DO NOT WRITE IN THIS SPACE. Time Officer Arrived 03: 01 AM City or Town WINDERMERE

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1 ORIDA TRAFFIC CRASH REPORT LONG FORM MAIL TO DEPT. HIGHWAY SAFETY & MOTOR VEHICLES, TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING, TALLAHASSEE, TIME & LOCATION Date of Crash 7/Nov/009 County Code/ 07 City Code 00 Time of Crash 0: 3 AM Feet or Mile(s) Time Officer Notified 0: 35 AM Direction E of DO NOT WRITE IN THIS SPACE Time Officer Arrived 03: 0 AM City or Town WINDERMERE Invest. Agency Report Number FHPD09OFF0568 (check if in City or Town) HSMV Crash Report Number County Orange At Node No. or Feet or Mile(s) From Node No. Next Node No. No. of Lanes At The Intersection Of (street, road or highway) or Feet or 50 Mile(s) Direction N. Divided On Street, Road or Highway. Undivided DEACON CIRCLE From Intersection Of (street, road or highway) DEACON COURT SECTION Pedestrian Vehicle X. Phantom Vehicle Traveling N 3 Year 009 on DEACON CIRCLE Make CADI Motor Vehicle Insurance Company (Liability or PIP) FEDERAL INSURANCE COMPANY Name of Vehicle Owner (Check Box If Same As ) GENERAL MOTORS COMPANY At 0 Use 0 Est. MPH 30 Veh. License Number 96XJH Posted Speed 5 Policy Number Est. Vehicle Damage $8,000 Vehicle Identification Number GYFK389R34. Disabling Vehicle Removed By: JOHNSON'S Current Address (Number and Street) 77 SCHUST RD. Tow Rotation List City and SAGINAW MI 3. Zip Code Name of Owner (Trailer or Towed Vehicle) Current Address (Number and Street) City and Zip Code Name of Motor Carrier (Commercial vehicle only) Current Address (Number and Street) City, and Zip Code US DOT or ICC MC Name of (Taken from license)/ Pedestrian ELDRICK T WOODS Current Address (Number and Street) 6348 DEACON CIRCLE City, and Zip Code WINDERMERE Date Of Birth 30/Dec/975 License Number W DL 5 3 AlC/Drug Test Blood 5 Results. Alc/Drug Phys.Def Res. Race Sex Inj. 4 S. Equip. 5. on Placard, and Digit Number From Bottom of Diamond Recommend Re-exam, if Yes Explain In Narrative 's Phone No. SECTION Pedestrian Vehicle. Phantom Year Make Use Veh. License Number Vehicle Identification Number Vehicle Traveling on At Est. MPH Posted Speed Est. Vehicle Damage. Disabling Motor Vehicle Insurance Company (Liability or PIP) Policy Number Vehicle Removed By:. Tow Rotation List 3. Name of Vehicle Owner (Check Box If Same As ) Current Address (Number and Street) City and Zip Code Name of Owner (Trailer or Towed Vehicle) Current Address (Number and Street) City and Zip Code Name of Motor Carrier (Commercial vehicle only) Current Address (Number and Street) City, and Zip Code US DOT or ICC MC Name of (Taken from license)/ Pedestrian Current Address (Number and Street) City, and Zip Code Date Of Birth License Number DL AlC/Drug Test Blood. on Placard, and Digit Number From Bottom of Diamond Recommend Re-exam, if Yes Explain In Narrative 's Phone No. CODE INFORMATION Vehicle 0 Automobile 0 Van 03 Light Truck/P.U.- or 4 rear tires Automobile 04 Medium Truck - 4 rear tires 05 Heavy Truck - or more rear axles 06 Truck Tractor (Cab-Bobtail) 07 Motor Home (RV) 08 Bus (driver + seats for 9-5) 09 Bus (driver + seats for over 5) 0 Bicycle Motorcycle Moped 3 All Terrain Vehicle 4 Train 5 Low Speed Vehicle 77 Other Vehicle Use 0 Private Transportation 0 Commercial Passengers 03 Commercial Cargo 04 Public Transportation 05 Public School Bus 06 Private School Bus 07 Ambulance 08 Law Enforcement 09 Fire/Rescue 0 Military Other Government Dump 3 Concrete Mixer 4 Garbage or Refuse 5 Cargo Van 77 Other 0 Single Semi Trailer 0 Tandem Semi Trailer 03 Tank Trailer 04 Saddle Mount/Flatbed 05 Boat Trailer 06 Utility Trailer 07 House Trailer 08 Pole Trailer 09 Towed Vehicle 0 Auto Transport 77 Other Residence (driver/ped.) County Of Crash Elsewhere In 3 Non-Resident Out Of 4 Foreign 5 Unknown DL A B 3 C 4 D/Chauffeur 5 E/Operator 6 E/Oper.