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Case Number: CACE-19-021368 Division: 02
Filing # 97311020 E-Filed 10/15/2019 03:07:38 PM
IN THE CIRCUIT COURT, IN AND
FOR BROWARD COUNTY, FLORIDA
CASE NO.
AMERISURE MUTUAL INSURANCE COMPANY
a/s/o Plumbing Mart of Florida, Inc.,
Plaintiff,
vs.
DAVID CHARLES WARREN KNIGHT,
Defendant.
COMPLAINT
COMES NOW the Plaintiff, AMERISURE MUTUAL INSURANCE COMPANY
a/s/o Plumbing Mart of Florida, Inc., by and through its
undersigned attorney and sues Defendant, DAVID CHARLES WARREN
KNIGHT, and alleges as follows:
1 This is an action for damages which exceed $15,000.00.
2 Venue is properly laid in this county pursuant to
Section 47.011 et seq., Fla. Stat.
3 Plaintiff is an insurance carrier licensed to do
business in Florida.
4 Defendant, DAVID CHARLES WARREN KNIGHT, on or about July
25, 2016, was the cause of an automobile accident involving a
vehicle insured by the Plaintiff.
5 Defendant, DAVID CHARLES WARREN KNIGHT, was cited by the
Florida Highway Patrol as the cause of the accident according to
wat
the Florida Traffic Crash Report attached hereto as Exhibit
,
#** FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 10/15/2019 03:07:37 PM.**#*
and incorporated by reference
6 As a result of Defendant, DAVID CHARLES WARREN KNIGHT
causing said accident, the Plaintiff has had to pay its insured
the amount of $30,264.95
7 owes Plaintiff
Defendant, DAVID CHARLES WARREN KNIGHT
the sum of $30,264.95, plus interest at the rate of 4.84% per
annum from July 25 2016
8 Plaintiff has demanded payment from the Defendant;
however, Defendant has refused to pay
WHEREFORE Plaintiff demands Judgment for damages of
$30,264.95 against the Defendant DAVID CHARLES WARREN KNIGHT
together with interest and court costs.
DATED this 15th day of October, 7iy Wy
Wil Vila M. Lindeman
Monias Bar #699640
Attorney for Plaintiff
William M. Lindeman, P.A
P.O. Box 3506
Orlando, FL 32802-3506
(407) 244-3294
(Fax) 244-3186
w.lindeman@wmlpa.com
legal@wmlpa.com
THIS COMMUNICATION IS AN ATTEMPT TO COLLECT A DEBT AND ANY
INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE
Exhibit “A”
FLORIDA TRAFFIC CRASH REPORT HIGHWAY SAFETY & MOTOR VEHICLES,
LENG FORM [97] SHORT FORM upzaTe [7] FFIC CRASH RECORDS
NEIL KIRKMAN BUILDING, TALLAHASSEE, FL 32399-0537
{Electronic Version)
Date of Crash Time of Crash Date of Report invest Agency Report Number SMV Crash Report Number
25:Jul/2016 08:52 AM 25%Jul/2016 06:52 AM 25/Jul/2016 07:37 AM FHPL160FF052420 85312454
CRASH IDENTIFIERS:
(Couniy Code [City Gode County of Crash Place or City ot Grash Within City Limits "Time Reported [Time Dispatched
40 PALM BEACH DELRAY BEACH No 25/Jul:2016 25/Jul’2016
6:
Time on Srene [Time Cleared Scene Completed Reason (i Investgatinn NOT Completed) NajifiedBy
25/Jul/2016 2euuub2016 10:95 Law Enforcement
ROADWAY INFORMATION
[Crash Gecured On Street, Road High O At Sireel Address? At Lalintade ‘and Longitude
NB INTERSTATE 95 (SR9) 26.430622497573498 -80.089978566393299
At Feet Or tiles Direction’ JOFrom Intersection With Streei, Road, Highway @ Or From Milepost #
2000 LINTON BLVD
Road System ideniiier Type Of Shoukder Type Of intersection
Imerstate 4 Paved 1 at Intersection
CRASH INFORMATION (Check if Pictures Taken) C
fight Condition [Weather Condition Roadway Surlace Conhton [School Bus Related [Manner OF Collision
i 1 ¥ No 4 Sideswipe, same direction
First Harmiul Event Type First Harmful Event First Harmful Event Location Within interchange ist Hamil Event Relation to Junction
1.On Roadway 1. Non.Junetion
(Conbibuting Cireuanste 5, Roel [Coniribuing Gircumsianccs, Roel Coninbulig Greumeiunces, Road
1None
(Coninbuting Gireunskances. Cavironment Coninbuing Circumstances. Crvironmcnl Coninboling Greumstances. Crviraninent
Work Zone Related rast In Work Zone Type OF Work Zone ew Tn Work Zone [Law Criforcomont In Work Zone
NEHICLE (Check if Commercial) oO
eta Tolar Vetus Tyo Titand Rar Woh License Number State Rog. Lxpiros Pormenent Ruy, VIN
/ehicle in Transport lo 044X FL 31/Deci2016 ANKAL29X2GS330615
Year Nake Model Siyie [Culor Uxlent ol Damage Tet Damage Towed Due To Damage Velucle Removed Uy Rotation
1986 | KW OTHER ™ WHI finor 100
insurance Company insurance Poly Number
‘STARR INDEMNITY 1000072610
[Name of Vehicle Owner (Check Box lf Business) Co ‘Current Address (Number and Street) City and State Zip Code
ELIO CESAR SALAZAR CHI 8737 SW 25 ST 33165-0000
Trailer Ticense Number [Stale Reg. Expires’ Permanent Reg. [VIN Year Make Tena Axies
ni
