Preview
FILED: BRONX COUNTY CLERK 04/22/2024 03:00 PM INDEX NO. 806585/2024E
NYSCEF DOC. NO. 9 RECEIVED NYSCEF: 04/22/2024
UCS-840
REQUEST FOR JUDICIAL INTERVENTION (rev. 01/01/2024)
Supreme COURT, COUNTY OF Bronx
Index No: Date Index Issued: For Court Use Only:
CAPTION Enter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet. IAS Entry Date
In the Matter of the Application for a stay of Arbitration of Progressive Advanced Insurance Company i/s/h/a
Progressive Insurance Company
Judge Assigned
Plaintiff(s)/Petitioner(s)
-against-
Christian Delgado, RST Solutions Inc Proposed Additional Respondent, Terrence A Burnett Proposed Additional
RJI Filed Date
Respondent, ABC Insurance Corp. Proposed Additional Respondent
Defendant(s)/Respondent(s)
NATURE OF ACTION OR PROCEEDING: Check only one box and specify where indicated.
COMMERCIAL MATRIMONIAL
☐ Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.) ☐ Contested
☐ Contract NOTE: If there are children under the age of 18, complete and attach the
MATRIMONIAL RJI Addendum (UCS-840M).
☐ Insurance (where insurance company is a party, except arbitration)
☐ UCC (includes sales and negotiable instruments) For Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13).
☐ Other Commercial (specify): REAL PROPERTY Specify how many properties the application includes:
NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d), ☐ Condemnation
complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C).
☐ Mortgage Foreclosure (specify): ☐ Residential ☐ Commercial
TORTS Property Address:
NOTE: For Mortgage Foreclosure actions involving a one to four-family, owner-
☐ Asbestos
occupied residential property or owner-occupied condominium, complete and
☐ Environmental (specify): attach the FORECLOSURE RJI ADDENDUM (UCS-840F).
☐ Medical, Dental or Podiatric Malpractice
☐ Partition
☐ Motor Vehicle
NOTE: Complete and attach the PARTITION RJI ADDENDUM (UCS-840P).
☐ Products Liability (specify):
☐ Other Negligence (specify): ☐ Tax Certiorari (specify): Section: Block: Lot:
☐ Other Professional Malpractice (specify): ☐ Tax Foreclosure
☐ Other Tort (specify): ☐ Other Real Property (specify):
OTHER MATTERS
SPECIAL PROCEEDINGS ☐ Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section]
☐ Child-Parent Security Act (specify): ☐ Assisted Reproduction ☐ Surrogacy Agreement ☐ Emergency Medical Treatment
☒ CPLR Article 75 - Arbitration [see NOTE in COMMERCIAL section] ☐ Habeas Corpus
☐ CPLR Article 78 - Proceeding against a Body or Officer ☐ Local Court Appeal
☐ Election Law ☐ Mechanic's Lien
☐ Extreme Risk Protection Order ☐ Name Change/Sex Designation Change
☐ MHL Article 9.60 - Kendra's Law ☐ Pistol Permit Revocation Hearing
☐ MHL Article 10 - Sex Offender Confinement (specify): ☐ Initial ☐ Review ☐ Sale or Finance of Religious/Not-for-Profit Property
☐ MHL Article 81 (Guardianship) ☐ Other (specify):
☐ Other Mental Hygiene (specify):
☐ Other Special Proceeding (specify):
STATUS OF ACTION OR PROCEEDING Answer YES or NO for every question and enter additional information where indicated.
YES NO
Has a summons and complaint or summons with notice been filed? ☐ ☒ If yes, date filed:
Has a summons and complaint or summons with notice been served? ☐ ☒ If yes, date served:
Is this action/proceeding being filed post-judgment? ☐ ☒ If yes, judgment date:
NATURE OF JUDICIAL INTERVENTION Check one box only and enter additional information where indicated.
☐ Infant's Compromise
☐ Extreme Risk Protection Order Application
☐ Note of Issue/Certificate of Readiness
☐ Notice of Medical, Dental or Podiatric Malpractice Date Issue Joined:
☐ Notice of Motion Relief Requested: Return Date:
☒ Notice of Petition Relief Requested: Stay Return Date: 06/25/2024
☐ Order to Show Cause Relief Requested: Return Date:
☐ Other Ex Parte Application Relief Requested:
☐ Partition Settlement Conference
☐ Poor Person Application
☐ Request for Preliminary Conference
☐ Residential Mortgage Foreclosure Settlement Conference
☐ Writ of Habeas Corpus
☐ Other (specify):
1 of 2
FILED: BRONX COUNTY CLERK 04/22/2024 03:00 PM INDEX NO. 806585/2024E
NYSCEF DOC. NO. 9 RECEIVED NYSCEF: 04/22/2024
RELATED CASES List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank.