-Rest. 7 None Required orsements Yes 3 No endorsement Required Race White Black 3 Hispanic 4 Other Sex Male Female Physical Defects No Defects Known Eyesight Defect 3 Fatigue/Asleep 4 Hearing Defect 5 Illness 6 Seizure, Epilepsy, Blackout 7 Other Physcial Defect Injury Severity None Possible 3 Non-Incapacitating 4 Incapacitating 5 Fatal (within 30 days) 6 Non-Traffic Fataility Alcohol/Drug Use Not Drinking or using Drugs Alcohol - Under Influence 3 Drugs - Under Influence 4 Alcohol & Drugs - Under Influence 5 Had Been Drinking 6 Pending ALC/DRUG Test Results Safety Equipment In Use Not in use Seat Belt / Shoulder Harness 3 Child Restraint 4 Air Bag - Deployed 5 Air bag - Not Deployed 6 Saftey Helmet 7 Eye Protection Location In Vehicle Front Left Front Center 3 Front Right 4 Rear Left 5 Rear Center 6 Rear Right 7 In Body Of Truck 8 Bus Passenger 9 Other ed No Yes 3 Partial Page of 6

2 SECTION Pedestrian Vehicle. Phantom Year Make Use Veh. License Number Vehicle Identification Number Vehicle Traveling on At Est. MPH Posted Speed Est. Vehicle Damage. Disabling Motor Vehicle Insurance Company (Liability or PIP) Policy Number Vehicle Removed By:. Tow Rotation List 3. Name of Vehicle Owner (Check Box If Same As ) Current Address (Number and Street) City and Zip Code Name of Owner (Trailer or Towed Vehicle) Current Address (Number and Street) City and Zip Code Name of Motor Carrier (Commercial vehicle only) Current Address (Number and Street) City, and Zip Code US DOT or ICC MC Name of (Taken from license)/ Pedestrian Current Address (Number and Street) City, and Zip Code Date Of Birth License Number DL # # Property Damaged - Other Than Vehicles FIRE HYDRANT Property Damaged - Other Than Vehicles TREE AND SOD AlC/Drug Test Blood on Placard, and Digit Number From Bottom of Diamond Est. Amount $3,000 Est. Amount $00 Owner's Name ORANGE CO UTIL Owner's Name JEROME ADAMS Address 800 PRESIDENTS DR Address 634 DEACON CIRCLE Recommend Re-exam, if Yes Explain In Narrative City ORLANDO City WINDERMERE 's Phone No.. Zip 3809 Zip Contributing Causes - /Pedestrian 0 No Improper Driving/ 0 Careless Driving 03 Failure to Yield Right-Of-Way 04 Improper Backing 05 Improper Lane Change 06 Improper Turn 07 Alcohol - Under Influence 08 Drugs - Under Influence 09 Alcohol & Drugs - Under Influence 0 Followed To Closely Disrecarded Traffic Signal Exceeded Safe Speed Limit 3 Disregarded Stop Sign 4 Failed To Maintain Equip./ Vehicle 5 Improper Passing 6 Drove Left of Center 7 Exceeded d Speed Limit 8 Obstructing Traffic First /Subsequent Harmful Event (s) 0 0 Collision With MV in Transport (Rear ) 0 Collision With MV in Transport (Head On) 03 Collision With MV in Transport (Angle) 04 Collision With MV in Transport (Left Turn) 05 Collision With MV in Transport (Right Turn) 06 Collision With MV in Transport (Sideswipe) 07 Collision With MV in Transport (Backed Into) 08 Collision With Parked Car 09 Collision with MV on Roadway 0 Collision With Pedestrian Collision With Bicycle Collision With Bicycle (Bike Lane) 3Collision With Moped 4 Collision With Train 9 Improper Load 0 Disregarded other Trafic Control Driving Wrong Side/Way Fleeing Police 3 Vehicle Modified 4 Distraction 77 All Other Vehicle Defect 0 No Defects 0 Def. Brakes 03 Warn/ Smooth Tires 04 Defective/ Improper Lights 05 Puncture/Blowout 06 Steering Mech. 07 Windshield Wipers 08 Equipment/Vehicle Defect 77 All Other (Explain In Point Of Collision 0 On Road 04 Median 0t On Road 05 Turn Lane 03 Shoulder Work Area 0 None 0 Nearby 03 Entered 5 Collision With Animal 6 MV Hit Sign / Sign Post 7 MV HIt Utility Pole / Light Pole 8 MV Hit Guardrail 9 MV Hit Fence 0 MV Hit Concrete Barrier Wall MV Hit Bridge/Pier/Abutment/Rail MV