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By Order of the Honorable Alvin K. Hellerstein, United States District Judge, dated June 22, 

2006, (“the Order”), Amended Master Complaints for all Plaintiffs were filed on August 18, 2006. 

NOTICE OF ADOPTION

All headings and paragraphs in the Master Complaint are applicable to and are adopted by the 

instant Plaintiff(s) as if fully set forth herein in addition to those paragraphs specific to the individual 

Plaintiff(s), which are listed below. These are marked with an “ ” if applicable to the instant Plaintiff(s), 

and specific case information is set forth, as needed, below.

Plaintiffs, DENNIS KOZAK, by his/her/their attorneys WORBY GRONER EDELMAN & 

NAPOLI BERN, LLP, complaining of Defendant(s), respectfully allege:

I. PARTIES

A. PLAINTIFF(S)

1. Plaintiff, DENNIS KOZAK (hereinafter the “Injured Plaintiff”), is an individual and a 

citizen of New York residing at 8 Uhl Street, Lake Ronkonkoma, NY 117792721.

(OR)

2. Alternatively, _______________ is the _____________ of Decedent 

_______________, and brings this claim in his (her) capacity as of the Estate of _______________.

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF NEW YORK

IN RE WORLD TRADE CENTER 

DISASTER SITE LITIGATION

21 MC 100 (AKH)

DENNIS KOZAK

Plaintiffs,

DOCKET NO. 

CHECK-OFF ("SHORT FORM") 

COMPLAINT

RELATED TO THE

MASTER COMPLAINT

 - against -

A RUSSO WRECKING, ET. AL.,

SEE ATTACHED RIDER,

 Defendants.

PLAINTIFF(S) DEMAND A TRIAL BY 

JURY

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3. Plaintiff, _________________ (hereinafter the "Derivative Plaintiff'), is a 

citizen of ________________ residing at ________________, and has the following relationship to the 

Injured Plaintiff:

SPOUSE at all relevant times herein, is and has been lawfully married to Plaintiff 

_____________, and brings this derivative action for her (his) loss due to the 

injuries sustained by her husband (his wife), Plaintiff _____________.

Parent Child Other: ______________________________

4. In the period from 9/11/2001 to 9/19/2001 the Injured Plaintiff worked for AMEC 

Construction as a ironworker at:

====================================

 The World Trade Center Site 

Location(s) (i.e., building, quadrant, etc.)________

_________________________________________

From on or about _9/11/2001_ until _9/19/2001_; 

Approximately _14_ hours per day; for

Approximately _14_ days total.

====================================

 The New York City Medical Examiner's Office 

From on or about _______ until _______, 

Approximately ________ hours per day; for

Approximately ________ days total.

====================================

 The Fresh Kills Landfill 

From on or about _______ until _______; 

Approximately ________ hours per day; for

Approximately ________ days total.

====================================

====================================

 The Barge 

From on or about _______ until ______; 

Approximately ________ hours per day; for

Approximately ________ days total.

====================================

 Other:* For injured plaintiffs who worked at 

Non-WTC Site building or location. The injured 

plaintiff worked at the address/location, for the 

dates alleged, for the hours per day, for the total 

days, and for the employer, as specified below: 

From on or about ______ until ______; 

Approximately ________ hours per day; for

Approximately ________ days total;

Name and Address of Non-WTC Site 

Building/Worksite: _________________

__________________________________

*Continue this information on a separate sheet of paper if necessary. If more space is needed to specify 

"Other" locations, please annex a separate sheet of paper with the information.

5. Injured Plaintiff 

Was exposed to and breathed noxious fumes on all dates, at the site(s) indicated 

above;

Was exposed to and inhaled or ingested toxic substances and particulates on all 

dates at the site(s) indicated above;

Was exposed to and absorbed or touched toxic or caustic substances on all dates at 

the site(s) indicated above;

Other: Not yet determined.________________________________

Please be as specific as possible when filling in the following dates and locations

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 6. Injured Plaintiff 

Has not made a claim to the Victim Compensation Fund. Pursuant to 

§405(c)(3)(B)(i) of the Air Transportation Safety and System Stabilization Act, 49 

U.S.C. § 40101, the issue of waiver is inapplicable.

