO TES/COMME1 SITS: 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 conjunction with your commercial auto. If there are any questions please contact me. Sincerely, Received: 1/11/01 4:25PM; ^^ 01/11/01 16:08 f?2ojQp2 9434 201 662 94-34 -> HP LaserjA3ioo; Page 2 ' INSURANCE OFFICE W" DEBELLIS aoo2 AGENCY LgWTWEfllP!. ACQBD n AGENT/BROKER OF RECORD CHANGE PRODUCER cooe INSURANCE COMPANY NAME CNAjCkis Co. DATE POUCY NUMBEHp) (oS5 g HuVA>TMX6,fiK 'wy> EFFECTIVE OATH Cfl-lg-OO EXPIRATION DATE OM8-QI UN5 OF BUSINESS _WfifWs_C£ii r Please be advised that we wish to name {WM^y "freftelRs floppy -mc / PRODUCER V / CODE* as our exclusive representative effective QQ-ra-iM DATE for the lines of business shown above, currently in force or submitted by application. This authorization replaces any other authorization that may have been previously completed for any other insurance representative for the stated lines of business. JSfPlease rescind the day waiting period □ There will be no rescission letter JSL £l INSURED'SjSIGNATURE DATE TITLE (IF APPLICABLE) (SsMPANy/iAME (IF APPLICABLE) (IF APPLICABLE) ACORD 36 (1/98) /a A/^riDn i^rtQQno *Tir»u ^aa<» DIA DeBELLIS INSURANCE AGENCY, INC. 492 FKANKLIN AVENUE, NUTLEY, NEW JERSEY 07110 • Tel: (973) 661-1500 • Fax (973) 661-9750 July 09,2001 Urban Moving 3 18 th St Weehawken, NJ Attn: Re: Insurance Proposal he b7C Dear 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 information I will need to obtain is as follows: 1. Copies 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. Sincerely, . — ■ ..— "-i ;..- «wu;otim* i.golt(^ Designation (ChecKunej ix vj" - Renewal U Inforca tffittSK^ § ^ ?ooK G ■ioowy Statement :>u have the right to receive at this time an itemization of the Amount Financed. (Til w»rrt an nvnnttlong) I do wrt went an rtsmtartion Total Premiums.. Cash Down Payment Required $ 38§2Q,| oo 9730 rOO l5Sn agreement no. and/or quote no. : ie.oo Amount Financed (The Amount of credit provided to me or on my behalf) FINANCE CHARGE (Dollar emdunl credit will cost me) INSURED/BORROWER <7l , ^ ^ - (Name, Addresa and Telephone NUituser) I URBAN MOVING SYSTEMS INC - L _ 3 18TH STREET WEEHAWKEN, NJ 07087 Total of Payments (Amount I will have paid after making all scheduled payments) 19S0 |33 $ 31170 133 Pm Phone No: AM Phone No; AGENTo'r^ROKER (Name and Business Address) ; DEBELUS AGENCY 492" FRANKLIN AVE NUTLEY.NJ 07110 Phone No; FaxNo: PPP CODE PPP .PREMIUM PAYMEHT PLAN Hudson City Centra - ^tntr of Green & Sfet» 3t Hut*MnJ^12«4 6tMt M00Q * P ** fi1MZi*87X> ■_ ANNUAL PERCENTAGE RATE (Cost of my credit figured as a ye arly ra ta) 16.00 % Amount of 3463:37 Pavm ent Sched tij_e Number of Payments Payable ; "nSonffi!; "lAnnuaVT Quarte rly 9 1at 09/05/01 Final Payment D 05/05/02 _L2ir*-=ii-v :■ . ,., TTL ««»•«««* a lata eharoe will be impoaed on any installment which I Pw^e^'^yprewmetollamountdueun^^^^^ Kt •noTHXJSe service charge of«l6lnCT. NY, PA $12 m NJ.nrf made wHn we W «^ p^™,*. The late charae «V «**• todudedtalne^e^lnl^^ cham. by etete. nctuded in flnence cns^s in i«. "v •-""•"'" ."*, j" uv ii i Mm and three the iffhount refundable Is less than one dollar ($1 in NY, NJ. MD) ana three •faiinnt (S3 in CT PA RIV or maximum allowed by state. afi&MMWtAi r security tor the payment* to be made. I am •wgnmg ?e"uWSd^ Zidn reduce the unearned premiums. This mean, that thla money can be used to pay amount* due under this agreement.^ charge by state. Contract Reference Reference should be made to the ten™ of this Agreement ae stated below and on the next page tor infbmjeHon about KSnt, default, the ri 8 hl to accelerate, the maturity of ttw obligation, and prepayment, rebatoa. and penalties Type of Insurance BA Policy Number and Prefix BINDER Full Name of Insurance Company and Now (N) Name and *ddr*as of Genera Agent or * renewal W Com pany Offi ce to Which P remium * Paid | Policy * -> EMPIRE INS/ Effective Date; Mo. Oay Yr.: ^^^s^^^^^tis^r^t^tssssss^ Taxes Premiums (Record to "A*) Policy Premiums 38920 38920 00 00 00 00 in mis Agreement, .....— —.---. (R»cordHi^r; :i charge as stated above. , 2. Taxes *F*«. I Understand the following .'understand the following'. o^^".. ^Pniiffeft listed above this fee la charged under Section 21 19 oflheNaw York Insure (CONTINUED ON REVERSE SIDE) . . f are , ncorpara ted by referenc e and constitute o part* ^0!*™™!: and un der certafn condition s to obtain a partial refundof th e finance cnarga. VT^Tf^^py rf thjajto jawm it to protect your legal ri ghja. . _ NOTICE TO INSURED LDoUSelgn this Agreement before' you read It or if it contain* any wank space. TYOuareiniiMto a afmpletaly filled In capypfml* Aoj^ment, stpa^&^^^- s ^ — ■ — ' — &- -^ , (5tonatu«o(lniw«a) : FOR IMPORTANT INFORMATION ' ^ ^BTonsluraaAdThbrfJIamltiraiuO '"" D* -t— b6 " b7C .EOSWOB o 1~p afioj ( iAt_j:? 1 • c • finv !ju :Aa mac DEBELLIS INSURANCE AGENCY, INC .492 FRANKLIN AVE. NUTLEY, NJ 07110 973-661-1500 FAX 973-66 1-9750 FACSIMILE TRANSMITTAL SHEET TO: FROM: b6 b7C I I COMPANY: Urban Moving Systems DATE: 08/01/01 FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: 03 PHONE NUMBER: SENDER'S REFERENCE NUMBER: RE: COMMERCIAL AUTO OUOTATION - REVISED YOUR REFERENCE NUMBER: 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 - Deposit 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 ^iVltnc*. ^9 [re£ ^J +> J*± Tky^^ Coupon are eoc Mt^ \&sed ( OiO I -s-srSr-^^^ ^* PPP - PREMIUM PAYMENT PLAN . You have the right to receive at this time ' an itemization of the Amount Financed. ™ l want an itemization 3C I do not want an itemization IPRPMIUM FINANCE AGREEMENTS ) DISCLOSURE STATEMENT 1 Policy Designation (Check One) S Commercial □ Personal □ Assigned Risk 2. Type of Agreement (Check One) H New Q APC □ Renewal Q Inforce 3 Preferred Billing Method (Check One) ■£ Coupon Book □ Monthly Statement LOAN AGREEMENT NO. AND/OR QUOTE NO. Total Premiums Cash Down Payment Required $ 38920 1 00 $ 9730 1 00 C Amount Financed (The Amount of credit provided to me or on my behalf) FINANCE CHARGE (Dollar amount credit will cost me) $ 29190 ,00 $ 1980 ,33 Total of Payments (Amount I will have . paid after making all scheduled payments) $ 31170 133 16.00 INSURED/BORROWER (Name, Address and Telephone Number) URBAN MOVING SYSTEMS INC 3 18TH STREET WEEHAWKEN, NJ 07087 ACCT. NO. Pm Phone No: AM Phone No: AGENT or BROKER (Name and Business Address) PPP C0 DE DEBELLIS AGENCY ^11 1OTOBMATIOW CO^^^ 492 FRANKLIN AVE *£££ ««m.A AftTFIED «* NUTLEY.NJ 07110 Phone No: Fax No: •^ PPP - PREMIUM PAYMENT PLAN Hudson City Centre - Corner of Green & State St _ Hudson, NY 12534 R 518-822-1000 * Fax 518-828-5729 ANNUAL PERCENTAGE RATE (Cost of my credit figured as a yearly rate) 16.00 % Amount of Each Payment 3463.37 Payment Schedule Number of Payments Payable Annual Quarterly Monthly 9 1st Payment Dilie 09/05/01 Final Payment Dt 05/05/02 Prepayment I may prepay the full amount due under this Agreement. If I Late Payment A late charge will be imposed on any Jn* n ™ rt a «J>J* l! * £jta£ is a non-ref5ndable service chargeof $10 in CT, NY, PA; $12 in NJ; not made within five (5) days of the "^^O^^ 1 *™- and MS) $15 in Rl 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 inTnanS uneamed'interest will be made if minimum of one dollar ($1.00) ($2 in TN). See back of form for maximum late ^'-^»'»«w — i*u™ charge by state. the amount refundable is less than one dollar ($1 in NY, N J, MD) and three dollars ($3 in CT, PA, Rl), or maximum allowedly state. Security Interest As a security for the payments to be made, I am assigning to you all unearned premiums under the Policies, and all loss payments which reduce the unearned premiums. This means that this money can be used to pay amounts due under this agreement. Contract Reference Reference should be made to the terms of this Agreement as stated below and on the next page for information about nonpayment, default, the right to accelerate, the maturity of this obligation, and prepayment, rebates, and penalties | SCHEDULE OF POLICIES: Personal Auto - Bl (Bodily Inj ury) - PP (Property Damage) - HO (Homeowners) - F (Fire) - ML (Multiline) - MC (Motorcycle) ■ BOP (Business Owners) * — — — I ' " .... _ . —. ~~t ti /ki\ /M\ T«rm . _. .. Type of Insurance BA Policy Number and Prefix BINDER Full Name of Insurance Company and Name and address of General Agent or Company Office to Which Premium is Paid EMPIRE INS/ New(N) or Renewal (R) Policy — > N Term In Mos. Cov. by Prem. 12 Effective Date Mo. Day Yr, 08 06 01 Taxes Policy Premiums 38920 38920 00 00 00 00 Wherever the word "Policy" is used, it means those things listed above in the Schedule of Policies. Whenever "you" is usetiFees____ SXeemenU^ it means the insured undersigned. .1^,,,^™^/^ (Record in "A") charge as stated above. 2 ^^^^as^sssasssssssssr SSSS3SSSSS. M >e p^. T » <* -mm. e^- »--« »y ■«— - -j*T ~?~*?r~: 1 . Do not sign this Agreement before you read it or if it eQitains NOTICE TO INSURED any blank space, 2. You are entitled to a completely filled in copy of this Agreement. 3 Under the law, you have a right to pay off in advance the full amount due and under certain conditions to obtain a partial refund of the finance charge. 4. Keep your copy of this Agreement to protect your legal rights. All insureds 1st sign as named In policies. If corpor ation, authorized officers m US t sign; If partnership, partner should sign as such; signatory actmg In representatures capaci tyrepresentsthataiilnsuredshaveauthorizedthlstransactio, ___ " iutat ^^ fam ^ ^= ^- : L """ ""(Signature and Title of Agent or Broker) By. tfo be -b7C Date (Signature of Insured) Date MntifSF NFXT PAGE FOR IMPORTANT INFORMATION ECS 5/95 From: URBAN MOVING SYSTEM: 3 18TH STREET WEEHAWKEN, NJ 07087 ^C 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: Welcomel 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? Finance 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 Insurance Co General Agent New/Renew Term Effective Date Premiums BINDER B B EMPIRE INS 08/06/01 n^%sm 3892000 Taxes Fees TOTAL 38920 00 Make check payable to Premium Payment Plan. Include check- fold, staple, mail Insured's Name: URBAN MOVING SYSTEMS INC p ue: 09/05/01 Address: 3 18TH STREET Amt Due: 3463.37 WEEHAWKEN, NJ 07087 Agent/Code: DEBELLIS AGENCY/ Premium Payment Plan * PO Box 668, Hudson, NY, 12534 * Tel. 518-822-1000 B8-1Q-81 93i-Q6 i»J6. 10.2001 2:2/™ B' ■\hBi UJKU lN&UK/mtaut Ins. ID = Eft; 03/ 01/ /IT98 PQ1/Q1 Vehicle 2000 GMC Van : a999 International ; vehicle Type : Truck .- : Not Otherwise Clas Class Code i 03199 fciab Factor : 1.30+0-00=1.30 P&Y Dam Factor : 1-I0r0.00~l.i0 Territory : io si Cost Netf * : $13 ,000 Age Group r 2 Truck Not otherwise Clas 33199 1.55+0.00=1.55 0.80r0.0O*G,8O 10 $35,000 3 ?!!ff! ga : Li * its : pr *^ = L^r™^^" Liability ttedical ?ay PIP DM Coverage Type Other Than Cal Collision Premium :$1, 000,000 $2543 :Kone 50 : Pedestrian 0. :$1. 000,000 $216. : Comprehensive : $1,000 ded 5141. : $1,000 ded $345. : $3245. 0D;$1,00Q,000 $3019.00 00-N D ne $0.00 62: Pedestrian 0.62 00:51,000,000 $216,00 r Comprehensive 00;$1,000 ded $138.00 00:S1,000 ded $401.00 52 : $3774.62 <3 focal Annual Premium ; $7,020.00 ■hx daa.q QS-10-Q1 92:27 TO: FROM: PQ3 /vt.T. JNPORMA-TIOJr COITOOHEB^ HEREiiiis ^classified ^V .• . -"■•" "•"\ rrr "■■" RUG 10 2001 12:32PM HP^RSERJET 3200 p.l New Jersey Headquarters ■3, 18* Street -Weehawken, NJ 07087 (201}55&-0031 Urban Moving Systems, Inc. New York Headquarters 446 West 50 m Street. New York, NY 1QT019 (212) 338-9267 Debellls Insuram [£S VIA FACSIMILE: 973-661-9750 bb hlC Dear The intonnaion you requested Isbelow. Please call me to confirm that you received them and that the application is on it's way. Urban Moving Systems, Inc, MC 320465 NYSDott-33739 US Dot 691256 PC 0076006 MC 398463 USDOT 923345 1 8-lo -ci ? lease -fi\x "<■ da p' &~s o-f all v/etac/e rea»s4nJtens a* Soon as pofis/ife. ^^/ 6U " (t AT.T. IKPOHMA.TIOW CO! >^T BY. 3«a&fc m ^ 6 RW. mm BC?. 01 LUCID LAljjii i iiAi/' * V 492 Franklin Avenue Nuiley, New Jersey 07110 Phone: (973)661-1500 Fax: (973)661-9750 Fax b6 b7C To: | From: Co.: ^To : 4"dr Pages: |Q ^■Q^oa Majiaj ■** §-3~£M Refifc * CC: V Urgent , Q For Review Q Please Comment q Please Reply Q Please Recycle ■* . * neose rzJituo <xpp +■ loss -ru.As . H.Vk j a«-e. orcUred. nccoa«aT sola coT ^35,^5.0. ^bsil #$- ^^130 recede/. A3eec/ bound ALL INFOEMATION <WmMB»\ ACORD COMMERCIALnNSURANCE APPLICATION HlsUKU n XPPLICANT INFORMATION SECTION PRODUCER I PHONE (AIC Mo FyI) ,(973)661-1500 FAX 073)661-9750 DeBellis Insurance Agency, Inc. 492 Franklin Avenue Nutley, N3 07110 SUB CODE: AGENCY CUSTOMER ID 00007675 CARRIER NAIC CODE: Inter-America Ins Agency 0ATE 08/03/2001 UNDERWRITER POLICIES OR PROGRAM REQUESTED CA INDICATE SECTIONS ATTACHED PROPERTY GLASS AND SIGN ACCOUNTS RECEIVABLE/ VALUABLE PAPERS CRIME/MISCELLANEOUS CRIME TRANSPORTATION/ MOTOR TRUCK CARGO EQUIPMENT FLOATER INSTALLATION/BUILDERS RtSK ELECTRONIC DATAPROC COMMERCIAL GENERAL LIABILITY BUSINESS AUTO "*' TRUCKERS/MOTOR CARRIER GARAGE AND DEALERS VEHICLE SCHEDULE BOILER & MACHINERY WORKERS COMPENSATION UMBRELLA STATUS OF SUBMISSION PACKAGE POLICY INFORMATION X X QUOTE X ISSUE POUCY ENTER THIS INFORMATION WHEN COMMON DATES AND TERMS APPLY TO SEVERAL UNES. OR FOR MONOUNE POLICIES. BOUND (Give Date and/or Attach Copy): PROPOSED EFF DATE PROPOSED EXP DATE BILLING PLAN PAYMENT PLAN AUDIT DATE 08/06/20 Dl TIME 12:01 X AM PM 08/06/2001 08/06/2002 X DIRECT BILL AGENCY BILL APPLICANT INFORMATION NAME (First Named insured & Other Named Insureds) URBAN MOVING SYSTEMS INC E J& & S0C 3 EC# ^22-3511891 if First Name d Insured): INDIVIDUAL PARTNERSHIP CORPORATION JOINT VENTURE SUBCHAPTER "S" CORPORATION LIMITED CORPORATION IT MAILING ADDRESS 1NCL Z1P+4 (of First Named Insured) 3 18TH STREET WEEHAWKEN, N3 07087 HUDSON INSPECTION CONTACT IfilSHSUw, C201) 558-0031 ACCOUNTING RECORDS CONTACT E NOT FOR PROFIT ORGANIZATION BUSINESS STARTED 1990 sisaL £xlU- PREMISES INFORMATION LOC# BLD* STREET, CITY, COUNTY, STATE, ZIP+4 CITY LIMITS INTEREST YR BUILT PART OCCUPIED 00001 00001 3 18TH STREET HUDSON WEEHAWKEN NJ 07087 X INSIDE OUTSIDE X OWNER TENANT be hie. C INSIDE OUTSIDE OWNER TENANT ■8 INSIDE OUTSIDE OWNER TENANT NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS BY PREM1SE(S) MOVING & STORAGE (HOUSEHOLD) GENERAL INFORMATION EXPLAIN ALLIES** RESPONSES YES 1. IS THE APPLICANT A SUBSIDIARY OF ANOTHER ENTITY OR DOES THE APPLICANT HAVE ANY SUBSIDIARIES? Z 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. ANY POUCY-OR COVERAGE DECUNED, CANCELLED OR NON-RENEWED nilRIMB THE PRIOR 3 YEARS? NOT APfr ICABI.E IN MQ REMARKS NO EXPLAIN ALL"YES H RESPONSES YES ^■^s^Rmp^m s ^^m^m^HM^ m ^ 8. DURING THE LAST TEN YEARS, HAS ANY APPLICANT BEEN CONVICTED OF ANY DEGREE OF THE CRIME OF ARSON? (In Rl, this question must be answered by any applicant for property Insurance. Failure to disclose the existence of an arson conviction Is a misdemeanor punishable by a sentence of up to one year of Imprisonment). 