Loading...
HomeMy Public PortalAboutPRR 18-2622TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered in person January 12, 2018 Latasha Goodwin Re: GS #2622 (Request for Crash Report 18-0068) Verbal Request for a copy of Crash Report 18-0068). Latasha Goodwin: The Town of Gulf Stream has received your verbal public records request. Motor Vehicle Crash Reports are confidential for a period of 60 days after the report is filed and they are not available to the general public at this time. On March 8, 2018, after expiration of the 60 -day period, per Florida Statue 316.066(2)(a), you should also be able to view your original request and response at the following link: http://www2.gulf-stream.org/weblink/0/doc/116321/Page1.aspx We consider this request closed. Sincerely, Reneé Rowan Basel As requested by Rita Taylor Town Clerk, Custodian of the Records This Traffic Crash Report can be purchased online at: wwwbuycreah.com WAS DOT PROPERTY INVOLVED IN THIS CRASH? FLORIDA TRAFFIC CRASH REPORT School Bus Related ' LONG FORM ❑ SHORT FORM ❑ UPDATE ❑V TOTAL# OF VEHICLE SECTION(S) 2 mixided aeu) 5 Dark -Not Llghled 8 Dark -Unknown 4 Flog, Smog, Smoke 5 SIeeVHBM 1 Freezing Rein ❑ 3 TOTAL # OF PERSON SECTION(S) MAIL TO: DEPARTMENT OF HIGHWAY SAFETY & MOTOR VEHICLES 4 Sideswipe, same direction ❑ 5 Sltleawipe, Opposite Direction 6 TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING TOTAL # OF NARRATIVE SECTION(S) 1 TALLAHASSEE, FL 32399-0537 1 8 Water ❑ CRASH GATE TIMEOFCRASH DATE OF REPORT REPORTING AGENCY CASE NUMBER HSMVCRASH REPORT NUMBER 01108!2018 8:00 AM 0111012018 180068 88 Unknown 87073108 CRASH IDENTIFIERS Indirectly Involved COUNTYCODE CITYCODE COUNTYOFCRASH PLACE OR CITY OF CRASH 3 Rain Narrative CHECK IF WTHIN TIME REPORTED TIME DISPATCHED 86 Unknown Fired Harmful Event Non -Collision Collision Non -Fixed Object Collision with Fixed Object First Harmful Event CITY LIMITS ❑V I OvenumlRollover 10 Pedesinan ix ImpactAnenuatooCrash 30 Concrete 06 q4 PALM BEACH GULF STREAM Location Location On Roadway 8:00 AM 8:00 AM TIME ON SCENE IME CLEARED SCENE CCHECK IF OMPLETED R REASON (If Investigation NOT Complete) 1 Notified By: I Moladn 1 8:05 AM 9:35 AM 3Shoulder 5 CargorEquipment 13 Animal 22 Shop Rall 34 Tmmc Sign Support 2 Law Enforcement ROADWAY INFORMATION (CHOOSE ONLY 1 OF 4 OPTIONS) First Harmful Event Lose or Shin 14 Motor Vehicle In 23 Culvert 35 Traffic Signal Support CRASH OCCURRED ON STREET, ROAD, HIGHWAY AT STREET ADDRESS © AT LATITUDE AND LONGITUDE S.R. (AIA) N. OCEAN BLVD 1300 7 Separator within Interchange Motor Vehlde 15 Parked Motor Vehicle 25 Ditch Support MILES 1 APPROM EDRCTI�WIiH STREET, ROAO,HIGHWAY © �OR FROM MILEPOSTk 100EET 7 No 1❑ 2 Yee Object Equipment 27 Guardrail Fars 3B Melleax B Ran Int Water/Canal 17 SW ck By Felling. ShiNng 28 GueNrall End 39 Other Fixed Object (well, HI DEN HARBOR 9 Outside Rightaf-way 10 Roadside S8 Unknown Road System IdentlRer 7 Forest Road Type of Shoulder Tyyk�e of Inlorsection 5 Traft Circle 8 Private Roadway ❑ 1 Interstate 4 County 9 Parking Lot 2 US. g ❑ 1 Paved ed 1 Nof at Intersection 6 Roundabout ❑ 2 FounWey Intersection 7 Other, Exp r More 3 3 T -Intersection 77 00rea Explain in Narrative 6 TurnsLoca 3 Stats B TumpikeRoll Na Other. Explain In Narretive 3 Curb 3 Curb 4 Y -Intersection CRASH INFORMATION (CHECK IF PICTURES TAKEN) Light Condition Weather Condition Roadway Surface Condition School Bus Related NAME Manner of Colllalonllmpact 1 Daylight 1 2 Dusk 5 Dark -Not Llghled 8 Dark -Unknown 4 Flog, Smog, Smoke 5 SIeeVHBM 1 Freezing Rein ❑ 5 Oil 6 Mud. DNL Gravel 7 Sand 1 No 2 Yes, Stlwol Bua 4 Sideswipe, same direction ❑ 5 Sltleawipe, Opposite Direction 6 3 Dewn Lighting 6 SlowingSand Sall 1 8 Water ❑ 1 Direct/ Involved ❑ y ADDRESS 6 Rearm Sitle 4 Dark -Lighted 77 Other, Explain In Narrative Din Klee, (standingimoving) 3 Yes, School Bus7 Rear m Rear ?Front to Rear 88 Unknown 7Severe CmssWWs 2 Cloudy 77 Other, Explain In 1Dry 77 Other, Explain in 2 Wet Narrative Indirectly Involved 77 Other, Explain In Narrative 2 Front to Front 3 Rain Narrative 41ce/Frost BB Unknown 3Angle 86 Unknown Fired Harmful Event Non -Collision Collision Non -Fixed Object Collision with Fixed Object First Harmful Event I OvenumlRollover 10 Pedesinan ix ImpactAnenuatooCrash 30 Concrete 2 Fre/Explosion 11 Pedalcyde - Cuslon 31 Other Traffic Banker Location Location On Roadway 3thromb on 12 Falvey vehicle (tram, 20 Bridge Overhead Structure 32 Tree (standing) 2 OR Roadway 14 4 Jackknife engine) 21 Bridge Pier a Support 33 Utility Pole/Light Support 3Shoulder 5 CargorEquipment 13 Animal 22 Shop Rall 34 Tmmc Sign Support � 4Median First Harmful Event Lose or Shin 14 Motor Vehicle In 23 Culvert 35 Traffic Signal Support 6 Gore 6 FIIVJumped From Trani 24 Cum W Ohler Post, Pole a, 7 Separator within Interchange Motor Vehlde 15 Parked Motor Vehicle 25 Ditch Support 81n Perking Lana or 7 Thmern or Felling 18 Work Zone/Malnasinance 26 Embankment 37 Fence Zone 7 No 1❑ 2 Yee Object Equipment 27 Guardrail Fars 3B Melleax B Ran Int Water/Canal 17 SW ck By Felling. ShiNng 28 GueNrall End 39 Other Fixed Object (well, 9 Outside Rightaf-way 10 Roadside S8 Unknown 9Other Collision came 29 Cable Bamer buil inp, cannel, eta) 88 Unknown 18 Other Nan -Fixed Ob act First Harmful Event Relation to Contributing Circumstances: Road a Wom, Travel-Ponshed Surface Contributing Circumstances: Environment Junction Grace ng 5 Railway EnwaraRamp 10 Raod Condition tl(wet, 1 Icy, show, slush, ❑ 11 11 11 ObstrucUan In Roadway El ❑ ❑ 7 Noo-Junction 15 Dressers,- Related 18 Sharetl-Use of Path or Trail 12 Debra 1 None 13 Trelflc Control Devito 1 Nana 5 In Roadway 2lntarsadbn 17 Aaslera0niffReleretbn Lane 4Wark Zane(wnsiruNaN Inoperative, Missing aObearetl Other. E 2 WeaPhysther am Narrative Expleln in 3lntmukmon-Related 18 Through Roadway mainlenancelutility 14 Non -Highway, Work 3 Oben Narrative al ObaVuctbn(e) 4 Ddveway/Alley Access 77 Other, Explain in Narrative 6 Shoulders (none, law, son, high) 77 Other, Explain In Narrative 4 Glare Glam 88 Unknown 88 Unknown Related as Unknown 7 Rut. Holes, Bumps BB Unknown Work Zone Related Craws In WorkZone kWo Type of Work Zone Workers In Work Zone Law Enforcement In Work eef o e Zone 1 Before 1 Lene Cbeure Zona I No Byes Sign 2Advance WemingAme ❑ 3Treivity 2 Lane ShINCrossover ❑ 3Wod aunt or ShoulderorMeork 4 Ex or Having Wed 1 No ❑ 8Yee 1 No ❑ 30wEnforPresent Be Unknown 4 Aerial/ Arda Y Area 77 Oahe Explain In Narrative Other, 88 Unknown 3 Lew Enforcement Vehicle 5 Tertninetion Area Only Present WITNESSES NAME RANDALL WILSON ADDRESS 246 SEA ROAD CITY &STATE GULFSTREAM LP CODE FL NAME ADDRESS CITY &STATE LP CODE NAME ADDRESS CITY &STATE ZIP CODE NON VEHICLE PROPERTY DAMAGE EST. AMT. OWNER'S NAME ❑ (CHECK VEH,# PER# PROPERTY DAMAGE -OTHER THAN VEH. EST. AML OWNER'S NAME ❑ (CHECK IF BUSINESS) ADDRESS CITY &STATE ZIP CODE VEH.# PERP ROPERTY DAMAGE -OTHER THAN VEH. EST. AMT. OWNER'S NAME ❑ (CHECK IF BUSINESS) ADDRESS CITY &STATE LP CODE HSMV x0010 S 1 7 Page of_ VEHI LE# 1 Check if Commercial Ct ❑ RepONng Agency Cane Number HSMV Crash Repon Number CHARGE CITATION NUMBER 180068 87073108 1 Vehicle In Transport CARELESS DRIVING VEHICLE LICENSE NUMBER STATE PERSON# REGISTRATION EXPIRES'ANZ Check It Permanent CHARGE Parked Motor Vehicle 3 Wording Vehicle 1 458PSX FL OPERATING WHILE DL 5U5PENDEDICANCELED/REVOKED I 12/31/2018 Recantation ❑ 1FTJW35F5TEB06730 Hit and Run 7 No 1 YEAR MAKE NAMEOF VIOLATOR MODEL STYLE COLOR DAMAGE: 1 Disabling 4 Mawr EST AMOUNT 2 Yes 1996 FORD TK RED -RED 2Fintol 88 Unknow $200.00 ova INSURANCE COMPANY (DRIVER) INSURANCE POLICY NUMBER Towed due to Damage: 1 VEHICLE REMOVED BY 1. Rotation 2. Owner Request 77 INFINITY ASSURANCE INSU 509820028573001 1Na zvee JAMES SWEENEY 3. Driver 4. Omer, Explain In Nartative NAME OF VEHICLE OWNER (CHECK IF BUSINESS) ❑ CURRENTADDRESS CITY &STATE LP MARIA BRENDA LUNA 504 WALKER AVE GREENACRES FL 33463 Trailer UCENSE NUMBER STATE REGISTRATION EXPIRES Checkif Pertnenent VIN YEAR MAKE LENGTH AXLES One: Registration ❑ Troller LICENSE NUMBER STATE REGISTRATION EXPIRES Check R Pelmonent VIN YEAR MAKE LENGTH AXLES Two: Registration ❑ VEHICLE N S E W OR-Road Unknown ON STREET, ROAD, HIGHWAY AT EST. SPEED POSTEDSPEEO TOTALLANES TRAVELING ❑ 0 ❑ ❑ ❑ ❑ S,R. A1A 15 35 2 HAZ. MAT. RELEASED 1 No HAZ. MAT. PLACARD 1 No NUMBER CLASS Arae d Inaial Impact I Most Damaged Area 09 09 ❑ 2Vea 1:1 3 4 5 6 3 4 5 6 18 Z 7 2 7 1B UnOv BB Unknown 88 Un BB Unlorovm mange 19 1 15 16 17 8 20 Windshield 20 1 15 16 17 8 MOTOR CARRIER NAME US DOT NUMBER 14 9 21 Trailer 21 14 9 13 1211 0 13 1211 0 MOTOR CARRIER ADDRESS CITY 77T77 ODE