Preview
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NEW YORK
DARRYL NOWAK, Index No.: 15400012018
Plaintiffs,
-against- F'IRST SUPPLEMENTAL
DISCOVERY RESPONSE
SEA WOLF MARINE TRANSPORTATIONLLC, WITTICH
BROTHERS MARINE, fl{C., and WEEKS MARINE INC.,
Defendants.
PLAINTIFF, DARRYL NOWAK through his attorneys, NAPOLI SHKOLNIK,
PLLC, supplements his response to the various discovery demands of all Defendants as follows:
In addition to the authorizations previously provided, fully executed HIPAA
compliant authorizations to obtain plaintiffs records maintained by the following entity are
annexed herewith:
. NYC DISTRICT COUNCIL OF
CARPENTERS BENEFIT FUNDS
395 Hudson Street
New York, New York 10014-7451
PLEASE TAKE FURTHER NOTICE that pursuant to CPLR $3101(h) the
Plaintiff reserves his right to amend and/or supplement this response should further information
become available up to and including time of trial herein.
Dated: New York, New York
March 3,2022
t l|lAPOI.I
Slll(OLl\lII(PLLI
fllonililtATtAw
1 of 30
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
Yours, etc.,
NAPOLI SHKOLNIK, PLLC
By: Joseph P. Napoli, Esq.
Attorneys for Plaintiff
360 Lexington Avenue - l lthFloor
New York, New York 10017-6502
(2r2) 3e7-r000
To: BETANCOURT VAN HEMMEN GRECO & KENYON, PLLC
Attorneys for Defendants
WEEKS MARINE INC.
75 South Broadway - 4th Floor
White Plains, New York 10601
(er4) 9e7"-tr00
MAHONEY & KEANE, LLP
Attorney s for Defendants
SEA WOLF MARINE TRANSPORTATION LLC,
and WITTICH BROTHERS MARINE, INC.
61 Broadway - Suite 905
New York, New York 10005
(212) 38s-1422
I'lAP0il
c S}lIOIl'lIl(PLLI
ATMIililIITLAW
2 of 30
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
AUTHORIZATION
TO: NYC District Council of Carpenters' Benefit Funds
395 Hudson St.
New York, NY 1,0014-7451.
Re: Danyl Nowak
DloE:1212311963
SSN 150-66-781s
Dear Sirs:
Please furnish Betancourt, Van Hemmery Greco & Kenyon LLC, 151 Bodman Place,
Suite 20O Red Bank, Newlersey 0770'J",with certified copies of all records pertaining to my
Vacation Plan. A photocopy of this authorization may be used in lieu of an original.
?r/fur
6urrytlo*J--
srArE oF Na )
)
couNry oF Na, /oL )
the J dav of M*o/, 2022, before me personally came _
No*Ih-- to me known and known to me to be the individual
des and who executed the foregoing instrument and acknowledged thathe
executed the same.
Notary Public
IVAN RODRIGUEZ
Nolary Publlc,State ol New York
No. 01 HO61 I 6071
.ommlssion
Qualllled ln Richmond Counly l.t
Explres September 2a,20-3- 7
3 of 30
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
AUTHORIZATION
TO: NYC District Council of Carpenters' Benefit Funds
395 Hudson St.
New York, NY L0014-7451,
Re: Darryl Nowak
D lO lB: 1212311.963
SSN: 150-66-7815
Dear Sirs
Please furnish Betancourt, van Hemmen, Greco & Kenyon LLC, 151 Bodman
Place, Suite 200, Red Bank, New Jersey 07701,, with certified copies of all records
pertaining to my Safety and Education file. A photocopy of this authorization may
be used in lieu of an original.
Darryl Nowak
STATE OF Nn-
) ss.:
COUNTY OF Nu, )
of /na'J before me pers onally
D*rrl("\tffifu' , to me known and
2022,
known to me to be the
came
individual
desc{b/d in and who executed the foregoing instrument and acknowledged thathe
executed the same.
Notary Public
IVAN FODRIGUEZ
i Notor!public, State of Newyorle
*.ss#tiJ'd*?ffif,i?l:t;y"**
4 of 30
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
AUTH TION
TO: NYC District Council of Carpenters'Benefit Funds
395 Hudson St.
New York, NY 10014-7451
Re Darryl Nowak
D lO lB: 1.212311.e63
SSN: 150-66-781,5
Dear Sirs:
Please furnish Betancourt, van Hemmen, Greco & Kenyon LLC, 151 Bodman
Place, Suite 200, Red Bank, New ]ersey 07707, with certified copies of all records
pertaining to my Pension Plan. A photocopy of this authoriz tion may be used in
lieu of an original.
