On February 12, 2020 a
Exhibit,Appendix
was filed
involving a dispute between
Ramzy Abi-Saab,
and
New York City Police Department,
The City Of New York,
for Torts - Motor Vehicle
in the District Court of New York County.
Preview
FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020
NYSCEF DOC. NO. 15 RECEIVED NYSCEF: 05/04/2020
Exhibit
A
FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020
From: 83/12/Z8 02:18 PM p. 1 of 5
o: Z1Z356Z759
NYSCEF DOC. NO. 15 RECEIVED NYSCEF: 05/04/2020
Page1 or 4 Pages New York State Departmentof Motor Vehicles
Precinct POLICE ACCIDENT REPORT (NYC) 19
006 MV-104AN (7/11) 2
AccidentNo. Complaint
MV-2018-006-001266 Number anis-ous-cosus AMENDED REPORT
ot¯ ¯
ceiviena .. DayafWeek MMtaryTime No. No.injured No.Kdled at Scene
NotInvestigated Sr-enePolicePhoics 20
2 Month Day vear Vehicles ---------------------------- 12
Reconstructed Yes No
11 15 2018 THURSDAY 23:45 1 1 0
VEH1CLE1 |_..| VEH1CLEOB1CYCLIST E PEDESTRIAN D OTHER PEDESTRIAN
VEHICLEn-Driver StateofUc.VEHLCLE-Driver Stateof Lic
2 ucenseIDNumber 807101238 NY ucenseIDNumber 21
5 Drivername-exactly DriverName- exactly
aspnntedonhcenseMEDINA, SAMANTHA asprintedonlicense ABI-SAAB, RAMZY
Address(fndudeNonher& Street) Apt.No. Address(fndudeNumber& Streen Apt.No.
State Cit orTown , . 22
or own ZipCode
e× n censed No.or Pub#c DateofBir0s Sex UnlicensedNo.of Public
Month Der Year Occupams Property Month Day Year Occupants Property
- F 1 Damaged M Damaged
Name-ctmly aspricuedon*erfstration Sex | Dateof Birth asprimedonregisgration
Name--exactly sex DaleofBirth
Month Day Year
MEDINA, SAMANTHA F
Address(fndudeNumber& Srece0 ApLNo. Haz : Released Address(IndvdeNumber& Sheet) Apt No.Haz. Released 23
4 at Mat. 7
Code
4
ty ar
own State 2)pCode CityorTown State Zip Code
QUEENS NY 11361
24
PlateNumber Stateof Reg. VehideYear& Make
VehicleType Ins.Code PlateNumber Stateof Reg. VehideYear&MakevehideType ins.Code
GZK9808 NY 2014 NISSAN SEDAN
TicketfArrest Ticket/Arrest
Numhr(s) M1865 8157Z Number(s)
Violation Violation
sectionls)
1192.3 secuon(s)
25
Check it involved vehicle is·. Check if involved vehicle is: Circle the diagram below that describes the accident, or draw your owm
1
6 more than 95 inches wide; ¤more than 95 inches wide; diagram in space #9. Number the vehicles.
V more than 34 feet tong; V more than 34 feet iong;
4
E
H
Doperated with an overweight perrmt:
Doperated
E
with an overdimension permit
RearEnd
operated with an overweight permit;
goperatedwith an overdimensionpennit. +
Lelt Tun RightAngle RightTurn
+
HeadOn
+
g 3. 5. 7.
VEH1CLE2 DAMAGE CODES
C
VEH1CLE1 DAMAGE CODES
Box 1 - Point of impacg 1 2 C Box 1 -Point of impact 1 2 (same _.. + RightTum Sidesnipe
topposite
26
_
4
7
L
E
Box 2 - Most Damage 2 18 L
E
Box 2 - Most Damage 2. + 0.
ACCtDENT DLAGP
4. 6. 8. -
Enter up to three 3 4 5 Enter up to three 3 4 5
more Damage Codes 18 18 18 more Damage Codes
2 27
VehicleBy VehicleBy 1
Towed: Towed:
To To
VEHICLE DAMAGE CODING: .. 7
1-13.