PHONENUMBER Vehicle Body Type 15 Low Speed Venitle TrmRicway Commercial Motor Vehicle Configuration 1e (Span) Utllity Vehicle 3 1 Two-Way, Not Divided 1 Vehicle 10,000 Me or lees Placarded 8 TractudTdple 1 for Hazardous Materials 9 Truck more than 10,0001ba(4,538 17 Cargo Ven (10,000 Iba (4,538 kg) or less 2 TWa-Way, Not Divided, wiM e Continuous Lea Tum Lane k (2-axle and kgh Cannot avanClassify more than 10.000it )) 10 van (seats for a-15 more Nen 1g0uck (or 1 Passenger Cu 18 Motor Coats 3 iwa-Way, Divided, Unprotected 3 Sin la-Unit Truck 3 or more axles acwpenta, including clever) mo ex occupants, In 8 ( ) ( 2 Pickup er Ven 19 Omer U" ks (10,000 ms n feetDivided, 4 Track Pulling Trellar(s) less) kg) nl Iese) 3 Planor Positive 4 Twan DlvitleQ 71 Bus (creels for more man 15 4 Two-Way, 7 Mame 20 Meavy Trucks (more 20 Ma Bo Median Bomar 5Tack Tractor (boSerm-Tr Other, mtludmg Bus 10,00 8 Bus than 10,000 lot (4,536 kg)) T7 Naar) 5 Ona-Wa TraMexa 6 Truck Traclar/Saml-Trailer 7) Omer, Explain In Narrative Y Y 7 Truck Tractor/Double TrvnJ< 11 Motorcycle 21 Farm, Labor Vehicle BB Unknown BE Unknown 12 Moppepdp 77 Other, Explain In Narrative Troller P. 13 All Tertain VeNtle (ATV) 88 Unknown 1 Smgls Saml Trailer B Role Troller 2 Tandem Semi Thaler 9Towed Vehicle Cargo Body Type COmm/Nan-Commerdel TRAILER/ TRAILER2 13 cial 3 Tank Trailer 10 Auto7ranppon 1 Interstea Comer Conmi er 3y,ryEnclaaed flax Conalnar Chassis S BoetTie lar nVfreller N ��o� Explain In ❑ Ch ❑ 1:1 1Anamer 2lnbastale Carver 5 PdaPTrallar Vehlden9 eUtililY Trailer BB Unknown 3 Not In CornmelcelGevamment 6Cerga Tank 15 Not Applicable 7 House Trailer 7 N0 Cargo 4 Not m COmmarcalOmar Trull 7 FmMad (vehicle 10,000 has 2 Bus Most Herlfl(Yl Event Non-Collision 1 10,0001sa (4,536 kg) or leas 8 Dump (4,538 kg) or less not Comm 10vanuFire/Explosio Over 210,001.25,OOOIas(4,536-11,793kg) 9Concrete Mixer displaying Has demand! GVWR/GCWR 2 3 More than 25,000 Has (11,793kg) 10 Auto Transport 77 Other. Explain in Immoraploslon 3lmmersbn 4Not Applicable 11 Garbage/Refuse Narrative 4lackknde Collision with Non-Flaetl OaJad Collision Fixed Object 12 Lag BB Unkna4n 14 5 CergolEquipmem Loss or Shift 10 Pectination 19 Impact AltanualarlCrash Cushion 29 Came Bader Emergency B Fal/Jumped Pam Motor Vehicle 11 Peclocycle 30 Concrete Traffic Barrer Vehicle Use 20 Bntlge Overhead Structurs 7 Thrown or Feeing Object 12 Railway Vehicle (vein, engine) 31 Omar Trane Bader Sequence of Events Been Into Weter/Canel 21 Bridge PierRail or Support 13 Animal 32 Tree(amnding) B Other Non-C011islon 22 Bridge Rall 1 14 Motor In Transport 33 UMIy Support ❑ 23 Craven Sign up Tat 2M 75 Perked Molar Vehicle 34 Traffic Sign Support Motor Ode Sequence of Events only) Work Zona/Malnlenance 24 Curb 35 Traffic Support I No 14 ❑ 4 40 equipment Failure (down Post, era, Equipment 25 Odrh 38 Omar Post, Pole, or Support Eq 2 Yea bake failure, etc.) 17 Strutlt By Fading, Shifting Cargo or 26 Embankment 37 Fence BE Unknown 41 of Anything Set In Motion by Motor 27 Guardrail Face 38 41h Ran Off Rn 42 Ran Os Roadway, Right ay, OtherMailbox Vehicle 28 Guaarsil End 39 Omer Fixed Object (well, 43 Ren 00 Roadway, Leo 1B Omer NarFFLaed Ob eIX aulWin Wnnel etc. 18Other ❑ 44 Caas Metllen Vehicle Maneuver Action Traffic Control Device For Vehicle Defects aS Caen/ Centenlne Roadway Grade 480ownhlll Runewey 3Tuming Las 1451awing IStraight Ahead 13 Stopped In Traffic This Vehlcla ❑ ❑ 1 Level 2 Hillcrest ❑ 4 Backing 15 Negodat ng a Curve 1 B Flashing Signal 1 None 4 5Tuming Right 78 Leaving Traltic Lena 9RelhveyCacaing Roadway Alignment 1No Controls 2Brakes 13 Wheels 1 3 Uphill 6 Changing Lanes 17 Entering Traffic Lena Device 4 School Zone Sign/ 3 Tires 14 Windmill 4 Dovnhiti 1 Straight 5 Sag (bottom) 1 2 Curve Right B Parked 77 Other, Explain In Nerrium 10 Person (including vi 10 Making U-Tum BB Unknown Deca Flagman, OR4 Lights (head. Windshieldcar, 3 Curve Lea signal, tall) 15 Minos 11 pwenakin lPeepin 5 Traffic Control Guam, eta.) Signal B 18 Truck Coapting 77 Omer, Explain In Special FanatiOtl 1 No Function 1 Wipers Taller HitW 15Camer Bus BStop Sign Narrative 2Fam Vehicle 2 Form Vehicle Fire Truck 9Exhars 10 Fla 15 Bra 7 Yield Sign B Exhaust Oty, Chains 1 of Motor Vehicle 3 Police Shame Bus Lab 77 11 Ferm Lobar Transport 18 Shuttle Bus UO'm 10 Batly, Goon 77 