Preview
FILED: KINGS COUNTY CLERK 12/26/2019 12:52 PM INDEX NO. 091261/2019
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS
X
WORKERS' :
COMPENSATION BOARD OF THE STATE OF NEW YORK,
Plaintiff,
-against- :
:
TRIPLE A GROUP USA INC :
AFFIRMATION
Defendant(s) :
OF
NON-PAYMENT
:
:
:
:
X
Workers'
The undersigned, an attorney in the officeofthe Compensation Board ofthe State ofNew
York, Plaintiffherein,hereby affirms thatthe following istrue under the penalty of perjury,upon
information and belief
Workers'
This affirmationisbased upon a review of the file
which ismaintained by the Compensation
Board initsregular course of business.
I am familiarwith the status of payment in thismatter. The award/penalty/assessment/demand for
deposit of security made against the defendant(s) in theamount of $4,500.00 is in default,
as more than
thirtydays have elapsed since the demand upon the defendant(s) herein for payment. No payment has
been received nor has the aforesaid securitybeen deposited incompliance with said demand todate,
except the sum of $0.00, leaving due and payble the sum of $4,500.00.
Dated: 25th day of November , 2019 .
S/
James R. McGinn, Esq.
Judgment Unit
C-45.45E 1/2009
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NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019
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FILED: KINGS COUNTY CLERK 12/26/2019 12:52 PM INDEX NO. 091261/2019
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS
X
WORKERS' :
COMPENSATION BOARD OF THE STATE OF NEW YORK,
Plaintiff,
-against- :
:
TRIPLE A GROUP USA INC :
AFFIRMATION
Defendant(s) :
OF
REGULARITY
:
:
:
:
X
Workers'
The undersigned, an attorney in the officeofthe Compensation Board ofthe State ofNew
York, Plaintiffherein,hereby affirms thatthe following istrue under the penalty of perjury,upon
information and belief
Workers'
This affirmationisbased upon a review of the file
which ismaintained by the Compensation
Board initsregular course of business.
Workers'
The Compensation Board of the State of New York, inaccordance with the provisions of the
Workers'
Compensation Law, has made an assessment/award in thesum of $4,500.00, against the
defendant(s). Attached hereto and made a part hereofare certifiedcopies of the Notice of Decision and
Award, and/or a certifiedcopy of the demand fordeposit of security,and/or a certifiedcopy ofthe chair's
order imposing, and the demand for payment of, assessments imposed by the chairpursuant to
Workers'
subdivision five ofsection fifty-twoand/or one hundred thirtyone of the Compensation Law, as
Workers'
required for of
filing judgment per Compensation Law, Section 26 and/or 219. Appeals before
the Board have been exhausted.
No payment of award has been made except $0.00, leaving $4,500.00 due and payable.
WHEREFORE, it is
respectfullyrequested that judgment be entered against the Defendant(s) herein in
the sum stated as remaining due and payable.
Dated: 25th day of November , 2019 .
S/
James R. McGinn, Esq.
Judgment Unit
C-45.1E 6/2007
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NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019
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FILED: KINGS COUNTY CLERK 12/26/2019 12:52 PM INDEX NO. 091261/2019
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019
STATE OF NEW YORK
WORKERS'
COMPENSATION BOARD
THISAGENCYEMPLOYSAND SERVES
JUDGMENT UNIT PEOPLEWITH DISABILITIESWITHOUT
328 STATE STREET DISCRIMINATION.
SCHENECTADY, NY 12305-2318
866-298-7830
TRIPLE A GROUP USA INC WCB EMPLOYER #: 2933082
320 ROEBLING ST STE 717 UlER #: 52-64047
BROOKLYN NY 11211-6262
FEIN/SS #: *****6664
It is
hereby certified
that thisis a true
and correct copy ofthe originalas filed
Workers'
with the CGmper.stion Board
S/
James R. McGinn, Esq.
*
DATE: 11/25/2019 FINAL NOTICE ±een±unit
Certifiedon 11/25/19
Non-Compliance
Item Description Dates Accident Date Balance Due
2017W0010455 Failure to Workers ' Ins 12/31/2016-03/31/2017 $4, 500. 00
Carry Comp
Total Balance Due $4,500.00
*
If payment isnot received immediately, judgment willbe filedand the employer issubject to seizure
of assets, both business and personal, without furthernotice from the Board.
In orderto insureprompt credit
of your payment, complete thefo!!owingwiththe
Date, Number and Amount of yourcheck and return with
it, along your payment to:
WORKERS'
COMPENSATION BOARD
FINANCE OFFICE
328 STATE STREET, SCHENECTADY, NY 12305-2318
Please detach and return bottom portion with your payment.
MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND".
PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK.
