On November 06, 2017 a
Exhibit,Appendix
was filed
involving a dispute between
Yvonne Anderson,
and
Abdourahamane Diallo,
Courtney Robinson,
Heart To Heart Social Adult Services Llc,
for Torts - Motor Vehicle
in the District Court of Kings County.
Preview
FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 11/22/2019
EXHIBIT F
FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017
NYSCEF DOC. NO.1
09e 32
of 4 Pa9es NewYorkState Departmentof Motor Vehicles RECEIVED NYSCEF: 11/22/2019
Precinct POLICE ACCIDENT REPORT (NYC) 19
0 75 MV-104AN (7/11) -
AccidentN3 Complain
t
MV-2017-075-000906 Number
Went Da DayofW MiliaryTima Nu.of No Inured No Kihd atScene
NotInveWgated LeftScene | Poh
Photos 20
- Month Day Year I ME .---- ----- ------- --.-- -..- -----
Yes No
0 O Reconstructed
3 2 2017 THURSDAY 08 : 00 |2
VEH1CLE1 VEHICLE2 BlCYCLIST¤ PEDESTRIAN¤OTHER PEDESTRIAN
VEHICLEi- Driver VEHICLE2- Driver
StateofLic. StateofLic.
2 LicenseIDNumber 711290945 NY LicenseIDNumber
92 863 82 83 NY 21
DriverName-exactly DriverName- exactly 4
aspmtedon licenseROBINSON, COURTNEY, S asparadonncense DIALLO, ABDOURAHAMANE
(Include:h:mbe& 5tman
Address Art. No. (IndudeNumber& Street)
Address Apt.No.
156-14 109 AVENUE 1 293 SHEPHERD AVENUE 2FL .___
State State ZipCode 22
CityorTown ZipCode CityorTown -
BROOKLYN NY 11433 BROOKLYN NY 11208
3 DateofBirth Sex UniicensedNo.of Public DateofBirth Sex UnlicensedNo of Public
Month |Day Year Occupants Property Montn Day Year Occupants Property
3 113 1972 M 8 Damaged 9 18 1993 M 1 Damaged
asprintedon registration
Name-exactly Sex DaleorBFth asprintedonregistration
Name-exactly Sex DateofBirth
Month Day Year Month| Day Year
HEART TO HEART SOCIAL ADULT SERVICE U DIALLO, ABDOURAHAMANE M 9 |18 1993
Address(includeNumber
& Street) Apt No.Haz. ReleasedAddress(includeNumber& Street) Apt.No,Haz. Released 23
209 EMPIRE BOULEVARD 293 SHEPHERD AVENUE 2FL
- orTown
City
BROOKLYN
State
NY
ZipCode or
City Town
BROOKLYN
State
NY
ZipCode
11208
Vehicle
Type
24
PlateNumber StateofReg. VehicleYear&MakeVehicleType ins.Code PlateNumber StateofReg.VehideYear&Make Ins.Code
5
GYT4048 NY 2015 FORD === 280 T704693C NY 2011 HYUNDAI SEDAN 36
Ticket/Arrest Ticket/Arrest
Number(s) Number(s)
Violation Violation
Section(s) Section(s)
Check if involvedvehicle is: Checkif involvedvehicle is. Circlethe diagrambelow that describesthe accident,or draw your own
g
6 ¤more than 95 inches wide: ¤more than 95 inches wide; diagramin space#9. Numberthe vehicles,
V Omore than 34 feet fong: V ¤more than 34 feet long; Right
Tum Head
1
E ¤operated
¤operated
with an overweight permit;
E
with an overdimensionpenmt·
¤operated
RearEnd
with an overweight permit;
Doperated with an overdimensionpermit. +
Le Turn A
Rightngle
+ On
+
H H 3. 5. 7
VEHICLE 1 DAMAGE CODES VEHICLE2 DAMAGE CODES Sideswipe LeftTum RightTum Sideswipe
C 1 2 C 1 2 (same ection) 4____ (oppose 1
Box 1 -Point of Impact Box 1 - Pointof Impact
7
L
E
Box 2 - Most Damage 8 8 L
E
Box 2 - Most Damage 2 2 2. + n.
ACCIDENTDIAGRAM
e. ; a.
