FILED: NEW YORK COUNTY CLERK 01/29/2016 02:23 PM

NYSCEF DOC. NO. 1

INDEX NO. 150757/2016

RECEIVED NYSCEF: 01/29/2016

SUPREME COURT OF THE STATE OF NEW YORK

COUNTY OF NEW YORK
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Plaintiff, :
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Defendant.
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Zurich American Insurance Company as

subrogee of Recall Holdings Ltd, Recall
Corporation, Recall Total Information
Management, New 10th Street LLC,
affiliates of those companies including
CitiPostal, Inc., and any other entity that
has received, directly or indirectly, benefits
under policy number MCP9842297-01
vs.
City of New York

Index No.:

SUMMONS

TO THE CITY OF NEW YORK:

YOU ARE HEREBY SUMMONED to answer the Complaint in this action and to serve
a copy of your Answer, or if the Complaint is not served with a Summons, to serve a Notice of
Appearance on the plaintiffs attorney(s), within twenty (20) days after the service of this
summons, exclusive of the day of service, or within thirty (30) days after completion of
service where service is made in any other manner than by personal delivery within the State. In
case of your failure to appear or answer, judgment may be taken against you by default for the
relief demanded in the Complaint.
New York County is designated as the place of trial because the plaintiff conducts
business in the County of New York and the defendants are municipal corporations in the
County of New York.
WHITE AND WILLIAMS LLP
By:
Christopher Konzelmann, Esquire
Attorneys for Plaintiff
7 Times Square, Suite 2900
New York, New York 10036
(212) 244-9500
Dated: January 29, 2016

16556400v.1

The address for the defendant is:

Zachary Carter
Corporation Counsel
New York City Law Department
100 Church Street
New York, NY 10007

-216556400v.1

SUPREME COURT OF THE STATE OF NEW YORK

COUNTY OF NEW YORK
Zurich American Insurance Company
as subrogee of Recall Holdings Ltd,
Recall Corporation, Recall Total
Information Management, New 10th
Street LLC, affiliates of those
companies including CitiPostal, Inc.,
and any other entity that has received,
directly or indirectly, benefits under
policy number MCP9842297-01
Plaintiff
vs.
City of New York
Defendant

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Index No.:

COMPLAINT

Zurich American Insurance Company as subrogee of Recall Holdings Ltd, Recall

Corporation, Recall Total Information Management, New 10th Street LLC, affiliates of
those companies including CitiPostal, Inc., and any other entity that has received, directly
or indirectly, benefits under policy number MCP9842297-01 [hereinafter referred to as
Zurich], by way of complaint against the defendant, avers as follows:
Parties
1.

Plaintiff Zurich as subrogee of Recall Holdings Ltd, Recall Corporation,

Recall Total Information Management, New 10th Street LLC, affiliates of those
companies including CitiPostal, Inc., and any other entity that has received, directly or
indirectly, benefits under policy number MCP9842297-01, is a New York corporation
engaged in the insurance business with a statutory home office located at One Liberty
Place, 165 Broadway, 32nd Floor, New York, New York 10006, and a principal place of
business at 1400 American Lane, Schaumburg, Illinois.
-116556400v.1

2.

Defendant City of New York is a municipal corporation that maintains its

principal place of business at 100 Church Street, New York, New York.
Venue and Jurisdiction
3.

Venue is proper in the County of New York.

The parties regularly

conduct business in the County of New York.

4.

The court has jurisdiction over the defendant. The defendant regularly

conducts business in the County of New York and maintain offices in the County of New
York.
5 North 11th Street and 20 North 12th Street, Brooklyn
5.

In January 2015, New 10th Street LLC owned the 117,000 square foot

building at 5 North 11th Street and 20 North 12th Street, Brooklyn.

6.

The building that existed in 2015 was constructed in phases. Building A,

constructed in or around 1984, was a 60,000 +/- square foot warehouse that included a
pump room for sprinkler equipment. Building B, constructed in or around 1996/1997,
was a 22,000 +/- square foot warehouse and loading dock. Building C, constructed in or
around 1999/2000, consisted of two components a warehouse and a four story structure
used for offices and recreational space.
7.