SEE DIAGRAM ON RIGHT. 9 OTHER
14.UNDERCARRIAGE 17. DEMOLLSHED a
15 TRAILER 18. NO DAMAGE B- 28
16.OVERTURNED 19. OTHER Cost of repairs
to any one vehicle than S1000.
will be more 2
a Unknown/Unable to Determine Yes No
ReferenceMarker Coordinates fitavailable) NEW YORK QUEENS RICHMOND
Place Where Occurred:
Accide-.t BRONXOKINGS
Latitude/Northing: CHRISTOPHER
Road on which accidentoccurred131 STREET
40.733032 (RooleNumberor StreetName) 29
at 1) intersectingstreet
Longitude/Easting: (RouteNumberorStreetName)
or2)50 O N S
-74 . D065 84
Foet Miles
OE W of
9r §trentName)
RouteNumlyer
[Mippost,NearestIntqrsecting
Accident Description/Officer·sNotes MOTORIST
WHILE TRAVELING WESTBOUND ON CHRISTOPHER STREET DID STRIKE 30
PEDESTRIAN MID BLOCK ON CHRISTOPHER ST AS THE PEDESTRIAN WAS WALKING WITH TRAFFIC IN THE -
STREET. MOTORIST DID NOT STOP. PEDESTRIAN DID CHASE VEHICLE TO INTERSECTION OF GREENWICH
ST / CHRISTOPHER ST, APROXX 50 FEET FROM ACCIDENT. PEDESTRIAN PREVENTED MOTORIST FROM
LEAVING THE LEAVE BY SITTING ON HOOD. MOTORIST HAD A SMELL OF ALCOHOL/ GLASSY EYES AND
8 9 10 11 12 13 14 15 16 17 BY TO 18 Names of all mvolved Date of Death Only
A a p - - - 24 M 6 12 6 - - RAMZY
ABI-SAAB,
L B 1 1 2 1 30 F - - - - - MEDINA, SAMANTHA
N
O
k
D
Officer s Rank Tax ID No. NCIC No, Precinct Post/SectorReviewing DatefTime Reviewed
and Officer
Saqnaturet 11/18/2018 07 :34
936427 03030 006 SGT MICHAEL I
Print Name
in Full RONALD V DARABANT CASALE
FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020
From: 03/12/20 02:18 PM p. Z of 5
o: Z123562759DOC.
NYSCEF NO. 15 RECEIVED NYSCEF: 05/04/2020
PERSONS KILLED OR INJURED IN ACCIDENT designation
(Letter of persons or injured
killed must c irespünd with designation
letter on front).
A Last Name First MJ. LastName First M.I.
ABI-SAAB RAMZY
Address Address
Date o irth Telephone (Area Code)
Last Name First M1 Last Name First M.I.
Address Address
Datt 91Birth Telephone(Area Code) pate of Birth Telephone (Area Code)
Month Day Year Month Day Year
Last Name First M.L
Highway Dist at Scene? Yes No
Address
pple pl Birth Telephone(Area Code) Shield No.
Montn Day Year
ENTER INSURANCE POLICY NUMBER FROM INSURANCE 1DENTlFICATION CARD, EXPIRATION DATE (INALL CASES), AND VIN.
Vehicle No. s VehicleNo.
ExpirationDate ExpirationDate
VIN 1N4AA5AP5EC45 6436 VIN
WITNESS (Attach separate sheet, ifnecessary)
Name Address Phone
DUPLICATE COPY REQUIREEFO-R2
Dept. ofMotor Vehicles O Motor Transport Division O NYC Taxi & Limeesine Comm. O Other CityAgency
(if anyoneis killed/iGjured) (P.D.vehicle invalved) (if a Licensedtaxior limousine (Specify)
involved)
Officeof Comptroller Personnel Safety Unit O Highway Unit
(if a City
vehicleinvolved) vehicle
(if a P.D. involved)
NOTIFICATIONS: (Entername, address, of friend or relative
and relationship notified.
If aided person
is üñ|de.d:f;éd,
list Missing
PersonSquad member who
was notified.
in either
case,give date and time of rwinceEen.)
