PDF Creator — exhibit (evidence of property insurance)

What This Document Is

A two-page ACORD Evidence of Property Insurance certificate, dated April 17, 2020, filed as exhibit 122-1 to the debtor's response (docket 122) to the U.S. Trustee's Motion to Dismiss or Convert. Docket 122.1.

Factual Summary

The certificate is issued by agency NFP Property & Casualty Services, Inc. (Oakland, MD) for insurer Seneca Insurance Company Inc, naming Panthera Enterprises LLC (215 Depot Ct SE, Leesburg, VA 20175) as the insured, policy number SSP1506701, effective April 17, 2020 through April 17, 2021. The insured locations are five buildings at 2506 Fish Pond Rd, Old Fields, WV 26845: Building 1 (Classrooms/Office, $450,000 replacement cost, $10,000 deductible), Building 2 (Shoot House, $100,000), Building 3 (Classrooms, $180,000), Building 4 (Shoot House, $250,000), and Building 5 (Garage at Skid Pad, $54,000); the extracted text notes "SEE ATTACHED ACORD 101" for additional buildings, including a sixth building at $75,000 (per the parent motion's citation).

Key Facts

Policy: Seneca Insurance Company Inc, policy #SSP1506701, effective 2020-04-17 through 2021-04-17.
Insured: Panthera Enterprises LLC, 215 Depot Ct SE, Leesburg, VA 20175.
Covers building replacement cost only, across at least five (per this motion's extracted attachment, six per the parent motion's citation) structures at 2506 Fish Pond Rd, Old Fields, WV, totaling roughly $1.1 million in combined per-building coverage limits (see caveats on exact total).
Filed as an exhibit to the debtor's April 24, 2020 response (docket 122) to the U.S. Trustee's insurance-based dismiss/convert motion (docket 112).

Source Caveats

extraction captured five of the buildings listed on the certificate's coverage table (Buildings 1-5); the source document also references an attached "ACORD 101" continuation and, per the parent conversion motion (docket 132), a sixth building at $75,000 — the complete building list and total coverage amount should be verified directly against the source PDF.
Use the linked source file for the complete two-page certificate, including the attached ACORD 101 continuation page.

