STATE OF FLORIDA TRAFFIC CRASH REPORTþ o o 2 · CRASH DATE TIME OF CRASH DATE OF REPORT REPORTING...

CRASH DATE TIME OF CRASH DATE OF REPORT REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER

LONG FORM SHORT FORM UPDATE(Shaded Areas)

MAIL TO DEPT. HIGHWAY SAFETY & MOTOR VEHICLES,

TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING,

TALLAHASSEE, FL 32399-0537

CRASH IDENTIFIERS

COUNTY CODE CITY CODE COUNTY OF CRASH PLACE OR CITY OF CRASH CHECK IF WITHINCITY LIMITS

TIME DISPATCHEDTIME REPORTED

TIME ON SCENE TIME CLEARED SCENE Notified By: 1 Motorist2 Law Enforcement

CHECK IFCOMPLETED

REASON (If Investigation NOT Complete)

ROADWAY INFORMATION (CHOOSE ONLY 1 OF 4 OPTIONS)

CRASH OCCURRED ON STREET, ROAD, HIGHWAY AT STREET ADDRESS #1

AT LATITUDE AND LONGITUDE2

AT FEET OR MILES N S E W AT / FROM INTERSECTION WITH STREET, ROAD, HIGHWAY3

OR FROM MILEPOST #4

Road System Identifier

1 Interstate2 U.S.3 State

4 County5 Local6 Turnpike/ Toll

7 Forest Road8 Private Roadway9 Parking Lot77 All other, Explain inNarrative

Type of Shoulder

1 Paved2 Unpaved3 Curb

Type of Intersection

1 Not at Intersection2 Four Way Intersection3 T Intersection4 Y Intersection

5 Traffic Circle6 Roundabout7 Five Point, or More77 Other, Explain in Narrative

CRASH INFORMATION (CHECK IF PICTURES TAKEN)

TOTAL # OF VEHICLE SECTION(S) _____

TOTAL # OF PERSON SECTION(S) _____

TOTAL # OF NARRATIVE SECTION(S) _____

Light Condition

1 Daylight2 Dusk3 Dawn4 Dark Lighted

5 Dark Not Lighted6 Dark UnknownLighting77 Other, Explain inNarrative88 Unknown

4 Fog, Smog, Smoke5 Sleet/Hail/Freezing Rain6 Blowing Sand, Soil,Dirt7 Severe Crosswinds77 Other, Explain inNarrative

Weather Condition

1 Dry2 Wet4 Ice/Frost

5 Oil6 Mud, Dirt, Gravel7 Sand8 Water (standing/moving)77 Other, Explainin Narrative88 Unknown

Roadway Surface Condition1 No2 Yes, School BusDirectly Involved3 Yes, School BusIndirectly Involved

School Bus Related

1 Front to Rear2 Front to Front3 Angle

4 Sideswipe, same direction5 Sideswipe, Opposite Direction6 Rear to Side7 Rear to Rear77 Other, Explain in Narrative88 Unknown

Manner of Collision/Impact

First Harmful Event

First Harmful Eventwithin Interchange

1 No2 Yes88 Unknown

1 Overturn/Rollover2 Fire/Explosion3 Immersion4 Jackknife5 Cargo/EquipmentLoss or Shift6 Fell/Jumped FromMotor Vehicle7 Thrown or FallingObject8 Ran into Water/Canal9 Other Non Collision

10 Pedestrian11 Pedalcycle12 Railway Vehicle (train,engine)13 Animal14 Motor Vehicle in Transport15 Parked Motor Vehicle16 Work Zone / MaintenanceEquipment17 Struck By Falling, ShiftingCargo18 Other Non Fixed Object

Non-Collision Collision-non Fixed Object Collision with Fixed Object

19 Impact Attenuator/CrashCushion20 Bridge Overhead Structure21 Bridge Pier or Support22 Bridge Rail23 Culvert24 Curb25 Ditch26 Embankment27 Guardrail Face28 Guardrail End29 Cable Barrier

30 Concrete Traffic Barrier31 Other Traffic Barrier32 Tree (standing)33 Utility Pole/Light Support34 Traffic Sign Support35 Traffic Signal Support36 Other Post, Pole or Support37 Fence38 Mailbox39 Other Fixed Object (wall,building, tunnel, etc.)

First Harmful Event

Location 1 On Roadway2 Off Roadway3 Shoulder4 Median6 Gore7 Separator8 In Parking Lane or Zone9 Outside Right of way10 Roadside88 Unknown

1 Non Junction2 Intersection3 Intersection Related4 Driveway/ Alley AccessRelated

First Harmful Event Relation toJunction

5 Railway Grade Crossing14 Entrance/Exit Ramp15 Crossover Related16 Shared Use Path or Trail17 Acceleration/Deceleration Lane18 Through Roadway77 Other Location88 Unknown

Contributing Circumstances: Road

1 None4 Work Zone (construction/maintenance/ utility)6 Shoulders (none, low, soft, high)7 Rut, Holes, Bumps

9 Worn, Travel Polished Surface10 Road Surface Condition(wet,icy, snow, slush, etc.)11 Obstruction in Roadway12 Debris13 Traffic Control DeviceInoperative, Missing or Obscured14 Non Highway Work77 Other, Explain in Narrative88 Unknown

Contributing Circumstances:

