4

w

RK

ATE

State
Police

ANDREW M. CUOMO

KEITH M. CORLETT

Governor

Superintendent

September 11, 2020
Trooper Thomas S. Victor
New York State Police
Middletown, NY

LETTER OF CENSURE

Dear Trooper Victor:
On April 7, 2020, 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 was determined to have been preventable on your part. On September 11, 2020, you
appeared before me, executed a waiver, and requested that I adjudicate the disciplinary action.
The accident occurred when you were traveling on East Main Street in the Town
of Wallkill behind another Division vehicle, 2F70, and another vehicle in front of that. The front
car stopped abruptly for a squirrel crossing the road. You braked but your vehicle, 2F60, struck
the rear of 2F70, subsequently pushing it into the car in front of him. Fortunately, there were no
mJunes. However, as professional driver, you are expected to drive more carefully.
It is my decision that you receive a letter of censure for your actions.
Additionally, I have determined that you would benefit from instruction with our Troop Safety
Officer. I trust that you will drive more cautiously in the future.

;;;/-C,#~
James C. Michael
Major
Troop F Commander

Building 22, 1220 Washington Avenue, Albany, NY 12226

I www.troopers.ny.gov

NEW YORK STATE POLICE

MEMORANDUM
Troop F Station SP Middletown
Date
To:

Major James C. Michael, Troop F Commander

From:

Trooper Thomas S. Victor

Subject:

DISCIPLINARY ACTION

June 3, 2020

/73.V

I hereby request to have the above-captioned investigation adjudicated by the
Troop Commander pursuant to Rule 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 the Troop Commander's adjudication, which may be a
determination of unfounded or, upon a finding of guilt, the imposition of
the following penalties:
1.

A letter of censure and/or

11.

An intra-troop transfer and/or

m.

A fine to be expressed in the loss of no more than five vacation
days to be worked by me with no additional compensation or
overtime.

TB-1SA PREVENTABLE TROOP VEHICLE ACCIDENT-REPORT OF ADJUDICATION (8/07)
DATE OF ACCIDENT/INCIDENT

VAN

1170169

104/ 07/20

TIME OF ACCIDENT/INCIDENT

VEHICLE PLATE NUMBER

19:40 am

12F60

DRIVER'S NAME (FIRST, MI, LAST)

!Thomas S. Victor
SHIELD NUMBER

STATION

lsPMiddletown

~283
I.

ORIGINAL FILE 3#

IAMSP169BQ2GJ9

Type(s) OF Adjudication

v7

01 - Clinical Phase
02 - Instruction - Troop Safety Officer or Traffic Supervisor
03 - EVOC assignment
04 - NO disciplinary action

--"-✓
-

OS - Counselling

06 - Censure
07 - Vacation Days (number) _ _ __

08 - Probation
09 - Suspension without pay

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

II. Date of Adjudication

APPROVED BY

_i_1_LL1cJ (J
RANK

INSP-8 (Rev 12/16)

PC #

Administrative Investigation Report

RCN,

9518721

SJS#

1

p age

.

New York State.Police

Date:

2ooo(lS2'I
04/07/2020

TvDe of lnvestiaation

□
□
□
Member Receivina Initial ComDlaint

Incident Review

Level 1 PC

Injury/Illn ess to Person Prior to
Custody

Injury/Illness to Person Being Taken
Into Custody

Division Vehicle PDAA

Division Vehicl e PIAA

□
□
[l]

Name (Last, First, Ml)

Rank

Prestigiacomo, Mark A.

Sergeant/SC

Reported By:

Field Generated

Date Occurred:

04/07/2020

Place of Occurrence:
County:

I

Ti me Occurred:

9 :40 am

Damage/Loss of Division Property

-

04/07/2020

TZS

Shield

F221 5022

I

Time Reported:

9 :40 am

East Main St.

Orange

Synopsis:

lnjurynllness to Person While in
Custody

Emp loyee ID #

Date Reported:

□
□
□

On-Duty lnjurynllness

cJTN:

I

T/Wallkill

CTV Code:

F3666

Three car PIAA involving 2F60 and 2F70 .

Member(s) Involved
Name (Last, First, Ml}

Rank

TZS

Sh ield

Victor, Thomas S.

Trooper

F221

0283

White

Mozer, Thomas J.

Trooper

F221

3611

White

-

Race

Involved Person #1 -

N/A

Name (Last, First, Ml)

DOB

Address

City

Employee ID #

Rank

Race

State

TZS

Shield

If Member:

How Occu rred:
Cl)

~

...0
~

:::,

£

Name of Hospital/EMS:
Treated by:
Treatment Refusal Witnessed by:
If Prisoner - Charges:
Use of Force:

Zlp

Phone

Duty Time Lost

ARS #

hrs

Nature:

en
en

Sex

I

Type of Force:

1)

2)

Page

.

New York ~ate Police

INSP-8 (Rev 11/16)

2

PC#

Administrative Investigation Report

9518721

SJS#

04/07/2020

Date:

Person Interviewed #1
Name (Last, First, Ml)

Race

Sex

Scott, Chelsea A.

Black

F

Name (Last, First, Ml)

Race

Se.ll

M

White

Tonnesen, Eric
State

NY
Operator (Last, First, Ml)

Sex

Race

White

Victor, Thomas S.

M

Make

Model

Year

Color

Reg. State

Reg. #

Ford

Explorer

2017

Blue

NY

2F60

Mileage

\/AN#

63,887

170169

Division Vehicles :

Vehicle #2
Operator (Last, First, Ml)

Race

Sex

Mozer, Thomas J .

White

M

Make

Model

Year

Color

Reg.State

Reg.#

Ford

Taurus

2014

Blue

NY

2F70

Division Vehicles :

Mileage

\/AN #

150,235

140365

N/A

#1
Type

Reason for Damage/Loss

Make

Model

Property Description

\/AN#

Reg. #

Cal/Ga

Year

Serial#

Damage Description

Property Val ue

$
DOB

Owner (Last, First. Ml)

Address

City

Sex

Race

State

Zip

Phone

Page

New York State Police

3

04/07/2020

95'18721
' Vehicle.# 3
'I

'

I

Sex

Race

Scott, Chelsea A.

Black

Make

Model

Year

Honda

Civic

2017

Mileage

VAN#

F

Color·

Reg. State

Reg.#

Blu,e

NY

HWT4495

Division Vehicles:

NIA

Vehicle#
Operator (Last, First, Ml)

DOB

Sex

Race

'l
Make

Model

Year

Color

Mileage

VAN#

Reg.State

Reg.#

Division Vehicles:

·-

Vehicle#

NIA
DOB

Operator (Last, First, Ml)

Make

Color

Model

Year

Mileage

VAN#

Sex

Race

Reg.State

Reg.#

.
Dlvls)on Vehicles:

NIA

Vehicle#
DOB

Operator (Last, F~rst, Ml)

Make

,

Model

Year

MIieage

VAN#

Sex

Race

Color

Reg.State

Reg.#

Division Vehicles:

NIA

Vehicle#
DOB

Operator (Last, First, Ml)

Make

Division Vehicles:

Model

Year

Mileage

VAN#

Sex

Race

Color

Reg.State

Reg.#

.

Page

New York State Police

INSP-8 (Rev 11/16)

PC#

Administrative Investigation Report.
SJS#

9518721

Date:

4

04/07/2020

Enclosures Check:List {Check all that annlvl
Last Name of Person(s) Submittlng Memo(s):
Memo(s)

[l]

Victor, Mozer

Last Name of Person(s) Signing DepositiOn(s) andlor Statement(s)~

Depositions
andlor
Statements

[l]

Scott, Tonnesen
\
EMS-Service or Medical Facility

Title and Last Name

Oeposltlon(s)

□

AMS Message

[l]

Medical

IJ Portal Message
GENL-34D

Photo Record
GENL--89 Use of

Chemical Agent
GENL-90 Use of
Taser X26/X26P
GENL-91 Vehicle

Pursuit Report
MV-104A Police
Accident Report
Non-SP

Collisionnncldent
Report (TRACS)

Audio Recording
Video Recording
GENL-81
Medical Release

GENL-81E
Medical Release

GENL-ll1M
Medical Release

Other Enclosures

□

[l]

□
□
□
[l]

□
□
□
□
□
□
[l]

#EncloSed:

Transcript enclosed:

Enter Source:

#Enclosed:

Transcript enclosed:

Enter Source:

Last Name(s):

Records Enclosed:

Yes

Records Enclosed:

Yes

Records Enclosed:

Yes

Employee(s) Last Name:

Member(s) Last Name_:

Describe:

SJS Report #9518721, Estimates 2F60 and 2F70

□
□
□

No

No

No

□
□
□

INSP-8 (Rev 11/16)

Page

New York State Police

5

PC#

Administrative Investigation Report

9518721

SJS#

Re

Date:

04/101,2020

rt of:

Name

Rank

TZS

Mark A . Prestigiacomo

Sergeant/SC

F221

Signature

Date

04/21 /2020
Name

Rank

TZS

Thomas J. Brozycki

Lieutenant

F200

Signature

Date

From:

J' . DA-'°'~ ,r

Signature.

