Agenda 10/22/2024 Item #16K 1 (Approve settlement and Chairman to execute a property damage release to settle lawsuit BCC vs. Abigail Arias Perez)10/22/2024
Item # 16.K.1
ID# 2024-1239
Executive Summary
*** This item continued from the October 8, 2024, BCC Meeting. *** Recommendation to approve a full value
settlement plus shared court costs of $2,018.50 and authorize the Chairman to execute a property damage release to settle
the lawsuit styled Collier County Board of County Commissioners v. Abigail Arias Perez pending in the County Court of
the Twentieth Judicial Circuit in and for Collier County, Florida, Case No. 24-SC-1661.
OBJECTIVE: To recover money spent by Collier County to repair a damaged traffic signal pole damaged in a car
accident.
CONSIDERATIONS: On May 14, 2024, Agenda Item No. 16.K.9, the Board of Commissioners of Collier County
(“Board”) authorized the County Attorney to file a lawsuit to recover damages from a February 24, 2023 accident that
damaged a county traffic signal pole.Abigail Arias Perez (“Perez”) was driving westbound on Golden Gate Parkway and
collided with another vehicle that was crossing the intersection at 47th Street Southwest. The other vehicle spun and
damaged a County traffic signal pole. The drivers each gave conflicting statements, and the responding Sheriff’s deputy
could not determine fault.
After initially denying responsibility and subsequent County Attorney’s Office intervention, the insurance company for
the other driver paid half of the damages in the amount of $1,904. The Board exhausted all other options and sued Perez
for the other half, which the proposed settlement seeks to resolve. Perez’s insurance company has offered to settle the
matter for full value ($1,904) plus half the court costs (totaling $229, half being $114.50), for a total settlement of
$2,018.50.
The County Attorney’s Office and the Risk Management Director recommend that the Board approve this settlement
and authorize the Chairman to execute a property damage release to settle the claim because the County will be made
whole, and a better result is unlikely.
FISCAL IMPACT: Approval of the Agreement will result in a payment to the County of $2,018.50 for damages and
court costs. Proceeds from this agreement will be deposited within Property and Casualty Fund (5016).
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this item.
LEGAL CONSIDERATIONS: This item is approved as to form and legality and requires majority vote for approval. -
DDP
RECOMMENDATIONS: To approve a full value settlement plus shared court costs of $2,018.50 and authorize the
Chairman to execute a property damage release to settle the lawsuit styled Collier County Board of County
Commissioners v. Abigail Arias Perez pending in the County Court of the Twentieth Judicial Circuit in and for Collier
County, Florida, Case No. 24-SC-1661.
PREPARED BY: Derek D. Perry, Assistant County Attorney
Michael K. Quigley, Risk Management Division Director
ATTACHMENTS:
1. Perez - Settlement Offer (002)
2. Perez - Release (002)
3. Perez - Complaint (002)
4. Perez - Backup Documentation (002)
Page 6679 of 7162
tJ/rtred UNITED AUTOMOBILE INSURANCE COMPANY
PO Box 694120, Miami, FL 33269-1120
Phone: 305-940-7299 Web: www.uaig.net
Automobile lnsuronce Compony
September 23,2024
COLLIER COLTNTY BOARD OF COUNTY COMMISIONERS
4800 Davis Blvd
Naples, FL 34104-5306
REF:Claim No.:
Policy No.:
Insured:
Loss Date:
Claimant:
010033 1918-002-03s
uAH37t472
ABIGAIL AzuAS PEREZ
February 24,2023
COLLIER COUNTY BOARD OF COUNTY COMMISIONERS
To Whom It May Concern
Please note, we are prepared to offer $2,018.50 in an effort to settle the above-referenced claim.
Enclosed is a Property Damage Release. Please have a representative from your company who is
authorized to release your company's subrogation rights execute the enclosed release in the
presence of a Notary Public. Upon receipt of the original properly executed release, payment will
be issued.
Ifyou have any questions, please do not hesitate to contact the undersigned
Sincerely,
Robert Gibbs
305-940-7299 x32576
Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim
or an appllcation containing any false, incomplete, or misleading information is guilty of a felony of the third
degree. PDSUB
Please visit us at www.uaig.net to check claim status or report a claim.Page 6680 of 7162
UNITED AUTOMOBILE INSURANCE COMPANY
Automobile lnsuronce Compony PO Box 694120, Miami, FL33269-1120
Phone: 305-940-7299 Web: www.uaig.net
September 23,2024
COLLIER COUNTY BOARD OF COLNTY COMMISIONERS
Claim No.: 0100331918-002-035
Policy No.: UAH 371472
PROPERTY DAMAGE RELEASE
The undersigned, for and in consideration of sum of two thousand eighteen AND 50/XX DOLLARS $2,018.50, do hereby
release and discharge ABIGAIL ARIAS PEREZ, his/hers heirs, executors and administrators (hereinafter referred to as
"Releases"), of and from any obligation, liability or responsibility arising out of his/her Property Damage claims and/or
actions for an accident, which occurred on or about February 24,2023 The execution of this Release does not affect the
Bodily lnjury portion of this claim, if any.
The undersigned acknowledges that they have read this Release and understand the terms outlined herein
Signed, sealed and delivered this 8th day of October 2024.
CAUTION: READ BEFORE SIGNING BELOW
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA Approved as to form and legality:
By:
Chris Hall, Chairman
State of Florida
SS.
County of Collier
My term expires ,20-
Stamp/Seal
Derek D. Perry
Assistant County Attorney
On this 8th day of October 2024, before me personally appeared Chris Hall, as Chairman of the Board of County
Commissioners of Collier County, to me known to be the person named herein and who executed the foregoing Release
and has acknowledged to me that the Board of County Commissioners of Collier County voluntarily executed the same.
NOTARY PUBLIC
Should you have any concerns regarding the release language or if you would like to add or subtract any language in the
Release, please contact us so we can discuss any proposed changes.
Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim
or an application containing any false, incomplete, or misleading information is guilty of a felony of the third
degree. PDSUB
Please visit us at www.uaig.net to check claim status or report a claim.
CAOPage 6681 of 7162
IN THE COUNTY COURT OF THE TWENTIETH JUDICIAL CIRCUIT
IN AND FOR COLLIER COUNTY, FLORIDA
SMALL CLAIMS DIVTSION
COLLIER COUNTY BOARD OF
COUNTY COMMISSIONERS,
Plaintift.
Case No
ABIGAIL ARIAS PEREZ,
Defendant.
COMPLAINT
COMES NOW, the Plaintifi COLLIER COI-NTY BOARD OF COUNTY
COMMISSIONERS, ('COUNTY"), by and through its undersigned counsel, and sues Defendant
ABIGAIL ARIAS PEREZ (*PEREZ"), and alleges:
l. This is an action for damages that does not exceed $8,000.00 and is within the jurisdictional
limits of this Honorable Court.
2. All events and occurrences set forth occurred and took place in Collier County, Florida.
3. The COUNTY is a political subdivision of the State of Florida.
4. At all times material, Defendant PEREZ is sui juris and a resident of Collier County,
Florida.
5. This Court hasjurisdiction over all parties and venue is proper in Collier County, Florida.
6. At all times material, the COLJNTY owned and maintained a traffic signal pole near the
intersection of Golden Gate Parkway and 47e Street Southwest.
7. On or about F ebruary 24,2023, Defendant PEREZ maintained a motor vehicle registration
in Collier County, Florida, and was otherwise the owner of a 2015 Nissan silver sedan.
8. On or about February 24,2023, around l:15 P.M., Defendant PEREZ was operating the
[2i-RMC-00803/l 847923/ r ]Page I of3
Filing # 198854290 E-Filed 05/21/2024 04:45:18 PM
FILED: COLLIER COUNTY, CRYSTAL K. KINZEL, CLERK, 05/21/2024 04:45:18 PM
11-2024-SC-001661-0001-XX
Page 6682 of 7162
motor vehicle that was registered in their name, on Golden Gate Parkway, when they
collided with another vehicle at the intersection of Golden Gate Parkway and 47s Street
Southwest, Collier County, Florida.
9. As a result ofthe collision, the other vehicle spun and struck and damaged a traffic signal
pole owned and maintained by the COUNTY.
10. At that time and place, Defendant PEREZ, as driver ofthe vehicle, negligently operated or
maintained the motor vehicle so that it caused another vehicle to cause damage to the
COUNTY's traffic signal pole.
COUNT I - NEGLIGENCE AGAINS T ABIGAIL ARIAS PEREZ
I l. The COIINTY, by reference, reiterates and adopts paragraphs I through l0 and further
states:
12. At the aforementioned place and time, Defendant PEREZ was operating a motor vehicle
and negligently operated and/or maintained the motor vehicle by failing to operate the
vehicle in a safe and reasonable manner.
13. Defendant PEREZ owed a duty to the COUNTY to ensure the vehicle was operated in a
careful and safe manner and to prevent the vehicle from colliding with another vehicle
causing damage to the COUNTY's property.
14. Defendant PEREZ breached this duty and negligently operated the vehicle.
15. As a direct and proximate result of the negligence of Defendant PEREZ, the COUNTY
suffered propeny damage totaling 53,807.27.
16. The other vehicle involved paid halfofthe damages, leaving a remaining damages balance
of $1,904.00. The relevant invoices and backup documentation are attached hereto as
Exhibit "A".
[23-RNrO-00803/l 847923/ r ]Pa-!:e 2 of 3
Page 6683 of 7162
WHEREFORE. Plaintiff COLLIER COUNTY BOARD OF COUNTY
COMMISSIONERS demands judgment against Defendant ABIGAIL ARIAS PEREZ for all
aforementioned remaining damages, pre-judgment interest. and interest from the entry ofjudgment
until paid, plus cost of litigation, and any further reliefthis Court deemsjust and proper.
Respectf'ul ly submitted.
B1
DEREK D. P Y,E
Florida Bar No. 1018383
Collier County Attorney's Office
3299 East Tamiami Trail, #800
Naples, FL 341l2
Telephone : (239) 252-8400
Facsimi le: (239) 252-6300
Counsel for Plaintif COLLIER CO{-)NTY
derek.perry@colliercountvfl .qov
nancv.bradlev@colliercoLrnt-vfl . gov
ronald.tomasko(a-)co lliercountvfl.gov
rosa.vi llarrealrZDcoll iercountyfl .sov
[23-RMG-00803/ l 847923/l ]Page 3 of3
Page 6684 of 7162
UAC t,N t1'F.D .\ t;1'( )i\ loBtLFt INSt, R.\ NCF. COI\ u'AN \'
PO Bo\ (r9-l l2t). Ili.rnri. l l. .t ll(,')- l I?(l
Ph(,nc: .105.9 l()-?'9() \\ L'h r\\ru'u:ug nct
\lJ\ i. l0:3
('( )l.Lll:R ( ot Nl \' TR.\I'l:lC OIS
-llt{[) [).rvrs l]lrrl
Naplcs. I'l- 3J l1!l-5.'1{)6
RI:l'
/'4_._.
( lrinr,.-o.:
Poli6Y \r')
Irrrurcrl:
I os: Date:
Sanccrcly
--
I)( rr ( ol-l.lllR (1)L StY TR.-\l:ll(' ( )PS
lhi\ letter r\ in rc!:ilrdr kr the Jho\t rBlrrcnrcd ccrdrlll
Thc prrrpore ol this lctlcr ir, (o dd[i\r )oU tlrJl tlc hr|c r(nrplclcd {rrr rr\c\lrlillrrnl on tlrc xt\rrc
rcli'rcrceJ ircident $ith our in\nr]ld. AltlGAll- {RIAS ltR[2. \\c harc ;rttcrrrpted trr galhcr
irn(l llrrl! nssers lhe i[f(nrution conccrning thc Jho!e clrirn l(nrr rll ir'\'ril]blc rour(es. including
\l;ttcrrrcnls. cslimll( dallugc\. phot.)\ Jnd a poltcc rcpo[t lrottt thts krrs- ,\s rorr rlrur tr: asirrc.
llrcrc itrc .orllicling sl.xlcnrcnts rcg:rrding lhis accidcllt
llcclusc lhere $ar ncithrr a conaluii\e fl(llcc in\s\trs.lti(nr nor irr(lll){Idcnt r\rlnr\\ slrtrllr(lll\
thnt fJr) corllinn cithcr puttics Je!r)unls ()f lhc ahorr.' loss. otrr irtre.li::ltrorr h:r\ rxrt rcru)lcd rn
crtahlishirtg legal liil,ilit! rrrr rrur inrurc,l. therelbrc rrc $ rll h( ullirhl('ro h()rro[ r r:ur clirinr
ll you hr\ c nn) quc\li()[s. plair.c conlllct thc ullJcr\r!lled
d
It rr Ilnttr)ot)r
.](15-9-ll)-7199 rllll?
