Daytona Beach Police Department NEWS RELEASE

Transcription

1 Daytona Beach Police Department NEWS RELEASE 9 Valor Blvd, Daytona Beach, Fl Phones (86) PIO 67-5 Media Line 67-5 Fax 67-5 Anonymous Text or Web Tips Text DBTIPS to CRIMES (7467) Crimestoppers of Volusia County TIPS (8477) July, 0 Re: Traffic Homicide Investigation Location: 400 block of LPGA Date of Incident: July 0, 0 Time: 0 hours Police Report Number: Correction Correction on the news release posted yesterday in regards to the accident. Information given about the driver of the motorcyclist passing several cars were incorrect this did not occur. Copy of the accident report is attached. Persons with information may text CRIMES (7467) with a cell phone or log on to and click on Anonymous Web Tips. When using a cell phone, all messages should begin with DBTIPS. Tipsters remain anonymous.

2 STATE OF FLORIDA TRAFFIC CRASH (Shaded Areas) LONG FORM SHORT FORM UPDATE MAIL TO DEPT. HIGHWAY SAFETY & MOTOR VEHICLES, TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING, TALLAHASSEE, FL CRASH DATE TIME OF CRASH 07/0/0 CRASH IDENTIFIERS TOTAL # OF VEHICLE SECTION(S) TOTAL # OF PERSON SECTION(S) TOTAL # OF NARRATIVE SECTION(S) COUNTY CODE CITY CODE COUNTY OF CRASH PLACE OR CITY OF CRASH CHECK IF WITHIN TIME REPORTED TIME DISPATCHED CITY LIMITS 08 0 VOLUSIA Daytona Beach 0: AM 0:5 AM TIME ON SCENE TIME CLEARED SCENE CHECK IF REASON (If Investigation NOT Complete) Notified By: Motorist COMPLETED Law Enforcement 0:4 AM :6 PM TRAFFIC HOMICIDE INVESTIGATION ROADWAY INFORMATION (CHOOSE ONLY OF 4 OPTIONS) CRASH OCCURRED ON STREET, ROAD, HIGHWAY AT STREET ADDRESS # AT LATITUDE AND LONGITUDE LPGA BLVD. AT FEET OR MILES N S E W AT / FROM INTERSECTION WITH STREET, ROAD, HIGHWAY OR FROM MILEPOST # US9 / INTERNATIONAL SPEEDWAY BLVD. 5 Road System Identifier 7 Forest Road Type of Shoulder Type of Intersection 5 Traffic Circle Interstate 4 County 8 Private Roadway Not at Intersection U.S. 5 Local 9 Parking Lot Paved 6 Roundabout State 6 Turnpike/ Toll 77 All other, Explain in Four Way Intersection 7 Five Point, or More T Intersection Curb 4 Y Intersection CRASH INFORMATION (CHECK IF PICTURES TAKEN) Light Condition Daylight Dusk Dawn 4 Dark Lighted First Harmful Event First Harmful Event within Interchange No Non Junction Intersection Intersection Related 4 Driveway/ Alley Access Related 4 5 Dark Not Lighted 6 Dark Unknown Lighting Weather Condition 4 Fog, Smog, Smoke 5 Sleet/Hail/ Freezing Rain 6 Blowing Sand, Soil, Clear Dirt Cloudy 7 Severe Crosswinds Rain Roadway Surface Condition 5 Oil 6 Mud, Dirt, Gravel 7 Sand 8 Water (standing/ Dry moving) Wet 77 Other, Explain 4 Ice/Frost in School Bus Related No, School Bus Directly Involved Yes, School Bus Indirectly Involved Non-Collision Collision-non Fixed Object Collision with Fixed Object Overturn/Rollover 0 Pedestrian 9 Impact Attenuator/Crash 0 Concrete Traffic Barrier Fire/Explosion Pedalcycle Cushion Other Traffic Barrier Immersion Railway Vehicle (train, 0 Bridge Overhead Structure Tree (standing) 4 Jackknife engine) Bridge Pier or Support Utility Pole/Light Support 5 Cargo/Equipment Animal Bridge Rail 4 Traffic Sign Support Loss or Shift 4 Motor Vehicle in Transport Culvert 5 Traffic Signal Support 6 Fell/Jumped From 5 Parked Motor Vehicle 4 Curb 6 Other Post, Pole or Support Motor Vehicle 6 Work Zone / Maintenance 5 Ditch 7 Fence 7 Thrown or Falling Equipment 6 Embankment 8 Mailbox Object 7 Struck By Falling, Shifting 7 Guardrail Face 9 Other