FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`FILED: BRONX COUNTY CLERK 06m2018 01:31 P
`NYSC 3F DOC. NO. 66
`NYSCEF DOC. NO. 66
`
`IND
`
`EX NO.
`23525/20163
`INDEX NO. 23525/2016E
`
` VYSCEF:
`
` «IIV-4 .D
`
`
`06/15/2018
`RECEIVED NYSCEF: 06/15/2018
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`OF THE STATE
`COURT
`SUPREME
`OF BRONX
`COUNTY
`------------------------------------------------------------------X
`JAY
`
`JIMENEZ,
`
`OF NEW YORK
`
`Index
`
`No.
`
`23525/2016E
`
`Plaintiff,
`
`RESPONSE
`
`TO DEMANDS
`
`-against-
`
`PR GRAND
`PS MARCATO
`
`OWNER CO.
`HOTEL,
`LLC.,
`ELEVATOR
`CO.
`INC.,
`
`and
`
`Defendants,
`
`------------------------------------------------------------------x
`
`Plaintiff,
`
`by her
`
`attorney,
`
`Natascia
`
`Ayers,
`
`of
`
`counsel
`
`of MICHAEL
`
`J. AVILES
`
`&
`
`ASSOCIATE,
`
`LLC.,
`
`in response
`
`to the Demands
`
`of defendant,
`
`P.S. MARCATO
`
`ELEVATOR
`
`CO.
`
`INC.,
`
`dated
`
`June
`
`23,
`
`2016,
`
`states
`
`as follows:
`
`RESPONSE
`
`TO DEMAND
`
`FOR COPIES
`
`OF PLAINTIFF'S
`
`MEDICALS:
`
`a. Attached
`
`medical
`
`records:
`
`hereto
`
`are copies
`
`of
`
`the following
`
`Bellevue
`Hospital;
`Dr. Hryhorowych;
`New York
`Sports
`
`and
`& Joint.
`
`b. Attached
`
`hereto
`
`are HIPAA
`
`compliant
`
`authorizations
`
`for
`
`the
`
`following:
`
`Bellevue
`Hospital;
`Dr. Hryhorowych;
`New York
`Sports
`
`and
`& Joint.
`
`RESPONSE
`
`TO DEMAND
`
`FOR NAMES
`
`AND ADDRESS
`
`OF WITNESSES:
`
`a. Plaintiff's
`
`colleague,
`
`Jamarious
`
`Filaro,
`
`was
`
`a witness
`
`to the
`
`accident
`
`and
`
`the
`
`condition
`
`of
`
`the
`
`elevator.
`
`Defendants'
`
`managers
`
`and
`
`employees
`
`were
`
`also
`
`aware
`
`of
`
`the
`
`pre-existing
`
`defective
`
`condition
`
`of
`
`the
`
`elevator.
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`RESPONSE
`
`TO DEMAND
`
`FOR NAMES
`
`& ADDRESSES
`
`OF ATTORNEYS:
`
`Michael
`
`Attorneys
`145 Hudson
`New York.,
`
`& Associates,
`J. Aviles
`for Plaintiff
`
`LLC
`
`5C
`
`St. Suite
`New York,
`
`10013
`
`PS MARCATO
`
`ELEVATOR
`
`CO.
`
`INC.
`
`Siegel
`
`94th
`
`& Schwartz
`defendant,
`
`Gottlieb,
`Attorneys
`for
`207
`E.
`St.
`NY 10128
`New York,
`File
`#.:
`1600-05
`Attn:
`Michael
`
`Gottlieb,
`
`Esq.
`
`& Bender
`Cotter
`Varvaro,
`for PR GRAND HOTEL
`Attorneys
`- Suite
`1133 Westchester
`Avenue
`NY 10604
`White
`Attn:
`Varvaro
`
`Plains,
`Joseph
`
`OWNER CO.
`S-325
`
`LLC
`
`RESPONSE
`
`TO DEMAND
`
`FOR EMPLOYMENT
`
`AUTHORIZATION:
`
`An authorization
`
`to obtain
`
`plaintiff's
`
`employment
`
`records
`
`from
`
`Local
`
`6 Union
`
`is
`
`annexed
`
`hereto.
`
`RESPONSE
`
`TO DEMAND
`
`FOR TAX AUTHORIZATION:
`
`Objection,
`
`improper
`
`demand.
`
`Plaintiff
`
`was
`
`employed.
`
`Plaintiff
`
`will
`
`provide
`
`a copy
`
`of his
`
`W-2s
`
`and
`
`an authorization
`
`has been
`
`given
`
`for
`
`his
`
`employment
`
`records.
`
`RESPONSE
`
`TO DEMAND
`
`FOR DISCOVERY
`
`& INSPECTION:
`
`Objection,
`
`improper
`
`demand.
`
`RESPONSE
`INFORMATION:
`
`TO NOTICE
`
`TO PRODUCE
`
`MEDICARE/MEDICAID
`
`LIEN
`
`a.
`
`to f. Not
`
`applicable,
`
`plaintiff
`
`does
`
`not
`
`receive
`
`Medicare/Medicaid
`
`benefits.
`
`2
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`RESPONSE
`
`TO COMBINED
`
`NOTICE
`
`FOR DISCOVERY
`
`AND INSPECTION:
`
`yet been
`have
`
`held.
`not
`yet been
`
`served.
`
`provided.
`have
`
`not
`depositions
`
`for
`
`1. Previously
`2. Depositions
`3. Notices
`4. Previously
`provided.
`provided.
`5. Previously
`6. None
`to date.
`7. None
`8. None.
`provided.
`9. Previously
`be provided.
`10. To
`
`to date.
`
`RESPONSE
`PHYSICIANS:
`
`TO NOTICE
`
`OF INTENTION
`
`TO SPEAK WITH
`
`TREATING
`
`An Arons
`
`authorization
`
`for Dr. Hryhorowych
`
`is annexed
`
`hereto.
`
`RESPONSE
`
`TO DISCOVERY
`
`& INSPECTION:
`
`photograph
`
`1. Plaintiff
`contracts.
`of any
`in possession
`is not
`2. The
`elevator
`number
`is unknown
`to plaintiff,
`attached..
`3. Plaintiff
`4. Plaintiff
`5. Plaintiff
`6. Plaintiff
`7. Plaintiff
`8. Attached
`
`is not
`in possession
`in possession
`is not
`in possession
`is not
`in possession
`is not
`is not
`in possession
`are four
`color
`
`(4)
`
`of any written
`elevator
`of any
`of any
`elevator
`of any
`of any
`photographs
`
`primary
`umbrella
`of
`
`except
`
`that
`
`it was marked
`
`"C'.
`
`See
`
`complaints.
`records.
`logs.
`insurance
`
`policy
`elevator
`
`the
`
`agreement.
`insurance
`or other
`in question.
`
`agreement
`
`RESPONSE
`
`FOR AUTHORIZATION
`
`FOR SSA:
`
`Plaintiff
`
`does
`
`not
`
`receive
`
`SSA benefits
`
`.
`
`RESPONSE
`
`TO EXPERT
`
`INFORMATION:
`
`Plaintiff
`
`has
`
`not
`
`yet
`
`retained
`
`the
`
`services
`
`of any
`
`experts
`
`to testify
`
`at
`
`the
`
`time
`
`of
`
`trial;
`
`when
`
`such
`
`experts
`3101(d).
`
`are retained
`
`the
`
`appropriate
`
`information
`
`shall
`
`be provided,
`
`pursuant
`
`to CPLR §
`
`Dated:
`
`New York,
`September
`
`N.Y.
