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HomeMy Public PortalAboutPRR 22-2919 TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered via e-mail November 18, 2022 Christopher Iuzzolino [mail to: homesalesbychris@gmail.com] Re: GS #2919 (Police Report) Please send a copy of the Police Report 22-2292. Dear Christopher Iuzzolino [mail to: homesalesbychris@gmail.com]: The Town of Gulf Stream has received your public records request on November 17, 2022. You should be able to view your original request and response at the following link, as of January 17, 2023, 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): PRR 22-2919 (laserfiche.com) The police crash report you requested is attached to this e-mail. We consider this request closed. Sincerely, Reneé R. Basel, CMC Reneé R. Basel, CMC Town Clerk, Custodian of the Records FLORIDA TRAFFIC CRASH REPORT WAS DOT PROPERTY INVOLVED IN THIS CRASH? LONG FORM ry] SHORT FORM ( UPDATE L ] TOTAL # OF VEHICLE SECTION(S) 1 (Shaded Areas) 3 MAIL TO: DEPARTMENT OF HIGHWAY SAFETY & MOTOR VEHICLES TOTAL # OF PERSON SECTION(S) TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING TOTAL # OF NARRATIVE SECTION(S) 1 TALLAHASSEE, FL 32399-0537 CRASH DATE TIME OF CRASH DATE OF REPORT REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER 11115/2022 1 10:00 AM 111/15/2022 222292 187073145 CRASH IDENTIFIERS COUNTY CODE COUNTY OF CRASH PLACE OR CITY OF CRASH CHECK IF WITHIN [TIME REPORTED TIME DISPATCHED ICITYCODE CITY LIMITS 06 44 PALM BEACH GULF STREAM 10:13 AM 10:13 AM TIME ON SCENE IME CLEARED SCENE CHECK IF REASON (If Investigation NOT Complete) Notified By: 1 Motorist 110:33 COMPLETED I Ifl 1:01 PM 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 N OCEAN BLVD 26.500187 -80.062931 AT FEET MILES kN S E W AT/FROM INTERSECTION WITH STREET, ROAD,HIGHWAY © OR FROM MILEPOST# a u59 [1 A SEA RD Road System Identifier 7 Forest Road Type of Shoulder T rot of Intersection 5 Traffic Circle 8 Private Roadway 1 of at Intersection 6 Roundabout 1 Interstate 4 County 2 U.S. 5 Local 9 Parking Lot 1 Paved 2 Unpaved 1 2 Four-Wa Intersection y 3 T-Intersection 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 CRASH INFORMATION (CHECK IF PICTURES TAKEN) Light Condition Weather Condition Roadway Surface Condition School Bus Related Manner of Collision/Impact 1 Daylight 1 2 Dusk 5 DarkNotLighted 6 Dark -Unknown 4 Flog, Smog, Smoke 5 Sleet/Hail/ 1 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 1❑ 8 Water 1 Directly Involved 6 Rear to Side 4 Dark -Lighted 77 Other, Explain in Dirt (standing/moving) 3 Yes, School Bus 7 Rear to Rear Narrative 88 Unknown Clear 1 7 Severe Crosswinds 2 Cloudy 77 Other, Explain in 1 Dry 77 Other, Explain in 2 Wet Narrative Indirectly Involved 1 Front to Rear 77 Other, Explain in Narrative 2 Front to Front 3 Rain 88 Unknown Narrative 4 Ice/Frost 88 Unknown 3 Angle First Harmful Event Non -Collision Collision Non -Fixed Object Collision with Fixed Object First Harmful Event 1 Overturn/Rollover 10 Pedestrian 19 ImpactAttenuator/Crash 