9. ANY UNCORRECTED FIRE CODE VIOLATIONS? <i ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSUR^ECOUPANY 'OR ANOTHER DPR<lnN ph pe^ CM APPLICATION FOR INSURANCE OR STATEMENT OF CLA M CONTAINING ANY MATERIALLY pIifprnFORWIATION OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITC^ IS A CRIME AND SUBJECTS THE PERSON TC TcR M1NAL AND TNY: SUBSTANTIAL! CIVIL PENALTIES. : APPLICANTS SIGNATURE PRODUCER'S SIGNATURE AD ACORD 125 (8/97) PIEASE COMPLETE REVERSE SIDE ©ACORD CORPORATION 1993 PRIOR CARRIER INFORMATION LINE CATEGORY 1993-2001 G E N C R Sa CA T Y CARRIER POLICY NUMBER POLICY TYPE I CUlMS I WCE CCCfl^SlCE CLAIMS CCCyRRGf.CE 1 CUIUS 1 M-CE j CCC'J^ENCE C'JHMS > Mi3E - OCC'-HRS-'iCE 1 ^ c;s"»?.a RETRO DATE i EFF-EXP DATE GENERAL AGGREGATE PRODUCTS CC-MP OP AGGREGATE PERSONAL &ADVINJ EACH OCCURRENCE *•* \ FIRE DAMAGE " MEDICAL EXPENSE S B to ODILY OCCURRENCE ,JURY AGGREGATE PR( D/ 3PERTY OCCURRENCE WIAGE AGGREGATE COMBINED SINGLE UMIT MODIFICATION FACTOR TOTAL PREMIUM t CARRIER VAN LINER INS CO POUCY NUMBER POLICY TYPE EFF-EXP DATE COMBINED SINGLE UMIT 1,000,000 BG IN. D ILY EA PERSON URY EAACCIDENT PROPERTY DAMAGE MODIFICATION FACTOR • TOTAL PREMIUM . p R P E R T Y CARRIER POUCY NUMBER POUCYTYPE EFF-EXP DATE A BUILDING AMT PERS PROP AMT MODIFICATION FACTOR TOTAL PREMIUM CARRIER POUCY NUMBER POUCYTYPE EFF-EXP DATE UMIT MODIFICATION FACTOR TOTAL PREMIUM LOSS HISTORY ENTER ALL CLAIMS (REGARDLESS OF FAULT) OR OCCURRENCES THAT MAY GIVE RISE TO CLAIMS FOR THE PRIOR 5 YEARS (3 YEARS IN KS & NY) | F NONE * LOSS SUMMARY DATE OF OCCURRENCE UNE TYPE/DESCRIPTION OF OCCURRENCE OR CLAIM DATE OF CLAIM AMOUNT PAID AMOUNT RESERVED CLAIM STATUS OPEN CLOSED OPEN CLOSED REMARKS NOTE: FIDELITY REQUIRES A FIVE YEAR LOSS HISTORY NOTICE OF INSURANCE INFORMATION PRACTICES ^ " " mnMt . , PERSONAL INFORMATION ABOUT YOU MAY BE COLLECTED FROM PERSONS OTHER THAN YOU. SUCH INFORMATION AS WELL AS 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 OUR FILES AND CAN REQUEST & CORRKTON 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 HOWTO SUBMITA REQUESTTO US. ACORD 126 (8/97) PRODUCER PHONE" (A/C, No, Ext): FAX (973)661-1500 (973)661-9750 DeSellis Insurance Agency, Inc. 492 Franklin Avenue Nutley, NJ 07110 CODE: : SUB CODE: ffJJTOMERlD: 00007675" applicant URBAN MOVING' 'SYSTEMS INC' (First Named Insured) EFFECTIVE DATE . EXPIRATION DATE 0IRECT3ILL PAYMENT PLAN 08/06/2001 1 08/06/2002 X agency bill . FOR COMPANY USE ONLY Q *,. COVERAGES : COVERED AUTO SYMBOLS 1 LIABILITY PERSONAL INJURY PROTECTION ADDITIONAL P.I.P. MEDICAL PAYMENTS UNINSURED MOTORIST UNDERINSURED MOTORIST S1 ! = 3 i'XIa UMTTS t'bi :■■■■ ■ EAPER s : -5 [xIt : i5 : ■: j 17 : = 2 I J3 \ \2 { :3 \ ;4 i j2 : :3 ; U ; X j 9 : X j csl j :BI EACH ACCIDENT \ PROPERTY DAMAGE I OR EQUIVALENT j NO-FAULT COVERAGE 1,000,000 DEDUCTIBLE : i 4 j J7 i 16 [XJ7 i Is j'xl 7 [TOTAL |$ ! EACH PERSON W/C S M/E $ u , ™,» rt ""^™ : STATES HIRED/BORROWED : M] LIABILITY I [XjCSL \ j EAPER $ JBI EACH ACCIDENT $ j PROPERTY DAMAGE $ : X j CSL \ \ EA PER * j Bl EACH ACCIDENT $ j PROPERTY DAMAGE $ I COST OF HIRE m~T 1^000^000 1,000,000 : . X ! IF ANY BASIS : STATES ;NJ NON-OWNED LIABILITY i GROUP TYPE : EMPLOYEES I ! VOLUNTEERS j PARTNERS NUMBER OF COVERAGES [ COVERED AUTO SYMBOLS j LIMITS TOWING & LABOR COMPREHENSIVE SPECIFIED CAUSES OF LOSS COLLISION PHYSICAL DAMAGE ! 3 [7 = 2 J :4 I 18 ■ 2 : j 4 I : 8 • 2 j !4 j ! 8 Is \X\7 :$ HIRED PHYSICAL DAMAGE STATES i #DAYS j #VEH j COVERAGE/DEDUCTIBLE : j I COMP $ ! j : j SPEC « j ■ jCOFL S • j : \ COLL $ COVERAGE IS: : PRIMARY : SECONDARY ENDORSEMENTS, FORMS, CONDITIONS COVERED <1) ANY AUTO AUTO (2) ALL OWNED AUTOS SYMBOLS (3) OWNED PRIVATE PASSENGER AUTOS (4) OWNED AUTOS OTHER THAN PRIVATE PASSENGER (5) ALL OWNED AUTOS WHICH REQUIRE NO-FAULT COVERAGE (6) OWNED AUTOS SUBJECT TO COMPULSORY U.M.LAW (7) AUTOS SPECIFIED ON SCHEDULE (8) HIRED AUTOS (9) NON-OWNED AUTOS UST ALL DRIVERS, INCLUDING FAMILY MEMBERS THAT WILL DRIVE COMPANY VEHICLES, AND EMPLOYEES WHO DRIVE OWN VEHICLES ON COMPANY BUSINESS. DRIVER* # i NAME (tncluda address, If required) ". ? 0001! «AT C n CB10 Yu : YEAR : DRIVERS UC EN SE NUMBER/ :STATE: USE . % DATE OF BIRTH : UC SOCIAL SECURITY NUMBER : UC : VEH# : USE VEH# j YEAR j make. GMC 0M01j2000|'— yfij CITY, STATE, ZIP WHERE GARAGED DRiVETOWORioSCHd """ T'X JcoMRITL ^ I^R^GESL ' UNDER 15 MILES j j PLEASURE : j RETAIL j X j UAB I . 15 MILES OR OVER j j FARM I. \ SERVICE I X j PIP [y.LN.: .^ "TERR""] GVWGCW ■ CLASS"' 15000 :ADD'LPIP A MOTOR - Tsicf FACTOR JSEATCP: RADIUS 20,935 'farthktterm I MED PAY i" y"| unins : A {Moron. TOWING & LABOR SPEC COFL ; F JFT I FTW ; i'{sp I" DEDUCTIBLES j ! ACV I X ! X ! COMP j j AA j X j STAMT j S X^coll j$ 20,935 Is comp: 'Ts'pec* ;COFL ...lj.000 1,000 COLL 15 MILES OR OVER * : FARM : : SfctwiwE : /\ : rtr : /v ; MOTOR COFL : .!••».". ««>-_ ; * _w ,.•-_. . •* .*., www w V -*. ^Hl@: 00002 1999 ..make INTERNATIONAL ! typ£ SYM/AGE MODELrTRUCK CITY, STATE, ZIP WHERE GARAGED . . . . . J Y*!:";:. AHJSGW15X675087 ' TERR " : "" GVW/GCW " " CLASS I 23000 ■ s FACTOR SEAT CP RADIUS COST NEW 42,259 FARTHEST TERM DRIVE TO WORK/SCHOOL USE UNDER 15 MILES | , PLEASURE 1 SMILES OR OVER ! | FARM CHECK COVERAGES ; ADD'L PIP X UNDRINS MOTOR I M=n dav TOWING : : MED PAY & LABOR : :"y": UNINS SPEC :" . . t A : MOTOR COFL ; 00003 3J .^.MEJMriONAL iJSS **** modeuTRUCK Ivjjl: 1HSDPPN9RH559152 X COMM'L • RETAIL ! X : LlAB I SERVICE j X I PIP VEH* . F JFT !ftw; LSP X COMP X COLL DEDUCTIBLES SPEC COFL ACV X COMP : jAA jXJSTAMT [S 1,000 Is '42,259 j's 1^000 coll' i SYM/AGE j CITY, STATE, ZIP WHERE GARAGED TERR : GVW/GCW :S 23000 CLASS j SIC FACTOR iSEATCP: RADIUS" COST NEW 26,000 farthestterm" DRivETOWO^ :"Y"TroMiupi i'CHECK T \^ntYt'om ""V " 'XfHt3lFa'SS"r""T'" """"V""" "l^x£":'---c-"-: :■--;- <0 _ K - j L™J C0MWL -.COVERAGES: j A 00 L PJP ..*. MOTOR j ;F LSP : DEDUCTIBLES | j ACV j X =COMP . c OF L UNDER15MILES I I PLEASURE I \ RETAIL I X ! UAB ! I MED PAY IWMSS \ ! irr "? ■ rnMD \ I a* "xl"^^,- [$*"" 1000 26 f 000 [$'" Ooo'coLL 15 MILES OR OVER ; PLEASURE JFARM VEH# ■ YEAR 00004" 1993: j RETAIL I X j UAB 1 SERVICE IXj PIP jx'] asg .KJ«bF0RD >m \^l modeuTRUCK" MED PAY UNINS MOTOR & LABOR SPEC COFL jFT j FTW X ; COMP X COLL j AA TYPE: ■ SYM/AGE : CITY. STATE, ZIP WHERE GARAGED DRtvETo "\S6rk/sW6ol1"use" j X j COMM'L 1 COVERAGES! I ADD'L PIP ivJJ^.lFpNK72O(PVA20054 TERR I GVW/GCW T CLASS* | 18000 r-UN0RTWs"r ;$ SIC . FACTOR -SEATCPJ' RADIUS COST NEW 15,000 farthestterm" X motor' : F : LSP I DEDUCTIBLES j JUNDER1SMILES I j PLEASURE j j RETAIL | X I UAB j JmEDPAY &LABOr!" I 15 MILES OR OVER : : FARM j SERVICE ! X I PIP fX^UJNINS MOTOR BODY TYPE: SPEC COFL I ^ L.?U C0MP [ = fiA I X I STAMT j $ JFTW j X \ COLL j S 15,000 [ $" ™ # 5 :^L!^^.freightliner RSS ' ' jsymwge: JACV j X jCOMP; : |ofT T,oqq 1,000 COLL COST NEW :_1.!«9!?M!^Q< I vm: 1FVABPAL91HH68277 cmr, STATE, ZIP WHERE GARAGED bRwi'TowoRwscHbou j UNDER 15 MILES ! | PLEASURE j 15 MILES OR OVER I ] FARM wrAL91HH68277 v j j $ 69 , 837 TERR j GVW/GCW j CLASS TsicT" FACTOR' 'T^TC^ ! 25500 ! ! ! j "y"T™m«'""T check ; A : COMM'L ; COVERAGES : ! RETAIL I X ! UAB ! p55wc5SiST'*"7^1'^ jA^Diwp'x^^Tj'p uIlsp > | MED PAY &LABOR PJ "" P*] COMP j ] AA jYf'sTAMT JS j SERVICE j X ] PIP j X j MOTOR COFL I ] FTW j'Xj COLL IT" '""69,837 '"" "Ts'PE'd" :COFL ..1,000 1,666 COLL *— '*!^ ^ jF J wjA L C0LL ■ ,-. 69 ' 837 J. $ 1,000 coll INTEREST • RAM If* •' kiAMC Akin Annseee ! dcccdcmocj. • : «>.*««.-..-..-«- __«...«.-» : .. INTEREST [RANK: j ADDITIONAL INSURED j LOSS PAYEE ! MORTGAGEE j UENHOLDER i EMPLOYEE AS LESSOR ; NAME AND ADDRESS • REFERENCE *: : CERTIFICATE REQUIRED [ INTEREST IN ITEM NUMBER [LOCATION: I BUILDING: | VEHICLE: \ BOAT: f OTHER : ITEM DESCRIPTION: .fXPL^^n^RESPONSES 1. WITH THE EXCEPTION OF ENCUMBRANCES, ARE ANY VEHICLES NOT SOLELY OWNED BY AND REGISTERED TO THE APPLICANT? i^.?.9.9}^?.i!??*5!LIl1S.^r.y?.X^ E :? USE THEIR AUTOS IN THE BUSINESS? HlTSS^y^^ IN 0PERAT ]?. N ?. 4. ARE ANYyEHICLES LEASED TO OTHERS? .f.'.^SS ^SX.YS! 10155 CUSTOMIZED, ALTERED OR HAVE SPECIAL EQUIPMENT? 6. ARE ICC, PUC OR OTHER FiUNGS REQUIRED? JYES: NOj: 7. DO > OPERATIONS INVOLVE TRANSPORTING HAZARDOUS MATERIAL? j I w [a. AW HOLD H^ 9. ANY VEHICLES USED BY FAMILY MEMBERS? £ X | " 1F so > PLEASE IDENTIFY IN REMARKS. I XI 1 10. DOES THE APPLICANT OBTAIN MVR VERIFICATIONS? j } XI 1Z ARE ANY DRIVERS NOT COVERED BY WORKERS COMPENSATION? I I X I 13. ANYVEHICLES OWNED BUT NOT SCHEDULED ON THIS APPLICATION? ! x IK \ x IX! DESCRIPTION OF GARAGE/STORAGE LOCATIONS I x Tx" "Tx" "T MAXiMUM DOLLARVALui SUEUECTTO LOSS REMARKS •:wfe DO NOT USE IN AR, AZ, CA, CT, DE, FL, GA, IA, IL, MD, NJ, NV t OK, OR, PA, RI, SC, WV; USE SPECIFIC STATE SUPPLEMENT. MINIMUM UM LIMITS REQUIRED IN DC, ME, MN, MO, VT, VA, WA, WI. 1££^^^ r;;jsii6SGuMAE™ (UM) AND UNDERINSURED MOTORISTS (UIM) COVERAGES HAVE j j SELECTING UM AND UIM LIMITS LOWER THAN MY LIABILITY LIMITS, OR BEEN EXPLAINED TO ME. I HAVE BEEN OFFERED THE OPTIONS OF: I REJECTING COVERAGE ENTIRELY. I UNDERSTAND THATTHE COV- ERAGE SELECTION AND LIMIT CHOICES INDICATED HERE WILL APPLY TO ALL FUTURE POLICY RENEWALS, CONTINUATIONS AND CHANGES UNLESS I NOTIFY YOU OTHERWISE IN WRITING. 1. 1 SELECT UM AND UIM LIMITS INDIC IN THIS APP 2. 1 REJECT UM BODILY INJURY COVERAGE 3. 1 REJECT UIM BODILY INJURY COVERAGE 4. 1 REJECT UM PROPERTY DAMAGE COVERAGE 5. 1 REJECT UIM PROPERTY DAMAGE COVERAGE (APPLICANTS SIGNATURE) (APPLICANTS SIGNATURE) (APPLICANTS SIGNATURE) (APPLICANTS SIGNATURE) (APPLICANTS SIGNATURE) producer PHg^ 0iExt): (973)661-1500 FAX "(973)661-9750 DeBellis Insurance Agency, Inc. 492 Franklin Avenue Nutley, NJ 07110 CODE: I SUBCODE; 00007675 appucant URBAN MOVING SYSTEMS INC (First Named Insured) wmmmmmmm d ate{mm/dd/yy> & mmmmmzim 08/03/2001 ® EFFECTIVE DATE EXPIRATION DATE 08/06/2001 J 08/06/2002 x DIRECT BILL AGENCY BILL PAYMENT PLAN FOR COMPANY USE ONLY nnnnV ,T* >** INTERNATIONAL V$& 00006 2001: MDE| jj^jj^ ! vm . ihis6^01H393754 v i" v 1* 63, 964 SIC FACTOR -SEATC'P: RADIUS FARTHEST TERM "' CITY, STATE, 21P WHERE GARAGED DRIVE TO WORK/SCHOOL j USE GVW/GCW 25500 : Y r rnmi-i = CHECK : : A : COMML : COVERAGES :_ I UNDER 15 MILES [ j PLEASURE \ j RETAIL |_X j UAB j I OVER 15 MILES j j FARM : j SERVICE I X j PIP j ADD'LPIP ! MED PAY fv'i UNINS ■ A : MOTOR ■"Y*"1tlMBR'fiSIS" A MOTOR TOWING & LABOR SPEC COFL 1ft [X :ftw : X JILSP iDEDUCTlBLisl ; A cv']'*X IcOMP i| fT .; 5 : * 2. : ■ «wl JCOMP [ JAA ^XJSTAMT [5 h 9.9.9. ;Coll Is 63,964 fs 1,000 coll VEH# : YEAR MAKE: : BODY ..:.n.PE:... j | MODEL: CITY, STATE, ZIP WHERE GARAGED DRrvifowo^ | UNDER 15 MILES [ ] PLEASURE I OVER 15 MILES I I FARM TERR "! GVW/GCW" : COMM*L | COVERAGES:.. ; RETAIL j SERVICE :UAB : PIP j ADD'LPIP | I MED PAY : : UNINS : ■ MOTOR "UNDRTNS" MOTOR " TOWING & LABOR SPEC COFL CLASS If i «: >•■ Ift I ;FTW; ! SYM/AGE | COST NEW i • | [S 'sic'T'"'^ "elsp rbWuSraijEsT i'^'\ Toowii" :"3!B? j COMP ^ | AA ! coll ! $ jACV j |COMP : COFL j STAMT j $ l$ COLL VEH* YEA * iMAKE: > * : MODEL: : BODY : TYPE: CITY, STATE, ZIP WHERE GARAGED DR^TOWORraSCHOOLTuSE ! UNDER 15 MILES j I PLEASURE j OVER 15 MILES j I- FARM TERR* j GVW/GCW*' TcOMWL'TcO^RAGEsi I ADD'LPIP MOTOR^ "1 I *: * * TOWING : RETAIL j : UAB = ;MEDPAY &LABCR 1 ,™""*. ! 1 «.« ? I UNINS SPEC : SERVICE j ; PIP ; j MOTOR COFL CLASS IF l Ift i 4 >■• I FTW I • SYM/AGE : COST NEW • i j Sic '-"FACTOR" TSEATW Jls'p j^?"™^^^^ I STAMT I $ j COMP ; i AA j COLL j $ : $ COLL VEH# ; YEAR I^jmawb \ 1"°.!?