(( : Alll(;i\lL.\RIASPtrRI:Z
..\rt\ pr,rs,r, |rlrt lttr,rrutelt ttttl llith intut ttt itt.irrrr. tlclrnl. ttt tlttrrrt'utt\ in\utt't lil(\
.t \lttl(tl,('ttl ttl tltiry rtr t .tlrl'rlit.tt!it\t t1ttttuittittq utt\'lilt(. itrt Itttl'l<,tt,. t)r nti\lt li !
inlontrtti,'rr it {tilt\ ttl d lr,ltur ol the thinl tkytt r
Composite Exhibit "A, to Complaint
0 I {x)_]] I 9 I ll-0{)2. I -15
t.rAH 37 t.172
AtltGA -.\Rt.,\s PTREZ
l'tbruary ?J. 1o1.r
Page 6685 of 7162
cLArM *3031STARS 50 -02242313728
DATE OF ACCIDENT 2-24,23
DATE OF COMPLETION
NAME HOURLY
RATE
OVERTIME
RATE
HOURS
WORKED
MAN HRS
COST
EOUIP
USED
EOUIP
RATE
EQUIPMENT
COST
MATERIAL USEO
TYPE COST
Ken [radill s 52 97 2 $ 105 94 TRK 14 00 $ 14 00
MrchaelSlephenson s 53 28 2 $ 106 56
$ 47 88 125 $ 59 85
Traffrc
PROJECT/LOCATION. Golden Gate Parkway and 47th ST SW
ACTIVITY: Pole for signal damage
AUTHORIZATION: Anlhony Khawaja, P E
DEPOSIT REIMEURSEMENT
CHECK TO 101-163630646984
RISK IIIANAGEUENT INVOICE
COLLIER COUNTY TRAFFIC OPERATION DEPARTMENT
28E5 S HORSESHOE DR
NAPLES, FL 34104
(239)252-8260 TELEPHONE (239)252-5868 F
14 00
000
3 024 32
3.310 67
496 60
REMARKS: Man Hours
Equipmenl
Material
Total
Admin- Ovhd
cost
Cost
Cost
Cost
cost
0.15
TOTAL
Submitied By
3,807.21
l-,
p0rl SpecJ asl
COMMENTS:ssl 4500220041
L Tralfic Accident ReporlX Vendor lnvoice
_ oamagdMaintenanoe Report
_ Roadway Lighting oamage Report
Approved By
Anthony Khawaja, P.E
Chref Engineer
Composite Exhibit "A" to Complairt
=
rI
I
Page 6686 of 7162
2-24-23 Golden Gate parkway and Sunshine upright dama8e Task 692377 Crash report CCSO 23-80045
CCTO Claim 3031 Stars 50-02242313728
6old.. G.r. Ptlry .r sunrhln. a(id.nt M.n ar6 PoL oamrg.O 'G'
a
o
o
Composite Exhibit "A" to Complaint
00:01r39
Page 6687 of 7162
o
2'24-23 Golden Gate parkway and Sunshine upright damage Task 692377 Crash report CCSO 23-80045
CCTO Claim 3031 Stars 50-02242313728
Ih.nk you fo. rubmiuing- Pl..r. ?.t.an lh
50022J2313728
Pla.'. 'ubmit.ry firppo7ting docu-@
o
o
Composite Exhibit "A" to Complaint
Page 6688 of 7162
3r
FLORIDA TRAFFIC GRASH REPORT
Loxc Fomr El SHoRTFoRM D upoArE !l!|dd^l.n)
MAIL TOr OEPARTTIIE'{T OF HIGHWAY SAFETY a OTOR VEHICLES
TRAFFIC CRASH RECOROS. NEIL KIRKMAI{ BUILOING
TALLAHASSEE, FL 32390-0537
w^r ool ,fioFERr, Avorv!o n lxll cR^a]r?
t2
2
,
t
FI!tr t:20 PM 1:20 Ptil
PIACE OR OIY OF CNASH
l:25 Plrt 3:08 Pl,!
RE SON (I ln€to&1 {Or Cdrd.i.)
ryffi 'l:t 5 PM 02t2a12023 23-80045 25705207
crri rSl iE ,F6OE
aP cooE
ap coo€
r.'2
orrGil*A.E EJ to*o( r6usr.Esst
couln aoorirY mattE or!
^ooiess DP COOE
Ft 3ar04r,ROPERTY DTTTAGE . OI}{ER IHAN \€H E rcH€cx rFol]gxEssr
CRASH OCCURR€O Oa,l SIR€EI, ROaO, HIGHIYAY E
trDD E W
2U S ,, otE, Erd- . r.,-E1
io.dw.y luit c. Coi<rtbn L.nar ol col{.L.rtrP.cl
a S{.rxt. rE .r.c,
5 $ddll.. Orporr. Dr..to.I
7ror, Er,l-nxr-ritrfu:r:r r o, zor! E4,.
alcf-d su.rl-,
2
I I 3I
la vYqt ,c/xrdl.g
17 gnd 8y F.r! 9rir{
rlln ilr.d Obl.cl
3 Ur, Plar-En 9*1
i9 Otg rrq, Oq.d (d
14 20 &naEo{iEi gllfu Locdon ! o. iod*.y
2 OrRortr.,
t
I
Fktt H.mlur Ev.nt i.l.tlon !o
!6Sn .a.rrrorPrrd!'rrt&cdd.&tD6.Ero
D Oo!. Errl, . i-dd
2
conrrrbutng crr.unrlrrE.t: Ro.d ,wc rr.rlPlar.a Srrle
r0 R.- S(le CaG! lxa.
rn*r.w, M.r! d Gorld
,r OnE E4l- i ll&-a
1
a gsn .r tlE, rr. ton hol
Contlbrllln! Clacum.brE.t: Envlrom.ni
1
.l
r &la n Fd !{o.t Zd
3 wcr 6 Slurrb a u.ar
a l,trr(6r c Vov,! Wct
,, OrE €rDl- m lln,la
l{ort. ln vlo.l zolr.
TOTAL ' OF VEHICLE SECTIONIS)
TOTAL ' OF PERSON SECTIOIi(S)
TOTAL ' OF I{ARRATIVE SECIIOI.IIS}
-EltGIIl'rE--
o7r2l/m23
tr
2
a
tr trtr
tr
TT
Composite Exhibit "A" to Complaint
Page 6689 of 7162
VEHICLE # I Check if Commercial E 23-EIXX5
xsxv cin i.oo.r ,.dn!.
25705261
I v€NrcrE LrcEr{s€ NUMa€R
AG54HW FL
REGiSYNANOI O(BR€S
11t',t612(J27 R.c*&n E It{aaL3AP0FN323362
1 2015
3mr
,|
$2,m0.00
llrsuRlNcE corrPlr{Y (oRrvER)
uirTfo Aurotouta tltuR SALD EAGLE TO$'IIIG I
,l OtE Eid-r{r.,{
rlgrn .c€ t oucY NUM6€i
trlrrX€ Of \€Xtcta OWNER tcJiEO( lF AUSNESS'
Al6Aa ARnt plnEa 3at t6,!r!,1ll]t 3T tt FL
Tr.aa. uc€NsE lluuBER REG]STRANori EIER€S
tr
Tr.r.. u@{s€ r{lJMa€i
tr
DtrtrDE O'I SIiEET RO D HICHWAY
GOLOEN GATE PARKWAY
IIFTTEEFI E{,s a
0t 0'l
zt
2\?i
5
3
r3 0!?I
3 5
t 1
4
c.rgo lo.ry ,yp.
Up.
Cohn Xonaomm.rd.l
cor rrl,cu r.ba vahlcL
r \€rr r0 000 t, d r, Pr-r.r..,
t S'EL{ r*k €.!r. -d 6v1/'rElle,rrooo0t {a 5I re)
3 s.'ca.un I^d( 13 r @...rs)
6 T.rd tr-rd/S.ct.-.r
7 Tul Tr&ld/Oo!* TrEk
2 Is.rhr. Nc O^{r.{, tdl r
3 l*vt y, Orrcq U.!.c.d.d
a f6lltr, 0n a.d Pdrnl.
t a , l-rv.rEa 619
l2 Loe
r i0 oo r. (r 5aa rc) d rs2lOfi1.2imb .t$!t tgtt)
3 t @oD 260@ r. (!r tBic)
Coinlrraloo
9Ind(net- 10@0t ia5I
ke), c.@r cbrry
r0 arrr.r!. v, (.! ar 0.r 5
GdrfG, rdtlg dE)
rr acl*r. t ,lur-15
*o+lnrt i.rrt tE)
n Or- Erdr n tnrE
la oGd l'n I.Gr! lro @0 b
20 u.artlrovy Tnd, {d.
, Orn .. ErCr n -.n
2 Trn s-n rr-tRAtn , 1r* r,_
3nol5Co'w..\3ovffi
1il
C..rr!. flr nd.'rtd Olt-r
r2lrr., vtE (6 d9.)
! a Mcr v.rrd. . trdD.n
raF r.dxccv.h&
It $b.t actlidlE
r, *cr Ar f.rE SrttrClao o rldra sa n rrc,! , ud6.
l.O{ t.r}s- .r tv.r6 qrl
a0 .q.lofd Fdu. {t5n r.
a2 R- OnRo.drY., Ralr
5 Cr!./EqfErr L{ a Srri
a FtJ4En Fro UdE \i.td.
$ urry Poal4ai srrcdl
3a O'l! Po, Pd.. c Sl,9dr
I ons a'r.d otfd Frr
V.nba LmtMr ldld
! st {n ^lE- r3 gorr.d tr Trri.3Turrlri la sbrrE
a Asr r5 ll.qer . Cln
a lurrrtnn tat.&! Ir.lt LfraCt E'E LrE rr ensrE I'.rt Ln
0 P$.d tt olE Eprr . lrr.dl0MlIrEU-tF AU.rM
1
1
1
1
Tr.ttk Conlrol O.vlc. Fo.
1
I
12
Ery
2
Composite Exhibit "A" to Complaint
2
n ffi
tr
ET
1e Flc rElrdrc.dt crae
2O6.q.Ocn S.irt r
tr
REG|SiE ror O(PnES
Page 6690 of 7162
PERSON # I A.c..rtrerq catrd?td
23-0045
HSrlV c.aa R.ad nunB
25705467
I tr
criRREr{ r ruEss (r{u* rn 9a)
FL 34tt5
,t,t/iat 969
sEl
1
ORIWF S LICENS€ NUMA€R
A-621-000.69-ar6-0 FL 8112t2023
INJUFY SEIERI'Y (TJ).!E-dD!iiffi"--' :lfi#.lff'I
Ititf 4.a6. r llt dct.lr
r xo cdr!0l.6r.8n 2a R& orl Ro.6Y.y
2 Or.rr.drvhc&E. d aTl)/a.oud,neqf6ltun.d'C.r!d S{,r3FdrY.sRar*or.wry ?. oa.!D.- orsio,llrn!.€s..!drc n.hl.
a insc.r Io , O€ad'.rttC/OG
SrF'Ia
12 ltor io. ra ,c Ccdid,
17 E!...a.d Pori.6 So..dI r'\lrclc Sr,. ot Wr..g W.y
2, F.l. ro xap tr Propi L&
I S6v.d -Av.d.d Ou
to wrE SFe6y Su,u. v
Rekr.t! d atBEMtu
/7 Oot, Co, drr{ AdEn
6 Sce Ep..6t, ar*kd
7, OnB. E{r-
'n
xi-r
I
ORIVER OR PASSEI{CER
ft
raolor v.lllcr. s..lln9 Porl0on:
sart
3 Thiftt
2 SL.p.. S.clio. orTrud C.b
3 olt Endor.d C.ryo^r..
{ Un.ndo..d C!,lo Ar..
I rr.5! Unlt
6 Rldha oo Moio. V.ntl. En do. (ho.r-
b.*lg un)
7 E@rRf rrr'9 Prlr.rslrllr'g
3 hd.,tE !.r4 .rf!, a.)
a Nd !trr. td* ddh|e. no
12 wrc+w.t Rrrt c w.rrt
,, Od! E&rn . nnat
AICOHOUORUO/EM5
37
3 rrr. ro rk5 REH.or.9/ly
a F.r@ ro oa.y Ir.tlb std
s .n Roi,., r's.or.r, (rrid!,
6 O.d.. \ir* Pd..d (.m.a6, !6rrrc l.vrt'a'r.odYre)
5 3
1 I el.crcE Ctun.r Ilrq,. ,E ir.l. .4r,
(dv9rfi.,.@ D\/o C.FJ
1
3
1
1
GUSE
3
,|IE:ETI@
EEIIEIE
lla,t.o-u*ParflIr-
l7 oirE Eidmnl{r-E
5l t*,!C,Cy.t! o S4!*
a ln Rorlit - On! larrl
7 rder b Rd'n l. e
a 6dt ro or r.@ s.rnr ((.t2)
lrotE Erd-nndr-
ffi
r fto. arlb.E (@ridd.n
2 Nd U..d - lrold r,lr.l Oer'r
I SrB* .n t4 €.1 Ut d
a R.!rd u!.0 . Ty!. unr,mI Cr{ Ral-' Sr-.. Forrd Fdro
a Clla R.!t- Syr.rn R., F*rR
!0 CiIR.rrl In Uir,Erl, OnE €rdr . lirrE
L*Ieia l*adr Al Ttn .a Cr-rr
r llE .cro - rrlka Gd6r*
2 rlrl.*b - (rmrt- c|B.*
3 rn *sa. - olla rr.drod( Mrt d G6$.r
a Milr..r , l.rr.d clle.r
5 ToEi r-. olr! L*..6
Ro.dr.y &dd r,.ri. l.
ffim
2 Otq P.4*a! (i,l*r, Ddb [ .
EJtr{. 'rr- !.ddra @*rre, dc
5 06r-r oi Mord llrrl d n Tr.rr.d
a o@s,t ol . xdJcc v.ir.
, U,*M Trr. or noldail
12E S lLnEntr.6l6
77 o|rs, €rrr-. i5a! t3 Ud(!F
r\TEOCIIFACILIIY IR rlSPORIED TO
ldtr 3
€.r€cr
cuRREiT ADORESS lrun6.. ra Srd)
SOURC€ G IF,^'ISPORT TO MEOC^! FACILiTY EMSAGETCY NAATE OR IO ,EDIC T IAC]UIY IRAIISPORIEO IO
EIECI
cuRRErT rooREss (nl,It ra srei)
sOURCE Of IRA'TSPOR T TO I'EOIC{ FACITIIY €US AOEIICY NA'J€ OQ D lrEElCA FAOU'I IRA^SPOEIEO TO
ffiffiHffi
Composite Exhibit "A'r to Complaint
tr
!
tr
tr
tr
Page 6691 of 7162
R.t r$CrFE, Cef,qtnr
23.800a5
HSr,v Cr, Rqdr Nunnr
25705267
Crash occurGd 6t th€ intorsoction of Golden Gste Pa,kway End 47th St Sw.
Vl was lravoling in ths outsidq west bound lene of Golden Gate Parkwsy. V2 wa5 lr.veling rlonh on 47th St Sw.
Vl Orivor slaled as he approech€d 47lh stre€t Sw he looked up and saw a gr€€n l'ght end proceed€d lo cross th€ intsls€clion.
V2 Orivor ststed sho was trev6ling no,lh on 47th Sl Sw. Nonh 6nd soulh bound had 6 gre€n light end she sntsrod in to th€ int€rsoclion,
continuir€ norlh.