PROPERTY DAMAGED (otherthan vehicles) OWNER OF PROPERTY (includecityagency, where applicable)
IF NYPD VEHICLE IS INVOLVED:
Police Vehicle Last Name
-Operator's First Name Rank Shield No. Tax ID. No. Command
Make of Vehide Year Type of Vehicle Plate No. Dept. Vehicle No. Assigned To What Command
Equipmentin Use At Time of Accident
Siren Hom Turret Light Flasher High-LevelWaming Lights Traffic
Cones Headlights
4-Way
ACTIONS OF POLICE VEHICLE
toCode Signal Complying with Station
House Directive
Responding
O Pursuing Violator RoutinePatrol
O Other (Describe)
MV-104AN
(7m) Page 2 of 4 Pages
FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020
Frolm: 83/12/20 02:18 PM p. 3 Of 5
O: 2123562759DOC.
NYSCEF NO. 15 RECEIVED NYSCEF: 05/04/2020
Pue 3 w 4 Pages New York State Depanment of Motor Vehicles
Precinct POLICE ACCIDENTREPORT (NYC) ,o
006 MV-104AN (7/11) -
AccidentNo. Complaint
uv-2018 -006-0012 66 NumDer 2n e-ous- oams
A..crutcatD., DayofWeek uldwyTime No.cr No.Injured No.KGted Notinvestigated
at Scene LenScene Polices
Photos 20
Montti Day Year Vehicles _.._. _..______._..
_._..-..__ _
Reconstructed Yes No
11 15 2018 THURSDAY 23:45 1 1 0
VEHICLE VEHICLE BlCYCLIST O PEDESTRIAN OTHER PEDESTRIAN
VEHICLE- Driver 5tateofUc.VEHICLE- Orwer StateofUc.
2 UcenseIDNumber LicenseIDNumber 21
- DriverName-exacity DriverName- exacGy -
aspnntedonlicense asprintedonlicense
Address(includeNumber& Street) ApLNo. Address(IndudeNumber& Street) Apt.No.
ZipCode 22
Cityor Town State ZipCode CityorTown State
3 Dateof Birth Sex Unhcensed No.of Public Datao frth Sex UnlicensedNo.of Pubsc
Month Day Year Occupants P Day eBF Occupants ope
- asprintedonregistration
Name-exactly Sex D a oIBirth
Month Day Year
aspdntedonregistration
Name-exactly Sex Dateof Sirm
Month Day Year
Address(includeflumber& Street) ApLNo. Haz. Î Released Address(IndudeNumber& Street) Apt.No.Haz. 23
: Released
4 Mat MaL
C°ae code
4
CityorTown State ZipCode Chyor Town State ZipCode
24
PlateNumber Stateof Reg. VehideYear& MakeVehicleType ins.Code PlateNumber Stateof Reg,VehideYear& Make VehicleType Ins.Code
Ticket/Arrest Ticket/Arrest
Numbes(s) Number(s)
violation Violacon
Section(s) Section(s)
25
Check if involved vehicle is: Check if involved vehicleis: Circle the diagram below that describes the accident, or draw your own
-
6 ¤more than 95 inches wide; more than 95 inches wide; diagramin spaca #9. Number the vehicles.
4 V Omore than 34 feet long; V Omore than 34 feet long:
E
H
operated with an overweight permit;
operated
E
with an overdimension permit
H
¤operatedwith an overweight permit;
RearEnd
operated with an overdimension permit.
LeRTum RightAngle RightTum
+
HeadOn
7.
+
3. 5.