`[ 6
`
`, 2016
`
`3
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`& ASSOCIATES,
`
`LLC
`
`MICHAEL
`
`J. AVILES
`for Plaintiff
`
`Attorney
`SuitefC
`145 Hudson
`Street,
`New York
`10013
`New York,
`307-0023
`(212)
`
`J ~
`
`By:
`
`Natasgc'
`Natascia
`r
`
`Ayer(
`
`f Counsel
`
`PS MARCATO
`
`ELEVATOR
`
`CO.
`
`INC.
`
`& Schwartz
`defendant,
`
`TO:
`
`Siegel
`for
`
`Gottlieb,
`Attorneys
`E. 94th
`St
`207
`NYC NY 10128
`File
`#.:
`1600-05
`Attn:
`Michael
`
`Cotter
`
`Varvaro,
`for
`Attorneys
`1133 Westchester
`
`White
`Attn:
`
`Plains,
`Joseph
`
`defendant,
`Avenue
`NY 10604
`Varvaro
`
`Gottlieb,
`
`Esq.
`
`& Bender
`
`PR GRAND HOTEL
`- Suite
`S-325
`
`OWNER CO.
`
`LLC
`
`4
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`"!
`I
`NYSCEF DOC. NO. 66
`-
`FI
`
`I
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`I
`
`F)
`
`4
`
`.,:;."'.-„M
`F
`
`Ftt'
`y:I
`FL»
`
`I
`
`F
`
`t
`
`j:=
`
`+
`
`,I
`
`'
`
`-'-»4':
`
`W4g-':9A<lil
`
`F
`
`I .I
`
`I
`
`AI
`
`)
`
`I
`
`M5
`
`-F.
`;.,-~t "
`
`»
`
`tlat
`
`2
`
`.
`
`I
`
`'I
`
`"P,
`
`g -FC>F,
`
`I
`
`!
`
`I
`
`é
`
`..Iw
`
`.
`
`.
`
`.
`
`..
`
`.
`
`FW~FIL
`,
`
`*
`
`I j
`
`:
`
`L»»»'I
`
`I
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`FILED: BRONX COUNTY CLERK y-l52018 01
`
`NYSCEF DOC. NO. 66
`NysczaF DOC. NO.
`_-
`,
`,
`~
`.
`.
`~
`>
`
`_.<.4
`
`L IND:
`X NO.
`23525/2016
`INDEX NO. 23525/2016E
`06/15/2018
`RECEIVED NYSCEF: 06/15/2018
`
`
`
`
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`
`NYSCEF DOC. NO. 66
`
`
` L‘J
`13x NO. 23525/2016:
`INDEX NO. 23525/2016E
`
`’
`018
`RECEIVED NYSCEF: 06/15/2018
`
`
`
`
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`FILED: BRONX COUNTY CLERK 062018 01:31 P
`
`rF pee NO 7 6.
`NYSCEF DOC. NO. 66
`
`13x NO. 23525/2016: L‘J
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`M PAVER S feden
`
`ONG f5W3W2014/4/007
`'4
`..
`.':../e!o~."8:.i
`ide
`tiflbation
`nuthber
`
`81
`
`003401
`.",.=;..;~=-.~,.;,~i~,:/N:-oe;4',o%....4.-.
`'number'
`90 numbë
`tI
`i "ciil
`RECIPIEN
`FSidu
`
`'
`
`"
`
`$
`5 F shinebeat
`
`p'roceeds"
`dëeds
`
`'
`
`C~~~,
`
`''
`
`'%g„'
`' JplAlc~5"
`
`+kpPK,,"
`
`Py
`
`'r~$';
`
`',"
`
`l
`
`„,,
`
`~
`
`"pt.
`
`I
`
`'3:Other.,income',
`
`4
`
`'
`
`.,-
`
`-:,:4.'FedBrat'tncGme~i...vvrtbbt~-'.
`$
`6
`
`led éãEañïf
`
`lleallh,"=;,»"-.;..-.—
`
`"'."-:.-.;~
`~.'>-~ p+Q~
`
`—.,
`
`'
`
`t's impQrtq
`ati
`'f'urrtis
`Ri
`
`'~is
`
`'.
`
`tute payments,
`ubst
`or
`interest
`dividends
`
`in
`
`u
`':
`
`$
`7 Nonemployee
`
`compensation
`
`8
`B
`
`'
`
`bein
`the.trItem'at
`
`8
`.
`proceeds
`insurance
`10 Crop
`-'
`..'.-~'.:.'.::
`''!<,',-"-.<f,",'~~i~$';>4„'l~
`
`.'
`
`~
`
`'::"-.:
`
`..:
`
`.'
`
`t
`
`~
`
`26-2749600
`ECIP\ENŸS
`name
`JIMENEL
`
`JAY
`
`,
`
`Street
`
`address
`
`(including
`LOR1NG
`22
`state
`
`apt
`
`no.)
`PLACE
`
`and ZIP or
`
`foreign
`
`postal
`
`code
`
`2226
`APT
`or
`town,
`
`City
`
`or province,
`
`country,
`
`l."
`
`'
`
`-:;:.-",.':-:
`
`BRONX
`Account
`number
`
`NY . 10453
`(see
`instructions)
`
`'
`
`-:
`
`15a
`
`0.0.340.1:J'
`0 0 3401LONG
`/5W3
`Section
`409A
`deferrals
`
`.
`
`8
`$8
`
`«rrnForm
`
`~O99-M~SO
`$099-Mf
`
`SC
`
`(keep
`(keep
`
`forfor
`
`your
`your
`
`records)
`records)
`
`
`
`www.irswww.irs
`
`gov/form1
`gov/form1099misc
`099misc
`
`Department
`Department
`
`otof
`
`thethe; Treasury
`Treasury
`
`—lntemal
`-...1ntemaI
`
`RR
`
`. 00
`395
`of
`sales
`9 Payer made
`direct
`or more
`of consumer
`$5,000
`products
`to a buyer
`for
`resale
`(recipient)
`
`>
`> N~P('i-» ~~+~.~s>j~'~% i;u+i~
`~:~
`"ig~gi
`"4/I
`
`13 Excess
`payments
`
`golden
`
`parachute
`
`ig5
`
`~+
`
`eP
`
`P%.
`Gross'.proceeds"
`14 Gross
`proceeds
`
`paid
`
`to an
`
`attorney
`
`.
`
`.
`
`deeMU
`requested
`a ne
`return,
`.
`penalty
`san
`
`o
`
`detenT
`
`ht (
`
`A
`156
`
`$
`
`Section
`
`409A
`
`income
`
`.
`
`16 State
`
`tax withheld
`
`8
`
`88
`
`8
`17 State/Payer's
`
`state
`
`no.
`
`18 Statein
`
`8
`
`I
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`'/
`Y
`
`f
`
`l
`
`r
`
`Y
`
`4
`
`"
`
`'
`
`'
`
`~
`
`J
`
`W 250
`'0'
`
`R IMiiEEiEBiGiMBEE
`'
`~
`~
`«~Y
`~
`
`-
`
`a
`
`r
`
`l
`
`M W
`
`gg1P
`
`'
`
`'
`
`4«
`
`k.
`
`'
`
`fS
`
`2
`
`jf.
`
`Y«YY'
`
`%,«33f ~
`EPR&W W E E@W
`
`J
`
`h
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`~
`
`ICO 9
`
`'
`
`..
