SUPREM E COURT OF THE STATE OF NEW YORK COUNTY OF _______________________________ __________________________________________________x Plaintiff(s)/Petitioner(s) U C S -840C 3/2011 Index No. __________________________________ RJI No. (if any) _____________________________ -against- COMMERCIAL DIVISION __________________________________________________x Defendant(s)/Respondent(s) Request for Judicial Intervention Addendum COM PLETE W HERE APPLICABLE [add additional pages if needed]: Plaintiff/Petitioner's cause(s) of action [check all that apply]: G G G G G G G G G G G G Breach of contract or fiduciary duty, fraud, misrepresentation, business tort (e.g. unfair competition), or statutory and/or common law violation where the breach or violation is alleged to arise out of business dealings (e.g. sales of assets or securities; corporate restructuring; partnership, shareholder, joint venture, and other business agreements; trade secrets; restrictive covenants; and employment agreements not including claims that principally involve alleged discriminatory practices) Transactions governed by the Uniform Commercial Code (exclusive of those concerning individual cooperative or condominium units) Transactions involving commercial real property, including Yellowstone injunctions and excluding actions for the payment of rent only Shareholder derivative actions -- without consideration of the monetary threshold Commercial class actions -- without consideration of the monetary threshold Business transactions involving or arising out of dealings with commercial banks and other financial institutions Internal affairs of business organizations Malpractice by accountants or actuaries, and legal malpractice arising out of representation in commercial matters Environmental insurance coverage Commercial insurance coverage (e.g. directors and officers, errors and omissions, and business interruption coverage) Dissolution of corporations, partnerships, limited liability companies, limited liability partnerships and joint ventures -- without consideration of the monetary threshold Applications to stay or compel arbitration and affirm or disaffirm arbitration awards and related injunctive relief pursuant to CPLR Article 75 involving any of the foregoing enumerated commercial issues -- without consideration of the monetary threshold Plaintiff/Petitioner's claim for compensatory damages [exclusive of punitive damages, interest, costs and counsel fees claimed]: $ _______________________________________________________________________________________ Plaintiff/Petitioner's claim for equitable or declaratory relief [brief description]: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Defendant/Respondent's counterclaim(s) [brief description, including claim for monetary relief]: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ I REQUEST THAT THIS CASE BE ASSIGNED TO THE COM M ERCIAL DIVISION. I CERTIFY THAT THE CASE M EETS THE JURISDICTIONAL REQUIREM ENTS OF THE COM M ERCIAL DIVISION SET FORTH IN 22 NYCRR § 202.70(a), (b) AND (c). Dated: ________________________ __________________________________________ SIGNATURE __________________________________________ PRINT OR TYPE NAM E American LegalNet, Inc. www.FormsWorkFlow.com