Preview
FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
Exhibit C
FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
LBBS File Nð: 50012-578
SUPREME COURT OF THE 8TATE OF NEW YORK
COUNTY OF KINGS
ABIMAEL TRUIILLO CRU2,
Index Noa 521854/18
Plaintiff,
-against- DEMAND FOR VERIFIED
BILL OF PARTICULARS
11 HOYT PROPERTY OWNER, L.P. and
TRITON CONSTRUCTION COMPANY, LLC,
Defendant s.
___.--___ ___-...__,. __.----,------x
C O U N S E L O R 8:
PLEASE TAKE NOTICE, that pursuant to Section 3041 et seq. of the Civil
Practice Law and Rules, you are hereby required to serve a Verified Bill of Particulars
upon the undersigned within thirty (30) days after receipt of this demand, setting forth the
following:
1. Plaintiffs present residence address.
2. The date and approximate time of day of the occurrence alleged in the
complaint.
3 The approximate location of the happening of the occurrence in sufficient
detail so as to pernjit accurate identification of such location.
4. A general description of the occurrence.
5. A general statement of the acts or omissions of each Defendant
constituting any negligence claimed.
6. Whether actual or constructive notice of any defective or dangerous
condition or activity is claimed and if so, set forth the nature and extent of
such condition or activity.
7. If actual notice is claimed, then set forth the following;
(a) The date or dates of each said notice,
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(b) The names of the agents and/or servants of the Defendants to
whom said actual notice was allegedly given on each of such dates.
(c) By whom said actual notice was allegedly given on each of such
dates.
(d) The substance of each said notice.
8 If constructive notice is claimed, the length of time said condition is
alleged to have existed prior to the happening of the alleged occurrence. If
the length oftime is not known, so state.
9. A statement of any injuries claimed to have resulted from the occurrence
including the approximate date of the onset of symptoms of each of the
injuries elaimed.
10. A description of those injuries claimed to be permanent.
11. The length of time that plaintiff was confmed to bed or home as a result of
the occurrence, with dates of confinement.
12. The length of time that each plaintiff was confined to a hospital or other
health care facility, as a result of the occurrence with the name and address
of each such hospital or facility and the dates of admission and discharge.
13. The date(s) plaintiff received treatment at any hospital out-patient
department or clinic with the name and address of each such hospital or
clinic.
14. The occupation of plaintiff at the time of the occurrence including the
name and address of each employer for the five (5) years preceding the
occurrence and plaintiffs job titleand annual earnings for each of said five
years.
15. The length of time plaintiff was totally disabled, as a result of the
occurrence including specific dates.
16. The length of time plaintiff was partially disabled, as a result of the
occurrence including specific dates.
I 7. The total of special damages incurred to date with regard to the following:
(a) Physician's services, including the name and address of each
physician who treated plaintiff for the injuries claimed to have
been caused by or aggravated by the occurrence.
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(b) Medical supplies, including a description of each supplier from
whom such supphes were purchased.
(c). Loss of eamings, including the dates plaintiff missed from work
and the manner in which said loss is computed.
(d) Hospital expenses and clinic charges.
(e) X-rays other than those for which charges were included in
hospital expenses.
Nurses'
(f) services, other than those for which charges were included
in hospital expenses
(g) All other items of special damage.
18. With respect to the amounts of special damages;
(a) State whether any part of the cost of physician's services, medical
supplies, hospital expenses, nurses services or loss of earnings was
replaced or indemnified from any collateral source such as
workers'
insurance, social security, compensation or employee
benefit programs.
(b) If the answer is in the affirmative, set forth separately as to each
item, the amount of reimbursement received, and the name and
address of the organization or program from whom such
reimbursement was received.
(c) For each organization or program, state the identifying number of
the policy or program, and itseffective dates.
(d) State whéther or not plaintiff has made claim f0r reimbursement
for economic loss to any collateral source which has not as yet
been paid.
(e) If the answer is in the affirmative, state the name and address of
the organization or program to whom such claim was presented,
the date of presentation, the amount claims, and the identifying
number of the policy or program.
(f) State whether or not plaintiff reasonably anticipates making a
claim in the future for reimbursement of future economic loss.
(g) If the answer is in the affirmative, state the name and address of
the organization or program to whom such claim(s) will be
presented, the identifying number of the policy or program, the
extent of total coverage or benefits available to plaintiff.
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19. The date of birth of plaintiff.
20. Set forth by Chapter, Article, Section and paragraph each statute,
ordinance, rule or regulation, if any, which it is claimed each Defendants
violated.
21. Set forth the names and addresses of all witnesses to the occurrence or to
the facts and circumstances surrounding it known to the plaintiff, his
attorneys or his representatives.
22. The nature arid extent of any services allegedly lost.
23, If plaintiff claims that one or more exceptions to the applicability of
Article 16 of the CPLR, enumerated in Section 1602, pertain to this action,
set forth the basis of this claim.
