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HomeMy Public PortalAboutPRR 17-2553TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered in person June 2, 2017 Robert McAliley Re: GS #2553 (Verbal Request for Incident Report 17-1034) Request is verbal for Incident Report 17-1034. Dear Robert McAliley: The Town of Gulf Stream has received your verbal public records request. The original public records request can be found at the following link: http://www2.gulf-stream.org/weblink/0/doc/111307/Page1.aspx Your request was answered while you waited. We consider this request closed. Sincerely, Reneé Rowan Basel As requested by Rita Taylor Town Clerk, Custodian of the Records Sworn Statement for Traffic Crash Report Information Motor Vehicle crash information is confidential and exempt from disclosure for a period of 60 days after the crash report is filed. §316.066(2)la) Florida Statutes (2014). Obtaining confidential information by someone who knows they are not entitled to do so Is a felony violation. The undersigned requests the following crash report (date/location/parties: The undersigned states that he/she or the organization represented qualify for immediate disclosure of the crash report according to the exemption checked below and does swear or affirm that the information contained in a crash report made confidential by statute will not be used for any commercial solicitation of accident victims, or knowingly be disclosed to any third party for the purpose of such solicitation, during the period of time that the information remains confidential. _ I am a party involved in the crash _ I am a legal representative to a party involved in the crash: Florida Bar Number _ 1 am a licensed insurance agent to a party involved in the crash, their insurer or insurers to which they applied for Insurance coverage, Florida License Number _ I am a person under contract to provide claims or underwriting In formation to a qualifying insurance company, Identified as: I am a prosecuting authority, Florida Bar Number I represent a radio or television station licensed by the FCC or newspaper qualified to publish legal notices or a free newspaper of general circulation, as defined in 316.066(2)(b) Florida Statutes. Name of Radio/Television/Newspaper I represent a local, state or federal agency that is authorized by law to have access to these reports. Name of local/state/federal agency _ I represent a Victim Services Program, as defined in §316.003(85), Florida Statutes (2014). Name of Program: Agency/Business/Represented Address (Area Code) Telephone Number City, State, Zip Code State of Florida, County of PAGn I' oA Sworn (or affirmed)agd subscribed before me this 2 � day of J e 20(� by Personally known_or Produced Identification—Type of Identification Produced: Print Type or Stamp, Commissioned Name of Notary HSMV-44010 (Rev.12/14) P mL RENEE' ROWAN BASEL MOY,4F Notary Public -State of Floritla Comrrmsmn a GG 025209 My Cor,,,.. I .pees Aug 20. 2020 %P,"e Bonn, :n National Notary Assn. FLORIDA TRAFFIC CRASH REPORT LONGFORM® SHII I UPDATE (shaded Neu) MAIL TO: DEPARTMENT OF HIGHWAY SAFETY & MOTOR VEHICLES TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING TALLAHASSEE, FL 32399-0537 TOTAL # OF VEHICLE SECTION(S) TOTAL # OF PERSON SECTION(S) 2 TOTAL # OF NARRATIVE SECTION(S) 1 CRASH GATE TIME OF CRASH DATE OF REPORT MPORTING AGENCY CASE NUMBER HSMV CRASH REPORTNUMeER 05/27/2017 9:25 AM 05/27/2017 17-1034 84212038 COUNiY CODE CRY CODE COUNfY OF CRASH PLACE OR CRY OF CRASH CHEIXIF WTRIIN TIME REPORTED TME DISPATCHED tCWH 44 PALM BEACH GULF STREAM 3 U7mrrS 925 AM 9:25 AM ME [!EARED