Preview
FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023
NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
--------------------------------------------------------------------X Index No.: 508174/2023
JAMES GEOFFREY
Plaintiff
-against- SUPPLEMENTAL BILL OF
PARTICULARS
SMITELL LLC SMITELL B-1 LLC
and EXTELL DEVELOPMENT COMPANY,
Defendants.
-----.....-- ____________---------------------------------------__--.x
SMITELL LLC SMITELL B-1 LLC
and EXTELL DEVLEOPMENT COMPANY,
Third-Party Plaintiffs,
-against-
SUNSHINE MF II LLC and SILVERLINING
INTERIORS, INC.,
Third-Party Defendants.
--------------------------------------------------------------------x
Plaintiff, JAMES GEOFFREY, by his attorneys, KRENTSEL GUZMAN HERBERT, LLP, as
and for his Supplemental Bill of Particulars as to Defendants, SMITELL LLC, SMITELL B-1
LLC and EXTELL DEVELOPMENT COMPANY, sets forth the following upon information
and belief:
defendants'
1. Solely due to negligence, Plaintiff sustained the following injuries:
Trauma, injury and damage to the left knee, including but not limited to: Plaintiff
underwent right shoulder arthroscopy dated April 14, 2023 with Dr. Matthew Wert
including: complete - humeral arthroscopic
synovectomy scope, chondroplasty head,
1 of 22
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NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023
major joint debridement of anterior labrum, arthroscopic major joint debridement
of superior partial debridement - rotator cuff - lysis and
labrum, supraspinatus,
resection of adhesions, ACL tears, multiple chondral fractures, multiple meniscal,
ligament, cartilage and tendon tears, requiring surgery, with resultant permanent and
disfiguring scarring, synovial effusion, chondromalacia, tendinosis, internal deformities,
severe internal derangement, severe inflammation, severe contusions, severe hematomas,
need for future surgeries, permanent limp, need for a knee replacement;
Trauma, injury and damage to the right shoulder, including but not limited to: massive
severely retracted superior rotator cuff tear, involving the entire supraspinatus and
anterior half of the infraspinatus tendons, supraspinatus and moderate
infraspinatus muscular atrophy, low-grade strain of the superior infraspinatus
muscle, subcentimeter partial-thickness articular surface tear of the subscapularis
tendon at the superior insertion and tendinosis. Long bicep tendinosis, rotator cuff
arthropathy, moderate glenohumeral joint osteoarthritis. Degenerative tear of the
superior labrum. Small effusion with chronic synovitis within the auxiliary and
subscapularis recesses. Moderate acromioclavicular joint osteoarthritis, small
subacromial spurs, and subacromial subdeltoid bursal fluid communicating with
the glenohumeral joint across the rotator cuff tear, multiple ligament, cartilage and
tendon tears, multiple chondral fractures, requiring surgery, with resultant permanent and
disfiguring scarring, severe joint effusion, internal derangement, severe deformities, need
for future surgeries and complete shoulder replacement;
Trauma, injury, damage to the cervical spine, including but not limited to: severe
2 of 22
FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023
NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023
foraminal stenosis on the left at C3-C4 and on the right at C5-C6, moderate on the
left and at the right at C6-C7 and bilaterally C7-T1 disc bulges, disc herniations,
sprains, strains, requiring multiple trigger point injections, epidurals and other spinal
surgeries, evidence of abnormal alignment with loss of normal cervical curvature with
resultant straightening; vertebral subluxation complex, numbness; muscle spasm; cervical
strain, cervical pain, cervaglia, cervical subluxation, radiculopathy, need for future invasive
spinal surgeries;
Trauma, injury, damage to the thoracic spine, including but not limited to: abnormal
alignment with loss of normal thoracic, thoracic spine derangement, sprain and strain,
vertebral subluxation complex;
Trauma, injury, damage to the lumbar spine, including but not limited to: foraminal
narrowing bilaterally at L3-L4 and L4-L5 and lower lumbar facet arthrosis, bulges,
herniations, severe lumbar and sacral radiculopathy, requiring multiple trigger point
injections and spinal epidural surgeries, with permanent deformities and permanent
disfiguring scarring, evidence of abnormal alignment with loss of normal with resultant
straightening; vertebral subluxation complex, numbness; muscle spasm; lumbaglia, lumbar
subluxation, radiculopathy, exacerbation and aggravation of prior injuries and conditions,
requiring future multiple trigger point injection and spinal surgeries, need for future spinal
surgeries;
PLEASE TAKE NOTICE that plaintiff reserves the right to supplement the above responses as
3 of 22
FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023
NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023
such information becomes known to him or his counsel, and/or in accordance with the CPLR and
applicable case law.
