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HomeMy Public PortalAboutPRR 23-2934TOWN OF GULF STREAM PALM BEACH COUNTY, FLORIDA Delivered via e-mail April 4, 2023 Dan Dorsheimer [mail to: ddorsheimer@aol.com] Re: GS #2934 (Request for Crash Report 23-0495) A verbal request for a Crash report that happened between Mr. Dorsheimer and a landscaping truck. Dear Dan Dorsheimer [mail to: ddorsheimer@aol.com]: The Town of Gulf Stream has received your verbal records request dated April 4, 2023. You should be able to view your original request and response at the following link, as of May 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 23-2934 (laserfiche.com) The police crash report you requested is attached to this e-mail. We consider this request closed. Sincerely, Reneé Basel, CMC Reneé Basel, CMC Town Clerk, Custodian of the Records WAS DOT PROPERTY INVOLVED IN THIS CRASH? FLORIDA TRAFFIC CRASH REPORT LONG FORM ❑ SHORT FORM UPDATE TOTAL # OF VEHICLE SECTION(S) 2 (Shaded Areas) MAIL TO: DEPARTMENT OF HIGHWAY SAFETY &MOTOR VEHICLES TOTAL # OF PERSON SECTION(S) 2 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 03/17/2023 12:50 PM 03/17/2023 230495 57073148 CRASH IDENTIFIERS COUNTY CODE CITY CODE COUNTY OF CRASH PLACE OR CITY OF CRASH CHECKIFWITHIN ITIME REPORTED TIME DISPATCHED 06 44 PALM BEACH GULF STREAM CITY LIMITS 12:50 PM 12:50 PM TIME ON SCENE ]ME CLEARED SCENE CHECK IF REASON (If Investigation NOT Complete) Notified By: 1 Motorist 12:50 PM 1:41 PM COMPLETED 2 Law Enforcement ROADWAY INFORMATION (CHOOSE ONLY 1 OF 4 OPTIONS) CRASH OCCURRED ON STREET, ROAD, HIGHWAY AT STREET ADDRESS # © AT LATITUDE AND LONGITUDE ORCHID LN 26.490571 -80.060159 AT FF FEET MILES N S E W © AT/FROM INTERSECTION WITH STREET, ROAD,HIGHWAY FROM MILEPOST # 67 V AVENUE AU SOLEIL .OR Road System Identifier 7 Forest Road Type of Shoulder Type of Intersection 5 Traffic Circle 5 1 Interstate 4 County 8 Private Roadway 2 U.S. 5 Local 9 Parking Lot 1 paved 2 2 Unpaved ]] 1 Not at Intersection 2 Four -Way Intersection 3 T-Intersection 6 Roundabout 7 Five -Point, or More 77 Other, Explain in 3 State 6 TumpikefToll 3 Curb 77 Other, Explain in Narrative Narrative 4 Y-Intersection CRASH INFORMATION (CHECK IF PI TURES TAKEN) 'd Light Condition Weather Condition Roadway Surface Condition School Bus Related Manner of Collision/Impact 1 Daylight 1 2 Dusk 5 Dark -Not Lighted lighting nknown 1 ❑ 4 Fog, Smog, Smoke 5 Sleet/Hail/ 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 4 Dark -Lighted Lighting Other, Explain in 6 Blowing Sand, Soil 8 Water Directl y Involved 6 Rear to Side Narrative Na rat ve 88 Unknown 1 Clear 2 Cloudy Dirt 7 Severe Crosswinds (standing/moving) 1 Dry 77 Other, Explain in 3 Yes, School Bus Indirectly Involved 1 Front 2 Front 7 Rear to Rear to Rear 77 Other, Explain In Narrative 3 Rain 77 Other, Explain in 2 Wet Narrative to Front 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 15 ❑ 2 Fire/Explosion 3 Immersion 11 Pedalcycle Cusion 31 Other Traffic Barrier 12 Railway vehicle (train, 20 Bridge Overhead Structure 32 Tree (standing) Location 1 On Roadway 2 Off Roadway 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 within Interchange 6 Fell/Jumped From Motor Vehicle Transport 24 Curb 36 Other Post, Pole or 15 Parked Motor Vehicle 25 Ditch Support 7 Separator 