Environment

1 None2 Weather Conditions3 Physical Obstruction(s)4 Glare

5 Animal(s) in Roadway77 Other, Explain inNarrative88 Unknown

Work Zone related1 No2 Yes88 Unknown

1 Before the First Work ZoneWarning Sign2 Advance Warning Area3 Transition Area4 Activity Area5 Termination Area

Crash in Work Zone

1 Lane Closure2 Lane Shift/Crossover3 Work on Shoulder or Median4 Intermittent or Moving Work77 Other, Explain in Narrative

Type of Work Zone1 No2 Yes88 Unknown

Workers in Work Zone Law Enforcement in

Work Zone

1 No2 Officer Present3 Law Enforcement VehicleOnly Present

WITNESSES

NAME ADDRESS CITY & STATE ZIP CODE TELEPHONE

VEHICLE # PERSON #

VEHICLE # PERSON #

NON VEHICLE PROPERTY DAMAGE

PROPERTY DAMAGE –OTHER THAN VEHICLE EST. AMOUNT OWNER’S NAME (Check if Business) ADDRESS CITY & STATE ZIP CODE




Page ___ of ___

1 Clear2 Cloudy3 Rain

STATE OF FLORIDA TRAFFIC CRASHREPORT

3

1 2

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2

1

84459649

1:00 PM1:00 PM

2014-0009108703/03/20144:38 PM

ORANGE46

02/09/2014

07

1:15 PM 9:11 PM

HOLLYWOOD WY

Orlando

6300

9 3 77

771887788

24

1

77 88

8

88

1

SHRUBBERY 2001 1 LOEWS HOTELS6300 HOLLYWOODWAY ORLANDO FL 32811

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2

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HSMV 90010 S (E) (rev 10/10)

VEHICLE # Check if CommercialREPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER

VIOLATIONS

VEHICLE N S E W Off-Road Unknown ON STREET, ROAD, HIGHWAYTRAVELING

HAZ. MAT. RELEASED1 No2 Yes88 Unknown

1 Vehicle in Transport2 Parked Motor Vehicle3 Working Vehicle

VEHICLE LICENSE NUMBER STATE REGISTRATION EXPIRES Check if PermanentRegistration

VIN

Hit and Run1 No2 Yes88 Unknown

YEAR MAKE MODEL STYLE COLOR DAMAGE:1 Disabling 4 Minor2 Functional 88 Unknown3 None

EST. DAMAGE

INSURANCE COMPANY (Driver) INSURANCE POLICY NUMBER Towed dueto Damage:1No 2 Yes

VEHICLE REMOVED BY 1. Rotation2. Owner Request3. Driver77. Other, Explain in Narrative

NAME OF VEHICLE OWNER (Check if Business) CURRENT ADDRESS CITY & STATE ZIP CODE

STATETRAILER # LICENSE NUMBER REGISTRATION EXPIRES Check if PermanentRegistration

VIN YEAR MAKE LENGTH AXLES

REGISTRATION EXPIRES Check if PermanentRegistration


TOTAL LANESPOSTED SPEEDAT EST. SPEED

HAZ. MAT PLACARD1 No2 Yes88 Unknown

HAZ. MAT NUMBER HAZ. MAT CLASS

MOTOR CARRIER NAME US DOT NUMBER

UndercarriageOverturn

WindshieldTrailer

Area of Initial Impact Most Damaged Area

18 181919

20 202121

MOTOR CARRIER ADDRESS CITY & STATE ZIP CODE PHONE NUMBER

Page ___ of ___

Vehicle Body Type

1 Passenger Car2 Passenger Van3 Pickup7 Motor Home8 Bus11 Motorcycle12 Moped

18 Motor Coach19 Other Light Trucks (10,000 lbsor less)

1 Interstate Carrier2 Intrastate Carrier3 Not in Commerce/Government4 Not in Commerce/Other Truck

Comm/Non-Commercial

1 Two Way, Not Divided2 Two Way, Not Divided, with aContinuous Left Turn Lane3 Two Way, Divided, Unprotected(painted >4 feet) Median4 Two Way, Divided, Positive MedianBarrier5 One Way Trafficway88 Unknown

Trafficway1 Vehicle 10,000 lbs or less Placardedfor Hazardous Materials2 Single Unit Truck (2 axle and GVWRmore than10,000 lbs (4,536 kg))3 Single Unit Truck (3 or more axles)4 Truck Pulling Trailer(s)5 Truck Tractor (bobtail)6 Truck Tractor/Semi Trailer7 Truck Tractor/Double Truck

8 Tractor/Triple9 Truck more than 10,000 lbs (4,536kg), Cannot Classify10 Bus/Large Van (seats for 9 15occupants, including driver)11 Bus (seats for more than 15occupants, including driver)77 Other, Explain in Narrative88 Unknown

Commercial Motor Vehicle Configuration

20 Medium / Heavy Trucks (morethan 10,000 lbs (4,536 kg))21 Farm Labor Vehicle77 Other, Explain in Narrative88 Unknown

1 10,000 lbs (4,536 kg) or less2 10,001 26,000 lbs (4,536 11,793 kg)3 More than 26,000 lbs (11,793 kg)4 Not Applicable

