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eCLAIM Receipt

You have successfully filed your claim.

By successfully filing your claim, you have certified that all information provided is true and correct to
the best of your knowledge and belief. You also understand that the willful making of any false
statement of material fact herein may subject you to criminal penalties and civil liabilities.

Please allow up to 30 days to receive an email acknowledging your claim.

If you have any questions please contact 212-669-3916.

Your Receipt Number is the following:

201800044748

You uploaded:
Claim Form: 1
Supporting Documents:1

5/24/2018 9:47 AM
Claimant Last Name:Powell
Claimant First Name:Karim
Office of the New York City Comptroller
1 Centre Street
New York City Comptroller
New York, NY 10007
Scott M. Stringer
Form Version: NYC-COMPT-BLA-PI1-D

Personal Injury Claim Form


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

I am filing: C On behalf of myself. (•'. Attorney is filing.


On behalf of someone else. If on someone else's Attorney Informat on (If claimant is represented by attorney)
behalf, please provide the following information.
Firm or Last Name: The Sanders Firm, P.C.
Last Name:
Firm or First Name:
First Name:
Address: 30 Wall Street
Relationship to
the claimant: Address 2: 8th Floor
City: New York
State: NEW YORK
Claimant Information
Zip Code: 10005
*Last Name: Powell
Tax ID:
*First Name: Karim
Phone #: (212) 652-2782
*Address:
*Email Address: esanders@thesandersfirmpc.com
Address 2:
*Retype Email
*City: esanders@thesandersfirmpc.com
Address:
*State:
The time and place where the claim arose
*Zip Code:
*Date of Incident: 03/27/2017 Format: MM/DD/YYYY
*Country: USA
Time of Incident: Format: HH:MM AM/PM
Date of Birth: Format: MM/DD/YYYY
*Location of Several locations within the service area of
Soc. Sec. # Incident: the 47th Precinct
HICN:
(Medicare #)
Date of Death: Format: MM/DD/YYYY
Phone:
*Email Address:
*Retype Email
Address:
Occupation: NYPD Police Officer
City Employee? Yes No C NA
Gender G Male C Female C Other
Address: 4111 Laconia Avenue
Address 2:
City: Bronx
*State: NEW YORK
Borough: BRONX
*Denotes required fields. A Claimant OR an AttorneyEmailAddress is required.
Office of the New York City Comptroller
1 Centre Street
New York City Comptroller
New York, NY 10007
Scott M. Stringer

*Manner in which
claim arose:
-See Attached-

*Denotes required field.


Office of the New York City Comptroller
1 Centre Street
New York City Comptroller
New York, NY 10007
Scott M. Stringer

The items of $5 Million Dollars (Mental Anguish and Punitive Damages)


damage or injuries
claimed are
(include dollar
amounts):
Office of the New York City Comptroller
1 Centre Street
New York City Comptroller
New York, NY 10007
Scott M. Stringer

Medical Information Witness 1Information

1st Treatment Date: Format: MM/DD/YYYY Last Name:


Hospital/Name: First Name:
Address: Address
Address 2: Address 2:
City: City:
State: State:
Zip Code: Zip Code: Phone:
Date Treated in Format: MM/DD/YYYY
Witness 2 Information
Emergency Room:
Was claimant taken to hospital by C Yes C No NA Last Name:
an ambulance?
First Name:
Employment Information (If claiming lost wages) Address
Employer's Name: Address 2:
Address City:
Address 2: State:
City: Zip Code: Phone:

State: Witness 3 Information


Zip Code:
Last Name:
Work Days Lost:
First Name:
Amount Earned
Weekly: Address
Address 2:
Treating Physician Information
City:
Last Name:
State:
First Name:
Zip Code: Phone:
Address:
Witness 4 Information
Address 2:
City: Last Name:
State: First Name:
Zip Code: Address
Address 2:
City:
State:
Zip Code: Phone:
Office of the New York City Comptroller
1 Centre Street
New York City Comptroller
New York, NY 10007
Scott M. Stringer

Complete if claim involves a NYC vehicle

Owner of vehicle claimant was traveling in Non-City vehicle driver

Last Name: Last Name:


First Name: First Name:
Address Address
Address 2: Address 2:
City: City:
State: State:
Zip Code: Zip Code:

Insurance Information Non-City vehicle information

Insurance Company Make, Model, Year


Name: of Vehicle:
Address Plate #:
Address 2: VIN #:
City: City vehicle information
State:
Plate #:
Zip Code:
Policy #:
Phone #: City Driver Last
Name:
Description of C Driver Passenger City Driver First
claimant: Name:
Pedestrian (`Bicyclist
C Motorcyclist 4•' Other

Total Amount Format: Do not include "$" or 7.


