Preview
FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019
NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
MONEGRO T. HERNANDEZ, Index No.: 527235/2019
Plaintiff, RESPONSE TO
COMBINED DEMAND
-against- FOR DISCOVERY AND
INSPECTION
BRIAN M. BLACKERMAN,
Defendant.
Plaintiff, MONEGRO T. HERNANDEZ, (hereinafter referred to as
"HERNANDEZ"), by his attorneys, ANGEL RODRIGUEZ, JR., PLLC., in response to the
Combined Demand for Discovery and Inspection of Defendant, BRIAN M.
BLACKERMAN, states and submits the following upon information and belief:
RESPONSETODEMANDFORINDEXNUMBER:
The above referenced action bears Supreme Court, Kings County Index number
527235/2019.
RESPONSE TO DEMAND FOR ALL PARTIES APPEARING:
The following is a list of all parties appearing in this action:
ANGEL RODRIGUEZ, JR., PLLC JAMES G. BILELLO & ASSOCIATES
Angel Rodriguez, Jr. Laia Chipkin, Esq.
Attorney for Plaintiff Attorneys for Defendant
MONEGRO T. HERNANDEZ BRIAN BACKERMAN
833 Kent Avenue 100 Duffy Avenue, Ste 500
Brooklyn, New York 11205 Hicksville, New York 11801
(718) 623-1000 (516) 861-1743
FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019
NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022
RESPONSE TO DEMAND FOR INSURANCE COVERAGE TO PLAINTIFF(S) ON
COUNTERCLAIM AND/OR CO DEFENDANT(S):
Not applicable.
RESPONSE TO DEMAND FOR WITNESSES:
Plaintiff is not aware of any non party witness(es) to this accident.
RESPONSE TO DEMAND FOR EXPERT WITNESSES:
Plaintiffs has yet to retain an expert witnesses. Plaintiffs will supplement this
response within a reasonable amount of time prior to trial.
RESPONSE TO DEMAND FOR ACCIDENT REPORTS:
Annexed hereto please find New York City Aided Acckient Report bearing
Accident report number MV-2016-094-012078.
RESPONSE TO DEMAND FOR STATEMENTS:
Plaintiff is not in possession of any statements made by the Defendant, his
agents, servants and/or employees.
RESPONSE TO DEMAND FOR PHOTOGRAPHS:
Plaintiff is currently not in possession of any photographs of the scene of the
accident.
RESPONSE TO DEMAND FOR TAX RETURNS:
Plaintiff has not made a claim for lost wages and as such, objects to the
production of his tax returns on the basis of relevance. Said items are not necessary
to the defense of the action.
FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019
NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022
RESPONSE TO DEMAND FOR SCHOOL AUTHORIZATIONS:
Not applicable.
RESPONSE TO DEMAND FOR EMPLOYMENT AUTHORIZATIONS:
Not applicable. Plaintiff was not employed at the time of the accident.
RESPONSETODEMANDFORNOFAULTRECORDS:
Annexed hereto please find a duly authorization enabling your office to obtain
Plaintiff's complete No Fault file from State Farm Insurance, P.O. Box 106170, Atlanta,
Georgia 30348; Claim No.: 329Q81624.
RESPONSE TO DEMAND FOR WORKERS COMPENSATION RECORDS:
Not applicable.
RESPONSE TO DEMAND FOR DISABILITY RECORDS:
Not applicable.
RESPONSE TO DEMAND FOR INFORMATION ON COLLATERAL SOURCE:
Not applicable.
RESPONSE TO DEMAND FOR MEDICAL INFORMATION:
Annexed hereto please find duly executed authorizations to obtain Plaintiff,
HERNANDEZ'
medical records from the following medical providers:
Wyckoff Heights Medical Center, 374 Stockholm Street, Brooklyn, New.York
11237;
Surgicore Surgical Center, 444 Market Street, Saddlebrook, New Jersey 07663;
Ajoy K. Sinha, M.D., FL MSJR Orthopaedics, 57-23 141 Street, Flushing, New
York 11368;
FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019
NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022
Frank Watkins, M.D., 1414 Newkirk Avenue, Brooklyn, New York 11226;
Clifton Burt, Pain Physicians, P.C., 176 Maplewood Avenue, Suite B, Clifton,
New Jersey 07013; and
Bamert Surgical Center, 680 Broadway, Suite 202, Patterson, New Jersey
07514.