-w-+
Enter up to three 3 4 5 Enter up to three 3 4 5
more DamageCodes 18 18 18 more DamageCodes 3 1 27
18_
VehicleBy Vehicle By 1
Towed- Towed:
To To
DIAGRAM ATTACHED ON SUBSEQUENT PAGE
VEHICLEDAMAGECODING: 7
1-13. SEE DIAGRAMON RIGHT. 1 REAR END
14 UNDERCARRIAGE 17. DEMOLlSHED 2 va
15. TRAlLER 18. NO DAMAGE 9. 2B
16. OVEP-TURNED 19, OTHER ,- 1
Cost of repairs to any one vehicle will be more than $1000.
n is Unknown/Unable to Determine Yes No
Reference Marker
Coordinates(if available)
PlaceWhere Accident BRONXTKINGS NEW YORK QUEENS RICHMOND
Occurred:¤
Latitude/Northing: FOUNTAIN
Roadon whichaccidentoccurred AVENUE
40.67239 (RouteNumberorStreetName) 29
at t) intersectingstreet SUTTER
AVENUE
Longitude/Easting: (RouteNumber
orStreetName)
or2)
N O S
-73.87463
Feet Miles (Milenest.
Nearest RouteNymberor StrvetNarr4)
Inter-,ecting
Accident Description/Officer'sNotes AT
TPO MV1 THAT HE WAS STOPPED AT THE RED LIGHT AT THE INTERSECTION 30
WHEN MV2 SUDDENLY COLLIDED WITH HIS REAR. MV2 STATES HE WAS TRAVELLING W/B ON SUTTER -
AVENUE WHEN HE ATTEMPTED TO STOP BUT COLLIDED WITH REAR OF MV1. ALL PASSENGERS AND
DRIVERS RMA ON SCENE. OFFICER DID NOT WITNESS ,
P
a 9 10 11 12 13 14 15 16 17 BY TO 18 Narnesof all invcIved Date of Death
nly_
A A 1 1 2 1 44 M - - - - - ROBINSON, COURTNEY, S
L B 1 7 2 1 87 F - - - - - ICILDA, MORGAN
c 1 7 2 1 80 F - - - - - MCCLEAN, EARSELINE
D 1 7 2 1 77 F - - - - - SURGENER, MARTHA
E 1 7 2 1 73 F - - - - - ANDERSON, YVONNE
F 1 7 2 1 69 M - - - - - CHRISTOPHER, ADRIANE
a
Officer's Rank Tax ID No. NCIC No.Precinct Post/SectorReviewing Date/TimeReviewed
Signature ) POM
956687 03030 075 SGT MANUEL A 03/02/2017 11: 47
Print Name
in Full JOSHUA GOMEZ ROSSELLO
FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017
NYSCEF DOC. NO. 32 (Letter of personskilled
RECEIVED
must correspond
or injurea with
NYSCEF:
letter 11/22/2019
assignationon front).
PERSONS KILLED OR INJURED IN ACCIDENT designation
Last Nanm First M1 LastName First M.I
Mdress Address
'7Me w S«th Te!ephane(Area cede) Date of Birth Telephana(Ataa code)
M3ata Day Year Month Day Year
Last Name Fhsi U. Last Name First M.i
Address Address
Date of Sinh Telephone(Area Code) Date of Birth Telephone(Area Code)
Month Day Year Month Day Year
Last Name First M.I.
Highway Dist at Scene? Yes No
Name:
Address
Date of BInn Telephone(Area Code) Shield No.
Month Day Year
ENTER INSURANCE POLICY NUMBER FROM INSURANCE IDENTIFICATION CARD, EXPlRATION DATE (IN ALL CASES), AND VIN.
Vehicle No. 1 PHPK1553190 Vehicle No,2 B612375
Expiration Date 09/26/2017 Expiration Date 03/01/2018
VIN 1FDEE3FLXFDA27861 VlN 5NPEC4AC3BH181811
WITNESS (Attachseparate sheet, if necessary)
Name Address Phone
DUPLICATE COPY REQUIRED FOR:
Dept. ofMotor Vehicles Motor Transport Division NYC Taxi & Limousine Comm. Other CityAgency
(if anyoneis killed/injured) (P.D.vehicleinvolved) (if a Licensed
taxior limousine (Specify)
involved)
Officeof Comptroller O Personnel Safety Unit Highway Unit
(if a City
vehicle involved) (if a P.D.
vehicleinvolved)
NOTlFICATIONS: (Entername, address, of friend or relative
and relationship If aided
notified. person is unidentified,
list Missing
Person Squad member who
was notified.