Trailer Ticense Number State Reg, Expires Permanent Reg. [VIN Year Make Teng Aales
0
Vehicle Direction [On Street, Road, Highway ATES], Speed [Posted Speed Total Lanes
Traveling North NB INTERSTATE 95 (SR9) 50 65 6
CMY Configuration [Cargo Body Type ‘Area of Initial Impact Wiosi Damaged Area
FTiniier Type (nailer two) ais sjely, 18. Undercarriage Gstelsle| 7 18. Undercarings
CCI]
Comm GVWIVCCWT [Traler Type (railler one)
alts 7 . 19. Overum,
2D, Windies
19. Overum
20. Windshield
Haz. Mai. Nelease Haz Mat Placard umber (Class Yareyayool = 24, Tralee ‘el sTey ay 21. Trailer
Motor Carier Name US DOT Number
Toto Carrier Address City and State ip Code Phone Number
[CommiNon-Commercial [Vehicle Body Type Vehicle Defects (one) IWehicle Detects (to) Ememjency Vehicle Use [Specuual Function of AV
20 Mediuin/Heav: Trucks
(more than 10, 41None lo 1No Special Function
4 )
Vehicle Maneuver Acton |Tratheway Roadway Grade Roadway Alignment Most Harmiul Event Most Harmful Event Detail
1 Straight Ahead 1 Level 4 Straight
osrtve
Ne Median Harré 2 Collision with Non-Fixed 14 Motor Vehicle in Transport
Tratin Goniral Nevice For This Vehicle [First (1) Sequence of Fvenis, [Second (2) Raquence ai Fvenia FThind (3) Sequence of Pvenis Fourth (4) Sanuence of Fventa
No Controls 2 Collision with Non-Fixed
14 Motor Vehicle in Transport
VEHICLE (Check If Commerelal) [~]
Vehicle [Motor Vehicle Ty Hit and Ron Veh license Number State Raq Pxpiren Peimanent Reg [¥IN,
3 1 Vehicle in fransport 1No DEIG61 FL 30/Jun/2017 STLZE4FE7EJ063878
Year Rake Minder fSiyle [ater Fiaent at namage Fat Damage ro Thie To Damage Vehicle Removed Ry Rotation
2014 TOYT SCION sw DBL Disabling 15000 ZUCALLAS TOWING Rotation
py hyigine hi ug ra
MV 90010 S Page
1 of 5
Date of rash Date of Report [invest Agenry Report Number SMV Grash Report Number
‘25/Jul/2016 06:52 AM 25/ku1/2016 06:52 AM FHPL 160FF052420 85312454
‘insurance Company Insurance Poly Namber
UK UK
Name of Vehicle Owner (Check Box il Business) x Current Address (Number and Street jy and Siaie Zip Code
PLUMBING MART OF FLORID) 24 SE 10TH STREET DEERFIELD BEACH FL 33441-0000
Trailer Ticense Number [Siate Reg. Expires Permanent Fleg. | VIN Year Make Tengit Axles
‘Trailer [Ticense Number State Teg, Expres Permanent Reg. [VIN Year Make tong Axles:
Vehicle Direction [On Steet Road Highway AVESt Speed Posted SpeedTotal Lanes
Traveling North NB INTERSTATE 95 (SR9) 65 6
EMV Contiquration [camo Rody Tyne ‘Area of Initial impart Most sata Area
valet Type (aller ane) [Trailer Type (trailer two) KS + sles [> se. undecareos 2}3 18, Urdercartage
Comm GVWIVCCWR
Haz. Mat. Melease Haz Mat. Placard Number [Cass
((«[] 19, Ovetum
20. Windahiokd eC Te
PST atl ©
19. Overum
20. Windahield
21, Tralee
‘efs] ey a] ] 3° 21. Troker
[Motor Carrier Name [* DOT Number
Totor Garier Address: City and State ip Code Phone Number
[Comm/Non-Commeraal Vehicle Body Type Vehicle Defects (one) Vehicle Defects (two) Emergency Valucle Use |Special Funchon of hav
{ Passenger Car 1 lone lo 1 'No Special Function
Vehicle Maneuver Acinn [Traticway Roarway Grate Raadway Aiqnment [Most Harmful Fvent [Rinat Harmful Fvent Detail
1 Straight Ahead Two-Way, Divieled,
Positive Median Barrior
1 Level 1 Straight 3 Collision with Fixed Object 30 Concrete Traffic Barrier
Trai: Control Device Lor this Vetucie | rst (1) Sequence ol Lvents [Second (2) Sequence ul Lveuts Thing (3) Sequence of Lveuls T uurlh (4) Sequence of Lents
rstrols 2 Collision with Non-Fixed 30 Concrete Tratfic Barrier
14 Motor Vehicle in Transport
VEHICLE (Check If Commercial) CO
Vehle {Motor Velucle lype thland Run Veh Liverse Nuinber state eg. Lapires Pennenunl Ruy. [VIN
4 Vehicle in Transport 4No FAITLV FL 2a!Novi2017 4B3AU42Y5TE258573
Year Make |Modet fe Color Extent of Damage st. Damage lowed Due 1o Damage Velucle Hemaved By Rotation
1996 pope |AVENGE! 2D REI Disabling 5000 res ZUCALLAS: Rotation
surance Company Insurance Polcy Number
NONE NONE
Name of Vehicle Owner (Gheck Box li Business) Cc Current Address (Number and Street) Zip Code
VID CHARLES WARREN KNIGHT 401 SW 51 AVE -T LAUDERDALE FL ‘39912-0000
Trailer Ticense Number Bae Tag Fapires Permanent Req [VIN Year Make Tena Axles
Trailer Teense Number State Hag Fapres Permanent Req {VIN Year Make Teng axles
vehicle Direction’ [OnSteet Road Highway AL ESL Speed [Posted Speed [Total Lanes
Traveling North NB INTERSTATE 95 (SR9) 65 65
EMV Configuration [argo Body Type ‘Area of Initial Impact Most Damaged Area
Traler Type (iraaior one) Trailer Type firaiior to) 2jslelete|z 46.Un fatal steal[iey 18.
