FLORIDA TRAFFIC CRASH REPORT LONG FORM X
SHORT FORM
Crash Date 4/9/2014
Time of Crash 3:05 PM
HIGHWAY SAFETY & MOTOR VEHICLES TRAFFIC CRASH RECORDS NEIL KIRKMAN BUILDING, TALLAHASSEE, FL 32399-0537
UPDATE
Date of Report 4/9/2014
Reporting Agency FLORIDA HIGHWAY PATROL
Reporting Agency Case Number HSMV Crash Report Number FHPD14OFF030470 83773522-01
CRASH IDENTIFIERS County Code City Code 7 54 On Scene Date/Time 4/9/2014 3:15 PM
County of Crash ORANGE Cleared Scene Date/Time 4/9/2014 11:28 PM
Place or City of Crash Within City Limits Reported Date/Time WINTER PARK NO 4/9/2014 3:07 PM Investigation Completed Reason (if Investigation Not Complete) NO PENDING THI
Dispatched Date/Time 4/9/2014 3:11 PM Notified By LAW ENFORCEMENT AGENCY
ROADWAY INFORMATION Crash Occurred on Street, Road, Highway 4035 SR-551 (GOLDENROD ROAD) At Feet Or Miles Direction 0.25 N Road System Identifier STATE
At Street Address # From Intersection With Street, Road, Highway UNIVERSITY BLVD Type of Shoulder CURB
CRASH INFORMATION
Pictures Taken Weather Condition CLEAR
Light Condition DAYLIGHT
First Harmful Event Type COLLISION WITH PERSON, MOTOR VEHICLE, OR NON-FIXED OBJECT Contributing Circumstances: Road NONE Contributing Circumstances: Environment NONE Work Zone Related NO
Crash in Work Zone
VEHICLE
And
Longitude W 81 17.1879 Or From Milepost Number
Type of Intersection NOT AT INTERSECTION
Roadway Surface Condition DRY
First Harmful Event Detail MOTOR VEHICLE IN TRANSPORT
At Latitude N 28 35.9023
School Bus Related NO
First Harmful Event Location ON ROADWAY
Manner of Collision FRONT TO REAR Within Interchange NO
First Harmful Event's Relation to Junction DRIVEWAY/ALLEY ACCESS RELATED
Contributing Circumstances: Road
Contributing Circumstances: Road
Contributing Circumstances: Environment
Contributing Circumstances: Environment
Type of Work Zone
Workers in Work Zone
Law Enforcement in Work Zone
Commercial Motor Vehicle Vehicle Motor Vehicle Type Hit & Run (by this vehicle) License Number State Reg. Expires Permanent Reg. VIN V01 MOTOR VEHICLE IN TRANSPORT YES 548INA FL 8/29/2014 NO 1D4HD48D55F508333 Year Make Model Style Color Extent of Damage Est. Damage Towed Due to Damage Vehicle Removed By Rotation 2005 DODG DURANGO 4D SIL FUNCTIONAL 800 NO Insurance Company Insurance Policy Number ALLSTATE INS. 0710755351020 State Zip Code Phone Number(s) Name of Vehicle Owner Current Address City Business PO BOX 592 GOLDENROD FL 32733-0000 EVELYN RIVERA CORCHADO License Number State Reg. Expires Permanent Reg. VIN Year Make Length Axles Trailer NO One State Reg. Expires Permanent Reg. VIN Year Make Length Axles Trailer License Number NO Two Vehicle Direction On Street, Road, Highway At Est. Speed Posted Speed Total Lanes NORTH GOLDENROD ROAD NB 40 45 4 Traveling CMV Configuration Cargo Body Type Area of Initial Impact Most Damaged Area
Comm GVWR/GCWR
Trailer Type (Trailer One)
;
Trailer Type (Trailer Two)
Haz. Mat. Release Haz Mat Placard
Haz. Mat. Number
Motor Carrier Name
Vehicle Maneuver Action STRAIGHT AHEAD
Vehicle Body Type (SPORT) UTILITY VEHICLE Trafficway TWO-WAY, DIVIDED, POSITIVE MEDIAN BARRIER
City
