New York State Licensed, Insured and Bonded Private Investigator License#11000074509
Date: June 26, 2007
Ms. XXXX XXXXXXXXXX Specialist 111 XXXXXXXXXX Insurance Company XXXXXXX Meadows Parkway, Syracuse, New York 13221 Phone- XXXXXXXX Re: Our Case # 07-117 Your Claim #XXXXXXXXXX Insured: XXXXXXXX General Contracting Claimant/Subject: XXXXXXXXXX DOB 07-24-1964 XXXXXXXXXAve Apt 1 White Plains, New York 10601 Type of Claim/Investigation: Surveillance Alleged Injury: Claims perm disability for her right shoulder and right knee/leg -post op Date Assigned: 06/01/2007 Date Investigated: 06/01-06/25/07 D/L: 6-9-05 SS# XXXXXXX
ASSIGNMENT Conduct Activity Check/Surveillance on Claimant to determine activity levels.
SUBJECTS PERSONAL INFORMATION Data information provided by Client/Investigator
PHYSICAL DESCRIPTION PROVIDED BY THE CLIENT None available
PERTINENT INFORMATION / DATA INFORMATION Employed XXXXX Restaurant-Westchester County, NY -Alleges as Cashier Data- no information provided by Client/Investigator IRB and DMV reveals following vehicles: 2007 Honda Civic LX XXXXX 2003 Lincoln Aviator XXXXXX, 1999 Ford Expedition, 1998 Ford Windstar, 1991 Ford Aeorstar, 1984 Jeep Cherokee, 1986 GMC Jimmy, 1982 Pontiac Firebird.
06/01/07 – Received file, conducted XXXXX search on subject.
06/02 /07 7:30PM Saturday – En route to Subject’s residence location
XXXXXXX, White Plains, New York. The following activity was noted: Location is a 3-family residence with parking in the street and behind the residence. None of subject’s registered vehicles were observed at location.
1013 MAMARONECK AVE • WHITE PLAINS, NEW YORK • 10605
PHONE/FAX: (914) 949 5634 • CELL: (914) 275-6255
Member ALDONYS-Associated Licensed Detectives of New York Member NAIS- National Association of Investigation Specialists
CFCLS-Certified Fraud Claim Law Specialist