On January 04, 2023 a
Exhibit,Appendix
was filed
involving a dispute between
Ashley Bracco,
and
Marcus O. Nieves,
Skyway Truck Parts Inc.,
for Torts - Motor Vehicle
in the District Court of Suffolk County.
Preview
FILED: SUFFOLK COUNTY CLERK 02/23/2024 02:41 PM INDEX NO. 600234/2023
NYSCEF DOC. NO. 24 RECEIVED NYSCEF: 02/23/2024
EXHIBIT D
FILED: SUFFOLK COUNTY CLERK 02/23/2024 02:41 PM INDEX NO. 600234/2023
'
NYSCEF DOC. LNO.
CODES
24 RECEIVED NYSCEF: 02/23/2024
Ed POUCE ACCIDENT REPORT 19
20-407035 -
MV-104A (6/04)
ZRHS07C5TTCZ ¡ A ECDEDýÈPÖRd
_ ACCIDENTDATE DAYOFWEEK MIL1TARY
TIME NO.OF NO.INJUREDNO.KILLED SCENEPOLICE
AT SCENE¡ LEFT
NOTINVESTIGATED
PHOTOS
MONTH DAY VEHICLES
YEAR
08 14 2020 Friday 16:40 3 O 0 RECONSTRUCTED
ACGDENT ¡YES 2 NO 20
VEHICLE 1 2VEHICLE 2 ]BICYCLIST OPEDESTR-IAN OOTHER PEDESTRIAN
VEHICR1 - DRIVER STATE
OFLIC. VEHICE2 - DRIVER STATE
OFLIC,
2 LICENSE
ID NUMBER 294311115 NY LICENSE
ID NUMBER 270811252 NY
NAME- EXACTLY
DRIVER NAME- EXACTLY
DRIVER 21
ASPRINTED ONLIGNSE CHANG, HUEIHSIEN ASPRINTED
ONLICENSEBRACCO, ASHLEY M
ADDRESS(INCLUDENUMBER
ANDSTREET) APT.NO. ADDRESS
(INCLUDE
NUMBER
ANDSTREET) APT.NO.
18 GREIS AVE 82 12TH AVE
CITYORTOWN STATE 2T2CODE GTYORTOWN -- STATE ZIPCODC 2
NESCONSET NY 117670000 HOLTSVILLE NY 117420000
1 DATEOF BIRTH SEX UNLICENSED
NO.OFOCCUPANTS
PUBLIC DATEOF BIRTH SEX UNLIGNSEDNO.OFOCCUPANTS
PUBLIC
MONTH DAY PROPE MONTH DAY YEAR E
YEAR
11 22 1961
F 01 03 12 1993 F 01 23
3
NAME- EXACTLY
ASPRINTED
ONREGISTRATION SEX DATEOFBIRTH NAME- EXACTLYASPRINTED
ONREGISTRATION SEX DATEOF BIRTH
MONTH DAY YEAR MONTH DAY YEAR
4 CHANG, HUEIHSIEN F 11 22 1961 ZERAFA, ASHLEY M F 03 12 1993
1 ADDRESS(INCLUDE
NUMBER ANDSTREET) APT.NO.HAZ. RELEASEDADDRESS(INCLUDENUMBERANDSTREET) APT.NO.HAZ. RELEASED 3
M -
18 GREIS AVE ¡ 82 12TH AVE
C Y ORTOWN STATE ZIPCODE CIW ORTOWN STATE ZIPCODE
S NESCONSET NY 11767 HOLTSVILLE NY 11742
PLATENUMBER STATE
OFREG, VEHICEYEAR& MAKE VEHICETYPEINS.CODEPLATENUMBER STATE
OFREG- EHICLE
YEAR& MAKE VEHICLE
TYPEINS.CODE
ADS7962 NY 2014 TOYT SUBN 410 GNS9410 NY 2014 ACUR 4DSD 639
72
TICKET/ARREST TICKET/ARREST
NUMBERS(S) NUMBERS(S)
1 VIOLATION VIOLATION
SECTION{S) SECHON(S)
CHECKIF INVOLVEDVENICEIS: CHECK
IF INVOLVED
VEHICLEIS: C[RCLE
THEDIAGRAM
BELOW
THAT DESCRIBE5
THEACCIDENT,
ORDRAWYOUR
OWN
951NCHES INSPACE
DIAGRAM #9.NUMBERTHEVEH1CLES.