A covered breezeway used as a loading dock separated Building A from

Building B.

-216556400v.1

Breezeway

Loading
Dock

Figure 1 - Pre Fire Photograph

Breezeway

Figure 2 - Pre Fire Floorplan

The breezeway was approximately twenty-five feet wide.

8.

10th Street LLC entered into a lease agreement for the building with

CitiPostal, Inc. starting in or around 2001.

CitiPostal, Inc. used the building for

warehousing.
9.

Section 5 of the lease agreement required CitiPostal, Inc. to insure the

building. Section 6 of the lease agreement required CitiPostal, Inc. to utilize insurance
proceeds to pay for building repairs necessitated by damage caused by fire.
-316556400v.1

10.

10th Street LLC transferred the property to New 10th Street LLC, subject to

the lease agreement, in 2004.

11.

Recall, which maintains its principal offices at One Recall Center, 180

Technology Parkway, Norcross, Georgia, acquired and/or otherwise absorbed CitiPostal,

Inc. in 2014. Recall Total Information Management then began operating the building
under the New 10th Street LLC lease.
Building Sprinkler Systems
12.

The New York City Fire Department [FDNY] recognizes that sprinkler

systems are effective for substantially reducing damage caused by fire:

Sprinkler systems are required by law in varoius
occupancies. They also may be installed voluntarily by the
owner of the building. The sprinklers are installed to
protect the building and its residents. The installation of
sprinklers has a major effect in reducing fire losses. About
96% of the fires are extinguished or controlled when
sprinklers are installed. The 4% failure was due to a
variety of causes including defective piping, closed supply
valves, frozen water lines, improper maintenance, and
blocked water supply piping.
http://www.nyc.gov/html/fdny/pdf/cof_study_material/s_12_citywide_sprinkler_systems.
pdf
13.

The FDNY also recognizes two specific functions of a sprinkler system

with a water flow alarm:

Functions of Alarms and Supervisory Signals A
sprinkler system with a water alarm serves two functions:
1) It is an effective fire extinguishing system, and 2) It is an
automatic fire alarm. An alarm is signaled as soon as a
sprinkler head has opened. This is important since it allows
the occupants time to leave the building. It also signals that
the Fire Department should be summoned.
http://www.nyc.gov/html/fdny/pdf/cof_study_material/s_12_citywide_sprinkler_systems.
pdf

-416556400v.1

14.

Buildings A, B, and C, along with the breezeway, were protected by a

sprinkler system.
January 31, 2015 Fires
15.

On January 31, 2015 at approximately 4:26 a.m., the heat from a small fire

in the buildings breezeway caused one or two sprinkler heads to activate. The sprinkler
head activation also caused the fire alarm to transmit a signal to the monitoring company.
16.

The alarm monitoring company received the activation signal at

approximately 4:27 a.m. and notified the FDNY.

17.

The FDNY incident report states that the dispatch center sent first

responders to the building at 4:29 a.m. FDNY personnel arrived at 4:36 a.m. A copy of
the incident report is attached as Exhibit A.
18.

FDNY members took complete control of the building, including the area

of fire origin, upon arrival.

19.

FDNYs taking complete control of the building created a special

relationship with the building owner and occupants.

20.

The FDNY incident report describes the situation found upon arrival and

the actions taken:

Received as a Class 3 alarm. Upon arrival found a fire on
what appeared to be storage shelves approx. 50 feet into the
building. Fire was controlled by the sprinkler system. L106 and L-146 performed appropriate salvage operations
and checked for extension. No extension to the structure. E229 operated a 2 line to wet down debris that was
smoldering.
FDNY personnel also went to the buildings sprinkler room and closed the main valve
that controlled the flow of water to the entire system.

-516556400v.1

21.

By closing the main water supply valve, FDNY personnel made the

sprinkler system completely inoperable and substantially increased the risk of a

conflagration if there was a rekindle of the initial breezeway fire or a separate fire
originating elsewhere.
22.