^. CITY, STATE, ZIP WHERE GARAGED * DJ^TOWORiwCHOoUuSE • I UNDER 15 MILES \* \ PLEASURE JOVER15M1LES j I FARM •BODY j.TYPE: I vm: T""terr""| gvw/gcw" > Mm ■■hi • CHECK • J COMML ; COVERAGES;. j RETAIL I | UAB | : SERVICE : PIP *!*";"""""■ ONDWHS'T* : ADD'LPIP MOTOR •. ":,. mD . v TOWING :" : MED PAY & LABOR : ": UNINS SPEC j" : MOTOR COFL i : SYM/AGE j COST NEW I * $ CLASS y'slcT* FACTOR |7 ["jlsp }™?"^^^ I FT [ I COMP I j AA I j STAMT I $ j ftw I j coa ; $ j $ COLL VEH# j YEAR ; make; city, state, zip where garaged drwetoworkVsc^ j UNDER 15 MILES j j PLEASURE !0VER15M1LES I j FARM : BODY A TYPE:.. j SYM/AGE i COST NEW im: "terr"! gvw/gcw" :S j COMML [ SpRAGESJ ] ADD'LPIP I RETAIL ! I UAB j I MED RW j ? ■ : \ UNINS ! SERVICE j : PIP = I MOTOR UNDRlNS • MOTOR : '"" TOWING :'" & LABOR • SPEC r COFL : |P I jFT j Iftw j SIC I FACTOR ISEATCPi RADIUS : FARTHEST TERM TlSP I'DEDUCTlBLis'l |'^"| TcOMPt :|ofl : COMP I j AA \ | STAMT : $ : COLL j S ; $ COLL VEH # j YEAR j "a KE? I j MODEU CITY, STATE, ZIP WHERE GARAGED 'OR^TO'wORkraCHOOLl'uSE \ UNDER 15 MILES j I PLEASURE ! OVER 15 MILES ! ! FARM : BODY ..LTYP.E:... : SYM/AGE i COST NEW :y : KN.: terr"! gvw/gcw" :$ CLASS SIC i FACTOR iSEATCPi RADIUS : FARTHEST TERM | COMML | CWERAGESJ. | ADD'LPIP ; RETAIL I SERVICE :UAB : PIP : MED PAY "1 UNINS • MOTOR —aNDRTNS":" MOTOR : *" TOWING I" & LABOR : " SPEC :"" COFL • *}*F T""\ IS? rDEDUCTIBLis*=" j ACV | jcOMPJ icofl I FT : I COMP [ I AA j FTW I : COLL I S : STAMT :$ COLL VEH# j YEAR Imake. ! MODEL: CITY, STATE, ZIP WHERE GARAGED : BODY •TYPE: :.V.!.Nj j SYM/AGE i COST NEW IS TERR GVW/GCW DRIVE TO WORK/SCHOOL : USE UNDER 15 MILES I I PLEASURE : OVER 15 MILES | I FARM : AnmikHi * CHECK : : COMML : COVERAGES; | RETAIL I SERVICE :LIAB I PIP : ADD'LPIP I MED PAY ■*i UNINS : MOTOR "UNDRtNS'7 MOTOR I 'TOWING : & LABOR : ' SPEC : COFL CLASS :F : •; Ift : ■: I FTW l SIC : FACTOR ISEATCPI RADIUS = FARTHEST TERM TLSP I'DEDUCTliilEsl {acvI JCOMP- -COFL : COMP ; : AA | j STAMT j $ ; COLL Is Is COLL 10 o JSI 07/31/00 00 c m e I s to VAHHSEff INSWAHCt COHPJKY ^ " M . 1 5 ' ■ ■ Sp ss-_ ~ . " < ' ^ ww» .. fOLl«V£ARi J? jC0| , HEW ;|ALWltO m%m 0.00 0,00 fl Z.B COVERAGE TVPt. "^ opB1 . I6W.25" , .^.s-sfc-w""* 8 * 8 rfltMfi U0LlOV,^BA0» 5 .000 ft a: C rt I- « 5 "* r * H • i * i ,«»P ****** i If \ ' V 1 • * /' , • * • "* r 9 PACE W 312 PAVOHIA AVENUE f I HAHHASSETT joffoin "J"" 02 cMliot VANltHEn INSBRflHCE COMPANY TOTAL IM. 1HD. RE^VERV ft? S.WWW*. AUTO 8TAWS B|ff Wl JEH jj». g; Jj{ g ,, £jl j. C 97-J2J80I1 09/OI/W CLOSED 01/10/00 SSSriiu NJ07ooo —• ssa 1 I RIDGEHEU) iwwn«™ 1 ^AcrnaipmB nfbLoss ^ ^ ims m ||/w UAMLW CLHTiflC— — ■ 1 CLMT/2 1 CLHT /3 a«T|5 CLHT JK .— r-esas 0,00 0,00 0,00 2512.76 0,00 2512.T6 2512,76 0.00 25 12,™ 0,00 2512,76 bb b7C I 9 2 s § o n r * a Q g \ H \ « 9 w 0) h LU K LU W ♦ to Wo <rt- H cosj tfl to hw N 4 ,. H rt H § W *g u H "10 o o i Z 0. w , w J D n ?AGE tt asp-,- a-r .-- a m h w n OS u S - H &« ©tfJ Ifl CD HN Al < H becoveby W/01/W' "cLirrn CWT ft CLHT f) cWTfl aHT IS CLKTI6 v- in* ss §g N H « » MS (Cfitfl OTHER TVPE c L gt LOSS - BI/PD LIABILITY D.O0 0.09 0.09 0.00 120.10 120.10 o,oo 320.10 J20.10 0.00 120,10 ,00 BUI I I' •W* « tf *m«««--«='»* JU=::0 * =s3,a,i " Twtfl 105i0.5« 0,( S-G? sTss 35 S *• - our it CLKT #1 cur "' cuff. clnt A CLHT fi DLHH& y9-1251?3 09/11/99 cuffii CLHT H ttWU CLPTfl CLHT f ; CLHT IS uSflUff NJO7O0O !'E 4Mi.kl *».« * WT|HI ?SDLOSS.Bl/rtLIM)lUTV 0,00 cuff ft ' ID 2® H 0) H IS 8 < rt r w H ■ 5 & e o \ H O CO c be b7C 3 < n t- UJ n u w 3 " w .-«-..*^— *• -—"■■* COVCBWETVfEiCOLLlSIO mm D . C fl CLOSED 2 |KBVB 7«,5fl .^-.-bbs**"**"^ ! S«^MSB? Li " »««»" .J' 00 t^n o.oo ' i* w, ' a ,, COVEBACE TyPE: Bl/fD UWJL1TV , ^ . «».» NJjj^ ••» ^ ^ ""--^^--«-»-» ,M ' ! ™ ,SJ ™ , ~- .,, , B o..» rw.i. CO to FACE 61 OM0OW5U WBANHOVW SW1W, Hie. M , M t]ol , J )12 PAVDNIA AVEHUE #f HANHAS5ETT W !«*•«» g q 1 total ■ wglfc Sep Sired h OPEN fAYHENTS «'« LE R«™« a g Sues '«•» w» iSlALS FoTuo.B.J 03 C0KHEHC1AL AUTO ^^ ^ ' ^ m g ■* DPER • <"™ ' 0,00 0iM 76.50 § g \ H s oo Q. too J <r> CO HN OJ * .. « * H H k gg w P H \ J ?0 2 Si Ho o o s • W n h 111 n LU w I J T<i60YA2 TIHE M*»!W PACE 60 rafr'S"™""" "" bbbsp — irf— ;« out mn »' «' K . ffUlM" ' w «iMi*gSS SKIS JStSUBi •■— c 00 ttjffl to 'tf) WH ft* Ho H a o s o w \ CM H S CO \ O CO o I s 'J J 8,00 0,00 o.oo 0,00 76.50 76,50 ; H2 22M ' MaJ»5 5T{HS ' ,HC1, tSm v own CKT #1 URSAH WVUtG SYSTEMS, IHC C COLLISION CLHT fl ' ClHTfJ CLHT 15 ^^--^^"-^^"^fT ^000 00 °' M 2*- 1 ~-T---sr-!w K «K S ; s « 9M289J EL I2ABETH HJ 07000 ^^ , 6tl ,o ww ,jBHCH , " lfE . , 8«i.iviii»iini • eiJirn l -1 CLHT ft' aw Hi tuff H5 cufffl CUT 5 .. 3 .« wfS^a4^ ««««»fc« uasam * 5=i,3 * M b/C V © m Gfl 0) H t- Z $£ r TO (0 rt c a s H \ CO c I f o "P W So h \ o J S 1 IDS n c PACE 59 aaassa MM .71 I' : N ! n j ■ ■ » ■« n CC 103 NT*" com CD CO HW 8;^ CO ° to rt (1) ,.* H H is 3K PAVOHIA AVENUE #1 HMBW&Tf 6 jawom NJ0 " 02 NET S* o?EH a. ssb a- i-- ■ }S Srves mmm .-. — .. i * M«ft^f,!^ W DE0M.BLE 0,00 ■ ^ 0.00 •* J 1»] H H D JlKWiWitT COST. WCl * BflSIHF K ic" KM WO225U00 « Mra nSw&i« rfl lllfi W0OOM516 t!RB*H MOVING 5VHEW, W. Mf BW we m m CITV NJ 0710? MMtf'ot V*Rt|HOI IHSDMHCE COWAMV Sf Si mbui mi • CUIH mn m , N1E «; B . ». g j j : S: "7 «.••••■ 9M11M7 07/8/M OflTflC CLHI |2 CLHT f 3 OLWW CLHI IS CLHT jfi s -ss=ss«ss8» CLOSED JERSEV CV 10/01/98 HJ 07000 VA ftOTIQW OTHER TYPE LOSS ^ ^ ^ _ |J/W L|M|l|iy 0,00 0.00 0,00 llll.1l 0,00 tin. 71 0.00 1400.70 0,00 {1(00.11 ;Ks ^^.---^" s « aw ^ srtsM,ttt ^ esssas5 ;-S— 3 attM«H«W53*M3Ji23*l^ 1: * £sSS=S=, """ P b6 b7C w c s C c s H C \ 09 Q ' 01 h LU n K 111 01 m «C "> (0" W lii W o, \ JUL 12 2001 3:22PM [-^LASERJET 3200 P-l New Jersey Headquarters 3 r 18 th Street Weehawken, NJ 07087 .(201)568-0031 '* 03J5T Urban Moving Systems, Inc. New York Headquarters 446 West 50 m Street New York, NY 10019 (212)338-9267 DeBellis Insurance Agency, Inc. VIA FACSIMILE: 973-661-9750 Re: Insurance proposal Dear Please review the fallowing and call me to let me know if you need anything else. be b7C Thank you, * 4 Jo Ouo+e • CPKG - 8fc*R $%,&£. ALL nTFOHMATIOlSr COOHTfl "ota^f/mSn by ft^^$M>fifa JUL 12 2001 3:22PM H 06/25/01 HON 14:35 FAX 1 61 J_RSERJET 3200 2 9200 BSC p. 2 @001 Baldwin Sadler Corporation dba-CA^Baldwin Sadler Insurance Services National Managing Speciality Underwriters CA License OB01356 . June 25, 2001 c?0/-SSV-0<PtS~ P0 Box 7001 Royersford t PA194BB0B41 (610)792-9100 (880)2279040 [6101792-9200 uroan Moving Systems, Inc. 3 18TH STREET WEEHAWKEN, NJ 07087 Re: Urban Moving Systems, Inc. (IHZ5623720; 16-AUG-00to 16-AUG-01] Dear be b7C Baldwin Sadler Corporation is a national managing specialty underwriter for cargo insurance for The Hanover Insurance Company. We have had no reported claims on the above captioned policy as of June 25, 2001. c Sincerely, COPY *&*• JUL 12 2001 3:22PM H|^L LRSERJET 3200 p. 3 Transmit.txt 1 PAGE LOSSES AS OF: 06/30/2001 ACROSS ACCOUNTS - BY ACCOUNT " RUN DATE: 07/05/2001 RMD DETAIL LOSS RUN 4J INSURED:URBAN MOVING SYSTEMS INC PRODUCER: 0004 J REPORTING OFFICE: r POLICY NUMBER: UB 688X6573 ACCIDENT PERIOD FROM: 01011990 TO 070520 01 CLAIMANT ACCIDENT 0/ CLAIM INJURY CLASS FILE NUMBER DATE C AMOUNT CODES CODE AD J PRE- CLAIM POLICY EFF. DATE: 09/18/2000 NO CLAIMS FOR THIS POLICY PERIOD STATE: AGE MEDICAL AMOUNT *TOTAL STATE NO. CLAIMS OPEN CLOSED *TOTAL POLICY NO. CLAIMS LOSSES AS OF: 06/30/2001 ACROSS ACCOUNTS - BY ACCOUNT RUN DATE:07/05/2001 RMD DETAIL LOSS RUN Injury Code: r' of "CKe"* 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 Class Code: The code numbe manual classification u employee is covered for Prefix CM claims will h 18 months after Policy JUL 1^; 2QJ311 3:22PM (^LASERJET 3200 ^ p. 4 ^ - Transmit.txt 9-Permanent Partial not in CA f TX, or Ni O-Hospital Reimbursement in CA 0/C - Open or Closed Indicator ^ % 1 PAGE * 1 * *" * li Selection Criteria for: 01-RMD DTL LOSS RUN Member Name:Q6360Q01 . Runtime: 15. 57.36 Parm Name: Parm Desc: IF ACCJ5ATE FROM 01011990 TO 07052001 IF POL_NBR EQ 688X6573 Format: Current or History Selection was: C The Type of Dollars Reported was: Claim Size Option: Report Title ««> Sort Fieldl: Heading:, Sort Field2: Heading: Sort Field3: Heading: Variable Selection Statements: > > > > > > > > > > > > > > > > Page 2 DEBELLIS INSURANCE AGENCY, INC 492 FRANKLIN AVE . NUTLEY, NJ 07110 973-661-1500 FAX 973-661-9750 FACSIMILE TRANSMITTAL SHEET TO: COMPANY: Urban Moving Systems FAX NUMBER: PHONE NUMBER: FROM: DATE: 08/01/01 TOTAL NO. OF PAGES INCLUDING COVER: 01 SENDER'S REFERENCE NUMBER: bo b7C RE: YOUR REFERENCE NUMBER: 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. "sssgEl***, RUG 10 2001 12:32PM HflM-ASERJET 3200 \QM_t P-l New Jersey Headquarters ■ 3 18 th Street -Weehawken, NJ 07087 (201)558-0031 Urban Moving Systems, Inc. New York Headquarters 446 West 50 lh Street New York, NY 10019 (212) 338-9267-,. noholllc InQiirgnno VIA FACSIMILE: 973-661-9750 be b7C Dear i The informaion you requested is below, way. Please call me to confirm that you received them and that the application is on it's Thank vnn. £_ Urban Moving Systems, Inc. MC 320465 NYSDott-33739 US Dot 691256 PC 0076006 MC 398463 USDOT 923345 ALL WFOBMATXm CONTAlS* JUL 12 2001 3:23PM HWtL RSERJET 32Q0 p. 12 Drivers bss^mbmB 3SfeEJ5g! IP bo b7C u Urfwr Houin .,-' \n%«.. ■■■,«***»,: RUG 02 2001 10:23nM URGttfT LHSERJET 3200 p.l New Jersey Headquarters 3 18 ,h Street Weehawken, NJ 07087 (201)5§8^)031 Slo'i- Si^-o^i? Pax Urban Moving Systems, Inc. New York Headquarters 446 West 50 th Street New York, NY 10019 (212) 338-9267 DaBellls Insurance Agency, Inc. VIA FACSIMILE: 973-661-9750 be b7C Dear Here is a rev i sed W of trucks that we rfeed covered by our policy. I apologize for the mix-up. Please give me a call so we can go over the details. JThanlfunn S\ urcan Moving systems, inc. Revised Vehicle Schedule 2000 GMC 1999 1994 1993 NTERNATIONAL INTERNATIONAL FORD 2001 FREIGHTUNER 6 2001 INTERNATIONAL" Van TRUCK TRUCK TRUCK TRUCK TRUCK 1GCEG15W4Y1 142815 1HTSCAAM5X6750B7 1HSDPPN9RH559152 1FDNK72CXPVA20054 1 FVABPAL91HH68277 1HISCAAM01H393754 20.935.00 $ 42,259.00 26,000.00 $ 15,000.00 $ 69,837.21 $ 63,964.60 / J J GW 3l5, 50C> JOJL INFOEMATIOKr CONTAE3EQ* EEREmmimpLASSlHED " A .. , «& >• <& ^\ Wl«-- *.4T1,«WS,«-. JUL 12 2001 3:27PM HI^RSERJET 3200 06/15/01 FR'r 09:43 FAX 516 eflUsCf p-22 @002 Urban Moving Systems inc 3 lath Street Weehawken.NJ 07087 Policy Number: Company: Effective Date: Expiration Date: Carriers Ins 08/05/2001 08/05/2002 JUL 12 2001 3:28PM .LASERJET 3200 p. 23 Annual Receipts: $1,168,970.00 * K Radius: • 90% 300 miles • 8% 120 miles • 2% 2500 miles piMuou ouiao wtfwUb. Gw^a^, : SjJmkQjX-^vWA 3> ^w^^fv T)M- Smxah mMe>> -0x&^ ALL INFORMATION CONTAINED HEREIN 15 UNCLASSIFIED DATE 07-30-2010 BY UC60322LP D&0 - %ap^xr) StuAfo, Goto " u z -tw om &Jd «x£ -to (Mh be blC JUL 12 2001 3:28PM H^LRSERJET 3200 4fc p. 24 ILL INFORMATION CONTAINED HEREIN 15 UNCLASSIFIED DATE 07-30-2010 BY UC60322LP/PLJ/CC Warehouse Insurance T^ \hjbOAL- Qua ujJlU Square footage: 16,000 . Construction: concrete cinder blocks Total value of items stored: $250,000 Security: closed circuit t.v. system and audio recording Who has access: warehouse personnel, storage manager Sprinklers: yes <: . Alarm System: ADT security linked to local police station 1 block from premises •bo b7C "&** JUL 12 2001 3:29PM .LRSERJET 3200 p. 25 ALL "INFORMATION CONTAINED HEREIN 15 UNCLASSIFIED MTE 07-30-2010 BY UC60322LP/PLJ/CC 481-0837 (09/99) .. HANOVER INSURANCE COMPANY Worcester, Massachusetts MOTOR TRUCK CARGO COVERAGE PART (12:01 A.M., standard time), forms a This endorsement, effective '" 8/16/00 part of Policy No. IHZ5623720 issued to Urban Moving Systems, Inc. by Hanover Insurance Company. bo b7C Authorized Representative l^S^T^ P ° liCy "**** T^ Read *• «*• P° Kc y care& % to determine ngnts, duties and what ia nr is nnf /w»m/4 J *««*«* Parti Parts II through □ Part'n D Partm D Part IV a PartV □ Part VI D PartVH □ PartVm □ PartDC □ PaxtX D Part XI Applies to All Insureds XI Apply Only if Checked Below: Spoilage or Freezing Owner's Goods Extension - Insured's Merchandise Owner's Goods Extension - Extended Coverage Period Specified Perils Including Theft Specified Perils Excluding Theft Theft From Locked Vehicle (Only). Reduced Theft Limit On Target Commodities Theft of An Entire Load (Only) ■ Theft From "Unattended" Vehicle Exclusion Vehicle Alarm Warranty 481-0837 (09/99) • Page 1 of 8 JUL 4& ZOO* 3: 29PM .LRSERJET 3200 p. 26 WC 00 00 00 (A) CONTINENTAL CASUALTY COMPANY 4 ML INFORMATION COHTAIHED HEREIN 15 UNCLASSIFIED DATE 07-30-2010 BY UC60322LP/PLJ/CC WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY l and suBject to all terms of this policy ; we agree £4$ you as follows: GENERAL SECTION In return for the payment of the premium < A. The Policy This policy includes at its effective date the Infor- mation Page and all endorsements and schedules listed" there. It is a contract of insurance between you (the employer named in Item 1 of the Informa- tion Page) and us (the insurer named on the Information PageV 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 em- ployer of the partnership's employees. C. Workers Compensation Law Workers Compensation Law means the workersor workmen's compensation law and occupational dis- ease law of each state or territory named in Item 3.A. of the Information Page. If 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 fed- eral occupational disease law or the provisions of any law that provide nonoccupational disability benefits. of E. State State means any state of the Unite<TStates America, and the District of Columbia. Locations This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page;, 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 INSURANCE B. A. How This Insurance Applies ^This workers compensation insurance applies to "bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or ag- gravated bv 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. We Will Pay We will pay promptly when due the benefits re- quired of you by the workers compensation law. We Will Defend We have the right and duty to defend at our ex- pense any claim, proceeding or suit against you for benefits payable by this insurance. We have the rfcnt to investigate and settle these claims, proceed- ings or suits. -We have no duty to defend a claim, proceeding or suit that is* not covered by this insurance. We Will Also Pay.