Vehicle Defects (one) NONE Roadway Grade LEVEL
Traffic Control Device for this Vehicle First (1) Sequence of Events NO CONTROLS COLLISION NON-FIXED OBJECT
Address Other
Comm/Non-Commercial
Haz. Mat. Class US DOT Number
Motor Carrier Address
Undercarriage
State
Vehicle Defects (two)
Roadway Alignment STRAIGHT
Second (2) Sequence of Events
Most Harmful Event COLLISION NON-FIXED OBJECT Third (3) Sequence of Events
Overturn Windshield Trailer Zip Code
; Phone Number
Emergency Vehicle Use Special Function of MV NO NO SPECIAL FUNCTION Most Harmful Event Detail MOTOR VEHICLE IN TRANSPORT Fourth (4) Sequence of Events
MOTOR VEHICLE IN TRANSPORT
VEHICLE
Commercial Motor Vehicle Vehicle Motor Vehicle Type Hit & Run (by this vehicle) License Number State Reg. Expires Permanent Reg. VIN V02 MOTOR VEHICLE IN TRANSPORT NO 0RLCRIB FL 6/24/2015 NO 4T1FA38P36U082474 Year Make Model Style Color Extent of Damage Est. Damage Towed Due to Damage Vehicle Removed By 2006 TOYOT SOLARA CV BLK FUNCTIONAL 4,000 YES A AND A TOWING Insurance Company Insurance Policy Number GEICO INS. 4180705933 Name of Vehicle Owner Current Address City State Zip Code Phone Number(s) Business KIMBERLY BAILEY CAMPBELL 7707 COUNTRY PL WINTER PARK FL 32792-9316 License Number State Reg. Expires Permanent Reg. VIN Year Make Trailer NO One State Reg. Expires Permanent Reg. VIN Year Make Trailer License Number NO Two Vehicle Direction On Street, Road, Highway At Est. Speed Posted Speed NORTH GOLDENROD ROAD NB 30 45 Traveling
Page 1 of 6
OFFICIAL COPY
Rotation ROTATION
Length Axles Length Axles Total Lanes 4
Crash Date 4/9/2014
Time of Crash 3:05 PM
Date of Report 4/9/2014
CMV Configuration
Reporting Agency FLORIDA HIGHWAY PATROL
Cargo Body Type
Comm GVWR/GCWR
Area of Initial Impact
Trailer Type (Trailer One)
Haz. Mat. Release Haz Mat Placard
Trailer Type (Trailer Two)
Haz. Mat. Number
Motor Carrier Name
Vehicle Maneuver Action TURNING RIGHT
Haz. Mat. Class US DOT Number
Motor Carrier Address Comm/Non-Commercial
Reporting Agency Case Number HSMV Crash Report Number FHPD14OFF030470 83773522-01
Address Other Vehicle Body Type PASSENGER CAR Trafficway TWO-WAY, DIVIDED, POSITIVE MEDIAN BARRIER
City
Vehicle Defects (one) NONE Roadway Grade LEVEL
Traffic Control Device for this Vehicle First (1) Sequence of Events NO CONTROLS COLLISION NON-FIXED OBJECT MOTOR VEHICLE IN TRANSPORT
Most Damaged Area
;
State
Vehicle Defects (two)
Roadway Alignment STRAIGHT
Undercarriage
Most Harmful Event COLLISION NON-FIXED OBJECT
Overturn Windshield Trailer
;
Zip Code
Phone Number
Emergency Vehicle Use Special Function of MV NO NO SPECIAL FUNCTION Most Harmful Event Detail PEDESTRIAN
Second (2) Sequence of Events COLLISION WITH FIXED OBJECT
Third (3) Sequence of Events COLLISION NON-FIXED OBJECT
OTHER FIXED OBJECT
PEDESTRIAN
Fourth (4) Sequence of Events
