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HomeMy WebLinkAboutTraffic Crash Investigation-2002 oE.N1NTER sip WINTER SPRINGS• c 4"`A 1/y�, FIRE DEPARTMENT Y 102 NORTH MOSS ROAD dEY WINTER SPRINGS,FLORIDA 32708 F(ORION 8 TELEPHONE:(407)327-2332 FAX(407)327-4750 July 30, 2002 GE ERC Commercial Insurance 525 W. Van Buren Chicago, IL 60607 ATTN: Kimberly Mozdzierz, Claims Specialist REF: Insured: City of Winter Springs Claimant: John Lee Brown Policy: 651-011238 Claim No: Ecd80170130 Dear Ms. Mozdzierz, Attached please find the traffic fatality information provided to me by the Police Department to the above referenced claim. If you have any questions or need additional information please feel free to contact me at 407-327-7575. Sincerely, Timothy J. Lallathin Fire Chief Cc: Risk Management -iNTEq ,� CITY OF WINTER SPRINGS, FLORIDA o' !7"9":79t4 %.% 1126 EAST STATE ROAD 434 o,-oR-op WINTER SPRINGS, FLORIDA 32708-2799 Telephone(407)327-1800 Utility/Public Works Fax(407)327-6695 Department July 26, 2002 GE ERC Commercial Insurance 525 W. Van Buren Chicago, IL 60607 ATTENTION: Kimberly Mozdzierz, Claims Specialist REFERENCE: INSURED: City of Winter Springs CLAIMANT: John Lee Brown POLICY: 651-011238 Claim No.: Ecd80170130 Dear Ms. Mozdzierz: Attached please find the information requested relative to the Edgemon Avenue traffic signal and the above referenced claim. I have included correspondence with FDOT as well as City Commission minute and agenda items where the signal was discussed. I understand the Police Department is providing the traffic fatality information under separate cover if they haven't already. If you have any questions or need additional information please feel free to contact me at 407-327-5989. Sincerely, /0'lq Kipton Lockcuff, P.E. Public Works/Utility Director Cc: Fire Chief w/o attachments 4 WINTER SPRINGS POLICE DEPARTMENT 1tsitQ SPRN„, It v8 IV V TRAFFIC CRASH INVESTIGATION PREPARED BY: CPL. JAMES R. WICKMAN CASE NUMBER: 2001024972 P� C 0 WINTER SPRINGS POLICE DEPARTMENT POLICE POLICE" TRAFFIC HOMICIDE INVESTIGATION TABLE OF CONTENTS Page(s) 1 Cover Sheet 2 Table of Contents 3-19 Investigative Report 20-21 Reconstruction Diagram 22-27 Accident Report 28-37 Witness List 38-42 Statements and/or Written Interviews (If applicable) 43-47 Chemical Test Information 48-54 Property Taken Into Custody(Personal) 55-56 Property Taken Into Custody (Vehicle) 57-58 Driver License Record 59-61 Death Certificate or Medical Examiner's Summary N/A Arrest Information 62-64 Other' FHP FAX NOTIFICATION 65-82 * QUESTIONNAIRE FOR BLACK AND LT FLANNIGANS ROI 83-84 * COPY OF BROWN'S LICENSE 85-87 * MEASUREMENTS 88-92 * DIGITAL PICTURES OF SCENE N/A Prosecutor's Release Investigation Reviewed by: Supervisor Date Case Number 2001024972 Page 2 WSPO Form# • WINTER SPRINGS POLICE DEPARTMENT P����� TRAFFIC HOMICIDE INVESTIGATION POLICE CASE SUMMARY PAGE 1 IDENTIFICATION ON THE 16TH DAY OF OCTOBER 2001, AT APPROXIMATELY 5:35 PM, IN THE CITY OF WINTER SPRINGS, COUNTY OF SEMINOLE, IN THE STATE OF FLORIDA, A TWO CAR COLLISION OCCURRED. THE VEHICLES INVOLVED WERE A 1991 FORD PICK-UP TRUCK AND A 1996 HARLEY DAVIDSON MOTORCYCLE. THE CRASH OCCURRED ON SR 419 AT THE INTERSECTION OF NORTH EDGEMON AVENUE. THE CRASH RESULTED IN THE OPERATOR OF THE MOTORCYCLE BEING TRANSPORTED TO ORLANDO REGIONAL MEDICAL CENTER BY LIFE FLIGHT HELICOPTER DUE TO HIS INJURIES, WHERE HE SUBSEQUENTLY DIED AS A RESULT OF THE INJURIES. AMBIENCE THE ROADWAY WAS DRY, THE CRASH OCCURRED DURING DAYLIGHT HOURS ON A CLOUDY DAY AND THE TEMPERATURE WAS APPROXIMATELY 80 DEGREES. HIGHWAY STATE ROAD 419 AT NORTH EDGEMON AVENUE IS AN ASPHALT ROADWAY WHICH HAS FOUR LANES AT THAT LOCATION. NORTH AND SOUTH OF THE CRASH LOCATION IT IS ONLY TWO LANES WIDE. AT THE CRASH SITE THERE ARE TWO THRU TRAVEL LANES, ONE EACH NORTH AND SOUTH BOUND. THERE IS A CENTER TURN LANE, FOR LEFT TURNS FROM SR 419 ONTO EDGEMON AVENUE, LOCATED BETWEEN THE TWO THRU LANES. FINALLY EACH THRU LANE HAS IT'S OWN RIGHT TURN LANE. AT THE CRASH LOCATION SR 419 IS CURVED AND BANKED. THE CURVE HAS A RADIUS OF 182.375 FT. THE HIGH SIDE OF THE CURVE IS LOCATED ON THE WEST SIDE OF THE INTERSECTION. THE SOUTHBOUND LANE IS BANKED AT 6.25%. THE DRAG FACTOR ON SR 419 WAS DETERMINED TO BE .90% UTILIZING THE DEPARTMENT DRAG SLED. NORTH EDGEMON AVENUE IS AN ASPHALT ROADWAY WITH TWO LANES. TRAFFIC CONTROL STATE ROAD 419 HAS A POSTED SPEED LIMIT OF 55 MPH FOR NORTH AND SOUTHBOUND TRAFFIC. THE SPEED LIMIT SIGN FOR SOUTHBOUND TRAFFIC IS POSTED .6 MILES NORTH OF THE CRASH LOCATION. THE DEPARTMENT OF TRANSPORTATION IN OCTOBER 1999 POSTED THE SIGN. DURING A REPAVING OF SR 419 IN 2001 IT WAS COVERED TO ALLOW FOR SLOWER CONSTRUCTION TRAFFIC. WHEN THE ROADWAY WAS REOPENED TO NORMAL TRAFFIC IN SEPTEMBER OF 2001 THE SIGN WAS UNCOVERED, HOWEVER, THERE IS NO DOT POSTING DATE ON THE SIGN. THE SIGN MEETS STATE REQUIREMENTS. ON SR 419 WHITE LINES ARE PAINTED ON THE EDGE OF THE ROADWAY LANES. DOUBLE YELLOW LINES ARE PAINTED INDICATING THE DIVIDER BETWEEN THE NORTH AND SOUTHBOUND LANES. THE RIGHT TURN LANES ARE SEPERATED FROM THE THRU LANES BY A SOLID WHITE LINE. THE CENTER TURN LANES ARE SEPERATED FROM THERE RESPECTIVE THRU LANES BY A SOLID WHITE LINE TO THE RIGHT AND A DOUBLE YELLOW LINE TO THE RIGHT. ALL TURN LANES ARE PROPERLY MARKED WTH WHITE TURN ARROWS. NORTH EDGEMON AVENUE RUNS NORTH AND SOUTH WITH A 20 MPH SPEED LIMIT SIGN POSTED .5 MILE SOUTH OF THE INTERSECTION. AT THE INTERSECTION OF SR 419 THERE IS A STOP SIGN WITH A STOP BAR. THE DEPARTMENT OF TRANSPORTATION ON 8 AUGUST 2001 POSTED THE SIGN AND IT MEETS STATE REQUIREMENTS. THE LANES ARE DIVIDED WITH A YELLOW LINE AND THE ROADWAY EDGES ARE MARKED WITH SOLID WHITE LINES. '3 WINTER SPRINGS POLICE DEPARTMENT VOICE POLICE TRAFFIC HOMICIDE INVESTIGATION CASE SUMMARY - PAGE 2 VEHICLE NUMBER ONE (V1) ' VEHICLE ONE IS A 1991 BLUE AND GREY EXTENDED CAB FORD F150 XLT PICK-UP TRUCK, FLORIDA LICENSE NUMBER F87HQH, VIN 1FTEX15N1MKA92032. THE TRUCK HAS AN AUTOMATIC TRANSMISSION, POWER STEERING, FRONT DISC AND REAR DRUM POWER BRAKES. THE VEHICLE HAD NO KNOWN DEFECTS OR ALTERATIONS THAT CONTRIBUTED TO THE CRASH. AT THE TIME OF THE CRASH TWO PEOPLE OCCUPIED VEHICLE ONE. THE TRUCK ALSO HAD LAWN MOWING EQUIPMENT IN THE BED AT THE TIME OF THE CRASH. DRIVER VEHICLE NUMBER ONE JOHN EDWARD BLACK, DATE OF BIRTH 09-28-46, VEHICLE OWNER, WAS DRIVING VEHICLE ONE. HE RESIDES AT 310 LOCH LOW LN, SANFORD FLORIDA, 32773. HIS FLORIDA LICENSE NUMBER IS B420-465-46-548-0, AND IT WAS VALID AT THE TIME OF THE CRASH. BLACK WAS ENROUTE HOME AT THE TIME OF THE CRASH. HE HAD JUST LEFT A RELATIVES HOUSE. HE RECEIVED NO INJURIES. PASSENGER VEHICLE ONE IRA FREDERICK BLACK, AGE 55, 220 PINE WINDS, SANFORD FLORIDA, 32773, WAS A FRONT SEAT PASSENGER IN THE TRUCK. HE HAD NO INJURIES. VEHICLE NUMBER TWO (V2) VEHICLE NUMBER TWO IS A 1996 RED HARLEY DAVIDSON 883 SPORTSTER MOTORCYCLE, FLORIDA LICENSE NUMBER 06153A, VIN IHD4CAM1OTY209311. THE MOTORCYCLE HAS A MANUAL TRANSMISSION, AND FRONT AND REAR DISC BRAKES. THE HEADLIGHT WAS OPERATIONAL AT THE TIME OF THE CRASH. THE MOTORCYCLE HAD NO KNOW DEFECTS OR ALTERATIONS WHICH CONTRIBUTED TO THE CRASH. BOTH TIRES DID HAVE LOW AIR PRESSURE WHEN CHECKED AFTERWARDS. DRIVER VEHICLE NUMBER TWO JOHN LEE BROWN, DATE OF BIRTH 03-27-52, VEHICLE OWNER, WAS DRIVING VEHICLE TWO. HE RESIDED AT 1036 WINTER SPRINGS BLVD, WINTER SPRINGS FLORIDA, 32708. HIS FLORIDA LICENSE NUMBER WAS B650-472-52-107-1, AND IT WAS VALID AT THE TIME OF THE CRASH. THE LICENSE DID HAVE A MOTORCYCLE ENDORSEMENT. HE WAS WEARING A HELMET AND FACE COVER AT THE TIME OF THE CRASH. BROWN WAS RETURNING HOME FROM WORK. BROWN WAS TRANSPORTED TO ORLANDO REGIONAL MEDICAL CENTER BY LIFE FLIGHT HELICOPTER, FOR TREATMENT OF HIS INJURIES, WHERE HE SUBSEQUENTLY DIED. BROWN WAS RELEASED TO THE VOLUSIA COUNTY MEDICAL EXAMINER FOR AN AUTOPSY. THE AUTOPSY INDICATES THE CAUSE OF DEATH TO BE COMPLICATIONS OF BLUNT FORCE INJURIES AS A RESULT OF THE CRASH. av • WINTER SPRINGS POLICE DEPARTMENT TRAFFIC HOMICIDE INVESTIGATION CASE SUMMARY PAGE 3 PRE-CRASH ON OCTOBER 16, 2001, AT APPROXIMATELY 5:30 PM, VEHICLE ONE DRIVEN BY JOHN BLACK, LEFT A RELATIVES HOUSE AT 445 ALDERWOOD CT., WINTER SPRINGS FLORIDA, BLACK WAS ENROUTE HOME AFTER WORKING ALL DAY. VEHICLE ONE TRAVELED NORTHBOUND ON EDGEMON AVENUE TO THE STOP SIGN AT NORTH EDGEMON AVENUE AND SR 419 AND STOPPED. BLACK LOOKED BOTH DIRECTIONS TO CLEAR TRAFFIC, PREPARING TO ENTER THE INTERSECTION AND MAKE A LEFT TURN ONTO NORTHBOUND SR 419. HE OBSERVED VEHICLE TWO AND OTHER TRAFFIC PROCEEDING SOUTHBOUND ON SR 419 APPROACHING THE INTERSECTION. FEELING HE HAD ADEQUATE CLEARANCE TO MAKE THE LEFT TURN IN FRONT OF THE ON-COMING TRAFFIC BLACK DROVE VEHICLE ONE INTO THE INTERSECTION. ON OCTOBER 16, 2001, AT APPROXIMATELY 5:00 PM, VEHICLE TWO DRIVEN BY JOHN BROWN, LEFT THE SEMINOLE COUNTY TAX COLLECTOR'S OFFICE, SANFORD FLORIDA, BROWN WAS ENROUTE HOME FROM WORK. BROWN TRAVELED BY AN UNKNOWN ROUTE TO US HIGHWAY 17-92 AND PROCEEDED SOUTHBOUND UNTIL REACHING SR 419. HE THEN MADE A LEFT TURN ONTO SR 419 AND PROCEEDED SOUTHBOUND. AFTER TRAVELING APPROXIMATELY 1.5 MILES, BROWN WAS APPROACHING THE INTERSECTION OF NORTH EDGEMON AND SR 419. BROWN SAW VEHICLE ONE MAKING A LEFT TURN OFF OF NORTH EDGEMON AVENUE ONTO SR 419 IN FRONT OF HIM AND APPLIED THE REAR BRAKE OF HIS MOTORCYCLE. THE REAR TIRE LEFT 121.8 FEET OF SKID MARK. BROWN THEN APPLIED THE FRONT BRAKE OF THE MOTORCYCLE. THE REAR TIRE LEFT ANOTHER 23.4 FEET OF SKID MARK. THE FRONT TIRE LEFT 28.9 FEET OF SKID MARK. AT CRASH THE FRONT TIRE OF VEHICLE TWO IMPACTED THE DRIVER'S DOOR OF VEHICLE ONE AND STARTED TO CRUSH THE DOOR PANEL. VEHICLE ONE'S FORWARD MOVEMENT CAUSED THE FRONT WHEEL AND FORK OF VEHICLE TWO TO TWIST TO THE LEFT. BROWN WAS PROPELLED UPWARDS AND FORWARDS. HIS HEAD AND BODY IMPACTED THE DRIVER'S DOOR, "A" PILLAR, MIRROR AND WINDSHIELD OF VEHICLE ONE. THE FRONT TIRE OF VEHICLE TWO ACHIEVED MAXIMUM ENGAGEMENT WITH THE FRONT DOOR PANEL OF VEHICLE ONE AFTER PENETRATING A FOOT. WHILE THE TWO VEHICLES WERE AT MAXIMUM ENGAGEMENT BLACK CONTINUED TO DRIVE HIS VEHICLE FORWARD. VEHICLE TWO TWISTED TO ITS LEFT SIDE AND DROPPED IN THE ROADWAY ON IT'S LEFT SIDE, APPROXIMATELY 4 FEET NORTH OF THE POINT OF IMPACT. BROWN CAME TO REST IN AN UPRIGHT FETAL POSITION OVER THE HANDLEBARS OF THE MOTORCYCLE. BLACK DROVE VEHICLE ONE STRAIGHT ACROSS THE INTERSECTION, WITHOUT STOPPING, AND STOPPED THE TRUCK IN THE 419 INDUSTRIAL PARK. VEHICLE ONE HAD A DENT OVER THE ENTIRE LEFT SIDE OF THE CAB (6 FT X 4 FT X 1 FT). IN THE DENT THERE WERE GASHES IN THE EXTERIOR SHEET METAL (2 INCHES IN UPPER DOOR, 3 INCHES IN LOWER DOOR). THE DRIVER'S SIDE RUNNING BOARD WAS BENT UNDER THE CAB AND MOUNTING BRACKETS BROKEN, THE DRIVER'S DOOR MIRROR WAS BROKEN AND THE LOWER CORNER OF THE WINDSHIELD WAS BROKEN AND HAD AN 8 INCH X 8 INCH X 2 INCH DEPRESSION/SHATTER PATTERN. VEHICLE TWO HAD THE FRONT FORK AND WHEEL TWISTED TO THE LEFT, AND THE FRONT FENDER HAD A 4 INCH X 4 INCH X 2 INCH CREASE. THE SPEEDOMETER HOUSING WAS BROKEN, BOTH MIRRORS WERE BROKEN, THE HEADLIGHT PS ■ '® PQ.