`
`~
`
`.
`
`Q
`
`'
`
`."
`
`-"
`
`.'g
`
`hl
`
`'I
`
`*
`
`S
`
`'
`
`~
`
`"'
`
`I.;'
`
`I
`
`'Is'
`
`'PP~I+SyQ
`
`g h
`
`>
`
`.
`
`"'EI
`
`fl=
`
`".".'0 j;40';S,
`
`l
`
`(b
`a 0
`O
`
`A
`o
`.:.cu
`',g) n
`;CO;CO
`
`~
`
`,
`
`„„~w„>
`
`' ~~
`
`j ~
`~~~
`
`.'
`«,",'co~ $'.XA~ '
`j
`
`e
`
`3
`
`C
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`TO:
`
`RE:
`
`HIPAA-COMPLIANT
`
`AUTHORIZATION
`
`A fax or photocopy
`
`of
`
`this authorization
`
`shall be as effective
`
`as an original.
`
`New York
`707 Eight
`New York,
`
`& Motel
`
`Hotel
`Avenue
`NY 10036
`
`Trades
`
`Employee:
`#.:
`Claim
`
`Jay Jimenez
`
`Date
`
`of accident:
`
`2/14/16
`
`Employer:
`
`Local
`
`6 - Union
`
`(Denihan
`
`Hospital
`
`Group
`
`The
`
`James
`
`Hotel)
`
`Records
`
`requested:
`
`[
`
`]
`
`records
`Medical
`including
`to CFR 55 164.502(a)
`pursuant
`and diagnostic
`tests,
`including
`
`and
`treatment
`psychiatric
`(i) & 164.524,
`PHL
`(2)
`CT scans, MRIs,
`X-Rays,
`
`communications,
`§ 18, and CPLR
`and billing
`EKGs,
`
`status
`and HIV
`information,
`- Entire medical
`record
`
`3121(a)
`records.
`
`[
`
`]
`
`Pharmacy
`
`records.
`
`[X
`
`]
`
`Employment
`
`W-2
`
`payroll
`
`records,
`
`and absences
`
`from work
`
`records,
`
`including
`
`statements,
`.
`
`[
`
`]
`
`[
`
`]
`
`Workers'
`
`Compensation
`
`file,
`
`[
`
`] No-Fault
`
`file,
`
`or
`
`[
`
`] Health
`
`insurance
`
`records.
`
`Other,
`
`specify:
`
`the
`
`authorize
`I,
`undersigned,
`hereby
`the
`records
`or
`to me,
`to my
`copy
`5C, NEW YORK,
`ST.
`SUITE
`purpose
`of
`my request:
`fulfilling
`
`to disclose
`you
`the
`MICHAEL
`attorneys
`NEW YORK,
`10013,
`
`above-indicated
`J. AVILES
`
`and
`records
`& ASSOCIATES,
`to the
`and
`307-0023,
`
`(212)
`
`request
`LLC.
`
`following
`
`a
`
`you deliver
`that
`145 HUDSON
`for
`the
`parties,
`
`V GOTTLIEB,
`AND
`VARVARO,
`
`SIEGEL & SCHWARTZ
`
`207 E. 94™ ST. NEW YORK, NY 10128
`
`COTTER & BENDER
`
`- 1133 WESTCHESTER
`
`AVENUE,
`
`SUITE S-325
`
`- WHITE
`
`PLAINS,
`
`NY 10604
`
`I HAVE MADE
`I UNDERSTAND
`A LEGALLY
`THAT:
`AND
`IS MY INSURER
`THE RECIPIENT
`1) EXCEPT WHERE
`I HAVE THE RIGHT TO REVOKE THIS AUTHORIZATION
`CONTESTABLE
`IN WRITING AT ANY
`CLAIM UNDER MY POLICY,
`TIME, BUT ANY SUCH REVOCATION
`ALREADY RELEASED IN RESPONSE TO THIS
`WILL NOT APPLY TO INFORMATION
`FOR AN UNAUTHORIZED
`2) ANY DISCLOSURE OF INFORMATION
`CARRIES WITH IT THE POTENTIAL
`AUTHORIZATION;
`RE-DISCLOSURE WHICH MAY NOT BE PROTECTED
`BY THE FEDERAL PRTVACY RULES; AND 3) TREATMENT,
`PAYMENT,
`I
`OR
`ON WHETHER
`SIGN THIS
`ELIGIBILITY
`FOR
`MAY
`NOT
`BE CONDITIONED
`BENEFITS
`ENROLLMENT,
`AUTHORIZATION.
`EXPIRES
`YEARS.
`THIS
`EXPIRATION:
`THIS AUTHORIZATION
`IN THREE
`AUTHORIZATION
`IS
`YOU TO SPEAK
`TO ANYONE
`OR OTHER RECORDS
`ONLY AND DOES NOT AUTHORIZE
`FOR MEDICAL
`EXCEPT MY ATTORNEYS,
`LLC., ABOUT MY MEDICAL
`& ASSOCIATES,
`CONDITION
`J. AVILES
`MICHAEL
`OR TREATMENT.
`~/
`
`DATE:
`
`AUGUST
`
`'J
`~
`
`~
`
`2016
`
`/
`
`/
`
`X
`
`-
`J AVILE
`MIÚHAEL
`POWER Q0 ATT5)
`
`NEY
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`HIPAA-COMPLIANT
`
`AUTHORIZATION
`
`A fax or photocopy
`
`of
`
`this authonzation
`
`shall be as effective
`
`as an original.
`
`TO:
`
`RE:
`
`New York
`707 Eight
`New York,
`
`& Motel
`
`Hotel
`Avenue
`NY 10036
`
`Trades
`
`Jay Jimenez
`
`Employer:
`
`Local
`
`6 - Union
`
`(Denihan
`
`Hospital
`
`Group
`
`The
`
`James
`
`Hotel)
`
`Employee:
`Claim
`#.:
`DOB
`SSN:
`Date
`
`of accident:
`
`2/14/16
`
`Records
`
`requested:
`
`[
`
`]
`
`records
`Medical
`including
`to CFR §§ 164.502(a)
`pursuant
`and diagnostic
`tests,
`including
`
`and
`treatment
`psychiatric
`(i) & 164.524,
`PHL
`(2)
`CT scans, MRIs,
`X-Rays,
`
`communications,
`5 18, and CPLR
`and billing
`EKGs,
`
`status
`and HIV
`- Entire
`
`3121(a)
`records.
`
`information,
`medical
`record
`
`[
`
`]
`
`Pharmacy
`
`records.
`
`[X
`
`]
`
`Employment
`
`records,
`
`including
`
`W-2
`
`statements,
`
`payroll
`
`records,
`
`and absences
`
`from work
`
`[
`
`]
`
`[ ]
`
`Workers'
`
`Compensation
`
`file,
`
`[
`
`] No-Fault
`
`file,
`
`or
`
`[
`
`] Health
`
`insurance
`
`records.
`
`Other,
`
`specify:
`
`the
`
`authorize
`I,
`undersigned,
`hereby
`the
`records
`to my
`or
`to me,
`copy
`5C, NEW YORK,
`ST.
`SUITE
`purpose
`of
`my request:
`fulfilling
`
`to disclose
`you
`MICHAEL
`attorneys
`NEW YORK,
`10013,
`
`the
`
`and
`records
`above-indicated
`& ASSOCIATES,
`J. AVILES
`to the
`and
`307-0023,
`
`(212)
`
`request
`LLC.
