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Home My Public Portal AboutPRR 17-2554 TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered via e-mail June 2, 2017 Glenn Weber [mail to: gweber@weberassoc.com] Re: GS #2554 (Police Report) Would like a copy of the police report #17-1034. Dear Glenn Weber [mail to: gweber@weberassoc.com]: The Town of Gulf Stream has received your public records request dated June 2, 2017. You should be able to view your original request and response at the following link: http://www2.gulf-stream.org/weblink/0/doc/111310/Page1.aspx We consider this request closed. Sincerely, Reneé Rowan Basel As requested by Rita Taylor Town Clerk, Custodian of the Records Sworn Statement for Traffic Cash Report Information Maw Vehicle cnrh Information is c ffdentral and exempt from disclosure for a period of 60 days after the rash report is filed. 3316.D66(2)(a) Florida Statutes 12034). Obtaining confidential information by someone Who knrws they are not entitled to do to Is a Many violation. Theundersigned requests the following cash report (date/toatlon/pardes: The undersigned states that he/aM air the organlhadon represented qualify for Immediate disclosure of the crash report according to the exemption chadmd below and does swear or affirm that the Information contained Ina cash report made mnndantW by stance will not be used for any commercial solicitation of a¢Jdent vrrNms, or knowingly be dhdased to any third party for the purpose of such solfciWon, during the period of time that the Information remains confidential. _ lam a party involved In the crash —I= a legal (apresenative to a party invoWd In the cash: Florida Dar Number I am a licensed insurance agent to a party Involved In the creek their insurer or Insurer to which they applied for Insurance coverage, Florida License Number —I an, a perwn undercordract to provide claims or undervrridng in formation to a qua0WS insurance company, kfentfiied a, _ I am a proseatin authority, Florida Bar Number I represent a radio or television station licensed by the FCC or newspaper qualified to publish legal notices car a free newspaper of gerwal circulation, as defined in 316.066(2)(b) Florida Statutes. Name of Aadlo/Televislon/Newspaper I represent a local, state or federal agency that is authorlted by law to have aims to these reports. Name of loot/state/federal agency _ I represent a Victim Services Program, as defined In 1316.A03485), Florida Statutes (2014). Name of program: L iv&; L. tlf[Srt� ori Name ,' stn^ j wtcGf Signature (Area Code) Telephone Number Agency/Business/Represented Addrus City, State, Zip Cade State of Florida. County of Swum (or affimed)and subscribed before methis _dayof .20_by Personally known_or produced identification Type of ldenldiation Produced: prlmType or Stamp, commissioned Name of Notary Signature of Notary Public or Certified Law Enforcement or corndional Officer HSMVA4010 {fieV.t2/14) FLORIDA TRAFFIC CRASH REPORT LONG FORM ® SHORT FORM ❑ UPDATE (shaded Areal MAIL TO: DEPARTMENT OF HIGHWAY SAFETY & MOTOR VEHICLES TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING TALLAHASSEE, FL 32399-0537 TOTAL # OF VEHICLE SECTION(S) —I TOTAL # OF PERSON SECTION(S) TOTAL # OF NARRATIVE SECTION(S) 1 CRASH DATE TIME OFCRASH DATE OF REPORT REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER 05/27/2017 9:25 AM 05/27/2017 17-1034 84212038 CRASH IDENTIFURS COUNN CODE CENCOOE COUNTY OF CRASH PLACE OR CIN OF CRASH (]EEOC IF