Omer, Explain in Doom 7 Taal 12 School Bus 17 Farts Labor Bus 11 Power Treln Narrative B Military 13 TranshCommuter Bus BS Unknown 12 Suspension 88 Unknown VIOLATIONS PERSON# NAMEOF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER 1 FERNANDO COORA SUEZ 316.1925(1) CARELESS DRIVING AIPKXIP PERSON# NAMEOF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER 1 FERNANDO COORA GUEZ OPERATING WHILE DL 5U5PENDEDICANCELED/REVOKED 322.34 2 () (SPECIFY REASO A1PKXBP PERSON# NAMEOF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER HSMV 90010 S PERSON# 1 Repan rap Agency Case Number HSMV Crash Report Number 180068 87073108 7 Driver VEHICLE4 NAME PHONE NUMBER Checks Rewmmand ❑ 2 Nonta lanst �1 1 RODRIGUEZCORA 3 Passe FERNANDO (681)ESM261 Driver Patzem CURRENT ADDRESS (Number and Street) DITYB STATE ZIP CODE 51514TH ST WEST PALM BEACH FL 33401 DATE OF BIRTH SEX: 1 ❑ DRIVERS LICENSE NUMBER STATE EXPIRES INJURY SEVERITY (INJ)4lncepecltatirg 2 Female 2 Possible 5 Fetal (within 30 clays) OBI0811962 68 Unknown R-362-240-62-288.1 FL 0810812024 3 Non-Inwpetltaung a Nan-TraAe Fatality 01 -Type Required EndOnemenls let Driven Actions at Time at Crash 3rd Condition At ❑ t A 2 B 3 C 1 No Conthbution Action 26 Ran off Roadway Time of 1 6 4 D/Chaulfeur 3 1 Yes 2 2 Operated MV in Caralsa or 27 Disregarded other Traffic Crash ❑ ❑ 5 E/Operss 2 No Negligent Manner Sign 6 E/Oper-Rest 3 No Rad. Endorsement 3 Failed to Yield Right-af-Way 28 Disregarded Other Road 1 Apparently Normal 7 None 4Improper Backing Markings 3 Asleep or Fabugea 8Improper Tum 29 Over-CorreNng/Over 5111(sick) or Fainted Drive Distracted By 4 Other Inside the Vehicle Steering 6 Seizure, Epilespsy, Blackout (explain in nartstive) 10 Followed too Closely 7 Physically Impaired tl 5 External Disaaction 2M 11 Ran Red Ughl 30 Swerved or Avoided Dua 8 EmoBonel (tlepraaalon, 1-1 1 Not Oonic Communication 2 E ices (cc hone,et.(outside the vehicle, explain 12 Drove loo Fast for Conainons to Wind, Slippery Surface, MV 4th angry, disturbed, ata) Devices (cellr phone, D etc. In narrative) 4 13 Ran Stop Sign B Under the Incidence of 3 OtherElectronicDevice Nan-Motariat In MadirationalDru BTexting 151mpraper Passing Ra g slAlconol (navigation device. DVD player) 17 77 Other, Explain N Narrative Posted Speed 31 Operated MV 31 Operated MV 68 Unknown 21 Wrong Side of Wrong Way Reckless orAOraeasiva Manner BB Unknown 88 Unknown Wong Si a sive M DRIVER VISION OBSTRUCTIONS 25 Failed to Keep In Proper Lane 77 Other Conthbuting Action ❑ 7 Vision Nol ObacVred 5 Load on Vehicle B Smoke 2 inclement Waathe 6Builcing(Fixed Object 1 10Glare DRIVER OR PASSENGER 3 Parkedl5lopped Vehicle 7 SlgnslBtllboards 77 All Othe, Explain 4 TreeslCrapslBushes 8 Fog In Narrative Holmet Use (HU) Eye Protection (EP) Restraint Systems DRIVER OR PASSENGER ❑ 1 DOT -Compliant ❑ 1 Yea (RS) SEAT ROW OTHER Motorcycle Helmet 2Nd Motor Vehicle Seating Position: LOCATION:20therHelmet 3 Not Applicable 1 Not Applicable (non-motods8 Seat Row Other (LOC) 1 E-1 3 N Helmet 2None Usetl- Motor Vehicle Occupant 3 Shoulder and Lap Belt Used 1 Lea 1Nol Applicable 4 Shoulder Bee Only Used 1 Air Bag Deployed 2 Midde 5 De o ea-0the 5 Lep Balt Only Used SecoFront 2 Sleeper Section of Truck Cab 2 Second y 3 Right 3 Other Enclosed Cargo Area Ejection (EJECT) (Imee. 6 Restraint Used -Type Unknown 77 Other 3Third 7Not Ejected 1NotA aDeplolrbel4 el[.) System g 4 Unenclosed Cargo Aree 2 8Deployed- 7 Child eplkeed (explain In 4 Fourth ❑ 2 Ejected, Totally 2 Not Deployed ea B Child Restraint System -Rear Fetl PerceintS-Rear Fa inti 5 Trailing Unit 1 Y narrative) 77 Other Row 3 Elected, 3 De Ia eE Front 7 Deployed- 9 ewste Seal 66 U tine) 6 Riding on Motor Vehicle Exterior (non- Partially P Y 7 Daployea-Curtain 1a Child Restraint e 88 Unknown y 4 DeployeaSiae 86 Deployment Type Unknown trailing unit) 4 Not Applicable Unknwn T7 Other, Explain In Narrative 88 Unknown 88 Unknown WONTIOTOWW N n-Motodst Description 1 Pe�esman ❑ Non-Molodst Location At Time of Crash BBidewalk Action Pdorto Crash 1lnteraection-Marked Crosswalk 5 Walking/Cyding an Sidewalk 2 Other Pedestrian (wheakhini "raw In e B MediaNCrossing Island 2InterseNon Crosswalk 6In Roadway Other building, skater, pedestrian conveyance, eta -Unmarked (working. 