Annexed are the following medical records. More particularly,
Operative Report regarding Plaintiffs Right Knee Surgery on February 20, 2017;
Narrative Reports preapred by Ajoy Sinha, M.D., dated, February 15, 2017 and
March 4, 2017;
MRI Reports of the Right Knee, Cervical Spine, Lumbar Spine and Left
Shoulder; and
Discharge instructions re Epidural Procedure.
Dated: Brooklyn, New York
January 16, 2022 Yours, etc;
ANGEL RODRI UEZ, JR., PLLC
ANGEL RODRIÒUEZ, JR.
Attorney for Plaintiff
MONEGROT.HERNANDEZ
833 Kent Avenue
Brooklyn, New York 11205
(718) 623-1000
TO: JAMES G. BILELLO & ASSOCIATES
Laia Chipkin, Esq.
Attorneys for Defendant
Brian Backerman
100 Duffy Avenue, Ste 500
Hicksville, New York 11801
(516) 861-1743
FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019
NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022
Page1 of 4 Pages NewYorkStateDepartmentof MotorVehicÊm
PrechcI POUCE ACCIDENT REPORT (NYC) 3g
094 MV-194AN (7/11) ..
Accident
No. Complemt
M\T-2016-094-012078 Nunter Darsumnsmim
DayatWeek MlillaryTime No.Injured No.Killed Nottrweg1lgeted LeftScene PeNce Phnm 20
85 ---------- etScens
--------
. Month Dey Year -
12 17 2016 SATURDAY 19:30 2 2 O Reconstructed u.
. VEMICLE1 .d VEMICLE 2 ¤ BICYCLIST¤ PEDESTRIAN O OTHERPEDESTRIAN
VEHICLE t-Driver 5tateof1.is. VEiMCLE x-Driver Steloof1.ic.
2 ucenea IDNumber 62262 8612 NY..__ License1 0Number 139719365 NT 21
Name
Driver -6Nactly DriverNeme -exactly
as_grirnedanscense MONEGRO-HERNANDE5, T . asorintedonicenseBLACKERMAN, BRIAN, M
MoreseVncIride Number& SIresñ Apl.No. Address UnclocieNumber &Stmes) Apt.No.
321 BEDFORD PK B 19006C 69 AVENUE 3A
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so UnknDwn/UnatHeto Determine Yes No
ReferericeMarker Coordina1es(iravailable)Place Where Accident Occurred: INGS O NEWYORK QUEENS RICHMOND
BRONX
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FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019
NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022
sisasoNsxa.LepoR INJURED IN ACCIDENT (latter designanon 4 persons Itgled or lrdured must correspond wHh leller designaiian on front).
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ENTER INSURANCE POLICY NUMBER FROM INSURANCE IDENTIFICATl0N CARD, EXPIRATION DATE (IN ALL CASES), AND VIN.
Vehicle No. s S76 4392-A14-32 Vehicle No.a 443 8490676
Expira#on Date 01/14/2017 Expiration Date 06 /96 /2018
VIN WP1AA29PS 8LA238 8 VIN 2DBI465G51T08165 8
WITNESS (Atlach separate sheet, if necessary)
.
DUPLICATE COPY REQUIRED FOR:
Dept of Motor Vehicles Motor Transport DMsion NYC Taxi & Urnm s Comm. Other City Agency
(If anyone is ldRed/Injured) (P.D. vehicle Involved) (ff a Licensed tiud or Amousine (Specify)
involved)
Office of Comptroller Personnel Safety Unit Highway Unit
(if a City Vehicle Involved) (if a P.D. vehicle Involved)
NOTIFICATIONS: (Enter name, address, end relationship of friend or relative notified. If aided permanis unidentified, tist Missing Person Squad member who
was notified. In either case, give date and time of nodfication.)