�_IC�' _ WINTER SPRINGS POLICE DEPARTMENT TRAFFIC HOMICIDE INVESTIGATION POLICE CASE SUMMARY PAGE 4 HOUSING WAS SCRAPPED, THERE WERE 5 DENTS ON THE LEFT SIDE OF THE TANK, BOTH PEGS WERE DAMAGED AND THE UPPER LEFT REAR SUSPENSION PAINT WAS SCRAPPED. POST CRASH INVESTIGATION OF THE CRASH REVEALED THE FOLLOWING FACTS, VEHICLE ONE WAS FACING NORTH ON NORTH EDGEMEON AVENUE, AT A STOP SIGN, PREPARING TO TURN NORTHBOUND ON SR 419. VEHICLE TWO WAS SOUTHBOUND ON SR 419 APPROACHING THE INTERSECTION OF SR 419 AND NORTH EDGEMON AVENUE. VEHICLE ONE PULLED OUT IN FRONT OF VEHICLE TWO. BROWN, THE OPERATOR OF VEHICLE TWO, APPLIED HIS VEHICLE'S REAR BRAKE. THE REAR TIRE LOCKED UP AND MADE A STRAIGHT SKID, LEAVING 121.8 FEET OF SKID MARK. AT THAT POINT BROWN APPLIED THE FRONT BRAKE. THE REAR TIRE LEFT ANOTHER 23.4 FEET OF SKID MARK. THE FRONT TIRE LOCKED UP AND LEFT 28.9 FEET OF SKID MARK BEFORE IMPACTING THE DRIVER'S DOOR OF VEHICLE ONE. THE POINT OF IMPACT WAS 31.1 FEET WEST AND 9.4 FEET NORTH OF THE REFERENCE POINT. THE REFERENCE POINT WAS IDENTIFIED AS THE EDGE OF THE ROADWAY 32.3 FEET NORTH OF THE ZERO POINT, WHICH IS LAMP POST#320725. VEHICLE ONE CONTINUED NORTHBOUND ACROSS THE INTERSECTION AND STOPPED IN THE SR 419 INDUSTRIAL PARK. VEHICLE TWO WAS MOVED SIDEWAYS 4 FEET AROUND IT'S CENTER OF GRAVITY, TWISTED TO THE LEFT AND CAME TO REST ON ITS LEFT SIDE. CONCLUSION THIS CRASH OCCURRED ON OCTOBER 16, 2001 AT ABOUT 5:35 PM ON SR 419 AT THE INTERSECTION OF NORTH EDGEMON AVENUE, IN THE CITY OF WINTER SPRINGS, SEMINOLE COUNTY, FLORIDA. THE CRASH INVOLVED A 1991 FORD F150 EXTENDED CAB PICK-UP TRUCK DRIVEN BY JOHN EDWARD BLACK OF 310 LOCH LOW LN, SANFORD FLORIDA, AND A 1996 HARLEY DAVIDSON 883 SPORTSTER MOTORCYCLE, DRIVEN BY JOHN LEE BROWN OF 1036 WINTER SPRINGS BLVD, WINTER SPRINGS FLORIDA. THE INCIDENT STARTED WHEN VEHICLE ONE PULLED OUT FROM THE STOP SIGN LOCATED ON NORTH EDGEMEON AVENUE AND SR 419. BLACK, THE OPERATOR OF VEHICLE ONE, FELT HE HAD ADEQUATE CLEARANCE TO COMPLETE A LEFT TURN IN FRONT OF TRAFFIC ON SR 419. VEHICLE TWO WAS SOUTHBOUND ON SR 419. BROWN, THE OPERATOR OF VEHICLE TWO, SAW OR ANTICIPATED VEHICLE ONE'S MOVEMENT 246 FT PRIOR TO IMPACT. THIS IS CALCULATED USING A 1.6 SECOND REACTION TIME, AT 43-MPH, AT POINT OF PERCEPTION. VEHICLE TWO TRAVELED 101 FEET PRIOR TO SKIDDING THE REAR TIRE 145.2 FEET AND THE FRONT TIRE 28.9 FEET. VEHICLE TWO'S FRONT TIRE THEN STRUCK THE RUNNING BOARD AND DRIVER'S DOOR OF VEHICLE ONE. A CONTRIBUTING FACTOR IN THE CRASH WAS VEHICLE TWO'S BRAKING. WITH THE BRAKES USED AT 100% EFFICIENCY, AT 43 MPH, WITH A DRAG FACTOR OF .90, THE SEVERITY OF THE CRASH COULD HAVE BEEN REDUCED. HOWEVER, IT IS THE CONCLUSION OF THIS INVESTIGATOR THAT THE PRIMARY CAUSE OF THE CRASH WAS THE FAILURE OF BLACK TO INSURE HE HAD ADEQUATE CLEARANCE TO COMPLETE HIS LEFT TURN AND HIS SUBSEQUENT FAILURE TO YIELD THE RIGHT OF WAY TO VEHICLE TWO. A6 esg 'POLIIC— WINTER SPRINGS POLICE DEPARTMENT uPQ ' TRAFFIC HOMICIDE INVESTIGATION ACCIDENT INFORMATION Date of Accident 10/16/2001 Day of Week TUESDAY Time of Day 5:35 PM County SEMINOLE City, Town, or Community WINTER SPRINGS If accident was outside city limits, indicate distance from nearest town. N/A Feet N/A Miles ❑ North ❑South ❑ East ❑ West of(City, Town) N/A Road on which accident occurred SR 419 At its intersection with NORTH EDGEMON AVENUE If no at intersection N/A Feet N/A Miles ❑ North ['South ❑ East ❑ West of N/A No of Vehicles Involved 2 No. of Injured 0 No. of Fatalities 1 Traffic Homicide Investigator Notified: Date 10/16/2001 Time 6:15 PM Prosecutor on Scene N/A Medical Examiner on Scene N/A Other Officers on Scene LT BROXTON, LT FLANNIGAN, LT FUGATE, LT BERNOSKY, INV CABLE, INV MENDELSON, INV TRACHT, INV PADGETT, CPL GOLD CPL WICKMAN, CPL COX, OFC TEW,OFC RANEY, OFC ACCOMONDO, OFC ROUSSELL Photographs Taken By INV CABLE, CPL COX Date 10/16/2001 Time 5:45 PM Photographs (Other than Investigator Case Number 2001024472 Page WSPD Form# 'PO e.c„e 'PONCE- WINTER SPRINGS POLICE DEPARTMENT TRAFFIC HOMICIDE INVESTIGATION VOICE' BACKGROUND INFORMATION Driver JOHN EDWARD BLACK Pedestrian N/A Trip Began 7:30 AM Location SANFORD FLORDIA Purpose GO TO WORK Last Stop Arrived Departed 5:30 PM Location 445 NORTH ALDERWOOD CT,WINTER SPRINGS FL Purpose RETURN HOME FROM WORK PHYSICAL CONDITION Permanent Illness or Deformities: ❑ None ❑ Epilipsy Temporary Condition or Illness N/A ❑ Heart Condition ❑ Hearing ❑ Diabetes ® Vision DRIVER'S HISTORY Familiar With Road ® Yes ❑ No Familiar With Vehicle ® Yes ❑ No 4 Years of Driving Experience 5 Previous HMV Convictions 0 Previous Accidents 0 Suspensions or Revocations Restrictions on Driver License Z Yes ❑ No (If yes, Explain Type) A-CORRECTIVE LENSES Case Number 2001024972 Page 8. WSPD Form# _Pp WINTER SPRINGS POLICE DEPARTMENT -Pp : TRAFFIC HOMICIDE INVESTIGATION BACKGROUND INFORMATION Driver JOHN BROWN [ Pedestrian N/A Trip Began 5:00 PM Location RAY VALDES TAX COLLECTORS OFFICE, 1ST STREET,SANFORD FL Purpose RETURNING HOME FROM WORK Last Stop Arrived Departed Location SR 419 AND NORTH EDGEMON AVE Purpose PHYSICAL CONDITION Permanent Illness or Deformities: ❑ None ❑ Epilipsy Temporary Condition or Illness ® Heart Condition ❑ Hearing ❑ Diabetes ❑ Vision DRIVER'S HISTORY Familiar With Road ® Yes ❑ No Familiar With Vehicle ® Yes ❑ No 40 Years of Driving Experience NONE Previous HMV Convictions NONE Previous Accidents NONE Suspensions or Revocations Restrictions on Driver License ® Yes ❑ No (If yes, Explain Type) MOTORCYCLE ENDORSEMENT Case Number 2001024972 Page 9 VWSPD Form# 'POLICE- WINTER SPRINGS POLICE DEPARTMENT -PO TRAFFIC HOMICIDE INVESTIGATION CHEMICAL TEST INFORMATION Name JOHN EDWARD BLACK ® Alive ❑ Deceased Test Offered: ❑ Breath ® Blood ❑ Urine ❑ Other N/A Was Test Refused: ❑ Yes ® No BREATH TEST INFORMATION Test Requested By N/A Test Given By N/A Date Time ❑ a.m. ❑ p.m. Location N/A Instrument N/A Results of Test N/A BLOOD TEST INFORMATION Test Requested By OFC TEW Blood Drawn By LT MOLNAR Title WSFD Date 10/16/2001 Time ❑ a.m. ❑ p.m. Location SR 419 AND N. EDGEMON Analyzed By NICHOLAS B.TISCIONE, CRIME LABORATORY ANALYST,TOXICOLOGY SECTION, ORLANDO FDLE LABORATORY Results of Test NO ETHYL ALCOHOL DETECTED/RESULTS RECEIVED 12/13/2001 CHAIN OF POSSESSION Received From OFC TEW ByCPL HERRERA Date11/16/2001 Time08:00 ❑ a.m. ® p.m. Received From CPL HERRERA ByDOUGLAS JONES Date11/17/2001 Time11:14 ® a.m. ❑ p.m. Received From By Date Time ❑ a.m. ❑ p.m. Received From By Date Time ❑ a.m. ❑ p.m• Received From By Date Time ❑ a.m. ❑ p.m. ADDITIONAL COMMENTS �o VSPD Form# WINTER SPRINGS POLICE DEPARTMENT up PD���f TRAFFIC HOMICIDE INVESTIGATION VEHICLE INFORMATION (Sheet#1) Post Collision Inspection Vehicle No. 1 Year and Make 1991 FORD Model F150 XLT Type EXTENDED CAB Color(s) BLU/GRY Owner JOHN EDWARD BLACK Address 310 LOCH LOW LN, SANFORD FL 32773 VIN 1FTEX15N1MKA92032 Mileage 65219.3 Weight 6250 Tag No. F87HQH Decal No. 30843997 State FL MVI Certificate No. N/A Expires N/A State N/A Transmission AUTOMATIC Gear PARK Steering POWER Brakes: Front DISC Rear DRUM Type POWER Did brakes contribute to accident: D Yes Z No Explain NIA LIGHTING AND ELECTRICAL SYSTEM Headlights Taillights Tag Lights Stoplights Turn Signals Parking Lights Other Lights Equipped 0 Yes D No ®Yes 0 No 0 Yes 0 No D Yes D Na 0 Yes 0 No Z Yes 0 No ®Yes 0 No Operative 0 Yes 0 No 0 Yes D No 0 Yes D No ®Yes 0 No 0 Yes 0 No ID Yes 0 No 0 Yes D No ®Low 0 High Headlight Switch Position D On El Off Wipers: ® Front 0 Rear Operative: ®Yes 0 No Condition POOR BLADES Horn: 0 Yes D No Operative: 0 Yes 0 No O Air Conditioning 0 On 0 Off 0 CB Radio 0 On 0 Off O Radio 0 On 0 Off D Other BODY EQUIPMENT AND CONDITION Exhaust System Safety Glass Condition Mirror(s) ® Good 0 Good Inside: ®Yes 0 No D Other 0 Other WINDSHIELD BROKEN Outside 0 Yes D No Left Front Right Front Left Rear Right Rear Other Windows D Up ® Down D Up ® Down 0 Up D Down ® Up D Down LF BROKEN Seat Belt Shoulder Harness ® Yes D No ® Yes D No Interior Exterior Other Body Condition 0 Good 0 Average 0 Poor 0 Good 0 Average 0 Poor Padded Interior Head Restraint Other ® Yes D No D Yes 0 N Case Nurhber 2001024972 Page 1\ WSPD Form# VEHICLE INFORMATION (SHEET#2) Vehicle No. 1 TIRE INFORMATION Did tire condition contribute: ❑ Yes ® No Explain Make Design Size Pressure Tread Depth Inside Middle Outside R/F GENERAL XP2000V4 P235170R15 34 2/32" 3/32" 