Comm GVWATGCWR
(TJ 19. Oveetumn
20. Windhield [«][ 19. Overtum
20. Windshield
Haz. Mal. Helease| Haz Mat. Placard [Number (Class alsa] ay 21. Traber ‘al 3] a] aT 0] 24. Taller
[Motor Carer Name US DOT Number
Wotor Carrier Address: City and State ip Code. Phone Number
CommiNon-Gommerial Wahicle ody Type Vehicle Nefecis (ane) Vehicle Naterts (ta) Fmemency Vehicle lise [Specual Functinn of AAV
ssenger Car 1None No 1No Special Function
Vehicle Mahetve! Ackan [Trahcway Toadway Grade Finaciway Alignment [Moat Harmful Fvent Knat Harti Fvant Detail
inging Lanes
postive MedianDivided,
Barrier
1 Level (Straight 3 Collision with Fixed Object 30 Concrete Trattic Barrier
Fraflic Coniral Device For is Vehicle [First (1) Sequence of Evenis [Second(2) Sequence of Evenis iid (a) Sequence of Events ‘aurih (4) Sequence of Events
No Controls 2 Collision with Non-Fixed 14 Motor Vehicle in Transport 30 Concrete Traffic Barrier
14 Motor Vehicle in Transport
PERSON RECORD
Person#] Description Vehicle # Nan Date of Binh Sex Phone Number re-Exam
101 DAVID CHARLES WARREN KNIGHT 24/Nov/1986
Address ily Siaie Zip Code
401 SW 31 AVE FT LAUDERDALE FL 39312
Driver License Number Tate Req. End. Injury Severity
523162864240 24/Novi2018 5 E/Operator lo Req 3 Non-incapacitating 1 Not Ejected
indorsement
Page
2 of 5 jie at Vat ee Agen un
Date of Crash Tate of Flepon invest Agency Report Number SMV Crash Report Number
25/Jul/2016 06:52 AM 2540ul/2016 06:52 AM 1 1SOFFO52420 85312454
Resireint yslem ir Bag Deployed [Heimat se’ Eye Frotection Sealing Location Seal [Seating Location Row [Seating Location Other
3 ‘Shoulder and Lap Belt 3 Deployed-Front ‘3Not Applicable 1 Lett 1 Front 41Not Applicable
Drivers Achons al Time of Crash thirsty Drivers Actions at Tinve of Grash (second) Diver Distracted By Vision Obstruction
3 Failed to Yield Right.of Way 1 Not Distracted 1 Vision Not Obscured
Drivers Achons al Tine of ish (ihurd) Drivers Actions al Trne of Crash {lourlli) Drivers Gundiion at Thine of Crash
1 Apparently Normal
Suspected Aicabul Use [Akohol Tested Alcohol Test Type Alcohol Test Resull TAC Suspected Dray Use Drug Tested Brig Test Type [brag Test Result
fest 1 Test Not Given
iver
Soumce of Trapt Medial Faciy EMS Agency Name or1D ERS Run Number Medical Faciily Transported To
OCA FIRE RESCUE BOCA RATON MEDICAL CENTER
PERSON RECORD
Persona] Description Vehicle # Nam Bate of Birth Sex Phone Number Re-Examn
fiver 2 ELIO CESAR SALAZAR CHIONG 26/Novi1972 1Male
lAddres ciy Biaie 7ip Gore
8737 SW 25 ST MIAMI FL 33185
Driver hicense Nimber Riaie B rea PIT | Tie Ene injury Severity
$426203724260 FL 26/Nov/2019 1/None ee Not Ejected
encorsemient
Restaint System ai Bag jeployexd Reimer Use [Eye Protection Seating Locaban Seal [Seating Location Row [Seating Location Other
3 Shoulder and Lap Belt 2 Nol Deployed ‘INot Applicable 1 Let ‘ront Not Applicable
Drivers Actions at Time of Craah (iirsty Drivers Actions at Tine of Gras {aacond) Driver Tiatracterd Vision Obatrietion
1 No Contributing Action 4 Not Distracted 1 Vision Not Obscured
avers Acuons al Lame of Grassi (urd) Drivers Acuonts al Lame of Gres! arth) Drivers Gunditon al Lune al Crensty
1 Apparently Normal
Suspecied Alcohol Use [Atcohol Tested lcahol Test Type ‘Alcohol Test Resuil BAC Suspected Drug Use [Drug Tested frag Test Type Drag Test Hesull
lo Test Not jo 1 Test Not Given
jiven,
Bouma of Transpior to Machina F FMB Agency Name ar It FRaS Run Number Medical Faciy Transparent To
1 Not Transported
PERSON RECORD
Persond]| Description [vehicle ame Phone Number
1 Driver TIMOTHY MICHAEL BEEBE
