Common use of INSURANCE PROCUREMENT Clause in Contracts

INSURANCE PROCUREMENT. Shareholder shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: Shareholder: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills Owners Corp., 00 X. Xxxxxxxxxx, Xxxxxxxxx, XX 00000 Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 Date of Move /Delivery/ Work CERTIFICATE HOLDER CANCELLATION Larchmont Hills Owners Corp., C/ X Xxxxxxxx Management Realty Corp. 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)

INSURANCE PROCUREMENT. Shareholder Unit Owner shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder Unit Owner shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder Unit Owner shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: ShareholderUnit Owner: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills Owners Corp.Beacon Hill Estates Cooperative Inc. 000 Xxxxxx Xxxx Xxxxx, 00 X. Xxxxxxxxxx, XxxxxxxxxXxxxx Xxxxx, XX 00000 Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 Date of Move /Delivery/ Work Work: CERTIFICATE HOLDER CANCELLATION Larchmont Hills Owners Corp., C/ Beacon Hill Estates Cooperative Inc. C/X Xxxxxxxx Management Realty Corp. 000 Xxxxxxxxxx Xxx, Xxxxxxxx. S-512 Harrison, NY 10528 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)) Contractual Liability* To avoid paying claims for large Labor Law 240 third-party Law suits, some insurance companies have removed contractual liability from their policies. In this case, your "Additional Insured" status with the contractor will be meaningless, and the contractor's insurance will not back the contractor's indemnification. Here are few methods to try to determine if your subcontractor has contractual liability:

INSURANCE PROCUREMENT. Shareholder shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: Shareholder: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills Owners 80 Xxxxxxx Tenants Corp., 00 X. Xxxxxxxxxx000 Xxxxxx Xxxxxx, XxxxxxxxxXx. Xxxxxx, XX 00000 NY 10552. Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 Date of Move /Delivery/ Work CERTIFICATE HOLDER CANCELLATION Larchmont Hills Owners Corp.80 Xxxxxxx Tenants Corp, C/ C/X Xxxxxxxx Management Realty Corp. 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)

INSURANCE PROCUREMENT. Shareholder shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: Shareholder: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills Xxxxxx Owners Corp., 00 X. Xxxxxxxxxx0000 Xxxxxx Xxx, XxxxxxxxxLarchmont, XX 00000 New York 10538. Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 Date of Move /Delivery/ Work CERTIFICATE HOLDER CANCELLATION Larchmont Hills Owners Corp.Xxxxxx Owner Corp. , C/ C/X Xxxxxxxx Management Realty Corp. 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)

INSURANCE PROCUREMENT. Shareholder Unit Owner shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder Unit Owner shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder Unit Owner shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: ShareholderUnit Owner: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills 555 Bronx Owners Corp.Corp, 00 X. Xxxxxxxxxx000 Xxxxx Xxxxx Xxxx, XxxxxxxxxXxxxxxx, XX 00000 Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 Date of Move /Delivery/ Work CERTIFICATE HOLDER CANCELLATION Larchmont Hills 555 Bronx Owners Corp., C/ C/X Xxxxxxxx Management Realty Corp. 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)) Contractual Liability* To avoid paying claims for large Labor Law 240 third-party Law suits, some insurance companies have removed contractual liability from their policies. In this case, your "Additional Insured" status with the contractor will be meaningless, and the contractor's insurance will not back the contractor's indemnification. Here are few methods to try to determine if your subcontractor has contractual liability:

INSURANCE PROCUREMENT. Shareholder Unit Owner shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder Unit Owner shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder Unit Owner shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: ShareholderUnit Owner: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills Owners Corp.000 Xxxxx Xxxxx Xxxx Xxxxxx Xxxx., 00 X. XxxxxxxxxxXxxxxxx, Xxxxxxxxx, XX Xxx Xxxx 00000 Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 Date of Move /Delivery/ Work CERTIFICATE HOLDER CANCELLATION Larchmont Hills 000 Xxxxx Xxxxx Xxxx Owners Corp., C/ C/X Xxxxxxxx Management Realty Corp. 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)) Contractual Liability* To avoid paying claims for large Labor Law 240 third-party Law suits, some insurance companies have removed contractual liability from their policies. In this case, your "Additional Insured" status with the contractor will be meaningless, and the contractor's insurance will not back the contractor's indemnification. Here are few methods to try to determine if your subcontractor has contractual liability:

INSURANCE PROCUREMENT. Shareholder Unit Owner shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder Unit Owner shall, by specific endorsements cause Cooperative Condominium and Managing Agent to be named as additional insureds. Shareholder Unit Owner shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. CooperativeCondominium: Managing Agent: ShareholderUnit Owner: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: ShareholderUnit Owner’s Name, Address and Apt. Number Larchmont Hills Owners Corp.Xxxxxxxxx Lofts on Main, 00 X. XxxxxxxxxxXxXxx Xxxxx, XxxxxxxxxNew Rochelle, XX 00000 NY 10805 Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 Date of Move /Delivery/ Work Work: CERTIFICATE HOLDER CANCELLATION Larchmont Hills Owners Corp., C/ Xxxxxxxxx Lofts on Main C/X Xxxxxxxx Management Realty Corp. 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)) Contractual Liability* To avoid paying claims for large Labor Law 240 third-party Law suits, some insurance companies have removed contractual liability from their policies. In this case, your "Additional Insured" status with the contractor will be meaningless, and the contractor's insurance will not back the contractor's indemnification. Here are few methods to try to determine if your subcontractor has contractual liability:

INSURANCE PROCUREMENT. Shareholder shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: Shareholder: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills Owners Corp.Xxxxxx Court Apartment Corp, 00 X. Xxxxxxxxxx000 Xxxxxxxx Xxx, XxxxxxxxxMamaroneck, XX 00000 NY 10543 Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 Date of Move /Delivery/ Work CERTIFICATE HOLDER CANCELLATION Larchmont Hills Owners Xxxxxx Court Apartment Corp., C/ C/X Xxxxxxxx Management Realty Corp. 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)

INSURANCE PROCUREMENT. Shareholder Unit Owner shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder Unit Owner shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder Unit Owner shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: ShareholderUnit Owner: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills Owners Corp.a) 00 Xxxxx Xxxxx Xxxx Owner’s Inc., 00 X. XxxxxxxxxxXxxxx Xxxxx Xxxx, XxxxxxxxxXxxxxxx, XX 00000 b) Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 Date of Move /Delivery/ Work Work: CERTIFICATE HOLDER CANCELLATION Larchmont Hills Owners Corp., C/ X 00 Xxxxx Xxxxx Xxxx Owner’s Inc. C/x Xxxxxxxx Management Realty Corp. Corp 000 Xxxxxxxxxx Xxxxxxxxxx, Xxx, Xxxxxxxx. Harrison, NY 10528 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)) Contractual Liability* To avoid paying claims for large Labor Law 240 third-party Law suits, some insurance companies have removed contractual liability from their policies. In this case, your "Additional Insured" status with the contractor will be meaningless, and the contractor's insurance will not back the contractor's indemnification. Here are few methods to try to determine if your subcontractor has contractual liability:

INSURANCE PROCUREMENT. Shareholder Unit Owner shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder Unit Owner shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder Unit Owner shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: ShareholderUnit Owner: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills Owners Crest Manor Housing Corp., 00 X. Xxxxxxxxxx000 Xxxxx Xxxxxxxx, XxxxxxxxxXxxxxxx, XX Xxx Xxxx 00000 Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 Date of Move /Delivery/ Work Work: CERTIFICATE HOLDER CANCELLATION Larchmont Hills Owners Corp., C/ Crest Manor Housing Corp C/X Xxxxxxxx Management Realty Corp. 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)) Contractual Liability* To avoid paying claims for large Labor Law 240 third-party Law suits, some insurance companies have removed contractual liability from their policies. In this case, your "Additional Insured" status with the contractor will be meaningless, and the contractor's insurance will not back the contractor's indemnification. Here are few methods to try to determine if your subcontractor has contractual liability:

INSURANCE PROCUREMENT. Shareholder Unit Owner shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder Unit Owner shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder Unit Owner shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: ShareholderUnit Owner: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills Owners Xxxxxxxxx Tenants Corp., 00 X. XxxxxxxxxxXxxxxxxx Xxxxxx, XxxxxxxxxXxxxx Xxxxxx, XX 00000 Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 Date of Move /Delivery/ Work CERTIFICATE HOLDER CANCELLATION Larchmont Hills Owners Xxxxxxxxx Tenants Corp., C/ C/X Xxxxxxxx Management Realty Corp. 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)) Contractual Liability* To avoid paying claims for large Labor Law 240 third-party Law suits, some insurance companies have removed contractual liability from their policies. In this case, your "Additional Insured" status with the contractor will be meaningless, and the contractor's insurance will not back the contractor's indemnification. Here are few methods to try to determine if your subcontractor has contractual liability:

INSURANCE PROCUREMENT. Shareholder Unit Owner shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder Unit Owner shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder Unit Owner shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: ShareholderUnit Owner: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills Owners Corp.number a) Orienta Gardens Owners, 00 X. XxxxxxxxxxInc., XxxxxxxxxOrienta Gardens, XX 00000 Mamaroneck, NY 10543 b) Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 Date of Move /Delivery/ Work Work: CERTIFICATE HOLDER CANCELLATION Larchmont Hills Owners Corp.Orienta Gardens Owners, C/ Inc. C/X Xxxxxxxx Management Realty Corp. Corp 000 Xxxxxxxxxx Xxxxxxxxxx, Xxx, Xxxxxxxx. Harrison, NY 10528 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)signature

INSURANCE PROCUREMENT. Shareholder Unit Owner shall obtain and maintain at all times during the term of this agreement, at its sole cost and expense, personal liability insurance with a minimum limit of $1,000,000. Shareholder Unit Owner shall, by specific endorsements cause Cooperative and Managing Agent to be named as additional insureds. Shareholder Unit Owner shall, by specific endorsement, cause the coverage afforded to the additional insureds thereunder to be primary to and not concurrent with other valid and collectible insurance available to the additional insureds. If the terms of this Agreement directly conflict with any other written agreements between the parties, the term contained in this Agreement shall supersede in that instance. Cooperative: Managing Agent: ShareholderUnit Owner: Signature: Signature: Signature: Name: Name: Name: Date: Date: Date: XXXXX CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YY) 00/00/0000 PRODUCER FAX * NAME AND ADDRESS OF INSURANCE CARRIER THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED * NAME AND ADDRESS OF INSURED (Must match signed contract) INSURER A: xxxxxxxxxx INSURER B: xxxxxxxxxx INSURER C: INSURER D: INSURER E: COVERAGES THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXP DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY $1,000,000/$2, 000.000 00/00/00 00/00/00 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $ 100,000 CLAIMS MADE OCCUR MED EXP (any 1 person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS – COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC B AUTOMOBILE LIABILITY $1,000,000 minimum 00/00/00 00/00/00 COMBINED SINGLE LIMIT (Ea Accident) $1,000,000 ANY AUTO ALL OWNED AUTOS XXX XX X XXXXXX INJURY (per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (per accident) $ NON OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY – EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ B EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ * WORKER’S COMPENSATION AND $1,000,000 minimum 00/00/00 00/00/00 WC Statutory Limits Other EMPLOYER’S LIABILITY E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE –EA EMPLOYEE $1,000,000 E.L. DISEASE –POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Also additionally insured: Shareholder’s Name, Address and Apt. Number Larchmont Hills Owners Corp.Xxxxxx 0000 Xxxxxxx Xxx. Tenants Corp, 00 X. XxxxxxxxxxBronxville, Xxxxxxxxx, XX 00000 NY 10708 Xxxxxxxx Management Realty Corp., 000 Xxxxxxxxxx Xxx, Xxxxxxxx, NY 10528 XX 00000 Date of Move /Delivery/ Work Work: CERTIFICATE HOLDER CANCELLATION Larchmont Hills Owners Corp., C/ 0000 Xxxxxxx Xxx. Tenants Corp C/X Xxxxxxxx Management Realty Corp. 000 Xxxxxxxxxx Xxx, Xxxxxxxx. S-512 Harrison, NY 10528 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINDUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Must have signature XX*IF WORKERS COMP IS NOT ON THIS CERTIFICATE – YOU MUST PROVIDE (2) CERTIFICATES FROM STATE INSURANCE FUND (ONE FOR EACH ADDITIONAL INSURED)signature