Loading...
HomeMy Public PortalAboutPRR 22-2898TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered via e-mail July 6, 2022 Charlie Taylor [mail to: charlestaylor141@icloud.com] Re: GS #2898 (Request for Crash Report 22-1347) Verbal Request for a copy of Crash Report 22-1347. Dear Charlie Taylor [mail to: charlestaylor141@icloud.com]: The Town of Gulf Stream has received your verbal public records request on July 5, 2022. You should be able to view your original request and response at the following link, as of September 6, 2022, because this record is confidential and exempt from disclosure for a period of 60 days after the crash report is filed per Florida Statue 316.066(2)(a): https://portal.laserfiche.com/Portal/DocView.aspx?id=179606&repo=r-430100cc The police crash report you requested is attached to this e-mail. We consider this request closed. Sincerely, Reneé Basel, CMC Deputy Town Clerk Sworn Statement to Obtain Traffic Crash Report Information Pursuant to Section 316.066(2), Florida Statutes, motor vehicle crash information is confidential and exempt from disclosure for a period of 60 days after the crash report is filed. Obtaining confidential information when not entitled to do so is a felony violation. The undersigned requests the following crash report (date/location/parties involved): 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 crash victims, or knowingly be disclosed to any third party for the purpose of such solicitation during the ;Zrioof time that the information remains confidential. m a art involved in the crash. party ❑ 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: ❑ 1 am a person under contract to provide claims or underwriting information to a qualifying insurance company, identified as: ❑ 1 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 Section 316.066(2)(b), Florida Statutes. Name of radio/television/newspaper: ❑ 1 represent a local, state or federal agency that is authorized by law to have access to crash reports. Name of local/state/federal agency: ❑ 1 represent a Victim Services Program, as defined in Section 316.003(8), Florida Statutes. Name of Program: Gk r-hc 1GL11d� Printed Nam Si -2> 13) 4o� -�391 Telephone Number with Area Code State of Florida Q County of gS�'^^ 17P.G.yi` Sworn (or affirmed) and subscribed before me by m this 5444 day of 20?Z by 1 Personally Known ❑ or Pr duced Identification (ID) Print/Type/Stamp Commissioned Notary Name Agency/Business/Represented ZZ00 S - 0 c ec c r\ 3N v(_1 . Address Dekccc,6ecur , F L 334�3 ity, State, Zip Co e RENEE' ROWAN EASEL Notary Public - State of Florida •gzCommission k GG 984730 oFw My Comm. Expires Aug 28. 