Exhibit,Appendix: Government Employees Insurance Company As Subrogee Of Randolph Ellis v. Alexis Rattray, John Doe, Being A Fictitious Name

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                                FILED:         QUEENS        COUNTY         CLERK        03/10/2021             10:06       AM                      INDEX    NO.   701299/2021
   NYSCEF     DOC.   NO.   6                                                                                  RECEIVED      NYSCEF:     03/10/2021
                               Request         for    Judicial      Intervention            Addendum                            UCS-840A (7/2012)


      Queens Supreme COURT, COUNTY OF Queens                                                                Index No:     701299/2021
      For use when additional space is needed to provide party or related case information.

      PARTIES:     For parties without an attorney, check "Un-Rep" box AND enter party address, phone number and e-mail address in "Attorneys" space.

              Parties                              Attorneys and/or Unrepresented Litigants                    Issue Joined      Insurance
       Un-
       Rep    List parties in same order as listed in the
                                                   For represented parties, provide attorney's name, firm name, address, phone
                                                                                                               For each defendant,
                                                                                                                                 For each defendant,
              caption and indicate roles (e.g., plaintiff,
                                                   and email. For unrepresented parties, provide party's address, phone and
                                                                                                               indicate if issue has
                                                                                                                                 indicate insurance
              defendant; 3rd party plaintiff, etc.)email.                                                      been joined.      carrier, if applicable.

              Name: GOVERNMENT EMPLOYEES
        ☐     INSURANCE COMPANY AS
                                                   ANGELO URSO JR., Law Offices of Ricky J. Lucyk, 2
                                                   Huntington Quad Ste 2n01 , Melville, NY   11747,
              SUBROGEE OF RANDOLPH ELLIS           aurso@geico.com                                              ☒  YES   ☐  NO
              Role(s): Plaintiff/Petitioner



      RELATED CASES:         List any related actions. For Matrimonial actions, include any related criminal and/or Famiy Court cases.




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