Loading...
HomeMy Public PortalAboutPRR 17-2577TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered in-person August 8, 2017 Chad Maloney [mail to: cmm2448(o)comcast.netl Re: GS #2577 (Request for Crash Report on 7/31/17 at Bellamar House — Case Number 17- 1487) Chad is requesting crash report on 7131117 at Bellamar House - Case Number 17-1487 Dear Chad Maloney [mail to: cmm2448(ccomcast.netl: The Town of Gulf Stream has received your public records requests dated August 8, 2017. You should be able to view your original request and response at the following link, as of October 3, 2017, due to the confidential and exempt from disclosure for a period of 60 days after the crash report is filed per Florida Statute 316.066(2)(a): http://www2.gulf-stream.org/weblink/O/doc/105295/Pagel.asi)x The police crash report you requested is available to be picked up at Town Hall any time between the office hours of 8:00 AM and 4:00 PM. We consider this request closed. Sincerely, I k?'4*Cr 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)(a) 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 Immedlate 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_ _ I 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/Televislon/Newspaper 1 represent a local, state or federal agency that is authorized by law to have access to these reports. Name of local/state/federal agency _ 1 represent a Victim Services Program, as defined in §316.003(65), Florida Statutes (2014). Name of Program: GNA_-) /R4 L10A�a P coed Name Signature Shel .374-- - f-3sr (Area Code) Telephone Number ff,F- I,1,AMA2 NOOSE_ Agency/BusinRepresentgqd ess/ l /1, OPiEAII 6;L✓r7 AddressC`r C�&-LF ,2CAltt City, State, Zip Code State of Florida, County of PALM �5h4 U4 Sworn (or affirmed) and subscribed before me this 8 day of Att QLS i 2p ) 7 Personally knowr_or Produced Identification --e_ Type of Identification Producoi �f Er—_' —a uwN Ste( Print Type or Stamp, Commissioned Name of Notary NSMV-44010 (Rev.12/14) RENEE' ROWAN EABEL =�.•s�•""•., t•= N01ary Public • Stale of Florida - • - COmm111310111 M GG 025200 My Comm. Expires Aug 2B. 2020 __ Bonded thmunh cow, . W,._.. This Traffic Crash Report can be purchased online at: www buycrash..m FLORIDA TRAFFIC CRASH REPORT LONG FORM ❑V SHORT FORM ❑ UPDATE ❑ (uweed Anei MAIL TO: DEPARTMENT OF HIGHWAY SAFETY & MOTOR VEHICLES TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING TALLAHASSEE, FL 32399-0537 WAS DOT PROPERTY INVOLVED IN THIS CRASH? TOTAL # OF VEHICLE SECTION(S) 1 TOTAL # OF PERSON SECTIONS) 2 TOTAL # OF NARRATIVE SECTIONS) 1 CRASH DATEME OF CRASH ODATEOF REPORT REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER 0713112017 820 PM 0713112017 17-1487 87073101 CRASH IDENTIFIERS OUNTYCOOE ITYCODE COUNTYOFCRASH PLACE OR CITY OF CRASH CHECK IF WITHIN IME REPORTEDMEDISPATCHED OB 44 PAL3A BEACH OutFsrREaM LITYLIMITB ❑V 8:20 PM 820 PM ME ON SCENE IME CLEARED SCENE CHECK IFCOMPLEEO 1z REASON Immaggetcrr NOT Complete) Notified By: 1 Makest 