1 No 7 Thrown or Falling 16 Work Zone/Maintainance 26 Embankment 37 Fence 81n Parking Lane or Zone 2 Yes Object 8 Ran into Water/Canal Equipment 27 Guardrail Face 38 Mailbox 17 Struck By Falling, Shifting 28 Guardrail End 39 Other Fixed Object (wall, 9 Outside Right-of-way1 10 Roadside 88 Unknown 9 Other Collision Cargo 29 Cable Barrier building, tunnel, etc.) 88 Unknown 18 Other Non -Fixed Ob�ect First Harmful Event Relation to Contributing Circumstances: Road g Wom, Travel -Polished Surface Contributing Circumstances: Environment 1 Junction s 5 Railway Grade Crossing Condition (wet, i icy, snow, slush, etc.) ❑ ❑ ❑ 10 Road Surface etc.) 14 Entrance/Exit Ram 11 Obstruction in Roadway❑ 11 ❑ 1 Non -Junction 15 Crossover - Related 12 Debris 1 None 2 Intersection 16 Shared -Use of Path or Trail 17 Acceleration/Deceleration 13 Traffic Control Device 4 Work Zone construction/ ( Inoperative, Missing or Obscured 1 None 5 Animal s ( ) in Roadway 3 intersection -Related Lane maintenance/utility 14 Non -Highway Work 2 Weather Conditions 77 Other, Ex lain in P 4 Driveway/Alley Access 18 Through Roadway 6 Shoulders (none, low, soft, high) 77 Other, Explain in Narrative 3 Physical Obstruction(s) Narrative Related 77 Other, Explain in Narrative 7 Rut, Holes, Bumps 88 Unknown 4 Glare 88 Unknown Work Zone Related Crash in Work Zone Type of Work Zone Workers in Work Zone 1 Before the First Work Zone Warning Sign 1 Lane Closure 1 No 2 Yes 2 Advance Waming Area ❑ 3 Transition Area 4 Activity 2 Lane Shift/Crossover ❑ 3 Work on Shoulder or Median 4 Intermittent or Moving Work 1 No ❑ 2 Yes 88 Unknown Area 77 Other, Unknown wrruececc 5 Termination Area Explain in Narrative88 NAME ADDRESS CITY & STATE ZIP CODE ELJZARDO VINCENTE 17322NDAVE#9 LAKEWORTH BEACH FL 33434 NAME ADDRESS CITY & STATE ZIP CODE NAME ADDRESS CITY & STATE ZIP CODE NON VEHICLE PROPERTY DAMAGE VEH. # PER # PROPERTY DAMAGE -OTHER THAN VEH. EST. AMT. OWNER'S NAME (CHECK IF BUSINESS) ADDRESS CITY & STATE ZIP CODE VEH. # PER # PROPERTY DAMAGE -OTHER THAN VEH. EST. AMT. OWNER'S NAME (CHECK IF BUSINESS) ADDRESS CITY & STATE ZIP CODE HSMV 90010 S 1 6 Page of VEHICLE # 1 Check if Commercial Reporting Agency Case Number ❑ HSMVCrash Report Number 230495 87073149 1 Vehicle in Transport VEHICLE LICENSE NUMBER STATE REGISTRATION EXPIRES VIN 2 Parked Motor Vehicle 3 Working Vehicle 2 2 Y33KNF FL 06/30/2023 Check if Permanent Registration ❑ SNHUNS628HU114174 Hit and Run 1 No 2 Yes 1 YEAR MAKE MODEL STYLE COLOR DAMAGE: 1 Disabling 4 Minor 1 EST. AMOUNT 88 Unknown 2017 FVCG SUNSHINE TL BLUE - BLU 2 Functional 88 Unknown 3 3 None $0.00 INSURANCE COMPANY (DRIVER) AUTO -OWNERS INSURANCE COMPANY INSURANCE POLICY NUMBER 5ya5o9os-0o Towed due to Damage: 11No 1 VEHICLE REMOVED BY 1. Rotation 2. Owner Request 3 2 Yes GUILLERMO LABOY 3. Driver 4. Other, Explain in Narrative NAME OF VEHICLE OWNER (CHECK IF BUSINESS) VIMM1I V ry V �rY 1 CURRENT ADDRESS CITY & STATE ZIP LAWNSCAPES BY 3591 LONE PINE RD DELRAY BEACH FL 33445 Trailer LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent VIN YEAR MAKE LENGTH AXLES one' Y33KNF FL 06/30/2023 Registration ❑ 5NHUNS628HU114174 2017 FVCG 14 2 Trailer LICENSE NUMBER T STATE REGISTRATION EXPIRES Check if Permanent VIN YEAR MAKE LENGTH AXLES . Vehicle Body Type 15 Low Speed Vehicle 16 (Sport) Utility Vehicle