Loading...
HomeMy Public PortalAboutPRR 23-2930 EHRLICH & NAPARSTEK Injury Lawyers ENINJURYLAW.COM EMAIL: BRITTANY@ENINJURYLAW.COM 1330 SE FEDERAL HIGHWAY STUART, FL 34994 TELEPHONE:(772) 842-8822 (561) 687-1717 FACSIMILE: (772) 286-9893 February 24, 2023 Via Email: rbasel@gulf-stream.org Gulf Stream Police Department 100 Sea Road Gulfstream, FL 33483 Plaintiff : Christopher Iuzzolino Defendant : Fern Frank Our File No. : 990917303 Report No. : 222292 Incident Date : November 15, 2022 Dear Custodian of Records: Please be advised that this firm has been retained by Christopher Iuzzolino in regard to the injuries suffered as a result of the November 15, 2022 accident. Pursuant to Article I, Section 24 of the Florida Constitution, and Chapter 119, Florida Statutes, we are requesting a complete copy of the following documents/records/recordings related to the motor vehicle collision that occurred on November 15, 2022 at N Ocean Blvd. in Gulf Stream, FL: 1) All 911 audio recordings, CAD reports, Call logs and notes, regarding the subject motor vehicle collision; 2) Dash cam video from all law enforcement vehicles that responded to the scene; 3) Bodycam video footage from all law enforcement officers/deputies who responded to the scene. 4) Florida Traffic Crash Report. 5.) Any and all color photographs. Please maintain an entire, UNREDACTED, copy of the 911 audio tapes, all call logs, notes, CAD reports, including the names, addresses and telephone numbers of any person heard on the audio recordings and/or noted within any written file. This collision is going to result in litigation and the UNREDACTED records will be Evidence in the case. Please do not destroy, alter, delete, or otherwise fail to maintain these records. If you refuse to provide to provide this information, Chapter 119, Florida Statutes, requires you to advise us in writing and indicate the applicable exemption to the Public Records Act. Also, please state with specificity the reasons for your decision, as required by Section 119.07, Florida Statutes. If the exemption you are claiming only applies to a portion of the records, please delete that portion and provide copies of the remainder of the records. We agree to pay the actual cost of duplication as defined in Section 119.07, Florida Statutes. If the charges for the production of these documents will exceed $25.00, kindly advise us prior to producing same. If you require any additional information, please do not hesitate to contact us at any time. If you anticipate that in order to satisfy this request, “extensive use” of information technology resources or extensive clerical or supervisory assistance as defined in Section 119.07, Florida Statutes, will be required, please provide a written estimate and justification. We request these records to be available within 10 days. If you need more information in order to expedite this request, please call with any questions. Sincerely, /s/ Matthew Naparstek Matthew Naparstek, Esq. TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered via e-mail March 7, 2023 Brittany Morgan [mail to: brittany@eninjurylaw.com] Re: GS #2930 (Police Report) Please be advised that this firm has been retained by Christopher Iuzzolino in regard to the injuries suffered as a result of the November 15, 2022 accident. Pursuant to Article I, Section 24 of the Florida Constitution, and Chapter 119, Florida Statutes, we are requesting a complete copy of the following documents/records/recordings related to the motor vehicle collision that occurred on November 15, 2022 at N Ocean Blvd. in Gulf Stream, FL: 1) All 911 audio recordings, CAD reports, Call logs and notes, regarding the subject motor vehicle collision; 2) Dash cam video from all law enforcement vehicles that responded to the scene; 3) Bodycam video footage from all law enforcement officers/deputies who responded to the scene. 