On June 30, 2021 a
Exhibit,Appendix
was filed
involving a dispute between
Michael West,
and
Allstate Insurance Company,
for Commercial - Contract
in the District Court of Queens County.
Preview
FILED: QUEENS COUNTY CLERK 02/24/2023 12:06 PM INDEX NO. 714855/2021
NYSCEF DOC. NO. 104 RECEIVED NYSCEF: 02/24/2023
Attorneys At Law
357 Veterans Memorial Highway
Commack, New York 11725
(631) 864-0800 - Fax (631) 864-3599
Samuel E. Felberbaum Christine Doukas
Bonnie S. Halbridge Paralegal
Robert C. Wirth
August 6, 2019
Via Certificate of Mailing
Allstate Insurance Company
PO Box 660636
Dallas, Texas 75266
Attention: No-Fault Department
Re: Claimant: Michael West
Insured: West
D/A: July 29, 2019
Claim No.: 0555072973
Dear Sir/Madam:
This is to advise you that we represent the above named claimant with respect to personal
injuries sustained in the above referenced accident.
Enclosed please find the completed No-Fault application on behalf of Michael West
Kindly commence payment of No-Fault benefits pursuant to the No-Fault provisions of
your assureds' policy.
Please take notice that we are making a claim under the Uninsured Motorist,
Underinsured Motorist and Supplementary Uninsured Motorist (SUM) coverage of your
insured's insurance policy.
If there is any further information required, please contact our office.
SEF/cd
Enc.
FILED: QUEENS COUNTY CLERK 02/24/2023 12:06 PM INDEX NO. 714855/2021
NYSCEF DOC. NO. 104 RECEIVED NYSCEF: 02/24/2023
NSW YORK MOTOR VEHICLE NO-FAULT INSURANCE LAW
APPLICATION FOR MOTOR VEHICLE NO-FAULT BENEFITS
NAME AND ADDRESS OF INSURER NAME, ADDRESS, AND PHONE NUMBER OF INSURER'S
CLAIMS REPRESENTATIVE-
DATE POLiCYHOLDER POLICY NUMBER DATE OF ACCIDENT CLAIM NUMBER
(dtir
TO tNABLE US TO DETERMINE IF YOUR ARE SNTITLcO TO BENEFITS UNDER THE NEW YORK NO-FAULT LF.W,
PLEASE COMPLETE THIS FORM AND RETURN IT PROMPTLY.
IMPORTANT: 1. TO BE ELIGIBLE FOR BENEFITS YOU MUST COMPLETE AND SIGN THIS APPLICATION.
2. YOU MUST SIGN ANY ATTACHED AUTHORIZATION(S).
3. RETURN PROMPTLY WITH COPIES OF ANY BILLS YOU HAVE RECEIVED TO DATE.
NAME AND. ADDRESS OF APPLICANT
1. YOUR NAME , -n 2. PHONENOS. HOME . BUSINESS
•5 V/-,l lO
I. YOUR ADDRESS
Uts} bil uhh-
^
A• ' « "• T r\ATCr /->C DISTU
DATE OF BIRTH 5. SOCIAL SECURITY NO.
(MO., STREET, CiTY OR.TOWN AND ZIP CODE}
jshpTpffNf PI IIISZ. f(9 a iisi
6.. D.ATE
i u. .ANt- TIME
; ;iv*w OF ACCIDENT T ^LACE OF ACCIDENT (STREET). CITY OR TOV^N AND STATE
7. PLAC
8. BRIEF DESCRIPTION OF ACCIDENT
KM-ra MS'M
A
fktniK
/J / /
(5\WJ \)rlifr(ii imAi n lf4-f
9. DEscRisEYouRiNAjRY'^y (^,1 bv\ /?0^. 7wVicC 7o A&^oacp .
ChAiAAfj^ {'hn^V [pV-Vnrili) leM-leQ Kf.Q/'i til K/i^e fcdiiiy •^/icArf(ylS
10. iOSNTITY OF VEHICLE YOU OCCUPIED OR OP£R.aTED ATTHE »T1ME OF THE ACCIDEN i: ' . Y^/in f/
. OV;NER'S NAME MAKE YEAR
» THIS VEHICLE WAS: j ^
A BUS OR SCHOOL BUS.
,1 ,|A TRUCK.rI: r-,
T^AN AUTOMOBILE.