Dated: New York, New York
July 19, 2023
TO:
REBORE, THORPE & POSARELLO, P.C.
Attorneys for Defendants/Third Parry Plaintiffs
SMITELL LLC, SMITELL B-1 LLC,
and EXTELL DEVELOPMENT COMPANY
500 Bi-County Blvd., Suite 102
Farmingdale, NY 11735
SUNSHINE MG II LLC
12th
767 Fifth Avenue FlOOr
New York, NY 10153
SILVERLINING INTERIOR INC.
3rd
2091 Broadway, PlOOr
New York, NY 10004
Yours, etc.,
By: Jas n He ert, Esq.
KREN UZMAN HERBERT, LLP.
Attorneys for Plaintiff
17 Battery Place - Suite 604
New York, New York 10004
(212) 227-2900
4 of 22
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NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023
ATTORNEY VERIFICATION
Jason Herbert, an attorney at law, duly admitted to practice in the Courts of the State of
New York, affirms under the penalties of perjury that:
He is the attorney for the plaintiff(s) in the above entitled action. That he has read the
foregoing PLAINTIFF'S SUPPLEMENTAL BILL OF PARTICULARS and knows the
contents thereof, and upon information and belief, deponent believes the matters alleged therein to
be true.
The reason this Verification is made by deponent and not by the plaintiff(s) is that the
plaintiff(s) herein reside(s) in a county other than the one in which the plaintiff s attorneys maintain
their office.
The source of deponents information and the grounds of his belief are communication,
papers, reports and investigation contained in the file.
DATED: New York, New York
July 19, 2023
Jason He ert Esq.
5 of 22
FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023
NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023
AFFIRMATION OF SERVICE BY MAIL
STATE OF NEW YORK )
) ss.:
COUNTY OF NEW YORK)
Jason Herbert, an attorney duly admitted to practice law before the Courts of the State of
New York, affirms the following under the penalties of perjury:
I am not a party to this action; I am over the age of 18 years; and reside in New York, New
York.
19*
That on the day of July 2023 deponent served the PLAINTIFF'S FIRST
SUPPLEMENTAL BILL OF PARTICULARS upon the following attorneys for the
defendant(s), as listed below, at the address designated by said attorneys for that purpose by
depositing a true copy of same enclosed in a postpaid properly addressed wrapper, in a post
office official depository under the exclusive care and custody of the United States Postal
Service within the State of New York.
TO:
REBORE, THORPE & POSARELLO, P.C.
Attorneys for Defendants/Third Parry Plaintiffs
SMITELL LLC, SMITELL B-1 LLC,
and EXTELL DEVELOPMENT COMPANY
500 Bi-County Blvd., Suite 102
Farmingdale, NY 11735
SUNSHINE MG II LLC
12*
767 Fifth Avenue Floor
New York, NY 10153
SILVERLINING INTERIOR INC.
3rd
2091 Broadway, FlOOr
New York, NY 10004
Dated: New York, New York
July 19, 2023
Jason Herit , Esq.
6 of 22
FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023
NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023
Index No: 508174/2023
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY
OF KINGS
==-_==============---=======-_===================
JAMES GEOFFREY,
Plaintiffs,
-against-
SMITELL LLC SMITELL B-1 LLC and EXTELL DEVELOPMENT COMPANY,
Defendants.
___________ _ _ _____________________________________Ç
SMITELL LLC SMITELL B-1 LLC and EXTELL DEVLEOPMENT COMPANY,
Third-Party Plaintiffs,
-against-
SUNSHINE MF II LLC and SILVERLINING INTERIORS, INC.,
Third-Party Defendants.
SUPPLEMENTAL BILL OF PARTICULARS
===--========--===============================
KRENTSEL & GUZMAN, LLP.
Attorneys for : Plaintiff(s)
Office and Post Office Address, Telephone
17 Battery Place, #604
New York, New York 10004
(212) 227-2900
_____________ __________ _
_ _ _ _ _________________
To
Attorney(s) for
Service of a copy of the within
is hereby admitted.
Dated,
Attorney(s) for
PLEASE TAKE NOTICE:
O NOTICE OF ENTRY
that the within is a (certified) true copy of a
duly entered in the office of the clerk of the within name court on 19
O NOTICE OF SETTLEMENT
that an order of which the within is a true copy
will be presented for settlement to the HON. one of the judges of the
within named Court, at
on 19 at M.