WITHIN TIME EPORTED TIME DISPATCHED 44 PALM BEACH IW GULF STREAM crr uMns X AM 9:25 AM ME ON SCENE ME CLEARED SCENE CHECK IF REASON (If Investigation NOT Complete) 9:25 AM 10:10 AM COMPLETED Notified By:1 Motorist i Law Enforcement e e• a CRASH OCCURRED ON STREET, ROAD, HIGHWAY . ATSTREETADDRESS# S A7LATITUDE AND LDNGtTUDE N. OCEAN BLVD. (S.R. AIA) FEET MILESN S E W FROM INTERSECTION WRH STREET, ROAD, HIGHWAY o OR FROM MILEPOST# E1000 GISEA RD. Road System Identifier 7 Forest Road Type of Shoulder Type of Intersection i Interstate 4County B Private Roadway STraMc Orcle 3 2 U.S. 5 Local 9 Parking Lot ❑ 1 Paved 1 Not at Intersection 6 Roundabout 35tate bTurnpike/Toll ))Other, Explain in Z 2Unpaved 2Four-Waylnterucmn 7Five-Point, or More Narrative 3 Curb 3 T-1 on 77 Other, Explain In Narrativea 4 Y•In[ersectlon CRASH N (CHECK IF PICTURES TAKEN) Light Condition Weather Condition Roadway Surface Condition School Bus Related of Collision/Impact 1 Daylight S Dark -Not Ughted 4 Fo& Smogggggg,,,,,, Smoke 5 011 1 No l/ 6 Mud, Dirt, Gravel 1 ZYes, School Bus 51deswlpe, Same Direction 1 2 Dusk 6Dark-Unknown ❑ S 3 Dawn LI hting Seung R Freezing Rahn 1❑ )Sand Directly Involved wipe, OppositeDirection 4 Dark•Ughted arranve plain In Sand, Soll, BWater ( plrtlowinB standln g/ 3 Yes, School Bus Rear to Rear Rea93 Unknown 1Goody 7 severe Crosswinds 1Dry 770the)r Explain Indirectly Involved SOtheear r E:alain In NamHve 77 Other, Explain In 7 Othe5 E 2 PNartaHve a 3Pain 41ce/Frost fig Unknown3 g Unknown First Harmful Event Non -Collison Collision Non•Fixed Object Collision with Fixed Object 1 Overturn/Rollover 10 Pedestrian 19ImpactAttenuator/Cmh 30 Concrete Tnflk Barrier 2Fire/Explosion 11 Pecialcycle Cushion 31 Other Traffic Barter rmful Event n 3lin 1.n 12 Railway Vehicle (train, 20 Bridge Overhead Structure 32 Tree (standing 4 Jackknife engine) ( g� 5Ca p E ul ment g ) 21 Bridge Pler or Support 33 L%Ity Pok/Ug tSupport n / G P 13 Animal 228ddge Rall 34Tnffic Sign First Harmful Event ! On Roadway 20N Roadway 1 ❑ 3Shoulder Su port Lossor Shpt 14 Motor Vehicle In Transport Z3 Culvert 35 Traffic Signal" p 4Median within Interchange 6 Fell/lumped From 35 packed Motor Vehicle 24 Curb 35 Other Post, l" or5u MotorVehide 16 Work Zone/Maintenance 25 Ditch 37 Fence Support SNo 7Thrown or Falling 6 Gore Bin Parkin LaneorZone g Equipment 1 2Yes Ob act 26 Embankment 3g Mailbox �n Smo ck By Fallln& Shihing 27 Guardrail Face 39 9Outside Right-of-way BB Unknown B into Water Canal G Other Fixed object (wall, 90ther Non{oil(1 ry 28 Guardrail End building, tunnel, etc) 10 Roatlslda fie Unknown Is Other Non -Fixed Object 29 Cable Barrier First Harmful Event Relation to Contributing Circumstances: Road Contributing Circumstances: Junction 9 Wpm Tnvel•PollshedSurface Environment Grade Crossing 10 Road Surface Condition we 1 14 Entrance/frit Pamp ❑ ❑ ❑ kkyy snow, slush,elc., ( 4 14 Entrance/Exit 15 Crossover- Petted 11 Debris ton In Roadway ❑ ❑ 1Non-lunctlon 165hared•Use Path or Tnll iNone 12 Debris 2 Intersection 17 Acceleration/Deceleration Lane 4 Work Zone (construction/ 13 Traffic Control Device 3 Intersection -Related 18 Through Roadway maintenance/utility) Inoperative Mlssingor Obscured 'None 5Animal(s In Roadway 4 Driveway/Alley Access 77 Other, Explain in Narrative 14 2 Weather Conditions 65houters(none, low, soh, high) On-HIy{swayy Work 77 Other, lain In Related BB Unknown 7 put, Holes, Bumps 770ther, Fxplaln In Namtive 3 Physln1 Obstrumon(sj Narrative 