Traff]cway 1 Two -Way, Not Divided 1 y Commercial Motor Vehicle Configuration 1 Vehicle 10,000lbs or less Placarded 8 Tractor/Triple 77 17 Cargo Van (10,000 Ibs (4,536 kg) or less) 2 Two -Way, Not Divided, with a Continuous Left Turn Lane for Hazardous Materials 9 Truck more than 10,000 Ibs (4,536 ❑ 2 Single -Unit Truck (2-axle and GVWR kg), Cannot Classify 1 Passenger Car 18 Motor Coach 3 Two -Way, Divided, Unprotected more than 10,000 Ibs (4,536 kg)) 10 Bus/Large van (seats for 9-15 2 Passenger Van 19 Other Light Trucks (10,000 Ibs (painted >4 feet) Median 3 Single -Unit Truck (3 or more axles) occupants, including driver) 3 Pickup (4,536 kg) or less) 4 Two -Way, Divided, Positive 4 Truck Pulling Trailer(s) 11 Bus (seats for more than 15 7 Motor Home 20 Medium/Heavy Trucks (more Median Barrier 5 Truck Tractor (bobtail) occupants, including driver) 8 Bus than 10,000 Ibs4,536 k ( 9)) 5 One -Way Trafficway 6 Truck Tractor/Semi-Trailer 77 Other, Explain in Narrativea 11 Motorcycle 21 Farm Labor Vehicle 88 Unknown 7 Truck Tractor/DoublTruck 88 Unknown 12 Moped 77 Other, Explain in Narrative Trailer Type 13 All Terrain Vehicle (ATV) 88 Unknown 1 Single Semi Trailer 8 Pole Trailer Comm/Non Commercial TRAILER 1 TRAILER 2 2 Tandem Semi Trailer 9 Towed Vehicle 3 Tank Cargo Body Type 13 Intermodal 2 ate Carrier ❑ 1 Interstate Carrier 6 ❑ Trailer 4 Saddle Mount/rrailer 5 Boat Trailer 10 Auto Transport 77 Other, Explain in Narrative 3 Van/Enclosed Box Container Chassis 4 Hopper 14 Vehicle Towing ❑ 3 Not n Notntrin Commerce/Government 6 Utility Trailer 88 Unknown 5 Pole -Trailer Another Vehicle 4 Not in Commerce/Other Truck 7 House Trailer 6 Cargo Tank 15 Not 1 No Cargo g Applicable 2 Bus 7 Flatbed (vehicle 10,000 Ibs Most Harmful Event Non -Collision 1 10,000 Ibs (4,536 kg) or less 8 Dump P (4,536 kg) or less not 1 Overtum/Rollover GVWR/GCWR 4 2 10,001-26,000lbs (4,536-11,793kg) 9 Concrete Mixer displaying HM placard 2 Fire/Explosion 3 More than 26,000lbs (11,793kg) 10 Auto Transport 77 Other, Explain in 3 Immersion 4 Not Applicable 11 Garbage/Refuse Narrative 15 4 Jackkn'rfe 5 Cargo/Equipment Loss or Shift Collision with Non -Fixed Object 10 Pedestrian Collision Fixed Object 12 Log 88 Unknown 29 Cable Bander Emergency 6 Fell/Jumped From Motor Vehicle 11 Pedalcycle 19 Impact Attenuator/Crash Cushion 7 Thrown or Falling Object 12 Railwa Vehicle train, en ine y ( engine) 20 Bridge Overhead Structure 30 Concrete Traffic Barrier 31 Other Traffic Barrier Vehicle Use 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 23 Culvert 33 Utility Pole/Light Support 1 ❑ 1st 15 2nd ❑ I40 46 Sequence of Events only] 15 Parked Motor Vehicle 16 Work Zone/Maintenance 34 Traffic Sign Support 24 Curb 35 Traffic Signal Support 40 equipment Failure (blown 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 3rd 4th 41 Separation of Units Anything Set in Motion by Motor 27 Guardrail Face 38 Mailbox 88 Unknown ❑ ❑ 42 Ran Off Roadway, Right y 9 43 Ran Off Roadway, Left Vehicle 18 Other Non -Fixed Object 28 Guardrail End 39 Other Fixed Object (wall, building, I nnel, etc. 44 Cross Median Vehicle Maneuver Action Traffic Control Device For Vehicle Defects 45 Cross Centerline 1 Straight Ahead 13 Stopped in Traffic Roadway Grade 1 Level 46 Downhill Runaway 3 Turning Left 14 Slowing 4 Backing 15 Negotiating