I concur with the findings of this In vestigation:

Yes

~

Yes

~

Date:

From:
Si gnature :

Date:

If Division

riate status:

□

Non-Preventable

Preventable

riate status:

If Personnel Com
Founded

Unsubstantiated

Closed by Investigation

D

H Founded, complete the following:
Ru le 3 Waiver Form attached

Date:

Disposition imposed under Rule 3:

No Action Warra nted

D

Letter of Censure

D

□

Copy of Memoran dum of Disposition to Member Attachec~

Intra - Troop Transfer

D

Probation
# of days:

□

Loss of A.L. Days
# of days:

□

I

INSP-8N (Rev 11/16)

Page 1 of 1

New Yark State Police

Administrative Investigation Report
Narrative

PC# ,
SJS #

9518721

Date:

04/07/2020

On April 7, 2020 at approximately 9:40 PM, Trooper THOMAS S. VICTOR (SP Middletown 1
shift) operating 2F60 and Trooper THOMAS J. MOZER (SP Middletown 1 shift) operating 2F70 were
involved in a three car PIAA on East Main Street in the Town of Wallkill. Sergeant/Station
Commander THOMAS A. FORTUNA, Sergeant LEE C. GUAGENTI and I, Sergeant/Station
Commander MARK A. PRESTIGIACOMO, were advised and responded to investigate.
Investigation revealed that 2F60 (V-1 ), 2F70 (V-2), and a 2017 Honda Civic bearing NY
registration HWT4495 (V-3) operated by CHELSEA A. SCOTT
were traveling eastbound
on East Main Street T/Wallkill when V-3 came to a sudden stop for an uninvolved vehicle ahead
which stopped abruptly for a squirrel crossing the road . Troopers VICTOR and MOZER also braked,
at which time 2F60 struck the rear of 2F70 subsequently pushing 2F70 into the rear of V-3 .
I interviewed Troopers VICTOR and MOZER who stated that they were both traveling
eastbound when V-3 came to a sudden stop causing them to brake. Trooper VICTOR stated that he
attempted to brake and veer to the right, but was unable to avoid 2F70. Members provided GENL-7
memoranda which are enclosures in this report.
Sergeant GUAGENTI interviewed CHELSEA SCOTT who stated that she stopped suddenly
for a vehicle ahead of her which stopped for a squirrel crossing the road. SCOTT stated that she
believed her vehicle was struck by 2F70, but she did not observe any damage and was uninjured. A
supporting deposition was secured from SCOTT which is an enclosure in th is report.
~
ant/Station Commander FORTUNA interviewed independent witness ERIC TONESSEN
~
ho corroborated the event as described above. A supporting deposition was secured
from TONESSEN which is an enclosure in this report.
Photographs of the scene and involved vehicles were secured, as well as an accident report
completed , which are enclosures in this report.
Estimates were received from T&C Auto Body in Middletown, NY in the amount of $6,908.66
for 2F60 and $13,590.64 for 2F70 which are enclosures in this report.
Closed by investigation.

NEW YORK STATE POLICE
MEMORANDUM
TROOP F
DATE

STATION Middletown

June 1, 2020

TO:

Deputy Superintendent Joseph A. Tripodo, Field Commander
Attn: Major, Division Traffic

FROM,

Majfil J=~ C. Michool. Troop F Cnmmrnde,

SUBJECT:

TROOP CAR ACCIDENT- 04/07/20
TROOPER THOMAS S. VICTOR

;:f!l

Reference is made to the attached self-explanatory investigative report regarding the
abov~ subject.
I have reviewed this accident and it is my opinion that it was preventable on the part
of Trooper Thomas Victor.
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.

Genl. 7

NEW YORK STATE POLICE

MEMORANDUM
Troop_E_Station

SP Middletown

Date_ _ _ _ _~A'--=p=ri~l~7~,2""'0"-'2=0

To:

Major James C. Michael, Troop Commander, Troop F

From:

Trooper Thomas S. Victor II

Subject:

DIVISION VEHICLE PIAA -----,.5. //

On Tuesday, April 7, 2020, I was working a 1 shift out of SP Middletown operating marked
New York State Division vehicle 2F60, a 2017 Ford Explorer. At approximately 9:40 a.m. I was
driving eastbound on East Main St, in the Town of Wallkill. At that time, 2F70 operated by
Trooper THOMAS J. MOZER was in front of me along with a blue 2017 Honda Civic bearing
New York registration HWT4495 operated by CHELSEA A. SCOTT in front of him. I observed
Trooper MOZER come to a stop due to SCOTT abruptly stopping. I attempted to avoid 2F70 by
slowing down and moving onto the shoulder but was unable to avoid striking the rear passenger
side bumper. Said collision caused damage to the front driver side bumper of 2F60 and rear
passenger side bumper of 2F70. The collision subsequently caused the airbags to deploy in 2F60.
Sergeant/Station Commander THOMAS A. FORTUNA and Sergeant LEE C. GUAGENTI
responded to the scene for the investigation. Both 2F60 ~d 2F70 were towed from the scene.

E-.;..

Genl. 7

NEW YORK STATE POLICE

MEMORANDUM
Troop_f_Station SP Middletown
Date_ _ ___,A'--'-"'-pr,.,_i,_17'-''"-'2..,0ce2,,,_0

To:

Major James C. Michael, Troop Commander, Troop F

From:

Trooper Thomas J. Mozer

Subject:

DIVISION VEHICLE PIAA

l:JM

I was advised by Sergeant/Station Commander THOMAS A. FORTUNA to compose a
memorandum regarding a Division vehicle personal injury automobile accident involving
marked Division vehicles 2F70 and 2F60. On April 7, 2020, I was working an assigned I shift
out of SP Middletown operating marked Division vehicle 2F70. At approximately 9:40AM I was
driving eastbound on East Main St, in the Town of Wallkill. A Vehicle ahead ofme came to a
sudden stop at which time I braked. Marked Division vehicle 2F60 being operated by Trooper
THOMAS S. VICTOR II, was traveling behind me. Trooper VICTOR was unable to stop in
time, striking 2F70 in the rear. Due to the impact, 2F70 was pushed into the rear of the stopped
vehicle in front of me, a blue 2017 Honda Civic bearing New York registration HWT4495 being
operated by CHELSEA A. SCOTT. 2F70 sustained rear end damage as well as front end damage
to the push bumper. 2F60 sustained front end damage. I did not incur any injuries resulting from
the accident. Sergeant/Station Commander THOMAS A. FORTUNA and Sergeant LEE C.
GUAGENTI responded to the scene for the investigation.·2F70 and 2F60 were towed from the
scene.

. GENL-4 (03105)

New York State Police

' SUPPORTING DEPOSITION (CPL§ '100.20)

PAGE

OF

THE PEOPLE OF THE STATE OF NEW YORK

-vs.

OEFENDANT(S)

LOCATION OF INCIDENT:

LOCATION OF DEPOSITION:

STATE OF NEW YORK

----- ---COURT

O~bQ..