SCENE CHECK IF REASON (Hlnvestlgatlon NOT Comlete)M 10:10 AM COMPLETED � Notified By:1 Motorist2 Law Enforcement tilvillilsCURRED ON STREET, ROAD, HIGHWAY •ATSTREE I ADORE55 N S AT IATITUOE AND LONGIr71DE EAN BLVD. (S.R. A1A)MILES N S E W FROM INTERSECTION WITH STREETROAD, HIGHWAYSEA RD. OR FROM MILEPOST# Road System Identifier 7 Forest Road Type of Shoulder Type of Intersection iInterstate 4County 8 Private Roadway5 TraRk Circle 2 US. 5 Leal 9 Parking Lo[ ❑ 1 Paved 1 Not at Intersection 6 Roundabout 35nte 6Turnpike/Toll ]]Other, Explain In 2 2Unpaved ZPour•Way lntersectlon 7FWa-Point, or More Narrative 3Curh 3T -Intersection 77 Other, Ex plain In Narrative e• e 4 Y•Intersectton Light Condltl5on Weather Condition Roadway Surface Condition School Bus Related Manner of Collisionlimpact ❑ 1 DayllBht N= Dark•Not UeMed 4 Fo&Smogg,, Smoke 5 Oil 1 No 1 2Dusk 60ark•Unknown 551eet/Hall/ 6Mud Dirt, Gravel lyes, School But 451deswi 3 Dawn Uyhtin{ 1 Froexing Rain 1 ]Sand i pe, Same Direction 4 Dark•UBhted imtive Explain In plRlowinB Sand, Soil, BWater standin ❑fly Involved SSldeswipe, Opposite Direction ( 8/ 3 Yes, School Bus 6 Rear to Side all Unknown 2awd 7 Severe Crosswinds IDry 77 mvthe)r Explain Indl;aly Involved 1 Front to Rear 7Rear to Rear 3 Rainy 77 Other, Explain In 2 Wet In Nanat)ve 2 Front to Front 77 Other, Explain In Narrative Negative 41ce/frost gg Unknown 3 Angle 88 Unknown First Harmful Event Non -Collision Cclllsion Non•Hrold Object Collision with Flied Object 1 Cyertum/Rollover io Pedestrian First Harmful Event 1i 2F Explosion Sl Pedal de 191mpactAttenuator/Cash 30 ConcreteTnlflcBarrier Location 3lmmenlon Cushion 310ther7nfflc Gamier IOn Roadway 32 Railway Vehicle nein, 20 Bridge {e Overhead Structure 32 Tree (standing) 20N Roadway S Caro/EQulpment engin°) ZS Bridge Plar or Support 33 Utility Pole/tight Support ❑ 35houlder First Harmful Event lass or Stint 13 Animal ZZ Bridle Rall 34 Traffic Sign Su port 1 4 Median 14 Motor Vehicle In Transport within Interchange 6 Fell/Jumped From 35 Pa ked Motor Vehicle Cuhren 35 Tnlflc Signal uppart fi Gore Motor Vehicle 24 Curb 36 Other Port, Pale or Support 75eparotor 1No 7Thrown or Failing 16 Work mese/Maintenance ZS pitch 37 Fence 81n ParkinY lane or Zone 1 2Yes Objett 8 E Equipment 26 Embankment 38 Mailbox 9OuWde Rightrof-way 88 Unknown 8 Ran Into Water /[anal 27 StruckSBy Falling, Shifting 27 Guanlnll Face 39 Dther Fixed Object (wall, 10 Roadside 9 Other Non.Coll n IB tither Non•Flxed Object 79 Cable Guardrail 'building, tunnel, etc,) BB Unknpwn First Harmful Even Relatlon to Contributing Circumstances: Road Contributing Circumstances:n ❑ Jun Entretion ❑ ❑ ❑ g Romd urfacePolnheion(w t, Environment 5 Railway Grade Crowing 10 Rom Surface Condition wet, 14 Entrance/Exit Ram snow, slush, eta) 15 Crossover. Path otl 11 Debris In Roadway ❑ ❑ 1 Non-function 15 CrossovtireRela 7nll SNone 12 Debris 2Intersection 17 Accelendon/Decelendon Lane 4 Work Zone (construction/ 13 Traffic Control Device 3 lntersectlen-Related 18 Through Roadway maintenancefutillty) Inoperative Missing or Obscured 1None 5AnlmaI%1n Roadway Related y/Alley Amns 77 Unknown in Narrative 6 Shoulders (none, low, sok, high) 14 Non-Hlahway Work 2 Weather [ondldons ]]Other, Explain In 7 Rut Holes, Bumps ].Other, Explain in Narrative 3 PhyslgI OhKruction(s) Nametive 88 Unknown 4 Glare 88 Unknown Work Zone Related Crash in Work Zone Type of Work Zone Workers in Work Zone Law Enforcement In ❑1 No 1 Before the First Work Zone l lane Closure 1 2Yet Warning 5lgn ILane Shift/Crossover lyes Work Zone Bg Unknown 2Advance Area Area ❑ 3 Work on Shoulder or Median ❑ 88 Unknown ❑ 