MORE THAN
95INCHES
WIDE; MORE THAN WIDE;
MORE THAN
34FEETLONG; MORE THAN
34FEET
LONG; REAR
END LEFT
WRN RIGFFT TURN HEAD
ANGLERIGHT ON 7
7 OPERATED
WITHANOVERWEIGHT
PERHIT; H OPERATED
WITHANOVERWEIGHT
PERMIT
OPERATEDWITHANOVERD3MENSION
PERMIT. OPERATED WITHANOVERDIMENSION
PERMIT
L VEHICLE 1DAMAGECODES L VEHICE2 DAMAGE CODES SIDESWIPE LEFT
WRN . TURN SMSW
RIGHT
E BOX1 - POINTOFIMPACT (oPPosrreemµCrt0N)27
1 2 E BOX1 - POINTOFIMPACT I 2
BOX2 - MOSTDAMAGE S S BOX2 - MOSTDAMAGE 8 8 2.
ENTER UPTOTHREE 3 4 5 ENTER UPTOTHREE 3 4 5
MOREDAMAGE CODES 9 7 MOREDAMAGE CODES 9 7 ACCIDENTDIAGRAM
VEHICLE
BY: VEHICLE
BY:
TOWEDTO: TOWEDTO: See the last page of the MV-104A for the
DAMAGE
VEHICLE CODING: 3 7 28
1-13SEEDIAGRAM
ONRIGHT. 9. 1
2 13 g
14.UNDERCARRIAGE17,DEMOLISHED COSTOFREPAIRS
TOANYONEVEHICLE
WILLBEMORETHAN$1,000,
15..TRAILER 18.NODAMAGE
16.OVERTURNED 19.OTHER
n n 10 UNKNOWN/UNABLE
TO DETERMINE Yes ¡ NO
COORDINATES
(IFAVAILABLE)PLACE WHEREACODENTOCCURRED: 29
REFERENCE
MARKER COUNTYSUFFOLK ¡ CY ¡VILLAGE TOWN OF ISLIP -
ROADONWHICHACCIDENT X495
4518580 (ROUTE
NUMBER
ORSTREET
NAME)
AT 1) INTERSECTING
LONGITUDE/EASTING: (ROUTE
NUMBERORSTREETNAME)
OR2) N S
1 OFEXITSS
647164 MILES
FEET E W INTERSECHNG
NEAREST
(MILEPOST, ROUTE
NUMBER
ORSTREET
NAME) 30
ACCIDENT DESCRIPTION/OFFICER'S
NOTES
Op. of V1 reports she slowing down in stop and go traffic when V3 rear ended V2 pushing V2 into the rear of her USE
COW
vehicle. Op of V2 reports she was in stop and go traffic when she was rear ended by V3.. Impact pushed her into V1.
Op of V3 reports his water bottle fell underneath his brake pedal and he therefore couldn't stop his vehicle until mgpT
he rear ended V2, pushing V2 into V1. Both operators of V1 and V2 report negative injuries at this time and refused
rescue but state their neck/back is a little sore from the impact. Ins of V3 is preferred mutual ins co of New
8 9 10 11 12 13 14 15 16 17 BY TO 18 NAMES
OFALLINVOLVED DA E OFDEATHONLY
A A - HUEIHSIEN
1 1 U 1 58 F CHANG,
L B 2 1 U 1 27 F - - BRACCO, ASHLEY M
C 3 1 U 1 22 M - - NIEVES, MARCUS O
N D
O E
V F
E OFFICER'S
RANK BADL,E/ID
NO. NCICNO. PRECINCT/POST
STATMN/BFAT $tJEWINGOFFICER DATE/TIME REVIEWED
D AFD SIGNATURE PO ¯¯¯ TROOP/ZONE SECTOR
SANTILLO, 8/14/2020
PRINTNAME
m ou- ROBERT KETELTAS 890277 05101 908 MICHAEL 20:35
00000001 LastMod: 8/14/2020 8:35 Pl4 http5://www.crashtogic.corn
FILED: SUFFOLK COUNTY CLERK 02/23/2024 02:41 PM INDEX NO. 600234/2023
OCALNO.