2/ 32" OF GENERAL XP2000V4 P235170R15 30 2/32" 3/32" 2/32" R/R GENERAL XP2000V4 P235/70R15 36 4/ 32" 5/32" 5/32" UR GENERAL XP2000V4 P235/70R15 30 5/32" 4/32" 5/32" UR In. / 32" /32" /32" R/R In. /32" /32" /32" POST VEHICLE DEMENSIONS Front Wheel to Bumper US 2.5 FT R/S 2.5 FT Rear Wheel to Bumper US 4.4 FT R/S 4.4 FT Wheelbase US 12.9 FT R/S 12.9 FT Track Width Front 5.6 FT Rear 5.5 FT DESCRIBE DAMAGE LEFT SIDE OF CAB DAMAGED, DENTED 6 FT X 4 FT X 1 FT, MAX CRUSH DEPTH IN DOOR 1 FT AT BOTTOM PORTION, 3 INCH GASH LOWER DOOR, 2 INCH GASH UPPER DOOR, RUNNING BOARD BENT UNDER AND BRACKETS BROKEN,WINDSHIELD LOWER LEFT CORNER BROKEN 8 INCH BY 8 INCH BY 1 INCH FRACTURE AREA, Case Nuhlber Page I2. NSPD Form# • ,po. � WINTER SPRINGS POLICE DEPARTMENT upp ; TRAFFIC HOMICIDE INVESTIGATION MOTORCYCLE, MOPED, PEDACYCLE POST COLLISION INSPECTION Vehicle No. 2 Year and Make 1996 HARLEY Model 883 SPORTSTER Color(s) RED Tag No.06153A Decal No. 03057887 State FL VIN 1HD4CAM10TY209311 Engine No. CAMT209311 Engine Size 883 Transmission 6 SP MANUAL Gear UNK Weight 500 Mileage UNK MVI Certificate No N/A Owner JOHN LEE BROWN Address 1036 WINTER SPRINGS BLVD,WINTER SPRINGS FL 32708 LIGHTING AND ELECTRICAL SYSTEM • Headlights Taillights Stoplights Turn Signal(s) Horn(s) Other Equipped ®Yes ❑ No ®Yes ❑ No ®Yes ❑ No ®Yes ❑ No ®Yes ❑ Na Operative ID Yes ❑ No ®Yes ❑ No ®Yes ❑ No Z Yes ❑ No ®Yes ❑ No ❑ Low ❑ High Brake System (Describe) DISC BRAKES FRONT AND REAR Exhaust System: ® Good ❑ Other Seating: ® Standard ❑ Other Windshield: ❑ Yes ® No Handlebar: ® Standard ❑ Other TIRE INFORMATION Front: Make DUNLOP Design ELITE ST Pressure 20 Tread Depth 3/ 32' 4/ 32" Rear: Make DUNLOP Design ELITE ST Pressure 20 Tread Depth 3/32" 5/32" Other N/A Helmet: ® Yes ❑ No Eye Protection: ® Yes ❑ No Mirror(s): Z Yes ❑ No DESCRIBE DAMAGE LEFT REAR TAIL LIGHT BROKEN, SEAT OFF, FRONT FORK TWISTED TO THE LEFT, FRONT FENDER HAS 4X4X2 INCH CREASE, BOTH MIRRORS BROKEN, SPEEDOMETER HOUSING BROKEN (UNABLE TO READ MILEAGE), HEADLIGHT COVER SCRAPED, 5 DENTS LEFT SIDE OF TANK, BOTH PEGS, DAMAGED, REAR SUSPENSION LEFT SIDE UPPER PAINT SCRAPED • Case Number 2001024972 Page 13 W$PD Form# 0 WINTER SPRINGS POLICE DEPARTMENT POLICE' TRAFFIC HOMICIDE INVESTIGATION DATA SHEET Vehicle No. 1 Occupant Position DRIVER Pedestrian N/A Name JOHN EDWARD BLACK Alias N/A Address 310 LOCH LOW LN, SANFORD FL 32773 Occupation YARD MAINTENANCE Home Phone# 407-323-7281 Business Phone N/A Business Address SAME AS ABOVE DOB 09-28-46 Race WHITE Sex MALE Height/Weight 505/UNK SS # 263-84-0025 Injured NO Fatal N/A First Aid By N/A Injured Transported To N/A Transported By N/A Autopsy Performed ❑ Yes ❑ No Pronounced By N/A Date/Time N/A Cause of Death N/A Legal Identification Made By N/A Next of Kin Notified N/A Relation N/A Notified By N/A Date/Time N/A Body Released To N/A Identification Photograph Taken: ❑ Yes ❑ No Fingerprints Taken: ❑ Yes ❑ No Personal Property Removed By WSPD Personnel: ❑ Yes ® No Seat Belts/Shoulder Harness Installed ® Yes ❑ No In Use: ® Yes ❑ No Ejected: ❑ Yes ® No If yes, through N/A • • I. Laceration 5. Internal Injury 9. Partially Severed 2. Abrasion 6. Burn 10. Severed 3. Contusion 7. Simple Fracture 11. Complaint of injury 4. Puncture 8. Compound Fracture 12. (specify) Additional Information (Hit-and-Run) Evidence Obtained: ❑ Hair ❑ Blood ❑ Clothing ❑ Skin ❑ Shoes ❑ Other Laboratory Information Case Number 2001024972 Page I'♦ WSPD Form# ❑p WINTER SPRINGS POLICE DEPARTMENT up ' TRAFFIC HOMICIDE INVESTIGATION DATA SHEET Vehicle No. 1 Occupant Position FRONT SEAT PASSENGER Pedestrian N/A Name IRA FREDERICK BLACK Alias N/A Address 220 PINE WINDS, SANFORD FL 32773 Occupation YARD MAINTENANCE Home Phone# UNK Business Phone UNK Business Address 310 LOCH LOW LN, SNAFORD FL 32772 DOB 55YOA Race WHITE Sex MALE HeighWVeight UNK SS# UNK Injured NO Fatal NO First Aid By N/A Injured Transported To N/A Transported By N/A Autopsy Performed ❑ Yes ❑ No Pronounced By N/A Date/Time N/A Cause of Death N/A Legal Identification Made By N/A Next of Kin Notified N/A Relation N/A Notified By N/A Date/Time N/A Body Released To N/A Identification Photograph Taken: ❑ Yes ❑ No Fingerprints Taken: ❑ Yes ❑ No Personal Property Removed By WSPD Personnel: ❑ Yes ® No Seat Belts/Shoulder Harness Installed ® Yes ❑ No In Use: ® Yes ❑ No Ejected: ❑ Yes ® No If yes, through N/A • I '1I • 1 ' • bbbfff 1 ' 1. Laceration 5. Internal Injury 9. Partially Severed 2. Abrasion 6. Burn 10. Severed 3. Contusion 7. Simple Fracture 11. Complaint of injury 4. Puncture 8. Compound Fracture 12. (specify) Additional Information (Hit-and-Run) Evidence Obtained: ❑ Hair ❑ Blood ❑ Clothing ❑ Skin ❑ Shoes ❑ Other , Laboratory Information Case Number 2001024972 Page 17 WSPD Form# egiatti _P,O a WINTER SPRINGS POLICE DEPARTMENT util MCP TRAFFIC HOMICIDE INVESTIGATION DATA SHEET Vehicle No. 2 Occupant Position OPERATOR Pedestrian N/A Name JOHN LEE BROWN Alias N/A Address 1036 WINTER SPRINGS BLVD,WINTER SPRINGS FL 32708 Occupation COUNTY WORKER Home Phone# 407-695-1851 Business Phone UNK Business Address 1ST ST,SANFORD FLORIDA 32773 DOB 03-27-52 Race WHITE Sex MALE HeightNVeight 506/UNK SS 4 264-15-1118 Injured YES Fatal YES First Aid By LT STEVE MOLNAR Injured Transported To ORLANDO REGIONAL MEDICAL CENTER Transported By LIFE FLIGHT Autopsy Performed Z Yes ❑ No Pronounced By UNK Date/Time 10/16/2001 Cause of Death COMPLICATIONS FROM BLUNT FORCE TRAUMA Legal Identification Made By UNK Next of Kin Notified YES Relation WIFE Notified By LT BERNOSKY Date/Time 10/16/2001 Body Released To WIFE Identification Photograph Taken: ❑ Yes ® No Fingerprints Taken: ❑ Yes Z No Personal Property Removed By WSPD Personnel: Z Yes ❑ No Seat Belts/Shoulder Harness Installed ❑ Yes ® No In Use: ❑ Yes Z No Ejected: 0 Yes ❑ No If yes, through N/A MOTORCYCLE• • I p• , 1 , ( ch.1 .. .. • i 1 1. Laceration 5. Internal Injury 9. Partially Severed 2. Abrasion 6. Burn 10. Severed 3. Contusion 7 Simple Fracture 11. Complaint of injury 4. Puncture 8. Compound Fracture 12. (specify) Additional Information (Hit-and-Run) Evidence Obtained: ❑ Hair ❑ Blood ❑ Clothing ❑ Skin ❑ Shoes ❑ Other , Laboratory Information Case Number 2001024972 Page I(p WSPD Form# V_ WINTER SPRINGS POLICE DEPARTMENT tp' TRAFFIC HOMICIDE INVESTIGATION SURFACE MARKS LEFT BY VEHICLE "" Vehicle No, 1 Surface Marks left By Vehicle Z Yes ❑ No (If yes, complete the following) Prior To Collision Right Front: Skid Marks Gouges Scuffs Furrows Right Rear: Skid Marks Gouges Scuffs Furrows Left Front: Skid Marks Gouges Scuffs Furrows Left Rear: Skid Marks 4.2 FT Gouges Scuffs Furrows After Collision Right Front: Skid Marks Gouges Scuffs Furrows Right Rear: Skid Marks Gouges Scuffs Furrows Left Front: Skid Marks Gouges Scuffs Furrows Left Rear: Skid Marks 2 FT Gouges Scuffs Furrows Type of Pavement ASPHALT Condition NEW Grade Percent 6.25 Superelevation 0 Drag Factor .90 Test Skid Marks Date/Time 10/17/2001 12:00 AM Temperature 80 DEGREES Drag Sled E Point Loading ❑ Additional Comments Case Number Page 17 WSPD Form# SPA WINTER SPRINGS POLICE POLICE TRAFFIC HOMICIDE INVESTIGATION SURFACE MARKS LEFT BY VEHICLE Vehicle No. 2 Surface Marks left By Vehicle ® Yes ❑ No (If yes, complete the following) Prior To Collision Right Front: Skid Marks 28.9 FT Gouges Scuffs Furrows Right Rear: Skid Marks 125 FT Gouges Scuffs Furrows Left Front: Skid Marks Gouges Scuffs Furrows Left Rear: Skid Marks Gouges Scuffs Furrows After Collision Right Front: Skid Marks 1 FT Gouges Scuffs Furrows Right Rear: Skid Marks 1 FT Gouges Scuffs Furrows Left Front: Skid Marks Gouges Scuffs Furrows Left Rear: Skid Marks Gouges Scuffs Furrows Type of Pavement ASPHALT Condition NEW Grade Percent 0 Superelevation 6.25 Drag Factor .90 Test Skid Marks Date/Time 10/17/2001 11:45 AM Temperature 80 DEGREES Drag Sled ® Point Loading ❑ Additional Comments Case Number2001024972 Page )% WSPD Form# dal WINTER SPRINGS POLICE *OW QQ���f TRAFFIC HOMICIDE INVESTIGATION PHYSICAL EVIDENCE Initial Point of Collision FROM LAMP POST#320725, NORTH 32.3 FT TO EDGE OF THE ROADWAY ON SR 4119, WHICH IS REFERENCE POINT. FROM REFERENCE POINT 31.1 FT WEST AND 9.4 FEET NORTH Wdth of Roadway(s) 57.6 FEET Surface Composition ASPHALT Did roadway contribute to accident ® No ❑ Yes If yes, explain Radius of Curve 182.375 FT Roadway Characteristics (Describe) SR 419 CURVED,WITH 6.25% SUPERELEVATION IN THE SOUTH BOUND LANE Type of Centerline Marking DOUBLE YELLOW LINE Was Edge Marked ❑ No ® Yes Traffic Control Devices STOP SIGN AND 20 MPH NORTH EDGEMON Weather Conditions CLOUDY Lighting Conditions DAYLIGHT Visual Obstructions NONE Width of Shoulders 4 FEET Distance of drop from pavement to shoulder FROM 0 TO 1 FT Condition of Shoulders GOOD Did shoulder appear to contribute to accident Z No ❑ Yes If yes, explain Area ❑ Residential ❑ Business Z Rural ❑ Other Speed Limit 55 Mph on SR 419 Erected YES Date Erected OCT 99 Speed Limit 20 Mph on EDGEM Erected YES Date Erected UNK Case Number 2001024972 Page Iq WSPD Farm# Vd 32 //9 r Ltc�9tm ow ,out ,T' 1 19 a CI)roter ,SP-iny: F/a,vc4 ` 4 ufia.,. ce,n//elln/ 6y: I D ✓anwu CO,z/rxa s A Dc/e + Tme eF Alea+✓.-•/In , J \vl it^j/dj 20�/ aed AH J U ay, L,{ F(a...3 4$ cp/. 1.41:e400o e% re U a VI • B m^n Qac V7 I re - c i N — VI D VI D O b to f{ sc Ft 2P 1 Case # aoaiodyv�z DSC i4Vi6/zee/ new: %73,s P10 e5 el .4 ✓44'G/l .7 tea,- 8 C .errof S,y/q C Ve6, /e I et, "nor VI , I Velcc<Ie J —4, VAh,/1/ I pafL prrar k- l,xperf — + ✓eLle I 10a1-4 alias- / ,H/,«/ VeiL,Je a p,/e•, 4 ;,np«-i CS Vtic,cle a a+ it # 6 . > Ga.�. - /7/e the I —CL_ Slap S', O tarty 4.1 3-la 71s- (Ze.