Hit Tree / Shrubbery 3 Collision With Construction Barricade Sign 4 Collision With Traffic Gate 5 Collision With Crash Attenuators 6 Collision With Fixed Object Above Road 7 MV Hit Other Fixed Object Collision With Moveable Object on Road 9 Mv Ran Into Ditch/Culvert 30 Ran Off Road Into Water 3 Overturned 3 Occupant Fell From Vehicle 33 Tractor/Trailer Jackknifed 34 Fire 35 Explosion 36 Downhill Runaway 37 Cargo Loss or Shift 38 Separation of Units 39 Median Crossover 77 All Other Vehicle Movement 0 Straight Ahead 0 Slowing/ Stopping/ Stalled 03 Making Left Turn 04 Backing 05 Making Right Turn 06 Changing Lanes 07 Entering/Leaving/ Parking Space 08 Properly Parked 09 Improperly Parked 0 Making U-Turn Passing Pedestrian 0 Crossing Not At Intersection 0 Crossing At Mid-block Crosswalk 03 Crossing At Intersection 04 Walking Along Road With Traffic 05 Walking Along Road Against Traffic 0 5 Emergency Operation less or 6 Construction/Maintenance Runaway Source Of Carrier Vehicle Not Applicable 77 All Other Shipping Papers 3 Vehicle Side 4 5 Other 07 Working in Road 08 Standing/Playing in Road 09 Standing in Pedestrian Island Vehicle Special Functions None Farm 3 Police Pursuit 4 Recreational 06 Working on Vehicle in Road 77 All Other 88 Unknown 7 77 Road System Identifier 0 Interstate 0 U.S County 05 Local 06 Turnpike / Toll Road Surface Condition 0 Dry 0 Wet 03 Slippery 04 Icy 77 All other 07 Forest Road 08 Private Roadway 77 All other (Explain In 0 Weather 0 Clear 0 Cloudy 03 Rain 04 Fog 77 All other Location Primarily Business Primarily Residential 3 Open Country 05 0 Lighting Condition 0 Daylight 0 Dusk 03 Dawn 04 Dark (Street Light) 05 Dark (No Street Light) 88 Unknown Road Surface 0 Slag/Gravel/Stone 0 Blacktop 03 Brick/Block 04 Concrete 05 Dirt 77 All Other (Explain in 05 0 Road Condtions At Time Of Crash 0 No Defects 0 0 Obstruction With Warning 03 Obstruction Without Warning 04 Road under Repair/ Construction 05 Loose Surface Materials 06 Shoulders - Soft/Low/High 07 Holes/Ruts/Unsafe Paved Edge 08 Standing Water 09 Worn/Polished Road Surface 77 All other (Explain In Vision Obstructed 0 Vision Not Obstructed 0 Inclement Weather 03 Parked/ Stopped Vehicle 04 Trees/Crops/Bushes 05 Load On Vehicle 06 Building/Fixed Object 07 Signs/Billboards 08 Fog 09 Smoke 0 Glare 77 All other (Explain In 0 Traffic Control 0 No Control 03 0 Special Speed Zone 03 Speed Control Sign 04 School Zone 05 Traffic Signal 06 Stop Sign 07 Yield Sign 08 Flashing Light 09 Railroad Signal 0 Officer/Guard/Flagperson Posted No U-Turn Passing Zone 77 All Other (Explain In Site Location 0 Not At Intersection/RR X-ing/Bridge 0 At Intersection 03 Influenced By Intersection 04 Driveway Access 0 05 Railroad 06 Bridge 07 Entrance Ramp 08 Exit Ramp 09 Parking Lot - Public 0 Parking Lot - Private Private Property Toll Booth 3 Public Bus Stop Zone 77 All Other (Explain In Trafficway Character 0 Straight - Level 0 Straight - Upgrade/Downgrade 03 Curve - Level 04 Curve - Upgrade/Downgrade Shoulder 0 Paved 0 Unpaved 03 Curb 3 Violator(s) Section # Name Of Violator ELDRICK T WOODS Statute Number Charge CARELESS DRIVING Citation Number 5839-STM Page of 6

3 ORIDA TRAFFIC CRASH REPORT NARRATIVE/DIAGRAM MAIL TO DEPT. HIGHWAY SAFETY & MOTOR VEHICLES, TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING, TALLAHASSEE, DO NOT WRITE IN THIS SPACE Time EMS Notified (Fatalities Only) Time EMS Arrived (Fatalities Only) Date Of Crash County/ City Code Invest. Agency Report Number HSMV Crash Report Number : : 7/Nov/ FHPD09OFF ( Vehicle one was traveling in a southeasterly direction while exiting the driveway of 6348 Deacon Circle. Vehicle one entered onto Deacon Court and continued to travel southeasterly. Vehicle one crossed over the roadway (Deacon Court) and the concrete curb onto the