Darryl Nowak
STATE OF N* /,'/- )
COUNTY OF fl* )
)
SS.
n the Q -ouu of 4q4---, 2022, before me personally came _
I
NaJaU to me known and known to me to be the individual
desc(ibed/n and who executed the foregoing instrument and acknowledged thathe
executed the same
Notary Public
, IVAN HODRIGUEZ
Notary public, State of New york
No.01RO6116071
.,",g$illl' EX Jil#'J#?lfl ?(
fJ,U[ !,,0
5 of 30
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
AUTHORIZATION
TO: NYC District Council of Carpenters' Benefit Funds
395 Hudson St.
New York, NY 100L4-7451.
Re Darryl Nowak
DIOIB: 1212311963
SSN:150-66-7815
Dear Sirs
Please furnish Betancourt, Van Hemmery Greco & Kenyon LLC, L5L Bodman Place,
Suite 20O Red Bank, NewJersey 0770'J.,with certified copies of all records pertaining to my
Union Membership. A photocopy of this authorization may be used in lieu of an original.
I Nowak
srArE oF N r- /o
ss.:
COUNTY OF N*y'r,^/--) )
DryrAfifr: /,hJ ,2 022,before me personally came _
me known and known to me to be the individual
describ&#and who executed the foregoing instrument and acknowledged thathe
executed the same.
Notary Public
j,/
IVAN RODRIOUEZ
Ntotarypubtic,State ot Newyork
_ No.
Qualilled
OlFQgj160zl
in Rlchmond Countv
s$nmission Expires Septernbsr eol Z0-
6 of 30
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
AUTHORIZATION
To: NYC District Council of Carpenters' Benefit Funds
395 Hudson St.
New York, NY 10014-7451.
Re Darryl Nowak
D lo lB: 1212311"963
SSN: 15 6-781.5
Dear Sirs
Please furnish Betancourt, Van Hemmen, Greco & Kenyon LLC, l5L Bodman
Place, Suite 200, Red Bank, New jersey 0770'1,, with certified copies of all records
pertaining to my Welfare Plan. A photocopy of this authorization may be used in
lieu of an original.
arryl Nowak
STATE OF UJ ,^L )
SS
COUNTY OF )
IX^e/ 2022, before me personally came _
me known an d known to me to be the individual
descri and who executed the foregoing instrument and acknowledged thathe
executed the same
Notary Public
, IVAN RODRIOUEZ
Notary Public, State ol New york
No.01HO61 16071
Qualified in Rlchmond
gmmission
County :t j
Expire"q September 2O', Z0:?7
7 of 30
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
AUTHORIZATION
TO: NYC District Council of Carpenters'Benefit Funds
395 Hudson St.
New York, NY L0014-745L
Re: Darryl Nowak
D lO lB: 1212311963
150-66-7875
Dear Sirs:
Please furnish Betancourt, van Hemmen, Greco & Kenyon LLC, 151 Bodman
Place, Suite 200, Red Bank, New Jersey 07701,, with certified copies of all records
pertaining to my union records and benefits. A photocopy of this authorization
may be used in lieu of an original.
D owak
STATE OF f,fa" /,
COUNTY OF t/*/,il- )
)
ss.:
onthe * t, z,z2,before
A/oael-
ou v
-&44-,
to me known
me personauy came
and known to me to be the individual
de in and who executed the foregoing instrument and acknowledged thathe
executed the same.
h-->
Notary Public
, IVAN FODRIGUEZ
Notary pubtic, $tate ol New york
No. 01 R061 1CI021
Oualiliod in Flichmond Countv
.ommission Expire$ sepremner idi zoZY
8 of 30
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
AUTHORIZATION
TO: NYC District Council of Carpenters'Benefit Funds
395 Hudson St.
New York, NY 10014-7457
Re: Darryl Nowak
DIOIB: 1212311"963
SSN:150-66-78L5
Dear Sirs:
Please furnish Betancourt, van Hemmen, Greco & Kenyon LLC, 151 Bodman
Place, Suite 200, Red Bank, New Jersey 0770'J., with certified copies of all records
pertaining to my Annuity Plan. A photocopy of this authorization m ay be used in
lieu of an original
Darryl Nowak
STATE OF tt/n,1r"L )
COUNTY OF tlo' ) SS
the Jd of //a'/ 2022, before me personally came
D" to me known and known to me to be the
individ described in and who executed the foregoing instrument and
acknow d that he executed the same
Notary Public
IVAN HODRIGUEZ
Notary public, State ol New Vork
No.01FO6116071
",,*8:illl'ExJl #.Js?l* /
f.",H !, ro 3
9 of 30
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NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
OCA Oflicial Form No.: 960
AUTHORIZATION F'OR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
[This form has been approved by the New York State Department of Healthl
PatientName Date of Birth Social SecurityNumber
Darryl Nowak 12123n963 150-66-7815
PatientAddress
927 Broadway, Bayonne, NJ 07002
I, or my authorized representative,
request that health information regarding my care and treatment be released as set forth on this form:
In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996
(HIPAA), I understand that:
l. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on
the appropriate line in Item 9(a). In the event the health information described
below includes any of these types of information, and I
initial the line on the box in Item 9(a), I specihcally
authorize release of such information to the person(s) indicated in Item 8.