30 Concrete 2 Fire/Explosion 11 Pedalcycle Cusion 31 Other Traffic Barrier Location 1 On Roadway 3 Immersion 12 Railway vehicle (train, 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 building, tunnel, etc.) 88 Unknown 18 Other Non -Fixed Obiect 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 1 icy, snow, slush, etc.) ❑ ❑ ❑ 10 Road Surface Condition (wet, 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 AnimalRoadway (s) ' in 2 Intersection 17 Acceleration/Dceleration Lane 4 Work Zone (construction/ Inoperative, Missing or Obscured P 9 2 Weather Conditions 77 Other, Explain in 3 Intersection -Related 18 Through Roadway 9 Y 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 Warning Sign 2 Advance Warning Area ❑ 3 Transition Area 2 Lane Sh'rft/Crossover 3 Work on Shoulder or Median 4 Intermittent or Moving Work ❑ 1 No 2 Yes 1 No 2 Officer Present 88 Unknown 4 Activity Area 77 Other, Explain in Narrative 88 Unknown 3 Law Enforcement Vehicle 5 Termination Area Only Present WITNESSES NAME ADDRESS CITY & STATE ZIP CODE YIANSON LEONTINO FIGUEIRA RUIZ 1008 WATER TOWER WAY APT 108 LANTANA FL 33462 NAME ADDRESS CITY & STATE ZIP CODE NAME 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 VEH. # PER # PROPERTY DAMAGE -OTHER THAN VEH. EST. AMT. OWNER'S NAME ❑ (CHECK IF BUSINESS) ADDRESS CITY & STATE ZIP CODE HSMV 90010 S 1 6 Page of VEHICLE # 1 Check if Commercial �JI Re porting Age ncyCase Number HSMV Crash Report Number 222292 87073145 1 Vehicle in Transport VEHICLE LICENSE NUMBER STATE REGISTRATION EXPIRES VIN Check rf Permanent 2 Parked Motor Vehicle 1 3 Working Vehicle Z581TA FL 06/12/2024 Registration 119XFB2F50EE228808 Hit and Run 1 No MAKE MODEL STYLE COLOR DAMAGE: 1 Disabling 4 Minor 4 EST. AMOUNT 2 Yes EllYEAR 2014 HOND civic 4 DOOR SEDAN SILVER - SIL 2 Functional 88 Unknown 88 Unknown 3 None INSURANCE COMPANY (DRIVER) INSURANCE POLICY NUMBER Towed due to Damage: 1 ❑ VEHICLE REMOVED BY 1. Rotation 2. Owner Request 3 GEICO GENERAL INSURANCE 0693219602 1 Nes o 2 Y DRIVER 3. Driver 4. Other, Explain in Narrative NAME OF VEHICLE OWNER (CHECK IF BUSINESS) F] CURRENT ADDRESS CITY & STATE ZIP FERN H FRANK I 3861 N OCEAN BLVD UNIT 2110 GULFSTREAM FL 33483 Trailer LICENSE NUMBER STATE REGISTRATION EXPIRES Check If Permanent VIN YEAR MAKE LENGTH AXLES One: Registration r Trailer LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent VIN YEAR MAKE LENGTH AXLES Two: Registration E VEHICLE N S E W Off -Road Unknown ON STREET, ROAD, HIGHWAY AT EST. SPEED POSTED SPEED TOTAL LANES TRAVELING C ❑ ❑ U Ll ❑ NORTH OCEAN BLVD 5 35 2 HAZ. MAT. RELEASED 1 No HAZ. MAT. PLACARD 1 No NUMBER CLASS Area of Initial Impact Most Damaged Area 09 09 2 Yes ❑ 2 Yes ❑ 3 4 5 2 6 3 4 5 6 7 18 Undercarriage 18 2 7 88 Unknown 88 Unknown 1 15 16 19 Overturn 19 17 8 20 Windshield 20 1 15 16 17 8 MOTOR CARRIER NAME US DOT NUMBER 14 9 21 Trailer 21 14 9 13 12 1110 13 12 1110 MOTOR CARRIER ADDRESS CITY T777F ODE PHONE NUMBER Vehicle Body Type 15 Low Speed Vehicle Trafficway Commercial Motor Vehicle