Request for Judicial Intervention: In The Matter Of The Application Of Country-Wide Insurance Company v. Frances Washington, Shamiek Engram, Allstate Insurance Company

• 
• 
• 
• 

						
                                
Preview
                                INDEX NO. 508374/2013
NYSCEF DOC. NO. 3 RECEIVED NYSCEF: 12/31/2013

REQUEST FOR JUDICIAL INTERVENTION |____ForCourtClerk Use Only: |

UCS-840 (7/2012)

4 AS Entry Date
Supreme COURT, COUNTY OF. Kings
_ fndge Assigned
meee ae ee eee S~SY
ROD

~ Enter the complete case caption. Do not use et al or et ano. If more space Is required,
CAPTION: attach a caption rider sheet.

In the Matter of the Application of
OUNTRY-WIDE INSURANCE COMPANY,

Plaintiff(s)/Petitioner(s)

cagainst=

For an Order Staying the Arbitration Demanded By FRANCES WASHINGTON,
Respondent(s),
-and-

|SHAMIEK ENGRAM and ALLSTATE INSURANCE COMPANY,
Proposed Additional Co-Respondents.

Defendant(s)/Respondent(s)

NATURE OF ACTION OR PROCEEDING: Check ONE box only and specify where indicated.
MATRIMONIAL COMMERCIAL.

| © contested

NOTE: For all Matrimonial actions where the parties have children under
the age of 18, complete and attach the MATRIMONIAL RJI Addendum.

For Uncontested Matrimonial actions, use Rul form UD-13.

Business Entity (including corporations, partnerships, LLCs, ete.)
O contract
© insurance (where insurer is a party, except arbitration)
© UCC (including sales, negotiable instruments)

TORTS © Other Commercial:
Asbestos (specty)
O Breast Implant NOTE: For Commercial Division assignment requests [22 NYCRR §
O Environmental: 202.70(d)), complete and attach the COMMERCIAL DIV RJI Addendum.
{speciy) REAL PROPERTY: _How many properties does the application include?
© Medical, Dental, or Podiatric Malpractice ‘Condemnation
© Motor Vehicle © Mortgage Foreclosure (specity): O Residential O commercial
© Products Liability: Property Address:
(specify) ‘Street Address city Slate Zip
© other Negligence: NOTE: For Mortgage Foreclosure actions involving a one- to four-family,
(specify) owner-occupied, residential property, or an owner-occupied
O other Professional Malpractice: condominium, complete and attach the FORECLOSURE RJ Addendum.
(specify) © Tax Certiorari - Section: _ Block: Lot:
© other Tort: © Tax Foreclosure
(pedi) © Other Real Property:
OTHER MATTERS. Kpesehy
Certificate of Incorporation/Dissolution [see NOTE under Commercial [SPECIAL PROCEEDINGS
© Emergency Medical Treatment © CPLR Article 75 (Arbitration) [see NOTE under Commercial]
O Habeas Corpus O CPLR Article 78 (Body or Officer)
O Local Court Appeal O Election Law
© Mechanic's Lien ©MHL Article 9.60 (Kendra's Law)
OvName Change © MHL Article 10 (Sex Offender Confinement-Initial)
© Pistol Permit Revocation Hearing © MHL Article 10 (Sex Offender Confinement-Review)
O Sale or Finance of Religious/Not-for-Profit Property © MHL Article 81 (Guardianship)
O other: O Other Mental Hygiene:
(specity) (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 w/notice been filed? O © tyes, date filed:
Has a summons and complaint or summons w/notice been served? oO © _ ityes, date served:

Is this action/proceeding being filed post-judgment? OO © _Iyes, judgment date:[NATURE OF JUDICIAL INTERVENTION:

Check ONE box only AND enter additional information where indicated.

infant's Compromise

O Note of Issue and/or Certificate of Readiness

© Notice of Medical, Dental, or Podiatric Malpractice

© Notice of Motion

© Notice of Petition

© order to Show Cause

© Other Ex Parte Application

© Poor Person Application

© Reaquest for Preliminary Conference

Relief Sought:

Relief Sought:

Date Issue Joined:

Return Date:
Relief Sought: 8,

Relief Sought:

© Residential Mortgage Foreclosure Settlement Conference

© writ of Habeas Corpus
© Other (specify):

Return Date: 01/30/2014
Return Date:

RELATED CASES:

List any retated actions. For Matrimonial actions, include any related criminal and/or Family Court cases,
If additional space is required, complete and attach the RJl Addendum. If none, leave blank.

Case Title

Index/Case No.

Court

Judge (if assigned)

Relationship to Instant Case

PARTIES:

For parties without an attorney, check "Un-Rep" box AND enter party address) phone number and &-mall address in space provided.
If additional space is required, complete and attach the RUl Addendum.

Un-

3rd-party plaintiff)

litigants, provide address, phone number and e-mail address.

Parties: Attorneys and/or Unrepresented Litigants: ea
List parties in caption order and Provide attomey name, firm name, business address, phone number and e-mall_| joined
Rep | indicate party role(s) (e.g. defendant; | address of all attorneys that have appeared in the case. For unrepresented (IN):

Insurance
Carrier(s):

|Country-Wide Insurance Company
Last Na

me Last Name First Name yes
Jaffe & Koumourdas, LLP contend
oO First Name Firm Name ‘ountry-Wide
Primary Role:
ict a fio wall street, 12th Floor New York New York 10005 Insurance Company
etitioner Street Address city State Zip
Secondary Role jf any): {Ono
Phone Fax
Washington
Last Name Last Name First Name yes
Frances jarku, Beno & Tsamblakos, PLLC
oO First Name Firm Name.
Primary Role:
99 Broadway, Suite 910 New York New York 10007
Respondent Street Address City State 2 loo
Secondary Role (if any):
eee +1 (212) 608-4140
Phone Fax e-mail
Last Name Last Name First Name Oo
YES
oO First Name Firm Name
Primary Role:
Street Address city State Zip
Secondary Role (if any): {Ono
Phone Fax e-mail
Last Name Last Name First Name lO
YES
oO First Name Firm Name
Primary Role:
Street Address city State Zip

‘Secondary Role (if any):

Phone

Fax

e-mail

| AFFIRM UNDER THE PENALTY OF PERJURY THAT, TO MY KNOWLEDGE, OTHER THAN AS NOTED ABOVE, THERE ARE AND HAVE,
BEEN NO RELATED ACTIONS OR PROCEEDINGS, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION PREVIOUSLY BEEN FILED IN

THIS ACTION OR PROCEEDING.

Dated: 12/30/2013

SIGNAT
Svetlana Yufa

ATTORNEY REGISTRATION NUMBER

PRINT OR TYPE NAME

Print Form