CommGVWR/GCWR

3 Van/Enclosed Box4 Hopper5 Pole Trailer6 Cargo Tank7 Flatbed8 Dump9 Concrete Mixer10 Auto Transport11 Garbage/Refuse12 Log

13 IntermodalContainer Chassis14 Vehicle TowingAnother Vehicle15 Not Applicable(vehicle 10,000 lbs(4,536kg) or less notdisplaying HM placard)77 Other, Explain inNarrative88 Unknown

Cargo Body Type

Trailer Type1 Single Semi Trailer2 Tandem Semi Trailer3 Tank Trailer4 Saddle Mount/Trailer5 Boat Trailer6 Utility Trailer7 House Trailer

8 Pole Trailer9 Towed Vehicle10 Auto Transport77 Other, Explain inNarrative88 Unknown

TRAILER 1 TRAILER 2

PERSON #

PERSON #

1 Overturn/Rollover2 Fire/Explosion3 Immersion4 Jackknife5 Cargo/Equipment Loss or Shift6 Fell/Jumped From Motor Vehicle7 Thrown or Falling Object8 Ran into Water/ Canal9 Other Non Collision

[40-46 Sequence of Events only]40 Equipment Failure (blown tire,brake failure, etc.)41 Separation of Units42 Ran Off Roadway, Right43 Ran Off Roadway, Left44 Cross Median45 Cross Centerline46 Downhill Runaway

10 Pedestrian11 Pedalcycle12 Railway Vehicle (train, engine)13 Animal14 Motor Vehicle in Transport15 Parked Motor Vehicle16 Work Zone / MaintenanceEquipment17 Struck By Falling, Shifting Cargo orAnything Set in Motion by MotorVehicle18 Other Non Fixed Object

Collision with Non-Fixed Object

Non Collision

Collision Fixed Object 29 Cable Barrier30 Concrete Traffic Barrier31 Other Traffic Barrier32 Tree (standing)33 Utility Pole/Light Support34 Traffic Sign Support35 Traffic Signal Support36 Other Post, Pole, or Support37 Fence38 Mailbox39 Other Fixed Object (wall,building, tunnel, etc.)

19 Impact Attenuator/Crash Cushion20 Bridge Overhead Structure21 Bridge Pier or Support22 Bridge Rail23 Culvert24 Curb25 Ditch26 Embankment27 Guardrail Face28 Guardrail End

Most Harmful Event

Sequence of Events

1 Straight Ahead3 Turning Left4 Backing5 Turning Right6 Changing Lanes8 Parked10 Making U Turn11 Overtaking/Passing

13 Stopped in Traffic14 Slowing15 Negotiating a Curve16 Leaving Traffic Lane17 Entering Traffic Lane77 Other, Explain inNarrative88 Unknown

Vehicle Maneuver Action Traffic Control Device For

This Vehicle

1 No Controls4 School Zone Sign/Device5 Traffic ControlSignal6 Stop Sign7 Yield Sign

8 Flashing Signal9 Railway CrossingDevice10 Person (includingFlagman, Officer,Guard, etc.)13 Warning Sign77 Other, Explain inNarrative88 Unknown

1 Straight2 Curve Right3 Curve Left

Roadway Alignment1 Level2 Hillcrest3 Uphill4 Downhill5 Sag (bottom)

Roadway Grade

1 No2 Yes88 Unknown

Emergency

Vehicle Use

Vehicle Defects

1 None2 Brakes3 Tires4 Lights (head,signal, tail)6 Steering7 Wipers9 Exhaust System10 Body, Doors11 Power Train

12 Suspension13 Wheels14 Windows/Windshield15 Mirrors16 Truck Coupling /Trailer Hitch /Safety Chains77 Other, Explain inNarrative88 Unknown

12 School Bus13 Transit/ Commuter Bus

9 Ambulance10 Fire Truck11 Farm Labor Transport

1 No Special Function2 Farm Vehicle3 Police7 Taxi8 Military

Special Function

of Motor Vehicle

14 Intercity Bus15 Charter/Tour Bus16 Shuttle Bus17 Farm Labor Bus88 Unknown

PERSON #

1st 2nd

3rd 4th

NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER

NAME OF VIOLATOR

NAME OF VIOLATOR

FL STATUTE NUMBER

FL STATUTE NUMBER

CHARGE

CHARGE

CITATION NUMBER

CITATION NUMBER

13 All Terrain Vehicle (ATV)15 Low Speed Vehicle16 (Sport) Utility Vehicle17 Cargo Van (10,000 lbsor less)

1 No Cargo2 Bus

TRAILER # LICENSE NUMBER STATE

2014-00091087 84459649

4T1BG22K6WU842045

$5,000

32818ORLANDO, FL

22020

CAR STORE (TOWING)

Red4DCAM

01/2015

TOYT1998

158PYF FL

GEICO GENERAL INSURANCECOMPANY 4128457654

ENEL BRUMAIRE 6448 LEMONWOOD CT

HOLLYWOOD WY (Private Parking Lot)

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2

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1 88

2 7HSMV 90010 S (V/P) (rev 10/10)

PERSON #REPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER

1 Driver2 Non Motorist3 Passenger

VEHICLE # NAME PHONE NUMBER Check ifRecommendDriver Re exam

CURRENT ADDRESS (Number and Street) CITY & STATE ZIP CODE

DATE OF BIRTH SEX:1 Male2 Female88 Unknown

DRIVER LICENSE NUMBER STATE EXPIRES INJURY SEVERITY1 None 4 Incapacitating2 Possible 5 Fatal (within 30 days)3 Non incapacitating 6 Non Traffic Fatality

