NEW YORK STATE POLICE

MEMORANDUM

TROOP F

STATION

DATE

August 16, 2016

TO:

Deputy Superintendent Stephen J. Smith, Field Command
Attn: Major, Division Traffic

FROM:

Major Joseph A. Tripodo ~op Commander

SUBJECT:

TROOP CAR AC
ENT - 04/18/16
TROOPER JAS NJ. LEWIS

Middletown

Reference is m i:le 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.
However, on August 9, 2016 First Deputy Superintendent Patricia M. Groeber
formally censured Trooper Lewis, in addition to deducting three (3) days of annual leave from his
leave accruals, in connection with this accident. Therefore, the matter is considered closed at Troop
with no further action being taken.
A copy of the First Deputy Superintendent's Censure is attached.
Attach.

NEW YORK STATE POLICE

MEMORANDUM

Troop F Station Middletown
Date
To:

Trooper Jason J. Lewis, SP M"ddletown - HTF

From:

Major Joseph A. Tripodo

Subject:

DIVISION VEHI

June 20, 2016 '

E ACCIDENT- 04/18/16

The investigatio into this matter has been completed. It has been determined that this
Troop Car Accident was preventable on your part.
On August 9, 2016, First Deputy Superintendent issued a letter of censure and
imposed a penalty of three (3) vacation days in connection with this accident.
Therefore, the matter is closed with no further action being taken.

CC:

Division HQ
Zone 2 Commander
Personnel File

NEW YORK STATE POLICE

MEMORANDUM

TROOP F

STATION

DATE

August 16, 2016

TO:

Major Joseph A. Tripodo, Troop Commaoder

FROM:

I/Sergeant Scott Mohl, Troop Traffic Supervisor J/C:1>1

SUBJECT:

TROOP CAR ACCIDENT - 04/18/16
TROOPER JASON J. LEWIS, SP MIDDLETOWN - HTF

Middletown

Reference is made to the attached self-explaoatory investigative report regarding the
above subject.

I have reviewed this accident aod it is my opinion that it was preventable.
The primary cause of this accident was following too closely.

Attach.

~1. 7

NEW YORK STATE POLICE

MEMORANDUM
Troop£.._Station

SP Monroe

Date____
J=un
__e--=23=1.__2__0'""'1__
6

To:

Major Joseph A. Tripodo, Troop Commander, Troop F

From:

Lieutenant Hector L. Hernandez~

Subject:

DMSION VEHICLE ACCIDENT - PIAA - 2F89
TROOPER JASON J. LEWIS - EOD 05/19/02 - SP MIDDLETOWN - HTF

Reference is made to AMS M e s s a g e ~ SP Middletown, dated
April 18, 2016, and the attached Genl. 84 Investigation Report of Sergeant/Station Commander AL I.
SHAMAH. SP Middletown, dated May 4, 2016, regarding the above-captioned subject.
I have reviewed the above referenced report of Sergeant/SC SHA MAH and discussed
this matter with him. I also conducted my own independent inquiry into the circumstances and actions
of Trooper LEWIS on this day, which resulted in him being involved in this collision. I concur with
Sergeant/SC SHAMAH' s results, finding it to be properly submitted. On April 18, 2016, Trooper
JASON J. LEWIS was working a 1-5 shift out of SP Middletown HTF and operating Division vehicle
2F89. At approximately 10:IOAM, with emergency lights and siren activated, Trooper LEWIS
attempted to stop a motorcycle (V-2) on State Route 17 eastbound in the Town of Goshen. The
operator ofV-2 failed to comply and then aggressively slowed down in an attempt to enter a marked
U.:turn. 2F89 was behind Y-2 and struck therearportionofV-2. 2F89 sustained damage to the front
bumper. Trooper LEWIS was wearing his seatbelt and was not injured.
Investigation into this matter determined that the direct cause of the accident was the
actions of the operator ofV-2, who continued to evade being taken into custody and made an illegal
U-turn directly in front of 2F89. I recommend that the accident be classified as "non-preventable" on
the part of Trooper LEWIS and no further administrative action be taken.
Attachment

NEW YORK STATE POLICE

MEMORANDUM
Troop£_Station
Date

SP Middletown
May 04, 2016

To:

Major Joseph A. Tripodo, Troop C~mrnander, Troop F

From:

Sergeant/SC Al Sbamah

Subject:

DIVISION VEHICLE ACCIDENT - PIAA - 2F89
TROOPER JASON J. LEWIS-APRIL 18, 2016

M

Reference is made to Administrative Messag~ Report #
SP
Middletown, dated April 18, 2016, and attached fuvesti ative
ption-ed
above
dated May 04, 2016. The operator of the motorcycle,
DOB
attempted to perform an illegal U-tum on State Route 17 in the Town of Goshen in an attempt to
flee. Trooper LEWIS entered the U-turn and was unable to decrease the speed of the troop car
and subsequently was unable to avoid striking the motorcycle in a side-swipe accident.
fuvestigation into this matter revealed Trooper LEWIS was in Emergency Operation, and
that during the pursuit Trooper LEWIS did everything reasonable to avoid the collision. The
operator of the motorcycle in an effort to continue to evade, attempted to make an illegal U-tum
prior to the accident. Based on this conclusion, it is recommended that this accident be classified
as "Non-Preventable" on Trooper LEWIS'S part.
Case closed by investigation.