In either case, give date and time of notification.)
PROPERTY DAMAGED (otherthan vehicles) OWNER OF PROPERTY (includecityagency, where applicable)
IF NYPD VEHICLE IS INVOLVED:
Police Vehicle-Operator's First Name
Last Name Rank Shield No. Tay1D.No. Command
Make of Vehicle Year Type of Vehicle PlateNo. Dept.VehicleNo. AssignedTo What Command
Equipmentin UseAt Time of Accident
Siren Hom Turret Light 4-Way Flasher High-LevelWarningLights Traffic
Cones Headlights
ACTIONS OF POLICE VEHICLE
Responding to Code Signal Q Complyingwith Station
House Directive
O Pursuing Violator Routine Patrol
Other (Describe)
MV-104AN
(7/11) Page 2 of 4 Pages
FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017
NYSCEF DOC. NO.3
Faga 32
of 4 9es NewYork State Departmentof MotorVehicles RECEIVED NYSCEF: 11/22/2019
' REPORT
Ptednct POLICE ACCIDENT (NYC)
075 MV-104AN (7/11)
AccidealNo Compl3]nt
MV-2017-075-000906 Number
Ac:-.dent
Date DayatWows Milin:vTime No.of No Irduati KiHed at.Scene
Notinvesthawd
Vehicles .. . ..._______.............
2 2017 THURSDAY 08: 00 2 0 0 Reconstructed O O
3
VEHICLE VEHICLE BICYCLIST O DEDESM!AN C OTHER PEDESTR!AN
3/EHICLE-Driwr VEHICLE- Driver
Stateof Lic. StateofLic.
LicenseIDNumber LicenseLDNumber 21
erName-exactly DriverName- exactly ..
asrinted onticense n pantd onHeense
Addres;(includeNurnDar
!. Street) Act.Na-Address(includeNumberE Strm) f-pt No.
orTown State ZipCode CityorTown State ZipCode
Dateof Birtn Sex UnlicensedNo of Public DateofBirth | Sex UnlicensedNo.of Public
Month Day yer Occupants Pro Month Day Year Occupants Prap
2
asprintedonregistration
Name-exactly Sex Date3rBirth asprintedonregistralian
Name--eractly Sex DateofBain
Man'.h Day Year Monm Day Year
Address(includeNumber& Street) Apl.No.Haz. (includeNumber& Street)
ReleasedAddress Apt.No.Haz. 23
Released|
.: Mat Mat.
Code Code
1
CityorTown State ZipCode CityorTown State ZipCode
24
PlateNumber StateofReg. VehicleYear&MakeVehicleType Ins.Code PlateNumber Stateof Reg VehicleYear&Make
VehicleType Ins.Code
5
Ticket/Arrest Ticket/Arrest
Number(s) Number(s)
Violation VioIalion
Section(s) SecGori(s)
Check if involvedvehicle is: Check if involvedvehicleis: Circle the diagram below that describesthe accident or draw your own
_
6 Omore than 95 inches wide; ¤more than 95 inches wide; diagram in space #9. Numberthe vehicles.
V ¤more than 34 feet long; V O morethan 34 feet long; RearEnd RightAngle RightTum HeadOn
-
1
E ¤operated
¤operated
with an overweight permit;
E
with an overdimensionpermit-
H
Doperated with an overweightpermit;
¤operatedwith an overdimertsionpermd. +
Left Tum
+
7.
+
H 3. 5.
VEHICLE 1 DAMAGE CODES I VEHICLE 2 DAMAGE CODES Sideswipe LeftTum RightTumSidaswipe 26
C 1 2 C 1 2 (same non) wsHe -
Box 1 - Point of Impact Box 1 -Point of impact
7
L
E
Box 2 -Most Damage L
E
Box 2 - Most Damage
Enter up to three
2. + 0.
