TB-lSA PREVENTABLE TROOP VEHICLE ACCIDENT-REPORT OF ADJUDICATION (8/07)
VAN

DATE OF ACCIDENT/INCIDENT

08247

05/27/2009

TIME OF ACCIDENT/INCIDENT

VEHICLE PLATE NUMBER

J12:lS A.M.

J2FS

DRIVER'S NAME (FIRST, MI, LAST)

jJa~on J. Lewis .
SHIELD NUMBER

STATION

ORIGINAL FILE 3#

3020

SP Monroe

AMSPW37000020

I.

Type(s) OF Adjudication

01 - Clinical Phase
02 - Instruction - Troop Safety Officer or Traffic Supervisor

03 - EVOC assignment
04 - NO disciplinary action
~

/5 - Counselling

------/;,L

06 - Censure
07 - Vacation Days (number) _ _ __
08 - Probation
09 - Suspension without pay

10 - Termination
11 - Other (specify) _ _ _ _ _ _ _ _ __

II. Date of Adjudication

APPROVED BY

RANK

DATE

NEW YORK STATE POLICE

MEMORANDUM

Troop F Station Middletown
Date
To:

Colonel John P. Melville, Field Commander
Attn: Major, Division Traffic

From:

Major Edward Raso, Troop Commander

Subject:

TROOP CAR ACCIDENT- 5/27/09
TPR. JASON J. LEWIS, SP MONROE

September 10, 2009

Reference is made to the previously-submitted repo1i regarding the above subject.
On September 10, 2009, Trooper Lewis appeared before me and executed his consent
to have me adjudicate this matter at Troop level.
Pursuant to Rule 3 of the New York State Police Administrative Manual, I have
detennined that he receive a letter of censure for his actions. Attached is a copy of the letter of
censure and consent waiver.
This matter is closed.

Attach.

HARRY J. CORBITT
SUl'ERl1"TE"WENT

i\lAJOR EDWARD RASO
TROOP COl\11\1AND£R

ST ATE OF NEW YORK

NEW YORK STATE POLICE
TROOP "F" HEADQUARTERS
55 CRYSTAL RUN ROAD
MIDDLETOWN, NY 10941
(845) 344-5300

September 10, 2009

Trooper Jason J. Lewis
New York State Police
Monroe, New York

LETTER OF CENSURE

Dear Trooper Lewis:

On May 27, 2009 you were operating your assigned Division vehicle when you were
involved in a troop car accident. This accident has been reviewed at Troop Headquarters and it\\ as
detennined to have been preventable on your part. On September 10, 2009 you appeared before me,
executed a waiver, and requested that I adjudicate the disciplinary action.
The accident occurred as you were entering Interstate 84. As you merged into the
driving lane, your Division vehicle made contact with another vehicle. Minor damage was incurred.
As a professional driver, you are expected to drive more carefully.

It is my decision that you receive a letter of censure for your actions. I trust that you
\vill drive more cautiously in the future.

Edward Raso
Major
Troop Commander

NEW YORK STATE POLICE
MEMORANDUM
TROOP F STATION Monroe
DATE

To:

Major Edward Raso, Troop Commander

From:

Trooper Jason Lewis

Subject:

DISCIPLINARY ACTION

July 19, 2009

'6,~

I hereby consent to have the above-captioned investigation adjudicated by the Troop
Commander under the provisions of Article 3, Disciplinary Action of the New York State Police
Manual.
I waive the following:
1.

The right to have this matter disposed of by the Superintendent or by a
formal hearing.

2.

Any right to appeal from the Troop Commander's adjudication which may be
a determination of unfounded or, upon a finding of guilty, the imposition of:
a.

A Letter of Censure and/or

b.

An intra-troop transfer, with my consent and/or

c.

A fine to be expressed in the loss of no more than five vacation days

to be worked by the member with no additional compensation or
overtime and/or
d.

A period of probation not exceeding 90 days which probation must be
for a definite period of time and must include conditions of probation
which, if violated, could subject me, without the right of a fmther
inquiry or a hearing, to the imposition of any one or more of the
penalties that can be imposed by the Troop Commander, and/or an
intra-troop transfer, without my consent.

