On March 29, 2019 a
Exhibit,Appendix
was filed
involving a dispute between
Rafik Arabov,
and
New York City Police Department,
Patrick Lacruz,
The City Of New York,
for Torts - Motor Vehicle
in the District Court of Queens County.
Preview
FILED: QUEENS COUNTY CLERK 03/01/2023 03:38 PM INDEX NO. 705559/2019
NYSCEF DOC. NO. 125 RECEIVED NYSCEF: 03/01/2023
EXHIBIT 2
FILED: QUEENS COUNTY CLERK 03/01/2023 03:38 PM INDEX NO. 705559/2019
NYSCEF DOC. NO. 125 RECEIVED NYSCEF: 03/01/2023
8½" Of this form are required.
This form is x 14". Three (3) completed copies
INSTRUCTIONS: This report is to be prepared by the investigating supervisor and Executive Officer, Precinct-Jf occurrence. Original copy
photos contained in a Envelope (see PG 2 7-06) to Personnel Safety DpsivS fopy to Patrol Boro,
will be f d with Jewelry Security
each copy forwarded.
2a4Co to Operator's Personnel Folder at Command, with a copy of the Police A cIdent Report (MV104AN) attached to
COLLISION REPORT-
POLICE DEPT. VEHICLE
PD 301-153 (Rev. 08-14) PATROLBORO COLLISION NO.
PART A (PREPARED BY INVESTIGATING 0
SUPERVISOR)
DATE OF COLLLSION TIME OF COLLISION PCT COLL NO PCT OF OCCURRENCE DEPT VEHICLE NO 1YPE OF VEHICLE FSD COLL. NO.
11/25/18 1845 4706 108 408617 SUBN
OPERATOR S RANK AND NAME TAX REG NO PPOINTMENT DATE COMMAND
PO LACRUZ, PATRICK F. 964597 10/18/17 110
DATE AND TOUR WORKING ATTlRE DATE OF BIRTH OPER MEAL NO HRS ON PATROL
El UNIFORM O CIVILIAN 05/06/90 1800 3HRS AND 45MINS
11/25/18 1500X2335
RECORDER'S RANK AND NAME TAX REG. NO APPOINTMENT DATE COMMAND
PO CHECO, JOSE A. 962312 10/20/16 |110
LOCATION OF COLLISION- STREET NAME OR HIGHWAY O Mil.ES O N O E STREET NAME OR HIGHWAY
OF
O FEET O S O W
ON QUEENS BOULEVARD WITH
5 ATWTERSECTION 45 AVENUE
g g
STATEMENTOF OPERATOROF DEPT VEHICLE
I WAS RESPONDING TO THE EDP JOB, TRYlNG TO MAKE A LEFT ONTO EB QB WHEN CIViLIAN VEH STRUCK RMP.
CIVillAN OPERATORS NAME (NON DEPT VEH) ADDRESS TELEPHONE NO
RAFIK 79-22 150 ST FLUSHING, NY 11367 FL2 347-545-1580
ARABOV,
STATEMENTOF CIVILIAN OPERATOR
I WAS GOING STRAIGHT. I DID NOT SEE THE POLICE CAR. I HAD GREEN LIGHT.
NAME OF WITNESS ADDRESS TELEPHONE NO
MARIUS 119-40 METROPOLITAN KEW GARDENS, NY 11415 APT E2 917-495-3996
CALIN, g g
STATEMENTOF WITNESS
I WAS STOPPING AND YlELDING TO EMERGENCY POLICE VEHICLE WHEN THE OTHER VEHICLE
OVER TOOK ME AT A HIGH RATE OF SPEED AND STRUCK POLICE VEHICLE.
INVESTIGATING SUPERVISOR WILL ELICIT THE FOLLOWING INFORMATION FROM OPERATOR:
ASSIGNMENT TYPE.