Configuration 16 (Sport) Utility Vehicle 1 1 Vehicle 10,000 Ibs or less Placarded 8 Tractor/Triple 1 Two -Way, Not Divided 1 for Hazardous Materials 9 Truck more than 10,000 Ibs (4,536 17 Cargo Van (10,000 Ibs (4,536 kg) or less) 2 Two -Way, Not Divided, with a ❑ 2 Continuous Left Turn Lane Single -Unit Truck (2-axle and GVWR kg), Cannot Classify 1 Passenger Car 18 Motor Coach more 3 Two -Way, Divided, Unprotected 3 than 10,000 Ibs (4,536 kg)) 10 Bus/Large van (seats for 9-15 Single -Unit Truck (3 or more axles) occupants, including driver) 2 Passenger Van 19 Other Light Trucks (10,000 Ibs (painted >4 feet) Median 4 Truck Pulling Trailers) 3 Pickup (4,536 kg) or less) 4 Two -Way, Divided, Positive 5 11 Bus (seats for more than 15 Truck Tractor (bobtail) 7 Motor Home 20 Medium/Heavy Trucks (more Median Barrier 6 occupants, including driver) Truck Tractor/Semi-Trailer 8 Bus than 10,000 Ibs (4,536 kg)) 5 One -Way Trafficway 7 77 Other, Explain in Narrative Truck Tractor/Double Truck 11 Motorcycle 21 Farm Labor Vehicle 88 Unknown gg Unknown 12 Moped 77 Other, Explain in Narrative Trailer Type 13 All Terrain Vehicle (ATV) 88 Unknown 1 Single Semi Trailer 8 Pole Trailer Cargo Body Type Comm/Non-Commercial 2 Tandem Semi Trailer 9 Towed Vehicle TRAILER 1 TRAILER 2 3 Tank Trailer 10 Auto Transport 13 odal 1 Interstate Carrier 4 Hopper 14 Vehicle Towing ❑ El 4 Saddle Mount/Trailer 77 Other, Explain in ❑ 3 Van/Enclosed Box Conttaineame r CChhassis 5 Boat Trailer Narrative 2 Intrastate Carrier 5Poie-Trailer Another Vehicle 6 Utility Trailer 88 Unknown 3 Not in Commerce/Government 4 Not in Commerce/Other Truck 7 House Trailer 6 Cargo Tank 15 Not Applicable 1 No Cargo 7 Flatbed (vehicle 10,000 Ibs Most Harmful Event Non -Collision 1 10,000lbs (4,536 kg) or less 2 Bus 8 Dump (4,536 kg) or less not Comm 2 10,001-26.000lbs (4,536-11,793kg) 9 Concrete Mixer displaying HM placard 1 Overturn/Rollover GVWR/GCWR 3 More than 26,000 Ibs (11,793kg) 10 Auto Transport 77 Other, Explain in 2 Fire/Explosion 4 Not Applicable 11 Garbage/Refuse Narrative 3 Immersion 12 Log 88 Unknown 4 Jackknife Collision with Non -Fixed Object Collision Fixed Object 5 Cargo/Equipment Loss or Shift 10 Pedestrian 14 6 Fell/Jumped From Motor Vehicle 11 Pecialcycle 19 29 Cable Barrier Emergency ImpactCushion 30 Concrete Traffic Barrier Vehicle Use 20 Overhead Structure Bridge Overhead Structure 7 Thrown or Falling Object 12 Railway Vehicle (train, engine) 31 Other Traffic Barrier21 Bridge Pier or Support Sequence of Events 8 Ran into Water/Canal 13 Animal 22 32 Tree (standing) 1 Bridge Rail ❑ 9 Other Non -Collision 14 Motor Vehicle in Transport 33 Utility Pole/Li 23 Culvert ght Support 1st 2nd 15 Parked Motor Vehicle 34 Traffic Sign Support 14 ❑ [40-46 Sequence of Events 40 equipment Failure (blown only] 16 Work Zone/Maintenance 24 Curb 35 Traffic Signal Support tire, Equipment 25 Ditch 36 Other Post, Pole, or Support 1 No brake failure, etc.) 17 Struck By Falling, Shifting Cargo or 26 Embankment 37 Fence 2 Yes 88 Unknown 41 Separation of Units