V l's tront csnt€r blmper struck V2's reer ,ight door. Vl contanu€d nonh tlrosl, with finsl rost jusl r./95t of lho inters€clion. Dug lo th€
imp€c,t, V2 spun ard continuqd nonh 99rt. V2 struck s tr.ftic lighl pole, with itnal .est lacing south in tho w€5t bound lano.
Both vohicles vvqrs remov€d irom scsn6 by B6ld Eagl6 Toring. Rotstion.
He2€ds w€rc remov6d trom sc6no by lh€ ,ire doparlment.
No injuries obs€rvgd or reponqd oa scong by Vl Drivo, or V2 psssengor. V2 Drivor reportod injuries on sc€n€ and wgs t.Snsponed to
physicia^s r69ion6l pi.l6 ridgq. by EMS. tor obseryelion.
Dus to cooflicling stories end no wilnessos. I am unabl€ lo dot6rmin€ taull
MlEfralMf
3 2 11t3t2020 !
SEI
2
LOC S
I 2 ,t 2 t0
CUnREi'l ADORESS ltiufta dn S5<)
EMS A6EI.ICY llAME oR D MEOCA!FACILIIY TRA'.ISPOR T'O IO
o EJECI
cuRREnr
^DoRESS
tNu6. rn st.at
souRc€ of rR xsPoxr ro raEucrL F cruw MEOC ! FICIUTY TRA"SFOETEO TO
NARRATIVE
ao0lTroraaL vroLATrorrs
REPORIIIIO OFFICEi
u28 cso B FAHEY COLLIER COUNTY SHERIFFS OFFI (lol
PI. __ oi _
Composite Exhibit "A" to Complaint
Page 6692 of 7162
23-80045
NiG AGEXCY CASE NUUoER
25705267
V1
P. o.,.
+
B
-t,
\.t
e
o gq
Not To Scale
I V2 Final Rest
\+
,-.+-
V1 Final rest
(,
u Golden Gate
Parkway
5!:ta
a){
t+
7
Composite Exhibit "A" to Complaint
v2
t
5
Page 6693 of 7162
Check if Commercial E Hsrav crr' R.rdr x6E
75105231
Aort rFi, cE ru'b
23{0045
1
V€HiCLELICENS€ NUMSER
EQBA25 FL
REGISIR NOT €IPIRES
l0/26/2023 tr 2HGFAtF52AH3055 t3
1 2010 3't0,000.00t2
rNsuRxrc€ co.rPAxY {oRrvlR)
!!aTATE Fil AraO CAIU
INSUR
'ICE
POTICY I{UUBER
BALD EAGLE TOWIT{G 1
a (!a. Erd- nrntu2
3,1114
iarE of wxrctE or4tEa (or€ c]( lF susJrtr€ss)AIAI{ CHATO CtUalAqrEtO FL
,r.a.. uc€Ns€ WMBEA STATE R€OISTRATIo|I
'XPIRES tr
LENGTH
LJ.. tn$rsa tatrLl€n AEG!SIN^NOI EXPiRES
tr
trtr
vEHIqI 8trtrtr OftSIREE'I ROTD H|GXWAY
lTTH ST SW
t1 tl18 urrlt n!: lare oEr, 1lft vrh.lr* &
2r . lr- ,21
i_=
MOTOR CrnRrEi @RESS
,|
1
C.rgo lody ryP.rr&Er, 3 rri,tCdirto.4omm.rcl.l
2 TE tt trc Oi a.{, int .
3 IN.rVr, lh,rla Uls..ffi
aIElSy 0d'& Fb.rE
rt Ar Ta- vdd. (lw)
19 olrE L{n TMll I l0 O(l0 b
?0 u<t rri..vy ].!.r! (ne
,l OiE Erdsnlr-nE
3 llC r CcllE.t I60GrrEr
a llor.Cotrtwioa; Trt
Co. r.rcLr XaErl,.h8b
! t.rEr. r0 m0 !. 6 E- tucE{
2 s.g.,u Ld( (2.rl..d 6vwR,le ra ro.@o lr (,r,5! rcD
3 srrc{lr r@k t3 d .@ ar..)
€ Lak I.&rS@Ir.5
7 I,Er i6./oqd. T,\Er
t Tnd d. rr 10.06 b ta.sil
r0 a6^r!. 6 l.r' & gr5
cr.d. Errlc di€)
traBl*&lc']*t! 1561!16.dn!ol,'Gl, o(rE Erd- . irt€
11
c.3r.. r'ii lloaLa Ot|..r
12 R-.y V.l* (r-. ,tad)
ra uc-v.h.l. . Trr.r.ri
r5 P-r.arr.rd v.r*l
laWdt ZriAltu.
!, stur g, rt, sriii ctg. c
&/r!9 9r n xm' t ur
5 CoolEqi'td 16. a sr
a F.rJ-io.a f@ trtu v.lrd.re ,r9-r ar.nrra/crdi crda
20 3.q. ocrt- SnJ.!r.
ll0-{ l.Sro or abnrr olr:
tE .q!'d f.lrt lhi. r.
30 lL, Por.^dt srs.i
!a OdE P9r. *, c lrr.i
X OoE tr.a OtF (*t
1
v.tlcL u. waracllon!sr.{rrrrr, llst.rr.dnr.t(.
316l{ L.i ra srd!
. B..tr!g r5 n.go.rr. c4*5TdErcR{n ralo{tr..tEt.!6C'E!.!LIE 17 Enqrr lr icla
3 Prt d 7r Ord, Erd, . xrrrar0M.xrtu.T6 30 uirM
I
I
Ir.fic Co.lrol O.vh.lor
I
I
r2
ry
67
Composite Exhibit "A" to Complaint
VEHICLE # 2
ffi fffi
I
tr
r r0@ 5.la t:l ra) d ts5.
2 10001 26d16. t.5lc Tilc)
3 Uc.rh- r.00o a. (lr r9ltcl
n ADOtAo6..y RCntr
Etr
1
Page 6694 of 7162
PERSON # 2 i.9dt! ^FE, C& xurr.'
23{(x}45
HSxv (}-i A.rdl llrnb
25705:167
2
!
cuRREraT
^@RE5S
llrrnl: rn sr6)
FL 3/t'114
1t?1t?oo1
2
CR'V€RS UCENS€ liuI'SER
C$20{'16-0,r.5.ll .l)u21t7024
Tf,JURY SaVEnrW {rr . rr.cdr{
3iffi.-*,-" :L3J#,?ff',7
a,ll*r a.ll'r. , Tln d cE t
r x.cdn .ild.r 2n Rn.fl 4o5..,2o!-a.crlv-crdBr AOrdn.d.rslr.rtox..lirx.E s9,
3 F- b Yd A{rr{1.}irr 23 O.,.9r.r.d o|r- Rd
a ln!.oo.. g..rrE Mrr.o.
a lr!.ea Tu. 29o6.Cr6llof,96rE
12 0.!c rco F.! lo C.n -6
r 7 Er...d.a Pot6, S9da
21 Vrdic S'l,. qr ritiqrg lt,
25 Fd ro l<er . Pi4a t*
a S.tu., E!a.r.y gL.lo{
77 onE, Erd-
'n
,lda*
A!COHOL,/ORUO/EMS
P..._or_
30 s€d d^v.,a.d E\l
lo $&n SbC6y Surr., !v,
R..rr5 c r.16r. xlc
n qrF CodttE r.ntr
oirvEi oi PAssEtlo€a
3..t
3 Thtd
2 SLa9a. Sactoi ol fntd C.!
3 olh.r Endol.d c.Op Arr
a unandot { c.rloAr..
5 Tr.rht Unn
6 Rldir€ m Molo. Wnlca €ir1o. (m.r-t{i3 u{r)
3 aalr. r. Y.rd Rln{r.llty
a tta4 lo Ob.y lr.l6c S{d
5 l. RodY.y r,!.or.t (r5nt'.
I Drsd Vd Rdr.( ldrr96 a6ll'r E wgar.odrro)
7 E.rrr!'E,r,t Prr../sD!dl,
a ri&.6€ (r*,9 .at. ac)
0 r{d vdr ((h cEaY9 N
l, ltlrdE rtt Rt! d w.lrrrroi! E*r.N--*
DiIVER OR
lloio. v.hlcl. s..tlng Poallion:
5 3
,t l€r.drfr atulo.r
idqodm d.rc. o\/o p..F,
(qr!. tE {rrcr.. .irr5
ENaa MtloN oElllitdrFF-l
i
r kr^ci.-a (d}dffio
2 rld ur.d . x.ad \ltlEt O.apd
! 90/da rn t.p s.r U..d
6 R6!rr urr, . IrF uirM
7 Crl. i.r-r Syratr tera F-r{
3 Cri, R.ri'd Syr6 . i.r f..na
r0 crrs R.tt-i Tyo. Uia,m
n Oas Errrr' n l-.n€
3
2
1
@
usa
I
r|sr! rrP.ord Trl
7l orhq arll- 6 xnlll*
r rlld6r . lllt d c,&r(2li.r..dr. Uin t.d Cr€'t
a rdqtcr-r. 6sa tado.r llft.a ctd*.r
a l.d..r . ur&n c@.r5Tndtd.oEfe.i.n
5 w*r{rcy.t{ on S4r.r
6 r. R.dr.y - 6- lrdtrre
,lAai 5R..ari., l.e
, od.E ro o, ,,m sd!.r tx.r a
n Olr, ErrL.r n l{n.r
2 OIE &5 (rrlr..Gr.r ,..6..nrafi! ria, rer.' ri.rrq d.
6 O€wn or Moro \& tor . T8r9dr
a ocq4jr oI . l{oJe. lrrEt
tU.rMTt..,(o{roH
2 ri&{ t C@ Ro!Y'.t
Ro.dr., &., T..ric (.
2
SOURCF tr ]RITTSPONT IO MEOCA FACILI]Y
2 EnS I t* E.rr€Fr/l or!. Err- n xea- a u,*,El 23-29715
FIEIICII FAC]UW TNASPORIEO IO
PtiYaro^n! tlororaal 'lr.t lr6a
B
CURRENI.mRESS lNd'r.r -d Srd)
souRcE of ln^,{sPoRI ro t€o{clL ractITY EMSAGENCYfiAr/EORIO MEOCA FAC LIiv N^XSPOFTEOIO
cuRR€xI ADmESS 0rarad rn $dr),PC@E
SqJRC€ OF IRAISPORTIO MEDICAIrICII]TY MEOCA!FACILIIY IR
'{SPOR
IEO TO
NT
EIIII
Itr
tr
tr
tr
5
tr
Composite Exhibit "Ail to Complaint
Page 6695 of 7162
C,Rft,County
Traffic Ops Tasks Report Transportatron Managemenl
Servrces Departmenl
Jit.n., olso(h Fo.s. colr y.rco rr E.n.;|ERE C,:mr rnCREll€NrP NcrA LSGS
Task lO PrioritylssueActivity.. Asset
692377
Status
Street
Details
Signalized
lntersection SlG111 High
Completed Location
Description
GOLDEN GATE PKWY
GOLDEN GATE PKWY @ SUNSHINE BLVD/47TH ST SW
lntersecting Street SUNSHlNE BLVD
112412023 Received callthat mast arm was hit accident number 23-80045
212812023 Crcaled a work order for SS&L to Repair, repaint upright and replace broken nut covers.
Remove Hazard / Secure
Scene
4t2712023
Composite Exhibit "A" to Complaint Page 1
Page 6696 of 7162
Traffic Ops Tasks Report
Counqt
T,anspoalation Managemenl
Services Department
Labor Log
2t24t2023
2t28t2023
4127t2023
Equipment Log
10148 Ken Martin
5431 Michael Stephenson
1321 Pamela Wilson
Standard
Standard
Standard
2.00
2.00
1.25
5.25
105.94
106.56
59.85
Total 272.35
212812023 CC2-1749 Vehicle Truck
Material Log
1.00
1.00
14.00
Total 14.00
0 Total 0
Other Log
3t31t2023
Task Cost
SOUTHERN SIGNAL AND
LIGHTING
3024.32 lnvoice # 2250618.01
Total 3024.32
272.35 14.00 3024.32 3310.670.00
4 t27 !202?,
Composite Exhibit "A" to Complaint
Date
Labor Rate Name Hours Cost
Cost
Material Description Purchase Order Quantity Cost
Notes
Other Cost Total CostLabor Cost Equipment Cost
Page 6697 of 7162
Collier County Traflic Operations Department
2885 South Horse3hoe Drive. Naples, FL 34104
Office: (239) 252-8260, Fax: (2391 252-5868
NOTICE TO PROCEED
NOTICE TO PROCEED # 23-'18 Srg
To: Southern Signal & Lighting
P.O. Box 5142
Hudson, FL34674
OAf Ei 0212412023
E ROUTINE ! El\,ERGENcY
County Purchase O7dgl l.lq; 4500220041
Collier County RFP #. 19'7541
Prepared By: l\ilike Slephenson
Cartegraph Task # 692377
Contact Name Gregory Garcra
Contact Phonei 239-253-2252
Job Location:Contract Time:Oesc of Work:
Golden Gate Pkwy @ Sunshine Blvd
Per Contracl
(Normal = 1 r,\€ek)
(Emergency = ess
lhan 2 houG)
Repair repatnt masl pole upright on lhe north\ /esl corner from
lop to botlorn and replace alldamaged and missing nul covers.
o NOTE: The aforementioned work shall be initiated per the Cont.act Time noted above (unless othervvise
requested in writing and approved by the Traffic Operations Chief Engineer) after receipt of this NTP which
must be attached to your invoice. County lnspection Staff shall be notified when each phase of the
aforementioned work is completed for review and approval. Upon review and approval of the aforementioned
work, prior to the submittal of any furnish or install payment request(s), an "As Built Schematic" of all
underground work, material quantities, andror labor shall be provided if the underground routing of existing
components was changed.
COLLIER COLINTY:CONTRACTOR
Authorized By
Print Name:
N Khawaja P E
E REJECTED
Reason:
Date Signature
Date ol Work Order Acceptance
Date Work Completed
! AooEPTED oare
Date Submitted lor Final lnspeclion
Dale Submitted for Reinspection
Traffic Signal & Roadway Lighting Technicianolnspected By
Composite Exhibit "A" to Complaint
Yo! are authorized lo use subconkaclors as needed for Ihls
NTP
Contract G.egory Garcia 239-252'5000 72 hours prior lo the
b€€rnnirE ot vrork
ol
Page 6698 of 7162
Southern Signal & Lighting, lnc.