1 A 2 B 3 C4 D/Chauffeur5 E/Operator6 E/Oper –Rest7 None

DL Type

Driver Distracted By1 Not Distracted2 Electronic CommunicationDevices (cell phone, etc.)3 Other Electronic Device(navigation device, DVD player)

4 Other Inside the Vehicle(explain in narrative)5 External Distraction(outside the vehicle, explainin narrative)6 Texting7 Inattentive88 Unknown

Required Endorsements

1 Yes2 No3 No Req. Endorsement

1 Vision Not Obscured2 Inclement Weather3 Parked / Stopped Vehicle4 Trees / Crops / Bushes

5 Load on Vehicle6 Building / Fixed Object

Driver Vision Obstructions

1 Not Applicable2 Not Deployed3 Deployed-Front4 Deployed-Side

Air Bag Deployed5 Deployed-Other(knee, air belt, etc.)6 Deployed-Combination7 Deployed-Curtain88 Deployment

1 No Contributing Action2 Operated MV in Careless orNegligent Manner3 Failed to Yield Right of Way4 Improper Backing6 Improper Turn10 Followed too Closely11 Ran Red Light12 Drove too Fast for Conditions13 Ran Stop Sign15 Improper Passing17 Exceeded Posted Speed21 Wrong Side of Wrong Way25 Failed to keepin Proper Lane

Drivers Actions at Time of Crash

Ejection1 Not Ejected2 Ejected, Totally

DRIVER

7 Signs / Billboards8 Fog

9 Smoke10 Glare77 All Other, Explain inNarrative

3 Ejected, Partially4 Not Applicable88 Unknown

1st 3rd

2nd 4th

1 Apparently Normal3 Asleep or Fatigued5 Ill (sick) or Fainted6 Seizure, Epilepsy, Blackout7 Physically Impaired8 Emotional (depression,angry, disturbed, etc.)

Condition At

Restraint Systems

1 Not Applicable (non-motorist)2 None Used - Motor Vehicle Occupant3 Shoulder and Lap Belt Used

Helmet Use

1 DOT CompliantMotorcycle Helmet2 Other Helmet3 No Helmet

1 Yes2 No3 Not Applicable

Eye Protection

9 Under the Influence ofMedications/Drugs/Alcohol77 Other, Explain in Narrative88 Unknown

4 Shoulder Belt Only Used5 Lap Belt Only Used6 Restraint Used - Type Uknown

77 Other, Explain in Narrative

NON-MOTORIST

1 Pedestrian2 Other Pedestrian (wheelchair, personin a building, skater, pedestrianconveyance, etc.)3 Bicyclist4 Other Cyclist5 Occupant of Motor Vehicle Not inTransport (parked, etc.)6 Occupant of a Non Motor VehicleTransportation Device7 Unknown Type of Non Motorist

Non-Motorist Description

1 None2 Helmet3 Protective Pads Used(elbows, knees, shins, etc.)4 Reflective Clothing (jacket,backpack, etc.)

5 Lighting6 Not Applicable77 Other, Explainin Narrative88 Unknown

Safety Equipment

1 Intersection Marked Crosswalk2 Intersection Unmarked Crosswalk3 Intersection –Other4 Midblock Marked Crosswalk5 Travel Lane Other Location6 Bicycle Lane7 Shoulder/Roadside

8 Sidewalk9 Median/Crossing Island10 Driveway Access11 Shared Use Path or Trail12 Non Trafficway Area77 Other, Explain in Narrative88 Unknown

Non-Motorist Location At Time of Crash

1 Crossing Roadway2 Waiting to Cross Roadway3 Walking/Cycling AlongRoadway with Traffic (in oradjacent to travel lane)

5 Walking/Cycling on Sidewalk6 In Roadway Other(working, playing, etc.)7 Adjacent to Roadway (e.g.,shoulder, median)8 Going to or from School (K12)9 Working in Trafficway(incident response)10 None77 Other, Explain in Narrative88 Unknown

4 Walking/Cycling AlongRoadway Against Traffic (in oradjacent to travel lane)

Action Prior to Crash

1 No Improper Action2 Dart/Dash3 Failure to Yield Right of Way4 Failure to Obey Traffic Signs,Signals, or Officer

Non-Motorist Actions/Circumstances

1st

2nd

5 In Roadway Improperly (standing,lying, working, playing)6 Disabled Vehicle Related (workingon, pushing, leaving/approaching)

7 Entering/Exiting Parked/StandingVehicle8 Inattentive (talking, eating, etc)9 Not Visible (dark clothing, nolighting, etc.)