OR A MOTORCYCLE
YES NO
11. WERE YOU THE DRIVER OF THE MOTOR VEHICLE?
VVERE YOU A PASSENGER IN THE MOTOR VEHICLE?
WERE YOU A PEDESTRIAN? 17^
WERE YOU A MEMBER.OF OUR POLICYHOLDER'S HOUSEHOLD?
DO YOU OR A RELATIVE WITH WHOM YOU RESIDE OWN A MOTOR VEHICLE?
CONTINUATION ON NEXT PAGE
MVS FORM NF-2 (Rev 1/2004)
Page 1 of 3
FILED: QUEENS COUNTY CLERK 02/24/2023 12:06 PM INDEX NO. 714855/2021
NYSCEF DOC. NO. 104 RECEIVED NYSCEF: 02/24/2023
APPLIGATION-FOR MOTOR'-yBHIGUS NO-FAULT BENcFlTS- - PAGE TWO
12. Vv-ERS YOU TREATED SY A DOCTOR(S) OR OTHER PERSON{S) FURNISHING.KEALTH SERVICES?
YES NO
Ir YES. NAME AND ADDRESS OF-SUGHOOCTOR(S) OR PERSON(S):
13. IF YOUR WERE TR£ATEDATAHOSPITAL(S); WEREYOU AN
OUT-PATiENT? IT' IN-PATIENT?
DATE OF ADMISSION: 7-IQ:(^
HOSPITAL'S.NAMEANDADDRESS; A-^1 P(U t/
14. AMOUNT OFHEALTH "15. WltL"YOU •HAVE'-MGRE'HEALTH' 1Q. .ATTHETIME OF YOUR ACCIDENT WERE
BILLSTQ DATE: TR^TMENT(S)?- YOU IN THE COURSE OF YOUR
YES^ NO EMPLOYMENT?
3 ! u/" I ^ YES NO ^
17..D1DY0U LOSE TIME DATE ABSENCE FROM HAVE YOU RETURNED TO
FROM WORK? WORK BEGAN: WORK?
YES^^ NO YES NO
IF YES. DATE RETURNED TO WORK: AMOUNT OF TIME'LOSTFROM WORK:
18. WHAT ARE YOUR GROSS AVERAGE NUMBER-OF DAYS YOU WORK NUMBER Or HOURS YOU WORK
WEEKLY HARSjiNGS? PER WEEK: PER-DAY:
1"9; -WEREYOU REGEIVING-UNEMPLOYMENTBENEFITS ATTHETIME OFTHEACCIDENT?
YES NO
20. LIST NAMES AND ADDRESS OF YOUR EMPLOYER AND OTHER EMPLOYERS FOR'ONE YS'VR PRIOR TO
ACCIDENT DATE AND GIVE OCCUPATION AND DATES OFEMPLOYMENT:
VP
1D.ADDRESS
EMPLOYER AND ADDRE
-empioKJiO
' OCCUPATION FROM TO
EMPLOYER AND ADDRESS OCCUPATION -ROM TO
EMPLOYE.R AND ADDRESS OCCUPATION FROM
2.1. .AS'A RESULT OF YOUR INJURY HAD-ANY OTHER SX.oENSES?
I ^ 1 N'C) j 1
IFYES.-ATTACH EXPLANATION.ANDAMpU.NXS Or .S.UGH.EXPENg.ES.
22. DUE TO THIS.AGCIDENTHAVH YOU RECEIVED OR'ARE YOU ELIGIBLEROR PAVMEN i S
UNDER ANY'OF THEFOLLOWING:
YES NO ^
NEVJ YGRK'STATE DISABILITY?
WORKERS' COMPENSATION?
CONTINUATION ON NEXT PAGE
NYS FORM Nr-2 (Rev 1.'200''t)
Page 2 of 3
FILED: QUEENS COUNTY CLERK 02/24/2023 12:06 PM INDEX NO. 714855/2021
NYSCEF DOC. NO. 104 RECEIVED NYSCEF: 02/24/2023
APPUCATEON FOR MOTOR VEHICLE NO-FAULT BENEFITS - - PAGE THREE
THE APPLICANT AUTHORIZES THE INSURER TO^SUBMIT ANY AND ALL OF THESE'FORMS TO ANOTHER PARTY
OR INSURER IF SUCH IS NECESSARY TO PERFECT ITS RIGHTS OF RECOVERY PROVIDED FOR UNDER THE
NO-FAULT LAW.