Made a claim to the Victim Compensation Fund that was denied. Pursuant to § 

405(c)(3)(B)(i) of the Air Transportation Safety and System Stabilization Act, 49 

U.S.C. § 40101, the issue of waiver is inapplicable.

Made a claim to the Victim Compensation Fund, that was subsequently withdrawn 

by Ground-Zero Plaintiff. Pursuant to § 405(c)(3)(B)(i) of the Air Transportation 

Safety and System Stabilization Act, 49 U.S.C. § 40101, the issue of waiver is 

inapplicable.

Made a claim to the Victim Compensation Fund that was granted. Pursuant to § 

405(c)(3)(B)(i) of the Air Transportation Safety and System Stabilization Act, 49 

U.S.C. § 40101, Ground Zero-Plaintiff has waived her/his right(s) to pursue any 

further legal action for the injuries identified in said claim.

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B. DEFENDANT(S)

The following is a list of all Defendant(s) named in the Master Complaint. If checked, all 

paragraphs pertaining to that Defendant are deemed pleaded herein.

_____________________________________________________________________________________

THE CITY OF NEW YORK

 A Notice of Claim was timely filed and 

served on _________ and 

 pursuant to General Municipal Law §50-

h the CITY held a hearing on _________ (OR)

 The City has yet to hold a hearing as 

required by General Municipal Law §50-h

 More than thirty days have passed and 

the City has not adjusted the claim

(OR)

 An Order to Show Cause application to

 deem Plaintiff’s (Plaintiffs’) Notice of 

Claim timely filed, or in the alternative to grant 

Plaintiff(s) leave to file a late Notice of Claim 

Nunc Pro Tunc (for leave to file a late Notice of 

Claim Nunc Pro Tunc) has been filed and a 

determination

 is pending

 Granting petition was made on _______

 Denying petition was made on _______

====================================

 PORT AUTHORITY OF NEW YORK AND 

NEW JERSEY ["PORT AUTHORITY"] 

 A Notice of Claim was filed and served 

pursuant to Chapter 179, §7 of The 

Unconsolidated Laws of the State of New 

York on 

 More than sixty days have elapsed since 

the Notice of Claim was filed, (and) 

 the PORT AUTHORITY has 

adjusted this claim

 the PORT AUTHORITY has not 

adjusted this claim.

====================================

1 WORLD TRADE CENTER, LLC

1 WTC HOLDINGS, LLC

2 WORLD TRADE CENTER, LLC

2 WTC HOLDINGS, LLC

4 WORLD TRADE CENTER, LLC

4 WTC HOLDINGS, LLC

5 WORLD TRADE CENTER, LLC

5 WTC HOLDINGS, LLC

 7 WORLD TRADE COMPANY, L.P.

A RUSSO WRECKING

ABM INDUSTRIES, INC.

ABM JANITORIAL NORTHEAST, INC.

AMEC CONSTRUCTION MANAGEMENT, 

INC.

AMEC EARTH & ENVIRONMENTAL, INC.

ANTHONY CORTESE SPECIALIZED 

HAULING, LLC, INC.

ATLANTIC HEYDT CORP

BECHTEL ASSOCIATES PROFESSIONAL 

CORPORATION

BECHTEL CONSTRUCTION, INC.

BECHTEL CORPORATION

BECHTEL ENVIRONMENTAL, INC.

BERKEL & COMPANY, CONTRACTORS, 

INC.

BIG APPLE WRECKING & CONSTRUCTION 

CORP

BOVIS LEND LEASE, INC.

BOVIS LEND LEASE LMB, INC.

BREEZE CARTING CORP

BREEZE NATIONAL, INC.

BRER-FOUR TRANSPORTATION CORP.