2024 ns of physical presence or Band d thr tiona! Notary Assn. ID Produce atu)�e of Notarv\Public or A Ce Form HSMV 94010 (revised March 2020) Law Enforcement or FLORIDA TRAFFIC CRASH REPORT WAS DOT PROPERTY INVOLVED IN THIS CRASH? LONG FORM 0 SHORT FORM UPDATE TOTAL # OF VEHICLE SECTION(S) 1 (Shaded Areas) 1 TOTAL # OF PERSON SECTION(S) MAIL TO: DEPARTMENT OF HIGHWAY SAFETY &MOTOR VEHICLES TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING TOTAL # OF NARRATIVE SECTIONS) 1 TALLAHASSEE, FL 32399-0537 CRASH DATE TIME OF CRASH DATE OF REPORT F22PI034 TIN AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER 07/02/2022 7:55 AM 07/02/2022 7 87073143 CRASH IDENTIFIERS COUNTY CODE CITY CODE COUNTY OF CRASH PLACE OR CITY OF CRASH CHECK IF WITHIN _ ITIME REPORTED TIME DISPATCHED 1 CITY LIMITS YJ 06 PALM BEACH GULF STREAM 7:55 AM 7:57 AM TIME ON SCENE IME CLEARED SCENE CHECK IF REASON (If Investigation NOT Complete) Notified By: 1 Motorist 18:37 COMPLETED R 2 8:01 AM AM 2 Law Enforcement ROADWAY INFORMATION (CHOOSE ONLY 1 OF 4 OPTIONS) CRASH OCCURRED ON STREET, ROAD, HIGHWAY AT STREET ADDRESS # © AT LATITUDE AND LONGITUDE SR AIIA 26.476108 -80.056713 AT FEET MILES N S E W AT/FROM INTERSECTION WITH STREET, ROADMIGHWAY OR FROM MILEPOST# 167 1 _ I © PELICAN LN Road System Identifier 7 Forest Road Type of Shoulder Type of Intersection 5 Traffic Circle 3 1 Interstate 4 County 2 U.S. 5 Local 8 Private Roadway 9 Parking Lot 1 Paved 1 2 Unpaved 1 1 Not at Intersection 2 Four -Way Intersection 3 T-Intersection 6 Roundabout 7 Five -Point, or More 77 Other, Explain in Narrative 3 State 6 Tumpike/Toll 77 Other, Explain in Narrative 3 Curb 4 Y-Intersection RASH INFORMATION (CHECK IF PICTURE TAKEN) Light Condition Weather Condition Roadway Surface Condition School Bus Related Manner of Collision/Impact ❑ 1 Daylight 1 2 Dusk 5 Dark -Not Lighted 6 Dark -Unknown 4 Flog, Smog, Smoke 5 SIeeVHail/ i Freezing Rain 5 Oil 6 Mud, Dirt, Gravel 7 Sand 1 No 2 Yes, School Bus 4 Sideswipe, same direction 5 Sideswipe, Opposite Direction 3 Dawn Lighting 6 Blowing Sand, Soil 8 Water 1 Directly Involved 6 Rear to Side 4 Dark -Lighted 77 Other, Explain in Narrative Dirt 1 Clear (standing/moving) 3 Yes, School Bus 1 Front 7 Rear to Rear to Rear 88 Unknown 7 Severe Crosswinds 2 Cloudy 77 Other, Explain in 1 Dry 77 Other, Explain in 2 Wet Narrative Indirectly Involved 77 Other, Explain in Narrative 2 Front to Front 3 Rain Narrative 4 Ice/Frost 88 Unknown 3 Angle 88 Unknown First Harmful Event Non -Collision Collision Non -Fixed Object Collision with Fixed Object First Harmful Event 1 Overtum/Rollover 10 Pedestrian 19 ImpactAttenuator/Crash 30 Concrete Cusion 31 Other Traffic Barrier Location 1 On Roadway 2 Fire/Explosion 11 Pedalcycle 3Immersion 12 Railway vehicle (Vain, 20 Bridge Overhead Structure 32 Tree (standing) 2 Off Roadway 11 4 Jackknife engine) 21 Bridge Pier or Support 33 Utility Pole/Light Support 3 Shoulder 5 Cargo/Equipment 13 Animal 22 Bridge Rail 34 Traffic Sign Support 1 4 Median First Harmful Event Loss or Shift 14 Motor Vehicle in 23 Culvert 35 Traffic Signal Support 6 Gore 6 Fell/Jumped From