Fixed Object (wall, 8 Ran into Water/Canal Cargo 8 Guardrail End building, tunnel, etc.) 9 Other Non Collision 8 Other Non Fixed Object 9 Cable Barrier First Harmful Event Relation to Junction 5 Railway Grade Crossing 4 Entrance/Exit Ramp 4 5 Crossover Related 6 Shared Use Path or Trail 7 Acceleration/Deceleration Lane 8 Through Roadway 77 Other Location Work Zone related No WITNESSES 0: AM Crash in Work Zone Before the First Work Zone Warning Sign Advance Warning Area Transition Area 4 Activity Area 5 Termination Area 0008 Contributing Circumstances: Road None 4 Work Zone (construction/ maintenance/ utility) 6 Shoulders (none, low, soft, high) 7 Rut, Holes, Bumps Type of Work Zone Lane Closure Lane Shift/Crossover Work on Shoulder or Median 4 Intermittent or Moving Work 9 Worn, Travel Polished Surface 0 Road Surface Condition(wet, icy, snow, slush, etc.) Obstruction in Roadway Debris Traffic Control Device Inoperative, Missing or Obscured 4 Non Highway Work Workers in Work Zone No Manner of Collision/Impact Front to Rear Front to Front Angle 4 Sideswipe, same direction 5 Sideswipe, Opposite Direction 6 Rear to Side 7 Rear to Rear First Harmful Event Location On Roadway Off Roadway Shoulder 4 Median 6 Gore 7 Separator 8 In Parking Lane or Zone 9 Outside Right of way 0 Roadside Contributing Circumstances: Environment None Weather Conditions Physical Obstruction(s) 4 Glare 5 Animal(s) in Roadway Law Enforcement in Work Zone No Officer Present Law Enforcement Vehicle Only Present NAME ADDRESS CITY & STATE ZIP CODE TELEPHONE NAME ADDRESS CITY & STATE ZIP CODE TELEPHONE NAME ADDRESS CITY & STATE ZIP CODE TELEPHONE VERL DAVID BEEBE 707 PINE TREE CT DELAND FL 74 SARAH FLORENCE MORROW BEEBE 707 PINE TREE CT DELAND FL 74 NON VEHICLE PROPERTY DAMAGE VEHICLE # PROPERTY DAMAGE OTHER THAN VEHICLE EST. AMOUNT OWNER S NAME (Check if Business) ADDRESS CITY & STATE ZIP CODE VEHICLE # PROPERTY DAMAGE OTHER THAN VEHICLE EST. AMOUNT OWNER S NAME (Check if Business) ADDRESS CITY & STATE ZIP CODE HSMV 9000 S (E) (rev 0/0) Page of 7

3 VEHICLE # Vehicle in Transport Parked Motor Vehicle Working Vehicle Hit and Run No Check if Commercial VEHICLE N S E W Off-Road Unknown ON STREET, ROAD, HIGHWAY TRAVELING HAZ. MAT. RELEASED No MOTOR CARRIER NAME VEHICLE LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent YEAR MAKE MODEL STYLE COLOR DAMAGE: TRIU UK MC INSURANCE COMPANY (Driver) INSURANCE POLICY NUMBER Towed due to Damage: No VIN EST. DAMAGE Disabling 4 Minor Functional Blue None $4,000 VEHICLE REMOVED BY. Rotation. Owner Request. Driver 77 DAYTOAN WRECKER 77. Other, Explain in NAME OF VEHICLE OWNER (Check if Business) CURRENT ADDRESS CITY & STATE ZIP CODE TRAILER # LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent VIN YEAR MAKE LENGTH AXLES TRAILER # LICENSE NUMBER 96 INSURANCE EXEMOTED JOHN WESLEY WARD Q009 STATE HAZ. MAT PLACARD No REGISTRATION EXPIRES HAZ. MAT NUMBER FL UNKNOWN Check if Permanent LPGA BLVD. US DOT NUMBER 0/04 VIN YEAR MAKE LENGTH AXLES HAZ. MAT CLASS LPGA BLVD Area of Initial Impact AT EST. SPEED POSTED SPEED 8 Undercarriage Overturn Windshield Trailer 9 0 TOTAL LANES Most Damaged Area MOTOR CARRIER ADDRESS CITY & STATE ZIP CODE PHONE NUMBER D890 HOLLY HILL, FL Vehicle Body Type Passenger Car Passenger Van Pickup 7 Motor Home 8 Bus Motorcycle Moped Most Harmful Event Sequence of Events st nd 4 rd Roadway Grade Level Hillcrest Uphill 4 Downhill 5 Sag (bottom) VIOLATIONS 4 All Terrain Vehicle (ATV) 5 Low Speed Vehicle 6 (Sport) Utility