VEHICLE 1 DAMAGE t ODES ) VEHICLE 2 DAMAGE CODES LanTum RightTum Sidesepc 26
C Box 1 - Point of Impact 1 2 C Box 1 -Point of Impact 1 2 (same edian) _4__ (opposhe -
7
L
E
Box 2 - Most Damage L
E
Box 2 - Most Damage 2. 4- 0. 4. 6. 8. +
Enter up lo three 3 4 5 Enter up to three 3 4 5 ACCIDENT DIAGRAM
more Damage Codes more Damage Codes
27
VehicleBy Vehide By 1
Towed: 'Iowed:
To To
. , , DIAGRAM ATTACHED ON SUBSEQUENT PAGE
VEHICLE DAMAGE CODING:
-
1-13.SEE DIAGRAM ON RIGHT, 9 OTHER
14. UNDERCARRIAGE 17. DEMOLISHED 2 ni
15 TRAILER 18. NO DAMAGE 9· 28
16. OVERTURNED 19. OTHER Cost of repairs
to any one vehicle
will be more
than S1000. 2
in 11 to Unknown/Unable to Determine Yes No
Reference Marker
Coordinateslif available) NEW YORKO QUEENS
P1ace Where Acchia Occurred: BRONX¤KINGS RICHMOND
Latitude/Northing: CHRISTOPHER
Road on wtúchaccidentoccurred131 STREET
4 O . 733032 (RouteNumberor StreetName) 29
at 1) intersectingstreet
Longitude/Easting: (RouteNumberor StreetName)
GREMEH STREE
-74 . 006 5 84 m2)
Feet O
Miles
or
(MiepostNgyrestintersectanq
NumberorStregiN9me)
N0g10
Acciden Description/Officer's Notes REMOVED
TO 7PCT. REFUSED TO BLOW ON BREATHALY2;ER. ARREST # M1865 8157Z 30
P
8 9 10 11 12 13 14 15 16 17 BY TO 18 Names of all involved Date of Death Only
A
L
N
O
L
D
Ollicer's Rank Tax ID No. NCIC No.Precinct Post/SectorReviewing Date/Time Reviewed
and Çg..- Orricer
Signature ‡SGT
936427 006 SGT I 11/18/2018 07 : 34
0303D MICHAEL
Print Name
in Full RONALD V DARABANT CASALE
FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020
NYSCEF DOC. NO. 15 From: 03/12/20 PM
02:18RECEIVED p. 4
NYSCEF:of 505/04/2020
o: 2123562759
PERSONS KILLED OR INJURED IN ACCIDENT (Letter
designation of persons or injured
killed rnust correspondwithletter
designation on front).
Last Name First M.1. Last Name First M1
Address Address
Date of Birth Telephone(Area Code) Opte of Birth Telephone (Area Code)
Month Day Year Month Day Year
Last Name First M1 Last Name First M1
Address Address
Dple of flirth Telephone(Area Code) Dato of Birth Telephone (Area Code)
Month Day Year Month Day Year
Last Name First MJ.
Highway Dist. at Scene? Yes No
Name:
Address
Date qf pirth Telephone (Area Code) Shield No.
Month Day Year
ENTER INSURANCE POLICY NUMBER FROM INSURANCE IDENTIFICATION CARD, EXPIRATION DATE (INALL CASES), AND VIN.
Vehicle No. Vehicle No.
Ex pirationDate ExpirationDate
VIN VIN
WITNESS (Attach separate sheet,ifnecessary)
Name Address Phone
DUPLICATE COPY REQUIRED FOR:
Dept of Motor Vehicles ¤ Motor Transport Division NYC Taxi & Limousine Comm. Other CityAgency
(if anyoneis killed/injured) (P.D.vehicle (if a Licensedtaxior limousine (Specify)
involved)
involved)
Officeof Cornptroller O Personnel Safety Unit Highway Unit
(if a City
vehicleinvolved) (if a P.D.
vehicleinvolved)
NOTIFICATIONS: (Entername, address, of friend
and relationship notified . If aided
or relative personis unidâñG|ied,
list Missing
PersonSquad member who
In either
was notified. case, give date and time of notification.)