The actions of FDNY personnel made the building substantially more

dangerous and substantially increased the risk of a catastrophic fire.

23.

FDNY personnel did not advise Recall personnel that they made the

sprinkler system inoperable, and left the building unprotected, by closing the main water
supply valve.
24.

The FDNY incident report states that all personnel left the site by 5:51

25.

The breezeway fire caused very minimal damage.

a.m.

Figure 3 - Breezeway Fire Damage

26.

Approximately 45 minutes after FDNY personnel left the site following

the breezeway fire, a Recall worker entered Building B through a man door adjacent to
-616556400v.1

the breezeway roll-up door on the 11th Street side of the building. As the worker moved
towards the center of the building, he saw an orange glow. The worker instructed a
second employee to call the FDNY.
27.

The buildings fire alarm system activated at 6:32 a.m., 47 minutes after

FDNY personnel cleared the scene from the initial incident.

28.

Because NYFD personnel had shut off the sprinkler systems main water

supply valve following the breezeway fire, and left the building unprotected, the fire
spread quickly.
29.

The second incident caused the complete destruction of the building.

Figure 4 - Post Fire

Insurance Coverage
30.

Zurich issued policy MCP9842297-01 to Recall Holdings Ltd. The policy

was effective June 30, 2014 to June 30, 2015.

31.

The Zurich policy provided benefits to various Recall Holdings Ltd.

affiliates and/or subsidiaries, including Recall Total Information Management

Corporation, along with New 10th Street, LLC (the entity that owned the building).

-716556400v.1

32.

The insureds submitted a claim to Zurich as a result of the January 31,

2015 fire at the building. Claimed losses included, but were not limited to, demolition
expenses, debris removal expenses, building damage, business property damage, business
interruption, and emergency response expenses. Zurich continues to adjust the claim and
to date has made payments exceeding $50,000,000.
33.

Pursuant to the terms of the insurance policy, and the applicable law,

Zurich is subrogated to its insureds rights and claims if the company pays a loss caused
by the actions and/or inactions of a third party.
34.

The actions and/or inactions of the FDNY created the conditions which

caused the January 31, 2015 fire discovered at approximately 6:32 a.m.

Zurich is

therefore subrogated to its insureds rights against the City of New York.
NOTICE OF CLAIM
35.

Within ninety days of the occurrence which is the subject of this

complaint, Zurich filed the required notice with the City. Zurich demanded that the City
adjust and pay the claim. A copy of the claim notice, and the Citys acknowledgement of
the notice, are attached as Exhibit B.
36.

Within ninety days of the occurrence which is the subject of this

complaint, Recall filed a notice with the City. Recall demanded that the City adjust and
pay the claim. A copy of the claim notice, and the Citys acknowledgement of the notice,
are attached as Exhibit C.
37.

More than 30 days have elapsed since Zurich and Recall presented their

claims to the City. The City has neglected and/or refused to pay the claims.
38.

Zurich is bringing this action within one year and ninety days of the event

at issue.
-816556400v.1

COUNT I
39.

Zurich incorporates the allegations contained in the preceding paragraphs

as if set forth at length herein.

40.

There was a special relationship between the FDNY and Zurichs insured

based in part on the FDNY taking complete control of the building during the initial
incident.
41.

The FDNY owed a duty to Zurichs insureds to exercise due and

reasonable care when responding to the initial breezeway fire on January 31, 2015 at
approximately 4:29 a.m.
42.

The FDNY breached the duty owed in one or more of the following ways:
a.

Closing the main water supply valve to the sprinkler thereby

rendering the system completely inoperable especially when doing
so was not necessary for suppression.

b.

Failing to advise Recall personnel that they shut off the main valve
to the sprinkler system thereby rendering the system inoperable.

c.

Failing to stop the flow of water from the activated sprinkler

head(s) by using a sprinkler wedge or sprinkler tongs which
would have allowed the sprinkler system to remain fully
operational.

d.

Failing to recognize that by closing the main water supply valve to

the sprinkler system, if the breezeway fire was not fully
extinguished, or there was a second fire, the sprinkler system
would not work thereby allowing a fire to spread quickly.

e.