THIS FORM IS'SUBSCRIBED ANO.AFFIRMED BY'THE
APPLieANT ASTRUE UNBER-THE PENALTIES OF-PER'JURY
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURAN.CE CQMPANY OR OTHER
PERSON FILES AN APPLICATION'FOR QOMMEROIAL-INSURANCE OR A STATEMENT OF CLAIM FOR ANY
COMMERCIAL OR PERSONAL INS.Ut^NOeSENEFlTS CONTAININGANY-MATERIALLYFALSE INFORMATION,
OR^CGNCEALS FOR THE PURPOSE OF MiSLEADiNG, INFORMATION CONCERNING ANY FACT MATERIAL
THcRETO, AND ANY PERSON WHQ, IN CONNECTION WITH- SUCH APPLICATION OR CLAIM, KNOWINGLY
MAKES OR KNOWINGLY ASSlSts, ABETS, SOLICITS OR CONSPIRES V^/ITH ANOTHER TO MAKE A FALSE
REPORT OF THE THEFT, DESTRUCTION, DAMAGE OR CONVERSION OF ANY MOTOR VEHICLE TO A LAW
ENFORCEMENT AGENCY, THE DEPARTMENT OF MOTOR VEHICLES OR AN INSURANCE COMPANY.
COMMITS A FRAUDULENT INSURANCE ACT^ WHICH IS A CRIME, AND SHALL ALSO BE SUBJECT TO A CIVIL
PENALTY NOT TO EXCEED FIVE THOUSAND DOLLARSAND THE VALUE.OF THE SUBJECT MOTOR VEHICLE
OR STATED CLAIM FOR EACH VIOLATION.
V 'k •
SIGNATURE OATS
• DO NOT DETACH
AUTHORIZATION FOR RELEASE OF WORK AND OTHER LOSS INFORMATION
THIS AUTHORIZATION OR PHOTOCOPY THEREOF, WILL AUTHORIZE YOU TO FURNISH ALL INFORMATION YOU MAY
HAVE REGARDING MY VilAGES, SALARY OR OTHER LOSS WHILE EMPLOYED BY YOU. YOUR ARE AUTHORIZED lO
PROVIDE THIS INFORMATION IN ACCORDANCE WITH THE NEW YORK COMPREHENSIVE MOTOR VEHICLE
INSURANCE REPARATIONS ACT (NO-FAULT LAW).
NAME (PRINT OR TYPE) SOCIAL SECURITY NO.
^
'w -SIGNATURE
^ f [f DATE
" DO:NOT DETACH
AUTHORIZATION FOR RELEASE OF HEALTH SERVICE OR TREATMENT INFORMATION
THIS AUTHORIZATION OR PHOTOCOPY THEREOF, WILL AUTHORIZE YOU TO FURNISH ALL IN.^ORMATION YOU MA.Y
HAVE REGARDING MY CONDITION WHILE UNDER YOUR OBSERVATION OR TREATMENT, INCLUDING THE HISTORY
OBTAINED. X-RAYS AND PHYSICAL FINDINGS, DIAGNOSIS AND PROGNOSIS. YOU ARE AUTHORIZED TO PROVIDE
THIS INFO.RMATION IN ACCORD/^J^CE WITH THE' NEW YORK COMPREHENSIVE MOTOR VEHICLE INSURANCE
REPARATIONS ACT (NO-FAULT LAW).
NAME (PRINT OR TYPE)
SIGNATURE
(P- PI 9BATE
(IF THE APPLICANT IS A MINOR. PARENT OR GUARDIAN SHALL SIGN AND INDICATE CAPACITY AND'RELATIONSHIP).
'LANGUAGE TO BEFILLED IN BY INSURER^OR SELF-INSURER.
NYS FORM Nr.2 (Rev 1/2004)
Page 3 of 3
FILED: QUEENS COUNTY CLERK 02/24/2023 12:06 PM INDEX NO. 714855/2021
NYSCEF DOC. NO. 104 RECEIVED NYSCEF: 02/24/2023
&etbet<6af.fjn$ f7Gdbri,cf([e.. <£c. cWi/V-/i
Attorneys At Law
357 Veterans Memorial Highway
aS US POSTAGE
$00,502
Commack/ New York 11725
bti First-Class
Mailed From 11725
£-1 is 08/07/2019
032A 0061837062
.