,Genl. 7

NEW YORK STATE POLICE
Enclosure #1

MEMORANDUM
Troop_E__Station SP MIDDLETOWN
Date._ _ _ _ ____,_,M"'a"-'y'--'3,.,,0...,._.2,...0'-'1=6

To:

Major Joseph A. Tripodo; Troop Commander, Troop F

From:

Trooper Jason J. Lewis

Subject:

DIVISION VEHICLE ACCIDENT- 2F89
TROOPER JASON J: LEWIS-APRIL 18, 2016

~

Member was ordered by SERGEANT/SC AL SHAMAH to write a memorandum
regarding a 1ROOP CAR ACCIDENT. "I was advised ofmy rights to representation pursuant to
Article 16.2 of the contract by Sgt/SC SHAMAH on April 23, 2016.
On April 18, 2016 at approximately 10:10am, I was working a 1-5 shift operating 2F89
and assigned to post 670. I was sitting stationary on State Route 17 in the Town of Wallkill when
I observed a yellow motorcycle traveling eastbound in the passing lane with no visible rear
license plate. I safely entered eastbound traffic and observed the motorcycle from a distance
accelerate at a high speed reaching 145mph, which was verified by my Stalker Radar. I radioed to
any available units east of my location and was answered back by several units. I advised that the
motorcycle was approaching the Philipsburg overpass over triple digits and I was told by Tpr' s
JAMES BRIENZA and JOSEPH VOUSDEN that they were east ofmy location. Shortly after I
observed the motorcycle slow down in the passing lane. I then witnessed the motorcycle enter the
u-turn abruptly, at which time the mertia from my troop car with full braking capacity resulted in
troop car and motorcycle coming in contact with each other. Contact was made in the u-turn due
to the operator of the motorcycle trying to evade all State Police units. The driver of the
motorcycle fell off and crune to rest on the grass. I exited my troop car and rendered medical
attention to the motorcycle driver with the assistance ofTpr's BRIENZA and VOUSDEN. I
observed a foot injury and contacted Sp Middletown Communications to dispatch an ambulance
and have a Sergeant respond to my location.

• Genl. 7

NEW YORK STATE POLICE

MEMORANDUM
Troop£...Station

SP Middletown

Date

April 18, 2016

To:

Major Joseph A. Tripodo, Troop Commander, Troop F

From:

Trooper Joseph C Vousden III

Subject:

DIVISION VEHICLE ACCIDENT - 2F89
TROOPER JASON J. LEWIS - APRIL 18, 2016

-

:re✓

Member was advised to write this memorandum by Sergeant SIC AL I.
SHAMAH concerning Motorcycle pursuit. Member was advised of his rights pursuant to Article
16.2 of the contract. Member does not waive these rights and provides the following written
account.
On April 18, 2016 I was working an assigned B-line in the Town of Goshen on
State Route 17 near the exit 122a work zone in marked unit Flt:17. At approximately 10:10 am I
heard Trooper JASON J. LEWIS advise on channel 2 that he was attempting to stop a yellow
motorcycle traveling eastbound near exit 121 area for traveling in excess of 100 miles an hour. I
then set up stationary in the U-tum just east of the Phillipsburg Road overpass along with
Trooper JAMES V. BRIENZA who was in marked unit Fl 08. We then visually observed the
yellow motorcycle approaching us eastbound at a high rate of speed in the left lane. Myself and
Trooper BRIENZA then entered the roadway in an attempt to get up to speed. Due to the high
rate of speed of the motorcycle it approached us rapidly and I then observed the motorcycle
attempt to make a left tum into the U-tum. I then observed marked unit 2F89 directly behind the
motorcycle attempt to stop at which point it struck the motorcycle which cause it to land on its
side in the center median. I then exited my vehicle and myself, Trooper LEWIS and Trooper
Brienza placed the subject in handcuffs.

Genl. 7

NEW YORK STATE POLICE

'1

Enclosure# 3

MEMORANDUM
Troop F
Station
Date

SP MIDDLETOWN
April 18. 2016

To:

Major Joseph A. Tripodo, Troop Commander, Troop F

From:

Trooper James V. Brienza

Subject:

DMSION VEHICLE ACCIDENT- 2F89
TROOPER JASON J. LEWIS -APRIL 18, 2016

jD

Member was ordered by Sergeant/Station Commander AL I. SHAMAH to
write this memorandum concerning motorcycle pursuit. Member was advised of his rights
pursuant to Article 16.2 of contract. Member does not waive these rights and provides the
following written account.
On April 18, 2016 while being assigned a shift from 6:00am to 2:00pm in and
around the work zone on State Route 17 in the Town of Goshen in marked State Police unit
F108. During that shift at approximately 10:10am I heard a transmission on channel 2
(car to car) from 2F89 operated by Trooper JASON J. LEWIS requesting assistance with a
yellow motorcycle traveling eastbound on.State Route 17, just west ofmy location ata high
rate of speed. While in the U-turn just east of the Phillipsburg Road overpass I was joined
by Trooper JOSEPH C. VOUSDEN operating marking State Police unit F107. When
Trooper VOUSDEN and I made visual contact with aforementioned yellow motorcycle and
2F89 traveling under the Phillipsburg overpass, Trooper VOUSDEN and myself entered
the roadway from U-turn both heading eastbound to assist Trooper LEWIS. I observed
motorcycle attempt to slow down quickly and enter the U-turn we had just exited. I
observed 2F89 following the motorcycle and the collision occurred. As a result of the
collision the operator of motorcycle was ejected and landed in the center median. Trooper
VOUSDEN, Trooper LEWIS, and myself exited vehicles and placed operator into custody.

