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Home My Public Portal AboutPRR 14-0966Your original request, dated June 6, 2014, is reproduced in the space below: 966 From: IrnawatyTirtarahardja [mailto:irnawatyt @gmail.com] Sent: Friday, June 06, 2014 7:17 AM To: Bill Thrasher; Rita Taylor Subject: PUBLIC RECORDS REQUEST damage by town PUBLIC RECORDS REQUEST damage by town To whom it may concern, Please forward this public record request to the Custodian of Records for your agency. I wish to make a public records request of the Town of Gulf Stream for public records. I do this pursuant to Florida Constitution Article 1. Section 24 and Florida Statutes Chanter 119.07. All records regarding or concerned with damage caused to anyone by an employee of the Town which were created or received in 2014. Please include records from all email accounts in the control of all town officials, appointees and employees and include all records that are responsive to this request. If you contend that any of the records I am seeking, or any portion thereof, are exempt from inspection or disclosure please cite the specific exemption as required by Florida Statute &119.07(l)(e) and state in writing and with particularity the basis for your conclusions as required by Florida Statute 6119.07(1)(8. Please take note of Florida Statue &119.07(c) and your affirmative obligation to (1) promptly acknowledge receipt of this public records request and (2) make a good faith effort which "includes making reasonable efforts to determine from other officers or employees within the agency whether such a record exists and, if so, the location at which the record can be accessed." I am, therefore, requesting that you notify every individual in possession of records that may be responsive to this public records request to preserve all such records on an immediate basis. If some records that are responsive to my request are obtainable sooner than other responsive records, I wish to receive those records as soon as they are available and I wish to receive the other records as soon as they become available. I request that no responsive records be withheld from me while waiting for other responsive records to be found. If the records are not available as digital records then please email me with instructions for me to pick the records up from you. I would prefer the records in electronic or digital form. If the public records being sought are maintained by your agency in an electronic format please produce the records in the original electronic format in which they were created or received. See Florida Statute §119.01(2)(0. If you anticipate the production of some of these public records will require a search of sufficient duration as to require any deposit payment from me, please notify me of any such required payment prior to conducting any portion of that search which would require such payment. Please first produce any responsive records that are readily available and do not require any deposit payment prior to producing. 968 If you anticipate the production of these public records to exceed $1.00 please notify me in advance of their production with a written estimate of the total cost. Please be sure to itemize any estimates so as to indicate the total number of pages and /or records, as well as to distinguish the cost of labor and materials prior to you expending any resources that would require payment from me. All responses to this public records request should be made in writing to the following email address: irnawatvt(cDgmail.com 0 mN<O Ooxm x ❑ < < CD ;a -i Zo- 0"om cn�CO;u ° A x�c z 'D O� co0 DM -n-z <;a' m o m O >� �3 mA T N y ;a Cl) OOZ T m O ym 00 OM nZ A mDO� �]T000 0 m m m �o m� :i)o O 0 mZ D Z O .m m m G7O G) A n cn z OcnDZ =M>� m 0 m Oj rC:0 mi Dm N Cnc < -< 'mzDmm z m my coo a: z o VV m 0�= nwi vim °m m v r �r�m7y mz O ma CD Z:J!C7 �Z�m� 0 0 C D r z mwm A U)O� < -+ r < Z C m r ° < fD �aT oco0=D m ❑ n = fns m O m O T 3 y p R M oo ODm -u> 7 z = m rg m e n Z V m y Z O X7 m �0Z ZC)�xm 0O 3 <D DOrn OSxzO c m Ony �x m iil _nmG�D m r r+ < y r o w W m y � O O Z 1 O A 03 1 Oo ZD o 3 C) m w O �M_ t<tlp= ffl o m 3 Z7o0 OcDa=o < m r O m 00 CA m yccn ODmOD r p C)y 00 m m N'' cn CO_ X -I m N m A N m A m :O Z7 0 ✓ O jz mZmmm { 3 y my m °om w ° m< Ff mG) mmc>�G) m 0 o cnz o rRntz o m0 m5 -1- 3 m A z DN -zi Dm Z D� 0 �m m°DOm 0 m m 0 G)0 o G)o o �-D+ O n °z xmm0w > z 0 m mm m c� ;o Om z v° mxDKzccn z w o y w mm m mw w xv j o D{ -zi m W x 0 v "� '� r Z m �1 m r �tA7 �7mrJ1 -� O o m .Z01 0 'D-� w m * x x p J m O r O m !, 0 Ill D rNiOrtim m O r O� m w w m -0 Mo 2 KDZ =— O .m A A C z D0KzD m w w Om m m a) m Z m vcn �p O m m A D m xOMU)Z \m A �DDmO ozzm = C)0o i n �m o O m = m m N D> F Z m xU) D mn�m� m CG)O DD D Zzmoz mO - -A - cn N m m np ❑ ❑ ❑❑ ZC D U) N C m Dm -4 tn �00 G) < m D om Zm m0�0 m *z v m pm r m>>ccn = < m <=r'z ° {mzD z m N 0 co n m O nomoW r.