Failing to fully and properly extinguish the breezeway fire.

f.

Failing to fully and properly check for extension and/or spread

following the breezeway fire.

g.

Failing to advise or otherwise warn on-site personnel that they may

not have fully extinguished the breezeway fire.

h.

Failing to follow standard operating procedures and/or guidelines

in responding to the breezeway fire.
-9-

16556400v.1

43.

i.

Failing to follow standard operating procedures and/or guidelines

in addressing the activation of one or two sprinkler heads in a large
commercial warehouse.

j.

Failing to follow standard operating procedures and/or guidelines

in ensuring that the breezeway fire was fully extinguished before
leaving the site.

k.

Failing to otherwise use due and reasonable care under the

circumstances.

The FDNYs breach of duty was a direct and proximate cause of the

incident that destroyed the Recall building.

WHEREFORE, Zurich demands judgment against the defendant for damages
exceeding $50,000,000 together with interest, attorneys fees, and the costs of this action.
Dated: January 29, 2016
WHITE AND WILLIAMS LLP

By:
Christopher Konzelmann, Esquire
Attorneys for Plaintiff
7 Times Square, Suite 2900
New York, New York 10036
(212) 244-9500

-1016556400v.1

Exhibit A

16535582v.1

Exhibit B

16535583v.1

eCLAIM Receipt
You have successfully filed your claim.
By successfully filing your claim, you have certified that all information provided is true and correct to
the best of your knowledge and belief. You also understand that the willful making of any false
statement of material fact herein may subject you to criminal penalties and civil liabilities.
Please allow up to 30 days to receive an email acknowledging your claim.
If you have any questions please contact 212-669-3916.
Your Receipt Number is the following:
201500016968

You uploaded:
Claim Form: 1
Supporting Documents:0
4/29/2015 10:46 AM
Claimant Last Name:Zurich American Insurance Company
Claimant First Name:See below

Office of the New York City Comptroller

1 Centre Street
New York, NY 10007

New York City Comptroller

Scott M. Stringer

Form Version: NYC-COMPT-BLA-PD1-B

Property Damage or Loss Claim Form

Electronically filed claims must be filed at the NYC Comptroller's Website. If your claim is not resolved
within 1 year and 90 days from the date of occurrence you must start legal action to preserve your rights.

I am filing: C - On behalf of myself.

On behalf of someone else. If on someone else's
behalf, please provide the following information.

(& Attorney is filing.

Attorney Information (If claimant is represented by attorney)
Firm or Last Name: White and Williams LLP

Last Name:
Firm or First Name:
First Name:
Relationship to
the claimant:

Claimant Information
*Last Name:

Zurich American Insurance Company

*First Name:

See below

Address:

1400 American Lane

Address:

1650 Market Street

Address 2:

Suite 1800

City:

Philadelphia

State:

PENNSYLVANIA

Zip Code:

19103

Tax ID:

Address 2:
City:

Schaumburg

State:

ILLINOIS

Zip Code:

60196

Country:

USA

2158646334

*Email Address:

konzelmannc@whiteandwilliams.com

*Retype Email
Address:

konzelmannc@whiteandwilliams.com

The time and place where the claim arose

Format: MM/DD/YYYY

Date of Birth:

Phone #:

Soc. Sec. #

*Date of Incident:

01/31/2015 Format: MM/DD/YYYY

Time of Incident:

4:30 AM

*Location of
Incident:

5 North 11th Street and 20 North 12th Street,

Brooklyn, NY

Address:

5 North 11th Street

Address 2:

20 North 12th Street

City:

N e w York

State:

NEW YORK

Borough:

BROOKLYN (KINGS)

Format: HH:MM AM/PM

HICN:
(Medicare #)
Date of Death:
Phone:
*Email Address:
*Retype Email
Address:
Occupation:
City Employee? ('Yes ( No (" NA
Gender

("" Male

(' Female (i' Other

Property Clerk
Voucher Number:

* Denotes required fields.