Via Certificaie of Mailing
Allstate Insurance Company
PO Box 660636
Dallas, Texas 75266
Attention: Mo-Fault Deoartment
752SSSuS3S
Document Filed Date
February 24, 2023
Case Filing Date
June 30, 2021
Category
Commercial - Contract
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
FILED: QUEENS COUNTY CLERK 02/24/2023 12:06 PM INDEX NO. 714855/2021 NYSCEF DOC. NO. 104 RECEIVED NYSCEF: 02/24/2023 Attorneys At Law 357 Veterans Memorial Highway Commack, New York 11725 (631) 864-0800 - Fax (631) 864-3599 Samuel E. Felberbaum Christine Doukas Bonnie S. Halbridge Paralegal Robert C. Wirth August 6, 2019 Via Certificate of Mailing Allstate Insurance Company PO Box 660636 Dallas, Texas 75266 Attention: No-Fault Department Re: Claimant: Michael West Insured: West D/A: July 29, 2019 Claim No.: 0555072973 Dear Sir/Madam: This is to advise you that we represent the above named claimant with respect to personal injuries sustained in the above referenced accident. Enclosed please find the completed No-Fault application on behalf of Michael West Kindly commence payment of No-Fault benefits pursuant to the No-Fault provisions of your assureds' policy. Please take notice that we are making a claim under the Uninsured Motorist, Underinsured Motorist and Supplementary Uninsured Motorist (SUM) coverage of your insured's insurance policy. If there is any further information required, please contact our office. SEF/cd Enc. FILED: QUEENS COUNTY CLERK 02/24/2023 12:06 PM INDEX NO. 714855/2021 NYSCEF DOC. NO. 104 RECEIVED NYSCEF: 02/24/2023 NSW YORK MOTOR VEHICLE NO-FAULT INSURANCE LAW APPLICATION FOR MOTOR VEHICLE NO-FAULT BENEFITS NAME AND ADDRESS OF INSURER NAME, ADDRESS, AND PHONE NUMBER OF INSURER'S CLAIMS REPRESENTATIVE- DATE POLiCYHOLDER POLICY NUMBER DATE OF ACCIDENT CLAIM NUMBER (dtir TO tNABLE US TO DETERMINE IF YOUR ARE SNTITLcO TO BENEFITS UNDER THE NEW YORK NO-FAULT LF.W, PLEASE COMPLETE THIS FORM AND RETURN IT PROMPTLY. IMPORTANT: 1. TO BE ELIGIBLE FOR BENEFITS YOU MUST COMPLETE AND SIGN THIS APPLICATION. 2. YOU MUST SIGN ANY ATTACHED AUTHORIZATION(S). 3. RETURN PROMPTLY WITH COPIES OF ANY BILLS YOU HAVE RECEIVED TO DATE. NAME AND. ADDRESS OF APPLICANT 1. YOUR NAME , -n 2. PHONENOS. HOME . BUSINESS •5 V/-,l lO I. YOUR ADDRESS Uts} bil uhh- ^ A• ' « "• T r\ATCr /->C DISTU DATE OF BIRTH 5. SOCIAL SECURITY NO. (MO., STREET, CiTY OR.TOWN AND ZIP CODE} jshpTpffNf PI IIISZ. f(9 a iisi 6.. D.ATE i u. .ANt- TIME ; ;iv*w OF ACCIDENT T ^LACE OF ACCIDENT (STREET). CITY OR TOV^N AND STATE 7. PLAC 8. BRIEF DESCRIPTION OF ACCIDENT KM-ra MS'M A fktniK /J / / (5\WJ \)rlifr(ii imAi n lf4-f 9. DEscRisEYouRiNAjRY'^y (^,1 bv\ /?0^. 