Preview
(FILED: NEW YORK COUNTY CLERK 0472972022 01:28 PM
INDEX NO. 153667/2022
NYSCEF DOC. NO. 7
REQUEST FOR JUDICIAL
SUPREME
Index N
COURT, COUNTY OF NEW YORK
Date Index Issued:
RECEIVED NYSCEF: 04/29/2022
Ucs-840
(rev. 02/01/2022)
INTERVENTION
For Court Use Only:
CAPTION
Enter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet.
IAS Entry Date
COUNTRY-WIDE INSURANCE COMPANY,
also OLIVIA LAUREN NG,
Plaintiff(s)/Petitioner(s}
Judge Assigned
-against-
THE CITY OF NEW YORK,
Ril Filed Date
Defendant(s)/Respondent(s}
NATURE OF ACTION OR PROCEEDING
Check only one box and specify where indicated.
O Insurance (where insurance company is a party, except arbitration)
O UCC (includes sales and negotiable instruments)
O other Commercial (specify):
NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d),
complete and attach the COMMERCIAL DIVISION Ril ADDENDUM (UCS-840C).
[COMMERICIAL MATRIMONIAL
'O Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.) ‘© Contested
O Contract NOTE: If there are children under the age of 18, complete and attach the
MATRIMONIAL Ril ADDENDUM (UCS-840M).
For Uncontested Matrimonial actions, use the Uncontested Divorce RJ! (UD-13).
REALPROPERTY _ Specify how many properties the application includes:
TORTS
© Asbestos
O Child Victims Act
‘© Environmental (specify):
'O Medical, Dental or Podiatric Malpractice
‘© Motor Vehicle
O Products Liability (specify):
© other Negligence (specify):
© other Professional Malpractice (specify):
© other Tort (specify):
(O Condemnation
'O Mortgage Foreclosure (specify):
Property Address:
NOTE: For Mortgage Foreclosure actions involving a one to four-family,
owner-occupied residential property or owner-occupied condominium,
complete and attach the FORECLOSURE Ril ADDENDUM (UCS-840F).
O Partition
NOTE: Complete and attach the PARTITION RJI ADDENDUM (UCS-840P).
O Tax Certiorari (specify): Section:__ Block:
O Tax Foreclosure
‘© other Real Property (specify):
OResidential Ocommercial
[OTHER MATTERS
SPECIAL PROCEEDINGS
© Child-Parent Security Act (specify): C)Assisted Reproduction O)Surrogacy Agreement|
© CPLR Article 75 — Arbitration [see NOTE in COMMERCIAL section]
‘O CPLR Article 78 — Proceeding against a Body or Officer
O Election Law
'O Extreme Risk Protection Order
O MHL Article 9.60 - Kendra’s Law
'O MHL Article 10 - Sex Offender Confinement (specify):
'O MHL Article 81 (Guardianship)
‘© other Mental Hygiene (specify):
Omnitial Oneview
© other Special Proceeding (specify):
CO Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section]
‘© Emergency Medical Treatment
O Habeas Corpus
‘© Local Court Appeal
'O Mechanic's Lien
© Name Change/Sex Designation Change
© Pistol Permit Revocation Hearing
© sale or Finance of Religious/Not-for-Profit Property
© other (specify): leave to acceptifile late Notice of Claim
STATUS OF ACTION OR PROCEEDING
Answer YES or NO for every question and enter additional information where indicated.
YES
Has a summons and complaint or summons with notice been filed? oO
Has a summons and complaint or summons with notice been served? oO
Is this action/proceeding being filed post-judgment? Oo
NO
@ _ifyes, date filed:
@ _ifyes, date served:
@ _ ifyes, judgment date:
NATURE OF JUDICIAL INTERVENTION
Check one box only and enter additional information where indicated.
Infant's Compromise
Extreme Risk Protection Order Application
Note of Issue/Certificate of Readiness
Notice of Medical, Dental or Podiatric Malpractice
Notice of Motion
Date Issue Joined:
Relief Requested:
Return Date:
Notice of Petition Relief Requested
leave to file/accept late Notice of Claim
Return Date:
Order to Show Cause Relief Requested:
Return Date:
Other Ex Parte Application Relief Requested:
Partition Settlement Conference
Poor Person Application
Request for Preliminary Conference
Residential Mortgage Foreclosure Settlement Conference
Writ of Habeas Corpus
Other (specify):
OOONODOON@®00000
1 of(FILED: NEW YORK COUNTY CLERK 0472972022 01:28 PM INDEX NO. 153667/2022
NkeGErED thes NOvist Sny related actions. For Matrimonial cases, list any related criminal or Family Court cases" hire avd blanke? » 0472972022
If additional space is required, complete and attach the RII ADDENDUM (UCS-840A).