REV. l/2011
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NEW YORK STATE POLICE
INVESTIGATION REPORT

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ENCLOSURE #1 GENL 7 TROOPER JASON LEWIS

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Page 1
GENL 84B

REV, 312011

NEW YORK STATE POLICE
TROOP

F

STATION

SP MIDDLETOWN

CONTINUATION SHEET

COMPLAINANT-LAST NAME. FlRST. MIC CLE

Box#22:
V-1: 2F89, VAN 1001~F89
V-2: NY Registration - 2 0 0 9 Yamaha Motorcycle, Color Yellow, VIN: JYARN23Y19A001652

Box#26
V-2 Insurance: 036, Unknown Company
1. On April 18, 2016 al approximately 10:11 am, I was contacted by SP Middletown Communications advising me
that there was an incident, located on State Route 17 eastbound near exit 122A In the Town of Goshen in the area of
MPM 365. The incident was a Troop Car PIM involving a motorcycle. I advised Captain BRENDAN CASEY a·nd was
assigned to investigate.
2. On April 18, 2016, at approximately 10:15 am, I arrived on scene of the incident. State Route 17 is a four lane
highway. The weather was cloudy and the driving surface was dry, in addition the traffic was heavy. Upon my arrival
both vehicles remained in position after the conclusion of the pursuit
3. On April 18, 2016, I Interviewed Trooper JASON LEWIS on scene. He advised me that he was working a
scheduled 1-5 shift out of SP Middletown-HTF, operating marked Division vehicle 2F89 (V-1). At approximately 10:10
am, he was conducting radar enforcement on State Route 17 when he observed a motorcycle traveling east bound
without a rear license plate. Trooper LEWIS attempted to stop the operator, however the operator failed to GOmply
and the pursuit was initiated. Trooper LEWIS broadcasted on car to car (channel 2) to advise any additional units that
were east of his position. Two TIM units advised Trooper LEWIS that they were located east of his position and would
set up at the next marked U-tum located just west of exit 122A. Nearly at the same time the operator of the
motorcycle was approaching the U-turn and both Tim units pulled out onto State Route 17 in an effort to slow the
operator. The motorcycle operator then attempted to enter the marked no U-turn and while aggressively slowing
down was struck in the right side and rear of the motorcycle by V-1 in a sideswipe collision. Trooper LEWIS was
advised to complete a GENL 7 memorandum, which is attached to this report as enclosure #1.
4. On April 18, 20161 interviewed Troopers JOSEPH VOUSDEN (TIM unit F107) and JAMES V. BRIENZA (TIM unit
F108) who witnessed and assisted the pursuit as well as assisting with the arrest of CHARLES FRANKLIN. Trooper
VOUSDEN and BRIENZA stated they first heard on channel 2 (car to car) there was a motorcycle coming in their
direction described as yellow motorcycle given by Trooper LEWIS. Trooper VOUSDEN was in contact with Trooper
JAMES BRIENZA and both units took up a position in the marked U-tt.im located on State Route 17 facir:1g westbound
to monitor the eastbound traffic. Both Troopers VOUSDEN and BRIENZA observed in the distance a yellow
motorcycle coming in their direction and both units pulled out of the U-turn in an effort to slow the traffic down. As
Trooper VOUSDEN and BRIENZA pulled out of the marked U-turn they noticed the operator of the motorcycle
attempt to execute a U-turn by entering into the marked no U-turn area. Trooper LEWIS was unable to slow as fast
as the motorcycle and collided with the rear of the motorcycle. The motorcycle then came to rest against a signpost
and the operator who was lying next to the motorcycle was placed in handcuffs. Both troopers VOUSDEN and
BRIENZA were advised to complete a GENL 7 memorandum and is attached to this report as enclosure #2 and #3
respectively.

5. On April 18, 2106 I photographed the vehicles and scene. A GENL 340 was completed and is attached to this
report as enclosure #4.
·
6. On April 18, 2016 ZJS t DAVID SCOTT res onded to Orange Regional Medical Center and attempted to interview
the operator of V-2
stated that he is retaining counsel, does not want to give a
statement, and does not want to sign a release for his medical records.
7. On April 18, 2016, at SP Middletown, I sent AMS message

A copy is attached to this report

Page 2

as enclosure #5.

8. On April 22, 2016 I completed a GENL 91 Vehicle Pursuit Report. A Copy is attached to this report as enclosure

#6.
9. On May 16, 2016, I completed an MV-104A and MV-104L. A copy is attached to this report as enclosure #7.
10. On June 1, 2016 I received vehicle estimate of damages for 2F89. A copy is attached to this report as enclosure
#8.
CLOSED BY INVESTIGATION.

---------------- -------

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·04/18/.16.
A >¢. : : 10:08 am
: ·10:10· a~ : ' . " '. ' .'Appro?(.
3 Miles .
. . . .. .... . . . ·. ·...
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~ 'vtL . P~a(Law. □ Qth~r . ml clea, □ raining p sriow ·o. fog/mist . :I!] ~y!iglit,t::ri1a..:..n ·o· dtisk . l'!i dry D·wet □ snQW(lee . ~.
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.Industrial

0

□ Rural

tr Other (Spe~fy) _

----,,-.-.....,..---

Location Pursuit Commenced:

Co~nfy:

ST RT 17E/B T/Wallkill

Orange

Location Pursuit Ended: ·

County:

ST RT 17 E/B T/G.oshen

Orange
Emergency Siren Used:

Emergency Lights Used:
Ii!]

Yes

O No

D N/A

Ii!]

Was PursLiitVehicfu Video

Yes

D No

□

N/A

Spike Belt Ti re Deflater Used:

D Yes

X No

Specify Type _ _.,......-,-----'-'--

Was Pursuit Videotaped?