~
‘Gate of Birth
O2/Novi1954 ‘Tal Ne
Address ily Siac Zp Code
408 HAYLEY DR ENTERPRISE AL 36330
Driver License Number Biate Expires or pe End Injury Severity
636444 AL ‘04iApri2020 (or 3.Non-incapacitating Not Ejected
Enbbtocindat
Resiraini System [aw Bag Deployed Heimet Use [Eye Protection ‘Seating Location Seat [Seating Location Row ‘Seating Localion Other
3 Shouldet and Lap Belt ‘3Not Applicable Left ront 1 Not Applicable
Deployed. Combination
Drivers Actions ai Time of Crash iirst) Drivers Actions at Tine of Grash (second) Driver Diswacted By Vision Obstruction
11No Contributing Action 41 Not Distracted 1 Vision Not Obscured
Drivers Actions ai Time of Crash jihirdy Drivers Actions at Time of Crash (fourth) Drivers Condition af Time of Crash
1 Apparently Normal
Suspecled cohol Use [Aicchol Tested [Alcohol Test Type ‘Alcohol Test Result aa Drug Use Drug Tested
Suspected [Brog Test Type [Drag Test Result
1 Test Not 1 Test Not Given
ven,
Soume of Transpo ears Facility FMS Agency Name ar ity FRB thin Nib Medical Faally Tranaporien To
BOCA FIRE RESCUE 7 BOCA RATON MEDICAL CENTER
VIOLATIONS:
Poront Nam Tlorida Staite Nomber [Charge [Citation
DAVIO CHARLES WARREN KNIGHT 316.085(2) IMPROPER-CHANGE-OF-LANE/ PULLING OUT IN FRONT ASBYBSE
OF VEHICLE GOI
NARRATIVE
imber Tae WR TERREL! L Troop / Post FLORIDA Ottic A umber ite Created
igtway PATROL 561-257-4040 Jul 25, 2016
263
1, Vo2, and VO3 were traveling northbound on Interstate 95 (State Road 9), south of Linton Blvd. ¥O1 was on the outside tratlic lane. VO2 was on the outside center
ratfic lane and VD3 vies on the inside center traffic lane.
1 committed an improper lane change onto V02's travel lane. At the result of this, VO1 enter into the path of travel of VO2 as VO1"s lett rear collided into Va2's right front,
rat point of impact.
1 then traveled ina northwesterly direction of travel, crossi northbound travel lanes of 1-95 and entering into the path of travel of V03, VO1's left side collided into
front of VO3. second pet int of iy ict. The force from em \pact caused VO3 to travel in a northwest erly direction of travel, crossing the inside traflic
oe median where Vo3's
iedian facing north,
side collided into a median concrete traffic barrier wall. third point of impact. Vo 3 came toa final rest at the third point of impact, on the
ter c in V03, VO1 also traveled in a northwesterly ection of travel where V1 crossed the inside trattic lane and onto the median where VO1's lett trom
llided into2a ined jan concrete tratlic barrier wall, fourth poi of impact. VOI then bounced off the harrier wall and came to 4 finel rest on the inside center and inside
aific lanes 4 ina easterly direction.
came fo @ controlled stop on the median, coming to a final rest in the area of the paint af impact, tacing north.
REPORTING OFFICER
Page 3 of 5 way Ire
Tale of Grash Date of Report invest Agenry Report Number PISMY Grash Report Number
25:Jul/2016 06:52 AM 25/Jul/2016 06:52 AM IPL 160FF052420 85312454
W/Badge * Rank and Name [Deparment Tye of Deparment
2263 TROOPER J. A. TERRELL FLORIDA HIGHWAY PATROL
of aD tye pest age 8 a
Page
4 of 5
ate of Crash Tairof Report invest Agenny Renan Number SMV Crash Report Number
25‘Jul/2016 06:52 AM 254Ju/2016 06:52 AM FHPL160FF052420 85312454
DIAGRAM NOT
TO SCALE
AN
POINT OF NORTH INDICATED
FINAL REST B Ww
POINT OF
FINAL REST
jh |
FOURTH POINT
OF IMPACT
VOT
THIRD POINT
OF IMPACT
AND POINT OF FINAL REST
| 3
®,
SECOND POINT &
OF IMPACT a
ce FIRST POINT
MEDIAN CONCRETE OF IMPACT
TRAFFIC BARRIER WALL nye
v02
| t
NORTHBOUND 1-95
0!