If additional space is required, complete and attach the RJI Addendum (UCS-840A).
Case Title Index/Case Number Court Judge (if assigned) Relationship to instant case
PARTIES For parties without an attorney, check the "Un-Rep" box and enter the party's address, phone number and email in the space
provided. If additional space is required, complete and attach the RJI Addendum (UCS-840A).
Un- Parties Attorneys and Unrepresented Litigants Issue Joined Insurance Carriers
Rep List parties in same order as listed in the For represented parties, provide attorney's name, firm name, address, phone For each defendant, For each defendant,
caption and indicate roles (e.g., plaintiff, and email. For unrepresented parties, provide party's address, phone and indicate if issue has indicate insurance
defendant, 3rd party plaintiff, etc.) email. been joined. carrier, if applicable.
Name: In the Matter of the FRANCIS SCAHILL, Scahill Law Group P.C., 1065 Stewart
☐ Application for a stay of Arbitration Avenue Suite 210, Bethpage, NY 11714, 516-294-5200,
of ... frank@scahillpc.com ☐ YES ☒ NO
Role(s): Plaintiff/Petitioner
Name: Delgado, Christian Law Offices of Roth & Khalife, LLP, 14 Wall Street, NEW
☐ YORK, NY 10005, (212) 608-3015 ☐ YES ☒ NO
Role(s): Defendant/Respondent
Name: RST Solutions Inc 1005 Azlen Ln, Chalfont, PA 18914
☒ ☐ YES ☒ NO
Role(s): Defendant/Respondent
Name: Burnett, Terrence A. 1061 Hall Place, Apt 4E, Bronx, NY 10459
☒ ☐ YES ☒ NO
Role(s): Defendant/Respondent
Name: ABC Insurance Corp.
☒ ☐ YES ☒ NO
Role(s): Defendant/Respondent
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR
PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS
ACTION OR PROCEEDING.
Dated: 04/22/2024 FRANCIS J SCAHILL
Signature
1983501 FRANCIS J SCAHILL
Attorney Registration Number Print Name
This form was generated by NYSCEF
2 of 2
Preview
FILED: BRONX COUNTY CLERK 04/22/2024 03:00 PM INDEX NO. 806585/2024E NYSCEF DOC. NO. 9 RECEIVED NYSCEF: 04/22/2024 UCS-840 REQUEST FOR JUDICIAL INTERVENTION (rev. 01/01/2024) Supreme COURT, COUNTY OF Bronx Index No: Date Index Issued: For Court Use Only: CAPTION Enter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet. IAS Entry Date In the Matter of the Application for a stay of Arbitration of Progressive Advanced Insurance Company i/s/h/a Progressive Insurance Company Judge Assigned Plaintiff(s)/Petitioner(s) -against- Christian Delgado, RST Solutions Inc Proposed Additional Respondent, Terrence A Burnett Proposed Additional RJI Filed Date Respondent, ABC Insurance Corp. Proposed Additional Respondent Defendant(s)/Respondent(s) NATURE OF ACTION OR PROCEEDING: Check only one box and specify where indicated. COMMERCIAL MATRIMONIAL ☐ Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.) ☐ Contested ☐ Contract NOTE: If there are children under the age of 18, complete and attach the MATRIMONIAL RJI Addendum (UCS-840M). ☐ Insurance (where insurance company is a party, except arbitration) ☐ UCC (includes sales and negotiable instruments) For Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13). ☐ Other Commercial (specify): REAL PROPERTY Specify how many properties the application includes: NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d), ☐ Condemnation complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C). ☐ Mortgage Foreclosure (specify): ☐ Residential ☐ Commercial TORTS Property Address: NOTE: For Mortgage Foreclosure actions involving a one to four-family, owner- ☐ Asbestos occupied residential property or owner-occupied condominium, complete and ☐ Environmental (specify): attach the FORECLOSURE RJI ADDENDUM (UCS-840F). ☐ Medical, Dental or Podiatric Malpractice ☐ Partition ☐ Motor Vehicle NOTE: Complete and attach the PARTITION RJI ADDENDUM (UCS-840P). ☐ Products Liability (specify): ☐ Other Negligence (specify): ☐ Tax Certiorari (specify): Section: Block: Lot: ☐ Other Professional Malpractice (specify): ☐ Tax Foreclosure ☐ Other Tort (specify): ☐ Other Real Property (specify): OTHER MATTERS SPECIAL PROCEEDINGS ☐ Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section] ☐ Child-Parent Security Act (specify): ☐ Assisted Reproduction ☐ Surrogacy Agreement ☐ Emergency Medical Treatment ☒ CPLR Article 75 - Arbitration [see NOTE in COMMERCIAL section] ☐ Habeas Corpus ☐ CPLR Article 78 - Proceeding against a Body or Officer ☐ Local Court Appeal ☐ Election Law ☐ Mechanic's Lien ☐ Extreme Risk Protection Order ☐ Name Change/Sex Designation Change ☐ MHL Article 9.60 - Kendra's Law ☐ Pistol Permit Revocation Hearing ☐ MHL Article 10 - Sex Offender Confinement (specify): ☐ Initial ☐ Review ☐ Sale or Finance of Religious/Not-for-Profit Property ☐ MHL Article 81 (Guardianship) ☐ Other (specify): ☐ Other Mental Hygiene (specify): ☐ Other Special Proceeding (specify): STATUS OF ACTION OR PROCEEDING Answer YES or NO for every question and enter additional information where indicated. YES NO Has a summons and complaint or summons with notice been filed? ☐ ☒ If yes, date filed: Has a summons and complaint or summons with notice been served? ☐ ☒ If yes, date served: Is this action/proceeding being filed post-judgment? ☐ ☒ If yes, judgment date: NATURE OF JUDICIAL INTERVENTION Check one box only and enter additional information where indicated. ☐ Infant's Compromise ☐ Extreme Risk Protection Order Application ☐ Note of Issue/Certificate of Readiness ☐ Notice of Medical, Dental or Podiatric Malpractice Date Issue Joined: ☐ Notice of Motion Relief Requested: Return Date: ☒ Notice of Petition Relief Requested: Stay Return Date: 06/25/2024 ☐ Order to Show Cause Relief Requested: Return Date: ☐ Other Ex Parte Application Relief Requested: ☐ Partition Settlement Conference ☐ Poor Person Application ☐ Request for Preliminary Conference ☐ Residential Mortgage Foreclosure Settlement Conference ☐ Writ of Habeas Corpus ☐ Other (specify): 1 of 2 FILED: BRONX COUNTY CLERK 04/22/2024 03:00 PM INDEX NO. 806585/2024E NYSCEF DOC. NO. 9 RECEIVED NYSCEF: 04/22/2024 RELATED CASES List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank. If additional space is required, complete and attach the RJI Addendum (UCS-840A). Case Title Index/Case Number Court Judge (if assigned) Relationship to instant case PARTIES For parties without an attorney, check the "Un-Rep" box and enter the party's address, phone number and email in the space provided. If additional space is required, complete and attach the RJI Addendum (UCS-840A). Un- Parties Attorneys and Unrepresented Litigants Issue Joined Insurance Carriers Rep List parties in same order as listed in the For represented parties, provide attorney's name, firm name, address, phone For each defendant, For each defendant, caption and indicate roles (e.g., plaintiff, and email. For unrepresented parties, provide party's address, phone and indicate if issue has indicate insurance defendant, 3rd party plaintiff, etc.) email. been joined. carrier, if applicable. Name: In the Matter of the FRANCIS SCAHILL, Scahill Law Group P.C., 1065 Stewart ☐ Application for a stay of Arbitration Avenue Suite 210, Bethpage, NY 11714, 516-294-5200, of ... frank@scahillpc.com ☐ YES ☒ NO Role(s): Plaintiff/Petitioner Name: Delgado, Christian Law Offices of Roth & Khalife, LLP, 14 Wall Street, NEW ☐ YORK, NY 10005, (212) 608-3015 ☐ YES ☒ NO Role(s): Defendant/Respondent Name: RST Solutions Inc 1005 Azlen Ln, Chalfont, PA 18914 ☒ ☐ YES ☒ NO Role(s): Defendant/Respondent Name: Burnett, Terrence A. 1061 Hall Place, Apt 4E, Bronx, NY 10459 ☒ ☐ YES ☒ NO Role(s): Defendant/Respondent Name: ABC Insurance Corp. ☒ ☐ YES ☒ NO Role(s): Defendant/Respondent Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING. Dated: 04/22/2024 FRANCIS J SCAHILL Signature 1983501 FRANCIS J SCAHILL Attorney Registration Number Print Name This form was generated by NYSCEF 2 of 2