· Equipped?

□ Yes

CEJ

No

□

Yes

cgi

No

OPERATOR INFORMAl'ION
License State:

· NY

Vehicle )'ear:.

Vehicle Ma.ke/Mo<lel:

_# 0t 6ccupani:

2009

YAMAHA

1.

lmpainnent

Driver Age: (Estimate [f nptldenlified)
□ < 16

□ 16-17

d

1S:-25 tl< 2&-35
.

.

: (~ast, First,

036-45 □ 46-55 D> 55

Ml)

Re~son.Gi.fen By Driver F</Fai)iiJg To S~p:.
"I WAs SCARED"

· •□ Alcohol

□ Drugs >JI Not ln:ipair~

_:_

. ~e~:. · ..
· >i

Male □ Female

·Date of Birth:

End of Pursuit:

□ Vehlde Stopped

D Legal Intervention
□ Member Tennlnated

Pursuit

Number Killed

Complete these
boxes if pul'S\Jlt

Division Vehicle

0

resulted In Death.
Damage or Injury.

Pursued Vehicle

0

Third Party

□ Vehicle

Lost

□ SupefVisor Ended Pursuit

>J! Vehide Crashed
ii Division Vehicle Crashed

Number Injured

0

Estimated Value of Property Damage

UNK
UNK

NIA

NIA

Description of Charges Flied:
VTL

Synopsis of Pursuit:
While stationary on ST RT 17 prior to Exit 120 E/8 I observed a yellow motorcycle with no rear plate. Upon safely entering heavy.traffic I observed
from a distance the motorcycle Increase his speed & violate numerous V&T Violations. I contacted additional units klcated further E/8 & advised
that the_motorcycle is coming towards them. Shortly after I observed 2 Troop vehicle's enter 17 E/B from u-tum. I obsesved the motorcycle slow down

so I drove on the median prior to the u-tum at which time the motorcycle abrupdy entered th~ u-tum causing the Troop car & motorcycle to rome

In contact with each other.

Date:

File3#:

Case#:

4122/16

Pursuit Supervisor Comments:
I responded after the pursuit was ended, and did not monitor ttle pursuit. The tnwstigatton shows the violator was operating on ST 17

E/8 in both the Town of Wallkill and the Town of Goshen. The incident concluded with a PIAA. where lhe operator of the motorcycle was injured.

No injuries n oted to the member. Ref AMS#

Date:

4/22/16

Zone Commander/ Second Line Supervisor Comments:

PvA..rc -

~

~~_,,2)

~~

Date:

Administrative Message Report
Enclosure # 5
Prin.t\Run Date 04/22/2016

AMS#
Oate\Time Reported\Discovered
04/18/2016 10:10

Agency ORI

TZS
F221

NYSP MIDDLETOWN

Message
DIVISION VEHICLE - PIM, PURSUIT
Investigated By

Units Responded
Photos YES
MAJOR KOPY, MAJOR TRIPODO, CAPTAIN SCI, CRU, IAB, TROOP COMMANDER, UF
CASEY, CAPTAIN GALLAGHER, CAPTAIN
KEYSER, S/INV. BEYEA, INV. SALOMON,
Z/SGT SCOTT, SGT/SC SHAMAH

Videotape NO

Narrative
At approximately 10:10 AM, Trooper Jason Lewis . HTF SP Middletown in marked unit 2F89 observed a yellow motorcycle
traveling eastbound on SR 17 in hea traffic commit a V&T violation. Trooper Lewis entered into the traffic to effect a V&T
stop. The motorcycle operated by
DOB increased his speed and proceeded to weave in and out of
congested traffic. Trooper Lewis contacted additional units located at the next U-turn to advise of approaching danger. Both
units operated by Troopers Vousden (F107) and Brienza (F108) enter the roadway from the marked U-Turn at MPM 365.9.
Operator of motorcycle attempted to avoid all units and entered the u-turn abruptly. Trooper Lewis also entered the U-turn and
was unable avoid striking the motorcycle. Motorcycle then looses control and strikes sign post located on east s ide of U-turn
coming to rest on grass median. Pursuit lasted approximately 1 minute and the motorcycte reached a speed of 145 MPH.
Pursuit not monitored due to short duration .
Inspector Michael Kopy, Major Joseph Tripodo, Captain Frank Keyser, Captain Brendan Casey, and Captain Pi erce Gallagher
advised and responded to scene.

#Vehicles
2

# Injured
1

# Deceased
0

Apparent Cause
PENDING INVESTIGATION

County

C/TN Name

Location\ Street Name \ Mile Post Marker

ORANGE

WALLKILL, TOWN OF - 3666

SR 17 E/B MPM 365.9

Weather Conditions

Road Conditions

1 - CLEAR

1 - DRY

Description of Damage
V-1 FRONT LEFT BUMPER, V-2 RIGHT SIDE DAMAGE TO BODY

Criminal Action
NUMEROUS V&T OFFENSES
Sent Date \ Sent Time
04/18/2016 15:42
Notification

I

Sent By
SHAMAHAL

Auth:;ized

I

CAPTAIN BRENDAN CASEY

BCI, FIELD COMMAND, TROOP, ZONE

Driver Information 1
Driver Name
LEWIS, JASON J
Address
1220 WASHINGTON AVE

DOB
-

---------

Gender
M

License State

Chemical Test NO
Driver Charged NO
Zip
12226

'--- - - -- - - State
----------

City
ALBANY

Violations

Page 1 of 3

NY

l
_,J•.;.._--..;._--------------------------------------Dri"9r Member?
Date of Entry
Member Rank
Member Shift
Member Shield
·-\. YES

TROOPER

05/24/2002

1

3020

8wner: liffonnation i1
Name (exactly as printed on registration)
NYSP,
Address
1220 WASHINGTON AVE

City

State

ALBANY

NY

Zip
12226

Insurance Company and Code

994 - GOVERNMENT OWNED
: ~~ it]
License Plate #
State

POLICE

Vehicle Year
2010

NY

Van#
100187
School Bus
Comm. Veh .
NYSPVeh.