Vehicle 7 Cargo Van (0,000 lbs or less) 8 Motor Coach 9 Other Light Trucks (0,000 lbs or less) 0 Medium / Heavy Trucks (more than 0,000 lbs (4,56 kg)) Farm Labor Vehicle Comm/Non-Commercial Interstate Carrier Intrastate Carrier Not in Commerce/Government 4 Not in Commerce/Other Truck 4th Special Function of Motor Vehicle Non Collision Overturn/Rollover Fire/Explosion Immersion 4 Jackknife 5 Cargo/Equipment Loss or Shift 6 Fell/Jumped From Motor Vehicle 7 Thrown or Falling Object 8 Ran into Water/ Canal 9 Other Non Collision [40-46 Sequence of Events only] 40 Equipment Failure (blown tire, brake failure, etc.) 4 Separation of Units 4 Ran Off Roadway, Right 4 Ran Off Roadway, Left 44 Cross Median 45 Cross Centerline 46 Downhill Runaway Roadway Alignment Straight Curve Right Curve Left No Special Function Farm Vehicle Police 7 Taxi 8 Military Trafficway Two Way, Not Divided Two Way, Not Divided, with a Continuous Left Turn Lane Two Way, Divided, Unprotected (painted >4 feet) Median 4 Two Way, Divided, Positive Median Barrier 5 One Way Trafficway TRAILER TRAILER Comm GVWR/GCWR Trailer Type Single Semi Trailer Tandem Semi Trailer Tank Trailer 4 Saddle Mount/Trailer 5 Boat Trailer 6 Utility Trailer 7 House Trailer Collision with Non-Fixed Object 0 Pedestrian Pedalcycle Railway Vehicle (train, engine) Animal 4 Motor Vehicle in Transport 5 Parked Motor Vehicle 6 Work Zone / Maintenance Equipment 7 Struck By Falling, Shifting Cargo or Anything Set in Motion by Motor Vehicle 8 Other Non Fixed Object Vehicle Maneuver Action Straight Ahead Turning Left 4 Backing 5 Turning Right 6 Changing Lanes 8 Parked 0 Making U Turn Overtaking/ Passing 9 Ambulance 0 Fire Truck Farm Labor Transport School Bus Transit/ Commuter Bus Stopped in Traffic 4 Slowing 5 Negotiating a Curve 6 Leaving Traffic Lane 7 Entering Traffic Lane 4 Intercity Bus 5 Charter/Tour Bus 6 Shuttle Bus 7 Farm Labor Bus Commercial Motor Vehicle Configuration Vehicle 0,000 lbs or less Placarded 8 Tractor/Triple for Hazardous Materials 9 Truck more than 0,000 lbs (4,56 Single Unit Truck ( axle and GVWR kg), Cannot Classify more than0,000 lbs (4,56 kg)) 0 Bus/Large Van (seats for 9 5 Single Unit Truck ( or more axles) occupants, including driver) 4 Truck Pulling Trailer(s) Bus (seats for more than 5 5 Truck Tractor (bobtail) occupants, including driver) 6 Truck Tractor/Semi Trailer 7 Truck Tractor/Double Truck 8 Pole Trailer 9 Towed Vehicle 0 Auto Transport 0,000 lbs (4,56 kg) or less 0,00 6,000 lbs (4,56,79 kg) More than 6,000 lbs (,79 kg) 4 Not Applicable Collision Fixed Object 9 Impact Attenuator/Crash Cushion 0 Bridge Overhead Structure Bridge Pier or Support Bridge Rail Culvert 4 Curb 5 Ditch 6 Embankment 7 Guardrail Face 8 Guardrail End Traffic Control Device For This Vehicle No Controls 4 School Zone Sign/ Device 5 Traffic Control Signal 6 Stop Sign 7 Yield Sign No Cargo Bus 8 Flashing Signal 9 Railway Crossing Device 0 Person (including Flagman, Officer, Guard, etc.) Warning Sign Cargo Body Type Van/Enclosed Box 4 Hopper 5 Pole Trailer 6 Cargo Tank 7 Flatbed 8 Dump 9 Concrete Mixer 0 Auto Transport Garbage/Refuse Log 9 Cable Barrier 0 Concrete Traffic Barrier Other Traffic Barrier Tree (standing) Utility Pole/Light Support 4 Traffic Sign Support 5 Traffic Signal Support 6 Other Post, Pole, or Support 7 Fence 8 Mailbox 9 Other Fixed Object (wall, building, tunnel, etc.) 0 Vehicle Defects None Brakes Tires 4 Lights (head, signal, tail) 6 Steering 7 Wipers 9 Exhaust System 0 Body, Doors Power Train Intermodal Container Chassis 4 Vehicle Towing Another Vehicle 5 Not Applicable (vehicle 0,000 lbs (4,56kg) or less not displaying HM placard) Emergency Vehicle Use No Suspension Wheels 4 Windows/ Windshield 5 Mirrors 6 Truck Coupling / Trailer Hitch / Safety Chains NAME OF VIOLATOR FL STATUTE NUMBER CHARGE NAME OF VIOLATOR FL STATUTE NUMBER CHARGE NAME OF VIOLATOR FL STATUTE NUMBER CHARGE HSMV 9000 S (V/P) (rev 0/0) Page of 7