PROPERTY DAMAGED (other than 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. Assigned To What Command
Equipmentin Use At Time of Accident
Siren Hom Turret Light 4-Way Flasher High-LevelWaming Lights¤ Traffic
Cones Heed!ights
ACTIONS OF POLICE VEHICLE
to Code Signag Complying House
with Station Directive
Responding
Pursuing Violator RoutinePatrol
Other (Describe)
MV-IDGNGnU Page 4 of 4 Pages
FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020
o: 2123562759 From: 03/12/20 02:18 PM p. 5 of 5
NYSCEF DOC. NO. 15 RECEIVED NYSCEF: 05/04/2020
Other : MV-2018-006-001266
Reporting Officer : SGT RONALD V DARABANT
Reviewing Officer : SGT MICHAEL I CASALE Reviewad Date : 11/18/2018 07:34
Document Filed Date
May 04, 2020
Case Filing Date
February 12, 2020
Category
Torts - Motor Vehicle
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Preview
FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020 NYSCEF DOC. NO. 15 RECEIVED NYSCEF: 05/04/2020 Exhibit A FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020 From: 83/12/Z8 02:18 PM p. 1 of 5 o: Z1Z356Z759 NYSCEF DOC. NO. 15 RECEIVED NYSCEF: 05/04/2020 Page1 or 4 Pages New York State Departmentof Motor Vehicles Precinct POLICE ACCIDENT REPORT (NYC) 19 006 MV-104AN (7/11) 2 AccidentNo. Complaint MV-2018-006-001266 Number anis-ous-cosus AMENDED REPORT ot¯ ¯ ceiviena .. DayafWeek MMtaryTime No. No.injured No.Kdled at Scene NotInvestigated Sr-enePolicePhoics 20 2 Month Day vear Vehicles ---------------------------- 12 Reconstructed Yes No 11 15 2018 THURSDAY 23:45 1 1 0 VEH1CLE1 |_..| VEH1CLEOB1CYCLIST E PEDESTRIAN D OTHER PEDESTRIAN VEHICLEn-Driver StateofUc.VEHLCLE-Driver Stateof Lic 2 ucenseIDNumber 807101238 NY ucenseIDNumber 21 5 Drivername-exactly DriverName- exactly aspnntedonhcenseMEDINA, SAMANTHA asprintedonlicense ABI-SAAB, RAMZY Address(fndudeNonher& Street) Apt.No. Address(fndudeNumber& Streen Apt.No. State Cit orTown , . 22 or own ZipCode e× n censed No.or Pub#c DateofBir0s Sex UnlicensedNo.of Public Month Der Year Occupams Property Month Day Year Occupants Property - F 1 Damaged M Damaged Name-ctmly aspricuedon*erfstration Sex | Dateof Birth asprimedonregisgration Name--exactly sex DaleofBirth Month Day Year MEDINA, SAMANTHA F Address(fndudeNumber& Srece0 ApLNo. Haz : Released Address(IndvdeNumber& Sheet) Apt No.Haz. Released 23 4 at Mat. 7 Code 4 ty ar own State 2)pCode CityorTown State Zip Code QUEENS NY 11361 24 PlateNumber Stateof Reg. VehideYear& Make VehicleType Ins.Code PlateNumber Stateof Reg. VehideYear&MakevehideType ins.Code GZK9808 NY 2014 NISSAN SEDAN TicketfArrest Ticket/Arrest Numhr(s) M1865 8157Z Number(s) Violation Violation sectionls) 1192.3 secuon(s) 25 Check it involved vehicle is·. Check if involved vehicle is: Circle the diagram below that describes the accident, or draw your owm 1 6 more than 95 inches wide; ¤more than 95 inches wide; diagram in space #9. Number the vehicles. V more than 34 feet tong; V more than 34 feet iong; 4 E H Doperated with an overweight perrmt: Doperated E with an overdimension permit RearEnd operated with an overweight permit; goperatedwith an overdimensionpennit. + Lelt Tun RightAngle RightTurn + HeadOn + g 3. 5. 