Make

VIN#
2FABP7BV6AX118598

FORD
Mileage
138885

NO
NO

Front Airbags Deployed
Side Airbags Deployed
fire Suppression Deployed

YES

Equipment
NO
Damage
Driver. liiformation 2
Driver Name

NO
NO
NO

Equipment Damage
Descri tion

-,_____

DOB

Gender
M

License State

Chemical Test NO
. Driver Charged YES

s_;i_e------=•=
·==....____

_A_d_d_r:_e_ss
_ _ _ _ ____.__ _ _ _ _ _ _. .i - -_ _ _ _ _ _
Violations
NUMEROUS V&T VlOLATIONS
Driver Member?

Member Rank.

Date of Entry

Member Shield

Member Shift

NO
Name (exactly.as printed on registration)

--------------.......-.-------~-~-,t_e_ _ _ _. .______
Insurance Company and Code
036 - AMERICAN TRANSIT INS CQ

~~ rl
License Plate#
State

-

NY

.

.

'

Vehicle Year

Make

2009

YAMA

Van#

VIN#

Mileage

School Bus
Comm. Veh.
NYSPVeh.

NO
NO
NO

Equipment
Damage

NO

Front Airbags Deployed
Side Airbags Deployed
Fire Suppression Deployed
Equipment Damage
Description

Page 2 of 3

NO
NO
NO

~
•

Injured \ Deceased

------------- ....
-,

r---G_e_.,,~.d_
,_e r___
R_a_
ce_ _ _ _ _ _ _----1
A i if-A-g_e_ __
State

NY

Description of Injury
COMPOUND FRACTURE R LEG

Injured Taken To (Medical Facility)
ORMC

In Custody

Seat Belt

NO

NO

Driver Member?

Ejected
YES

Member Rank

Position in Vehicle

Relative Notified
YES
Date of Entry

NO

Page 3 of 3

Member Shield

ARS#

of 3

Page

New York State Department of Motor Vehicles

Page$

taJ□

i=:a:;:;,::..:;,,=.---.-.-Y-

MV-1 04A (6/04)

--1Day of Week

~-~e-ar-

18

POLICE AC CIDENT REPORT
No. of

Military Time

Monday

2016

No. Injured No . Kllled

Vehicles

10 : 10

Enclosure# 7

1

2

0

Left Scene

Not Investigated at &:ene

- · - ---- - --- - - Accident Reconstructed

~

0

Police PhOtos

~ Yes O No

Q BICYCLIST □PEDESTRIAN □OTHER PEDESTRIAN

VEHICLE
Stateof llc.
NY

State of Uc.
NY

J
~tNo.

Sex

F
Address (lndud& Numbe< and Slreet)

~

Apt.No.

1220 WASH AVB BLDG 22

Zip Code.

State
NY
State al Rog. Vehocle Year & Make

NY

APt,No.

State

12226

NY

Vehicle Type

2010 FORD

In$ Code

Ins. Code

99 4

0 36

POLI

Violation
Section(s)

1s:

ec

wide;

ve t e 1s:
more than 95 inches wide;

V
E
H

re than 34 feet tong;

operated with an overweight permit;

1nvo

4113 , 1252B, 1 252C
Cirde the diagram below that describes the accident, or draw your own
diagram In space #9. Number the vehicles.

more than 34 feel long,

Had (ln

operated with an overweight permit:

I

t: :'.::S~JIT!~~[:1: J~~;l2~~[~~~~]:::j

L Box 1 - Point of Impact

2 L Box t . Point of Impact
E Box 2 - Most Damage
-4+--s"' Enter up to three
2 more damage codes
1

E Box 2 - Most Damage

12

Enter up to three
,---3:+-more damage codes

C (::::S~;l:IB~~[:l:J!1~~~~~~~~:S~: ::~

12

Vehicle By:
Towed To: NYSP
VEHICLE DAMAGE COOING:

7
3

4

6

5

ACCIDENT DIAGRAM

4

5

See the l a st page of the MV- 104A for the

Vehicle By:
Towed To: NYSP

' - - - - - - - - -- - - - - -i a ccident di agra m.

1-13 SEE DIAGRAM O N RJGHT.
14. UNDERCARRIAGE
16. TRAILER
16. OVERTURNED

9.

17. DEMOLISHE D
18. NO DAMAGE
1&. OTHER

Cost of repalrs to any one vehicle wiD be more than $1000.