2. lf I am authorizing the releaseof HlV-related, alcohol or drug treatment, or mental health treatment information, the recipient is
prohibited from redisclosing such information without my authorization unless permitted to do so under federal or state law. I
understand that I have the right to request a list of people who may receive or use my HlV-related information without authorization. If
I experience discrimination because of the release or disclosure of HlV-related
information, I may contact the New York State Division
of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are
responsible for protecting
my rights.
3. I have the right to revokethis authorizationat any time by writing to the health care provider listed below.
I understand that I may
revoke this authorizationexcept to the extent that action has already been taken based on this authorization.
4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for
benefits will not be conditioned
upon my authorization of this disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (exceptas noted above in ltem 2), and this
redisclosuremay no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INF'ORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIF'IED IN ITEM 9
7. Name and address of health provider or entity to release this information:
NYC District Council of Carpenters' Benefit Funds, 395 Hudson St., New York, NY 10014
8. Name and address of person(s) or categoryof person to whom this information will be sent:
Betancourt, Van Hemmen, Greco & Kenyon LLC,151 Bodman Pl., Suite 200, Red Bankn NJ 07701
9(a). Specific information to be released:
E Medical Record from (insert date) to (insert date)
El Entire Medical Record, includingpatient histories, office notes (except
psychotherapy notes), test results, radiology
studies, films,
, referralr, consults, billing records, insurance
records, and records sent to you by other health care providers.
ffiAll Welfare Plan records Include:(Indicate by Initialing)
v Alcohol/Drug Treatment
Mental Health Information
Authorization to Discuss Health Information HlV-Related Information
(b)tr SV initialing here I authorize
Initials Name of individual health care provider
to discuss my health information with my attomey, or a governmental agency, listed here:
(Attomey/Firm Name or Govemmental Agency Name)
10. Reason for release of information: will expire:
11. Date or event on which this authorization
E At request of individual
@ Other: Iitigation at conclusion of litigation
12. If not the patient,
name of person signing form: 13. Authority to sien onKf p.atient:116"
"'u o 92
^/l-
All items on this form have been completed and my questions about this form have been a
copy of the form.
Date:
NA R 02 lr,lld o,
patientor by law
* Human Immunodeficiency Virus that causes AIDS. The New York State Pubtic Health Law protects information
identify someone as having HIV symptoms or infection and information
regarding a person's contacts. "%ru
"""}
10 of 30
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
OCA Oflicial Form No.: 960
AUTHORIZATION FOR RELEASE OF HEALTH INF'ORMATION PURSUANT TO HIPAA
[This form has been approved by the New York State Department of Health]
Patient Name Date of Birth Social Secwity Number
Darryl Nowak 12t23n963 150-66-7815
Patient Address
927 Brordway, Bayonne, NJ 07002
I, or my authorized representative,
request that health information regarding
my care and treatment be released as setforth on this form:
In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996
(HIPAA), I understand that:
1. This authorization may include discloswe of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on
the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I
initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8.
2. If I am authorizing the releaseof HlV-related, alcohol or drug treatment, or mental health treatmentinformation, the recipient is
prohibited from redisclosing such. information without my authorization unless permitted to do so under federal or state law. I
understand that I have the right to request
a list of people
who may receive or use my HlV-related information without authorization. If
I experience discriminationbecause of the release or disclosure of HlV-relatedinformation, I may contact the New York State Division
of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are
responsible for protecting
my rights.
3. I have the right to revoke this authorization at any time by writing to the health care provider
listed below. I understand that I may
revoke this authorizationexcept to the extent that action has already been taken based on this authorization.