>m m� m m D mx mo < NO Di m = �unDiD=D O i mv �mm - n mm D� O x ozm v -i m D A cn Z _I > z o03N z m m M m� y o❑❑ �, mM> m m m (A N C m -yi N p n w �A-p m..m =...m = oz mm -u N = C z -Acco z mz z mz z z❑ m3 xm3 p= m Mm m mm m °M m Zm m m m y Nz A, ACCIDENT SETTLEMENT I, VINCENT D. YANIRO, have accepted Town of Gulf Stream Check #11833 in the amount of $400.00 to cover the cost of minor damage to my 2012 Nissan Murano, said damage being caused by a Gulf Stream Police Department vehicle. This settlement satisfies any and all claims against the Town of Gulf Stream related to this incident that occurred on March 16, 2014. STATE OF FLORIDA COUNTY OF PALM BEACH Sworn to (or affirmed) and subscr' before me this day of �j &h d 2014 by Vincent D. Yaniro �' f' n v LOq"� ag= e fgE,lorloa w,o� 'tlY" � t 9915 Type of Identification L a,(/93 71 ° 7 yfy FLORIDA TRAFFIC CRASH REPORT LONG FORM � SHORT FORM UPDATE Shaded Areas) MAIL TO: DEPARTMENT OF HIGHWAY SAFETY & MOTOR VEHICLES TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING TALLAHASSEE, FL 32399 -0537 ,-, TOTAL k OF VEHICLE SECTIONS) 2 TOTAL N OF PERSON SECTiON(5) 2 TOTAL N OF NARRATIVE SECTIONS) 1 C HDA TIME OF CRASH OgTE DF REPORT REPORTINGA NCY CASE NUMBER HSMVCRASH RE PORT NUM BE 03/16/2014 1 11:50 AM 3/16/2014 14- 003707 1 84328584 CRASH IDENTIFIERS COU C E CO NTY FCRASH .PLACE OR CITY OF CRASH CHECK IF WITHIN TIME flEPORTED TIME DISPATCHED 06 40 PALM BEACH DELRAY BEACH CITY OMITS 0 TIME UN SCENE TIME CLEARED SCENE CHECK IF RE N i Investigation NOT Complete 11:50 AM 11:50 AM COMPLETED 11:57 AM 12:23 PM � 1 2 La. Notifflad Erf.r Motorist ❑ 2LawEnfortemanr 2 ROADWAY INFORMATION (CHOOSE ONLY 1 OF 4 OPTIONS) CRASH OCCURRED ON STREET,ROAO, HIGH WAY Al bTFIETADDRESS I AT LATITUDE AND LONGITUDE GEORGE BUSH BLVD O 718 IN ERE I NWI H TREET,ROAD,HI HWAY ❑ ❑ ❑ ❑ — ORFROMMI P Tp Road System Identifier 7 Forest Road Type of Shoulder Type of Intersection 1 Interstate 4 County 8 Private Roadway ❑ HIS 5 Loral 9 Parking Lot 9 3 State 6 Turnpike all 77 Other, Explain In 1 Paved 1 Not at Intersection 5 Traffic Circle Z Unpaved ❑ 2 Four -Way Intersection 6 Roundabout Narrative 1 3 Curb 1 3 T- Intersection 7 Five- Point, or More 4 Y- Intersection 77 Other, Eaplain in Narrative CRASH INFORMATION (CHECK IF PICTURES TAKEN) iL Light Condition Weather Condition Roadway Surface Condition School Bus Related Manner of Collision/Impact 1 Daylight 5 Oark -Not Lighted 4 Fog, Smag Smoke 2 Dusk 6Dark- Unknown 5 Sleet /Hail/ �• 3 Dawn Llghung Freeaing Rain 5 011 1 No 6 Mud, Dirt, Gravel ❑ 2 Yes, School Bus 4 Sideswipe, same direction 7 Send 1 OIreRIy Involved 4 Dark- Ughtetl 77 Other, Explain in 6 Blowing Sand, Soil, Narrative 8 Water (standing/ 3 Yes, School Bus 5 Sideswipe, Opposite Directlo 6 Rear to Side 1 Clear Dirt 88 Unknown 2 Cloudy 7 Severe Crosswinds 1 D moving) Indirectly Involved 7 Rear to Rear 2 �Ve1 770ther, Explain 1 Front to Rear Rear to, Re 3 Rain 77 Other, Explain In 77 lain In Narrative 41ce /Frost in Narrative 2 Front to Front P Narrative 88 Unknown 3 Angle 88 Unknown First Harmful Event Nan - Collision Collision Non -Fixed Object Collision with Fixed Object 10verturn First Harmful Event /Rollover 10 Pedestrian 19 Impact Attenuator /Crash 30 Concrete Traffic Barrier 2 Fire /Explosion 11 Pedalcycle Cushion 31 Other Location 1 On Roadway Traffic Barrier 14 3Immersion 12 Railway Vehicle (train, 20 Bridge Overhead Structure 32 Tree (standing) 4lackknife engines 218ridge Pier or Support 33 Utility Pole 2 OH Roadway 3 Shoulder /Light Support S Cargo /E uipment 13 Animal Z2 Brid eRail 34 iraffc Si n5uap First Harmful Event Loss or Sh 14 Motor Vehicle In Transport 23 Culvert 35 Traffic 5 gnat o O 4Metlian 6 Gore Support within Interchange 6 Fell/Jumped From 15 Parked Motor Vehicle 24 Curb 36 Other Post, Pole or Support Motor Vehicle 16 Work Zone /Maintenance 25 Ditch 7 Separator 37 Fence 1 No 7 Thrown or Falling Equipment 26 Embankment 38 Mailbox 2 Yes Object l7 81n Parking Lane or Zone 9 Outside Right -of -way 1 Struck by Falling, Shifting 27 Guardrail Face 39 Other Fixed Object (wall, 88 Unknown 8 Ran Into Water /Canal Cargo 28 Guardrail End building, tunnel, etc.) 90ther Non Collision 10 Roadside 88 Unknown - 18 Other Non Fixed Object 29 Cable Barrier First Harmful Event Relation to Contributing Circumstances: Read Contributing Circumstances: F4 Junction S Railway Grade Crossing 14 EntrancerExit 10 Road Surface Condition Iwet, ICy, sn0 w,1U3h, ❑ ❑ ❑ ID Road Travel POonditi n1wel, Environment Ramp 15 Crossovere Related 11 Obstruction in Roadway R 12 Debris 1 Nondunttion 16 Shared -Use Path or hall 2 Intersection 17 ACCeleratle n /Deceleration Lane 1 None 13 Traffic COnimt Device 4 Work Zone )construction/ Inoperative, Missing or Obscured 1 None 3 Intersection Related 18 Through Roadway 4 Driveway /Alley Access 77 Other, Explain in Narrative maintenance utility) 14 Non I lisshway Work 6 Shoulders (none, low, soh, high) 7701her, Cxplain in Narrative s 2 Weather 3 Ph Physi 5Animal(s) m