PERSON RECORD # Person Type Vehicle # Name Injury Severity Ejection Driver ReExam 1 DRIVER V01 ROBERT ALEX CORCHADO NONE NOT EJECTED NO Date of Birth Sex Condition at Time of Crash Address Phone Number 12/08/1985 M OTHER, EXPLAIN IN NARRATIVE 7309 GRAND AVE, WINTER PARK FL 32792 Driver License Number State Expires Type Required Endorsements C623761854480 FL 12/08/2021 CLASS E / OPERATOR NO REQUIRED ENDORSEMENTS Restraint Systems Air Bag Deployed Helmet Use Eye Protection SHOULDER AND LAP BELT USED NOT DEPLOYED NOT APPLICABLE Motor Vehicle Seating Position: Row Motor Vehicle Seating Position: Seat Motor Vehicle Seating Position: Other FRONT LEFT Driver Distracted By Driver Vision Obstructions NOT DISTRACTED VISION NOT OBSCURED Driver Actions at Time of Crash 1 (based on judgement of investigation officer) Driver Actions at Time of Crash 2 (based on judgement of investigation officer) OPERATED MOTOR VEHICLE IN CARELESS OR NEGLIGENT MANNER Driver Actions at Time of Crash 3 (based on judgement of investigation officer) Driver Actions at Time of Crash 4 (based on judgement of investigation officer) Suspected Alcohol Use Alcohol Tested UNKNOWN TEST NOT GIVEN Source of Transport to Medical Facility NOT TRANSPORTED
Alcohol Test Type
Alcohol Test Result
EMS Agency Name or ID
BAC EMS Run Number
Suspected Drug Use Drug Tested Drug Test Type UNKNOWN TEST NOT GIVEN Medical Facility Transported To
Drug Test Result
PERSON RECORD # Person Type Vehicle # Name Injury Severity Ejection Driver ReExam 2 DRIVER V02 ALBERT DEAN CAMPBELL NONE NOT EJECTED NO Date of Birth Sex Condition at Time of Crash Address Phone Number 10/31/1952 M APPARENTLY NORMAL 7707 COUNTRY PL, WINTER PARK FL 32792 Driver License Number State Expires Type Required Endorsements C514024523910 FL 10/31/2016 CLASS E / OPERATOR NO REQUIRED ENDORSEMENTS Restraint Systems Air Bag Deployed Helmet Use Eye Protection SHOULDER AND LAP BELT USED NOT DEPLOYED NOT APPLICABLE Motor Vehicle Seating Position: Row Motor Vehicle Seating Position: Seat Motor Vehicle Seating Position: Other FRONT LEFT Driver Distracted By Driver Vision Obstructions NOT DISTRACTED VISION NOT OBSCURED Driver Actions at Time of Crash 1 (based on judgement of investigation officer) Driver Actions at Time of Crash 2 (based on judgement of investigation officer) OTHER CONTRIBUTING ACTION Driver Actions at Time of Crash 3 (based on judgement of investigation officer) Driver Actions at Time of Crash 4 (based on judgement of investigation officer) Suspected Alcohol Use Alcohol Tested NO TEST GIVEN Source of Transport to Medical Facility NOT TRANSPORTED
Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type BLOOD PENDING NO TEST GIVEN BLOOD EMS Agency Name or ID EMS Run Number Medical Facility Transported To
Drug Test Result PENDING
PERSON RECORD # Person Type Vehicle # Name Injury Severity Ejection 3 PASSENGER V02 KIMBERLY BAILEY CAMPBELL NONE NOT EJECTED Date of Birth Sex Address Phone Number 06/24/1960 F 7707 COUNTRY PL, WINTER PARK FL 32792 Restraint Systems Air Bag Deployed Helmet Use Eye Protection SHOULDER AND LAP BELT USED NOT DEPLOYED NOT APPLICABLE Motor Vehicle Seating Position: Row Motor Vehicle Seating Position: Seat Motor Vehicle Seating Position: Other FRONT RIGHT Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To NOT TRANSPORTED `