BURO HAPPOLD CONSULTING ENGINEERS, 

P.C.

C.B. CONTRACTING CORP

CANRON CONSTRUCTION CORP

CONSOLIDATED EDISON COMPANY OF 

NEW YORK, INC.

CORD CONTRACTING CO., INC

CRAIG TEST BORING COMPANY INC.

DAKOTA DEMO-TECH

DIAMOND POINT EXCAVATING CORP

DIEGO CONSTRUCTION, INC.

DIVERSIFIED CARTING, INC.

DMT ENTERPRISE, INC.

D'ONOFRIO GENERAL CONTRACTORS 

CORP

EAGLE LEASING & INDUSTRIAL SUPPLY

EAGLE ONE ROOFING CONTRACTORS INC.

EAGLE SCAFFOLDING CO, INC.

EJ DAVIES, INC.

EN-TECH CORP

ET ENVIRONMENTAL

EVANS ENVIRONMENTAL

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EVERGREEN RECYCLING OF CORONA

EWELL W. FINLEY, P.C.

EXECUTIVE MEDICAL SERVICES, P.C.

F&G MECHANICAL, INC.

FLEET TRUCKING, INC.

FRANCIS A. LEE COMPANY, A 

CORPORATION

FTI TRUCKING

GILSANZ MURRAY STEFICEK, LLP

GOLDSTEIN ASSOCIATES CONSULTING 

ENGINEERS, PLLC

HALLEN WELDING SERVICE, INC.

H.P. ENVIRONMENTAL

HUDSON MERIDIAN CONSTRUCTION GROUP, LLC 

F/K/A MERIDIAN CONSTRUCTION CORP.

KOCH SKANSKA INC.

LAQUILA CONSTRUCTION INC

LASTRADA GENERAL CONTRACTING 

CORP

LESLIE E. ROBERTSON ASSOCIATES 

CONSULTING ENGINEER P.C.

LIBERTY MUTUAL GROUP

LOCKWOOD KESSLER & BARTLETT, INC.

LUCIUS PITKIN, INC

LZA TECH-DIV OF THORTON TOMASETTI

MANAFORT BROTHERS, INC.

MAZZOCCHI WRECKING, INC.

MORETRENCH AMERICAN CORP.

MRA ENGINEERING P.C.

MUESER RUTLEDGE CONSULTING 

ENGINEERS

NACIREMA INDUSTRIES INCORPORATED

NEW YORK CRANE & EQUIPMENT CORP.

NICHOLSON CONSTRUCTION COMPANY

PETER SCALAMANDRE & SONS, INC.

PHILLIPS AND JORDAN, INC.

PINNACLE ENVIRONMENTAL CORP

PLAZA CONSTRUCTION CORP.

PRO SAFETY SERVICES, LLC

PT & L CONTRACTING CORP

REGIONAL SCAFFOLD & HOISTING CO, 

INC.

ROBER SILMAN ASSOCIATES

ROBERT L GEROSA, INC

RODAR ENTERPRISES, INC.

ROYAL GM INC.

SAB TRUCKING INC.

SAFEWAY ENVIRONMENTAL CORP

SEASONS INDUSTRIAL CONTRACTING

SEMCOR EQUIPMENT & MANUFACTURING 

CORP. 

SILVERITE CONTRACTING CORPORATION

SILVERSTEIN PROPERTIES

SILVERSTEIN PROPERTIES, INC.

SILVERSTEIN WTC FACILITY MANAGER, 

LLC

SILVERSTEIN WTC, LLC

SILVERSTEIN WTC MANAGEMENT CO., 

LLC

SILVERSTEIN WTC PROPERTIES, LLC

SILVERSTEIN DEVELOPMENT CORP.

SILVERSTEIN WTC PROPERTIES LLC

SIMPSON GUMPERTZ & HEGER INC

SKIDMORE OWINGS & MERRILL LLP

SURVIVAIR

TAYLOR RECYCLING FACILITY LLC

TISHMAN INTERIORS CORPORATION,

TISHMAN SPEYER PROPERTIES,

TISHMAN CONSTRUCTION

CORPORATION OF MANHATTAN

TISHMAN CONSTRUCTION

CORPORATION OF NEW YORK

THORNTON-TOMASETTI GROUP, INC.