4. I understand that signing this authorizationis voluntary. My treatment, payment, enrollment in a health plan, or eligibility for
benefits will not be conditioned upon my authorizationof this disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this
redisclosure may no longer be protectedby federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH AIYYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIF'IED IN ITEM 9
7. Name and address of health provider or entity to release this information:
NYC District Council of Carpenters' Benefit Funds, 395 Hudson St., New York, NY 10014
8. Name and address of person(s) or category of person to whom this information will be sent:
Betancourt, Van Hemmen, Greco & Kenyon LLC, 151 Bodman Pl., Suite 200, Red Ban\ NJ 0770f
9(a). Specificinformation to be released:
E Medical Record from (insert date) to (insert date)
@ Entire Medical Record, including patient histories, office notes (except
psychotherapy notes), test results,
radiology studies, films,
referrals,
consults,billing records, insurancerecords, and records sent to you by other health care providers.
@ Other: All Annuity Plan records Include:(Indicate by Initialing)
Authorization to Discuss Health Information
W{
AlcohoVDrug
Mental Health
HlV-Related
Treatment
Information
Information
O) tr BV initialing here I authorize
Initials Name of individual health care provider
to discuss my health information with my attomey, or a govemmental agency, listed here:
(Attomey/Firm Name or Govemmental Agency Name)
10. Reason for release of information: Il. will
Date or event on which this authorization expire:
E At request of individual
@ Other: litigation at conclusion of litigation
12. If not the patient,
name of person signing form 13. Authority to sign on behalf of patient:
+^"
All items on this form have been completed and my questions about this form have been provided a
copy of the form.
Date:
ilAR 02
or representative law
* Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information
identify someone as having HIV symptoms or infection and information
regarding a person's contacts.
'u"ty
11 of 30
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
OCA OfficialForm No.:960
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
[This form has been apprüved by the New York State Department of Health]
Patient Name Date of Birth Social SecurityNumber
Darryl Nowak 12/23/1963
Patient Address
927 Broadway, Bayonne, NJ 07002
I,or my authorizedrepresentative,request thathealthinformatión regarding my careand treatmentbe released as set forth
on thisform:
In accordance with New York StateLaw and the PrivacyRule of theHealth Insurance and
Portability Ac-takility Act of 1996
(HIPAA), I understand that:
l. This authorization may include disclosure of information relatingto ALCOHOL and DRUG ABUSE, MENTAL HEALTH
except and CONFIDENTIAL HIV* RELATED INFORMATION ifI place on
initials
TREATMENT, psyche*_herapynotes, only my
the appropriateline inItem 9(a).In the event thehealth information described below includesany ofthese types ofinformation, and I
initial
the lineon the box in Item 9(a),Ispecificallyauthorizerelease ofsuch information to theperson(s) indicatedin Item 8.
2. If I am authorizing the release ofHIV-related, alcohol ordrug treatment,or mental health treatment information,the recipientis
prehibited from redisclosing such information without my authorizationunless permitted to do so under federalor state law. I
understand thatI have the rightto requesta list
of people who may receiveor use my HIV-related information without authorization.If
I experience discriminationbecause ofthe releaseor disclosureof HIV-related information,I may contactthe New York StateDivision
of Human Rights at(212) 480-2493 or the New York City Commission of Human Rights at(212) 306-7450. These agencies are
responsible forprotectingmy rights.
3. I have the rightto revoke this authorizationat any time by writingto the healthcare previder listedbelow. I understand thatI may
revoke thisauthorization except tothe extentthat actionhas already been taken based on thisauthorization.
4. I understand that signing thisauthorization is voluntary. My treatment, payment, enrollment ina health plan, or for
eligibility
benefitswill notbe conditioned upon my authorization ofthisdisclosure.
5. Information disclosedunder thisauthorization might be redisclosed by the recipient (except as noted above in Item 2), and this
redisclosuremay no longerbe protected by federalor statelaw.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b).
7. Name and address ofhealth provider orentityto releasethisinformation:
Carpenters'
NYC District Council of Benefit Funds, 395 Hudson St.,New York, NY 10014
8. Name and address ofperson(s) or category ofperson to whom thisinformation will be sent:
Betancourt, Van Mcmmen, Greco & Kenyon LLC, 151 P:±r:: Pl.,Suite 200, Red Bank, NJ 07701
9(a). Specificinformation to be released:
O Medical Record from (insertdate)__ to(insertdate)
O EntireMedical Record, includingpatient office
histories, notes (except psychotherapy notes),testresults,radiologystudies,films,
referrals,
consults, records,
billing insurance records,and records sentto you by other healthcare providers.
O Other: All Safty & Education records Include: (Indicateby ! ::::-'::g)
Alcohol/Drug Treatment
Mental Health Information
Authorization to DiscussHealth Infõrmation HIV-Related Information
(b)O By here
initialing I authorize
Initials Name of individual
healthcare provider
to discussmy health information with my attorney,or a gsvemmental agency, listedhere:
(Attorney/FirmName or Gcv-mcñtal Agency Name)
10. Reason forrelease ofinfarmation: 11. Date or event on which thisauthorizationwill expire:
O At requestof individual
O Other: litigaticñ at concissic= of litigation
12. Ifnot the patient,name ofperson signing form: 13. Authority to signon behalf of patiap
All items on thisform have been completed and my questionsabout thisform have been answer . fl provided a
copy of theform.