10 Improper Turn/Merge11 Improper Passing12 Wrong Way Riding or Walking77 Other, Explain in Narrative88 Unknown

SUSPECTEDALCOHOL USE:1 No2 Yes88 Unknown

ALCOHOL TESTED:1 Test Not Given2 Test Refused3 Test Given88 Unknown if Tested

ALCOHOL TEST TYPE:1 Blood2 Breath3 Urine77 Other, Explain inNarrative

ALCOHOLTEST RESULT:1 Pending2 Completed88 Unknown

BAC SUSPECTEDDRUG USE:1 No2 Yes88 Unknown

DRUG TESTED:1 Test Not Given2 Test Refused3 Test Given88 Unknown if Tested

DRUG TEST TYPE:1 Blood3 Urine77 Other,Explain in Narrative

DRUG TEST RESULT:1 Positive2 Negative3 Pending88 Unknown

SOURCE OF TRANSPORT TO MEDICAL FACILITY1 Not Transported2 EMS 3 Law Enforcement77 Other, Explain in Narrative 88 Unknown

EMS AGENCY NAME OR ID

Page ___ of ___

EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO

26 Ran off Roadway27 Disregarded other TrafficSign28 Disregarded Other RoadMarkings29 Over Correcting/OverSteering30 Swerved or Avoided : Dueto Wind, Slippery Surface, MV,Object, Non Motorist inRoadway, etc.31 Operated MV in Erratic,Reckless or Aggressive Manner77 Other Contributing Action

ADDITIONAL PASSENGERS

PERSON # VEHICLE # NAME


DATE OF BIRTH INJ SEX LOC: S R O EJECT HU EP ABD RS


EMS AGENCY NAME OR ID EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO

Time of Crash

DRIVER OR PASSENGER

DRIVER OR PASSENGER

(HU)

7 Child Restraint System - Forward Facing8 Child Restraint System - Read Facing9 Booster Seat10 Child Restraint Type Uknown

(RS)

(ABD)

Uknown

1 Left2 Middle3 Right77 Other(explain innarrative)88 Unknown

1 Front2 Second3 Third4 Fourth77 Other Row88 Unknown

1 Not Applicable2 Sleeper Section of Truck Cab3 Other Enclosed Cargo Area4 Unenclosed Cargo Area5 Trailing Unit6 Riding on Motor Vehicle Exterior (non-trailing unit)88 Unknown

Motor Vehicle Seating Position:

Seat Row Other

(EJECT)

(EP)

LOCATION:(LOC)

SEAT ROW OTHER

ALCOHOL/DRUG/EMS






2014-00091087 84459649

CARLINE B JEAN

6448 LEMONWOOD CT ORLANDO, FL 32818

1

04/07/1974 B656100746270 FL 04/2021

26

77

88

3

2 5

1

1

6

88

1

77

21

88

1

88

1 1 1

o

377

3 7HSMV 90010 S (V/P) (rev 10/10)


VIOLATIONS





VIN



EST. DAMAGE













WindshieldTrailer


18 181919

20 202121


Page ___ of ___

Vehicle Body Type




Comm/Non-Commercial







CommGVWR/GCWR



Cargo Body Type



TRAILER 1 TRAILER 2

PERSON #

PERSON #





Non Collision



Most Harmful Event

Sequence of Events




This Vehicle





Roadway Grade

1 No2 Yes88 Unknown

Emergency

Vehicle Use

Vehicle Defects






Special Function

of Motor Vehicle


PERSON #

1st 2nd

3rd 4th


NAME OF VIOLATOR

NAME OF VIOLATOR

FL STATUTE NUMBER

FL STATUTE NUMBER

CHARGE

CHARGE

CITATION NUMBER

CITATION NUMBER


1 No Cargo2 Bus


2014-00091087 84459649

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4 7HSMV 90010 S (V/P) (rev 10/10)








DL Type













DRIVER




1st 3rd

2nd 4th


Condition At

Restraint Systems


Helmet Use



Eye Protection




NON-MOTORIST





Safety Equipment










1st

2nd














Page ___ of ___









Time of Crash

DRIVER OR PASSENGER

DRIVER OR PASSENGER

(HU)


(RS)

(ABD)

Uknown





Seat Row Other

(EJECT)

(EP)

LOCATION:(LOC)

SEAT ROW OTHER

ALCOHOL/DRUG/EMS






2014-00091087 84459649

o

5 7HSMV 90010 S (V/P) (rev 10/10)

ADDITIONAL VIOLATIONS

NARRATIVEREPORTING AGENCY CASE NUMBER HSMV CRASH REPORT NUMBER

ID/BADGE NUMBER


REPORTING OFFICER

PERSON #

Page ___ of ___

NAME OF VIOLATOR FL STATUTE NUMBER CITATION NUMBERCHARGE

PERSON # NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER

RANK & NAME DEPARTMENT FHP SO PD OTHER











2014-00091087 84459649

On 03/03/2014 at 1932 hours, I Ofc. M. Hanson (16131) responded to 6300 Hollywood Wy (TheRoyal Pacifc Resort Self-Park Parking Lot) reference to a recovered vehicle. Vehicle 1 (V1) wasfound fully submerged in a lake adjacent to the parking lot. Driver of V1 was located, deceasedwithin V1. Evidence indicates that the driver of V1 entered her vehicle on 02/09/2014 atapproximately 1638 hours. V1 left the parking lot roadway and jumped a curb and struck someshrubs. The vehicle continued and crossed another roadway. V1 then exited the parking lot in asoutheastern direction, drove down an embankment and into a lake. This initial report is beingforwarded to the Orlando Police Department's Traffic Homicide Unit for further investigation.