8:20 PM 8:45 PM ZIP CODE FL 33483 VEH.p 2 Law Fnkrcemem ROADWAY R ESTAMT CRASH OCCURRED ON STREET. ROAD, HIGHWAY ATSTREETADDRESSY ATLATITUDE AND LONGITUDE SR AIA NORTH OCEAN BLVD 3960 ZIPCODE AT FEET MILES ATNROM INTERSECTION WITH STREET. ROAD,HIGHWAY �OR FROM MILEPOST# 300 V ❑ ❑ [W]© 1 Road System Identifier T Forest Road Type of Shoulder TTa of Intermaetlan 5 Tremc CdGe OF nvala Rawey 1 Into late 4 Count' 9 Pard,Lct 2 U.S. 5 Local 1 Paved 2 Unpaved 1 of at Intervention 8 Roundabout 2 Four -Way Intersection 7 Five -Point, or More 3 T. matriarchal 77 Other, Explain In Narrative 77 Other, Explain In 3 State 6 TumpikeRoll Na ati. 3 Curb 4 Y-Inkrsecllon V Light Condition Weather Condition Road", Surface Condition School Bus Related Manner of Collieion4mpacl 1 Daylight 5 Duk -Not Lighted 5 2 Dusk 8 Dark -Unknown 4 Flap, Smog, Smoke 5 SleatHe ll 1 Fre" Rain 5 Oil S Mud. Din, Gravel 7 Said 1 No 2 Yes, Schad Bue 4 Sideevdpe, same direction 5 Sideswipe, Opposite Direction ❑ 3 Dawn Lighting 4 Derkllghted 7T Other, Explain In 8 Blowing Sand, Soil 8 Water Direutiy Invalvetl El 6 Rear W Side Narrative Din t Clear (standing/moving) 3 Yes, Sdrad But 7 Rear W Rear 1 Front Rear BB Unknown 7 Severe Chinni 2 1 Dry 77 Over. Explain In Indirect Involved y 77 Other, Explain in Hematite W Z Front W Front RWnClou77 Other, Explain In 3 Rain 2 Wet Naoatve 08 Unknown Nanatve 41.IFrost 88 Unknown 3 Angle First Harmful Event Non -Collision Collision Non{Load Object Colllllon with Filled Object First Harmful Event I Ower1urwRdaiver f0 Parallel i9lmpact AtenuakrlC. 30 Concrete 2 FimlExpgvk n 11 Pedelrycle Curtain 31 other Traffic Banner Location t On Rha d#ay 3Immersion 12Ralhaeywhide(baln, 20 Bridge Ovedread SlmClum 32Tme(stendng) ]Off Roadway 39 4 Jackknife engine) 21 Bridge Piw or Support 33 Utility Pot.lUghl Support 3Shoulder 5 Caryo/Equft ment 13 Animal 22 Brkge Rall 34 Trask Sign Support2 4 Median Find Hennlul Event Loss or Shift 14 Motor Vehicle in 23 Culwn 35 Traffic Signal Support fiGore B F.IVJumped From Transport 24 Curb 36 Order Past, Pat. or 7 Separator within Interchange Motor Vehkde 15 Parked Motor Vehicle 25 Ditch Support 81n Parking Lane or 1No 7ThmwniaFelling 18Work ZoneRdaintakence 28 Embankment 37 Fen. Zone Object Equipment 27 Dissected Face 38 Mailbox 9Outside Righlaf-way 1 2 Yes 8 Ran Int Water/Genal 17 Struck By Felling, ShHdng 28 Guadiad End 39 Other Fixed Object (wall, 10 Raedeke BB Unknown 9 Other Collbkn caw 29 Cable Benner balding. tunnel, ek.) 88 Unknown 18 Other Nor-Flxxdj Oblect First Harmful Event Relation to Contributing mumatances: Road 9Mrs Travel -Polished Sud.. on ut ng rcumstanees: Environment Junction 4 5 Rahway Greece Crossing1:1toy. 10 Read Surface Condign (wet, anew. son. etc.) 14 EntranolEkt Ramp 11 Obstrudain In Roal ❑ ❑ ❑ I NortJunc on 15 Crossover- Related 12 Debra 1 Nona 18 Shared -Use of Path w Troll 2lntenectain 17 AwIereOo Lane Miss Device 4 Work Zone (.nstruNON I In Treed noNian+IIg Missing Obscured lNorm In Roadway 5 AOther