`
`following
`
`a
`
`you deliver
`that
`145 HUDSON
`for
`the
`parties,
`
`GOrrLIEB,
`, AND
`VARVARO,
`
`i/
`
`SIEGEL & SCHWARTZ
`
`207 E. 94™ ST. NEW YORK, NY 10128
`
`COTTER & BENDER
`
`- 1133 WESTCHESTER
`
`AVENUE,
`
`SUITE S-325
`
`- WHITE
`
`PLAINS,
`
`NY 10604
`
`I UNDERSTAND
`A LEGALLY
`I HAVE MADE
`THAT:
`AND
`IS MY INSURER
`THE RECIPIENT
`1) EXCEPT WHERE
`CONTESTABLE
`IN WRITING AT ANY
`CLAIM UNDER MY POLICY,
`I HAVE THE RIGHT TO REVOKE THIS AUTHORIZATION
`TIME, BUT ANYSUCH
`ALREADY RELEASED IN RESPONSE TO THIS
`REVOCATION
`WILL NOT APPLY TO INFORMATION
`2) ANY DISCLOSURE OF INFORMATION
`FOR AN UNAUTHORIZED
`CARRIES WITH IT THE POTENTIAL
`AUTHORIZATION;
`RE-DISCLOSURE
`WHICH MAY NOT BE PROTECTED
`BY THE FEDERAL PRIVACY RULES; AND 3) TREATMENT,
`PAYMENT,
`ON WHETHER
`I
`OR
`SIGN THIS
`BE CONDITIONED
`ELIGIBILITY
`FOR
`MAY
`NOT
`BENEFITS
`ENROLLMENT,
`AUTHORIZATION.
`EXPIRATION:
`YEARS.
`THIS
`IS
`EXPIRES
`IN THREE
`THIS AUTHORIZATION
`AUTHORIZATION
`TO ANYONE
`OR OTHER RECORDS
`YOU TO SPEAK
`ONLY AND DOES NOT AUTHORIZE
`FOR MEDICAL
`MY ATTORNEYS,
`LLC., ABOUT MY MEDICAL
`& ASSOCIAT-ES,
`EXCEPT
`J. AVILES
`MICHAEL
`CONDITION
`OR TREATMENT.
`
`DATE:
`
`AUGUST
`
`sg
`
`, 2016
`
`X
`
`/
`
`L J.
`LES
`MICH
`POWER OF ATTORNEY
`
`/'r
`Z'
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`ss.:
`
`) )
`
`)
`
`STATE
`
`OF NEW YORK
`
`COUNTY
`
`OF NEW YORK
`
`Suzette
`
`Holmes,
`
`being
`
`duly
`
`sworn,
`
`deposes
`
`and
`
`says:
`
`That
`
`attorneys
`
`for
`
`she is over
`the plaintiff(s)
`
`eighteen
`herein.
`
`years
`
`of age,
`That
`on September
`
`is not
`
`a party
`(~j,
`
`to this
`2016
`
`,
`
`and
`action;
`she served
`
`is employed
`the within:
`
`by the
`
`RESPONSE
`
`TO NOTICE
`
`TO PRODUCE
`
`upon
`
`the
`
`depositing
`depository
`within
`
`following,
`a true
`under
`the State
`
`at
`
`the
`of
`
`address(es)
`same
`enclosed
`copy
`the
`exclusive
`care
`and
`of New York.
`
`designated
`by
`in a postpaid
`of
`
`custody
`
`said
`
`purpose
`that
`for
`attorney(s)
`wrapper
`addressed
`properly
`Post Office
`States
`the United
`
`by
`in an official
`Department
`
`4 Schwartz
`
`defendant,
`
`PS MARCATO
`
`ELEVATOR
`
`CO.
`
`INC.
`
`Siegel
`for
`
`94th
`
`Gottlieb,
`Attorneys
`E.
`207
`St.
`NYC NY 10128
`File
`#.:
`1600-05
`Attn:
`Michael
`
`Gottlieb,
`
`Esq.
`
`Cotter
`Varvaro,
`for
`Attorneys
`1133 Westchester
`White
`Attn:
`
`Plains,
`Joseph
`
`& Bender
`defendant,
`Avenue
`NY 10604
`Varvaro
`
`PR GRAND HOTEL
`- Suite
`S-325
`
`OWNER CO.
`
`LLC
`
`'
`
`(
`
`Suzette
`
`Holmes
`
`)
`
`Sworn
`
`me this
`to before
`of September,
`
`Day
`
`2016
`
`pgglkH
`
`Notary
`
`)7Pttg
`
`Public
`
`SHAlKH
`RAUF
`of New York
`*@~, Public,
`State
`Notary
`No.01RA6232234
`in Queens
`Quatimd
`
`County
`
`~|3
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`MICHAEL
`
`J. AVILES
`145 Hudson
`
`& ASSOCIATES,
`- Suite
`5C
`Street
`
`LLC
`
`New York,
`Telephone
`Telecopier
`
`10013
`New York
`(212) 307-0023
`(212) 307-0187
`maviles@miavileslaw.com
`
`October
`
`24,
`
`2016
`
`E-MAIL:
`
`& Schwartz
`
`Siegel
`94th
`
`Gottlieb,
`207 E.
`New York,
`Attn:
`Amy
`
`St.St.
`NY 10128
`L. Mandel,
`
`Esq
`
`Re:
`
`Jimene
`
`v. PR Grand
`
`Hotel,
`
`et al.,
`
`Dear Ms. Mandel:
`
`In response
`to your
`October
`17, 2016
`the New York
`authorization
`for
`Trades
`Hotel
`New York,
`New York,
`to all parties.
`
`10036,
`
`correspondence,
`Employees
`
`enclosed
`
`Benefit
`
`Fund,
`
`find
`please
`305 West
`
`an
`44th
`
`
`
`Street,Street,
`
`you
`
`have
`
`any
`
`questions
`
`or concerns
`
`regarding
`
`the
`
`above,
`
`please
`
`contact
`
`the
`
`If
`undersigned.
`
`NA:sah
`Encls.
`cc:
`
`Cotter
`Varvaro,
`1133 Westchester
`White
`
`Plains,
`
`JosephJoseph
`
`Attn:Attn:
`
`& Bender
`Avenue
`NY 10604
`
`VarvaroVarvaro
`
`-.--.-
`
`Very
`
`truly
`
`yours,
`
`NataseirAÿéE
`
`- Suite
`
`S-325
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`HIPAA-COMPLIANT
`
`AUTHORIZATION
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`A fax or photocopy
`
`of
`
`this authorization
`
`shall be as effective
`
`as an original.
`
`TO:
`
`RE:
`
`New York
`305 West
`New York,
`
`Trades
`
`Employees
`
`Benefit
`
`Fund
`
`Hotel
`44d'
`
`St.
`NY 10036
`
`Jay Jimenez
`Management
`James Hotel
`Employer:
`of Accident:
`Date
`02/14/16
`
`DOB: ~~
`
`SSN:
`
`Company
`
`Records
`
`requested:
`
`[X]
`
`[
`
`]
`
`[X]
`
`[
`
`[
`
`]
`
`]
`
`psychiatric
`records
`Medical
`including
`to CFR §§ 164.502(a)
`pursuant
`and diagnostic
`tests,
`including
`
`(2)(i)
`X-Rays,
`
`and
`treatment
`& 164.524,
`PHL
`CT scans, MRIs,
`
`communications,
`§ 18, and CPLR
`and billing
`EKGs,
`
`Pharmacy
`
`records.