COUNTY OF

OF

On

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COUNTY OF _ _o=C2JlortJ=;;;;..;;:t.;..::~c-------

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DATE:

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STAT E OF NEW YORK

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state the following:

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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

-i rt+.
---

day of >rPa.. 1t..
(SIGNATURE OF OEPONENTI

-OR-

* Subscribed and Sworn to before me

this

day of

- -- -

fMTNESS)

- ------ ----

• This form need be swom to only when specillcally ,vquired by Ille oourt

Page 1 - ORIGINAL

Page 2 - COPY

TlME ENOED:

lb~ 12- AJ.-<
(NAME OF PERSON TAKING DEPOSITION)

Page 3-COPY

Page4-COPY

£.3

-

-

.

.

GENL-4 (03105)

- -- e-'-f

New York State Polir.a

SUPPORTING DEPOSITION (CPL§ 100.20)

PAGE

OF

THE PEOPLE OF THE STATE OF NEW YORK

-vs.

DEFENDANT(S)

LOCATION OF INCIDENT:
STATE OF NEW YORK

- - - - -- -COURT

COUNTY OF _ _ __

OF

On

LOCATION OF DEPOSITION:

_

_

_

STATE OF NEW YORK

_ __ __

COUNTY OF _

at

Dvbl¾J

state the following:

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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

1~

day of

~{

•

2b ~t_)

2
~
CP
~

-OR-

* Subscribed and Sworn to before me
this

(WITNESS)

- - - sworn
- ta only..,~-specifically
- -- - - - -- "This fonn oced
required 1110 coun
be

TIME ENDED:

o:DJ--1/

day of

by

Page 1 - ORIGINAL

Page 2-COPY

Page3 -COPY

Page4-COPY

12. Div/Precinct

I. Agency

F2 TROOP F • ZONE 2

I

F22 1

7,8,9. Date Reported (Day, Date, Time)
TUESDAY 04/07/2020 09 :40

-

Ne\\ York Staie-

-

INCIDENT REPORT

13· ORI
NY l 350200

r 0,11,12. Occur red On/From (Day, Date, Twne)

Is. Case No.

16. l_ncident No.

95 18721
113,14,15. Occurred To (Day, Date, T ime)

T UESDAY 04/07/2020 09:40

11 '· Business Name

16. l ncident T ype
ACCIDENT-PERSONAL IN JURY
19. Incid ent A ddress (S treet Nam e, Bl dg. No~ Apt. No.)
EAST MA IN ST
20. City/State/Zip
NEW YORK
21. Loc11tiou Code (TSLED)

123. No. of ~ic1ims

126. Victim also Compla.inant'!

1 24. No. of Susp~cts

WALLKILL TOWN 3666
Location Type
STREET

ASSOCIATED PERSONS
S. TYPE

Name (Last, First, Middle, Title}

DRIVER 3

SCOTT, C HELS EA. A

LAW
ENFORCEMENT

MOZER, T HOMAS , J

LAW
ENFORCEME1'ff

VlGTOR. THOMAS, S

1220 W ASHJNGTON AVE
BLDG#22 A LBANY Y 12226

VEHICLE
59. Vehicle Status
DESTROYED/DAMAGED/VANDALIZED
63. Pl ate Type
LA W ENFORCEMENT

68. Stvle
SEDAN. 4 DOOR
71a. Towed By
1-lOLLYWOOD

60. Licen se Plate No.
2F60
165. Year 66. Make 67. Model
FORD EXPlORER
20 17

161.State 1:62. Exp. Yr.
NY

2020

.
1

Vallue

170. Color(s)
BLUE

169. VLN
I FM5K8ATI HGC3501 4
7th. Towed To
TROOP

72. Vehicle Notes

59. Vehicle Status
DESTROYED/ DAMAGED/VA NDALIZED
63. Pl ate T ype
LAW ENFORC EM ENT

60. License Plate No .
2F70
66.
Make 67. Model
165. Year
FORD TAURUS
20 14

16 1. State 1:62. Exp. Yr.

NY

68. Stvle
SEDAN. 4 DOOR
7la. Towed By

169. VIN
IFAHP2MT6EGI72231
71b. Towed To

ROCK BOTTOM

TROOP

j·

VaJluc

2020

170. Color(s )
BLUE

72. Vehicle Notes

59. Vehicle Status
OTH ER
63. Plate T ype
PASSENGER AUTOMOBILE (REGULAR PLATES)
68. Style
SEDAN, 4 DOOR
71a. Towed Ry
DRIVEN FROM SCENE

60. License Plate No.
HWT4495

161. State 1:62. Exp. Yr.
NY
202 1

165. Year 66. Make 67. Model
HONDA C IVIC , CIVIC DEL SOL
169. VIN

.
1

Val!ue

170. Color(s)
BLUE

7 th. Towed To
DRJVEN FROM SC ENE

72. Vehicle Notes
NO DAMAGE TO V-3

Page I of 2

4/2 1/2020

17:49: 52

NARRATIVE
Date of Action

!Date Written

I

04107/2020

104107/2020

I PRESTIGIACOMO, MARK (SGT SIC)

Officer Nam~-&"Ranir-

•'

Narrative

Investigated a three car Division vehicle PIAA on East Main St. T/Wallkill. Refer to admin report for details.

ADMINISTRATIVE
74, Inquiries

175. NYSPIN Message No.

77. Reporting Officer Signature (Include Rank)
SGT SIC MARK PRESTIGIACOMO

81. Status
CLOSED - NO MEDIA

76. Complainant Signature
78. ID No.
5022

182. Status Date

79. Supervisor Signature (Include Rank)

SGT SIC MARK PRESTIGIACOMO

80. ID No.
5022

83. Notified/TOT

04/07/2020

I Solvability Total

Page 2 of2

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

0

-- - - - - - - - - 17:49:52

Administrative Message Report
Print\Run Date °'4/07/2020

AMS#

SJS # 9511721

AMSP169BQ2GJ9

Date\Time Reported\Discovered
04/07/2020 09:40

Agency ORI

TZS

NYSP MIDDLETOWN

F221

Message
DIVISION VEHICLE - PIAA, ON DUTY INJURY
Investigated By

Photos YES

Units Responded

Videotape NO

UF

LT. THOMAS BROZYCKI, SGT/SC MICHAEL
BEERS, SGT/SC THOMAS FORTUNA,
SGT/SC MARK PRESTIGIACOMO, SGT
LEE GUAGENTI

_tf!rrative
TrooP.er Thomas Victor operating 2F60 (V-1 ), Trooper Thomas Mozer operating 2F70 (V-2), and V-3 operated by Chelsea A .
Seo~
are traveling eastbound on East Main Street T /Wallkill when OP V-3 brakes suddenly for a squirrel crossing
the road. Troopers Victor and Mozer also brake. t which tim 2F
trik
he rear of 2F70 subse uentl ushin 2F70 into
the rear of V-3. Troo er Victor sustained

Lt Thomas J . Brozycki was notified and responded.
Major James C. Michael notified by Captain Peter J. Cirigliano.

# Injured

#Vehicles
3

# Deceased

1

County
ORANGE

0

Apparent Cause
PENDING INVESTIGATION

CfTNName

Location\ Street Name \ Mile Post Marker

WALLKILL, TOWN OF - 3666

EAST MAIN STREET

Weather Conditions

Road Conditions
1-DRY

1 -CLEAR

Description of Damage
V-1 FRONT DRIVER SIDE, V-2 REAR PASS SIDE/PUSH BUMPER, V-3 NO DAMAGE

Criminal Actio n
N/A
Sent By
FORTUNA THOMAS

Sent Date \ Sent Time
04/07/2020 13:40

Notification

Auth;;a•d

I

LT. THOMAS J. BROZYCKI

TROOP, ZONE

Driv r Information 1
Driver Name

DOB

VICTOR, THOMAS S
------------Address
1220 WASHINGTON AVE

Gender
M

License State

Chemical Test

NO

Driver Charged

NO

- - - - - - - - - State
- - - - - -Zip
-City
ALBANY

NY

12226

Violations

Driver Member?
YES

Member Rank
TROOPER

Date of Entry
05/27/2018

Page 1 of 3

Member Shield
283

Member Shift
1

OWner lnfo.fm!tion
Name (exactly as printed on registration)
NYS POLICE,
Address

City
ALBAN Y

1220 WASH AVE BLOG 22
Insurance Company and Code
994 - GOVERNMENT OWNED
Vehicle Information 1
License Plate #
State
POLICE
NY

Vehicle Year
2017

State
NY

Make
FORD

Van#
170169

Zip
12226

VIN#
1FM5K8AT3HGC35014

Mileage
63887

School Bus

NO

Front Airbags Deployed

YES

Comm. Veh.