10 Driveway Access y– ( g. 3 Bicdist 3Intersecton-OIhe4 Mlablork-Marked Crosswalk 11 Shared -Use Path or Trail 7 Crossing Roadway playing, etc.) 4 Other Cyclist Ra�y(a 9. ene-Oma- Marked Crosswalcation 12 Non-Tra6kway Area 2 Waiting to Cross Roadway 7Adshoulder, 5 Occupant of Motor Vehicle Not in Transport 5 STrevl 77 Other, Explain in Narrative 3 Waiking/Cyding Along median) oulde , e (perked. ak) Bicycle Lane S to hon) School (K-12) 6 Bicycshoulleer/Roetlsitle BB Unknown ReadwaymthTraffe(Inor Scy B Occupant M a Non -Morar Vehicle Biding In Trip adjacent to travel lane) (Incident response) Tramponatlon Device Non-Motorrst ActionfulGircurnstances 4 Walking/Cydkng Along 10 None 7 Unknown Type of Non -Motorist ta) ❑ 1Na Improper Action Roadway AgalnslTralflc(in 77 Other, Explain in Narrative or adjacent lane) 86 Unknown 2 Failure 3 Failure l OcieYield Right -Way 4 Failure to Obey Traffic Sign 7 None Safety Equipment 5 Lighting 2 Helmet 6Not Appiicoble 3lbows,ve Pada Used ❑ Signals, or ORcer 7EnteringlExWng PerkemStantling 10 Improper TUMMarge xM 51n Roadway lmpmpery(steMing, Vehicle tt improper Passing 77 Other, Explain (elbows, knees, shine, etc) In Nertative lying, working, playk o B Inaaenth a (talking, eating, etc) 12 Wrong -Way Riding or Walking 4 Reciedlve Clothing Us[km• 88 Unknown ❑ 8 Dlsebletl Vehltle Related (working 9 Not Visible (dark clothing, no 77 Other, Explain in Narrative backpack, am) on, puankg, leaving/eppreatlNg) kighbng, old) BB Unknown ALCOHOUDRUGIEMS SUSPECTED ALCOHOL TESTED: ALCOHOLTESTTYPE: COHOL SAC SUSPECTED DRUG TESTED: DRUG TEST TYPE:DRUG TEST RESULT: USE: ❑ No vad N.t Test fenl� ❑ 1 Blood Breath ❑2COMPLETED❑ -ST RESULT. OY sG USE 1 2 Test Not Test e ❑T70NerI Blood❑ 3 Urine 214 siouve age ve ❑ mALCOHOL 21 32 Tesl GlvPENDING 77IOther,2Explen 3Test Giv1 3Poending 88 Unknown 00 Unknown, If Tested In Nanasve 8a UNKNOWN 88 Unknown BB Unknown. if TesMd Explath In Nartagve 88 Unknown SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY NAME OR ID EMS RUN NUMBERMEDICAL FACILITY TRANSPORTED TO 7 NolTransportetl 2 EMS 3 Lew Enforcement 1 T7 Other, Explain In Narrative BB Unknowl) ADDITIONAL PASSENGERS PERSONA VEHICLEA rME DATE OF BIRTH I INJ SEX LOC:S R O EJECT HU EP ABO RS CURRENT ADDRESS (Number and Street) CITY STATE ZIP CODE SOURCE OF TRANSPORTTO MEDICAL FACILITY EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACIUTY TRANSPORTED TO t xan.o.Y) zexsa uv w.aanu�.. rmwe .seWYa ❑ PERSONA VEHICLEM AME DATE OF BIRTH I INJ I SEX I LOC:S I R O 1 EJECT I HIJ I EP ABO RS CURRENT ADDRESS (Number elle Street) CITY STATE ZIP CODE RCEO,rsueNS TRANSPORTMEDICAL SOURCE OF TRANSPORT TO MEDICAL FACILITY EMSAGENCY NAME OR IO EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO sna xn w IYNYa Y V,bpn HSMV90070S 3 7 Page of NARRATIVE Reporting Agency Case Number HSMV Crash Report Number CHARGE 180068 87073108 .DRIVER OF V-1 WAS DRIVING SOUTHBOUND IN THE 1300 BLOCK OF N. OCEAN BLVD. V-2 WAS FOLLOWING BEHIND AT A SAFE AND REASONABLE DISTANCE. DRIVER OF V-1 ABRUPTLY APPLIED HIS BRAKES AND STOPPED IN THE ROADWAY. V-2 CAME TO A STOP ALSO. DRIVER OF V-1 PUT HIS VEHICLE IN REVERSE IN AN ATTEMPT TO BACK UP AND MAKE A TURN HE HAD MISSED. DRIVER OF V-2 ATTEMPTED TO DRIVE TO THE RIGHT AWAY FROM BACKING V-2 AND HER VEHICLE WAS STRUCK IN THE RIGHT REAR. FUNCTIONAL DAMAGE. NO INJURIES. DRIVER REMOVED V-2 AND A COWORKER(JAMES SWEENEY) RESPONDED AND DROVE AWAY V-1. ADDITIONAL PASSENGERS PERSON # VEHICLE # rME DATE OF BIRTH INJ SEX LOC: S R O EJECT MU EP I ABD RS CURRENT ADDRESS (Number and Street) CITY STATE ZIP CODE SOURCE OF TRANSPORTTO MEDICAL FACILITY EMS AGENCY NAME OR IO EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO PERSONA VEHICLE# AME DATE OF BIRTH INJ I SEX I LOC:S I R O 1 EJECT I HU I EP ABO I RS CURRENT ADDRESS (Number and Sunset) CITY STATE ZIP CODE SOURCE OF TRANSPORT TO MEDICAL FACILITY TOMEDICAL EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACIUTV TRANSPORTED TO rxNRCEO zeae>Y.ORT e ❑ Nu pYNYs ADDITIONAL VIOLATIONS PERSONk I NAMEOF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER PERSONk NAMEOF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER REPORTING OFFICER ID/BADGE# RANK OFFICER NAME DEPARTMENT TYPEOFDEPT. 