`
`status
`HIV
`information,
`- Entire medical
`record
`
`and
`
`3121(a)
`records.
`
`Employment
`
`benefits,
`
`etc.,
`
`W-2
`records,
`including
`and absences
`from work
`
`statements,
`from date
`
`payroll
`records,
`to date.
`of hire
`
`insurance/disability
`
`benefits,
`
`union
`
`Workers'
`
`Compensation
`
`file,
`
`[
`
`] No-Fault
`
`file,
`
`or
`
`[
`
`] Health
`
`insurance
`
`records.
`
`Other,
`
`specify:
`
`the
`
`authorize
`undersigned,
`I,
`hereby
`the
`or
`records
`to my
`to me,
`copy
`5C, NEW YORK,
`SUITE
`ST.
`purpose
`of
`my request:
`fulfilling
`
`you
`to disclose
`MICHAEL
`attorneys
`NEW YORK,
`10013,
`
`the
`
`and
`records
`above-indicated
`& ASSOCIATES,
`J. AVILES
`to the
`and
`307-0023,
`(212)
`
`request
`LLC.
`
`following
`
`a
`
`you deliver
`that
`145 HUDSON
`for
`the
`parties,
`
`GOTTLIEB,
`AND
`VARVARO,
`
`SIEGEL
`
`& SCHWARTZ,
`
`27 E. 94TH ST. NYC NY 10128
`
`COTTER
`
`& BENDER-1133
`
`WESTCHESTER
`
`AVE. WHITE
`
`PLAINS,
`
`NY 10604
`
`THAT:
`I UNDERSTAND
`A LEGALLY
`I HAVE MADE
`AND
`IS MY INSURER
`THE RECIPIENT
`1) EXCEPT WHERE
`CONTESTABLE
`IN WRITING AT ANY
`I HAVE THE RIGHT TO REVOKE THIS AUTHORIZATION
`CLAIM UNDER MY POLICY,
`TIME, BUT ANY SUCH REVOCATION
`ALREADY RELEASED IN RESPONSE TO THIS
`WILL NOT APPLY TO INFORMATION
`2) ANY DISCLOSURE OF INFORMATION
`FOR AN UNAUTHORIZED
`CARRIES WITH IT THE POTENTIAL
`AUTHORIZATION;
`RE-DISCLOSURE WHICH MAY NOT BE PROTECTED
`BY THE FEDERAL PRIVACY RULES; AND 3) TREATMENT,
`PAYMENT,
`ON WHETHER
`I SIGN THIS
`OR
`BE CONDITIONED
`ELIGIBILITY
`FOR BENEFITS
`MAY
`NOT
`ENROLLMENT,
`AUTHORIZATION.
`YEARS.
`THIS
`EXPIRATION:
`IN THREE
`AUTHORIZATION
`IS
`THIS AUTHORIZATION
`EXPIRES
`OR OTHER RECORDS
`YOU TO SPEAK
`TO ANYONE
`ONLY AND DOES NOT AUTHORIZE
`FOR MEDICAL
`EXCEPT MY ATTORNEYS,
`LLC., ABOUT MY MEDICAL
`& ASSOCIATES,
`J. AVILES
`CONDITION
`MICHAEL
`yl
`OR TREATMENT.
`
`/
`
`/
`
`1/y',:.
`
`-
`
`X M
`
`J. AVILES
`ICHAEL
`POWER OF ATTORNEY
`
`DATE:
`
`OCTOBER
`
`24,
`
`2016
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`HIPAA-COMPLIANT
`
`AUTHORIZATION
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`A fax or photocopy
`
`of
`
`this authorization
`
`shall be as effective
`
`as an original.
`
`TO:
`
`RE:
`
`New York
`305 West
`New York,
`
`Trades
`
`Hotel
`44d' St.
`NY 10036
`
`Employees
`
`Benefit
`
`Fund
`
`Jay Jimenez
`Management
`James Hotel
`Employer:
`of Accident:
`Date
`02/14/16
`
`DOB: 4~M
`
`SSN:
`
`Company
`
`Records
`
`requested:
`
`[X]
`
`[
`
`]
`
`[X]
`
`[
`
`[
`
`]
`
`]
`
`records
`psychiatric
`Medical
`including
`to CFR §§ 164.502(a)(2)(i)
`pursuant
`and diagnostic
`tests,
`X-Rays,
`including
`
`and
`treatment
`4 164.524,
`PHL
`CT scans, MRIs,
`
`communications,
`§ 18, and CPLR
`and billing
`EKGs,
`
`Pharmacy
`
`records.
`
`status
`HIV
`information,
`- Entire medical
`record
`
`and
`
`3121(a)
`records.
`
`Employment
`
`benefits,
`
`etc.,
`
`W-2
`records,
`including
`and absences
`from work
`
`payroll
`records,
`statements,
`from date of hire
`to date.
`
`insurance/disability
`
`benefits,
`
`union
`
`Workers'
`
`Compensation
`
`file,
`
`[
`
`] No-Fault
`
`file,
`
`or
`
`[
`
`] Health
`
`insurance
`
`records.
`
`Other,
`
`specify:
`
`the
`
`authorize
`I,
`undersigned,
`hereby
`the
`records
`or
`to me,
`to my
`copy
`5C, NEW YORK,
`ST.
`SUITE
`purpose
`of
`my request:
`fulfilling
`
`to disclose
`you
`the
`MICHAEL
`attorneys
`NEW YORK,
`10013,
`
`above-indicated
`J. AVILES
`
`and
`records
`& ASSOCIATES,
`to the
`and
`307-0023,
`
`(212)
`
`request
`LLC.
`
`following
`
`a
`
`you deliver
`that
`145 HUDSON
`for
`the
`parties,
`
`GOTTLIEB,
`AND
`VARVARO,
`
`SIEGEL
`
`& SCHWARTZ,
`
`27 E. 94™ ST. NYC NY 10128
`
`COTTER
`
`& BENDER
`
`-1133 WESTCHESTER
`
`AVE. WHITE
`
`PLAINS,
`
`NY 10604
`
`I UNDERSTAND
`THAT:
`1) EXCEPT WHERE
`A LEGALLY
`I HAVE MADE
`THE RECIPIENT
`IS MY INSURER AND
`CLAIM UNDER MY POLICY,
`CONTESTABLE
`I HAVE THE RIGHT TO REVOKE THIS AUTHORIZATION
`IN WRITING AT ANY
`BUT ANY SUCH REVOCATION
`WILL NOT APPLY TO INFORMATION
`ALREADY RELEASED IN RESPONSE TO THIS
`TIME,
`2) ANY DISCLOSURE OF INFORMATION
`CARRIES WITH IT THE POTENTIAL
`FOR AN UNAUTHORIZED
`AUTHORIZATION;
`RE-DISCLOSURE WHICH MAY NOT BE PROTECTED
`BY THE FEDERAL PRIVACY RULES; AND 3) TREATMENT,
`PAYMENT,
`OR ELIGIBILITY
`FOR
`MAY
`I
`ON WHETHER
`BENEFITS
`NOT
`BE CONDITIONED
`SIGN THIS
`ENROLLMENT,
`AUTHORIZATION.
`EXPIRATION:
`THIS AUTHORIZATION
`YEARS.
`IN THREE
`THIS
`AUTHORIZATION
`IS
`EXPIRES
`OR OTHER RECORDS
`YOU TO SPEAK
`FOR MEDICAL
`ONLY AND DOES NOT AUTHORIZE
`TO ANYONE
`EXCEPT MY ATTORNEYS,
`ABOUT MY MEDICAL
`& ASSOCIATES,
`MICHAEL
`J. AVILES
`LLC.