7. VEH1CLE2 DAMAGE CODES C VEH1CLE1 DAMAGE CODES Box 1 - Point of impacg 1 2 C Box 1 -Point of impact 1 2 (same _.. + RightTum Sidesnipe topposite 26 _ 4 7 L E Box 2 - Most Damage 2 18 L E Box 2 - Most Damage 2. + 0. ACCtDENT DLAGP 4. 6. 8. - Enter up to three 3 4 5 Enter up to three 3 4 5 more Damage Codes 18 18 18 more Damage Codes 2 27 VehicleBy VehicleBy 1 Towed: Towed: To To VEHICLE DAMAGE CODING: .. 7 1-13. SEE DIAGRAM ON RIGHT. 9 OTHER 14.UNDERCARRIAGE 17. DEMOLLSHED a 15 TRAILER 18. NO DAMAGE B- 28 16.OVERTURNED 19. OTHER Cost of repairs to any one vehicle than S1000. will be more 2 a Unknown/Unable to Determine Yes No ReferenceMarker Coordinates fitavailable) NEW YORK QUEENS RICHMOND Place Where Occurred: Accide-.t BRONXOKINGS Latitude/Northing: CHRISTOPHER Road on which accidentoccurred131 STREET 40.733032 (RooleNumberor StreetName) 29 at 1) intersectingstreet Longitude/Easting: (RouteNumberorStreetName) or2)50 O N S -74 . D065 84 Foet Miles OE W of 9r §trentName) RouteNumlyer [Mippost,NearestIntqrsecting Accident Description/Officer·sNotes MOTORIST WHILE TRAVELING WESTBOUND ON CHRISTOPHER STREET DID STRIKE 30 PEDESTRIAN MID BLOCK ON CHRISTOPHER ST AS THE PEDESTRIAN WAS WALKING WITH TRAFFIC IN THE - STREET. MOTORIST DID NOT STOP. PEDESTRIAN DID CHASE VEHICLE TO INTERSECTION OF GREENWICH ST / CHRISTOPHER ST, APROXX 50 FEET FROM ACCIDENT. PEDESTRIAN PREVENTED MOTORIST FROM LEAVING THE LEAVE BY SITTING ON HOOD. MOTORIST HAD A SMELL OF ALCOHOL/ GLASSY EYES AND 8 9 10 11 12 13 14 15 16 17 BY TO 18 Names of all mvolved Date of Death Only A a p - - - 24 M 6 12 6 - - RAMZY ABI-SAAB, L B 1 1 2 1 30 F - - - - - MEDINA, SAMANTHA N O k D Officer s Rank Tax ID No. NCIC No, Precinct Post/SectorReviewing DatefTime Reviewed and Officer Saqnaturet 11/18/2018 07 :34 936427 03030 006 SGT MICHAEL I Print Name in Full RONALD V DARABANT CASALE FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020 From: 03/12/20 02:18 PM p. Z of 5 o: Z123562759DOC. NYSCEF NO. 15 RECEIVED NYSCEF: 05/04/2020 PERSONS KILLED OR INJURED IN ACCIDENT designation (Letter of persons or injured killed must c irespünd with designation letter on front). A Last Name First MJ. LastName First M.I. ABI-SAAB RAMZY Address Address Date o irth Telephone (Area Code) Last Name First M1 Last Name First M.I. Address Address Datt 91Birth Telephone(Area Code) pate of Birth Telephone (Area Code) Month Day Year Month Day Year Last Name First M.L Highway Dist at Scene? Yes No Address pple pl Birth Telephone(Area Code) Shield No. Montn Day Year ENTER INSURANCE POLICY NUMBER FROM INSURANCE 1DENTlFICATION CARD, EXPIRATION DATE (INALL CASES), AND VIN. Vehicle No. s VehicleNo. ExpirationDate ExpirationDate VIN 1N4AA5AP5EC45 6436 VIN WITNESS (Attach separate sheet, ifnecessary) Name Address Phone DUPLICATE COPY REQUIREEFO-R2 Dept. ofMotor Vehicles O Motor Transport Division O NYC Taxi & Limeesine Comm. O Other CityAgency (if anyoneis killed/iGjured) (P.D.vehicle invalved) (if a Licensedtaxior limousine (Specify) involved) Officeof Comptroller Personnel Safety Unit O Highway Unit (if a City vehicleinvolved) vehicle (if a P.D. involved) NOTIFICATIONS: (Entername, address, of friend or relative and relationship notified. If aided person is üñ|de.d:f;éd, list Missing PersonSquad