24. Set forth with specificity how itis alleged the Defendants violated §200 of
the Labor Law of the State of New York.
25. Set forth with specificity how itis alleged the Defendants violated §202 of
the Labor Law of the State of New York.
26. Set forth with specificity how itis alleged the Defendants violated §240 of
the Labor Law of the State of New York.
27. Set forth with specificity how itis alleged the Defendants violated §241 of
the Labor Law ofthe State of New York.
28. Set forth with specificity how itis alleged the Defendants violated §241(6)
of the Labor Law of the State of New York,
29. Set forth with specificity those sections of the U.S. Department of Labor
Occupations, Safety & Health Standards sections that plaintiff alleges each
Defendants violated.
30. Set forth with specificity those sections of the Industrial Code of the State
of New York that plaintiff alleges each Defendants violated.
31 State on what date plaintiffs first applied for health insurance coverage
pursuant to the Affordable Care Act ("ACA") under any state or federal
plan.
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(a) State the period of time said heahh insurance coverage was/is in
effect.
(b) State the period of time said health insurance coverage has been in
effect.
(c) identify the state in which plaintiff purchased said health insurance
policy(les) and the level of plan purcitased (plMinum_ gold, silver or
bronze),
32. State what health insurance coverage plaintiffs presently have in effect.
33. Identify the name of the health insurance carrier(s) and the policy
number(s) under which heahh insurance was issued and the dates of each
respective policy.
34. State the annual cost including
(a) The premium cost; and
(b) The out of pocket limit for each policy.
35. Indicate whether plaintiffs were/are eligible for any government issued
subsidies, under the ACA, and the amount of such subsidies award with
respect the purchase of said coverage.
36. State whether plaintiffs listed the following factors in the applicable for
coverage under the ACA such as age, members in the household, residing
county, etc.
plaintiffs' plaintiffs'
37. State on what date spouses or any member of family
applied for health insurance coverage pursuant to the ACA which affords
health insurance coverage to plaintiffs under any state or federal plan
("Family Plan").
(a) State the period of time said Family Plan was in effect.
(b) State what Family Plan coverage you presently have in effect.
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NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
(c) State the period of time said Family Plan has been in effect.
(4) Identify the state in which plaintiffs purchased said health
insurance policy(ies) and the level of plan purchased (platinum, gold,
silver or bronze).
(e) Identify the name of the health insurance carrier(s) and the policy
number(s) under which health insurance was issued and the dates of each
respective policy.
(f) State the annual cost including the premium cost and the out of
pocket limit for each policy.
PLEASE TAKE FURTNER NOTICE that in the event plaintiff fails to comply
with the foregoing demand within thirty (30) days, Defendants wiD move to preclude the
offering of any evidence as to the matters herein demanded, together with the costs of
such application.
Dated: New York, New York
November 26c2018
Yours, etc.
LEWIS BRISBOIS BISGAARD & SMITH LLP
MFC1 E . Z
Atto neys for Defendants
11 OYT PROPERTY OWNER, L.P. and
TRITON CONSTRCCTION COMPANY, LLC
77 Water Street, Suite 2100
New York, New York 10005
(212) 232 1300
TO:
Nicholas Liakas, Esq.
LIAKAS LAW, P.C.
13*
65 Broadway, Floor
New York, New York 10006
Attorneys for Plaintiff
4842-3162-5089 i
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NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
LBBS FileNo: 50012-5711
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINOS
______..___....---------*-----------------x
ABIMAEL TRUJILLO CRUZ,
Index No.: 521854/18
Plaintiff,
-against- NOTICE TO TAKE
EXAMINATION BEFORE
11 HOYT PROPERTY OWNER, L.P. and TRIAL
TRITON CONSTRUCTION COMPANY, LLC,
Defendants.
C O C N S E L O R S:
PLEASE TAKE NOTICE, that pursuant to the applicable rides of this court, the
undersigned will take on behalf of Defendants, 11 HOYT PROPERTY OWNER, L.P.
AND TRITON CONSTRUCTION COMPANY, LLC., on a date and time to be
determined by the parties, at the offices of LEWIS BRISBOIS BISGAARD & SMITH
LLP, 77 Water Street, 21st Floor, New Wrk, New York 10005, the oral examination
of Plaintiff ABIMAEL TRÚJILLO CRUZ, (as adverse parties herein), and the same
will continue from day to day until completed, conceming all of the relevant facts and
circumstances in connection with this litigation, including negligence, contributory
negligence, liability or damages,
The Defendants reserve the tight to use electronic audio and visual means to
record said examinations in conjunction with or instead of stenographic recordings
pursuant to applicable Court rules.
PLEASE TAKE FURTHER NOTICE, that at the time of the taking of the
testimony, the aforesaid party is hereby required to produce all medical bills, accident
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reports, salary records and/or property records which may be used by the person(s) so
testifying to refresh their recollection as to the rnatters herein above set forth.