LINTON BLVD
Pages ol 5
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Case Number: CACE-19-021368 Division: 02 Filing # 97311020 E-Filed 10/15/2019 03:07:38 PM IN THE CIRCUIT COURT, IN AND FOR BROWARD COUNTY, FLORIDA CASE NO. AMERISURE MUTUAL INSURANCE COMPANY a/s/o Plumbing Mart of Florida, Inc., Plaintiff, vs. DAVID CHARLES WARREN KNIGHT, Defendant. COMPLAINT COMES NOW the Plaintiff, AMERISURE MUTUAL INSURANCE COMPANY a/s/o Plumbing Mart of Florida, Inc., by and through its undersigned attorney and sues Defendant, DAVID CHARLES WARREN KNIGHT, and alleges as follows: 1 This is an action for damages which exceed $15,000.00. 2 Venue is properly laid in this county pursuant to Section 47.011 et seq., Fla. Stat. 3 Plaintiff is an insurance carrier licensed to do business in Florida. 4 Defendant, DAVID CHARLES WARREN KNIGHT, on or about July 25, 2016, was the cause of an automobile accident involving a vehicle insured by the Plaintiff. 5 Defendant, DAVID CHARLES WARREN KNIGHT, was cited by the Florida Highway Patrol as the cause of the accident according to wat the Florida Traffic Crash Report attached hereto as Exhibit , #** FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 10/15/2019 03:07:37 PM.**#* and incorporated by reference 6 As a result of Defendant, DAVID CHARLES WARREN KNIGHT causing said accident, the Plaintiff has had to pay its insured the amount of $30,264.95 7 owes Plaintiff Defendant, DAVID CHARLES WARREN KNIGHT the sum of $30,264.95, plus interest at the rate of 4.84% per annum from July 25 2016 8 Plaintiff has demanded payment from the Defendant; however, Defendant has refused to pay WHEREFORE Plaintiff demands Judgment for damages of $30,264.95 against the Defendant DAVID CHARLES WARREN KNIGHT together with interest and court costs. DATED this 15th day of October, 7iy Wy Wil Vila M. Lindeman Monias Bar #699640 Attorney for Plaintiff William M. Lindeman, P.A P.O. Box 3506 Orlando, FL 32802-3506 (407) 244-3294 (Fax) 244-3186 w.lindeman@wmlpa.com legal@wmlpa.com THIS COMMUNICATION IS AN ATTEMPT TO COLLECT A DEBT AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE Exhibit “A” FLORIDA TRAFFIC CRASH REPORT HIGHWAY SAFETY & MOTOR VEHICLES, LENG FORM [97] SHORT FORM upzaTe [7] FFIC CRASH RECORDS NEIL KIRKMAN BUILDING, TALLAHASSEE, FL 32399-0537 {Electronic Version) Date of Crash Time of Crash Date of Report invest Agency Report Number SMV Crash Report Number 25:Jul/2016 08:52 AM 25%Jul/2016 06:52 AM 25/Jul/2016 07:37 AM FHPL160FF052420 85312454 CRASH IDENTIFIERS: (Couniy Code [City Gode County of Crash Place or City ot Grash Within City Limits "Time Reported [Time Dispatched 40 PALM BEACH DELRAY BEACH No 25/Jul:2016 25/Jul’2016 6: Time on Srene [Time Cleared Scene Completed Reason (i Investgatinn NOT Completed) NajifiedBy 25/Jul/2016 2euuub2016 10:95 Law Enforcement ROADWAY INFORMATION [Crash Gecured On Street, Road High O At Sireel Address? At Lalintade ‘and Longitude NB INTERSTATE 95 (SR9) 26.430622497573498 -80.089978566393299 At Feet Or tiles Direction’ JOFrom Intersection With Streei, Road, Highway @ Or From Milepost # 2000 LINTON BLVD Road System ideniiier Type Of Shoukder Type Of intersection Imerstate 4 Paved 1 at Intersection CRASH INFORMATION (Check if Pictures Taken) C fight Condition [Weather Condition Roadway Surlace Conhton [School Bus Related [Manner OF Collision i 1 ¥ No 4 Sideswipe, same direction First Harmiul Event Type First Harmful Event First Harmful Event Location Within interchange ist Hamil Event Relation to Junction 1.On Roadway 1. Non.Junetion (Conbibuting Cireuanste 5, Roel [Coniribuing Gircumsianccs, Roel Coninbulig Greumeiunces, Road 1None (Coninbuting Gireunskances. Cavironment Coninbuing Circumstances. Crvironmcnl Coninboling Greumstances. Crviraninent Work Zone Related rast In Work Zone Type OF Work Zone ew Tn Work Zone [Law Criforcomont In Work Zone NEHICLE (Check if Commercial) oO eta Tolar Vetus Tyo Titand Rar Woh License Number State Rog. Lxpiros Pormenent Ruy, VIN /ehicle in Transport lo 044X FL 31/Deci2016 