4 Driver Non Motorist Passenger VEHICLE # NAME PHONE NUMBER Check if Recommend JOHN W WARD Driver Re exam DATE OF BIRTH SEX: DRIVER LICENSE NUMBER STATE EXPIRES INJURY SEVERITY None 4 Incapacitating Possible 5 Fatal (within 0 days) 0/8/9 FL 5 0/08 Non incapacitating 6 Non Traffic Fatality DRIVER DL Type Required Endorsements Drivers Actions at Time of Crash Condition At A B C Yes st No Contributing Action 6 Ran off Roadway rd 4 D/Chauffeur No Operated MV in Careless or 7 Disregarded other Traffic Time of Crash 5 5 E/Operator No Req. Endorsement Negligent Manner Sign Apparently Normal 6 E/Oper Rest Failed to Yield Right of Way 7 None 8 4 Improper Backing Markings Disregarded Other Road 5 Ill Asleep (sick) or or Fatigued Fainted Driver Distracted By 4 Other Inside the Vehicle nd 6 Improper Turn 9 Over Correcting/Over 4th 6 Seizure, Epilepsy, Blackout Not Distracted (explain in narrative) 0 Followed too Closely Steering 7 Physically Impaired Electronic Communication 5 External Distraction Ran Red Light 0 Swerved or Avoided : Due 8 Emotional (depression, Devices (cell phone, etc.) (outside the vehicle, explain Drove too Fast for Conditions angry, disturbed, etc.) to Wind, Slippery Surface, MV, Other Electronic Device in narrative) Ran Stop Sign Object, Non Motorist in 9 Under the Influence of (navigation device, DVD player) 6 Texting 5 Improper Passing Roadway, etc. Medications/Drugs/Alcohol 7 Inattentive 7 Exceeded Posted Speed Operated MV in Erratic, Wrong Side of Wrong Way Reckless or Aggressive Manner Driver Vision Obstructions 5 Failed to keepin Proper Lane 77 Other Contributing Action 5 Load on Vehicle 6 Building / Fixed Object 7 Signs / Billboards 8 Fog DRIVER OR PASSENGER Vision Not Obscured Inclement Weather Parked / Stopped Vehicle 4 Trees / Crops / Bushes Motor Vehicle Seating Position: Seat Row Other Left Middle Right 77 Other (explain in narrative) Front Second Third 4 Fourth 77 Other Row Non-Motorist Description Pedestrian Other Pedestrian (wheelchair, person in a building, skater, pedestrian conveyance, etc.) Bicyclist 4 Other Cyclist 5 Occupant of Motor Vehicle Not in Transport (parked, etc.) 6 Occupant of a Non Motor Vehicle Transportation Device 7 Unknown Type of Non Motorist Safety Equipment None 5 Lighting Helmet 6 Not Applicable Protective Pads Used 77 Other, Explain (elbows, knees, shins, etc.) in 4 Reflective Clothing (jacket, backpack, etc.) SUSPECTED ALCOHOL USE: No ALCOHOL TESTED: Test Not Given Test Refused Test Given if Tested Not Transported EMS Law Enforcement VEHICLE # NAME LOCATION: (LOC) Not Applicable Sleeper Section of Truck Cab Other Enclosed Cargo Area 4 Unenclosed Cargo Area 5 Trailing Unit 6 Riding on Motor Vehicle Exterior (nontrailing unit) 9 Smoke 0 Glare 77 All Other, Explain in Helmet Use (HU) DOT Compliant Motorcycle Helmet Other Helmet No Helmet Eye Protection Yes No Not Applicable Restraint Systems (RS) Not Applicable (non-motorist) None Used - Motor Vehicle Occupant Shoulder and Lap Belt Used Air Bag Deployed 4 Shoulder Belt Only Used 5 Deployed-Other 5 Lap Belt