7AS21754 PATROL OFFICER R. BATISTA GULF STREAM POLICE DEPARTM POLICE DEPARTMENT (PO) HEW 900105 4 7 Page of_ MSMV 900105 S 7 Page of VEHICLE# 2 Check if Commercial11,1111, Agency Case Number HSMV Crash Report Number ❑ 180068 1 87073108 1 Vehicle In Transport VEHICLE UCENSE NUMBER STATE REGISTRATION EXPIRES Check 4 Permanent VIN 2 Parked Motor Vehicle 1 .3 Working Vie IHDY03 FL 11/2912019 Rogistrabon ❑ 3N1AE17AP1HY278185 1 iarM Run YEAR MAKE MODEL STYLE COLOR DAMAGE: EST. AMOUNT 1 Oeebling 4 Minor 58 Unknown 1 2017 NISS 4UOOR SEDAN GRAY-GRY 3Nome onal SB Unknown $2,000.00 INSURANCE COMPANY (DRIVER) INSURANCE POLICY NUMBER Towed due er VEHICLE REMOVED BY 1. Rotation UNITED AUTOMOBILE INSUR DADOOa647684 to Damage: 2. Owner Request iNo 2Yee LATASHABLAKE-GOO 4. ONExpleln In Nerreuve NAME OF VEHICLE OWNER (CHECK IF BUSINESS) ❑ CURRENTADDRESS CITY &STATE LP LATASHA M BLAKEGOODWIN 5920 NW 14TH ST SUNRISE FL 33313 Trailer LICENSE NUMBER STATE REGISTRATIONEXPIRES Checkil Permanent VIN YEAR MAKE LENGTH AXLES One; Registration I—I Thiser LIGEIVSENUNIER STATE REG15TRATIONEXPIRES uneuarennanem VIN YEAR MAKE LENGTH AXLES Two: RegOoation ❑ VEHICLE N S E W O4 -Road Unknown ON STREET, ROAD, HIGHWAY AT EST. SPEED POSTEOSPEED TOTALLANES TRAVELING ❑ ❑v ❑ ❑ ❑ ❑ S.R. Al N. OCEAN BLVD 5 35 2 KAZ MAT. RELEASED I HA7 MAT. PLACARD NUMBER CLASS Area of Initial Impact I most Damaged Area t No ❑ 1 Na ❑ OB O6 2Yee 2Yee 2 3 4 5 6 7 18 UMaerturn 18 2 3 4 5 6 7 88 Unknown Be Unknown 19 MOTOR CARRIER NAME US DOT NUMBER i4 15 16 17 B 20 windshield 20 1 15 16 17 8 13 12 11 0 27 l Trailer l21 14 13 1211 0 9 CARRIERADDRESS Vehicle Body Type 15 Lox Speed Vehicle 18 (Sport) Utility Vehlde 1 TrafBcway 1 Two -Way, Not Divided 13 Ati amain Vehicle (ATV) 88 Unknown ❑2Single-Unit CommlNon-Commercial 17 Cargo Van (10,0001bs 1 (nteeontsate Carrier :nte 2 Two -Way, Not Divided, with a 10 BusfLerge van (seats for 845 15 Not Appliesble Carver (4,530 kg) or less) B Dump Continuous Left Tum Lena 1 Passenger Car 18 Motor Coach 5 Truck Tractor (bobtei) 3 Two -Way, Divided, Unprotected 2 Passenger Van 19 Other Ught Trucks (10,000 lbs (pointed>4 feet)Median 3 Pickup (4,536 kg) or less) 4 Two -Way, Divided, Positive 7 Motor Home 20 Mef ium/Heavy Trucks (mon Median Bomar 8 Bus than 70,000 lbs (4,536 kg)) 5One-Way Tramovey 11 Motorcycle 21 Farm Labor Vehicle 72 Mo 77 Oliver, Explain in Narrative 13 Ati amain Vehicle (ATV) 88 Unknown ❑2Single-Unit CommlNon-Commercial B Truck mon than 10,00) lbs (4,538 I Cannot Classify 1 (nteeontsate Carrier :nte more then 13.000 be (4,536 kg)) 10 BusfLerge van (seats for 845 15 Not Appliesble Carver occupants, Including driver) B Dump 4 Truck Puking Traller(s) 3 Not N Commerce/Government Most Harmful Event 14 Sequence of Events 1 at nd] 14 2❑ E 4th Non -Collision 1 Overtum/Rollc mr 2 Rn/Explosion 3 lmmeraion 4 Jackknife 5 Cargo/Equipmant Loss or Shift 6 Fel[Numpetl From Motor Vehicle 7 Thmwn or falling Object 8 Ran Into WetsrfCanal 90ther Non-Collislon [40-46 Sequence of Events only) 40 equipment Failure (blown tin, broke failure, el 41 Separation of Units 42 Ran O4 Roadway, Right 43 Ran O4 Roadway, Left 44 Cross Median __,......._.... Commercial Motor Vehicle Configuration This Vehicle B Flashing Signal 1 Vehicle 10,000 lips or less Placement B Tmdorrrd* ❑2Single-Unit for Hazardous Materials Truck(2- eanti GVWR B Truck mon than 10,00) lbs (4,538 I Cannot Classify ❑ more then 13.000 be (4,536 kg)) 10 BusfLerge van (seats for 845 15 Not Appliesble 3 Single -Unit Truck (3 or mon axles) occupants, Including driver) B Dump 4 Truck Puking Traller(s) 71 Bus (seats for more than 15 displaying HM plawre 5 Truck Tractor (bobtei) occupants, Including driver) 11 Garbage/Refuse 6 Truck Tnctor/SembTraller 77 Ogler, Explain In Narrative 34 Traffic Sign Support 7 Truck Tnctcr/Double Truck ..._.__._ __,......._.... Trailer Type This Vehicle B Flashing Signal I Single Semi Troller 8 Pole Trager 3 Van/Enclosed Box 2 Tandem Semi Trailer 9 Towed VehicleTRAILER 1 TRAILER 2 3 Ten' Troller 10 Auto Transport 4SaddleMourtnrailer 77 Other. Explain In ❑ ❑ 5 Boat Trailer NertaWe 1 No Cargo 8 Cargo Tank 15 Not Appliesble 8 Utility Trailer 68 Unknown Comm 110,000lips (4,536 kg) or less GVWRIGCWR 4 210,001-28,000 one (4,5W-11,7B3kg) 3 Mon than 26,000Ibs (I1,793kg) Collision with Non -Fixed Object 10 Pedestrian 11 Peddrycle 12 Railway Vehicle (vain, engine) 13 Animal 14 Motor Vehicle in Transport 15 Parked Motor Vehicle 18 Work Zonemlaintenance Equipment 17 Struck By