Tttaktag ftodr Sa$u &, Br$to $tn.c 2oo4
Phone # 727-819-2061
Fa\* 727-4574097
southernsignalandlighting@gmail.com
Account # '114725
lnvoice #
Revised lnv #
Date 3t31t2023
SSL Job fl 22506'18 Golden Gate Pky @ Sunshine
Location GG Pky @ Sunshine Blvd
wo#23-18 StG
PO#
Bid #
Project
Bill Ref 692377
"c;t a
Bill To
Collier County Board of County Commission
Attn: Accounts Payable
3299 Tamiami Trl E Ste 700
Naples, FL 34112-5749
Item Description Unit of ltleasure unit Price Quantity Amount
Supervisor
Laborer
HeavyEq-BKT
Materials
l\raterial Cost
N,talerial Markup
MaterialTax
lUate.ial Freight
l\ aterials
Malerial Cosl
lvlaterial Markupl aterialTax
Material Freight
Materials
Material Cost
MaterialMarkup
Material Tax
Malerial Freighl
Materials
MaterialCosl
Material Markup
Material Freight
^raterialsMaterialCost
iraterial Maftup
MaterialTax
Material Freighl
Labor Per Man Hour - Supervisor
Labor Per Man Hour - Laborer
Heavy Equipment - Bucket Truck
SHLXNSOO UDB 1,25G
Mad(up on Materials
Tax on Malerals
Freight on Materials
Materials
MAC646 ULDEEP 2G
Markup on Materials
Tax on Materials
Freight on Materials
Materials
DENATURED ALCOHOL
Markup on [,raterials
Tax on Malerials
Freighl on Materials
Malenals
BOLT COVERS
Markup on Malenals
Freighl on Materials
Malerials
1/4.20 X ,1 SOCKET SET SCREW SS
Markup on Materials
Tax on Materials
Freight on Materials
i/H
MH
HR
77.00
60.50
152.7 4
10.oo%
7 .OO%
0.00
0.00
136.80
10.00%
7.000/o
0.00
0.00
70.00
10.00%
0.00
0.00
1.72
10.00%
7.00%
0.00
14
14
11
0.5
0.5
0.5
2
12
76.37
7.64
0.00
89.36
68.40
6.84
4.79
0.00
80.03
140.00
14 00
0.00
154.00
20.64
1.44
0.00
Total
Payments/Cred its
Balance Due
Remit To Address:
16909 US Highway 19
Hudson, FL 34667
Page 1
2250618.01
Name l ast Arm Painting Repairs
4500220041
19-7541
19.63
10.00%
?.o0%
0.00
0.00
1,078.00
E47.00
726.OO
9.82
0.98
0.69
0.00
11.49
Composite Exhibit "A" to Complaint
Page 6699 of 7162
Southern Signal & Lighting, lnc.
y'lafung /?odr Ja$u & B gltet $t'.c 2oo4
Phone f 727-E19-2061
Fax * 727-851-4097
southemsignalandlighting@gmail.com
Account # 114725
BillTo
Collier County Board of County Commission
Attn: Accounts Payable
3299 Tamiami Trl E Ste 700
Naples, FL 34112-5749
lnvoice #2250618.01
Revised lnv #
Date 3t31/2023
SSL Job #2250618 Golden Gate Pky @ Sunshine
Name Mast Arm Painting Repairs
Location GG Pky @ Sunshine Blvd
wo#23-18 SIG
PO#4500220041
Bid d 19-7541
Project
Bill Ref 692377
Item Degcription Unit of ileasuie Unit Price Quantity Amount
Materials
MaterialCost
Material Markup
MaterialTax
Material Freight
Malerials
4 VELOUR ROLLER
Markup on Materjals
Tax on Materials
Freight on Malerials
Materials
000
3.056
10.000/"
? .oo%
0.00
0.00
24.1A
12.22
1.22
0.86
0.00
14.30
53,024.32
Payments/Credits $0.00
Balance Due $3,024.32
Remit To Address:
16909 US Highway'19
Hudson, FL 34667
Page 2
Composite Exhibit "A" to Complaint
Total
Page 6700 of 7162
Colller County Traflic Operations Oepartment
2885 South Horseshoe Otive. Nad€s, FL 34104
Olfice: (239) 252-8260, Fax: (239 252.5868
NOTICE TO PROCEED
NOTTCE TO PROCEED # 23-18 sig
To: Southern Signal & Lighting
P.O. Box 5142
Hudson, FL 34674
DATE: 0212412023
E] ROUTINE N EMERGENCY
county Purchase Order No' 4500220041
Collier County RFP #: 19'7541
Prepared By: Mike Stephenson
Cartegraph Task # 692377
Conlact Name: Gregory Garcia
Contact Phone: 239-253-2252
Des tion o, Work:
You are aulhorized lo use subconlracloG as Eeded tol lhis
Con acl Grego,y Garcia 239-252-g)00 72 hou6 prio. to lhe
begtr'ning ofwork
Job Location
Golden Gate Pkwy @ Sunshine BIvd
Per Contract
(Normal = 1 weet)
(Emetgencl = 1s55
than 2 hours)
NOTE: The aforementioned worl shall be initiated per the Contract Time noted above (unless olherwise
requested in writing and approved by the Traftic Operations Chie, Engineer) after .eceipt of this NTP which
must be attached to your invoice. County lnspection Staff shall be notilied when each phase of the
aforementioned work is completed for review and approval. Upon review and approval of the aforementioned
work, prior to the submittal of any ,urnish or install payment request(s), an "As Built Schematic" of all
underground work, material quantities, and/or labor shall be provided if the underground routing of existing
components was changed.
COLLIER COUNTY:CONTRACTOR
d Authorized 8y
Prinr Name:
c
E REJECTED
Reason.
Date
N. Khawaja, P
href ngineer of Tra rations
DANIELA G
COLEMAN
Oigilallysign€d by DANIELA G
COTEMAN
__ ___-0 lr0a0l-1t E!la53i0400:
Srgnature
Dale Submitted for Reinspection
lnspecled By
Traffic Signal & Roadway Lighting Technician
Contract Time:
Repair. regeinl m:Lst pole uprighl on the norlhwesl corner froo
lop to bollom and replace alldamagedand missing nul covers.
E ACCEPTED oate:
Date of Work Order Acceptance
Dale Work Completed. __
Date Submrtled for Frnal lnspection:_
Page 6701 of 7162
2-24-23 Golden Gate parkway and Sunshine upri8ht da mage Task 692377 Crash report CCSO 23-80045
CCTO Claim 3031 Stars 50-02242313728
to
o
o
Composite Exhibit "A" to Complaint
\tl
€I
D I
tt I
(
:t
Page 6702 of 7162
o
o
2-24-23 Golden Gate parkway and Sunshine upright damage Task 692377 Crash report CCSO 23-80045
CCTO Claim 3031 Stars 50-02242313728
I
o
Composite Exhibit "A" to Complaint
...__
,/
\
\
.L-'l
\
I
I
\
\\..l
r
I
v
s.,,
t,,
Iry,
\
L
\\
E
Page 6703 of 7162
UAIC;1'.
UNITED AlJTOiVIOBILE INSURANCE COlVIPANY . PO Box 694120. Miami. FL 33269-1 I �O UM£0 AUTDl..,-J!31LE NSURANCf COMPAN'< 1 J \.fay 4, 2023 Phone: 305-9-10-7299 \Neb: w\vw.uaig.net COLLIER COUNTY TRAFFIC OPS 4800 Davis Blvd Naples, FL 34104-5306 REF: Claim No.: Policy No.: Insured: Loss Date: 0100331918-002-145 UAH 371472 ABIGAlL ARIAS PEREZ February 24, 202:' Dear COLLIER COUNTY TRAFFIC OPS: This lener is in regards to the above referenced accident. The purpose of this lener is to advise you that we have completed our investigation on the above referenced accidem with our insured, ABIGAIL ARIAS PEREZ. Wt: have attempted to gather and fairly assess the information concerning the above claim from all available sources. including statements, estimate damages, photos and a police report from this loss. As you may be aware, there are conflicting statements regarding this accident. Because there was neither a conclusive police investigation nor independent witness statements thar ·an confirm either panics accounts of the above loss, our inve�tigation has not resulted in establishing legal liability on our insured, therefore we wi II be unable 10 honor your claim If you have any questions, please contact the un lcrsigned. Sincerely, Eric Tinunons 305-940-7299 .x32737CC: ABIGAIL ARIAS PEREZ A11r person who knm1,·i11gly und 1,·irh inrenr lo it1j11re. de/iw,d. or decein• 011\" insurer files a statement cf cloim or an app/icutio11 cullflli11i11,� am· Jiilse. i11comp/e1e, ;Jr 111i.1/e{l:/i11g i11(ormation is guilrr <fufdony 0{1he third degree. Composite Exhibit "A" to Complaint
Page 6704 of 7162
RISK MANAGEMENT INVOICE
COLLIER COUNTY TRAFFIC OPERATION DEPARTMENT
2885 S HORSESHOE DR
NAPLES, FL. 34104
(239)252-8260 TELEPHONE (239)252-5868 FA)
Traffic Operations:
NAME
Ken Martin
Michael Stephenson
Pamela Wilson
PROJECT/LOCATION:
ACTIVITY:
AUTHORIZATION:
X
HOURLY OVERTIME HOURS MAN HRS.
RATE RATE WORKED COST
$ 52.97 2 $ 105.94
$ 53.28 2 $ 106.56
$ 47.88 1.25 $ 59.85
Golden Gate Parkway and 4 7th ST SW
Pole for signal damage
Anthony Khawaja, P.E.
DEPOSIT REIMBURSEMENT
CHECK TO: 101-163630-646984
REMARKS: Man Hours
Equipment
Material
Vendor
Total
Admin. Ovhd.
COMMENTS:
SSL 4500220041
Cost
Cost
Cost
Cost
Cost
0.15
TOTAL
X Traffic Accident Report
X Vendor Invoice
Damage/Maintenance Report ----Roadway Lighting Damage Report ----
EQUIP.
USED
TRK
272.35
14.00
0.00
3,024.32
3,310.67
496.60
3,807.27
EQUIP.
RATE
14.00
CLAIM #3031STARS 50-02242313728
DATE OF ACCIDENT:2-24-23
DATE OF COMPLETION:
EQUIPMENT MATERIAL USED
COST TYPE COST
$ 14.00
Submitted By: }:� �
Pamela WV§dn t V
�a:t3.[ o/Lpport S.PeG,ialist I
Approved By:\ � /' \. �
Anthony Khawajc:31, P.E.
Chief Engineer
Composite Exhibit "A" to Complaint
Page 6705 of 7162
•
•
•
2-24-23 Golden Gate parkway and Sunshine upright damage Task 692377 Crash report CCSO 23-80045
CCTO Claim 3031 Stars 50-02242313728
J Golden Gate Pkwy at Sunshine Accident Mast Arm Pole Damage
MeyerTerri
O To O WibonP1mrl•
Cc O S1q:,hunonMkhnl
Ken call@d and ls taking pies,
Task 6923n
Crash Raport 23-8004.5
Respect-fully,
Tt.rrilllq,r
TMC Te<hnicion
CALL TIME
00:01:39
START PA.GE✓
GENERAL INFOAMATION
CLAIM NUMBER
._._....
LOSSOATE
212412023 ''""""
212'4'2C23
12392�28�
TRANSPORTATION Et#GINEERtNG OMSION
Golden Gate Pano.way and sunshine
COlLIER COUNTY
QY @N
000
<-:) Rep� «) R.p� AD .... : �·�-� ��.��:--]
Fii.:!/.?4/20231:51 PM
CLAtMANTFULL NAME STATUS
In Progress
ii
000
Composite Exhibit "A" to Complaint
Page 6706 of 7162
•
•
•
2-24-23 Golden Gate parkway and Sunshine upright damage Task 692377 Crash report CCSO 23-80045