. PROPIERTY DAMAGED (other than vehicles) OWNER OF PROPERTY (include city agency, where appilcable)
IF NYPD VEHICLE IS INVOLVED:
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ACTIONS OF POLlCE VEHICLE
Responding to Cod6 Slgnal Complying With Sta8on House Directive
Pursuing Violatnr Routine Patrol
Other(Descrine)
uv.1ceanam) Page 2 of 4 Pages
FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019
NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022
Page3 of 4 Pegas NewYorkStateDeperimentofMotorVehicles
Peeinot POLICE ACCIDENT REPORT (NYC)
094 gy.tg4AN (7/M)
Accident
No. Complaint
MV-2016- 094-01207 8 wmoor PZMIM USTeF5n
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DIAGRAN ATTACHED ON aumsayujiiNT PAGE
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16. OVERTURNED 19. OTHER ,, Cost of repairs to any one vehicle will be more than $1000. 1
a Unknown/Uilable to Detertrline Yes No
Coordinaten(if avakable) Place Where Accident Occurred: BRONX@KINGS NEW YORKO QUEENS O RICHMOND
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Preview
FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019 NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS MONEGRO T. HERNANDEZ, Index No.: 527235/2019 Plaintiff, RESPONSE TO COMBINED DEMAND -against- FOR DISCOVERY AND INSPECTION BRIAN M. BLACKERMAN, Defendant. Plaintiff, MONEGRO T. HERNANDEZ, (hereinafter referred to as "HERNANDEZ"), by his attorneys, ANGEL RODRIGUEZ, JR., PLLC., in response to the Combined Demand for Discovery and Inspection of Defendant, BRIAN M. BLACKERMAN, states and submits the following upon information and belief: RESPONSETODEMANDFORINDEXNUMBER: The above referenced action bears Supreme Court, Kings County Index number 527235/2019. RESPONSE TO DEMAND FOR ALL PARTIES APPEARING: The following is a list of all parties appearing in this action: ANGEL RODRIGUEZ, JR., PLLC JAMES G. BILELLO & ASSOCIATES Angel Rodriguez, Jr. Laia Chipkin, Esq. Attorney for Plaintiff Attorneys for Defendant MONEGRO T. HERNANDEZ BRIAN BACKERMAN 833 Kent Avenue 100 Duffy Avenue, Ste 500 Brooklyn, New York 11205 Hicksville, New York 11801 (718) 623-1000 (516) 861-1743 FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019 NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022 RESPONSE TO DEMAND FOR INSURANCE COVERAGE TO PLAINTIFF(S) ON COUNTERCLAIM AND/OR CO DEFENDANT(S): Not applicable. RESPONSE TO DEMAND FOR WITNESSES: Plaintiff is not aware of any non party witness(es) to this accident. RESPONSE TO DEMAND FOR EXPERT WITNESSES: Plaintiffs has yet to retain an expert witnesses. Plaintiffs will supplement this response within a reasonable amount of time prior to trial. RESPONSE TO DEMAND FOR ACCIDENT REPORTS: Annexed hereto please find New York City Aided Acckient Report bearing Accident report number MV-2016-094-012078. RESPONSE TO DEMAND FOR STATEMENTS: Plaintiff is not in possession of any statements made by the Defendant, his agents, servants and/or employees. RESPONSE TO DEMAND FOR PHOTOGRAPHS: Plaintiff