grass median of Deacon Court. Vehicle one swerved to the left in an attempt to travel northbound on Deacon Circle. Subsequently, vehicle one crossed over Deacon Circle and the concrete curb onto the grass shoulder on the east side of the roadway. As a result, the right side of vehicle one collided with a row of hedges. Vehicle one then swerved back to the left (west) crossing back over Deacon Circle and the concrete curb onto the grass shoulder on the west side of the roadway. Vehicle one then traveled in a northerly direction and the front of vehicle one collided with a fire hydrant in the front lawn of 6348 Deacon Circle. Vehicle one continued to travel in a northerly direction crossing over the driveway of 634 Deacon Circle and the front of vehicle one collided with a tree. Vehicle one came to a final rest facing northbound in the front of 634 Deacon Circle. The driver of vehicle one received injuries and was transported to Health Central Hospital.Photographs: On scene photographs were taking by Isleworth Security Officers and Jerome Adams Jr. by cell phone (resident of 634 Deacon Circle). Post scene photographs were taking by the Florida Highway Patrol. Subsequent harmful events: Code 77 - Final collision with a tree. Violator(s) Witness Name Current Address City & Zip Code Witness Name Current Address City & Zip Code First Aid Given By - Name OCFR Was Investigation Made At Scene? Yes Investigator - Rank & Signature TPR. EVANS Physicain or Nurse Parametic or EMT 3 Police Officer 4 Certified st Aider 5 Other If No, Then Where? Is Investigation Complete? Yes ID/Badge Number 79/567 Injured Taken To: HEALTH CENTRAL If No, Then Why? Date of Report 7/Nov/009 Department FHPD By - Name Photos Taken? Yes HEALTH CENTRAL If Yes, By Whom? Invest. Agency Other FHP X SO CPD Other Page 3 of 6

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5 ORIDA TRAFFIC CRASH REPORT UPDATE CONTINUATION X DO NOT WRITE IN THIS SPACE MAIL TO DEPT. HIGHWAY SAFETY & MOTOR VEHICLES, TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING, TALLAHASSEE, Date of Crash 7/Nov/009 County / City Invest. Agency Report Number FHPD09OFF0568 HSMV Crash Report Number SECTION Pedestrian Vehicle. Phantom Year Make Use Veh. License Number Vehicle Identification Number Vehicle Traveling on At Est. MPH Posted Speed Est. Vehicle Damage. Disabling Motor Vehicle Insurance Company (Liability or PIP) Policy Number Vehicle Removed By:. Tow Rotation List 3. Name of Vehicle Owner (Check Box If Same As ) Current Address (Number and Street) City and Zip Code Name of Owner (Trailer or Towed Vehicle) Current Address (Number and Street) City and Zip Code Name of Motor Carrier (Commercial vehicle only) Current Address (Number and Street) City, and Zip Code US DOT or ICC MC Name of (Taken from license)/ Pedestrian Current Address (Number and Street) City, and Zip Code Date Of Birth License Number DL AlC/Drug Test Blood. on Placard, and Digit Number From Bottom of Diamond Recommed Re-exam, if Yes Explain In Narrative 's Phone No. SECTION Pedestrian Vehicle. Phantom Year Make Use Veh. License Number Vehicle Identification Number Vehicle Traveling on At Est. MPH Posted Speed Est. Vehicle Damage. Disabling Motor Vehicle Insurance Company (Liability or PIP) Policy Number Vehicle Removed By:. Tow Rotation List 3. Name of Vehicle Owner (Check Box If Same As ) Current Address (Number and Street) City and Zip Code Name of Owner (Trailer or Towed Vehicle) Current Address (Number and Street) City and Zip Code Name of Motor Carrier (Commercial vehicle only) Current Address (Number and Street) City, and Zip Code US DOT or ICC MC Name of (Taken from license)/ Pedestrian Current Address (Number and Street) City, and Zip Code Date Of Birth License Number DL AlC/Drug Test Blood. on Placard, and Digit Number