a Curve This Vehicle 8 Flashing Signal 1 ❑ ❑ 2 Hillcrest Roadway Alignment 5 Turning Right 16 Leaving Traffic Lane 9 Railway Crossing 1 None 1 3 Uphill P 6 Changing Lanes 17 Entering Traffic Lane 1 No Controls 2 Brakes 13 Wheels 4 Downhill 1 Straight 4 School Zone Sign/ Device 3 Tires 1 ❑ 8 Parked 77 Other, Explain in Narative 10 Person (including 14 Windows/ 5 Sag (bottom) 2 Curve Right 10 Makin U-Turn 88 Unknown 9 Device Flagman, Officer, 4 Lights (head, Windshield 3 Curve Left 11 Overtaking/Passing5 Traffic Control Guard, etc.) signal, tail) 15 Mirrors Special Function 1 No Special Function 9 Ambulance 14 IntercityBus Signal 9 6 Stop Sin 77 Other, Explain in P g 6 Steering 16 Truck Coupling 7 Wipers Trailer Hitch/ 1 of Motor Vehicle 2 Farm Vehicle 10 Fire Truck 15 Bus Narrative 7 Yield Sign 88 Unknown 9 Exhaust System Safety Chains 3 Police 11 Farm Labor Transport 16 Shuttle Bus Shuttle 10 Body, Doors 77 Other, Explain in 7 Taxi 8 Military 12 School Bus 17 Farm Labor Bus 13 Transit/Commuter Bus 88 Unknown 11 Power Train Narrative VIOLATIONS 12 Sus ension 88 Unknown 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 1 Driver VEHICLE# NAME 2 Non -Motorist E 2 I 3 Passenger DAN CURRENT ADDRESS (Number and Street) 945 INDIGO PT DATE OF BIRTH SEX: DRIVERS LICENSE 1 Male 1 2 Female88 04/01/1949 Unknown D62516749121 DL Type Required Endorsements 1A2B3C 4 D/Chauffeur F 1 Yes 5 E/Operator 2 No 6 E/Oper-Rest 3 No Req. Endorsement 7 None Driver Distracted By 4 Other Inside the Vehicle (explain in narrative) 1 Not Distracted 1 5 External Distraction 2 Electronic Communication (outside the vehicle, explain Devices (cell phone, etc. in narrative) 3 Other Electronic Device 6 Taxiing (navigation device, DVD player) 7 Inattentive 88 Unknown Reporting Agency Case Number HSMV Crash Report Number 230495 87073149 PHONE NUMBER Check if Recommend ❑ GREGG DORSHEIMER (717) 679-2637 Driver Re -exam CITY & STATE ZIP CODE GULFSTREAM FL 33483 NUMBER STATE EXPIRES INJURY SEVERITY (INJ) 4lncapacitating 1 None 2 Possible 5 Fatal (within 30 days) 1 0 FL 04/01/2028 3 Non-Incapadtating 6 Non -Traffic Fatality tat Drivers Actions at Time of Crash 1 No Contribution Action 26 Ran off Roadway 77 2 Operated MV in Careless or 27 Disregarded other Traffic Negligent Manner Sign 3 Failed to 'field Right -of -Way 28 Disregarded Other Road 4 Improper Backing Markings 6 Improper Turn 29Over-Correcting/Over Steering 2nd 10 Followed too Closely 11 Ran Red Light 30 Swerved or Avoided : Due 1 12 Drove too Fast for Conditions to Wind, Slippery Surface, MV, 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 orAgressive Manner 25 Failed to Keep in Proper Lane 77 Other Contributing Action 3rd 4th TimeCondition At Time ❑ of 1 Crash 1 Apparently Normal 3 Asleep or Fatigued 5111(sick) or Fainted 6 Seizure, Epilepsy, 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 -i NOT UDscurea 5 Load on Vehicle 9 Smoke 2 Inclement Weather 6 Building/Fixed Object 10 Glare ❑vision 77 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) DOT Eye Protection (EP) Restraint Systems M IRS) DRIVER OR PASSENGER SEAT ROW OTHER ❑ 1 Compliant Motorcycle Helmet ❑ 1 yes 2 No Motor Vehicle Seating Position: TION: Poocc, 2 Other Helmet 3 Not Applicable 1 Not Applicable (non -motorist) Seat Row Other ) 1 1 3 No Helmet 2 None Used -Motor Vehicle Occupant 1 Left 1NotApplicable 3 Shoulder and Lap Belt Used 2 Middle 1 Front 2 Sleeper Section of Truck Cab 2 Second P Air Bag Deployed 5 Deployed -Other 4 Shoulder Belt Only Used 5 Lap Belt Only Used 3 Right 9 77 Other (explain in 3 Other Enclosed Cargo Area 3 Third 4 UnenGOsed Cargo Area 4 Fourth Ejection (EJECT) 1 Not Ejected 1 2 Ejected, Totally (knee, air belt, etc.) ❑ 1 Not 6 Deployed- 2 6 Restraint Used - Type Unknown System 7 Child Restraint System - Forward Facing narrative 88 Unknown 5 Trailing Unit 77 Other Row 6 Riding on Motor Vehicle Exterior (non- E 1 y 3 Ejected, Deployed 2 Not Deployed Combination 3 Deployed -Front y 7Daployed-Curtain 8 Child Restraint System -Rear Facing 9 Booster Seat 88 Unknown trailing unit) Partially 4 Not Applicable 4 Deployed -Side 88 Deployment 10 Child Restraint Type Unknown 88 Unknown 88 Unknown Unknown 77 Other, Explain in Narrative N n-Motorist Description 1 Pe�estnan 2 Other Pedestrian Non -Motorist Location At Time of Crash 1 Intersection - Marked Crosswalk 8 Sidewalk 9 MediaNCrossing ❑Action Prior to Crash 5 Walking/Cycling on Sidewalk (wheelchair, person in a building, skater, pedestrian conveyance, etc. 2 Intersection - Unmarked Crosswalk Island 10 Driveway Access 6 In Roadway — Other (working, 3 Bicyclist y 3 Intersection - Other4 Midblock - Marked Crosswalk 11 Shared -Use Path or Trail 1 Crossing Roadway playing, etc.) 4 Other Cyclist 4 Midblock - Marked Crosswalk 5 Travel Lane - Other Location 12 Non-Trafficway Area 2 Waiting to Cross Roadway Adjacent to Raodwa e. 7 Ada y ( g., 5 Occupant of Motor Vehicle Not in Transport 6 Bicycle Lane Bicyclshoule 77 Other, Explain in Narrative 3 Walking/Cycling Along shoulder, median ) (parked, etc.) 6 Occupant of a Non -Motor Vehicle 7 side 88 Unknown Roadway with Traffic (in or adjacent to travel lane) 8 Going to or from School (K-12) 9 Working in Trafficway Transportation Device Non-motonSt ACtlonsicircumstances 4 Walking/Cycling Along (incident response) 7 Unknown Type of Non -Motorist 1No ImproperAction Roadway Against Traffic (in 10 None tat ❑ 2 Dart/Dash or adjacent to travel lane) 77 Other, Explain in Narrative 3 Failure to Yield Right-of-Wa 88 Unknown 1 None Safety Equipment 5 Lighting 4 Failure to Obey Traffic Signs 2 Helmet 3 Protective Pads Used 6 Not Applicable zmd ❑ Signals, or Officer 7 Entering/Exiting Parked/Standing 10 Improper Tum/Merge Vehicle 11 Improper Passin (elbows, knees, shins, etc.) 77 Other, Explain in Narrative 5 In Roadway Improperly (standing, lying, working, playing) g 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 ALCOHOL/DRUG/EMS SUSPECTED ALCOHOL USE: 1 No 1 ALCOHOL TESTED: 1 Test Not Given 2 Test Refused ❑ ALCOHOL TEST TYPE: 1 Blood 2 Breath ❑ LCOHOL EST RESULT. BAC SUSPECTED DRUG USE: DRUG TESTED: 1 Test Not Given I DRUG TEST TYPE: 1 Blood DRUG TEST RESULT: 1 Positive 2 Yes 3 Test Given 3 Urine 77 Other, Explain 2 COMPLETED TED ❑ 1 Yes No 2 Test Refused ❑ 3 Test Given 3 Urine 77 Other, ❑ 2 Negative 3 Pending ❑ 88 Unknown 88 Unknown, if Tested in Narrative 88 UNKNOWN Unknown 88 Unknown, rf Tested Explain in Narrative 88 Unknown SOURCE OF TRANSPORT TO MEDICAL FACILITY 1 Not Transported EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 2 EMS 3 Law Enforcement 1 77 Other, Explain in Narrative 88 Unknown NONE NONE NONE