88 Unknown 4 Glare ea Unknown Work Zone Ralated Crash in Work Zone Type o} Work Zone Workers in Work Zone Law Enforcement In 1 No 1 Before the First Work Zone Vane Closure Work Zone 1 2 Yes ❑ 2WarningAdvce N ❑ 2lana ShlWCrossover ❑ 2 yes 88 Unknown 2Advance Naming Area 3 Work on Shoulder or Median 88Unknown ❑ INe 3 TranskyAion Neo 4 Intermittent or Moving Work 2Offlcer Present rea S Terminatbn Area 77 Other, Explain In Narrative 3 Law Enforcement Vehide Only Present WITNESSES NAME ADDRESS CITY & STATE ZIP CODE LESLIE A. MARTEL 3951 N. OCEAN BLVD. 111703 GULF STREAM FL 33483 NAME ADDRESS GTT & STATE ZIP CODE JOHN THOMAS PARKER 104 LOCUST LN, ROYAL PALM BEACH FL 33411 NAME ADDRESS CIN & STATE ZIP CODE KENNETH TREADWELL 2305 SEAFORD DR. WELLINGTON FL 33414 PROPERTYNONI VEHICLE DAMAGE VEHICLE# PERSON# PROPEPTY DAMAGE —OTHER THAN VEXIGE ESi.AMOUNT DINNER 'SNAMEO(Check if Business) N ADDRESS CITY IS ZIPCODE 2 FENS WINDSOR ROAD BIKE 0 ROBERT GEORGE MCALILEY 330 POINTE VEDRA RD PALM SPRINGS FL 33406 VEHICLE# PERSON# PROPERTY DAMAGE— OTHER THAN VEHICLE EST.AMGUNT OWNER'S NAME (Check if Business) ADDRESS UTY&STATE ZIPCODE HSMV 90010 S (E) (rev 10/10) page 1 of 6 91e mmercial REPORTINGAGENCY ENUMBE HSMV CRASH REPORT NUMBER 17-1034 84212038 1 Vehicle In Tnnspon VEIII[LE LICENSE NUMBER STATE REGISTMTIONEXPIRES Check RPermanent VIN 2 Parked Motor Vehide 1 3Wolkingvehkle NA Registration PH1214-270352 INCHRan Run YEAR MAKE MODEL STYLE COLOR DAMAGE: 2 Yas 1 88 unkrwwn 2012 CLUB EST. AMOUNT 4 Minor 0 1 Furth PRECEDENT 12 EN WHI GRN 2Funotlonal BB Unknown ❑3 3 None INSURANCE COMPANY INSURANCE POLICY NUMBER ow w VEHICLE REMOVED BY 1. Rotalbn NA to Dama`e: 2.Owner Request I 3 I NA 1 No 1Yes T JARROD BACKOUS 3. Dnver ISI NAME OF VEHICLE OWNER(CheekHBusineui GLEN CURRENTADDRE554.Other Ex lalnin Nam e cRY a STATE LP WEBER CODE 3960 N. OCEAN BLVD. # 6 GULF STREAM FL 33483 Trailer# LICENSE NUM BER STATE REGISTRATIONEXPIRES Chock R Permanent VIN YEAR MAKE LENGTH AXLES 1 Registration ❑ Tn11erN LICENSE NUMBER STATE REGISTRATION EXPIRES [heck if Pemwnent VIN YEAR MAKE LENGTH AXLES 2 Registration VEHICLE N S E W OR•poed Unknown TRAVELINGO [] � 1-1 N. ON STREET, ROAD, HIGHWAY OCEAN ATEST.SPEED OSTEDSPEED TOTALLANES HAL MAT. Q BLVD. (S.R.A1A) 5 35 2 RE 1Ye 11'No ❑ AAAI.HAZ. MAT. NUMBER HAL MAT. CLASS Arla of Inttfal Impact Most Damaged Area 2 Yes 1 2 Yes 1 80 Unknown BB Unknown MOTOR CARRIER NAME s r al z , s s r 18 Undercarriage 18 USDOTNUMBER O n n n 19 Dvertum 19 O ,s n ^ x 20 Windshield 20 � u u u u m s 21 Trailer 21 w u u n a s MOTOR CARRIER ADDRESS CRY a STATE ZIP CODE PHONE NUMBER Vehicle Body Type Trafflewayy COMMOrClal Motor Vehicle Configuration 15 Low Speed Vehicle l Two-Way, Not Divided S Vehlele 10,000 lbs or Ips Placarded 8 Tnctor/Triple 36 Sport1 UtliRy Vehicle 1 2 Two•Way, Not Divided, with a for Hazardous Materials 15 �T 17 Van1100001to (4,536 kg) or less) 9 Trude more than 10,0001bs (4,536 Continuous Left Turn Lane n (. 251^gle•Unk Truck (2-axle and GVWR k¢j, Cannot Claszi S Passenger 38 Motor Coach 19 Other Light p more than l0,0001bs (4,536 kg)) Sb Bus/Large Van�seatsfor9-15 37W°•Way, Divided, Unprotected I�—I (ppealnt-we feet) 39ngke-Unit Truck(3 or more axles) occupants, 2 Passenger Van (IO,11001hs Van 3 Pickup (4,536 kg) or leu) includin driver ITwo•Way, Divided, Positive Median 8 ) Barrier 4 Truck Pulling Trailers it Bus (seats for mon than 15 7 Motor Home 20 Medium/Hea Trucks (more than Sone-Way Tralflcway 5 Truck Tractor lbobtalll occupants, Including driver) BBus 10,000Ibs 4,536 88 Unknown Track Tractor/Semi-Trailer 77 Other, Explain In Nam ve )� 6 11 Motorcycle 21 Fam , pl in Ice 12 Mo7yed ]]Other, Explain In Narrative 13AII7ernin 83 Unknown 76 Troller Type ]Truck Tractor/Double Truck 88 Unknown TNALER t .