CCTO Claim 3031 Stars 50-02242313728
Thank you for submitting. Pleas,e i-etain th
,t Number: 50022 2313728
Please submit any supporting docu
Iii@@
Composite Exhibit "A" to Complaint
Page 6707 of 7162
3 WAS DOT PROPERTY INVOLVED IN THIS CRASH?
FLORIDA TRAFFIC CRASH REPORT
LONG FORM � SHORTFORM 0 UPDATE 0
(Shaded Areas)
MAIL TO: DEPARTMENT OF HIGHWAY SAFETY p MOTOR VEHICLES
TRAFFIC CRASH RECORDS, NEIL KIRKMAN BUILDING
TALLAHASSEE, FL 32399-0537
TOTAL# OF VEHICLE SECTION(S)
TOTAL# OF PERSON SECTION(S)
TOTAL# OF NARRATIVE SECTION(S)
2
2
1
CRASH DATE
02/24/2023
TIME OF CRASH
1:15 PM
DATE OF REPORT
02/24/2023
REPORTING AGENCY CASE NUMBER
23-80045
HSMV CRASH REPORT NUMBER
25705267
CRASH IDENTIFIERS
COUNTY CODE CITY CODE COUNTY OF CRASH
64
TIME ON SCENE
1:25 PM
00 COLLIER
CRASH OCCURRED ON STREET, ROAD, HIGHWAY
GOLDEN GATE PKWY
PLACE OR CITY OF CRASH
UNINCORPORATED
REASON (If Investigation NOT Complete)
, .. AT STREET ADDRESS# I•
□
AT LATITUDE
26.183530
AT FEET I MILES p [][]□Ill AT/FROM INTERSECTION WITH STREET, ROAD,HIGHWAY
47TH ST SW
Road System Identifier 7 Fores, Road Type of Shoulder �� of Intersection 8 Private Roadway 1 t at Intersection 1 Interstate 4 County 9 Parking Lot Ci] 1 Paved 0 2 Four-Way Intersection 2U.S. 5 Local 77 Other, Explain in 2 Unpaved 3 T.lntersect10n 3 State 6 Tumpike/T oU Narrative 3Curb 4 Y-lnlersection
CRASH INFORMATION (CHECK IF PICTURES TAKEN) I ILight Condition Weather Condition Roadway �i�ace Condition School Bus Related 4 Fog, Smog, Smoke
TIME REPORTED
1:20 PM
TIME DISPATCHED
1:20 PM
Notified By: 1 MotoriS1
2 Law Enforcement
ANO LONGITUDE
-81.701891 I a OR FROM MILEPOST#
5 Traffic C�cle 6 Roundabout 7 Five.Point, or More 77 Other, Explain in Narrative
Manner of Collision/Impact Ci] 1 Daylight 5 Dark-Not Lighted 4 Sideswipe, same d�ection Ci] 5 Sleet/Hail/ 6 Mud, Dirt, Grave! 1 No 020usk 6 Dark-Unknown Freezing Rain Ci] 7 Sand Ci] 2 Yes, School Bus 5 Sideswipe, Opposite Direction 30awn Lighting 6 Blowing Sand, Soil 8 Water Directly Involved 6 Rear to Side 4 Dark-Lighted 77 Other, Explain in Dirt (standing/moving) 3 Yes, School Bus 7 Rear to Rear Narrative 1 Clear 1 Front to Rear 88 Unknown 2 Cloudy 7 Severe Crosswinds 1 Dry 77 Other, Explain in Indirectly Involved 77 Other, Explain in Narrative 2 Front to Front 3Ra,n n Other, Explain in 2Wet Narrative 88Unknown 3Angle Narrative
First Harmful Event Non-Collislon 1 Overturn.'Rollover 2 Fire/Explosion G 3 lrnrnersion 4 Jackknife 5 Cargo/Equipment
First Harmful Event Loss or Shift 6 Fell/Jumped From within Interchange Motor Vehicle
1 No 7 Thrown or Falling Object 2Yes 8 Ran into Water/Canal 88 Unknown 9 Other CoHision
First Harmful Event Relation to 0 Junction 5 Railway Grade Crossing 14 Entrarice/Exit Ramp 15 Crossover • Related 1 Non.Junction 16 Shared-Use of Path or Trail 2 Intersection 17 Acceleration/Deceleration 3 lntersection-Retated lane 4 Driveway/Aney Access 18 Through Roadway Related � Other, Explain in Narrative
Work Zone Related Crash In Work Zone
4 Ice/Frost 88Unknown
Collision Non-Fixed Object Collislon with Fixed Object 10 Pedestrian 19 lmpact Atlenuator/Crash 30 Concrete 11 Pedalcycle Cusion 31 Other Traffic Barrier 12 Railway vehicle (train, 20 Bridge Overhead Structure 32 Tree (standing)
engine) 21 Bridge Pier or Support 33 Utility Pole/Light Support 13Animal 22 Bridge Rail 34 Traffic Sign Support 14Motor Vehicle in 23 Culvert 35 Traffic Signal Support Transport 24 Curb 36 Other Post, Pole or 15 Parked Motor Vehide 25 Ditch Support 16 Work Zone/Maintainance 26 Embankment 37 Fence Equipment 27 Guardrail Face 38 Mailbox 17 Struck By Faffing. Shifting 28 Guardrail End 39 Other Fixed Object (wan, Ca,go 29 Cable Barrier buildinsi. tunnel, etc. l 18 Other Non-Fixed Obiect
First Harmful Event
Location 1 On Roadway 2 Off Roadway Ci] 3Shoulder 4 Median 6Gore 7 Separator 8 In Parking Lane or Zone 9 Outside Right-of-way 10 Roadside 88 Unknown
Contributing Circumstances: Road 9 Worn, Trave�Polished Surface Contributing Circumstances: Environment Ci]
1 None
□
4 Work Zone (construction/
maintenancelut.Rity
□
6 Shoulders (none, low, soft, high)
7 Rut, Holes, Bumps
10 Road Surface Condition (wet, Ci] □ □ icy, snow, sk.Jsh, etc.) 11 Obstruction in Roadway 12 Debns 13 Traffic Control Device 1 None 5 Animal(s) in Roadway Inoperative, Missing or Obscured 2 Weather Conditions 77 Other, Explain in 14 Non-Highway Work 3 Physical Obstruction(s) Narrative 77 Other Explain in Narrative 4 Glare 88 Unknown 88Unknown
Workers In Work Zone Type of Work Zone 1 Before the First Work Zone 1 Lane Ck>sure wamingSign Ci] 1 No □ 2Advarice Warning Area 2 Lane Shift/Crossover □ 1 No □ 2Yes 3 Transition Area □ 3 Work on Shoulder or Median 2Yes 88 Unknown 4ActivilyArea 4 Intermittent or Moving Work 88 Unknown 5 Termination Area 77 Other, Explain in Narrative
WITNESSES
NAME ADDRESS CITY&STATE ZIP CODE
NAME ADDRESS CITY &STATE ZIP CODE
NAME ADDRESS CITY&STATE ZIP CODE
NON VEHICLE PROPERTY DAMAGE
VEH.# lt'tK# PROPERTY DAMAGE· OTHER THAN VEH. EST.AMT. OWNER'S NAME � (CHECK IF BUSINESS) ADDRESS CITY & STATE ZIP CODE
2 TRAFFIC SIGNAL 5000 4800 DAVIS BLVD NAPLES FL 34104 COLLER COUNTY TRAFFIC OPS
VEH.# PER# PROPERTY DAMAGE -OTHER THAN VEH. EST.AMT. OWNER'S NAME □ (CHECK IF BUSINESS) ADDRESS CITY & STATE ZIP CODE
HSMV90010 S 7 Page ____ of
Composite Exhibit "A" to Complaint
Page 6708 of 7162
VEHICLE# 1 Check if Commercial O Reporting Agency Case Number I HSMV Crash Report Number 23-80045 25705267 1 Vehicie in Transport �I VEHICLE LICENSE NUMBER I STATE REGISTRATION EXPIRES I VIN 2 Parked Motor Vehicle I Check if Permanent 3 Wor1<ing Vehicle AG54HW FL 11/16/2023 Registration 0 1N4AL3AP0FN323362 Hiland Run
�
YEAR MAKE MODEL l'STYLE COLOR I DAMAGE: � I EST. AMOUNT 1 No 1 Disabling 4 Minor 2Yes 2015 NISS 4DOOR SEDAN SILVER· SIL 2 Functional 88 Unknown $12,000.00 88 Unknown 3None INSURANCE COMPANY (DRIVER) INSURANCE POLICY NUMBER I Towed due 0 VEHICLE REMOVED BY 1. Rotation
� UNITED AUTOMOBILE INSUR to Damage: 2. Owner Request UAH000371472 BALD EAGLE TOWING 3. Driver 1No 2Yes 4. Other, Explain in Narrative NAME OF VEHICLE OWNER (CHECK IF BUSINESS) □I CURRENT ADDRESS CITY & STATE ZIP ABIGAIL ARIAS PEREZ 2323 66TH ST SW NAPLES FL 34116
TraiJer LICENSE NUMBER STATE REGISTRATION EXPIRES Check ii Permanent VIN YEAR MAKE LENGTH AXLES
One: Registration □ Trailor LICENSE NUMBER STATE REGISTRATION EXPIRES Check ii Permanent VIN YEAR MAKE LENGTH AXLES Two: Registration □ VEHICLE N s E w Off-Road Unknown ON STREET, ROAD, HIGHWAY TRAVELING □□□� □□ GOLDEN GATE PARKWAY HAZ. MAT. RELEASED HAZ. MAT. PLACARD NUMBER CLASS 1 No □ 1 No □ 2Yes 2Yes 88 Unknown 88 Unknown MOTOR CARRIER NAME US DOT NUMBER
MOTOR CARRIER ADDRESS I CITY
Vehicle Body Type 15 Low Speed Vehicle Trafflcway
�
16 (Sport) Utility Vehicle � 1 Two-Way, Not Divkied 17 Cargo Van (10,000 lbs 2 Two-Way, Not Divided, with a (4,536 kg) or less) Continuous Left Tum Lane 1 Passenger Car 18 Motor Coach � 3 Two-Way, Divided, Unprotected
Area or lrlltlal Impact
2 I 3 I 4 Is 6 7])0[(16 17 8 14 9 '13 '12111 �o
�
AT EST. SPEED
I I 18 Undercarriage 19 Overturn 20 Windshield 21 I Trailer I STATE I ZIP CODE
I/POSTED SPEED
35 FOTALLANES
I 18 19 20 I 21
�
Most uamaged Area
l 3l4ls 6 7
]
2 -0:(16 17 !.. 14 9 l13I12 11 hO I PHONE NUMBER
Commercial Motor Vehicle Configuration 1 Vehicle 10,000 lbs or less Placarded 8 Tractor/Triple □ for Hazardous Materials 9 Truck more than 10,000 lbs (4,536 2 Single-Unn Tr uck (2-axle and GVWR kg), Cannot Classify more than 10,000 lbs (4,536 kg)) 10 Bus/Large van (seats for 9-15 3 Single-Unn Truck (3 or more axles) occupants, including driver) 2 Passenger Van 19 Other Light Trucks (10,000 lbs (painted >4 feet) Median 4 Truck Pulling Trailer(s) 3 Pickup (4,536 kg) or less) 4 Two-Way, Divided, Positive 11 Bus (seats for more than 15 7 Motor Home 20 Medium/Heavy Trucks (more Median Barrier 5 Truck Tractor (bo�I) occupants, including driver) 8 Bus than 10,000 lbs {4,536 kg)) 6 Truck Tractor/Semi-Trailer 77 Other, Explain in Narrative 5 One-Way Tralficway 7 Truck Tractor/Double Truck 11 Motorcycle 21 Farm Labor Vehicle 88 Unknown 88 Unknown
m.1ff�ain Vehicle (A TV) 77 Other, Explain in Narrative Trailer Type 88 Unknown 1 Single Semi Trailer 8 Pole Trailer 2 Tandem Semi Trailer 9 Towed Vehicle Cargo Body Type 13 lntermodal Comm/Non-Commercial TRAILER 1 TRAILER 2 3Tank Trailer 1 o Auto Transport □ □ 4 Saddle Mount.fTrailer 77 Other, Explain in □ 3 Van/Enclosed Box Container Chassis □ 1 Interstate Carrier 4 Hopper 14 Vehicle Towing 2 Intrastate Carrier 5 Boat Trailer Narrative 5 Pole-Trailer Another Vehicle 3 Not in Commerce/Government 6 Utility Trailer 88 Unknown 6 Cargo Tank 15 Nol Applicable 4 Not in Commerce/Other Truck 7 House Trailer 1 No Cargo 7 Flatbed (vehicle 10,000 lbs 1 10,000 lbs (4,536 kg) or less 2Bus 8Dump (4,536 kg) or less not Most Harmful Event Non-Collision Comm 0 -1 Overturn/Rollover OVWR/OCWR 2 10,00 1-26,000 lbs (4,536-11,793kg) 9 Concrete Mixer displaying HM placard 2 Fire/Explosion 3 More than 26,000 lbs (11,793kg) 10 Auto Transport 77 Other, Explain in
El
Sequence of Events
1st 2n d □
3rd 4th □ □
Roadway Grade 1 Level 2 Hillcrest 3Uphill
31mmersion 4 Not Applicable 4 Jackknife Collision with Non-Fixed Object 5 Cargo/Equipment Loss or Shift 10 Pedestrian 6 Fe/I/Jumped From Motor Vehicle 1 1 Pedalcycle 7 Thrown or Faffing Object 12 Railway Vehicle (train, engine) 8 Ran into Water/Canal 13Animal 9 Other Non.Collision 14 Motor Vehicle in Transport 15 Parked Motor Vehicle (40-46 Sequonc. of Events only) 16 Wor1< Zone/Maintenance 40 equipment Failure (blown tire, Equipment brake failure, etc.) 17 Struck By FaUing, Shifting Cargo or 41 Separation of Units -Anything Set in Motion by Motor 42 Ran Off Roadway, Right Vehicle 43 Ran Off Roadway, Left 18 Other Non-Fixed Obiect 44 Cross Median Vehicle Maneuver Action 45 Cross Centerline 1 Straight Ahead 13 Stopped in Trallic 46 Downhiff Runaway 3Tuming Left 14 Slowing
� 4Backing 15 Negotiating a Curve 5 Turning Right 16 Leaving T ralfic Lane Roadway Alignment 6 Changing Lanes 17 Entering Traffic Lane
11 Garbage/Refuse Narrative Col/ls/on Fixed Object 12Log 88 Unknown
19 Impact Menuator/Crash Cushion 29 Cable Barner Emergency 20 Bridge Ovemead Structure 30 Concrete T ralfic Barrier Vehicle Use 31 Other Traffic Barrier 21 Bridge Pier or Support 32 Tree (standing) � 22 Bridge Rail 33 Utilny Pole/Light Support 23 Culvert 34 Traffic Sign Support 24 Curb 35 T raffle Signal Support 1 No 25 Ditch 36 Other Post, Pole , or Support 2Yes 26 Embankment 37 Fence 88 Unknown 27 Guardrail Face 38 Mailbox 28 Guardrail End 39 Other Fixed Object (wall, buildina, tunnel, etc.)