Dated: New York, New York
November 26, 2018
Yours, etc.
LEWIS BRISBOiS BISGAARD & SMITH LLP
Midl-I LLÉ N. L EZ
Attor eys for Defendants
11 HOYT PROPERTY OWNER, L.P, and
TRITON CONSTRUCTiON COMPANY, LLC
77 Water Street,Suite 2100
New York, New York 10005
(212) 2324300
TO:
Nicholas Liakas, Esq.
LIAKAS LAW, P.C.
13'''
65 Broadway, Floor
New Tork, New Ýork 10006
Attorneys for Plaintiff
(212) 937+7765
48424162-50894
FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
LBBS File No: 50012-571I
SUPREME COURT QF THE STATE OF NEW YORK
COUNTY OF KINGS
____ __ .....,-------------------------------------x
ABIMAEL TROJILLO CRUZ,
Index No.: 521854/18
Plaintiff,
-against- DEMAND FOR
AUTHORIZATION FOR
11 HOYT PROPERTY OWNER, L.P. and SOCIAL SECURITY
TRITON CONSTRUCTION COMPANY, LLC, PRINTOUT
Defendants,
______________________________________------.x
C O U N 8 E L O R 8:
PLEASE TAKE NOTICE, that demand is hereby made upon you to provide to
the undersigned, pursuant to the applicable Rules of this Court and the CPLR, duly
executed HIPAA compliant authorization(s) to the Social Security Administration for a
printout regarding plaintiffs Itemized Statement of Earnings from first employment to
present, within twenty (20) days of this dema¾ in the fonn attached herete.
PLEASE TAKE FURTHER NOTICE, that upon failure to produce the
aforesaid item(s) in the time required by this Demand, a motion will be made to the Court
for the appropriate relief with costs.
Dated: New York, New York
November 26, 2018
4842-3162,5089.1
- -- ... ..
FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
Yours, etc.
LEWIS BRISBOIS BISGAARD & SMITH LLP
MICH LE N. Z
Attor eys for Defendants
11 11 YT PROPERTY OWNER, L.P. and
TRITON CONSTRUCTION COMPANY, LLC
77 Water Street, Suite 2100
New York, New York 10005
(212) 232-1300
TO:
Nicholas Liakas, Esq.
LIAKAS LAW, P.C.
13*
65 Broadway, Floor
New York, New York 10006
Attorneys for Plaintiff
(212) 937-7765
4B42-3162-5089;1
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NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
HIPAA COMPLIANT AUTHORIZATION
TO: SOCIAL SECURITY ADMINISTRATION
Office of Central Records
300 North Greene Street
Baltimore, MD 21201
Social Security Number:
Kindly permit attorneys LEWIS BRIBBOIS BISGAARD & SMITH LLP, or
bearer, to inspect and make copies of your complete Itemized Statement of Earnings from
first employment of ABiMAEL TRUJILLO CRUZ,. who was injured due to an
accident on
STATE OF NEW YORK )
) as.
COUNTY OF )
On this day of , 2018, before me
personally came and appeared to me known and
known to me to be the individual described who executed the foregoing instrument, and
she/he duly acknowledged to me thatshe/he executed the same.
Notary Public
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NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
LBBS FileNo: 50012-5711
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
-------- ---------------------------------x
ABIMAEL TRUJILLO CRUZ,
Index No.; 521854/18
Plaintiff,
-against- DEMAND FOR
COLLATERAL SOURCE
11 HOYT PROPERTY OWNER, LP. and PAYMENT
TRITON CONSTRUCTION COMPANY, LLC, INFORMATION
Defendants.
---------------- - ------------ --------x
C O U N S E L O R 8:
PLEASE TAKE NOTICE, that pursuant to the applicabic Rules of this Court,
you are required to serve within twenty (20) days after receipt of this notice the following
information:
L The names, addresses arid ainounts received to date from all persons,
firms, or organizations which have reimbursed plaintiff for the cost of medical care,
custodial care, rehabilitation services, loss of earnings or other economic loss, and other
costs including but not limited to;
(a) Insurance;
(b) Social Security Benefits;
Workers'
(c) Compensation Benefits
(d) Disability Benefits
(e) Employee Benefits Program;
(f) Any other source.
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2. Where teimbursement was or is pursuant to a policy of any type, state the
name of the policy holder, the policy number, and the name of the insurer of the policy; a
list of claims submitted pursuant to the policy, and the amount of rñ0ñey received
pursuant to each claim.