NYSCEF DOC. COD 24
S RECEIVED NYSCEF: 02/23/2024
20-407035 19
MV-104A (6/04) 9
ZRH907C5TTCZ O H MEÑDÊÖXÊPÖü
1 NO.INIURED NO.KILLED LEFTSCENEPOLIRPHOTOS
ACCIDENTDATE DAYOFWEEK MILITARY
TIME NO.OF
MONTH DAY VEHICLES
NOTINVESTIGATED
----------------
¡
ATSCENE
YEAR
08 14 2020 Friday 16:40 3 0 0 ACCIDENT RECONSTRUCTED¡ ¡YES O NO 20
4
VEHICLE 3 UVEHICLE ]BICYCLIST OPEDESTRIAN OOTHER PEDESTRÏAN
3 - DRIVER
VEHICLE STATEOFUC. - Driver
VEHICLE STATEOFLIC.
2 UCENSEID NUMBER N42165177609972 NJ uCENSE
ID NUMBER
NAME- EXACTLY
DRIVER NAME- EXACTLY
DRIVER 21
ASPRINTED ONLIGNSE NIEVES, MARCUS O ASPRINTED ONLICENSE
ADDRESS(INCLUDENUMBERANDSTREET) APT.NO. ADDRESS(INCLUDE ANDSTREET)
NUMBER APT.NO.
105 NORTH 11 STREET
GTYORTG STATE -ZIPCODE CITYORTOWN nme -½TATE ZIPCODE ¬--22
NEWARK NJ 071070000
DATEOF BIRTH SEX UNUCENSED
NO.OFOCCUPANTS
PUBLIC DATEOF BIRTH SEX UNLICENSED
NO.OFOCCUPANTS
PUBLIC
MONTH DAY P9ROPER MONTH DAY YEAR O ER
YEAR
09 22 1997 M 01 23
3
NAME- EXACTLY
ASPRINTED
ONREGISTRATION SEX DATEOF BIRTH NAME- EXACTLY
ASPRINTED
ONREGISTRATION SEX DATEOF BIRTH
MONTH DAY YEAR MONTH DAY YEAR
4 skyway trucks C
ADDRESS(INCLUDE NUMBER
ANDSTREET) APT.NO.HAZ. RELEASEDADDRESS
(INCLUDE ANDSTREET)
NUMBER APT.NO.HAZ. I ELËASED
oA MA
23 2ND ST
CIN ORTOWN STATE ZIPCODE CITYORTOWN STATE ZIPCODE
s KEARNY NJ 07032
PLATENUMBER STATE
OFREG. VEHICLE
YEAR& MAKE VEHICLE
TYPEINS.CODE PLATE
NUMBER STATE
OFREG- VEHICLE
YEAR& MAKE VEHICLE
TYPEINS.CODE
XHFA42 NJ 2012 CHEV PICK 989
TICKET/ARREST TICKET/ARREST
NUMBERS(S} NUMBERS(S)
6
VIOLATION VIOLATION
SECTION(S) SECTION(S)
CHECKIF INVOLVEDVEHICLE
IS: CHECK
IF INVOLVEDVEHICLE
IS: CIRCLE
THEDIAGRAM
BELOWTHATDESCRIBES
THEACGOENT,
ORDRAW
YOUR
OWN
95INCHES DIAGRAM
INSPACE THE
#9.NUMBER VEHICLES.
MoRE THAN
95INCHE$
WIDE; MORE THAN WIDE;
E MORE THAN
34FEETLONG; MORE THAN
34FEETLONG; REAR
END LEFT
TURN RIGHT TURN HEAD
ANGLERIGHT ON
7 H OPERATED
WITHANOVERWEIGHT
PERMIT; H WITHANOVERWEIGHT
OPERATED PERMIT:
L 3. s. 7.
TURN SmE5WE
L VEHICLE1 DAMAGE
E BOX1 - POINTOFIMPACT
CODES
1
L VEHICLE2 DAMAGE
2 E BOX1 - POINTOFIMPACT
CODES
1 2 W
SIDESWIPE
DIRmom
LEFT
TURN RIGHT
27
BOX2 - MOSTDAMAGE 2 2 BOX2 - MOSTDAMAGE a.
