Preview
FILED: KINGS COUNTY CLERK 07/12/2023 05:32 PM INDEX NO. 500896/2021
NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
130 Livingston Street, 11th Floor Law Department - Torts
Brooklyn, New York 11201
July 7, 2023
ELEFTERAKIS, ELEFTERAKIS & PANEK
80 Pine Street, 38th Floor
New York, New York 10005
Attorney(s) for Plaintiff(s)
Re: Starling de Jesus Abreu Rodriguez v. MTA &
NYCTA
TA File No.: TA-2020-04-19-03-001
Index No.: 500896/2021
Dear Counselor(s):
Pursuant to Plaintiff’s Notice for Discovery and Inspection, dated November 4,
2021, Defendant(s) METROPOLITAN TRANSPORTATION AUTHORITY and NEW
YORK CITY TRANSIT AUTHORITY (NYCTA) hereby respond, upon information and
belief, as follows:
1. ‘All records of construction, inspection, repair, and/or renovation re Pitkin Yard
… for two years prior to, and including April 19, 2020’:
RESPONSE:
Defendants object on the grounds that the demand seeks irrelevant
documents, is overly burdensome and overly broad. Plaintiff’s alleged
accident occurred while he was climbing onto a subway car in the process of
cleaning/washing the car. There was no construction or renovation work
involved.
2. ‘All records pertaining to the frequency, or cycle, of inspections made by the
Defendants, its representatives, agents, etc. of the premises known as Pitkin Yard
… for two years prior to and including, April 19, 2020’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad in seeking documents, material or
information regarding the entire Pitkin Yard facility. Upon information
and belief MTA/NYCTA employees, supervisors, etc., did not inspect the
disinfecting/cleaning work being performed by plaintiff and his coworkers.
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NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
3. ‘All contracts, sub-contracts, riders thereto, and change orders relative to the
subject site and the work being performed by any party on the date of loss, April
19, 2020’:
RESPONSE:
Defendants object to this demand as seeking irrelevant documents, overly
burdensome and overly broad as it is seeking documents related to any work
by any party. Notwithstanding and without waiving said objection, attached
please find a copy of the contract, attached as Exhibit A, between NYCTA
and Home Clean Hole (HCH) related to the work (disinfecting and cleaning
subway trains) plaintiff was performing at the time of the alleged accident.
*(Also attached to the contract are two ‘Change Orders’, a ‘Budget
Adjustment’, and the Certificate of Insurance taken out by Home Clean Home
related to the contract.)
4. ‘All contracts, sub-contracts, riders thereto, and change orders relative to the
subject site and the work being performed by any party on the date of loss
between Defendant regarding construction/renovation work…’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad as it refers to all contracts, etc., and work by
any party. Plaintiff’s alleged accident occurred while he was climbing onto
a subway car in the process of cleaning/washing the car. There was no
construction or renovation work involved.
5. ‘All work orders, progress reports, progress photographs, inspection records, and
safety meeting minutes for construction work being performed at the subject
premises for six months prior to, and including, April 19, 2020’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad. Notwithstanding and without waiving said
objection, plaintiff’s alleged accident occurred while he was climbing onto a
subway car in the process of cleaning/washing the car. There was no
construction or renovation work involved. Defendants are not in possession
of any work orders, other than those provided under paragraph 3, supra.
Defendants are not in possession of progress reports or photographs or
inspection records or safety meeting minutes for the NYCT – HCH contract
related to the train disinfection/cleaning work.
6. ‘All contracts and agreements between the Defendant and Plaintiff’s employer at
the subject premises in effect on April 19, 2020’:
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NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad. See response to paragraph 3, supra,
regarding the exchange of contract documents.
7. ‘Incident/accident reports created by Defendant as a result of Plaintiff’s accident
on April 19, 2020’:
RESPONSE:
Defendants did not create any accident reports related to plaintiff’s alleged
accident as Defendants were not notified of the subject accident at the time
it occurred. Defendants later discovered that an HCH employee was
claiming injury from earlier on that date and detailed learning about the
accident in an email, attached as Exhibit B.