�� x 1 Singke Seml Tralier 2 Tandem Semi Trailer SPole Trailer Cargo Body Type Vehicle (ATV) ( ComeNNonarrier clal 331ntemodal 3TankTniler 9Towed Vehicle 3Van/Endosed Box Container Chassis 4 Saddle Moura t/Tnller E 5HOVper 1 Interstate Carrier tate Carrier ❑ 5Boat Talker 770ther,=111I 14 Vehicle Towing Exp al in in SCaK-Trani 6 URlity Treikr Narrative 6Carrggo Tank Another Vehicle 15 Not Appppllable 3 Not In Commerce/Govemmant 3 No': 7 House Trailer 88 Unknown 2 No Cargo 7 Flatoed vehicle SO,000 lhs a Not in Commerce/Other Truck Most Harmful Event -Collision 2 Bus 8 Dump �4'536kg) or less noe S10,0001bs 4536 )orless 9Concrete Mixer Comm 230,001.26, lbs 4,536.11,793 10 Auto Transport Oil,;h` ng HM placard) I Overturn/Rollover GVWR/GCWR 3More than 26000 t IS Garbo 77 Other, Ex Iain in (11,793 kg) He/Refuse P 2 Fla/Explosion Narsol 4Not Appilable 12 Log 88 Unknown 11 3Immersion 4 SCa Collision with Norl•Fixed Object Collision Fixed ObJeet 29 [able Barrier 10 Pedestrian Emergency Cag/fe o/Equipment Loss or5hlft 11 de 19 Impact Attenuator/Crash Cushion 30 Concrete Traffic Baffler 6 Fell lumped From Motor Vehicle Sequence ofEvents 7Thrown orFalllngOblect e Ran Into Water CCaaI a[ 90ther Non{pll Sion Railway 20 Bridge Overhead Structure 33 OtherTraffic Barrier Vehicle Use 13 A�ImwaalYVehicle(ualn,engine) 23 Bridge Pier or Support 32 Tree(standinggl 22 Bridge Reil 33 UtllRy, Pole/Lig tSupport S4 Motor Vehicle In Transport 23 Culvert 34 Traffic Sign Su El I i I lul I40{65rqulmx of Events anlyj port SS Parked Motor Vehkle 24 Curb 3a Traffic Slgnal5upport S6 Work Zone /Maintenance 360ther U 4o EqulpmmtFallure (blown n, EnnulVVmeat 25 Ditch Post, Pole, or Support 1No are 4th brake failure, alae) 4:2 SepRan O Ro d Units 42 Ren ON Roadway, Right 26 Embankment 37 Fence 175truck By Felling, ShiRini Cargo or Z7 Guardrail Face 38 Mailbox 2Yes Ve hang Set In Motion W Motor 28 Guardrail End 39 Other Fixed Oben Wall,88 Unknown Vehlele building, Ran Lett ❑ tunnel, etc.)143 18 Other Non-Flied Object44 sOff Meoadway, Cross Median Cross [entarlin GDownhill Runawa P Ve Ice Maneuver Ae onas Trafiie Control Device For Vehicle Defects46 Istelght Ahead 13 StoedIn Trafficdway 37umin¢ Leh This Vehicle 1 LevRoadway Alignment 4 ❑ 2 Hillcrest ❑ 1 3U hill 15vai ht P g a Downhill 1 2 Curve III 4 Backing 35 Nlegotlatlng a Curve S 88 STurningg Right ❑ 8 Flashing Signal 6Chan In Lanes 16 Leavin8 Traffic lane 8 8 N N 17 Ent' Traffic Lane 9 Railway Crossing 12 Suspension 8 Parked 1 None 13 Wheels Device 5 Sag 3 Curve Left to Makin U-Turn 77 Other, lain In g P 1 No Controls 10 Person 2 Brakes 14 Windows/ (bottom) Namtive (including SS Overtaking/ 45chnoI Zone Sign/ Flagman, Officer, 3TIres Windshield 88 Unknown Passing Device Guard, etc.) 4Lights(head, 15 Mirrors Special Function 1 No Special Funcdon 9 Ambulance 14 Imo But 5Traffic Control 13 Waming Sign signal, tall) 16 Truck Coupling/ 2 Farm Vehicle 10 Fire Signal 77 6 leering Treller Hitch/ Truck 15 Charter ourBw Other, Explain in 1 of Motor Vehicle 3 Polite 11 Fem LaborTrensport S65huttla Bus 6 to 51q" Namtive 7 Wipers Safettyy Chains ]Yield Slgn 9Exhaust System ]]Other, 7 Tul 12 School Bus 17 Farm Labor Bus 88 Unknown Explain In 8 