YEKSUN V IVEHCCLE # NAME JDATE OF BIRTH I INJ I SEX I LOC: S I R 10 1 EJECT I HIT I FP I ARn I RR ­i i i f �ivio r���i f ivr�nic — w EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO 1 Nd Tdnaporta 2 EMS 3 Lew Enlam�ron177 Other, Erywin Other,­ 77 Nert mW Un1ro PERSON # VEHICLE # AME [=TF7EX I LOC: S R O JEJECT 1HUallPCID P ABD IRS CURRENT ADDRESS (Number and Street) CITY STATE E 1 Nd Tla re to 2 EMS 31— Elf— 770M , En"in in Narrathe W Unbwwn HSMV 90010 S 3 6 Page of_ EMS RUN NUMBER Reporting Agency Case Number HSMV Crash Report port Number 230495 1 87073149 ON MARCH 17, 2023 AT APPROXIMATELY 1250 HOURS I WAS APPROACHED BY THE DRIVER/OWNER OF VEHICLE #2 WHO WAS REPORTING THAT HE WAS INVOLVED IN A MOTOR VEHICLE CRASH JUST OUTSIDE HIS DRIVEWAY. I FOLLOWED HIM BACK TO THE LOCATION AND CONDUCTED A CRASH INVESTIGATION. I TOOK PHOTOGRAPHS OF THE SCENE, POINT OF IMPACT AND DAMAGE. THE INTERVIEW WAS CAPTURED ON MY BODY WORN CAMERA. THERE WERE NO REPORT OF INJURIES AND THE DAMAGE WAS MINIMAL. THE POINT OF IMPACT OCCURRED ON A TOWN ROAD JUST OUTSIDE A RESIDENTIAL DRIVEWAY IDENTIFIED AS 960 ORCHID LANE, GULF STREAM, FL. DRIVER #2 VERBALLY STATED THAT WHILE BACKING OUT OF HIS RESIDENTIAL DRIVEWAY LOCATED AT 950 ORCHID LANE HE STRUCK THE REAR PORTION OF A UTILITY/LANDSCAPING TRAILER. HE STATED FURTHER THAT THE REAR DOOR OF THE UTILITY TRAILER WAS COMPLETELY IN THE DOWN POSITION. TRAFFIC CONES WERE NOT DISPLAYED FOR THE PURPOSE OF WARNING. THE TRAFFIC CONES WERE ACTUALLY INSIDE THE TRAILER AT THE TIME OF THE INCIDENT. THE VEHICLE HE WAS DRIVING IS DESIGNED LOW TO THE GROUND AND THEREFORE HE COULD NOT SEE THE DOOR ON THE GROUND. PRIOR TO MAKING CONTACT WITH THE PRIMARY EMPLOYEE OF THE LANDSCAPING COMPANY I DID OBSERVE THE TRAFFIC CONES WERE NOT POSITIONED AROUND THE UTILITY TRAILER. THE UTILITY TRAILER WAS POSITIONED JUST OUTSIDE THE NEIGHBORS RESIDENTIAL DRIVEWAY LOCATED AT 960 ORCHID LANE. THE COMPANIES DUMP TRUCK WAS ON SCENE, HOWEVER, IT WAS NOT ATTACHED TO THE UTILITY TRAILER. THE UTILITY TRAILER WAS UNOCCUPIED AT THE TIME OF IMPACT. THE UTILITY TRAILER IS OWNED BY A LOCAL LANDSCAPING COMPANY IDENTIFIED AS VEHICLE #1 1 INTERVIEWED THE LEAD EMPLOYEE OF THE COMPANY WHO WAS IDENTIFIED AS MR GUILLERMO LABOY. MR LABOY WAS NOT PRESENT AT THE TIME OF IMPACT AS HE WAS TAKING THE DUMP TRUCK FILLED WITH DEBRIS FOR DISPOSAL. HE ASSISTED ME WITH LANGUAGE TRANSLATION FOR HIS FELLOW EMPLOYEE'S. UPON HIS RETURN HE WAS MADE AWARE OF THE INCIDENT BY HIS EMPLOYEE'S AND DRIVER #2. THE ONLY WITNESS TO THE IMPACT WAS AN EMPLOYEE WHO IS IDENTIFIED IN THE WITNESS SECTION. THE WITNESS TOLD HIM THAT HE WAS LYING DOWN NEXT TO THE UTILITY TRAILER WHEN VEHICLE #2 SUDDENLY BACKED OUT OF THE DRIVEWAY STRIKING THE UTILITY TRAILER DOOR. I DID NOT WITNESS THIS CRASH AND THERE WERE NO INDEPENDENT EYEWITNESS TO THIS CRASH. VEHICLE # 2 SUSTAINED THE MAJORITY OF THE DAMAGE. I OBSERVED A DENT AND SCRATCH DAMAGE TO THE LOWER PORTION OF THE REAR BUMPER. IT WAS NOT EVIDENT OF ANY UNDERCARRIAGE DAMAGE. THE DRIVER OF VEHICLE #2 WAS ABLE TO DRIVE THE VEHICLE FROM THE SCENE. THE WIRE HARNESS FOR THE UTILITY TRAILERS DOOR HAD TRANSFER PAINT ON IT. THE DOOR WAS OPERATIONAL. THE TRAILER WAS RE ATTACHED TO THE DUMP TRUCK AND REMOVED FROM THE SCENE. IT APPEARS THE DAMAGE IS CONSISTENT BASED ON ALL THE VERBAL STATEMENTS. NO