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.