,
ENTER UPTOTHREE 3 4 5 ENTER UPTOTHREE 3 4 5
MOREDAMAGE CODES MOREDAMAGE CODES ACCIDENTDIAGRAM
VEHICLE
BY: VEHICLE
BY:
TOWEDTO: TOWEDTO:
4 5 6
VEHICLE
DAMAGE
CODING: 3 7 28
1-13SEEDIAGRAM
ONRIGHT.. 9
2 13 8
14.UNDERCARRIAGE17,DEMOLISHED COSTOFREPAIRS
TOANYONEVEHICLE
WILLBEMORE
THAN$1,000.
15.TRAILER 18.NODAMAGE
1 9
g
16.OVERTURNED 19.OTHER UNKNOWN/UNABLE
TO DETERMINE¡Yes ¡ No
CDORDINATEs
(IFAVAILABLE)PLACE
WHEREACIDENTOTURRED: 29
REFERENG
MARKER -
COUNTYSUFFOLK ¡ CITY ¡ VIU_AGE ¡TOWN OF
ROADONWHICHACCIDENT
(ROUTE
NUMBER
ORSTREET
NAME)
AT 1} INTERSECTING
LONGITUDE/EASTING: (ROUTE
NUMBER
ORSTREET
NAME)
on 23 UN 5
FEET MILES ¡• ¡W NEAREST
(MILEPOST, INTERSEC NG
ROUTE
NUMBER
ORSTREET
NAME) 30
ACCIDENT
DESCRIPTION/OFFICER's
NOTES
#PCAO100721364 CU E
Jersey policy
R
-my
N
8 9 10 11 12 13 14 15 16 17 BY TO 18 NAMES
OFALLINVOLVED DATEOFDEATH
ONLY
A A
L
L B
C
N D
O E
V F
E OFFICER'S
RANK NO.. NOCNO..
BADGE/ID STATION/8EAT REVIEWING
PRECINCT/POST OFFICER DATE/TIME REVIEWED
D AFD SIGNATURE PO -- - TROOP/ZONE SECTOR
SANTILLO, 8/14/2020
PRINTNAME
IN FUu. ROBERT KETELTAS 890277 05101 908 MICHAEL 20:35
00000001 LastMOd:8/14/2020 8:35 PM https://www.crashlogic.com
FILED: SUFFOLK COUNTY CLERK 02/23/2024 02:41 PM INDEX NO. 600234/2023
°°"°°°°s
NYSCEF DOC. NO. 24 RECEIVED NYSCEF: 02/23/2024
POUCE ACCIDENT REPORT
20-407035 3o4 (s,o43
ZRH907C5TTCZ O $ EÑÔE XÈXOXÈ
DAYOFWEEK MILITARY
TIME No.OF SCENEPOLIRPHOTOS
ACCIDENTDATE NO.INJUREDNO.KIt1ED ATSCENE¡ LEFT
NOTINVESTIGATED
MONTH DAY VEHICE
YEAR
08 14 2020 16:40 3 0 0 RECONSTRUCFED
ACCIDENT YES NO
Friday
. . hov
. i495
RANK
OFFICER'S NO. NCICNO.
