Form 201

(9) State whether any insurer, as described in Interrogatories #7 and #8 above, has disclaimed/

reserved its duty to indemnify any insured or any other person protected by said policy.

(10) If applicable, describe in detail the damage to your vehicle.

(11) If applicable, please state the name and address of an appraiser or firm which appraised or

repaired the damage to the vehicle owned or operated by you.

(12) If any of the Defendants are deceased, please state the date and place of death, whether an

estate has been created, and the name and address of the legal representative thereof.

(13) If any of the Defendants is a business entity that has changed its name or status as a business

entity (whether by dissolution, merger, acquisition, name change, or in any other manner) since the

date of the incident alleged in the Complaint, please identify such Defendant, state the date of the

change, and describe the change.

(14) If you were the operator of any motor vehicle involved in the incident that is the subject of this

action, please state whether, at the time of the incident, you were operating that vehicle in the course

of your employment with any person or legal entity not named as a party to this lawsuit, and, if so,

state the full name and address of that person or entity.

(15) If you were the operator of any motor vehicle involved in the incident that is the subject of this

action, please state whether you consumed or used any alcoholic beverages, drugs or medications

within the eight (8) hours next preceding the time of the incident alleged in the Complaint and, if so,

indicate what you consumed or used, how much you consumed, and when.

(16) Please state whether, within eight (8) hours after the incident alleged in the Complaint, any

testing was performed to determine the presence of alcohol, drugs or other medications in your blood,

and, if so, state:

(a) the name and address of the hospital, person or entity performing such test or screen;

(b) the date and time;

dicate what you consumed or used, how much you consumed, and when.

(16) Please state whether, within eight (8) hours after the incident alleged in the Complaint, any

testing was performed to determine the presence of alcohol, drugs or other medications in your blood,

and, if so, state:

(a) the name and address of the hospital, person or entity performing such test or screen;

(b) the date and time;

(c) the results.

(17) Please identify surveillance material discoverable under Practice Book Section 13-3 (c), by

stating the name and address of any person who obtained or prepared any and all recordings by film,

photograph, video, audio or any other digital or electronic means, of any party concerning this lawsuit

or its subject matter, including any transcript thereof which are in your possession or control or in the

possession or control of your attorney, and state the date on which each such recordings were obtained

and the person or persons of whom each such recording was made.

(18) If you were the operator of any motor vehicle involved in the incident that is the subject of this

action, please state whether you were using a cell phone for any activity including, but not limited to,

calling, texting, emailing, posting, tweeting, or visiting sites on the Internet for any purpose, at or

immediately prior to the time of the incident.

PLAINTIFF,

BY