4) Florida Traffic Crash Report. 5.) Any and all color photographs. Please maintain an entire, UNREDACTED, copy of the 911 audio tapes, all call logs, notes, CAD reports, including the names, addresses and telephone numbers of any person heard on the audio recordings and/or noted within any written file. This collision is going to result in litigation and the UNREDACTED records will be Evidence in the case. Please do not destroy, alter, delete, or otherwise fail to maintain these records. Dear Brittany Morgan [mail to: brittany@eninjurylaw.com]: The Town of Gulf Stream has received your public records request dated February 24, 2023. You should be able to view your original request and response at the following link: PRR 23-2930 (laserfiche.com) The crash report and photos can be found at the link above. As to dash cam video and bodycam video footage, there is no such record. The City of Delray Beach serves as the Town’s Dispatch. The Town has submitted your request to the City of Delray Beach to provide these records and they have stated that 911 audio is retained for 90 days pursuant to the State of Florida Record Retention laws and is purged after 90 days. Therefore the 911 audio no longer exists. 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 ', V] SHORT FORM [ UPDATE [ ;! 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 11/15/2022 1 10:00 AM 11/15/2022 222292 187073145 CRASH IDENTIFIERS COUNTY CODE COUNTY OF CRASH PLACE OR CITY OF CRASH 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 �V I 2 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 -80.052931 AT FEET MILES N S E ; © ATIFROM INTERSECTION WITH STREET, ROAD,HIGHWAY OR FROM MILEPOST# 59 ' SEA RD ' Road System Identifier 7 Forest Road Type of Shoulder Type pe of Intersection 5 Traffic Circle 8 Private Roadway 1 Not at Intersection 6 Roundabout ❑1 Interstate 4 County 9 Parking Lot 3 2 U.S. 5 Local Other, 1 Paved ❑ 2 Unpaved 2 1 2 Four -Way Intersection y 3 T-Intersection 7 Five -Point, or More 77 Other, Ex lain in Narrative P 77 Explain in 3 State 5 Tumpike/TolI 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 Dark -Not Lighted 6 Dark- Unknown 4 Flog, Smog, Smoke 5 Sleet/Hail/ 1 Freezing Rain 5 Oil 6 Mud, Dirt, Gravel 7 Sand 1 No 4 Sideswipe, same direction 5 Sideswipe, Opposite Direction 3 Dawn Lighting 6 Blowing Sand, Soil 1 8 Water 2 Yes, School Bus 1 Directly Involved 6 Rear to Side 4 Dark -Lighted 77 Other, Explain in Narrative Dirt 1 Clear (standinglmoving) 3 Yes, School Bus 1 Front to 7 Rear to Rear Rear 88 Unknown Severe Crosswinds 2 Cloudy y 1 Dry 77 Other, Explain in Indirectly Involved 77 Other, Explain in Narrative 2 front to Front 77 Other, Explain in 3 Rain 2 Wet Narrative 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 Impact Attenuator/Crash 30 Concrete 2 Fire/Explosion 11 Pedalcycle Cusion 31 Other Traffic Barrier Location 1 On Roadway 3 Immersion 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 5 Cargo/Equipment 13 Animal 22 Bridge Rail 34 Traffic Sign Support 3 Shoulder 