Roadway Conditions ]]Other, EExplain in Related 88 Unknown 7 Rut, Hales, Bumps 8 88 Unknown veal 4 Glare Obstruttionlsl Narrative Na Unknown Work Zone Related Crash in Work Zone Type of Work Zone Workers In Work Zone Law Enforcement In 1 No 1 •p 2Yes 88 Unknown 1 Bel the First Work Zone Warning Sin 2 Advance Warning Area 1 Lane Closure 2Lane Shift /Crossover ❑ 3 Work on Shoulder Median 1 No 2Yes ❑ Work Zone ❑ 1 No 3 Transition Area or 4 Intermittent or Moving Work BB llnknOwn 20Hicer Present WITNESSES 4 Activity Area 5 Termination Area 77 Other, Explain In Narrative 3 Law En /orcemrm Vehicle Only Present NAME ADDRESS CITY &STATE LP CODE NAME ADDRESS CITY &STATE ZIP CODE NAME ADDRESS CITY &STATE ZIP CODE NON VEHICLE PROPERTY DAMAGE VEHICLEp PERSONA PROPERTY9AMAGE -OTHER THAN VEHICLE EST.AMOUNT OWNER'S NAME ❑(Check if BUSlness) - ADDRESS CITY &STATE, LP CODE VEHICLE# PERSON #.PROPERTY DAMAGE- -OTHER THAN VEHICLE EST.AMOUNT OWPnrAb NAME❑(Lhecklt Business) ADDRESS CITY &STATE ZIP CODE' HQMV 90010 S E / ( ) (rev 10 10) Page 1 of 7 eo0w, IOM, _ 1 REPORTING AGENCY CASE NUMBER HSMV CRASH REPORTNUMBER 14- 003707 84328584 1VehiUe in Transport VEHICLE LICENSE NUMBEfl' STATE REGISTRATION EXPIRES Check if Permanent VIN 2Parked Motor Vehide ], CITY210618 3 Working Vehide FL Registratlon QX 1FM5K8AR5DGC82933 Htt an un YEAR MAKE 1 No se Unknown �' 2013 FORD MODEL STYLE COLDR DAMAGE: EST. AMOUNT 101sablii 4 Miner EDGE � SUV WHI 2funclonal BBUnknawn 4 500 INSURANCE COMPANY- 3NOne INSURANCE POLICY NUMBER due VEHICLE REMOVED BT lftatadon FLORIDA MUNICIPAL INS TRUST �$ towetl to Damage: 1 DRIVER 20wner Request 1 No 2 vas 3 Driver NAME OF VEHICLE OWNER (Check If Business)® CURRENT ADDRESS 4Other Ex lain In Narra ve CITY TOWN OF GULF STREAM ZIP CODE 100 SEA RD GULF STREAM, FL 33483 TRINLICENSE NUMBER STATE REGISTRATION E %PIRE$ Che[k if Permanent VIN YEAR MAKE RegistrationLFN('TH AXLES TRANSE NUMBER STATE RE GISTRATIONEXPIRES Checkif Permanent VIN YEAR MAKE Reg istatlon❑ LENGTH AXLES VEHICLE N S E W Off -Road Unknown TRAVELING ❑ ❑ ❑ ❑ ❑ ON STREET, ROAD, HIGH WAY AT EST. SPEED POSTED SPEED TOTAL LANES 718 GEORGE BUSH BLVD 5 15 2 MAT. RE HAL MAT. PEA A? MAL MAT. NUMBER 2 Ye Z Vrs 2 Ves HAZ MAT. CLASS Area of Initial Impact �C-- i� ♦ Most Damaged Area 88 Unknown 88Unknown 2 18 UnderarHage 18 2 i < • s MOTOR CARRIER NAME US DOT NUMBEfl 1 19 Overturn 19 0 Windshield 20 1 16 1• 17 6 Mil MOTOR CAflRIEfl ADDRESS 14 21 T r 21 s4 b 12 11 1a e COY &STATE C PHONE NUMBER,., Vehicle Body Type 35 Low Speed Vehicle 16 (Sport)tltilttv Vehicle 1 C 17 Carrggoo Van (Sb 0001hs i6 TafBcway Commercial Motor Vehicle Conflguatlon 1Two -Way, Not Divided 1Vehicle 10,(%X1 has or less Placarded STactor/Tdple 2Two -Way, Not Divided, with a for Hazardous Materials 9Truck (4.536 xg)or lessj 1 Passenger Car 1iBB Motor Coerh more than 10,000 Has (4,536 Continuous Left Ti Lane 2Single -Unit Truck (2-axle and GVWR ka) Cannot Classify 3 Two -Wa ,Divided, Unprotected more than 30 DDO lbs (4,536 kg) lU bus/La Van (seats far 9.15 IoTwote�feetl 190[her U 2 Passenger Van ght Trucks(SO,ODO Ibs Median 35ingle- Untt4nxk(3 or more axles) occupants, including driver) DI dad, Positive 4 Truck 3 Pldcup (4.536 k¢I or less) 20 MedfUm/HeeWW Barney y, v!! Median Puffing Trailer(s� 11 Bus (seats for more than 15 S Truck Trotter IIbohtail Trucks 7 Motor Home 10,000Ibs q,536 kgJ (more the 1 88Ure;%wV rafflcway 6 Truck Tractor/Seml- Trailer 777�gpher, s(•splain IngNanm�Nve 7Tnxk 11M 21 Farm Us rVehic�e TMIler Type Tractur/DOUble Trailer 88 Unknown 12 Mot77ede 77 Other, Explain In Narrative TRAILER 1 TRAILER Z 1 Single Semi Taller 13 AII7erraln Vehicle (ATV) 88 Unknown Tan am Semi Troller 8Pale Troller Cargo Body Type 13lntermodal 3 Tank Trailer 9Towed Vehicle 3Vanp /Endosed Box Container dassU Cl 10 Auto ❑ Interstate Carrier merelal SBOetTallerntRrailer Ex ainr In SPolaTrailer 14 Vehicle Towing 2lntrastate Comer 3 ❑ 6tJLillty jailer Naratve 6Cer4o Tank A^other VehiUe BS Unknown It oCargo 15 NOt AUu liahle Not In Commerce /Government 4 Not in Commerce/Other 7House Trailer 7Flat ad 2 us ilQ0001hs Truck Most Harmful Event Non -Collision l Overturn 9Dump 'vehicle 110,OOD Ibs t4�536kkgg or less 9 Concrete Mixer 4 536 kg) or less not Comm ❑ 210,001- 26,Otl0 IbR4536-117,3k 10 auto Transport displaying NM placard) GVWRJGCWR g) 77 Other Explain in /Rollover 2 Fire /Explosion 3MOre than 26000 he (11,T�3 kgJ 11 Gerbege /Refuse Narrative 4 Not 3 lmmerslon 14 4 Jackknife Applicable 12 Log 88 Unknown eWllalon with Non -Fixed Object Collision with a Fixed Object 5 Cargo /Equipment Loss or Shift 6 Fell /Jumped From Motor Vahlde 29 Cable Barney 10 1 PPedestrian 19 Impact Attenualor /Crash Cushion 30 Concrete Traffic Berner Emergency cy Sequence of Events 7 Thrown or Falllnqq ObjIect ran 8Ran Into Water�Carel 10 Bridge Overhead Structure 31 Other Traffic Barrier Vehicle Use 12 13 Animal Vehicle (train, engine) 21 Bridge Pier or Support 32 Tree (standing 34 Motor Vehicle