- We will also pay these costs, in addition to other amounts payable under thisjnsurance, as part of any claim, proceeding of suit we defend: 1. reasonable expenses incurred at our request, but not loss of earnings; 2. 3. 4. premiums for bonds to release attachments and for appeal bonds in bond ( amounts up to the amount payable under this insurance; litigation costs taxed against you; interest on a judgment as required by law until we offer the amount due under this insurance; and 5. . expenses we incur. E. Other Insurancte 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 ex- hausted, the shares of all remaining insurance will be equal until the loss is paid. E. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers com- pensation law including those required because: 1. of your serious and willful misconduct; you knowingly employ an. employee in violation of law; youllail to .comply with a health or safety law or regulation; or 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. 2. 3- 4. Page 1 of 5 JUL 12 2001 3:31PM 1^^. HSERJET 3200 481-0837 (09/99) p.i PARTI GENERAL TERMS AND CONDITIONS Throughout this policy, the words "you" aitd <t your" refer to the Named Insured shown in the Declarations. The words "we," te us" and "our** refer to the Company providing this insurance. This coverage part,, Part I, replaces the "Conditi^|$*ori the reverse of the Declarations Page (if any). Other *words and phrases that appear in quotation marks have special meaning. Refer to Section G - DEFINITIONS. 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 CoverageTcrrn, 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 issued by you, or as a contract carrier under contract. We cover property only while: a. contained in or on any land vehicle while in "transit?* "and/or during *loading" or "unloading;" or b. 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: a. accounts, bills, blueprints, currency, deeds, evidences of debt, money, notes, securities, cornmercial paper or other documents of value; b. bullion, gold, silver, platinum or other precious alloys or metals, jewelry, watches, precious or semiprecious stones or similar valuable property; c furs; d. paintings, statuary and other works of art; e. "intermodal*' containers, trailers or other carrying conveyance; f. live animals, birds or fish 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 cornrnjotion, flood, or by collision upset or overturn of the vehicle carrying the property, if these causes cf "loss" would be covered under ihis Coverage Form; g. contraband, or property in the course of illegal transportation or trade; ■ >* :3k pads, tarpaulins, handtrucks, chains, tiedowns . ■■* : -^| and similar equipment uscd^on or in connection with vehicles you owner operate. 3. Covered Causes of Loss Covered Causes of Loss means your legal liability as a common or 'contract motor carrier, either as " imposed by law or assumed by contract, for Direct Physical "Loss" to Covered Property except those Causes of "Loss" listed in the Exclusions. 4. Coverage Extensions a. Earned Freight Charges We cover your earned freight charges that ypu are unable to collect as a result of a "loss" covered by this Coverage Porm. The most we will pay in any one occurrence is $3,000. This limit is separate from the Limits of Insurance shown in the Declarations. b, Debris Removal (1) We will pay your -expense to 'remove debris of Covered Property caused by or resulting from a Covered Cause of Loss that oceans during the policy period. The expenses will be paid only if they are reported to us within 180 days of the earlier of (a) the date of direct physical "loss;" or * (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. c 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 coverage applies when there is no "loss" to the Covered Property. The mast we will- ' pay in any one occurrence is $6,000. This limit is separate from the Limits of Insurance . shown in the Declaration. 481-083-7 (09/99) Page 2 of 8 JUL 12 2001 3:31PM ^p LRSERJET 3200 .481-0837 (09/99) P-2 The additional coverages for Debris Removal ' and Reloading Expenses do not apply to the cost to: (a) extract "pollutants" from land or •water; or \ ^ * ■ flb) rXmiave, restore or replace polluted land or •water. B. EXCLUSIONS I. We "will not pay your liability for. a "loss" caused directly or indirectly by any of the following. Such *loss" ia excluded regardless of any other cause or event that contributes concurrently or in any sequence to the "loss." a. Governmental Action Seizure or destruction of property by order of governmental authority. But we -will pay for acts of destruction ordered by governmental authority and taken at the time of a fire to prevent its spread if the fire would be covered under this Coverage Part. b. Nuclear Hazard (1) any weapon employing atomic fission or fusion; or (2) nuclear reaction of radiation, or radioactive contamination from any. other ■ cause. But we will pay for direct "loss" caused by resulting fixe if the fire would be covered under this Coverage Form. c. War and Military 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 or other agents; or (3) insurrection, rebellion, revolution, usurped power or action taken by governmental authority in hindering or defending against any of these. X We will not 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. dishonest acts by you, your employees or authorized representatives (including operators . under contract to you). 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. c. spoilage, deterioration, contamination, freezing, rusting, extremes of temperature, shrinkage, evaporation, loss -of weight, or change in flavor, finish or texture. 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. We will not pay your liability for a "loss" caused by or resulting from any of the following. But if "loss" by a Covered Cause of loss results, we will, pay for the resulting "loss." a. Weather conditions. But this exclusion only applies if weather conditions contribute in any way with a cause in event excluded in paragraph 1 above to produce the "loss." b. Wear and tear, any quality in the property that causes it to damage or destroy itself, insects, vermin and rodents. 4. We will not pay for any costs or penalties yon incur for violation of any law or regulation that applies to your delay in payments, denial or settlement of any claim made against you by others for 'loss" to Covered Property, C. LIMITS OF INSURANCE 1. The most we will pay for "loss" in any one occurrence. is the applicable Limits of Insurance shown in the Declarations. 2. The most we will pay fox "loss" in any one occurrence to Race Horses, Show Animals,*or High Valued Breeding Animals is 150% of the commodity meat price per pound on the day of the "loss" on the Chicago Mercantile Exchange. D. DEDUCTIBLE We will pay only the amount of the adjusted "loss" in any one occurrence in excess of the Deductible amount shown in the Declarations, up to the applicable Limit of Insurance. E. GENERAL CONDITIONS The foUowing conditions apply in addition" to the Common Policy Conditions: 1. Coverage Territory We cover properly within: 481-0837 (09/99) Page 3 of 8 JUL 12 2001 3:31PM HP^RSERJET 3200 p. 3 481-0837 (09/99) a. the states of the United States (excluding Alaska); b. Canada but we do nor cover any property in transit to or fomHawaii. 2. Valuation Hie value of property will be the least of the following amounts: a. 1. the amount for which you are liable; 2. the amount of invoice, or in the absence of an invoice, 'the actual cash value of tliat property as of the time of "loss;" b. the coat of reasonably restoring that property to its condition immediately before "loss;" or c. the- cost of replacing that property -with substantially identical property. In the event of "loss " the value of property vail be detearnined as of the time of "loss." 3. Labels In the event "of "loss" only at the identifying labels or wrappers containing the Covered Property, we will pay the costto replace those labels or wrappers if the 'loss" is caused by or results from a Covered Cause of Loss. 4. Concealment, Misrepresentation or Fraud This Coverage Part is voitTm any case of fraud, intentional concealment or misrepresentation of a material fact, .by you or any other Insured, at any time, concerning; a. this Coverage Part; b. the Covered Property; c. your interest in the Covered Property; or d. a claim under tins Coverage Part 5. Legal Action Against TJs No one may bring a legal action against us under this Coverage Part unless: a. there has been fail compliance with alL the terms of this Coverage Part; and b. the action is brought within 2 years after you first have knowledge of the "loss." 6. Records ^ You shall keep accurate records of your trucking business and all* "gross receipts" from transporting* \ the property covered by this Coverage Form. You shall retain these records for three years after the policy ends. - 7. Reimbursement to \Js We may endorse this policy at your request to' ' comply with the requirements of the Interstate Commerce "Commission or any other governmental authority. . — If we pay any "loss" solely because of any such- endorsement, you will promptly reimburse us for that payment and any other expense we have in connection with, that payment. 8. Adjxw tment and Payment of Loss At our option, we.,may adjust the "loss" with and pay to: a. you, for the account of whom it -may concern; or b. your customer, or the owners of the Covered Property. If legal actions are taken to 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 liability 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 iiom this insurance. 11*. Policy Period We' cover "loss" commencing during the policy period shown in the Declarations. 11. Excess Insurance You agree that no excess insurance over and above the Limits of Insurance of this policy shall be provided by any other policy. F. LOSS CONDITIONS ' 1. Abandonment There can be no abandonment of any property to us. 2, Appraisal " If we and you disagree on .the value of the property or the amount of "loss " either may make written demand for an appraisal of the "loss"" In. this event each party will select a competent and impartial appraiser. The two appraisers will select an umpire. If they cannot agree, either may request that selection be made by a judge of a court having 481-0837 (09/99) Page 4 of 8 JUL 12 2001 3:32PM LASERJET 3200 p. 4 481-0837 (09/99) jurisdiction. The appraisers will state separately the value of the property and amount of "Loss." If they fail to agree, 1hjey toII submit their difference to the umpire. A decision agreed to by any two will be binding. Each part will: a. pay its choseif appraiser; and b. bear the. other expenses of the appraisal and umpire equally. If there is an appraisal, we will still retain, our right to deny the claim. 