< ZP Q00/O 15/772 Did FLORIDA TRAFFIC CRASH R ORT $ LONG FORM ❑ SHORT FORM oo NOT WRITE IN THIS SPACE MAIL TO DEPT. OF HIGHWAY SAFETY&MOTOR VEHICLES TRAFFIC CRASH RECORDS TALLAHASSEE,FLORIDA 32399-0500 DATE/OIF CRAS/H� TIME OF CRASH TIME OFFICER NOTIFIED THE OFFICER ARRIVED INVEST.AGENCY REPORT NUMBER HSMV CRASH REPORT.NUMBER /0I/TaIo' 5-JcnM®PM ) q/ DAM RPM 5 t2 fM©PM iCO10 +-lc/ L2. 58377505 7508 m COUNTY I CODE Fen en Mlles N S E wr CITY OR TOWN (Cad A In CJy or Tow) COUNTY o 17 10 01-175 (L SPRiNC S /2 S nuNci.0 a6 AT le I �'I NEXT NWE NO. NO.OF LANES ��-� ON STREET.ROAD OR HIGHWAY E 2 11 l 2 UNONIDED S IK (-4 1 'f F-RTWIERSECIIOIIOF or. FEETIMLES H..-...:5 E CU-,.OFINTh%CTIg10F . N. ab6ernaN /ONE 10 2n n=raf - _ ' " ` DRIVER I Pram �� '/� YEAR MANE ..TYPE 115E VEH..UCENSE NUMBER STATE VEHICLE ID9(NFICATON.NUMBER . rT 2 I i 5 8 I gRIWT OF IMPACT ACTION 2HX&Rem 1 / [A F it rextSzr K/} 2D3Z 5 xIA r ' Fie' "Q3 fPF F$`f .. ®f��� ' DAMAGE 5 NFFoRMAIIDN TRAILER TYPE M II 10 A 18 Ulnwrage e __ YW C V ICLE TIUV, NNG,y�, ON Al Est MPH Posted Sped EST VpE CIECAFIAGE; 1 Disabling CALLER DAMAGE 21 Fre01n ill 5 Z L11C1 10 51 §F 'Fi0C%OE e e Pa 11 Tram Damage INSURANCE CatieNt OREIRf, ,-.::::/,,,,: ,,-;Iq[ICTIIIRBESr, VEHICLE REMOVED BY'. I ow Rotation list 3 OMMB e r "tte.a.1' ttaBF-AG (M e-t t3X ''f TKA CouAtT`/ T0c32 Td.C4144144 Rppt 4 ann j OYAEAS Ntte)ee tlMFT,t,..¢Drree ,�, re �+.ac� dIRAENT�Ala1IX�E�SSRMobenrd SUeat M QD`ANDSTAiE :212W[E: 1 NCR' eXNBe CURRENT ADDRESS Number and Slag CITY AND STATE DP CODE c ST!(EwaFeNm IARVUwnuKlhtlpMSrj+ 7412.PF„„rh '�'.M,F�eeyj'W»�"�i{y •CtRRETT DTESSPIIImdai°IM trwq'x 4np,. 6STA1.Ey4y�}r'[eLOEa, LMTEOFBIRM -2 3764/4. W '..�� . .;:AC.>`-L eic,,I U� heft. LAST s CSAAReLliii } tOt Star ic, .,1b�t-2BrK0 Th. OPNER.IICENSB N4f,EEW y� WIE ■ SAC IESii Urro RESULTS ALIDRUG PHYS.DES RES Jae& Tin SEX NJ. S.EQUIP EJECT. HAZAAWUS MATERIALS I Yes 2 No PLACARDED I Yes 2 No RECOMMEND I Yes 2 No II YES.Eepnn in DRIVER'S PHONE NO. SENDNGERSNAMTRANSPORTED ^ Ft El ADDRESS RED 7dTY SAIEIDP u0� E`LW. ?IW.�S.EQUIP EJECT.! PASSENGER'S NAME(Ackleonel on Cane/law Page) CURRENT tRrA FL'ZQICK 6L dL ,¢,:c PINE wYA:C5 Sr'YATFc2o FL 52.773 SS 3 i I I I DRIVER 1 Phantom YYEARV B . MANE ' . THE USE; CVEM;,UCENSE,NUMBEA;TATE YEHIC[EWENTIRGi�INUMBEA y , PONT OF IMPACT ALTW 2al.A Run 13 "1*" #Ik : : 'IO ©( 01�1"I534 .F�1Ri4CRn.fir I2b' 31.1 - 5 3 A s 5 rAREAOF I S ratan EJO� E' TRAILER TYPE OQ(01m I DAME E e 2oMania C VEHICLE TPAVE NG ON At En MPH Posted Speed EST VEHICLE DAMAGE., I Omaha TRAILER DAMAGE 21 Fire t 51 � 04 ri S R 41 G u k 5S $ 'OOQ' 2 3 No Dames Fr $ w 71 I u NSLVUNCECOMPANY WOO OR PERT PWCONIAWER. VEHICLE REMOVED BY'. �iN RMatan lit 3 Dover f�£LSrA 04/595-61-0,014 4_0.9 0/9I 7RI C_•T.lury TOG:: era.oMwr'aw91w a Other l Li Nj ,IaNNFA'sNLLNMIEICROtB4FWI LLRPQT:ADORE55(NUmtw.and SRwR JaTV PND SIAIE. . ;DP WOE. 2 OWNER'S FULL NAME TIRmTfm altalt le) CURRENT ADDRESS(Number and SireeI) CRY AND STATE } DP CODE cD RIVER(Eaatlln as on DOM UtgnM)I Pedelme CURRENT ADDREsse rtrmd Saab CITY&STATEIZIP CODE DATE OF SRC 2 -'ic 5.5A-} 'W. BRxuonl /034, A4A7E + .nRea.Z4 l ub aArNt' _ 50.; FL 3270$ 3' 7 S,7( Cr) DRYER ULIIEENUMOER " h�? ) STATE i. Im�." BAST 3 URN RESULTS ALIDRUG PHYS.DEC. RES RACE SEX. INJ S.EQUIP. EJECT . Al4cc JC NC 1 r "51 2BmN 5Nm° I i , L1IM % I I I I 5 5I I HAZARDOUS MATERIALS J Yes 2 No PLACARDED I Yes 2 No RECOMMEND I Yes 2 No If YES,Explain in DRIVERS PHONE NO. BENG TRANSPORTED REFYAM Fl VI n ® ❑ R NaUffire 40j 1 109;5. CURRENT ADDRESS CITY&STATE IOP AGE LW. ICU. S.EOUIP EJECT. VFmn F 1YFF I VFNIFI F lISP TRAIT FR TPF I SFSNFNrF Oar w(Mai PHYSIrAI OFFERS Al mHi I MUG INF LOGPON PI AutemrbM 01 Pmma Tanynmmm ml Stye Sam Trailer I County 01 CraN 1 No Delon Frown Nor GIhEVg or Using Pugs IIn"hide) 02 Prager Van 02 Commercial Pasngere 02 Tandem Sem, 2 HIaMwe in Stare 2 EJmaM Defect Alcohol-Undo Influence I flora TeX C w Pickup/Light Truce 03 Cameral Cabe Tama 3 NmAeWMI N 9tla 3 Fatigue/4410V Drugs-Under ace 2 F.an CmM O 12 rear 0311 04 PWt Transportation w Tank Trailer Ftreon 5 Unknown 4 Hearing Dam AYUS 5 Dings-Urta Influence 3 F,M Fq t NM Malum Tna 14 x1 * 05 hale School Eva N Saddle MoMI DL ryFE ma 5fl Htl&M Dairy a Pow'Lift w Sa mom r ee Main hem Bt RYM B S¢ua.Epbpy.BIS4t PerLL'nc B.AC Ted Remit 5 Rev Gnrs E Ito acavCI Or Ambulance 05 Bost Reim IA zR 5c JPTdl. glwPRryal Ue1M aRev YQt `p w Ronk Home IICa) w la Roscus stl 06 House raev DICMUmw 2 BIYx I JURY SEVERm SAFETY CURRENT IN USE 7 In BO]r a RU'J. 07 Motor Mane IRV) w FMWmr 07 House rreem 5 ElOpta :xIpiMF 8 Bu Pvapo w Bus 10 When/ w Pole inter B EIOpc i OBMr 2 ,F Sett PO U°°/%MNt Hvay 9 Ms tEt4 In on w&qw II Mr cwwmmem w Towed vanes 7 none d Non P0.11 spy R®psp EJECTED T 10 a nOXw 77 Other REQUIRED SDI 51Fem 44/1141n 90 Ak 8.0 w 1Yw 0S 12 la Temp Vehicle ENWR$ENFNIS J MS B NTTIe1k Fataoly SS POMNL 9 Yet ti Train 2 FS,IF POthr 1st 2 N 9NR HSMV SN:V(195)S r ti' R 1 Fnantom YEAR MAKE TYPE USE VEH.LICENSE NUMBER STATE VEHICLE IDENTFCATON NUMBER 3 a 5 6 2 POINT OF IMPACT ACIIO 0 HA&Run 2� 4�_ ABE OF 8 TRAILER OR TOW HICLE 1 TRAILER TYPE I ®��Im6 OAM4GE e INFORMATION la I pl 12 III10 9 *Overturn t8 Undercamage M VEHICLE CRAVE NG ON Al Est MPH Pos1M Speed EST VEDICLE DAMAGE I Disabling _ EST.'.RAILER DAMAGE 20 Windshield r-ki t— h r 2 Functional zl we 5 3 No Damage 5 22 Tzar I yINSURANCE COMPANY VLJABILILY OR RP) POLICY NUMBER VEHICLE REMOVED BY 2 Tow Ln 3 Dm* n 2iw Dyne Regp aaher A c j OWNER'S FULL NAME(Oatltd DrherG ex CLMFM ADDRESS(Number and Sleet) CITY AND STATE ZIP CODE 3 OWNER'S FULL NAME(Taller a Towed Vehicle) CURREN ESS Pumper and Seen) CITY AND STATE DP WOE a ORWFAEvasyasm pnvtbnaelJ PeNSMan CURRENT ADDRESB*Set j. [iCl&SPAT;I DPWOF " OAlE0FBI0.TI aDRIVERUCENSE NUMBER L STATE icc a BAC TEST 3 Una RESULTS AL,DRUG PHYS OEF. R RACE SEX a IN.) S EQUIP EJECT. d '^` �d 2 BrealA 5 Nona % HAZARDOUS MATERIALS 1 Yes 2 No PLACARDED 1 Yes 2 No RECOMMEND I Yes 2 No If YES Ewan In DRIVER S PH 0. BEING TRANSPORTED Fl Fl REE%AM 1-1 Nemdve ( 1 Fl PASSENGER'S NAME(Addawd on Communion Pagel CURRENT ADDRESS CITY 6 STATE/ZIP AGE LOG lNI. EQUIP EJECT. I k. VEXCLFS. ,;ESTANOUNC QWNFFBNPNE ,; xA00PE (]['k fifATE ZIP. PAOPEFMOMUGEIl OTHER➢MNVEINCLES EST,AL WLI ADDRESS' OTY ,STALE ..Zt WNTNBUTNG CAUSES-DRIVERIPED. VEHICLE DEFECT VEHICtEMOVEMENT. . VEHICLE SPECAL FUNCTIONS 01 Nolmprna Driving/Action I 2 3 01 NoWelects I 2 3 01 SeaglAhead I 2 3 I None 1 2 3 02 Canes Drab ( 02 Dei.Braked ox 9bxxgl SUppedl9abd 5 2 Fnn 03 Fated to end Rigr.Fway c 3 C -,\ 03 Worn/Smooth h Trim Z� 77 \ 0.3 Making Lan rum 63 OT \ 3 Poke Purwi 04 Impr[gr Barking Ca Palmer Improper 04 Backing 4 Reck/Pon& 05 'macaw Lane Change �) Lights 05 Maaing Right Tun 11 Passing 5 Emergency Opera:au 06 Improper Turn CP 05 Please/Blowout \ 06 Changing Lanes f2 Dneness w B CaswdcniNantene 07 AaonolUmer Influence aT \ 06 Steering Meth \ \ 07 Entering/Leming Raking Space Runaway Veti ng Drug-Under Influence 02 WindsAidd Wipers 08 Properly Puked 77 Al Other 09 Akohd&Drugs Under Influence \\IN \ W Equipment/Vehicle 77 al Othe 09 Improperly Parked (Explam in 10 Followed Too Closely Dena IExplem in Nanalrvel IC%eking U.Twn Narradvel II Disegaraed S Traffic Sgna LOCATION ON ROADWAY PEDESTRIAN ACTON LOCATION TYPE 12 Exceeded Soh Sped Urn 19 Improper Load 13 PSregarded Slop Sign 20 0eregaroea Other I On Road I 2 3 01 Oossing Nd at Wernam 07 Other Wining 1 2 3 la Fared to Magian Equip/Vehicle Traffic Cater 2 Ng On Read 02 Crossing at Pea&Gaswa in Road I Wrap 15 D^aMer Pass 21 Dm+ng Wrong Side/Way 3 Shaker 03 Capp a Inlmbrvi 08 SW9 I( Business 16 Drove Leh M Tinier 22 Flaking Nee a Median ' \ 04 Wring Along Red WO sl Traffic Traffic In Road l\ \ \ 2 Piny* 1 17 Exceeded Staled Speed Unit 23 Vehicle Waked s Turn Lane) 6 Waking IkVeh in TRMC W.Wing in 7AN aM IEW P""NRa 18 Obstructing Traffic 77 NI Offer(Erna* Salary Zone 06 Wuang on Vehicle s Pad Penske)card M Unknown 3 Caen Country FIRST I SUBSEQUENT HARMFUL EVENT ROAD SYSTEM IDENTIFIER LIGHTING CONDITION 01 Collision With MV In Transport(Rear-end) 15 Colleen MIA Mima 29 MV Ran Into 1TICNCuSM 01 Interstate 0]Fnnl had 01 Daylight 02 Caleon With MV in Ramped(Headanl 16 MV Hit SiiS)gn PM 30 Ran Oft Road Into Water 02 U.S. 77 Al Other I 02 Dun 03 Cellar Wnh MV In Trasport(A2g*) tT MV Hit U9LN PdeaigAI Pole 31 Overturned 03 State C 03 Darer 04 Galleon WO MV In Ira-moat(LM Tun) 18 MV MI Guardrail 72 Oaupant Fell horn Vehicle 04 County J M Dark(Street UgMI C 05 Colson With MV in Transport(Right Turnl 19 MV He Fence 33 TmMlTrukt Jacketed 05 Local 05 Dark(No Street Light) 06 Colson Well MV in Transport(SiWSMpf 20 MV Hn Concrete Berner Wall 3a are 06 lavnpike/Toll M Unknown 07 Canon WW1 MV in Transact(Backed Into) 21 MV He BddQNPIerlAbutmenMal 15 EONSipn 08 Conant With Parked Car 22 MV Hi Tree/Shrubbery i1 All plMr EWaIn] ROAD SURFACEiCQV01TON WEATHER ROAD SURFACE TYPE 03 Colleen With MV n Other Roadway 23 Galleon WM Construction BnnadeiYgr F S 01 D n Car 01 91 1Granll6ldne 10 Cason WO Pedestnan 24 Calias MA Trak Gad W N 11 CcMbn Wall Bicycle 25 Cdbs'n WAA Crash Attenuators 02 Wet 02 Gpgy 02 BIMMp 12 Colleen With Bicycle(Bike Lane) 26 Cason With Fixed Object Above Road G'{ \\ ng SAPP Q j 03 Ran C77 W Back/Block C,? +3 Cdlsim With Moped 27 MV Hit Other Axed Obpd a pct Other IE a al Oa Concrete 04 WIIISon With Train 26 Collision WIC Maeade 0bpct On Ron pan) IEpal 05 Din 77 All Other IEpknl CONTRIBUTING CAUSES ROAD CONTRIBUTING CAUSES TRAFFIC CONTROL SITE LOCATION TRAFFICWAY ENVIRONMENT CHARACTER 01 No Detects 01 V lot Obscured 01 No Control I1 No Passing Zone 31 Not At InnmectonI RR Wing/Bridge • St'agM-Less 02 0bstrxbon Willa Wrthout Warning 02 Inclement Weather 02 School Zone 77 All OIAer LEA aim) 02 At Intersection 2 SbagaUpgredel 03 Road Under Repair)CnsWCtwn 03 Parked!Slopped Venda 03 Traffic Sgns as Influenced By Iniersecflm Downgrade M Loose Sudace Manuals 04 Trees/Crops/Bushes 04 Stop Sign M Driveway Access 3 CurveleM 06 Hdee�ulIUnsafe Paved Edge �i 06 CV Vehicle Object C' 06 Flashing age Lae C4 06 Bridged Crossing C-� 1CDonwnngUadedal CT Standing Water \ 07 Signs/BObcnds \ 07 Railroad Sgna \ 07 Enema Ramp '1 Pnate Paopoly TYPE SHOULDER l 08 Womlh4shed Road Sadace 08 Fog 08 Offcerl Guard/Ragman 08 at Ramp P All Ogler 1 Pak % 77 All other(Explain) 09 Smoke CO Pons No UTurn W Parking Lot Pubic IExelan 10 Glare P MI Other IExutam8 10 Soeca Sped Zone 10 PUNK Lot-Prone ) 2 Unpaved 3 Curb V%BA1RF ,.:::ELSTATUTENUMBER'.: FUME --'T- CNINBE - OTATEBtP.