[Case Title index/Case Number. [Court [judge (if assigned) Relationship to instant case
PARTIES For parties without an attorney, check the “Un-Rep” box and enter the party's address, phone number and email in the space provided.
If additional space is required, complete and attach the RII ADDENDUM (UCS-840A).
Un- |Parties Attorneys and Unrepresented Litigants Issue Joined Insurance Carriers
Rep |List parties in same order as listed in the |For represented parties, provide attorney's name, firm name, address, phone and _|For each defendant, |For each defendant,
caption and indicate roles (e.g., plaintiff, |email. For unrepresented parties, provide party's address, phone and email indicate if issue has _|indicate insurance
defendant, 3° party plaintiff, etc.) been joined. carrier, if applicable.
Te] [Name: country-wide insurance Company _ | Jaffe & Velazquez, LLP, 40 Wall Street, 13th Fi, New York, NY 10005 Wi
LJ IRole(s): vas 212-809-7800, mvilton@jvattorneys.com Oyes @no Country-Wide
Petitioner oH Ins. Co.
yy poletel The City of New York __/c/o Corporation Counsel Oves @no
Respondent [=J/100 Church Street, 5th Fl, New York, NY 10007
Name:
LI JRole(s): Oves Ono
Name:
LI |Role(s): Oyves Ono
Name:
Role(s): Oves Ono
r |Name:
Role(s): Oves Ono
r |Name:
Role(s): Oves Ono
[7 |Name:
Role(s): Oyves Ono
r |Name:
LU Jrole(s): Oyes ONO
Name:
LI |Role(s): Oves Ono
Name:
Role(s): Oyves Ono
Name:
Role(s): Oyes Ono
[-] |Name:
Role(s): Oyes Ono
[ |Name:
Role(s): Oves Ono
[ |Name:
UI lrolets): Oves Ono
| AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS,
EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING.
akira Velen
Dated: 4/29/2022
Signature
5502547 Martina Vilton
Attorney Registration Number Print Name
2 of 2
Preview
(FILED: NEW YORK COUNTY CLERK 0472972022 01:28 PM INDEX NO. 153667/2022 NYSCEF DOC. NO. 7 REQUEST FOR JUDICIAL SUPREME Index N COURT, COUNTY OF NEW YORK Date Index Issued: RECEIVED NYSCEF: 04/29/2022 Ucs-840 (rev. 02/01/2022) INTERVENTION For Court Use Only: CAPTION Enter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet. IAS Entry Date COUNTRY-WIDE INSURANCE COMPANY, also OLIVIA LAUREN NG, Plaintiff(s)/Petitioner(s} Judge Assigned -against- THE CITY OF NEW YORK, Ril Filed Date Defendant(s)/Respondent(s} NATURE OF ACTION OR PROCEEDING Check only one box and specify where indicated. O Insurance (where insurance company is a party, except arbitration) O UCC (includes sales and negotiable instruments) O other Commercial (specify): NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d), complete and attach the COMMERCIAL DIVISION Ril ADDENDUM (UCS-840C). [COMMERICIAL MATRIMONIAL 'O Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.) ‘© Contested O Contract NOTE: If there are children under the age of 18, complete and attach the MATRIMONIAL Ril ADDENDUM (UCS-840M). For Uncontested Matrimonial actions, use the Uncontested Divorce RJ! (UD-13). REALPROPERTY _ Specify how many properties the application includes: TORTS © Asbestos O Child Victims Act ‘© Environmental (specify): 'O Medical, Dental or Podiatric Malpractice ‘© Motor Vehicle O Products Liability (specify): © other Negligence (specify): © other Professional Malpractice (specify): © other Tort (specify): (O Condemnation 'O Mortgage Foreclosure (specify): Property Address: NOTE: For Mortgage Foreclosure actions involving a one to four-family, owner-occupied residential property or owner-occupied condominium, complete and attach the FORECLOSURE Ril ADDENDUM (UCS-840F). O Partition NOTE: Complete and attach the PARTITION RJI ADDENDUM (UCS-840P). O Tax Certiorari (specify): Section:__ Block: O Tax Foreclosure ‘© other Real Property (specify): OResidential Ocommercial [OTHER MATTERS SPECIAL PROCEEDINGS © Child-Parent Security Act (specify): C)Assisted Reproduction O)Surrogacy