Dated,
Yours, etc.
LAW OFFICE OF KRENTSEL & GUZMAN, LLP.
7 of 22
FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023
NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023
Power of Attorney
To Execute HIPAA Medical Record Authorization Forms Pursuant to NY Public
Health Law § 18(1)(G) As Amended 10/26/04
I, 9wt.-g S Ç¿o dE y
(Insert your name and address)
do hereby appoint Krentsel Guzman Herbert, LLP, with offices at 17 Battery Pl., Suite 604, New York, New York
10004, my attorney-in-fact to act (each agent may act separately) in my name, place and stead in any way which
I myself could do, if I were personally present to execute HIPAA medical record authorization forms pursuant to
NY Public Health Law Health Law §18(1)(G) as amended 10/26/04. This power of attorney may be revoked by
me at any time. This Power of Attorney shall not be affected by my subsequent disability or incompetence.
To induce any third party to act hereunder, I hereby agree that any third party receiving a duly executed copy or
facsimile of this instrument may act hereunder, and that revocation or termination hereof shall be ineffective as
to such party unless
third and until actual notice or knowledge of such revocation or termination shall have been
received by such third party, and I for myself and for my heirs, executors, legal representatives and assigns, hereby
agree to indemnify and hold harmless any such third party from and against any and all claims that may arise
against such third party by reason of such third party having relied on the provisions of this instrument.
In Witness Whereof I have hereunto signed my name this / ( day of /rd , 20 P-3
Af
(Signature
ACKNOWLDGEMENT
STATE OF NEW YORK )
) ss.:
COUNTY OF )
On this _1_L day of U () ,
20 before me the undersigned, personally
appeared , personally known to be or proved to me on the basis of
satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged
to me that he executed the same in his capacity, and that by his signature on the instrument, the individual, or the
person who acted on behalf of the individual, executed the instrument and that such individual made such
appearance before the undersigned at , New York.
S T
OF NEW YORK .
NOTARY PUBUC
Qualified
in KingsCounty
8 of 22
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NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023
OCA Official Form No.: 960
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
[This form has been approved by the New York State Department of Health)
Patient Name: | nata of Rirth SOCial H' '~:
JAMES GEOFFREY
Patient Address: 131 East 21st, #2M, Brooklyn, NY 11226
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:
1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
HIV*
TREATMENT, except psychotherapy notes, and CONFIDENTIAL 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 persons(s)
indicated in Item 8.
2. If I am authorizing the release of HIV 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 a right to request a list of people who may receive or use my HIV related information
without authorization. If I experience discrimination because of the release or disclosure of HIV-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 revoke this authorization at any time by writing to the health care provider listed below. I understand
that I may revoke this authorization except 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 (except as noted above in Item 2),
and this redisclosure may no longer be protected by federal or state law.
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 of health provider or entity to release this information:
Dr. Matthew Wert/Atlantic Orthopedics & Sports Medicine; 554 4th Avenue, Suite A, Brooklyn, NY 11215
8. Name and address of person(s) or category of person to whom this information will be sent:
REBORE, THORPE & POSARELLO, P.C.; 500 Bi-County Blvd., Suite 102, Farmingdale, NY 11725
9(a). Specific information to be released:
[ ] Medical Record from to
[X] Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology
studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers.
[ ] Other: IncI ( Indicate by Initialing)
Alcohol/Drug Treatment
Mental Health Information
Authorization to Discuss Health Information IV-Related information
(b) [ ] By initialing here I authorize
Initials Name of individual health care provider
to discuss my health information with my attorney, or a governmental agency, listed here:
(Attorney/Firm Name or Governmental Agency Name)
10. Reason for release of information: 11. Date or event on which this authorization will expire:
[ ] At request of individual
[X] Other: Litigation At The Termination Of This Matter
12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient:
Krentsel Guzman Herbert, LLP; Jason Herbert, Esq. Power of Attorney
All items on this fd have been completed and my questions about this form have been answered. In addition, I have
been provided a co y of the form.
Date:
Signature of tien or representative authorized by law.
*Human Immu ficiency Virus that causes AIDS. The New York State Public Health Law protects information which
reasonably could identify someone as having HIV symptoms or infection and information regarding a person's contacts.
9 of 22
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NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023
OCA Official Form No.: 960
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
[This form has been approved by the New York State Department of Health]
Patient Name: I nata of Rirth: Social security Number:
JAMES GEOF FREY
Patient Address: 131 East 21st, #2M, Brooklyn, N Y 11226
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:
1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
HIV*
TREATMENT, except psychotherapy notes, and CONFIDENTIAL 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 persons(s)
indicated in Item 8.