8. ‘Safety contractors and sub-contractors present at subject premises’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad. Defendants are unaware of any safety
contractors (other than possible HCH employees) related to the
disinfection/cleaning work plaintiff was engaged in at the time of his
accident.
9. ‘Copies of progress photographs, blueprints, construction job schematics,
diagrams and shop drawings of the instrumentalities involved in, and the location
of, the occurrence alleged in the Verified Complaint’:
RESPONSE:
Defendants object to your demand as seeking inapplicable and irrelevant
documents, overly burdensome and overly broad. Plaintiff’s alleged
accident occurred while he was climbing onto a subway car in the process of
cleaning/washing the car. There was no construction or renovation work
involved, and no progress photographs, blueprints, construction job
schematics, diagrams, shop drawings, etc., related to the subject cleaning
work.
10. ‘Drawings from the architect or engineer for the work being performed by any
party on the date of loss’:
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NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad. There were not architect/engineer drawing
related to the subject cleaning work.
11. ‘Any correspondence to, or from, the Defendant pertaining to subject
construction project’:
RESPONSE:
Objection, the subject work did not involve a construction project.
Defendants further object to your demand as seeking irrelevant documents,
overly burdensome and overly broad.
12. Any documents sent to, or from, the Defendant concerning the subject accident’:
RESPONSE:
Defendants object to your demand as overly burdensome and overly broad.
Notwithstanding said objections, attached please find a copy of an email
from Superintendent Stolarski, attached herein as Exhibit B, detailing how
he had learned of plaintiff’s alleged accident some three hours after it had
occurred.
13. ‘Any records or documents reflecting prior knowledge pertaining to alleged
hazardous conditions causing the accident involving Plaintiff’:
RESPONSE:
Objection, assuming facts not in evidence. Notwithstanding and without
waiving said objection, Defendants are not in possession of such records.
14. ‘Safety records for this project, and work for a period of six months prior to, and
including, April 19, 2020’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad. Notwithstanding said objections,
Defendants are not in possession of any ‘safety records’ for the subject
cleaning project.
15. ‘Copies of each and every permit and license relating to the subject job site and
premises’:
RESPONSE:
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Defendants object to your demand as seeking inapplicable and irrelevant
documents, overly burdensome and overly broad.
16. ‘Documents reflecting the names, addresses, and current employment status of
each employee present on the job site on the date of Plaintiff’s accident’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad. Notwithstanding and without waiving said
objection, attached as Exhibit C please find a copy of the NYCTA Pitkin
Yard Security Post Activity Log listing all of plaintiff’s fellow ‘Home Clean
Home’ employees who were on site on April 19, 2020.
17. ‘Documents reflecting the work to be performed by Plaintiff on the date of the
accident, April 19, 2020’:
RESPONSE:
Defendants are not in possession of any documents that show specifically
what work Plaintiff was performing on the date of the accident. Please see
the NYCTA-HCH contract, attached as Exhibit A, for a description of the
general work being performed. Please also see the ‘Antimicrobial
Treatment – Daily Shop Report,’ attached as Exhibit D, which show that
HCH cleaned 28 subway cars at Pitkin Yard on the date of the alleged
accident, 4/19/20.
18. ‘Copies of daily, weekly, and monthly work logs, progress reports, safety reports
and minutes of safety meetings for 120 days prior to, and 30 days following,
August [?] 1, 2020’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad. Notwithstanding said objections,
Defendants are not in possession of such records.
19. ‘Copies of work diaries for 120 days prior to, and 30 days following, April 19,
2020’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad. Notwithstanding said objections,
Defendants are not in possession of such records.
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NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
20. ‘Accident reports and investigation records regarding and related to Plaintiff’s
accident’:
RESPONSE:
See Defendants response to paragraphs 7 and 12, supra.
21. ‘Any construction repair, design change, maintenance records, or documents
following Plaintiff’s accident’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad. Defendant further objects as the underlying
subject work did not involve construction.