Anything Set in Motion by Motor 27 Guardrail Face 38 Mailbox 3rd 4th 42 Ran Off Roadway, Right ❑ ❑ 43 Ran Off Roadway, Left Vehicle 28 Guardrail End 39 Other Fixed Object (wall, 18 Other Non -Fixed Object building, tunnel, etc. 44 Cross Median Vehicle Maneuver Action Traffic Control Device For Vehicle Defects 45 Cross Centerline Roadway Grade 46 Downhill Runaway 1 TurinStraight Ahead 13 Stopped in Traffic 3 Turning Left 14 Slowing This Vehicle ❑ 1 Level 2 Hillcrest 4 Backing 15 Negotiating a Curve 5 5 Turning Right 16 Leaving Traffic Lane 1 8 Flashing Signal 1 None 9 Railway Crossing Roadway Alignment 1 3 Uphill 6 Changing Lanes 17 Entering Traffic Lane 1 No Controls 2 Brakes 13 Wheels Device 4 School Zone Sign/ 3 Tires 14 Windows/ 4 Downhill 1 Straight 8 Parked 77 Other, Explain in Narrative 10 Person (including Device 4 Lights (head, Windshield 5 Sag (bottom) 1 2 Curve Right ❑ 10 Making U-Turn 88 Unknown FlagmanOfficer, 5 Traffic Control , , signal, tail) 15 Mirrors 3 Curve Left 11 Overtaking/Passing Guard, etc.) Signal 6 Steering 16 Truck Coupling Special Function 1 No Special Function 9 Ambulance 14 Intercity Bus Explain in 6 Stop Sign 77 Other, 7 Wipers Trailer Hitch/ Narrative Motor Vehicle 2 Farm Vehicle 10 Fire Truck 15 harter/Tour Bus 7 Yield Sign 9 Exhaust System Safety Chains 88 Unknown ❑ Of 1 3 Police S 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 1 12 Suspension 88 Unknown V701. ATIONS 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 6 Page of_ PERSON # 1 ReportingAgencyCase Number HSMV Crash Report Number 222292 87073145 1 Driver VEHICLE # NAME PHONE NUMBER Check if 2 Non -Motorist 1 ❑ 1 1(347) 466-2037 Recommend 3 Passenger FERN H FRANK Driver Re -exam CURRENT ADDRESS (Number and Street) CITY 8 STATE ZIP CODE 3861 N OCEAN BLVD UNIT 2110 GULFSTREAM 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) 06/1 Z/1956 2 Female 68 unknown F652248567120 FL O6H 2/2026 2 Possible 6 Non -Traffic Fatality 3Norr-Incapacitating DRIVER DL Type Required Endorsements 1st Drivers Actions at Time of Crash 3rd Condition At ❑ A 2 B 3 C 1 No Contribution Action 26 Ran off Roadway Time of 1 1-1 51 Nos 77 Negligent Manner erated MV in Carelss or 27 Disregarded other Traffic ❑ Crash 5 ED/Operatorr 2 1 Apparently Normal 6 E/0 P q er-Rest 3 No Re . Endorsement 3 Failed to Yield Right -of -Way 28 Disregarded Other Road 3 Asleep or Fatigued 7 None 4 Improper Backing Markings I11 (sick) or Fainted Driver Distracted By 6 Improper Turn29 Over-Correcting/Over 6 4 Other Inside the Vehicle Steering S Seizure, Epilespsy, Blackout (explain in narrative) 10 Followed too Closely 7 Physically Impaired 1 Not Distracted 5 External Distraction 2nd 11 Ran Red Light 8 Emotional (depression, 1 30 Swerved or Avoided . Due 2 Electronic Communication 4th angry, disturbed, etc.) (outside the vehicle, explain 12 Drove too Fast for Conditions to Wind, Slippery Surface, MV, 9 Under the Influence of Devices (cell phone, etc. in narrative 13 Ran StopSin 9 Object, Non -Motorist in Medications/Dru s/Alcohol 3 Other