DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If
SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
CONTACT
NAME:
PHONE
(A/C, No, Ext):
E-MAIL
ADDRESS:
PRODUCER
FAX
(A/C, No):
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A :
INSURED
Tenant Vendor
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
COVERAGES
INSR
LTR
CERTIFICATE NUMBER:
ADDL SUBR
INSD WVD
TYPE OF INSURANCE
REVISION NUMBER:
POLICY EFF
POLICY EXP
(MM/DD/YYYY) (MM/DD/YYYY)
POLICY NUMBER
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE
LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES (Ea occurrence)
OCCUR
PRODUCTS - COMP/OP AGG
100,000
$ 10,000
$ 2,000,000
$ 2,000,000
$ 2,000,000
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
MED EXP (Any one person)
PERSONAL & ADV INJURY
GENERAL AGGREGATE
E
GEN'L AGGREGATE LIMIT APPLIES PER:
PROPOLICY
LOC
JECT
OTHER:
AUTOMOBILE LIABILITY
SCHEDULED
AUTOS
NON-OWNED
AUTOS ONLY
UMBRELLA LIAB
OCCUR
EXCESS LIAB
CLAIMS-MADE
OTHER
Y/N
N/A
$
$
1,000,000
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident)
$
$
EACH OCCURRENCE
$
AGGREGATE
$
$
PER
STATUTE
OTHER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT
SA
DED
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
M
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
PL
ANY AUTO
$ 1,000,000
$
1,000,000
FULL REPLACEMENT COST
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Additional Remarks Schedule, may be attached if more space is required)
HWA 1290 Management LLC, SO Hudson Westside I Corp., 1290 Management II LLC, HWA 1290 III LLC, HWA 1290 IV LLC, HWA 1290 V LLC, HWA 1290
Management Member, LLC, Vornado Office Management LLC, its managing agent, any ground lessor, Vornado Realty Trust, Vornado Realty L.P. and their
partially controlled subsidiaries, divisions, affiliates, and/or joint ventures, and their owners, each lessor, each mortgagee and their respective partners,
members, affiliates, subsidiaries, trustees, officers, employees and their successors and assigns as their interest may appear (ATIMA) -
are hereby added as Additional Insureds on a primary and non-contributory basis with respect to the General Liability coverage as required by written contract.
The policy for general liability includes a waiver of subrogation.
Lease is the governing document for all insurance requirements - terms, as noted, are for guidance only.
Waiver of Sub as respects CGL & WC
Denoted as Additional Insured on all coverage, where applicable.
CERTIFICATE HOLDER
Vornado Realty Trust
agent for HWA 1290 III LLC, HWA 1290 IV, LLC and 1290
HWA V LLC
Route 4 East
Paramus, NJ 07652
Attn: Risk Management
CANCELLATION
as
210
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
30 day NOC, 10 day non payment of premium
AUTHORIZED REPRESENTATIVE