output.txt

C LexisNexisⓇ
PAGE COUNT: 5
CLIENT :
DIVISION :
ADJUSTER:
CLAIM :
TRANSACTION # :
DATE :
COUNTY:
STATE:
8811
DATE OF LOSS :
STREET:
CITY:
0053C00000BSLLQ
00002410
PARTY 1:
PARTY 2 :
PARTY 3:
CAR :
NOTE :
DRIVER LICENSE:
ADDITIONAL INFO :
1348431222
05/03/2021
INVESTIGATING AGENCY:
REPORT NUMBER :
REPORT TYPE :
04/22/2021
SW 65 AVE
DADE
FL
TIME OF LOSS :
WEST MIAMI PD
85863976
Auto Accident
MAKE :
TAG :
YEAR:
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Date of Crash
22/Apr/2021 02:51 AM
FLORIDA TRAFFIC CRASH REPORT
LONG FORM X
SHORT FORM
CRASH IDENTIFIERS
County Code City Code
01
93
Time on Scene
22/Apr/2021
02:54 PM
At Feet
light Condition
ROADWAY INFORMATION
Crash Occured On Street, Road, Highway
Or Miles
1 Daylight
First Harmful Event Type
Time Cleared Scene Completed
22/Apr/2021 04:00
PM
Yes
Contributing Circumstances: Road
1 None
Trailer
One:
Make
Year
2020 ΤΟΥΤ
Insurance Company
1 Vehicle in Transport
Model Style
Road System Identifier
5 Local
CRASH INFORMATION (Check if Pictures Taken)
Weather Condition
1 Clear
Contributing Circumstances: Environment
1 None
Work Zone Related Crash In Work Zone
1 No
VEHICLE (Check if Commercial)
Vehicle Motor Vehicle Type
1
(Electronic Version)
Time of Crash
22/Apr/2021 02:51 AM
License Number
Trailer License Number
Two:
Vehicle
Traveling: North
CMV Configuration
Comm GVWR/GCWR
County of Crash
Motor Carrier Name
Name of Vehicle Owner (Check Box If Business)
Comm/Non-Commercial
SW 65TH AVE
Direction
Vehicle Maneuver Action
1 Straight Ahead
HSMV 90010 S
Year Make
2021 VOLK
Insurance Company
4 Not Applicable
Haz. Mat. Release Haz Mat. Placard
Hit and Run
1 No
State
Reg. Expires
State Reg. Expires
Direction On Street, Road, Highway
West
4D
First Harmful Event
14
1 Vehicle in Transport
Model Style
Motor Carrier Address
MIAMI-DADE
INFINITY AUTO INSURANCE COMPANY
Vehicle Body Type
VEHICLE (Check if Commercial)
Vehicle Motor Vehicle Type
2
1 Passenger Car
Date of Report
22/Apr/2021 12:00 AM
Color
WHI
Number
4D
UPDATE
Hit and Run
1 No
Reason (if Investigation NOT Completed)
Trafficway
1 Two-Way, Not Divided
Color
Type Of Shoulder
Veh License Number
GWSQ92
Extent of Damage
Disabling
From Intersection With Street, Road, Highway
WHI
Traffic Control Device For This Vehicle First (1) Sequence of Events
1 No Controls
2 Collision with Non-Fixed
Object
14 Motor Vehicle in Transport
Trailer Type (trailer one)
Cargo Body Type
Permanent Reg. VIN
Place or City of Crash
Roadway Surface Condition School Bus Related
1 Dry
Permanent Reg. VIN
Contributing Circumstances: Road
Contributing Circumstances: Environment
Type Of Work Zone
Invest. Agency Report Number
2101198
STATE FARM AUTO INSURANCE
Veh License Number
First Harmful Event Location
1 On Roadway
Vehicle Defects (one)
1 None
Roadway Grade
1 Level
WEST MIAMI
Current Address (Number and Street)
SW 16 ST
HIGHWAY SAFETY & MOTOR VEHICLES,
TRAFFIC CRASH RECORDS
NEIL KIRKMAN BUILDING, TALLAHASSEE, FL 32399-0537
● At Street Address#
1 Paved
Class
Extent of Damage
Minor
US DOT Number
SW 16TH ST
Trailer Type (trailer two)
State
FL
Est. Damage
Towed Due To Damage
5000
Yes
Insurance Policy Number
Reg. Expires
State
FL
Est. Damage
Roadway Alignment
1 Straight
Second (2) Sequence of Events
Page 1 of 4
City and State
Vehicle Defects (two)
Within City Limits
Yes
Reg. Expires
Type Of Intersection
3 4 5 6
15 16 17
14 13 12 11 10
HSMV Crash Report Number
85863976
Insurance Policy Number
Workers In Work Zone
Permanent Reg. VIN
2 At Lattitude
25.75596
1 No
Within Interchange First Harmful Event Relation to Junction
18 Through Roadway
No
Contributing Circumstances: Road
Contributing Circumstances: Environment