member who was notified. in either case,give date and time of rwinceEen.) PROPERTY DAMAGED (otherthan vehicles) OWNER OF PROPERTY (includecityagency, where applicable) IF NYPD VEHICLE IS INVOLVED: Police Vehicle Last Name -Operator's First Name Rank Shield No. Tax ID. No. Command Make of Vehide Year Type of Vehicle Plate No. Dept. Vehicle No. Assigned To What Command Equipmentin Use At Time of Accident Siren Hom Turret Light Flasher High-LevelWaming Lights Traffic Cones Headlights 4-Way ACTIONS OF POLICE VEHICLE toCode Signal Complying with Station House Directive Responding O Pursuing Violator RoutinePatrol O Other (Describe) MV-104AN (7m) Page 2 of 4 Pages FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020 Frolm: 83/12/20 02:18 PM p. 3 Of 5 O: 2123562759DOC. NYSCEF NO. 15 RECEIVED NYSCEF: 05/04/2020 Pue 3 w 4 Pages New York State Depanment of Motor Vehicles Precinct POLICE ACCIDENTREPORT (NYC) ,o 006 MV-104AN (7/11) - AccidentNo. Complaint uv-2018 -006-0012 66 NumDer 2n e-ous- oams A..crutcatD., DayofWeek uldwyTime No.cr No.Injured No.KGted Notinvestigated at Scene LenScene Polices Photos 20 Montti Day Year Vehicles _.._. _..______._.. _._..-..__ _ Reconstructed Yes No 11 15 2018 THURSDAY 23:45 1 1 0 VEHICLE VEHICLE BlCYCLIST O PEDESTRIAN OTHER PEDESTRIAN VEHICLE- Driver 5tateofUc.VEHICLE- Orwer StateofUc. 2 UcenseIDNumber LicenseIDNumber 21 - DriverName-exacity DriverName- exacGy - aspnntedonlicense asprintedonlicense Address(includeNumber& Street) ApLNo. Address(IndudeNumber& Street) Apt.No. ZipCode 22 Cityor Town State ZipCode CityorTown State 3 Dateof Birth Sex Unhcensed No.of Public Datao frth Sex UnlicensedNo.of Pubsc Month Day Year Occupants P Day eBF Occupants ope - asprintedonregistration Name-exactly Sex D a oIBirth Month Day Year aspdntedonregistration Name-exactly Sex Dateof Sirm Month Day Year Address(includeflumber& Street) ApLNo. Haz. Î Released Address(IndudeNumber& Street) Apt.No.Haz. 23 : Released 4 Mat MaL C°ae code 4 CityorTown State ZipCode Chyor Town State ZipCode 24 PlateNumber Stateof Reg. VehideYear& MakeVehicleType ins.Code PlateNumber Stateof Reg,VehideYear& Make VehicleType Ins.Code Ticket/Arrest Ticket/Arrest Numbes(s) Number(s) violation Violacon Section(s) Section(s) 25 Check if involved vehicle is: Check if involved vehicleis: Circle the diagram below that describes the accident, or draw your own - 6 ¤more than 95 inches wide; more than 95 inches wide; diagramin spaca #9. Number the vehicles. 4 V Omore than 34 feet long; V Omore than 34 feet long: E H operated with an overweight permit; operated E with an overdimension permit H ¤operatedwith an overweight permit; RearEnd operated with an overdimension permit. LeRTum RightAngle RightTum + HeadOn 7. + 3. 5. VEHICLE 1 DAMAGE t ODES ) VEHICLE 2 DAMAGE CODES LanTum RightTum Sidesepc 26 C Box 1 - Point of Impact 1 2 C Box 1 -Point of Impact 1 2 (same edian) _4__ (opposhe - 7 L E Box 2 - Most Damage L E Box 2 - Most Damage 2. 4- 0. 4. 6. 8. + Enter up lo three 3 4 5 Enter up to three 3 4 5 ACCIDENT DIAGRAM more Damage Codes more Damage Codes 27 VehicleBy Vehide By 1 Towed: 'Iowed: To To . , , DIAGRAM ATTACHED ON SUBSEQUENT PAGE VEHICLE DAMAGE CODING: - 1-13.SEE DIAGRAM ON RIGHT, 9 OTHER 14. UNDERCARRIAGE 17. DEMOLISHED 2 ni 15 TRAILER 18. NO DAMAGE 9· 28 16. OVERTURNED 19. OTHER Cost of repairs to any one vehicle will be more than S1000. 