Electronic Device 6 Textin 15 Improper Passingg Roadway, etc. 77 Other, Explain in Narrative (navigation device, DVD player) 7 Inattentive 17 Exceeded Posted S eed P 31 Operated MV in Erratic, 88 Unknown 88 Unknown 21 Wrong Side of Wrong Way Reckless orAgreessive Manner 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 1 2 Inclement Weather 6 Building/Fixed Object 10 Glare DRIVER OR PASSENGER 3 Parked/Stopped Vehicle 7 Signs/Billboards 77 All Other, Explain ❑ 4 Trees/Craps/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 Seating Position: ATION: 2 Other Helmet 3 Not Applicable 1 Not Applicable (non -motorist) PLOOCC Seat Row Other ) 11 3 No Helmet 2 None Used - Motor Vehicle Occupant 3 Shoulder and Lap Belt Used 1 Left 1 Not Applicable 4 Shoulder Belt Only Used 1 Front Air Bag Deployed 2 Midde 2 Sleeper Section of Truck Cab 5 Deployed -Other 5 Lap Belt Only Used z Second 3 Right 3 Other Enclosed Cargo Area Ejection (EJECT) 6 Restraint Used - Type Unknown g (knee, air belt, etc.) 77 Other 3 Third 4 Unenclosed Cargo Area 1 Not Ejected ❑ 1 Not Applicable 6 Deployed- 7 Child Restraint System - Forward Facing 2 Deployed - (explain in 4 Fourth 2 Ejected, Totally 2 Not Deployed Combination 8 Child Restraint System -Rear Facing 5 Trailing Unit E narrative) 77 Other Row 3 Ejected, 3 Deployed -Front 9 Booster Seat 7 Deployed -Curtain 88 Unknown 6 Riding on Motor Vehicle Exterior (non- Partially 4 Deployed -Side g8 Deployment 10 Child Restraint Type Unknown 88 Unknown trailing unit) 4 Not Applicable 77 Other, Explain in Narrative Unknown 68 Unknown 88 Unknown N n-Motorist Description 1 Per�estnan ❑ Non -Motorist Location At Time of Crash 8 Sidewalk ❑ Action Prior to Crash 1 Intersection - Marked Crosswalk 5 Walking/Cyclingon 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 CrossingRoadway playing, etc.) Y 3 Bicyclist 4 Other Cyclist 4 Midblock - Marked Crosswalk 12 7 Adjacent to Raodway (e.g., y Area 2 Waiting to Cross Roadway 5 Occupant of Motor Vehicle Not in Transport 5 Travel Lane -Other Location 77 Other, Explain in Narrative 3 Walking/Cycling Along shoulder, median) Other, Explain 6 Bicycle Lane 8 Going to or from School (K-12) (parked, etc.) 88 Unknown Roadway with Traffic in or 7 shoulder/Roadside 9 Working in Trafficway 6 Occupant of a Non -Motor Vehicle adjacent to travel lane) I (incident response) Transportation Device Non-Mototist Actlonsluircurnstances 4 Walking/Cycling Along 10 None 7 Unknown Type of Non -Motorist 1st ❑ 1 No Improper Action Roadway Against Traffic (in 77 Other, Explain in Narrative 2 Dart/Dash or adjacent to travel lane) 88 Unknown 3 Failure to Yield Right -of -Way 4 Failure to Obey Traffic Signs 1 None Safety Equipment 5 Lighting 2 Helmet 6 Not Applicable 3 Protective Pads Used ❑ Signals, or Officer 7 Entedng/Exiting Parked/Standing 10 Improper Tum/Merge 2M ❑ Vehicle 11 Improper Passing 77 Other, Explain (elbows, knees, shins, etc.) in Narrative 5 In Roadway Improperly (standing, 8 Inattentive (talking, g, ) Wrong -Way g g lying, working, playing) (alkin eating, etc 