FLORIDA TRAFFIC CRASH REPORT HIGHWAY SAFETY & MOTOR VEHICLES,

LONG FORM SHORT FORM X UPDATE TRAFFIC CRASH RECORDS

NEIL KIRKMAN BUILDING, TALLAHASSEE, FL 32399-0537
(Electronic Version)
Date of Crash Time of Crash Date of Report Invest. Agency Report Number HSMV Crash Report Number
10/Jul/2023 12:35 PM 10/Jul/2023 12:35 PM 10/Jul/2023 01:13 PM FHP23ON0359025 89655254

CRASH IDENTIFIERS
County Code City Code County of Crash Place or City of Crash Within City Limits Time Reported Time Dispatched
01 0 MIAMI-DADE UNINCORPORATED No 10/Jul/2023 10/Jul/2023
12:40 PM 12:58 PM
Time on Scene Time Cleared Scene Completed Reason (if Investigation NOT Completed) Notified By
10/Jul/2023 10/Jul/2023 01:34 Yes Law Enforcement
01:06 PM PM

ROADWAY INFORMATION
Crash Occured On Street, Road, Highway At Street Address# At Lattitude and Longitude
SOUTHBOUND STATE ROAD 7 25.921628327610001 -80.213242574755796
At Feet Or Miles Direction From Intersection With Street, Road, Highway Or From Milepost #
5 North NORTHWEST 16000 BLOCK
Road System Identifier Type Of Shoulder Type Of Intersection
3 State 3 Curb 1 Not at Intersection
CRASH INFORMATION (Check if Pictures Taken)
light Condition Weather Condition Roadway Surface Condition School Bus Related Manner Of Collision
1 Daylight 1 Clear 1 Dry 1 No 4 Sideswipe, same direction
First Harmful Event Type First Harmful Event First Harmful Event Location Within Interchange First Harmful Event Relation to Junction
14 1 On Roadway No 1 Non.Junction
Contributing Circumstances: Road Contributing Circumstances: Road Contributing Circumstances: Road
1 None
Contributing Circumstances: Environment Contributing Circumstances: Environment Contributing Circumstances: Environment
1 None
Work Zone Related Crash In Work Zone Type Of Work Zone Workers In Work Zone Law Enforcement In Work Zone
1 No

VEHICLE (Check if Commercial)

Vehicle Motor Vehicle Type Hit and Run Veh License Number State Reg. Expires Permanent Reg. VIN
2 1 Vehicle in Transport 1 No QXXX23 FL 31/Mar/2024 No JTDKAMFU2M3146847
Year Make Model Style Color Extent of Damage Est. Damage Towed Due To Damage Vehicle Removed By Rotation
2021 TOYOT PRIUS 4D SIL Minor 200 No
Insurance Company Insurance Policy Number
UNKNOWN UNKNOWN
Name of Vehicle Owner (Check Box If Business) X Current Address (Number and Street) City and State Zip Code
TERMINIX 20189 NE 16TH PLACE MIAMI FL 33179-0000
Trailer License Number State Reg. Expires Permanent Reg. VIN Year Make Length Axles
One:
Trailer License Number State Reg. Expires Permanent Reg. VIN Year Make Length Axles
Two:
Vehicle Direction On Street, Road, Highway At Est. Speed Posted Speed Total Lanes
Traveling: South SOUTHBOUND STATE ROAD 7 30 40 2
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 Number Class

Motor Carrier Name US DOT Number

Motor Carrier Address City and State Zip Code Phone Number

Comm/Non-Commercial Vehicle Body Type Vehicle Defects (one) Vehicle Defects (two) Emergency Vehicle Use Speciual Function of MV
1 Passenger Car 1 None 1 No 1 No Special Function
Vehicle Maneuver Action Trafficway Roadway Grade Roadway Alignment Most Harmful Event Most Harmful Event Detail
1 Straight Ahead 4 Two-Way, Divided, 1 Level 1 Straight 2 Collision with Non-Fixed 14 Motor Vehicle in Transport
Positive Median Barrier Object
Traffic Control Device For This Vehicle First (1) Sequence of Events Second (2) Sequence of Events Third (3) Sequence of Events Fourth (4) Sequence of Events
1 No Controls 2 Collision with Non-Fixed
Object
14 Motor Vehicle in Transport