Area of Initial Impact
Year
8
Year
9
109901108885001
City and State
MIAMI FL
Make
Time Reported
22/Apr/2021
02:51 PM
2 Four-Way Intersection
Vehicle Removed By
WHITE
Manner Of Collision
18. Undercarriage
19. Overturn
20. Windshield
21. Trailer
Most Harmful Event
2 Collision with Non-Fixed
Object
Third (3) Sequence of Events
Make
At Est. Speed
10
Notified By
Permanent Reg. VIN
Law Enforcement
and Longitude
-80.301739
Law Enforcement In Work Zone
✪ Or From Milepost #
225
2 Front to Front
2T3K1RFV6LW059180
Towed Due To Damage Vehicle Removed By
WHITE
No
Time Dispatched
22/Apr/2021
02:51 PM
Zip Code
3 4 5 6
Length
Length
1 15 16 17
14 13 12 11 10
Rotation
Owner Request
Posted Speed
25
Most Damaged Area
8
9
Zip Code
33165
Axles
Axles
Total Lanes
2
Emergency Vehicle Use Speciual Function of MV
1 No
1 No Special Function
Most Harmful Event Detail
14 Motor Vehicle in Transport
Fourth (4) Sequence of Events
18. Undercarriage
19. Overturn
20. Windshield
21. Trailer
Phone Number
Rotation
Date of Crash
22/Apr/2021 02:51 AM
Name of Vehicle Owner (Check Box If Business)
Trailer License Number
One:
Trailer
Two:
License Number
Vehicle
Traveling: West
CMV Configuration
Comm GVWR/GCWR
Motor Carrier Name
Direction On Street, Road, Highway
4 Not Applicable
Haz. Mat. Release Haz Mat. Placard
Comm/Non-Commercial
Vehicle Maneuver Action
1 Straight Ahead
PERSON RECORD
Person# Description
1
Address
Driver License Number
Address
Restraint System
3 Shoulder and Lap Belt
Used
Motor Carrier Address
1 Driver
PERSON RECORD
Person# Description
3
State
Reg. Expires
State Reg. Expires
PERSON RECORD
Person# Description
2
Address
Restraint System
Date of Report
Vehicle Body Type
Trafficway
3 Passenger
Driver License Number
Source of Transport to Medical Facility
1 Not Transported
Traffic Control Device For This Vehicle First (1) Sequence of Events
1 No Controls
2 Collision with Non-Fixed
Object
14 Motor Vehicle in Transport
Drivers Actions at Time of Crash (first)
1 No Contributing Action
Drivers Actions at Time of Crash (third)
1 No Contributing Action
Suspected Alcohol Use Alcohol Tested
1 No
1 Driver
1 Passenger Car
1 Two-Way, Not Divided
State
Air Bag Deployed
Source of Transport to Medical Facility
1 Not Transported
Number
Vehicle #
1
City
1 Not Applicable
22/Apr/2021 02:51 AM
Restraint System
Air Bag Deployed
3 Shoulder and Lap Belt 3 Deployed-Front
Used
FL
State
Vehicle #
1
Air Bag Deployed
Drivers Actions at Time of Crash (first)
1 No Contributing Action
Drivers Actions at Time of Crash (third)
Trailer Type (trailer one)
Permanent Reg. VIN
Permanent Reg. VIN
Cargo Body Type
FL
Roadway Grade
1 Level
Name
Vehicle Defects (one)
1 None
Alcohol Test Type
Expires
Current Address (Number and Street)
Helmet Use
EMS Agency Name or ID
Vehicle # Name
2
City
MIAMI
Name
Helmet Use
EMS Agency Name or ID
EUSTIS
Expires
Helmet Use
Invest. Agency Report Number
2101198
SW 16 ST
US DOT Number
Class
Trailer Type (trailer two)
City
Drivers Actions at Time of Crash (second)
1 No Contributing Action
Drivers Actions at Time of Crash (fourth)
13 Ran Stop Sign
Alcohol Test Result BAC
Roadway Alignment
1 Straight
Second (2) Sequence of Events
DL Type
State
Eye Protection
5 E/Operator
DL Type
Eye Protection
City and State
Vehicle Defects (two)
EMS Run Number
State
Eye Protection
5 E/Operator
EMS Run Number
Page 2 of 4
34 5 6
14 13 12 11 10
FL
Req. End.
3 No Req
Endorsement
Seating Location Seat
1 Left
Drivers Actions at Time of Crash (second)
Drivers Actions at Time of Crash (fourth)
MIAMI
15 16 17 8
Area of Initial Impact
Date of Birth
Seating Location Seat
3
HSMV Crash Report Number
85863976
Year
Date of Birth
Year
FL
Req. End.