12 Wron Wa Riding or Walking 4 Reflective Clothing ijacket, 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 ALCOHOUDRUG/EMS SUSPECTED ALCOHOL TESTED: ALCOHOL TEST TYPE: [ALCOHOL BAC SUSPECTED DRUGTest TESTED: DRUG TEST TYPE: DRUG TEST RESULT: ALCOHOL USE: 2 Test Refused n ❑ reath 7Urine Eplain ❑ EST RESULT ❑ ❑ DRUG USE: E188 d n ❑ 7BOther, lood ❑ 1 Positive Yes 3 Test Given88 ther,, 2 COMPLETED TED 3 Test Gv en 3 Pending2 Unknown 88 Unknown, if Tested in Narrative 88 UNKNOWN 8 Unknown Unknown, if Tested Explain in Narrative 88 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 ADDITIONAL PASSENGERS PERSON # VEHICLE # [AME DATE OF BIRTH INJ SEX LOC: S R 0 EJECT HU EP ABD IRS CURRENT ADDRESS (Number and Street) CITY STATE ZIP CODE SOURCE OF TRANSPORT TO MEDICAL FACILITY 1 NW TranarateE 2 EMS S law Enfacemeirt 77 Ot-. Er . in Narrative; Unkrio+m ❑ EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO PERSON # VEHICLE #[IAME DATE OF BIRTH I INJ I SEX I LOC: S I R O EJECT J HU EP I ABD I RS CURRENT ADDRESS (Number and Street) CITY STATE ZIP CODE SOURCE OF TRANSPORT TO MEDICAL FACILITY NAME OR ID RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 Nd Tr—W. 2 EMS 3 Law Enforcement 77 Older, Expla,n in Narrative 88 Unknown TEMS ❑ JEMSAGENCY HSMV 90010 S 3 6 Page of _ PERSON # 4 1 Driver I VEHICLE # I NAME 2 Non -Motorist E 3 Passenaer CHRISTOPHER Reporting Agency Case Number 222292 MICHAEL IUZZOLINO CITY & STATE HSMV Crash Report Number 87073146 PHONE NUMBER Check I r -1 Recommend L 19644613550 Driver Re -exam 10704 SANTA LAGUNA DR BOCA RATON FL 33428 DATE OF BIRTH SEX: DRIVERS LICENSE NUMBER STATE EXPIRES INJURY SEVERITY (INJ) 4 Incapacitating 2 Female 2 Possible 1 Male 1 None 5 Fatal (within 30 days) 01/09/1963 88 Unknown 3 Non -Incapacitating 6 Non -Traffic Fatality DL TypeC ❑ Required Endorsements ❑ 1A2B3 4 D/Chauffeur 1 Yes 5 E/Operator 2 No 6 E/Oper-Rest 3 No Req. Endorsement 7 None Distracted By 4 Other Inside the Vehicle ❑Driver (explain in narrative) 1 Not Distracted 5 External Distraction 2 Electronic Communication the vehicle, explain Devices (cell hone, etc. P in n narrative) 3 Other Electronic Device 6 Texting (navigation device, DVD player) 7 Inattentive 88 Unknown 1st Drivers Actions at Time of Crash ❑1 No Contribution Action 2 Operated MV in Carelss or 26 Ran off Roadway 27 Disregarded other Traffic Negligent Manner Sign 3 Failed to Yield Right -of -Way 28 Disregarded Other Road 4 Improper Backing Markings 6 Improper Turn 29Over-Correcting/Over Steering 2nd 1 OF ollowed too Closely 11 Ran Red Light 30 Swerved or Avoided : Due Drove too Fast for Conditions to Wind, Slippery Surface, MV, ❑12 13 Ran Stop Sign Object, Non -Motorist in 15 Improper Passing Roadway, etc. 17 Exceeded Posted Speed 31 Operated MV in Erratic, 21 Wrong Side of Wrong Way Reckless orAgreessive Manner 25 Failed to Keep in Proper Lane 77 Other Contributing Action ❑ 1 Vision Not Obscured 5 Load on Vehicle 9 Smoke 2 Inclement Weather 6 Building/Fixed Object 10 Glare 3 Parked/Stopped Vehicle 7 