1

,

Latitude/ Northing

7

8 , 3 : 1 ;0

-~------<

---------

~ Yes

Unknown/Unable to determine

No

Place Where Accident Occurred :
County

l----.--~--.-~ 458 5 430

0

\0

12

1-_R_e_fe_re_nce
__
M_a_rk_e_r~ Coordinates (if available)

LJ City Ci ViPage

ORANGE

Road on which accident occurred

~

Town

of

GOSHEN

STATE ROUTE 17
(Route Number or Street Name)

at 1) intersecting street

Longitude/Easting

553943

.5

or 2)

N

S
E -..... W

feet

of

EXIT 122A

(Route Number or Street Name)

(M11ep(>SI Neatest IOlelSeC1)ng Route NumDe,- or Street Name)

Accident Description/Officer's notes

The accident occurred in a police vehicle owned and operated by the New York State Police while
responding to an emergency . V- 1 marked State Police vehicle, with a ll e merge ncy l ights and si r en
activated , was attempt ing t o stop V- 2 on State Route 17 Eastbound . V- 2 £ail s to comply and enters
a marked U-turn . V-1 was behind V-2 and strikes the rear portion of V-2 . V-2 comes to rest in
gra ss s houlder . Driver V- 2 comes to rest adjacent to V- 2 .
8

A
L A 1
L
2

9

,o

11

1

4

1

M

1

6

3

M

12

13

14

15

16

11

09

5

17 BY

9993

TO 18

Names of all Involved

O.te of Death Only

Review ing Officer

Date/Time Reviewed

MOHL , SCOTT

5/18/2016
12 : 26

3503

I
N
V
0

L
V

E
0

cer'a Ra nk

and Signature
Print Name in
Full

SGT S/C
AL I SHAi.\.fAH

actl--L-

Badge/ID No.

NCIC No.

Preci nt/Post Station/Beat
Troop/Zone Sector

3 606

13501

E'2

21

N

Page 2

of

3

New York State Department of Motor Vehicles

Pages

POLICE ACCIDENT REPORT

Local Codes

MV-104A (6/04)

J..MENDEO R£POPT
1""'~"-¥=i-......,,,,....-.---.,,,.,..,.- ~Day of Week

Military Time

Monday

1 0 : 10

No. of
Vehides

No. Injured No. Killed

2

1
Q

---•ntiawlda:
14 ...
II:

0

-fnd

l.rit.J,Tu,m

1.

3. ' ~

----

C
2 L

Vehicle By;
TCNIIICI To:

PEDESTRIAN

Police Photos

0ves O No

(JoTHER PEDESTRIAN

Circle the diagram below that describes the accident, or draw your own
diagram In space #9. Number the 11ehides.

. . , . . . wlll •-WIIIIMIPll'ffllt

-----.--5- 4

0

Accident Reconstructed

□BICYCLIST

VEHICLE

long;

1111A ttllfl

Left Soene

Not Investigated at Scene

_J

Lll!Tum

2
1 • Pairltdlmpm
2-MoltCMmlge _ _,,,_ _ __
E
up ID..,_
3
4
5 ACCIDENT DIAGRAM
damagecodea
Vltlicle By;
.__...__ __._----1

~

T-.1 To·

VEHICLE DAMAGE CODING:
1-13 SEE DIAGRAM ON RIGHT.
14. UNDERCAARJAGE
1$. TRAILER
16. OVERTURNED

Reference Marker

9.

17. DEMOU SHED
18. NO DAMAGE
19. OlliER

Cost of repairs to any one vehicle will be more than $1000.

,,

C00<dlnates (if available)

latitude/Northing

0

10

County

ORANGE

City L. Village

Road on which accident occurred

lJ Yes

Unknown/Unable to determine

=

Place Where Accident Occumtd:

C

Town

LJ No

of
(Route Number or Slreet Name)

at 1) intersecting street

1--~- - - . - - - , - - - 1 l ongitude/Easting

N

or 2)

-f,-ee~t- ,iiiie;--

E

s
w

(Route Number or Street Name)
of _ __ _ _ _ _ _ _~ - - ---,,.-..,.,..--,- - (Mi epost. Nearest inter$1!Cting Route Number or Street Name)

Accident Description/Office(s notes

ADDIT I ONAL TI CKETS FOR DRIVER #2

1212 , _

4113

N
8

9

10

11.. nicer'• Rank

SGT S/C

A
L IA

11

12

13

14

16

16

17 BY

TO 18

Names of all Involved

Date of Death Only

Re11Iew1ng Officer

Datemme Reviewed

MOHL, SCOTT

5 /18/ 2 016
12 : 26

L 18
I le
N
le

V
0

E

L F

V

E
D

and Signature
Print Name in

Full

AL I SHAM.AH

ac.tl--L

Badge/ID No.

3606

NCIC No.

13501

Precint/Post Station/ Beat
Troop/Zone Sector

F2

21

..

Page 3

of 3

Pages

ta.Jo

l'-'A""cddiT.~:=lrO""at.,_e
h
--,,-;:;;;--,---.:r:c.,
:::-----1Day of Week
9

4

18

2016

Monda y

New York State Department of Motor VehiciEis

POLICE ACCIDENT REPOIRT
MV-104A (6/04)
Military Time

No. of

10 : 10

2

Vehicles

No. Injured No. Kllled

l

O

Not Investigated at Scene

Left Scene

0

Acc:klent Reconstruct~ •• -~

Police Photos

~ Yes

O No

State Route 17
Westbound

---■

a •

State Route 17
Eastbound

a

■

■

■

■

u a

t
New York State Department of Motor Vehiclles

REPORT OF MOTOR VEHICLE ACC::IDENT
POLICE LINE OF DUTY ACCIDENT

□
Page 1

of

AMENUED REPORT

Pages

Precinct

F2 21

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

Accident Date

County

Accident Time

I

4
18 / 2 0 16 ~ilitary
]
,_M_on_th_ _o_a-"-y_ _Y_ea_r___..T_im
_ e_ _ _1_0_:_
10
_ _ ___..o_ RA_N_G_E _ _ _ _ _ _ __

NAMES OF DRIVERS: (Please Print or Type)
Plate

M.I.

State
ofVeh.
Reg.