'
TB~l 8 (l /0~)

NEW YORK STATE POLICE
'

DIVISION VEHICLE ACCIDENT/INCIDENT COVER PAGE
OPERATOR OF SP VEHI CLE:

(TRAFFIC SECTION COMPLETE)

Received At Traffic :

Reviewed By:

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(Date)

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(FLEET MANAGEMENT COMPLETE)

Received From Traffic:

(D/A)

REPAIR INFORMATION:

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Order Number:

(Date)

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Amount : $

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Case Closed :
Initials:

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Date Paid :

(Date)

Forwarded From Fleet To Records :

Returned To Service Date:

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Estimates :

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(Date)

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TOT Attorney Gen eral:

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INSURANCE INFORMATION:

MISCELLANEOUS:

Check Number:

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Amount: $

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NEW YORK STATE POLICE

MEMORANDUM

TROOP F

STATION

DATE

June 26, 2009

TO:

Deputy Superintendent John P. Melville, Field Command
Attn: Major, Division Traffic

FROM:

Major Edward Raso, Troop Cornman~

SUBJECT:

TROOP CAR ACCIDENT - 5/27/09
TPR. JASON J. LEWIS, SP MONROE

Middletown

Reference is made to the attached self-explanatory investigative report regarding the
above subject.
I have reviewed this accident and it is my opinion that it was preventable.
Member has consented to adjudication by the Troop Commander under the provisions
of Article 3, Disciplinary Action, Rules of the New York State Police. Results of the adjudication
will be forwarded to you upon completion of same.

Attach.

NEW YORK STATE POLICE

MEMORANDUM

TROOP F

STATION

DATE

June 26, 2009

TO:

Major Edward Raso, Troop Commander

FROM:

T/Sergeant Scott Mohl, Troop Traffic Supervisor~

SUBJECT:

TROOP CAR ACCIDENT- 5/27/09
TPR. JASON J. LEWIS, SP MONROE

Middletown

Reference is made to the attached self-explanatory investigative report regarding the
above subject.
I have reviewed this accident and it is my opinion that it was preventable.
The primary cause of this accident was unsafe lane change.

Attach.

) Genl. 7

NEW YORK STATE POLICE

MEMORANDUM
Troop_F_Station

SP Monroe

Date _ _ ___,J,_,u00n,,,e:...,2::e3:.1.,,,_20"'0""9'--

TO:

Major Edward id.,Troop Commander, Troop F

FROM:

Captain Stephtvs, Zone Commander, Zone 2

SUBJECT:

DIVISION VEHICLE PDAA- 2F5
TROOPER JASON J. LEWIS - SP MONROE - EOD 5/19/02

Reference is made to the AMS Message# AMSPW3 7000020, SP Middletown, dated
May 27, 2009, and the attached Genl. 84 Investigation Report of Zone Sergeant DAVID G. SCOTT
dated May 27, 2009, regarding above subject matter.
I have reviewed the attached two-car property damage accident report submitted by
Zone Sergeant SCOTT and concur with his findings. On May 27, 2009, Trooper JASON J. LEWIS
was operating non-video equipped marked Division vehicle 2F5 with emergency lights and siren
activated, along with Trooper DESMOND LEWIN as the passenger. Trooper LEWIS entered
Interstate 84 westbound from State Route 17 westbound in the Town of Wallkill, Orange County.
As Trooper LEWIS merged into the driving lane, he made contact with the front, right fender of
another vehicle. Troopers LEWIS and LEWIN were wearing their seatbelts and uninjured. The
damage sustained to 2F5 consisted of a broken tail light and a scratch on the fender.
Investigation has concluded that the culpability for this accident lies solely upon the
actions of Trooper LEWIS and could have only been prevented by him. It is recommended this
accident be classified as "preventable" on the part of Trooper LEWIS and further administrative
action be considered.
Attachment

1

Genl. 7

NEW YORK STATE POLICE

MEMORANDUM
SP Monroe

Troop_f_Station

Date

June 18. 2009

To:

Major Edward Raso, Troop Commander, Troop F

From:

Zone Sergeant David G. Scott

Subject:

DIVISION VEHICLE/TWO CAR PDAA 2F5
TROOPER JASON J. LEWIS/SP MONROE

~

Reference: AMSPW37000020, SP Middletown, dated May 27, 2009.
Genl. 84 Investigation Report of Sergeant DAVID G. SCOTT, dated May 27,
2009, same subject.
On May 27, 2009 at 12:15 AM, Trooper JASON J. LEWIS (EOD 05/19/2002 SP
Monroe) was operating marked Division vehicle 2F5 with Trooper DESMOND LEWIN (EOD
4/21/08 SP Monroe) as the passenger. The Troopers were en route to a home invasion
robbery/shooting in the Town of Deerpark. Trooper LEWIS entered 1-84 westbound via St Rt
17 westbound at exit 121W in heavy rain. His emergency lights and siren were activated as he
rounded the entrance ramp to 1-84. He observed a tractor-trailer westbound on 1-84 in the
driving lane, however he lost sight of that vehicle at the end of the ramp. As Trooper LEWIS
merged onto 1-84, the driver's side rear of 2F5 made slight contact with the passenger side,
front comer of the tractor-trailer. Both vehicles stopped on the shoulder and Trooper LEWIS
verified that there were no injuries.
Investigation into the collision revealed that the culpability lie with Trooper LEWIS,
the operator of 2FS. The damage to both vehicles was relatively minor. The accident is
classified as "preventable" on the part of Trooper LEWIS. It is recommended that this matter
be closed by investigation.