NO

Side Airbags Deployed

NO

NYSPVeh.

YES

Fire Suppression Deployed

NO

Equipment
NO
Damage
Driver Information 2

Equipment Damage
Description

Driver Name

DOB

MOZER, THOMAS J

Gender
M

License State

Chemical Tent

NO

Driver Charged

NO

------------------------State
Zip

-

-Address
--------------

City

1220 WASHINGTON AVE

ALBANY

NY

12226

Violations

Driver Member?
YES

Member Rank

Date of Entry

Member Shield
3611

Memb1er Shift

Owner Information 2
Name (exactly as printed on registration)
NYS POLICE,
A ddress

City

1220 WASH AVE BLDG 22

ALBA NY

State
NY

Zip
12226

Insurance Company and Code
994 - GOVERNMENT OWNED
Vehicle Information 2
License Plate #
State
POLICE
NY

Vehicle Year
2014

Van#
140365

Make
FORD

VIN#
1FAHP2MT6EG172231

Mileage
150235

School Bus

NO

Front Airbags Deployed

NO

Comm. Veh .

NO

Side Airbags Deployed

NO

NYSPVeh.

YES

Fire Suppression Deployed

NO

Equipment
NO
Damage
Driver Information 3

Equipment Damage
Description

Driver Name

Gender

SCOTT, CHELSEAA

F

Page 2 of 3

License State

Chemical Te5rt
Driver Charg,ed

NO
NO

=A_d_d_re_s_•=====-------------'----------·-~-~-------=-=ip===----Violations

Driver Member?
NO

Member Rank

Date of Entry

Member Shield

Member Shift

Owner Information 3

Name (exactty as printed on registration)
SCOTT, CHELSEA A

State
NY

Insurance Company and Code
678 - PROGRESSIVE ADVANCED INS

Vehicle Information 3
License Plate #
State
HWT4495

Vehicle Year
2017

NY

VIN#

Make

HOND

Van#

Mileage

School Bus
Comm. Veh.

NO

Front Airbags Deployed
Side Airbags Deployed

NO

NO

NYSPVeh.

NO

Fire Suppression Depluyed

NO

Equipment
Damage

NO

Injured 1Dt '8as~

erso~tion 1

Equipment Damage
Description

INJURED

Injured \ Deceased
Injured \ Deceased Name
VICTOR, THOMAS S

Ftace

Gender
M

Address
1220 WASH AVE BLDG 22

City
A LBANY

State
NY

Injured Taken To (Medical Facility)

Position in Vehicle

ORANGE REGIONAL MEDICAL CENTER

01 -DRIVER

ln Custody
NO
Driver Member?
YES

NO

Seat Belt
NO

Ejected

Relative Notified

NO

YES

Member Rank

TROOPER

Date of Entry
05/07/2018

Page 3 of 3

ME1mber Shield
283

Zip
12226

ARS#

006 24382

__..,.

c-7
PeQe 1

of

3

New York State Department of Motor Vehicles

Pages

Local Codes

POLICE ACCIDENT REPORT

9518721

ear

Day or Week

VEHICLE

No. of
Vehldes

Military Time

Tuesday

2020
VEHICLE 1- Driver
License ID Number
nve r ame - exactly
es printed on rocense

MV-104A (6/04)

□ AMENDED REPORT

SPP169BQ2BD1

09:40

~~t ~n~~t~g~t~ _a~ 5:-:n~ _

O Left Scene
D

Police Photos

D

~ Ye$
No
□BICYCLIST □PEDESTRIAN 0 0TH ER PEDESTRIAN

0

Accident Reconstructed

~ VEHICLE 2
Slate of Lie.

State of Lie.

NY

NY
nver ame - exa
as printed 011 license

VICTOR II, THOMAS S
Apt.

1220 WASH AVE BLDG 22

NY

01

City or T<Mn

State

ALBANY

NY

r-·---·----.
Dato I Birth

□

· DamS!)ed

...

ear

Day

:

Sex

~

Unlicensed

□

Zip Code

Vehicle Year & Make

VehidefYPe

2017 FORD

POLI

S8X

Cate Of Bir1h
Oay
Ontll

Apt No.

City or Town

Stal♦

ALBANY

NY

Ins. Code

Plat• Number

994

POLICE

Stare of Reg. Velliele Year & Mal<e

NY

~ic
Prope:1)1
DamagM

01

1220 WASH AVE BLDG 22

12226

NY

12226

No•. of Occupants

□

M
,stration

, R818!1$8d Address (Include Number and Strool)

State al Reg.

Zip Code

NY

NYS POLICE,

Apt.No•.

1220 WASH AVE BLDG 22

State

ALBANY

Public
Propeny

onth

NYS POLICE,
Address (lnc!IJde Number and Street)

City or Town

oa,a or Birth

sex

Nam9 - exac11y 8$ pdnted on registradon

Apt No.

1220 WASH AVE BLDG 22

12226

o. of Occupal\ls

MOZER, THOMAS ,T

Address (Jndude Number and Street)

No.

Zip Code

State

1

1

1

Address (Include Number and Street)

5

No. Injured No. Kiled

3

2014 FORD

~.

□
eer

, Re!eased

~J-

□

Z.,Ccc!e

12226
Vehicle Type

POLI

Ins. Code
994

1ick8t!All'8SI
Num!>el(s)
Violalion

Sec6on(s)

s:
ide;

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

ide;
feet tong;

lghlpermit;

Ill an overweight permit;

t:::2~Ell~~r:1:J~~~g~~~Q:~~~::j

L Box 1 • Point of Impact
Box 2 - Most Damage
Enter up to three
more damago codes

1

E

Vehlele By:
Towed To:

12

3

1
4

2

I

2 L Box 1 - Point of Impact
E Box 2 - Mo~t Damage
Enter up to three
5
2 more damage codes

l:IOLLYWOOD

SP MIDDLETOWN

7
4

3

6

7

2

8

2
5 ACCIOE:NT DIAGRAM

Vehlcle By; ROCK BOTTOM
Towed To: SP MIDDLETOWN

See the last page of the MV-1 04A for the
accident diagram.

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

Refe~nce Marker

9.

17. DEMOUSHED
18. NO DAMAGE
19. OTHER

Cost or repaiss to any one vehlde Will be more than $1000.

D Unknown/Unable to determine

Coordinates (if available)
Latitude/Northing

Place Where Ac:cldent Occurred:

4588301

Road on which accident occurred

County

ORANGE

□ City □ Village ~ Town
EAST MAIN

~ Yes

of

WALLKILL

STREET

"""'~"-""""""""a....;;..;.;c==------.(R'"'c""u"'te""N"'u""m"'
tier
=oc""s"1re""e""t°"Na
~m=o~i- - 1---,.---.---i---l Longitude/Easting

551607

al 1) intersecting street

.3

or 2)

-1ee,......,.t-

mlles

0N Os

oe ~w

(Route Numbei or Sireet Name)

of DUNNING ROAD
(Milepo$~ Nearest iltersecting

Rout• Number or Street Name)

Accident Description/Office(s notes

V-1, V-2, and V-3 were traveling eastbound on East Main Street T/Wallkill when OP v- 3 b~aked
suddenly for a squirrel crossing the road. OPS V-1 and V-2 also braked, at which time 'V- 1 struck
the rear of V-2 subsequently pushing V- 2 into the rear of V-3. WITNESS #1 ERIC TONNESEN 153
RIDGEBURY ROAD NEW HAMPTON, NY 10958 (845) 820- 7092

NCICNo,

2752

14301

PrecinllPost StationlBe11t
Troop/Zone Sector

Reviewing Officer

Dato/Time Reviewed

BELGIOVENE,

F2

MICHAEL

4/10/2020
09:45

41

N

New York State Oepartment of Motor Vehicles

Pages

of 3

Local Codes

POLICE ACCIDENT REPORT

9518721
SPP169BQ2BD1

□

i:,.::a;;;:;;:::..:;,=.------~.-a-r ......i Day of Week

2020

Military Time

Tuesday

VEHICLE

VEHICLE 3- Driver
License ID Number
Driver Name - exactly
as printed on license

MV-104A (6/04)

AMENDED REPORT

09:40

No. of
Vehicles

No. Injured No. Killed

1

3

Nol lnveMigated at Scene

0

3
Stale of Lie.

NY
SCOTT, CHELSEA A

State

NY

nlicensed

□

Vehicle Year & Make

2017 HOND

. '..-: ..
,,, ; ·· · Circle the diagram below that deseribes the accident, or draw your cwn
· /'i/.1,.' diagram In space #9. Number the vehicles,

V

•:jiff,
,,- ., 1:+--~

E
H

t'-a

U1A Tutro

l.