3. Duly executed and acknowledged written HIPAA compliant
authorizations directed to all persons, firms, or organizations which have reimbursed
plaintiff for costs of medical care, custodial care, rehabilitation services, loss of earnings
or other economic loss or other costs or to whom such claims have been submitted to
obtain copies of the policies under which said payments or claims were made, copies of
allchecks and other indicia of payment, and copies of claims submitted for payment.
any
PLEASE TAKE FURTNER NOTICE, HIPAA compliant authorizations for
any insurance documents and policy produced in respense to the demand herein shall be
for the complete document and policy including but not limited to declaration sheets,
riders, limitations, endorsements, amendmentsecancellations, face sheets and/or binders,
etc.
PLEASE TAKE FURTHER NOTICE, that if it isclaimed that no such persons,
firms or ogañizations have reimbursed plaintiff for such costs, then dernand is hereby
made that the above-named party set forth by affidavit of such fact.
Dated: New York, New York
November 26, 2018
4842-3162-5089.1
FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
Yours, etc.
LEWIS BRISBOIS BISGAARD & SMITH LLP
MIÒHELL N. L
Attorne for Defendants
11 HO T PROPERTY OWNER, L.P, and
TRITON CONSTRUCTION COMPANY, LLC
77 Water Street, Suite 2100
New York, New York 10005
(212) 232-1300
TO:
Nicholas Liakas, Esq.
LIAKAS LAW, P.C.
65 Broadway, 139 Floor
New York, New York 10006
Attorneys for Plaintiff
(212) 937-7765
4642-3162-5089.1
FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
LBBS File No:50012-5711
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
--------------- _,...---..--- ----------x
ABIMAEL TRUJILLO CRUZ,
index No.; 521854/18
Plaintiff,
-against- DEMAND FOR
AUTHORIZATIONS
11 HOYT PROPERTY OWNER, L.P. and
TRITON CONSTRUCTION COMPANY, LLC,
Defendants.
C O U N S E L O R &
PLEASE TAKE NOTICE, that Defendants 11 HOYT PROPERTY OWNER,
L.P. AND TRITON CONSTRUCTION COMPANY3 LLC., by their attorneys LEWIS
BRISBOIS BISGAARD & SMITH LLP, hereby demand that plaintiff, in accordance
with the applicable Rules of the Civil Practice Law & Rules, local Court Rules and Case
Law, serve within twenty (20) days after receipt of this demand, a duly executed and
acknowledged written HIPAA compliant authorization permitting defendantf attorneys
to obtain the complete Ambulance Call Report or Prehospital Care Report of the plaintiff
ABIMAEL TRUJiLLO CRUZ from the date of the alleged accident.
PLEASE TAKE FURTHER NOTICE, that said HIPAA compliant
authorization must appropriately contain the full and proper name and address of the
entity from which the records are to be released, together with any information necessary
to identify plaintiff, such as social security number, medical record number, and initials
within section 9(a) of the autherization to obtain the requisite records.
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PLEASE TAKE FURTHERNOTICE, that failure to comply with this Demand
within twenty (20) days from receipt hereof will leave you subject to the provisions of the
CPLR and may result in the plaintiff being precluded at trial from testifying or offering
into evidence any evidence pertaining to or contained in the items demanded herein.
PLEASE TAKE FURTHER NOTICE, that this shall be deemed a continuing
derüãüd the pendency of this action if any of the above requested items are
during
subsequently obtained.
PLEASE TAKE FURTHER NOTICE, that upon failure to produce the
aforesaid items at the time and place required in this demand, a motion will be made to
the Court for the appropriate relief with cost.
Dated: New York, New York
November 26, 2018
Ÿours, etc.
LEWIS BRISBOIS BISGAARD & SMITH LLP
MICH LE N. I(O0 Ed
Atto eys for Defendants
11 OYT PROPERTY OWNER, L.P. and
TRITON CONSTRUCTION COMPANY, LLC
77 Water Street, Suite 2100
New York, New York 10005
(212) 2324300
TO:
Nicholas Liakas, Esq.
LIAKAS LAW, P.C.
13"'
65 Broadway, Floor
New York, New York 10006
Attorneys for Plaintiff
(212) 937-7765
4842-316.2-5089.1
FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
LBBS File Nb: 50012-5711
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
AB1MAEL TRUJiLLO CRUZ,
Index Noa 521854/18
Plaintiff,
-against- DEMAND FOR
DAMAGES
11 HOYT PROPERTY OWNER, L,P. and
TRITON CONSTRUCTION COMPANY, LLC,
Defendants.
--..------------------------------------------ x
C O U N 8 E L O R 8:
PLEASE TAKE NOTICE, that pursuant to CPLR 3017(c), Defendants, 11
HOYT PROPERTY OWNER, L.P. and TRITON CONSTRUCTION COMPANY,
LLC., hereby request that within twenty (20} days, the plaintiff serve a supplcmcñtal
demand for relief, setting forth the total damages to which he deems himself entitled.
PLEASE TAKE FURTHER NOTICE, that upon failure to produce the
aforesaid item(s) at the time and place required in this dcmand, a motion will be made to
the Court for the appropriate relief with costs.