New York State Police Investigation Report

GE.NL-84 REV b1/9BE

F

SP Monroe

A

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State Zlp

CrrN

15. Case No.

j 10A. Occupation

I'F3s13Iiv CODE p2.05272009
Date Occurred: From -To
-

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10B.Bus.Phone

11)1" County
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£,M19c.o- Specific Location

N ""!Wallkill
T 14. Owner If other than Complainant

~me Occurred: Fromffo

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113. Date Rotted

05272 09

12:15 AM -

l)Weathec

Address

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County

Address

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Apt

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6. Complainant Name (Last, First, Middle)

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Case No.

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Stolen M.J - Keys in Ignition
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Q

():,thee (Specify)
Name of Owner or Licensee
Address

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Rds Fired

Lie. No.

Unexpended
Rounds

County of Issue

Date of Issue

Name of Receiver
l()~Acct.lJlnsuff Fund0Accl Closed
Identifiable
Doc. No.

Bank Drawn On - Address

Photo-Suspect

I

IDoc Amount

'61.13

D V-1: Driver's Rear Tail Linh! Assemblv

''-2: Passenoer Front Quarteroanel hole & scratches
'" i~__'. Property ~ Yes
Name of Insurer
ll; INS.OR Insured?
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Disposition
No.
Date

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No

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Name of Maker. ID or Address Given

M Joe Date

No

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0

Name (Last, Rrst, Middle)-Address

Age

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.....A. Report Date

05 27 09

New York State Police Investigation Report
CODE: Assault ~'A Ho!'!ilctde =,H su.i~lde = S Atte.;:;~ed Stiicl!1e =.

~:i .8_1 ·
::,t,;;

Code

As

N~u.ral Death:: Ni>'·•

Name {last, First. Middle)

- - - - -~ - ~
Age

Sex

D08

ospital and/or Physician

Nature of Injuries

?!~
S-2
Jfil Nat~;~ ;;r

Accident Vlcti!fl. = AV' Otiiir = o (S~ify).

Address

31f b--""="'- :----,=----,-,-..,,.--c=--,--------- - - - - - - + - - - - - - ---------- - - -- - -----,r.:-.,-,--c=-.,.-----,
ate of Death

,;if;

Code

i;

\ { Date of Death

Sex

Age

Sex

Age

Hospltal and/or Physician
Coroner or Medical Examiner
Name (Last First. Middle)

Palhologlst

Address
Hospital and/or Physician

Nab.ire of Injuries

,..Al

Pathologist

Address

Injuries

· c/; Date of Death
,]ff, S-3 • Code

,j

1/:YQNo Q

roner or Med"tcal Examiner

Autops
Yes

Coroner or Medical Examiner

Palhologlsl

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Crime

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Judge - Name - Address - liUe

No Q
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im________________________-------------------''--------------!1------- - - - - - --+--'-'--'="'--c.;.c.-'="-I

:!;~Q,jli
,:if15. udgo - Name - Address - Title

Lie. No.

ame{s)of Lleensee{s)

The Presence or absence

or any individual factor is indicated by checking Yes or No
Yes

Identification/ Description Of Suspect Vehicle

Q
Q

Significant Physical Evidence

Q

Witness lo Crime

1. Genl. 7- Tr:>r. Lewis

No

Property Traceable/ !dentifiable

Yes

Q
Q

No

Distinctive I Significant MO

Yes

Q

No

Significant Community Interest

No
QNo

8. Estimate of Re airs

2. Genl. 7-T r. Lewin
3. Genl. 4- Mr. Howlett
4. Genl. 34D & Photo ra hs

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:;itili
···.:e~;

5. AMS #AMSPW37000020
6 . MV- 104A

,l i 7. MV-104L

Witnesses

Victims

Titles

Wanted
Shleld No.

43BCaseNo.

Aj>pn:ived

GENL-84b REV 11/97E

NEW YORK STATE POLICE
CONTINUATION SHEET

I

TROOP F

SP Monroe

COMPLAINANT - LAST1 FIRST, MIDDLE
(Complainant (L,F.M)) .

PAGE1

I

CASE NUMBER

(Case Number}

09-38

,

BOX 22 VEHICLE (CONTINUED)
V-2 Description- Make/Freightliner YR/2007 Reg. No./920999. State/ME Color/White Body Model/Unknown
Vin/lFUJBBCKl 7LX28497

BOX #26 INSURANCJ; (CONTINUED)
V-2 Insured by: Contin~ntal ~asualty Co. Policy: 0-1080826304
1.