`CONDITION
`OR TREATMENT.
`
`'/I ~l
`
`/j',
`
`DATE:
`
`OCTOBER
`
`24, 2016
`
`'.'
`
`-
`
`X
`r
`J. AVH
`MICÚAEL
`AAORNEY
`POWER OF
`
`'>
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`-, ;1, )
`j.'u
`RECEIVED NYSCEF: 06/15/2018
`//
`''1n'~',~i
`!l~
`~4 l$
`
`MICHAEL
`
`J. AVILES
`145 Hudson
`
`& ASSOCIATES,
`- Suite
`5C
`Street
`
`LLC
`
`New York,
`Telephone
`Telecopier
`
`10013
`New York
`(212) 307-0023
`(212) 307-0187
`maviles@m javileslaw.com
`
`E-MAIL:
`
`February
`
`7, 2017
`
`& Schwartz
`
`Gottlieb,
`207
`E.
`New York,
`Attn:
`Amy
`
`Siegel
`94th
`StSt.
`NY 10128
`L. Mandel,
`
`Esq
`
`Re:
`
`Jimene
`
`v. PR Grand
`
`Hotel,
`
`et al.,
`
`Dear
`
`Ms. Mandel:
`
`"fresh"
`
`Hospital
`you
`are
`
`In response
`authorization
`Group.
`aware
`
`that
`
`to your
`correspondence
`to obtain
`plaintiff's
`I assume
`you were
`referring
`the Power
`of Attorney
`does
`
`30.
`dated
`January
`employment
`records
`to the
`authorization
`not
`expire.
`
`2017,
`from
`
`enclosed
`the
`James
`to be current
`
`a
`
`find
`please
`Hotel/Denihan
`I am sure
`in that
`
`If you
`undersigned.
`
`have
`
`any
`
`questions
`
`or concerns
`
`regarding
`
`the
`
`above,
`
`please
`
`contact
`
`the
`
`NA:sah
`
`
`
`Encls.Encls.
`
`Very
`
`truly
`
`yours,
`
`I'.l
`
`N
`
`'
`
`-
`
`rs
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`HIPAA-COMPLIANT
`
`AUTHORIZATION
`
`A fax or photocopy
`
`of
`
`this authorization
`
`shall be as effective
`
`as an original.
`
`TO:
`
`RE:
`
`/ Denihan
`James Hotel
`Street
`27 Grand
`New York, NY 10013
`
`Hospitality
`
`Group
`
`Jay Jimenez
`Management
`James Hotel
`Employer:
`of Accident:
`02/14/16
`Date
`
`DOB: %~M
`~®8®~
`
`SSN:
`
`Company
`
`Records
`
`requested:
`
`[
`
`]
`
`[
`
`]
`
`[X]
`
`[
`
`[
`
`]
`
`]
`
`records
`Medical
`including
`to CFR 55 164.502(a)
`pursuant
`and diagnostic
`tests,
`including
`
`and
`treatment
`psychiatric
`(2) (i) & 164.524,
`PHL
`CT scans, MRIs,
`X-Rays,
`
`communications,
`§ 18, and CPLR
`and billing
`EKGs,
`
`status
`and HIV
`- Entire
`
`3121(a)
`records.
`
`information,
`record
`medical
`
`Pharmacy
`
`records.
`
`Employment
`union
`
`benefits,
`
`records,
`etc.,
`
`including
`absences
`
`and
`
`payroll
`W-2
`statements,
`of hire
`from date
`from work
`
`records,
`to date.
`
`insurance/disabinty
`
`benefits,
`
`Compensation
`
`file,
`
`[
`
`] No-Fault
`
`file,
`
`or
`
`[
`
`] Health
`
`insurance
`
`records.
`
`Workers'
`
`Other,specify:
`
`the
`
`authorize
`I,
`undersigned,
`hereby
`the
`records
`to my
`or
`to me,
`copy
`5C, NEW YORK,
`SUITE
`ST.
`purpose
`of
`my request:
`fulfilling
`
`you
`the
`to disclose
`MICHAEL
`attorneys
`NEW YORK,
`10013,
`
`and
`records
`above-indicated
`& ASSOCIATES,
`J. AVILES
`and
`to the
`307-0023,
`(212)
`
`request
`LLC.
`
`following
`
`a
`
`you deliver
`that
`145 HUDSON
`for
`the
`parties,
`
`GOTTLIEB,
`
`SIEGEL
`
`& SCHWARTZ,
`
`27 E. 94™ ST. NYC NY 10128
`
`THAT:
`I HAVE MADE
`I UNDERSTAND
`A LEGALLY
`IS MY INSURER AND
`1) EXCEPT WHERE
`THE RECIPIENT
`IN WRITING AT ANY
`CONTESTABLE
`I HAVE THE RIGHT TO REVOKE THIS AUTHORIZATION
`CLAIM UNDER MY POLICY,
`TIME, BUT ANY SUCH REVOCATION
`WILL NOT APPLY TO INFORMATION
`ALREADY RELEASED IN RESPONSE TO THIS
`FOR AN UNAUTHORIZED
`2) ANY DISCLOSURE OF INFORMATION
`CARRIES WITH IT THE POTENTIAL
`AUTHORIZATION;
`RE-DISCLOSURE
`WHICH MAY NOT BE PROTECTED
`BY THE FEDERAL PR1VACY RULES; AND 3) TREATMENT,
`PAYMENT,
`I SIGN THIS
`OR
`ON WHETHER
`ELIGIBILITY
`BE CONDITIONED
`FOR
`BENEFITS
`MAY
`NOT
`ENROLLMENT,
`AUTHORIZATION.
`IN THREE YEARS. THIS
`EXPIRATION:
`AUTHORIZATION
`IS
`THIS AUTHORIZATION
`EXPIRES
`OR OTHER RECORDS
`YOU TO SPEAK
`TO ANYONE
`FOR MEDICAL
`ONLY AND DOES NOT AUTHORIZE
`MY ATTORNEYS,
`MY MEDICAL
`& ASSOCIATES,
`EXCEPT
`A'BOUT
`CONDITION
`MICHAEL
`J. AVILES
`LLC.,
`.
`OR TREATMENT.
`
`,
`
`J. AVILES
`
`X M
`
`IC
`PO
`
`DATE:
`
`FEBRUARY
`
`7, 2017
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`Power
`Record
`Law §18(1)(G)
`
`of
`Attorney
`Authorization
`As Amended
`
`..
`Forms
`10/26
`
`Pursuant
`IO4.
`
`Medical
`Health
`
`To NY Public
`
`To
`
`Execute
`
`HIPAA
`
`'t;::! Jd',
`
`. «~e.~
`i.:Nartd:.Z'
`
`~380
`f:1~:
`
`of
`
`.
`Un;.i~~.;,jIi'.
`/cia>fA".~k
`(insert
`yout
`
`'
`:'::g
`name
`
`'
`
`and
`
`.:..
`
`..
`
`plpg.
`
`Qeriv,
`QFPA'I
`
`~CD>-I48
`I't9:iQ>-.le5
`I~YM
`
`address)
`
`'
`
`1 444
`''
`'lI dkl
`do
`appoint:
`hereby
`$†æ0 We sc
`u~~
`u~~
`at
`offices
`with
`[
`my attorneys-in-fâct
`to act
`(each
`I myself.could
`stead
`in any way
`which
`HIPAA
`medical
`record
`authorization
`as amended
`10/26/04.