3 No Req
Endorsement
Seating Location Seat
3 Right
Most Harmful Event
2 Collision with Non-Fixed
Object
Third (3) Sequence of Events
Date of Birth
City and State
EUSTIS FL
Make
Suspected Drug Use Drug Tested
1 No
At Est. Speed
25
Make
18. Undercarriage
19. Overturn
20. Windshield
21. Trailer
Sex
2 Female
Injury Severity
Zip Code
1 None
1 15)
Sex
2 Female
14 13
Zip Code
Seating Location Row
1 Front
Injury Severity
1 None
Length
Length
Sex
2 Female
Zip Code
Posted Speed
25
Most Damaged Area
Emergency Vehicle Use Speciual Function of MV
1 No
1 No Special Function
Driver Distracted By
1 Not Distracted
Drivers Condition at Time of Crash
1 Apparently Normal
Drug Test Type
16 17
Seating Location Row
1
5 6
Phone Number
State
11 10
Medical Facility Transported To
ΝΑ
Seating Location Row
1 Front
Most Harmful Event Detail
14 Motor Vehicle in Transport
Injury Severity
1 None
Fourth (4) Sequence of Events
33165
Ejection
8
9
FL
Medical Facility Transported To
ΝΑ
Zip Code
32726
Axles
Axles
Phone Number
Total Lanes
2
Seating Location Other
Driver Distracted By
1 Not Distracted
Drivers Condition at Time of Crash
18. Undercarriage
19. Overturn
Phone Number
20. Windshield
21. Trailer
Vision Obstruction
1 Vision Not Obscured
1 Not Ejected
32726
Ejection
1 Apparently Normal
Re-Exam
No
Zip Code
33165
Seating Location Other
1
Drug Test Result
Ejection
1 Not
Ejected
Re-Exam
No
1 Not Ejected
Seating Location Other
1 Not Applicable
Vision Obstruction
1 Vision Not Obscured
Date of Crash
22/Apr/2021 02:51 AM
Suspected Alcohol Use Alcohol Tested
1 No
Source of Transport to Medical Facility
1 Not Transported
PERSON RECORD
Person# Description
4
Address
Restraint System
3 Shoulder and Lap Belt
Used
3 Passenger
VIOLATIONS
Person#
1
Source of Transport to Medical Facility
1 Not Transported
Date of Report
Name
ID/Badge #
152
Air Bag Deployed
22/Apr/2021 02:51 AM
Alcohol Test Type Alcohol Test Result
EMS Agency Name or ID
Vehicle #
2
1 Not Applicable
Name
Helmet Use
EMS Agency Name or ID
City
Invest. Agency Report Number
2101198
BAC Suspected Drug Use Drug Tested
1 No
EMS Run Number
PATROL C.LOPEZ
Eye Protection
Florida Statute Number Charge
316.074(1)
APOPKA
EMS Run Number
Seating Location Seat
3
NON VEHICLE PROPERTY DAMAGE
Vehicle# Person# Property Damage - Other Than Vehicle Est. Amount Business Owner's Name
1
STOP SIGN
1000
Yes
FL DEPT. OF
TRANSPORTATION
Date of Birth
Page 3 of 4
HSMV Crash Report Number
85863976
Drug Test Type
Medical Facility Transported To
ΝΑ
Sex
2 Female
Injury Severity
1 None
State
Seating Location Row
1
FAIL TO OBEY TRAFFIC CONTROL SIGNAL (FAILED TO
STOP AT TRAFF
FL
Medical Facility Transported To
ΝΑ
Drug Test Result
Zip Code
32703
Seating Location Other
1
Department
WEST MIAMI POLICE DEPARTMENT
Citation
Address
City & State
605 SUWANNEE ST, MS 52 TALLAHASSEE FL
Ejection
1 Not
Ejected
NARRATIVE
V-2 WAS HEADING WEST BOUND FROM 64 AVE AND SW 16 ST. V-1 HAD COME TO A STOP ON 65 AVE SW 16 ST FACING NORTH BOUND. V-1 DID NOT ALLOW V-2 THE
RIGHT OF WAY AND CAUSED A COLLISION IN THE PROCESS. V-1 HAD DAMAGE TO THE RIGHT-SIDE TIRE WHICH WAS DENTED IN COMPLETELY NOT ALLOWING
THE VEHICLE TO MOVE. V-1 ALSO HAD THE FRONT RIGHT AND REAR DOOR DAMAGED DUE TO THE ACCIDENT. V-2 HAD DAMAGE TO THE FRONT BUMPER & GRILL.
V-2 ALSO HAD THE FRONT GLASS DAMAGED DUE TO IMPACT. ADDITIONALLY, V-1 ALSO RAN OVER A STOP SIGN ON THE SOUTH EAST CORNER OF 65 AVE SW 16
ST.
ENGINE 40 RESPONDED TO THE SCENE UNDER LT.DIAZ ALARM #90250. ALL INVOLVED PARTIES WERE ATTENDED TO AND CLEARED ON SCENE.
REPORTING OFFICER
Rank and Name
ACIGHSE
Zip Code
32399
Type of Department
PD
Date of Crash
22/Apr/2021 02:51 AM
STOP V-2
POINT OF IMPACT
SW 65 AVE
Date of Report
V-1
22/Apr/2021 02:51 AM
16 ST
STOP
Invest. Agency Report Number
2101198
NOT TO SCALE
Page 4 of 4
HSMV Crash Report Number
85863976