In 23 Bridge Rail 331Nmry 90ther Non- Collslon 464 equenceo Even ts on 14 Transport p 23 Culvert 34 TafRC 51 pp 519115 tSupport ❑ 15 Work Motor Vehicle gn l uport 16 Work Zone /Maintenance 24 Curb 357raffic Signal Support 40 Equipment Failure (biown tire, E uipment 25 Ditch 36 Other Post, Pole, Support 42 Be- Off on of Unks 1�l_3r�tl IIj I�q '��l bake!allure, etc) 42 flan ON Be edwey, Rlah 43 Ran Oft ROatlway, or 1No I�Struckb Fallln Shlftln6Caroor 26 Embankment 37 Fence INO AnvthlnH Set in Motion hY Motor 27 Guardrail Face 38 Mailbox Bg Unknown Vehicle 2a Guartlmll Entl 39 Other Fixed OhIM (wall, Leh LJ 44 Cross Median 18 Other Non-Fixed Object building, tunnel, etc) 45 Crass Centerline Vehicle Maneuver Action Traffic Control Device For Vehicle Defect, 460ownhlll RUnawa IStraight Ahead ❑ Roadway Gntle 3 Turning Left 135topped In Traffic This Vehicle 1 Level Roadway Alignment 4aacd 1451owling 2 Hillcrest 4 STUmIn ❑ RI h[ 15 Negotiatinga Curve Bflashln 51 nal Flashing 1 I6 Leaving Traffi<Lene 1 1 3 Uphill IStai ht 6Chan in lanes 9Rallwa y g H 17 Enterinq Suspension 4 Downhill ❑ 2 Curve fll55ht 8 5 Sag (bostom) 1 SO Parked TrafBC one Device I None 13 77 Other, Explain in 1 N° Controls 3 Curve Lett Making -Turn 10 Person (Including 2 Brakes 14 Windows/ 110verta in Na 4School Zone Sin Flagman, Officer, Sign/ g 3Tlres as Unknown Windshield Unknown Passln Device Guard, etc.) 4 LIghts (head, 15 Mirrors Special Function INO Special Function 9Ambulance 5Taffic Control 13 Waming Sign sinal, tall 141ntertlty BUS 51 nal 77 O[her, x I gg ) l6 Truck Coupling/ '2 Motor Vehicle 10 Fire Truck g pain in 65Jeering Of 3PO11CeVehide 15 Chaner/Tour BUS Trailer Hitch/ 13 Farm labor Transport 16 Shuttle Bus 65top Sign Narrative 7Wipers Safety Gains 7 7 Yle d Sin 86 Unknown 12 School g BUS 9 Exhaust System 770[ er, Explain In e Mlllta 17 Farm Lobar Bus h Military N 13 Transit/Commuter Bus a8 Unknown 30 Body, Doors Narrative • • 11 Power Train 88 Unknown PERSON a NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATON NUMBER PERSONA NAME OF FESTUUTENUMBER CHARGE [BATON NUMBER PEPSON4 NAMEOFV0LATOR FIL STATUTENUMBER CHARGE CITATION NUMBER HSMV 80010 S NJP1 (rev 1011 OR _ Page ? of 7 VEHICLE # 2 Check if Commercial REPORTING AGENCY CASENUMBER HSMVCRASH REPORTNUMBER 1VehkJe In TrampoR VEHICLE LICENSE NUMBER 14- 003707 84328584 STATE REGISTRATIONEXPIRES Checkif Permanent VIN 2 Parked MotorVehid 1 Y43CBA rking Vehicle Registration N3' 04/30/2014 ❑ 3N8AMY6CW100347 Run YEAR MAKE 188Unknown MODEL. STYLE COLOR DAMAGE: 2 Yes 1 2012 HISS 'INSURANCE EST. AMOUNT 1 Disabling 4 Minor A MURANO SOV BLU 3 Nunctlonal BB Unknown ❑ 500 COMPANY INSURANCE POLICY NUMBER Towed due VEHICLE REMOVED BY 1 Rotation to Damage: DRIVER 2Omer Request STATE FARM INDEMNITY CO X232938E0630L NAME OF VEHICLE OWNER (Check ti BUSiness)� INo 2Yes 3D Ner Cl/RRENT AOORFSS her Ex IaIn In Narrawe VINCENT D. YANIRO C1T1• &STATE ZIP CODE TRAILER 17 DORCHESTER DRIVE BASKING RIDGE, N3 07920 # UCENSE NUMBER. STATE REGISTRATION EXPIRES Check if Permanent VIN ., Registration ❑ YEAR MAKE LENGTH AXLES TRA:LEftb UCENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent VIN Registration❑ YEAR MAKE LENGTH AXLES VEHICLE N S E W Off -Road Unknown TRAVELING ❑ ❑ X ❑ ❑ ❑ ON STREET, ROAD, HIGHWAY AT F5T. SPEED POSTED SPEED TOTAL LANES 718 GEORGE BUSH BLVD 15 1 HAL MAT. REUbn I HAZ. MAT. PLACAn HAZ MAT. NUMBER HAZ MAT. CIASS 1 No 2Yes Area of Initial Impact I r-- Most Damaged Area 2Yes —i 88 Unknown 88 Unknown MOTOR CARRIER NAME ' • 2 s 4 a e > IB Undercarriage Ie 2 s < e a > US DOT NUMBER 7 1s to is a 19 Overturn 19 20 Windshield MOTOR CARRIER ADDRESS 74 17 1Z it to a 21 Tr�aik -r_21 t4 n 1z H to • CITY& STATE 1 D PHONE NUMBER Vehicle Body Type ❑ 1+`Law Speed Vehtde • i6 (Sport) Utility Vehicle 1 16 17 Car % °Van(100001bs TrafBcway Commercial Motor Vehicle Configumbon iTwo -WaY, Not Divided 1Vehicle 10 000 or less Placarded 2Two -Way, Not Divided, with for Vehicle 00Materials BTrabor/Triple Hazardous 9 Truck (4.536 xg)orless� Continuous Left Turn Lane 25In more than 10,00016s(4,S36 Truck (2-axle and GVWR k 1 Ca ^ ^ °t Classify 3Two -Wa Divided, Unprotected 1Passenger Car 18 Motor Coach 2PassengerVan 190ther Ught Trucks (10, HIS; y P , more than 19 000 Ihs 4,536k 1�aimed Yfeet Median 35in IcUnit frock (3 or moregtixles xuv eoLgtsr ncludln edrUiver9 -15 XTwo ) l ) 3 Pickup 4 536 kg) or less) dMMlum -Way, DIWEetl, POSltive Median 4 Truck Pullinguck(r(s g Barrier 11 Bus (seats for more then 15 5 Truck Tractor Ibohtai� /Herald Trucks more the 7 Motor Home ( 8 Bus 4,53611x1 5One•Wa Trafficwa 6Truck Tractor/Semi- Trailer 77 pets plalnina driver) y Y 77 Other, �xplaln in NarratNe BB Unk ^own 21 Fa016s 11 Motorcycle ii Farm labor VehirJe Trailer Type )Truck Tractor /Double Troller 88 Unknown 12 Mooed 77 Othat Explain In Narrative TRAILER 1 TRAILER 2 I Single Seml Trailer y Type 73 All peraln Vehicle (ATV) BB Unknown 2Tandem Seml Trailer BPOie Trailer Cargo