1No 4 Transition Ara°° 4 Intermittent or Moving Work 20M:er Present 5 Termination Ana 77 Other, Explain In Narrative 31aw Enforcement Vehicle Only Present NAME ADDRESS CRY & 5FATE 2IP CODE LESLIE A. MARTEL 3951 N. OCEAN BLVD. # 703 GULF STREAM FL 33483 NAME ADDRESS CRY &STATE LP CODE JOHN THOMAS PARKER 104 LOCUST LN. ROYAL PALM BEACH FL 33411 NAME ADDRESS CITY a STATE rap 341E KENNETH TREADWELL 2305 SEAFORD DR. WELLINGTON FL 33414 VEHICLE# PERSON#PROPERTY 7FENS AMAGE—OTHER THAN VEHICLE EST.AMOUNT OWNER'SNAMEOMiick aausiness) ADDRESS CRY&STATE ZIPCODE 7CLE1PEMI.1 NDSOR ROAD BIKE 0 ROBERT GEORGE MCALILEY 330 POINTE VEDRA RD PALMSPRINGS FL 33406 MAGE—OTHERTH�VIHICLEEIT. OWNER'$NAME (Check if BuslrKss) ADDRESS CITY &STATE ZIP CODE HSMV 90010 S (E) (rev 10/10) Page I of 6 VEHICLE EPD INGAGENCY NUMBER HSMV CRASH REPORT NUMBER 1 CommercialCheck if 17-1034 84212038 I Vehicle in TransportVEHICLEUBERCEM E NUMSTATE REGISMATION EXPIRES rnack if Permanent VIN 2 Parked Motw Vehide ❑ NA as 1. 3 Working Vehide PH1214-270352 Hit an Run 1Na ❑ YEAR MAKE MODEL STYLE COLOR DAMAGE: 1 Disabling 4 Minor EST, AMOUNT 88 Unknown 2012 CLUB PRECEDENT 12 EN WHI GRN 2Functional 88 Unknown 3 0 INSURANCE COMPANY INSURANCE POLICY NUMBER Tow us VEHICLE Dama e: VEHI[LE REMOVED BY BY 1. Rotation Owner Requert 3 NA NA 1Na x>ga T JARROD BACKOUS 3'Dr NAME OF VEHICLE OWNER p(Check if Business) CURRENTADOgE55 4. Other Iain In Name ve' GLEN WEBER CRr & srATE LP CODE 3960 N. OCEAN BLVD. # 6 GULF STREAM FL 33483 TraikrX LICENSE NUMBER STATE REGISTRATION EXPIRES ChedcHPermanent WN Y� MANE 1 LENGTH AXLES Realstatlon ❑ TallerN LICENSE NUMBEfl STATE REGISTRATION EXPIRES CAeckl(Perm+nent N YEAR MAKE LENGTH AXLES 1 Registration ❑ VEHICLE N 5 E W 05 -Road Unknown ON STREET, ROAD, HIGHWAY VEUNG AT EST. SPEED POSTED SPEED TOTAL LANES ❑ ❑ ❑ ❑ ❑ N. OCEAN BLVD. (S.R.A1A) 5 35 2 1 Na HAL MAT. NUMBER HAL MAT. l:lA53ImpactMost 2 Yes 1 3Yu 1 Area of Initial Damaged Area 98 Unknown 99 Unknown MOTOR CARRIER NAME US DOT NUMBER \r I r 1 1 1 r 1B Lin as 1B 21 3 1 5 1 , O n n a 19 Wertum 19 / p,1 .1 „ x / 20 Windshield 20 / MOTOR CARRIER ADOflE55 N 1] ,} If A 1 21 Trailer21 Y q 9 n n r CITY & STATE LP CODE PHONE NUMBER Vehicle Body Type is Low Speed Vehicle 16 (Sport Utllfry VMkle 15 Traffleway 1Two-Way,Not Divided 1 ith a [on Commercial Motor Vehicle Configuration i Vehicle 10,000 lbs or less Placarded STnttor rile /T p 17 Cargo an (10 Doo lbs ntl uVolit lei hr�n <�n� 14,536 ke)orleaJ 37wo-Way, Divided, Unprotected (or Hazardow Matedais 9Truck more than l0,0001bs (4,536 2Anelo-Unk7ruck (2 -axle and GVWR k¢), Cannot Oass S Passenger Car 18 Motor Coach ( ainted>4 feet Median more than 30,000lbs (4,53fi kg)J 1 Bw/large Van seass for 9 -IS 2 Passenger Van 19 Other Ught Trucks (20,000 Its; H ( 3 Pickup (4,536 kill or less) 20 �TWaW+YrDIv ed,PwMveMedlan Banter 351nglrUnit Tmck to w more axles) acctius/ ,lncludln dHver 4TruckPullin T e ) B raller(s� 11 Bus (seats far mon than 35 S7ruck Tnstor lbobtall 7 Motor Home Medium/Hea Tmcks(more than 50ne-WAY Trafgcway B Bus If1,00016s (4,636 11 8B Unknown occupants, Including driver) 6 Truck TraRor/5eml-Troller 77 Other, Explain 11 Mworryde 21 Femn Labor Veh a 12M 77 Other, Explain In Nanative 88 Unknown Tr811•r T • In Notre ve YP 77nck Tractor/Double Truck 88 Unknown TRAILER I TMILER2 2 n aSerol Trailer 2T+nd+m Seml7niler BPole Trailer Cargo Body Type 13 All In Vehicle ATV (ATV) CommlNon•Commercial 3Tank7raller 9Towed Vehicle 3 Van/Enclosed Box 131ntermodal 45addle Mount/Tralier 3D Auto Trans rt 1 4Ho per j; tamer hauls 1 Interstate Carder 2 lntnstata Carrier ❑ 5 goat roller 6UHIiry Troller 77 beer, Ex