FURTHER ACTION TAKEN. END OF REPORT. and ,UUMUt Ur I NANJNUK I I U MEDICAL FACILITY IEMS AGENCY NAME OR ID EMS RUN 1 N. Tra P{v 2 EMS 3 Lan Enfacemml ]] ahx. E yl ,i . Nana N U.b— SEX (Number EJECT 11Nd Tray PW. 2 EMS 3 Lan Enlwcmnenf 7TOttirr, EgwlO in I EMS RUN NUMBER I MEDICAL FACILITY TRANSPORTED TO N.1. Unknown ADDITIONAL VIOLATIONS REPORTING OFFICER ID/BADGE # RANK OFFICER NAME DEPARTMENT TYPE OF DEPT. 751 SERGEANT BERNARD O'DONNELL GULF STREAM POLICE DEPARTM POLICE DEPARTMENT (PD) HSMV 90010 S 4 6 Page Of DIAGRAM REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER 230495 1 87073149 DIAGRAM NOT REQUIRED HSMV 90010 S 5 6 Page of_ rting Agency Case Number HSMV Crash Report Number VEHICLE # 2 Check if Commercial 87073149 1 Vehicle in TransportVEHICLE LICENSE NUMBER L230495 STATE STRATION EXPIRES VIN 2 ParkedMotorVehicle 1 Check'rf Permanent3 Working Vehicle B2RDA FL 1/2025 Registration IWPOCD2A96MS263492 1Hit and Run 2 Ye2021 1 YEAR MAKE MODEL STYLE COLOR DAMAGE: 1 Disabling 4 Minor EST. AMOUNT 88 Unknown FORS 911 CONVERTIBLE SILVER - SIL 2 Functional 88 Unknown $2,000.00 3 None INSURANCE COMPANY (DRIVER) THE CINCINNATI INSURANC INSURANCE POLICY NUMBER Towed due to Damage: 1 VEHICLE REMOVED BY 1. Rotation 2. Owner Request 3 A020668935 1 No 2 Yes DAN DORSHEIMER 3. Driver 4. Other, Explain in Narrative NAME OF VEHICLE OWNER (CHECK IF BUSINESS) ❑ CURRENT ADDRESS CITY & STATE ZIP DAN GREGG DORSHEIMER I 946 INDIGO PT GULFSTREAM FL 33483 Trailer LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent VIN YEAR MAKE LENGTH AXLES One: Registration ❑ Trager LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent VIN YEAR MAKE LENGTH AXLES Two: Registration ❑ VEHICLE N S E W Off -Road Unknown ON STREET, ROAD, HIGHWAY AT EST. SPEED POSTED SPEED TOTAL LANES TRAVELING O ❑ D ORCHID LANE 3 20 2 HAZ. MAT. RELEASED 1 No HAZ. MAT. PLACARD 1 No NUMBER CLASS Area of Initial Impact Most Damaged Area 08 18 2 Yes 88 Unknown 2 Yes 88 Unknown ❑ 2 3 4 5 6 7 18 Undercarriage 18 2 3 4 5 6 7 1 15 16 17 8 19 Overturn 19 1 20 Windshield 20 15 16 17 6 MOTOR CARRIER NAME US DOT NUMBER 14 9 21 Trailer 21 14 9 13 12 11 10 13 12 11 10 MOTOR CARRIER ADDRESS CITY STATE ZIP CODE PHONE NUMBER Vehicle Body Type 15 Low Speed Vehicle Trafficway Commercial Motor Vehicle Configuration 16 (Sport) Utility Vehicle 1 17 Cargo Van (10,OD0Ibs 1 Two -Way, Not Divided 1 Vehicle 10,000 Ibs or less Placarded 8 Tractorfrriple for Hazardous Materials 9 Truck more than 10,000 Ibs 4,536 2 Two -Way, Not Divided, ( (4,536 kg) or less) with a Continuous Left Turn Lane 2 Single -Unit Truck (2-axle and GVWR kg), Cannot Classify 1 Passenger Car 18 Motor Coach 3 Two -Way, Divided, Unprotected more than 10,000 Ibs (4,536 kg)) 10 Bus/Large van (seats for 9-15 2 Passenger Van 19 Other Light Trucks (10,000 Ibs (painted 14 feet) Median 3 Single -Unit Truck (3 or more axles) occupants, including driver) 3 Pickup (4,536 kg) or less) 4 Two -Way, Divided, Positive 4 Truck Pulling Trailer(s) 11 Bus (seats for more than 15 7 Motor Home 20 Medium/Heavymore Trucks ( Median Barrier 5 Truck Tractor (bobtail) 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 11 Motorcycle 21 Farm Labor Vehicle 88 Unknown 7 Truck Tractor/Double Truck 88 Unknown 12 Moped 77 Other, Explain in Narrative Trailer Type 1 Single Semi 13 All erain Vehicle (ATV) 88 Unknown Trailer 2 Tandem Semi Trailer 8 Pole Trailer 9 Towed Vehicle Cargo Body Type Comm/Non-Commercial TRAILER 1 TRAILER 2 3 Tank Trailer 10 Auto Transport 13 Intermodal 1 Interstate Carrier ❑ El Saddle ilex railer 5 Boat Trailer 3 Van/Enclosed Box Container Chassis N Other, Explain in ❑ 4 Hopper 14 Vehicle Towing Narrative ❑ 2 Intrastate Cartier 6 Utility Trailer 5 Pole -Trailer Another Vehicle 88 Unknown 3 Not in Commerce/Government 6 Cargo Tank 15 Not Applicable 4 Not in Commerce/Other Truck 7 House Trailer 1 No Cargo 7 Flatbed (vehicle 10,000lbs Most Harmful Event Non -Collision 1 10,000 Ibs (4,536 k or less 2 Bus 8 Dum Comm ( g) p (4,536 kg) or less not 1 Overturn/Rollover GVWR/GCWR 2 10,001-26,000 lbs (4,536-11,793kg) 9 Concrete Mixer displaying HM placard 2 Fire/Explosion 3 More than 26,000lbs If 1,793kg) 10 Auto Transport 77 Other, Explain in 3Immersion 4 Not Applicable 11Garbage/Refuse Narrative 4 Jackknife 14 5 Cargo/Equipment Loss or Shift Collision with Non -Fixed Object 10 Pedestrian Collision Fixed Object 12 Log 88 Unknown 29 Cable Barrier Emergency 6 Fell/Jumped From Motor Vehicle 11 Pedalcycle 19 Impact Attenuator/Crash Cushion 30 Concrete Traffic Barrier Vehicle Use 7 Thrown or Falling Object 12 Railway Vehicle (train, engine) 20 Bridge Overhead Structure 31 Other Traffic Barrier Sequence Of Events 8 Ran into Water/Canal 13 Animal Support Pier or Supp 21 Bridge32 Tree (standing) 9 Other Non -Collision 14 Motor Vehicle in Transport 22 Bridge Rail 23 Culvert 33 Utility Pole/Light Support 1st 2nd 14 15 [40-46 Sequence of Events only] 14 175 15 Parked Motor Vehicle 16 Work Zone/Maintenance 34 Traffic Sign Support 24 Curb 35 Traffic Signal Support 1 No 40 equipment Failure (blown tire, Equipment 25 Ditch 36 Other Post, Pole, or Support brake failure, etc.) 17 Struck By Falling, Shitting Cargo or 2 Yes 26 Embankment 37 Fence 3rd 41 Separation of Units 4th Anything Set in Motion by Motor 88 Unknown 27 Guardrail Face 38 Mailbox 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 1 Straight Ahead 13 Stopped in Traffic Roadway Grade 46 Downhillill Runaway 1 Level 3 Turning Left 14 Slowing 4 Backing 15 Negotiating a Curve This Vehicle 8 Flashing 2 Hillcrest 4 Roadway Alignment 5 Turning Right 16 Leaving Traffic Lane Signal 1 None 9 Railway Crossing 1 3 Uphill 6 Changing Lanes 17 Entering Traffic Lane 1 No Controls Device 2 Brakes 13 Wheels School Zone Sign/ 4 Downhill 1 Straight 8 Parked 77 Other, Explain in Narrative ative 10 Person (including 3 Tires 14 Windows/ 5 Sag (bottom) 2 Curve Right ❑ 10 Making U-Turn 88 Unknown Device Flagman, Officer, 4 Lights (head, Windshield 3 Curve Left 11 Overtaking/Passing 5 Traffic Control Guard, etc.) signal, tail) 15 Mirrors Special Function 1 No Special Function 9 Ambulance 14 Intercity Bus Signal 77 ether, Explain in 6 Steering 16 Truck Coupling , 6 Stop Sign 7 Wipers Trailer Hitch/ of Motor Vehicle 2 Farm Vehicle 10 Fire Truck Charter/rour Bus Narrative 7 Yield Sign 88 Unknown 9 Exhaust System Safety Chains 3 Police 11 Farm Labor Transport 16 Shuttle Bus 10 Body, Doors 77 Other, Explain in 7 Taxi 12 School Bus 17 Farm Labor Bus 11 Power Train Narrative T ^' n 8 Military 13 Transit/Commuter Bus 88 Unknown `n^ .1-- 1 12 Suspension 88 Unknown 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 6 6 Page of_