On December 21, 2023 a
Exhibit,Appendix
was filed
involving a dispute between
Progressive Advanced Insurance Company,
and
Canal Insurance Company
Proposed Additional Respondent,
Freedom Trans Corp.
Proposed Additional Respondent,
Josue I. Velis Ventura,
Kenneth L. Jacobs
Proposed Additional Respondent,
Shark Logistics Corp.
Proposed Additional Respondent,
for Special Proceedings - CPLR Article 75
in the District Court of Suffolk County.
Preview
FILED: SUFFOLK COUNTY CLERK 01/16/2024 01:31 PM INDEX NO. 631416/2023
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 01/16/2024
EXHIBIT
FILED: SUFFOLK COUNTY CLERK 01/16/2024 01:31 PM INDEX NO. 631416/2023
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 01/16/2024
PAGE 1 OF1 PAGE )EW YORK STATE DEPARTMENT OF MOTOR VEF' ES
LOCAL CODES ·
POLICE ACCIDENT REPOr .
23-524510
MV-104A (6/04)
ZR4410H20V 6N ¡ AME/VDED REPORT
ACCIDENT DATE DAYOFWEEK MILITARYTIME O OF No.INJUREDN0,KILLED NOTINVESTIGATED ATSCENE LEFTSCENEPOUCEPHÔTOT
MONTH DAY YEAR -------------
2023 18:20 2 O 0 ACCIDENT
RECONSTRUCTED YES 2NO
08 08 Tuesday a
'"
VEHICLE : y VEHICLE 2 N . OTHER PEDESTRIAN
. VEHICLE1 - DRIVER . 0FLIC.
STATE 2 - DRIVER
VEHICLE SfATEOFLIC.
2 UCENSE IDNUMBER UCENSEIDNUMBER 740643008 NY
DRIVERNAME * EXACTLT NAME
DRIVER aEXACTLY 21
ASPRINTED ONLICENSE PARKED ASPRINTED ONLICENSE 'IACOBS,KENNETH L
(INCLUDE
A6DiiF-SS NUMBERANDSTREET) APT,NO. ADDRESS(INCLUDENUMBliR ANDSTREET) APT.No.
1 W FARMS SQUARE2N
· STATE ZIPCODE CITYORTOWN STATE %IPCODE
CITYORTOWN 22 .
BRONX NY 104600000 50
OCCUPANTs-
1 DATEOFBIRTH SEX UNLICENSED NO.OFOCCUPANTS PUBLIC DATEOFBIRTH seX UNucENSED NO.OF PUBLIC .
MONTHDAY YEAR PROPERTY
MONTHDAY YEAR ¤ DAMAGED
00 12 19 1967 M 01 23
NAME - EXACTLY ÄSPRINTEDONREGISTRATION SEX DATEOFBIRTH NAME - EXACTLYASPRINTED ONREGISTRATION SEX DATEOP·BIRTH
MONTH DAY YEAR MONTH DAY YEAR
4 VELISVENTURA, JOSUE I 12 23 1997 SHARK LOGISTICS CORP
ADDRESS (INCLUDE NUMBER ANDSTREET) APT.No.HAZ, RELEASED ADDRESS (INCLUDENUMBER ANDSTREET) APT.NO.HAZ. RE9EAS
D 7
nA
9 FULTON ST 1192 GREEN ST
' STATE ZIPCODE
CITYORTOWN STATE ZIPCODE CIfYORTOWN
s BRENTWOOD NY 11717 ISELIN . NJ 08830
1 NUMBER STATE OPREG,VEHICLE YEAR & MAKE VEHICLE WPEINS,CODEPLATE NUMBER STATE OFREG. VEHICLE YEAR8tMAKE VEHICLETYPEINS.CODE
JRA9938 NY 2009 NISS 4DSD 678 AY3583 NJ 2018 FRED TRAC 989
TICKET/ARREST . TICKET/ARREST 25
NUMBERS(S)4410H20WTH, 10
NUMBERS($) 4410H20WRL, 4410H20WDP
x4OLATION VIOLATION
SECTION(S) SECTION(S) 5091, 340A,5111A
CHECK IPINVOLVED VEHICLE
IS: C1ECK IF INVOLVED VEHICLEIS: WEDIAGPAM
CIRCLE BELOW THATDESCRISES
THE
ACCIDENT,ORDRAYOUR OWN
MORE THAN95IACHES DIAGRAM #9.NUMBER
INSPACC THEVEHICLES.