3. ■ Duties in the Event of Loss You must see that the following are done in the event of "loss" to Covered Property. a. Notify the police if a law may have been broken. V Give us prompt notice of the 'loss." Include a description of the property involved. c As soon as possible, give us a description of how, when and where the "loss" occurred. & Take all reasonable steps to protect the Covered Property from further damage. If feasible, set the damaged property aside and in merest possible order for examination. Also keep a record of your expenses, for consideration in the settlement of the claim. e» Make no statement that will assume any obligation or admit any liability, for any 'loss 1 ' for which wc may be liable, without our consent. f. Permit us to inspect the property and records proving 'loss." g. If requested, permit us to question you under oath, at such times as may be reasonably required, about any matter relating to this insurance or your claim, including your books and records. In such event your answers must be signed. h. Send us a signed, sworn statement of "loss" containing me information we request to settle the claim You must do this within 60 days after our request. We will supply you with the necessary forms. i. Promptly send us any legal papers or notices received concerning the "loss." j. Cooperate with us in the investigation or settlement of the claim k You must promptly make claim in writing " against any other .party who may be liable for the "loss."' 4. Insurance Under Two or More Coverages If two or more of this policy's coverages apply to the same "loss," we will not pay more than the actual amount of the *loss." 5. Loss 'Payment * We will pay or make good any Toss" covered . under this Coverage Part within 30 days after. a. we reach agreement with you; h. the entry of final judgment; or c the filing 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 not 7. Pair, Sets or Parts • a. Pair or Set. In case of "loss" to any part of a pair or set we may: 1. repair or replace any part to restore the pair or set to its value before the "loss," or 2. pay the difference between the value of the pair or set before and after the "16ss ." b. Parts. In case of "loss" to any part of Covered Properly consisting of several parts when complete, we will only pay for the value of the lost or damaged part, 8. Privilege to Adjust with Owner 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 the owners of the property. A receipt for payment from the owners of that property will satisfy any claim of yours. b. Provide a defense far legal proceedings brought against you. If provided, the expense of this defense will be at our cost and will not reduce the applicable Limit of Insurance under this insurance. 481-0837 (09/99) Page 5 of 8 JUL 12^001' 3:33PM HF fcRSERJET 3200 p. 5 PART FOUR- YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by 4 this policy. Your other duties are listed here, A. C. D, E. Provide for immediate medical and other services required by the Workers compensation Jaw. Give us or our agent the names and addresses of the injured persons and of witnesses, and other infor- mation we may need. ^ Promptly give us all notices, demands and legal papers related to the injury, claim, proceeding or suit* 5. Cooperate with us and assist us, as we may request, in the investigation, settlement or defense of any claim, proceeding or suit. Do nothing after an injury occurs that would inter- fere with our right to recover from others. Do not voluntarily m^ payments, assume'obTiga- tions or mcur expenses, except at your own cost. PART FIYE - PREMIUM Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and classi- fications. We may change our manuals and apply the changes to this policy if authorized by law or a governmental agency regulating this insurance. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classi- fications. 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 pre- mium basis by endorsement to this policy. Remuneration •Premium for each .work classification is determined- by multiplying a rate times a premium basis. Re- muneration is the most common premium basis. Tins premium basis includes payroll and all other remuneration paid or payable during the policy period for the services or: 1. All your officers and employees engaged in work covered by this policy; and 2. All other persons engaged in work that could make us liable under Part One (Workers Com- pensation Insurance) of this policy. If yon do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This para- graph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligations. Premium Payments You will pay all premium when due. You will pay the premium even* if part or all of a workers com- pensation law is not valid. Final Premium The premium shown on the Information Page, schedules, and^ endorsements is an estimate. The final premium will be determined after this policy F, G, ends by using the actual, not the estimated, pre- mium 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- bal- ance. If it is less, we will refund the balance to you. The final premium will not be less than 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. 2. If yon cancel^ final premium will be more than prq rata; it will be based on the time this policy was in force, and increased by our short-rate cancellation table and procedure. Final pre- mium will not be less than the minimum pre- ■ mium. 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. 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. PART SIX - CONDITIONS * Inspection We have the right, but are not obliged to inspect your workplaces at any time. Gair inspections are not safety inspections. They relate only to the insur- ability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes." While they may help reduce losses, we 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 organi- zations have the same rights we have under this provision. Page 4 of 5 JUL 12 2001 3:33PM H^LnSERJET 3200 p. G . 5. Recoveries Any recovery or salvage* on a "loss" will accrue entirely to our benefit until the sum paid by us has 'been made up. 10. Reinstatement of Limit After Loss Tlie Limit of Insurance will not be reduced by the payment of any claim, except for total "loss" of a scheduled item, in which event we will refund the unearned premium on that item * 11. p-ansfer of Rights of Recovery Against Others To Us If any person ^organization to or for whom we make payment under this- insurance has rights to recover damages from another, those rights are . fraiisferredtous. That person or organization must do everything necessary to secure our rights and must do nothing after "loss" to impair them. You may accept bills of lading or shipping receipts issued by other carriers that limit their liability to less than the actual value of the property. G. Definitions "Loss" means accidental loss or damage. "Gross receipts" means the total amount of receipts to which you are entitled for Hie packing, loading unloading and transporting of Covered Property regardless of whether you or another carrier originated &e transportation. "PoUutants" means any solid, liquid; gaseous or thermal irritant or contaminant including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste.* Waste- includes material to be recycled, reconditioned or reclaimed. "Transit" begins with the actual movement oflhe goods from the point of shipment bound for a specific destination. It remains in transit durmg the ordinary reasonable and necessary stops, intermptions, delays or transfers incidental to the route and method of shipment including rest periods taken by the driver(s). Transit finds upon acceptance of the goods by or on behalf of the consignee at destination, but shall not extend beyond 168 hours following arrival at destination. 'TntcraadaT containers arc containers used in corohmaticnwithanomermoaeoftrarisportatiOT 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 transporting conveyance to the 481-0837 (09/99)* ground, or a loading platform immediately adjacent to the transporting conveyance. H. Cancellation This policy may be cancelled by the Insured by surrender thereof to the Company or any ,pf its authorized agents or by mailing to the Company written notice stating when thereafter such cancellation shallbe effective. . This policy may be cancelled by the • Company by mailing to the Insured at the address shown m this policy or last known address written notice stating when, not less than rive (5) days mereaftex such cancellation shall be effective. Ihe mailing of notice as aforesaid shall be sufficient proof of notice. Thetirrc of surrender or the effective date of the cancellation' stated m the notice shall become the end of the policy period Delivery of such written notice either by the Insured or by the Company shall be equivalent to mailing. If the Insured cancels, earned premiums shall be computed m accordance with the customary short rate . table and procedure. If the Company cancels, earned : premiums shall be computed pro 'rata. Premium agistment may be made at the time cancellation is effected and, if not then made, shall be made as soon as practicable after cancellation becomes 'effective. The Company's check or the check of its representative mailed or delivered as aforesaid shall be a sufficient tender of any refund of premium due to the Insured, I Changes Notice to any agent or knowledge possessed by any agent or by any other person shall not effect a waiver or a change in any part of this policy or estop the Company from asserting any right under the terms of thia policy ' nor shall the terms of this policy be waived or changed^ except by endorsement issued to form a part of this • policy, J. Conformity to Statute Terms of this policy which are in conflict with 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 LASERJET 3200 p. 7 481-0837 (09/99) I 1 •Si PART II SPOILAGE OREREEZING We will pay for "logs" to -Covered Property caused by spoilage or freezing due to mechanical or electrical breakdown of refrigeration- or heating equipment, while on vehicles you own. or ^operate, subject to the following additional conditions: * We will not pay for spoilage or freezing due to: 1. lack of fuel required to operate refrigeration or hearing equipment; 2. disconnecting 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 rnanufacturei's recommended schedule. "Maintenance" means: 1, to inspect cooling and heating equipment by you or your qualified representative at least once . every 30 days; 2, repair or replace equipment as necessary; 3, record maintenance activities. These records will be available to us uponreqpiest PART m OWNER'S GOODS EXTENSION - INSURED'S MERCHANDISE We provide coverage for loss or damage to your lawful goods and merchandise. The property must be in your custody and actually in "transit," in or on vehicles operated by you. We do not cover your property while: . - 1 /* in or on your premises; 2. in any garage or other building where your vehicle(s) are usually kept 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 policy declarations for 1. the property of others for which you are legally liable; 2. the value of your own goods; or 3. both combined. PART IV OWNER'S GOODS EXTENSION - EXTENDED COVERAGE PERIOD • Coverage on your property attached upon "loading" and ceases when '^unloaded." ie Loading" means the lifting or moving of the Covered Property from the ground or loading platform immediately adjacent to the transporting vehicle onto the transporting vehicle. <c Unloading w means the lowering or moving of the Covered Property fiom the transporting vehicle to 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 loading platform. We will not cover property while it is being installed, erected or dismantled. PARTV SPECIFIED PERILS INCLUDING THEFT Clause A3. COVERED CAUSES OF LOSS is replaced by the following: Covered Causes of Loss 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. fire, explosion, windstorm; 2. collision of a cargo carrying vehicle with any other vehicle or object, excluding contact with any portion of the roadbed, or curbing, and excluding the coming' together of railroad cars during shifting or coupling; 3. overturning of .the cargo carrying vehicle; 4. collapse of bridges and culverts; 5. stranding, sinking, burning or collision of any regular ferry or railroad carfloat (including general average and salvage charges for which you may be liable); 6. ct fiood" 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 c. any rapid accumulation or runoff of surface water. 7. theft of an entire shipping package. 481-0837 (09/99) Page 7 of 8 JUL 12 2001 3:34PM 1 LASERJET 3200 .481-0837 (09/99)* p. a FART VI SPECIFIED PERILS EXCLUDING THEFT SrMLn? 7 ^ causes of loss -.^ commdaorcoirtractmotor carrier, either as imposed bylaw or assumed by contract for 'loss" to Covered Property cauaedbyorresultingfioxa: " -^ 1 fire, explosion, windstorm; 2. collision of a cargo carrying vehicle viifli any other vehicle or object, excluding contact with any portion of the roadbed, or curbing, and excluding the coming together of railroad cars during shifting or coupling overturning of the cargo carrying vehicle; collapse of bridges and culverts; stranding, sinking, burning "or collision of any regular- ferry or railroad cariloat (including general average and salvage charges for which you may be liable), "flood" means "loss" to property", but only while such property is m transit, caused by any of the ■ following: . a. the overflow of any body of water, b. thQ release of water impounded by a dam; or c any rapid accumulation or runoff of surface water. O P 'ART IX 3. 4. 