adaeredon 18 Through Roadway 3 ln&swetolley , melnt.riancehidlitylders(none. 14 NanJggnway Work Work Mat 2 Weather OondWona 77 m Explain In E Accefild 4 DHveweylAlley Ac.ss Explain In NenetWe (none, lav, still, high) 88 Other, Explain in Nanedve Sun, 3 Physical Obetroctbn(s) Namdve Namalk Related 88 Unkrawn 88 Unknown 1 Rul, Holes, Bumps Ba Unknown 7 Hot 4 Glare BB Unknown Work Zone Related Crash in Work Zone Type of Work Zone Workers In Work Zone Law Enforcement In Work 1 Before the First Won. Zane 1 Lene Closure Zane iN. Warning Sign ❑4ActlAy 2 Lane ShlNCrossovar ❑ d Intermittent orMlaifin 1 No ❑ 1 No ❑3l�iw Officer 88 Unknown Area n Oenln1, oro 88 Unknown Vehicle S Termhaton Area Only Present WI INL55L5 CHAD NAME MALONEY ADDRESS HSI N OCEAN BLVD CITY a STATE GULFSTREAM FL APCODE 33483 NAME ADDRESS CITY &STATE ZIP CODE NAME ADDRESS CITY &STATE ZIP CODE VEHICLEAMA VEH.# PER# ROPERTY DAMAGE - OTHER THAN VEH. BARRIER WALL OR GUARDRAIL EST. AMT 508BELLAMAR OWNER'S NAME Q (CHECK IF BUSINESS) HOUSE CONDO'S ADDRESS CITY It STATE HSINORTHOCEANSUGULFSTREAM ZIP CODE FL 33483 VEH.p PER# ROPERTY DAMAGE - OTHER THAN VER ESTAMT OWNER'SNAIAE ❑ (CHECK IF BUSINESS) ADDRESS CITY &STATE ZIPCODE HSMV 90010 S 1 5 Page of Number VEHICLE # 1 Check if Commercial❑v H870731 NAME OF VIOLATOR VMYM ONYSHCHENK 77"°P 4j'CeieNmbe 1Rapon 0 1 VehkJe In Transport VEHICLE LICENSE NUMBER STATE REGISTRATION EXPIRES VIN Check If Pemahan 2 Perked MokV VaNde I AT278L PERSON 3 Working VaNde INJ I Reglabalkn Q IFUJGLDSIGLGZ3320 Hit ar Run ❑ 1 No1 vEAR MAKE NAME OF VIOLATOR MODEL STYLE COLOR CITATION NUMBER DAMAGE: 1 Disa lig 4 Minor EST AMOUNT 881Jnknoxm 016 FREI CASCADIA R ITE-WLII 9fiFlounctlonel BS Unkmwm 3 0.00 INSURANCE COMPANY (DRIVER) NATIONAL INDEMNITY COMPANY INSURANCE POLICY NUMBER Towed don loos F-7. 11 I VEHICLE REMOVED BY 1.=eUon er Request I ❑ INS ACP2900001094 2W 1 No 2vea VADYM ONYSHCHENK p0 man 4. Othen Fiadin In Nemdve NAME OF VEHICLE OMER(CHECK IF BUSINESS) O CURRENTADDRESS CITY &STATE DP ZIP ALWAYSAFFORDABLE METUCHEN NJ 335 HIGH ST. UNIT Big 1 08940 Trager LICENSE NUMBER STATE REGISTRATION EXPIRES heck BParnenent VIN YEAR MAKE LENGTH ALES One' TML69N NJ Regioal O IKKVES320EL235057 014 KENW 53 Trelbr LICENSE NUMBER STATE REGISTRATION EXPIRESB Permanent VIN YEAR MAKE LENGTH AXLES Twx Rpwaatlon ❑ VEHICLE N S E W Off -Road Unknwm ON STREET, ROAD, HIGHWAY TEST. SPEED POSTED SPEED TOTALLANES TRAVELING ❑ ❑ 0 ❑ ❑ F1 RATA NORTH OCEAN BLVD 5 5 . MAT. RELEASED 1No HAL MAT. PLACARD INo NUMBER CLASS Area d Initial Impact Moat Deme ed Area p 07 21 g 2 Vas 88 Unknown 2Ves 88 Unkmwn 19 Owrtuoh 19 15 18 17 B 20 Windshield 20 1 15 T8 2 3 4 5 6 7 18 Undarrardage 1B 2 3 4 #10 MOTOR CARRIER NAME US DOT NUMBER ALWAYS AFFORDABLE MOVING 8 5T 1456907 14 13 12 11 0 2t Trailer 21 14 13 12 MOTOR CARRIER ADDRESSCfTV STATE ZIPCODE PHONENUMBER 325 HIGH ST 982 METuCHEN J 08640 (see 1254 -Ml Vehicle Body Type 15 Lox Speed vehicle Tm lcway Ccmmermai Motor Vehicle Configuration 18 (Sport) UWIry VMitle 20 1 Two -We Not Divided 1 Vehicle 10,00(l see or lase Placarded 8 TradoHTdple I y ler Hazardous interests 9 Truck more than 10,000 lbs(4SM 17 Cerya Ven (t0,0001bsL43 (4,536 kg) or leas) 2 Two-way, Not Divided, with a Conflouaue Left Tum Lane g 2 Skgle-Un t Truck (2 -axle and GV WR kg), Cannot Classify 1 Passenger Car 18 Motor Coach Wo -Wag Divided, Unprotected more Nan 10p001bi (4,536 kg)) 10Busange van(wedfor&1S 2 Passenger Ven 190therLlpdTmcks(1o,0001banied" feet) Meddn 3 SIng1a4Jnit Truck(3 on more ales) accaped, Including driver) 3 Pickup (4,538 kg) or less) Wey, Divided. Poaitive 4 Track Pulling Traller(al 11 Bum (med far more Nan 15 7 Motor Home 20 MedlurOkavy Trucka(Mo.dn Border 5 Track Tractor(bodalq occupants, Including driver) Ba.. Nen 10.D00IN (4,536 kill) w -way Traftim 6 Truck TrzdoHSeml-Traller 77 Other, Explain In Nemtive 11 Motorcycle 21 Farm Labor Vehicle n 7 Track TretlorrCade Track 88 Unknown 12 Moppeetltl 77 Order, Explain In Namtlm Trallar TVpe 1 Single Trailer 13 All Tsnaln Vehlde (ATV) 88 Undrown ami 8 Pole Tosser Tandemller Trailer glowed VMJclepo Cargo Body Type CommlNcn•Cummercfal TRAILERI TRAILER 22 131ntermotlal ]Tank Lawler 10 AUN77 t Interstate Carmen T, Eaphon 3 WATIrclosad Bos Container Chassis I 4 East T ManVTreller NamatI, Expleln in 4 Hopper 14 Vehkle Tow' S Baal Treibr Nemtive 1 °g 2lnimadte Cellar 5 Pole -Trailer Another Vehicle w 3 Not In Camm.n:su 6 U81ay Trailer 88 Unknwm nk 6 Cargo Tank 15 Not Applizable OI 4 Not In CommamNOlher Lurk Truck 7 House Trailer 1 No Came N ] Fletaetl (vehicle 10,00016. Most Harm/ul Event Non43dllolun 110,000 got (4,5M kg) w leas 2Bus 8Dum as not Comm P disc Ike) or I Overtuplosioovn GVWRIGCWR p)) Te Mher placem pt HM pain 2 3 More Nen 28,000Ilea (11,783kg) 10 Aub 3 Man. o.28,00 2SMout(11, ry3kg) 10AWa 77 Other, 77Order, Espleln in hun.raplosion ]ImmeMen ga)Rfrt 4Not Applicable 11 GeNegameNea NamWe 4 Jackknife Collision with Non -Fixed Object Collision Fried Object 12 Log 66 Unknown 39 5 Cago/Equipment Lasa or She 10 Pedesdan 29 Cable Bardet Emergency 6 FN/Jumped From Mawr Venice 19 Impact AttenuatadCresh Cushion 11 Pe ialcyde 20 Bridge Overhead Structure 30 Conned Traffic Banner Vehicle Use 7 Tamm or Felling Obled 12 RalWay Vehicle (man, engine) 31 Other Traffic Banner Z1 Btltlge Pler a Support SegUBRGe 01 EVBnfa BRan lnlo WeteHCenel t3Animd 32 Tree (staring) 9 Other Non -Collision 14 Motor Vehicle In Transport 2Z Bridge ftell 33 UtIs Pol I ry, eNpht Support 23 Culver tet 2M 15 Pared Mohr Vntera 34 Tralflc Sign Support [40d63egwnu of Event; only] 18 WaMZonelMelntenance 24 Cut 35 Treftic Signal Support No 39 40 equipment Failure (dawn firs, ❑ ❑ Equipment 25 Ditch 38 Other Post, Pole, cur Support 1 2vea broke f inure, etc) 17 Struck By Felling, Shifting Cargo or 26 Embankment 37 Fence 41 Separation of UNd 3rd 4th 42 Ran O8 Roadway, Right Anything Set In Motion by Molar 27 Guardrail Face 38 Mallbos 88 Unknown Vehicle 28 Guerdrall End 39 Other Most Object(well, ❑ E]43 Ren O8 Roadway, Left 1 B