O CRIME IN PROGRESS O P/4STCRIME O CANVASS O OTHER (DESCRIBE)
El PRIORITY EMERGENCY O NON.PRORITY O ROUTINE PATROL
WAS VEHICLE IN PURSUIT? VEH. EMER. EQUIP. USED El YES TYPE OF EQUIPMENT gFSIREN USED O YES
O YES El NO AT TIME OF COLLISION? O NO TURRET LIGHTS AND SIREN ON CONSTANT? El NO
SEAT BELTS USED? OPERATOR El YES O NO PROR TO COLLISION, DID OPERATOR El YES TYPE OF HAZARDS
RECORDER lidYES O NO PERCElVE ANY HAZARDS ? O NO ON COMING TRAFFIC
ACTIONS TAKEN WHEN HAZARDS PERCElVED
ACTIVATING EMERGENCY EQUIPMENTS AND PROCEEDING WITH CAUTION
INVESTIGATING SUPERVISOR'S >BSERVATIONS
TRAFFIC CONTROL DEVICE El YES TYPE OF DEVICE WAS DEVICE El YES
AT LOCATON? O NO TRAFFIC LIGHTS FUNCTIONAL? O NO
DID OPERATOR'S ACTIONS CONTRIBUTE TO COLLISION? DID RECORDER'S ACTIONS CONTRIBUTE TO COLLISION? OPERATOR AT FAULT?
El YES O NO O YES El NO El YES O NO
VIDEO OBTAINED? COLLISION VIDEO COLLISION PHOTOS
O YES El NO INVOICE NUMBER ENVELOPE NUMBER 1100199308
PRELIMINARY STATEMENT OF INVESTlGATING SUPERVISOR - MUST INCLUDE STATEMENT REGARDING DEPT. VEHICLE
OPERATOR'S ACTIONS. (THIS IS NOT A FINAL AGENCY DETERMINATION)
OFFICERS WERE RESPONDING TO AN EDP JOB WITH LIGHTS AND SIREN ACTIVATED WHEN THEY WERE STRUCK BY
CIVILIAN VEHICLE AT THE INTERSECTION OF QUEENS BLVD AND 45 AVE. CIVILIAN VEHICLE DID HAVE RIGHT OF WAY AT
TIME OF COLLISION.
RANK NAME (PRINT) TAX NO CMD GNATURE DATE
SGT TRAN 929274 110 11/25/18
PAR B (Prepared by the Executive Officer, recinct of Occurrence, under the s sigro½e Precinct
Commanding onicer)
OPERATOR GLASSES |NO. OF DEPT VEH NO OF DˆPT VEH NO ON-DEPT DATE INITIALLY
El YES O NO COLLISIONS 1 COLLISIONS AT FAULT VEH COLLISIONS 0 RECElVED LIC.
INFORMATION 05/02/15
NO OF TIMES ATTENDED DEF D1DCOLLISION OCCUR O YES NO OF CONSECUTIVE TOURS HOW MANY WERE
DRIVER TRAINING COURSE ON OVERTIME TOUR? )i(NO PRIOR TO COLUSON TOUR OVERTIME TOURS?