Signs/Billboards 77 All Other, Explain 4 Trees/Crops/Bushes 8 Fog in Narrative Helmet Use (HU) DRIVER OR PASSENGER ❑ 1 DOT -Compliant Motorcycle Helmet Motor Vehicle Seating Position: LOCATION: A III HER 2 Other Helmet Seat Row Other (LOC)1-1 F1 3 No Helmet 1 Left 1 Not Applicable 3rd 4th i al :I3e13lc%*� McL4:I Condition At ❑ Time of Crash 1 Apparently Normal 3 Asleep or Fatigued 5 III (sick) or Fainted 6 Seizure, Epilespsy, Blackout 7 Physically Impaired 8 Emotional (depression. angry, disturbed, etc.) 9 Under the Influence of Medications/Drugs/Alcohol 77 Other, Explain in Narrative 88 Unknown Eye Protection (EP) ❑ Restraint Systems ❑ 1 Yes IRS) 2 No 3 Not Applicable 1 Not Applicable (non -motorist) 2 Middle 1 Front 2 Sleeper Section of Truck Cab I Air Bag Deployed 5 Deployed -Other 3 Right 77 Other 2 Second 3 Third 3 Other Enclosed Cargo Area g 4 Unenclosed Cargo Area Ejection (EJECT) 1 Not Ejected (knee, air belt, etc.) 1 NotA livable 1:1PP 6 in 4 Fourth 5 TrailingUnit ❑ 2 Ejected, Totally 3 Ejected, 2 Not Deployed Combination Combination narrative) 88 Unknown 77 Other Row 6 Riding on Motor Vehicle Exterior (non- Partially 3 De to ed-Front p y 7 Deployed -Curtain 88 Unknown 4 Deployed -Side 88 Deployment trailing unit) 4 Not Applicable Unknown 88 Unknown 88 Unknown 2 Other Pedestrian (wheelchan. person in a 3 building, skater, pedestrian conveyance, etc. 3 Bicyclist 4 Other Cyclist 5 Occupant of Motor Vehicle Not in Transport (parked, etc.) 6 Occupant of a Non -Motor Vehicle Transportation Device 7 Unknown Type of Non -Motorist 2 None Used - Motor Vehicle Occupant 3 Shoulder and Lap Belt Used 4 Shoulder Belt Only Used 5 Lap Belt Only Used 6 Restraint Used - Type Unknown 7 Child Restraint System - Forward Facing 8 Child Restraint System - Rear Facing 9 Booster Seat 10 Child Restraint Type Unknown 77 Other, Explain in Narrative Non -Motorist Location At Time of Crash 8 Sidewalk Action Prior to Crash 5 1 Intersection - Marked Crosswalk 2 Intersection - Unmarked Crosswalk 9 Median/Crossing Island 10 Driveway Access E 5 Walking/Cycling on Sidewalk 6 In Roadway — Other (working, 3 Intersection - Other4 Midblock - Marked Crosswalk 11 Shared -Use Path or Trail 1 Crossing Roadway playing, etc.) 4 Midblock - Marked Crosswalk 12 Non-Trafficway Area 2 Waiting to Cross Roadway 7 Adjacent to Raodway (e.g., 5 Travel Lane - Other Location 77 Other. Explain in Narrative 3 Walking/Cycling Along shoulder, median) 6 Bicycle Lane Y 88 Unknown Roadway with Traffic or 8 Going to or from School (K-12) 7 shoulder/Roadside adjacent to travel lane) ) g Working y e�a on- o o s ions rcum antes 4 Walking/Cycling Along (incident response) elspon 1st 1 1 No Improper Action 2 Dart/Dash Roadway Against Traffic (in or adjacent to travel lane) 10 None 77 Other, Explain in Narrative 88 Unknown 1 None Safety Equipment 5 Lighting 2 Helmet 3 Failure to Yield Right -of -Way 4 Failure to Obey Traffic Signs Signals, or Officer 7 Entering/Exiting Parked/Standing 10 ImproperTum/Merge 3 Protective Pads Used 6 Not Applicable 77 Other, Explain 