I

=:.&'..11o111

C

~----

Head On

RlglltAAgle

_J

1.

~

L Box 1 - Point of Impact
. 2 L o .
E Box 2 - Most Damage
9
1 I:! E ~x·
Enter up 10 three
- -3- +---4+---1
5
.. · ' ·"
3 more damage codes

i'°"'":~r--:~~·:~·
::,;,·,~'
-.;:15 ACCIDENT DIAGRAM

f{t·

Vehicle By:
Towed To:
VEHICLE·DAMAGE CODING:

MS SEE DIAGRAM ON RIGHT.
14. UNDERCARRIAGE

17. DEMOLISHED

U. TRAILER
11;, OVERTURNED

18. NO DAMAGE
19. OTHER

9.
Cost of repairs to any one vehicle will be more than $1000,
11

Reference Marker

Coordinates (if available}
Latitude/Northing

D Unknown/Unable to determine

"

·

D Yes

O No

Place Where Accident Occurred:

County

D City D

ORANGE

Village

D

Town

o!

Road on whidl accident occurred
(Route Numter or S1r8el Name)

~-.--.----.---1 Longijude/EasUng

at 1) intersecling street
or.2)

-~,e-e~IAccident Description/Officer's notes

0
D NE

B

SW

(Route Ni.rn6ar or Stroot Name)

of

-.,.,.,,,--,-,.,..,.,.,..,,.-.,-,,....,.,..,,..,.,..,.,.,...,.~==.c:::==:;-(Milepcsl Nearest interseCling Route Nuinber ~r Street Name)

of 3

Page 3

Pages

New York State Department of Motor Vehicles

Local Codes

POLICE ACCIDENT REPORT

9518721

SPPl69BQ2BDl

□

AMENDED REPORT

~•"="'~"'~~J!.~e!Dae,to,___,,----,-"-__JDay of Week
0

4

7

2020

Military Time

Tuesday

09:40

MV-104A (6/04)
No. of
Vehicles

3

No. Injured No. Killed

l

East Main St T/Wallkill

0

Not Investigated at Scene

D Lett Scene
D

A~cid;nt Re-~n;t~cie"°d - - -□

Police Photos

~ Yes

D No

CD

New York State Department of Motor Vehicles

REPORT OF MOTOR VEHICLE ACCIDENT
POLICE LINE OF DUTY ACCIDENT

□
Page 1

AMENDED REPORT

Panes

of

Precinct

'E'241

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

951 8721
SPP1 69BQ2BD1

Accident nme

Accident Date
4
Month

I

7
Day

/

2020 In
Military
Year

Time

County

09:40

ORANGE

NAMES OF DRIVERS: {Please Print or Type)
Driver

Driver

ofVeh.

Plate

License.

M.I.

Reg~

'Number

State

License
Number ·

Stat~

...
'First

Last
VEH 1

□

VICTOR II

THOMAS

s

NY

POLI CE

NY

MOZER

THOMAS

J

NY

POLICE

NY

SCOTT

CHELSEA

A

NY

HWT4 495

NY

VEH 2

□
VEH 3

□
VEH4

VEH 5

VEH 6

Pursuant to Section 605 of the New York State Vehicle and Traffic Law, the attached Police Acddent
Report is also the motorist report for vehicle number(s)
1, 2

* 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 operation (as defined by V&T Section 114-b)
when the accident occurred.
Date

04/1 0/2020
MV-104L (4/07)

--- -- ----

Signature of Owner or Police Vehicle/Police Agency Representative

09:45

-

-

-

www.nysdmv.com

NCIC#

14301

New York. State Department of Motor Vehicles

REPORT OF MOTOR VEHICLE ACCIDENT
POLICE LINE OF DUTY ACCIDENT

□
of

Page 1

AMENDED REPORT

Pages

Precinct
F241
Local Accident Number
.9518721

IMPORTANT: If you are the officer in charge, complete and sign
this form, and attach it to the MV-104A or MV-1 04AN.

SPP169BQ2BD1

Accident Date
4
Month

I

7

Accident Time
/

2020 Military
Year

Day

County

In

nme

ORANGE

09:40

NAMES OF DRIVERS: (Please Print or Type)
$tale
ofVeh.

*

L~st

F.i.t st

. M.I.

Driver

RetJ.

Plate
Nurnber

.License
State

Driver ·
.License
Number

VEH 1

□

VICTOR II

THOMAS

s

NY

POLICE

NY

MOZER

THOMAS

J

NY

POLICE

NY

SCOTT

CHELSEA

A

NY

HWT4495

NY

VEH 2

□
VEH 3

□
VEH4

VEH S

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, 2

• 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 operation (as defined by V&T Section 114-b)
when the accident occurred.
Date

04/10/2020
MV-104L (4/07)

Signature ol Owner of Police Vehicle/Police Agency Representative

09:45

✓--

-

-~ -

www.nysdmv.com

NCIC#

14301

£6
-

GENL. 340 /Rev 05/151

INSTRUCTIONS:

,DIGITAi- PHOTO RECORD
STATION

CASE NUMBER

Sp Middletown

FlU LEAD NUMBER

INCIDENT DATE

9518721

• Complete a separate fonn for each Investigation
• Print or hlne all enbies
PHOTO DATE
TIME

04/07/2020

INVESTIGATING MEMBER

04/07/2020

/0'.

/1,,,IJM

Sgt/Sc Thomas Fortuna

CASE TYPE

COMPLAINANT - DEFENDANT - OPERATOR- DECEASED

Troop car PIAA/Member OD!

NYSP

COUNTY

ADDRESS OR LOCATION

Orange

East Main St Mjddletown NY 10940

GENERAL DESCRIPTION OF SCENE/ ITEM($)

I IMAGE TYPE OR FILE FORMAT
0 JPEG O TIF O Raw

'

ACTION REQUESTED

0

Troop Car PIAA
Fuji

COMPLETED

PHOTOGRAPHER'S NAME

Sgt/Sc Thomas Fortuna

CAMERA

BEGAN ' ~

JO './0

I

PAGEO

1

OF

1

ll?l Retain

04/07/2020

ll?J CD/DVD O E-MAIL O Other _ _

IMAGE#

1

DSCF1348

View of east main St facing east

39

2

1349

Rear of2F26

40
41

IMAGE#

3

1350

4

1351

Drivers side 2F26
Rear2F26

5

1352

Drivers side 2F60

43

6

1353

Pass side 2F60

44

7

1354

45

8

1355

Front of2F60
POI 2F60 .

9

1356

Rear2F70

47

10

1357

PO_l2F70

48

11

1358

POl2F70

49

12

1359

Pass side 2F70

50

13

1360

Front2F70

51

42

46

14

1361

Drivers side 2F70

52

15

1362

Rear of Honda Civic HWT4495

53

16

1363

54

17

1364

"
"

18

"
"

O Print

MANNER SUBMITTED: (Check one)

CAMERA
PHOTO 10#

DESCRIPTION:

Bum To CD/DVD

DATE SUBMITTED TO FIU

55

1365

Inspection/ Reg 2F70

56

19

1366

Inspection/Reg 2F60

57

20

1367

2F70 Push guard

58

21

1368

Front QP of2F70

59

22

1369

Pass side QP of2F70

60

23

61

24

62

25

63

26

64

27

65

28

66

29

67

30

68

31

69

32

70

33

71

34

72

35

73

36

74

37

75

38

76

CAMERA
PHOTO 10#

DESCRIPTION:

INSP-8PS (Rev 11/16)

New York State Police

Photo 1 of 6

Photo Sheet
Case#

9518721

INSP-8PS (Rev 11 /16)

New York State Police
Photo 2 of 6

Photo Sheet
Case#

9518721

INSP-8PS (Rev 11/16)

New York State Police

Photo 3 of 6

Photo Sheet
Case#.