Military 13 Transh/Commuter Bus 99 Unknown 10 Body, Doors Narrative 11 Power Train 88 Unknown PFASON#a NAMEOFVIOLATOR FL SFATUTE NUMBER CHARGE CITATION NUMBER 1 JARROD AUSTIN BACKOUS 316.1925(1) CARELESS DRIVING AlPKZIP PERSON# NAMEOFWOLATOR FLSTATUTE NUMBER CHARGE OTAMONNUMBER 1 JARROD AUSTIN BACKOUS 316.212(2)(A) VIOLATION OF OPERATION OF GOLF CART Al PKZ2P PERSONN NAME OF VIOLATOR FLSTATUTENUMBER CHARGE CITATION NUMBER HSMV 90010S (V) (rev 10/10) Page 2 of 6 1 REPORTING AGENCY CASE NUMBER H5MV CRASH REPORT NUMBER 17-1034 84212038 IVEHICTLERNAE PHONE NUMBER Check if1RROD 7r— ❑ AUSTIN BACKOUS 202-494-5266 Recommend NRRENTAODRFSS (Number and Street) Driver Re•eKam CIfY &STATE PL. LF [ODE ALEXANDRIA VA 22301 DATE OF BIRM SIX DRIVER LICENSE NUMBER STATE IXPIRES INIURY SEVERftt FIN—JT- IMale 1 1None 4lriwpparRatln9 06/06/1980 288 Femake 66000553205 VA 06/06/2022 2Possible sFatallwithln 3o days) 3 Non -Incapacitating fi Non -YY. c Fatality DL Type Required Endorsements Driver's Actions at Time of Crash q p/1 ur 2 Na 6 3C E/ 5 Operator 3NoRaq.Endorsement t� 1 No Contributing Action 26 Ran off Roadway Condition At 27 Disregarded other Traffic Time of 77 2N,711jntMannCarelessor SIgg^g SW 6 E/Oper•Rezt 7 None fresh ❑ Negligent Manner 2B DIsre aNed Other Road IApparend Normal t 3 11 to Yield Right -of. Way ❑ Mark rags 3 Asiee ar ad ued 4 Improper Backing B D verD etraCte y 4 Other Inside the Vehide glrpurn 29 Over-Correctin Over- 51111SI or Fainted 1 Not Distracted "Plain In narrative) 2ntl 10 Fopllowed too CloselySteering � 4th 6 Se sure, Epilepsy, Blackout 2 Electronic Communication 5 emal Distraeon 11 Ran Red Light 30 Swerved or Avoided: Due 7 Physically Impaired Devices (call phone, ate.) (outside the vehicle, In 2 12 Drove too Fast for Conditions to Wind, Slippery Surface, B Emotional(depression, MV, Object• angry, disturbed, ❑ El 3 Other Electronic Device explain narrative) (navigation deWce, DVD player) 6ToenB 7Inattentive 13 Ran Stop Sign Non-MotodstIn etc) SS Improper Passingg Roadway etc. 9 Underthe ln0uenceof 330pentedMVin Erratic, Medications/Drugs/Alwhol Driver Vision Obs; 88 Unknown 17 Exceeded Postetl5 eed 21WfonggSideorWrOngWay Reckless or Aggressive Manner 77Other, Explain lnNarrative Wayne 77 Other contributing Action BB Unknown 25 Failedto 1 Vislon Not Obscured 5 Load on Vehicle 9 Keep Inrong Smoke 1 1 2 lndament Weather6Buliding/Fixad Object 10 Glare•, 3Parked/Stoppped Vehicle 751gns/Billboards 77 All Other Explain 4 trees/crops/Bushes B Fog s e In Narrative Helmet Use (HU) Eye Protection (EP) Restraint Systems 1007{omyyllant 1 Yes ❑2 Motor Vehicle Seating Position: LOCATDN: SEAT (Lac)3 Seat 01 R Motorgcle Helmet 3 2 No (RS) ROW OTHER 20ther Helmet ❑ 3Not Applicable 'Not Applicable No Helmet Row Other 1 Lea Front 2None Used•Motor Vehicle Occupant bhou1der and lap Bah Used 1 1 Not Applicable 2 Middle 25econd 251eeper Section or i ruck Cab �I{M 3Thlyd 30ther EnclosedrCarga Area r a e O e 4 9 P y s DePloyed-Other 4 Shoulder Belt Only Used (ASD) 'knee, air bell, etc) 5 Lep Belt Only Used EJecH (EJECT) 60ep Other 4Fourth 4Unendoxd Ca c, ea In 77 Other RowQ�a[EJeRed Unit naxmdve) BBU known an led, 6RertfalntUxd-Type Unknown 1Nain 44 'Not Applla2 Not Isy bled Comb nation 7ChIItl Restraint System -Forward Facing gin 8 Child Restraint System - Rear Facing 3Ele�ctM; Paartlilly 6 Riding Motor Vehicle Extedor(non- 3Deployed-Front Oelployment 9Booster Seat $B Unknown rolling unit) BB Unknow 4rNNJ. Applicable 4Depl0Ve•Side Unknown 