Employer TRIPLE A GROUP USA INC WCB Employer # 2933082
Customer ID # 1875386
Check
Check Date Check #
Amount
C-45.37 5/2004 Page 1 of 2
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NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019
Non-Compliance
Item Description Dates Accident Date Balance Due
MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND".
Mail payment along with this form to:
WORKERS'
COMPENSATION BOARD
FINANCE OFFICE
328 STATE STREET
SCHENECTADY, NY 12305-2318
C-45.37 5/2004 Page 2 of 2
6 of 7
FILED: KINGS COUNTY CLERK 12/26/2019 12:52 PM INDEX NO. 091261/2019
NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019
SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS
X
WORKERS' :
COMPENSATION BOARD OF THE STATE OF NEW YORK, JUDGMENT
Plaintiff,
-against- : EMP# : 2933082
: JUD# : 2057778
TRIPLE A GROUP USA INC :
Defendant(s) : INDEX # :
FILING DT:
:
:
:
X
Workers'
By order of the Chair of the Compensation Board of the Stateof New York, demand forthe
payment of the sum of $4,500.00, representing Awards and Penalties having been made against the
above captioned Defendant(s), after due notice, having defaulted inpayment thereof,except the sum of
$0.00 leaving $4,500.00 due and payable.
NOW, upon the certifiedcopies of notices attached hereto,and upon motion ofthe General Counsel of
Workers'
the Compensation Board of the State of New York, attorney for pursuant
Plaintiff, toSection
Workers'
26 of the Compensation Law of the State of New York providing forentry ofjudgment by the
Workers'
County Clerk in event of such default, it is
ADJUDGED, that the Plaintiff, Compensation Board
of the Stateof New York, 328 State Street,Schenectady, NY 12305 does recover from the
above-captioned Defendant(s), whose lastknown address(es) are; 320 ROEBLING ST STE 717,
BROOKLYN, NY 11211-6262, respectively; the sum of $4,500.00, and the Plaintiff
have execution
therefore.
Judgment signed this: day of
Clerk
James R. McGinn, Esq.
Attorney forPlaintiff
Workers'
Compensation Board
328 State St.
Schenectady, NY 12305
C-45 6/2007
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Preview
FILED: KINGS COUNTY CLERK 12/26/2019 12:52 PM INDEX NO. 091261/2019 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS X WORKERS' : COMPENSATION BOARD OF THE STATE OF NEW YORK, Plaintiff, -against- : : TRIPLE A GROUP USA INC : AFFIRMATION Defendant(s) : OF NON-PAYMENT : : : : X Workers' The undersigned, an attorney in the officeofthe Compensation Board ofthe State ofNew York, Plaintiffherein,hereby affirms thatthe following istrue under the penalty of perjury,upon information and belief Workers' This affirmationisbased upon a review of the file which ismaintained by the Compensation Board initsregular course of business. I am familiarwith the status of payment in thismatter. The award/penalty/assessment/demand for deposit of security made against the defendant(s) in theamount of $4,500.00 is in default, as more than thirtydays have elapsed since the demand upon the defendant(s) herein for payment. No payment has been received nor has the aforesaid securitybeen deposited incompliance with said demand todate, except the sum of $0.00, leaving due and payble the sum of $4,500.00. Dated: 25th day of November , 2019 . S/ James R. McGinn, Esq. Judgment Unit C-45.45E 1/2009 1 of 7 FILED: KINGS COUNTY CLERK 12/26/2019 12:52 PM INDEX NO. 091261/2019 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019 2 of 7 FILED: KINGS COUNTY CLERK 12/26/2019 12:52 PM INDEX NO. 091261/2019 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS X WORKERS' : COMPENSATION BOARD OF THE STATE OF NEW YORK, Plaintiff, -against- : : TRIPLE A GROUP USA INC : AFFIRMATION Defendant(s) : OF REGULARITY : : : : X Workers' The undersigned, an attorney in the officeofthe Compensation Board ofthe State ofNew York, Plaintiffherein,hereby affirms thatthe following istrue under the penalty of perjury,upon information and belief Workers' This affirmationisbased upon a review of the file which ismaintained by the Compensation Board initsregular course of business. Workers' The Compensation Board of the State of New York, inaccordance with the provisions of the Workers' Compensation Law, has made an assessment/award in thesum of $4,500.00, against the defendant(s). Attached hereto and made a part hereofare certifiedcopies of the Notice of Decision and