7wVicC 7o A&^oacp . ChAiAAfj^ {'hn^V [pV-Vnrili) leM-leQ Kf.Q/'i til K/i^e fcdiiiy •^/icArf(ylS 10. iOSNTITY OF VEHICLE YOU OCCUPIED OR OP£R.aTED ATTHE »T1ME OF THE ACCIDEN i: ' . Y^/in f/ . OV;NER'S NAME MAKE YEAR » THIS VEHICLE WAS: j ^ A BUS OR SCHOOL BUS. ,1 ,|A TRUCK.rI: r-, T^AN AUTOMOBILE. OR A MOTORCYCLE YES NO 11. WERE YOU THE DRIVER OF THE MOTOR VEHICLE? VVERE YOU A PASSENGER IN THE MOTOR VEHICLE? WERE YOU A PEDESTRIAN? 17^ WERE YOU A MEMBER.OF OUR POLICYHOLDER'S HOUSEHOLD? DO YOU OR A RELATIVE WITH WHOM YOU RESIDE OWN A MOTOR VEHICLE? CONTINUATION ON NEXT PAGE MVS FORM NF-2 (Rev 1/2004) Page 1 of 3 FILED: QUEENS COUNTY CLERK 02/24/2023 12:06 PM INDEX NO. 714855/2021 NYSCEF DOC. NO. 104 RECEIVED NYSCEF: 02/24/2023 APPLIGATION-FOR MOTOR'-yBHIGUS NO-FAULT BENcFlTS- - PAGE TWO 12. Vv-ERS YOU TREATED SY A DOCTOR(S) OR OTHER PERSON{S) FURNISHING.KEALTH SERVICES? YES NO Ir YES. NAME AND ADDRESS OF-SUGHOOCTOR(S) OR PERSON(S): 13. IF YOUR WERE TR£ATEDATAHOSPITAL(S); WEREYOU AN OUT-PATiENT? IT' IN-PATIENT? DATE OF ADMISSION: 7-IQ:(^ HOSPITAL'S.NAMEANDADDRESS; A-^1 P(U t/ 14. AMOUNT OFHEALTH "15. WltL"YOU •HAVE'-MGRE'HEALTH' 1Q. .ATTHETIME OF YOUR ACCIDENT WERE BILLSTQ DATE: TR^TMENT(S)?- YOU IN THE COURSE OF YOUR YES^ NO EMPLOYMENT? 3 ! u/" I ^ YES NO ^ 17..D1DY0U LOSE TIME DATE ABSENCE FROM HAVE YOU RETURNED TO FROM WORK? WORK BEGAN: WORK? YES^^ NO YES NO IF YES. DATE RETURNED TO WORK: AMOUNT OF TIME'LOSTFROM WORK: 18. WHAT ARE YOUR GROSS AVERAGE NUMBER-OF DAYS YOU WORK NUMBER Or HOURS YOU WORK WEEKLY HARSjiNGS? PER WEEK: PER-DAY: 1"9; -WEREYOU REGEIVING-UNEMPLOYMENTBENEFITS ATTHETIME OFTHEACCIDENT? YES NO 20. LIST NAMES AND ADDRESS OF YOUR EMPLOYER AND OTHER EMPLOYERS FOR'ONE YS'VR PRIOR TO ACCIDENT DATE AND GIVE OCCUPATION AND DATES OFEMPLOYMENT: VP 1D.ADDRESS EMPLOYER AND ADDRE -empioKJiO ' OCCUPATION FROM TO EMPLOYER AND ADDRESS OCCUPATION -ROM TO EMPLOYE.R AND ADDRESS OCCUPATION FROM 2.1. .AS'A RESULT OF YOUR INJURY HAD-ANY OTHER SX.oENSES? I ^ 1 N'C) j 1 IFYES.-ATTACH EXPLANATION.ANDAMpU.NXS Or .S.UGH.EXPENg.ES. 22. DUE TO THIS.AGCIDENTHAVH YOU RECEIVED OR'ARE YOU ELIGIBLEROR PAVMEN i S UNDER ANY'OF THEFOLLOWING: YES NO ^ NEVJ YGRK'STATE DISABILITY? WORKERS' COMPENSATION? CONTINUATION ON NEXT PAGE NYS FORM Nr-2 (Rev 1.'200''t) Page 2 of 3 FILED: QUEENS COUNTY CLERK 02/24/2023 12:06 PM INDEX NO. 714855/2021 NYSCEF DOC. NO. 104 RECEIVED NYSCEF: 02/24/2023 APPUCATEON FOR MOTOR VEHICLE NO-FAULT BENEFITS - - PAGE THREE THE APPLICANT AUTHORIZES THE INSURER TO^SUBMIT ANY AND ALL OF THESE'FORMS TO ANOTHER PARTY OR INSURER IF SUCH IS NECESSARY TO PERFECT ITS RIGHTS OF RECOVERY PROVIDED FOR UNDER THE NO-FAULT