16131 OFC. MYRON HANSON Orlando Police Department

6 7

ooþHSMV 90010 S (N/D) (rev 10/10)

Page ___ of ___7 7






CRASH IDENTIFIERS




CHECK IFCOMPLETED






OR FROM MILEPOST #4





Type of Shoulder









Light Condition




Weather Condition




School Bus Related




First Harmful Event


1 No2 Yes88 Unknown






First Harmful Event









Environment





Crash in Work Zone




Work Zone


WITNESSES


VEHICLE # PERSON #

VEHICLE # PERSON #






Page ___ of ___



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1 2

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2

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1

84459649

1:00 PM1:00 PM

2014-0009108703/10/20144:38 PM

ORANGE46

02/09/2014

07

1:15 PM 9:11 PM

HOLLYWOOD WY

Orlando

6300

9 3 77

771887788

24

1

77 88

8

88

1


o

o

1 7

o o þ

þþ

2

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o

HSMV 90010 S (E) (rev 10/10)


VIOLATIONS





VIN



EST. DAMAGE













WindshieldTrailer


18 181919

20 202121


Page ___ of ___

Vehicle Body Type




Comm/Non-Commercial







CommGVWR/GCWR



Cargo Body Type



TRAILER 1 TRAILER 2

PERSON #

PERSON #





Non Collision



Most Harmful Event

Sequence of Events




This Vehicle





Roadway Grade

1 No2 Yes88 Unknown

Emergency

Vehicle Use

Vehicle Defects






Special Function

of Motor Vehicle


PERSON #

1st 2nd

3rd 4th


NAME OF VIOLATOR

NAME OF VIOLATOR

FL STATUTE NUMBER

FL STATUTE NUMBER

CHARGE

CHARGE

CITATION NUMBER

CITATION NUMBER


1 No Cargo2 Bus


2014-00091087 84459649

4T1BG22K6WU842045

$5,000

32818ORLANDO, FL

22020

CAR STORE (TOWING)

Red4DCAM

01/2015

TOYT1998

158PYF FL




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2 7HSMV 90010 S (V/P) (rev 10/10)








DL Type













DRIVER




1st 3rd

2nd 4th


Condition At

Restraint Systems


Helmet Use



Eye Protection




NON-MOTORIST





Safety Equipment










1st

2nd














Page ___ of ___









Time of Crash

DRIVER OR PASSENGER

DRIVER OR PASSENGER

(HU)


(RS)

(ABD)

Uknown





Seat Row Other

(EJECT)

(EP)

LOCATION:(LOC)

SEAT ROW OTHER

ALCOHOL/DRUG/EMS






2014-00091087 84459649

CARLINE B JEAN


1

04/07/1974 B656100746270 FL 04/2021

26

77

88

3

2 5

1

1

6

88

1

77

21

88

1

88

1 1 1

o

377

3 7HSMV 90010 S (V/P) (rev 10/10)


VIOLATIONS





VIN



EST. DAMAGE













WindshieldTrailer


18 181919

20 202121


Page ___ of ___

Vehicle Body Type




Comm/Non-Commercial







CommGVWR/GCWR



Cargo Body Type



TRAILER 1 TRAILER 2

PERSON #

PERSON #





Non Collision



Most Harmful Event

Sequence of Events




This Vehicle





Roadway Grade

1 No2 Yes88 Unknown

Emergency

Vehicle Use

Vehicle Defects






Special Function

of Motor Vehicle


PERSON #

1st 2nd

3rd 4th


NAME OF VIOLATOR

NAME OF VIOLATOR

FL STATUTE NUMBER

FL STATUTE NUMBER

CHARGE

CHARGE

CITATION NUMBER

CITATION NUMBER


1 No Cargo2 Bus


2014-00091087 84459649

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4 7HSMV 90010 S (V/P) (rev 10/10)








DL Type













DRIVER




1st 3rd

2nd 4th


Condition At

Restraint Systems


Helmet Use



Eye Protection




NON-MOTORIST





Safety Equipment










1st

2nd














Page ___ of ___









Time of Crash

DRIVER OR PASSENGER

DRIVER OR PASSENGER

(HU)


(RS)

(ABD)

Uknown





Seat Row Other

(EJECT)

(EP)

LOCATION:(LOC)

SEAT ROW OTHER

ALCOHOL/DRUG/EMS






2014-00091087 84459649

o

5 7HSMV 90010 S (V/P) (rev 10/10)



ID/BADGE NUMBER


REPORTING OFFICER

PERSON #

Page ___ of ___














2014-00091087 84459649

On 03-03-14 at 1939hrs, I CSI G. Crosby responded to the employee parking lot located at 6300Hollywood Way in reference to a traffic crash. On arrival and after being briefed by InvestigatiorA. Gruler, I took seventy-three (73) color digital photographs. Photographs show overall views ofthe scene to include a retention pond that the victim's vehicle was pulled from and overallexterior views of a Toyota Camry Florida Tag 158 PYF with the left front window partially downand damage to the right front and right rear side. Additional photographs show what appearedto be tire impressions across a curb over some bushes then over the outer curb of the travel laneand down the embankment to where the vehicle entered the retention pond. Photographs showthe victim Carline Jean B/F 04-07-74 inside the vehicle and overall views of her after she wasremoved from the vehicle by the Investigator of the Orange County Medical Examiner's Office.No other action was taken.