`§18(1)(g)
`time.
`This
`Power
`of Attorney
`shall
`incompetence.
`
`b
`
`5
`
`and
`
`.
`N'
`~~
`, New York
`.,:~~
`-<~i:I<'
`.,
`place
`in my name,
`act
`separately)
`may
`execute
`present
`to
`I were
`if
`personally
`do,
`Law
`to NY Public
`Health
`pursuant
`forms
`by me at any
`revoked
`be
`of attorney
`power
`may
`or
`by my subsequent
`be affected
`disability
`
`agent
`
`This
`not
`
`To
`induce
`any
`a duly
`executed
`copy
`revocation
`or
`termination
`until
`actual
`notice
`or
`such
`third
`and
`and
`third
`
`third
`
`by
`
`representatives
`third
`reason
`
`from
`party
`of such
`
`In Witness
`
`to act
`facsimile
`hereof
`knowledge
`party,
`assigns,
`against
`
`party
`or
`
`party
`
`third
`that
`agree
`I hereby
`hereunder,
`arty
`act
`of
`this
`instrument
`hereunder,
`may
`third
`as
`to such
`be
`ineffective
`shall
`termination
`or
`of such
`revocation
`I for myself
`for my heirs,
`and
`and
`to indemnify
`agree
`'
`.
`all
`claims
`ay ari
`that
`on the
`ions
`pr
`
`receiving
`party
`that
`and
`unless
`been'
`have
`been
`legal
`
`and
`
`any
`third
`
`such
`
`party
`
`by
`
`party
`shall
`executors,
`harmless
`hold
`such
`. ainst
`.
`
`thi"thi"
`Instrument.
`thi
`
`l'I:
`
`and
`
`hereby
`and
`any
`relied
`having
`
`Whereof
`
`I have
`
`hereunto
`
`signed
`
`my
`
`n
`
`me
`
`his '. 2
`
`..
`
`da
`
`of::
`of:
`df
`
`';,
`
`.,
`
`20U¿
`
`IG.'A"
`lG
`
`
`
`A'.VT RR::
`
`
`
`'ACKN'0.,ACKN'O.,
`
`'ED'O'
`EDO
`
`I)
`
`NTNT
`
`E OF NEW YORK
`STAT
`OF NCuper
`CÖlJNTY
`„it;
`
`'I'
`Öri
`
`Z"
`this·.2
`5mc
`to
`
`daysgf
`ys.æ
`be
`
`acknowledged
`signartrurte.:
`signature
`
`before
`
`the
`
`the
`on
`executed
`undersigned
`
`R{Mit{
`i'
`'-'-."
`y përsdrigl‡
`the
`individual
`to me
`that
`instrument,
`the
`
`,20
`, 20/4
`known
`whose
`executed
`individual,
`and
`
`he
`the.the.the
`instrument
`~.g
`
`at:
`
`/4%3on.s?
`
`lb:be'
`lb:before-
`before
`t6 be
`name
`
`me the
`appeMed
`persditally
`uridersignsar
`."-,'
`f:-
`i
`basis
`of
`pn
`b
`d toWe
`prôv
`the
`satisfactoly
`js: subscribed
`totta ithe?Withirt
`ilistruniefit
`that
`end
`in
`same
`capacity,
`by
`who
`racted
`the
`on
`person
`tif
`behalf
`such
`such
`app¾âiance
`individual
`'made
`t 3
`.., New York,¾Doo
`
`his
`
`the
`
`that
`
`or
`
`äñd
`his
`the
`
`
`
`54-(452-(4
`
`I k/k
`
`tjIr/r
`
`'r74o~~
`
`Notary
`Notary
`
`u'at;~"i,4t'.~~n ~
`<>Pl~ '
`"'~orrt~jsslvrt
`
`Op~
`
`(3 '0
`-
`
`Za
`
`H7
`
`\'
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`(i'<
`')
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`GOTTLIEB
`
`MICHAEL H. GOTTLIEB
`JONATHAN D. SIEGEL
`STUART D. SCHWARTZ
`
`DANIEL J. GOODSTADT
`AMY L. MANDEL
`JAIME S. HYMAN
`LAURA R. MCKENZIE
`LAUREN M. SOLARI
`
`J. Aviles
`Michael
`145 Hudson
`New York,
`
`& Associates,
`Suite
`5C
`Street,
`New York
`10013
`
`LLC
`
`& SCHWARTZ,
`SIEGEL
`AT LAW
`ATTORNEYS
`Street
`207 East
`Level
`Mezzanine
`New York, New York
`
`94"1
`94
`
`10128
`
`LLP
`
`TELEPHONE (6461449-8141
`FAX (6461370-1671 .
`E-MAIL: GSS@GSSLAWLLP.COM
`
`January
`
`30, 2017
`
`RE:
`
`Jimenez
`Index
`
`v. PR Grand
`No.:
`23525/2016E
`
`Hotel
`
`Owner
`
`Co.,
`
`LLC and P.S. Marcato
`
`Elevator
`
`Co.,
`
`Inc.
`
`Dear
`
`Counselors:
`
`provided
`
`We are in receipt
`for
`the Plaintiff,
`was
`attorney
`necessary
`them to provide
`for
`order
`an authorization
`for
`the
`
`of
`
`the
`
`Jay
`specifically
`Plaintiff
`above.
`
`the
`correspondence
`from
`The
`correspondence
`Jimenez.
`to the
`directed
`James
`s employment
`records.
`You.
`Thank
`
`Hotel
`James
`advised
`Hotel/Denihan
`provide
`Please
`
`regarding
`that
`a fresh
`
`the
`authoriZation
`power
`of
`
`Hospitality
`a power
`
`Group
`of attorney
`
`in
`
`and
`
`Truly
`
`Yours,
`
`Very
`GOTT
`
`E
`
`SCHWARTZ,
`
`LLP
`
`By:
`
`. Mandel
`
`CC:
`
`Cotter
`Varvaro,
`1133 Westchester
`White
`
`Plains,
`
`& Bender
`Avenue,
`New York
`
`S-325
`
`Suite
`10604
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`MICHAEL
`
`J. AVILES
`145 Hudson
`
`& ASSOCIATES,
`- Suite
`5C
`Street
`
`LLC
`
`New York,
`Telephone
`Telecopier
`
`New York
`10013
`(212) 307-0023
`307-0187
`(212)
`
`E-MAIL:
`
`maviles@m javileslaw.com
`
`July
`
`7, 2017
`
`& Schwartz
`
`Gottlieb,
`20fE.
`New York,
`Attn:
`Michael
`
`Siegel
`94th
`St.
`NY 10128
`Gotlieb,
`
`Esq
`
`Cotter
`Varvaro,
`1133 Westchester
`White
`Attn:
`
`Plains,
`Joseph
`
`& Bender
`Avenue
`NY 10604
`Esq.
`Varvaro,
`
`- Suite
`
`S-325
`
`Re:
`
`Jimene
`
`v. PR Grand
`
`Hotel,
`
`et al.,
`
`Dear
`
`Counsellors:
`
`matter.
`
`Please
`find
`We will
`authorizations
`
`enclosed
`provide
`were
`
`provided,
`
`plaintiff's
`plaintiff's
`to all
`
`W-2's
`W-2
`for
`
`parties,
`
`for
`
`with
`and
`2014
`years
`2015,
`is available.