Order Noa-Flxed0 build hmal etc. 44 Cmes Median Vehicle Maneuver Action Traffic Control Device For Vehicle Detects 45 DmssillRu Roadway Grade 46 Cran Campine Runaway toppe 3Tuminq Left 14 Slowing 15baght Left 13 slopped in Trelfie This Vehlele ❑ ❑ 1 Level 2 Hllloremt 4 Backing 15 Negolwing o Curve I 8 Flashing Signal 1 None 5 Turning Right 16 Lsadng Traffic Lane 9 Railway Creasirp Roadway Alignment 1No Cords 2Brekm 13 Wheols T 3 Uphill 6 Changing Lanes 17 Entering Traffic Lane Device 4 School Z. Sign, 3Tuee 14 Wlrowar 4 Downhill 1 11 Parked 77 Difheq Explain h NenaWe 10 Parson (including 1evice 5 Sep (bo0om) 2 Cum Cum 4 Lights (heed. Wlrsbleltl 10 Making U -Tum Be88 Unknown Flagman, Officer, Left 7 Cum Left 5 Traffic Control aglow, talo 15 Minors 11 Overtakl IPassl Guard, etc.) signal B Tmdt Coupling 77 Other, Explain In Special Function 1 Na Specht Function BAmbuTnu Wipers Bus BSlop Sign 7WIwn Tr HAW 1 2 Farm Vahltla of Motor Vehlele NamBve 10 Fire Truck 15 15 Chi en Safety Bus 7 Yield Sign B Exhaust System Seery Chains,Expl 88 unknaxn 3 Police 11 Farm Labor Tre08pM 16 Stands Bus 10 Body, Ooore 77 Order, Explain in 77u1 Farm LBus 12 School Bus 17 Form Labor Bus it PowarTreln Namtive 8 Military 13 TreneNCommNar Bus BB Unknown I I 12 Su slon BB Unknown PERSON# 1 NAME OF VIOLATOR VMYM ONYSHCHENK FL STATUTE NUMBER 16.1985(1) CHARGE ACKING- IMPROPER CITATION NUMBER 1292FJZ PERSON NAMEOF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER PERSON NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER HSW90010S 2 5 Page of_ PERSON# 1 Reporting Agency Case Number HSMV Cash Repan Number 17.1487 87073101 1 Driver VEHICLE NAME PHONE NUMBER Checkf El2 Non4Joforist 1 1 Recommend 3 Passe e! VAOYM ONYSHCHENKO 347)SIT]i 151 Drivers R"ison CURRENT ADDRESS( Number and Sheat) CITY& STATE ZIP LODE 3705 SHORE PKWY BROOKLYN NY 11235 OATS OF BIRTH SEX:a DRIVERS LICENSE NUMBER STATE EXPIRES MNURY SEVERITY"Man 5 Fatal El 09128/1984 2 Female 88 Unknown 159866138 NY 2 0912812020 3 Possible (within 30 days) Non-Incapactating 6 Non -Traffic Fatality DL type Raqulrad Endorsements tel Driven Actions at Tkrw of Crash 3rd ❑ tLCondition Al A 2B 3C 1 No Corbaution Action 26 Ran of Fannie, y 1 4 DlChaufeur El 1 Yes 2 Operate l MV in Came. cur 27 Disregarded other Traffic❑ Tiros of 5 ElOpeaar g No Negligent Manner Sign 6 ElOper-Reel 3 No Req. Endorsement 3 Fesal to Yield Rightcl-Way 28 Disregarded Other Road 1 Apparently Normal 7 None 4 Improper Backing Markings 3 Asleep or FaWged or Fainted Driver Discounted By6Immatua Tum 29 Over-CorrsctinglOver 5111 (suckSolo)e Blackout 4 Other Inside Me Vehicle Ste ave 1 Not Disposed (explain in narative) 2nd 10 Followed tap Closely 7 Physically Impaired 86 5 External Dlstacoan 11 Ran Red Light 30 Swerved or Avoided: Due 8 Emotional (destruction, 2 Electronic Communication (.