Dated: New York, New York
November 26, 2018
4842-3162-5089.1
FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018
NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019
Yours, etc.
LEWIS B B S BISGAARD & S iTH LLP
Preview
FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 Exhibit C FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 LBBS File Nð: 50012-578 SUPREME COURT OF THE 8TATE OF NEW YORK COUNTY OF KINGS ABIMAEL TRUIILLO CRU2, Index Noa 521854/18 Plaintiff, -against- DEMAND FOR VERIFIED BILL OF PARTICULARS 11 HOYT PROPERTY OWNER, L.P. and TRITON CONSTRUCTION COMPANY, LLC, Defendant s. ___.--___ ___-...__,. __.----,------x C O U N S E L O R 8: PLEASE TAKE NOTICE, that pursuant to Section 3041 et seq. of the Civil Practice Law and Rules, you are hereby required to serve a Verified Bill of Particulars upon the undersigned within thirty (30) days after receipt of this demand, setting forth the following: 1. Plaintiffs present residence address. 2. The date and approximate time of day of the occurrence alleged in the complaint. 3 The approximate location of the happening of the occurrence in sufficient detail so as to pernjit accurate identification of such location. 4. A general description of the occurrence. 5. A general statement of the acts or omissions of each Defendant constituting any negligence claimed. 6. Whether actual or constructive notice of any defective or dangerous condition or activity is claimed and if so, set forth the nature and extent of such condition or activity. 7. If actual notice is claimed, then set forth the following; (a) The date or dates of each said notice, 4842-3f62-5089.1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 (b) The names of the agents and/or servants of the Defendants to whom said actual notice was allegedly given on each of such dates. (c) By whom said actual notice was allegedly given on each of such dates. (d) The substance of each said notice. 8 If constructive notice is claimed, the length of time said condition is alleged to have existed prior to the happening of the alleged occurrence. If the length oftime is not known, so state. 9. A statement of any injuries claimed to have resulted from the occurrence including the approximate date of the onset of symptoms of each of the injuries elaimed. 10. A description of those injuries claimed to be permanent. 11. The length of time that plaintiff was confmed to bed or home as a result of the occurrence, with dates of confinement. 12. The length of time that each plaintiff was confined to a hospital or other health care facility, as a result of the occurrence with the name and address of each such hospital or facility and the dates of admission and discharge. 13. The date(s) plaintiff received treatment at any hospital out-patient department or clinic with the name and address of each such hospital or clinic. 14. The occupation of plaintiff at the time of the occurrence including the name and address of each employer for the five (5) years preceding the occurrence and plaintiffs job titleand annual earnings for each of said five years. 15. The length of time plaintiff was totally disabled, as a result of the occurrence including specific dates. 16. The length of time plaintiff was partially disabled, as a result of the occurrence including specific dates. I 7. The total of special damages incurred to date with regard to the following: (a) Physician's services, including the name and address of each physician who treated plaintiff for the injuries claimed to have been caused by or aggravated by the occurrence. 4842-3162-5089.1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 (b) Medical supplies, including a description of each supplier from whom such supphes were purchased. (c). Loss of eamings, including the dates plaintiff missed from work and the manner in which said loss is computed. (d) Hospital expenses and clinic charges. (e) X-rays other than those for which charges were included in hospital expenses. Nurses' (f) services, other than those for which charges were included in hospital expenses (g) All other items of special damage. 18. With respect to the amounts of special damages; (a) State whether any part of the cost of physician's services, medical supplies, hospital expenses, nurses services or loss of earnings was replaced or indemnified from any collateral source such as workers' insurance, social security, compensation or employee benefit programs. (b) If the answer is in the affirmative, set forth separately as to each item, the amount of reimbursement received, and the name and address of the organization or program from whom such reimbursement was received. (c) For each organization or program, state the identifying number of the policy or program, and itseffective dates. (d) State whéther or not plaintiff has made claim f0r reimbursement for economic loss to any collateral source which has not as yet been paid. (e) If the answer is in the affirmative, state the name and address of the organization or program to whom such claim was presented, the date of presentation, the amount claims, and the identifying number of the policy or program. (f) State whether or not plaintiff reasonably anticipates making a claim in the future for reimbursement of future economic loss. (g) If the answer is in the affirmative, state the name and address of the organization or program to whom such claim(s) will be presented, the identifying number of the policy or program, the extent of total coverage or benefits available to plaintiff. 