MORE THAN WIDE
95INCHES WIDE;
MORE THAN34FEETLONG RF.AR
END LEFTTURN RIGHT
ANGLERIGHT TURNHEAD $26
MORE THAN34PEETLONG; 0N
H OPERATEDWimAN 0VERWEIGHT
PERMIT) OPERAWD WITHA NOVERWERü PERMLT; µ4,
2 OPERATEDWITH PERMIT.
AN0VERDIMENSION OPERATED WITHANOVERDIMENSION PERMIT. 1, 3. 5. 7,
RTd|lh-TCE--" INi--"---
VEHICLE1PAMAGE CODES L VEHICLE2 DAMAGE CODES SIDESWIPE LEFT TURN , . Ti55s
E BOX1 - POINT OFIMPACT 1 2 E BOX1- POINTOFIMPACT 1 2 pp 4. 99 5".mmm 27
- 1
SOX2 - MOST DAMAGE 6 6 BOX2 MOST DAMAGE 2 2 a. o, N a.
ENTER UPTo THREE 3 4 5 EhffERUPTo THREE 3 4
MORE DAMAGE CODES MORE DAMAGE CODES ACCIDENT DIAGRAM
VEHICLE
DYi BYi
VEHICLE
TOWEDTOI TOWEDTOf
VEHICLEDAhlAGE
CODING: 3 7
1-13SEEDIAGRAMONRIGHT. 9
14.UNDERCARRIAGE 17.DEMOLISHED COST TOANYONEVEHICLE
OFREPAIRS WILLBEMORE THAN$1,000.
15,TRAILER 10.NODAMAGE o
16.OVERTURNED 19.OTHER 12 11 10 ¡UNKNOWN/UNABLE TODETERMINE 2Yes No
..... ,
CooRDINATES
(IPAVAILABLE)PLACE WHERE OCCURRED
ACCIDENT
REFERENCE MARKER COUNTYSUFFOLK CITY ¤VILLAGE TOWNOF ISt.IP
LATITUDE/NORTHING|
ROAD DNWHIC‰ ACCIDENT PLOSIMgoNEWOODSRD .
(ROUTE
NUMBERORSTREET ''
NAME)
AT1) INTERSECTING
LONGITUDE/EASTING: m0UTENMBERORSTREETNA
OR2) to . N 2 S OFEXPRESS DRN
FEET MILES E W INTERSEC11NG
NEAREST
(MILEPOST, ROUTE NUMBERORSTREETNAME) 30
ACCIDENT NOTES
DESCRIPTION/oFFICER'S
VEH 1 PARKEDN/B IN PABKING LOT . OPERATOR CLEANING OUT VEHICLE. VEH 2 PARKEDW/B IN PARKING LOT. OP 2 REPORTSHE
NAY HAVE NOT HAD THE VEHICLE IN PARK OR EMERGEN0YBRAKE ENABLEDCAUSING VER 2 TO ROLL INTO VER 1. OP 1 TRANSPORTED COßE
TO SOUTHSIDE HOSPITAL VIA CIHVA RESCUEFOR COMPLAINT OF PAIN , pr
N
--
8 9 10 11 12 13 14 15 16 17 BY To 18 NAMES
0FALLINVOLVED DATE
nF hMTHAMIY
A A
L
L B ;2 M - - -
1 4 1 55 JACOBS, KENNETH L
r C
N D
O E
L
v F
E RANK
OFFICER's 'e . BADGE/ID
No, NCICNo, STATION/BEATREVIEWING
PRECINCT/POST OFFICER DATE/TIMEREVIEWED
D AFDSIGNATURE PO .. . . ... , '. TROOP/Z0NESECTOR
VI S CUSO, 8/43/-2023-
NR
NUL FRANCIS TREZZA 708718 05101 1 406 ROBERT 10:30
00000001 LastMod:8/13/202310130AM https!//Www,crashlogic.cOm
FILED: SUFFOLK COUNTY CLERK 01/16/2024 01:31 PM INDEX NO. 631416/2023
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 01/16/2024
Pfmd87tdA NOVCLl8WOTHERPEDESTRIANWÛAhoN Âlift, MTdo ÝMf$Ó lÑ1 AMÒRS
d. Pedimida@icyrjiM©thpr Pedes7lqnAt Int¾rkMlop m
defjdm/lBhyslMLQt5tRA W DE9Ld0!M Vehicubar :
coho olvene 9NAccolemin
E Deen 9
TlqN . . n tracile
Croitain . Sign 8 afng h
roMioppg A Der dance
" O Defe
21Crossin alnstSIgrial. Screleus . 6. g Overs lan
Cfrked Blona, hi rk9 Gil J OrdQUWhicle '. . X. u ,. igh.t W Shed
.øoamwa Oher Than Gehoo Bus W
8,.. Aoleo .RIre Faiure
Gmasing;NoSlond of . 1 Worldn haR . 9. n C1 afy a
. .. elk .... . . 12 Playln $8Jew Hitch Da
.. asp
.. RId IUn ka 3 01her id a 9 WindshipMndda
Trs ,1% .Cÿngdairega .. ble e
4.Not in Ron way (I rive&ss@away
.