Agreement| © CPLR Article 75 — Arbitration [see NOTE in COMMERCIAL section] ‘O CPLR Article 78 — Proceeding against a Body or Officer O Election Law 'O Extreme Risk Protection Order O MHL Article 9.60 - Kendra’s Law 'O MHL Article 10 - Sex Offender Confinement (specify): 'O MHL Article 81 (Guardianship) ‘© other Mental Hygiene (specify): Omnitial Oneview © other Special Proceeding (specify): CO Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section] ‘© Emergency Medical Treatment O Habeas Corpus ‘© Local Court Appeal 'O Mechanic's Lien © Name Change/Sex Designation Change © Pistol Permit Revocation Hearing © sale or Finance of Religious/Not-for-Profit Property © other (specify): leave to acceptifile late Notice of Claim STATUS OF ACTION OR PROCEEDING Answer YES or NO for every question and enter additional information where indicated. YES Has a summons and complaint or summons with notice been filed? oO Has a summons and complaint or summons with notice been served? oO Is this action/proceeding being filed post-judgment? Oo NO @ _ifyes, date filed: @ _ifyes, date served: @ _ ifyes, judgment date: NATURE OF JUDICIAL INTERVENTION Check one box only and enter additional information where indicated. Infant's Compromise Extreme Risk Protection Order Application Note of Issue/Certificate of Readiness Notice of Medical, Dental or Podiatric Malpractice Notice of Motion Date Issue Joined: Relief Requested: Return Date: Notice of Petition Relief Requested leave to file/accept late Notice of Claim Return Date: Order to Show Cause Relief Requested: Return Date: Other Ex Parte Application Relief Requested: Partition Settlement Conference Poor Person Application Request for Preliminary Conference Residential Mortgage Foreclosure Settlement Conference Writ of Habeas Corpus Other (specify): OOONODOON@®00000 1 of(FILED: NEW YORK COUNTY CLERK 0472972022 01:28 PM INDEX NO. 153667/2022 NkeGErED thes NOvist Sny related actions. For Matrimonial cases, list any related criminal or Family Court cases" hire avd blanke? » 0472972022 If additional space is required, complete and attach the RII ADDENDUM (UCS-840A). [Case Title index/Case Number. [Court [judge (if assigned) Relationship to instant case PARTIES For parties without an attorney, check the “Un-Rep” box and enter the party's address, phone number and email in the space provided. If additional space is required, complete and attach the RII ADDENDUM (UCS-840A). Un- |Parties Attorneys and Unrepresented Litigants Issue Joined Insurance Carriers Rep |List parties in same order as listed in the |For represented parties, provide attorney's name, firm name, address, phone and _|For each defendant, |For each defendant, caption and indicate roles (e.g., plaintiff, |email. For unrepresented parties, provide party's address, phone and email indicate if issue has _|indicate insurance defendant, 3° party plaintiff, etc.) been joined. carrier, if applicable. Te] [Name: country-wide insurance Company _ | Jaffe & Velazquez, LLP, 40 Wall Street, 13th Fi, New York, NY 10005 Wi LJ IRole(s): vas 212-809-7800, mvilton@jvattorneys.com Oyes @no Country-Wide Petitioner oH Ins. Co. yy poletel The City of New York __/c/o Corporation Counsel Oves @no Respondent [=J/100 Church Street, 5th Fl, New York, NY 10007 Name: LI JRole(s): Oves Ono Name: LI |Role(s): Oyves Ono Name: Role(s): Oves Ono r |Name: Role(s): Oves Ono r |Name: Role(s): Oves Ono [7 |Name: Role(s): Oyves Ono r |Name: LU Jrole(s): Oyes ONO Name: LI |Role(s): Oves Ono Name: Role(s): Oyves Ono Name: Role(s): Oyes Ono [-] |Name: Role(s): Oyes Ono [ |Name: Role(s): Oves Ono [ |Name: UI lrolets): Oves Ono | AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING. akira Velen Dated: 4/29/2022 Signature 5502547 Martina Vilton Attorney Registration Number Print Name 2 of 2