°�' . _ 'T ' .cr3:1;), 'ih i . s. .+'dam - s r.s t r a _ y! 4. R rx :,-- --- ,F. $ v W C �#-. : 'Mx .ems�„3, 'V"1:<" , a. .. £<„h-....are— - s ti FLORIDA TRAFFIC CRASH ..SPORT NARRATIVE/DIAGRAM DO NOT WRITE IN THIS SPACE MAIL TO: DEPT.OF HIGHWAY SAFETY B MOTOR VEHICLES TRAFFIC CRASH RECORDS TALLAHASSEE,FLORIDA 32399-0500 EMS INFO TIME EMS AM PM TIME EMS AM pM COUNTY CITY CODE DATE OF CRASH INVEST AGENCY REPORT NUMBER HSMV CRASH REPORT NUMBER FATALS NOTIFIED ARRIVED — ONLY Soo rl® SIIa rl® I�411c )o–I�-ol ace lr.�aUq;a �t�3�7seS NAP TIVE I ADDITIONAL PASSENGERS VEN/GL� / c✓AS 5T6GReq) AT 777-c 570? S764-1 an/ N. c. 66p7oN FFeF , 71' SR S/69. Ct`rHCCE a SAS SOd7hfLa2I4' cN SR Ll/9 A4P224Crn4U6 /v, 2--666-466N Lc eH,ct6` / PucC6d oN7 6N7o SRL/9 7o MAKE A CdF7 1,4/✓0 fzin°ry Ta oR7d6avN • Log/LE cCE / LuAS c/eosS/BUG 77h6 SauiN 3CU.v/) U1NL , (rfl /cc E ,9? 57/2uc/c 7/n= 6eF7 UCN/CCE / 4 r TNe 6AI A C , 75N/CLE a /f%7) AT-TerrAPTerri 70 5r)/' tiur cciAS unv4BLE 7u c.)c 5-c 6c C.4usC ve-thct( / /f90 /!a/ t(F7 (5tO /6I/ SPACC F4C L,'c nCCC 2 7c /°e4C7 I,�SSN/CLE / C&VT/Nt CO ,4C/:CSS S,2 y/9 RR,E'k/N6 14r TNT / /ti7C,C 5,-"f47-6±, /4buS77 ,1C PAR,f• K%Oi J 6CTCCiS ARC K/L/OLc/J 7o CZ'/57 cN crir-Qtck 12N/GGC 47 7710 774/r oF T/t/S ,t ccfceT. u67R b6/r/CCS & &/ C MCL Fc2 Cc:/D7/Aic // 6 /n, /65T/0a7/cnf. SEC PASS Safely X X PASSENGER NAME ADDRESS CITY d STATE ZIP Age Loc. Inl. Equip. Elam '–tlIBMWR-- -Ey$TMUTE NUMBER NAME CHARGE ORATION – VIOLATOR FL STATUTE NUMBER NAME CHARGE CITATION WITNESS.NAME ADDRESS CITY&STATE ZIP —^ Ro2DELT !✓l (e t4‘3 RkA)PPPL€ PL. ovitoa FL 32 7(0 5- WITNESS.NAME ADDRESS CITY&STATE ➢P 2 w)buam PowtzL /3voy adysscy ue€ wny cQCAAiDD FL 32.5'22 FIRST AID GIVEN BY-NAME I Physician or Nurse 1 Certified In Amer INJURED TAKEN TO-. BY-NAME 2 Paramen[or EMT 5 Other aII G. R .IY) C 3 Police Officer _ . WAS 1 YES 2 NO WHERE? IS INVESTIGATION I YES F2 NNIO WHY? DATE OF REPORT PHOTOS I YES 22�NO 3 INVEST AGENCY 4 OTHER INVESTIGATION AI(T SCENE n COMPLETE' ^ 01 T�I I /I 01/1 C ti TAKEN? N I ® 1 INVESIMATOR K&SIGNATO' .... ID I BADGE NUMBER DEPARTMENT IyJ - RIP 50 CFO OTHER ore.R.7-E-3 Cal1111.■ /3'-! Gu��/N7pz s'a/,iGS /6cmT • • ►.7 • HSMV 90005 Nev.1195)S Page 3 d W Pages • DIAGRAM NOT TO SCALE, INDICATE NORTH WITH ARROW Sh419 .Fz \ ww1�e rziiL,as AZeC_ �A I a«srzlAt- 0‘ IMPACT cb6E 1cti ;ve Page Y a 4, Pages FLORIDA TRAFFIC CRASH-"SPORT El E CONTINUATIOE. DO NOT WRITE IN THIS SPACE • MAIL TO'. DEPT. OF HIGHWAY SAFETY&MOTOR VEHICLES TRAFFIC CRASH RECORDS TALLAHASSEE.FLORIDA 32399-0500 COUNTY/CITY CODE DATE OF CRASH INVEST AGENCY REPORT NUMBER HSMV CRASH REPORT NUMBER LI \no Io—I .R —GI a00(OayQRn; Sb'3T5�5 0 Iohanlom YEAR MAKE TYPE USE YEN LICENSE NUMBER STATE VEHICLE IDENTIFICATION NUMBER POINT OF IMPACT ACTION IIBRun Fi 1 3 • 5 R I CIRCLE 3 Im (OIWA AREA OF S, TRAILER TI TOWED LE TRAILER TYPE Q� DAMAGE INFORMATION IA 13 II 10 Ig�eeamage e 20 W'ntlshieltl C VEHICLE TRAVELING ON At ES: Posted EST VEHICLE DAMAGE IDifabling EST.TRAILER DAMAGE tI Fire E ">� 2 Functional E 22PaiW 1 s S Na Damage INSURANCE COMPANY'LIABILITY OR PIP( POLICY NUMBER VEHICLE REMOVED BY 4 Tow 0 \ 2 Tow DwANe RQgmeK 3 Other n OWNER'S FULL NAME(Check if Driver) CURRENT ADDRESS(Numbs,and Sheen CITY AND STATE ZIP CODE rl OWNER'S FULL NAME(Trailer a Towed Vempe) CURRENT Ae:r 55 Wamoer and Street) CITY AND STATE ZIP CODE 1- DRIVER Healy as an Driver Licenser l Pedestrian CURRENT ADDRESS Member and ..: CITY&STATE ZIP CODE DATE OF BIRTH DRIVER LICENSE NUMBER STATE a hies BAC TEST 3 Unne RESULTS ALIDRUG PHYS.DEF RE RACE SEX INJ. S EQUIP EJECT rued �o I Bleed 4 Refused 2 HAZARDOUS MATERIALS I Yes 2 No PLACARDED( I Yesah 2 Nome RECOMMEND I Yes 2 No If YES.Explain m DRIVER'S PHO - a BEING TRANSPORTED 11 n R 11 RE-EXAM Narrative PASSENGER'S NAME(Additional on Continuation Pagel CURRENT ADDRESS CITY&STATE:ZIP AGE LOC INJ. '. sUIP EJECT. Cq Phantom YEAR MAKE TYPE USE VEH.LICENSE NUMBER STATE VEHICLE IDENTIFICATION NUMBER POINT OF IMPACT ACTON rt 3 Run USE 2 3 I 3 I I CIRCLE 3NI ' Enos AREADF $ TRAILER OR TOWED LE TRAILER TYPE E DAMAGE INFORMATION 13 Uoarranage Q u 13 I Ii II I 19aenurn N W ON Al Est MPH Posted Saved EST.VEHICLE DAMAGE I Deeming EST TRAILER DAMAGE A Fire tlsmela C VEHICLE TRAVELING 2 Functional 22 Trailer S 3 No Damage s INSURANCE COMPANY LIABILITY OR PIP) POLICY NUMBER VEHICLE REMOVED BV 0 1 Tow Rotation 01 3 Driver n 2 Tow Owner's's Nuns 4 Other OWNERS FULL NAME,ICheck it Driver) CURRENT ADDRESS iNumber and Streell CITY AND STATE ZIP CODE T1 OWNER'S FULL NAME(Trailer a Towed`leh¢lel CURRENT+:: SS(Number arw Street) CITY AND STATE LP CODE -F DRIVER IExaciy as on Driver Lrenwl I Pedestrian CURRENT ADDRESS(Number and -I CITY d STATE I ZIP CODE GATE OF BIRTH DRIVER LICENSE NUMBER STATE EL PEG BAG TEST 3 Urine RESULTS AL DRUG PHYS.DEF. R RACE SEX INJ. S.EQUIP EJECT PIPE' 1 Blood a Refused n D 2 Bream 5 None n et) HAZARDOUS MATERIALS 1 Yes 2 No PLACARDED 1 Yes 2 No RECOMMEND t Yes 2 No N YES.Explain in DRIVERS PNOM1L�yD. BEING TRANSPORTED ^ 7 I1 7 REEXAM 7 El Narrative \ PASSENGER'S NAME(Additional on Continuation Pagel CURRENT ADDRESS CITYIB STATE I ZIP AGE LOC. INJ. 00IP EJECT I INVESTIGATOR-RANK AND SIGNATURE ID/BADGE NUMBER DEPARTMENT HP SO CPD OTHER 0 R C R-Tr - )3v Lti'r ILL rLlrz `LPI2L t pouch 7 7 N 11 HSMV 90004(Rev.11192)S Page_ Ca oliCom =agea --PROPERPI➢pMAGED-OTHER THAN VEHICLES EST.AMOUNT OWNER'S NAME ADDRESS OTT STATE ZIP p PROPERTY DAMAGED-OTHER THAN VEHICLES ES.AMOUNT OWNER'S NAME ADDRESS Cltt STATE ZIP 2 • q PROPERTY DAMAGED•OTHER THAN VEHICLES EST.AMOUNT •• EP S NAME ADDRESS CITY STATE ZIP 3 $ M PROPERTY DAMAGED OTHER THAN VEHICLES EST.AMOUNT OWNER'S NAME ADDRESS CITY STATE ZIP 4 $ CONTRIBUTING CAUSES-DRIVERIPED. VEHICLE DEFECT VEHICLE MOVEMENT VEHICLE SPECIAL FUNCTIONS BI No •riving!Acton 01 No Oelecls D1 Orson!Ahead I None 02 Careless Owing 02 Del.Brakes 02 Slowing I Slopped I Marled 2 Fans 02 Failed to YSd Rigid-of-Way 09 Worn l Smwlh Tres 03 Making Lek Turn 3 Pdive Pursuit W impropen Backing 04 Detective'Improper W Backing 4 Recreational 05 improper Lane Change Lights 05 Making Rohl Turn n Passing 5 Emergency Opinion D6 Improper Turn i.turn"Blowout M Changing Lanes 12 Driverless or 6 Construction!Maintenance 07 Alcohol-Uncles Influence _ _ 06 Steen 07 Enlenngtlaavng Parking Space Runaway Vert W Drugs-Under Influence 07 Windshield Wipers a Mr M Properly Parked 77 All Other 09 Alcohol 6 Drugs-Under Influence 00 Equipment I Vehicle IExplein' - 09 improperly Parked lEegain in ID Followed Too Closely Delect •mins J Turn Narrative) II Disregarded Hank Signal LOCATION ON ROADWAY PEDESTRIAN AC • '2 Exceeded Sale Speed Limit 19 Improper Load 13 Disregarded Slop Sign 20 Disregarded Other I On Road __ 01 Crossing Not at nrersectgn Wowing ___ 14 Failed Maintain Equip I Vehicle Traffic Control 2 Not On Road 02 Crssamg at Mi-lwk Claswed in Road 15 Improper Passing 21 Olnng Wrong Sicel Way 3 Shoulder 03 Crossing at norm-clan M SMnwgPlasing 16 Drove Let M Center 222 Fleeing Police 4 Median 04 Walking Along Road With Traffic in Road _ 17 Exceeded Slated Speed Lmi 22 Vehpk Modified 5 Turn Lent M Waling Along Road Against s'anc 09 Stank no 77 AR gClEplaiN 16 Obstructing Trakk 77 All Other IExplaini Safely Zone 36 Wooing on vehicle In Road Peoemnan Island 66 unknown _ sec. PASS. Additional Passengers/Narrative Safety a • PASSENGER NAME ADDRESS CITY 6 STATE ZIP Age mac. In; Equal Elea \ I WITNESS-NAME ADDRESS CITY 6 STATE ZIP haOSLPH ijLtLe '42O AMELTH`IST Loa, LA'LC 1n,A,:-0 FL 4Jr7yn /Y /N.5Ky 2 s--3 MAC GI 6)C2 IZO VJ;IC-FE.t?, SP(ZINGS ft SC )C . WAS INVESTIGATION I Yes 2 No Where? IS INVESTIGATION 1 Yes 2 No-Why! DATE OF REPORT PHOTOS 1- Yes 2-No 3-Investigating Agency 4 Other MADE AT SCENE' ® COMPLETE? 