`when
`same
`2013
`on October
`for
`W-2's
`
`plaintiff's
`
`reference
`
`Please
`
`24,
`
`to the above
`that
`be advised
`2016.-
`
`NA:sah
`
`Encls.
`
`-, Very
`
`truly
`
`yours~
`yoµrs
`
`Natascia
`
`Ayers
`
`
`
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`NYSCEF DOC. NO. 66
`
`INDEX NO. 23525/2016E
`
`RECEIVED NYSCEF: 06/15/2018
`
`.'Q%6Q.'~~-
`
`™
`
`10~ I
`
`Wh
`
`tate 6 pWhceyheuntry
`
`P
`
`1 Rents
`
`b
`
`OMB=MoM
`
`.",..."
`~
`
`-. "...::
`
`'-i>,,'."
`
`':-'",
`
`m~44',,:-„.,
`
`+
`
`„".~j~g~
`
`r:"
`
`)lvEfiaE
`..
`tH1
`
`l0
`
`',:::::
`)F1.",D
`
`7»TH"
`
`1
`
`F L
`
`( 212
`
`) 242-2417
`
`2 Royalties
`
`'
`
`.::,'..;,:
`
`.
`
`..
`
`'.„.
`
`":.::-'.::.",.";",'i:.....:'2
`
`)7'~
`
`t'lta42
`
`$
`3 Other
`
`income
`
`-'
`
`'
`
`' --'-':
`
`003401
`'numbe'r'
`-
`numbëF
`
`"
`
`$
`FishTn'g'boat'pr'oceeds"'
`5Fishinifbdät
`óceëds
`
`I
`
`"
`
`$
`7 Nonemployee
`
`.
`
`compensation
`
`/
`
`,
`
`=
`
`tax withheld
`
`-'Form.1N9-MISC
`'
`4 Federal
`income
`-'
`
`$
`.
`.
`',
`6MedicäIäñdtealtifEâiëpayfitentä
`
`.
`
`-
`
`.
`
`".
`
`'
`
`.',.':(.",",
`Qjjpy
`a,F~'j..Recipe'j
`
`'~x
`
`I
`
`r
`
`$
`S'ub'stitu'te',pay'ment's~fn>lY>8,:"
`8 Substitute
`payments
`in lieu o
`or
`dividends
`interest
`
`i@~+
`This
`<~-.;-~
`':~;"i"j-'.< ~ '''
`::.'',
`the
`
`I
`
`.
`
`~
`
`,.ijf 0
`
`.
`
`-'.'
`
`.
`
`~ .
`
`PAYER'Sfederal
`
`2014/4/00
`identification
`
`7 81
`humber
`
`RECIPIENT'S
`
`I
`
`'I
`
`q
`
`::2 I-'2
`RECIPIENT'S
`
`749600
`name
`
`JAY
`
`J IMENEZ
`
`Street
`
`."
`.
`
`apt.
`
`$
`. 00
`3 95
`direct
`9 Payer made
`sales
`of
`or more
`$5,000
`of consumer
`products
`to a buyer
`resale
`for
`(recipient)
`
`11...
`
`11
`
`+
`
`C3D.
`
`',
`
`$
`10 Crop
`
`insurance
`
`Ice
`
`proceeds
`
`-
`
`"..;.."
`
`',:.:
`
`'
`
`'
`
`8....;.:.
`12
`
`m
`
`R5
`'if
`
`is importa
`~:~~"':
`information
`fumis
`being
`intemal
`service.
`@ques'd
`required,
`~"„'4%i,
`a net
`return,
`'."."- ";",'",:
`penalty
`'
`-"
`=--':
`sanctio1
`imposed
`this
`
`"
`
`taxable
`':,'::;:.::."
`determ
`
`at
`
`ha
`
`i
`
`ctfiem'"'(inciuding'.apt.'
`address
`(including
`LOR I NG
`
`no.)
`PLACE
`,':PER'CE
`
`2 2 2 6
`APT
`22
`q;-Mte.'-o'
`or
`town,
`
`k»'.
`
`City
`
`state
`
`or province,
`
`country,
`
`and· ZIP or
`and
`
`foreign
`
`postal
`
`code
`
`'."'."-,"'";;j;.';;;;-
`'.:.;-"-:
`
`BRONX
`Account
`number
`
`;",
`".''":;
`
`NY
`.'ÃY
`(see
`
`10 453
`instructions)
`
`13 Excess
`payments
`
`golden
`
`parachute
`
`14 Gross
`
`proceeds
`
`paid
`
`to an
`
`attorney
`
`Section
`
`409A
`
`income
`
`$$
`16 State
`
`tax withheld
`
`.
`
`$$
`17 State/Payer's
`
`state
`
`no.
`
`..',
`
`18 Stateint
`.'::%8::Stake"inc
`
`0 0 3 401LONG/5W3
`deferrals
`409A
`Section
`
`>
`
`15s
`
`$:,:=®
`"F'oim'1099-'"
`1099-MISCMISC
`Form
`
`'
`
`A
`15b
`
`$$
`
`.._____________..______..___..
`
`NY
`___..
`
`___
`
`$8
`$$
`
`__....____.
`
`$
`88
`——internal
`lntemai
`
`R»RI
`
`
`
`(keep(keep
`
`forfor
`
`
`
`youryour
`
`
`
`records)records)
`
`
`
`www.irs.gov/form1099miscwww.irs.gov/form1099misc
`
`Department
`Oepartment
`
`ofof
`
`thethe Treasury
`Treasury
`
`'E''
`
`-T
`A
`
`4
`
`
`
`.. m ana•re- ima
`FILED: BRONX COUNTY CLERK 06/15/2018 01:31 PM
`20 Localty name
`19
`oca mcomeinu
`20 LocaMyname
`.............,....................812.85.
`....NY..New.Yoth.R.....,......
`Yn&.R......I
`......,
`NYSCEF DOC. NO. 66
`„...,81'.................................S1265..
`
`
`
`NY New York RNY..New. York R..................NY..New.Y.o.rkR.............
`FesunW4Wage4 Tasen
`page.essheTreassary OeGINo.15864988
`cffs
`FevenW4Wage5 YanStatervientDeg4.oftheTreasury-sRSOMRNo.19444083
`
`INDEX NO. 23525/2016E
`1 Goa incometar
`y nafne
`RECEIVED NYSCEF: 06/15/2018
`......
`..........................61235.
`.EY.Eewyog,.g,...
`FoseW4Wage5 TauStatesneestDeptoft*ieTresourystra0945seetsagmee
`
`Ilmoe
`
`
`
`I...J..
`
`w-2
`
`I
`
`.
`
`Copy
`
`2014
`
`Employee
`Reference
`";L''"denra"
`
`StatementStatement
`Copy C tor Employee Records
`1 Wages tes. other camp.
`2 FeGeralmcome lan withheld
`3o770.90
`-'
`3424.07
`3 Social sec*nty wages
`4
`al security tax withheld
`30698.32
`1907.80
`veamare wages and tes
`8 Medicare saxwanhnia
`30770.90
`
`446.18
`only'
`Employer use only
`
`t
`
`d dontroi number
`~on!rot
`
`: L-mployer's
`
`name. address.
`
`ana hP cooe
`
`JAMES HOTEL MGMT CO LLC
`551 FIFTH AVENUE
`NEW YORK NY 10176-0001
`Emtaoyir's FED ID numoer
`
`5ecunl)'
`sac4at secon:y tips
`
`Aovänce EIC payment
`
`72 58
`
`a Em
`
`I
`
`ce's SSA number
`
`8