Traffic Control Device For Vehicle Defects
This Vehicle
� □ 0 8 Flashing Signal 1 None 9 Railway Crossing 1 No Controts Device 2 Brakes 13Wheels
� 4 Downhill
�
1 Straight 8Parked 77 Other, Explain in Narrative 4 School Zone Sign/ 1 O Person (including 3r�es 14Windows/ Device 4 Lights (head, Wmshield 5 Sag (bottom) 2 Curve Right 10 Making U-Tum 88 Unknown 5 T raff,c Control Flagman, Ollice<, signal, ta!) 15 Mirrors 3Curve Left 11 Overtal<inglPassing Guard, etc.) Signal TT Other, Explain in 6 Steering 16 Truck Coupling
Special Function 1 No Special Function 9 Ambulance 14 lntercrty Bus 6 Stop Sign Narrative 7Wipers Trailer Hitch/
� of Motor Vehicle 2 Farm Vehicle 10 Fire Truck 15 Charter IT our Bus 7 Yield Sign 88 Unknown 9 Exhaust System Safety Chains 3Police 1 1 Farm Labor Transport 16 Shuttle Bus 10 Body, Doors 77 Other, Explain in 7 Taxi 12 School Bus 17 Farm Labor Bus 11 Power Train Narrative 8 Military 13 Transit/Commuter Bus 88 Unknown 12 Suspension 88 Unknown VIULAIIUN:O PERSON# NAME OF VIOi.ATOR FL STATUTE NUMBER CHARGE CITATION NUMBER
PERSON# NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER
PERSON# NAME OF VIOi.ATOR FL STATUTE NUMBER CHARGE CITATION NUMBER
HSMV 90010 S 2 7Page ____ ol
Composite Exhibit "A" to Complaint
Page 6709 of 7162
PERSON# 1 I Reporting Agency Case Number
23-80045
I HSMV Crash Report Number
25705267 1 Driver � VEHICLE# I NAME I PHONE NUMBER I vneckif □ 2 Non-Motorist Recommend 3 Passenger 1 ABIGAIL ARIAS PEREZ Oriver Re--exam CURRENT ADDRESS (Number and Street) I NAPLES 2323 66TH ST SW DATE OF BIRTH
11/16/1969 DL Typo 0 1A 2B 3C 4 D/Chauffeur 5 E/Operator 6 E/Oper-Rest 7None
SEX: 1 Male 2 Female 88 Unknown [J DRIVERS LICENSE NUMBER
A-621-000-69-416-0 Required Endorsements 1st 0 � 1 Yes 2No 3 No Req. Endorsement
STATE
FL u",v"'" Drivers Actions 1 No Contribution Action 2 Operated MV in Careless or Negligent Manner 3 Failed to Yield Righl--0f-Way 4 Improper Backing
CITY& STATE
FL EXPIRES
8/12/2023
at Tim• of Crnh 26 Ran off Roadway
I ZIP CODE
34116 I l���!y SEVERITY (INJ) 4 lncapacttating 2 Possible 5 Fatal (within 30 days) 3 Non-lncapacttating 6 Non-Traffic Fatality 3rd Condition At Time of 27 Disregarded other Traffic □ Cruh Sign 1 Apparently Normal 28 Disregarded Other Road 3Asleep or Fatigued Markings 5 111 (sick) or Fainted
[J
[J
6 Improper Turn 29 Over-Correcting/Over Drtvor Dls1n1ctod By ◄ Other Inside the Vehic� Steering 6 Seizure, Eplepsy, Blackout [J (explain in narrative) 1 O Followed too Closely 7 Physically Impaired t Not Distracted 2nd 8 Emotional (depression.
2 E�tronic CommunK:ation 5 External Distraction □ 11 Ran Red Light 30 Swerved or Avoided : Due 4th angry, disturbed, etc.) (outstde the vehicle, explain 12 Drove too Fast for Conditions to Wind, Slippery Surface, MV, Devices (cell phone, etc. in narrative) 13 Ran Stop Sign Object, Non.Motorisl in □ 9 Under the Influence of 3 Other Electronic Device 6 Texting 15 Improper Passing Roadway, etc. Medications/Drugs/Alcohol (navigation device. DVD player) 7 Inattentive 17 Exceeded Posted Speed 31 Operated MV in Erratic. n Other, E xplain in Narrative 88 Unknown 21 Wrong Side of Wrong Way Reckless or Agressive Manner 88 Unknown DRIVER VISION OBSTRUCTIONS I 25 Failed to Keep in Proper Lane TT Other Contributing Action
[J 1 Vision Not Obscured 5 Load on Vehicle 9 Smoke 2 Inclement Weather 6 Building/Fixed Object 10Glare DRIVER OR PASSENGER 3 Parked/Slopped Vehicle 7 Signs/Billboards 77 All Other, Explain 4 Trees/Crops/Bushes 8 Fog in Narrative Ho!mot Uso (HU) Eyt Protoctlon (EP) 0 Restraint Systtms DRIVER OR PASSENGER □ 1 DOT-Compliant □ 1 Yes (RS) SEAT ROW OTHER I Motorcycle Helmet 2No Motor Vehicle Seating Position: !:LOCATION. 117 Fl n 2 Other Helmet 3 Nol Applicable 1 Not Applicable (non-motorist) Seat Row Other (LOC) 3No Helmet 2 None Used -Motor Vehicle Occupant 3 Shoulder and Lap Belt Used 1 left 1 Not Applicable 4 Shoulder Belt Only Used 2Middle 1 Front 2 Sleeper Section of Truck Cab Air Bag Doployod 5 Lap Belt Only Used 2 Second 5 Deployed-Other 3Righl 3 Other Enclosed Cargo Area Ejection (EJECT) (knee, air belt, etc ) 6 Restraint Used • Type Unknown
77 Other 3 Third 4 Unenclosed Cargo Area [J 1 Nol Ejected 0 1 Not Applicable 6 Deployed-7 Child Restraint System -Fo,ward Facing (explain in 4 Fourth 5 Trailing Unit 2 Ejected. To tally 2 Not Deployed Combination 8 Child Restraint System -Rear Facing narrative) 770therRow 3 Ejected. 3 Deployed-F ronl 7 Deployed-Curtain 9 Booster Seat 88 Unknown 88 Unknown 6 Riding on Motor Vehicle Exterior (non-Partially 4 Deployed-Side 88 Deployment 10 Child Restraint Type Unknown trailing unit) 4 Not Applicable Unknown 77 Other, Explain in Narrative 88 Unknown 88 Unknown nvr,•m-1 -m� 1 □ Non-l/lotorlst Doscripdon □ Non-Motorist Location At Time of Crash SSidewalk □ Action Prior to Crash 1 Pedestnan 5 Walking/Cycling on Sidewalk 2 Other Pedestrian (wheefchair, person in a 1 Intersection -Marl<ed Crosswalk 9 Median/Crossing Island 2 Intersection -Unmarked Crosswalk 10 Driveway Access 6 In Roadway -Other (working. building, skater, pedestrian conveyance, etc. 3 Intersection -Olher4 Midblock -Marked Crosswalk playing, etc.) 3 Bicyclist 11 Shared-Use Path or Trail 1 Crossing Roadway 4 Midbfock -Marked Crosswalk 7 Adjacent to Raodway (e.g., 4 Other Cyclist 5 Travel Lane -Other Location 12 Non-Trafficway Area 2 Waiting to Cross Roadway shoulder, median) 5 Occupant of Motor Vehicle Not in Transport 6 Bicycle Lane 77 Other, Explain in Narrative 3 Walking/Cycling Along 8 Going to or from School (K-12) (parked, etc.) 88 Unknown Roadway with Traffic (in or 7 shoulder/Roadside 9 Working in Trafficway 6 Occupant of a Non-Motor Vehicle adjacent lo travel lane) (incident response) Transportation Device Non .... ,..,�onsc ,.._ ... uona. .... ,rcum�nc.s 4 Walking/Cycttng Along 10 None 7 Unknown Type of Non-Motorist 1st □ 1No Improper Action Roactway Against Traffic (in 77 Other, Explain in Narrative 2 Dart/Dash or adjacent to travel lane) 88 Unknown 1 None Safety Equipment 3 Failure to Yield Right-of-Way 5 Lighting □ 4 Failure to Obey Traffic Signs 2Helmet 6 Not Applicable 2nd □ Stgnals, or Officer 7 Entering/Exiting Parked/Standing 10 Improper Tum/Merge 3 Protective Pads Used 77 Other, Explain 5 In Roadway Improperly (standing, Vehicle 11 Improper Passing (elbows, knees, shins, etc.) in Narrative □lying, working, playing) 8 lnattentrve (talking, eating, etc) 12 Wrong-Way Riding or Walking 4 Reflective Clothing fjacket, 88 Unknown 6 Disabled Vehicle Related (working 9 Not Visible (dark clo1hing, no 77 Other, Explain in Narrative backpack, etc.) on, pushing, leaving/approaching) lighting. etc ) 88 Unknown ALCOHOUDRUG/EMS SUSPE CTED ALCOHOL TESTED: ALCOHOL TEST TYPE: l'\LCOHOL BAC �USPECTED pRUG TESTED: DRUG TEST TYPE: DRUG TEST RESULT: ALCOHOL USE: [J 1 Test Not Given □ 1 Blood 2 Breath □ !TEST RESULT □□ DRUG USE [J 1 Test Not Given □ 1Blood □ 1 Positive □ 1 No 2 Test Refused 3Urine 1 PENDING 1 No 2 Test Refused 3Urine 2 Negative 2Yes 3 Test Given 77 Other, E xplain 2COMPLETED �Yes 3 Test Given 77 Other. 3 Pending 88 Unknown 68 Unknown, if Tested in Narrative 68UNKNOWN 138 Unknown 88 Unknown, if Tested Explain in Narrative 88 Unknown SOURCE OF TRANSPORT TO MEDICAL FACILITY EMS AGENCY NAME OR ID EMS RUN NUMBER rEDICAL FACILITY TRANSPORTED TO 1 Not Transported [J 2 EMS 3 Law Enforcernerlt 77 Other, Explain in Narrative 88 Unknown
" PERSON# !V EHICLE# rAME ATE OF BIRTH INJ rEX roe: s R l o rJECT ru rp I ABO rs
CURRENT ADDRESS (Number and Street) I CITY I STATE I ZIP CODE
SOURCE OF TRANSPORT TO MEDICAL FACILITY □ EMS AGENCY NAME OR ID I EMS RUN NUMBER I MEDICAL FACILITY TRANSPORTED TO
1 Not T'llnaport•:I 2 Er.1S 3 L•w l11fo_,.,,.11\ 1T Olhar. Ex.,!a"';,, Mll,...1-H1Jnlcno""'1 PERSON # !VE HICLE# rAME ATE OF BIRTH !NJ rEX ILOC:S R l o rJECT ru rp I ABO I RS
CURRENT ADDRESS (Number and Street) I CITY I STATE I ZIP CODE
SOURCE OF TRANSPORT TO MEDICAL FACILITY □ EMS AGENCY NAME OR ID I EMS RUN NUMBER I MEDICAL FACILITY TRANSPORTED TO
1 Nol Tn1111;:1oiu,d 2 ELIS l Law Ento�-o,t 17 0041( Expll.11""
IZ.!TIILWIIU!l.llnlt'M' HSMV 90010 S 3 7 Page ____ of
Composite Exhibit "A" to Complaint
Page 6710 of 7162
NARRATIVE Reporting Agency Case Number
23-80045
Crash occurred at the intersection of Golden Gate Parkway and 47th St Sw.
HSMV Crash Report Number 25705267
V1 was traveling in the outside west bound lane of Golden Gate Parkway. V2 was traveling north on 47th St Sw.
V1 Driver stated as he approached 47th street Sw he looked up and saw a green light and proceeded to cross the intersection.
V2 Driver stated she was traveling north on 47th St Sw. North and south bound had a green light and she entered in to the intersection,
continuing north.
V1's front center bumper struck V2's rear right door. V1 continued north west, with final rest just west of the intersection. Due to the
impact, V2 spun and continued north east. V2 struck a traffic light pole, with final rest facing south in the west bound lane.
Both vehicles were removed from scene by Bald Eagle Towing, Rotation.
Hazards were removed from scene by the fire department.
No injuries observed or reported on scene by V1 Driver or V2 passenger. V2 Driver reported injuries on scene and was transported to
physicians regional pine ridge, by EMS, for observation.
Due to conflicting stories and no witnesses, I am unable to determine fault.
PERSON# VEHICLE# AME ATE OF BIRTH
3 2 NANAUZ GUTIERREZ CRUZ 11/3/2020
CURRENT ADDRESS (Number and Street) CITY
SOURCE OF TRANSPORT TO MEDICAL FACILITY
�
EMS AGENCY NAME OR ID
1 Not TISIIIOOll•'3 2 HIS J Lt# Enfo!Qa�II\ 77 0-.n•,. Elq,1-,,, ti'!
Nt,,..W.IIU,,knO'M'I
PERSON# VEHICLE# AME
CURRENT ADDRESS (Number and Street) CITY
SOURCE OF TRANSPORT TO MEDICAL FACILITY □ EMS AGENCY NAME OR ID
1 Not T�11tpo.,." 2 EMS J Ltw £11fo11:t11Nnt T7 Oihu £ui.� ,n lw�we II Unltftown
ADDITIONAL VIOLATIONS
PERSON# NAME OF
PERSON# NAME OF
REPORTING OFFICER
IDitlADGE#
4428
HSMV 90010 S
VIOLATOR
VIOLATOR
RANK
CSD
FL STATUTE NUMBER
FL STATUTE NUMBER
OFFICER NAME
B FAHEY
7 Page ____ of
INJ SEX LOC· S R 0 EJECT EP ABO RS
2 2 1 2 10
EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO
SEX R 0 EJECT EP ABO RS
EMS RUN NUMBER MEDICAL FACILITY TRANSPORTED TO
CHARGE CITATION NUMBER
CHARGE CITATIUN NUMBER
DEPARTMENT
COLLIER COUNTY SHERIFFS OFFI
TYPE OF DEPT.