aalll In SPoprTroller e PI I An other Vehide Narrative 6Carrggo Tank Anoth 3 Not In Commas/Goers m 7HounTraller AFpFpliable 33Unknown 1No Cargo 7Flouted vehicle S0,li00Pos (4,536k AIN ot In Commerce/bherrnxit Most Harmful Event Non -Collision _ 2Bus aDamp Trot 110,000 @s 4536 k or less 9 Concrete Mixer dis la a) or less placard) GVWRIGCWR ❑ 210,1101-26, lbs ��53611,793kg) 10AMariana port P ynBHM S Ovenum/Rollover 3 More than 26,000 bs (11,793 kg) 11 Garbage /ilefwe 77 Other, Explain In 2Fln/Explosion 4Nat Appllable 12 Log Narrative 11 31mmeNon Jackknife Collision with Non -Fixed Object BS Unknown Collision Fixed Object 29 Cable Banter 5 Ca /Equipment Lou tar Shift 10 Pedestrian 11 Pedalryck Emergency 19 Impact Attenuator/Cash Cushion 30 Concrete Traffic earner eY of Events 7 Thlrmn or Fallied ng Object Vehicle 13 Railway Vehicle (train, engine) Vehicle Use 21B Bridge Dror Supperhead ort Structure 31 Other Traffic 32T Tree (standing BRan Into Water/ Canal IIISeeigs[uuee7llnce 9 Other Nan-Collblon 14 Motor Vehicle in Transport 15 Motor Vehicle Sg [Support 22 Bridge flail 33 Traffic 23 Culvert 34 TnRy Si e U g port 1 24 Curb 35 Traffic (40-auipmeenseoje(blo 40Equlpmantte.) (blown tin, Work S6Workrnt /Maintenance E ui ole, ort 26 Ditch 36 Other post, Pole, or Support nnW] LJ and blh basks failure, ate) VV mem 1 Struck By Falling, ShiRl Cargo or 26 Embankment 37 Fence 1No 27 Guardrail 38 2 Yes of Units 41 Ran Off Roadway, 42 Ran Off Roadway, glYht 43 Ran OR VIM ❑ F-1 Ve ding Sat In Motion by, am Vehicle 180ther Non -Flied Object Face Mailbox 28 Guardrail End 39 Other Fixed Object wall, 8g Unkmwn bullding, tunnel, etc.) 49 Cross Median 45 Crou Centerline Roadway Grade 46 Downhill Runawa Y VshlceManN on 15tnl�ht Ahead 135[0 ed In Traffic 37um n6 Left p� Traffic Control Device For Vehicle Defects ❑ This Vehicle ❑1 level Roadway Alignment 4 2HIIIcrest 1 3Uph111 ❑ SStnight 4 Downhill 1 2 Curve 111 ht d Backing 35 Nlegotlatlng a Curve S 6Turnlnq Right 16 Leavin Traffic Lane ❑ B Flashing Signal 88 8Changlna Lana 17 Entering TnRcLane 9Railway C Crossing 125uspensien a Parked g L Device 1 None 13 Wheels S Sag (bottom) 3 Curve Left SO Makingg U -Tum 77 Other, p lain S No Controls 2 Brakes 14 Windows/ No 11 OvertlIng/ 10 Perron )including 4Sd=IZone Sign/ Fl O 3Tires Windshield fixer, Passing 88 unknown uaman, Device Guard, etc) 4 Ughis (head, 15 Mirrors; Special Function iNoSpacialFunction uonce 141nterclryBus 2 Farm Vehicle 30 Are Truck 35 mart r/Tour Bw 1 of Motor Vehicle 3 Police 13 Farm SicalacControl 13 We min SIgn 5lgnal,Iail) 16 Truck Coupling/ 55S0I gin 77 Other, Ixplaln In 6 Steering Taller Hitrh/ p g 7 Wipers 7 Taxi 3252hool tabor Transport i65hunle auz NamHve Safety Chaim; 7Yfeld San 9Exhaust System 77 Bus 17 Farm Labor Bus 8 Military 13Transit/Commuter Bus BitUnknown 88 Unknown Other, Explain In 10 Body, Doors Narrative VIOLATIONS 11PowerTraln 88 Unknown ROUNN NAME OFVIOLA70R R. STATUTE NUMBER CHARGE CiTATIO1 NUMBER JARROD auS71N BACKOUS 316.1925(1) CARELESS DRIVING PKZ1 A1PKZIP PERSON NAME OFVIOtATOR FLSrATUTENUMBER CHARGE NUMBER 1 JARROD AUSTIN BACKOUS 316.212(2)(A) VIOLATION OF OPERATION OF GOLF CAFrr PKZ2 A1PKZ2P PERSON If NAME OF VIOLATOR R.STATUTENUMBER CHARGE ORATION NUMBER HS Mv 90010 5 (V) (rev 10/10) Page 2 of 6 e 1 REPORTING AGENCY [ASE NUMB P HSMV CRASH REPO PT NUMBER 17-1034 84212038 2 Non- ❑ VEHICLE M NAME 2 Non-Mat rirt 3 Pasxnger 1 PHONE NUMBER Check if 1 JARROD AUSTIN BACKOUS'—in end 202 494-5266 NRRENTANORE55 (Number and Street) D iwrRe P xam . �$ STATE 619 UPLAND PL. 7JPCODE ALEXANDRIA VA 22301 DATE OF BIRTH SEX DRIVER LICENSE NUMBER S Male STATE EXPIRES IWURYSEVERITY