2. If I am authorizing the release of HIV 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 a right to request a list of people who may receive or use my HIV related information
Preview
FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023 NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS --------------------------------------------------------------------X Index No.: 508174/2023 JAMES GEOFFREY Plaintiff -against- SUPPLEMENTAL BILL OF PARTICULARS SMITELL LLC SMITELL B-1 LLC and EXTELL DEVELOPMENT COMPANY, Defendants. -----.....-- ____________---------------------------------------__--.x SMITELL LLC SMITELL B-1 LLC and EXTELL DEVLEOPMENT COMPANY, Third-Party Plaintiffs, -against- SUNSHINE MF II LLC and SILVERLINING INTERIORS, INC., Third-Party Defendants. --------------------------------------------------------------------x Plaintiff, JAMES GEOFFREY, by his attorneys, KRENTSEL GUZMAN HERBERT, LLP, as and for his Supplemental Bill of Particulars as to Defendants, SMITELL LLC, SMITELL B-1 LLC and EXTELL DEVELOPMENT COMPANY, sets forth the following upon information and belief: defendants' 1. Solely due to negligence, Plaintiff sustained the following injuries: Trauma, injury and damage to the left knee, including but not limited to: Plaintiff underwent right shoulder arthroscopy dated April 14, 2023 with Dr. Matthew Wert including: complete - humeral arthroscopic synovectomy scope, chondroplasty head, 1 of 22 FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023 NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023 major joint debridement of anterior labrum, arthroscopic major joint debridement of superior partial debridement - rotator cuff - lysis and labrum, supraspinatus, resection of adhesions, ACL tears, multiple chondral fractures, multiple meniscal, ligament, cartilage and tendon tears, requiring surgery, with resultant permanent and disfiguring scarring, synovial effusion, chondromalacia, tendinosis, internal deformities, severe internal derangement, severe inflammation, severe contusions, severe hematomas, need for future surgeries, permanent limp, need for a knee replacement; Trauma, injury and damage to the right shoulder, including but not limited to: massive severely retracted superior rotator cuff tear, involving the entire supraspinatus and anterior half of the infraspinatus tendons, supraspinatus and moderate infraspinatus muscular atrophy, low-grade strain of the superior infraspinatus muscle, subcentimeter partial-thickness articular surface tear of the subscapularis tendon at the superior insertion and tendinosis. Long bicep tendinosis, rotator cuff arthropathy, moderate glenohumeral joint osteoarthritis. Degenerative tear of the superior labrum. Small effusion with chronic synovitis within the auxiliary and subscapularis recesses. Moderate acromioclavicular joint osteoarthritis, small subacromial spurs, and subacromial subdeltoid bursal fluid communicating with the glenohumeral joint across the rotator cuff tear, multiple ligament, cartilage and tendon tears, multiple chondral fractures, requiring surgery, with resultant permanent and disfiguring scarring, severe joint effusion, internal derangement, severe deformities, need for future surgeries and complete shoulder replacement; Trauma, injury, damage to the cervical spine, including but not limited to: severe 2 of 22 FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023 NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023 foraminal stenosis on the left at C3-C4 and on the right at C5-C6, moderate on the left and at the right at C6-C7 and bilaterally C7-T1 disc bulges, disc herniations, sprains, strains, requiring multiple trigger point injections, epidurals and other spinal surgeries, evidence of abnormal alignment with loss of normal cervical curvature with resultant straightening; vertebral subluxation complex, numbness; muscle spasm; cervical strain, cervical pain, cervaglia, cervical subluxation, radiculopathy, need for future invasive spinal surgeries; Trauma, injury, damage to the thoracic spine, including but not limited to: abnormal alignment with loss of normal thoracic, thoracic spine derangement, sprain and strain, vertebral subluxation complex; Trauma, injury, damage to the lumbar spine, including but not limited to: foraminal narrowing bilaterally at L3-L4 and L4-L5 and lower lumbar facet arthrosis, bulges, herniations, severe lumbar and sacral radiculopathy, requiring multiple trigger point injections and spinal epidural surgeries, with permanent deformities and permanent disfiguring scarring, evidence of abnormal alignment with loss of normal with resultant straightening; vertebral subluxation complex, numbness; muscle spasm; lumbaglia, lumbar subluxation, radiculopathy, exacerbation and aggravation of prior injuries and conditions, requiring future multiple trigger point injection and spinal surgeries, need for future spinal surgeries; PLEASE TAKE NOTICE that plaintiff reserves the right to supplement the above responses as 3 of 22 FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023 NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023 such information becomes known to him or his counsel, and/or in accordance with the CPLR and applicable case law. Dated: New York, New York July 19, 2023 TO: REBORE, THORPE & POSARELLO, P.C. Attorneys for Defendants/Third Parry Plaintiffs SMITELL LLC, SMITELL B-1 LLC, and EXTELL DEVELOPMENT COMPANY 500 Bi-County Blvd., Suite 102 Farmingdale, NY 11735 SUNSHINE MG II LLC 12th 767 Fifth Avenue FlOOr New York, NY 10153 SILVERLINING INTERIOR INC. 3rd 2091 Broadway, PlOOr New York, NY 10004 Yours, etc., By: Jas n He ert, Esq. KREN UZMAN HERBERT, LLP. Attorneys for Plaintiff 17 Battery Place - Suite 604 New York, New York 10004 (212) 227-2900 4 of 22 FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023 NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023 ATTORNEY VERIFICATION Jason Herbert, an attorney at law, duly admitted to practice in the Courts of the State of New York, affirms under the penalties of perjury that: He is the attorney for the plaintiff(s) in the above entitled action. That he has read the foregoing PLAINTIFF'S SUPPLEMENTAL BILL OF PARTICULARS and knows the contents thereof, and upon information and belief, deponent believes the matters alleged therein to be true. The reason this Verification is made by deponent and not by the plaintiff(s) is that the plaintiff(s) herein reside(s) in a county other than the one in which the plaintiff s attorneys maintain their office. The source of deponents information and the grounds of his belief are communication, papers, reports and investigation contained in the file. DATED: New York, New York July 19, 2023 Jason He ert Esq. 5 of 22 FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023 NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023 AFFIRMATION OF SERVICE BY MAIL STATE OF NEW YORK ) ) ss.: COUNTY OF NEW YORK) Jason Herbert, an attorney duly admitted to practice law before the Courts of the State of New York, affirms the following under the penalties of perjury: I am not a party to this action; I am over the age of 18 years; and reside in New York, New York. 19* That on the day of July 2023 deponent served the PLAINTIFF'S FIRST SUPPLEMENTAL BILL OF PARTICULARS upon the following attorneys for the defendant(s), as listed below, at the address designated by said attorneys for that purpose by depositing a true copy of same enclosed in a postpaid properly addressed wrapper, in a post office official depository under the exclusive care and custody of the United States Postal Service within the State of New York. TO: REBORE, THORPE & POSARELLO, P.C. Attorneys for Defendants/Third Parry Plaintiffs SMITELL LLC, SMITELL B-1 LLC, and EXTELL DEVELOPMENT COMPANY 500 Bi-County Blvd., Suite 102 Farmingdale, NY 11735 SUNSHINE MG II LLC 12* 767 Fifth Avenue Floor New York, NY 10153 SILVERLINING INTERIOR INC. 3rd 2091 Broadway, FlOOr New York, NY 10004 Dated: New York, New York July 19, 2023 Jason Herit , Esq. 6 of 22 FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023 NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023 Index No: 508174/2023 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS ==-_==============---=======-_=================== JAMES GEOFFREY, Plaintiffs, -against- SMITELL LLC SMITELL B-1 LLC and EXTELL DEVELOPMENT COMPANY, Defendants. ___________ _ _ _____________________________________Ç SMITELL LLC SMITELL B-1 LLC and EXTELL DEVLEOPMENT COMPANY, Third-Party Plaintiffs, -against- SUNSHINE MF II LLC and SILVERLINING INTERIORS, INC., Third-Party Defendants. SUPPLEMENTAL BILL OF PARTICULARS ===--========--=============================== KRENTSEL & GUZMAN, LLP. Attorneys for : Plaintiff(s) Office and Post Office Address, Telephone 17 Battery Place, #604 New York, New York 10004 (212) 227-2900 _____________ __________ _ _ _ _ _ _________________ To Attorney(s) for Service of a copy of the within is hereby admitted. Dated, Attorney(s) for PLEASE TAKE NOTICE: O NOTICE OF ENTRY that the within is a (certified) true copy of a duly entered in the office of the clerk of the within name court on 19 O NOTICE OF SETTLEMENT that an order of which the within is a true copy will be presented for settlement to the HON. one of the judges of the within named Court, at on 19 at M. Dated, Yours, etc. LAW OFFICE OF KRENTSEL & GUZMAN, LLP. 7 of 22 FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023 NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023 Power of Attorney To Execute HIPAA Medical Record Authorization Forms Pursuant to NY Public Health Law § 18(1)(G) As Amended 10/26/04 I, 9wt.