A Claimant OR an Attorney Email Address is required.

District Attorney
Release Number:

New York City Comptroller

Scott M. Stringer

*Ma nner in which

claim arose:

Office of the New York City Comptroller

1 Centre Street
New York, NY 10007

Claimant Zurich American Insurance Company issued policy number MCP98412297-01 to Recall Holdings LTD. The
policy provided coverage to various Recall Holdings LTD affiliates and/or subsidiaries, including Recall Corporation,
the entity that operated the storage facility at 5 N 11th Street and 20 N 12th Street, Brooklyn.
The New York City Fire Department responded to a small and controlled fire at the Recall facility on January 31, 2015
at approximately 4:30 a.m. The fire had been contained by the building's zoned sprinkler system. FDNY members
disabled the entire system leaving the building without any sprinkler system protection.
FDNY members left the site approximately one hour after arrival but never fully extinguished the fire. FDNY members
did not advise of their departure nor did they take sufficient steps to make sure the building was safe, that the fire
was fully extinguished, or that the sprinkler system was returned to service. The fire rekindled, spread, and ultimately
destroyed the building. Preliminarily, this claim is based on four alleged errors. First, failing to fully extinguish the fire
before leaving the site. Second, disabling the entire sprinkler system. Third, failing to restore the sprinkler system
before leaving the site. Fourth, failing to advise the building occupants that they had disabled the entire sprinkler
system.
Recall Holdings LTD and its affiliates and/or subsidiaries insured under the policy submitted claims to Zurich
American Insurance Company seeking recovery for their losses. Claimed losses include, but are not limited to, the
building, property in the building, demolition expenses, debris removal expenses, business interruption losses,
emergency response expenses, and third party liability claims from customers, the building owner, and surrounding
businesses. This specifically includes damage to the structure owned by New 10th Street, LLC.
Zurich American Insurance Company has made or will make in the future payments that ultimately go to New 10
Street, LLC due to certain contractual relations.
The claimants submitting this notice are Zurich American Insurance Company as subrogee of Recall Holdings LTD,
Recall Corporation, Recall Total Information Management, New 10 Street, LLC, affiliates and/or subsidiaries of those
companies, and any other entity that may receive, directly or indirectly, policy benefits. Zurich American Insurance
Company may bring the claims its own name, or in the names of the entities that receive policy benefits, including
those identified in the preceding sentence.
Recall Corporation and/or its affiliated companies have submitted or will submit in the future a separate notice.

* Denotes required field.

The items of
damage claimed
are (include dollar
amounts):

e claim adjustment process is ongoing. Zurich American Insurance Company may pay in excess of $60,000,000.00
among other things, damage to the building, property in the building, demolition expenses, debris removal
penses, business interruption losses, emergency response expenses, and third party liability claims from customers,
building owner, and surrounding businesses.

Office of the New York City Comptroller

1 Centre Street
New York, NY 10007

New York City Comptroller

Scott M. Stringer

Witness 1 Information

Witness 4 Information

Last Name:

Last Name:

First Name:

First Name:

Address

Address

Address 2:

Address 2:

City:

City:

State:

State:

Zip Code:

Zip Code:

Witness 2 Information

Witness 5 Information

Last Name:

Last Name:

First Name:

First Name:

Address

Address

Address 2:

Address 2:

City:

City:

State:

State:

Zip Code:

Zip Code:

Witness 3 Information

Witness 6 Information

Last Name:

Last Name:

First Name:

First Name:

Address

Address

Address 2:

Address 2:

City:

City:

State:

State:

Zip Code:

Zip Code:

Police Information

Please indicate which of the following reports you have

Police Officer Last

Name:
Police Officer First
Name:
Shield Number:
Precinct:
Report Number:

DAccident Report
ElAided Report
E]Complaint Report

Office of the New York City Comptroller

1 Centre Street
New York, NY 10007

New York City Comptroller

Scott M. Stringer

City vehicle information

Insurance Information
Do you have insurance?

C Yes

1' No

Did you report your accident to your insurance

company?

C" Yes

C' No

Were you paid by your insurance company?