2 5 In Roadway Improperly (standing, Vehicle 11 Improper Passing (elbows, knees, shins, etc.) in Narrative lying, working, playing) 8 Inattentive (talking, eating, etc) 12 Wrong -Way Riding or Walking 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 Al CAFIAI InRl IrA/FM-R SUSPECTED ALCOHOL TESTED: ALCOHOL TEST TYPE: ALCOHOL BAC SUSPECTED DRUG TESTED: DRUG TEST TYPE: DRUG TEST RESULT: ALCOHOL USE: Test Not 2 Test Refused Given ❑ 1 Blood �� Eplain reath ❑ TEST RESULT ❑ ❑ 1 DRUG USE: 2 ❑ Test Not Test Given ❑ I Blood 3 Urine ❑ 1 Positive ❑ 2 Yes 3 Test Given Other, Explain 2 COMPLETED 3 Test Grvened , 3 Pend hg 88 Unknown 88 Unknown, if Tested in Narrative 88 UNKNOWN 88 Unknown 88 Unknown, rf Tested Explain in Narrative 88 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 2 DELRAY BEACH FIRE RESCUE DB22014995 DELRAY BEAC H MEDICAL CENTER 77 Other, Explain in Narrative 88 Unknown ADDITIONAL PASSENGERS PERSON 11 VEHICLE #[1AME DATE OF BIRTH INJ I SEX I LOC: S I R 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 Nd Tnnapo 2 EMS 3 — Enforcement n Other. ERp— In NamaM1ve 88 Unknown ❑ PERSON "AME DATE OF BIRTH INJ I SEX I LOC: S IR 1 O EJECT J HU 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 Nol T—p— 2 EMS 3 Law Edorcement 77 Other. Explain in Narrative 88 Unknown ❑ 1 JEMS HSMV 90010 S 4 6 Page of_ Reporting Agency Case Number HSMV Crash Report Number NARRATIVE 222292 87073145 VEHICLE 1 WAS TRAVELING NORTHBOUND EN -ROUTE TO 3851 NORTH OCEAN BLVD. V1 PASSED A CYCLIST THAT WAS ALSO TRAVELING NORTHBOUND. V1 SLOWED TO MAKE A RIGHT TURN INTO THE ENTRY OF 3851 NORTH OCEAN BLVD, HOWEVER, NOT ENOUGH DISTANCE WAS ALLOWED FOR THE CYCLIST TO REDUCE SPEED. CYCLIST MADE CONTACT WITH THE LEFT REAR OF V1 CAUSING DAMAGE TO THE LEFT REAR TAIL LIGHT (PHOTOS TAKEN). CYCLIST SUSTAINED INJURIES TO SHOULDER AND HAND. ALSO SCRAPES AND ABRASIONS TO BODY INCLUDING FACIAL AREA. HELMET USED BY CYCLIST. CYCLIST TRANSPORTED TO DELRAY MEDICAL CENTER. END. ADDITIONAL PASSENGERS PERSON # VEHICLE # AM DATE OF BIRTH INJ SEX LOC: S R 0 EJECT HU EP ABD RS 2 1 [ALFRED SALSANO 11/17/1944 1 1 3 1 1 1 2 3 CURRENT ADDRESS (Number and Street) CITY STATE ZIP CODE 62 AVERY OR N CENTER MORICHES NY 11934 SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO i NO Tr dOl 2 EMS 3 Law Enloroc M ]] Ot- Fop- in N-- M U,b 1 ❑ PERSON # VEHICLE # DATE OF BIRTH INJ SEX LOC: S R 0 EJECT HU EP ABD RS 3 1 �AME MARY SALSANO 10/14/1948 1 I 2 1 2 1 1 2 3 CURRENT ADDRESS (Number and Street) CITY STATE ZIP CODE 62 AVERY DR N CTR MORICHES NY 11934 SOURCE OF TRANSPORT TO MEDICAL FACILITY AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO ❑EMS 1 Not TranapoRed 2 EMS 3 Law Enlorcement ]] Other, Explain in 1 Narrative M Unknmun ADDITIONAL V• • 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 TYPE OF DEPT. IOFC POLICE DEPARTMENT J(PD) 750 TODD SUTTON GULF STREAM POLICE DEPARTM HSMV 90010 S 5 6 Page of_ DIAGRAM REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER 222292 1 87073145 3851 N. OCEAN BLVD �i HSMV 90010 S 6 6 Page of