10 Child Restraint Type Unknown 8s Unknown 77 Other, Explain In Narrative Non•Motorlst Description Non -Motorist Location At Time of Crash Action Prior to Crash 2 Pedestrian IIntersection-Marked Crosswalk BSidewaik SWalkin C Z/Vding on Sidewalk building,skater, pedestrlen conveyance, etc.) 3 Intersection -Other 10 Driveway Access 61n Box way—Other(workin& 2uldIn Other skatr, ed tirlan lo'verxnina 2lntersectim- Unmarked Crosswalk 9Median/Crossing Island 1:1 3 Blrycllst playing, etc.) 4Mldblock-Marked Crosswalk 11 Shared -Use Path or Trail 7Ad)acent to Roadway (e.g., 40ther Cyclls[ 5Travel Lone -Other Location 12 Non•Tralfinva11 Area 1Crossin Realm Crossing shoulder, median' S Occupant of Motor Vehide Not In Transport 6 Should Lane 77 Other, Explain In Narrative 2 WaMng to Cross Roadway s Goln to or from School =pant of 75houlder/Roadside eg Unknown 3 Walking/Cychrif] Alon 88 (K-12) 9 Wncidentiresponse)y 60amspottion Roadway with TrafRc�In or 7nnsportadon Device Non•Motorlat AcdonslClroumatences 1 response) Device 7 Unknown Type of Non -Motorist 3 No Improper Action adJacenttotravdlone) 3 None Safe Equipment tat Safety3Fallura 1 None 2 Dart/Dash 4 Walking/Cyclli AlonYY 77 other, Explain in Narrative RoadwayttotrtTl to Yield Rlght•of-Way, Ror oadway AgainstTr as Unknown 5Lighting 2 Helmet ❑ lane) 4 Failure to Obey Traffic Signs, lane) 6Not Applicable 3 Protective pads Use 77 Other, Explain 'elbows, knees, shins, etc.) In Namdve ❑ 2nd 4 Re0ecdve 0athing Qacket, gB Unknown Signals, or Officer 7 Entering/Exltlng Parked/Standing 10 Improper Tum/Merge S In Roadvn Im ro ed (standing, Vehicle 111m Yy g, T Y p ( & proper Passing 6DI 12 Vehide 9Not Viiible dalrk cgothln^ Warradalking backpack, etc) no1e) able RiiaBed workln 770th#8EWx Ialnlidn &or I & N on, pushing, leaving/approachiml lighting, etc) g8 Unknownp SUSPECtED ALCOHOL 0: ALCOHOL E: ALCOHOL USE: 2 Tast Not Given 1 Bbod 1 No ❑ i Test Refuxd 2 Brcaffi a s ALCOHOL SUSPECTED DRUG T ED: DRUG DUG TESTR ULT: TEST RESULT: ❑ BAC DRUG USE: ❑ 'Test Not Given❑ 1 Blood 1 Positive 1 Pending 1 No 1 2 Test Refused 3 Urine 1 3Testnwn 77 Other, as 68 Unknown e9 Unknown, If Tested 770Ner, Fis ■ n In N 2 Negative 2Completed 2Yas 3Tast Given 77 Oth.n 3Panding 88 Unknown 88 Unknown 88 Unknown, HTested Explain In Narrative BB Unknown SOURCE OF 1 Not Transportedrted poRi TO MEDICAL FA IUtt EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 2 EMS S law Enforcement t ❑ 770ther Ez lain In Namtive BS Unknown PERSON#VEHICLE R NAME DATEOFBIRTH INJ SIX LAGS R 0 EJECT HU EP ABD RS 3 1 ALICIA PILARJOHN BACKOUS 10/14/1980 1 2 3 1 1 1 3 1 2 I 1 I I I I CURRENT ADDRESS (Number and Street) CITY &STATE 7JP CODE 619 UPLAND PL. ALEXANDRIA VA 22301 SOURCE OF TRANSPORT TO MEDICALFACIUTY EMS AGENCY NAMEORID EMS RUN NUMBER MEDICALFACRJTYTRANSPORTEO TO 1 Not Transported 2EMS 3Law Enforcement 1 ❑ 770ther Ex IIImdve BB Unknown PERSON# VEHICLE#NAME DATEOFBIRTH IW SEK LOC:s R O EIECr HU EP ABD - 4 1 COLBY IRS BACKOUS 07/10/2012 1 1 77 t t 1 3 1 2 NRRENTADDRESS(Number and Street) [ITV&STATE LP CODE 619 UPLAND PL. ALEXANDRIA VA 22301 SOURCE OFTRANSPORTTO MEDICALFACIII V EMSAGENCY NAME OR ID EMS RUN NUMBER MEDICALFACI ::: TRANSPORTED TO Not Transported '7 2 EMS 3 Law Enforcement t 770ther Ex Iain In Namdve 98 Unknown HSMV 90010 S (P) (rev 10/10) page 3 of 6 PERSON r2 REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER 17-1034 84212038 1D er ❑ VEHICtEp NAME 2 N Passenger 3 Pusenger 2 PHONE NUMBER Check if ROBERT