\ `

Yes

C" No

Is payment pending?

C` Yes

C`" No

Insurance Company
Zurich American Insurance Company
Name:
1400 American Lane

Total Amount
Claimed:

$60,000,000.00

The Total Amount Claimed can only be entered Format: Do not

once the following required fields are entered:
include "$"or ,".

Address 2:
City:

Schaumburg

State:

ILLINOIS

Zip Code:

60196

Policy#:

MCP9842297-01

Phone #:

City Driver Last

Name:
City Driver First
Name:

Deductible Amount:

Address:

Plate #:

Claimant Last Name

Claimant First Name
Claimant Email orAttorney Email
Date of Incident
Location of Incident
Manner in which claim arose

Agent Name:

1 certify that all information contained in this notice is true and correct to the best of my knowledge and belief. l understand that the willful
making of any false statement of material fact herein will subject me to criminal penalties and civil liabilities.

Exhibit C

16551686v.1

eCLAIM Receipt
You have successfully filed your claim.
By successfully filing your claim, you have certified that all information provided is true and correct to
the best of your knowledge and belief. You also understand that the willful making of any false
statement of material fact herein may subject you to criminal penalties and civil liabilities.
Please allow up to 30 days to receive an email acknowledging your claim.
If you have any questions please contact 212-669-3916.
Your Receipt Number is the following:
201500016972
You uploaded:
Claim Form: 1
Supporting Documents:0
4/29/2015 2:14 PM
Claimant Last Name:Recall Corp.
Claimant First Name:see below

Office of the New York City Comptroller

1 Centre Street
New York, NY 10007

New York City Comptroller

Scott M. Stringer

Form Version: NYC-COMPT-BLA-PDI-B

Property Damage or Loss Claim Form

Electronically filed claims must be filed at the NYC Comptroller's Website. If your claim is not resolved
within 1 year and 90 days from the date of occurrence you must start legal action to preserve your rights.

I am filing:

6i Attorney is filing.

' On behalf of myself.

On behalf of someone else. If on someone else's
behalf, please provide the following information.

Attorney Information (If claimant is represented by attorney)

Firm or Last Name:

Pillsb ury Winthrop Shaw Pittman LLP

Firm or First Name:

Matthew D. Stockwell

Address:

1540 Broadway

Last Name:
First Name:
Relationship to
the claimant:

Address 2:

Claimant Information
*Last Name:

Recall Corp.

*First Name:

see below

Address:

One Recall Center

Address 2:

180 Technology Parkway

City:

Norcross

State:

GEORGIA

City:

New York

State:

NEW YORK

Zip Code:

10036

Tax ID:
Phone #:

2128581000

*Email Address:

matthew.stockwell@pillsburylaw.com

*Retype Email
Address:

matthew.stockwell@pillsburylaw.com

The time and place where the claim arose

Zip Code:
Country:

*Date of Incident:

01/31/2015 Format: MM/DD/YYYY

Time of Incident:

4:30 AM

*Location of
Incident:

5 N 11th Street and 20 N 12th Street,

Brooklyn, NY

SA

Format: MM/DD/YYYY

Date of Birth:
Soc. Sec. #
HICN:
(Medicare #)
Date of Death:
Phone:
*Email Address:
*Retype Email
Address:
Occupation:
City Employee?
Gender

Address:

('Yes (."No ('NA

" Male

t" Female

(e

Other

Address 2:
City:
State:
Borough:
Property Clerk
Voucher Number:

* Denotes required fields.

A Claimant OR an Attorney Email Address is required.