Transport 24 Curb 36 Ohter Post, Pole or 7 Separator within Interchange Motor Vehicle 15 Parked Motor Vehicle 25 Ditch Support 8 In Parking Lane or 7 Thrown or Falling 16 Work Zone/Maintainance 26 Embankment 37 Fence Zone 1 No 2 Yes Object Equipment 27 Guardrail Face 38 Mailbox 8 Ran int Water/Canal 17 Struck By Falling, Shifting 28 Guardrail End 39 Other Fixed Object (wall, 9 Outside Right-of-way 10 Roadside 88 Unknown 9 Other Collision Cargo 29 Cable Barrier buildinq, tunnel, etc.) 88 Unknown 18 Other Non -Fixed Object First Harmful Event Relation to Contributing Circumstances: Road 9 Worn, Travel -Polished Surface Contributing Circumstances: Environment 1 Junction 5 Railway Grade Crossing 14 Entrance/Exit Ramp ❑ ❑ ❑ 10 Raod Surface Condition (wet, 1 icy, snow, slush, etc.) 11 Obstruction in Roadway ❑ ❑ ❑ 1 Non -Junction 15 Crossover - Related 16 Shared -Use of Path or Trail 12 Debris 1 None 13 Traffic Control Device 1 None 5 Animals in Roadway () Y 2 Intersection 17 AccelerationlDceleration Lane 4 Work Zone (construction/ Inoperative, Missing or Obscured P 9 2 Weather Conditions 77 Other, Explain in 3 Intersection -Related 18 Through Roadway maintenance/utility 14 Non -Highway Work 3 Physical Obstruction(s) Narrative 4 Driveway/Alley Access 77 Other, Explain in Narrative 6 Shoulders (none, low, soft, high) 77 Other, Explain in Narrative 4 Glare 88 Unknown Related 88 Unknown 7 Rut, Holes, Bumps 88 Unknown Work Zone Related Crash in Work Zone Type of Work Zone Workers in Work Zone Law Enforcement in Work 1 Before the First Work Zone 1 Lane Closure Zone 1 No ❑ 2 Yes 1 Warning Sign 2 Advance Warning Area ❑ 3 Transition Area 2 Lane ShifVCrossover 3 Work on Shoulder or Median 4 Intermittent or Moving Work ❑ 1 No ❑ 2 Yes 1 No 2 Officer Present 88 Unknown 4 Activity 77 Other, Explain in Narrative 88 Unknown 3 Law Enforcement Vehicle 5 Termination Area Only Present WITNESSES NAME ADDRESS CITY & STATE ZIP CODE NAME ADDRESS CITY & STATE ZIP CODE NAME ADDRESS CITY & STATE ZIP CODE NON VEHICLE PROPERTY DAMAGE VEH. # PER # PROPERTY DAMAGE -OTHER THAN VEH. EST. AMT. OWNER'S NAME (CHECK IF BUSINESS) ADDRESS CITY & STATE ZIP CODE VEH. # PER # PROPERTY DAMAGE -OTHER THAN VEH. EST. AMT. OWNER'S NAME ® (CHECK IF BUSINESS) ADDRESS CITY & STATE ZIP CODE HSMV 9DO10 S 1 5 Page of — VEHICLE # 1 Check if Commercial Reporting Agency Case Number ❑ HSMV Crash Report Number 221347 87073143 1 VehiGe in Transport VEHICLE LICENSE NUMBER STATE REGISTRATION EXPIRES VIN Check ff Permanent 101/02/2023 2 Parked Motor VehiGe 3 Working Vehicle 1 GW17C MI Registration ❑ WAUENAF46JA095938 Hit and Run 1 No YEAR MAKE MODEL STYLE COLOR DAMAGE: 1 Disabling 4 Minor 4 EST. AMOUNT 2 Yes 201$ AUDI A4 4 DOOR SEDAN BLACK - BILK 2 Functional 88 Unknown $300.00 88 Unknown 3 None INSURANCE COMPANY (DRIVER) INSURANCE POLICY NUMBER Towed due too 9 e: 1 VEHICLE REMOVED BY 1. Rotation Request 14. TRIPLE A