9518721

INSP-8PS (Rev 11/16)

New York State Police
Photo 4 of 6

Photo Sheet
Case #

9518721

INSP-8PS (Rev 11/1 6)

New York State Police
Photo 5 of 6

Photo Sheet
Case#

9518721

INSP-BPS (Rev 11 /16)

New York State Police
Photo 6 of 6

Photo Sheet
Case#

9518721

.'
T & C AUTO BODY, INC.
770 Rt 17 M, Po Box 2164, MIDDLETOWN, NY
10940
Phone: (845) 343-3443
FAX: (845) 342-4330

Workfile ID:
PartsShare:

6153a430
5P6BSF

State ID:

7000221

Preliminary Estimate
Customer: New York State Police 2F60

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

Insured:

New York State Police 2F60

Type of, Loss:

Policy#:

Claim#:

Date of Loss:

Days to Repair:

O

Point of Impact:

Owner:
New York State Police 2F60

Inspection Location:
T & C AUTO BODY, INC.

55 Qystal Run Rd

770 Rt 17 M

Middletown, NY 10941

Po Box 2164

(845) 344-5300 Day

Insurance Company:

MIDDLETOWN, NY 10940
Repair Facility
(845) 343-3443 Business

VEHICLE.
2017 FORD Police Interceptor Utility Vehicle AWD (Fleet) 4D UTV 6-3.SL Turbocharged Gai;oline Gasoline Direct Injection Blue
VIN:

1FM5K8AT3HG05014

Interior Color:

License:

2F60

Exterior Color:

Blue

Mileage Out:

State:

NY

Production Date:

3/2017

Condition:

TRANSMISSION ·

Mileage In:

., Privacy Glass

63,887

Vehicle Out:

Good

Job#:

AM Radio

Head/Curtain Air Bags

FM Radio

SEATS

CONVENIENCE

Stereo

Cloth Seats

Air Conditioning

Search/Seek

Bucket Seats

Power Steering

Intermittent Wipers

CD Player

Redining/Lounge Seats

Power Brakes

TIit Wheel

SAFETY

WHEELS
Styled Steel Wheels

Automatic Transmission

overhead Console

4 Wheel Drive

POWER

Power Windows

Cruise Control

Drivers Side Air Bag

Power Locks

Rear Defogger

Passenger Air Bag

PAINT

Power MirTors

Message Center

Anti-Lock Brakes (4)

Clear Coat Paint

Power Driver Seat

Steering Wheel Touch Controls

4 Wheel Disc Brakes

OTHER

Power Adjustable Pedals

Rear Window Wiper

Traction Control

Rear Spoiler

DECOR

Backup camera

Stability Control

Dual Mirrors

RADIO

Front Side Impact Air Bags

4/.8/2020 3:58:26 PM

002479

,)·.•·

':·

(

Preliminary Estimate
Customer: New York State Police 2F60

lob Number:

2017 FORD Police Interceptor Utility Vehide AWD (Fleet) 4D lJTV 6-3.5L Turbocharged Gasoline Gasoline Direct Injection Blue

Line

1
2
3
4

Oper

Description

Part Number

Qty

Extended
Price$

Labor

Paint

FRONT BUMPER

O/H front bumper

3.8

*

Repl

#

R&I Bumper cover (installl on parts

5

*

Repl

LI Side Sl!Pt!Qrt (SP ~UQQligd)

6

#

R&I

LT Side support (installl on parts
vehicle)

Bumi;ier cgver (SP ~ui;i:i;i:l!eQ)

FB5Zl7D957EB

1

l!..O.Q

Ind.

0.0

2.0

vehide)

7

FB5Zl7E8148

1

0 00

2
1

0.00

Repl

LT Side support rivet

W702852S300

8

*

Repl

Abs!lc:b!ilr (SP suggligd)

FBSZ17C882C

9

#

R&I

Absorber (installl on parts
vehide)

10

•

Repl

~O!tier molding (SP SYRPlied)

11

#

R&I

Lower molding (installl on parts
vehicle)

12

*

LT Valgnce (SP sugglh~d)

14

#

R&I

LT Valance (installl on parts
vehicle)

15

•

Repl

LT Side trim (SP suggll~)

16

#

R&I

LT Side trim (installl on parts
vehide)

17

*

Repl

LI Side trim nut

18

#

Repl

Push bar (SP supplied)

19

#

R&I Push bar (installl on parts vehicle)

20

GRILLE

21

*

Repl

l!lct.
FBSZ8419APTM

1

lLlll!

FB5Zl7626DA

1

0.00

Ind •

0.0

G[illg POUCE l!'!I!;8~~EIOR (SP

0.3
0.2

FB5Zl78968CA

1

l!.l1!!

Ind •

l!lct.
W7042775439

1
1

2.0
1.0

FBSZ8200GB

1

l!.QQ

W709367S439

1

l!..O.Q

FB5Zl3008AF

1

0.00

Ind.

supplied)

#

R&I

Grille (installl on parts vehicle)

23

*

Repl

Grille 1:;lig (SP supplied)

24

FRONT LAMPS

25

*

Repl

LT Headlamg
supplied)

Repl

Aim headlamps

R&I

LT Headlamp housing (installl on
parts vehicle)

26

Ind.

0.2

•

22

1.12

R&I License plate
Repl

13

Ind.

hgysj □ g

(SP

27

#

28

HOOD

29

*
*

Repl

30
31

It

Repl

Hood (installl on parts vehicle)

32

*

Repl

BI tlinge (SP supglied)

l:fQQd (ALU) (SP sugglied)

!ash

1

Ind.
0.5

lad.

FB5Zl6612A

1

l)._QQ

1.1

Add for Underside(Complete)

!l.l!
0.0

1
BB5Zl6796A

1

0.6
l!..O.Q

0.3

0.0

Note: lABOR: lime is after hood and cowl grille are removed.

33

#

4/8/2020 3:58:26 PM

Repl

RT Hinge (installl on parts
vehicle)

1

002479

0.3

Page 2

Preliminary Estimate
Customer: New York State Police 2F60

Job Number:

2017 FORD Police Interceptor Utility Vehide AWD (Fleet) 4D UTV 6-3.SL Turbocharged Gasoline Gasoline Direct Injection Blue
Note: LABOR: Time is after hood and cowl grille are removed.
34

•

Repl

LI

Hi □9f (SP suggljgr;!)
BBSZ16797A
Note: LABOR: Time is after hood and cowl grille are removed.

1

35

#

Repl

LT Hinge (install! on parts
vehicle)

1

36

•

Repl

Late□

37

#

Repl

Latch (install! on parts vehicle)

3B

COWL

R&I

Cowl grille

R&I

Cowl grille (from parts car)

0.3

ILlill

0.3

Note: LABOR: Time ls after hood and cowl grille are removed.

39
40

#

41

FENDER

(Se SYtmlied)

•
•

44

#

Repl

LT Fender (install! on parts
vehicle)

45

•

Repl

LI Wbeel tll;!t:e (SP su1212!iei;!)

46

#

R&I

LT Flare (install! on parts vehicle)

47

•

Repl

LT Frgnt braQ;gt (Se sum;ilied}

48

#

Repl

LT Front bracket (install! on parts
vehicle)

Repl

LT Upper rail (HSS)

Rpr

LT Apron/rail assy (HSS)

49

so

•

Repl

LI Fendgr

1

lLl!Q

0.3

1

0.3
Incl.

43

42

BBSZ16700A

(Se SUIJR!ied)

0.5
FBSZ16006A

1

2.3

1

1.2

Add for Edging

51

FBSZ16039AB

I

2.QQ

BBSZ16A143A

1

0.00

0.3
0.3
0.1

1
BBSZ16155A

1

0.1
806.63 s

3.5

s

JJ!

Overlap Minor Panel

52

Repl

53

LT Upper inner rail (HSS)

#

55

RESTRAINT SYSTEMS

56

Rpr
Repl

BBSZ16B04SA

1

105.56 s

4.2

0.8
-0.2

Wire harness
Driver air bag w/o PLATINUM

u
-0.2

Overlap Minor Panel

54

0.8

1.0
FBSZ78043B13AA

I

435.85 m

Ind.