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 Vehice 25 Ditch Support 8 In Parking Lane or 1 No 7 Thrown or Falling 16 Work Zone/Maintainance 26 Embankment 37 Fence Zone 1❑ 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 Oblect First Harmful Event Relation to Contributing Circumstances: Road g Wom, Travel -Polished Surfac.F Contributing Circumstances: Environment Junction 5 Railway Grade Crossing 14 Entrance/Exit Ramp 1 icy, snow, slush, etc.) ❑ ❑ ❑ 10 Road Surface Condition (wet, 11 Obstruction in Roadway Ill ❑ El1 1 Non -Junction 15 Crossover - Related 12 Debris 1 None 16 Shared -Use of Path or Trail 13 Traffic Control Device 1 None 5 Animal(s) in Roadway 2 Intersection 17 Acceleration/Dceleration Lane 4 Work Zone (construction/ Inoperative, Missing or p g Obscured 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 il blaming Sign 2Advance Warning Area 3 Transition Area 2 Lane ShiflCrossover 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 gg 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 Reporting Agency Case Number HSMV Crash Report Number 222292 1 87073145 1 Vehicle in Transport VEHICLE LICENSE NUMBER STATE REGISTRATION EXPIRES Check rf Permanent VIN 2 Parked Motor Vehicle 3 Working Vehicle 1 Z581TA FL 06/12/2024 Registration L 19XFB2F50EE228808 Hit and Run 1 No YEAR MAKE MODEL STYLE COLOR DAMAGE: 1 Disabling 4 Minor 4 EST. AMOUNT 2 Yes 2014 HOND C1v1C 4 DOOR SEDAN SILVER - SIL 2 Functional 88 Unknown 88 Unknown 3 None INSURANCE COMPANY (DRIVER) INSURANCE POLICY NUMBER Towed due to Damage: VEHICLE REMOVED BY 1. Rotation 2. Owner Request GEICO GENERAL INSURANCE 0693219602 1 No 2 Yes DRIVER 3. Driver 4. Other, Explain in Narrative NAME OF VEHICLE OWNER (CHECK IF BUSINESS) CURRENT ADDRESS CITY & STATE ZIP FERN H FRANK 3851 N OCEAN BLVD UNIT 2110 GULFSTREAM FL 33483 Trailer LICENSE NUMBER STATE REGISTRATION EXPIRES Check I Permanent VIN YEAR MAKE LENGTH AXLES One: Registration D Trailer LICENSE NUMBER STATE REGISTRATION EXPIRES Check I Permanent VIN YEAR MAKE LENGTH AXLES Two: Registration r� VEHICLE N S E W Off -Road Unknown ON STREET, ROAD, HIGHWAY AT EST. SPEED POSTED SPEED TOTAL LANES TRAVELING -- Ell D � NORTH OCEAN BLVD 5 35 2 L 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 2 5 6 3 4 5 6 7 18 Undercarriage 18 2 7 88 Unknown 88 Unknown 1 15 19 Overturn 19 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 12 1110 13 12 1110 MOTOR CARRIER ADDRESS CITY 777F 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 2 Two -Way, Not Divided, with a GVWR kg), Cannot Classify (4,536 kg) or less) Continuous Left TurnLane 2 Single -Unit Truck (2-axle and more than 10,000 Ibs 4,536 k ( 9)) 10 Bus/Large van (seats for 9-15 1 Passenger Car 18 Motor Coach 9 3 Two -Way, Divided, Unprotected y 3 Single -Unit Truck (3 or more axles) occupants, including driver) 2 Passenger Van 19 Other Light Trucks (10,000lbs (painted >4 feet) Median 4 Truck Pulling Trailer(s) 3 Pickup (4,536 kg) or less) 4 Two -Way, Divided, Positive 11 Bus (seats for more than 15 5 Truck Tractor (bobtail) 7 Motor Home 20 Medium/Heavy Trucks (more Median Barrier occupants, including driver) 8 Bus than 10,000 Ibs (4,536 kg)) 5 One -Way Trafficway 6 Truck Tractor/Semi-Trailer 77 Other, Explain in Narrative 7 Truck Tractor/Double Truck 11 Motorcycle 21 Farm Labor Vehicle 88 Unknown g8 Unknown Trailer T e 12 Moped 77 Other, Explain in Narrative P 13 All Terrain Vehicle (ATV) 88 Unknown 1 Single emi Trailer 8 