PERSON RECORD # Non-Motorist # Person Type Name Injury Severity 4 NM01 NON-MOTORIST / OTHER PEDESTRIAN LILY QUINTUS FATAL(WITHIN 30 DAYS) Date of Birth Sex Address Phone Number 03/02/2010 F 3018 LAKEWOOD POINT, ORLANDO FL 32817 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 NO IMPROPER ACTION Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To EMS OCFR 30820 ARNOLD PALMER HOSPITAL
PERSON RECORD # 5
Non-Motorist # Person Type NM02 NON-MOTORIST / OTHER PEDESTRIAN
Page 2 of 6
Name JUNE DECALZADA
OFFICIAL COPY
Injury Severity INCAPACITATING
Crash Date 4/9/2014
Time of Crash 3:05 PM
Date of Report 4/9/2014
Reporting Agency FLORIDA HIGHWAY PATROL
Reporting Agency Case Number HSMV Crash Report Number FHPD14OFF030470 83773522-01
Date of Birth Sex Address Phone Number 02/10/2011 F 461 MOHAVE TERREC, ORLANDO FL 32746 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 NO IMPROPER ACTION Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To EMS OCFR 30820 ARNOLD PALMER HOSPITAL
PERSON RECORD # Non-Motorist # Person Type Name Injury Severity 6 NM03 NON-MOTORIST / OTHER PEDESTRIAN KALEB INFANTE INCAPACITATING Date of Birth Sex Address Phone Number 12/23/2009 M 2853 TCU BLVD, ORLANDO FL 32817 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 OTHER, EXPLAIN IN NARRATIVE Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To EMS OCFR 30820 ARNOLD PALMER HOSPITAL
PERSON RECORD # Non-Motorist # Person Type Name Injury Severity 7 NM04 NON-MOTORIST / OTHER PEDESTRIAN DANE KELLEY NON-INCAPACITATING Date of Birth Sex Address Phone Number 05/11/2010 M 908 SHAW CIRCLE, MELBOURNE FL 32940 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 NO IMPROPER ACTION Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To EMS OCFR 30820 ARNOLD PALMER HOSPITAL
PERSON RECORD # Non-Motorist # Person Type Name Injury Severity 8 NM05 NON-MOTORIST / OTHER PEDESTRIAN JADE LAWRENCE NON-INCAPACITATING Date of Birth Sex Address Phone Number 03/23/2010 F 8228 RIVIERA SHORE CT, ORLANDO FL 32817 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 NO IMPROPER ACTION Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To EMS OCFR 30820 ARNOLD PALMER HOSPITAL
PERSON RECORD # Non-Motorist # Person Type Name Injury Severity 9 NM06 NON-MOTORIST / OTHER PEDESTRIAN ELIJAH TORRES-LOGAN NON-INCAPACITATING Date of Birth Sex Address Phone Number 03/25/2010 M 10149 E MAR COMMONS BLVD #163, ORLANDO FL 32825 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 NO IMPROPER ACTION Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To EMS OCFR 030470 ARNOLD PALMER HOSPITAL
PERSON RECORD # Non-Motorist # Person Type Name Injury Severity 10 NM07 NON-MOTORIST / OTHER PEDESTRIAN RICHARD RIVERA INCAPACITATING Date of Birth Sex Address Phone Number 09/08/2008 M 7277 GRAND AVE, WINTER PARK FL 32792 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 NO IMPROPER ACTION Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To EMS OCFR 030470 ARNOLD PALMER HOSPITAL`
PERSON RECORD # Non-Motorist # Person Type 11 NM08 NON-MOTORIST / OTHER PEDESTRIAN Date of Birth Sex Address 02/28/2010 F 9525 BANDELIER DR, ORLANDO FL 32817 Non Motorist action / Circumstance Prior To Crash OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 NO IMPROPER ACTION Non Motorist Safety Equipment 1 NONE
Page 3 of 6
Name JAMIE DUNA
Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 2 Non Motorist Safety Equipment 2
OFFICIAL COPY
Injury Severity NON-INCAPACITATING Phone Number
Crash Date 4/9/2014
Time of Crash 3:05 PM
Date of Report 4/9/2014
Suspected Alcohol Use Alcohol Tested NO TEST NOT GIVEN Source of Transport to Medical Facility EMS
Alcohol Test Type
Reporting Agency FLORIDA HIGHWAY PATROL Alcohol Test Result
EMS Agency Name or ID OCFR`
Reporting Agency Case Number HSMV Crash Report Number FHPD14OFF030470 83773522-01
BAC
Suspected Drug Use Drug Tested Drug Test Type NO TEST NOT GIVEN EMS Run Number Medical Facility Transported To 030470 ARNOLD PALMER HOSPITAL
Drug Test Result
PERSON RECORD # Non-Motorist # Person Type Name Injury Severity 12 NM09 NON-MOTORIST / OTHER PEDESTRIAN MEKAYLA HEALY NONE Date of Birth Sex Address Phone Number 09/18/2008 F 4845 LAKE SHARP DR, ORLANDO FL 32817 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 NO IMPROPER ACTION Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To EMS OCFR 030470 ARNOLD PALMER HOSPITAL
PERSON RECORD # Non-Motorist # Person Type Name Injury Severity 13 NM10 NON-MOTORIST / OTHER PEDESTRIAN ETHAN LOPEZ NON-INCAPACITATING Date of Birth Sex Address Phone Number 12/03/2009 M 402 BELVEDER WAY, SANFORD FL 32773 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 NO IMPROPER ACTION Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To EMS OCFR 030470 ARNOLD PALMER HOSPITAL
PERSON RECORD # Non-Motorist # Person Type Name Injury Severity 14 NM11 NON-MOTORIST / OTHER PEDESTRIAN ISIBELLE STRUBE NON-INCAPACITATING Date of Birth Sex Address Phone Number 08/21/2009 F 2831 DELCREST CT, WINTER PARK FL 32817 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 NO IMPROPER ACTION Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To EMS OCFR 030470 ARNOLD PALMER HOSPITAL
PERSON RECORD # Non-Motorist # Person Type Name Injury Severity 15 NM12 NON-MOTORIST / OTHER PEDESTRIAN XAVIER VALEZ NON-INCAPACITATING Date of Birth Sex Address Phone Number 11/22/2008 M 3733 N GOLDENROD ROAD, WINTER PARK FL 32792 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 NO IMPROPER ACTION Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To OTHER, EXPLAIN IN NARRATIVE ARNOLD PARMER HOSPITAL
PERSON RECORD # Non-Motorist # Person Type Name Injury Severity 16 NM13 NON-MOTORIST / OTHER PEDESTRIAN DONNA BRASHEARS INCAPACITATING Date of Birth Sex Address Phone Number 09/12/1971 F 3023 CENTER AVE, ORLANDO FL 32806 Non Motorist action / Circumstance Prior To Crash Non Motorist Location at Time of Crash OTHER, EXPLAIN IN NARRATIVE OTHER, EXPLAIN IN NARRATIVE Non Motorist Action / Circumstance at Time of Crash 1 Non Motorist Action / Circumstance at Time of Crash 2 NO IMPROPER ACTION Non Motorist Safety Equipment 1 Non Motorist Safety Equipment 2 NONE Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result NO TEST NOT GIVEN NO TEST NOT GIVEN Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To EMS OCFR 030470 ORLANDO REGIONAL MEDICAL
WITNESS RECORD # 17
Name ALAN B ROOT
Address 8412 ALVERON AVE, ORLANDO FL 32817
Phone Number
Address 8412 ALVERON AVE, ORLANDO FL 32817
Phone Number