Date:
gn f patient
or represenÈtive-authorized by law.
* Human Virus thatcauses AIDS. The New York StatePublic Health Law protects infermation wb ase ould
Ins::±Ecicacy
someone
identify as havingHIV symptoms orinfectionand infarmaties regardinga person's contacts.
12 of 30
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018
NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022
OCA Olficial Form No.: 960
AUTHORIZ
Preview
FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK DARRYL NOWAK, Index No.: 15400012018 Plaintiffs, -against- F'IRST SUPPLEMENTAL DISCOVERY RESPONSE SEA WOLF MARINE TRANSPORTATIONLLC, WITTICH BROTHERS MARINE, fl{C., and WEEKS MARINE INC., Defendants. PLAINTIFF, DARRYL NOWAK through his attorneys, NAPOLI SHKOLNIK, PLLC, supplements his response to the various discovery demands of all Defendants as follows: In addition to the authorizations previously provided, fully executed HIPAA compliant authorizations to obtain plaintiffs records maintained by the following entity are annexed herewith: . NYC DISTRICT COUNCIL OF CARPENTERS BENEFIT FUNDS 395 Hudson Street New York, New York 10014-7451 PLEASE TAKE FURTHER NOTICE that pursuant to CPLR $3101(h) the Plaintiff reserves his right to amend and/or supplement this response should further information become available up to and including time of trial herein. Dated: New York, New York March 3,2022 t l|lAPOI.I Slll(OLl\lII(PLLI fllonililtATtAw 1 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 Yours, etc., NAPOLI SHKOLNIK, PLLC By: Joseph P. Napoli, Esq. Attorneys for Plaintiff 360 Lexington Avenue - l lthFloor New York, New York 10017-6502 (2r2) 3e7-r000 To: BETANCOURT VAN HEMMEN GRECO & KENYON, PLLC Attorneys for Defendants WEEKS MARINE INC. 75 South Broadway - 4th Floor White Plains, New York 10601 (er4) 9e7"-tr00 MAHONEY & KEANE, LLP Attorney s for Defendants SEA WOLF MARINE TRANSPORTATION LLC, and WITTICH BROTHERS MARINE, INC. 61 Broadway - Suite 905 New York, New York 10005 (212) 38s-1422 I'lAP0il c S}lIOIl'lIl(PLLI ATMIililIITLAW 2 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 AUTHORIZATION TO: NYC District Council of Carpenters' Benefit Funds 395 Hudson St. New York, NY 1,0014-7451. Re: Danyl Nowak DloE:1212311963 SSN 150-66-781s Dear Sirs: Please furnish Betancourt, Van Hemmery Greco & Kenyon LLC, 151 Bodman Place, Suite 20O Red Bank, Newlersey 0770'J",with certified copies of all records pertaining to my Vacation Plan. A photocopy of this authorization may be used in lieu of an original. ?r/fur 6urrytlo*J-- srArE oF Na ) ) couNry oF Na, /oL ) the J dav of M*o/, 2022, before me personally came _ No*Ih-- to me known and known to me to be the individual des and who executed the foregoing instrument and acknowledged thathe executed the same. Notary Public IVAN RODRIGUEZ Nolary Publlc,State ol New York No. 01 HO61 I 6071 .ommlssion Qualllled ln Richmond Counly l.t Explres September 2a,20-3- 7 3 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 AUTHORIZATION TO: NYC District Council of Carpenters' Benefit Funds 395 Hudson St. New York, NY L0014-7451, Re: Darryl Nowak D lO lB: 1212311.963 SSN: 150-66-7815 Dear Sirs Please furnish Betancourt, van Hemmen, Greco & Kenyon LLC, 151 Bodman Place, Suite 200, Red Bank, New Jersey 07701,, with certified copies of all records pertaining to my Safety and Education file. A photocopy of this authorization may be used in lieu of an original. Darryl Nowak STATE OF Nn- ) ss.: COUNTY OF Nu, ) of /na'J before me pers onally D*rrl("\tffifu' , to me known and 2022, known to me to be the came individual desc{b/d in and who executed the foregoing instrument and acknowledged thathe executed the same. Notary Public IVAN FODRIGUEZ i Notor!public, State of Newyorle *.ss#tiJ'd*?ffif,i?l:t;y"** 4 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 AUTH TION TO: NYC District Council of Carpenters'Benefit Funds 395 Hudson St. New York, NY 10014-7451 Re Darryl Nowak D lO lB: 1.212311.e63 SSN: 150-66-781,5 Dear Sirs: Please furnish Betancourt, van Hemmen, Greco & Kenyon LLC, 151 Bodman Place, Suite 200, Red Bank, New ]ersey 07707, with certified copies of all records pertaining to my Pension Plan. A photocopy of this authoriz tion may be used in lieu of an original. Darryl Nowak STATE OF N* /,'/- ) COUNTY OF fl* ) ) SS. n the Q -ouu of 4q4---, 2022, before me personally came _ I NaJaU to me known and known to me to be the individual desc(ibed/n and who executed the foregoing instrument and acknowledged thathe executed the same Notary Public , IVAN HODRIGUEZ Notary public, State of New york No.01RO6116071 .,",g$illl' EX Jil#'J#?lfl ?