The URL can be used to link to this page

Home My Public Portal AboutPRR 23-2980 T OWN OF G ULF S TREAM P ALM B EACH C OUNTY, F LORIDA Delivered via e-mail December 21, 2023 Stefan Dekock \[mail tostefandekock15@gmail.com\] Re: GS #2980 (Police Report) A verbal request for a police report regarding an incident on December 15, 2023, at the Gulf Stream Bath and Tennis Club. Dear Stefan Dekock \[mail tostefandekock15@gmail.com\]: The Town of Gulf Stream has received your verbal public records request on December 19, 2023. You should be able to view your original request and response at the following link: PRR 23-2980 (laserfiche.com) We consider this request closed. Sincerely, Reneé R. Basel, MMC Reneé R. Basel, MMC Town Clerk, Custodian of the Records DRIVER EXCHANGE UPDATESHORT FORMLONG FORM FLORIDA TRAFFIC CRASH REPORT 0 # OF WITNESSES 2 # OF VEHICLES 0 # OF VIOLATIONS 0 # OF NVPD 1 # OF DRIVERS 0 # OF PASSENGERS 0 # OF NONMOTORIST SUBSEQUENT CRASH EXEMPT FROM PUBLIC RECORDS 12/15/2023 CRASH DATE 9:31 PM TIME OF CRASH 12/15/2023 DATE OF REPORT 20230151504 REPORTING AGENCY CASE #HSMV CRASH REPORT # 06 COUNTY CODE 44 CITY CODE PALM BEACH COUNTY OF CRASH GULF STREAM PLACE OR CITY OF CRASH YES WITHIN CITY LIMITS TIME REPORTED TIME DISPATCHED TIME ON SCENE TIME CLEARED SCENE COMPLETED REASON (If Investigation NOT Complete) LAW ENFORCEMENT NOTIFIED BY CRASH IDENTIFIERS VEHICLE ONE WAS IN THE 900 BLOCK OF A1A/NORTH OCEAN BOULEVARD SOUTH BOUND WHEN VEHICLE ONE LEFT THE ROADWAY TRAVELING WEST ACROSS THE SIDEWALK INTO THE PARKING LOT STRIKING VEHICLE TWO WHICH WAS PARKED FACING EAST WITH ITS FRONT RIGHT CORNER TO VEHICLE TWO FRONT RIGHT CORNER CAUSING DAMAGE VEHICLE TWO WAS UNOCCUPIED PERSON TWO IS OWNER NARRATIVE VEHICLE ONE WAS IN THE 900 BLOCK OF A1A/NORTH OCEAN BOULEVARD SOUTH BOUND WHEN VEHICLE ONE LEFT THE ROADWAY TRAVELING WEST ACROSS THE SIDEWALK INTO THE PARKING LOT STRIKING VEHICLE TWO WHICH WAS PARKED FACING EAST WITH ITS FRONT RIGHT CORNER TO VEHICLE TWO FRONT RIGHT CORNER CAUSING DAMAGE VEHICLE TWO WAS UNOCCUPIED PERSON TWO IS OWNER NARRATIVE PARKING LOT ROAD SYSTEM IDENTIFIER 1260 AT STREET ADDRESS # PELICAN LN CRASH OCCURRED ON STREET, ROAD, HIGHWAY AT FEET OR MILES Direction AT/FROM INTERSECTION WITH STREET, ROAD,HIGHWAY 26.476123 AT LATITUDE -80.056873 AND LONGITUDE No STREET LIST USED? Yes Locator Used?OR FROM MILEPOST #TYPE OF