0 0
TYPE OF DEPARTMENT VEHICLE RMP/SEDAN O 2 WHEEL SCTR. O MCY O OTHER (Specdy) OPERATOR QUALIFIED TO pl ES
QUALIFIED TO OPERATE O TRUCK O 3 WHEEL SCTR O VAN DRIVE VEH. INVOLVED? O NO
IF OPERATOR IS NOT ASSIGN TO PCT DATE OF PRECINCT VEHICLE COLLISION
OF OCCUR , NAME OF SUPV NOTIFIED SAFETY REVIEW BOARD MEETING
11/28/2018
BOARD RECOMMENDATION - MUST INCLUDE EXPLANATION FOR RECOMMENDATIONS MADE BELOW
NYPD OPERATOR YES CIVILIAN OPERATOR O YES NEITHER O YES BOTH O YES
AT FAULT? O NO AT FAULT? O NO AT FAULT? O NO AT FAULT? O NO
RECOMMENDATIONS
RANK NAME (PRINTED) TAX NO CMD SIGNATURE DATE
CAPT Sankerdial 929118 108
PART C: Final Agency Determination By O APP
Commanding Officer Precinct Of Occurrence O PR ED
3
RANK NAME (PRINTED) TAX NO MD SION T - DAT
DI FOrgiOne 895454 108
Document Filed Date
March 01, 2023
Case Filing Date
March 29, 2019
Category
Torts - Motor Vehicle
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Preview
FILED: QUEENS COUNTY CLERK 03/01/2023 03:38 PM INDEX NO. 705559/2019 NYSCEF DOC. NO. 125 RECEIVED NYSCEF: 03/01/2023 EXHIBIT 2 FILED: QUEENS COUNTY CLERK 03/01/2023 03:38 PM INDEX NO. 705559/2019 NYSCEF DOC. NO. 125 RECEIVED NYSCEF: 03/01/2023 8½" Of this form are required. This form is x 14". Three (3) completed copies INSTRUCTIONS: This report is to be prepared by the investigating supervisor and Executive Officer, Precinct-Jf occurrence. Original copy photos contained in a Envelope (see PG 2 7-06) to Personnel Safety DpsivS fopy to Patrol Boro, will be f d with Jewelry Security each copy forwarded. 2a4Co to Operator's Personnel Folder at Command, with a copy of the Police A cIdent Report (MV104AN) attached to COLLISION REPORT- POLICE DEPT. VEHICLE PD 301-153 (Rev. 08-14) PATROLBORO COLLISION NO. PART A (PREPARED BY INVESTIGATING 0 SUPERVISOR) DATE OF COLLLSION TIME OF COLLISION PCT COLL NO PCT OF OCCURRENCE DEPT VEHICLE NO 1YPE OF VEHICLE FSD COLL. NO. 11/25/18 1845 4706 108 408617 SUBN OPERATOR S RANK AND NAME TAX REG NO PPOINTMENT DATE COMMAND PO LACRUZ, PATRICK F. 964597 10/18/17 110 DATE AND TOUR WORKING ATTlRE DATE OF BIRTH OPER MEAL NO HRS ON PATROL El UNIFORM O CIVILIAN 05/06/90 1800 3HRS AND 45MINS 11/25/18 1500X2335 RECORDER'S RANK AND NAME TAX REG. NO APPOINTMENT DATE COMMAND PO CHECO, JOSE A. 962312 10/20/16 |110 LOCATION OF COLLISION- STREET NAME OR HIGHWAY O Mil.ES O N O E STREET NAME OR HIGHWAY OF O FEET O S O W ON QUEENS BOULEVARD WITH 5 ATWTERSECTION 45 AVENUE g g STATEMENTOF OPERATOROF DEPT VEHICLE I WAS RESPONDING TO THE EDP JOB, TRYlNG TO MAKE A LEFT ONTO EB QB WHEN CIViLIAN VEH STRUCK RMP. CIVillAN OPERATORS NAME (NON DEPT VEH) ADDRESS TELEPHONE NO RAFIK 79-22 150 ST FLUSHING, NY 11367 FL2 347-545-1580 ARABOV, STATEMENTOF CIVILIAN OPERATOR I WAS GOING STRAIGHT. I DID NOT SEE THE POLICE CAR. I HAD GREEN LIGHT. NAME OF WITNESS ADDRESS TELEPHONE NO MARIUS 119-40 METROPOLITAN KEW GARDENS, NY 11415 APT E2 917-495-3996 