AUT700642149 1 No 2 Yes 2 DRIVER 3. Driver Other, Explain in Narrative NAME OF VEHICLE OWNER (CHECK IF BUSINESS) CURRENT ADDRESS CITY & STATE ZIP CHARLES WESLEY TAYLOR 768 RIVARD BLVD GROSSE POINTE MI 48230-1255 Trailer LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent VIN YEAR MAKE LENGTH AXLES One: Registration ❑ Trailer LICENSE NUMBER STATE REGISTRATION EXPIRES Check If Permanent VIN YEAR MAKE LENGTH AXLES Two: Registration ❑ VEHICLE N S E W Off -Road Unknown ON STREET, ROAD, HIGHWAY AT EST. SPEED POSTED SPEED TOTAL LANES TRAVELING ❑ R ❑ ❑ ❑ ❑ ISR AIA 135 35 2 HAZ. MAT. RELEASED 1 No HAZ. MAT. PLACARD 1 No NUMBER CLASS Area of Initial Impact Most Damaged Area 12 12 2 Yes ❑ 2 Yes ❑ 3 4 2 5 6 3 4 5 6 7 18 Undercarriage 18 2 7 88 Unknown 88 Unknown 1 15 16 17 8 19 Overturn 19 1 15 16 17 6 20 Windshield 20 MOTOR CARRIER NAME US DOT NUMBER 14 9 21 Trailer 21 14 9 13 121110 13 121110 MOTOR CARRIER ADDRESS CITY T777 ODE PHONE NUMBER Vehicle Body Type 15 Low Speed Vehicle Trafficway Commercial Motor Vehicle Configuration F-111 16 (Sport) Utility Vehicle 1 Two -Way, Not Divided 1 Vehicle 10,000 Ibs or less Placarded 8 Tractor/Triple for Hazardous Materials 9 Truck more than 10,000 Ibs (4,536 17 Cargo Van (10,000 Ibs 2 Two -Way, Not Divided, with a kg), Cannot Classify (4,536 kg) or less) Continuous Left Turn Lane ❑ 2 Single -Unit Truck (2-axle and GVWR more than 10,000 Ibs (4,536 kg)) 10 Bus/Large van (seats for 9-15 1 Passenger Car 18 Motor Coach 3 Two -Way, Divided, Unprotected 3 Single -Unit Truck or more axles) occupants, including driver) 2 Passenger Van 19 Other Light Trucks (10,000 Ibs (painted >4 feet) Median r 4 Truck Pulling Trailer(s) 3 Pickup (4,536 kg) or less) 4 Two -Way, Divided, Positive 5 Truck Tractor (bobtail) 11 Bus (seats for more than 15 7 Motor Home 20 Medium/Heavy Trucks (more Median Barrier occupants, including driver) 6 Truck Tractor/Semi-Trailer B Bus than 10,000 Ibs 4,536 k ( g)) 5 One -Way Trafficway 77 Other, Explain in Narrative 7 Truck Tractor/Double Truck p 11 Motorcycle 21 Farm Labor Vehicle 88 Unknown 88 Unknown 12 Moped 77 Other, Explain in Narrative Trailer Type 13 All Terrain Vehicle (ATV) 88 Unknown 1 Single Semi Trailer B Pole Trailer Cargo Body Type Comm/Non-Commercial TRAILER 1 TRAILER 2 2 Tandem Semi Trailer 3 Tank Trailer 9 Towed Vehicle 10 Auto Transport 13 Intermodal 1 Interstate Cartier 4 Saddle Mount/Trailer 5Boat Trailer ❑ ❑ 77 Other, Explain in 3 Van/Enclosed Box Container Chassis Narrative ❑ 4 Hopper 14 Vehicle Towing 2 Intrastate Carrier ❑ 6 Utility Trailer 88 Unknown 5 Pole -Trailer Another Vehicle 3 Not in Commerce/Government 7 House Trailer 6 Cargo Tank 15 Not Applicable 1 No Cargo 4 Not in Commerce/Other Truck 7 Flatbed (vehicle 10,000 Ibs 2 Bus Most Harmful Event Non -Collision 1 10,000 Ibs (4,536 kg) or less B Dump (4,536 kg) or less not Comm IOvertum/Rollover ❑ 2 10,001-26,000lbs GVWR/GCWR 4 (4,536-11,793kg) 9 Concrete Mixer displaying HM placard 2 Fire/Explosion 3 More than 26,000 Ibs (11,793kg) 10 Auto Transport 77 Other, Explain in 4 Not Applicable 11 Garbage/Refuse Narrative 11 4lmmersion 4 Jackkn'rfe Collision with Non -Fixed Object 5 Cargo/Equipment Loss or Shift 10 Pedestrian 12 Log 88 Unknown CoIIIslon Fixed Object 29 Cable Barrier Emergency 19 Impact Attenuator/Crash Cushion 6 Fell/Jumped From Motor Vehicle 11 Pedalcycle 30 Concrete Traffic Barrier Vehicle Use 20 Bridge Overhead Structure 7 Thrown or Falling Object 12 Railway Vehicle (train, engine) 31 Other Traffic Barrier 21 Bridge Pier or Support Sequence Of Events 8 Ran into Water/Canal 13 Animal 32 Tree (standing) 9 Other Non -Collision 14 Motor Vehicle in Transport 22 Bridge Rail 33 Utility Pole/Light Support 1 23 Culvert ❑ 1st 2nd 15 Parked Motor Vehicle 34 Traffic Sign Support 11 ❑ [40-46 Sequence of Events only] 16 Work Zone/Maintenance 40 equipment Failure (blown tire, Equipment 24 Curb 35 Traffic Signal Support 1 No 25 Ditch 36 Other Post, Pole, or Support brake failure, etc.) 17 Struck By Falling, Shifting Cargo or 2 Yes 26 Embankment 37 Fence 88 Unknown 41 Separation of Units Anything Set in Motion by Motor 27 Guardrail Face 38 Mailbox 3� 4th 42 Ran Off Roadway, Right 43 Ran Off Roadway, Left Vehicle 18 Other Non -Fixed Object 28 Guardrail End 39 Other Fixed Object (wall, building, tunnel, etc. ❑ 44 Cross Median Vehicle Maneuver Action Traffic Control Device For Vehicle Defects Roadway Grade 45 Cross Centerline 46 Downhill Runaway 1 Straight Ahead 13 Stopped in Traffic 3 Turning Left 14 Slowing This Vehicle ❑ ❑ 1 Level 4 Backing 15 Negotiating a Curve 1 8 Flashing Signal 1 None 2 Hillcrest Roadway Alignment 1 3 Uphill 1 5 Turning Right 16 Leaving Traffic Lane ❑ 6 Changing Lanes 17 Entering Traffic Lane 9 Railway Crossing 1 No Controls 2 Brakes 13 Wheels Device 4 School Zone Sign/ 3 Tires 14 Windows/ 4 Downhill ❑ 1 Straight 1 8 Parked 77 Other, Explain in Narrative 10 Person (including Device 4 Lights (head, Windshield 5 Sag (bottom) g 2 Curve Right ght 10 Making U-Turn 88 Unknown Flagman, Officer, Traffic Control signal, tail) 15 Mirrors 3 Curve Left 11 Overtaking/Passing5 Guard, etc.) Signal 6 Steering 16 Truck Coupling Special Function 1 No Special Function 9 Ambulance 14 Intercity Bus 77 Other, Explain in 6 Stop Sign 7 Wipers Trailer Hitch/ Narrative 1 of Motor Vehicle 2 Farm Vehicle 10 Fire Truck 15 Charter/Tour Bus 7 Yield Sign 9 Exhaust System Safety Chains 88 Unknown 3 Police 11 Farm Labor Transport 16 Shuttle Bus 10 Body, Doors 77 Other, Explain in 7 Taxi 12 School Bus 17 Farm Labor Bus 11 Power Train Narrative 8 Military 13 Transit/Commuter Bus 88 Unknown 12 Suspension 88 Unknown VIULATIUNS PERSON # NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER PERSON # NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER PERSON # NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER HSMV 90010 S 2 5 Page of_ PERSON # 1 Reporting Agency Case Number HSMV Crash Report Number 221347 87073143 1 Driver VEHICLE # NAME PHONE NUMBER Check if ❑ 2 Non -Motorist i ❑ 1 407-9381 1. Recommend 3 Passenger CHARLES ANDREW TAYLOR (313) Driver Re -exam CURRENT ADDRESS (Number and Street) CITY 8 STATE ZIP CODE 2000 S OCEAN BLVD APT 702 DELRAY BEACH FL 33483 DATE OF BIRTH SEX: 1 Male ❑ DRIVERS LICENSE NUMBER STATE EXPIRES INJURY SEVERITY (INJ) 4 Incapacitating 1 None 5 Fatal (within 30 days) ❑ 2 Female 2 Possible 01/14/1997 88 Unknown T460141970140 FL 01/14/2030 3 Non -Incapacitating 6 Non -Traffic Fatality DRIVER DL Type Required Endorsements 1st Drivers Actions at Time of Crash 3rd Condition At I No Contribution Acton 26 Ran off Roadwa Time f 1 Crash Negligent Ma nerV in Carelss or 27 n Disregarded other Trafic El F 5 E/Operaorr 2 No 6 E/O er-Rest 3 No Re . Endorsement 3 Failed to Yield Right -of -Way 28 Disregarded Other Road 1 Apparently Normal P q 3Asleep or Fatigued 7 None 4 Improper Backing Markings 5 III (sick) or Fainted 6 Improper Turn 29 Over-Correcting/Over Driver Distracted By 4 Other Inside the Vehicle Steering 6 Seizure, Epilespsy, Blackout 1 1 Not Distracted 2nd 8 Emotional (depression, ❑ (explain in narrative) 10 Followed too Closely 7 Physically Impaired 5 External Distraction 11 Ran Red Light 30 Swerved or Avoided : Due 4th disturbed, etc.) 2 Electronic Communication outside the vehicle, explain ❑ 12 Drove too Fast for Conditions angry, Devices cell hone, etc. ( O Wind, Slippery Surface, MV, ( P in narrative) 13 Ran Stop Sign Object, Nan -Motorist in 9 Under the Influence of Medications/Drugs/Alcohol 3 Other Electronic Device 6 Texting 15 Improper Passing Roadway, etc. (navigation device, OVD player) 7 Inattentive 17 Exceeded Posted Speed 31 Operated MV in Erratic, 77 Other Explain in Narrative 88 Unknown 21 Wrong Side of Wrong Way Reckless orAgreessive Manner 88 Unknown 25 Failed to Keep in Proper Lane 77 Other Contributing Action DRIVER VISION OBSTRUCTIONS 1 1 Vision Not Obscured 5 Load on Vehicle 9 Smoke 2 Inclement Weather 6 Building/Fixed Object 10 Glare DRIVER OR PASSENGER 1 3 Parked/Stopped Vehicle 7 Signs/Billboards 77 All Other, Explain ❑ 4 Trees/Crops/Bushes 8 Fog in Narrative Helmet Use (HU) Eye Protection (EP) Restraint Systems DRIVER OR PASSENGER ❑ 1 DOT -Compliant ❑ 1 Yes 3 IRS) SEAT ROW OTHER Motorcycle Helmet 2 No Motor Vehicle Sating Position: ATION: 2 Other Helmet 3 Not Applicable 1 Not Applicable (non -motorist) PLOOCC Row Other ) 11 1 3 No Helmet 2 None Used - Motor Vehicle Occupant Seat 3 Shoulder and Lap Belt Used 1 Left 1 Not Applicable 4 Shoulder Belt Only Used 1 Front Air Bag Deployed 2 Middle 2 Sleeper Section of Truck Cab 5 Deployed -Other 5 Lap Belt Only Used 3 Right 2 Second Ejection EJECT 6 Restraint Used -Type Unknown 9 3 Other Enclosed Cargo Area (EJECT) (knee, air belt, etc.) 