ACCIDENT DIAGRAM
4. s a. -9
Enter up to three 3 4 5 3 4 5
more DamageCodes moreDamageCodes
27
Vehide By Vehicle By 1
Towed: Towed:
To To
DIAGRAM ATTACHED ON SUBSEQUENT PAGE
VEHICLE DAMAGECODING:
1-13. SEE DIAGRAMON RIGHT. 1 REAR END
14. UNDERCARRIAGE 17. DEMOLISHED 2 a
15. TRAILER 18. NO DAMAGE ,A 28
16. OVERTURNED 19. OTHER --s 1
Cost of repairs to any one vehicle will be rnore than $1000.
12 Unknown/Unable to Determine YeS No
ReferenceMarkerCoordinates(if available)
Place Where AccidentOccurred: BRONXOKlNGS NEW YORKO QUEENS RICHMOND
Latitude/Nor1hing: FOUNTAIN AVENUE
Roadon whichaccidentoccurred
40 . 67239 (RouteNumberorStreetName) 29
at 1)intersectingstreet SUTTER
AVENUE
Longitude/Easting: (RouteNumberorStreetName)
N S
-73.87463 or2)
Feet Miles
OE Ow of
(MdupmtNearestIntermr•ing
RouteNumber
orStreetName)
Accident Descrption/Officer's Notes 30
... _
L*5E
_ cus
3HEET
P
8 9 10 11 12 13 14 15 16 17 BY TO 18 Namesof all involved Dateof Death Onl
A G 1 7 2 1 79 M - - - - - JOSPEH
CHRISTOPHER,
L H 1 7 2 1 82 M - - - - - JAMES
EVER,
I 2 1 2 1 23 M - - - - - DIALLO, ABDOURAHAMANE
O
L
Officer's Rank Tax ID No. NCIC No.Precinct Post/Sector
Reviewirig Datefrime Reviewed
and Officer
Signature $POM
956687 03030 075 SGT MANUEL A 03/02 /2017 11: 47
Print Name
in Full JOSHUA GOMEZ ROSSELLO
FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 11/22/2019
PERSONS KILLED OR INJURED IN ACCIDENT (Letter
designationof personskilled or injured
must correspond with letter desionation
on front).
LastName First M.L LastName First ML
.. . . .
Address Address
_Qatte_ojR.dh Telephorie(Area Code) Date at With Teleohone(Area Code)
Ab9th Day Year Month Day Year
Last Name First M.L Last Name First M.l
Address Address
pale of BMh Telephone(Area Code) Date of Birth Telephone(Area Code)
!/.cnth Day Year Month Day Year
Last Name First M.I.
Highway Dist.at Scene? Yes No
Name:
Address
Date of Birth Telephone(Area Code) Shield No.
Month Day Year
ENTER INSURANCE POLICY NUMBER FROM INSURANCE IDENTIFICATION CARD, EXPIRATION DATE (IN ALL CASES), AND VIN.
Vehicle No. Vehicle No.
ExpirationDate Date
Expiration
VlN VIN
WITNESS (Attachseparate sheet, if necessary)
Name Address Phone
DUPLICATE COPY REQUIRED FOR:
Dept. ofMotor Vehicles Motor Transport Division NYC Taxi& Limousine Comm. Other CityAgency
(if anyoneis killed/injured) (P.D.vehicle involved) (if a Licensed
taxior limousine (Specify)
involved)
Officeof Comptroller Personnel Safety Unit Highway Unit
(if a City
vehicle involved) (if a P.D.
vehicleinvolved)
NOTIFICATIONS: (Enter name,address,and relationship
of friend or relative list Missing Person Squad
notified. If aided person is unidentified, member who
was notified.
In either case, give date and time of notification.)