11933 CSI GARY R, CROSBY Orlando Police Department

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First Harmful Event


1 No2 Yes88 Unknown






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84459649

1:00 PM1:00 PM

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ORANGE46

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HOLLYWOOD WY

Orlando

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Non Collision



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This Vehicle





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1 No2 Yes88 Unknown

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of Motor Vehicle


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1st 2nd

3rd 4th


NAME OF VIOLATOR

NAME OF VIOLATOR

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FL STATUTE NUMBER

CHARGE

CHARGE

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CITATION NUMBER


1 No Cargo2 Bus


2014-00091087 84459649

4T1BG22K6WU842045

$5,000

32818ORLANDO, FL

22020

CAR STORE (TOWING)

Red4DCAM

01/2015

TOYT1998

158PYF FL




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DRIVER OR PASSENGER

DRIVER OR PASSENGER

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(RS)

(ABD)

Uknown





Seat Row Other

(EJECT)

(EP)

LOCATION:(LOC)

SEAT ROW OTHER

ALCOHOL/DRUG/EMS






2014-00091087 84459649

CARLINE B JEAN


1

04/07/1974 B656100746270 FL 04/2021

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18 181919

20 202121


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PERSON #





Non Collision



Most Harmful Event

Sequence of Events




This Vehicle





Roadway Grade

1 No2 Yes88 Unknown

Emergency

Vehicle Use

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Special Function

of Motor Vehicle


PERSON #

1st 2nd

3rd 4th


NAME OF VIOLATOR

NAME OF VIOLATOR

FL STATUTE NUMBER

FL STATUTE NUMBER

CHARGE

CHARGE

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CITATION NUMBER


1 No Cargo2 Bus


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2014-00091087 84459649

On March 19, 2014 at 1145 hours, I, CSI Styer (#14857) along with CSI Walsh (#16123) respondedto 6300 Hollywood Way, in reference to a follow up to a traffic fatality. We completed six (6)scans of the parking lot and lake using the Leica C-10 scan station.

We departed the scene at 1435 hours. Upon arrival at OPH, the data from the scans wasdownloaded and stored in the Leica software system.

14857 CSI CHANTAL M. STYER Orlando Police Department

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OR FROM MILEPOST #4





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Light Condition




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School Bus Related




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1 No2 Yes88 Unknown






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1:00 PM1:00 PM

2014-0009108705/29/20144:38 PM

ORANGE46

02/09/2014

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HOLLYWOOD WY

Orlando

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TRINA GREGORY 4544 DILFORD DR RALEIGH NC 27604 865-202-0728


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1 No Cargo2 Bus


2014-00091087 84459649

4T1BG22K6WU842045

$5,000

32818ORLANDO, FL

22020

CAR STORE (TOWING)

Red4DCAM

01/2015

TOYT1998

158PYF FL




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Seat Row Other

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(EP)

LOCATION:(LOC)

SEAT ROW OTHER

ALCOHOL/DRUG/EMS






2014-00091087 84459649

CARLINE B JEAN


1

04/07/1974 B656100746270 FL 04/2021

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Sequence of Events




This Vehicle





Roadway Grade

1 No2 Yes88 Unknown

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of Motor Vehicle


PERSON #

1st 2nd

3rd 4th


NAME OF VIOLATOR

NAME OF VIOLATOR

FL STATUTE NUMBER

FL STATUTE NUMBER

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CITATION NUMBER


1 No Cargo2 Bus


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2014-00091087 84459649

On March 03, 2014, at approximately 1700 hours, the Orange County Sheriff’s Office Detectivesand Dive team were called to the Loews Royal Pacific Hotel located at 6300 Hollywood WayOrlando Florida 32819. They began to search the retention pond located adjacent to theemployee/overflow parking lot. The Dive Team located Vehicle # 1, a 1998 red Toyota Camry 4door, bearing Florida tag # 158PYF 30 feet into the retention pond and 12 feet below the surface.Dive Team members connected Vehicle # 1 to a tow truck and it was pulled out of the retentionpond and onto the north embankment where a female corpse was found inside the vehicle.

On March 03, 2014, at approximately 1900 hour, I, Detective Kenneth Brown respondedthe Loews Royal Pacific Hotel. I was briefed by Detective Joey Busque of the Orange CountySheriff’s Office. I inspected the exterior, interior of Vehicle # 1 and observed the position of finalrest for the sole occupant of Vehicle # 1. Vehicle # 1’s gear shift was in the drive position withthe overdrive button activated. The sole occupant was not secured by a seatbelt. Vehicle # 1had a large dent on the right rear quarter panel consistent with side swiping a concrete pole. Iobserved a second dent on the front right quarter panel just above the right front headlight. Iobserved two tire tracks leading from the retention pond and up the embankment. There wereno tire marks observed on the parking lot surface. I observed two tire tracks through a medianlocated at the southern end of row # 2. A tire mark was observed on the right curb borderingparking space # 1081. I walked the entire lot looking for any additional visual evidence pertinentto this crash with negative results. I did not observe any possible video surveillance that mayhave captured the crash. I located the crash scene and began my investigation.