2 in 11 to Unknown/Unable to Determine Yes No Reference Marker Coordinateslif available) NEW YORKO QUEENS P1ace Where Acchia Occurred: BRONX¤KINGS RICHMOND Latitude/Northing: CHRISTOPHER Road on wtúchaccidentoccurred131 STREET 4 O . 733032 (RouteNumberor StreetName) 29 at 1) intersectingstreet Longitude/Easting: (RouteNumberor StreetName) GREMEH STREE -74 . 006 5 84 m2) Feet O Miles or (MiepostNgyrestintersectanq NumberorStregiN9me) N0g10 Acciden Description/Officer's Notes REMOVED TO 7PCT. REFUSED TO BLOW ON BREATHALY2;ER. ARREST # M1865 8157Z 30 P 8 9 10 11 12 13 14 15 16 17 BY TO 18 Names of all involved Date of Death Only A L N O L D Ollicer's Rank Tax ID No. NCIC No.Precinct Post/SectorReviewing Date/Time Reviewed and Çg..- Orricer Signature ‡SGT 936427 006 SGT I 11/18/2018 07 : 34 0303D MICHAEL Print Name in Full RONALD V DARABANT CASALE FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020 NYSCEF DOC. NO. 15 From: 03/12/20 PM 02:18RECEIVED p. 4 NYSCEF:of 505/04/2020 o: 2123562759 PERSONS KILLED OR INJURED IN ACCIDENT (Letter designation of persons or injured killed rnust correspondwithletter designation on front). Last Name First M.1. Last Name First M1 Address Address Date of Birth Telephone(Area Code) Opte of Birth Telephone (Area Code) Month Day Year Month Day Year Last Name First M1 Last Name First M1 Address Address Dple of flirth Telephone(Area Code) Dato of Birth Telephone (Area Code) Month Day Year Month Day Year Last Name First MJ. Highway Dist. at Scene? Yes No Name: Address Date qf pirth Telephone (Area Code) Shield No. Month Day Year ENTER INSURANCE POLICY NUMBER FROM INSURANCE IDENTIFICATION CARD, EXPIRATION DATE (INALL CASES), AND VIN. Vehicle No. Vehicle No. Ex pirationDate ExpirationDate VIN VIN WITNESS (Attach separate sheet,ifnecessary) Name Address Phone DUPLICATE COPY REQUIRED FOR: Dept of Motor Vehicles ¤ Motor Transport Division NYC Taxi & Limousine Comm. Other CityAgency (if anyoneis killed/injured) (P.D.vehicle (if a Licensedtaxior limousine (Specify) involved) involved) Officeof Cornptroller O Personnel Safety Unit Highway Unit (if a City vehicleinvolved) (if a P.D. vehicleinvolved) NOTIFICATIONS: (Entername, address, of friend and relationship notified . If aided or relative personis unidâñG|ied, list Missing PersonSquad member who In either was notified. case, give date and time of notification.) PROPERTY DAMAGED (other than 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. Assigned To What Command Equipmentin Use At Time of Accident Siren Hom Turret Light 4-Way Flasher High-LevelWaming Lights¤ Traffic Cones Heed!ights ACTIONS OF POLICE VEHICLE to Code Signag Complying House with Station Directive Responding Pursuing Violator RoutinePatrol Other (Describe) MV-IDGNGnU Page 4 of 4 Pages FILED: NEW YORK COUNTY CLERK 05/04/2020 02:11 PM INDEX NO. 151554/2020 o: 2123562759 From: 03/12/20 02:18 PM p. 5 of 5 NYSCEF DOC. NO. 15 RECEIVED NYSCEF: 05/04/2020 Other : MV-2018-006-001266 Reporting Officer : SGT RONALD V DARABANT Reviewing Officer : SGT MICHAEL I CASALE Reviewad Date : 11/18/2018 07:34