PROPERTY DAMAGED (otherthan vehicles) OWNER OF PROPERTY (includecityagency, where applicable)
IF NYPD VEHICLE IS INVOLVED:
Police Vehicle-Operator's First Name
Last Name Rank Shield No. Tax ID. No. Command
Make of Vehicle Year Type of Vehicle Plate No. Dept. Vehicle No. AssignedTo What Command
Equipmentin UseAt Time of Accident
O Siren ¤ Horn Turret Light- 4-Way Flasher High-LevelWarningLights D Traffic
Cones D Headlights
ACTIONS OF POLICE VEHICLE
O Responding to Code Signal Complying with Station
House Directive
Pursuing Violator O RoutinePatrol
Other (Describe)
MV-104AN
(7/11) ,Page 4 of Pages
4
FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017
NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 11/22/2019
Rear End : MV-2017-075-000906
Reporting Officer : POM JOSHUA GOMEZ
Reviewing Officer : SGT MANUEL A ROSSELLO Reviewed Date : 03/02/2017 11:47
N
Vehictet Vehicle 2
Document Filed Date
November 22, 2019
Case Filing Date
November 06, 2017
Category
Torts - Motor Vehicle
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 11/22/2019 EXHIBIT F FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017 NYSCEF DOC. NO.1 09e 32 of 4 Pa9es NewYorkState Departmentof Motor Vehicles RECEIVED NYSCEF: 11/22/2019 Precinct POLICE ACCIDENT REPORT (NYC) 19 0 75 MV-104AN (7/11) - AccidentN3 Complain t MV-2017-075-000906 Number Went Da DayofW MiliaryTima Nu.of No Inured No Kihd atScene NotInveWgated LeftScene | Poh Photos 20 - Month Day Year I ME .---- ----- ------- --.-- -..- ----- Yes No 0 O Reconstructed 3 2 2017 THURSDAY 08 : 00 |2 VEH1CLE1 VEHICLE2 BlCYCLIST¤ PEDESTRIAN¤OTHER PEDESTRIAN VEHICLEi- Driver VEHICLE2- Driver StateofLic. StateofLic. 2 LicenseIDNumber 711290945 NY LicenseIDNumber 92 863 82 83 NY 21 DriverName-exactly DriverName- exactly 4 aspmtedon licenseROBINSON, COURTNEY, S asparadonncense DIALLO, ABDOURAHAMANE (Include:h:mbe& 5tman Address Art. No. (IndudeNumber& Street) Address Apt.No. 156-14 109 AVENUE 1 293 SHEPHERD AVENUE 2FL .___ State State ZipCode 22 CityorTown ZipCode CityorTown - BROOKLYN NY 11433 BROOKLYN NY 11208 3 DateofBirth Sex UniicensedNo.of Public DateofBirth Sex UnlicensedNo of Public Month |Day Year Occupants Property Montn Day Year Occupants Property 3 113 1972 M 8 Damaged 9 18 1993 M 1 Damaged asprintedon registration Name-exactly Sex DaleorBFth asprintedonregistration Name-exactly Sex DateofBirth Month Day Year Month| Day Year HEART TO HEART SOCIAL ADULT SERVICE U DIALLO, ABDOURAHAMANE M 9 |18 1993 Address(includeNumber & Street) Apt No.Haz. ReleasedAddress(includeNumber& Street) Apt.No,Haz. Released 23 209 EMPIRE BOULEVARD 293 SHEPHERD AVENUE 2FL - orTown City BROOKLYN State NY ZipCode or City Town BROOKLYN State NY ZipCode 11208 Vehicle Type 24 PlateNumber StateofReg. VehicleYear&MakeVehicleType ins.Code PlateNumber StateofReg.VehideYear&Make Ins.Code 5 GYT4048 NY 2015 FORD === 280 T704693C NY 2011 HYUNDAI SEDAN 36 Ticket/Arrest Ticket/Arrest Number(s) Number(s) Violation Violation Section(s) Section(s) Check if involvedvehicle is: Checkif involvedvehicle is. Circlethe diagrambelow that describesthe accident,or draw your own g 6 ¤more than 95 inches wide: ¤more than 95 inches wide; diagramin space#9. Numberthe vehicles, V Omore than 34 feet fong: V ¤more than 34 feet long; Right Tum Head 1 E ¤operated ¤operated with an overweight permit; E with an overdimensionpenmt· ¤operated RearEnd with an overweight permit; Doperated with an overdimensionpermit. + Le Turn A Rightngle + On + H H 3. 