4842-3162-5089,1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 19. The date of birth of plaintiff. 20. Set forth by Chapter, Article, Section and paragraph each statute, ordinance, rule or regulation, if any, which it is claimed each Defendants violated. 21. Set forth the names and addresses of all witnesses to the occurrence or to the facts and circumstances surrounding it known to the plaintiff, his attorneys or his representatives. 22. The nature arid extent of any services allegedly lost. 23, If plaintiff claims that one or more exceptions to the applicability of Article 16 of the CPLR, enumerated in Section 1602, pertain to this action, set forth the basis of this claim. 24. Set forth with specificity how itis alleged the Defendants violated §200 of the Labor Law of the State of New York. 25. Set forth with specificity how itis alleged the Defendants violated §202 of the Labor Law of the State of New York. 26. Set forth with specificity how itis alleged the Defendants violated §240 of the Labor Law of the State of New York. 27. Set forth with specificity how itis alleged the Defendants violated §241 of the Labor Law ofthe State of New York. 28. Set forth with specificity how itis alleged the Defendants violated §241(6) of the Labor Law of the State of New York, 29. Set forth with specificity those sections of the U.S. Department of Labor Occupations, Safety & Health Standards sections that plaintiff alleges each Defendants violated. 30. Set forth with specificity those sections of the Industrial Code of the State of New York that plaintiff alleges each Defendants violated. 31 State on what date plaintiffs first applied for health insurance coverage pursuant to the Affordable Care Act ("ACA") under any state or federal plan. 4842-3162-5089.1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 (a) State the period of time said heahh insurance coverage was/is in effect. (b) State the period of time said health insurance coverage has been in effect. (c) identify the state in which plaintiff purchased said health insurance policy(les) and the level of plan purcitased (plMinum_ gold, silver or bronze), 32. State what health insurance coverage plaintiffs presently have in effect. 33. Identify the name of the health insurance carrier(s) and the policy number(s) under which heahh insurance was issued and the dates of each respective policy. 34. State the annual cost including (a) The premium cost; and (b) The out of pocket limit for each policy. 35. Indicate whether plaintiffs were/are eligible for any government issued subsidies, under the ACA, and the amount of such subsidies award with respect the purchase of said coverage. 36. State whether plaintiffs listed the following factors in the applicable for coverage under the ACA such as age, members in the household, residing county, etc. plaintiffs' plaintiffs' 37. State on what date spouses or any member of family applied for health insurance coverage pursuant to the ACA which affords health insurance coverage to plaintiffs under any state or federal plan ("Family Plan"). (a) State the period of time said Family Plan was in effect. (b) State what Family Plan coverage you presently have in effect. 4842-3162-5089 1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 (c) State the period of time said Family Plan has been in effect. (4) Identify the state in which plaintiffs purchased said health insurance policy(ies) and the level of plan purchased (platinum, gold, silver or bronze). (e) Identify the name of the health insurance carrier(s) and the policy number(s) under which health insurance was issued and the dates of each respective policy. (f) State the annual cost including the premium cost and the out of pocket limit for each policy. PLEASE TAKE FURTNER NOTICE that in the event plaintiff fails to comply with the foregoing demand within thirty (30) days, Defendants wiD move to preclude the offering of any evidence as to the matters herein demanded, together with the costs of such application. Dated: New York, New York November 26c2018 Yours, etc. LEWIS BRISBOIS BISGAARD & SMITH LLP MFC1 E . Z Atto neys for Defendants 11 OYT PROPERTY OWNER, L.P. and TRITON CONSTRCCTION COMPANY, LLC 77 Water Street, Suite 2100 New York, New York 10005 (212) 232 1300 TO: Nicholas Liakas, Esq. LIAKAS LAW, P.C. 13* 65 Broadway, Floor New York, New York 10006 Attorneys for Plaintiff 4842-3162-5089 i FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 LBBS FileNo: 50012-5711 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINOS ______..___....