On May 27, 2009 Trooper JASON J. LEWIS (EOD 05/19/2002 SP Monroe) advised ZJSgl DAVID G. SCOTT that he
had been involved in a minor property damage collision with Division Vehicle 2F5 while entering I-84 in the Town of
Wallkill. Zone 2 Commander, Captain STEPHEN NEVINS was advised and assigned Sergeant SCOTT to investigate.

2.

On May 27, 2009 I interviewed Tpr. LEWIS who stated that he was heading to a home invasion robbecy/shooting in the
Town of Deerpark at approximately 12:15am. He was operating Division Vehicle 2F5 with Trooper DESMOND
LEWIN (EOD 04/21/2008 SP Monroe) as the passenger. Trooper LEWIS activated the emergency lights and siren and
entered 1-84 westbound from St Rt 17 westbound via exit 121 W. As he enlered 1-84, he drove through a period of very
heavy rain. Trooper LEWIS stated that he observed a tractor-trailer traveling west on 1-84 as he rounded the entrance
ramp and that it appeared to be in the driving Jane of the highway. Prior to mer~ng onto 1-84, he did not see the tractortrailer in his rear view mirror and entered the lane of travel. He immediately felt a tap on the rear of 2F5. Trooper
LEWIS pulled to the shoulder and the tractor-trailer did as well. Upon inspection, Trooper LEWIS observed a small
hole in the driver's side tail light of2FS. He interviewed the driver of the tractor-trailer and determined that there were
no injuries. His statements were reduc~d to writing on a Genl. 7 and are attached as.Enclosure #1.

3.

On May 27, 2009 I interviewed Trooper DESMOND LEWIN. His account of the incident supports that of Trooper
LEWIS, except that Trooper LEWIN' WilS looking out of the passenger side window and did not see the tractor-trailer.
He stated that he' was not injured. Trooper LEWIN'S statements were reduced to writing on a Geni 7 and are attached
as Enclosure #2.

4.

On May 27, 2009 I interviewed Mr. BERNARD A. HOWLETT (DOB
al
the scene. He stated that he was heading west on I-84 at about 12:15 am and observed a State Trooper. with the
emergency lights on entering the highway from an entrance ramp on his right side. Mr. HOWLETT stated that it was a
long entrance ramp and he observed the Trooper from a great distance. He was able to move from the driving lane to
the passing lane and reduced his speed to allow the Trooper to merge. He didn't see the Trooper actually enter 1-84, as
the Trooper came off the ramp either next to or behind his tractor-trailer. The Trooper came up on his right and either
attempted to get in front of the truck or drifted into his lane. He heard an impact and pulled off _the road, in front of the
Trooper. Mr. HOWLETT was not injured and there is only minor damage to his vehicle. Mr. HOWLETT'S statements
were reduced to· writing on a Genl: 4 and ar~ attached as Enclosure #3.

5.

On May 27, 2009 I examined and photographed the damage to both vehicles. 2F5 had a broken driver's side tail light,
while the tractor-trailer had some scratches and a small hole in the passenger side, front quarter panel. The description
of the accident as reported by Trooper LEWIS, Trooper LEWIN and Mr. HOWLETT, appeared to be consistent with
the scene and the damage to the vehicles. There were no independent witnesses identified and no other physical
evidence was located at the scene. The scene consisted of two westbound lanes of travel on 1-84 with one merge lane on
the north side of the roadway that emanated from St Rt 17 at exit 121 W. The photographs and Genl. 34D are attached
as Enclosure #4.
~

'

7.

On May 27, 2009 I prepared and sent AMS# AMSPW37000020 from SP Middletown. A copy is attached as Enclosure
#5.
On May 27, 2009 I prepared an MV-104 A. A copy is attached as Enclosure #6.

8.

On May 27, 2009 I prepared an MV-104L. A copy is attached as Enclosure #7.

9.

On May 27, 2009 the Troop F AMI obtained a repair estimate for 2F5 from T&C Auto Body, 770 Rt 17M, Middletown,
NY I 0940. The total estimate of repair is $761.13. A copy of said estimate is attached as Enclosure #8.

10.

Closed by Investigation.

6.

I·

Genl. 7

NEW YORK STATE POLICE

MEMORANDUM
Troop_f_Station MONROE
Date_ _ _-----'M='-'A,_,_Y___,3"-'0'-'-1-=2'-"0-=0-=-9

To:

·Major Edward Raso, Troop Commander, Troop F

From:

Trooper Jason J L e w i s · ~

Subject:

DAMAGE TO DIVISION VEHICLE

Writer was advised by Zone Sergeant DAVID SCOTT to submit a memorandum
regarding DAMAGE TO DIVISION VEHICLE 2F5.
On May 27, 2009 at approximately 12:15am, I was operating marked unit 2F5
with TROOPER DESMOND LEWIN as the passenger, en route to a home invasion/shooting in
the Town of Deerpark. The emergency lights and siren in 2F5 were activated. While en route fo
said location there was an extreme down pour of rain. I proceeded to exit State Route! 7 west at
exit 121 wonto Interstate 84 westbound. While on the entrance ramp to I-84, I observed a tractor
trailer travelling west bound in the driving lane. Prior to merging into the driving lane I looked
into my rear view mirror and did not see any vehicles. As I then merged into the driving lane I
felt a tap on the rear of2F5. I pulled over onto the shoulder as did the tractor trailer. The only
damage I observed on 2F5 was the driver's side tail light which had a small 2-3 inch hole in the
tail light. Both myself and Tpr Lewin had no injuries. I then approached the tractor trailer and·
spolce to the operator who also had no injuries. I then contacted Z/Sgt Scott who responded to
scene.

Genl. 7

NEW YORK STATE POLICE

MEMORANDUM
Troop

F Station

Date

SP MONROE

May 30. 2009

To:

Major Edward Raso, Troop Commander, Troop F

From:

Trooper Desmond L. Lewin

Subject:

DAMAGE TO DIVISION VEIDCLE

~!)./

I was instructed by Zone /Sgt DAVID SCOTT to submit a memorandum
regarding DANAGE TO DMSION VEIDCLE 2F5.
On Wednesday May 27, 2009 Trooper JASON LEWIS and I were working a 2shift tour of duty out of SP Monroe in marked unit 2F5. Trooper LEWIS was the driver and I
was the passenger in said vehicle. We were en route to assist SP Middletown with a home
invasion/shooting in the Town of Deer Park. Wbile en route to said location Trooper LEWIS
exited State Route 17 at exit 121 west onto Interstate 84. I was looking out the passenger side
window when I felt a slight bump in the back of2F5. Trooper LEWIS pulled over onto the
shoulder and a white tractor trailer also stopped in front of2F5. I exited the vehicle and
observed a small crack on the drive side tail light. No injuries were sustained during the
accident. Trooper LEWIS then contacted Zone Sergeant SCOTT who responded to the accident
scene.

~

GENL-4' (03105)

. SUPPORTING DEPOSITION (CPL § 100.20')

PAGE

OF

THE PEOPLE OF THE STATE OF NEW YORK

-vs.

DEFENDANT(S)

LOCATION OF INCIDENT:

LOCATION OF DEPOSITION:

STATE OF NEW YORK

- - - - - - - -COURT
COUNTY OF _ C)
c,___/l_~_ ~_O_ _ __ __

STATE OF NEW YORK

COUNTY OF

OF

_.O~~--'-~-=--..b, c.,,...-:;
,_'=---- - - -(A./A-<-t-1<..JL.(__

OF

I I

TI~

at

STARTE~

Lt'LO~

NOTICE
(Penal Law§ 210.45)
In a written instrument, any person who knowingly makes a false statement which such person does not believe to
be true has committed a crime under the laws of the state of New York ·punishable as a Class A Misdemeanor.

Affirmed under penalty of perjury
this

'J-1 nf

ff;f
_ °'J___
i, t,l){}f

day ot ___

~ ~
(SIGNATURE OF DEPON i!NT )

- OR-U
• Subscribed and Sworn to before me

TIME ENDED:

this

-need
-- swcm
-

• Tl\19 10ml

be

3

New York State Police

day of

- ------

IO only - n specifically required by lhe court

Oor, o

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, 05/.27/2009 Monroe 09-38 AMS-TCA 2-Car PDAA-Tpr. Jason J. Lewis - 2F5

105 3824.JPG
5/27/2009 1: 19:43 AM

105_3825.JPG
5/27/2009 1 :20: 11 AM

105_3826.JPG
5/27/2009 ·1:20:28 AM

105_3827.JPG
5/27/2009 1:22:29 AM

..

. 05/,_27/2009 Monroe 09-38 AMS-TCA 2-Car PDAA-Tpr. Jason J. Lewis - 2F5

105 3828.JPG
5/27/2009 1:22:43 AM

105 3829 .J PG
5/27/2009 1 :22:53 AM

105 3830.JPG
5/27/2009 1:23:08 AM

105 3831 .JPG
5/27/2009 1:23:32 AM

Administrative Message Report ·
Prlnt\Run Date 05/27/2009

I AJIJ)S# AR/ISP~370Ql)020
___
. ____________ _;.,_,____
Date\Time Reported\Discovered
Agency ORI'
05/27/2009 00:15

-=------- -~-~"-'---~--:

..;..al

TZS
F221

NYSP MIDDLETOWN

Message
DIVISION VEHICLE - PDM

Investigated By

Units Responded

Z/SGT DAVID G. SCOTT

UF .