From Bottom of Diamond Recommed Re-exam, if Yes Explain In Narrative 's Phone No. # 3 Property Damaged - Other Than Vehicles HEDGES Est. Amount $00 Owner's Name ISLEWORTH HOA Address DEACON CIRCLE City WINDERMERE # Property Damaged - Other Than Vehicles Est. Amount Owner's Name Address City Zip Zip # Property Damaged - Other Than Vehicles Est. Amount Owner's Name Address City Zip # Property Damaged - Other Than Vehicles Est. Amount Owner's Name Address City Zip Witness Name Current Address City & Zip Code Witness Name Current Address City & Zip Code Was Investigation Made At Scene? Yes Investigator - Rank & Signature TPR. EVANS If No, Then Where? Is Investigation Complete? Yes ID/Badge Number 79/567 If No, Then Why? Date of Report 7/Nov/009 Department FHPD Photos Taken? Yes If Yes, By Whom? Invest. Agency Other FHP X SO CPD Other Page 5 of 6

6 Contributing Causes - /Pedestrian 0 No Improper Driving/ 0 Careless Driving 03 Failure to Yield Right-Of-Way 04 Improper Backing 05 Improper Lane Change 06 Improper Turn 07 Alcohol - Under Influence 08 Drugs - Under Influence 09 Alcohol & Drugs - Under Influence 0 Followed To Closely Disrecarded Traffic Signal Exceeded Safe Speed Limit 3 Disregarded Stop Sign 4 Failed To Maintain Equip./ Vehicle 5 Improper Passing 6 Drove Left of Center 7 Exceeded d Speed Limit 8 Obstructing Traffic First /Subsequent Harmful Event (s) 0 Collision With MV in Transport (Rear ) 0 Collision With MV in Transport (Head On) 03 Collision With MV in Transport (Angle) 04 Collision With MV in Transport (Left Turn) 05 Collision With MV in Transport (Right Turn) 06 Collision With MV in Transport (Sideswipe) 07 Collision With MV in Transport (Backed Into) 08 Collision With Parked Car 09 Collision with MV on Roadway 0 Collision With Pedestrian Collision With Bicycle Collision With Bicycle (Bike Lane) 3Collision With Moped 4 Collision With Train 9 Improper Load 0 Disregarded other Trafic Control Driving Wrong Side/Way Fleeing Police 3 Vehicle Modified 4 Distraction 77 All Other Vehicle Defect 0 No Defects 0 Def. Brakes 03 Warn/ Smooth Tires 04 Defective/ Improper Lights 05 Puncture/Blowout 06 Steering Mech. 07 Windshield Wipers 08 Equipment/Vehicle Defect 77 All Other (Explain In Point Of Collision 0 On Road 04 Median 0t On Road 05 Turn Lane 03 Shoulder Work Area 0 None 0 Nearby 03 Entered 5 Collision With Animal 6 MV Hit Sign / Sign Post 7 MV HIt Utility Pole / Light Pole 8 MV Hit Guardrail 9 MV Hit Fence 0 MV Hit Concrete Barrier Wall MV Hit Bridge/Pier/Abutment/Rail MV Hit Tree / Shrubbery 3 Collision With Construction Barricade Sign 4 Collision With Traffic Gate 5 Collision With Crash Attenuators 6 Collision With Fixed Object Above Road 7 MV Hit Other Fixed Object 8 Collision With Moveable Object on Road 9 Mv Ran Into Ditch/Culvert 30 Ran Off Road Into Water 3 Overturned 3 Occupant Fell From Vehicle 33 Tractor/Trailer Jackknifed 34 Fire 35 Explosion 36 Downhill Runaway 37 Cargo Loss or Shift 38 Separation of Units 39 Median Crossover 77 All Other (Additional Vehicle Movement 0 Straight Ahead 0 Slowing/ Stopping/ Stalled 03 Making Left Turn 04 Backing 05 Making Right Turn 06 Changing Lanes 07 Entering/Leaving/ Parking Space 08 Properly Parked 09 Improperly Parked 0 Making U-Turn Passing Pedestrian less or Runaway Vehicle 77 All Other Vehicle Special Functions None Farm 3 Police Pursuit 4 Recreational 5 Emergency Operation 6 Construction/Maintenance Source Of Carrier Not Applicable Shipping Papers 3 Vehicle Side 4 5 Other 0 Crossing Not At Intersection 07 Working in Road 0 Crossing At Mid-block Crosswalk 08 Standing/Playing 03 Crossing At Intersection in Road 04 Walking Along Road With Traffic 09 Standing in 05 Walking Along Road Against Pedestrian Island Traffic 06 Working on Vehicle in Road 77 All Other 88 Unknown Page 6 of 6