Only Used Ejection (EJECT) (ABD) (knee, air belt, etc.) 6 Restraint Used - Type Uknown Not Ejected 6 Deployed- 7 Child Restraint System - Forward Facing Ejected, Totally Not Applicable Combination 8 Child Restraint System - Read Facing Ejected, Partially Not Deployed 7 Deployed-Curtain 9 Booster Seat 4 Not Applicable Deployed-Front 88 Deployment 0 Child Restraint Type Uknown 4 Deployed-Side Uknown NON-MOTORIST Non-Motorist Location At Time of Crash Action Prior to Crash Intersection Marked Crosswalk Intersection Unmarked Crosswalk Intersection Other 4 Midblock Marked Crosswalk 5 Travel Lane Other Location 6 Bicycle Lane 7 Shoulder/Roadside st nd ALCOHOL TEST TYPE: Blood Breath Urine SEAT ROW OTHER Non-Motorist Actions/Circumstances No Improper Action Dart/Dash Failure to Yield Right of Way 4 Failure to Obey Traffic Signs, Signals, or Officer 5 In Roadway Improperly (standing, lying, working, playing) 6 Disabled Vehicle Related (working on, pushing, leaving/approaching) ALCOHOL TEST RESULT: Pending Completed EMS AGENCY NAME OR ID LPGA BLVD HOLLY HILL, FL 7 8 Sidewalk 9 Median/Crossing Island 0 Driveway Access Shared Use Path or Trail Non Trafficway Area ALCOHOL/DRUG/EMS BAC SUSPECTED DRUG USE: No Crossing Roadway Waiting to Cross Roadway Walking/Cycling Along Roadway with Traffic (in or adjacent to travel lane) 4 Walking/Cycling Along Roadway Against Traffic (in or adjacent to travel lane) 7 Entering/Exiting Parked/Standing Vehicle 8 Inattentive (talking, eating, etc) 9 Not Visible (dark clothing, no lighting, etc.) EMS RUN NUMBER DRIVER OR PASSENGER DRUG TESTED: Test Not Given Test Refused Test Given if Tested 5 Walking/Cycling on Sidewalk 6 In Roadway Other (working, playing, etc.) 7 Adjacent to Roadway (e.g., shoulder, median) 8 Going to or from School (K ) 9 Working in Trafficway (incident response) 0 None 0 Improper Turn/Merge Improper Passing Wrong Way Riding or Walking DRUG TEST TYPE: Blood Urine 77 Other, Explain in MEDICAL FACILITY TRANSPORTED TO DRUG TEST RESULT: Positive Negative Pending ADDITIONAL PASSENGERS (EP) Not Transported EMS Law Enforcement VEHICLE # NAME Not Transported EMS Law Enforcement HSMV 9000 S (V/P) (rev 0/0) Page of 7

5 VEHICLE # Vehicle in Transport Parked Motor Vehicle Working Vehicle Hit and Run No Check if Commercial VEHICLE N S E W Off-Road Unknown ON STREET, ROAD, HIGHWAY TRAVELING HAZ. MAT. RELEASED No MOTOR CARRIER NAME VEHICLE LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent YEAR MAKE MODEL STYLE COLOR DAMAGE: Silver, 00 CHRY PT 4D Aluminum None INSURANCE COMPANY (Driver) INSURANCE POLICY NUMBER Towed due VEHICLE REMOVED BY to Damage: STATE FARM MUTUAL AUTOMOBILE No VIN Disabling 4 Minor Functional EST. DAMAGE. Rotation. Owner Request. Driver Other, Explain in NAME OF VEHICLE OWNER (Check if Business) CURRENT ADDRESS CITY & STATE ZIP CODE TRAILER # LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent VIN YEAR MAKE LENGTH AXLES TRAILER # LICENSE NUMBER GTFC STATE HAZ. MAT PLACARD No REGISTRATION EXPIRES HAZ. MAT NUMBER FL INS. CO JOHN J REILLEY Check if Permanent LPGA BLVD. US DOT NUMBER 06/04 VIN YEAR MAKE LENGTH AXLES HAZ. MAT CLASS ALDORO TER Area of Initial Impact AT EST. SPEED POSTED SPEED TOTAL LANES Most Damaged Area MOTOR CARRIER ADDRESS CITY & STATE ZIP CODE PHONE NUMBER C4FY48BT40799 DAYTONA WRECKER DELTONA, FL 0 8 Undercarriage 8 9 Overturn 9 0 Windshield 0 Trailer 50 $4, Vehicle Body Type Passenger Car Passenger Van Pickup 7 Motor Home 8 Bus Motorcycle Moped Most Harmful Event