( fJ,U[ !,,0 5 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 AUTHORIZATION TO: NYC District Council of Carpenters' Benefit Funds 395 Hudson St. New York, NY 100L4-7451. Re Darryl Nowak DIOIB: 1212311963 SSN:150-66-7815 Dear Sirs Please furnish Betancourt, Van Hemmery Greco & Kenyon LLC, L5L Bodman Place, Suite 20O Red Bank, NewJersey 0770'J.,with certified copies of all records pertaining to my Union Membership. A photocopy of this authorization may be used in lieu of an original. I Nowak srArE oF N r- /o ss.: COUNTY OF N*y'r,^/--) ) DryrAfifr: /,hJ ,2 022,before me personally came _ me known and known to me to be the individual describ&#and who executed the foregoing instrument and acknowledged thathe executed the same. Notary Public j,/ IVAN RODRIOUEZ Ntotarypubtic,State ot Newyork _ No. Qualilled OlFQgj160zl in Rlchmond Countv s$nmission Expires Septernbsr eol Z0- 6 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 AUTHORIZATION To: NYC District Council of Carpenters' Benefit Funds 395 Hudson St. New York, NY 10014-7451. Re Darryl Nowak D lo lB: 1212311"963 SSN: 15 6-781.5 Dear Sirs Please furnish Betancourt, Van Hemmen, Greco & Kenyon LLC, l5L Bodman Place, Suite 200, Red Bank, New jersey 0770'1,, with certified copies of all records pertaining to my Welfare Plan. A photocopy of this authorization may be used in lieu of an original. arryl Nowak STATE OF UJ ,^L ) SS COUNTY OF ) IX^e/ 2022, before me personally came _ me known an d known to me to be the individual descri and who executed the foregoing instrument and acknowledged thathe executed the same Notary Public , IVAN RODRIOUEZ Notary Public, State ol New york No.01HO61 16071 Qualified in Rlchmond gmmission County :t j Expire"q September 2O', Z0:?7 7 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 AUTHORIZATION TO: NYC District Council of Carpenters'Benefit Funds 395 Hudson St. New York, NY L0014-745L Re: Darryl Nowak D lO lB: 1212311963 150-66-7875 Dear Sirs: Please furnish Betancourt, van Hemmen, Greco & Kenyon LLC, 151 Bodman Place, Suite 200, Red Bank, New Jersey 07701,, with certified copies of all records pertaining to my union records and benefits. A photocopy of this authorization may be used in lieu of an original. D owak STATE OF f,fa" /, COUNTY OF t/*/,il- ) ) ss.: onthe * t, z,z2,before A/oael- ou v -&44-, to me known me personauy came and known to me to be the individual de in and who executed the foregoing instrument and acknowledged thathe executed the same. h--> Notary Public , IVAN FODRIGUEZ Notary pubtic, $tate ol New york No. 01 R061 1CI021 Oualiliod in Flichmond Countv .ommission Expire$ sepremner idi zoZY 8 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 AUTHORIZATION TO: NYC District Council of Carpenters'Benefit Funds 395 Hudson St. New York, NY 10014-7457 Re: Darryl Nowak DIOIB: 1212311"963 SSN:150-66-78L5 Dear Sirs: Please furnish Betancourt, van Hemmen, Greco & Kenyon LLC, 151 Bodman Place, Suite 200, Red Bank, New Jersey 0770'J., with certified copies of all records pertaining to my Annuity Plan. A photocopy of this authorization m ay be used in lieu of an original Darryl Nowak STATE OF tt/n,1r"L ) COUNTY OF tlo' ) SS the Jd of //a'/ 2022, before me personally came D" to me known and known to me to be the individ described in and who executed the foregoing instrument and acknow d that he executed the same Notary Public IVAN HODRIGUEZ Notary public, State ol New Vork No.01FO6116071 ",,*8:illl'ExJl #.Js?l* / f.",H !, ro 3 9 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 OCA Oflicial Form No.: 960 AUTHORIZATION F'OR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA [This form has been approved by the New York State Department of Healthl PatientName Date of Birth Social SecurityNumber Darryl Nowak 12123n963 150-66-7815 PatientAddress 927 Broadway, Bayonne, NJ 07002 I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I understand that: l. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I initial the line on the box in Item 9(a), I specihcally authorize release of such information to the person(s) indicated in Item 8. 2. lf I am authorizing the releaseof HlV-related, alcohol or drug treatment, or mental health treatment information, the recipient is prohibited from redisclosing such information without my authorization unless permitted to do so under federal or state law. I understand that I have the right to request a list of people who may receive or use my HlV-related information without authorization. If I experience discrimination because of the release or disclosure of HlV-related information, I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are responsible for protecting my rights. 3. I have the right to revokethis authorizationat any time by writing to the health care provider listed below. I understand that I may revoke this authorizationexcept to the extent that action has already been taken based on this authorization. 