GEORGE MCALILEY 561-601-3512 Recommend CURRENTADDRE55 (Number and Street) CITY &STATE Orlver Re-exam 333 POINTE VEDRA RD. ZIP CODE PALM SPRINGS FL 33406 DATE OF BIRTH SIX DRIVER LICENSE NUMBER STATE E%PIfl: I, 1111 SEVERITY JIM 'IU pWa ng 11/19/1946 2Femala 1 M244767462510 FL 07/11/2020 2P soasible S Fagl (wkhin 30 deYs1 BB Unknown ?f 1 3 Non -Inca .Nogg Fatality DL Type Required Endorsements is Driver's Actions at Time of Crash 1A 2B 3C 40 Chauffeur 1Ves 2Nc 5 Operator 3 No Req. Endorsement tet 1No Contributing Action 26 Ran off Roadway Y Condition At 2 Operated MV In Careless or 270NregarddotherTrafBc Sign Time of Crash 6 E/Oper• Rest 7lNJene n Failed to Manner 28 Disregarded Other Road SAppparcntlY Normal Markings 3Asleepu or Fatigued ❑ 4Imi Improper ❑ erBackinght-of•Way D Ver Distractedy 4 Other Inside the Vehlde 2nd 6lmprop�er Tum g 29 Over-Correctng/Over- 5 In (SIN) or Fainted S Not Distracted "plain in namtive) 10 Followed too Closely Stewing 65e:ure, Epilepsy, Blackout 2 Electronic Communication 5 emal Dlsmctlon 13 Ran Rd tight y 30 Swerved or Avoided : Due 7 Physically Impaired Devices (cell phone, etc.) Ioubltlethevehicle, 3 Other Electronic Device ezplaln in narrative) 12 Drove too Fast for Conditions to Wind Slippery Surface, ❑ 8 Emodonal (depression, 13 Ran Stop Sign MV,Obfect, Non-Motorlstin angry, dlsturbed, etc.) (invitation devira, DVDplayer) ��^�aHdentive 151mproper Pauln9 310pentaedMVln Enrol 9 Medigtlansn/ROrugs/Almhol 17 Exceeded Posted Speed Driver Vision ObstructlOnf 88 Unknow'" 21 Wrong Slda or Wrong Way Reckless or Aggressive Manner 77 Other, Explain in Narrative 25 Failed to Keep In Proper lane 77 Dther Contributing Action 88 Unknown 1 Vision Not Obxured 5 Load on Vehicle 9 Smoke 2lnckment Weather 6Bullding/Fixed Objed 10 Ggre 3 Parked/Stopppeed Vehlde 751gns/Blilboards 77 AH OHIer Ezplaln 4 Trws/Crops/.ashes a Fog e ' In Narrative Helmet Use (HU) Eye Protection (EP) ❑ Restraint Systems 1 DDT-CompIlent 1 Yes Motorcycle Nelmet 2 No (RS) Motor VBhlCls Ssating POSltiOn: LOCATION: SEAT ROW OTHER 2other Helmet ❑ 3Not Applicable Seet Row OlhBr (lOQ 1Not Applicable 3 No Helmet 2None Used - Motor Vehicle Occupant 1 Led SFront 1Not Appllnble 2 Middle 25econd 251eeper Sedon of Truck Gb 3 RI`ht 3 ThIM 3 Other 3 Shoulder and 1a f a(3 eta Oyer SDepleyed-0ther 4 Shoulder Belt Only Used (ABO) 6knee,air etc) 5 Lap Belt Only Used E)ectlon losed a Ca o Ana 770ther 4Fourth 4Unenclased Cargo Area (explain in 770ther Row STrailing Unit narrative) 88 Unknown d- (EJECT) 6 Deployyed- 6 R x Int Used • Ty a Unknown 1Not E)exed 1Nat Applicable Combination 7C�i11tl Restraint SysAem- Forward Feting 2 ettedd, 77otall 2Not DePloyd 7Deployd-Curtain 8 Child Restraint System - Rear Facing 6 Riding on Motor Vehkle Exerlor(non• 3 Ep7�ened, PartaYly 3 Deployed -Front 88 Dedoyment 9 Booster Seat 88 Unknown tniling unit) 88 Unknown 4 at Applicable 4 Deployed -Side Unkknnown IO Child Restraint Typa Unknown 88 Unknown 77 Other, Explain In Namtive Non-Motorlat Description Non -Motorist Location At Time of Crash Action Prior to Crash S Pedestrian IIntersection 2 Other Pedestrian (wheelchair, person ince 2 Intersection• building, skater, pedestrian conveyance, etc.) 3lntersecdon—Other 3 381 In 4Midblock-Markd - Marked Crosswalk 95idewalk SWalkina/Cycling ri Sidewalk Unmarked Crosswalk 9Median/Crossing Island filo Roadway—Other (working, SO DivewayAaess 3 playing etc Crosswalk 115hard•Use Path or Trail hoan1 7playin, to�oadway (e.g., got