Pole Trailer Cargo Body Type Comm/Non-Commercial 2 Tandem Semi Trailer TRAILER 1 TRAILER 2 3 Tank Trailer 9 Towed Vehicle 10 Auto Transport 13 odal 1 Interstate Carrier 4 Hopper 14 Vehicle Towing ❑ ❑ 4 Saddle MountfTrailer 77 Other, Explain in ❑ 3 Van/Enclosed Box Conttaineame r CChhassis 5 Boat Trailer Narrative 2 Intrastate Carrier 5Pnle-Trailer Another Vehicle 6 Utility Trailer 88 Unknown7 3 Not in Commerce/Government 4 Not in Commerce/Other Truck House Trailer 1 No Cargo 6 Cargo Tank 15 Not Applicable 7 Flatbed (vehicle 10,000lbs Most Harmful Event Non -Collision 2 Bus Comm 1 10,000 Ibs (4,536 kg) or less 8 Dump (4,536 kg) or less not 4 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 1 4 29 Cable Barrier Emergency 19 Impact Attenuator/Crash Cushion 6 Fell/Jumped From Motor Vehicle 11 Pedalcycle 7 Thrown or Falling Object 12 Railway Vehicle (train, engine) 30 Concrete Traffic Barrier Vehicle Use 20 Bridge Overhead Structure 31 Other Traffic Barrier Sequence of Events 8 Ran into Water/Canal 13 Animal 21 Bridge Pier or Support 32 Tree (standing) 9 Other Non -Collision 14 Motor Vehicle in Transport 22 Bridge Rail 1 33 Utility Pole/Light Support ❑ 1 st 2nd 15 Parked Motor Vehicle 23 Culvert 34 Traffic Sign Support 14 ❑ [40.46 Sequence of Events 40 equipment Failure (blown only] 16 Work Zone/Maintenance tire, Equipment 24 Curb 35 Traffic Signal Support 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 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 45 Cross Centerline Roadway Grade 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 ❑ 3 Uphill 1 5 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 8 Parked 77 Other, Explain in Narrative 10 Person (including Device 4 Lights (head, Windshield 1 2 Curve Right 5 Sag (bottom) ght 10 Making U-Tum 88 Unknown Flagman, Offcer, 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 77 Other, Explain in 6 Stop Sign Narrative 7 Wipers Trailer Hitch/ 2 Farm Vehicle 10 Fire Truck 15 hour Bus 7 Yield Sign 9 Exhaust System Safety Chains ❑ 1 of Motor Vehicle 3 Police Shuttle 11 Farm Labor Transport 16 Shuttleuttle Bus 88 Unknown 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 VIOLAI IONS 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 Reporting Agency Case Number HSMV Crash Report Number 222292 87073145 1 Driver VEHICLE # NAME PHONE NUMBER Check f 1 r—I 2 Non-Motonst 1 ❑ 1 1 Recommend 1 3 Passenger FERN H FRANK (347) 466-2037 Driver Re -exam CURRENT ADDRESS (Number and Street) CITY & 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)El 06/12/1956 2 Female 88 unknown F652248567120 FL 06/12/2026 2 Possible 6 Non -Traffic Fatality 3 Non -Incapacitating DRIVER DL Type Required Endorsements 1st Drivers Actions at Time of Crash 3rd Condition At ❑ 1 A 2 B 3 C 1 No Contribution Action 26 Ran off Roadway Time of i Crash F-5 1 F 2 No 77 Negligent Manner Carelss or 27 Disregarded other Traffic El 5 ED/Operator 1 Apparently Normal 6 E/Oper-Rest 3 No Req. Endorsement 3 Failed to Yield Right -of -Way 28 Disregarded Other Road 3 Asleep 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 (explain in narrative) 10 Followed too Closely 7 Physically Impaired 2nd 1 Not Distracted 5 External Distraction 11 Ran Red Light 8 Emotional (depression, 1 9 30 Swerved or Avoided : Due 2 Electronic Communication outside the vehicle, explain El 12 Drove too Fast for Conditions 4th angry, disturbed, etc.) ( P to Wind, Slippery Surface, MV, 9 Under the Influence Devices (cell phone, etc. in narrative 13 Ran StopSin of ) g Object, Non -Motorist in 3 Other Electronic Device r Medications/Dru s/Alcohol 6 Texting 15 Improper Passing Roadway, etc. 9 (navigation device, DVD 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 (RS) SEAT ROW OTHER Motorcycle Helmet 2 No Motor Vehicle Seating Position: LOCATION: 2 Other Helmet 3 Not Applicable 1 Not Applicable (non -motorist) Seat Row Other (LOC) 1 1 3 No Helmet 2 None Used - Motor Vehice Occupant 3 Shoulder and Lap Belt Used 1 Left 1 Not Applicable 4 Shoulder Belt Only Used 1 Front Air Bag Deployed g P y 2 Middle2 Sleeper Section of Truck Cab 5 Deployed -Other 5 Lap Belt Only Used 2 Second 3 JectionE ( Right 9 3 Other Enclosed Cargo Area EJECT) (knee, air belt, etc.) 6 Restraint Used -Type Unknown 77 Other 3 Third 1 Not Ejected ❑ 1 NotA licable 7 Child Restraint System - Forward Facing 4 Unenclosed Cargo Area 2 6 Combination in 4 Fourth 2 Ejected, Totally 2 Not Deployed ed 8 Child Restraint System -Rear Facing e 5 Trailing Unit 1 P Y Combination ❑ narrative) 77 Other Row 3 Ejected, 3 Deployed -Front 7Depioyed-Curtain 9 Booster Seat Partially 10 Child Restraint Type Unknown 88 Unknown 88 Unknown 6 Riding on Motor Vehicle Exterior (non- Party 4 Deployed -Side 88 Deployment YP trailing unit) 4 Not Applicable Unknown 77 Other, Explain in Narrative 88 Unknown 88 Unknown N n-Motorist Description 1 Pedestrian ❑ Non -Motorist Location At Time of Crash 8 Sidewalk Action Prior to Crash 1 Intersection - Marked Crosswalk 5 Walkin /C clin on Sidewalk y 9 ❑ 2 Other Pedestrian (wheelchan, person in a 9 Median/Crossing Island d 2 Intersection -Unmarked Crosswalk 6 In Roadway --Other (working, building, skater, pedestrian conveyance, etc. 10 Drivewa Access y 3 Intersection - Other4 Midblock -Marked Crosswalk 11 Shared -Use Path or Trail playing, etc.) 1 Crossing Roadway 3 Bicyclist 4 Other Cyclist 4 Midblock -Marked Crosswalk 7 Adjacent to Raodway (e.g., 12 Non-Trafficway Area 2 Waiting to Cross Roadway 5 Occupant of Motor Vehicle Not in Transport 5 Travel Lane - Other Location shoulder, median) 77 Other, Explain in Narrative 3 Walking/Cycling Along 6 Bicycle Lane 8 Going to from School (K-12) (parked, etc.) 6 Occupant of a Non -Motor Vehicle Roadway with 88 Unknown Y ( in 7 shoulder/Roadside Roadwa with Traffic in or y Working in Traificway adjacent to travel lane) Transportation Device (incident response) on- o ons ion rcums noes 4 Walking/Cycling Along 10 None 7 Unknown Type of Non-Motonst Ftsc ❑ 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 Entering/Exiting Parked/Standing 10 Improper Tum/Merge z^a Vehicle 11 Improper Passing 77 Other, Explain (elbows, knees, shins, etc.) in Narrative 5 In Roadway Improperly (standing, lying, working, playing) B 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 ALCOHOL/DRUG/EMS SUSPECTED ALCOHOL TESTED: ALCOHOL TEST TYPE: LCOHOL BAC SUSPECTED DRUG TESTED: DRUG TEST TYPE: DRUG TEST RESULT: ALCOHOL USE: st Not 2 Test Refused Given ❑ 1 Blood Breath �� E EST RESULT F-1 ID 1 DRUG USE: 2 ❑ Test Not Given Test lood 7 BOther, ❑ 1 Positive ❑ 2 Yes 3 Test Given Other,2Explain 2 COMPLETED 3 Test G vened 3 Pending 88 Unknown 88 Unknown, if Tested in Narrative 88 UNKNOWN 88 Unknown 88 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 11 VEHICLE # [AME DATE OF BIRTH I INJ SEX LOC: S R 0 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 EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 NW Tran_p 2 EMS S law Enimrement 77 04-. E.