SHOULDER NOT AT INTERSECTION TYPE OF INTERSECTION ROADWAY INFORMATION CRASH INFORMATION (CHECK IF PICTURES TAKEN) LIGHT CONDITION WEATHER CONDITION ROADWAY SURFACE CONDITION SCHOOL BUS RELATED MANNER OF COLLISION/IMPACT FIRST HARMFUL EVENT FIRST HARMFUL EVENT LOCATION WITHIN INTERCHANGE FIRST HARMFUL EVENT RELATION TO JUNCTION CONTRIBUTING CIRCUMSTANCES: ROAD CONTRIBUTING CIRCUMSTANCES: ROAD CONTRIBUTING CIRCUMSTANCES: ROAD CONTRIBUTING CIRCUMSTANCES: ENVIRONMENT CONTRIBUTING CIRCUMSTANCES: ENVIRONMENT CONTRIBUTING CIRCUMSTANCES: ENVIRONMENT WORK ZONE RELATED CRASH IN WORK ZONE TYPE OF WORK ZONE WORKERS IN WORK ZONE LAW ENFORCEMENT IN WORK ZONE 1 312/20/2023 1:55 PMOF VEHICLE CHECK IF COMMERCIAL 1 VEHICLE # NO HIT AND RUN 2006 VEHICLE YEAR 29CFSL VEH LICENSE # FL STATE HYUN VEHICLE MAKE 4 DOOR SEDAN VEHICLE STYLE BLUE - BLU VEHICLE COLOR 5NPEU46FX6H064412 VIN NO PERM. REG. 07/15/2025 REG. EXPIRES VEHICLE MODEL VEHICLE IN TRANSPORT VEHICLE STATUS EXTENT OF DAM. $ EST. DAM. NO TOWED DUE TO DAMAGE DRIVER VEHICLE REMOVED BY ROTATION GEICO GENERAL INSURANCE INSURANCE COMPANY (DRIVER) 4210558351 INSURANCE POLICY NUMBER JONATAS NA CASIMIR 200 DAVIS RD CURRENT ADDRESS DELRAY BEACH CITY FL STATE 33445 ZIP CODE TRAILER 1: LICENSE # STATE REG. EXPIRES PERM. REG.VIN YEAR MAKE LENGTH AXLES TRAILER 2: LICENSE # STATE REG. EXPIRES PERM. REG.VIN YEAR MAKE LENGTH AXLES DIRECTION ON STREET, ROAD, HIGHWAY AT EST. SPEED POSTED SPEED TOTAL LANES CMV CONFIGURATION CARGO BODY TYPE NOT APPLICABLE COMM GVWR/GCWR TRAILER TYPE (TRAILER ONE) TRAILER TYPE (TRAILER TWO) HAZ. MAT. RELEASE HAZ. MAT. PLA NUMBER CLASS MOTOR CARRIER NAME US DOT NUMBER MOTOR CARRIER ADDRESS CITY STATE ZIP CODE PHONE NUMBER COMM/NON-COMM VEHICLE BODY TYPE VEHICLE DEFECTS (1)VEHICLE DEFECTS (2)EMERGENCY VEHICLE USE UNIT #SPECIAL FUNCTION OF MV VEHICLE MANEUVER ACTION TRAFFICWAY ROADWAY GRADE ROADWAY ALIGNMENT MOST HARMFUL DETAIL TRAFFIC CONTROL FOR THIS VEHICLE FIRST SEQUENCE OF EVENTS SECOND SEQUENCE OF EVENTS THIRD SEQUENCE OF EVENTS FOURTH SEQUENCE OF EVENTS AREA OF INITIAL IMPACT MOST DAMAGED AREA 18 UNDERCARRIAGE 18 20 WINDSHIELD 20 21 TRAILER 21 19 OVERTURN 19 NAME OF VEHICLE OWNER (CHECK IF BUSINESS) VEHICLE CHECK IF COMMERCIAL 2 VEHICLE # NO HIT AND RUN 2018 VEHICLE YEAR THF8136 VEH LICENSE # NC STATE SUBA VEHICLE MAKE MP VEHICLE STYLE VEHICLE COLOR 4S4BSACC5J3305391 VIN NO PERM. REG. 