22. ‘The complete job-file relative to the construction project at the subject premises
known as Pitkin Yard…’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad. Defendant further objects as the underlying
subject work did not involve construction.
23. ‘Defendant’s construction safety procedures or policies’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad. Defendant further objects as the underlying
subject work did not involve construction.
24. ‘All invoices for any safety equipment present, or available, at the job site on
April 19, 2020’:
RESPONSE:
Defendants object to your demand as seeking irrelevant documents, overly
burdensome and overly broad.
25. ‘Employee logs or records identifying each employee of Defendant present at the
situs of the accident of April 19, 2020’:
RESPONSE:
See Defendants response to paragraph 16, supra.
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NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
26. ‘Any records identifying the make and model of any heavy earth moving
equipment in use at the site of the accident on April 19, 2020’:
RESPONSE:
Objection. Defendants object to your demand as inapplicable, irrelevant
and immaterial to the subject claim. Upon information and belief, ‘earth
moving equipment’ was not involved in plaintiff’s alleged accident’.
27. ‘Any records identifying the operator(s) of any heavy earth moving equipment in
use at the site of the accident on April 19, 2020’:
RESPONSE:
Objection - see Defendants response to paragraph 26, supra.
28. ‘Any and all progress records and daily reports and/or logs for the subject jobsite
for a period of 60 days to [?] and including April 19, 2020’:
RESPONSE:
Objection. Defendants object to this demand as irrelevant and immaterial
to the subject claim. See Defendants response to paragraphs 7 and 12, supra.
29. ‘Any and all surveillance recordings, including but not limited to films, tapes,
videos, recording, motion pictures, photographs, recorded statements, videotaped
statements taken of the Plaintiff by or on behalf of Defendant, Defendant’s
employees, servant, investigators, agents and/or any other representative of said
parties’:
RESPONSE:
None in Defendants’ possession at this time.
30. ‘Any and all progress photographs taken at the subject jobsite for a period of 60
days to and including April 19, 2020’:
RESPONSE:
Objection. Defendants object to this demand as irrelevant and immaterial
to the subject claim. None. See Defendants response to paragraphs 5, 9, and
28, supra.
31. ‘Any and all progress photographs taken of the scene of the accident and/or the
instrumentalities causing and/or contributing to the happening of the accident
April 19, 2020’:
RESPONSE:
FILED: KINGS COUNTY CLERK 07/12/2023 05:32 PM INDEX NO. 500896/2021
NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
None
32. ‘Copy of OSHA 300 log for a period of 60 days and including April 19, 2020’:
RESPONSE:
Objection. Defendants object to your demand as irrelevant and immaterial
to the subject claim. Plaintiff was not an NYCTA employee being supervised
by NYCTA for the purposes of OSHA 300.
33. ‘Copy of any citation with reference to the subject job site by OSHA or by other
City, State or Federal agency for a period of one year to and including April 19,
2020’:
RESPONSE:
Objection. Defendants object to your demand as seeking irrelevant
documents, overly burdensome and overly broad.
34. ‘Employee logs or records identifying each employee of Defendant present at the
situs of the accident of April 19, 2020’:
RESPONSE:
No NYCTA employees witnessed plaintiff’s accident.
35. ‘Any records identifying the make and model of any heavy earth moving
equipment in use at the site of the accident on April 19, 2020’:
RESPONSE:
Objection. Defendants object to this demand as irrelevant and immaterial
to the subject claim. Upon information and belief, ‘earth moving
equipment’ was not involved in plaintiff’s alleged accident’. See Defendants
response to paragraph 26, supra.
36. Any records identifying the operator(s) of any heavy earth moving equipment in
use at the site of the accident on April 19, 2020’:
RESPONSE:
Objection - see Defendants response to paragraph 27, supra.
37. ‘Any and all progress records and daily reports and/or logs for the subject jobsite
for a period of 60 days to and including April 19, 2020’:
RESPONSE:
Objection - see Defendants response to paragraph 18, supra.