%too the vehicle, explain 12 Drove ten Feel ler CandBfons 4th angry, tlleWNed, etc.) Devices (mil phone, etc. b Wind, Slippery Sudam, MV. 9 Under Ne Influence of In..We) 13 Ran Step Sign 3 Other Electronic Device Object. Non -Monet In 6TesWg 15 Improper Passing Roadway, etc. MetlimticnsfDags/Almhol (hevlgahin devlm, OVO player) Y ) 7Inattentive 17 Exceedetl Posted Speed 31 Operated MV In Emak, 77 Mer, Explain In Nio alive 88 Unknown 21 Wrong Side of Wrtmg Way Reckless or Agmesshro Manner 88 UnM. DRIVER VISION Felled W Keep In Proper Lane 77 Other Conlrlbuling Action OBSTRUCTIONS I Visa Visken Nol Obsmrstl 5 Lcatl on VMltle9 Smoke 2 lrclement Weather a BulldinglFhed Object lD Glare DRIVER OR PASSENGER 1 ❑ 3 ParkeNSbpped Market 7 Slgnel9fllbmnds 77 All Other, Explain 4 TreeslCraps/Suahes 8Fog In Narrative Hatchet Uae(HU) Eys Proaction IEP) Rawmaintflyslxns DRIVER OR PASSENGER ❑ 1 GO pliant 1 Yes IRS) Melarrycle Helmet 2N. ❑ Motor Vehicle Seating Position: OUTION: 20tlh Helmet 3Noa Applicable 1 Not Applimbb(non-molarin) SEAT ROWFEI Seat Row Other Loc) 13Na Helmet 2None Used- Motor Vehicle Occupant 3 Shoulder and Lep Sell Used 1 Lefl 2 UfaMid1Front lNot Applicable Alr Bag Oeployatl 4 Shoulder Beit Only Umtl 3 Right 2 Second 2 Sleeper Section of Truck Cab 5 Depinyed-0 er 5 Lap Belt Only Used kl -IECT) 6Restraint Usetl-Type Unknown (knee, err EelL etc.) n Other 3 Third 3 Other Enclosed Cargo AreaNot Electe ! i Not Applicable _ 7 Child Restraint System - Forward Facing (explain ar 4 Foutlh 4 Unenclosed Cargo Alae Elected, Totally 1 2 Not epioynd8 Deployetl 8 Chfltl Resirslnt 8 stem - Rear Fetlnramble) 3Deployetl-Front Combination Y g 77 Other Row 5 Tailing UGiI Elm, BB Unmown d Deployed -Side ] Dapbyetl-Cumin 9Spwfer Seat 68 Unknown 6 Riding an Motor Vehicle Exterior (non -Nally 80 Deployment10 Child Restraint Type Unknown tailing Unit) Not Applicable Unknown 77 Other, Explain In Nantive Unknown NON -MOTORIST .MM ❑1 PerPeetrla ober Description N-48oarist Location At Time of crash B Sidewalk Action prior us crash ❑ 1 Intersection - Marked Crosswalk 9 MetlleNCauing Island ❑ 5 WelkinglCydbq on Sidewalk 20ther PndeeMen (xTeelchatl, mraon Ina Wilding, skater, statesman conveyance, etc. 2lnareeclbn -Unmarked Crosswalk 10 Driveway Access B in Roadway —Other (workthg, 3 alryctist chan- Offient Crosswalk 11 Shand -Um Pen or Tail ICrouhp Roadway p ying, etc.) 40ner Creed 4Midbloask Marked Crouwlaock-Marked lk 12 Nan-Trafimvay Area Welting a Cases Raatlway Raodway III 50cupant& Motor Vehice Not In Transpan S Tavel Una-OlhLocation shoulaAdjacentIn 77 Other, Expain In NAMM)" Anne rine Ian) instead ala) 6 Bicycle Lane SB Unknown Roadway with Tmlflc (Ina 8 Going to or from School (K-12) B Occupant of a Non -Motor Vehicle 7shoplderrttcad.k. tljemnto nivel lane) 9 Working in Tmfflcway Transported. Device on o c Fume rams 4Wa1dng/Cyding Along 10 Nona incident response) 7 Unknown Type of Nan-Malmist tat 1 No Improper Action Roadway Austria Traffic lin 7T Oner, Explain In Namara. Dar ash or adjacent 0 travel lana) BB Unknown 3 Failure W Yield Rlghlof-Way 4 Failure W Obey Trarflc Signe 1 Nom Safety Equlpmmt 5 Lighting Helmet 6 Not Applicable❑ Protective Pacts Used gee Signal, for Of car 7 Ents inglExltlnu Parked/Standing 10 Improper Tuarye ❑ rare 6 Vehicle 11 Improper Passing Raatlway 77 Other, Explain elbows, knee, Mine, etc.) In kl.a . I Improperly (sanding, lying, working. playing) 8Inattentive (talking, eating, arc) 12 Wrong -Way Rising or Walking ReBective Clothing gecket, IS Unknown 7 D, Explain In Narrative 6 Disabled Vehicle Related (wwklrq 9 Not Visible (do* clearing, no 7ear .it,&. etc.) an, pushing. Ieavinglapprmchlng) lighting, ala) 88 Unknown ALCOHOLIDRUGIEMS SUSPECTED COHOLTESTED: ALCOHOL TESTTYPE:COHOL BAC USPECTED RUGTESTED: RUG TEST TYPE: RUG TEST RESULT. 11 NoAl-COHOL USE: Tat Not 2 Teat ReWsatln ❑ Blood Breslin i UOtherZExplaa ❑ 1 P NDING ❑ Test Not Test Reh.es USE: 1 Given ❑ BkKd 1 Un0lhen ❑ positive Negative 2Ye 3Tet Given MPLETED YNo Trost GivenWutl 32 Purging 11 BB Unknown 88 Unknown, Il Testetl InNamtive 8UNKNOWN Unknown B Unknown, If Tested Explain In Namtivs SB Unknown SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY NAME OR IO EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 Not Transp iratl 2 EMS 3 Lew Enforcement 1 77 Darer, Explain In Nang" 68 Unknown ADDITIONAL PASSENGERS ERSONIs EHICLEN rME ATE OF BIRTH INJ SE% LOC:S R 0 EJECT HU EP I ASO I RS CURRENTADDRESS(Numberand Street) CITY I STATE ZIP CODE SOURCE OF TRANSPORT TO MEDICAL FACILITY MSAGENCYNAMEDRID EMS RUN NUMBER MEDICAL FACILITYTRANSPORTED TO I., . as�,8 sunswu�wsmmn0xaa Exwe ❑ PERSON If rHICUE # rME ATE Of BIRTH INJ SEX IAC: S R O EJECT MUEP ABO RS CURRENTADDRESS(Number and Street) CITY STATE ZIP CODE OURCE OF TRANSPORT TO MEDICAL FACILITY MS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO I ae nnraaa s sus I.— n ow, erw e �wr m.wla 1:1 HSMV 90010S 3 5 Page oI_ NARRATIVE R°Pw*.9Apeecy C.. N.M HSMV Cr.eh ReW Number CHARGE 17-1487 87073101 VEHICLE 1 WAS BACKING OUT OF THE DRIVEWAY OF 3960 NORTH OCEAN BLVD ONTO SR AIA. Vi BACKED INTO A CONCRETE WALL. THE CONCRETE WALL IS LOCATED ON THE FRONT PROPERTY OF 3951 NORTH OCEAN BLVD. AS A RESULT OF THE COLLISION THE CONCRETE WALL SUSTAINED DAMAGE. SEVERAL PHOTOGRAPHS WERE TAKEN. END OF REPORT. ADDITIONAL PASSENGERS ERSON# EHICLE# E ATEOFBIRTH INJ SE% LOOS R 0 EJECT HU EP ABO RS CURRENTADDRESS INumbm eM SVeet) CITY STATE ZIP CODE SOURCE OFTRANSPORTTO MEDICAL FACILITY MSAGENCYNAMEORID EMS RUN NUMBER MEDICAL FACILITYTRANSPORTED TO 1HY irNNy�CSfNell�ANsmrif Wr.FgrnF N�nYw NYNuwr ❑ PERSON EHICLE# JAME ATEOFBIRTH INJ SE% LOC:S R O EJECT P AEG RE CURRENTADDRESS (Numh.r eM Street) CITY STATE plp"DIE SOURCE OF TRANSPORT TO MEDICAL FACILITY MI MS AGENCY NE OR ID EMS RUN NUN19ER MEDICAL FACILITY TRANSPORTED TO w ❑ irfw�l.,uww.rna.r.fm.ne ADDITIONAL VIOLATIONS PERSON# NAME OF VIOLATOR FL STATVfE NUMBER CHARGE CITATION NUMBER PERSON NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER REPORTING OFFICER IDIBADGE # RANK FFICER NAME DEPARTMENT PE OF DEPT. 750 OFC TODD E. SUTTON GULF STREAM POLICE DEPARTM GLIDE DEPARTMENT HSMV 90010 S HSMV 900105 5 5 Page of