is currently not in possession of any photographs of the scene of the accident. RESPONSE TO DEMAND FOR TAX RETURNS: Plaintiff has not made a claim for lost wages and as such, objects to the production of his tax returns on the basis of relevance. Said items are not necessary to the defense of the action. FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019 NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022 RESPONSE TO DEMAND FOR SCHOOL AUTHORIZATIONS: Not applicable. RESPONSE TO DEMAND FOR EMPLOYMENT AUTHORIZATIONS: Not applicable. Plaintiff was not employed at the time of the accident. RESPONSETODEMANDFORNOFAULTRECORDS: Annexed hereto please find a duly authorization enabling your office to obtain Plaintiff's complete No Fault file from State Farm Insurance, P.O. Box 106170, Atlanta, Georgia 30348; Claim No.: 329Q81624. RESPONSE TO DEMAND FOR WORKERS COMPENSATION RECORDS: Not applicable. RESPONSE TO DEMAND FOR DISABILITY RECORDS: Not applicable. RESPONSE TO DEMAND FOR INFORMATION ON COLLATERAL SOURCE: Not applicable. RESPONSE TO DEMAND FOR MEDICAL INFORMATION: Annexed hereto please find duly executed authorizations to obtain Plaintiff, HERNANDEZ' medical records from the following medical providers: Wyckoff Heights Medical Center, 374 Stockholm Street, Brooklyn, New.York 11237; Surgicore Surgical Center, 444 Market Street, Saddlebrook, New Jersey 07663; Ajoy K. Sinha, M.D., FL MSJR Orthopaedics, 57-23 141 Street, Flushing, New York 11368; FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019 NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022 Frank Watkins, M.D., 1414 Newkirk Avenue, Brooklyn, New York 11226; Clifton Burt, Pain Physicians, P.C., 176 Maplewood Avenue, Suite B, Clifton, New Jersey 07013; and Bamert Surgical Center, 680 Broadway, Suite 202, Patterson, New Jersey 07514. Annexed are the following medical records. More particularly, Operative Report regarding Plaintiffs Right Knee Surgery on February 20, 2017; Narrative Reports preapred by Ajoy Sinha, M.D., dated, February 15, 2017 and March 4, 2017; MRI Reports of the Right Knee, Cervical Spine, Lumbar Spine and Left Shoulder; and Discharge instructions re Epidural Procedure. Dated: Brooklyn, New York January 16, 2022 Yours, etc; ANGEL RODRI UEZ, JR., PLLC ANGEL RODRIÒUEZ, JR. Attorney for Plaintiff MONEGROT.HERNANDEZ 833 Kent Avenue Brooklyn, New York 11205 (718) 623-1000 TO: JAMES G. BILELLO & ASSOCIATES Laia Chipkin, Esq. Attorneys for Defendant Brian Backerman 100 Duffy Avenue, Ste 500 Hicksville, New York 11801 (516) 861-1743 FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019 NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022 Page1 of 4 Pages NewYorkStateDepartmentof MotorVehicÊm PrechcI POUCE ACCIDENT REPORT (NYC) 3g 094 MV-194AN (7/11) .. Accident No. Complemt M\T-2016-094-012078 Nunter Darsumnsmim DayatWeek MlillaryTime No.Injured No.Killed Nottrweg1lgeted LeftScene PeNce Phnm 20 85 ---------- etScens -------- . Month Dey Year - 12 17 2016 SATURDAY 19:30 2 2 O Reconstructed u. . VEMICLE1 .d VEMICLE 2 ¤ BICYCLIST¤ PEDESTRIAN O OTHERPEDESTRIAN VEHICLE t-Driver 5tateof1.is. VEiMCLE x-Driver Steloof1.ic. 2 ucenea IDNumber 62262 8612 NY..