. p Rø8r Ice
instTrs a
h: sødag DTatrao.
1 or eri mprope$-
[adWIndpw
$0 O er VeNputer
6% n in Front off ùla or :
tri ·En0mu
athedWhkik.· . danifirAal#an
sical -
.BL'GiaW
158Cresidng II . 1% r f nfraiDisregaMed
Trattleü na RDmaál . W ea Tumln
3 840p ashhig U Area stobdruasanteabha
Flaw Light 8 8 Pdi SE Favemat Defed
I hanging 90 ement g
y aw n an
onatmelon 20 Othéf Rhone rdy
th .
. ..
50853ramo nlrr2De e
impo er n-Wonkjng
. ulsidgear Dinkndon bo
GHT CONDT NS 20se niÆ|nnil
9th batructedkimise
York Stefe VehUe .. - .
Portméht wo h c es
Ro d dad
Osrk&ndLM(ghted . M Ia
P4 0 (Ù T no
ROADWAYCH AefER. ÊP LMNIN AÖQl0ENTD 50Tl 1 O Ad N De .
3. agralgi liloret
cum at H wee at . .
T0ADWAY SU ACE CONIffr.N OCATEN OP MOST Le B 0 ce theft
. d Dry . 3 ïáld .% SMN 5
6 SEVEMEPHYSMAL Lef(Turnan 0 Other
st Snh ed A
SWB n
Face
o a dR a n
T. ek .. . O R&í
,. --. . . Abdäms Poles DCAT©N OF f%st EVENT
WHICHVE mm0COURIEF 0. Elp p n Roadwa .
L V hth NoAl .A.A47strainVehic ATV O toff Räedmo/ ..
hr Khee.L tepM Type0)0hNT 00 Ll610 T
no bÎiat h ar½hitle D
SA T RQUIPMENTM820 in op)8ION.WITH MXED ECT
M
2. p Belt Seve 14 g itspier Ühil
Document Filed Date
January 16, 2024
Case Filing Date
December 21, 2023
Category
Special Proceedings - CPLR Article 75
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
FILED: SUFFOLK COUNTY CLERK 01/16/2024 01:31 PM INDEX NO. 631416/2023 NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 01/16/2024 EXHIBIT FILED: SUFFOLK COUNTY CLERK 01/16/2024 01:31 PM INDEX NO. 631416/2023 NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 01/16/2024 PAGE 1 OF1 PAGE )EW YORK STATE DEPARTMENT OF MOTOR VEF' ES LOCAL CODES · POLICE ACCIDENT REPOr . 23-524510 MV-104A (6/04) ZR4410H20V 6N ¡ AME/VDED REPORT ACCIDENT DATE DAYOFWEEK MILITARYTIME O OF No.INJUREDN0,KILLED NOTINVESTIGATED ATSCENE LEFTSCENEPOUCEPHÔTOT MONTH DAY YEAR ------------- 2023 18:20 2 O 0 ACCIDENT RECONSTRUCTED YES 2NO 08 08 Tuesday a '" VEHICLE : y VEHICLE 2 N . OTHER PEDESTRIAN . VEHICLE1 - DRIVER . 0FLIC. STATE 2 - DRIVER VEHICLE SfATEOFLIC. 2 UCENSE IDNUMBER UCENSEIDNUMBER 740643008 NY DRIVERNAME * EXACTLT NAME DRIVER aEXACTLY 21 ASPRINTED ONLICENSE PARKED ASPRINTED ONLICENSE 'IACOBS,KENNETH L (INCLUDE A6DiiF-SS NUMBERANDSTREET) APT,NO. ADDRESS(INCLUDENUMBliR ANDSTREET) APT.No. 1 W FARMS SQUARE2N · STATE ZIPCODE CITYORTOWN STATE %IPCODE CITYORTOWN 22 . BRONX NY 104600000 50 OCCUPANTs- 1 DATEOFBIRTH SEX UNLICENSED NO.OFOCCUPANTS PUBLIC DATEOFBIRTH seX UNucENSED NO.OF