Award, and/or a certifiedcopy of the demand fordeposit of security,and/or a certifiedcopy ofthe chair's order imposing, and the demand for payment of, assessments imposed by the chairpursuant to Workers' subdivision five ofsection fifty-twoand/or one hundred thirtyone of the Compensation Law, as Workers' required for of filing judgment per Compensation Law, Section 26 and/or 219. Appeals before the Board have been exhausted. No payment of award has been made except $0.00, leaving $4,500.00 due and payable. WHEREFORE, it is respectfullyrequested that judgment be entered against the Defendant(s) herein in the sum stated as remaining due and payable. Dated: 25th day of November , 2019 . S/ James R. McGinn, Esq. Judgment Unit C-45.1E 6/2007 3 of 7 FILED: KINGS COUNTY CLERK 12/26/2019 12:52 PM INDEX NO. 091261/2019 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019 4 of 7 FILED: KINGS COUNTY CLERK 12/26/2019 12:52 PM INDEX NO. 091261/2019 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019 STATE OF NEW YORK WORKERS' COMPENSATION BOARD THISAGENCYEMPLOYSAND SERVES JUDGMENT UNIT PEOPLEWITH DISABILITIESWITHOUT 328 STATE STREET DISCRIMINATION. SCHENECTADY, NY 12305-2318 866-298-7830 TRIPLE A GROUP USA INC WCB EMPLOYER #: 2933082 320 ROEBLING ST STE 717 UlER #: 52-64047 BROOKLYN NY 11211-6262 FEIN/SS #: *****6664 It is hereby certified that thisis a true and correct copy ofthe originalas filed Workers' with the CGmper.stion Board S/ James R. McGinn, Esq. * DATE: 11/25/2019 FINAL NOTICE ±een±unit Certifiedon 11/25/19 Non-Compliance Item Description Dates Accident Date Balance Due 2017W0010455 Failure to Workers ' Ins 12/31/2016-03/31/2017 $4, 500. 00 Carry Comp Total Balance Due $4,500.00 * If payment isnot received immediately, judgment willbe filedand the employer issubject to seizure of assets, both business and personal, without furthernotice from the Board. In orderto insureprompt credit of your payment, complete thefo!!owingwiththe Date, Number and Amount of yourcheck and return with it, along your payment to: WORKERS' COMPENSATION BOARD FINANCE OFFICE 328 STATE STREET, SCHENECTADY, NY 12305-2318 Please detach and return bottom portion with your payment. MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND". PLEASE INCLUDE YOUR WCB EMPLOYER NUMBER ON YOUR CHECK. Employer TRIPLE A GROUP USA INC WCB Employer # 2933082 Customer ID # 1875386 Check Check Date Check # Amount C-45.37 5/2004 Page 1 of 2 5 of 7 FILED: KINGS COUNTY CLERK 12/26/2019 12:52 PM INDEX NO. 091261/2019 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019 Non-Compliance Item Description Dates Accident Date Balance Due MAKE CHECKS PAYABLE TO "UNINSURED EMPLOYERS FUND". Mail payment along with this form to: WORKERS' COMPENSATION BOARD FINANCE OFFICE 328 STATE STREET SCHENECTADY, NY 12305-2318 C-45.37 5/2004 Page 2 of 2 6 of 7 FILED: KINGS COUNTY CLERK 12/26/2019 12:52 PM INDEX NO. 091261/2019 NYSCEF DOC. NO. 1 RECEIVED NYSCEF: 12/26/2019 SUPREME COURT OF THE STATE OF NEW YORK, COUNTY OF KINGS X WORKERS' : COMPENSATION BOARD OF THE STATE OF NEW YORK, JUDGMENT Plaintiff, -against- : EMP# : 2933082 : JUD# : 2057778 TRIPLE A GROUP USA INC : Defendant(s) : INDEX # : FILING DT: : : : X Workers' By order of the Chair of the Compensation Board of the Stateof New York, demand forthe payment of the sum of $4,500.00, representing Awards and Penalties having been made against the above captioned Defendant(s), after due notice, having defaulted inpayment thereof,except the sum of $0.00 leaving $4,500.00 due and payable. NOW, upon the certifiedcopies of notices attached hereto,and upon motion ofthe General Counsel of Workers' the Compensation Board of the State of New York, attorney for pursuant Plaintiff, toSection Workers' 26 of the Compensation Law of the State of New York providing forentry ofjudgment by the Workers' County Clerk in event of such default, it is ADJUDGED, that the Plaintiff, Compensation Board of the Stateof New York, 328 State Street,Schenectady, NY 12305 does recover from the above-captioned Defendant(s), whose lastknown address(es) are; 320 ROEBLING ST STE 717, BROOKLYN, NY 11211-6262, respectively; the sum of $4,500.00, and the Plaintiff have execution therefore. Judgment signed this: day of Clerk James R. McGinn, Esq. Attorney forPlaintiff Workers' Compensation Board 328 State St. Schenectady, NY 12305 C-45 6/2007 7 of 7