5. 7 VEHICLE 1 DAMAGE CODES VEHICLE2 DAMAGE CODES Sideswipe LeftTum RightTum Sideswipe C 1 2 C 1 2 (same ection) 4____ (oppose 1 Box 1 -Point of Impact Box 1 - Pointof Impact 7 L E Box 2 - Most Damage 8 8 L E Box 2 - Most Damage 2 2 2. + n. ACCIDENTDIAGRAM e. ; a. -w-+ Enter up to three 3 4 5 Enter up to three 3 4 5 more DamageCodes 18 18 18 more DamageCodes 3 1 27 18_ VehicleBy Vehicle By 1 Towed- Towed: To To DIAGRAM ATTACHED ON SUBSEQUENT PAGE VEHICLEDAMAGECODING: 7 1-13. SEE DIAGRAMON RIGHT. 1 REAR END 14 UNDERCARRIAGE 17. DEMOLlSHED 2 va 15. TRAlLER 18. NO DAMAGE 9. 2B 16. OVEP-TURNED 19, OTHER ,- 1 Cost of repairs to any one vehicle will be more than $1000. n is Unknown/Unable to Determine Yes No Reference Marker Coordinates(if available) PlaceWhere Accident BRONXTKINGS NEW YORK QUEENS RICHMOND Occurred:¤ Latitude/Northing: FOUNTAIN Roadon whichaccidentoccurred AVENUE 40.67239 (RouteNumberorStreetName) 29 at t) intersectingstreet SUTTER AVENUE Longitude/Easting: (RouteNumber orStreetName) or2) N O S -73.87463 Feet Miles (Milenest. Nearest RouteNymberor StrvetNarr4) Inter-,ecting Accident Description/Officer'sNotes AT TPO MV1 THAT HE WAS STOPPED AT THE RED LIGHT AT THE INTERSECTION 30 WHEN MV2 SUDDENLY COLLIDED WITH HIS REAR. MV2 STATES HE WAS TRAVELLING W/B ON SUTTER - AVENUE WHEN HE ATTEMPTED TO STOP BUT COLLIDED WITH REAR OF MV1. ALL PASSENGERS AND DRIVERS RMA ON SCENE. OFFICER DID NOT WITNESS , P a 9 10 11 12 13 14 15 16 17 BY TO 18 Narnesof all invcIved Date of Death nly_ A A 1 1 2 1 44 M - - - - - ROBINSON, COURTNEY, S L B 1 7 2 1 87 F - - - - - ICILDA, MORGAN c 1 7 2 1 80 F - - - - - MCCLEAN, EARSELINE D 1 7 2 1 77 F - - - - - SURGENER, MARTHA E 1 7 2 1 73 F - - - - - ANDERSON, YVONNE F 1 7 2 1 69 M - - - - - CHRISTOPHER, ADRIANE a Officer's Rank Tax ID No. NCIC No.Precinct Post/SectorReviewing Date/TimeReviewed Signature ) POM 956687 03030 075 SGT MANUEL A 03/02/2017 11: 47 Print Name in Full JOSHUA GOMEZ ROSSELLO FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017 NYSCEF DOC. NO. 32 (Letter of personskilled RECEIVED must correspond or injurea with NYSCEF: letter 11/22/2019 assignationon front). PERSONS KILLED OR INJURED IN ACCIDENT designation Last Nanm First M1 LastName First M.I Mdress Address '7Me w S«th Te!ephane(Area cede) Date of Birth Telephana(Ataa code) M3ata Day Year Month Day Year Last Name Fhsi U. Last Name First M.i Address Address Date of Sinh Telephone(Area Code) Date of Birth Telephone(Area Code) Month Day Year Month Day Year Last Name First M.I. Highway Dist at Scene? Yes No Name: Address Date of BInn Telephone(Area Code) Shield No. Month Day Year ENTER INSURANCE POLICY NUMBER FROM INSURANCE IDENTIFICATION CARD, EXPlRATION DATE (IN ALL CASES), AND VIN. Vehicle No. 1 PHPK1553190 Vehicle No,2 B612375 Expiration Date 09/26/2017 Expiration Date 03/01/2018 VIN 1FDEE3FLXFDA27861 VlN 5NPEC4AC3BH181811 WITNESS (Attachseparate sheet, if necessary) Name Address Phone DUPLICATE COPY REQUIRED FOR: Dept. ofMotor Vehicles Motor Transport Division NYC Taxi & Limousine Comm. Other CityAgency (if anyoneis killed/injured) (P.D.vehicleinvolved) (if a Licensed taxior limousine (Specify) involved) Officeof Comptroller O Personnel Safety Unit