VEHICLE (Check if Commercial)

Vehicle Motor Vehicle Type Hit and Run Veh License Number State Reg. Expires Permanent Reg. VIN
1 1 Vehicle in Transport 1 No AW08CX FL 05/Nov/2023 No WBSWD935X8PY41684
Year Make Model Style Color Extent of Damage Est. Damage Towed Due To Damage Vehicle Removed By Rotation
2008 BMW M3 2D WHI Functional 400 No
Insurance Company Insurance Policy Number
PROGRESSIVE AMERICAN INS CO 956595197

HSMV 90010 S Page 1 of 4

Date of Crash Date of Report Invest. Agency Report Number HSMV Crash Report Number
10/Jul/2023 12:35 PM 10/Jul/2023 12:35 PM FHP23ON0359025 89655254

Name of Vehicle Owner (Check Box If Business) Current Address (Number and Street) City and State Zip Code
LEANDRO CARABAJAL 21103 NE 38TH AVE # 77 AVENTURA FL 33180-4021
Trailer License Number State Reg. Expires Permanent Reg. VIN Year Make Length Axles
One:
Trailer License Number State Reg. Expires Permanent Reg. VIN Year Make Length Axles
Two:
Vehicle Direction On Street, Road, Highway At Est. Speed Posted Speed Total Lanes
Traveling: South SOUTHBOUND STATE ROAD 7 40 40 2
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 Number Class

Motor Carrier Name US DOT Number

Motor Carrier Address City and State Zip Code Phone Number

Comm/Non-Commercial Vehicle Body Type Vehicle Defects (one) Vehicle Defects (two) Emergency Vehicle Use Speciual Function of MV
1 Passenger Car 1 None 1 No 1 No Special Function
Vehicle Maneuver Action Trafficway Roadway Grade Roadway Alignment Most Harmful Event Most Harmful Event Detail
6 Changing Lanes 4 Two-Way, Divided, 1 Level 1 Straight 2 Collision with Non-Fixed 14 Motor Vehicle in Transport
Positive Median Barrier Object
Traffic Control Device For This Vehicle First (1) Sequence of Events Second (2) Sequence of Events Third (3) Sequence of Events Fourth (4) Sequence of Events
1 No Controls 2 Collision with Non-Fixed
Object
14 Motor Vehicle in Transport

PERSON RECORD
Person# Description Vehicle # Name Date of Birth Sex Phone Number Re-Exam
1 1 Driver 1 LEANDRO CARABAJAL 05/Nov/1989 1 Male No
Address City State Zip Code
21103 NE 38TH AVE # 77 AVENTURA FL 33180
Driver License Number State Expires DL Type Req. End. Injury Severity Ejection
C612520894050 FL 24/Jan/2025 5 E/Operator 3 No Req 1 None 1 Not Ejected
Endorsement
Restraint System Air Bag Deployed Helmet Use Eye Protection Seating Location Seat Seating Location Row Seating Location Other
3 Shoulder and Lap Belt 2 Not Deployed 3 Not Applicable 1 Left 1 Front
Used
Drivers Actions at Time of Crash (first) Drivers Actions at Time of Crash (second) Driver Distracted By Vision Obstruction
77 Other Contributing Action 1 Not Distracted 1 Vision Not Obscured
Drivers Actions at Time of Crash (third) Drivers Actions at Time of Crash (fourth) Drivers Condition at Time of Crash
1 Apparently Normal
Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result
1 No 1 Test Not 1 No 1 Test Not Given
Given
Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To
1 Not Transported