Address 1705 NORTHEAST 4TH PLACE, CAPE CORAL FL 33901
Phone Number
Address 702 SOLANDERA DRIVE, ORLANDO FL 32807
Phone Number
WITNESS RECORD # 18
Name DENNIS A DICKQUIST
WITNESS RECORD # 19
Name RONNEY AVELLAN
WITNESS RECORD # 20
Name JOEL ROSADO
NON VEHICLE PROPERTY DAMAGE Property Damage (Other than Vehicle) WATER SPRINKLER AND BUILDING WALLS
Page 4 of 6
Est. Damage Business Person# Property Owner 5,000 YES KINDERCARE LEARNING CENTER (4035 Goldenrod Road, Orlando, Fl 32817)
OFFICIAL COPY
Crash Date 4/9/2014
Time of Crash 3:05 PM
Date of Report 4/9/2014
Reporting Agency FLORIDA HIGHWAY PATROL
Reporting Agency Case Number HSMV Crash Report Number FHPD14OFF030470 83773522-01
NARRATIVE ID Number 2693
Rank TROOPER
Name R. REYES
Troop / Post D
Officer Agency FLORIDA HIGHWAY PATROL
Phone Number 407-737-2300
V2 was traveling northbound on SR-551 (Goldenrod Road) in the right/outside travel lane north of University Blvd., approaching the private driveway to the Kinder Care Learning facility located at 4035 Goldenrod Road Winter Park, FL. on the east shoulder of the roadway. V01 was also traveling northbound on SR-551 (Goldenrod Road) in the right/outside travel lane north of University Blvd, approaching V02, which was slowing to turn. As V02 driver slowed down to make a right-hand turn into the Kinder Care Learning Center private driveway, for reasons unknown, V01 failed to slow down. The front of V01 struck the right rear of V02. At impact, V01 fled the scene of the crash traveling north on SR551. The collision propelled V02 forward out of control in a southeasterly direction, and into the parking lot of the Kinder Care. V02 continued out of control and traveled over the curb and through the parking lot. V02 then continued into a secondary collision and impacted the exterior wall of the Kinder Care facility. V02 drove through the exterior wall and entered the playroom area on the northwest corner of the structure. Upon entering the playroom area, the front and undercarriage area of V02 struck NM01, NM02, and NM03. V02 continued traveling eastbound inside of the structure entering the second room coming to final rest approximately three feet from the east exterior wall. It should be noted that during the collisions within the daycare, debris struck twelve (12) occupants of the daycare to include one adult and 11 children. At Law Enforcement request, the driver of V02 gave a voluntary blood sample. Fire Engine #63 and Rescue #63 were notified at 1506. They were in route at 1507; and arrived at 1509. Lily J. Quintus date of Birth 03/02/2010, was pronounced deceased at Arnold Palmer Hospital by Doctor Mark Levy at 18:15 Traffic Homicide Investigator: Cpl. Brian Gensler #743 Traffic Homicide Case #714-07-023 REPORTING OFFICER ID Number 2693
Page 5 of 6
Rank TROOPER
Name R. REYES
Troop / Post D
OFFICIAL COPY
Officer Agency FLORIDA HIGHWAY PATROL
Phone Number 407-737-2300
Crash Date 4/9/2014
Time of Crash 3:05 PM
Date of Report 4/9/2014
Reporting Agency FLORIDA HIGHWAY PATROL
DIAGRAM OF CRASH
Page 6 of 6
OFFICIAL COPY
Reporting Agency Case Number HSMV Crash Report Number FHPD14OFF030470 83773522-01