.L t!'=
·

Photos YES

Videotape NO

rr
- a~·t-:-iv.e- ~- ~ - - -- - - - - -- - -- - -- -- - - - - - -- -- ~ ~ --~ry

a
·
,_

TPR JASON LEWIS WAS OPERATING 2F5 (V-1) W ITH TPR. DESMOND LEWIN AS THE PASSENGER IN HEAVY RAIN.
THE TROOPERS ENTERED 1-84 WESTBOUND FROM ST RT 17 WESTBOUND WITH EMERGENCY LIGHTS AND SIREN
ACTIVATED, EN ROUTE TO A HOME INVASION ROBBERY/SHOOTING IN THE TOWN OF DEERPARK. V-2 WAS A 2007
FREIGHTLINER WITH TRAILER. V-2 WAS TRAVELING IN THE RIGHT LANE OF 1-84 WESTBOUND WHEN THE
OPERATOR OBSERVED 2F5 ROUND THE CURVED ENTRANCE RAMP AHEAD. V-2 MOVED TO THE LEFT LANE AND
SLOWED TO YIELD TO THE TROOP CAR. 2F5 MERGED INTO THE DRIVING LANE OF 1-84 AND UPON PASSING V-2 ON
THE RIGHT SIDE,. MA0E CONTACT WITH THE FRONT, RIGHT FENDER OF V-2. MINOR DAMAGE TO BOTH VEHICLES.
LT. FRANK KEYSER ADVISED.

# Vehicles

# Injured

2

0

# Deceased
0

Apparent Cause
FAILED TO KEEP RIGHT

County

CfTNName

ORANGE

WALLKILL, TOWN bF - 3666

Location\ Street Name \ Mile Post Marker
1-84 W/B MM.19.0
Road Conditions

Weather Conditions
3- RAIN

2 - WET

Description of Damage
V-1 BROKEN TAIL LIGHT; V-2 SCRATCH ON FENDER

Criminal Action
NONE

Sent Date \ Sent Time
05/27/2009 03:09

Sent By
Scott D

Notification ZONE

[ruiv'er 'lnformatio~; 001
Driver Name

Gender
M

LEWIS, JASON J

Address
1220 W ASHINGTON AVE

City
ALBANY

License State
State
NY

Chemical Test NO
Driver Charged NO
Zip

12226

Violations
Driver Member?
YES

Member Rank

Date of .Entry

TROOPER

05/19/2002

Name (exactly as printed on r~gistration)
NYSP,

Page 1 of 2

Member Shield
3020

Member Shift
2

-~ddress
1220 WASHINGTON AVE

City

State

Zip

ALBANY

NY

12226

'

lnsurar.:ice Company and Code
994 - GOVERNMENT OWNED

:

Qleblcle Information 001 ·
Lic~nse Plate #
State
POLICE

.

•.

NY

'Make

2008

VIN#
2FAHP71V38X104891

FORD

Van#·

Mileage
37445

08247

Front Airbags Deployed
Side Airbags Deployed
Fire Suppression Deployed

NO
NO
YES.

School Bus
Comm. Veh.

NYSPVeh.
Equipment
Damage

1

, c' ..

Vehicle Year

NO
NO
NO

Equipment Damage
Oescri~tlon

NO

.

,Vlolaticms
Member Rank

Driver Member.7

Date of Entry

·Member Shield

Member Shift

NO

[Owner lnfor.mation .P02

,/ ·
• \:
Name (exactly as printed on registration)
PENSKE THUCI( LEASING CO L,

Address
RT 10 GREEN HILLS BX 405.

City

State

Zip

READING

PA

19603

Insurance Company and Code·
989- OUT OF STATE INS CO- ITP

[Vefiicle 1Mormati6n 002
License Plate#
State
920999
ME

Vehicle Year
2007

Equipment
Damage

VIN#

FRHT
Mileage

Van#
School Bus
Comm. Veh.
NYSPVeh.

Make

I

NO
YES
NO
NO

·•

Front Airbags Deployed
Side Airbags Deployed .
Fi~e Suppression Deployed

,Equipment Damage
Description

Page 2 of2

NO,
NO
NO

Page

l

of

2 Pages

New York State Department of Motor Vehicles

Local Codes

POLICE ACCIDENT REPORT

3030528

MV-104A (3/04)

SPPZ81000007

□

MENDED REPORT
MOitary Time

No. or

No. Injured No. Kilted Not Investigated at Scene

Vetiides

00:35

2

0

0

□

Lefl Scene

D

~ld~~i·R~~;~Wd;d··· □Y

T

□ PEDESTRIAN

Police Photos
181Yes

□ OTHER PEDESTRIAN
Slate of Lie.

Slate of Uc.

NY

JASON

ME

BERNARD A

J

Addre$S (lnelude Number and Stroot)

369

20

□ No

Apt.No.

NININGER RD
Slate

Zip Code
10950

NY
Unlicense<f

□

□

bOR

Sex

Sex

C
pt.No.
State

LP ,
az.