Felling, Shifting Cargo or Anything Set In Motion by Motor Vehicle 45 Cross Canadine II 1Straight Ahead 48 Downhill Runaway 3 Turning Left E4 Backing 13 5Tuming Right 6 Changing Lanes B Perked 10 Making U -Tum it Ovsnakino/Pas 2 HOlorest Roadway Alignment 17 3 owll 4 Downhill 1Soeight 5 Sag (bottom)1 2 Curve Right 3 Curve Left Special Function 1 No Special Function arm of Motor Vehicle 3 PoliceVehicle 7 Tex[ 9 Ambulance 10 Fire Truck 11 Fan Labor Transport 12 Smock Bus Cargo Body Type 1 This Vehicle B Flashing Signal 131ntamwtlel 3 Van/Enclosed Box Container Chassis 4 Hopper ❑ 14 Vehicle Towing 5 Pole -Trailer Another Vehicle 1 No Cargo 8 Cargo Tank 15 Not Appliesble 2 Bus 7 Flased (vehicle 10.000 too B Dump (4,536 kg) or less not B Colla Mixer displaying HM plawre 10 Auto Transport 77 Other, Explain in 11 Garbage/Refuse Narrative 4 Slowing 15 Negotiating a Curve 1 This Vehicle B Flashing Signal CHARGE 29 Cable Bomar Emergency ie Impact Aftenuator/Crash Cushion 30 Concrete Traffic Banner Vehicle Use 20 Bridge Overhead Structure 31 Other Traffic Baffler 1 No Controls 21 Bridge Pier or Support at 32 Tree (standing) 13 Wheels 77 Other, Explain In Narrative 4 Smock Zone 22 BridgeReil 33 Utilay Support 14 WrMowsf 88 Unknown Device 23 Culvert 34 Traffic Sign Support Windshield 19 5 Traffic Control Guam, etc.) 24 Curb 35 Traffic Signal Support 1 No 25 Ditch 38 Other Post, Pole, or Support 2 Yea 26 Embankment 37 Face 88 Unknown 27 Guordrati Fete 38 Mailbox Trailer Ham/ 28 Guardrail End 39 Other Fixed Object (well, BB Unknown 4 Slowing 15 Negotiating a Curve 1 This Vehicle B Flashing Signal CHARGE CITATION NUMBER 16 Leaving Think: Lane NAMEOF VIOLATOR BRa1May Creasing 1 Nona CITATION NUMBER 17 Entering Traffic Lane 1 No Controls Device 2 Brakes 13 Wheels 77 Other, Explain In Narrative 4 Smock Zone SIGN 1D pans (Including 3 Tins 14 WrMowsf 88 Unknown Device Flagmen, Officer, 4 Lights (heed, Windshield 19 5 Traffic Control Guam, etc.) Signe, tail) 15 Minors Signal 77 011ier, Explain In 16 Truck Coupling 14 fi eild Sign Nertative 7Wiperng Trailer Ham/ 15 CharleIntercity TouBus Bus 7 Yield Sign BB Unknown 9 9 Exhaust t Chains Shuttle 18 ShuNa Bus DooSystm 10 Botly, Door Body. 77Oty 770theq Explain II 17 Farm Labor Bus 11 Power Train Narrative PERSONN NAMEOF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER PERSON# NAMEOF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER PERSON# NAMEOF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER HSMV 900105 6 7 Page of PERSON# 2 Repomng Agency Can Number HSMV Crash Report Number _ 180068 87073108 1 Driver VEHICLE NAME PHONE NUMBER Check If Recommend El 2 Nan-Motorist � 2 BLAKEGOODWIN 243-7284 Peasen r LATASHA M (954) Drivervar Rsazem CURRENT ADDRESS (Number and Smi CITY& STATE ZIP CODE 6920 NW 14TH ST SUNRISE FL 1 33313 DATE OF BIRTH SEX: DRIVERS LICENSE NUMBER STATE EXPIRES INJURY SEVERITY (INJ) 41mospadtatig None 5 FeMI 30 tleYs) ❑ 2 Female 2 Possible (within 1112911979 ee unknown B-422.533-79.929.0 FL 1112912025 3 Non4nrapactiong 8Non-Treftic Fatality DL Type Required Endorsements let Driven Actions at Time of Crash 3rd Condition At El 1 Yes 2 Operated MV In Carlin or 27 Disregarded otherTraffic ❑ ❑ ❑ ❑ Crash 2 No NegligentMannerSigDlaregeNed 5 EE100� 1 Apparently Normal Ror 3 NO Req. Endorsement 3 Right-of-Way Other Road y or 7 Nona 4Improper Backing Markings 3Asleap or Fetiuged Tum 29 Over-0onemknglOver 111 sla) or Fainted Driver Distracted By6Improper 4 Other Inside the Vehicle Steednp BSa5 EpilespsyBlackout (explain in narrative) 10 Followed too Closely 7 Physically Impaired 1-1 1 Not Distracted 5 External Distraction 2nd 11 Ran Red Ught 30 Swerved or Avoided Due 8 Emotional (depression, 2 nmic outside the vehicle, explain 12 Drove loo Fast for Conditions 4M angry, d1sturbed, ato) ( P Wind, Slippery Surface, MV, nic Comae. ef%bn Devices Elect phone, aro. In nanagve) 13 Ren Slop Sign Object Nan-Matotlst In 9 Under Ne InflummoegWAl of Devices O ❑ Device er Passing wind Taxiing Roadway, etc. ( Other Electroron 77 Other, Exp)wWns0in In (navigation clowns, DVD player) 7lnadentive 17 Exceeded Posted Speed 77 Other, Explain In Narrative device, 7Inae15 Exceeded Pee 31 Operated In Emetic, B8 Unknow 60 Unknow 21 Wrong Side of Wrong Way Reckless or Agraessiva Manner or gra DRIVER VISION OBSTRUCTIONS 25 Failed