__ License1 0Number 139719365 NT 21 Name Driver -6Nactly DriverNeme -exactly as_grirnedanscense MONEGRO-HERNANDE5, T . asorintedonicenseBLACKERMAN, BRIAN, M MoreseVncIride Number& SIresñ Apl.No. Address UnclocieNumber &Stmes) Apt.No. 321 BEDFORD PK B 19006C 69 AVENUE 3A CayarTcian este ZIpbade CityorTown atete 2ipCoda 22 BRONX NY QUEENS NY 3 Sex Urecensed No.of Public Da Sex UnlIcensed No.of Monih Day Year Occupants PoDPerly Month Qay Year Occupants · Pubic Damaged Property 9 19 197o M .. 1 10 2 ise2 M 1 Damsea Name-exactly aspdnted o nreglelration Sex Name-execGy asprintedanregistraBon Sek Da Month Day Year Month Day Yanr SANCHE5, ROBINSON, A M 1 9 naA BLACKERMAN, BRIAN, M M 10 2 Isas Address Çnclude Number& street) Apt,N o. Her Î Released Mdress (Mchkie Number & Strear) Apl.No. Har. Releason25 3 2455 CRUGER AVENUE 5G c1 19006C 69 AVENUE 3A CityorTown 6tate ZipCode CIWorTown $tate ZipC a BRONX NY . QUEENS NY PlateNumber toofReg Vehicle Year&Make VehicleType Ina.CodePlateNumber StateofReg.Vehicle Your&Mghe hicleType Inn,Code 5 GXA6915 NY 2008 PORSCHE *==a=="- 328 HFH4769 NY 2001 usacsons-Asus SEDAN 100 licket/Arrest Ticketthreat Number(a) Number(s) Violation Violation Seogion(s) Section(s) Cheaklf Involvedvehicisio: Checkifinvolvedvehiclels: Circlethe diagrambelowthatdescftbestheaccidentor drawyourown 1 8 Omore than95incheswide; Orriote than95incheswide; dia mmirta ce#9. Numberthevehicles. 4 V Omore than$4feet long; V ¤rnore than34feet long; AcarEnd in RightAngle ltlglitTum HeadOn E operatedWithanoverweightpermit; E Ooperatedwithan overweightpermit H operatedwhhan overdimension permit· H OOPara1ed withan overdimension permit. 7 g VIDilCLE1 DAMAGECODES g VEHICLE2 DAMAGECODES LeftTurn RightTom Side 26 C Box1- Pointof Impact 1 2 C Box 1- Pointof Impact 1 2 ( 1 7 L Box2 - MostDamage 1 1 L Box2 - MostDemoge 4 4 •ef- 0. 2 E Enterup tothree moreDamageCode$ 12 3 18 4 T E Enterup to those moreDamageCodes 3 3 4 18 2. S ACCDENTDIAGRAtWI 4. 6, a. 4 18 2 2 vehicle Bygearaeravroupmsesavzcas sm: venlete Byguararrsm;monvsasavzess xme 1 Towed; Towed: Tono aven STantr oncongra wrnan Tom num syssex noons mEuni VEMICLEDAMAGECODING: 1-13.SEEDIAGMAMONRIGHT. . 9 OTHER 14- UNDERCARRIAGE1L OEMOLISHED a 15. TRAILER 18. NODAMAGE e. 16. OVERTURNED to. OTHER Costof repairs to any one vehicle will be rnore than $1000. 1 so UnknDwn/UnatHeto Determine Yes No ReferericeMarker Coordina1es(iravailable)Place Where Accident Occurred: INGS O NEWYORK QUEENS RICHMOND BRONX Latitude/Nathing: Roadonwhichaccidentoccurred14 LOMBARDY STREET 40 . 