Note: FRONT DEPLOYMENT
Deployed air bag
module(s)
Clockspring
if driver air bag
has deployed
Control Module (RCM)
Front impact sensors
Deployed seat
belt assemblies
Height adjuster
Occupant module
if DTC B1231
can't be deared
SIDE DEPLOYMENT
Deployed air bag
module(s)
Control Module (RCM)
Side impact sensors
Deployed seat
belt assemblies

4/8/2020 3:58:26 PM

002479

Page 3

Preliminary Estimate
Customer: New York State Police 2F60

Job Number:

2017 FORD Police Interceptnr Utility Vehide AWD (Fleet) 4D UTV 6-3.SL Turbocharged Gasoline Gasoline Direct Injection Blue
Height adjuster
Occupant module
if DTC B1231
can't be deared
Seat back pad
Seat back trim cover
ROOF DEPLOYMENT
Deployed air bag
module(s)
control Module (RCMJ
Side impact sensors
Occupant module
If DTC B1231

can't be deared
Headliner
Windshield pillar trim
Upper center pillar
trim
Pillar trim
Rear pillar trim
SEAT BELT DEPLOYMENT
Deployed seat
belt assemblies
Control Module (RCM)
OCtllpant module
If DTC B1231
can't be deared
INSPECTION COMPONENTS
Undeployed air bag
module(s)
Steering wheel
Steering column
Instrument panel and
mount points
Instrument panel knee
bolsters and mounts

Impact sensor mount
points
Seat belts and mounts

points

Seats and mount points
Seat back frame
Wiring harness
Occupant sensor

57

Air bag system diagnosis pinpoint
test

m

2.1

58

Air bag system diagnosis ck
system operation

m

0.5

59

Repl

RT Ft impact sensor

FR3Z14B004A

1

149.23 m

0.3

60

Repl

LT Ft impact sensor

FR3Z14B004A

l

149.23 m

0.3

61

Repl

Clockspring w/o heated steering
wheel

GB5Z14A664E

1

207.47 m

1.2

62

Repl

control module

HBSZ14B321A

1

476.87 m

0.3

Repl

Note: LABOR: lime is after front center console is removed.
LT Side impact sens rear
FR3Z14B004A

1

149.23 m

0.3

63

4/8/2020 3:58:26 PM

002479

Page 4

Preliminary Estimate
Customer: New York State Police 2F60

Job Number:

2017 FORD Police Interceptor Utility Vehide AWD (Fleet) 4D UTV 6-3.SL Turbodharged Gasoline Gasoline Direct Injection Blue
64

Repl

LT Head air bag

65

Repl

LT Side impact sens front

DB5Z78042D95A

1

648.29 m

0.6

GN1Z14B345A

1

43.84 m

0.3

Note: LABOR: Time is after front door trim panel is removed.

66

Repl

LT Seat belt assy

DB5Z78611B09AD

1

67

Repl

LT Height adjuster

BB5Z78602B82AA

1

47.30

68

Repl

LT Tensioner

FB5Z78610E45A

1

109.48

0.3

69

Repl

LT Budde end w/POUCE
INTERCEPTOR

EB5Z7861203AB

1

137.18

0.2

216.88

0.3

Note: LABOR: Time is after seat is removed.

70

CONSOLE
R&I

71

R&I frt console assy

0.7

72

PILLARS, ROCKER &. FLOOR

73

•

Repl

LT Wodshld 121[ tdm ebO □¥ w[o
PLATINUM (Se sugglied)

74

#

R&I

LT Windshld pillar trim (installl on
parts vehicle)

R&I

LT Scuff plate front, w/o
illumination ebony

0.1

R&I

LT Scuff plate frcnt (frcm parts
car)

0.1

R&I

LT Lwr ctr plr trim ebony

0.3

75
76

#

77

FB5Z7803599AA

1

Incl •
Iill:!.,

Note: LABOR: Time Is after front and rear scuff plates are remoVed.

78

#

R&I

LT Lwr ctr plr trim (from parts
car)

79

•

Repl

LI UQ[ ci;r g!r bi[!) ebooy (SP
supplied)

80

#

R&I

LT Upr ctr plr trim (installl on
parts vehicle)

R&I

LT Scuff plate rear ebony

0.1

R&I

LT Scuff plate rear (from parts
car)

0.1

R&I

LT R&I front seat

0.5

R&I

LT R&I trim panel

0.5

R&I

LT Qtr trim panel w/o inflatable
2nd row seat belts w/6 speaker
audio-ebony

0.5

0.3
BB5Z7824347AC

1

lLllQ

Ind.

Note: LABOR: Time is after lower center pillar trim panel Is removed.

81
82

#

83

SEATS &. TRACKS

84

85

FRONT DOOR

86
87

Iill:!.,

QUARTER PANEL

88

89

#

R&I

LT Qtr trim

90

•

Repl

LI R~gr Qillar tdm '.!J.1.9 12
s12eaker eudiQ eba □¥ (SP

0.5
FB5Z7831011AA

1

lLl)Q

0.2

supplied)

91

#

92

ROOF

93

•

4/8/2020 3:58:26 PM

R&I

LT Rear pillar trim (installl on
parts vehicle) •

Repl

t:lei:!dli□er '!:!.I.SJ.

Cf2r AC. tamellgca:,:

0.2

FBSZ7851944FE

002479

1

4.7

Page 5

•
Preliminary Estimate
Customer: New York State Police 2F60

Job Number:

2017 FORD Police Interceptor UHlity Vehide AWD (Fleet) 4D UlV 6-3.SL Turbocharged Gasoline Gasoline Direct InjecHon Blue

(SP supplied}
94

#

R&I

Headliner (insralll on parts
vehide)

4.7

95

#

Rpr

Prepull left apron

96

#

Repl

Weld thru primer

1

8.50

0.3

97

#

car Cover

1

8.00

0.3

98
gg

#

Rpr

Disable SRS

#

Rpr

De Nib &. Polish

2.0 F

0.6
1.0

SUBTOTALS

3,700.66

54.4

2.4

ESTIMATE TOTALS
Category

Basis

Rate

Parts

Cost$
3,700.66

Body Labor

52.4 hrs

@

Paint Labor

2.4 hrs

@

Frame Labor

2.0 hrs

@

$ 55.00 /hr
$ 55.00 /hr
$ 55.00 /hr

Paint Supplies

2.4 hrs

@

$35.00/hr

Subtotal

2,882.00
132.00
110.00
84.00
6,908.66

Grand Total

6,908.66

DeducHble

0.00

CUSTOMER PAY

0.00

INSURANCE PAY

6,908.66

MyPriceLink Estimate ID / Quote ID:
677151577802285056 / 65977278

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 PENALlY 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, 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.

4/8/2020 3:58:26 PM

002479

Page 6

..

,.

;)

:r,:ii,. ·c fil'tg::~{):QYi l~P. ,
VD,Rt17Mi·P.o;Box,tf64,
' MIDD(l:rOWN>NY.
,_ •.
-.,~"'~••-'--~·

~

Wor1<file'ID:

:7f•M~~,

•StateID;

,7000221

1/iartisshane\

-~

.1Q!,!40J

5~6hjf-

Ph9n~;,CE!45) ~4;i.;;Hit'.{
'FAX: (~45)T312Sf330
.....-

..

.

P~llirii!lary ~sl:im.ite

.-- - --·

,._

t:ustomer:,NeW,York'state'l:fol.i.~:2fJO'

l11S)Jred:.
N"'v York State ~olice 2FZO
'fype ~fL"55:
Point of Impact:

Owri,,i-:.