District Attorney
Release Number:

NEW YORK

Format: HH:MM AM/PM

New York City Comptroller

Scott M. Stringer

*Manner in which
claim arose

Office of the New York City Comptroller

1 Centre Street
New York, NY 10007

In the early morning hours (-4:30 am) of January 31, 2015, the Fire Department of New York (FDNY) responded to a
small fire at claimant's warehouse(s) that was located at 5 N 11th Street and 12 N 12th Street, Brooklyn, NY. The fire
was initially contained by the facility's zoned sprinkler system. While elements of the FDNY were gaining control of
the fire, others went and disabled all zone's of the warehouse's fire sprinkler system. This left the warehouse without
protection from fire.
After less than an hour, and before the fire was fully extinguished, the FDNY departed from the warehouse(s). The
FDNY gave no notice of its departure; nor did it provide any instructions or install any safeguards against further fire.
As a result, the fire regained strength and began to spread.
The FDNY was called back to the warehouse(s) but by the time the FDNY returned, the fire was uncontrollable.
Eventually, the fire consumed the entire warehouse(s) and its contents; it was a total loss. Claimants loss was, in
whole or in part, caused by the acts and/or omissions of the FDNY.
The loss of real and personal property and the resulting disruption of claimant's business has damaged claimant in an
amount in excess of $70,000,000. The loss includes the physical structure, demolition/debris removal, third-party
claims (from customers that lost materials, to their customers, to the building owner and surrounding businesses and
neighbors), rebuilding obligations and options, and administrative and incident response costs. In addition,claimant
will seek indemnity/contribution for any third-party claims brought against it.
Recall Corp. provides this notice for itself and its affiliates (including but not limited to CitiPostal, Inc. and CitiStorage,
Inc.), insurers, and assigns.

* Denotes required field.

The items of
damage claimed
are (include dollar
amounts):

As of this writing, claimant has lost or incurred over $70,000,000 in damages and incurred and expected liabilities
from the loss of real and personal property, and the resulting disruption of claimant's business. This includes loss of
the physical structure; demolition/debris removal; third-party claims (from customers that lost materials, to their
customers, to the building owner and surrounding businesses and neighbors); rebuilding obligations and options;
and administrative and incident response costs. In addition, claimant anticipates that its liabilities and damages will
continue to grow as additional private parties and public agencies assert (and claimant defends) claims, assessments,
and other costs against the claimant.

Office of the New York City Comptroller

1 Centre Street
New York, NY 10007

New York City Comptroller

Scott M. Stringer

Witness 1 Information

Witness 4 Information

Last Name:

Last Name:

First Name:

First Name:

Address

Address

Address 2:

Address 2:

City:

City:

State:

State:

Zip Code:

Zip Code:

Witness 2 Information

Witness 5 Information

Last Name:

Last Name:

First Name:

First Name:

Address

Address

Address 2:

Address 2:

City:

City:

State:

State:

Zip Code:

Zip Code:

Witness 3 Information

Witness 6 Information

Last Name:

Last Name:

First Name:

First Name:

Address

Address

Address 2:

Address 2:

City:

City:

State:

State:

Zip Code:

Zip Code:

Police Information

Please indicate which of the following reports you have

Police Officer Last

Name:
Police Officer First
Name:
Shield Number:
Precinct:
Report Number:

Li Accident Report
LiAided Report
Complaint Report

Office of the New York City Comptroller

1 Centre Street
New York, NY 10007

New York City Comptroller

Scott M. Stringer

City vehicle information

Insurance Information
Yes

(" No

Did you report your accident to your insurance

company?

Yes

('No

Were you paid by your insurance company?

Yes

C No

(`"Yes

C" No

Do you have insurance?

Is payment pending?

Plate #:

City Driver Last

Name:
City Driver First
Name:

Deductible Amount:
Insurance Company Zurich Insurance
Name:
Address:

1400 American Way

Address 2:

Tower 2 Floor 5

City:

Schaumberg

State:

ILLINOIS

Zip Code:

60196

Policy #:

MCP9842297-01

Phone #:

Total Amount
Claimed:

$70,000,000.00

The Total Amount Claimed can only be entered

once the following required fields are entered:

Format: Do not
include "$"or ,".

Claimant Last Name

Claimant First Name
Claimant Email or Attorney Email
Date of Incident
Location of Incident
Manner in which claim arose

Agent Name:

I certify that all information contained in this notice is true and correct to the best of my knowledge and belief. I understand that the willful
making of any false statement of material fact herein will subject me to criminal penalties and civil liabilities.