ANKAL29X2GS330615 Year Nake Model Siyie [Culor Uxlent ol Damage Tet Damage Towed Due To Damage Velucle Removed Uy Rotation 1986 | KW OTHER ™ WHI finor 100 insurance Company insurance Poly Number ‘STARR INDEMNITY 1000072610 [Name of Vehicle Owner (Check Box lf Business) Co ‘Current Address (Number and Street) City and State Zip Code ELIO CESAR SALAZAR CHI 8737 SW 25 ST 33165-0000 Trailer Ticense Number [Stale Reg. Expires’ Permanent Reg. [VIN Year Make Tena Axies ni Trailer Ticense Number State Reg, Expires Permanent Reg. [VIN Year Make Teng Aales 0 Vehicle Direction [On Street, Road, Highway ATES], Speed [Posted Speed Total Lanes Traveling North NB INTERSTATE 95 (SR9) 50 65 6 CMY Configuration [Cargo Body Type ‘Area of Initial Impact Wiosi Damaged Area FTiniier Type (nailer two) ais sjely, 18. Undercarriage Gstelsle| 7 18. Undercarings CCI] Comm GVWIVCCWT [Traler Type (railler one) alts 7 . 19. Overum, 2D, Windies 19. Overum 20. Windshield Haz. Mai. Nelease Haz Mat Placard umber (Class Yareyayool = 24, Tralee ‘el sTey ay 21. Trailer Motor Carier Name US DOT Number Toto Carrier Address City and State ip Code Phone Number [CommiNon-Commercial [Vehicle Body Type Vehicle Defects (one) IWehicle Detects (to) Ememjency Vehicle Use [Specuual Function of AV 20 Mediuin/Heav: Trucks (more than 10, 41None lo 1No Special Function 4 ) Vehicle Maneuver Acton |Tratheway Roadway Grade Roadway Alignment Most Harmiul Event Most Harmful Event Detail 1 Straight Ahead 1 Level 4 Straight osrtve Ne Median Harré 2 Collision with Non-Fixed 14 Motor Vehicle in Transport Tratin Goniral Nevice For This Vehicle [First (1) Sequence of Fvenis, [Second (2) Raquence ai Fvenia FThind (3) Sequence of Pvenis Fourth (4) Sanuence of Fventa No Controls 2 Collision with Non-Fixed 14 Motor Vehicle in Transport VEHICLE (Check If Commerelal) [~] Vehicle [Motor Vehicle Ty Hit and Ron Veh license Number State Raq Pxpiren Peimanent Reg [¥IN, 3 1 Vehicle in fransport 1No DEIG61 FL 30/Jun/2017 STLZE4FE7EJ063878 Year Rake Minder fSiyle [ater Fiaent at namage Fat Damage ro Thie To Damage Vehicle Removed Ry Rotation 2014 TOYT SCION sw DBL Disabling 15000 ZUCALLAS TOWING Rotation py hyigine hi ug ra MV 90010 S Page 1 of 5 Date of rash Date of Report [invest Agenry Report Number SMV Grash Report Number ‘25/Jul/2016 06:52 AM 25/ku1/2016 06:52 AM FHPL 160FF052420 85312454 ‘insurance Company Insurance Poly Namber UK UK Name of Vehicle Owner (Check Box il Business) x Current Address (Number and Street jy and Siaie Zip Code PLUMBING MART OF FLORID) 24 SE 10TH STREET DEERFIELD BEACH FL 33441-0000 Trailer Ticense Number [Siate Reg. Expires Permanent Fleg. | VIN Year Make Tengit Axles ‘Trailer [Ticense Number State Teg, Expres Permanent Reg. [VIN Year Make tong Axles: Vehicle Direction [On Steet Road Highway AVESt Speed Posted SpeedTotal Lanes Traveling North NB INTERSTATE 95 (SR9) 65 6 EMV Contiquration [camo Rody Tyne ‘Area of Initial impart Most sata Area valet Type (aller ane) [Trailer Type (trailer two) KS + sles [> se. undecareos 2}3 18, Urdercartage Comm GVWIVCCWR Haz. Mat. Melease Haz Mat. Placard Number [Cass ((«[] 19, Ovetum 20. Windahiokd eC Te PST atl © 19. Overum 20. Windahield 21, Tralee ‘efs] ey a] ] 3° 21. Troker [Motor Carrier Name [* DOT Number Totor Garier Address: City and State ip Code Phone Number [Comm/Non-Commeraal Vehicle Body Type Vehicle Defects (one) Vehicle Defects (two) Emergency Valucle Use |Special Funchon of hav { Passenger Car 1 lone lo 1 'No Special Function Vehicle Maneuver Acinn [Traticway Roarway Grate Raadway Aiqnment [Most Harmful Fvent [Rinat Harmful Fvent Detail 1 Straight Ahead Two-Way, Divieled, Positive Median Barrior 1 Level 1 Straight 3 Collision with Fixed Object 30 Concrete Traffic Barrier Trai: Control Device Lor this Vetucie | rst (1) Sequence ol Lvents [Second (2) Sequence ul Lveuts Thing (3) Sequence of Lveuls T uurlh (4) Sequence of Lents rstrols 2 Collision with Non-Fixed 30 Concrete Tratfic Barrier 14 Motor Vehicle in Transport VEHICLE (Check If Commercial) CO Vehle {Motor Velucle lype thland Run Veh Liverse Nuinber state eg. Lapires Pennenunl Ruy. [VIN 4 Vehicle in Transport 4No FAITLV FL 2a!Novi2017 4B3AU42Y5TE258573 Year Make |Modet fe Color Extent of Damage st. Damage lowed Due 1o Damage Velucle Hemaved By Rotation 1996 pope |AVENGE! 