Highway Unit (if a City vehicle involved) (if a P.D. vehicleinvolved) NOTlFICATIONS: (Entername, address, of friend or relative and relationship If aided notified. person is unidentified, list Missing Person Squad member who was notified. In either case, give date and time of notification.) PROPERTY DAMAGED (otherthan vehicles) OWNER OF PROPERTY (includecityagency, where applicable) IF NYPD VEHICLE IS INVOLVED: Police Vehicle-Operator's First Name Last Name Rank Shield No. Tay1D.No. Command Make of Vehicle Year Type of Vehicle PlateNo. Dept.VehicleNo. AssignedTo What Command Equipmentin UseAt Time of Accident Siren Hom Turret Light 4-Way Flasher High-LevelWarningLights Traffic Cones Headlights ACTIONS OF POLICE VEHICLE Responding to Code Signal Q Complyingwith Station House Directive O Pursuing Violator Routine Patrol Other (Describe) MV-104AN (7/11) Page 2 of 4 Pages FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017 NYSCEF DOC. NO.3 Faga 32 of 4 9es NewYork State Departmentof MotorVehicles RECEIVED NYSCEF: 11/22/2019 ' REPORT Ptednct POLICE ACCIDENT (NYC) 075 MV-104AN (7/11) AccidealNo Compl3]nt MV-2017-075-000906 Number Ac:-.dent Date DayatWows Milin:vTime No.of No Irduati KiHed at.Scene Notinvesthawd Vehicles .. . ..._______............. 2 2017 THURSDAY 08: 00 2 0 0 Reconstructed O O 3 VEHICLE VEHICLE BICYCLIST O DEDESM!AN C OTHER PEDESTR!AN 3/EHICLE-Driwr VEHICLE- Driver Stateof Lic. StateofLic. LicenseIDNumber LicenseLDNumber 21 erName-exactly DriverName- exactly .. asrinted onticense n pantd onHeense Addres;(includeNurnDar !. Street) Act.Na-Address(includeNumberE Strm) f-pt No. orTown State ZipCode CityorTown State ZipCode Dateof Birtn Sex UnlicensedNo of Public DateofBirth | Sex UnlicensedNo.of Public Month Day yer Occupants Pro Month Day Year Occupants Prap 2 asprintedonregistration Name-exactly Sex Date3rBirth asprintedonregistralian Name--eractly Sex DateofBain Man'.h Day Year Monm Day Year Address(includeNumber& Street) Apl.No.Haz. (includeNumber& Street) ReleasedAddress Apt.No.Haz. 23 Released| .: Mat Mat. Code Code 1 CityorTown State ZipCode CityorTown State ZipCode 24 PlateNumber StateofReg. VehicleYear&MakeVehicleType Ins.Code PlateNumber Stateof Reg VehicleYear&Make VehicleType Ins.Code 5 Ticket/Arrest Ticket/Arrest Number(s) Number(s) Violation VioIalion Section(s) SecGori(s) Check if involvedvehicle is: Check if involvedvehicleis: Circle the diagram below that describesthe accident or draw your own _ 6 Omore than 95 inches wide; ¤more than 95 inches wide; diagram in space #9. Numberthe vehicles. V ¤more than 34 feet long; V O morethan 34 feet long; RearEnd RightAngle RightTum HeadOn - 1 E ¤operated ¤operated with an overweight permit; E with an overdimensionpermit- H Doperated with an overweightpermit; ¤operatedwith an overdimertsionpermd. + Left Tum + 7. + H 3. 5. VEHICLE 1 DAMAGE CODES I VEHICLE 2 DAMAGE CODES Sideswipe LeftTum RightTumSidaswipe 26 C 1 2 C 1 2 (same non) wsHe - Box 1 - Point of Impact Box 1 -Point of impact 7 L E Box 2 -Most Damage L E Box 2 - Most Damage Enter up to three 2. + 0. ACCIDENT DIAGRAM 4. s a. -9 Enter up to three 3 4 5 3 4 5 more DamageCodes moreDamageCodes 27 Vehide By Vehicle By 1 Towed: Towed: To To DIAGRAM ATTACHED ON SUBSEQUENT PAGE VEHICLE DAMAGECODING: 1-13. SEE DIAGRAMON RIGHT. 