Sequence of Events st nd 4 rd Roadway Grade Level Hillcrest Uphill 4 Downhill 5 Sag (bottom) VIOLATIONS 4 All Terrain Vehicle (ATV) 5 Low Speed Vehicle 6 (Sport) Utility Vehicle 7 Cargo Van (0,000 lbs or less) 8 Motor Coach 9 Other Light Trucks (0,000 lbs or less) 0 Medium / Heavy Trucks (more than 0,000 lbs (4,56 kg)) Farm Labor Vehicle Comm/Non-Commercial Interstate Carrier Intrastate Carrier Not in Commerce/Government 4 Not in Commerce/Other Truck 4th Special Function of Motor Vehicle Non Collision Overturn/Rollover Fire/Explosion Immersion 4 Jackknife 5 Cargo/Equipment Loss or Shift 6 Fell/Jumped From Motor Vehicle 7 Thrown or Falling Object 8 Ran into Water/ Canal 9 Other Non Collision [40-46 Sequence of Events only] 40 Equipment Failure (blown tire, brake failure, etc.) 4 Separation of Units 4 Ran Off Roadway, Right 4 Ran Off Roadway, Left 44 Cross Median 45 Cross Centerline 46 Downhill Runaway Roadway Alignment Straight Curve Right Curve Left No Special Function Farm Vehicle Police 7 Taxi 8 Military Trafficway Two Way, Not Divided Two Way, Not Divided, with a Continuous Left Turn Lane Two Way, Divided, Unprotected (painted >4 feet) Median 4 Two Way, Divided, Positive Median Barrier 5 One Way Trafficway TRAILER TRAILER Comm GVWR/GCWR Trailer Type Single Semi Trailer Tandem Semi Trailer Tank Trailer 4 Saddle Mount/Trailer 5 Boat Trailer 6 Utility Trailer 7 House Trailer Collision with Non-Fixed Object 0 Pedestrian Pedalcycle Railway Vehicle (train, engine) Animal 4 Motor Vehicle in Transport 5 Parked Motor Vehicle 6 Work Zone / Maintenance Equipment 7 Struck By Falling, Shifting Cargo or Anything Set in Motion by Motor Vehicle 8 Other Non Fixed Object Vehicle Maneuver Action Straight Ahead Turning Left 4 Backing 5 Turning Right 6 Changing Lanes 8 Parked 0 Making U Turn Overtaking/ Passing 9 Ambulance 0 Fire Truck Farm Labor Transport School Bus Transit/ Commuter Bus Stopped in Traffic 4 Slowing 5 Negotiating a Curve 6 Leaving Traffic Lane 7 Entering Traffic Lane 4 Intercity Bus 5 Charter/Tour Bus 6 Shuttle Bus 7 Farm Labor Bus Commercial Motor Vehicle Configuration Vehicle 0,000 lbs or less Placarded 8 Tractor/Triple for Hazardous Materials 9 Truck more than 0,000 lbs (4,56 Single Unit Truck ( axle and GVWR kg), Cannot Classify more than0,000 lbs (4,56 kg)) 0 Bus/Large Van (seats for 9 5 Single Unit Truck ( or more axles) occupants, including driver) 4 Truck Pulling Trailer(s) Bus (seats for more than 5 5 Truck Tractor (bobtail) occupants, including driver) 6 Truck Tractor/Semi Trailer 7 Truck Tractor/Double Truck 8 Pole Trailer 9 Towed Vehicle 0 Auto Transport 0,000 lbs (4,56 kg) or less 0,00 6,000 lbs (4,56,79 kg) More than 6,000 lbs (,79 kg) 4 Not Applicable Collision Fixed Object 9 Impact Attenuator/Crash Cushion 0 Bridge Overhead Structure Bridge Pier or Support Bridge Rail Culvert 4 Curb 5 Ditch 6 Embankment 7 Guardrail Face 8 Guardrail End Traffic Control Device For This Vehicle No Controls 4 School Zone Sign/ Device 5 Traffic Control Signal 6 Stop Sign 7 Yield Sign No Cargo Bus 8 Flashing Signal 9 Railway Crossing Device 0 Person (including Flagman, Officer, Guard, etc.) Warning Sign Cargo Body Type Van/Enclosed Box 4 Hopper 5 Pole Trailer 6 Cargo Tank 7 Flatbed 8 Dump 9 Concrete Mixer 0 Auto Transport Garbage/Refuse Log 9 Cable Barrier 0 Concrete Traffic Barrier Other Traffic Barrier Tree (standing) Utility Pole/Light Support 4 Traffic Sign Support 5 Traffic Signal Support 6 Other Post, Pole, or Support 7 Fence 8 Mailbox 9 Other