- ❑ PERSON # VEHICLE # [AME DATE OF BIRTH INJ SEX LOC: S R O EJECT HU EP ABD RS 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 NW Transported 2 EMs 3 Lew Ent--nl 77 O .,. E.galn in Nanatrve ll8 Unknown ❑EMS HSMV 90010 S 3 6 Page of _ PERSON # 4 1 Driver VEHICLES NAME 2 Non -Motorist El I 3 Passenger CMRISTOPNER CURRENT ADDRESS (Number and Street) 10704 SANTA LAGUNA OR DATE OF BIRTH SEX: DRIVERS 1 Male � ❑ 2 Female 01/09/1963 66 Unknown DL Type Required Endorsements ❑ 1A283C ❑ 4 D/Chauffeur 5 E/Operator 6 E/Oper-Rest 1 Yes 2 No 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 outside the vehicle, explain Devices ( phone, hone, etc. i n narrative) 3 Other Electronic Device 6 Taxiing (navigation device, DVD player) 7 Inattentive 88 Unknown DRIVER T vision Not UDscurec 5 Load on Vehicle 9 Smoke 21 cl W th Reporting Agency Case Number HSMV Crash Report Number 222292 87073145 PHONE NUMBER Check if rrII Recommend u MICHAEL IUZZOLINO 9544613660 Driver Re -exam CITY & STATE ZIP CODE BOCA RATON FL 1 33428 NUMBER STATE EXPIRES INJURY SEVERITY (INJ) 4Incapacitating 1 None 2 Possible 5 Fatal (within 30 days) 3 Non -Incapacitating 6 Non -Traffic Fatality 1st Drivers Actions at Time of Crash 3rd ❑2 1 No Contribution Action 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 29 Over-Correctmg/Over Steering 2nd 0 Followed too Closely 111 Ran Red Light 30 Swerved or Avoided: Due 4th 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 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 ❑ Inement ea er 6 Building/Fixed Object 10 Glare 3 Parked/Stopped Vehicle 7 Signs/Billboards 77 All Other, Explain DRIVER OR PASSENGER 4 Trees/Crops/Bushes 8 Fog in Narrative Helmet Use (HU) Eye Protection (EP) Restraint Systems DRIVER OR PASSENGER 1 DOT -Compliant 1 Yes ❑ (RS) SEAT ROW OTHER Motorcycle ❑ Helmet ❑ 2 No Motor Vehicle Seating Position: LOCATION: 2 Other Helmet 3 Not Applicable 1 Not Applicable (non -motorist) Seat Row Offer (LOC) 3 No Helmet 2 None Used - Motor Vehicle Occupant 3 Shoulder and Lap Belt Used 1 Left 1 Not Applicable 1 Front Air Bag Deployed 4 Shoulder Belt Only Used 2 Midde 2 Sleeper Section of Truck Cab 2 Second 5 Deployed -Other 5 Lap Belt Only Used 3 Right 9 3 Other Enclosed Cargo Area 77 Other 3 Third 4 Unenclosed Cargo Area E action E 1 (JECT) 1 Not Ejected (knee, air belt, etc.) 1:11 Not Applicable 6 Deployed- 6 Restraint Used - Type Unknown 7 Child Restraint System - Forward Facing (explain in 4 Fourth 5 Trailing Unit ❑ 2 Ejected, Totally 2 Not Deployed Combination 8 Child Restraint System - Rear Facing narrative 77 Other Row 88 Unknown 88 Unknown 6 Riding on Motor Vehicle Exterior (non- 3 Ejected, 1 Partially 3 Deployed -Front 7 Deployed -Curtain 4 Deployed -Side 88 Deployment 9 Booster Seat 10 Child Restraint Type Unknown trailing unit) 4 Not Applicable Unknown 77 Other, Explain in Narrative 88 Unknown 88 Unknown NON N n-Motorist Description 1 Other tnan 2 Other Pedestrian (wheelchari, in a Non -Motorist Location At Time of Crash 1 Intersection - Marked Crosswalk 8 Sidewalk 9 g Island Action Prior to Crash 5 Walking/Cycling on Sidewalk i Q person 3 building, skater, pedestrian conveyance, etc ❑ 2 Intersection -Unmarked Crosswalk 5 3 Intersection - Other4 Midblock -Marked Crosswalk ❑ 10 Drivewa Access Driveway Access Y 6 In Roadway —Other (working, playing, etc.) 3 Bicyclist 11 Shared -Use Path or Trail 1 Crossing Roadway 9 Y 7 Adjacent to Raodway 