1 Not Ejected 1 NotApplicable 6 Deployed- 7 Child Restraint System - Forward Facing 77 Other 3 Third 4 Unenclosed Cargo Area (explain in 4 Fourth 2 Ejected, Totally 2 Not Deployed Combination 8 Child Restraint System - Rear Facing 5 Trailing Unit 1 ❑ narrative 3 Ejected, 9 Booster Seat Other Row 6 Ridingon Motor Vehicle Exterior non- / 3 Deployed -Front 7 Deployed -Curtain 88 Unknown ( Partially 4 Deployed -Side 88 Deployment 10 Child Restraint Type Unknown gg Unknown 88 trailing unit) 4 Not Applicable Unknown 77 Other, Explain in Narrative 88 Unknown 88 Unknown N n-Motorist Description 1 Pe ❑ Non -Motorist Location At Time of Crash 8 Sidewalk ❑ Action Prior to Crash 1 Intersection - Marked Crosswalk 5 Walking/Cycling on Sidewalk 9 Median/Crossing Island 2 Other Pedestrian wheelchari, person in a 2 Intersection - Unmarked Crosswalk 10 Driveway Access 61n Roadway —Other (working, building, skater, pedestrian conveyance, etc. 3 Intersection - Other4 Midblock - Marked Crosswalk 11 Shared -Use Path or Trail 1 Crossing Roadway playing, etc.) 3 Bic Gist y 4 Other Cyclist 4 Midblock - Marked Crosswalk 7 Adjacent to Raodway (e.g., 12 y Area 2 Waiting to Cross Roadway shoulder, median) 5 Occupant of Motor Vehicle Not in Transport p p 5 Travel Lane - Other Location 77 Other, Explain in Narrative 3 Other, Explain Along 6 Bicycle Lane 8 Going to or from School (K-12) (parked, etc.) 88 Unknown Roadway with Traffic (in or Roadway with Traffic 7 shoulder/Roadside 9 Working in Trafficway adjacent to travel lane) 6 Occupant of a Non -Motor Vehicle (incident response) 4 Walking/Cycling Along Transportation Device 7 Unknown Type of Non -Motorist Non-Motorlst ACtIonsluircumiti—nc—es 10 None 1 No Improper Action Roadway Against Traffic (in 77 Other, Explain in Narrative t.t ❑ 2 DartfDash or adjacent to travel lane) 88 Unknown 3 Failure to Yield Right -of -Way ❑ 4 Failure to Obey Traffic Signs ❑ 7 Entering/Exiting Parked/Standing 10Improper Tum/Merge Signals, or Officer znd Vehicle 11 Improper Passing 1 None Safety Equipment 5 Lighting 2 Helmet 6 Not Applicable 3 Protective Pads Used 77 Other, Explain 5 In Roadway Improperly (standing, Riding Walking (elbows, knees, shins, etc.) in Narrative lying, working, playing) 8lnattentive (talking, eating, etc) 12 Wrong -Way or 4 Reflective Clothing (jacket, 88 Unknown ❑ 6 Disabled Vehicle Related (working 9 Not Visible (dark clothing, no 77 Other, Explain in Narrative backpack, etc.) on, pushing, leaving/approaching) lighting, etc.) 88 Unknown ALCOHOL/DRUG/EMS SUSPECTED ALCOHOL TESTED: ALCOHOL TEST TYPE: LCOHOL DRUG TESTED: DRUG TEST TYPE: DRUG TEST RESULT: USE: ❑ 2 Y Test Not 12 Test n ❑ lood 2 7 BOther,, ❑ ❑ EST RESULT.DNl sGSE: 1 ❑ Given ❑ Test d 7 BOther, D 1 Positive ❑ PFUSPECTED s 3 Test Gvened Explain 2 COMPLETED 32 Test Give nact 3 Pending Narrative 88 Unknown 88 Unknown, rf Tested in Narrative 88 UNKNOWN 8 Unknown 88 Unknown, if Tested Explain in BS 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 1 77 Other, Explain in Narrative 88 Unknown ADDITI NAL PASSENGER PERSON # VEHICLE # [AME DATE OF BIRTH I INJ SEX LOC: S IR O EJECT J HU EP ABD IRS CURRENT ADDRESS (Number and Street) CITY STATE ZIP CODE SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 Not Tnn Ppw 2 EMS 3law EnfmcevaM 77 -. E.