5. tf. PARTyE THEFT FROMLOCKED VEHICLE (ONLY) Sij? ? ot *s far - w> cm * ed ^ ** ° f c °^d Property from "unattended" vehicles -wfcich you own or operate, unless: J 1. at the time of <W the doors, windows and compartments of the vehicle® were closed and locked; 2. there are visible signs on the exterior of the vehicle that the theft wasaresult of forced entry. THEFT OF AN ENTIRE LO 4JD (ONLY) Theft coverage provided by your policy for Covered Property in or on vehicles is limited to "loss" caused by theft of aa entire carload, truckload, trailerload or container, excluding theft by your employees or authorized representative (whether ornot such person^are acting alone or in collusion^ith cthcrpersons or such acts occur durin fi the hours of employment). S PARTX THEFT FROM "UNATTENDED" VEfflCLE EXCLUSION We will not pay for "loss" by theft of Covered Property from an Wtended*' ve&cle winch you own or operate 2^ n f^[ max f^ ehi ^ without apeison on or in the vehicle, whoae duty is to-safeguard the vehicle and its PARTXI ' VEHICLE ALARM WARRANTY We will iurf pay for any "loss" caused by theft of Covered woperty tram vehicles owned or operated by you, unless: I. tiie vehicle(s) are equipped with a Theft Alarm " System; this alarm equipment is maintamed in good wkrng order at all times and inspected and approved at least once each 60 days by the marnifacturer, or any of its authorized representatives, and proper inspection certificates issued; the alarm equipment protecting the cargo compartment of each vehicle ia in the "02?' position, while merchandise is in the compartment, except while being loaded or unloaded; 2. during loading and unloading, at least one employee will attend the cargo compartment to guard the contents. PART VET REDUCED THEFT LIMIT ON TARGET COMMODITIES The most we will pay for loss" caused by theft of , alcoholic hever^ (other thaa beer and Wx dru^slnd Spacco products, and p mri a,. b metalft ^d a in^jT^^ »25,G00 many one "less.'* «rf -. 481-0837' (09/99) Page 8 of 8 JUL 12 2001 3:35PM LRSERJET 3200 p. 9 B* Long Term Policy If the policy period is longer than one year and six- teen 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 repre- sentative as insured. Cancelation L You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect, 2. D. 4. 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 :o take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Infor- mation Page will be sufficient to prove notice. The policy period will end on the day and hour stated an the cancelation, notice. 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 com- ply with the law. Sole Representative The insured first 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. Injrftness yhereof, the company has caused this policy to be signed by its President and Secretair at Hartford Connecticut, and countersigned on the information page by a duly authorized agent ofthZm^ ' b6 b7C n ^ WC 00 00 00 (A) ALL INFORMATION CONTAINED .HEREIN 15 UNCLASSIFIED 'DATE 07-30-2010. BY- UC60322LP/PLJ/CC CP-3349 Edition 2-92 Printed in U.&A. .(12-94) .-Includes copyright material of the National Council on Compensation Insurance, used with its permission. ©1991 National Council on Compensation Insurance." 013013 Page-5of5 JUL 1,2; 2X10:1 3:35PM I^LRSERJET 3200 A p. 10 • ALL IHF0EHA.TI0N COHTAIHED HERE II IS UNCLASSIFIED CJNIPi MTE 07^0-2010 BY UC60322LP/PLJ/CC WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPEAR For Alt tka Commitments Yon ittka* INFORMATION PAGE WC 00 00*0* ( A) POLICY NUMBER: (6S59UB-674X651-5-00) W TAX IDENTIFICATION NO.: 223511891000 NEW-Oo" INSURER: CONTINENTAL CASUALTY COMPANY ■ 1. INSURED- NCCI CO CODE: 10243 PRODUCER: «« mo. systems IN o 4 , roEmLlttNN , co INC WEEHAWKIN n/o70 8 7 . ™ ™™ "•» MANHASSET NY 11030-4308 Insured Is a corporation Other work places and Identification numbers.are shown in the schedule® attached. 2. The policy period is from 09-18-00 to 09-18-01 12:01 A.M. at the Insured's mailing address, " ^ S^5ra™ l S WMdE! Part0 - of ^P°'^ a PP"estotheWor ke rsCom P e n . NJ Bodily mjory by Dtoee:-, / ,00000 E&m'&yee .. • C. OTHER STATES IteUMNCB Part Three of the policy applies to it. state,, .any, Ifetedhere: COVERAGE EXCLUDED. *S D ' This P° ,ic V' inc,ud es these endorsements and schedule's: ' S SE * LISTIN( ? QF ENDORSEMENTS - EXTENSION OF INFO PAGE 45 4 ' I!l B P re ^ iumf ° r ' h t polic y wi,lb . edetemiine d by our Manuals of Rtfes. Classifications Rates and Ratine .Sf Plans. Ail required Information is subject to verification and change by mjdSSS^SS^^ DATE OF ISSUE: 10-20-00 H* "..".., OFFICE: CNA ' .040 " .ST ASSIGN: Nd PRODUCER: A E GOETTELMANN &-CO INC . ! I 01 3014 725LW ■ . . j' JUL 12 2001 3:36PM .LRSERJET 3200 p. 11 far AI7 th» CemmilmonU You JUj*«* WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY EXTENSION OF INFO PAGE -SCHEDULE- WC 00 00 01 ( A) ■ POLICY NUMBER: (6S59UB-G74X651 -5-00 ) INSURER; CONTINENTAL CASUALTY COMPANY INSURED'S. NAME: URBAN MOVING SYSTEMS INC EXP. MOD, EFFECTIVE DATE: 09-18-00 CODE CLASSIFICATION LOCATION 001 01 FEIN '223511891 ENTITY CD 001 MD R Xnw^I lFICATI0N N0 - : 223511891000 URBAN MOVING SYSTEMS INC 3. 18TH STREET WEEHAWKIN.'NJ 07087 FURNITURE MOVING & STORAGE DRIVERS . ' W SS CLERICAL OFFICE EMPLOYEES NOC 8293 8810 RATE BUREAU ID: 317266 PREMIUM BASIS ESTIMATED TOTAL ANNUAL REMUNERATION 236620 IF ANY RATES PER $100 OF REMUNERATION 1 0243-NJ ESTIMATED. ANNUAL PREMIUM 9.*11 .25 21556 TOTAL PREMIUM SUBJECT TO EXPERIENCE' MODIFICATION CONTINGENT EXP MOD: 1.356 MODIFIED PReSSm .* no./ £™ L . £ STIMATED ANNUAL STANDARD PREMIUM 6.00% PLAN PREMIUM ADJUSTMENT PROGRAM (0942) . 2.90% PREMIUM DISCOUNT (0064) . EXPENSE CONSTANTS 0900} 8.80% 0935 NJ SECOND INJURY FUND SURCHARGE -.TOTAL ESTIMATED PREMIUM DEPOSIT AMOUNT DUE 21556 29230 29230 1754 848 160 2572 32868 32868 013015 DATE OF ISSUE; 10-20-00 HB ST ASSIGN; NJ SCHEDULE NO: 01 OF LAST JUL 12 2001 3:36PM W^ LASERJET 3200 ^k o p. 12 % OVA rbrAtt IheCommitottxrttYou Maka* WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY n - " .. ENDORSEMENT WC 00 04 12 (00) POLICY NUMBER: (6S59UB-674X651 -5-00 ) CONTINGENT EXPERIENCE RATING MODIFICATION FACTOR ENDORSEMENT The premium for this policy will be adjusted by an experience rating modification factor. The factor shown in the schedule Is 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. « ovi OBU . SCHEDULE STATE MODIFICATION NJ 1 .3560 DATE OF ISSUE: -10-20-00 ST ASSIGN: NJ 013016 JUL 12 2001 3:36PM LASERJET 3200 p. 13 OVA frMihtcmnHun^ti^u^f WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ••- . • % ENDORSEMENT WC 29 04 07 (00) POLICY NUMBER: (6S59UB-674X651-5-00) NEW JERSEY PREMIUM DISCOUNT ENDORSEMENT (SCHEDULE X) wVST Je T y £? mlU ? f ° r thiS P0licy and the pollcies ' if an * listed in 'tem 2 of the Schedule may be elidible for a discount. This endorsement shows the discount rates in item 1 of the Schedule SiTi2 prem.um discount will be determined by our Manual and your New JB^^SS!^2^£S!SlSSi ipe'cttfrathglluTh caTes ""* retr ° SPeCt,VS "*" ^ *" ° f the premiUm "^ not be sub J 6 « * «* So much of the New Jersey Standard Premium as is subject to retrospective rating shall not be subiect 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 premium is subject to retrospective rating. (b) Determine thediscouot as though only the premium subject to retrospective rating is discounted. (c) The difference between (a) and (b) Is the applicable premium discount. SCHEDULE 1 * £ REM i U ? P'SCOUM 1 "- The first $5,000 of the Standard Premium shall be charged In full without discount ToS^SS^S^^ t0 K S """"l* 3 - 5% ' the next $400 ' 000 sha " be «S«ta a distoun of o.o%, and the remainder shall be subject to a discbunt of 7.0%. 2. OTHER POLICIES: <. v O13017 DATE OF ISSUE: 1 0-20-00 ' ■ ST ASSIGN: NJ JUL 12 2001 3:36PM ^P LHSERJET 3200 p. 14 WORKSHEET FOR WORKERS' COMPENSATION TELEPHOMF rppodtim^ 2SKP R H EM l MBERWHeN COMPlEniW WE .NFORMAT.ON below TELEPHONE REPORTING _D0 NOT DELAY IM CALLING !F YOU DO NOT HAVE ANSWERS TO ALL ™T H E QUEST.ON S ACCOUNT INFORMATION" CALlStS PHOHE NUMBSWSXTENSION ( ) iwPLOYER'SNAME " PARENT CQMHANY/INSURED S NAME CALLER'S NAME (FIRST, MJ" LAST) EMPLOYER'S ADDRESS (STREET. CITY. STATE & ZIP) ' CALLERS TITLE LOCATION CODE | NATURE OF BUSINESS. BENEFIT STATE EMPLOYER'S MAILING ADDRESS (STREET. CITY. STATE &.2P> □ SAME tMPLCYEE-SNAME (FIRST, MI. LAST) EMPLOYEE INFORMATION POLICY FORM POUCr NUMBER" C6S59UB-674X651-5-001 tMPLOYEBS MAILING ADDRESS (SIREtT. CITY, STATE & ZIP) MARITAL STATUS! EMPLOYMENT STATUS CODE " D FULL-TIME OPART.TIMF NO. OF DEPENDENTS GENDER □ male D female SOCIALSECURrTY NUMBER '^LU^SHOMEADORESSTH E ^ Dyes Dno CLASS CODE | DATE OF BIRTH DATE OF INJURY TIME OF INJURY ACCIDENT INFORMATION WAGE PERIOD HOMEPHONE NUMBER ( ) LOCAIIONS^ACaDg NT^ ^^ ^^^ DATE CLAIM REPORTED TO EMPLOYER WAS THE ACCIDENT ON THE bMPLOYER'S PREMISES" D YES D NO UID EMPLOYEE LOSE ANYTIME FROM WORK? □ YES D NO . DATE DISABILITY BEGAN ,:'f ^f^ .^ BACK AT W0R K?'F Y£s . PATE RETURNED | DATE DISABILITY ENDED FULL DESCRIP HON OF ACCIDENT IS /WAS EMPLOYEE'S SAURY CONTINUED? □ YES □ NO DATS EMPLOYEE LAST WORKED COUNTY WAS EMPLOYEE'S INJURY RELATED TO A COMPANY-SPONSORED EVENT? □yes Dno WAS EMPLOYEE PAID FOR DATE OF INJURY? Dyes Dno DATE EMPLOYEE LAST PAID WAS ACCIDENT FATAL? IF YES DATE OF DEATH □ yes D NO CAUst o.= ACCIDENT (EG.. SUP/FALL, LIFTING, CHEMICAL) CONTRIBUTING FACTORS IF OTHER PARTIES WERE INVOLVED NAME (FIRST, MUAST) FMO.uk vtmuj- ACCIDENT, DRIVE R'S LICENSE NUMBEK STATE WHERE ISSUED EQUIPMENT, MATERIAL OR SUBSTANCE I WOLVED ' ADDRESS PHONE NUMBER WEKfc iJAhtGUARDS PROVIDED?' Dyes Dno WITNESS INFORMATION NAVE (FIRST. ML LAST) DESCRIPTION OF SAFEGUARDS WERE SAFEGUARDS USED? Dyes Dno ADDRESS PHONE NUMBER sb=s PART OF BODY INJURED (E.G. HEAD. NECK. ARM. LEG} ===== CUMULATIVE INJURY? IF YES. LENGTH OF EXPOSURE' lis Dyes Dno C^aS^PLY) NAM5 ^ST.^LAST, INJURY INFORMATION NATUHb L* INJURY (EG. FRACTURE. SPRAIN. LACERATION) NATURE OF DUTIES PRSVOUS RELATED CONDITION? NO □ yes D D first aid - WHATTYPE OF FIRST AID WAS ADMINISTERED? PRE-EXISTING MEDICAL CONDmON(S) LENGTH OF TIME DOING ACTIVITY 1ST DAY OF TREATMENT _. HOSPITAL/ U CLINIC - NAME AND /U3DRESS (STREET. CITY, STATE S ZIP) NAME AND ADDRESS (STREEI*. CITY, STATE & ZIP) D PHYSICIAN- TREATMENT O130ia PHONE NUMBER ( )■■ MJNTCG9S TREATMENT LENGTH OF STAY SPECIALTY 1 ST DAY OF TREATMENT 1ST DAY OF TREATMENT CONTINUED ON REVERSE SIDF I JUL 12. J20Q1 3 : 37PM LflSERJET 3200 p. 15 WORKERS' COMPENSATION - FIRST REPORT OF INJURY - STATE SPECIFIC QUESTIONS Alabama Employee's county Employer's 10 (U.C. Account) Number •Specific product (e.g., tires) Alaska " ~ Side of body affected (left or right) * ** Employer's Alaska address (if different from mailing address) Date and time employee reft work Scheduled days off Time workday began Was accident caused by failure of a machine or product? f ir^iry was caused by a mechanical part, specify part If the accident was caused by anyone besides employee, gfre name and address If fatal, name and address of dependents If you doubt validity of claim, state reason Alaska Unemployment Insurance Account Number (U.I. Acct No.) Arizona ~~" ~~" r ™ ' Last date of work after injury Number of days per week company usually works Department number If validity of claim is doubted, state reason If another person 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 injured paid for the day of Injury? (if yes, specify amount) Was employee-hired for permanent employment? Number of months employment available during the year Is employee furnished lodging 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 other than fixed weekly or monthly salary? £>oes employee earn extra pay for overtime? (If yes, basis of payment/hourly amount) 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 (Trom- thrpugh/amoum) Gross wages of employee from date of hire through date of accident Has employee received a wage increase within 12 months prior to injury? (If yes, specify date, wage/per before and wage/per after Gross earnings from date of increase through day prior to injury Was employee in overtime when injured? California " * r ~~~ ~~ State Unemployment Insurance Account Number Type of employer (private/state/cKy/county/schoof district/other government) Was employee unable to work for at least one fujl day after the date " of injury? Date employee was provided claim form Colorado . : "* How long has employee worked Tor this employer? Employee's fength of experience at this assignment Years of education completed (6 to 20) Number of employees If employee has not returned to work, estimate date 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 health insurance benefits discontinue, what will the weekly cost be for continuing such benefits? If fatal, give name, relationship and address of closest dependent of deceased . Is employee receiving overtime, commissions or piecework? Connecticut Reason fer-report (lost iime/medical-health carefcccupational disease/correct prior report) Time employee's workday began Extent of accident/health and life coverage for employee For Occupational Disease£^> % , Date of last exposure ^ ^ Date of diagnosis as occupational^ related Employer's Registration Number (CRN) Was employee treated in an emergency room? Delaware Employer's UC Reporting Number Empfoyee's county If employee has returned to.work. at same wage? District of Columbia if employee has returned to work, at what time? Was injured hired In DC? Was injured given Form #7 DCWC? Piece or time worker Florida ~™ — Time injury was reported Rale of pay /per Was physician/hospital authorized by employer? Does the employer agree with the description of accident? Did the employee knowingly refuse to use safety equipment provided by you, the employer? ■ Did 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 : IF gratuities (tips/etc.) were received in the course of employment estimate weekly value * Length of time employed by you at this occupation If mechanical apparatus or vehicle caused injury, what part of it caused injury? Type of treatment (inpatient/outpatient) If fatal, name and address of nearestjelative - What was employee doing when the accident occurred? Illinois "~ Illinois Unemployment Compensation Number SIC Number Total number of employees at the location where illness or Injury occurred Was employee given Industrial Commission Handbook? Did incident result in occupational injury or occupational disease? What unsafe act by a person caused or contributed to the injury 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 disability Is the injury expected to produce permanent disability? 