07/15/2024 REG. EXPIRES VEHICLE MODEL PARKED MOTOR VEHICLE VEHICLE STATUS EXTENT OF DAM. $ EST. DAM. YES TOWED DUE TO DAMAGE OWNER VEHICLE REMOVED BY ROTATION PROGRESSIVE SOUTHEASTER INSURANCE COMPANY (DRIVER) 969236910 INSURANCE POLICY NUMBER STEFAN DE KOCK 803 UNIVERSITY BLVD CURRENT ADDRESS JUPITER CITY FL STATE 33458 ZIP CODE TRAILER 1: LICENSE # STATE REG. EXPIRES PERM. REG.VIN YEAR MAKE LENGTH AXLES TRAILER 2: LICENSE # STATE REG. EXPIRES PERM. REG.VIN YEAR MAKE LENGTH AXLES DIRECTION ON STREET, ROAD, HIGHWAY AT EST. SPEED POSTED SPEED TOTAL LANES CMV CONFIGURATION CARGO BODY TYPE NOT APPLICABLE COMM GVWR/GCWR TRAILER TYPE (TRAILER ONE) TRAILER TYPE (TRAILER TWO) HAZ. MAT. RELEASE HAZ. MAT. PLA NUMBER CLASS MOTOR CARRIER NAME US DOT NUMBER MOTOR CARRIER ADDRESS CITY STATE ZIP CODE PHONE NUMBER COMM/NON-COMM VEHICLE BODY TYPE VEHICLE DEFECTS (1)VEHICLE DEFECTS (2)EMERGENCY VEHICLE USE UNIT #SPECIAL FUNCTION OF MV VEHICLE MANEUVER ACTION TRAFFICWAY ROADWAY GRADE ROADWAY ALIGNMENT MOST HARMFUL DETAIL TRAFFIC CONTROL FOR THIS VEHICLE FIRST SEQUENCE OF EVENTS SECOND SEQUENCE OF EVENTS THIRD SEQUENCE OF EVENTS FOURTH SEQUENCE OF EVENTS AREA OF INITIAL IMPACT MOST DAMAGED AREA 18 UNDERCARRIAGE 18 20 WINDSHIELD 20 21 TRAILER 21 19 OVERTURN 19 NAME OF VEHICLE OWNER (CHECK IF BUSINESS) 2 312/20/2023 1:55 PMOF2312/20/2023 1:55 PMOF 1 PERSON # 1 VEHICLE # JONATAS NAME CASIMIR 7/15/1964 DOB M SEX PHONE NUMBER RE- EXAM 200 DAVIS RD ADDRESS DELRAY BEACH CITY FL STATE 33445 ZIP CODE C256420642550 DRIVER LICENSE NUMBER FL STATE 4/8/2024 EXPIRES 5 - CLASS E/OPERATO DL TYPE REQ. END.INJURY SEVERITY EJECTION RESTRAINT SYSTEMS AIR BAG DEPLOYED HELMET USE EYE PROTECTION SEAT ROW OTHER DRIVERS ACTION AT TIME OF CRASH (FIRST)DRIVERS ACTION AT TIME OF CRASH (SECOND)DRIVER DISTRACTED BY DRIVER VISION OBSTRUCTION DRIVERS ACTIONS AT TIME OF CRASH (THIRD)DRIVER ACTIONS AT TIME OF CRASH (FOURTH)DRIVERS CONDITION AT TIME OF CRASH SUSPECTED ALCOHOL USE ALCOHOL TESTED ALCOHOL TEST TYPE ALCOHOL TEST RESULT BAC SUSPECTED DRUG USE DRUG TESTED DRUG TEST TYPE DRUG TEST RESULT POSITIVE DRUG TEST RESULTS TRANSPORT TO MEDICAL FACILITY BY EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO DRIVER 758 ID/BADGE # OFFICER RANK O'NEAL, ALLEN OFFICER NAME GULF STREAM POLICE DEPARTMENT DEPARTMENT POLICE DEPARTMENT (PD) TYPE OF DEPT. REPORTING OFFICER 3 312/20/2023 1:55 PMOF