1 Ic- 'Lc_GI TAKEN? N f 11 Il VIOLATOR FL STATUTE NUMBER NAME CHARGE CITATION - • WINTER SPRINGS POLICE DEPARTMENT JPOEICE` TRAFFIC HOMICIDE INVESTIGATION WITNESS LIST Name JOHN EDWARD BLACK Statement ❑ Yes ❑ No Address310 LOCH LOW LN, SANFORD FL 32773 Place of EmploymentSELF Phone Numbers: Home 407-323-7281 Work SAME Can Testify To:ACTIONS AND OBSERVATIONS AS OPERATOR OF V-1 Name IRA FREDERICK BLACK Statement ❑ Yes ® No Address220 PINE WINDS, SANFORD FL 32773 Place of EmploymentSALF Phone Numbers: Home 407-323-7281 Work SAME Can Testify To:ACTIONS AND OBSERVATIONS AS PASSENGER OF V-1 Name ROBERT MAURER Statement ® Yes ❑ No Address1648 HAWAPPLE PL, OVIEDO FL 32765 Place of EmploymentUNK Phone Numbers: Home 407-366-8804 Work UNK Can Testify To:OBSERVATIONS AS OPERATOR OF VEHICLE FOLLOWING MOTORCYCLE SOUTHBOUND ON SR 419 Case Number 2001024972 Page aB WSPD Form# "POLICY WINTER SPRINGS POLICE DEPARTMENT app® TRAFFIC HOMICIDE INVESTIGATION WITNESS LIST Name JOSEPH BURKE Statement Z Yes ❑ No Address420 AMETHYST WAY, LAKE MARY FL 32746 Place of EmploymentUNK Phone Numbers: Home 407-330-7810 Work UNK Can Testify To:WHAT HE OBSERVED AS OPERATOR OF THIRD OR FOURTH VEHICLE BEHIND VEHICLE 2, SOUTHBOUND ON SR 419 Name LYNNE PINK Statement ® Yes ❑ No Address323 DORNOCH CT, WINTER SPRINGS FL 32708 Place of EmploymentUNK Phone Numbers: Home 407-797-6718 Work 407-854-6150 Can Testify To:WHAT SHE OBSERVED AS OPERATOR OF VEHICLE STOPPED IN LEFT TURN LANE OF NORTHBOUND SR 419,WAITING TO TURN ONTO EDGEMON Name WILLIAM POWELL Statement ® Yes ❑ No Address13008 ODYSSEY LAKE WAY, ORLANDO FL 32827 Place of EmploymentUNK Phone Numbers: Home 407-730-1889 Work 407-685-1975 Can Testify To:WHAT HE OBSERVED AS THE OPERATOR OF A VEHICLE TRAVELING SOUTHBOUND ON SR 419 BEHIND VEHICLE 2 Case Number 2001024972 Page �9 WSPD Form# uP0fICE WINTER SPRINGS POLICE DEPARTMENT VOW� TRAFFIC HOMICIDE INVESTIGATION WITNESS LIST Name ADAM MINSKY Statement Z Yes ❑ No Address453 MACGREGOR RD,WINTER SPRINGS FL 32708 Place of EmploymentUNK Phone Numbers: Home 407-327-4037 Work 407-461-8054 Can Testify To:WHAT HE SAW AS OPERATOR OF A VEHICLE NORTHBOUND ON NORTH EDGEMON COMING UP BEHIND VEHICLE ONE AT THE TIME OF THE CRASH Name EMS CHIEF MARC BAUMGART Statement ❑ Yes ® No Address102 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS FIRE DEPT Phone Numbers: Home N/A Work 407-327-7561 Can Testify To:OBSERVATIONS MADE DURING SCENE MANAGEMENT FOR FIRE DEPARTMENT AFTER ARRIVING ON SCENE Name LT STEVE MOLNAR Statement ❑Yes ® No Address102 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS FIRE DEPT Phone Numbers: Home N/A Work 407-327-7561 Can Testify To:OBSERVATIONS MADE ON SCENE WHILE INVOLVED IN PATIENT CARE Case Number 2001024972 Page la WSPD Form# WINTER SPRINGS POLICE DEPARTMENT POLICE PONCE- TRAFFIC HOMICIDE INVESTIGATION WITNESS LIST Name BATTALION CHIEF DAVE MYERS Statement ❑ Yes ® No Address102 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place,of EmploymentWINTER SPRINGS FIRE DEPT Phone Numbers: Home N/A Work 407-327-7561 Can Testify To:OBSERVATIONS MADE ON SCENE DURING SCENE MANAGEMENT FOR FIRE DEPT Name PARAMEDIC JEFF MCCALL Statement ❑ Yes ® No Address102 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS FIRE DEPT Phone Numbers: Home N/A Work 407-327-7561 Can Testify To:OBSERVATIONS MADE ON SCENE DURING PATIENT CARE Name PARAMEDIC JINI MONAHAN Statement ❑Yes Z No Address102 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRING FIRE DEPT Phone Numbers: Home N/A Work 407-327-7561 Can Testify To:OBSERVATIONS MADE ON SCENE DURING PATIENT CARE Case Number 2001024972 Page 31 WSPD Form M • -POCIEF. WINTER SPRINGS POLICE DEPARTMENT 'PO . TRAFFIC HOMICIDE INVESTIGATION WITNESS LIST Name EMT DAVE ROBINSON Statement ❑ Yes ® No Address102 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS FIRE DEPT Phone Numbers: Home N/A Work 407-327-7561 Can Testify To:OBSERVATIONS MADE ON SCENE DURING PATIENT CARE Name EMT DAVE HILLIARD Statement [' Yes ® No Address102 NORTH MOSS RD, WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS FIRE DEPT Phone Numbers: Home N/A Work 407-327-7561 Can Testify To:OBSERVATIONS MADE ON SCENE DURING PATIENT CARE Name EXPLORER JOE MUNDO Statement ❑ Yes ® No Address102 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS FIRE DEPT Phone Numbers: Home N/A Work 407-327-7561 Can Testify To:OBSERVATIONS MADE ON SCENE AS RUNNER FOR FIRE DEPT PERSONNEL Case Number 2001024972 Page dal WSPD Form# .,p0® WINTER SPRINGS POLICE DEPARTMENT uP0 TRAFFIC HOMICIDE INVESTIGATION WITNESS LIST Name LT BROXTON Statement ❑ Yes Z No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING OFFICER Name LT FUGATE Statement ❑ Yes Z No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING OFFICER Name LT BERNOSKY Statement ❑ Yes Z No Address300 NORTH MOSS RD, WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRING POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING OFFICER Case Number 2001024972 Page 39 WSPD Form It =POLICE' WINTER SPRINGS POLICE DEPARTMENT "MU' TRAFFIC HOMICIDE INVESTIGATION WITNESS LIST Name LT FLANNIGAN Statement ❑Yes ® No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING THI OFFICER Name CPL WICKMAN Statement ❑ Yes ® No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING THI OFFICER, COMPLETED THI Name OFC TEW Statement ❑ Yes Z No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING THI, COMPLETED ACCIDENT REPORT Case Number 2001024972 Page 3y NSPD Form# _PO WINTER SPRINGS POLICE DEPARTMENT "P® TRAFFIC HOMICIDE INVESTIGATION WITNESS LIST Name CPL GOLD Statement ❑ Yes ® No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING OFFICER Name CPL COX Statement ❑ Yes Z No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRING POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING OFFICER Name OFC ROUSSELL Statement ❑ Yes ® No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING OFFICER Case Number 2001024972 Page 31 WSPD Form# 'Pale -� WINTER SPRINGS POLICE DEPARTMENT PONCE' TRAFFIC HOMICIDE INVESTIGATION WITNESS LIST Name DET CABLE Statement ❑ Yes ® No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS A REPSONDING INVESTIGATOR/PHOTOGRAPHER Name DET MENDELSON Statement ❑ Yes ® No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING INVESTIGATOR Name DET PADGETT Statement ❑ Yes Z No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING INVESTIGATOR Case Number 2001024972 Page 31 WSPD Form* efle �PD�� � WINTER SPRINGS POLICE DEPARTMENT Cf- TRAFFIC HOMICIDE INVESTIGATION WITNESS LIST Name DET TRACHT Statement ❑ Yes ® No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING INVESTIGATOR Name OFC RANEY Statement ❑ Yes ® No Address300 NORTH MOSS RD,WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING OFFICER Name OFC ACCOMANDO Statement ❑ Yes ® No Address300 NORTH MOSS RD, WINTER SPRINGS FL 32708 Place of EmploymentWINTER SPRINGS POLICE Phone Numbers: Home N/A Work 407-327-1000 Can Testify To:OBSERVATIONS MADE AS RESPONDING OFFICER Case Number 2001024972 Page 87 NSPD Form# NARRATIVE CONTINUATION a.. 5 � , 9 , 0 , 6 , 0 0 WINTER SPRINGS POLICE DEPARTMENT O.w.,% z , ,V , q, ?_L - F ..�,.A.FL/ a l CanR.7/4 y /1 ti4&t. 1bL9 R1 /3i,4 44 . .60k1gE.55 %-M 6Aib49-(71;46 frIALee, C'ilek/,0,_ F _ CS__o .2uch, - gCL..4 - -- YB, i0.. >eszb .�� [rte ar dyz Mein 3 kl&r 61frot s,,j c9774 4_ _ /r/N , ;,J t1/44Ei; - -C /)aicr.'j/y..F ,4 q %f( f eic 74'06? 74221Jt 1 Ro,i- % - (2r,� 7n-c(20,<' - ine: ntytee '4, Srec:P - ;1A:1a11(e '& " 4te 441) A41) AVa7t. 4 - ifW= iy>vsriNir%Vr/ek ?-_ L 4j r; &InCe < /-0e;')//4, /44-: / z _ ( ! 7 =2-5,440/46:1-am'. / �7 ���`�� �/�tA. }, W y 501/1 ,/�y� 7. .'( ) 7g >-441 )4'�`, c'It i/-. %" /i,t ,CL'yc,"C /o "`n' � i fi ) Afitei e Y2)-E / -2;744 t'/OIY l " i42Jrj `; �o-rlrld 4'l'°E ,j',i i- , x/R k 64 ei'e-,47 "7L ' bA6c-4>//!si: e:5v7- n Gtt4 ' 443 is,c (l 7112,^,..v G.4-• "I VA/I, ,4 > f l Seri/� Lul i /74, '7t "%s°J 5-dingovvie ALPD Q ,5 5/>142,M;> £1)/2 :2it,1u DO YOU SWEAR OR AFFIRM T AT THE ABOVE STATEMENT(S)IS I ARE / I U �/ � ti� ' /�// TRUE/lN CORRECT 7 YR ,44-(474-1111 f O'^ r / •RN TO/AN� UBSCRI/B�E�1 E//—FORE ME, / (SlgnaWra ofPe Making Statement) THIS /C° DAY OF C — / VS'G LAW ENFORCEMENT OFFICER CONDUCTING OFFICIAL INVESTIGATION eeonnmq Omw ll0. Md Appronnp Supervisor 0 a0 • NARRATIVE CONTINUATION • 1. —1, ;.s.00N,..i ' 0 5 , 9 ' 0 6 0 0 WINTER POLICE DEPARTMENT C 0 y CI , 7 a ,C) ; � d ` N.. . fat V , 3 q Et:Gsmoi) ECG ' C; — _,,, 1�Jn..k.__-_,.. —,v --r.1,c p\ ==:s-zn,rl j? _ 1. — - — - T. 15 -r. K9 N^?.-i_y.x- '-ri.. , 'if'r ‘ 5> v ),I y i--' - ;?.) i. X,.-J--- nr (..ef :.(ru.r) "(:\-- y.) \.,, ,---. _\`( --4a� I----�W '\ l ,h�� A , o r. ;k2(ITV -M.AT- L1-31_ 3. 3 rvk cs-v wV7)-s - - P c _ u,p Billy Powell - —- - - -- • a J' Child Protective Investigator — Child Protective Services. ^ n�'` (407)665-KIDS(5437) — ---- --- - �e Direct(407)665-65, I. ■ Abuse Registry 600-961 ` DONALD F.ESLINGER 1 '°'!`. SHERIFF SEMINOLE COUNTY ■' "y' t h_ ,vim ;NT(S)ISI ARE _-__...._ __....__.. ICTO S ��' I I ND SUBSC !Bel BE 0 EME,e� � ) , 1 (Slghature of Person Maki Statement) THIS / DAY 0 LAN ENFORCEMENT OFFICER CONDUCTING OFFICIAL INVESMGATION ,o N. wo, I�,.wrvLO, 4;s NARRATIVE CONTINUATION y ORP N.,p., � 5 9 0 , 6 , 0 0 RWINTER SPRINGS POLICE DEPARTMENT (j c1 , T 7 a a�n ,a / (o lo �I �...R.N..nn. � I w (�{l� erlyGiwo n AcdrrSS 97,5 Jh h o /nt'/l/nty — q _�/5s, I as_ 3 (it q_ c'GIlTs cv-- � -ff -- __f$, ,i7_�— or lilt, _ sheet ii �f I,:/ �h LX / • Y&t. 1at /rid de( Cdr, r oifi:tIs f/ JPvc/C t.h,P_ uet,(7 out a/` (7 a;^_ rc/ t 'JCvd5 rn,/J sr htr°% 4!^! 3 fir Cc t1- c(t 0 DO YOU SWEAR OR F RM MTHE ABOVE STATEMENT(S)ISI ARE �� - i/i e �'� TRUE AN CORRE y di=T TO AND'SUBSCRIBED BEFORE ME, / �y L Or mature of Person Making Statement) THIS , DAY OF Q l / G/ LAW ENFORCEMENT OFFICER CONDUCTING OFF IC WL INJESTIGATI ON Reponme�.. D Dim Mp.oanp S. ms.) Ad. NARRATIVE CONTINUATION 5p^ 9m, 0y 6 0 0 WINTER SPRINGS POLICE DEPARTMENT Op•p( J G P q- 9 7 g,- /,.I O ..LC, AO A ! .,.... Al Cite K, t igi/y C� /- yd r n cet - \ --0 ic cktiti.cN, __ 'Lc H (--,±c 2 I. \ ( Ctv ) S��Q_12,4C _. A � CUA A , t )II . 0 I)=1( k 4i ( /C \.,�v �kl1C � NL 6 C. tCC -1 6O ?-�, y" � A C 6L.11 S 11 ,, z ) Lam« , L->hL=- . ,7Ct � lCi I� r-, : I ck_L 1 -t,‘_r,L kt C .1‘._(' � �� G r) CTS l 6r (') l 1i1 `( ) 1El ` C L'> yC ' cilI ( I ^, L r ' 'C, , __ _ 6101 i, �E _I .k_ L�� DO YOU SW- OR AFFIRM THAT I HE ABOVE STA EMENT(S)IS/ARE //`f se`, °� T-UE AND 0--ECT9 L I T TOO D BSCRIBED BEFORE ME, , V.i. Ign o t/YI i, L / DAY OF L!C. ?CO/ (Signa're of Person (a.' g = emeM) I LAW ENFORCEMENT OFFICER CONDUCTING OFFICIAL INVESTIGATI nepwn9 bI¢er J qt. lµpomy Wwm.w Oil/ NARRATIVE CONTINUATION .0....ORI..moa ::.•oLm.n 5 9 0 6 0 0 WINTER SPRINGS POLICE DEPARTMENT j .,NeolN..m,., r u l� 7 n v r✓l -e= Adorn S�� + M�nSk Ad dr- S uC3 AiLveijor Rd Uc7 3—J -i-10 -, ccil Lk, / Lit' ry 'D, C .Q T 10 N.- C4 -1, w:i ! : 'J; "kJ) J:1 F. 1-j LO' f . <-1l SrnQ- cnrt p( k 11T�__c.,< :} . CA One 0 it , ( ! 1■1 F S. -_ C__,,, t 'o,_ < ,_ t ,/.0 A, 1. (DLd(CL! ✓`{, to ';J..'p S ,) r• �M A di � , —. Cc-cb% L CA 1Cj .. ("\ C`Eoch4( 'w12, C0 --1-\,«,Y Iorrc . k Ix. 1noL I< Cf" ( l<. 