Mat.
Code

Apt.No.

RT 10 GREEN .HILLS BX 405
,ty or

Zip Code
12226

NY

C

Atld~ss (Include Number and Stteel)

e

0\\11

Slate

READING
Ins. Code

PA

P1a1e, Number

994

Stale of Reg. Vehftle Year

920999

ME

Make

007 FRHT

licket/Arrest
Number(s)

Violation
Sectlon(s)

Violation

Sedion(s)

VEHICLE DAMAGE CODING:

1-13 SEE DIAGRAM ON RIGHT.
14. UNDERCARRIAGE
17, DEMOLISHED
15. TRAILER
18. NO DAMAGE
16. OVERTURNED
19.0THER

9.

IZ

Reference Marner

-

....-

Coordinates (if available)

Place Where Accident Occurred;

Lattitude/Northing:

Count)'. ORANGE

4588739

Road on which accident occurred

......--+---1 Longitude/Easting:

552710

012

181

••

II

at 1) intersecting street

Cost of repairs to any one vehicle will be more than S1000.
Unknown/Unable to detemtine
Yes

□ City

ST

□ Village

181 Town

D No

or WALLKILL

I;.;..._8_4______-:=-.,-...,-,...,....-,-..,,,,-,,.,.,..,.,.,..,.,.,.,...--------cROllle Number or Slreel Name)
EXIT 4 W/B ENT RAMP

RT 17
□N □ s

>~t
-miles
- - DE
••~

D

OW

of

(Roule Number or Street Name)
fMilepost, Nearest lntetSedlng Rou1e Number or Street Name)

Accident Description/Offteer's notes

THE ACCIDENT OCCURRED IN A POLICE VEHICLE OWNED/OPERATED BY THE NEW YORK STATE POLICE WHILE
RESPONDING TO AN EMERGENCY. V-1 WAS A MARKED STATE POLICE CAR, TRAVELING WITH EMERGENCY
LIGHTS AND SIRENS ACTIVATED. V-1 ENTERED I-84 WESTBOUND FROM THE ST RT 17 WESTBOUND EXIT 4W
RAMP IN HEAVY RAIN. V-1 MERGED INTO THE DRIVING LANE AND MADE CONTACT WITH V-2.

N

•Page

2

of

2

New York State Department of Motor Vehicles

Pages

POLICE ACCIDENT REPORT

Local Codes

3030528
SPPZB1000007

MV-104A (3/04)

□

MENDED REPORT

1-"'cc!e'S!!'e!"""''"''-------lDay of Week
Month

s

Day

Year

27

2009

Wednesday

Military Time

00,35

No. pf
Vehicles

2

No. Injured

0

No. Killed Not Investigated at Scene □

0

A~id~~f-F{~~~-;t-~ci~d--- □-

Left Scene

[]

Police Photos

r8l Yes O No

New York State Department of Motor Vehicles

REPORT OF MOTOR VEHICLE ACCIDENT
POLICE LINE OF DUTY ACCIDENT

□
Page 1
Precinct

of

1

AMENDED REPORT

Pages

F2ll

IMPORTANT: If you are the officer In charge, complete and sign
this form, and attach it to the MV-104A or MV-104AN.

Local Accident Number
3030528

SPPZ81000007

Accident Date
5
/ 27
Month Day

I

County

Accident Time
In

2009 Military
Year

ITim.,.

00 : 35

ORANGE

NAMES OF DRIVERS: (Please Print or Type)

'. s:~;.·m·:~ i ~ ~

First'_:·

Last-

:.

. M.I~

s.taJe~;£:t~~·.'~:'

;o.~::~~fr ·;N~~:er

·. P~'if: '.

'License ·,

state ·

.L?~1r:f i::.'· ,.
Nurpb~t·:.

VEH1

181

LEWIS

JASON

J

NY

POLICE

NY

HOWLETT

BERNARD

A

ME

920999

MB

VEH2

□
VEH3

VEH4

VEH5

VEH6

Pursuant to Section 605 of the New York State Vehicle and Traffic Law, the attached Police Accident
Report is also the motorist report for vehicle number(s) ____1_ _ __
* Pursuant to Section 605(a)(4) of the Vehicle and Traffic Law, check only the box for each police officer operating a
police vehicle (as defined by V & T Section 132-a)durlng emergency operation (as defined by V&T Section 114-b)
when the accident occurred.
Date

6/22/2009 16:21
MV-104L (4/07)

Signature of Owner of Police Vehicle/Police Agency Representative

-r;, :.S-c.::;r:

_s,/,;• .,.;:.,'~

www.nysdmv.com

NCIC#

13502

'

'

Job Number:

05/27/2009 at 01:39 PM
2479

T & C AU'I'O E!ODY, INC.
License J:7000221 Federal ID #:061202813
770 RT. 17 M
PO BOX 2164
MIDDLETOWN, NY 10940
(845) 343-3443 Fax: (845) 342-4330
PRELIMINARY ESTIMATE

written By: Courtney TAVA fIA-941110
Adjuster:
Insured: New York State
Owner: New York State
Address: 55 Crystal Run
Middletown, NY
Other: (845)344-5300

Police 2F5
Police 2F5
Rd
10941

Cl.aim#

Policy#
Deductible:
Date of Loss:
Type of Loss:
Point of Impact:
Business:

Inspect T & C AUTO BODY, INC.
Location: 770 RT. 17 M
PO BOX 2164
MIDDLETOWN, NY 10940
Insurance
Company:

(845) 343-3443

Days to Repair

2008 FORD CROWN VICTORIA POLICE 8-4,6L-FI 40 SED Blue
VIN: 2FAHP7lV38Xl04891 Lie:
2F5
NY Prod Date:
Air Conditioning
Rear Defogger
Body Side Moldings
Dual Mirrors
Power Steering
Power Brakes
Power Locks
Power Driver Seat
AM Radio
FM Radio
Search/Seek
Anti-Lock Brakes (4)
Passenger Air Bag
4 Wheel Disc Brakes
Bucket Seats
Automatic Transmission

Int:
odometer: 37534
Tilt Wheel
Clear Coat Paint
Power Windows
Power Mirrors
Stereo
Driver Air Bag
Cloth Seats
Overdrive

----------------~-------------------~-----------------------------------------PAINT
QTY EXT. PRICE LABOR
DESCRIPTION
OP.
NO.

--------------------~---------------------------------------------------------REAR BUMPER
1
o.o
0.5
Rpr Bumeer cover (Buff time)
2*
3
4
5
6*
7

8#
9#
10#
ll#

REAR LAMPS
Repl LT Tail lamp assy solid red
black molding
QUARTER PANEL
Rpr LT Quarter panel w/o antenna
ho
Add for Clear Coat
Repl LT Qtr Stripe & remove old
R&I LT Qtr Antena
Repl Corr is ion Protection
Car Cover
1

1

134.83

0.6
2.5

l

l.O
0.5

55.00
0.2

1
1

5.00

2.6

0.3

o.s

Ub/ I 1/t!UUtl

•

U I:

IJj

l"i'\1\

..'
Job Number:

05/27/2009 at 01:39 PM
2479
PRELIMINARY ESTIMATE

2008 FORD CROWN VICTORIA POLICE 8-4.6L-FI 4D SEO Blue Int:

------------------------------------------------------------------------------PAINT
QTY EXT. PRICE LABOR
OP,
DESCRIPTION
NO.
------------------------------------------------------------------------------l
2.50
Hazardous Waste
12#
------------------------------------~-----------------------------------------4.6
4.l
Subtotals ==>
197.33
Parts
Sody Labor
Paint Labor
Paint Supplies

4.1 hrs
4.6 hrs
4.6 hrs

@ $
@ $
@ $

197.33
205.00
230,00
128,80

50.00/hr
50.00/hr
28.00/hr

SUBTOTAL

$

761.13

GRAND TOTAL

$

761.13

ADJUSTMENTS:
Deductible

0.00

CUSTOMER PAY
INSURANCE PAY

$

0. 00

S

761.13

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR
OTHER PERSON FILES AN APPLICATION FOR COMMERCIAL INSURANCE OR A STATEMENT OF
CLAIM FOR ANY COMMERCIAL OR PERSONAL INSURANCE BENEFITS CONTAINING ANY
MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING,
INFORMATION CONCERNING ANY FACT MATERIAL THERETO, AND ANY PERSON WHO, IN
CONNECTION WITH SUCH APPLICATION OR CLAIM, KNOWINGLY MAKES OR KNOWINGLY
ASSISTS, ABETS, SOLICITS OR CONSPIRES WITH ANOTHER TO MAKE A FALSE REPORT OF
THE THEFT, DESTRUCTION, DAMAGE OR CONVERSION OF ANY MOTOR VEHICLE TO A LAW
ENFORCEMENT AGENCY, THE DEPARTMENT OF MOTOR VEHICLES OR AN INSURANCE COMPANY,
COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME, AND SHALL ALSO BE SUBJECT
TO A CIVIL PENALTY NOT TO EXCEED FIVE THOUSAND DOLLARS AND THE VALUE OF THE
SUBJECT MOTOR VEHICLE OR STATED CLAIM FOR EACH VIOLATION.
You are entitled to the return of all replaced parts, except warranty and
exchange parts, buc you must ask for them in writing before any work is done.
If you authorize work by phone, the shop must keep any replaced parts, and make
them available when you pick up the vehicle.

2