St1t:t<lt-t'"' S Ul"t-lCt::
(SO)
Composite Exhibit "A" to Complaint
Page 6711 of 7162
DIAGRAM
V1 Final rest
i
HSMV90010S
REPORTING AGENCY CASE NUMBER
23-80045
� .......
en
�
5 Page __ of
HSMV CRASH REPORT NUMBER
25705267
Not To Scale �------'....:....;;;_;__.::...., V2 Final Rest
Golden Gate
Parkway
Composite Exhibit "A" to Complaint
Page 6712 of 7162
VEHICLE# 2 Check if Commercial D Reporting Agency Case Number I HSMV Crash Report Number
23-80045 25705267 1 Vehicle in Transport � I VEHICLE LICENSE NUMBER 'STATE REGISTRATION EXPIRES I VIN 2 Parked Motor Vehicle I Check if Permanent 3 Working Vehicle EQBA25 FL 10/26/2023 Registration D 2HGFA1F52AH305613 Hit and Run
�
YEAR MAKE MODEL I SlYLE COLOR 'DAMAGE:
� 'EST .AMOUNT 1 No 1 Disabbng 4Minor 2Yes 2010 HOND 4D00R SEDAN BLACK-BLK 2 Functional 88 Un known $10,000.00 88 Unknown 3None INSURANCE COMPANY (DRIVER) INSURANCE POLICY NUMBER I Towed due 0 VEHICLE REMOVED BY 1. Rotation
� AUSTATE FIRE AND CASUA to Damage: 2. Owner Request 9886141790402 BALD EAGLE TOWING 3. Driver 1 No 2Yes 4. Other, Explain in Narrative NAME OF VEHICLE OWNER (CHECK IF BUSINESS) □ I CURRENT ADDRESS CllY &STATE I ZIP ALAN RICHARD CRUZ BAQUERO 8420 BORBONI CT NAPLES FL 34114 Trailer LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent VIN YEAR MAKE LENGTH AXLES One: Registration □ Trailer LICENSE NUMBER STATE REGISTRATION EXPIRES Check if Permanent VIN YEAR MAKE LENGTH AXLES Two: Registration □ VEHICLE N s E w Off-Road Unknown I ON STREET, RO AD , HIGHWAY TRAVELING �□□□□ □47TH ST SW HAZ.MAT RELEASED HAZMAT PLACARD NUMBER CLASS 1 No □ 1 No □ 2Yes 2Yes 88 Unknown 88 Unknown MOTOR CARRIER NAME US DOT NUMBER
MOTOR CARRIER ADDRESS I CITY
Vehicle Body Type 15 Low Speed Vehicle Trafficway 8 16 (Sport) Utillty Vehicle 8 1 Two-Way, Not Divided 17 Cargo Van (10,000 lbs 2 Two-l'Vay, Not Divided, with a (4,536 kg) or less) Continuous Left Tum Lane 1 Passenger Car 18 Motor Coach � 3 Two-Way, Oivtded, Unprotected
Area or lnitiai Impact
2 I 3 I 4 IS 6 7 ]@[(ls 17 8 14 9 113b2111 10
B
AT EST. SPEED
I I 18 Undercamage 19 Overturn 20 Windshield 21 I Trailer I STATE I ZIP CODE
rOSTED SPEED I TOTAL LANES
I 18 19 20 I 21
B Most uamaged Area
2 I 3 4 1s 6 7_ 1@� 17� 14 9 113 12 11 10 I PHONE NUMBER
, v��n;i�i�cJ!lo����a��• Confll!Jlf���/Triple □ for Hazardous Materials 9 Truck more than 10,000 lbs (4,536 2 Single-Uni Truck (2-axle and GVWR kg), Cannot Classify more than 10,000 lbs (4,536 kg)) 10 Bus/large van (seats 10< 9-15 3 S1ngle-Unft Truck (3 or more axles) occupants, including driver) 2 Passenger Van 19 Other Light Trucks (10,000 lbs (painted >4 feet) Median 4 Truck Puffing Trailef(s) 3Pickup (4 536 kg) or less) 4 Two-way, Divided , Positive 11 Bus (seats for more than 15 7Motor Home 20 Medium/Heavy Trucks (more Median Barrier 5 Truck Tractor (bobtail) occupants, including driver) 8Bus than 10,000 lbs (4,536 kg)) 6 Truck Tractor/Semo Trailer 77 Other, Explain in Narrative 5 One-Way Traff,cway 7 Truck Tractor/Oouble Truck 11 Motorcycle 21 Farm Labor Vehicle 88 Unknown 88 Unknown 12 Moped 77 Other , Explain in Narrative Trnl���rTrailef 8 Pole Trailer 13 All Terrain Vehicle (A TV) 88 Unknown 2 Tandem Semi Trailer 9 Towed Vehicle Cargo Body Type 13 lntermodai Comm/Non-Commercial TRAILER 1 TRAILER 2 3 Tank Trailer 1 O Auto Tran sport □ □ 4 Saddle Mount/Trailer 77 Other, Explain in □ 3 Van/Enclosed Box Container Chassis 1 Interstate Carrier 4 Hopper 14 Vehicle Towing □2 Intrastate Canier 5 Boat Trailer Narrative 5 Pole-Trailer Another Vehicle 3 Not in Commerce/Government 6 Util<y Trailer 88 Unknown 6 Cargo Tank 15 Not Applicable 4 Not in Commerce/Other Truck 7 House Trailer 1 No Cargo 7 Flatbed (vehicle 10,000 lbs 1 10,000 lbs (4,536 kg) or less 2Bus 8Dump (4,536 kg) or less not Most HarmfUI Event Non-Collision Comm
�
-1 Overturn/Rollover GVWRJGCWR 2 10,001-26,000 lbs (4536-11,793kg) 9 Concrete Mixer displaying HM placard 2 Fife/Explosion 3 More than 26,000 lbs (11,793kg) 10 Auto Transport 77 Other, Explain in 31mmersion 4 Not Applicable 11 Garbage/Refuse Narrative 4 Jackknife Cofflslon with Non-flxed Object Collision Fixed Object 12 Log 88 Unknown G 5 Cargo/Equipment Loss or Shift 10 Pedestrian 19 Impact Attenuator/Crash Cushion 29 Cable Barrier Emergency 6 FeWJurnped From Motor Vehicle 11 Pedalcycle 30 Concrete Traffic Barrier Vehicle Use 7 Thrown or Faning Object 12 Railway Vehicle (train, engine) 20 Bndge Overhead Structure 31 Other T raffle Barrier Sequence of Events 8 Ran into Water/Canal 13Animal 21 Bndge Pier or Support 32 Tree (standing) 89 Other Non-Collision 14 Motor Vehicle in Transport 22 Bndge Rail 33 Utillty Pole/Light Support 23 Culvert 1st 2nd 15 Parked Motor Vehicle 34 Trame Sign Support □ (40-46 Sequence ol Events only) 16 Work Zone/Maintenance 24 Curb 35 Traffic Signal Support 1 No 40 equipment Failure (blown tire, Equipment 25 Ditch 36 Other Post, Pole, or Support 2Yes brake failure, etc.) 17 Struck By Falling, Shirting Cargo or 26 Embankment 37 Fence BS Unknown 3rd 41 Separation of Units -Anything Set in Motion by Motor 27 Guardrail Face 38 Mailbox 4th 42 Ran Off Roadway, Right Vehicle 28 Guardrail End 39 Other Fixed Object (wall, □□ ◄3 Ran orr Roadway, Left 18 Other Non-Fixed O"""t building, tunnel, etc.) 44 Cross Median Vehicle Maneuver Action Traffic Control Device For Vehicle Defects 45 Cross Center1ine 1 Straight Ahead 13 Stopped in Traffic This Vehicle 8 □Roadway Grade 46 Downhin Runaway 3 Turning Left 14 Slowing 01 Level 8 4Backing 15 Negotiating a Curve 8 Flashing Signal 1 None 8 2HiHcrest Roadway Alignment 5 Turning Right 16 Leaving Traffic Lane 9 Raitway Crosstng 3Uphifl 6 Changing Lanes 17 Entering Traffic Lane 1 No Controls Device 2 Brakes 13 Wheels 4 School Zone Sign/ 3T�es 14 Windows/ 4 Downhill 8 1 Straight 8 Parked 77 Other, Explain in Narrative Device 10 Person (including 4 Lights (head, Wllldshiefd 5 Sag (bottom) 2 Curve Right 10 Making U-Tum 88 Unknown 5 Traffic Control Flagman, Officer, signal, tan) 15 Mirrors 3CurveLeft 11 Overtaking/Passing Guard, etc.) Signal n Other, Explain in 6 Steering 16 Truck Coupling Special Function 1 No Special Function 9Ambulance 14 lnterc�y Bus 6 Stop Sign Narrative 7 Wipers Trailer Hitch/ 8 of Motor Vehicle 2 Farm Vehicle 1 O Fire Truck 15 Charter IT our Bus 7 Yield Sign 88 Unknown 9 Exhaust System Safety Chains 3Police 11 Farm Labor Transport 16 Shuttle Bus 10 Body, Doors 77 Other, Explain in 7Taxi 12 School Bus 17 Farm Labor Bus 11 Power Train Narrative 8 Military 13 T ransit/Commoter Bus 88 Unknown 12 Suspension 88 Unknown VIOLATIONS PERSON# NAMEOF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER
PERSON# NAME OF VIOLA TOR FL STATUTE NUMBER CHARGE CITATION NUMBER
PERSON# NAME OF VIOLATOR FL STATUTE NUMBER CHARGE CITATION NUMBER
HSMV 90010 S 6 7 Page ____ or
Composite Exhibit "A" to Complaint
Page 6713 of 7162
PERSON# 2 I Reporting Agency Case Numbef 23-80045 I HSMV Crash Report Number 25705267 1 Driver 2 Non-Motorist 3 Passenger i.7 VEHICLE# LJ 2 CURRENT ADDRESS (Number and Street) 8420 BORBON! CT
I NAME ALANNA RENAE
I NAPLES
CRUZ I PHONE NUMBER
CITY & STATE FL I ZIP CODE 34114
I����□Driver Re-exam
DA TE OF BIRTH SEX· DRIVERS LICENSE NUMBER 1 Male 2 Female 4/21/2004 88 Unknown C-620-016-04-641-0
STATE EXPIRES
FL 4/21/2028 11��1!,V SEVERITY (INJ) ◄ Incapacitating 2 Possible 5 Fatal (within 30 days) 3 Non-Incapacitating 6 Non-Traffic Fatahty
DL Ty.,. 1A2B 3C 4 D/Chauffeur 5 E/Operator 6 E/Oper-Rest 7None Driver Dlslrllcted By 1 Not Otstracted 2 Electronic Communication Devices (cell phone. etc. 3 Other Electronic OeV'lce (navigation device, DVD player)
Requir� Endorsements 1 Yes 2No 3 No Req. Endorsement
4 Other Inside the Vehicle (explain in narrative) 5 External Distraction ( outside the vehicle, explain in narrative) 6 Texting 7 Inattentive 88 Unknown DRIVER VISION OBSTRUCTIONS I 1 Vision Not Obscured 5 Load on Vehicle 9 Smoke 2 Inclement Weather 6 Building/Fixed Object 10 Glare
1st
Lll<IVCI< Drivers Actions 1 No Contribution Action 2 Operated MV IO Care!ss or Negligent Manner 3 Failed 10 Yield Right-of.way 4 Improper Backing 6 Improper Tum 2 d 10 Followed too Closely n 11 Ran Red Light □ 12 Drove too Fast for Conditions 13 Ran Stop Sign 15 Improper Passing 17 Exceeded Posted Speed 21 Wrong Side of Wrong way 25 Failed lo Keep ., Proper Lane
3 Parked/Stopped Vehicle 7 Signs/Billboards 77 All Other, Explain 4 Trees/Crops/Bushes 6 Fog in Narrative Helmet Use (HU)
It Tim• of Crash 26 Ran off Roadway 27 Disregarded other Traffic Sign 28 Disregarded Other Road Markings 29 Over-Correctiog/Over Steering 30 Swerved or Avoided : Due to Wind, Slippery Surface, MV, Oti,ec� Non-Motorist in Roadway, etc. 31 Operated MV in Erratic, Reckless or Agreessive Manner 77 Other Contributing Action
3rd □
4th □
DRIVER OR PASSENGER
Condition At Time of Crash 1 Apparently Normal 3Asleep or Fatigued 5 Ill (sick) or Fainted 6 Seizure, Epilespsy, Blackout 7 Physically lmpained 8 Emotional (depression, angry, dis1urbed, etc.) 9 Under the Influence of Medications/Drugs/Alcohol 77 Other, Explain in Narrative 88 Unknown
ReSlrlllnt Syswms (RS) DRIVER OR PASSENGER I □ 1 DOT-Compliant
1 ,-------,S�EA=T��R�O�W�-o=TH..,E�R�� Motorcycle Helmet Motor Vehlcle Seating Position: LOCATION: r.71 r.71 n 2 Other Helmet 1 Not Applicable (non-motorist) Seat Row Other (LOCJ 11 I 11 I 3 No Helmet 2 None Used • Motor Vehicle Occupant 3 Shoulder and Lap Belt Used 4 Shoulder Belt Only Used 1 Lelt 1 Front 1 Not Applicable 2 Midde 2 Second 2 Sleeper Section of Truck Cab 3 Right 3 Third 3 other Enclosed Cargo Area ,--,,E""J•-c-,Uo_n_("E!c-JE=c""T)=----� 1 Not Ejected Air Bag Deployed 5 Deployed-Other (knee, air belt, etc.) 6 DeployedCombination
5 Lap Belt Only Used 6 Restraint Used . Type Unknown
[{:) ii���:r Row : �r:�1�c�o��� Cargo Area 88 Unknown 88 Unknown 6 Riding on Mot or Vehicle Exterior (non2 Ejected, Totally 3 Ejected, Partially
r:l 1 Not Applicable LJ 2 Not Deployed 3 Deployed-Front 4 Deployed-Side 7 Deployed-Curtain 88 Deployment Unknown
7 Child Restraint System • Forward Facing 8 Child Restraint System • Rear Facing 9 Booster Seat tralling unit) 88 Unknown □ Non�otorlst Description 1 Pedesinan 2 Other Pedestnan (wheelchari, person in a building, skater, pedestnan conveyance, etc 3Bicyclis1 4 Other Cyctis1 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 1 None 2Helmet Safety Equipment 3 Protective Pads Used (elbows, knees, shins, etc.) 4 Reflective Clothing 0ackel. backpack, etc .)