FILED: KINGS COUNTY CLERK 07/12/2023 05:32 PM INDEX NO. 500896/2021
NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
38. ‘Any and all surveillance recordings, including but not limited to films, tapes,
videos, recording, motion pictures, photographs, recorded statements, videotaped
statements taken of the Plaintiff by or on behalf of Defendant, Defendant’s
employees, servant, investigators, agents and/or any other representative of said
parties’:
RESPONSE:
None – see Defendants’ response to paragraph 29, supra.
39. ‘Any and all progress photographs taken at the subject jobsite for a period of 60
days to and including April 19, 2020’:
RESPONSE:
Objection. Defendants object to this demand as irrelevant and immaterial
to the subject claim. See Defendants response to paragraphs 5, 9, 28, and 30
supra.
40. ‘Any and all progress photographs taken of the scene of the accident and/or the
instrumentalities causing and/or contributing to the happening of the accident.
RESPONSE
None. See Defendants’ response to paragraph 31, supra.
Please be advised that Defendants Metropolitan Transportation Authority and New York
City Transit Authority reserve the right to supplement and/or amend this response up to and
including the time of trial of this action.
Very truly yours,
Michael Pomposello, Esq.
Executive Agency Counsel
(718) 694–3973
Encl.
FILED: KINGS COUNTY CLERK 07/12/2023 05:32 PM INDEX NO. 500896/2021
NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
EXHIBIT A
FILED: KINGS COUNTY CLERK 07/12/2023 05:32 PM INDEX NO. 500896/2021
NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
Purchase Order
Dispatch via Print
Purchase Order Date Revision Page
6030383343 03/26/2020 1 of 3
Payment Terms Freight Terms Currency
Net 30 Destination USD
MTA New York City Transit Buyer Phone Buyer Email Address
2 Broadway - 19th Floor Joan H Schaffer 646/252-6272 joan.schaffer@nyct.com
NEW YORK NY 10004
United States Ship To: 2 Broadway - 19th Floor
NEW YORK NY 10004
Supplier: 0000236702 United States
HOME CLEAN HOME INC
NICOLE LEVINE Attention: Not Specified
1324 E 15TH ST
BROOKLYN NY 11230 Bill To: MTA Business Service Center
333 W. 34th St
New York NY 10001
United States
Tax Exempt? Y Tax Exempt ID: 11-6002815 Email: invoice@mtabsc.org (invoices only)
Line-Sch Item/Description UOM Quantity PO Price Extended Amt Due Date
1- 1 Disinfection, EA 1 $360,000.00000 $360,000.00 03/25/2020
Treatment, and Testing
of Subway Cars in
accordance with the
Scope of Work.
Mfg ID Mfg Part#
Contract ID: 600000000025953 Contract Line: 1 Category Line: 0 Release: 2
Item Total
$360,000.00
This P.O. is for the following services to be performed in accordance with the Scope of Work:
1) Cleaning for an estimated quantity of five hundred (500) subway cars at a price of $420.00 per
car.
2) The disinfection and application of an antimicrobial treatment for an estimated quantity of
thousand (1,000) subway cars at a price of $150.00 per car.
3) Quality assurance sampling for an estimated quantity of (12) subway cars at a price of $400.00 per
car.
All work shall be performed in accordance with the Contract Documents and will take place at various
NYC Transit maintenance shops in Brooklyn, Manhattan, Queens, and the Bronx.
The following quantity-sensitive discounts shall be honored:
500-999 subway cars - 5%
1,000-1,999 subway cars - 7%
2,000-2,999 subway cars - 10%
3,000+ subway cars - 15%
This acceptance and order constitutes the entire agreement between the parties and shall only be
modified as stated below.
“No changes shall be made to this acceptance and order, unless properly amended, in writing, by the
NYCTA Materiel division.”