Crash scene investigation revealed Vehicle # 1 began to travel east in the parking lotfrom parking space # 1081. Parking space # 1081 is the southernmost parking space of row # 2.Vehicle # 1 drove over the curb and through the median adjacent to parking space # 1081.Vehicle # 1 continued traveling east across two travel lanes and over the south side curb. Vehicle# 1 then drove over two shrubs and down a 46 foot embankment. Vehicle # 1 entered the

11470 Det. KENNETH BROWN Orlando Police Department

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2014-00091087 84459649

retention pond and was later found 30 feet from the waterline and submerged approximately 12feet on the pond floor.

The sole occupant presumed to be Driver # 1 was photographed as she lay at final rest within thevehicle. The sole occupant was lying in between the front seats with her feet near the gear shiftand her upper torso resting on the left rear seat. The sole occupant was not secured by aseatbelt. Orange County Medical Examiner’s Office personnel extracted the sole occupant andsubsequently identified her as Carline Brumaire Jean. Carline Brumaire Jean was designated asDriver # 1.

This investigation revealed the following facts:

1. This was a single vehicle crash involving one fatality. Driver # 1 was the sole occupant ofVehicle # 1.

2. There are no known eye witnesses who observed the crash prior to Vehicle # 1 entering theretention pond and or video recordings of this crash.

3. Witness Trina Gregory was driving on the Interstate 4 west bound on ramp from the southbound lanes of South Kirkman Road and observed Vehicle # 1 sinking in the pond. Ms. Gregorycalled Orlando Police Communications Center at approximately 1641 hours, and advised OrlandoPolice of what she observed.

4. The scene was not discovered until 23 days after the crash and there was very little physicalevidence discovered during this investigation.

5. Vehicle # 1 was traveling east in an access controlled parking lot located at 6300 Hollywood


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Way.

6. Vehicle # 1 traveled up and over a curb, onto a raised median, over shrubbery, onto theroadway where she crossed diagonally across two marked travel lanes. Vehicle # 1 continued inan eastern direction where it traveled up and over a second curb, over another shrub and downan embankment before entering the water.

7. Driver # 1 was not using her cell phone at the time of the crash.

8. This investigation revealed no evidence this crash was not a suicide or caused by a criminalact.

9. Post crash vehicle inspections did not reveal any mechanical defects that may havecontributed to the crash nor did they reveal any crash damage that would have suggest Vehicle #1 made contact with another vehicle prior to entering the water. Vehicle # 1’s engine wasrunning and the headlights were on when it entered the retention pond.

10. The damage mentioned on the right rear quarter panel was confirmed as prior damage andnot related to this crash investigation. There is a dent located on Vehicle # 1’s front rightquarter panel that is still unexplained.

11. There are no known reports of vehicle owners claiming damage to parked vehicles duringthis investigative period.

12. Driver # 1 obtained a Florida Learner’s License on February 11, 2014. Driver # 1 wasoperating Vehicle # 1 without a licensed driver occupying the front passenger seat.


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13. Absent any additional information, this crash was determined to be a result of vehicleoperator error.

14. Driver # 1 violated Florida State Statue 322.1615 subsection (2): Learner’s driver’s license.

(2) When operating a motor vehicle, the holder of a learner’s license must be

Accompanied at all times by a driver who:

(a) Holds a valid license to operate the type of vehicle being operated;

(b) Is at least 21 years of age; and

(c) Occupies the closest seat to the right of the driver of the motor vehicle.

(4) A licensee who violates subsection (2) or (3) is subject to the civil penalty

imposed for a moving violation as set forth in chapter 318.

This case is considered CLOSED.


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CRASH IDENTIFIERS




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OR FROM MILEPOST #4





Type of Shoulder









Light Condition




Weather Condition




School Bus Related




First Harmful Event


1 No2 Yes88 Unknown






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Crash in Work Zone




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ORANGE46

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HOLLYWOOD WY

Orlando

6300

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TRINA GREGORY 4544 DILFORD DR RALEIGH NC 27604 865-202-0728


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NAME OF VIOLATOR

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1 No Cargo2 Bus


2014-00091087 84459649

4T1BG22K6WU842045

$5,000

32818ORLANDO, FL

22020

CAR STORE (TOWING)

Red4DCAM

01/2015

TOYT1998

158PYF FL




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ALCOHOL/DRUG/EMS






2014-00091087 84459649

CARLINE B JEAN


1

04/07/1974 B656100746270 FL 04/2021

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Comm/Non-Commercial







CommGVWR/GCWR



Cargo Body Type



TRAILER 1 TRAILER 2

PERSON #

PERSON #





Non Collision



Most Harmful Event

Sequence of Events




This Vehicle





Roadway Grade

1 No2 Yes88 Unknown

Emergency

Vehicle Use

Vehicle Defects






Special Function

of Motor Vehicle


PERSON #

1st 2nd

3rd 4th


NAME OF VIOLATOR

NAME OF VIOLATOR

FL STATUTE NUMBER

FL STATUTE NUMBER

CHARGE

CHARGE

CITATION NUMBER

CITATION NUMBER


1 No Cargo2 Bus


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(EP)

LOCATION:(LOC)

SEAT ROW OTHER

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This supplement was generated for the purpose of correcting a typographical error in this crashreport. Driver # 1 obtained a Florida Learner's License on February 11, 2013.


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STATE OF FLORIDA TRAFFIC CRASH REPORTþ o o 2 · CRASH DATE TIME OF CRASH DATE OF REPORT REPORTING...

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