72178 tRouteNumber atStreet Name) 20 ! street at 1)intemecting Longitude/Easting: (Route Number arStreet Neme) N S -73 .94028 °' 2) 300 E IW of MORGAN AVENUE w Me Notes AT Accident0escription/OIfioer's TPO OP OF VEH#1 STATES THAT HE WAS TRAVELLING E/B ON LOMBARDY ST 30 GOING STRAIGHT WHICE IS A ONEWAY WHEN, VEH#2 HAD SUDDENLY ENETERED THE ROAD FROM A 1 LOT, WHICH LED VEH#1 TO PARKING STRIKE VEH#2 . OP OF VEH#2 STATED HE WAS ON THE PARKING e LOT AND ATTEMTING TO MERGE ONTO LOMBARDY. HE FURTHER STATES HE MADB SURE TRAFFIC WAS CLEAR AND WHEN TRYING TO ENETER THE ONE WAY, HE WAS STRUCK BY VBE#1, WHO WAS .GQTNG P 8 Q 10 11 12 13 14 1ry t S 17 BY TO 111 Namesof aginy9|ved Dateof DeathOnly Aa 1 1 4 46 6 T 1 M | 12 |12 28V -7142 MONHGRO-HERNANDEE, L B 2 1 4 1 34 M 6 12 6 - - BLACKERMAN, BRIAN, M O . D Officer'sRank - TSXID No NCICN.o. Precinct PostfSector Reviewing Qate/TimeReviewed and Sl'Insture‡ M --.. 956641 03030 D94 Ofilcer SGT FRANCIS M 12/2o/2016 coses PrirdName inFull NAZMUL FERDOUg COOPER FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019 NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022 sisasoNsxa.LepoR INJURED IN ACCIDENT (latter designanon 4 persons Itgled or lrdured must correspond wHh leller designaiian on front). A I.astName . Fiest M.L I.astName Mat M.L NDBIEGRO-HERNPGIDE5_ _ T Address Address 321 BEDFORD PK APT B BRONE NT Telephone(AreeCode) Birth Telephonepgea code) p 19 197o ( ) 347975 B241 ( ) B LastName Rat M.I. LastNepts First MJ. BLACEERMiIN BREAW M Ad©ess Ad@oss 19006C 69 AVENUE APT 3A QUEENS NT Telephano(Areacoge) . Talaphona(AmeCode) M°ª a pe ) 9174780609 ( 1 HighwayOlat.atScene? ¤Yea No Name: Tulsphone(AmaCode) GhleloNo. ENTER INSURANCE POLICY NUMBER FROM INSURANCE IDENTIFICATl0N CARD, EXPIRATION DATE (IN ALL CASES), AND VIN. Vehicle No. s S76 4392-A14-32 Vehicle No.a 443 8490676 Expira#on Date 01/14/2017 Expiration Date 06 /96 /2018 VIN WP1AA29PS 8LA238 8 VIN 2DBI465G51T08165 8 WITNESS (Atlach separate sheet, if necessary) . DUPLICATE COPY REQUIRED FOR: Dept of Motor Vehicles Motor Transport DMsion NYC Taxi & Urnm s Comm. Other City Agency (If anyone is ldRed/Injured) (P.D. vehicle Involved) (ff a Licensed tiud or Amousine (Specify) involved) Office of Comptroller Personnel Safety Unit Highway Unit (if a City Vehicle Involved) (if a P.D. vehicle Involved) NOTIFICATIONS: (Enter name, address, end relationship of friend or relative notified. If aided permanis unidentified, tist Missing Person Squad member who was notified. In either case, give date and time of nodfication.) . PROPIERTY DAMAGED (other than vehicles) OWNER OF PROPERTY (include city agency, where appilcable) IF NYPD VEHICLE IS INVOLVED: PoliceVehicle -opends's MistName LastName Rank ShieldNo. TaxID.No. Comrnand eqWpinentinUsaAt1nmeofAccident O 85•a ¤ '*a* O TunetLWW 4Way Flasher High-Level Wamtng Lights TirafAoCones O HeadHghts ACTIONS OF POLlCE VEHICLE Responding to Cod6 Slgnal Complying With Sta8on House Directive Pursuing Violatnr Routine Patrol Other(Descrine) uv.1ceanam) Page 2 of 4 Pages FILED: KINGS COUNTY CLERK 01/18/2022 02:55 PM INDEX NO. 527235/2019 NYSCEF DOC. NO. 42 RECEIVED NYSCEF: 01/18/2022 Page3 of 4 Pegas NewYorkStateDeperimentofMotorVehicles Peeinot POLICE ACCIDENT REPORT (NYC) 094 gy.tg4AN (7/M) Accident No. Complaint MV-2016- 094-01207 8 wmoor PZMIM USTeF5n