PUBLIC . MONTHDAY YEAR PROPERTY MONTHDAY YEAR ¤ DAMAGED 00 12 19 1967 M 01 23 NAME - EXACTLY ÄSPRINTEDONREGISTRATION SEX DATEOFBIRTH NAME - EXACTLYASPRINTED ONREGISTRATION SEX DATEOP·BIRTH MONTH DAY YEAR MONTH DAY YEAR 4 VELISVENTURA, JOSUE I 12 23 1997 SHARK LOGISTICS CORP ADDRESS (INCLUDE NUMBER ANDSTREET) APT.No.HAZ, RELEASED ADDRESS (INCLUDENUMBER ANDSTREET) APT.NO.HAZ. RE9EAS D 7 nA 9 FULTON ST 1192 GREEN ST ' STATE ZIPCODE CITYORTOWN STATE ZIPCODE CIfYORTOWN s BRENTWOOD NY 11717 ISELIN . NJ 08830 1 NUMBER STATE OPREG,VEHICLE YEAR & MAKE VEHICLE WPEINS,CODEPLATE NUMBER STATE OFREG. VEHICLE YEAR8tMAKE VEHICLETYPEINS.CODE JRA9938 NY 2009 NISS 4DSD 678 AY3583 NJ 2018 FRED TRAC 989 TICKET/ARREST . TICKET/ARREST 25 NUMBERS(S)4410H20WTH, 10 NUMBERS($) 4410H20WRL, 4410H20WDP x4OLATION VIOLATION SECTION(S) SECTION(S) 5091, 340A,5111A CHECK IPINVOLVED VEHICLE IS: C1ECK IF INVOLVED VEHICLEIS: WEDIAGPAM CIRCLE BELOW THATDESCRISES THE ACCIDENT,ORDRAYOUR OWN MORE THAN95IACHES DIAGRAM #9.NUMBER INSPACC THEVEHICLES. MORE THAN WIDE 95INCHES WIDE; MORE THAN34FEETLONG RF.AR END LEFTTURN RIGHT ANGLERIGHT TURNHEAD $26 MORE THAN34PEETLONG; 0N H OPERATEDWimAN 0VERWEIGHT PERMIT) OPERAWD WITHA NOVERWERü PERMLT; µ4, 2 OPERATEDWITH PERMIT. AN0VERDIMENSION OPERATED WITHANOVERDIMENSION PERMIT. 1, 3. 5. 7, RTd|lh-TCE--" INi--"--- VEHICLE1PAMAGE CODES L VEHICLE2 DAMAGE CODES SIDESWIPE LEFT TURN , . Ti55s E BOX1 - POINT OFIMPACT 1 2 E BOX1- POINTOFIMPACT 1 2 pp 4. 99 5".mmm 27 - 1 SOX2 - MOST DAMAGE 6 6 BOX2 MOST DAMAGE 2 2 a. o, N a. ENTER UPTo THREE 3 4 5 EhffERUPTo THREE 3 4 MORE DAMAGE CODES MORE DAMAGE CODES ACCIDENT DIAGRAM VEHICLE DYi BYi VEHICLE TOWEDTOI TOWEDTOf VEHICLEDAhlAGE CODING: 3 7 1-13SEEDIAGRAMONRIGHT. 9 14.UNDERCARRIAGE 17.DEMOLISHED COST TOANYONEVEHICLE OFREPAIRS WILLBEMORE THAN$1,000. 15,TRAILER 10.NODAMAGE o 16.OVERTURNED 19.OTHER 12 11 10 ¡UNKNOWN/UNABLE TODETERMINE 2Yes No ..... , CooRDINATES (IPAVAILABLE)PLACE WHERE OCCURRED ACCIDENT REFERENCE MARKER COUNTYSUFFOLK CITY ¤VILLAGE TOWNOF ISt.IP LATITUDE/NORTHING| ROAD DNWHIC‰ ACCIDENT PLOSIMgoNEWOODSRD . (ROUTE NUMBERORSTREET '' NAME) AT1) INTERSECTING LONGITUDE/EASTING: m0UTENMBERORSTREETNA OR2) to . N 2 S OFEXPRESS DRN FEET MILES E W INTERSEC11NG NEAREST (MILEPOST, ROUTE NUMBERORSTREETNAME) 30 ACCIDENT NOTES DESCRIPTION/oFFICER'S VEH 1 PARKEDN/B IN PABKING LOT . OPERATOR CLEANING OUT VEHICLE. VEH 2 PARKEDW/B IN PARKING LOT. OP 2 REPORTSHE NAY HAVE NOT HAD THE VEHICLE IN PARK OR EMERGEN0YBRAKE