0)c CS11 \ C367CCcI, ce'-f '.p•- 1L- LIp vC -I"I-a i. AI' . C Tivnk \1<_. )U r, 1._. 1 jc.&c LA - k Iti.�- .CI LNdC��. f .11.'7 I._ t�.�vc 'IIC 'h b•tr ll. (CAC\ w,t, - ),_ rn1�iar„yc ■g \..1 C4 j 4 -(I I )Yr.,.J rt)4 fcc rr4. ,I't-7 11( Th. fn! ti J'r c J. 11-1\' bNJPC- tIlu -'S)1 *Irt'< .FI I „ n - - J C — > WIMII HIE MEM lie DO YOU SWEAR OR AFFIRM THAT THE ABOVE STATEMENT(S)ISI ARE , rc -'A i , TRUE AN• CORRECT? - SWORN TO f D SUBSCRIBED BEFORE ME�/,,,��nn (Signature of Person Making Statem THIS I� DAY OF kro68P- 2oVI LAW ENFORCEMENT OFFICER CONDUCTING OFFICIAL INVESTIGATION Reymunu Om(a 110 IDi I,AOwovino•.o•Maor if CJ ` • z I. � r R'∎ YC J 5 � 1 � ! , . 99 g a I t JA [ r •i t rib iiig r 7 Y .:L...y Yx}. � £Ay� Jc a ': �.. y �} .,„ 1 . VII � 4,;1 `it -� t pad I in 41 B i"• - Y t .. .z al • t 9 a 4 I . / Y ,r- _ �J r Ja • C X 1 1 1p lf, e J1) 1t1 V' { J `�Y 3 1 ` tp41 ` . \la P 1 a 1 IV 1. r I r J!as , � ass} , ; tier/ ,, • \ . . ' '''''''4.t, ",/ '■L"t..-, . IV, .1 . ' ' .-' I\. +4' rginlics. ^ Xilifigr 1 V.( 1 CAA.;,..--4',;„:5 F-kf•-‘..1-•. - ' ' - - z. ' .., - Pc: -'4•:- (1--- ;' -' -' ...c- JA-., .,, Ir''''...t- -• 1AA, - ' ,, ,,,' . ,, i ' l‘ 1, : '-'-^j,,„ , r.,,t --,,,-..,p49.',..-„, ,i • , tc‘,.. „.„,„;„::-..,,r.,,,, , ,n, -ix-P.-4e,m,-:.2•A::::,•;,- , frt„..,"-o..14-t-f •r'. .'. -,‘'1,:e i-,:- 4,-11,--'7.,. _1 ' ti..t.: . . - ite. iz :54 ,1' ' 1- .k--' - .. 4r,,e).-::t.,!•. frj.. (.1:t,....''''-..: 7; ',. ' it i -b-4:-•;.0 - - ; ,,... ' A dt1-4--41%., t ' • ‘ --:- • ' hi i ■ ) I N.°'. , . J. . ,1 I - I ,, A, • ,t, -,,r ■ I i t , . . - . .1 . ' 11) iv 4 /1 i 110 oad X91 1111,1 , • _ comer -. ®'= Rey, r rJ •u. Inc.'' , . • • AV • '.x ..33- / :: A N 4 • .. i • : , == , II I T i CO a i .,'': .co 1* • k .. .. I �� m • f !I t- � �' d cs' r .. - t 1=11 I 1 C T� ��it wnp ilii�+ r -, re '� I, 1: i • .Z. . ilk. i V .a �s n 4n N . —�C.Cp r<x. w 11 IX ' I V 3t W `; fV LR 4 r , Iv ∎ ; ' a �■ �+ k% b . ryei ! 0 41 , '' c 4t a Ary; s a.S j i .1 nyl * y .1 aa.. . . $ . -,..is 40 ,, rRi r:_ iiiiiitur rbe • P.. gin' 4 . " se • El • • �, - & w"" k . «. ailiin- !I, .. 41•44, y. f 1i • . . • • pR . it . fl ■ ' / i • • WINTER SPRINGS FIRE DEPT Patient Care Report Page 1 Prepared: 7/08/02, 14:20:38 Program: ES160L riot INFORMATION: Incident number: 07-01-002617-000 Date: 10/16/01 Address: 651 SR 419 Road INTERSECTN SEMINOLE COUNTY, FL 32708 District: 24 Transported to: ORLANDO REGIONAL MEDICAL CENTR PATIENT INFORMATION: Name: JOHN L. BROWN Race: Caucasian/White Address: 1036 WINTER SPRINGS BL Sex: Male WINTER SPRINGS, FL 32708 SSN: DOB: 3/27/1952 Phone number: Age: 49 Years old RESPONDING UNITS: Enroute to Arrive at Enroute to Total Transporting/ Unit Dispatch scene scene hospital At hospital In service on scene attending unit AIRES 17:45:42 17:49:33 17:57:01 18:08:55 18:21:04 18:29:10 00:11:54 Yes 10.00 Miles 5024 17:43:28 17:43:31 17:43:34 00:00:00 00:00:00 18:17:15 00:33:41 EM1 17:39:57 00:00:00 17:40:02 00:00:00 00:00:00 18:17:25 00:37:23 E24 17:39:45 17:40:43 17:42:03 00:00:00 00:00:00 18:45:20 01:03:17 E35 17:44:54 17:46:10 17:49:24 00:00:00 00:00:00 18:12:15 00:22:51 MS24 17:43:44 17:43:47 17:43:49 00:00:00 00:00:00 18:09:31 00:25:42 R24 17:39:45 17:40:52 17:42:01 00:00:00 00:00:00 18:13:18 00:31:17 GLASGOW COMA SCORE: Time: 17:43 Eyes: To pain (2) Verbal: None (1) Motor: Flexion (3) Total Score: 6 INJURY SITE AND TYPE: FACE /FX/DS CHEST/CONTU UPEX /FX/DS HAND /F%/DS LWEX /FX/DS LWEX /LACER ACTIONS TAXAN: ASSESSMENT-AIRWAY: PATENT ASSESSMENT-BREATHING: BALES ASSESSMENT-CIRCULATION: RADIAL, Yes resp. ASSESSMENT-COLOR: CYANOTIC ASSESSMENT-MOSITURE: MOIST ASSESSMENT-PUPILS: REACTIVE-LEFT ASSESSMENT-PUPILS: REACTIVE-RIGHT ASSESSMENT-TEMP: WNL ASSIST: SCFD CALL LEVEL: ALS CALL STATUS: EMERGENCY TO SCENE CALL STATUS: EMERGENCY TO HOSPITAL DATE fi TIME OF INJURY, Time: 17:35 WINTER SPRINGS FIRE DEPT Patient Care Report Page 2 Prepared: 7/08/02, 14:20:38 Program: ES160L ACTIONS TAKEN: DELAY: NO DELAY DISPOSITION: TRANSPORT EXPOSURE, NO resp. MECHANISM OF INJURY: MOTOR VEH TRAFFIC ACC NATURE OF CALL (D) : TRAPPIC ACCIDENT NATURE OF CALL (8) : TRAFFIC ACCIDENT PROTECTION: HELMET TRAUMA ALERT CRITERIA: GCSS < OR 12 TYPE OF TRANSPORT: AIR PROCEDURES: INTERVENTION-AIRWAY: SUCTION, Time: 17:50, Succ., Att: 001 INTERVENTION-AIRWAY: CRIC, Time: 17:57, Slice. , ACC: 001 INTERVENTION-BREATHING: OXYGEN, Time: 17:50, Succ. INTERVENTION-BREATHING: Sa 02, Time: 17:58, Succ. INTERVENTION-CIRCULATION: CARDIAC MONITOR, Time: 17:59, Succ., Att: 001 INTERVENTION-SECONDARY: MANUAL IMMOB, Time: 17:44, Succ., Att: 001 INTERVENTION-SECONDARY: BACKBOARD, Time: 17:55, Succ., Att: 001 VITAL SIGNS 1, Time: 18:00, Pulse: 90, Resp: 8, BP: 136/110, SINUS TACHYCARDIA MEDICATIONS: Type Time Dosage Route Given by VERSED 17:58 5.0 MG INTRAVENOUS MONAHAN, JAMES FLUIDS: Type Time Dosage Rate Gauge Given by NORMAL SALINE 17:55 250.0 CC OPE ML/HOUR 18 MONAHAN, JAMES NORMAL SALINE 17:56 250.0 CC OPE ML/HOUR 18 MONAHAN, JAMES PATIENT NARRATIVE: SEE BELOW PERSONNEL: Employee name Unit Position Assigned station MYERS, DAVID G. BC24 BC Station 24 MOLNAR, STEVEN M. E24 LT/P Station 24 LAVERTY, MARK E24 FF Station 24 ROBINSON, DAVID E24 FF Station 24 HILLIARD, DAVID E24 FF Station 24 MCCALL, JEFFREY M. R24 FF/P Station 24 MONAHAN, JAMES R24 PF Station 24 BAUMGART, MARC J. MS24 BC Station 24 OTHER NARRATIVES: PAST MEDICAL HISTORY UNKNOWN CURRENT MEDICATIONS UNKNOWN ALLERGIES UNKNOWN CHIEF COMPLAINT MOTORCYCLE ACCIDENT, MULTI TRAUMA WINTER SPRINGS FIRE DEPT Patient Care Report Page 3 Prepared: 7/08/02, 14:20:38 Program: ES160L U1'II6N NARRATIVES: Patient Narrative R24 E24 RESPONDED TO TRAFFIC ACCIDENT WITH BC24 AND MS24. U/A FOUND A 49 Y/0 W/M PT SLUMPED OVER IN ROADWAY NEXT TO MOTORCYCLE. BYSTANDERS S TS THAT HE HIT A FULL SIZE TRUCK IN THE DRIVERS SIDE DOOR. AFTER INSPE CTION OF TRUCK SEVERE DAMAGE NOTED TO DRIVER SIDE DOOR (A) POST AREA. PT WAS NOT ALERT BUT BREATHING WHEN APPROACHED BY CREW. THERE WAS A LA RGE AMOUNT OP BLOOD COMING FROM PTS HEAD. PT WAS BREATHING BUT NOT ADE QUATELY APROX. 16 TO 18 TIMES A MINUTE WITH GARGLED SOUNDS. MANUAL CRS PINE WAS APPLIED WHILE PT WAS FULLY EXPOSED. NO D-CAP BTLS NOTED TO BA CK AND SPINE LOOKED TO BE INLINE. HELMET WAS REMOVED WHILE PROTECTING C-SPINE. PT LEGS WERE STRAITENED TO PREPARE HIM FOR A LOG ROLL ONTO LB B. PT HAD NOTICEABLE FX'S TO BOTH LEGS POSSIBLE FEMUR TO LEFT LEG AND OPEN TIB FIB FX'S TO RIGHT LEG. PT WAS ROLLED AS A SINGLE UNIT ONTO LBB. PTS AIRWAY WORSENED SUCTIONING WAS ATTEMPTED WITH LITTLE RE LIEF. HEAD TO TOE REVEALED OBVIOUS FACE AND HEAD TRAUMA, SHALLOW CHEST RISE NO SUBCUTANEOUS EMPHYSEMA NOTED, LUNG SOUNDS PRESENTED WITH RALE S, BRUISING NOTED TO CHEST AREA, ABD SOFT AND NONDISTENDED, PELVIS INT ACT, FX NOTED TO LEFT WRIST. ETT WAS ATTEMPTED UNSUCCESSFUL DUE TO ORA L AND FACIAL TRAUMA. AIRWAY WAS MADE PATENT BY A CRIC WITH A p6 ETT WH ITCH WAS SECURED WITH A STACK OF 4X4'S AND COMMERCIAL ETT HOLDER. LUN G SOUNDS REVEALED EQUAL WITH GOOD CHEST RISE, PTS COLOR IMPROVED SLIGH TLY. TWO # 18 GAGE IV'S WERE ESTABLISHED NO INFILTRATION NOTED. PT BEG AN TO LIFT ARMS AND FLEXING BODY SLIGHTLY. PT WAS GIVEN 5 MG VERSED PT BECAME FLACCID. PT STRAPPED TO LBB, PLACED ON STRETCHER, AND MOVED TO R24, ENROUTE TO LANDING ZONE CO2 DETECTOR PUT IN PLACE WITH POSITIVE COLOR CHANGE, LUNG SOUNDS REASSESSED SHOWING GOOD LUNG SOUNDS ON THE RIGHT DIMINISHED ON LEFT. PT PLACED ON MONITOR SHOWING NSR WIT H AN SA02 OF 93% INITIALLY AND A HEART RATE IN THE 80'S. PT B/P WAS 13 6/110, AIR RESCUE 3 MEDIC MET AT LANDING ZONE PT REPORT GIVE BY PARAME DIC MONAHAN. PTS LUNG SOUNDS ASSESSED BY AIR RESCUE 3 MEDIC WHILE ETT WAS REPOSITIONED LUNG SOUNDS BECAME BETTER. AIR RESCUE 3 MEDIC STS THA T HE WOULD PLURAL DECOMPRESS IF NEED BE ENROUTE. PT CARE TRANSFERRED T O AIR RESCUE 3 WITHOUT INCIDENT. TWO PEOPLE IN THE TRUCK THAT WAS STRUCK REFUSED TREATMENT OR TRANSPORT DRIVER:JOHN BLACK 310 LOCHLOW LANE SANFORD, FL. (407)323-7281 DOB.O 9/26/1946 PASSENGER:IRA BLACK 310 LOCHLOW LANE SANFORD, FL. 9407) 323-7281 DOB. 09/28/1946 Wednesday 17 of Jul 2002 , Faxination —>407 327 4753 Page 2 of 3 525 W. Van Buren Chicago, IL 60607 GE ERC Phone 11. (312)821-4084 Commercial Insurance Fax P. (312)8214099 E-mail:Ximberty.mozdziez @cwegis.corn Website www caregis corn Coregis . July 17, 2002 Chief Timothy Lallathin Fire Chief- City of Winter Springs 102 N. Moss Road Winter Springs, FL 32708 VIA FACSIMILE: 407-327-2332 RE: INSURED: City of Winter Springs CLAIMANT: John Lee Brown POLICY: 651-011238 Claim No: Ecd80170130 Dear Chief Lallathin: Please be advised that Coregis Insurance Company ("Coregis") acknowledge receipt of the Notice of Claim letter sent by Michael Jones attorney on behalf of John Lee Brown. I have been assigned the handling of this matter. In light of the facts alleged and our experience that such matters often evolve into civil litigation, we have set this matter up under the above noted claim number and will conduct an investigation. This claim falls under the terms and conditions of the Insured's Municipal Package Policy number 651-011238 with effective dates from October 1, 2001 to October 1, 2002 and limits of $100,000 statutory per person, $200,000 statutory per Occurrence, $1,900,000 excess of statute per person, $1,800,000 excess of statute per Occurrence and $2,000,000 total Occurrence and $5,000,000 in the Aggregate for the policy year. This policy is also written with a$25,000 deductible per occurrence. Coregis has the right and duty to defend covered claims. The Claimant's estate alleges that his death on October 16, 2001 was caused by the negligent conduct of the Insured through their alleged "improper and / or failure to properly maintain a traffic control device at State Road 419 