J

NY

POLICE

*
Last

First

umber

Driver
License
State

Driver
License
Number

VEH 1

~

LEWIS

JASON

VEH 2

■

::J
VEH 3

NY

·-

NY

NY

VEH 4

VEH 5

VEH 6

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) during emergency opera1tion (as defined by V&T Section 114-b)
when the accident occurred.
Signature of Owner of Police Vehicle/Police Agency Representative

Date

05/18/2016
MV-104L (4/07)

12 : 26

INCIC#
1350 1

www.nysdmv.com

\.,t;.Nt,.. .::s4U (K8V U;;,/10)

C.1GITAL F;>HOTO RECORD
STA"flON

INSTRUCTIONS:
FIU LEAD NUMBER

CASE NUMBER

INCIDENT DATE

• SP Middletown

04/18/16

04/18/16

INVESTIGATING MEMBER

PHOTOGRAPHER'S NAME

Sgt/SC A1 Shamah

Sgt/SC Al Sbamah

CASE TYPE

---

I

I

CAMERA

Kodak

I0

ACTION REQUESTED

I

IMAGE TYPE OR FILE FORMAT

~ JPEG

O TIF O

Raw

CAMERA
PHOTO ID#

1

JOO 2551

2

1

PAGE#

OF

181 CD/DVD

DESCRIPTION:

IMAGE#

3

100 2553

Yellow I Black Yamaha (upright front)

41

4

100 2554

2F89 - Rear

42

5

100 2556

2F89 - Driver Side

43

6

100 2557

2F89 - Front Bumper, Driver side

44

7

1 100 2558

8

100 2559

2F89 - Passenger Side from front

46

100 2560

2F89 - Passenger Side from rear

47

100_2561

2F89 - VAN number

48

l 00 _2562

2F89 - inside door MFD sticker wNfN

49

13

100 2564

14

100 2565

----- Scene from west entrance of u-turn

15

100_2566

Pavement markings located in U-tum

16

100 2567

17

100 2568

MPMSR 17 E/B
MPM SR I 7 E/B SAA no Traffic

,.._2F89 - Close up of front end damage

--

-

50

DESCRIPTION:

-

52

51
53

-

----+-

---

18

I

19

I

54
55
56

-20

57

21

59

-

tj

58
~

-22

-

-

23

-

-

--

60

--

62

25

63

26

64

27

65

28
29

66
67

30

-31

68

32

-

70

--

72

33
34
35
36

-

61

24

-

OE-MAIL O Other _ _

CAMERA
PHOTO ID#

45

, 2F89 - Front

--

I

Retain

39

--

~ 100_25i j 2F89 - Dash with mileage

--

0

05/01/16

J

40

- .2..2._J
I

181 Print _2

MANNER SUBMITTED: (Check one)

100_2552

l

Bum To CD/DVD

DATE SUBMITTED TO FIU

Yellow I Black Yamaha (upright side)
Yellow I Black Yamaha (upright rear)

9
10

cuMPlETED

10:20AM

ST RT 17 E/B near exit 122A

HWY U-Tum

-

---~
I 10:25AM

ADORES$ OR LOCATION

GENERAL DESCRIPTION OF SCENE / ITEM($)

I

o ~u~N

COMPI.AINANT • DEFENDANT · OPERATOR- DECEASED

Troop Car PIAA
co~
Orange

IMAGEJt

ri

• Complete a separate form to, ••ch tnvut1n,.,1,.,.
• Print or tvne all entries
Enclosure# 4
PHOTO DATE

69

-

---

-

..--

-

-

--

-

-

-

-

71

--

73

--

74
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•

6/1/2016 9:33 AM

FROM: Fax

TO: 845-346-3544

PAGE: 002 OF 005

Enclosure # a ,

Workfile ID:
State ID:

T & C AUTO BODY, INC.

7000iil-

770 Rt 17 M, Po Box 2164, MIDDLETOWN, NY
10940
Phone: (845) 343-3443
FAX: (845) 342-4330

,

Preliminary Estimate
Customer: New York State Police 2F89

lob Number:
Written By: Courtney Tava, IA-941110

Insured:

New York.State Police 2F89

Type of Loss:

Policy#:

Oaim#:

Date of Loss:

Days to Repair:

O

Point of Impact:
OWner:

Inspection Location:

New Yori< State Police 2F89

T & C AUTO BODY, INC.

55 Crystal Run Rd

770 Rt 17 M

Middletown, NY 10941

Po Box 2164

(845) 344-5300 Business

MIDDLETOWN, NY 10940

Insurance company:

Repair Facility
(845) 343-3443 Business

VEHICLE
Year:

2010

Body Style:

4DSED

VIN:

2FABP7BV6AX118598

Mileage In:

Make:

FORD

Engine:

8-4.6L-FI

License:

2F89

Mileage Out:

NY

VehideOut:

Model: CROWN VICTORIA
POUCE

Production Date:

State:

Color:

condition:

Job#:

Blue 7187 Int:

138B85

TRANSMISSION

DECOR

RADIO

Front Side Impact Air Bags

Automatic Transmission

Dual Mirrors

AM Radio

SEATS

Overdrive

Body Side Moldings

FM Radio

Bucket Seals

POWER
Power Steering
Power Brakes

11nted Glass

Stereo

PAINT

Wood Interior Trim

Search/Seek

Clear Coat Paint

CONVENIENCE

SAFETY

Power Windows

Air Conditioning

Drivers Side Air Bag

OTHER
Power Trunk/Gate Release

Power Locks

Intermittent Wipers

Passenger Air Bag

Power Mirrors

11ItWheel

Ana-Lock Brakes (4)