4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (exceptas noted above in ltem 2), and this redisclosuremay no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INF'ORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIF'IED IN ITEM 9 7. Name and address of health provider or entity to release this information: NYC District Council of Carpenters' Benefit Funds, 395 Hudson St., New York, NY 10014 8. Name and address of person(s) or categoryof person to whom this information will be sent: Betancourt, Van Hemmen, Greco & Kenyon LLC,151 Bodman Pl., Suite 200, Red Bankn NJ 07701 9(a). Specific information to be released: E Medical Record from (insert date) to (insert date) El Entire Medical Record, includingpatient histories, office notes (except psychotherapy notes), test results, radiology studies, films, , referralr, consults, billing records, insurance records, and records sent to you by other health care providers. ffiAll Welfare Plan records Include:(Indicate by Initialing) v Alcohol/Drug Treatment Mental Health Information Authorization to Discuss Health Information HlV-Related Information (b)tr SV initialing here I authorize Initials Name of individual health care provider to discuss my health information with my attomey, or a governmental agency, listed here: (Attomey/Firm Name or Govemmental Agency Name) 10. Reason for release of information: will expire: 11. Date or event on which this authorization E At request of individual @ Other: Iitigation at conclusion of litigation 12. If not the patient, name of person signing form: 13. Authority to sien onKf p.atient:116" "'u o 92 ^/l- All items on this form have been completed and my questions about this form have been a copy of the form. Date: NA R 02 lr,lld o, patientor by law * Human Immunodeficiency Virus that causes AIDS. The New York State Pubtic Health Law protects information identify someone as having HIV symptoms or infection and information regarding a person's contacts. "%ru """} 10 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 OCA Oflicial Form No.: 960 AUTHORIZATION FOR RELEASE OF HEALTH INF'ORMATION PURSUANT TO HIPAA [This form has been approved by the New York State Department of Health] Patient Name Date of Birth Social Secwity Number Darryl Nowak 12t23n963 150-66-7815 Patient Address 927 Brordway, Bayonne, NJ 07002 I, or my authorized representative, request that health information regarding my care and treatment be released as setforth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I understand that: 1. This authorization may include discloswe of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8. 2. If I am authorizing the releaseof HlV-related, alcohol or drug treatment, or mental health treatmentinformation, the recipient is prohibited from redisclosing such. information without my authorization unless permitted to do so under federal or state law. I understand that I have the right to request a list of people who may receive or use my HlV-related information without authorization. If I experience discriminationbecause of the release or disclosure of HlV-relatedinformation, I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are responsible for protecting my rights. 3. I have the right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorizationexcept to the extent that action has already been taken based on this authorization. 4. I understand that signing this authorizationis voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorizationof this disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosure may no longer be protectedby federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH AIYYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIF'IED IN ITEM 9 7. Name and address of health provider or entity to release this information: NYC District Council of Carpenters' Benefit Funds, 395 Hudson St., New York, NY 10014 8. Name and address of person(s) or category of person to whom this information will be sent: Betancourt, Van Hemmen, Greco & Kenyon LLC, 151 Bodman Pl., Suite 200, Red Ban\ NJ 0770f 9(a). Specificinformation to be released: E Medical Record from (insert date) to (insert date) @ Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films, referrals, consults,billing records, insurancerecords, and records sent to you by other health care providers. @ Other: All Annuity Plan records Include:(Indicate by Initialing) Authorization to Discuss Health Information W{ AlcohoVDrug Mental Health HlV-Related Treatment Information Information O) tr BV initialing here I authorize Initials Name of individual health care provider to discuss my health information with my attomey, or a govemmental agency, listed here: (Attomey/Firm Name or Govemmental Agency Name) 10. Reason for release of information: Il. will Date or event on which this authorization expire: E At request of individual @ Other: litigation at conclusion of litigation 12. If not the patient, name of person signing form 13. Authority to sign on behalf of patient: +^" All items on this form have been completed and my questions about this form have been provided a copy of the form. Date: ilAR 02 or representative law * Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information identify someone as having HIV symptoms or infection and information regarding a person's contacts. 