Memo on water main additions and retaining wall project, May

NYC 9/11 Public Portal Document

03/10/2024 00:40 212-669-4980 PAGE 04/25

Offi of the New York City Comptroller N w York City Comptroller 1 Centre Street .4 New York. NY x 0007 ^ lm C 1.11i ForriVersion: NYC-COMPT•BLA•PD1•M

Property Damage or Loss Claim Form Claim must be filed in person or by registered orcertifed mail within 90 days of the occurrenceat the NYC Comptroller's Office, I Centre Street, Room 1225. New York, New York 10007. it must be notarized. If Claim is not resolved within 1yearand 90 days of the occurrence, you must start legal action to preserve your rights. TYPE OR PRINT I assn filing: On behalf of myself, On behalf of someone else. If on someone else's behalf, please provide the following information, C Attorney is filing. Last Name: Rodriguez - Attorney Information (if dalumant Is represented by attorney) I First Name: fLuiS Firm or Last Name:

Relationship to Firm or First Name: self the claimant: address: Address 2: Claimant Information City: "Last Name: [Rodriguez State: 'First Name: i.0IS .~— Zip Code: Address: Ta* ID Address 2: s _ Phone C: City: Email Address: State: ANEW YORK Zip Code. 10463 Country: Date of Birth: Format: MM/DDA"Y Soc. Set, C PII - -- .--.~ HICN: (Medicare a) n/a

Date ofDeath: n/a fF0rMot. MMA30AWY Phone: Email Address: PII Occupation: Rtt# ~a~o w'•yt'7 City Employee? ("'Yes CC No ^ NA Gender •(+^ Mate C Female C' Other

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NYC-WTC 000159261