BADGE/ID PRECINCT/POST
STATION/BEAT REVIEWING
OFFICER DATE/TIME REVIEWED
ANDSIGNATURE PO . è 2 nfMié TROOP/ZONE SECTOR
SANTILLO, 8/14/2020
PRINTNAME
IN FULL ROBERTKETELTAS 890277 05101 908 MICHAEL 20:35
00000001 Last Mad: 8/14/2020 8:35 PM https://www.crashiogic.com
FILED: SUFFOLK COUNTY CLERK 02/23/2024 02:41 PM INDEX NO. 600234/2023
NYSCEF DOC. NO. 24 RECEIVED NYSCEF: 02/23/2024
PEDESTRIAN#BMYOUSTMTHER PEDESTR1ANLOCATION APPARENT CONTRIBUTING FACTOR$
1.. Pedestren/Encycht/Other Pedestriariat Intersacüon Human Vehicular Vehicle
1 PedestriaWBicydisitO%er Pedestrian Nd.at Int=rsection:..... 2. AlcohaUnvolvement 41- Accelerator Defective 19
4
PEDESTRIAN/B1CYCLIST/ & Bacidag Unsafety 42.. Brakes Defecave
4. Griver InattentiarwDisixacilon' n. Headrights Defec ive.
OTHER PEDESTRIAN ACT.N . . . Inexperience'
1 Crossing, WithSigIaO 8. Goíng tofFroniS6pped & Driver . 4L Other Lightin Defects .
1
E Crossing, Against Signal
Document Filed Date
February 23, 2024
Case Filing Date
January 04, 2023
Category
Torts - Motor Vehicle
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
FILED: SUFFOLK COUNTY CLERK 02/23/2024 02:41 PM INDEX NO. 600234/2023 NYSCEF DOC. NO. 24 RECEIVED NYSCEF: 02/23/2024 EXHIBIT D FILED: SUFFOLK COUNTY CLERK 02/23/2024 02:41 PM INDEX NO. 600234/2023 ' NYSCEF DOC. LNO. CODES 24 RECEIVED NYSCEF: 02/23/2024 Ed POUCE ACCIDENT REPORT 19 20-407035 - MV-104A (6/04) ZRHS07C5TTCZ ¡ A ECDEDýÈPÖRd _ ACCIDENTDATE DAYOFWEEK MIL1TARY TIME NO.OF NO.INJUREDNO.KILLED SCENEPOLICE AT SCENE¡ LEFT NOTINVESTIGATED PHOTOS MONTH DAY VEHICLES YEAR 08 14 2020 Friday 16:40 3 O 0 RECONSTRUCTED ACGDENT ¡YES 2 NO 20 VEHICLE 1 2VEHICLE 2 ]BICYCLIST OPEDESTR-IAN OOTHER PEDESTRIAN VEHICR1 - DRIVER STATE OFLIC. VEHICE2 - DRIVER STATE OFLIC, 2 LICENSE ID NUMBER 294311115 NY LICENSE ID NUMBER 270811252 NY NAME- EXACTLY DRIVER NAME- EXACTLY DRIVER 21 ASPRINTED ONLIGNSE CHANG, HUEIHSIEN ASPRINTED ONLICENSEBRACCO, ASHLEY M ADDRESS(INCLUDENUMBER ANDSTREET) APT.NO. ADDRESS (INCLUDE NUMBER ANDSTREET) APT.NO. 18 GREIS AVE 82 12TH AVE CITYORTOWN STATE 2T2CODE GTYORTOWN -- STATE ZIPCODC 2 NESCONSET NY 117670000 HOLTSVILLE NY 117420000 1 DATEOF BIRTH SEX UNLICENSED NO.OFOCCUPANTS PUBLIC DATEOF BIRTH SEX UNLIGNSEDNO.OFOCCUPANTS PUBLIC MONTH DAY PROPE MONTH DAY YEAR E YEAR 11 22 1961 F 01 03 12 1993 F 01 23 3 NAME- EXACTLY ASPRINTED ONREGISTRATION SEX DATEOFBIRTH NAME- EXACTLYASPRINTED ONREGISTRATION SEX DATEOF BIRTH MONTH DAY YEAR MONTH DAY YEAR 4 CHANG, HUEIHSIEN F 11 22 1961 ZERAFA, ASHLEY M F 03 12 1993 1 ADDRESS(INCLUDE NUMBER