EFTA00799337.pdf

SWORN STATEMENT IN PROOF OF LOSS TO THE AIG Property Casualty Company Agency at: Insurance Office Central Ohio Amount S 39,611,905 Policy No. PCG 0021940015 Date of Exp. July 15th, 2018 BY YOUR POLICY OF INSURANCE ABOVE DESCRIBED, YOU INSURED Jeffrey Epstein according to the terms and conditions therein, the below mentioned property against loss from the following cases: Property Insured as Per Policy t•-10. Fed, coa_t cic>tt Litat_is- Rae:. '1 0 in re.Sve-‘ %Le-LOGS Against Loss From "All Risk" , i.e. co.—turn 00- 11-e r rt•Pct A loss occurred on the island of Little S.:lames. USVI on the days of Septem 6th, 19th, & 20th of 2017 about the hours of -- o'clock —M. which, upon the best of M knowledge i at d belief, was ca as follows: Hurricane amage and destruction of o fia ne art from Irma, (CA 1744) and Hurricane Maria (CAT l745 n•e-turrebr-a 4 k..2.4 1 ae_ L tr. _14/.)(30..‘ iiimi_‘,Pc.k• -')Pw•-1Ken.,..,1 5c_ r.,....al, Aln actual cash value of the prope described by ia policy, t e actual am lint o 4."—Le As . . . c total insurance thereon at the time o mar ancrasmago as snown mannered scneauleptioom named In this policy, nd tine amounrraimcd under this policy arc as tollows: C CASH VALUE WHOLE LOSS WHOLE INSURANSE AMOUNT NAMED IN AMOUNT CLAIMED UNDER `Ha— II (hSeC tp.00 de--TrUI.L. POLICY THIS POLICY --- LtrafiC - tmos CS 39.61 .905.00 ) o C S 39.611,905.06) SI.000,000.00 Except as noted below theifroperty deerreeradc belonged at the me of,, etd4essi.to etTre E • stein and no othe person or persons ha ny interes therein; no assignment or transfer, or encumbrance of has been mac nd no change in the title, use, or possession of said roperty h occurred since the issuance of this policy,Eedxcept INSURED CLAIMS and ill accept IN FULL SATISFACTION AND COMPROMIS • SETTLEMENT un4pr this policy the sum of I nd demand no Tor A ND HEREBY AUTHORIZE PAYMENT TO ter 'L.° Ilert_Liaras cruf" ; ' a c-1 4" Al-al.-r- 41.-e- Lane. vier , -fl ri ..5 . .4., In consideration of the payment to be made hereunde , ereby assi and transfer to the said urers each and all claims and demands against any person, persons, corporation or property, arising from D'honnected with wet , (and the said Insurers is subrogated in the place of and to the claims and demands of the undersigned ag inst said person, persons, corporation or property)in4hespeenviees, to the extent of the amount vc amed; and agree to immediately notify McLAREN Y G INTERNATIONAL., (for account of the Underwriters) in case of any recovery o he roperty for which claim is being made hereunde also agree to either turn over to said McLARENS YOUNG INTERNATIONAL for dra. account of the Insurers, any such recovery which may made, or reimburse said McLARENS YOUNG INTERNATIONAL for account of the 64 Ansurers, any such recovery which manyantrade, or rcim rsc said McLARENS YOUNG INTERNATIONAL. to the extent of the payment foiticr3 iiroperty which may be recovered, or value at the t me of recovery,(whicheyer is the greater), subject to the decision of the Insurer. ...,.., ..., covet-hr.-1 ...cm. Wit. Lo ,S Thc sai4:iiiiiiimderrnrge was not caused by design or procurement on ricpart; nothing has been done by or withcietuivity or consent, to violate the conditions of the policy, or render it void, no articles arc mentioned hirEiViir A annexed schedules but such as were interested the .Wirtiairtsisired under this policy, and belonged to at the time of c in— ^r •Itinvagc; no r roperty semi,hurlarsern in any manner concealed, and no attempt to deceive the said Insurers as to the xtent ofirons ' , s in any planner been made. i 1-Peo•-•,- i t -R- Lc•S s 0.4.-4 C,. 4t-a- t-cirpS Lb z Nt..3(.3- 4,.. ILI_Lv -. I-4,s SPECIAL CONDITIONS: Compromised t loss atnount. No deductible applies. 1-c"'' a_ 4,0 T.,S Any other information that may be required will be famished upon request and considered a part of this proof. It is expressly understood and agreed that the furnishing of this blank to the assured or the preparing of Proofs by an adjuster, or any agent of the Insurers named in the policy is not a waiver of any rights of said Insurers. "ANY PERSON KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURANCE COMPANY FILE A STATEMENT OR A CLAIM CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE." WITNESS hand at this day of 20 State of Signature of Assured County of Personally appeared before me, the day and date above written signer of the foregoing statements, who made solemn oath to the truth of same, and that no material fact is withheld of which said Insurers should be advised. (SEAL) NOTARY PUBLIC EFTA00799337  LOSS SUMMARY Loss s‘Setrk Net-Lb ten oN) op SDP:V -Me b 13,Q - Ws O Cab Lo6S Acc6 OTCII) e l) ..)%150CECc DESCRIPTION SOMPPPES4430i3S -)tigliehOSS- Scheduled Jewelry *71,125 n 1 fiEetr=1:4MRONWifiglaIITr— Sub=total=ferlIgIWIWtetHewetry— Unscheduled Jewelry nil nil Scheduled Fine Art $521,055 $521,055 Less: Loss Adjustment $63,714 Sub-Total for Scheduled Fine Art $457,341 Unscheduled Fine Art $946,951 $946,951 Less: Loss Adjustment $531,523 Sub-Total for Unscheduled Fine Art $415,428 Net Adjusted Loss $872,769 Less: Deductible Nil Adjusted Net Loss .$1,539,131 $872,769 I 4-ItoS ct.k, ) i Compromised Net Loss and Claim $1,000,000 EFTA00799338