TORRETTA TRUCKING, INC

TOTAL SAFETY CONSULTING, L.L.C

TUCCI EQUIPMENT RENTAL CORP

TULLY CONSTRUCTION CO., INC.

TULLY ENVIRONMENTAL INC.

TULLY INDUSTRIES, INC.

TURNER CONSTRUCTION CO.

TURNER CONSTRUCTION COMPANY

ULTIMATE DEMOLITIONS/CS HAULING

VERIZON NEW YORK INC,

VOLLMER ASSOCIATES LLP

W HARRIS & SONS INC

WEEKS MARINE, INC.

WEIDLINGER ASSOCIATES, CONSULTING 

ENGINEERS, P.C.

WHITNEY CONTRACTING INC.

WOLKOW-BRAKER ROOFING CORP

WORLD TRADE CENTER PROPERTIES, 

LLC

WSP CANTOR SEINUK GROUP

YANNUZZI & SONS INC

YONKERS CONTRACTING COMPANY, INC.

YORK HUNTER CONSTRUCTION, LLC

 ZIEGENFUSS DRILLING, INC.

 OTHER: ____________________________

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 Non-WTC Site Building Owner

 Name: ________________________________

 Business/Service Address: ________________

 Building/Worksite Address: _______________

 Non-WTC Site Lessee

 Name: ________________________________

 Business/Service Address: ________________

 Building/Worksite Address: _______________

 Non-WTC Site Building Managing Agent

 Name: ________________________________

 Business/Service Address: ________________

 Building/Worksite Address: _______________

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II. JURISDICTION

The Court’s jurisdiction over the subject matter of this action is:

 Founded upon Federal Question Jurisdiction; specifically; ; Air Transport Safety & System 

Stabilization Act of 2001, (or); Federal Officers Jurisdiction, (or); Other (specify): 

____________________________; Contested, but the Court has already determined that it has 

removal jurisdiction over this action, pursuant to 28 U.S.C. § 1441.

III CAUSES OF ACTION

Plaintiff(s) seeks damages against the above named defendants based upon the following theories 

of liability, and asserts each element necessary to establish such a claim under the applicable substantive 

law:

Breach of the defendants' duties and 

obligations pursuant to the New York 

State Labor Law(s) including §§ 200 

and 240

Common Law Negligence, including 

allegations of Fraud and Misrepresentation

Breach of the defendants' duties and 

obligations pursuant to the New York 

State Labor Law 241(6)

 Air Quality;

 Effectiveness of Mask Provided;

 Effectiveness of Other Safety Equipment 

Provided 

Pursuant to New York General Municipal 

Law §205-a

(specify: __________________________);

 Other(specify): Not yet determined.__

Pursuant to New York General Municipal 

Law §205-e

Wrongful Death

Loss of Services/Loss of Consortium for 

Derivative Plaintiff

 Other: _______________________________

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IV CAUSATION, INJURY AND DAMAGE

1. As a direct and proximate result of defendant’s culpable actions in the rescue and/or 

recovery and/or construction, renovation, alteration, demolition and all work performed at the premises,

the Injured Plaintiff sustained (including, but not limited to) the following injuries:

Cancer Injury: N/A.

Date of onset: ______________

Date physician first connected this injury to 

WTC work: ______________

Cardiovascular Injury: Chest Pain

Date of onset: To be supplied at a later 

date

Date physician first connected this injury 

to WTC work: To be supplied at a later 

date

Respiratory Injury: Cough; Shortness of 

Breath; Wheezing

Date of onset: 10/23/2006

Date physician first connected this injury to 

WTC work: To be supplied at a later date

Fear of Cancer

Date of onset: 10/23/2006

Date physician first connected this injury 

to WTC work: To be supplied at a later 

date

Digestive Injury: Heartburn/acid 

reflux/GERD

Date of onset: 10/23/2006

Date physician first connected this injury to 

WTC work: To be supplied at a later date

Other Injury: Chronic Headaches; Sleep 

Problems; Sleeping Problems

Date of onset: 10/23/2006

Date physician first connected this injury 

to WTC work: To be supplied at a later

date

NOTE: The foregoing is NOT an exhaustive list of injuries that may be alleged.