Date: 2020-04-17

Full text

LENDER'S LOSS PAYABLE
PHONE
AGENCY
COMPANY
(A/C, No, Ext):
FAX
E-MAIL
(A/C, No):
ADDRESS:
SUB CODE:
AGENCY
CUSTOMER ID #:
INSURED
LOAN NUMBER
POLICY NUMBER
EFFECTIVE DATE
EXPIRATION DATE
THIS REPLACES PRIOR EVIDENCE DATED:
LOCATION/DESCRIPTION
COVERAGE / PERILS / FORMS
AMOUNT OF INSURANCE
DEDUCTIBLE
NAME AND ADDRESS
CONTINUED UNTIL
TERMINATED IF CHECKED
ADDITIONAL INSURED
LOSS PAYEE
MORTGAGEE
LOAN #
PERILS INSURED
BASIC
BROAD
SPECIAL
THE  POLICIES  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
EVIDENCE  OF  PROPERTY  INSURANCE  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.  LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THIS   EVIDENCE  OF  PROPERTY  INSURANCE  IS  ISSUED  AS  A  MATTER  OF  INFORMATION  ONLY  AND  CONFERS  NO  RIGHTS  UPON  THE
ADDITIONAL  INTEREST  NAMED  BELOW.  THIS  EVIDENCE  DOES  NOT  AFFIRMATIVELY  OR  NEGATIVELY  AMEND,  EXTEND  OR  ALTER THE
COVERAGE  AFFORDED  BY  THE  POLICIES  BELOW.    THIS  EVIDENCE  OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE
ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST.
SHOULD   ANY   OF   THE   ABOVE   DESCRIBED   POLICIES   BE  CANCELLED  BEFORE  THE  EXPIRATION  DATE  THEREOF,  NOTICE  WILL  BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
PROPERTY INFORMATION
COVERAGE INFORMATION
REMARKS (Including Special Conditions)
CANCELLATION
ADDITIONAL INTEREST
ACORD 27 (2016/03)
© 1993-2015 ACORD CORPORATION.  All rights reserved.
EVIDENCE OF PROPERTY INSURANCE
DATE (MM/DD/YYYY)
CODE:
AUTHORIZED REPRESENTATIVE
The ACORD name and logo are registered marks of ACORD
4/17/2020
(301) 334-3343
Seneca Insurance Company Inc
NFP Property & Casualty Services, Inc.
102 South Second Street
Oakland, MD 21550
(301) 334-4843
Panthera Enterprises LLC
215 Depot Ct SE
Leesburg, VA 20175
Loc # 1, Bldg # 1, 2506 Fish Pond Rd, Old Fields, WV 26845, Classrooms Office
Loc # 1, Bldg # 2, 2506 Fish Pond Rd, Old Fields, WV 26845, Shoot House
Loc # 1, Bldg # 3, 2506 Fish Pond Rd, Old Fields, WV 26845, Classrooms
Loc # 1, Bldg # 4, 2506 Fish Pond Rd, Old Fields, WV 26845, Shoot House
Loc # 1, Bldg # 5, 2506 Fish Pond Rd, Old Fields, WV 26845, Garage at Skid Pad
SEE ATTACHED ACORD 101
Loc # 1, Bldg # 1
  Building, SPEC, Replacement Cost
$450,000
10,000
Loc # 1, Bldg # 2
  Building, SPEC, Replacement Cost
$100,000
10,000
Loc # 1, Bldg # 3
  Building, SPEC, Replacement Cost
$180,000
10,000
Loc # 1, Bldg # 4
  Building, SPEC, Replacement Cost
$250,000
10,000
Loc # 1, Bldg # 5
  Building, SPEC, Replacement Cost
$54,000
10,000
Loc # 1, Bldg # 6
  Building, SPEC, Replacement Cost
$75,000
10,000
SEE ATTACHED ACORD 101
West Virginia Economic Development Authority
160 Assocation Dr
Charleston, WV 25311
JAMESNICHOLS
SSP1506701
4/17/2020
4/17/2021
PANTENT-02
X
No. 2:19-bk-00787    Doc 122-1    Filed 04/24/20    Entered 04/24/20 16:49:19    Page 1
of 2

FORM NUMBER:
EFFECTIVE DATE:
The ACORD name and logo are registered marks of ACORD
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE
FORM TITLE:
Page           of
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
ACORD 101 (2008/01)
AGENCY CUSTOMER ID:
LOC #:
AGENCY
NAMED INSURED
POLICY NUMBER
CARRIER
NAIC CODE
© 2008 ACORD CORPORATION.  All rights reserved.
NFP Property & Casualty Services, Inc.
PANTENT-02
Seneca Insurance Company Inc
1
04/17/2020
ACORD 27
EVIDENCE OF PROPERTY INSURANCE
10936
Panthera Enterprises LLC
215 Depot Ct SE
Leesburg, VA 20175
SSP1506701
JAMESNICHOLS
1
Locations:
Loc # 1, Bldg # 6, 2506 Fish Pond Rd, Old Fields, WV 26845, Armory
Loc # 1, Bldg # 7, 2506 Fish Pond Rd, Old Fields, WV 26845, Tower
Loc # 1, Bldg # 8, 2506 Fish Pond Rd, Old Fields, WV 26845, Live-Fire Shoothouse
Coverage Information:
Loc # 1, Bldg # 7
Building, SPEC, Replacement Cost, Amount of Insurance: $40,000, Deductible: 10,000
Loc # 1, Bldg # 8
Building, SPEC, Replacement Cost, Amount of Insurance: $1,000,000, Deductible: 10,000
No. 2:19-bk-00787    Doc 122-1    Filed 04/24/20    Entered 04/24/20 16:49:19    Page 2
of 2

File and source

File: gov.uscourts.wvnb.75953.122.1.pdf
Size: 242,666 bytes
SHA-256: fcfbca8ec82d4670fd992fabd20c7f31932a865bb0cb2225c6844c3844c0a8b6
Our copy: gov.uscourts.wvnb.75953.122.1.pdf
Original: No public link identified.