IW) 06/06/1980 ZFemale 1 86000553205 1None 41nwcc��adnnnB Bg Unkrrown VA 06/06/2022 3Nmnu days) 5Forta rkiieopadbting 4fRC Fata DL Type Required Endorsements DrlvsFs Actions at Time of Crash 1A2B3C 6 4DChauffeur 3 ZNo 5F/Operator 3 No tat S No Contributing Action Y Condition At 26 Ran off Bud 71d 20pera[ed MV In Careless or 27 Disregarded other7ra}Iic Req. Endorsement 6 None 7 Nane 7•/ Sign TimeOf Cresh 1 gala to Manner 28 DbregardM Other Road I AooarenUy Normal ❑ 3Falled to Yield pight•of-Way 4Improper Markin 3Ass. or Fad Driver D s"MOO bay 4 �P rlMde the Ve, ❑ Shot Distracted ex lain in narrative 1 5 BackingHs guetl cle and 6lmroer7um 29 over-Connecting/Over- 5111(sick) or Fainted SO Followed too Closely Steering 4011 6 Se zure, Epilepsy, Blackout 2Electronk Communication aural Distraction phone, 30heer eaPlWn namlive) 11 Ran RedU ht 305werved wApveo(ryded: Due 7PhY3iwlly Impaired 8 Emotional urbed for Conditions MR. 33 Pan Stop lR 1:1 Electes ronic (navigation device, DVD player) 71naCe^Rh'va Slgnrt On 1eR Nort•Moto ngry, distetc) 15 Improper Passing 9 Under rthe Influence of 310peratedMVln Emtiy whol BB Unknown 21 Wrongedeor Wron Wa Reckless or Driver Vislon Obstructions 17 Exceeded Poste Speed Aggressive Manner 77 Other, Explain in Narraove 25 Falletl Keep n other Contributing Action ge Unknownp 1 Vision Not Obscured 51oad on Vehlde to In Proper Lane 9 Smoke 1 2 Inclement Weather 6aullding/Flxed Object 10 Glare •. 3 Parked/S[oppped Vehicle 7 Signs/Billboards 77 All Other Explain 4 rreei/Crops/gushes 8 Fog s e In Namtive Helmet Use (HU) Eye Protection (EP) ❑ Restraint Systems 1 DOT-CogqmlIppeelI'am I Yes 2 Motor Vehicle Seating Position: LOCATON:SEAT ROW OTHER ❑2OtherHelmMelmet 2 No Seat Row Other (LOC) 1 3NotApplipble 1NotApyllnbe(RS) 3No Helmet 2 None Used• Motor Vehicle Occupant El E I Lek 1 Front 1 Not Appllpble 2 Middle 25econd 251eeper Section of Truck Cah 3 RIyyM 3Third 3Other Enclosed Carrppo Area 770ther r ag ap nye 3Shouder and Lap Belt Used SDeployed-Other 4M cler Bek Only Used Ejection EJEC (ABD) (knee, air belt, etc) Slap Bek Only Usetl ( n 6Deployed- 4Fourth 4Unendosed Ca &Area 6PeuRlnt Used-Type Unknown (explain In 77 Other Raw STnllin Unk S¢hQ��ot Ejected yy Shot Appllpy ble Combination 7ChIItl Restraint System-Forward facing ant Syrtem•Rear Facing narrow) gg Unknown 6Riding on Motor Vehicle Exterior(mn• 3EIeRetl; PaNally E 3Deplo�yeE-Front pelWooymant sin g 011 Re BB Unknown urging unit) 88 Unknown 88 Se 4 kit Appllpble 4Deployed•Slde Unknown 30 Child Pemaint Type Unknown 88 Unknown 770Ner, EZPlain In Namove 1 Pedestrian Ned striae t DascrlpUon Non-Motorist Location At Time of Crash Action Prior to Crash Ilmomectlon-Marked building, skater, pedestrian pnveyanp, etc) 3lnterxction—Other ❑40tM20ther Pedestrian (wheelchair, person Ina 2Intersection 4Mltlhlak•Marked ❑ Crosswalk e5ldewalk • Unmarked Crosswalk 9 Median/Uossing Island 5 Walkina/Cyding on Sidewalk 10 Driveway Access 61n R�addway—Other(working, Crosswalk 115harcd-Use Path playing, etc. fiu tips[ orTnll Cy5 Travel Lana • Other Location 12 Non-TnRkway Area 7 Adjacent to poadway (e.g., 1 Crossin Roadwa 50ccupant of Motor Vehlde Not In Trans 8 shoulder, metllan) 1parked, etc) 7Sh'ycld Rwdslde gng unh W^plainln Namtive 2 Waidngto[rou Roadway BGaing to or from School(K-12) 6l7aupant of a Non-MotorVehick 3Walking/Cyclinqq Alon 9Wo ng in Tnfn_ay Trans tat nDeyke Non•Motorist ActlOnalClreumatances Roadway with Tnfflcpin or Ilnddent response) 7 Unknown Type of Non•Motofirt Safety Equipment 1al 1No Improper Action adjacent to travel lane) 1 None 2 Dart/Dash 4Walking/Cycling AlonYY 770 the r, Explain In