4 Other Cyclist 4 Midblock -Marked Crosswalk 12 Non-Trafficwa Area Y (e.g.. 2 Waiting to Cross Roadway 5 Occupant of Motor Vehicle Not in Transport 5 Travel Lane -Other Location 6 Bicycle Lane 77 Other, Explain in Narrative shoulder, median) 3 Walking/Cycling Along 8 Going to or from School (K-12) (parked, etc.) 6 Occupant of a Non -Motor Vehicle 7 shoulder/Roadside 88 Unknown Roadway Roadwa with Traffic in or with y ( 9 Working in Trafficway adjacent to travel lane) Transportation Device 7 Unknown Type of Non -Motorist on- o o s on rcums nces ❑ 1 No Improper Action tst 1 (incident response) 4 Walking/Cycling Along 10 None Roadway Against Traffic (in 77 Other, Explain in Narrative lane) 2 Dart/Dash or adjacent to travel Unknown 3 Failure to Yield Right-of-Way88 1 None Safety Equipment 5 Lighting 2 Helmet 4 Failure to Obey Traffic Signs Signals, or Officer 7 Entering/Exiting Parked/Standing 10 Improper Tum/Merge 6 Not Applicable 3 Protective Pads Used 77 Other, Explain 2MI I 51n Roadway Improperiy (standing, Vehicle 11 Improper Passing (elbows, knees, shins, etc.) in Narrative 4 Reflective Clothing (jacket, ❑ u lying, working, playing) 6 Disabled Vehicle Related 8 Inattentive (talking, eating, etc) 12 Wrong -Way Riding or Walking 9 Not Visible (dark clothing, no 77 Other, Explain in Narrative 88 Unknown backpack, etc.) (working on, pushing, leaving/approaching) lighting, etc.) 88 Unknown ALCOHOL/DRUG/EMS SUSPECTED ALCOHOL TESTED: ALCOHOL TEST TYPE: ALCOHOL BAC SUSPECTED DRUG TESTED: DRUG TEST TYPE: DRUG TEST RESULT: ALCOHOL Test Not 2 Test Refused Given ❑ ood 2 Breath IOrittheer,, ❑ EST RESULT. ID I PENDING G USE: 1 2 P Test Not RefusedNo Test Given ❑ ood 3 UlOther, nne❑ 1 Positive sUSE: 2 Yes 3 Test Given 77 Explain 2 COMPLETED Yes 3 Test Given 3 Pending ❑ 88 Unknown 88 Unknown, if Tested in Narrative 88 UNKNOWN 88 Unknown 88 Unknown, f Tested Explain in Narrative 68 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 Z DELRAY BEACH FIRE RESCUE DELRAY BEAC H MEDICAL CENTER 77 Other, Explain in Narrative 88 Unknown DB22014995 ADDITIONAL PASSENGERS PERSON # VEHICLE # [AME DATE OF BIRTH I INJ SEX LOC: S 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 EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 NU Tw"ro M 2 EMS 3 Law Enlapmon! 77 ONa. Eq l m NarraNe E& Unlacwn ❑ PERSON ]VEHICLE # AME DATE OF BIRTH INJ SEX I LOC: S I R O 1 EJECT I HU EP ABD RS 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 Tran -( 2 EMS 3 — ErrtacemeM 77 O ,, E*Wa m NarraEve. Unmpwn 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 # DATE OF BIRTH INJ SEX LOC: S R O EJECT HU EP ABD RS IVEHICLEl 2 1 [ALME FRED SALSANO 11/17/1944 1 1 3 1 1 1 2 3 CURRENT ADDRESS (Number and Street) CITY STATE ZIP CODE 62 AVERY DR N CENTER MORICHES NY 11934 SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 W Ttarrelwfle0 2 EMS 3 Lew EnlwcemeM )l Othw, E,Idain In Narrative BB Unknown 1 ❑ PERSON # VEHICLE # AME DATE OF BIRTH INJ SEX LOC: S R 0 EJECT HU EP ABD RS 3 1 MARY SALSANO 10/14/1948 1 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 1 NIX TransWo 2 EMS 3 Law Enforcement ]] —h Eep— In 1 ❑ JEMS NanatWe 88 Unk— 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 TYPE OF DEPT. POLICE DEPARTMENT 750 OFC TODD SUTTON GULF STREAM POLICE DEPARTM (PD) HSMV 90010 S 5 6 Page of _ DIAGRAM REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER 222292 1 87073145 HSMV 90010 S 6 6 Page of 3851 N. OCEAN BLVD -Afi CL 41U� Ln I