-g S Ç¿o dE y (Insert your name and address) do hereby appoint Krentsel Guzman Herbert, LLP, with offices at 17 Battery Pl., Suite 604, New York, New York 10004, my attorney-in-fact to act (each agent may act separately) in my name, place and stead in any way which I myself could do, if I were personally present to execute HIPAA medical record authorization forms pursuant to NY Public Health Law Health Law §18(1)(G) as amended 10/26/04. This power of attorney may be revoked by me at any time. This Power of Attorney shall not be affected by my subsequent disability or incompetence. To induce any third party to act hereunder, I hereby agree that any third party receiving a duly executed copy or facsimile of this instrument may act hereunder, and that revocation or termination hereof shall be ineffective as to such party unless third and until actual notice or knowledge of such revocation or termination shall have been received by such third party, and I for myself and for my heirs, executors, legal representatives and assigns, hereby agree to indemnify and hold harmless any such third party from and against any and all claims that may arise against such third party by reason of such third party having relied on the provisions of this instrument. In Witness Whereof I have hereunto signed my name this / ( day of /rd , 20 P-3 Af (Signature ACKNOWLDGEMENT STATE OF NEW YORK ) ) ss.: COUNTY OF ) On this _1_L day of U () , 20 before me the undersigned, personally appeared , personally known to be or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the individual, or the person who acted on behalf of the individual, executed the instrument and that such individual made such appearance before the undersigned at , New York. S T OF NEW YORK . NOTARY PUBUC Qualified in KingsCounty 8 of 22 FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023 NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023 OCA Official Form No.: 960 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA [This form has been approved by the New York State Department of Health) Patient Name: | nata of Rirth SOCial H' '~: JAMES GEOFFREY Patient Address: 131 East 21st, #2M, Brooklyn, NY 11226 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: 1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH HIV* TREATMENT, except psychotherapy notes, and CONFIDENTIAL 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 persons(s) indicated in Item 8. 2. If I am authorizing the release of HIV 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 a right to request a list of people who may receive or use my HIV related information without authorization. If I experience discrimination because of the release or disclosure of HIV-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 revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization except 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 (except as noted above in Item 2), and this redisclosure may no longer be protected by federal or state law. 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 of health provider or entity to release this information: Dr. Matthew Wert/Atlantic Orthopedics & Sports Medicine; 554 4th Avenue, Suite A, Brooklyn, NY 11215 8. Name and address of person(s) or category of person to whom this information will be sent: REBORE, THORPE & POSARELLO, P.C.; 500 Bi-County Blvd., Suite 102, Farmingdale, NY 11725 9(a). Specific information to be released: [ ] Medical Record from to [X] Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers. [ ] Other: IncI ( Indicate by Initialing) Alcohol/Drug Treatment Mental Health Information Authorization to Discuss Health Information IV-Related information (b) [ ] By initialing here I authorize Initials Name of individual health care provider to discuss my health information with my attorney, or a governmental agency, listed here: (Attorney/Firm Name or Governmental Agency Name) 10. Reason for release of information: 11. Date or event on which this authorization will expire: [ ] At request of individual [X] Other: Litigation At The Termination Of This Matter 12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient: Krentsel Guzman Herbert, LLP; Jason Herbert, Esq. Power of Attorney All items on this fd have been completed and my questions about this form have been answered. In addition, I have been provided a co y of the form. Date: Signature of tien or representative authorized by law. *Human Immu ficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could identify someone as having HIV symptoms or infection and information regarding a person's contacts. 9 of 22 FILED: KINGS COUNTY CLERK 07/19/2023 03:12 PM INDEX NO. 508174/2023 NYSCEF DOC. NO. 50 RECEIVED NYSCEF: 07/19/2023 OCA Official Form No.: 960 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA [This form has been approved by the New York State Department of Health] Patient Name: I nata of Rirth: Social security Number: JAMES GEOF FREY Patient Address: 131 East 21st, #2M, Brooklyn, N Y 11226 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: 1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH HIV* TREATMENT, except psychotherapy notes, and CONFIDENTIAL 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 persons(s) indicated in Item 8. 2. If I am authorizing the release of HIV 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 a right to request a list of people who may receive or use my HIV related information