Na move 3 Failure Roadway Against Tra c(in B8 Unknown SNona S Lighting ❑ to Yield Right-ot•Way or adjacent to 2 Helmet 6Not Appllpble travel lane) 4 Failure to Obey TrafRc Sign, 3 Protective Pads Used 77 Other, E� )lain elbows, knees, shim, etc) In Namove and 4 Bg Unknown Signals, or OfRcer 7 Entering/Exdng Parked/Standing 10 Improper Tum/Marge S In Roatlwayy Impfoperly (rtandin4 Vehicle 12 Improper Passing ❑ IYyIng, workin6, playing/ 8 inattentive hlkingg,, 12 Wrong-Way backpack,ve etothln89acket, ) ❑ eating, etc) Rldin& or Walking 6Olubled Vehicle Relatetl (workingg 9 Not Vliible'tlark clothlne. no 77 Other, Explain In Namove on, pushing, leaving/approaching) lighting. etc.) 88 Unknown PE D e ALCOHOL D: ALCOHOL TYPE ALCOHOL Bre.SAC SUSPECTED DUG D: DRUG TEST�YPE, DRUG TEST RESULT: IAINCOXOL USE: 1 Teat Not Given I Blend TEST RESULT: DRUG USE: ❑ 1 Test Not Given❑ 1 Blood ❑ 1 Positive 2 Yes 3 Test Given v C S Pending 1 No 1 2 Tert Retuned 3 Carina 1❑ 3 Test Glwn ❑ 3 Urine 3 Urine M Unknown m Unknown, If Tamed 77 Omer, Bx sin m 2 Cortiple[ed 2 Negative 2 YM 3 Tat Given n Other, 3 Ponding 88 UnMknown 88 Unknown 8g Unknown, H Toted Explain In Nemtive 88 Unknown SOURCE ns ported ORT TO MEDT LF EMSAGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 Not Transported 2 EMS 3 Law Enforcement 1 ❑ 77 Other Ex in In Namtive 88 Unkrwwn PERSONIN VEHICLE N NAME 3 1 ALICIA DATE OF BIRTH INl SIX LOC: S R 0 EJECT HU EP AND RS PILARJOHN BACKOUS 10114/1960 1 2 3 1 1 1 3 1 2 I I I CURRENT ADDRESS (Numberand Street) CRY a STATE 819 UPLAND PL. ZIP CODE ALEXANDRIA VA 22301 URCE OF TRANSPORT TO MEDICAL FA ILf1Y EM5 AGENCY NAME OR IO EMS RUN NUMBER MEDICAL FACILITY TRANSPORTEDTO 1 Not Transported Ex 1 ❑ 770tlter Ex Ialnln Narrow 88 Unknown PERSONJN VEHICLEIN NAME 4 1 COLBY GATE OF BIRTH IW S=RO HU EP ABD RS BACKOUS 0711 01z 1 3 1 2 CURRENTADDRESg (Number and Street) CITY&STATE 619 UPLAND PL. 7JP CODE ALEXANDRIA VA 22301 SOURCETransported TRANSPORT TO MEDICAL FACILITY EMS AGENCY NAMEGRID 1 Not TrEMS RUN NUMSEK MEDICAL FACILITY TRANSPORTED TO 3 1 ❑ 770th! Exwalnin Namtive 88 Unknown HSMV 90010 S (P) (rev 10/10) page 3 of 6 PERSON # 2 REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER 17-1034 84212038 1 Driver ❑ yEHICLE N NAME 3 Passenger 2 PHONE NUMBER Chetk H g ROBERT GEORGE MCALILEY 561601-3512 Recommend Cl1RRENTADDRESS (Number and Sueet) Driver Re exam [ffV &STATE 333 POINTE VEDRA RD. ZIP CODEPALM SPRINGS FL 33406 DATEOFBIRTH SEX DRIVER LICENSE NUMBER 3Male STATE EXPIRES 111 11 None SEVERfiY IW) 11/19/1946 88Unkrown 1 M244767462510 FL 07/11/2020 2P hie sFen�wn�in Daays) ❑4 3 Nan. Incapacitating 6 Non- raffle Fatality DL Type Required Endorsements DHveri ADtions at Time of Crash 4 D/Ch 26 Ran off Roadway 40/[haufFeur 2No tk 1No Cmtrlbutlng Actlon Y lro Condition At 5E/Operator 20perated MV in Careless or 27 Disregarded other Traffic 3 No Endorsement Sign ❑ Time of Crash ❑ 6 E/Oper•Rat �' Ne Ilgant Manner 28DHregarded Other Road 1Apppaarent)yy Normal 7 None 3 Failed to Yield inghtcf• wayMarkin 3 ASIee a Fatl 4ImImproperTackin Bs geed D Ver Istreetis y 4Other lmlda the Vehicle 61mror Tum g 29 Over-Correcting/Over. 5111 sltk)or Fainted 1 Not Distracted ( ain in narrdtin) ltttl 10 Followed too Closely Steering 6 Suture, Epilepsy, Blackout ❑ 2 Electronk Communiwtbn 5 emal Distraction 11 Ran Red U ht y 30 Swerved or Avoided : Due 7 Physically Impaired Devicesic I hone, ac.J (outside the nhlcie, to Wind, SlipCCery Surface, 8 Emotional(depresslon, ( P 12 Drove opo est for Conditions MV, Object, Non•Motorist In ❑ angry, disturbed, etcl 30ther El C.", hcDevice explain In narrative) 33 pan Stop51 gn (navigatla device, DVD player) 6 Testing IS Impropr paasaloadway etc 9 Under the Influence of 7 Inattentive 17 Exceeded Ponttl Speed 31 OperatedMV in Emd4 Mediatlons/Drugs/Akohol Driver Vision Obstructions 98 Unknown Reckless aAggressive Manner 77 Other, Explain In Narrative 23 Wrong Side or Wrong Way 770ther Contributing Action Bg Unknown 1 Vision Na Obscured 5 Load on Vehicle 9 Smoke 25 Falled to Keep in Proper lane 2lnclement Weather 6 Building/Rxed Object SO Glare e - 3Parked/StopppedVehicle 75agns/Blllboards 77 Ala Other, Explain d Treas/[rops/Bushes a Fog In Narrative Helmet Use (HU) Eye Protection (EP) ❑ Restraint Systems I DOT-Com��Ilam IYes ) Motorrycle Helmet 2 No (RS) Motor Vehicle Seating Position: LOCATION: SEAT ROW OTHER 2Other Helmet 3Not Applicable iNot Applicable Seat Row Other I(LOC) 1 3 N Helmet 2 None Used• Motor Vehicle Occupant 1 Left 1 From 1 Not Applicable L 1:1 El r ag Dep oys 5 Deployed -other L77Other, lder and Lap Belt Used 2 Middle 25econd 251eeper Section of Truck Cab ((der Beat Only Used 3FT` 3Third 30ther EtldmadV oArea Election (EJECT) (ABD) 6 knee, n a air belt, etc.)elt Only Used 770ther 4Fourth 4Unendosed Cargo Area 1Not acted 1NatA IlwbleCombinationpeaInt Used-Tvoe Unknown (explain In ]]Other Raw STrallln Unit IJ Applicable Restraint System- Forward Facing g ❑2Ejected, Top11y 2Not Deployyed 7 Deployed•Curtaln Resraint System• Rear Facing namtive) 88 Unknown 6 Riding on Motor Vehkle Esteripr (nm- 3 ectadd, iartlaliy 3 Deployed -Front 88 Deployment er Seat flO Unknown tnllingunit) 4 of APPlkable 4Deployed- SIda Unkknnown Restraint TWe Unknown U known as Unknown r, Explain In Narrative Nan -Motorist Description Non•MotoNst Location At Timis of Crash Action Prior to Crash 1 Pedestrian 1Intersection-Marked Crosswalk 8Ndewalk 20ther Pedestrian (wheelchair, person Ina 2Intersection - Unmarked Crosswalk 9Median/Crossing Island SWalkln¢¢//Cyclingg on Sidewalk 3 bulltlln&skater, pedenrian conveyance, ac.l 3lnterseNon—Other IO Driveway Access filo Roasrway—Other(working, 3 BIryclist 5 4MINhick-Marked Crosswalk 11 Shared -Use Path or Trail playing, etc.1 40ther Cydlrt ❑ 5 Travel Lane -Other Lowden 12 Non-Traffiuway Area lCrossln Roadwa 7 Adjacent to poadway(e.g., 6 Occupant of Motor Vehicle Not In Tram B V shoulder, median (parked, etc. Port 6 Bicycle lane 77 Dther, Explain In Narrative 2 We ting to Cross aadway 8 Gain to or fromhool (K•32) Dau 1 ]Shoulder/floedslde Bg Unknown 3 Walking/CydingY Alone{ 9Workl t. in Traflany 6 Transportatlon Oevl000pr Vehicle Non -Motorist Actions/Circumstances Roadway vmm 1 ramc:(in or (Incident response) 7 Unknown Type of Non -Motorist 1 No Improper Action adjacent travel lane) 10 None 1 Dart/Dash 4 Walking/Cycling Along 77 Other, Explain in Narrative S None Safety Equipment ❑ tel 1 3 Failure to Yield Right -of -Way Roadway AgalnstTrac(in 88 Unknown 2 Helmet SLighdng 2 4 Failure to Obey Trafpc5lgns, aadjacent to travel lane) 6 Not Appikable Signals, or Officer 7Entering/EaiHng Parked/Standing SD lmproparTum Marga 3 Protective Pada Used 5 other, Exoyln S In Roadwa Improperi (standin& EnteVehirJe 111mproperPa Tum4M elbows, ething(laes, shins, etc.) In NamWe ❑ and ❑ IIviv(nR6, working, playing 81nanentive taikiny eating. etc) 12 Wrong -Way Rldln`` a Walking 4 backpack, etc) (Jacket, Ba Unknown 6 61sabled Vehicle Related (workin 9 Not Visibledark clothing. no 77 other, Explain In Namtive p k. 1 on, Pushing, leaving/approachingi lighting, etc.) 88 Unknown SU OLU AICOMOL D: Alp)HOL E ALCOHOL e e 2 ye HOL USE: 2 Tart Xetfwed nn j & aeh TEST tlE56 LT: = NUG USEEl 1 21 Tat Tat Yes 3 Test GefPECTIED u n❑ ive n Dotnl�iaTer�� PU 