2D REI Disabling 5000 res ZUCALLAS: Rotation surance Company Insurance Polcy Number NONE NONE Name of Vehicle Owner (Gheck Box li Business) Cc Current Address (Number and Street) Zip Code VID CHARLES WARREN KNIGHT 401 SW 51 AVE -T LAUDERDALE FL ‘39912-0000 Trailer Ticense Number Bae Tag Fapires Permanent Req [VIN Year Make Tena Axles Trailer Teense Number State Hag Fapres Permanent Req {VIN Year Make Teng axles vehicle Direction’ [OnSteet Road Highway AL ESL Speed [Posted Speed [Total Lanes Traveling North NB INTERSTATE 95 (SR9) 65 65 EMV Configuration [argo Body Type ‘Area of Initial Impact Most Damaged Area Traler Type (iraaior one) Trailer Type firaiior to) 2jslelete|z 46.Un fatal steal[iey 18. Comm GVWATGCWR (TJ 19. Oveetumn 20. Windhield [«][ 19. Overtum 20. Windshield Haz. Mal. Helease| Haz Mat. Placard [Number (Class alsa] ay 21. Traber ‘al 3] a] aT 0] 24. Taller [Motor Carer Name US DOT Number Wotor Carrier Address: City and State ip Code. Phone Number CommiNon-Gommerial Wahicle ody Type Vehicle Nefecis (ane) Vehicle Naterts (ta) Fmemency Vehicle lise [Specual Functinn of AAV ssenger Car 1None No 1No Special Function Vehicle Mahetve! Ackan [Trahcway Toadway Grade Finaciway Alignment [Moat Harmful Fvent Knat Harti Fvant Detail inging Lanes postive MedianDivided, Barrier 1 Level (Straight 3 Collision with Fixed Object 30 Concrete Trattic Barrier Fraflic Coniral Device For is Vehicle [First (1) Sequence of Evenis [Second(2) Sequence of Evenis iid (a) Sequence of Events ‘aurih (4) Sequence of Events No Controls 2 Collision with Non-Fixed 14 Motor Vehicle in Transport 30 Concrete Traffic Barrier 14 Motor Vehicle in Transport PERSON RECORD Person#] Description Vehicle # Nan Date of Binh Sex Phone Number re-Exam 101 DAVID CHARLES WARREN KNIGHT 24/Nov/1986 Address ily Siaie Zip Code 401 SW 31 AVE FT LAUDERDALE FL 39312 Driver License Number Tate Req. End. Injury Severity 523162864240 24/Novi2018 5 E/Operator lo Req 3 Non-incapacitating 1 Not Ejected indorsement Page 2 of 5 jie at Vat ee Agen un Date of Crash Tate of Flepon invest Agency Report Number SMV Crash Report Number 25/Jul/2016 06:52 AM 2540ul/2016 06:52 AM 1 1SOFFO52420 85312454 Resireint yslem ir Bag Deployed [Heimat se’ Eye Frotection Sealing Location Seal [Seating Location Row [Seating Location Other 3 ‘Shoulder and Lap Belt 3 Deployed-Front ‘3Not Applicable 1 Lett 1 Front 41Not Applicable Drivers Achons al Time of Crash thirsty Drivers Actions at Tinve of Grash (second) Diver Distracted By Vision Obstruction 3 Failed to Yield Right.of Way 1 Not Distracted 1 Vision Not Obscured Drivers Achons al Tine of ish (ihurd) Drivers Actions al Trne of Crash {lourlli) Drivers Gundiion at Thine of Crash 1 Apparently Normal Suspected Aicabul Use [Akohol Tested Alcohol Test Type Alcohol Test Resull TAC Suspected Dray Use Drug Tested Brig Test Type [brag Test Result fest 1 Test Not Given iver Soumce of Trapt Medial Faciy EMS Agency Name or1D ERS Run Number Medical Faciily Transported To OCA FIRE RESCUE BOCA RATON MEDICAL CENTER PERSON RECORD Persona] Description Vehicle # Nam Bate of Birth Sex Phone Number Re-Examn fiver 2 ELIO CESAR SALAZAR CHIONG 26/Novi1972 1Male lAddres ciy Biaie 7ip Gore 8737 SW 25 ST MIAMI FL 33185 Driver hicense Nimber Riaie B rea PIT | Tie Ene injury Severity $426203724260 FL 26/Nov/2019 1/None ee Not Ejected encorsemient Restaint System ai Bag jeployexd Reimer Use [Eye Protection Seating Locaban Seal [Seating Location Row [Seating Location Other 3 Shoulder and Lap Belt 2 Nol Deployed ‘INot Applicable 1 Let ‘ront Not Applicable Drivers Actions at Time of Craah (iirsty Drivers Actions at Tine of Gras {aacond) Driver Tiatracterd Vision Obatrietion 1 No Contributing Action 4 Not Distracted 1 Vision Not Obscured avers Acuons al Lame of Grassi (urd) Drivers Acuonts