to Keep In Proper Lana 77 Other Contributing Action 1 Vision Nol Obacuned 5 Load on Vehicle 9 Smoke 2 Inclement Weather 6 Building/Fixed Object ID Glare DRIVER OR PASSENGER 1 3Perketl5bpped Vehicle 731gnslBlllboertla 77AllOther, Explain ❑ 4 TreeslCropsxBuahes 8 Fop In Narrative Helm et Use (HU) Eye Protection (EP) Resinlnl5ystems DRIVER OR PASSENGER ❑ 1 DOT-Compliant ❑ 1 Yes IRS) SEAT ROW OTHER Motorcycle Helmet 2No Molar Vehicle Seating Position: LOCATION: 2Omer Helmet 3Not Applicable 1 Nol Applicable Enan-mommr) Seat RDW Other (LOC) 1 1 3 No Helmet 2 None Used - Motor Vehicle Occupant 3 Shoulder and Lap Balt Used 1 Leh iNol Applicable 4 Shoulder Sell Only Used 1 Front Air Bap Deployed 2 Middle 2 Sleeper Section of Truck Cab De. ther 5 Lap Belt Only Used 28ecohtl p 3 Right 3Othaf EAdaelsd Carpo Area Ejection (EJECT) (knee. air belt, ate.) aRhild Re Used ( airb-0etc. System -Forwn 77 Other 3ThIN 2 c Elected 6 Deployed. Y g 4Uneadosetl Cargo Area led 1Not Applicable 7Chlltl Reetreint5 stem-ForweN Facing (explain in 4FDpriIn 6Trailing Unit 1❑ 2Eletleq Totally 1 2Nat Deployed Combination eChlltl Rmtrainl System -Rear Facing narretiva) 77 Other Row, 3 Elected, 3 De la etl-Front 9 Booster Seat P Y 7Deployed-Curtain BB Unknown 88 Unknown 6 Riding on Motor Vehicle Exterior (non- Penally 4 Deployed-Side Be Deployment 10 Ghgd Restraint Type Unknown trailing unit) 4Not Appliwbla Unknown 77 Other, Explain In Narrative 88 Unknown ee Unknow I Perpe9N.,nm dot Description ❑ 1 mNanxibtn„Marketl Crosswalk st Location At a of Crash 8 Sled- Ik Action Prior to Crash S Walking/Cycling on Sitlewlk ❑ ❑ 2 Other Pedes nom (wheelchatl, paean in a 9 MatliaNCmssing Island 2lntersection- Unmarked Crosswalk 61n RoadwayOther(working, Wilding, skater, pedestrian conveyance eta 10 Driveway Access — 3 Bicyclist Midblleocic-Marked Crosswalk 11 Shared-Use Path or Trill 1 Crossing Roadway jgCj g, am) 4 Other Cyclist 4 Mierrsecon Marked Crosswalk 12 Non-TrsRicway Area 2WelUngto Cmsa Roadway Reodway (e,p., 5 Occupant of Motor Vehicle Not In Transport 5 Travel Lexie-Other Location shoulder,itRac Explain in NBMUVB 3 WalkinglCycling Along B shoulder, to median) horn School (K-02) 6 Travel Lane fromS Bicyclshoule (Parked. etc.) BB UnknownOther,77 In Trani 7 side Roadway with TfaBic (In or 9 Workinggto in r n ay 8 Occupant of a Non-MoV Vehicle adiecant to travel lane) 9 cident Transportation Device on• o o s con rctum ances 4 WalkinglCyding Along 10 None 7 Unknown Type of Non-Motorist tat ❑ iNo lmproperAction Roadway Against Tnftic lin 77 Other, Explain In Narrative 2 DeNDash or adjacent to travel lana) 3 Failure to Yield RighWf-Way 88 Unknown 4 Failure to Obey Traffic Signe 1 None Safety Equipment 5 Lighting 2 Helmet 6 Not Appliwbla 3 Prolective Pada Used77 ❑ Signals, or OBiwr 7 EnleringlExlting ParkedlStanding 101mproper Tum/Merge Vehicle 111mproper Passing Other. Explain (elbows, knees, shins, at cJ In Nerretiva 51n Roadway lmpropetly (standing, lying, working, playing) 8Inattentive (talking, eating, Glc) 12 Wrong-Way, Riding or Walking 4 Rejective Clothing gedet• 88 Unknown ❑ 6 Disabled Vehicle Related (working 9 Not Vlafble (dark clothing, no 77 Other, Explain In Nanadve backpack, etc) on, pushing. Ieavinglepproachig) fighting, ala) ee Unknown ALCOHOLIDRUGIEMS SUSPECTED JALCOHOL TESTED: ALCOHOL TEST TYPE ALCOHOL BAC SUSPECTED DRUG TESTED: DRUG TEST TYPE: DRUG TEST RESULTALCOHOLU. 9E: ❑ 1:12CONETE IESTRESULT 1 PENDING [:]❑G USE. I No 2 ❑ Test Not lw��Urine Test Test pr, BB Bkive BB Unknown, Tested NherExplain In rve UNKNOWN88 Unown 8U1kn� kT Explain e Unknown SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 Not Transported 2 EMS 3 Law Enforcement 77 Other. Explain In Narrative Be Unknow ADDITIONAL PASSENGERS PERSON# VEHICLE# AME DATE OF BIRTH I INJ I SEX LOGS R O EJECT HU EP ABD RS CURRENT ADDRESS (Number and Street) CITY STATE LP CODE SOURCE OF TRANSPORT TO MEDICAL FACILITY❑ EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO x w n..e.m 2 W' x Y. eX.vi.r n w, rYw w W... 1 1 PERSON VEHICLE# AME DATE OF BIRTH INJ I SEX LOC:S R O EJECT HU EP ABD RS CURRENT ADDRESS (Number and Stmt) CITY STATE ZIP CODE SOURCE OF TRANSPORTTO MEDICALFACIUTY EMSAGENCYNAMEORID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO r wn.ew� x sw s u.ewa.s rr oe.. rsunw HawMYVKnv.m HSMV Soot S 7 7 Piga of