erCydlst 5 Travel Lane •Other Location 12 Non-TrafBcway Area 3 Crossing Roadway Adjacent to S Occupant of Motor Vehkle Not in Transport 6ekydelane 77 Explain In Narrative 2Waiting to Cross Roadway B Going to from School (parked, UOther,nkmno or (K-12) etc.) 75houlder/Roadside BB Unknown 3 Walking/Cycling Alon 9 Workin In 6 pant a Vehicle Roadwa with Traffic y Dn-Motor Transportation Device Non -Motorist or (Incident response) dof ces y 7 Unknown adjacent to travel lane) ype of Non -Motorist Type Safety Equipment tet None SLlghdng No Action 10 None 1 No Improper Action 4 Walking/Cycling Alon 77 Other, Explain In Narrative 2 Dart/Dash 8Y 1 3FalluratoYield Riht-of-We RwdwayAgalnstTnflicJln 88 Unknown or adjacent to travel lane) 2 2 Helmet .Not 4Failure to ObeyTraffic Signs, g Appll<able 3 Protective Pada Used 770thes ExWaln //elbows, knees, shins, etc.) In Nam ve 2nd 4 NeRecdve Clothing Oacket Signals, or Officer 7Enteing/FxlHng parked/Standing 10 Improper Tum Merge S In floadwa ImpropeA (standing, Vehicle 11 Improper I n& workin , I y proper Passing Peying7 8lnattentive (talkinteating, etc) 12 Wrong -Way Rlding Walking Ba Unknown ❑ backpack etc) b or 6 lace Ied Vehicle Related (workin 9 Not Visible (dark clothing, no 77 Other, Explain In Namtive on, pushing, leaving/approachingi lighting, etc) 88 Unknown SUSPECTED ALCOHOLTESTED: ALCOHOLT E: HOL USE: lTest Not Given 181od ❑2Test Refused ❑ 28r••th 1 3 Test Given a ALCOHOL SUSPECTED DRUG TESTED: DRUG P : DRUG TEST RESULT: TEST RESULT: BAC DRUG USE: lTest Not Given 1&Pod 1Posmve 1pending ❑� SNo 2Test Refused ❑ 3Uine 2NegaHve 3 Urine nknown ee Unknown, If Taxed 770thar, Explain In 2 CO :1. d 2 Yes 3 Test Gwen 77 Other, 3 Pending 88 Unknown 88 UMtnown 88 Unknown, ffTexed Explain In Namtive 88 Unknown GE OF TpANSPOpTN MEDICAL FA IUtt EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILffY TRANSPORTED TO Not Transported 2 S ,3 Law DELRAY BEACH FIRE RESCUE 6792 BETHESDA MEMORIAL HOSPITAL her Ex lain in Narrative 88 Unknown ❑ PERSON VEHICLE# NAME DATE OF BIRTH IW SEX LOC:S R O EJECT HU EP ABD RS 1 MILES BACKOUS 101 201a t 1 3 1 4 1 3 2 1 2 CURRENT ADDRESS JNumber and Street) CITY &STATE ZIP CODE UPLAND PL. ALEXANDRIA VA 33406 CE OFTRANSPORTTO MEDICAL FA[IL171' EMSAGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO Transported 1 3 Law Enforcementher ❑ Ex in In Namtive a8 Unknown ONM VEHICLEM NAME DATEOF9IRTH IW SEX LOC:S R O EJECT I HU I EP ABD RS CURRENT ADDRESS (Number and Street) [NY & STATE 71P CODE SOURCE OF TRANSPORT TO MEDICAL FAUUTY EMS AGENCY NAME GRID EMS RUN NUMBER MEDICALFACILfiY TRANSPORTED TO 1 Not Tnnsportetl 2 EMS 3 Law Enforcement ❑ 77 Other Explain In Narrative 88 Unknown 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 to 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'S 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 AT A SAFE DISTANCE. TREADWELL SAW VEHICLE # 1 STOPPED AT THE STOP SIGN AND THEN BEGIN TO TRAVEL ACROSS N. OCEAN BLVD./S.R. A1A. 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 MCALILEY'S BICYCLE AS MCALILEY WAS SOUTHBOUND AS DESCRIBED ABOVE ON N. OCEAN BLVD./S.R. A1A. 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. F1 Cm & STATE INS R. BATISTA I GULF STREAM POLICE DEPARTMENT HSMV 90010 S (N) (rev 10/10) Page 5 of 6 LP IN 3901 N.O.B. I S.R. A1A North Ocean Bv. Double Yellow Markings 3900 N.O.B. 17-1034 l Not To Scale HSMV 90010 S (D) (rev 10/10) Page 6 of 6 Sea Rd. 84212038 3851 N.O.B. ement Power Pole 10 Sea Rd. See Rd.