$5,000,000.00
Claimed:

The Total Amount Claimed can only be entered once the following
required fields are entered:

Claimant Last Name


Claimant First Name
Claimant Address,City,State,Zip Code, and Country
Claimant Email or Attorney Email
Date ofIncident
Location ofIncident (including State)
Manner in which claim arose

I certify that allinformation contained in this notice is true and correct to the best ofmy knowledge and belief I understand that the willful
making ofany false statement ofmaterial fact herein will subject me to criminalpenalties and civil liabilities.
Claimant self-identifies as a Jamaican Male.

Claimant alleges that on March 27, 2017, he was operating a 2001 Honda Accord traveling
southbound on Paulding Avenue.

Claimant alleges that after traveling onto Colden Avenue he noticed a marked RMP behind with
its lights activated.

Claimant alleges that he immediately pulled over to a safe portion of the roadway. The RMP
stopped behind him. The RMP was occupied with 2 Caucasian male police officers.

Claimant alleges that over the intercom, one of the officers demanded he turn off the vehicle and
place the ignition key upon the roof.

Claimant alleges that the operator approached the driver side of the vehicle and requested his
driver's license and registration.

Claimant alleges that he replied, "I'm on the job."

Claimant alleges that he's right hand dominant and was armed at the time.

Claimant alleges that consistent with the department policy, he reached for his NYPD shield and
identification card in his left front pocket. The police credentials were carried in a standard issue
shield and ID holder.

Claimant alleges that the officer 'claimed' he couldn't see it, so the police credentials were
handed to him.

Claimant alleges that the officer inspected the police credentials and returned them to him.

Claimant alleges that the recorder then approached the driver side, 'seized' his ignition key and
said, "Fuck that shit!"

Claimant alleges the recorder walked away with the ignition key while talking on a cellular
telephone.

Claimant alleges that approximately 3-5 mins later, the recorder ordered him to step out of his
vehicle.

Claimant alleges that the recorder then demanded his NYPD identification card again or
threatened to place him in handcuffs.

Claimant alleges that the recorder said, "He's in charge."

Claimant alleges that he asked the recorder "What's this about?"


Claimant alleges that the recorder then ordered him to turn around. The recorder then arrested
him for some 'unknown' violation of the law.

Claimant alleges that the recorder asked him if he was going to call CCRB.

Claimant alleges that the operator didn't intervene.

Claimant alleges that neither the operator nor the recorder requested a police supervisor consist
with department policy.

Claimant alleges that the officers had him standing outside in handcuffs.

Claimant alleges that approximately 10-15 minutes, the patrol supervisor (Caucasian Male)
arrived.

Claimant alleges that the patrol supervisor ordered the officers to place him into his marked
RMP.

Claimant alleges that approximately 3-5 minutes later, the operator removed the handcuffs.

Claimant alleges that approximately 3-5 minutes later, the platoon commander arrived and
ordered him to surrender his firearm and police credentials.

Claimant alleges that the platoon commander ordered the patrol supervisor to transport him to
report to the 47th Precinct.

Claimant alleges that the police 'seized' his vehicle.

Claimant alleges upon arrival, he met with a PBA Delegate (Caucasian Male) and relayed the
aforementioned to him.

Claimant alleges that as required by department policy, the PBA Delegate failed to notify the
Internal Affairs Bureau.

Claimant alleges that the PBA Delegate told him that the operator and recorder accused him of
`evasive' driving.

Claimant alleges that the PBA Delegate told him that the recorder 'knew' him from a prior
interaction regarding a parked vehicle.

Claimant alleges that as required by department policy, the PBA Delegate failed to notify the
Internal Affairs Bureau.

Claimant alleges that, he told the PBA Delegate the officers are 'lying' and the GPS data from
their assigned marked RMP will prove it.
Claimant alleges that the PBA Delegate 'discouraged' him from challenging the 'veracity' of the
officers' claims.

Claimant alleges that the PBA Delegate told him, just answer the questions and don't offer
anything else.

Claimant alleges that after about 5.5 hours in police custody, he was interviewed by the Duty
Captain (Caucasian Male) and then held another 2 hours or so.

Claimant alleges that shortly thereafter, a Lieutenant (Caucasian Male) assigned to Bronx
Investigations told him he was placed on 'Modified Duty' status and told to report to the
Identification Section to obtain a new police identification card.

Claimant alleges that shortly thereafter, the Department Advocate's Office served him with
Charges and Specifications accusing him of 'failure to show ID.'

Claimant alleges that on April 3, 2017, he was transferred to Brooklyn Central Booking.

Claimant alleges that on April 11, 2018, he was 'restored' to 'Full Duty' status and transferred to
the 114th Precinct.