CALIN, g g STATEMENTOF WITNESS I WAS STOPPING AND YlELDING TO EMERGENCY POLICE VEHICLE WHEN THE OTHER VEHICLE OVER TOOK ME AT A HIGH RATE OF SPEED AND STRUCK POLICE VEHICLE. INVESTIGATING SUPERVISOR WILL ELICIT THE FOLLOWING INFORMATION FROM OPERATOR: ASSIGNMENT TYPE. O CRIME IN PROGRESS O P/4STCRIME O CANVASS O OTHER (DESCRIBE) El PRIORITY EMERGENCY O NON.PRORITY O ROUTINE PATROL WAS VEHICLE IN PURSUIT? VEH. EMER. EQUIP. USED El YES TYPE OF EQUIPMENT gFSIREN USED O YES O YES El NO AT TIME OF COLLISION? O NO TURRET LIGHTS AND SIREN ON CONSTANT? El NO SEAT BELTS USED? OPERATOR El YES O NO PROR TO COLLISION, DID OPERATOR El YES TYPE OF HAZARDS RECORDER lidYES O NO PERCElVE ANY HAZARDS ? O NO ON COMING TRAFFIC ACTIONS TAKEN WHEN HAZARDS PERCElVED ACTIVATING EMERGENCY EQUIPMENTS AND PROCEEDING WITH CAUTION INVESTIGATING SUPERVISOR'S >BSERVATIONS TRAFFIC CONTROL DEVICE El YES TYPE OF DEVICE WAS DEVICE El YES AT LOCATON? O NO TRAFFIC LIGHTS FUNCTIONAL? O NO DID OPERATOR'S ACTIONS CONTRIBUTE TO COLLISION? DID RECORDER'S ACTIONS CONTRIBUTE TO COLLISION? OPERATOR AT FAULT? El YES O NO O YES El NO El YES O NO VIDEO OBTAINED? COLLISION VIDEO COLLISION PHOTOS O YES El NO INVOICE NUMBER ENVELOPE NUMBER 1100199308 PRELIMINARY STATEMENT OF INVESTlGATING SUPERVISOR - MUST INCLUDE STATEMENT REGARDING DEPT. VEHICLE OPERATOR'S ACTIONS. (THIS IS NOT A FINAL AGENCY DETERMINATION) OFFICERS WERE RESPONDING TO AN EDP JOB WITH LIGHTS AND SIREN ACTIVATED WHEN THEY WERE STRUCK BY CIVILIAN VEHICLE AT THE INTERSECTION OF QUEENS BLVD AND 45 AVE. CIVILIAN VEHICLE DID HAVE RIGHT OF WAY AT TIME OF COLLISION. RANK NAME (PRINT) TAX NO CMD GNATURE DATE SGT TRAN 929274 110 11/25/18 PAR B (Prepared by the Executive Officer, recinct of Occurrence, under the s sigro½e Precinct Commanding onicer) OPERATOR GLASSES |NO. OF DEPT VEH NO OF DˆPT VEH NO ON-DEPT DATE INITIALLY El YES O NO COLLISIONS 1 COLLISIONS AT FAULT VEH COLLISIONS 0 RECElVED LIC. INFORMATION 05/02/15 NO OF TIMES ATTENDED DEF D1DCOLLISION OCCUR O YES NO OF CONSECUTIVE TOURS HOW MANY WERE DRIVER TRAINING COURSE ON OVERTIME TOUR? )i(NO PRIOR TO COLUSON TOUR OVERTIME TOURS? 0 0 TYPE OF DEPARTMENT VEHICLE RMP/SEDAN O 2 WHEEL SCTR. O MCY O OTHER (Specdy) OPERATOR QUALIFIED TO pl ES QUALIFIED TO OPERATE O TRUCK O 3 WHEEL SCTR O VAN DRIVE VEH. INVOLVED? O NO IF OPERATOR IS NOT ASSIGN TO PCT DATE OF PRECINCT VEHICLE COLLISION OF OCCUR , NAME OF SUPV NOTIFIED SAFETY REVIEW BOARD MEETING 11/28/2018 BOARD RECOMMENDATION - MUST INCLUDE EXPLANATION FOR RECOMMENDATIONS MADE BELOW NYPD OPERATOR YES CIVILIAN OPERATOR O YES NEITHER O YES BOTH O YES AT FAULT? O NO AT FAULT? O NO AT FAULT? O NO AT FAULT? O NO RECOMMENDATIONS RANK NAME (PRINTED) TAX NO CMD SIGNATURE DATE CAPT Sankerdial 929118 108 PART C: Final Agency Determination By O APP Commanding Officer Precinct Of Occurrence O PR ED 3 RANK NAME (PRINTED) TAX NO MD SION T - DAT DI FOrgiOne 895454 108