013019 WUNTDG98 Pagel of 4 JUL 12 2001 WORKERS' COMPENSATION - FIRST REPORT OF INJURY - STATE SPECIFIC QUESTIONS i ! Does the employee receive either piecework or commission? Does the employes declare tips as mccme? Enployers Account Number New Hampshire If underage 18, is there a Child Labor Employment Certificate on file? Was injured hired In New Hampshire? Piece or time worker Time disability began Has injured filed a Farm 8a WCA? Part of machine on which accident occurred? Kind of power {e.g., hand, foot, electrical, steam, etc.) Was accident caused by insured's faiiuf e to use or observe safety equipment or regulation? Probable length of disability If employee has returned to work, at what time? Federal I.D. Number, Has employee returned to full or light duty? Initial treatment (none, employer, emergency, hospitalized, outpalient, clinic or office visit) if employee Is a leased or temporary worker, client's business name Is there a managed care program? (If yes, name of provider) Is there a written safety program in force? Is there an active safety committee? Number of employees, full time and part time SIC Code New Jersey Number of employees Was employee unable to work on 'any day after the in^ry? SIC Number Employer's Registration Number New Mexico Federal ID Number NM Unemployment Insurance Number Does your business have a safety program? (If yes, specify admini- stered period - weekly/monthly/ annuallyfother - if other, specify) Highest educational level attained Total lost work days If occupational iflness, date diagnosed and description of diagnosis ■ Was employee under the influence of drugs/alcohol? (Yes/no7 unknown) New York . ~~^ Code Number NYS U.l. Employer Registration Number Total earnings paid during 52 weeks prior to date of accident (include bonuses, overtime, value of lodging, etc.) Dfd employer provide medical care? (If yes, when?) Has the injury/illness been previously reported on Form C-2.1? Indicate days of week that employee regularly works If fatal., name, address and relationship of nearest relative North Carolina Employer Code Number • Time disability began Kind of power (hand, foot, electrical, steam, etc.) Part of machine on which Injury occurred Was accident caused by injured^ failure to use or observe safety " equipment or regulation? Probable length of disability . Ifemployee has returned to work, at what time7 * North Dakota Will employee be off the job for five or more consecutive days? " Time employee left work due to this Injjry Time workday began on the day of injury If employee has not returned to work, estimate date of return Employee's gross lota) .earnings for the past 52 weeks List each dependent under age 18, or under age 22 if attending school, or incapable of self support (name, birth date and relationship) Exact location of injury (e.g., plant, department, building, etc.) Workers Compensation Account Number Season length On months) ■% Ohio Time accident reported to employer Has employee ever filed a previous application for this injury? Has employee filed any other claims with the Bureau or Industrial Commission? ()f yes, specify claim number and body parts) Employee's county Employer's Risk Number if under your employ for less than 12 months prior to injury, list former employers, dates if employment, wages and number of weeks Oklahoma SIC Number Oregon Education (number of years completed, or GED) Side of body affected (left or right) Department regularly employed Type of employer 0ndlvidualfcorporation/partnership/o(her) 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 accident? Time worker left work 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 act? Was employee amputated? South Dakota Federal ID Number Unemployment Number SIC Code Number Number of employees Is the employee an officer or partner? Time workday began Exemption information (employee/spouse/over 65/bltnd/other dependents) Does employee receive pay in kind? (If yes, explain) Type of treatment (outpatient, emergency room or in house) Injury Codes: Body part injured (2 digits) Cause of in^jry (2dtgits) Nature of injury (2digits) Tennessee Federal ID Number (f paid on other than a time basis, such as piece work or commissions, indicate method and actual average weekly earnings if board, lodging or other advantages were furnished in addition to- wages, state nature and estimated weekly value tf employee has returned to work, at what wage? If fatal, name and address of nearest relative Texas Federal Tax ID Number Does the employee speak English? flf no; specify language) Employee's mailing county If married, spouse's name O13020 WUNTDG98 Page 3 of 4 ^^ JUL 12 2001 3:38PM '• RSERJET 3200 p. 17 POLICY NUMBER POLICY PERIOD FROM TO COVERAGE IS PROVIDED IN THE ;CX10568264 08/05/00 08/05/01 PROVIDENCE WASHINGTON INSURANCE COMPANY UW0032 04/95 JUL 12 2001 3:42PM LRSERJET 3200 p. 18 POLICY NUMBER CX105S8264 POLICY PERIOD FROM TO 08/05/00 08/05/01 COVERAGE IS PROVIDED IN THE PROVIDENCE WASHINGTON INSURANCE COMPANY JUL 12 2001 3:47PM • LASERJET 3200 10 p. 19 POUCY NUMBER CXI0568264 POLICY PERIOD FROM TO 08/05/00 08/05/01 COVERAGE IS PROVIDED IN THE PROVIDENCE WASHINGTON INSURANCE COMPANY UW0034 0795 r JUL, ,1:2 2G@3 3:51PM i LASERJET 3200 p. 20 11 •POLICY NUMBER CX10568264 POLICY PERIOD FROM TO 08/05/00 0iJ/05/01 COVERAGE IS PROVIDED IN THE PROVIDENCE WASHINGTON INSURANCE COMPANY JUL 12 2001 3:55PM LASERJET 3200 p. 21 12 PROVIDENCE WASHINGTON INSURANCE CO LOCATIONS SCHEDULE POLICY # CXI 05 68 2 64 URBAN MOVING SYSTEMS, INC 312 PROVONIA AVENUE #1 JERSEY CITY, NJ 07302 •» AGENT: A.E GOETTELMANN* £ CO. # 31001540 ~ Prems BIdg No. No. Street 001 001 445 WEST BOTH STREET (LIABILITY ONLY) 002 -001 3 18TH STREET City County NEW YORK WEEHAWKEN HUDSON St Zip NY 10019 NJ 07087 JUL 12 2001 3:55PM ■kLRSERJET 3200 POLICY NUMBER: CX10568264 -FORM SCHEDULE p. 22 COMMERCIAL POLICY Forms and Endorsements applying to this Coverage Part and made a part of this policy at time of issue: FORMS APPLICABLE TO ALL PREMISES AND COVERAGES Form Edition Description FORM SCHP 12 96 FORM SCHL 12 96 IL0017 11 85 IL0023 04 98 IL0183 04 98 IL0208 04 98 IL0268 07 00 IL0935 08 98 PROPERTY FORMS SCHEDULE LIABILITY FORMS SCHEDULE COMMON POLICY CONDITIONS NUCLEAR ENERGY LIABILITY EXCLUSION ENDT NEW YORK CHANGES -FRAUD NEW JERSEY CHANGES -CANCELLATION & NONRENEWAL NEW YORK CHANGES - CANCELLATION & NONRENEWAL EXCLUSION OF CERTAIN COMPUTER RELATED LOSSES o ILL INFORMATION CONTAINED HEREIN 15 UNCLASSIFIED DATE 07-30-2010 BY UC60322LP/PLJ/CC *s> 'Page 1 of 1 JUL 12 2001 3:55PM j& LASERJET 3200 A p. 23 POLICY NUMBER: CX105G8264 . COMMERCIAL PROPERTY ■FORM SCHEDULE Forms and Endorsements applying to this Coverage Part and made a part of this polxcy at time of issue: FORMS APPLICABLE TO ALL PREMISES AMD COVERAGES " * Form Edition Description CP0010 06 95 BUILDING AND PERSONAL PROPERTY COV FORM CP0090 07 88 COMMERCIAL PROPERTY CONDITIONS IL0003 04 98 CALCULATION OF PREMIUM FORMS APPLICABLE TO SPECIFIC PREMISES AND COVERAGES Form .Edition Description CP1030 06 95 CAUSES OF LOSS-SPECIAL FORM PREMS 002 BLDG 001 YOUR PERSONAL PROPERTY ILL INFORMATION CONTAINED HEREIN .15 UNCLASSIFIED DATE 07-30-2010 BY UC60322LP/PLJ/CC Page 1 of 1 JUL ,1% 2QtJi; 3:55PM POLICY NUMBER: CX10568264 .FORM SCHEDULE 4 LRSERJET 3200 p. 24 COMMERCIAL LIABILITY Forms and Endorsements applying to this Coverage Part .and made a part of this policy at time of issue: FORMS APPLICABLE* TO ALL PREMISES AND COVERAGES Q Form Edition Description CG0001 01 96 CG0001 07 98 CG0104 04 97 CG0163 07 98 CG2147 07 98 CG2147 10 93 CG2149 07 98 CG2160 09 98 CG2620 10 93 CG2621 10 91 CG2624 08 92 CG2649 06 99 IL0003 04 98 IL0021 04 98 IL0021 11 85 U9935 07 91 COMML GENERAL LIABILITY COV FM (OCCURRENCE) COMM GEN LIAB COV FORM- OCCUR VERSION NEW YORK CHANGES -PREMIUM AUDIT NY CHGES COMML GENL LIAB 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 ILL INFORMATION CONTAINED . HEREIN 15 UNCLASSIFIED DATE 07-30-2010 BY UC60322LP/PLJ/CC Page 1 of 1 JUL 12 2001 3:55PM 1 LASERJET 3200 p. 25 $ 44,404 $ 86,574 URBANMOVING!$E$34 $ 153,195 $ 184,331 URBANMOVING!$D$34 ILL INFORMATION CONTAINED HEREIN 15 UNCLASSIFIED DATE 07-30-2010 BY UC60322LP/PLJ/CC JUL 12 2001 3:56PM • LRSERJET 3200 p. 26 insured Name: URBAN MOVING SYSTEMS INC Policy Number 6S59 UB 688X6573 Policy Term: 09/1 8/2000 - 09/1 8/2001 Audit Term: % , 09/18/2000-12/17/2000 NJ 09/18/2000 001 01 8293 01 8810 02 ANNUALIZED PAYROLL EXPOSURES FOR YEAR ENDED 12/31/00 FURNITURE MOVING & STORAGE, DRIVERS CLERICAL OFFICE EMPLOYEES NOC SAI; Loc: Aud ID: &LL INFORMATION CONTAINED ^EEEIN 15 UNCLASSIFIED PATE 07-30-2010 BY UC60322LP/PLJ/CC David MacGregor Co. a j:. m-w/vct- .- 'fflf) Uf-37?7 TTV— a~V \x. y j Cczziin Nszi- j. t* ^ CZ — ^li— 1.^:: .«• —— *'— o ^ Dss £: Tzzs cf rinotr^i^- ^ ,;^ 5 ,o #- .* //^ st- wteMwrtti aj3 b6 b7C j? j^ .— . o 7K vCPS Vs. <L V. CONTj gpffiSSi |fc#/k&^ I DATE: 07-30-2Q CLASSIFIED BY (Rev. 08-28-2000) PEAS 01; 1.4 (C) DECLASSIFY OH: 07-30-2035 m 22LP/PLJ/CC ALL iifo: * HEKEII I i WHERE SHO* I COHTAIHED LASSIFIED EXCEPT 0TIER1ISE SEGM^T FEDERAL BUREAU OF INVESTIGATION Precedence : ROUTINE To : Newark From: Newark C-9 Contact UL Approved B; Drafted By: Case ID #: Title: R) Attn: Date: 09/17/2001 IMA (Rotor) , Squad C-9 b2 .b6 b7C bl titoh Synopsis: J^AT^equest sub- files for to captioned investigation. Derived/From : G-3 Declassify On: XI Details: $$|A>n 09/14/2001, Newark Division, with the assistance or 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) . j^^i^he following sub-files are requested to serve as repositories for the investigative information developed on the five (5) Israeli Nationals described herein: Sub-file b6 b7C Investigation at Newark continues , J ♦♦ CLASSIFIED] REASON: !.4( (L^r -^ WHERESHOWN OTHER 1 bl <•# ^ .*^M* (Rev. 08-28-2000) 'fc * ^<& *'* all ..information cohtaihed hereii 15 otcl1ss1fied except where shoot otherwise SECRET DATE: 07-30-2010 CLASSIFIED BY UC60322LP/P1J/CC reason: 1.4 (cj FEDERAL BUREAU OF INVESTIGATION DECLASSIFY OH: 07-30-2035 (SI Precedence : ROUTINE To : Newark From: Newark C-9 ConftacLt : SA Approved By- Drafted By: Case ID #: ^f Title: yg^ Date: 09/17/2001 Attn: Squad C-9 Synopsis: b2 b6 b7C ( K%l eport ):>3 (Pfo) Administrative: DerivedVtf'rom : G-3 Declassify On: XI tt^The attached pursuant to a criminal subnnfina served on f Iwere obtained Details: ($/{$) On 09/14/2 001, Newark Division, with the assistance of 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) . (^3®The attached to a criminal subpoena serv< were obtained pursuant sd on (j^QfO&ccording to the display windows of the telephones, tlie following telephone numbers correspond to the following individuals : a CLASS REASON DEetASSIFYON siMket b3 b3 W SECRET To : Newark fi-irwn. Mewark ( £ ) Re-s £§<J J09/17/2001 • bl b6 b7C (w^r (presumably (presumably (NFI) Investigation at Newark continues ♦♦ SEc&ET 2 FD-302 (Rev. 10-6-95) DATE: 07-30-2010 CLASSIFIED BY UC60322LP/PLJ/CC REASON: 1.4 (c) DECLASSIFY OH: 07-30-2035 ALL IIFORMATION COHTAIHED HEKEII IS UNCLASSIFIED EXCEPT WHERE SHOWN OTHERWISE W* ; FEDERAL BUREAU OF INVESTIGATION Date of transcription 09/12/2001 born |_ ]of I Union City, New Jersey, was interviewed at her residence. SEter being advised of the identity of the interviewing agent and the nature of the interview, she provided the following be b7C information. (U) Afte 1 frQyn[ I born [ Aft er being sho wn nu mbered photograp hs of] Uj£lK[ (#4) and recognized r Uae_£I recognized Lkprnl (#3), photograph. [_ J (#5), I born UM2), stated she Jbelieved she . from standing in line for the bus at the Port Authority in New York, New York.