LAW. THIS FORM IS'SUBSCRIBED ANO.AFFIRMED BY'THE APPLieANT ASTRUE UNBER-THE PENALTIES OF-PER'JURY ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURAN.CE CQMPANY OR OTHER PERSON FILES AN APPLICATION'FOR QOMMEROIAL-INSURANCE OR A STATEMENT OF CLAIM FOR ANY COMMERCIAL OR PERSONAL INS.Ut^NOeSENEFlTS CONTAININGANY-MATERIALLYFALSE INFORMATION, OR^CGNCEALS FOR THE PURPOSE OF MiSLEADiNG, INFORMATION CONCERNING ANY FACT MATERIAL THcRETO, AND ANY PERSON WHQ, IN CONNECTION WITH- SUCH APPLICATION OR CLAIM, KNOWINGLY MAKES OR KNOWINGLY ASSlSts, ABETS, SOLICITS OR CONSPIRES V^/ITH ANOTHER TO MAKE A FALSE REPORT OF THE THEFT, DESTRUCTION, DAMAGE OR CONVERSION OF ANY MOTOR VEHICLE TO A LAW ENFORCEMENT AGENCY, THE DEPARTMENT OF MOTOR VEHICLES OR AN INSURANCE COMPANY. COMMITS A FRAUDULENT INSURANCE ACT^ WHICH IS A CRIME, AND SHALL ALSO BE SUBJECT TO A CIVIL PENALTY NOT TO EXCEED FIVE THOUSAND DOLLARSAND THE VALUE.OF THE SUBJECT MOTOR VEHICLE OR STATED CLAIM FOR EACH VIOLATION. V 'k • SIGNATURE OATS • DO NOT DETACH AUTHORIZATION FOR RELEASE OF WORK AND OTHER LOSS INFORMATION THIS AUTHORIZATION OR PHOTOCOPY THEREOF, WILL AUTHORIZE YOU TO FURNISH ALL INFORMATION YOU MAY HAVE REGARDING MY VilAGES, SALARY OR OTHER LOSS WHILE EMPLOYED BY YOU. YOUR ARE AUTHORIZED lO PROVIDE THIS INFORMATION IN ACCORDANCE WITH THE NEW YORK COMPREHENSIVE MOTOR VEHICLE INSURANCE REPARATIONS ACT (NO-FAULT LAW). NAME (PRINT OR TYPE) SOCIAL SECURITY NO. ^ 'w -SIGNATURE ^ f [f DATE " DO:NOT DETACH AUTHORIZATION FOR RELEASE OF HEALTH SERVICE OR TREATMENT INFORMATION THIS AUTHORIZATION OR PHOTOCOPY THEREOF, WILL AUTHORIZE YOU TO FURNISH ALL IN.^ORMATION YOU MA.Y HAVE REGARDING MY CONDITION WHILE UNDER YOUR OBSERVATION OR TREATMENT, INCLUDING THE HISTORY OBTAINED. X-RAYS AND PHYSICAL FINDINGS, DIAGNOSIS AND PROGNOSIS. YOU ARE AUTHORIZED TO PROVIDE THIS INFO.RMATION IN ACCORD/^J^CE WITH THE' NEW YORK COMPREHENSIVE MOTOR VEHICLE INSURANCE REPARATIONS ACT (NO-FAULT LAW). NAME (PRINT OR TYPE) SIGNATURE (P- PI 9BATE (IF THE APPLICANT IS A MINOR. PARENT OR GUARDIAN SHALL SIGN AND INDICATE CAPACITY AND'RELATIONSHIP). 'LANGUAGE TO BEFILLED IN BY INSURER^OR SELF-INSURER. NYS FORM Nr.2 (Rev 1/2004) Page 3 of 3 FILED: QUEENS COUNTY CLERK 02/24/2023 12:06 PM INDEX NO. 714855/2021 NYSCEF DOC. NO. 104 RECEIVED NYSCEF: 02/24/2023 &etbet<6af.fjn$ f7Gdbri,cf([e.. <£c. cWi/V-/i Attorneys At Law 357 Veterans Memorial Highway aS US POSTAGE $00,502 Commack/ New York 11725 bti First-Class Mailed From 11725 £-1 is 08/07/2019 032A 0061837062 . Via Certificaie of Mailing Allstate Insurance Company PO Box 660636 Dallas, Texas 75266 Attention: Mo-Fault Deoartment 752SSSuS3S