al Lame of Gres! arth) Drivers Gunditon al Lune al Crensty 1 Apparently Normal Suspecied Alcohol Use [Atcohol Tested lcahol Test Type ‘Alcohol Test Resuil BAC Suspected Drug Use [Drug Tested frag Test Type Drag Test Hesull lo Test Not jo 1 Test Not Given jiven, Bouma of Transpior to Machina F FMB Agency Name ar It FRaS Run Number Medical Faciy Transparent To 1 Not Transported PERSON RECORD Persond]| Description [vehicle ame Phone Number 1 Driver TIMOTHY MICHAEL BEEBE ~ ‘Gate of Birth O2/Novi1954 ‘Tal Ne Address ily Siac Zp Code 408 HAYLEY DR ENTERPRISE AL 36330 Driver License Number Biate Expires or pe End Injury Severity 636444 AL ‘04iApri2020 (or 3.Non-incapacitating Not Ejected Enbbtocindat Resiraini System [aw Bag Deployed Heimet Use [Eye Protection ‘Seating Location Seat [Seating Location Row ‘Seating Localion Other 3 Shouldet and Lap Belt ‘3Not Applicable Left ront 1 Not Applicable Deployed. Combination Drivers Actions ai Time of Crash iirst) Drivers Actions at Tine of Grash (second) Driver Diswacted By Vision Obstruction 11No Contributing Action 41 Not Distracted 1 Vision Not Obscured Drivers Actions ai Time of Crash jihirdy Drivers Actions at Time of Crash (fourth) Drivers Condition af Time of Crash 1 Apparently Normal Suspecled cohol Use [Aicchol Tested [Alcohol Test Type ‘Alcohol Test Result aa Drug Use Drug Tested Suspected [Brog Test Type [Drag Test Result 1 Test Not 1 Test Not Given ven, Soume of Transpo ears Facility FMS Agency Name ar ity FRB thin Nib Medical Faally Tranaporien To BOCA FIRE RESCUE 7 BOCA RATON MEDICAL CENTER VIOLATIONS: Poront Nam Tlorida Staite Nomber [Charge [Citation DAVIO CHARLES WARREN KNIGHT 316.085(2) IMPROPER-CHANGE-OF-LANE/ PULLING OUT IN FRONT ASBYBSE OF VEHICLE GOI NARRATIVE imber Tae WR TERREL! L Troop / Post FLORIDA Ottic A umber ite Created igtway PATROL 561-257-4040 Jul 25, 2016 263 1, Vo2, and VO3 were traveling northbound on Interstate 95 (State Road 9), south of Linton Blvd. ¥O1 was on the outside tratlic lane. VO2 was on the outside center ratfic lane and VD3 vies on the inside center traffic lane. 1 committed an improper lane change onto V02's travel lane. At the result of this, VO1 enter into the path of travel of VO2 as VO1"s lett rear collided into Va2's right front, rat point of impact. 1 then traveled ina northwesterly direction of travel, crossi northbound travel lanes of 1-95 and entering into the path of travel of V03, VO1's left side collided into front of VO3. second pet int of iy ict. The force from em \pact caused VO3 to travel in a northwest erly direction of travel, crossing the inside traflic oe median where Vo3's iedian facing north, side collided into a median concrete traffic barrier wall. third point of impact. Vo 3 came toa final rest at the third point of impact, on the ter c in V03, VO1 also traveled in a northwesterly ection of travel where V1 crossed the inside trattic lane and onto the median where VO1's lett trom llided into2a ined jan concrete tratlic barrier wall, fourth poi of impact. VOI then bounced off the harrier wall and came to 4 finel rest on the inside center and inside aific lanes 4 ina easterly direction. came fo @ controlled stop on the median, coming to a final rest in the area of the paint af impact, tacing north. REPORTING OFFICER Page 3 of 5 way Ire Tale of Grash Date of Report invest Agenry Report Number PISMY Grash Report Number 25:Jul/2016 06:52 AM 25/Jul/2016 06:52 AM IPL 160FF052420 85312454 W/Badge * Rank and Name [Deparment Tye of Deparment 2263 TROOPER J. A. TERRELL FLORIDA HIGHWAY PATROL of aD tye pest age 8 a Page 4 of 5 ate of Crash Tairof Report invest Agenny Renan Number SMV Crash Report Number 25‘Jul/2016 06:52 AM 254Ju/2016 06:52 AM FHPL160FF052420 85312454 DIAGRAM NOT TO SCALE AN POINT OF NORTH INDICATED FINAL REST B Ww POINT OF FINAL REST jh | FOURTH POINT OF IMPACT VOT THIRD POINT OF IMPACT AND POINT OF FINAL REST | 3 ®, SECOND POINT & OF IMPACT a ce FIRST POINT MEDIAN CONCRETE OF IMPACT TRAFFIC BARRIER WALL nye v02 | t NORTHBOUND 1-95 0! LINTON BLVD Pages ol 5