FILED: KINGS COUNTY CLERK 07/12/2023 05:32 PM INDEX NO. 500896/2021
NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
Purchase Order
Dispatch via Print
Purchase Order Date Revision Page
6030383343 03/26/2020 2 of 3
Payment Terms Freight Terms Currency
Net 30 Destination USD
MTA New York City Transit Buyer Phone Buyer Email Address
2 Broadway - 19th Floor Joan H Schaffer 646/252-6272 joan.schaffer@nyct.com
NEW YORK NY 10004
United States Ship To: 2 Broadway - 19th Floor
NEW YORK NY 10004
Supplier: 0000236702 United States
HOME CLEAN HOME INC
NICOLE LEVINE Attention: Not Specified
1324 E 15TH ST
BROOKLYN NY 11230 Bill To: MTA Business Service Center
333 W. 34th St
New York NY 10001
United States
Tax Exempt? Y Tax Exempt ID: 11-6002815 Email: invoice@mtabsc.org (invoices only)
Line-Sch Item/Description UOM Quantity PO Price Extended Amt Due Date
In addition to any rights of termination granted herein or by law the Authority may terminate this
contract at any time and for any reason or no reason upon giving seven (7) days written notice
thereof, whereupon the Authority shall have no liability to the contractor.
The contractor shall maintain during the life of this contract a comprehensive general liability
insurance policy with broad form endorsement issued by an insurance company approved by the
Authority, insuring the contractor and naming the Authority as an additional insured at all times
during the life of this contract with limits of at least one million dollars ($1,000,000) per
occurrence for bodily injury and property damage combined. Such policies shall contain no exclusions
unacceptable to the Authority. Such policy shall contain agreement by the insurance company issuing
the policy that the policy will not be cancelled, terminated, or modified without thirty (30) days
prior notice to the contract manager. At least two (2) weeks prior to the expiration of the original
policy or any renewal thereof a new policy or renewal of such insurance shall be delivered to the
contract manager. Contractor shall obtain all other insurance coverages required by law.
Total PO Amount
$360,000.00
Goods will not be accepted, or bills audited for payment, unless the following conditions are
complied with:
1. Place order number and delivery point on all bills, packing slips and shipping labels. Shipments
made via UPS/RPS must indicate the number of cartons shipped, i.e. 1 of 3, 2 of 3 etc.
2. Bills must be submitted to: MTA Business Service Center, 333 W. 34th Street, New York, NY 10001
3. Send packing slip with each shipment to delivery point. The carton containing the packing slip
must be marked "Packing Slip Enclosed".
4. When Purchase Orders are consolidated and shipped in multipaks, each Purchase Order must be
individually boxed and labeled.
5. Deliveries should not be made sooner than 14 calendar days prior to the delivery date unless
authorized by a request to expedite. In this case, the expeditor's name and phone number must appear
on the packing slip.
ALL OTHER EARLY DELIVERIES WILL BE REJECTED.
SEPARATE INVOICES REQUIRED FOR EACH DELIVERY POINT.
SALES TAX NOT TO BE INCLUDED
The law specifically provides thatt the tax does not apply to receipts from sales by or to the state,
municipalities and any other political subdivision thereof.
Note: That pursuant to the directive of Joseph H. Murphy, Commissioner of Taxation and Finance of the
State of New York dated 7/22/65, this purchase order may be accepted in lieu of an exemption
certificate with the vendor retaining a copy to prove that the sale was exempt.
For Storeroom Addresses and Receiving hours, please visit our website at
FILED: KINGS COUNTY CLERK 07/12/2023 05:32 PM INDEX NO. 500896/2021
NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
Purchase Order
Dispatch via Print
Purchase Order Date Revision Page
6030383343 03/26/2020 3 of 3
Payment Terms Freight Terms Currency
Net 30 Destination USD
MTA New York City Transit Buyer Phone Buyer Email Address
2 Broadway - 19th Floor Joan H Schaffer 646/252-6272 joan.schaffer@nyct.com
NEW YORK NY 10004
United States Ship To: 2 Broadway - 19th Floor
NEW YORK NY 10004
Supplier: 0000236702 United States
HOME CLEAN HOME INC
NICOLE LEVINE Attention: Not Specified
1324 E 15TH ST
BROOKLYN NY 11230 Bill To: MTA Business Service Center
333 W. 34th St
New York NY 10001
United States
Tax Exempt? Y Tax Exempt ID: 11-6002815 Email: invoice@mtabsc.org (invoices only)
Line-Sch Item/Description UOM Quantity PO Price Extended Amt Due Date
http://www.mta.info/nyct/procure/miscdocs.htm
Authorized Signature
FILED: KINGS COUNTY CLERK 07/12/2023 05:32 PM INDEX NO. 500896/2021
NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
CONTRACT EXECUTION
CONTRACT NO.: SSE 307355
In WITNESS WHEREOF, this Contract has been executed by both the NEW YORK CITY
TRANSIT AUTHORITY and Ap Scm O v P. , the
"Acknowledgment"
CONTRACTOR*, on the day and year indicated on the applicable documents.