and North Edgemon Avenue.' COREGIS INSURANCE CARRIERS Coregis Insurance Company California Insurance Company Headquartered in Chicago Domiciled in California Licensed in all slates Licensed in several stales America's Public Entity Insurer"' nu —19-21292 12:29 92'/. P.02 Wednesday 17 of Jul 2002, Faxination ->407 327 4753 Page 3 of 3 2 In accordance with this investigation, we request that you provide us with a copy of all documentation concerning this matter including, but not limited to traffic accident reports, scene photos, committee reports, traffic studies and correspondence with the FDOT concerning the installation of a traffic control device at Edgemon and/or Moss roads. We welcome you to forward any additional information you believe would assist us In the evaluation of this claim. If a lawsuit is filed, it is important that you send us a copy of any summons, petition or complaint filed against the Insured upon receipt. In that event, we will provide a full analysis of coverage at that time. The failure of Coregis Insurance Company ('Coregis")to cite any further terms and conditions of the insurance policy is not to be construed as a waiver of any rights, which Coregis may have under the insurance contract. Of course, all of your rights under the policy are also preserved. If you have any questions or concerns regarding this matter, please feel free to contact me at 1-800-879-4427 x4084. Sincerely, • r / F L_ Kimberly A. Mozdzierz Claims Specialist Ki mberly.mozdzi erz6coregis.corn CC: Linda Burtchett Risk Management Associates Via Facsimile: 407-331-4800 Ronald McLemore City Manager— City of Winter Springs Via Facsimile: 407-327-4753 Kip Lockcuff Public Works Utility Director—City of Winter Springs Via Facsimile: 407-327-6695 _... ._ ,.,..... 92% P.03 Wednesday 17 of Jul 2002 , Faxination —>407 327 4753 Page 1 of 3 �J FF GEERC Commercial Insurance Coregis Insurance Company 525 West Van Buren,Suite 500 Chlcago,IL 60577 Phone: 312 82 1-4000 To McLemore From:Mozdzierz,Kimberly (GE ERG.CDR) Fax M073271753 Total number of pages 3 Date 07/17/02, Subject ack of claim ecd80170130 mailfax of The Information aontcnedso this lacsmale message s conbdenfa Information intended only for the use of the indmmual or entity named above. Any dtsseminabon,distnbubon or duplication of his communications sent pah,blred If this facsm,le has been removed m error,please,mmediataly call the person above and return the anginal message to the above address. Thank you Till "'-""r"'"") ra.99 924 P.131 City of Winter Springs 102 North Moss Road, Winter Springs, Florida 32708 Fire Department FAXDate: 07/08/2002 Number of pages including cover sheet: 2 To: From: Linda Burtchett Timothy J. Lallathin Risk Management Associates City of Winter Springs P.O.Box 161507 Altamonte Springs,FL 32716 Phone: (407)331-4400 Phone: (407)327-2332 Fax: (407)331-4800 Fax phone: (407)327-4750 REMARKS: ❑ Urgent ® For your review ❑ Reply ASAP ❑ Please comment Linda, To keep you informed the City of Winter Springs received the enclosed letter from Leffler&Associates, P.A. This letter is in reference to an accident involving a motorcycle and a pickup truck where the motorcycle rider, John Lee Brown died as a result of his injuries. The accident occurred on 10/16/2001 and the victim was air-lifted to Orlando Regional Medical Center. The accident occurred at the intersection of State Road 419 and North Edgemon Avenue. A stop sign on North Edgemon Avenue was the only traffic control device in place at the time of the accident. Since the accident a traffic signal light was added to this intersection. Thank you and if you need any additional information please call me at(407) 327-7575. /-J/)S O —ten Act VA-1,z/ Feb. 6/ 2. DO Z-- . /cmbt,IV /nDz-d i CCZ. aci,m44 ECE ybi is 130 • Leffler & Associates, P.A. Attorneys and Counselors at Law Box 196130 Telephone X407)695-7666 P.O. Writer Springs,FL 32719-6130 Facsimile(407)695-7157 Kenneth M.Leffler Michael re9�q„s�SesC. 3_.,.Yt. ,�£—. A N June 28, 2002 -7 J(%l 0 ` 2002 CERTIFIED MAIL RETURN RECEIPT REQUESTED TO r(4 ATY HALL vcs a ry C .. CCj C� CF(C City of Winter Springs Paul Partyka, Mayor 1126 E. State Road 434 Winter Springs, Florida 32708 Re: Estate of John Lee Brown To Whom It May Concern: Pursuant to § 768.28(6), Florida Statutes, Estate of John Lee Brown, by and through his undersigned attorney, hereby notify the above agencies that they intend to pursue a claim against the City of Winter Springs, it's agents and representatives for negligence arising out of the improper and/or failure to properly maintain a traffic control device at State Road 419 and North Edgemon Avenue, Winter Springs, Florida, or in the alternative, negligently delaying the installation of a traffic control device. For your information, and as required by said statute, John Lee Brown's birth date is March 27, 1952, Driver's License Number 13650-472-52-107-1, Social Security number is 264- 15-1118, and place of birth is Louisville, Kentucky. With reference to John Lee Brown, there does not exist any unpaid claims of $200.00 for any adjudicated penalties, fines, fees, victim restitution fine obligations, or other judgments in excess of $200.00, whether imposed by a civil, criminal, or administrative tribunal, owed by the claimant to the State of Florida, a state agency, or an officer or subdivision of the State of Florida. If additional information is needed, please contact the undersigned. Please acknowledge receipt hereof in writing within thirty (30) days from the date of this correspondence. Your attention to this matter and acknowledgment of this notice pursuant to Florida Statute § 768.28(6) is appreciated. Very truly yours, u Michael D. Jo es MDJ/jmh Wednesday 17 of Jul 2002, Faxination —>4073274750 Page 1 of 3 GE ERC Commercial Insurance Coregis Insurance Company 575 West Van Buren,Suite 500 Chicago,IL 60677 Phone: 317871-4000 To'Timothy lallathin FromMozdzier4 Kimberly (GE ERC,COR) Pax:14073272332 Total number of pages 3 Date Subject ack of claim ecd80170130 mallfaetif the mlormabun contained m this lacsmlle message Is conhdensai mtormatian mlendod only for rhe use of Irks mdindual or on Ply newt I above received in error;�please mtmedlatel a call the er person above and return the crooner message to the shove address.cThank you bean ye persona Wednesday 17 of Jul 2002, Faxination —>4073274750 Page 2 of 3 re,� Chicago. IL 60607 GE ERG Phone n (312)821-4084 Commercial Insurance Fax 1l: (312)821-4099 E-mail kimberly.mozdzierz@coregss.com Website wwwcoregis.corn Coregis July 17, 2002 Chief Timothy Lallathin Fire Chief- City of Winter Springs 102 N. Moss Road Winter Springs, FL 32708 VIA FACSIMILE: 407-327-2332 RE: INSURED: City of Winter Springs CLAIMANT: John Lee Brown POLICY: 651-011238 Claim No: Ecd80170130 Dear Chief Lallathin: Please be advised that Coregis Insurance Company("Coregis") acknowledge receipt of the Notice of Claim letter sent by Michael Jones attorney on behalf of John Lee Brown. I have been assigned the handling of this matter. In light of the facts alleged and our experience that such matters often evolve into civil litigation, we have set this matter up under the above noted claim number and will conduct an investigation. This claim falls under the terms and conditions of the Insured's Municipal Package Policy number 651-011238 with effective dates from October 1, 2001 to October 1, 2002 and limits of $100,000 statutory per person, $200,000 statutory per Occurrence, $1,900,000 excess of statute per person, $1,800,000 excess of statute per Occurrence and $2,000,000 total Occurrence and $5,000,000 in the Aggregate for the policy year. This policy is also written with a$25,000 deductible per occurrence. Coregis has the right and duty to defend covered claims. The Claimant's estate alleges that his death on October 16, 2001 was caused by the negligent conduct of the Insured through their alleged "improper and /or failure to properly maintain a traffic control device at State Road 419 and North Edgemon Avenue." COREGIS INSURANCE CARRIERS Coregis Insurance Company California Insurance Company Headquartered in Chicago Domiciled in Legume Licensed in all states Licensed in several states America's Public Entity Insurer"' Wednesday 17 of Jul 2002, Faxination ->4073274750 Page 3 of 3 2 In accordance with this investigation, we request that you provide us with a copy of all documentation concerning this matter including, but not limited to traffic accident reports, scene photos, committee reports, traffic studies and correspondence with the FDOT concerning the installation of a traffic control device at Edgemon and/or Moss roads. We welcome you to forward any additional information you believe would assist us in the evaluation of this claim. If a lawsuit is filed, it is important that you send us a copy of any summons, petition or complaint filed against the Insured upon receipt. In that event, we will provide a full analysis of coverage at that time. The failure of Coregis Insurance Company('Coregis")to cite any further terms and conditions of the insurance policy is not to be construed as a waiver of any rights, which Coregis may have under the insurance contract. Of course, all of your rights under the policy are also preserved. If you have any questions or concerns regarding this matter, please feel free to contact me at 1-800-879-4427 x4084. Sincerely, \ <. Kimberly A. Mozdzierz Claims Specialist Kimberly.m ozdzierze co reg i s.co m CC: Linda Burtchett Risk Management Associates Via Facsimile: 407-331-4800 Ronald McLemore City Manager-City of Winter Springs Via Facsimile: 407-327-4753 Kip Lockcuff Public Works Utility Director- City of Winter Springs Via Facsimile: 407-327-6695