of Phois- DayofWeek MilitaryTgne NcLInjured No.Kined & d Sm LeftScena PoIce 20 Month Day Year . eNdes ,__,,,,_ _____ ________,__, _ 12 17 2016 SATURDAY 19 :30 2 2 O . Reconstnated 16 VEHICLE l..) VEHICLE BICYCLISTO PEDESTRIAN O OTHERPEDESTRIAN VÈlilCt.E- Ddver StateofLio. VFJ·llCLE - Oriver Stateof Uc, 2 Ucense IDNumber LicenseIDNumber * DriverName - DriverNameexactly -exacgy ., appintedongoense asprintedonIcense Address(lank IrNorlbef&Stree0 Apt No. Address (rnchfeNumber &$49ey Apt CityorTown State ZipCeda CityorTown 8tate 21pCooe 22 3 Sex Unlicensed No,of Public O Sex UnlIcensed No.of Publlp Morith Day Yea Onoupants P Month Day Year Occupenis y 1 Neme-exactly onreglelrason asprinted Sex ageefanth asprinted Name-mectly • onregletration $SM DateolB Month Day Year Month Day ear (41shne Address a Stree0 Number Apt.No. Ham d AGdrese Mureer& $ue80 (include ApLNo. Naz. 23 4 Mat MM. I - 1 code Code CityorTenn State ZipCode CityorTown state ZIpCode PlateNumber Stateofflag. VehIdaYearb Nake Vehicle Type Ina.CodePlateNumber StateofRep.VeNcle Year& Make Vehicle Type ins.Code _ Nanber(s) Number(s) Violation Violation Section(e) Section(s) ChecitIfinvolvedvehicleis: Checitif involvedvehicleis: Circlethediagrambelowthatdescribestheaccident,of drawyourown - 6 Omore thatt95incheewide; Omore than95Incheswide; diagramin space#9.Numberthevehicles. 4 V [·]marethan34feet long; V Omore than34feet loo9l RearEnd LeltTum RigNAnge RightTurn HeadOn E H operatedwithenoverweightpermit; operatedwithanoverdimensionperrnit• E H operatedwithanoverweightpermit: operatedwithenoverdlmensenped 7. ...9p. + VEHICLE1 DAMAGECODES VEHICLE2 DAMAGECODES C Box1- Pointof Impact 1 2 c Box1-Point of Irnpact 1 2 Neta (sainalrecuon) LeftTum . + RightTum Sideswlpe _ topponNo - 26 L Box2 - MostDamage 5-- L Box2 - MostDamage 1 ,,.. o 4 E Erderupto three 3 E Enterup to three 3 4 5 ACCIDENTDIAGRAM moreDamageCodes moreDamageCodes veNde veNcle sy 1 Towed• sy Towed: To To DIAGRAN ATTACHED ON aumsayujiiNT PAGE VEHICLEDAMAGECODING: ; 1-13.SEEDIAGRAMONRIGHT. 9 OTHER 14. UNDERCARRIAGE17. DEMOLISHED 15. YRAR.ER 16. NO DAMAGE . 9. 16. OVERTURNED 19. OTHER ,, Cost of repairs to any one vehicle will be more than $1000. 1 a Unknown/Uilable to Detertrline Yes No Coordinaten(if avakable) Place Where Accident Occurred: BRONX@KINGS NEW YORKO QUEENS O RICHMOND Latitude/Northing; Roadonutich accidentoccurred14 LOMARDY STREET 4 O. 72178 Number (Route arStreetNems) at 1)Interseconn streat Number (Noute orStreet Neme) Longitude/Easting or 2) 3o0 O MORGAN AVENUE -73 .94028 O E [Z]W of fMiepost. Mesmet Route Intersectine nestreetNemo1 NÔmPw AccidentDescription/OfficehNotes STRAIGHT. AND DRIVING AT A HIGH SPEED. VEH#1 WAS TAKEN TO WOODHULL 0 HO SPITAL, BUS$2 8V. EMS YUSUPOV#4147 . JOB#4 86 , OP OF VEH#2 RNA. P 8 9 10 11 12 15 14 15 10 17 BY .TO 18 NMteaOfell Involved Dateof DeathOnly L - - . N .. -. ._ _ - .. O _ ___ .___ D Omeer'sRank TexIDNo. NCICNo. Precinct PosrGector Reviewing Date/11me Reviewed and Sim1sture $ . M 956641 030$0 094 Officer