The CONTRACTOR, if a corporation, has also affixed its seal to this instrument on the day and
CONTRACTOR"
year indicated on the "Acknowledgment for the document.
THE NEW YORK CITY TRANSIT AUTHORITY
by:
Assistant Chief Procurement Officer
THE CONTRACTOR
, C/Rp CCA (Seal)
Exact Name of Contracto
by: ( p C p..Q
Title: f)
*The Contractor, if a partnership, joint venture or corporation, must execute this Contract in the
exact firm or corporate name as it appears in its partnership or joint venture agreement or certificate
of incorporation. If the Contractor is a corporation and this Contract is executed by an Officer
other than the President or Vice President, the Contractor shall furnish a certified copy of by-laws
or a resolution authorizing said Officer to sign, unless same has previously been furnished to the
Authority. If the Contractor is a joint venture or partnership, and an individual executes this
Contract on behalf of more than one member of the joint venture or partnership, documentation
shall be furnished establishing such individual's authority to bind each such member.
SSE 307355
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NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
ACKNOWLEDGEMENT FOR THE AUTHORITY
STATE OF NEW YORK )
) SS:
COUNTY OF NEW YORK )
On this 2nd day of April 2020 before me personally appeared
Steven Picillo, Assistant Chief Procurement Officer to me known, who being
by me first duly sworn, did depose and say: That he is the Assistant Chief
Procurement Officer of the Materiel Division, of the New York City Transit
Authority, the public benefit corporation described in and which executed the
foregoing instrument and that he acknowledged to me that he signed his name
thereto pursuant to the authorization of said Authority.
Joan Holland Schaffer
Notary Public, State of New York
No. 01SC6180588
Qualified in Kings County
Commission Expires January 14, 2024
FILED: KINGS COUNTY CLERK 07/12/2023 05:32 PM INDEX NO. 500896/2021
NYSCEF DOC. NO. 88 RECEIVED NYSCEF: 07/12/2023
CONTRACT EXECUTION
ACKNOWLEDGMENT FOR CONTRACTOR
STATE OF r )
e oc k ) SS.:
COUNTY OF )
On this day of o 20 20 , before me personally appeared
c o/e , known to me to be the person who executed the
foregoing instrument, who, being duly sworn by me did depose and say that s/he resides at
/ 72 v e e .sr , in the City of A. k ( , in the
of , in the State of A/T ; and further that s/he:
County k,,
[Mark an X in the appropriate box and complete the accompanying statement.]
¡ (Ifan individual): executed the foregoing instrument in her/his name and on her/his own behalf.
(If a corporation): is the Duner of
Ho e C /ean He , the corporation in said instrument;
that, by authority of the Board of Directors of said corporation, s/he is authorized to execute the
foregoing instrument on behalf of the corporation for the purposes set forth therein; and that,
pursuant to that authority, s/he executed the foregoing instrument in the name of and on behalf of
said corporation as the act and deed of said corporation.
¡ (If a partnership): is the of
, the partnership described in said
instrument; that, by the terms of said partnership s/he is authorized to execute the foregoing
instrument on behalf of the partnership for the purposes set forth therein; and that, pursuant to that
authority, s/he executed the foregoing instrument in the name of and on behalf of said partnership
as the act and deed of said partnership.
¡ (If a limited liability company): is a duly authorized member of