Body 13lntermodel 3 Tank Traller 9 Towed Vehicle 3 Van /Enclosed Box 13 Inteer ci auH CommMon- Commercial ❑ 10 Auto Transport hassi S Interstate Caller 4 Saddle Mount/Tniler 4 Hopper 14 Vehicle 5 Boat 77 Other, Explain In S Po a- 14 V icVehicle Towing 2 Not Intrastate Co Cartier 3 Not In Commerce ❑ Tnile railer Another 6Utility Trailer Narrative 1loCa 6Carso Tank 15 hiclee 88 Unknown reo pp /Government 4 Nat in Commerce /Other Truck 7 House Trailer 7 Fletba 2 us BDump jvehitle 1t1,ODD not (a Moat Harmful Even! Overtu /Ralf S OVertum /Rollover S 10 :00, Ibs f4.536kgg11 or less 9 Concrete Ml+er 536 kg) or less not Comm ❑ 210,001.26,1 lb 1A,536.11793 kg) Ii Garhe ePefuse 770theraExplalnacrard) GVWRIGCWR 2 Fire/Exploslon on 3More than 26000 b,, (11,7U3 kg) g / Narrative 4Not Applicable 3 Immersion 14 Jackknife 12 Log 88 Unknown le° ColHtlon with Non -R..d Object Coniston with a Fixed Object 5 5Ca 6 Fell Jumped From Motor Vehicle 10 Pedestrian 29 Cable Barter Emergency 11 Pedolrycle Cushion °Y Traffic Bridge Overhead bother Sequence of Events 7Thrown or Fallingg Ob act 8 Ran Into 20 Structure 31 Traf�fric 13 An Tway Vehicle (train, engine) 21 Bridge Pier or Support 32 Tree (Banding' Vehicle Use 22 Brltlge Rail n- at S ona� �..J 9 Other Non -Call slon 14 Segventto verb on 14 Motor Vehicle in Transport 33 Utlliry PoleNght Support ❑ P° 23 Culvert 34 Trame 51 p 15 Work Motor Vehicle sign l art S6 Work Zone 24 Curb 35 ment Failure (blown tire, /Maintenance 25 Ditch g^aI Other o u cart Equipment 360ther Post, Pole dr a. - tonetc.) ation of Unhs �1f 9�d II ff Roadway, Rlah 26 Embankment Support 1 No 17 Strvck by Falling, ShlhinS Cargo °r 27 Guardrail Face 37 Fence 2Yes An hln Set nn Motion b M 28 Guardrail End 7.B Malib°x a Y otor 88 Unknown Ve Icle 39 Other FNed Object (wall, H ROatlway, LeR 18 Other Non•Fixed Object building, tunnel, et c) �..1 Median CenteHlne Vehicle Maneuver Action Traffic Control Device For Vehicle Defects ❑ Roadway Grade hill RUnawa I Turn Iht Ahead 13 ad in Traffic This Vehicle 3 Turn rag Le h 14 Slowo g 1 Level Roadway Alignment 4 2 HIIIcreB 8 5 ❑ Backing Turnip Right 15 Negotlating a Curve ❑ 8 Flashing Signal b g 16 Leavin Traffic 1 fi g 1 3 U hill ], P 1 Straight 6 4 Downhill 2 Curve flight 8 Lane Changing Lanes 17 Enterin Traffic Wne 9 Railway Crossing 12 Suspension Device 1 None 13 Wheels Parked 77 Other, fix ialn In 5 Sag (bottom) .11 3 Curve Left SO MakincU -Tum Narrative E P 1 Na Controls 10 Person (Including 2 Brakes 14 Windows/ Sl Overt# ing/ 45chool2one Sign Officer, /Flagman, 3Tlres Windshield fig Unknown Passim Device Guard, etcq) 6 4 Lights (head, 15 Minors Special Function 1 NOSPecial Function 9Ambulance 141nterclty BUS 51Traffc Control 13W InInExSll^ signal, tail) 16 Truck Coupling/ of Motor Vehicle 10 Fire Truck g pain In 6 Steering 1 3 Pol VVehicle 15 Charter/Tour Bus Trailer Hitch/ 11Farm Labor Transport 16 Shuttle BUS 65top Sign Narrative 7Wlpers Safety Chains 7 Taxi 12 7 Yield Sign 88 Unknown School Bus 9 Exheurt 5 h p � lain in B Military 13 Transit/CpmmuterBoz BB Unknosvnor Bus SO Body, Do ,, Narrative • • 11 Power Train 88 Unknown PERSON# NAME CIF VIIXATOR FL $TATUIE NUMBER CHARGE CITATIONNUMBER PERSON# NAME OF VIOLATOR FIL ATUTENUMBER CHARGE CITATION NUMBER PERSON# NAME OF -VIOLATOR FLSTATLITE NUMBER CHARGE GTATION NUMBER HSMV 90010 S N /P1 frev 1011m Page -2- of 7 PERSON 1 REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER 14- 003707 84328584 1DHVer ❑ yEHICLE# NAME PHONE NUMBER CAelk if 2 Non- Motorirt 1 3 Passenger 1 ADAM, L. GOREL Recommend (561) 278 -8611 Ddver Re exam ❑ CURRENT ADDRESS (Number and Streett CITY &STATE 71P CODE 246 SEA RD GULF STREAM, FL 33483 GATE OF BIRTH 5EX: ❑ DRIVER LICENSE NUMBER STATE EXPIRES INJURY SEVERITY (INl) 1 Male 02/03/1971 2 Female �. I None 41nca atltatln BB Unknown 6640012710430 FL 02/03/2019 2POSSl61e sFata��whmn �o days) 3 Non -Inca tltatin 6 Nan- raf8c Fatall a• DL Type Required Endorsements Drivers Aetlona at Time of Crash T1A 28 3C 1 Yes 1st 26 Ran off Roadway rd Condition At 5 D//Chauffeur ❑ 2 No 1 No rated MV In Action 27 Disregarded other Traffic EJOperetor 3 3 No Re Endorsement 2 Operated MV in Careless or 51 n ❑ Time of Crash ❑ 6 E/Oper•flest q' Neglisant Manner 4 7 None 3 Failed to Yield Right -of -Way 28 Disregarded Other goad l Apfarently Normal 1 .Proper Backing Markings 3Asleep or Fatigued Driver Distracted By 4 Other Inside the Vehicle 6Improper Turn 29 Over- COrcecting/Over- 5111 sic or Fatigued (Ex lain in Narrative) 2nd Steering 6 Se�zure Epilepsy, Blackout 1 Not Distracted s5 P 30 Followed loo Closely 30 Swerved or Avoided: Due 4th 7 Physically Impaired 2 Electronic Communication External the 11 Ran Redo as to Wind, Slip Surtace, MV, 8 Emotional ((deppression, 1 Devices ell phone etc.) outside the vehicle, explain ❑ 120rove too last far Conditions Object, Non - Motorist In angry distur6etl, etc.) 3 Other Electronic Isevke n narrative) 13 Ran Stop Sign g (navigation