---------*-----------------x ABIMAEL TRUJILLO CRUZ, Index No.: 521854/18 Plaintiff, -against- NOTICE TO TAKE EXAMINATION BEFORE 11 HOYT PROPERTY OWNER, L.P. and TRIAL TRITON CONSTRUCTION COMPANY, LLC, Defendants. C O C N S E L O R S: PLEASE TAKE NOTICE, that pursuant to the applicable rides of this court, the undersigned will take on behalf of Defendants, 11 HOYT PROPERTY OWNER, L.P. AND TRITON CONSTRUCTION COMPANY, LLC., on a date and time to be determined by the parties, at the offices of LEWIS BRISBOIS BISGAARD & SMITH LLP, 77 Water Street, 21st Floor, New Wrk, New York 10005, the oral examination of Plaintiff ABIMAEL TRÚJILLO CRUZ, (as adverse parties herein), and the same will continue from day to day until completed, conceming all of the relevant facts and circumstances in connection with this litigation, including negligence, contributory negligence, liability or damages, The Defendants reserve the tight to use electronic audio and visual means to record said examinations in conjunction with or instead of stenographic recordings pursuant to applicable Court rules. PLEASE TAKE FURTHER NOTICE, that at the time of the taking of the testimony, the aforesaid party is hereby required to produce all medical bills, accident 4842-3162-5089.1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 reports, salary records and/or property records which may be used by the person(s) so testifying to refresh their recollection as to the rnatters herein above set forth. Dated: New York, New York November 26, 2018 Yours, etc. LEWIS BRISBOiS BISGAARD & SMITH LLP Midl-I LLÉ N. L EZ Attor eys for Defendants 11 HOYT PROPERTY OWNER, L.P, and TRITON CONSTRUCTiON COMPANY, LLC 77 Water Street,Suite 2100 New York, New York 10005 (212) 2324300 TO: Nicholas Liakas, Esq. LIAKAS LAW, P.C. 13''' 65 Broadway, Floor New Tork, New Ýork 10006 Attorneys for Plaintiff (212) 937+7765 48424162-50894 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 LBBS File No: 50012-571I SUPREME COURT QF THE STATE OF NEW YORK COUNTY OF KINGS ____ __ .....,-------------------------------------x ABIMAEL TROJILLO CRUZ, Index No.: 521854/18 Plaintiff, -against- DEMAND FOR AUTHORIZATION FOR 11 HOYT PROPERTY OWNER, L.P. and SOCIAL SECURITY TRITON CONSTRUCTION COMPANY, LLC, PRINTOUT Defendants, ______________________________________------.x C O U N 8 E L O R 8: PLEASE TAKE NOTICE, that demand is hereby made upon you to provide to the undersigned, pursuant to the applicable Rules of this Court and the CPLR, duly executed HIPAA compliant authorization(s) to the Social Security Administration for a printout regarding plaintiffs Itemized Statement of Earnings from first employment to present, within twenty (20) days of this dema¾ in the fonn attached herete. PLEASE TAKE FURTHER NOTICE, that upon failure to produce the aforesaid item(s) in the time required by this Demand, a motion will be made to the Court for the appropriate relief with costs. Dated: New York, New York November 26, 2018 4842-3162,5089.1 - -- ... .. FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 Yours, etc. LEWIS BRISBOIS BISGAARD & SMITH LLP MICH LE N. Z Attor eys for Defendants 11 11 YT PROPERTY OWNER, L.P. and TRITON CONSTRUCTION COMPANY, LLC 77 Water Street, Suite 2100 New York, New York 10005 (212) 232-1300 TO: Nicholas Liakas, Esq. LIAKAS LAW, P.C. 13* 65 Broadway, Floor New York, New York 10006 Attorneys for Plaintiff (212) 937-7765 4B42-3162-5089;1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 HIPAA COMPLIANT AUTHORIZATION TO: SOCIAL SECURITY ADMINISTRATION Office of Central Records 300 North Greene Street Baltimore, MD 21201 Social Security Number: Kindly permit attorneys LEWIS BRIBBOIS BISGAARD & SMITH LLP, or bearer, to inspect and make copies of your complete Itemized Statement of Earnings from first employment of ABiMAEL TRUJILLO CRUZ,. who was injured due to an accident on STATE OF NEW YORK ) ) as. COUNTY OF ) On this day of , 2018, before me personally came and appeared to me known and known to me to be the individual described who executed the foregoing instrument, and she/he duly acknowledged to me thatshe/he executed the same. Notary Public 4842-3182-5089.1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 LBBS FileNo: 50012-5711 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS -------- ---------------------------------x ABIMAEL TRUJILLO CRUZ, Index No.; 521854/18 Plaintiff, -against- DEMAND FOR COLLATERAL SOURCE 11 HOYT PROPERTY OWNER, LP. and PAYMENT TRITON CONSTRUCTION COMPANY, LLC, INFORMATION Defendants. ---------------- - ------------ --------x C O U N S E L O R 8: PLEASE TAKE NOTICE, that pursuant to the applicabic Rules of this Court, you are required to serve within twenty (20) days after receipt of this notice the following information: L The names, addresses arid ainounts received to date from all persons, firms, or organizations which have reimbursed plaintiff for the cost of medical care, custodial care, rehabilitation services, loss of earnings or other economic loss, and other costs including but not limited to; (a) Insurance; (b) Social Security Benefits; Workers' (c) Compensation Benefits (d) Disability Benefits (e) Employee Benefits Program; (f) Any other source. 4842-3162-5089.1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 2. Where teimbursement was or is pursuant to a policy of any type, state the name of the policy holder, the policy number, and the name of the insurer of the policy; a list of claims submitted pursuant to the policy, and the amount of rñ0ñey received pursuant to each claim. 