PERSON RECORD
Person# Description Vehicle # Name Date of Birth Sex Injury Severity Ejection
2 3 Passenger 1 PAULINO ALEJANDRO GONZALEZ PAREDES 25/Mar/1994 1 Male 1 None 1 Not
Ejected
Address City State Zip Code
940 W 29TH ST APT 10 HIALEAH FL 33012
Restraint System Air Bag Deployed Helmet Use Eye Protection Seating Location Seat Seating Location Row Seating Location Other
3 Shoulder and Lap Belt 2 Not Deployed 3 Not Applicable 3 1
Used
Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To
1 Not Transported

PERSON RECORD
Person# Description Vehicle # Name Date of Birth Sex Phone Number Re-Exam
3 1 Driver 2 DAVID GARCIA 02/Mar/1987 1 Male No
Address City State Zip Code
1351 NE 191ST ST APT E419 MIAMI FL 33179
Driver License Number State Expires DL Type Req. End. Injury Severity Ejection
G620160870820 FL 02/Mar/2025 5 E/Operator 3 No Req 1 None 1 Not Ejected
Endorsement
Restraint System Air Bag Deployed Helmet Use Eye Protection Seating Location Seat Seating Location Row Seating Location Other
3 Shoulder and Lap Belt 2 Not Deployed 3 Not Applicable 1 Left 1 Front
Used
Drivers Actions at Time of Crash (first) Drivers Actions at Time of Crash (second) Driver Distracted By Vision Obstruction
1 No Contributing Action 1 Not Distracted 1 Vision Not Obscured
Drivers Actions at Time of Crash (third) Drivers Actions at Time of Crash (fourth) Drivers Condition at Time of Crash
1 Apparently Normal

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Date of Crash Date of Report Invest. Agency Report Number HSMV Crash Report Number
10/Jul/2023 12:35 PM 10/Jul/2023 12:35 PM FHP23ON0359025 89655254

Suspected Alcohol Use Alcohol Tested Alcohol Test Type Alcohol Test Result BAC Suspected Drug Use Drug Tested Drug Test Type Drug Test Result
1 No 1 Test Not 1 No 1 Test Not Given
Given
Source of Transport to Medical Facility EMS Agency Name or ID EMS Run Number Medical Facility Transported To
1 Not Transported

VIOLATIONS
Person# Name Florida Statute Number Charge Citation
1 LEANDRO CARABAJAL 316.085(2) IMPROPER-CHANGE-OF-LANE/ PULLING OUT IN FRONT AI0B5VE
OF VEHICLE GOI
Person# Name Florida Statute Number Charge Citation
3 DAVID GARCIA 316.066(1)(d) CRASH - FAILURE TO PROVIDE PROOF OF INSURANCE AI0B5WE
(ALL PARTIES)
NARRATIVE
------------------------------------------------------------------------------------------------------------------------
ID Number Rank Name Troop / Post Officer Agency Phone Number Date Created
2994 TPR REGIS, S. E FLORIDA HIGHWAY PATROL 305-470-2500 Jul 10, 2023
The Driver of Vehicle 01 (V01) was traveling south on State Road 7 (Northwest 7 Avenue), in the left turn lane, north of Northwest 16000 Block. The Driver of Vehicle 02
(V02) was traveling south on State Road 7 in the left lane, north of Northwest 16000 Block. While traveling, the Driver of V01 made an improper change of lane from the
left turn lane onto the left lane, causing V01's right side to collide with V02's left side. V01 and V02 were removed from the roadway prior to my arrival. This crash
investigation is complete.

REPORTING OFFICER
ID/Badge # Rank and Name Department Type of Department
2994 TPR REGIS, S. FHPE FHP

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Date of Crash Date of Report Invest. Agency Report Number HSMV Crash Report Number
10/Jul/2023 12:35 PM 10/Jul/2023 12:35 PM FHP23ON0359025 89655254

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