ANDSTREET) APT.NO.HAZ. RELEASEDADDRESS(INCLUDENUMBERANDSTREET) APT.NO.HAZ. RELEASED 3 M - 18 GREIS AVE ¡ 82 12TH AVE C Y ORTOWN STATE ZIPCODE CIW ORTOWN STATE ZIPCODE S NESCONSET NY 11767 HOLTSVILLE NY 11742 PLATENUMBER STATE OFREG, VEHICEYEAR& MAKE VEHICETYPEINS.CODEPLATENUMBER STATE OFREG- EHICLE YEAR& MAKE VEHICLE TYPEINS.CODE ADS7962 NY 2014 TOYT SUBN 410 GNS9410 NY 2014 ACUR 4DSD 639 72 TICKET/ARREST TICKET/ARREST NUMBERS(S) NUMBERS(S) 1 VIOLATION VIOLATION SECTION{S) SECHON(S) CHECKIF INVOLVEDVENICEIS: CHECK IF INVOLVED VEHICLEIS: C[RCLE THEDIAGRAM BELOW THAT DESCRIBE5 THEACCIDENT, ORDRAWYOUR OWN 951NCHES INSPACE DIAGRAM #9.NUMBERTHEVEH1CLES. MORE THAN 95INCHES WIDE; MORE THAN WIDE; MORE THAN 34FEETLONG; MORE THAN 34FEET LONG; REAR END LEFT WRN RIGFFT TURN HEAD ANGLERIGHT ON 7 7 OPERATED WITHANOVERWEIGHT PERHIT; H OPERATED WITHANOVERWEIGHT PERMIT OPERATEDWITHANOVERD3MENSION PERMIT. OPERATED WITHANOVERDIMENSION PERMIT L VEHICLE 1DAMAGECODES L VEHICE2 DAMAGE CODES SIDESWIPE LEFT WRN . TURN SMSW RIGHT E BOX1 - POINTOFIMPACT (oPPosrreemµCrt0N)27 1 2 E BOX1 - POINTOFIMPACT I 2 BOX2 - MOSTDAMAGE S S BOX2 - MOSTDAMAGE 8 8 2. ENTER UPTOTHREE 3 4 5 ENTER UPTOTHREE 3 4 5 MOREDAMAGE CODES 9 7 MOREDAMAGE CODES 9 7 ACCIDENTDIAGRAM VEHICLE BY: VEHICLE BY: TOWEDTO: TOWEDTO: See the last page of the MV-104A for the DAMAGE VEHICLE CODING: 3 7 28 1-13SEEDIAGRAM ONRIGHT. 9. 1 2 13 g 14.UNDERCARRIAGE17,DEMOLISHED COSTOFREPAIRS TOANYONEVEHICLE WILLBEMORETHAN$1,000, 15..TRAILER 18.NODAMAGE 16.OVERTURNED 19.OTHER n n 10 UNKNOWN/UNABLE TO DETERMINE Yes ¡ NO COORDINATES (IFAVAILABLE)PLACE WHEREACODENTOCCURRED: 29 REFERENCE MARKER COUNTYSUFFOLK ¡ CY ¡VILLAGE TOWN OF ISLIP - ROADONWHICHACCIDENT X495 4518580 (ROUTE NUMBER ORSTREET NAME) AT 1) INTERSECTING LONGITUDE/EASTING: (ROUTE NUMBERORSTREETNAME) OR2) N S 1 OFEXITSS 647164 MILES FEET E W INTERSECHNG NEAREST (MILEPOST, ROUTE NUMBER ORSTREET NAME) 30 ACCIDENT DESCRIPTION/OFFICER'S NOTES Op. of V1 reports she slowing down in stop and go traffic when V3 rear ended V2 pushing V2 into the rear of her USE COW vehicle. Op of V2 reports she was in stop and go traffic when she was rear ended by V3.. Impact pushed her into V1. Op of V3 reports his water bottle fell underneath his brake pedal and he therefore couldn't stop his vehicle until mgpT he rear ended V2, pushing V2 into V1. Both operators of V1 and V2 report negative injuries at this time and refused rescue but state their neck/back is a little sore from the impact. Ins of V3 is preferred mutual ins co of New 8 9 10 11 12 13 14 15 16 17 BY TO 18 NAMES OFALLINVOLVED DA E OFDEATHONLY A A - HUEIHSIEN 1 1 U 1 58 F CHANG, L B 2 1 U 1 27 F - - BRACCO, ASHLEY M C 3 1 U 1 22 M - - NIEVES, MARCUS O N D O E V F E OFFICER'S RANK BADL,E/ID NO. NCICNO. PRECINCT/POST STATMN/BFAT $tJEWINGOFFICER DATE/TIME REVIEWED D AFD SIGNATURE PO ¯¯¯ TROOP/ZONE SECTOR SANTILLO, 8/14/2020 PRINTNAME m ou- ROBERT KETELTAS 890277 05101 908 MICHAEL 20:35 00000001 LastMod: 8/14/2020 8:35 Pl4 http5://www.crashtogic.corn FILED: SUFFOLK COUNTY CLERK 02/23/2024 02:41 PM INDEX NO. 600234/2023 OCALNO. NYSCEF DOC. COD 24 S RECEIVED NYSCEF: 02/23/2024 20-407035 19 MV-104A (6/04) 9 ZRH907C5TTCZ O H MEÑDÊÖXÊPÖü 1 NO.INIURED NO.KILLED LEFTSCENEPOLIRPHOTOS ACCIDENTDATE DAYOFWEEK MILITARY TIME NO.OF MONTH DAY VEHICLES NOTINVESTIGATED ---------------- ¡ ATSCENE YEAR 08 14 2020 Friday 16:40 3 0 0 ACCIDENT RECONSTRUCTED¡ ¡YES O NO 20 4 VEHICLE 3 UVEHICLE ]BICYCLIST OPEDESTRIAN OOTHER PEDESTRÏAN 3 - DRIVER VEHICLE STATEOFUC. - Driver VEHICLE STATEOFLIC. 2 UCENSEID NUMBER N42165177609972 NJ uCENSE ID NUMBER NAME- EXACTLY DRIVER NAME- EXACTLY DRIVER 21 ASPRINTED ONLIGNSE NIEVES, MARCUS O ASPRINTED ONLICENSE ADDRESS(INCLUDENUMBERANDSTREET) APT.NO. ADDRESS(INCLUDE ANDSTREET) NUMBER APT.NO. 105 NORTH 11 STREET GTYORTG STATE -ZIPCODE CITYORTOWN nme -½TATE ZIPCODE ¬--22 NEWARK NJ 071070000 DATEOF BIRTH SEX UNUCENSED NO.OFOCCUPANTS PUBLIC DATEOF BIRTH SEX UNLICENSED NO.OFOCCUPANTS PUBLIC MONTH DAY P9ROPER MONTH DAY YEAR O ER YEAR 09 22 1997 M 01 23 3 NAME- EXACTLY ASPRINTED ONREGISTRATION SEX DATEOF BIRTH NAME- EXACTLY ASPRINTED ONREGISTRATION SEX DATEOF BIRTH MONTH DAY YEAR MONTH DAY YEAR 4 skyway trucks C ADDRESS(INCLUDE NUMBER ANDSTREET) APT.NO.HAZ. RELEASEDADDRESS (INCLUDE ANDSTREET) NUMBER APT.NO.HAZ. I ELËASED oA MA 23 2ND ST CIN ORTOWN STATE ZIPCODE CITYORTOWN STATE ZIPCODE s KEARNY NJ 07032 PLATENUMBER STATE OFREG. VEHICLE YEAR& MAKE VEHICLE TYPEINS.CODE PLATE NUMBER STATE OFREG- VEHICLE YEAR& MAKE VEHICLE TYPEINS.CODE XHFA42 NJ 2012 CHEV PICK 989 TICKET/ARREST TICKET/ARREST NUMBERS(S} NUMBERS(S) 6 VIOLATION VIOLATION SECTION(S) SECTION(S) CHECKIF INVOLVEDVEHICLE IS: CHECK IF INVOLVEDVEHICLE IS: CIRCLE THEDIAGRAM BELOWTHATDESCRIBES THEACGOENT, ORDRAW YOUR OWN 95INCHES DIAGRAM INSPACE THE #9.NUMBER VEHICLES. MoRE THAN 95INCHE$ WIDE; MORE THAN WIDE; E MORE THAN 34FEETLONG; MORE THAN 34FEETLONG; REAR END LEFT TURN RIGHT TURN HEAD ANGLERIGHT ON 7 H OPERATED WITHANOVERWEIGHT PERMIT; H WITHANOVERWEIGHT OPERATED PERMIT: L 3. s. 7. TURN SmE5WE L VEHICLE1 DAMAGE E BOX1 - POINTOFIMPACT CODES 1 L VEHICLE2 DAMAGE 2 E BOX1 - POINTOFIMPACT CODES 1 2 W SIDESWIPE DIRmom LEFT TURN RIGHT 27 BOX2 - MOSTDAMAGE 2 2 BOX2 - MOSTDAMAGE a. , ENTER UPTOTHREE 3 4 5 ENTER UPTOTHREE 3 4 5 MOREDAMAGE CODES MOREDAMAGE CODES ACCIDENTDIAGRAM VEHICLE BY: VEHICLE BY: TOWEDTO: TOWEDTO: 4 5 6 VEHICLE DAMAGE CODING: 3 7 28 1-13SEEDIAGRAM ONRIGHT.. 