,eoi,ci:#:
'Dale ofl.oss:•

Oaifn./1;
to Repair:

oays

o;

i,;,,pectk,!' l~~t.icifri

New.'York Stife ~ohteslf,'Q
55 try,iraiRun Rd:

'J.& cAiJto BODY, iiiJt:

;1

?JO:~UZM'

,Po lioxziM

Miqq/_2towy,, NY'1G9-1J

(845):~:s~oo·o;,y:

l,IIDDLETDW~~NH@:!jl
Rell.air Faq_l)!Y
\845) 343·3'!4:i 'ilusmess

i

20i 4 FORD· ecili~ •i:r1terC~l'!9r,,~'@.. (l;leetJ't\D _SEQ lic.J.Slf;Turtiocrfai~ed:Gasoline ,Gasofine~Dlrecffnji,ction'Bftl_e_
VIN:.
License:

iFAHP2MT6EGi7izii:
2F70

1~1:§ji<jr;~gl()i;:
Extelior-Cofor:

state:

~)'

,pij:,giiction'Date:

.Mllea9e'fn:•
'Mii~_ageo_utj
'Condition:

·liiue

TRAN~lSSIOf:1
Automatic Tiansnifssfon.

ifli]te<l'Glais'

Clverheact'tonsoteJ
~~--t .,.,,_T'

S~f,jg

4.Wtieel Dnve'

CONVENIENCE

Sean':iiis.eii:
CD'Player.

POWE~
Pf?wer:s~erin~.

po_~er~~rj~es
Power Windo.W

• "'!

I-

J)ir\conalti<irtinir
J~ri\11\\,en\ \O!i~if
'r.l1o\Nheei .
tiulse ConWi

~pwerJ~,

.n -D~
--·-Ilea[
. ogger

P,OWe1\MiITOl"S

M~~ge,cente_r
sleering'Wh~J{o_ug:]'.9'~

1sq;;z3s;

FMilAaio.

§ll_c_kl,t,Se~ts

~ems- .

SA!;EJ,Y

Redini')9i!:D'!.~ge
'.wi:IEEis

Drtv~.~~~~r,e.@:

i51:y1ea•§lii.e\ \'iJieeis,

Passef!ger.wr Bag,
,Aiiti;Lock Brakes (4)
,,:i:wfie_elpis(BraK~
fi:QiJL~ld~J111tiact1lir ijag~-

PowerDriver Seai
f'oWeT~AdJustable Pedals.

'i'e1e;;copicWli'!!'I

i'ieai!7Curtajn Air Bags

DECOR

'!lcllPIO

rn1_iJR:espot:~~9'f:i

,AM'Racf<9

·LaneDeparture.Wamlng

.4]1i/2D2<f2:2B:46 PM

sEJiTs
oath,seats

OQJ'_IZ.9;

W!!ii

,oear,toat'Palnt1
f9THE!f

'Tracaao:cantrol'•
•Stabillty,C6ntrol
~·11.···--·-· -~

.

.

,,

.

'iireliminafy'Estimate
-··,. .-e<,

··~··LJ·'"-·1.f

1_--·

l.......J

'""-'-'

CU$mer: New:\'orkstate P.olice 2f70.
•;t_l)_j:4' FOl!p_Poii[!! _lnten;elltQf AW.P'"(Aeet).'IQSED:6:,3:sL Turiioiliar~ed~Gasoiine.Gasoiine,Direct-liiJect)on Bl~l
a.

· Part Number·

,J..in0.

11:xtendac

;tabor.

. :~~-$,
l

R_l;AR BUMl'E~'

Pm{eiir 5umQ!!f'
·RetiP Bumper cover w'[park ~ f

2
3
~

2;~
,DG1Z17K835GAITTM

AddfortiearCoai;

'f.3

J@il/m teverse ~
rR,;pl jj;t SJ~e ~!(iflReP,l Buf11pe'r_cover retainer;
~""' Clf.~ ¥e'~roil.
Repi ~f~~eetpt
"kepi Ldwer-.cover
'{leiil Rr §# q,vei ri_,#;,

:RePI: Ct ul~ef~9)Ver. liv~
,Repl Rf.Lowe, cover reia[nen
.ReP! -Absorber,
;;·:.~~-"" '"
'Rejli RTAbsorberretaini;r'
;Rep! Jinpacrban

Jt_epl F?afKS'ehsor
•Rep! 'Wire:hamesswt.o.passive entry

')'foparl< seiisa"i= ' - _, • --

PGtZl~.":4'198
{iGjl1t~t~Ai\1

O,~
·ri.i .

17.42,

rAG'fzi'l_CfflSl\1
13M§46N629

i1&0 1
1,

1,

N80434:is

•Ind.

"fB.90
,215'16
,3,(io•

Jffd;

·3,00
1,50·

ij8~343S·
V/70934355311;

DG.iitnat..:

'177.33

•W709343S5311i
1Bg1Zl1;9Q6,~

).50

'?!~c?j

-Qt;s:ZISKB59A.0Jiffi'.

fu,82

EGlil.51<868AA

•ll,J,1'7

'18

Irid.

10~4'
,ii;.i'

~

19
2.0
21

3.2

•!i1d,.

1

Rep!

':!~~!an,_~ as,w~'!_'lfo SPeCi~I:

ReRI. .~•,.,,.
'RTBackup'lamp
"J~ij~i,f'Uli:.,..._~. -~r,,L,'.
• ..

'DGl413404CC
DG1Z1~04~1

~·J ......,} ,...; ,';,,;-,':.;,.,..,:;._,,,_,,~.,, ..• ~,1,,;,.. ·<,.....---,;.,.;:--;.,,.,:;,

=•~c."=·•~· L•c;~s:.,;~~Jl:r;:•t,'c,

'.J,
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155:37

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Z!
1f.§I

®/>J. TLii_n1n,d]UWfii,;p_qil~r,

23

25

AJ!dlgr:~i~r:{o_a}
,Add'for.·iJnderside(tompleie)'

26

:M~ro,_ae~(eoar

24

it~' :~~Pl<!.le_"RQ)J~;

·27

,0:2i

IINTERGEPTQR;'

Rep/, :Wealiierstrip

'RDr' Seru
"& Measure'
--~---.

3ff

,#,

, Rpr .Pull Rfrear·

'Ji"' - ,REA,R-BQDY&_F_~(?O!I: -

32
):i
34_

:35,
}fi

AGtZ51'137l0Ac

!l

lni:32

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.

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B
..,,.~:,-~•- ~_:!:•~--,c----~~-~""'",,,.,.._ __,_~ -=--=,,,,._.,,.~•-.;,;..•---.c!t•-- -~.;;-...,;-.,-_;....,..-:;;f~
........ a;.._--;.:=,.;..=.

~·-~~

1

.:..;;:,µ-~,

'~!'Pt C,llj\ar•bii<:lypa~I

220.65

1:S

,0:4

Qj,,iii~~:Mai[!r:11dj)'ahel,Add iiirt;iearcoat1

:0'.3

·ii]

1\dci'for,lnside

0

'.0,.lld (of,O~f,yi_:il;

3i

kepi ,iii iiaii:exin,

38

ll),'pl 1'.~a·r tiifd~'panelleliK.1,i75

39

B.~- IR~!:<A@tn.~fu.~~~

Ii'

3fl8:~?; )j;
:5_1t9Ti&i
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£25'

o'.s

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:Preliminary l;sti'!l~

..,_,......__.

> ,••---=, ':,-• _-•:.;,•

T

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,Cilstcill\er; ·N1a1w '(oJk State·:Police· 21'70 j
_2014 FOR!>·Polic:eit½l'C:\ll!t!J(I\I\/It(l:liaet) 4D SED. 6°3.St:Turbochargeq ~91)~f,Gc$line_Dlrect:!nleclion Blua

:O:\i'eifat>.Miiiof Panel

'~

fl:epii :s~ppott, ,
~o:fi>r'tfelfr,tooi'

5Giz~ml760A,
BG!Z5411250A'

<I'!

!!~® RT•Roo,::ei<tii
ii.di! ibr.ctear coat

.>is

:Rep! s;1f1r1m

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48

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47

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AG12542il057A

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P.G1~541Q5"'26MPI

-67:27

,I:)

,7

"Add fi?r'O~sr Coat'

58

ReP,I Rf:1/Jneelho~•liner
llepJ :RT,"'-'l)~Jhause 11ner;mre1:,

sii

.i~epr; -~f~!!WP-W9!'!!ng
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·60,
6!

62,
63

¢'!~d~p~1;![n.ojf._~ij'~
,Repl• Oi-effiane'Giass'Kit

64 '#'
-.. 65
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66

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73_

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,c1ea:n ad!Lesiii•
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