5 Lighting 6 Not Applicable 77 Other, Explain in Narrative 86Unknown
SUSPECTED ALCOHOL TESTED:
4 Not Applicable 88 Unknown 10 Child Restraint Type Unknown 77 Other, Explain in Narrative □ Non-Motorist Location At Tlm• of c,-.sh 1 Intersection • Marked CroSS1Valk 2 Intersection -Unmarked Crosswalk 3 lnterreclion • Other4 Midblock -Marked Crosswalk 4 Midblock • Marked Crosswalk 5 Travel Lane -Other Location 6 Bicycle lane 7 shoulder/Roadside
8 Sidewalk 9 Median/Crossing Island 10 Dnveway Access 11 Shared-Use Path or Trail 12 Non-TraffiC1Vay /vea 77 Other Explain in Narrative 88 Unknown
□ Action Prior to Crash
1 Cross,ng Roadway 2 wailing to Cross Roadway 3 Walking/Cycling Along Roadway with Traffic (in or adjacent to travel lane) l-------,N:r::o"n=-u=,,o"n"'strA=,c11"',o"n=�w"',r"'cu"m=sta=1n"'ce"s,-----------f4 Walking/Cycling Along □ 1N o Improper Action Roadway Against Traffic (in 1•t 2 Dart/Dash or adjacent to travel lane) 3 Failure 10 Yield Right-of-way □ 4 Failure to Obey Traffic Signs 10 Improper Tum/Merge 11 Improper Passing
5 Walking/Cycting on Sidewalk 6 In Roadway -Other (working. playing, etc.) 7 Adjacent to Raodway (e.g, shoulder, median) 8 Going to or from School (K-12) 9 Working in Tramcway (incident response) 10 None 77 Other, Explain in Narrative 88 Unknown □ Signals, or Officer 7 Enlerinj;'Eding Parked/Standing 2nd 5 In Roadway Improperly (standing, Vehicle □lying, working, playing) 8 Inattentive (talking, ea1ing, etc) 6 Disabled Vehicle Related (working 9 Nol Visible (dark clothing, no on, pushing, leaving/approaching) lighting. etc.) 12 Wrong-way Riding or Walking n Other, Explain in Narrative 88Unknown ALCOHOUDRUG/EMS ALCOHOL TEST TYPE· ALCOHOL BAC !SUSPECTED DRUG TESTED: DRUG TEST TYPE: µRUG TEST RESULT: ALCOHOL USE: 8 1 Test Not Given □ 1 No 2 Test Refused 2 Yes 3 Test Given 1 Blood 2 Breath □ TEST RESULT. □□ PRUG USE: 1 Test Not Given □ 1 Blood □1 Positive 3 Urine 1 PENDING 1 No 8 2 Test Refused 3 Urine 2 Negative □ 77 Other, Explain 2 COMPLETED 12 Yes 3 Test Given 77 Other, 3 Pending in Narrative 88 UNKNOWN Isa Unknown 88 Unknown, if Tested Explain in Narrative 88 Unknown 88 Unknown 88 Unknown, if Tested SOURCE OF TRANSPORT TO ME DICAL FACILITY 1 Not Transported 02 EMS 3 lalV Enforcement 2 n Other, Explain in Narrative 88 Unknown PERSON # !VEHICLE# rAME
CURRENT ADDRESS (Number and Street)
EMS AGENCY NAME OR ID M076
SOURCE OF TRANSPORT TO ME DICAL FACILITY 1 Not T,.."IIOOM� l El.15 l l•·· Enb-ir.nt 17 0-J'lt( La, .. ,,, 111
Nt"l',t. .... ll lJncn.-"" □ EMS AGENCY NAME OR ID
PERSON # !VEHICLE# rAME
CURRENT ADDRESS (Number and Street)
SOURCE OF TRANSPORT TO MEDICAL FACILITY □ EMS AGENCY NAME OR ID t Nol T,..,._;u:i,._.d l El.tS I L•· .. Ento�ma11117 O!nti ll<o:.111 ,n ru .... : 11 l'-,lmt"lffl
HSMV 90010 S
EMS RUN NUMBER
23-29736
JA TE OF BIRTH INJ I SEX I LOC· s
EMS RUN NUMBER
ATE OF BIRTH INJ I SEX I LOC:S
EMS RUN NUMBER
7 7 Page ____ of
R I STATE
R
I STATE
MEDICAL FACILITY TRANSPORTED TO PHYSICIANS REGIONAL PINE RIDGE
I ZIP CODE
MEDICAL FACILITY TRANSPORTED TO
I ZJP CODE
ME DICAL FACILITY TRANSPORTED TO
Composite Exhibit "A" to Complaint
Page 6714 of 7162
Traffic Ops Tasks Report Transportation Management
Services Department
• crsilyofSouth'F ��.Countyc'Co :r,Esri, fRE.Garm· .l�CREMENTP,NGA. SGS
Task ID Issue Activity , Asset Priority
692377
Status
Street
Details
4/27/2023
Completed Location
Description
GOLDEN GA TE PKWY
Remove Hazard / Secure
Scene
Signalized
Intersection SIG111 High
GOLDEN GATE PKWY@SUNSHINE BLVD/47TH ST SW
Intersecting Street SUNSHINE BLVD
1/24/2023 Received call that mast arm was hit accident number 23-80045
2/28/2023 Created a work order for SS&L to Repair, repaint upright and replace broken nut covers.
Generated by Cartegraph Page 1 Composite Exhibit "A" to Complaint
Page 6715 of 7162
Traffic Ops Tasks Report Transportation Management
Services Department
Labor Log
Date Labor
2/24/2023 10148 Ken Martin
2/28/2023 5431 Michael Stephenson
4/27/2023 1321 Pamela Wilson
Equipment Log
Date Egui ment Description
2/28/2023 CC2-1749 Vehicle Truck
Material Log
Rate Name
Standard
Standard
Standard
Hours Cost
2.00 105.94
2.00 106.56
1.25 59.85
5.25 Total 272.35
Usage Cost
1.00 14.00
1.00 Total 14.00
Date Material Descri tion Purchase Order Quantit Cost
Other Log
Date
3/31/2023
Task Cost
Labor Cost
272.35
4/27/2023
Vendor Name Cost
SOUTHERN SIGNAL AND
LIGHTING
3024.32
Equipment Cost
14.00
Total 3024.32
Material Cost
0.00
Generated by Cartegrap,1
0 Total 0
Notes
Invoice# 2250618.01
Other Cost Total Cost
3024.32 3310.67
Page 2 Composite Exhibit "A" to Complaint
Page 6716 of 7162
•
•
•
Collier County Traffic Operations:Department
2885 South Horseshoe Drive• Naples, FL 34104
Office: (239) 252-8260, Fax: (239) 252-5868
NOTICE TO PROCEED# 23-18 Sig
TO: Southern Signal & Lighting
P.O. Box 5142
Hudson, FL 34674
Job Location:
Golden Gate Pkwy @ Sunshine Blvd
NOTICE TO PROCEED
DATE: 02/24/2023
Ii] ROUTINE O EMERGENCY
County Purchase Order No: 4500220041
Collier County RFP #: 19-7541
Prepared By: Mike Stephenson
Cartegraph Task#: 692377
Contact Name: Gregory Garcia
Contact Phone: 239-253-2252
Contract Time: Description of Work:
Repair, repaint mast pole upright on the northwest corner from
top to bottom and replace all damaged and missing nut covers.
Per Contract
You are authorized to use subcontractors as needed for this (Normal = 1 week) NTP
(Emergency = less Contract Gregory Garcia 239-252-5000 72 hours prior to the
than 2 hours) beginning of work
NOTE: The aforementioned work shall be initiated per the Contract Time noted above (unless otherwise
requested in writing and approved by the Traffic Operations Chief Engineer) after receipt of this NTP which
must be attached to your invoice. County Inspection Staff shall be notified when each phase of the
aforementioned work is completed for review and approval. Upon review and approval of the aforementioned
work, prior to the submittal of any furnish or install payment request(s), an "As Built Schematic" of all
underground work, material quantities, and/or labor shall be provided if the underground routing of existing
components was changed.
0 REJECTED
Reason:
Date:
0 ACCEPTED Date:
Inspected By: ________________ _
Traffic Signal & Roadway Lighting Technician
CONTRACTOR:
Authorized By:
Print Name:
Signature
Date of Work Order Acceptance: ______ _
Date Work Completed: __________ _
Date Submitted for Final Inspection: _____ _
Date Submitted for Reinspection: ______ _
Composite Exhibit "A" to Complaint
Page 6717 of 7162
Southern Signal & Lighting, Inc.
Phone # 727-819-2061
Fax# 727-857-4097
southernsignalandlighting@gmail.com
Account# 114725
Bill To
Collier County Board of County Commission
Attn: Accounts Payable
3299 Tamiami Tri E Ste 700
Naples, FL 34112-57 49
Item Description
Supervisor Labor Per Man Hour -Supervisor
Laborer Labor Per Man Hour -Laborer
HeavyEq-BKT Heavy Equipment -Bucket Truck
Materials
Material Cost SHLXN800 UDB 1.25G
Material Markup Markup on Materials
Material Tax Tax on Materials
Material Freight Freight on Materials
Materials
Materials
Material Cost MAC646 ULDEEP 2G
Material Markup Markup on Materials
Material Tax Tax on Materials
Material Freight Freight on Materials
Materials
Materials
Material Cost DENATURED ALCOHOL
Material Markup Markup on Materials
Material Tax Tax on Materials
Material Freight Freight on Materials
Materials
Materials
Material Cost BOLT COVERS
Material Markup Markup on Maierials
Material Freight Freight on Materials
Materials
Materials
Material Cost 1/4-20 X 1 SOCKET SET SCREW SS
Material Markup Markup on Materials
Material Tax Tax on Materials
Material Freight Freight on Materials
Remit To Address:
16909 US Highway 19
Hudson, FL 34667
Invoice# 2250618.01
Revised Inv#
Date 3/31/2023
SSL Job# 2250618 Golden Gate Pky @ Sunshine
Name Mast Arm Painting Repairs
Location GG Pky @ Sunshine Blvd
WO# 23-18 SIG
PO# 4500220041
Bid# 19-7541
Project
Bill Ref 692377
Unit of Measure Unit Price Quantity Amount
-MH 77.00 14 1,078.00
MH 60.50 14 847.00
HR 66.00 11 726.00
152.74 0.5 76.37
10.00% 7.64
7.00% 5.35
0.00 0.00
0.00 89.36
136.80 0.5 68.40
10.00% 6.84
7.00% 4.79
0.00 0.00
0.00 80.03
19.63 0.5 9.82
10.00% 0.98
7.00% 0.69
0.00 0.00
0.00 11.49
70.00 2 140.00
10.00% 14.00
0.00 0.00
0.00 154.00
1.72 12 20.64
10.00% 2.06
7.00% 1.44
0.00 0.00
Total
Payments/Credits
Balance Due
Page 1
Composite Exhibit "A" to Complaint
Page 6718 of 7162
Southern Signal & Lighting, Inc. /t-takin(J '/c,tJaJs Sa61l>' & 731'i(JAtll1' SinctZ 2001/-Invoice# 2250618.01
Revised Inv#
Phone# 727-819-2061
Fax# 727-857-4097 Date 3/31/2023
southernsignalandlighting@g mail.com SSL Job# 2250618 Golden Gate Pky@ Sunshine
Account# 114725 Name Mast Arm Painting Repairs
Location GG Pky @ Sunshine Blvd
WO# 23-18SIG
Bill To PO# 4500220041
Collier County Board of County Commission Bid# 19-7541
Attn: Accounts Payable
3299 Tamiami Tri E Ste 700 Project
Naples, FL 34112-5749
Bill Ref 692377
Item Description Unit of Measure Unit Price Quantity Amount
Materials 0.00 24.14
Materials
Material Cost 4 VELOUR ROLLER 3.056 4 12.22
Material Markup Markup on Materials 10.00% 1.22
Material Tax Tax on Materials 7.00% 0.86
Material Freight Freight on Materials 0.00 0.00
Materials 0.00 14.30
Remit To Address: Total $3,024.32
16909 US Highway 19 Payments/Credits $0.00
Hudson, FL 34667 Balance Due $3,024.32
Page 2
Composite Exhibit "A" to Complaint
Page 6719 of 7162
Collier County Traffic Operations1Department
2885 South Horseshoe Drive• Nap.les, FL 34104
Office: (239) 252-8260, Fax: (239) 252-5868
NOTICE TO PROCEED
NOTICE TO PROCEED# 23-18 Sig DATE: 02/24/2023
TO: Southern Signal & Lighting
P.O. Box 5142
Hudson, FL 34674
Job Location:
Golden Gate Pkwy @ Sunshine Blvd
[i] ROUTINE O EMERGENCY
County Purchase Order No: 4500220041
Collier County RFP #: 19-7541
Prepared By: Mike Stephenson
Cartegraph Task#: 692377
Contact Name: Gregory Garcia
Contact Phone: 239-253-2252
Contract Ti me: Description of Work:
Repair, repaint mast pole upright on the northwest corner from
top to bottom and replace all damaged and missing nut covers.
Per Contract
You are authorized to use subcontractors as needed for this (Normal = 1 week) NTP
(Emergency = less Contract Gregory Garcia 239-252-5000 72 hours prior to the
than 2 hours) beginning of work
NOTE: The aforementioned work shall be initiated per the Contract Time noted above (unless otherwise
requested in writing and approved by the Traffic Operations Chief Engineer) after receipt of this NTP which
must be attached to your invoice. County Inspection Staff shall be notified when each phase of the
aforementioned work is completed for review and approval. Upon review and approval of the aforementioned
work, prior to the submittal of any furnish or install payment request(s), an "As Built Schematic" of all
underground work, material quantities, and/or labor shall be provided if the underground routing of existing
components was changed.
0 REJECTED
Reason:
Date:
0 ACCEPTED Date:
Inspected By: ________________ _
Traffic Signal & Roadway Lighting Technician
CONTRACTOR:
Authorized By:
Print Name: _____________ _ DANIELA G
COLEMAN
Digitally signed by DANIELA G
COLEMAN
Date: 2023 03 31 15-40·53 -04'00' Signature
Date of Work Order Acceptance: ______ _
Date Work Completed: __________ _
Date Submitted for Final Inspection: _____ _
Date Submitted for Reinspection: ______ _
Composite Exhibit "A" to Complaint
Page 6720 of 7162
•
•
•
2-24-23 Golden Gate parkway and Sunshine upright damage Task 692377 Crash report CCSO 23-80045
CCTO Claim 3031 Stars 50-02242313728
Composite Exhibit "A" to Complaint
Page 6721 of 7162
•
•
2-24-23 Golden Gate parkway and Sunshine upright damage Task 692377 Crash report CCSO 23-80045
CCTO Claim 3031 Stars 50-02242313728
Composite Exhibit "A" to Complaint
Page 6722 of 7162