9 2 13 8 14.UNDERCARRIAGE17,DEMOLISHED COSTOFREPAIRS TOANYONEVEHICLE WILLBEMORE THAN$1,000. 15.TRAILER 18.NODAMAGE 1 9 g 16.OVERTURNED 19.OTHER UNKNOWN/UNABLE TO DETERMINE¡Yes ¡ No CDORDINATEs (IFAVAILABLE)PLACE WHEREACIDENTOTURRED: 29 REFERENG MARKER - COUNTYSUFFOLK ¡ CITY ¡ VIU_AGE ¡TOWN OF ROADONWHICHACCIDENT (ROUTE NUMBER ORSTREET NAME) AT 1} INTERSECTING LONGITUDE/EASTING: (ROUTE NUMBER ORSTREET NAME) on 23 UN 5 FEET MILES ¡• ¡W NEAREST (MILEPOST, INTERSEC NG ROUTE NUMBER ORSTREET NAME) 30 ACCIDENT DESCRIPTION/OFFICER's NOTES #PCAO100721364 CU E Jersey policy R -my N 8 9 10 11 12 13 14 15 16 17 BY TO 18 NAMES OFALLINVOLVED DATEOFDEATH ONLY A A L L B C N D O E V F E OFFICER'S RANK NO.. NOCNO.. BADGE/ID STATION/8EAT REVIEWING PRECINCT/POST OFFICER DATE/TIME REVIEWED D AFD SIGNATURE PO -- - TROOP/ZONE SECTOR SANTILLO, 8/14/2020 PRINTNAME IN FUu. ROBERT KETELTAS 890277 05101 908 MICHAEL 20:35 00000001 LastMOd:8/14/2020 8:35 PM https://www.crashlogic.com FILED: SUFFOLK COUNTY CLERK 02/23/2024 02:41 PM INDEX NO. 600234/2023 °°"°°°°s NYSCEF DOC. NO. 24 RECEIVED NYSCEF: 02/23/2024 POUCE ACCIDENT REPORT 20-407035 3o4 (s,o43 ZRH907C5TTCZ O $ EÑÔE XÈXOXÈ DAYOFWEEK MILITARY TIME No.OF SCENEPOLIRPHOTOS ACCIDENTDATE NO.INJUREDNO.KIt1ED ATSCENE¡ LEFT NOTINVESTIGATED MONTH DAY VEHICE YEAR 08 14 2020 16:40 3 0 0 RECONSTRUCFED ACCIDENT YES NO Friday . . hov . i495 RANK OFFICER'S NO. NCICNO. BADGE/ID PRECINCT/POST STATION/BEAT REVIEWING OFFICER DATE/TIME REVIEWED ANDSIGNATURE PO . è 2 nfMié TROOP/ZONE SECTOR SANTILLO, 8/14/2020 PRINTNAME IN FULL ROBERTKETELTAS 890277 05101 908 MICHAEL 20:35 00000001 Last Mad: 8/14/2020 8:35 PM https://www.crashiogic.com FILED: SUFFOLK COUNTY CLERK 02/23/2024 02:41 PM INDEX NO. 600234/2023 NYSCEF DOC. NO. 24 RECEIVED NYSCEF: 02/23/2024 PEDESTRIAN#BMYOUSTMTHER PEDESTR1ANLOCATION APPARENT CONTRIBUTING FACTOR$ 1.. Pedestren/Encycht/Other Pedestriariat Intersacüon Human Vehicular Vehicle 1 PedestriaWBicydisitO%er Pedestrian Nd.at Int=rsection:..... 2. AlcohaUnvolvement 41- Accelerator Defective 19 4 PEDESTRIAN/B1CYCLIST/ & Bacidag Unsafety 42.. Brakes Defecave 4. Griver InattentiarwDisixacilon' n. Headrights Defec ive. OTHER PEDESTRIAN ACT.N . . . Inexperience' 1 Crossing, WithSigIaO 8. Goíng tofFroniS6pped & Driver . 4L Other Lightin Defects . 1 E Crossing, Against Signal