ENABLEDCAUSING VER 2 TO ROLL INTO VER 1. OP 1 TRANSPORTED COßE TO SOUTHSIDE HOSPITAL VIA CIHVA RESCUEFOR COMPLAINT OF PAIN , pr N -- 8 9 10 11 12 13 14 15 16 17 BY To 18 NAMES 0FALLINVOLVED DATE nF hMTHAMIY A A L L B ;2 M - - - 1 4 1 55 JACOBS, KENNETH L r C N D O E L v F E RANK OFFICER's 'e . BADGE/ID No, NCICNo, STATION/BEATREVIEWING PRECINCT/POST OFFICER DATE/TIMEREVIEWED D AFDSIGNATURE PO .. . . ... , '. TROOP/Z0NESECTOR VI S CUSO, 8/43/-2023- NR NUL FRANCIS TREZZA 708718 05101 1 406 ROBERT 10:30 00000001 LastMod:8/13/202310130AM https!//Www,crashlogic.cOm FILED: SUFFOLK COUNTY CLERK 01/16/2024 01:31 PM INDEX NO. 631416/2023 NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 01/16/2024 Pfmd87tdA NOVCLl8WOTHERPEDESTRIANWÛAhoN Âlift, MTdo ÝMf$Ó lÑ1 AMÒRS d. Pedimida@icyrjiM©thpr Pedes7lqnAt Int¾rkMlop m defjdm/lBhyslMLQt5tRA W DE9Ld0!M Vehicubar : coho olvene 9NAccolemin E Deen 9 TlqN . . n tracile Croitain . Sign 8 afng h roMioppg A Der dance " O Defe 21Crossin alnstSIgrial. Screleus . 6. g Overs lan Cfrked Blona, hi rk9 Gil J OrdQUWhicle '. . X. u ,. igh.t W Shed .øoamwa Oher Than Gehoo Bus W 8,.. Aoleo .RIre Faiure Gmasing;NoSlond of . 1 Worldn haR . 9. n C1 afy a . .. elk .... . . 12 Playln $8Jew Hitch Da .. asp .. RId IUn ka 3 01her id a 9 WindshipMndda Trs ,1% .Cÿngdairega .. ble e 4.Not in Ron way (I rive&ss@away . . p Rø8r Ice instTrs a h: sødag DTatrao. 1 or eri mprope$- [adWIndpw $0 O er VeNputer 6% n in Front off ùla or : tri ·En0mu athedWhkik.· . danifirAal#an sical - .BL'GiaW 158Cresidng II . 1% r f nfraiDisregaMed Trattleü na RDmaál . W ea Tumln 3 840p ashhig U Area stobdruasanteabha Flaw Light 8 8 Pdi SE Favemat Defed I hanging 90 ement g y aw n an onatmelon 20 Othéf Rhone rdy th . . .. 50853ramo nlrr2De e impo er n-Wonkjng . ulsidgear Dinkndon bo GHT CONDT NS 20se niÆ|nnil 9th batructedkimise York Stefe VehUe .. - . Portméht wo h c es Ro d dad Osrk&ndLM(ghted . M Ia P4 0 (Ù T no ROADWAYCH AefER. ÊP LMNIN AÖQl0ENTD 50Tl 1 O Ad N De . 3. agralgi liloret cum at H wee at . . T0ADWAY SU ACE CONIffr.N OCATEN OP MOST Le B 0 ce theft . d Dry . 3 ïáld .% SMN 5 6 SEVEMEPHYSMAL Lef(Turnan 0 Other st Snh ed A SWB n Face o a dR a n T. ek .. . O R&í ,. --. . . Abdäms Poles DCAT©N OF f%st EVENT WHICHVE mm0COURIEF 0. Elp p n Roadwa . L V hth NoAl .A.A47strainVehic ATV O toff Räedmo/ .. hr Khee.L tepM Type0)0hNT 00 Ll610 T no bÎiat h ar½hitle D SA T RQUIPMENTM820 in op)8ION.WITH MXED ECT M 2. p Belt Seve 14 g itspier Ühil