2 Negative RESULT❑ 2 yes 1❑ 3 Test Ginn ❑ 3 Urine Z Completed e8 Unknown 88 Unknown, If Tested 77 Other, Explain In W Unknown ❑ BB Unknown N Unknown, HT1 Explain In Namtive 88 Unknown SOURCEns TRANSPORT TO MEDICAL FACILITY ❑ EMS AGENCY NAME OR ID 21 Not EMS Law End 2 EMS RUN NUMBER MEDICAL FACILITY TflANSPORTED TO 77 Othe3Eil WEn In Namtive ee Unknown DELRAY BEACH FIRE RESCUE 6792 BETHESDA MEMORIAL HOSPITAL as e PERSON N VEHICLE N NAME DATE OFBIRTH IW SEX LOL•S I q 0 E1ECr HU EP ABD RS 5 1 MILES BACKOUS 10/0712014 1 1 3 1 4 1 3 2 1 2 CURREMADDRE55 (Number and SVeet) CITY &STATE ZIP CODE 619 UPLAND PL. ALEXANDRIA VA 33406 SOURCE OF TRANSPORT TO MEDICAL FACILfiY 1Not Tra❑ EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FA awEnf FACILITYTNANSPORTED TO nt 77 Other ExIni Narredve 98 Unknown PERSON N VEHICLE N NAME GATE OF BIRTH IW SEK LOOS R O EIECi HU EP ABD RS CURRENTADDRESS (Numberand Street) CffY&STATE ZIP CODE SOURCEOF nsorted TRANSPORT TO MED=FACIUTYEM' AGENCV NAME OP ID EMS RUN NUMBER MEOIGLFApl1TYTMNSPORTEDTO 1 Not Transported2EMS SlawEnforcement 770ther Ex In In Narrative 9 HSMV 90010 S (P) (rev 10/10) Page 4 of 6 17-1034 184212038 VEHICLE # 1 WAS TRAVELING EAST ON SEA RD. DRIVER # 1 STATED THAT HE STOPPED AT THE STOP SIGN BEFORE ATTEMPTING TO DRIVE ACROSS N. OCEAN BLVD/S.R. A1A DRIVER # 1 THEN PROCEEDED TO DRIVE EAST ACROSS N. OCEAN BLVD/S.R. A1A AND AS VEHICLE # 1 WAS ALMOST HALFWAY ACROSS THE HIGHWAY IT LOST POWER. DRIVER # 1 STATED THAT AT THAT TIME HE BEGAN BACKING UP VEHICLE #1 AT WHICH TIME VEHICLE # 1 STRUCK THE NON-MOTORIST/BICYCLIST WITH VEHICLE # 1'8 RIGHT REAR BUMPER. THE NON-MOTORIST/BICYCLIST, MCALILEY STATED THAT HE WAS TRAVELLING SOUTH ON N. OCEAN BLVD./S.R. A1A ALONG THE FAR RIGHT PAVEMENT OF THE ROADWAY. MCALILEY AND TWO OTHER BICYCLISTS WHO WERE TRAVELLING WITH MCALILEY WERE ALL FOLLOWING EACH OTHER IN A SINGLE FILE. MCALILEY WAS RIDING A BLUE IN COLOR FENS WINDSOR MEN'S ROAD BIKE WHICH DID NOT APPEAR TO HAVE ANY VISIBLE DAMAGE AS A RESULT OF THIS CRASH. WITNESS PARKER WAS THE LEAD BICYCLIST IN THEIR GROUP OF THREE BICYCLISTS, PARKER SAID THAT HE SAW VEHICLE # 1 STOPPED AT THE STOP SIGN BEFORE ENTERING THE CROSSWALK. PARKER CONTINUED SOUTHBOUND. WITNESS TREADWELL WAS THE LAST BICYCLIST IN THEIR GROUP OF THREE. TREADWELL WAS FOLLOWING MCALILEY SOUTHBOUND ATA SAFE DISTANCE. TREADWELL SAW VEHICLE # 1 STOPPED AT THE STOP SIGN AND THEN BEGIN TO TRAVEL ACROSS N. OCEAN BLVD./S.R. AIA TREADWELL SAW VEHICLE # 1 STOP AT THE DOUBLE YELLOW LINES LANE MARKINGS AND THEN BEGIN TO BACK UP. TREADWELL THEN SAW VEHICLE # 1 BACK UP AND STRIKE MCAULEY'S BICYCLE AS MCALILEY WAS SOUTHBOUND AS DESCRIBED ABOVE ON N. OCEAN BLVD./S.R. AIA. WITNESS MARTEL SAW VEHICLE # 1 BACK UP AS DESCRIBED ABOVE AND STRIKE MCALILEY AS HE RODE HIS BICYCLE SOUTHBOUND. CAPTAIN MAHONEY OF THE DELRAY BEACH FIRE RECUE SAID THAT MCALILEY WAS COMPLAINING OF RIGHT SHOULDER PAIN. MCALILEY WAS TRANSPORTED BY FIRE RESCUE TO BETHESDA MEMORIAL HOSPITAL FOR FURTHER EXAMINATION/TREATMENT. DRIVER # 1 WAS CITED REFERENCE TWO TRAFFIC VIOLATIONS: CARELESS DRIVING AS DESCRIBED ABOVE WHICH RESULTED IN THE CRASH AND VIOLATION OF OPERATION OF A GOLF CART DUE TO TRYING TO CROSS A STATE HIGHWAY AT A LOCATION THAT HAD NOT BEEN DESIGNATED BY THE STATE TO BEA GOLF CART CROSSING. END OF REPORT. 7A52/754 I OFC. HSMV 90010 S (N) (rev 10/10) FNI a R. BATISTA Cm CfTY & Page 5 of 6 GULF STREAM POLICE DEPARTMENT CODE CODE 3901 N.O.B. I S.R. A1A North Ocean Bv. Double Yellow Markings 3900 N.O.B. 17-1034 Not To Scale HSMV 90010 S (0) (rev 10/10) Page 6 of 6 Sea Rd. 84212038 3851 N.O.B. I • ement Power Pole 10 Sea Rd. Sea Rd.