3. Duly executed and acknowledged written HIPAA compliant authorizations directed to all persons, firms, or organizations which have reimbursed plaintiff for costs of medical care, custodial care, rehabilitation services, loss of earnings or other economic loss or other costs or to whom such claims have been submitted to obtain copies of the policies under which said payments or claims were made, copies of allchecks and other indicia of payment, and copies of claims submitted for payment. any PLEASE TAKE FURTNER NOTICE, HIPAA compliant authorizations for any insurance documents and policy produced in respense to the demand herein shall be for the complete document and policy including but not limited to declaration sheets, riders, limitations, endorsements, amendmentsecancellations, face sheets and/or binders, etc. PLEASE TAKE FURTHER NOTICE, that if it isclaimed that no such persons, firms or ogañizations have reimbursed plaintiff for such costs, then dernand is hereby made that the above-named party set forth by affidavit of such fact. Dated: New York, New York November 26, 2018 4842-3162-5089.1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 Yours, etc. LEWIS BRISBOIS BISGAARD & SMITH LLP MIÒHELL N. L Attorne for Defendants 11 HO T PROPERTY OWNER, L.P, and TRITON CONSTRUCTION COMPANY, LLC 77 Water Street, Suite 2100 New York, New York 10005 (212) 232-1300 TO: Nicholas Liakas, Esq. LIAKAS LAW, P.C. 65 Broadway, 139 Floor New York, New York 10006 Attorneys for Plaintiff (212) 937-7765 4642-3162-5089.1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 LBBS File No:50012-5711 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS --------------- _,...---..--- ----------x ABIMAEL TRUJILLO CRUZ, index No.; 521854/18 Plaintiff, -against- DEMAND FOR AUTHORIZATIONS 11 HOYT PROPERTY OWNER, L.P. and TRITON CONSTRUCTION COMPANY, LLC, Defendants. C O U N S E L O R & PLEASE TAKE NOTICE, that Defendants 11 HOYT PROPERTY OWNER, L.P. AND TRITON CONSTRUCTION COMPANY3 LLC., by their attorneys LEWIS BRISBOIS BISGAARD & SMITH LLP, hereby demand that plaintiff, in accordance with the applicable Rules of the Civil Practice Law & Rules, local Court Rules and Case Law, serve within twenty (20) days after receipt of this demand, a duly executed and acknowledged written HIPAA compliant authorization permitting defendantf attorneys to obtain the complete Ambulance Call Report or Prehospital Care Report of the plaintiff ABIMAEL TRUJiLLO CRUZ from the date of the alleged accident. PLEASE TAKE FURTHER NOTICE, that said HIPAA compliant authorization must appropriately contain the full and proper name and address of the entity from which the records are to be released, together with any information necessary to identify plaintiff, such as social security number, medical record number, and initials within section 9(a) of the autherization to obtain the requisite records. 4842-3162-5089.1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 PLEASE TAKE FURTHERNOTICE, that failure to comply with this Demand within twenty (20) days from receipt hereof will leave you subject to the provisions of the CPLR and may result in the plaintiff being precluded at trial from testifying or offering into evidence any evidence pertaining to or contained in the items demanded herein. PLEASE TAKE FURTHER NOTICE, that this shall be deemed a continuing derüãüd the pendency of this action if any of the above requested items are during subsequently obtained. PLEASE TAKE FURTHER NOTICE, that upon failure to produce the aforesaid items at the time and place required in this demand, a motion will be made to the Court for the appropriate relief with cost. Dated: New York, New York November 26, 2018 Ÿours, etc. LEWIS BRISBOIS BISGAARD & SMITH LLP MICH LE N. I(O0 Ed Atto eys for Defendants 11 OYT PROPERTY OWNER, L.P. and TRITON CONSTRUCTION COMPANY, LLC 77 Water Street, Suite 2100 New York, New York 10005 (212) 2324300 TO: Nicholas Liakas, Esq. LIAKAS LAW, P.C. 13"' 65 Broadway, Floor New York, New York 10006 Attorneys for Plaintiff (212) 937-7765 4842-316.2-5089.1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 LBBS File Nb: 50012-5711 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS AB1MAEL TRUJiLLO CRUZ, Index Noa 521854/18 Plaintiff, -against- DEMAND FOR DAMAGES 11 HOYT PROPERTY OWNER, L,P. and TRITON CONSTRUCTION COMPANY, LLC, Defendants. --..------------------------------------------ x C O U N 8 E L O R 8: PLEASE TAKE NOTICE, that pursuant to CPLR 3017(c), Defendants, 11 HOYT PROPERTY OWNER, L.P. and TRITON CONSTRUCTION COMPANY, LLC., hereby request that within twenty (20} days, the plaintiff serve a supplcmcñtal demand for relief, setting forth the total damages to which he deems himself entitled. PLEASE TAKE FURTHER NOTICE, that upon failure to produce the aforesaid item(s) at the time and place required in this dcmand, a motion will be made to the Court for the appropriate relief with costs. Dated: New York, New York November 26, 2018 4842-3162-5089.1 FILED: KINGS COUNTY CLERK 09/24/2019 10:09 PM INDEX NO. 521854/2018 NYSCEF DOC. NO. 19 RECEIVED NYSCEF: 09/24/2019 Yours, etc. LEWIS B B S BISGAARD & S iTH LLP