1 REAR END 14. UNDERCARRIAGE 17. DEMOLISHED 2 a 15. TRAILER 18. NO DAMAGE ,A 28 16. OVERTURNED 19. OTHER --s 1 Cost of repairs to any one vehicle will be rnore than $1000. 12 Unknown/Unable to Determine YeS No ReferenceMarkerCoordinates(if available) Place Where AccidentOccurred: BRONXOKlNGS NEW YORKO QUEENS RICHMOND Latitude/Nor1hing: FOUNTAIN AVENUE Roadon whichaccidentoccurred 40 . 67239 (RouteNumberorStreetName) 29 at 1)intersectingstreet SUTTER AVENUE Longitude/Easting: (RouteNumberorStreetName) N S -73.87463 or2) Feet Miles OE Ow of (MdupmtNearestIntermr•ing RouteNumber orStreetName) Accident Descrption/Officer's Notes 30 ... _ L*5E _ cus 3HEET P 8 9 10 11 12 13 14 15 16 17 BY TO 18 Namesof all involved Dateof Death Onl A G 1 7 2 1 79 M - - - - - JOSPEH CHRISTOPHER, L H 1 7 2 1 82 M - - - - - JAMES EVER, I 2 1 2 1 23 M - - - - - DIALLO, ABDOURAHAMANE O L Officer's Rank Tax ID No. NCIC No.Precinct Post/Sector Reviewirig Datefrime Reviewed and Officer Signature $POM 956687 03030 075 SGT MANUEL A 03/02 /2017 11: 47 Print Name in Full JOSHUA GOMEZ ROSSELLO FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 11/22/2019 PERSONS KILLED OR INJURED IN ACCIDENT (Letter designationof personskilled or injured must correspond with letter desionation on front). LastName First M.L LastName First ML .. . . . Address Address _Qatte_ojR.dh Telephorie(Area Code) Date at With Teleohone(Area Code) Ab9th Day Year Month Day Year Last Name First M.L Last Name First M.l Address Address pale of BMh Telephone(Area Code) Date of Birth Telephone(Area Code) !/.cnth Day Year Month Day Year Last Name First M.I. Highway Dist.at Scene? Yes No Name: Address Date of Birth Telephone(Area Code) Shield No. Month Day Year ENTER INSURANCE POLICY NUMBER FROM INSURANCE IDENTIFICATION CARD, EXPIRATION DATE (IN ALL CASES), AND VIN. Vehicle No. Vehicle No. ExpirationDate Date Expiration VlN VIN WITNESS (Attachseparate sheet, if necessary) Name Address Phone DUPLICATE COPY REQUIRED FOR: Dept. ofMotor Vehicles Motor Transport Division NYC Taxi& Limousine Comm. Other CityAgency (if anyoneis killed/injured) (P.D.vehicle involved) (if a Licensed taxior limousine (Specify) involved) Officeof Comptroller Personnel Safety Unit Highway Unit (if a City vehicle involved) (if a P.D. vehicleinvolved) NOTIFICATIONS: (Enter name,address,and relationship of friend or relative list Missing Person Squad notified. If aided person is unidentified, member who was notified. In either case, give date and time of notification.) PROPERTY DAMAGED (otherthan vehicles) OWNER OF PROPERTY (includecityagency, where applicable) IF NYPD VEHICLE IS INVOLVED: Police Vehicle-Operator's First Name Last Name Rank Shield No. Tax ID. No. Command Make of Vehicle Year Type of Vehicle Plate No. Dept. Vehicle No. AssignedTo What Command Equipmentin UseAt Time of Accident O Siren ¤ Horn Turret Light- 4-Way Flasher High-LevelWarningLights D Traffic Cones D Headlights ACTIONS OF POLICE VEHICLE O Responding to Code Signal Complying with Station House Directive Pursuing Violator O RoutinePatrol Other (Describe) MV-104AN (7/11) ,Page 4 of Pages 4 FILED: KINGS COUNTY CLERK 11/22/2019 11:28 AM INDEX NO. 521507/2017 NYSCEF DOC. NO. 32 RECEIVED NYSCEF: 11/22/2019 Rear End : MV-2017-075-000906 Reporting Officer : POM JOSHUA GOMEZ Reviewing Officer : SGT MANUEL A ROSSELLO Reviewed Date : 03/02/2017 11:47 N Vehictet Vehicle 2