tlewce, OVO player) 6Taiting i5lmproper Sign Roadway, etc 911nderthe Influence of 7lnattentive 17 Exceeded Pon Seed 31 pperaletl MV in Erratic, Medications /Drugs/Alcohol Driver Vision Obstructions 98 Unknown Zl Wron Sltle of Sp Way Reckless or Aggressive Manner ]]Other, Explain In Narrative Wrong y 77 Other Contributing Factor Be Unknown 1 Man Not Obscured 5 oad cn Vehicle 9 Smoke ZS Faile to Keep In Proper Lane 2 Inclement Weather 6 ulldina�/Fbed Object 30 Glare .. •. -, 1 3 Parked /Stopped Vehicle 7 gns /B1Ilboards 77 All Other, Expl In Helmet USB H 4 Trees /Crops /Bushes 8 fog in Narrative ( U) Eye Protection (EP) Restraint Systems DRIVER OR P 1 DOT -Compliant 1 Yes IRS) Mother Helmet Helmet 2 No Motor Vehicle Seating Position: LDCAnON: SEAT ROW OTHER Z Other Helmet ❑ 3 Not Applicable (La) 3 No Helmet 1 Not AVVlkable Seat Row Other 2 None Used -Motor Vehicle Occupant 1 Left 1Front 1 Not A licable 1 ❑ Air Bag Deployed 3Shoulder and Up Belt Used 00 5 DeployedeOther p 2 Middle 3Third Second 3Othe Enclose Ca TrAr a (ABD) knee au hell, etc.) 5Lap Belt Bey Only Used 3 Rig4ht 3 Third 3 Other Enclose Cargo Area Ejection (EJECT) E Deotoyed• S lap Belt Only Used 77 her 4 Fourth 4 Unenclosed Cargo Area 1 Not E acted ❑ 1 Not Applicable Com6lnation 6 Restraint Used •Type Unknown (explain In 77 Other Row 5Trailing Unit ❑ 2 Rlettee • Totallyy 2 Not Deployed 7 Deployed - Curtain 7 Child Restraint System- Forward Facing narrative) 88 Unknown 6 Rlding an Motor Vehicle Erterlor (non• 3 etted • Panlall 2 3 Deployed - Front g8 Deployment 8 Child Restraint System- Rear Facing 98 Unknown trallina unit 1 y 4 Deployed•Side Unknown 9 Booster Seat 88 Unknown 4 of Applicable 10 Child Restraint -T pe Unknown 88 Unknown 77 Other, Explain in aarrative NON-MOTORIST 7Type torist DescNon - Motorist Location At Time of CA ction Prior to Crash rian I Intersection• Marked Crosswalk 8 Sidewalk Pedestrian lwheelchair, person ina 2lmersection- Unmarked Crosswalk 9 Median / Crossing Island 5 Welkina/Cyclinggon Sidewalk Cskater, pe estdan conveyance, etc.) 3Intersection -Other 10 Driveway Access 61n Roadway— Other(working l ❑4Mldblock- Marked Crosswalk 11 Shared -Use Path or Trail FFlaying etc.) ydi)f STravel Lane -Other Location 12 Non- Trafflcway Area 1 Crossing Roadwa 7AId�'Ilacent to Roadway(e.g., a ttc'f Motor Vehkle NOt in Transpo j5ryoulder /Haadside BB aker�WnPlain In Narrative 2Walting to Cross gaadway BGOinet°orfrom SNool K -12 ant or a Non -Motor Vehicle 3 Welking/Cycling Along rtation Device Non - Motorist Actions/Circumstances Roadway wkh Traffic (in or 9WdrA gespornse y ad a cent to travel lane) wn Type of Non- Motorist NO lmproper Action 4 ad Along ONone rt/eash Roadway 77 Other, Explain In Narrative Safety Equipment ❑ tat ❑ 3 Failure to Yield Right-of-Way Y o rave Traffic In or 88 Unknown 8 Y atljacenlYO travel lane) 3 None 5 Lighting 4 Failure to Obey Traffic Signs, 2 Helmet 6 Not Applicable 51gnals, or Officer 7 Entering/Exiting Parked /Standing 10 Improper Turn �Merge 3 Protective Pads Used 77 Other Explain ❑ 5 in Roadway Improperly (standing Vehicle 11lm Improper g (elbows, knees, shins etc) In Narrative 2nd I in workin a in p per Pass yy yy g, p Y ) 8lnattentive ftaikln�, eating etc.) 12 Wrong -Way Rldin¢ or Walking A flefleaHe Clothing ]jacket, 88 unknown 601sabled Vehicle Related (working 9 Not Vlslbie (clerk c athing no ]]Other, Explain in Narrative backpack etcl on, Pushing leaving /approa <hin8) lighting, etc.) 88 Unknown a e a• SUSPECTED 1TestN AtCOHOLTESTED: ALCOHOL TEST TYPE: ALCOHOL BAC SUSPECTED OgUG TESTED: DRUG TEST TYPE: DRUG TEST RESULT: ALCOHOL USE: lTert Not Galen 1 Blood TEST RESULT: DRUG USE: ❑ I Test Not Given 1 Blootl ^ 1 Positive 1 Na 2 Test gefused 2 Breath 1 Pending 1 No 2 Test Refused 3 Urine NII —il' 2 NO alive ❑ 2 Yes ❑ 3 Test Given 3 Urine 2 Cam toted 88 Unknown 1 88 unknown, IFTeste 77 Other, Exp a n n 88 Unknown 2 Yes 3 Test Given 77 Other, 3 Pending Nsrre Iva 88 Unknown 98 Unknown, if Teste Explain in e"at ve 88 Unknown SOURCE ns TRANSPORTTO MEDICAL FACILITY❑ EMS AGENCY NAME OR III EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 Not Transported 2EMS 3Law Enforcement 77 Other, Explain In Narrative 98 Unknown PERSONA VEHICLE* NAME a a a DATEOFBIRTH INJ SEX LOC:S R 0 EJECT HU EP JAB RS 3 2 SUSAN I YANIRO 01/14/1950 1 2 3 1 1 B 3 CURRENT ADDRESS (Number and 5treetl C,RYgSTATE 1 ZIP CODE 5 PALM UARE DELRAY BEACH, FL 33483 SOU0 RCE OF TRANSPORT TO MEDICAL FACILITY❑ EM5AG: NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSP0RTEDTO 1 Not Transported 2 EMS 3 Law Enforcement 77 Other, Explain In Narrative BE Unknown PERSON* VEHICLE.