Power Adjustable Pedals

Rear Defogger

4 Wheel Disc Brakes

6/1/2016 9:30:40 AM

002479

Page 1

6/1/2016 9:33 AM

•

FROM: Fax

TO: 845-346-3544

PAGE: 003 OF 005

Preliminary Estimi)te
Customer: New York State Police 2F89

Job Number:

Vehicle: 2010 FORD CROWN VICTORIA POLICE 4D SED 8-4.6L-FI Blue 7187

Line

1

Oper

Description

Qty

Extended
Price$

Labor

Paint

6wn17D957APTM

1

372.48

2.3

2.8

4W7Z17F799AA

1

B2.15

0.1

W7019135303

4

10.48

4wn17757A

1

118.83

FRONT BUMPER

2

Repl

3

Bumper cover
Add for Clear Coat

4

Repl

LT Absorber

5

Repl

Absorber rivet

6

Repl

Impact bar

R&I

Push Bar

9

Repl

LT Headlamp assy

10

Repl

LT Side marker lamp w/strobe
light

Repl

Alm headlamps

Rpr

LT Fender

7

#

8

FRONT LAMPS

11
12

FENDER

13

•

14

1.1

0.4
1.0

4wn13008A

1

102.64

0.4

1W7215A201AB

1

286.95

Ind,

1

0.5
.'I.,

Add for Clear Coat

#

Rpr

Remove LT Fend. SP Graphics &
adhesive

16

#

Repl

SP LT Fend.Graphics

17

FRONT SUSPENSION

15

Part Number

1.1
0.8
1

'

145.00

0.5

18

Repl

Wheel alignment align front
wheels

1

m

1.3

19

Repl

Wheel alignment check rear
alignment

1

m

0.5

Repl

20

#

Rex additive

1

18.00

21

#

Hazardous Waste

1

3.50

22

#

Car Cover

1

6.00

23

#

Paint & Materials as per Mitchell
RMC

1

330.36

24

#

Repl

Corrosion Protection

1

15.95

25

#

Rpr

Tint Color

26

#

Rpr

Color Sand & Buff

0.3

0.3
0.5
1.0

SUBTOTALS

6/1/2016 9:30:40 AM

2.8

002479

1,492.34

13.9

8.3

Page 2

6/1/2016 9:33 AM

FROM: Fax

TO: 845-346-3544

PAGE: 004 OF 005

Preliminary Estimate

•
Customer: New York State Police 2FB9

lob Number:

Vehicle: 2010 FORD CROWN VICTORIA POLICE 4D SED 8-4.6L-FI Blue 7187

ESTIMATE TOTALS
category

Basis

Rate

Parts

Cost$

1,492.34

Body Labor

13.9 hrs

@

$ 50.00 /hr

695.00

Paint Labor

8.3 hrs

@

$ 50.00 /hr

415.00

Subtotal

2,602.34

Grand Total

2,602.34

o.oo
o.oo

Deductible
CUSTOMER PAY
INSURANCE PAY

2,602.34

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON
FILES AN APPLICATION FOR COMMEROAL INSURANCE OR A STATEMENT OF CLAIM FOR ANY COMMERCIAL OR
PERSONAL INSURANCE BENEFITS CONTAINING ANY MAlER!ALLY FALSE INFORMATION, OR CONCEALS FOR THE
PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MAlERIAL THERETO, AND ANY PERSON WHO,
IN CONNECTION WITH SUCH APPLICATION OR CLAIM, KNOWINGLY MAKES OR KNOWINGLY ASSISTS, ABETS,
SOLIOTS 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 OVIL PENALTY NOTTO 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, but 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.

6/1/2016 9:30:40 AM

002479

Page 3

6/1/2016 9:33 AH

•

FROM: ·FaK

TO: 845-346-3544

PAGE: 005 OF 005

Preliminary Estimate
Customer: New York State Police 2F89

Job Number:

Vehicle: 2010 FORD CROWN VICTORIA POLICE 4D SED 8-4.6L-FI Blue 7187

Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless
otherwise noted, (a) all items are derived from the Guide DR2JA03, CCC Data Date 5/16/2016, and potentially other
third party sources of data; and (b) the parts presented are OEM-parts manufactured by the vehicles Original
Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM
(Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM
vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or dismunt.
OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships.
Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data provided by third party sources of data
may have been modified or may have come from an alternate data source. TIide sign (NJ items indicate MOTOR
Not-Included Labor operations. The symbol ( <>) indicates the refinish operation WILL NOT be performed as a
separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts
are described as Non OEM, NM or NAGS. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are
described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are
provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information
are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items
indicate manual entries.
Some 2016 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated
data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE
estimator has a list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership.
The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to
be repaired or replaced:
SYMBOLS FOLLOWING PART PRICE:
m=MOTOR Mechanical ccmponent. s=MOTOR Structural component. T=Miscellaneous Taxed charge category.
X=Miscellaneous Non-Taxed charge category.
SYMBOLS FOLLOWING LABOR:
D=Diagnostic labor category. E=Electrica! labor category. F=Frame labor category. G=Glass labor categor/.
M=Mechanical labor categor/. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories.
OTHER SYMBOLS AND ABBREVIATIONS:
Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. Blnd=Blend. BOR=Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reccnnect. HSS=High Strength Steel.
HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non
Adjacent. NSF=NSF International Certified Part. 0/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace.
R&I=Remove and_Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel.
Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line.
CCC ONE Estimating - A product cf CCC Information Services Inc.
The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR
CRASH ESTIMATING GUIDE:
BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency, NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.

6/1/2016 9:30:40 AM

002479

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