*,n in Nan _ 88 uni- ❑ PERSON # VEHICLE 11 [AME DATE OF BIRTH ]NJ I SEX I LOC: S I R O EJECT HU EP ABD RS CURRENT ADDRESS (Number and Street) CITY STATE ZIP CODE SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY NAME OR ID NUMBER MEDICAL FACILITY TRANSPORTED TO 1 N. Tramp I EMS 3lrw EnfM n177 98 . Erwin in Navarre W Unkrgm ❑ 7777N HSMV 90010 S 3 5 Page of Reporting Agency Case Number HSMV Crash Report Number NARRATIVE 221347 87073143 VEHICLE 1 WAS TRAVELING SOUTHBOUND IN THE 900 BLOCK OF SR (A1A), AN UNKNOWN BICYCLIST WAS RIDING IN THE NORTHBOUND LANE. THE DRIVER (PER #1) STATED THE BICYCLIST WAS RIDING WITH A LARGE PACK OF BICYCLIST AND STARTED TO DRIFT TO THE FAR LEFT OF HER LANE, HITTING OR NEARLY HITTING THE PEDESTRIAN CROSSWALK SIGN PLACED IN THE MIDDLE OF THE ROAD. THE BICYCLIST THEN CROSSED OVER INTO THE DRIVERS LANE, CAUSING DRIVER (PER #1)TO TAKE EVASIVE ACTION BY STEERING MORE TO THE RIGHT. THE BICYCLIST HIT THE LEFT SIDE OF THE DRIVER'S CAR CAUSING MINOR DAMAGE TO THE DRIVER SIDE MIRROR. THE BICYCLIST HAD LEFT THE SCENE BEFORE OUR ARRIVAL. ACCORDING TO PERSON #1 AND PASSENGER #1 THE BICYCLIST STATED SHE HAD NO INJURIES AND WAS ALRIGHT, THEN PLACED HER BICYCLE INTO A VAN THAT WAS FOLLOWING THE GROUP OF BICYCLIST AND LEFT THE AREA AND DID NOT PROVIDE THE DRIVER (PER #1) WITH ANY EXCHANGE INFORMATION BEFORE LEAVING THE SCENE. ADDITIONAL PASSENGERS PERSON It�AME DATE OF BIRTH INJ SEX LOC: S R O EJECT HU EP ABD IRS ]VEHICLE 2 1 AMY TAYLOR 7/24/1960 1 2 3 1 1 1 1 3 CURRENT ADDRESS (Number and Street) CITY STATE ZIP CODE 2000 S OCEAN BLVD APT 702 DELRAY BEACH FL 33483 SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 Nd Tnnsppted 2 EMS 3 Law Enlorcxrent T any,, E,- in 1 Nanative M UnW ❑ PERSON ]VEHICLE # AME DATE OF BIRTH I INJ I SEX I LOC: S I R O [7HU EP ABD IRS CURRENT ADDRESS (Number and Street) CITY STATE ZIP CODE SOURCE OF TRANSPORT TO MEDICAL FACILITY AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 W Trans "a 2 EMS 3 taw EMacemmt TI dnar, E, l— In Nart wN UnMww,t ❑EMS ADDITIONAL VIOLATIONS PERSON # NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER PERSON # NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER REPORTING OFFICER ID/BADGE # RANK OFFICER NAME DEPARTMENT OF DEPT. 766 OFFICER JOSEPH YUNGK GULF STREAM POLICE DEPARTM JTYPE POLICE DEPARTMENT (PD) HSMV 90010 S 4 5 Page of_ REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER DIAGRAM 221347 1 87073143 HSMV 90010 S SR (A1A) 5 Page _ 5 Of POINT OF IMPACT 4 COVER FROM MIRROR