'u"ty 11 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 OCA OfficialForm No.:960 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA [This form has been apprüved by the New York State Department of Health] Patient Name Date of Birth Social SecurityNumber Darryl Nowak 12/23/1963 Patient Address 927 Broadway, Bayonne, NJ 07002 I,or my authorizedrepresentative,request thathealthinformatión regarding my careand treatmentbe released as set forth on thisform: In accordance with New York StateLaw and the PrivacyRule of theHealth Insurance and Portability Ac-takility Act of 1996 (HIPAA), I understand that: l. This authorization may include disclosure of information relatingto ALCOHOL and DRUG ABUSE, MENTAL HEALTH except and CONFIDENTIAL HIV* RELATED INFORMATION ifI place on initials TREATMENT, psyche*_herapynotes, only my the appropriateline inItem 9(a).In the event thehealth information described below includesany ofthese types ofinformation, and I initial the lineon the box in Item 9(a),Ispecificallyauthorizerelease ofsuch information to theperson(s) indicatedin Item 8. 2. If I am authorizing the release ofHIV-related, alcohol ordrug treatment,or mental health treatment information,the recipientis prehibited from redisclosing such information without my authorizationunless permitted to do so under federalor state law. I understand thatI have the rightto requesta list of people who may receiveor use my HIV-related information without authorization.If I experience discriminationbecause ofthe releaseor disclosureof HIV-related information,I may contactthe New York StateDivision of Human Rights at(212) 480-2493 or the New York City Commission of Human Rights at(212) 306-7450. These agencies are responsible forprotectingmy rights. 3. I have the rightto revoke this authorizationat any time by writingto the healthcare previder listedbelow. I understand thatI may revoke thisauthorization except tothe extentthat actionhas already been taken based on thisauthorization. 4. I understand that signing thisauthorization is voluntary. My treatment, payment, enrollment ina health plan, or for eligibility benefitswill notbe conditioned upon my authorization ofthisdisclosure. 5. Information disclosedunder thisauthorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosuremay no longerbe protected by federalor statelaw. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b). 7. Name and address ofhealth provider orentityto releasethisinformation: Carpenters' NYC District Council of Benefit Funds, 395 Hudson St.,New York, NY 10014 8. Name and address ofperson(s) or category ofperson to whom thisinformation will be sent: Betancourt, Van Mcmmen, Greco & Kenyon LLC, 151 P:±r:: Pl.,Suite 200, Red Bank, NJ 07701 9(a). Specificinformation to be released: O Medical Record from (insertdate)__ to(insertdate) O EntireMedical Record, includingpatient office histories, notes (except psychotherapy notes),testresults,radiologystudies,films, referrals, consults, records, billing insurance records,and records sentto you by other healthcare providers. O Other: All Safty & Education records Include: (Indicateby ! ::::-'::g) Alcohol/Drug Treatment Mental Health Information Authorization to DiscussHealth Infõrmation HIV-Related Information (b)O By here initialing I authorize Initials Name of individual healthcare provider to discussmy health information with my attorney,or a gsvemmental agency, listedhere: (Attorney/FirmName or Gcv-mcñtal Agency Name) 10. Reason forrelease ofinfarmation: 11. Date or event on which thisauthorizationwill expire: O At requestof individual O Other: litigaticñ at concissic= of litigation 12. Ifnot the patient,name ofperson signing form: 13. Authority to signon behalf of patiap All items on thisform have been completed and my questionsabout thisform have been answer . fl provided a copy of theform. Date: gn f patient or represenÈtive-authorized by law. * Human Virus thatcauses AIDS. The New York StatePublic Health Law protects infermation wb ase ould Ins::±Ecicacy someone identify as havingHIV symptoms orinfectionand infarmaties regardinga person's contacts. 12 of 30 FILED: NEW YORK COUNTY CLERK 03/03/2022 02:00 PM INDEX NO. 154000/2018 NYSCEF DOC. NO. 162 RECEIVED NYSCEF: 03/03/2022 OCA Olficial Form No.: 960 AUTHORIZ