^.) Lead covered for control number 1148. (juC^ DAI CLASS REASON: 1.4j SSSs^sfSte^ ALLir HEREIN jSUNCB^SStEliD EXCEPT hi} investigation on 09/12/2001 at Union City, New Jersey Date dictated 09/12/2001 bl This document contains neither recommendations nor rrmnlnsimjg of th ft FRT Tt is the nronertv of the FBI and is loaned to vour agency, it and its contents are not to be distributed outside your agency m ,FD-302 (Rev. 10-6-95) ALL INFORMATION CONTAINED HERE II IS UNCLASSIFIED EXCEPT WHERE SHOOT OTHERWISE DATE: 07-30-2010 CLASSIFIED BY UC60322LP/PLJ/CC REASON: 1.4 (C) DECLASSIFY ON: 07-30-2035 FEDERAL BUREAU STIGATION Date of transcription 09/11/2001 [ On 09/1 1/01, Special Agents (SA) and b6 b7C interviewed Police Officer ] of the F ederal Bureau of Investigation (FBI) , East Rutherford Police Department, East Rutherford, New Jersey, who provided the following information: ^t) stated that while assigned to a traffic detail, diver ting traf fic from Route 3 East to Route 12 North and Route 3 West , | l observed a white qhevrole^. van traveling slower than other vehicle on Route 3 East. recalled a message transmitted by dispatch of a national broadcast to be on the lookout for a white Chevrolet van bearing NJ registr ation JYJ 13Y, related to the terro rist attack earlier in th e day. I I immediately informed I I of the possibility that he has observed the white CHEVROLET van wanted in connection of the terrorists attack. £ u) stopped the vehicle al ong with and the occupants from the vehicle. [_ 1 who assisted in removing j advised that the following occupants were transported to the State Police facilities ins ide the Meadow land s Sports Complex by New Jersey Stat e Tro opers : f white ma le DO D OB: f i -1 white male. CuT 0b7| I wh 1 whi te ma le; f DOB:L ite male; and _^^^_^ DOB I white male I ] dUbT , , advised that prior to the S tate Troo pers ; transporting the occupants to their facility, I ~1 was told by "We are Israeli. We are not your problem. Your problems are our problems ] then told the incident told r . « Ct*T The Palestinians are the problem." "We were on the west side highway during 93 W advised that he will write a detailed Police i§ reported for his department documenting the incident . ^ u \ Wt AU^NFGRMATIONCONTSfi 4 ' HEREIN ISURet^SiFtED EXCEPT WHERE SBGWtfOTRERWLSE Investigation on 9/ll/ 1 at NEW JERSEY lb 7 A Ib6 b7C Filed] by a ^fijLfyj Date dictated 9/11/01 bl SA This document contains neither recommendations nor conclusions of th< it and its contents are not to be distributed outside your agency. ft): jS * Chief of Police * John R. LaGreca .ST RUTHERFORD POLICE DEPARTMENT 312 Grove Street East Rutherford, New Jersey 07073 Telephone 201-438-0165 CSRR 014157 [X] PRELIMINARY POLICE REPORT [ ] SUPPLEMENTAL REPORT DATE TIME DAY LOCATION 09/11/01 1556 Tue Rt-3 East Service Rd. Nature of Report Police Information COMPLAINANT Address LN P0- FN Mile 7.9 DOB he hlC Ph. 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 Rtl20 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 2 000 chevy 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 t o be a newer model chevy with at least two occupants . I immediately informed | ] (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 fann y pouch type of bag. This officer then physically removed him. I I removed the passenger and one othe r passenger from the passenger si de of the van and with minor assistance from | | the other two occupants were removed placed on the grass off to the shoulder and this officer read all five 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 bv State Troopers t o await the arriv al of the FBI. w/m dob I I addresses s The oc cupants were ( Driver) | given: | ( Brooklyn NY a nd f [Isr ael wear ing blue jeans torn I w/m dob I I ] Miami Beach Fl 3 313 9 Wearing jean overalls., I I no knees and a gray and black shirt. [ address g iven/ wearing a pink shirt and blue jeans. |_ 3: J w/m dob No address given and uncert ain of clothing description but indiv idual was holding a n American Express Card^ dob [ J of ■i: r Manhatten NY | only personal belongings were a pack of Cigarettes and black sunglasses. I am not sure to w/m j the position of the other passengers. .J&L taesst^ W+*. Report of P0- batb. Officer in Charge * Chief of Police * John R. LaGreca EAST RUTHERFORD POLICE. DEPARTMENT 312 Grove Street East Rutherford, New Jersey 07073 Telephone 201-438-0165 CSRR 014157 DATE 09/11/01 [x] PRELIMINARY POLICE REPORT [ ] SUPPLEMENTAL REPORT TIME DAY LOCATION 1556 Tue Nature of Report Police Information Rt 3 East Service Rd #7.9 he hie COMPLAINANT LN PO Address FN DOB Ph. 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 prob lems are our proble ms, The Palestinians are the problem. I was also told by "We were on the west side highway during the incident." The black bag that the driver was fumbling with contained all of his belonging s (see attached Receipt from the FBI for its contents) . "T was 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 agen ts i nvolved in the investigation. Two o f which were and Report of PO- Officer in Charge Chief of Police * John R. LaGreca EAST RUTHERFORD POLICE. DEPARTMENT 312 Grove Street East Rutherford, New Jersey 07073 Telephone 201-438-0165 CSRR 014157 DATE 09/11/01 [ ] PRELIMINARY POLICE REPORT [X] SUPPLEMENTAL REPORT TIME DAY L OCATION 1556 COMPLAINANT LN Address ERPD Tue Nature of Report Police- Information FN Rt-3 South-Service-Rd Ph. b6 b7C DOB 32 I While on a traffic detail diverting traffi c to Rt closed, we were informed by our desk officer PO broadcast looking for a 2000 white Chevy van, NJ rea. least 3 people. After a short period of time, PO | traffic detail with me, advised me that a van which was slowly approaching us PO [ 120 as Rt. 3 east was that there was a 13Y, occupied by at who was on the approached the driver ' s was able to see at Officer matches that description of the broadcast side of the vehicle and I approached the passenger siae. I least 4 people in the van, two in the front and two in the back. | read the plate num ber and I contacted the desk for confirmation on the plate 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 vehi cle was i n fact the plate that the FBI had stated in the broadcast While P0| I was 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 passenger he s tated " we're Isre ali" . He was identified, via Isreal passport as were on their way to roommate . 1 W/M Dob f ]of Isreal. He advised me that they 1 in Brooklyn where they are staying with a He did not have the exact address . I I and I I arrived 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 Cou nty Bomb Squad, State Police and FBI notified. the vehicle was NY. The rear passengers were: W/M Dob T of The driver of 1 Brooklyn, of ^ ^ t W/M Dob I | Miami Bea ch, FL (he was wearing blue jean overalls) ; | Dob I Kno address given - wearing a pink shirt and blue jeans) ; and W/M ] W/M Dob[ i of [ J Manhatten, NY. All five were seperately FBI agents responded and tooK over the scene transported to the State Police facilities in the Meadowlands Sports Complex by State Troopers, Further investigation by the FBI. Report of Officer in Charge DC d7C .-"" J Federal Bureau of iNVEsnomoN ONE GATEWAY OT. MARKET STREET NEWARK, NJ 07102 SPECIAL AGENT b7C / p-57^«, b6 b7C 1 $W^ cJU^To^fc" Mi Aw/ foJv." ^2 .33/31ooan yXI j ex ■ U-^fe A^ c k- £ 1- f ***■ L SecotLy,^ s^y } 3&LAd -6.«^i j pjy ?Q £ , ^A/^Co " fl&v*. r^ooo CAusJu j (rCttrlSUjiJYiiLigxig- *%>•» kW.'A; T^p^pVatJ. ofe!) ALL XNSQEOCAXKftr C0NTAU3ED ! \ V.. <*475 7 ■A- A -A' A A- A A A A -A- A -A A A A- A A* A A A A A A A A A A LAPD-90230 09/1:1/01 1615 STATEWIDE BROADCAST aaaaaaaaaaaaaaaaaaaaaaaaaa AM.NJNSFODOO 13 i 10 09/11/2001 05286- 13 i 10 09/11/2001 06032 NJ TXT CAP) REQUEST NATIONAL BROADCAST TO i A L L R E E I V E R S RE P I. - VEHICLE POSSIBLY RELATED TO NYC TERRORIST ATTACK * * CORRECTION ON REGISTRATION A WHITE 2000 CHEVROLET- VAN WITH NEW JERSEY REG/JRJ13Y WITH "URBAN MOVING SYSTEMS" SIGN ON BACK WAS -SEEN AT THE LIBER I Y STATE PARK, JERSEY CITY N.J. AT THE TIME OF THE FIRST IMPACT OF A -JFT ATRIINER INTO THE WORLD TRADE CENTER. THREE INDIVIDUALS WITH THE VAN WERE SEEN CELEBRATING AFTER THE INITIAL -IMPACV^AND SUBSEQUENT EXPLOSION. F.B.T, NEWARK FIELD OFFICE IS REQUESTING THAT IF THE VAN IS iOOATFD, HOLD FOR PRINTS AND DETAIN INDIVIDUALS. CONTACT S.A. " 4 1 T H ANY I NFO RM AT I ON , a NJSP OPERATIONAL DISPATCH NJNSPODOO JO aa MSB ROUTED TO CRTS FROM NJSP OPE bo b7C 1606ET aa MSG ROUTED TO CRTS . FROM NJSP OPERATIONAL DISPATCH a 09/11/01 16 1 r ALL XHPOHMAOTOSr CGHTAIHED* Do ■b7C S> NEW JERSEY ' k,tifL Mofofl'sMe' Services LEASED VEHICLE REGISTRATION .. ~.._... hi i iiiiiMiu.xiUMlliUlllff'IIUuyiriiliulQnlAfF/'Ji.l III - MOTOR VEHICLE SERVICES I RECEIPT DOCUMENT ONLY *X r 5W T£^ ", HOV 2001 VIN: 1GCEG15W4Y1142815 Kff DL:B1B&! S " tv N y 11530 DUPLICATE PT:PA jToOOO FEB 5.00 AR BG20012390037 'pO BOX 83 GARDEN CITY M 11530 ME: CHE YEAR:2000 TYPE: VAN MODEL: COLOR:WT PT:PA AX:2 GW: 5000 EQ: 5000 REGCD:15 REGD : FD REG: POST AUDIT: PLATE FEE: 5.00 TOTAL: AR 5.00 BG20012390037 '()tfl/$'' '*'"■'' v'*'i'''"''' * « . IkWi/Wv'/i '' .M^ffiVf&iftMW""' ' ' ' • ''_," t - ^," w>w "^.^ t ^ M - " ^^* J — — __ , : — -— ■ wmw ny « "^ ___™"*, ™ «— — — .... ~— — >*> " ™ " * ' ItMWWMXIMM Mi,m^;^»r.^,"A, l ,',:" ll iy,;,a :raim ,.'. ",' '' i *t»'!t t fk':f\flf< t * , t'^:'\* - " » INSURANCE IDENTIFICATION CARD IV2A (1-96) (STATE) NJ COMPANY NUMBER COMPANY 111 EMPIRE FIRE & MARINE INS CO POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE CABIND080601 YEAR 08/06/2001 10/06/2001 MAKE/MODEL GMC/VAN VEHICLE IDEMJ1FICATION NUMBER 1GCEG15W4Y1142815 "",r'," < i i i ,', ', iti •'••X ' •"■'' . AGENCY/COMPANY ISSUING CARD DeBellls Insurance Agency, Inc. 492 Franklin Avenue (973)661-1500 Nutley, NJ 07110 INSURED URBAN MOVING SYSTEMS INC 3 18TH STREET WEEHAWKEN.NJ 07087 SEE IMPORTANT NOTICE ON REVERSE SIDE t * 'FD-597 (Rev 8-11-94) File #• Page UNITED STATES DEPARTMENT OF JUSTICE FEDERAL BUREAU OF INVESTIGATION Receipt for Property Received/Returned/Released/Seized / of On (date) °l- II -oi (Name) (Street Address). (City) /S*^J<J*j^ XU bo b7C tern(s) listed below were: )g Received From ^| Returned To ^j Released To ^\ Seized Description of Item(s): to <Zs& ^ 3z -e*ci. " s* - 30 IacL r //>o CO -t- -tr&- -y^tto C*7l C>/~//<c fag-HlSX. <&o*fc- zg-yg- SQlOtz, cAj-Ai SbcL^ £st t S%J5/%bk dOHTA3SE&- gsaggSSSSaSKI^^w B^gro^ Sid 5*7^ Received By: (Signature) Received From: x *5 (Signature) t / Ffc-597 (Rev 8-11-94) Page UNITED STATES DEPARTMENT OF JUSTICE FEDERAL BUREAU OF INVESTIGATION Receipt for Property Received/Returned/Released/Seized 4_>4 File # ^^ £> - h \\j - On (date) Cf{ | llLzQQlI (Name)_ (Street Address)_ bo b7C item(s) listed below were: *s?f[jR.eceived From "'□""Returned To □ Released To □ Seized (City) fig/^fcjJ/K^ MV Description of Item(s): '_ ^L & u \ ( J t , p/^/yy P^cfc t PciJT^)*})^ D -I Avo^e^ ^^K. £ X» /\ 7,^ UA££ 3 £J h & TA& ( - m-at^ g^-x^-^^-j. QnJJJbdrSJLKjEt=£& Jt - qxCC 1. iMst-rcmK CA/tt? tevto 7; J( 1 ?te),ijio emu C 7 '^ JUjl± CO b^L ^.i. nwoKAiATiour contained HSRIOT/IS ^CLASSIFIED ***&mri»smamfijLWM r^w #- Jufctfil* 9 - $ ,^r //) Repeived By: ^ <?o. Received From: (Signature) * = ^r (Signature; Ui FD-302 (Rev. 10-6-95) DATE: 07-30-2010 CLASSIFIED BY UC60322LP/PLJ/CC REASON: 1.4 (C) DECLASSIFY 01: 07-30-2035 * FEDERAL BUREAU OF INVESTIGATION ALL INFORMATION CONTAINED HEREIN IS UNCLASSIFIED EXCEPT WHERE SHOOT OTHERWISE Date of transcription 09/14/2001 In connection with a canvass conducted by the below-. . referenced Special Agent at the apartment building located at | | Union City, NJ, to identify individuals reporting any unusual activity around the apartment building over the prior few days, the following interview was conducted: (u\ E date of birth ~~] Union City, NJ, telephone [ was interviewed. Alter' being advised of the official identity of the interviewing agent and the purpose of the interview she provided the following information:^) The morning of the interview, a white van was parked in the rear parking lot of the apartment complex. The van was white and had no windows on the sides. It appeared to be a utility van for an electric company. The name of the company, since forgotten, was in red letters on the van. ^u) 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. Cu) b6 b7C This report is being submitted in connection with Lead NK1148.£tO <s$<*>* ALL IN HEREIN IS U WHERE ED FiED EXCEPT ISE DATE CLASSIFIED B^" REASON:! ?fcrbly+x=r IF¥ON:_^&£i&. b7A bo b7C Investigation on 09/11/2001 at Union City, NJ Date dictated Q9/14/200.1 bl This document Contains neither recommendations nor Conclusions Of theT pT Tt in thfl imnniutir nf thn BBT n«H in Innnnri 1 In imm rnimmr it and its contents are not to Be distributed outside your agency. FD-302 (Rev. 10-6-95) • # tALL INFORMATION CONTAINED HERE II IS UNCLASSIFIED EXCEPT WHERE SHOOT OTHERWISE -1- DATE: 07-30-2010 CLASSIFIED BY UC60322LP/PLJ/CC FEDERAL BUREAU OF INVESTIGATION REASON: 1.4 (C) DECLASSIFY ON: 07-30-2035 Date of transcription 09/14/2001 Pursuant to a Federal Grand Jury subpoena issued in the District of New Jersey, I I TmJ These records were placed in a 1-A envelope. (u} \ b3 CL^mfegr^ jg, a aM^» 1 cM^=r REASON: 1.4( <L ) DECLASS ALUNFORMfMNCQNS^D HEREIN IS UN2&^glED EXCEPT WHERESHOWNOTHEF investigation on 09/14/01 at Newark, NJ b7A File t by SA jQtjj) '..^r^gjffit^ ^ ed ' ctated 09/14/01 b6 -b7C -&■ This document contains neither recommendations nor conclusions of the FE it and its contents are not to be distributed outside your agency. bl FEDERAL- BUREAU OF INVESTIGATION FOIPA DELETED PAGE INFORMATION SHEET No Duplication Fees are charged for Deleted Page Information Sheet(s). 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