Fixed Object (wall, building, tunnel, etc.) 0 Vehicle Defects None Brakes Tires 4 Lights (head, signal, tail) 6 Steering 7 Wipers 9 Exhaust System 0 Body, Doors Power Train Intermodal Container Chassis 4 Vehicle Towing Another Vehicle 5 Not Applicable (vehicle 0,000 lbs (4,56kg) or less not displaying HM placard) Emergency Vehicle Use No Suspension Wheels 4 Windows/ Windshield 5 Mirrors 6 Truck Coupling / Trailer Hitch / Safety Chains NAME OF VIOLATOR FL STATUTE NUMBER CHARGE NAME OF VIOLATOR FL STATUTE NUMBER CHARGE NAME OF VIOLATOR FL STATUTE NUMBER CHARGE HSMV 9000 S (V/P) (rev 0/0) Page 4 of 7

6 Driver Non Motorist Passenger VEHICLE # NAME PHONE NUMBER Check if Recommend JOHN J REILLEY Driver Re exam DATE OF BIRTH SEX: DRIVER LICENSE NUMBER STATE EXPIRES INJURY SEVERITY None 4 Incapacitating Possible 5 Fatal (within 0 days) 06//949 FL 06/04 Non incapacitating 6 Non Traffic Fatality DRIVER DL Type Required Endorsements Drivers Actions at Time of Crash Condition At A B C Yes st No Contributing Action 6 Ran off Roadway rd 4 D/Chauffeur No Operated MV in Careless or 7 Disregarded other Traffic Time of Crash 5 5 E/Operator No Req. Endorsement Negligent Manner Sign Apparently Normal 6 E/Oper Rest Failed to Yield Right of Way 7 None 8 4 Improper Backing Markings Disregarded Other Road 5 Ill Asleep (sick) or or Fatigued Fainted Driver Distracted By 4 Other Inside the Vehicle nd 6 Improper Turn 9 Over Correcting/Over 4th 6 Seizure, Epilepsy, Blackout Not Distracted (explain in narrative) 0 Followed too Closely Steering 7 Physically Impaired Electronic Communication 5 External Distraction Ran Red Light 0 Swerved or Avoided : Due 8 Emotional (depression, Devices (cell phone, etc.) (outside the vehicle, explain Drove too Fast for Conditions angry, disturbed, etc.) to Wind, Slippery Surface, MV, Other Electronic Device in narrative) Ran Stop Sign Object, Non Motorist in 9 Under the Influence of (navigation device, DVD player) 6 Texting 5 Improper Passing Roadway, etc. Medications/Drugs/Alcohol 7 Inattentive 7 Exceeded Posted Speed Operated MV in Erratic, Wrong Side of Wrong Way Reckless or Aggressive Manner Driver Vision Obstructions 5 Failed to keepin Proper Lane 77 Other Contributing Action 5 Load on Vehicle 6 Building / Fixed Object 7 Signs / Billboards 8 Fog DRIVER OR PASSENGER Vision Not Obscured Inclement Weather Parked / Stopped Vehicle 4 Trees / Crops / Bushes Motor Vehicle Seating Position: Seat Row Other Left Middle Right 77 Other (explain in narrative) Front Second Third 4 Fourth 77 Other Row Non-Motorist Description Pedestrian Other Pedestrian (wheelchair, person in a building, skater, pedestrian conveyance, etc.) Bicyclist 4 Other Cyclist 5 Occupant of Motor Vehicle Not in Transport (parked, etc.) 6 Occupant of a Non Motor Vehicle Transportation Device 7 Unknown Type of Non Motorist Safety Equipment None 5 Lighting Helmet 6 Not Applicable Protective Pads Used 77 Other, Explain (elbows, knees, shins, etc.) in 4 Reflective Clothing (jacket, backpack, etc.) SUSPECTED ALCOHOL USE: No ALCOHOL TESTED: Test Not Given Test Refused Test Given if Tested Not Transported EMS Law Enforcement VEHICLE # NAME LOCATION: (LOC) Not Applicable Sleeper Section of Truck Cab Other Enclosed Cargo Area 4 Unenclosed Cargo Area 5 Trailing Unit 6 Riding on Motor Vehicle Exterior (nontrailing unit) 9 Smoke 0 Glare 77 All Other, Explain in Helmet Use (HU) DOT Compliant Motorcycle Helmet Other Helmet No Helmet Eye Protection Yes No Not Applicable Restraint Systems (RS) Not Applicable (non-motorist) None Used - Motor Vehicle Occupant Shoulder and Lap Belt Used Air Bag Deployed 4 Shoulder Belt Only Used 5 Deployed-Other 5 Lap Belt Only Used Ejection (EJECT) (ABD) (knee, air belt, etc.) 6 Restraint Used - Type Uknown Not Ejected 6 Deployed- 7 Child Restraint System - Forward Facing Ejected, Totally Not Applicable Combination 8 Child Restraint System - Read Facing Ejected, Partially Not Deployed 7 Deployed-Curtain 9 Booster Seat 4 Not Applicable Deployed-Front 88 Deployment 0 Child Restraint Type Uknown 4 Deployed-Side Uknown NON-MOTORIST Non-Motorist Location At Time of Crash Action Prior to Crash Intersection Marked Crosswalk Intersection Unmarked Crosswalk Intersection Other 4 Midblock Marked Crosswalk 5 Travel Lane Other Location 6 Bicycle Lane 7 Shoulder/Roadside st nd ALCOHOL TEST TYPE: Blood Breath Urine SEAT ROW OTHER Non-Motorist Actions/Circumstances No Improper Action Dart/Dash Failure to Yield Right of Way 4 Failure to Obey Traffic Signs, Signals, or Officer 5 In Roadway Improperly (standing, lying, working, playing) 6 Disabled Vehicle Related (working on, pushing, leaving/approaching) ALCOHOL TEST RESULT: Pending Completed EMS AGENCY NAME OR ID ALDORO TER DELTONA, FL 75 8 Sidewalk 9 Median/Crossing Island 0 Driveway Access Shared Use Path or Trail Non Trafficway Area ALCOHOL/DRUG/EMS BAC SUSPECTED DRUG USE: No Crossing Roadway Waiting to Cross Roadway Walking/Cycling Along Roadway with Traffic (in or adjacent to travel lane) 4 Walking/Cycling Along Roadway Against Traffic (in or adjacent to travel lane) 7 Entering/Exiting Parked/Standing Vehicle 8 Inattentive (talking, eating, etc) 9 Not Visible (dark clothing, no lighting, etc.) EMS RUN NUMBER DRIVER OR PASSENGER DRUG TESTED: Test Not Given Test Refused Test Given if Tested 5 Walking/Cycling on Sidewalk 6 In Roadway Other (working, playing, etc.) 7 Adjacent to Roadway (e.g., shoulder, median) 8 Going to or from School (K ) 9 Working in Trafficway (incident response) 0 None 0 Improper Turn/Merge Improper Passing Wrong Way Riding or Walking DRUG TEST TYPE: Blood Urine 77 Other, Explain in MEDICAL FACILITY TRANSPORTED TO DRUG TEST RESULT: Positive Negative Pending ADDITIONAL PASSENGERS (EP) Not Transported EMS Law Enforcement VEHICLE # NAME Not Transported EMS Law Enforcement HSMV 9000 S (V/P) (rev 0/0) Page 5 of 7

7 NARRATIVE Vehicle was traveling north on LPGA Blvd approaching a lane closure/lane shift area. Traffic was being stopped for some roadway construction that was occurring in the roadway. V- had come to a complete stop and saw V- rapidly approaching him from behind. V- struck the rear of V- and was pronounced deceased at the scene by DBFD personnel. There were no skid marks or any signs of braking by V-. W- and W-, who were behind V-, also advised that V- did not brake prior to impact. Sergeant Eisner and Lieutenant Garvin were on scene. Traffic Homicide Investigator's arrived and completed their investigation. V- was released to its owner, and V- was towed by Daytona Wrecker Service to their compound. ADDITIONAL PASSENGERS VEHICLE # NAME Not Transported EMS Law Enforcement VEHICLE # NAME Not Transported EMS Law Enforcement ADDITIONAL VIOLATIONS NAME OF VIOLATOR FL STATUTE NUMBER CHARGE NAME OF VIOLATOR FL STATUTE NUMBER CHARGE REPORTING OFFICER ID/BADGE NUMBER RANK & NAME DEPARTMENT FHP SO PD OTHER 44 OFF STEVEN JESSMER Daytona Beach PD HSMV 9000 S (N/D) (rev 0/0) Page 6 of 7

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