2. As a direct and proximate result of the injuries identified in paragraph "1 ", above, the 

Ground Zero-Plaintiff has in the past suffered and/or will in the future suffer the following compensable 

damages:

===========================================================================

Pain and suffering

Loss of the enjoyment of life

Loss of earnings and/or impairment of 

earning capacity

Loss of retirement benefits/diminution of 

retirement benefits

Expenses for medical care, treatment, and

rehabilitation

Other: 

 Mental anguish

 Disability

 Medical monitoring

 Other: Not yet determined.__________

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===========================================================================

3. As a direct and proximate result of the injuries described supra, the derivative 

plaintiff(s), if any, have in the past suffered and/or will in the future suffer a loss of the love, society, 

companionship, services, affection, and support of the plaintiff and such other losses, injuries and 

damages for which compensation is legally appropriate.

WHEREFORE, plaintiff(s) respectfully pray that the Court enter judgment in his/her/their favor 

and against defendant(s) for damages, costs of suit and such other, further and different relief as may be 

just and appropriate.

Plaintiff(s) demands that all issues of fact in this case be tried before a properly empanelled 

jury.

Dated: New York, New York

April 25, 2007

Yours, etc.,

Worby, Groner Edelman & Napoli Bern, LLP

Attorneys for Plaintiff(s), Dennis Kozak

By: ________________________________

Christopher R. LoPalo (CL 6466)

115 Broadway

12th Floor

New York, New York 10006

Phone: (212) 267-3700

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ATTORNEY VERIFICATION

CHRISTOPHER R. LOPALO, an attorney at law, duly admitted to practice 

in the Courts of the State of New York, affirms under the penalties of 

perjury that:

He is the attorney for the plaintiff(s) in the above-entitled action. 

That he has read the foregoing SUMMONS AND VERIFIED COMPLAINT and knows 

the contents thereof, and upon information and belief, deponent believes 

the matters alleged therein to be true.

The reason this Verification is made by deponent and not by the 

plaintiff(s) is that the plaintiff(s) herein reside(s) in a county other 

than the one in which the plaintiff's attorneys maintain their office.

The source of deponent's information and the grounds of his belief 

are communication, papers, reports and investigation contained in the 

file.

DATED: New York, New York

April 25, 2007

_________________________

CHRISTOPHER R. LOPALO

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Docket No:

 UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF NEW YORK

=======================================================================

DENNIS KOZAK,

Plaintiff(s)

- against -

A RUSSO WRECKING, ET. AL.,

Defendant(s).

=======================================================================

SUMMONS AND VERIFIED COMPLAINT

=======================================================================

WORBY GRONER EDELMAN & NAPOLI BERN, LLP

Attorneys for: Plaintiff(s)

Office and Post Office Address, Telephone

115 Broadway - 12th Floor

New York, New York 10006

(212) 267-3700

=======================================================================

To

Attorney(s) for

=======================================================================

Service of a copy of the within

is hereby admitted.

Dated,

________________________________

Attorney(s) for

=======================================================================

PLEASE TAKE NOTICE:

 NOTICE OF ENTRY

that the within is a (certified) true copy of an 

duly entered in the office of the clerk of the within named court on 20__

NOTICE OF SETTLEMENT

that an order of which the within is a true copy

will be presented for settlement to the HON. one of the 

judges of the

within named Court, at

on 20 at M.

Dated,

Yours, etc.,

WORBY GRONER EDELMAN & NAPOLI BERN, LLP

=======================================================================

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