* NAME - DATE OF BIRTH INl SEX LOC:S R O EIEC( HU EP ABD IS CURRENT ADDRESS (Number and 5treetl CRY &STATE 21P CODE SOURCE OF TRANSPORT TO MEDICAL FACILITY❑ EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 Not Transported 7EMS ter ExplaEnforcement e 88 Unknovm HSMV groin c rums 1.1 nil m Page 4 of 7 r-, ,A`l PERSON REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER 2 14- 003707 84328584' 1 Dover VEHICLE4 NAME PHONE NUMBER Check if 2NOn- Motorist 1 3 Passenger 2 . VINCENT D. YANIRO Recommend ❑ (908) 963 -6926 - Driver Re exam CURRENT ADDRESS (Number and Steet) CITY &—STATE LPCOOE 17 DORCHESTER DRIVE BASKING RIDGE, N7 DATE OF BIRTH SEX: 07920 DRIVER LICENSE NUMBER STATE EXPIRES IN SEVERITY (INl) 1 Male 07/23/1944 2Femalie 1 Y04337696407444 1N0 4lnappackatin ❑ .: 88 Unknown N] 12/31/2017 3Non51n1ce 1ina a antalin a DL Type Required Endorsements Drivers Actions at Time of Crash SA 38 3C 26 Ran off Roadway 4 D/Chauffeur ❑ 1 No 1 No Contributing Action Y Bid Condition At 5 S EE//Operator ❑ 2 Operated MV In Careless or 27 Disregarded other Traffic Time of Crash 3 3 No Req. Endorsement S' 6 E/Oper -Rest Negligent Manner IR" NN 1 2g uregarded Other Road IAp rent)yy Normal 1 7 one 3 Failed to Yield Right-of-Way Markings 3At�ee or Fati ed 4 Improper Backing 8 Bu Driver Distracted By OUther Inside-the Vehicle 6Improper Turn 29 Over-Correning/Over• 5111sic) or Fatigued (Explain In Narrative Ind Steering 6 Se�zure Epilepsy, Blackout 3 Ere tonic Co 5 1 10 Followed too Closely 30 Swerved or Avolded:Due 4th 7 Physically Impaired Devices is Communication External Distraction ❑ 11flan Red UFas to Wind SliPU Surface, MV,❑ 8 Emotional depression, 1 Devices ((cell !outside the vehicle, explain 12 Drove too Fast for COntlttlons phone etc.) Oblen, fJon- Motorist in angry distur6etl, etc.) 3 Otherflectronlc device ^namtWe) 13 Ran Stop Sign g (navigation device, DVD player) 6Taxiing IS Improper Pessine Roadway, etc. 9 Under the Influence of 7lnattentive 17 Exceeded Posts Speed 31 D erated MV In Erratic, Metli<atlans /DruBS /Alcohol 80 Unknown p ReckPess 77 Other, Ezplaln In Narrative or Aggggressive Manner Driver Vision Ob6truetlon5 21 Wrong Side of Wrong Way 77 Other Contrihuting Factor 88 Unknown 1 Vision Not Obscured 5 ad on Vehicle 9 Smoke 25 Feiletl to Keep in Proper Lane 21mlement Weather 6 ulltling/Flzeci Object lO Glare s. •, , 1 3 Parked /5to pad Vehicle 7 I cis /Billboards 77AIIOther,Expl in 4 Trees /Crops /Bushes 8 og in Narrative Helmet Use ..F Eye Protection (EP) ❑ Restraint Systems .. • • PASSENGER 1 OO7- Compliant 1 Yes Motorcycle 3 Helmet 2 No (RS) Motor Vehicle Be ating Position: LOCATION: SEAT ROW OTHER 2 Other Helmet 3 Not Applicable Row Other (LDq 3 No Helmet 3 Not Applicable 2 None Used - Motor Vehicle Occupant a ❑ 1 Front 1 Not Applicable 1 Air Bag Deployed 5 Deployed -Other 3 Shoulder and Lap eek Used 25econd 2 Sleeper Senlano Truc a (ABD) knee air bek 4 Shoulder Bak Only Used L2MIddle alc.l 3ThIrd 3 Other Enclose Cargo Area Ejection (EJECT) Oeptoyed - 5 Lap Bak Only Used er 4 Fourth 4 Unenciosed Cargo Aree 1 Not E erred 1 Nat Applicable [ombinatlon 6 Restraint Used •Type Unknown nin ]]Other POw STralling Unk 2EJJ'ened- TOtallVV 2NOf DePliaYbl ]Deployed- CUrtaln ]Child Restraint System - Forward Facing ve) 88 Unknown 6 Riding Motor 3 Deplayedpa - u Restraint System an Vehicle Exterior (non• 3 e'ened • Partially -Rear Facing nown trailing unit) 4 otA licable 4Depl�yed -Side Unknown 9Booster Seat 88 Unknown BB... n 30 Child Restraint -TYpe Unknown 77 Other, Explain in Narrative None Motorist Description Non - Motorist Location At Time of Crash Action Prior to Crash 1 Pedestrian 3 EldycglIs,t tap pe Milan conveyance, etc) El20ther Pedenrlan !wheelchair, person ins 3 t 1Intersection- Marked Crosswalk 8Sidewalk 2lntenect ion- Unmarked Crosswalk 9 Median / Crossing Island 5Walkina/Cydin ■tlon Sidewalk ❑ 3 Intersection -Other 10 Driveway Attest 61n Real way— 4Midblock- Marked Crosswalk 11 Shared -Use Path or Trail pplaying, etc.) Other O Other Cyclist 5 Travel Lane• Other Location 12 Non -Traf may Area S Crossing Roadwsv 7 Adjacent to Roadway (e.g., MSOagatcof MotorVehlcle Not in Transp of 6Bicycle Lane 77 Other, Explain In Narrative 2 Waiting to Gass Roadway shoulder, median) ]Shoulder /Roadside 88 Unknown 3 Walking/Cyding BGoln to or from School 66 cwpant a Non -Motor Vehicle Along (g -12 WO ^8i ^TrafRcway 7 Unknovm Type ofiNOn- Motorist Roadway wkh Traffic (In or /9,II Non-Motorisl NO�m troperi �uem9tanoes adlacent to travel lane) in response) walking/Cycling pp 4 Ayng None 2 Dart/ h 77 Explain Safety Equipment ❑ 1 None 5 Lighting list ❑ in Narrative duet t adjacent Against vet Ian fic (In or 98 3 Failure to Yield Traffic adjacent to travel lane) 88 Unknown Unknown 4 Failure to Obey Traffic Signs, 2 Helmet 6NOt Applicable 3 Protective Pads Used 77 Other Explain etc.) In Narrative SiSnals, or Officer 7 Entering/Exiting Parked /Standing 10 Improper Tum /Merge S In Roadway Impproperly (standing, Vehicle 11 Improper 2nd working xyins) 8Inattentive talkinE, eating, tc. 12 Wron Way j elle tive Cl,shins backpack, �acket, 8 Unknown ❑ 6IYying, Ridin, or Walkin Vleavinq aateda Cvhoinking 9Not Visible dark clothing &no 77 Other, Explain In Narratve g p onpushin & g/ pp g) lighting, etc.) 98 Unknown • • s• SUSPECTED ALCOHOLTESTED: ALCOHOL TESTTVPE: ALCOHOL BAC SUSPECTED DRUG TESTED: DRUG TEST TYPE: DRUG TEST RESULT: ALCOHOL USE: 1 Test Not Given 1 Broad I� TEST RESULT: ❑ DRUG USE: ❑ 1Test Not GWenl 1 NO 1 Blood I"'� 1 PosgltWe 3Test Refused 3 Breath I I 1 Pending 1 No 2 Test Refused 2 Yes 3 Test Galen 3 Urine I_I_II 2 Co. leted ILaJ 3 Urine I�l' 2 Negative 88 Unknown �• 88 Unknown, HTeste ]]Other, Ez ain n p 2 Yes 3 Test Given 77 Other, 3 Pending ❑ ❑ t N atlu p 88 Unknown 89 Unknown 89 Unknown, If Tes[e Explain In arcat ve 88 Unknown SOURCEns TRANSPORT TO MEDICAL FACILITY❑ EMS AGENCY NAME OR IO EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 Not Transported 2 EMS 3 Law Enforcement 77 Other, Explain In Narrative 88 Unknown PEg50NN VEHICLE 91 NAME DATE: OF BIRTH INJ SEX LOC'.5 R O EJECT HU EP ABD RS CURRENT ADDRESS (NUmber and Street) CITY & STATE LP CODE SOURCE TRANSPORT 10 MEDICAL FACILITY❑ EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 Not Transported 2 EMS 3 taw Enforcement Law En ]]Other, Explain in Narrative 88 Unknown P NAME DATE OF BIRTH INJ SIX LOC: S R O ELECT HU EP ABD RS CURRENTADDRE55(NUmber and Street) CITY &STATE ZIP CODE 1 Not Transported 1 Not Tr OF TRANSPORT 10 MEDICAL FACILITY❑ EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITYTRANSPORTEOTO 2 EMS 3 Law Enforcement 77 Other, Explain in Narrative BR Unknown HSMV 00010 S rvJpl frev 1m1m Page 5 of 7 REPORTING AGENCY CASE'NUMBER " HSMV CRASH REPORT. NUMBER NARRATIVE 14- 003707 1 84328584 This crash occurred in the parking lot of 718 George Bush Blvd (7- Eleven). V2 was stopped in the parking lot area of 718 George Bush Blvd facing east. V1 (Gulf Stream PD unit #752) was initially parked in a marked parking space at 718 George Bush Blvd. V1 attempted to back up in a northern direction. Upon doing so, the left rear of V1 struck the right rear of V2. Both vehicles sustained very minimal exterior damage. According to D2 he was stopped in the parking lot area of 718 George Bush Blvd because he was trying to find directions to a location. According to D1 he was attempting to back up in a northern direction to get onto George Bush Blvd westbound. D1 did not see V2. There were no injuries and no independent witnesses reported on scene. D1 is determined at fault for the crash. Both parties were issued a case number. Photographs were taken of both vehicles. D56 �CSO BILL HSMV 80010 S (N /D) (rev 10110) Page 6 of 7 POLICE * *END ** EP Page ! of I 0 .11 4 F i 4 F I Ar 1, *may f R 1 Wes' 1. i 1• iF 4 1 •r 1 $J a • r . a , u F � rV AA :1 I VI I fA br x11 n NVA $r ♦ r I' ' gt t IY 9 -L� ...f..._ _ .__.... 1+;; RYO i 9'k' � � to -: i� i ' + j[ �i . .1._� g•. J�� 9 �� . ...r'. G�. �� y` ct. •� � ., x.., Y +; '. i. rfHB G*J row �n _ 1 p' S I A•� t I' i u rfHB G*J row �n _ 1 . I r „ ACCIDENT SE TOWN OF GULF STREAM op- PAYMENT APPROVED .4 Amount 1100 gy Date Check #_ 11 Date I, VINCENT D. YANIRO, have accepted Town of Gulf Stream Check #11833 in the amount of $400.00 to cover the cost of minor damage to my 2012 Nissan Murano, said damage being caused by a Gulf Stream Police Department vehicle. This settlement satisfies any and all claims against the Town of Gulf Stream related to this incident that occurred on March 16, 2014. STATE OF FLORIDA COUNTY OF PALM BEACH Sworn to (or affirmed) and subscribe before me this day of, IF 2014 by Vincent D. Yaniro �29 Rlr7LT ignat Notary Pub �� My Comm. E;t mmis fication co Type of Identification L 04113 76,6-Y 0 7 yf�Y Item # F300 To reorder, please call Blackbaud Forms at our toll free number, 866.422.3676 • , .11833 i TOWN OF GULF STREAM OPERATING ACCOUNT To: Vincent D Yaniro Accident Settlement 001 - 53110- 521 -10 Legal Services - PD TOWN OF GULF STREAM OPERATING ACCOUNT 100 SEA ROAD GULF STREAM, FL 33483 -7427 (561) 276 -5116 PAY * *Four hundred and 00/100 Dollars ** TO THE ORDER OF Vincent D Yaniro SUNTRUST BANK 63- 215/631 11833 FRAUD ltd ARMOR' CHECK DATE CHECK NO. 3/18/2014 11833 CHECK AMOUNT $--400.00 ` OR IG I MP 3NIN39 - — 7NUINE •GEHU �' AUTHORIZED SIGNATURE AUTHORIZED SIGNATURE s VO L L8 3 311' I: TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered via e-mail October 14, 2014 irnawaty Tirtarahardja [mail to: imawatyt @gmail.com] Re: GS #966 (damage by town) All records regarding or concerned with damage caused to anyone by an employee of the Town which were created or received in 2014. Dear imawaty Tirtarahardja [mail to: irnawatvt(@,,gmail.coml, This letter provides you with the full production of public records you have requested in your email dated June 6, 2014. Your original request can be viewed at the following link: htty: / /www2. gulf- stream. ore(WebLink8 /0 /doc /18219/Pagel .asox. Be advised that the responsive documents can be found at the same link. Please note that the checking account number has been redacted pursuant to Fl. Stat. 119.071((5)(b). We consider this matter closed. Sincerely, Town Clerk Custodian of the Records