314-24 Attachment.pdf

96 97 98 99 05 01 01 07 1 of 3 Page 1. Case Number New Jersey Police Crash Investigation Report Fatal 19024549 2. Police Dept. of 10. Crash Occurred On: DEVON DR N Dir 25 Road Name At Intersection with N Feet S Miles 15 16 Code 01 WEST ORANGE 3. Station/Precinct - 14 100a 4. Date of Crash mm dd 100b 23. Veh. # 5. Day of Week Su M Tu W 6. Time 7. Municipality 05 101 102 103 104 02 24. Policy No. 25. NJ Ins. Code 53. Veh. # Parked 26. Driver's First Name 106 107 108 27. Number & Street 01 28. City 01 30. Eyes 109 110 111 112 113 114 115 116 117 01 - DL Class Restrictions - - 2 - - - . - - - - - - - - 55. NJ Ins. Code - Parked 56. Driver's First Name - Ped Initial Pedalcylist Last Name - Resp. to Emergency Hit & Run 59. Sex - - 58. City State - - Endorsements 31. State 60. Eyes 63374 62812 Initial 34. Expires mm yy yy Restrictions - - Last Name -- -Initial - 119 COLES STREET - JERSEY CITY 38. Make 39. Model 40. Color 41. Year HONDA PILOT GY Zip NJ 07302 - 123 64. Expires mm yy - yy - 01 - - - - Last Name 124 11 - 125 - 2019 J38-KTT 44. VIN - 43. State NJ 45. Expires 12/22 5 F N Y F 6 H 5 4 K B 0 2 3 0 3 2 46. Vehicle Removed to: State Zip - - 68. Make 69. Model 70. Color 71. Year 72. Plate No. - - - - - 74. VIN 126a 99 73. State - 126c -- -- - - - - - - - - - - - - - - - - - Towed Disabled Towed Impounded - 47. Authority - 48. Alcohol Drug Test No Given: Type: Breath Driven Towed Disabled Left at Scene Towed Impounded 126e Towed Disabled & Impounded 39 127a 77. Authority Driver Owner Yes Police Refused Urine Blood 0. - - % Results: Towed Disabled & Impounded Pending 50. Carrier No. - - - - - - - - - - - - - USDOT MC/MX None Driver Owner 49. Hazardous Material None On Board Spill - - - - Hazard Class 51. GVWR / GCWR 10,000 lbs. 78. Alcohol Drug Test No Given: Type: Breath 0. Results: Placard No. (trucks & buses only) Yes % Refused Urine Blood Pending - - - - - - - - - - - - - 10,001 - 26,000 lbs. MC/MX 26,001 lbs. 52. Motor Carrier or Government Entity - Police 80. Carrier No. USDOT None 127b 79. Hazardous Material None On Board - Spill - - - - Hazard Class 81. GVWR / GCWR 10,000 lbs. Placard No. (trucks & buses only) 10,001 - 26,000 lbs. 39 129 12 - 135. Damage to Other

127b 79. Hazardous Material None On Board - Spill - - - - Hazard Class 81. GVWR / GCWR 10,000 lbs. Placard No. (trucks & buses only) 10,001 - 26,000 lbs. 39 129 12 - 135. Damage to Other Property State Zip City State Zip - - - - - No Yes (If Yes, describe) 128 Number & Street City - 127d - 26,001 lbs. - - 127c 127e 82. Motor Carrier or Government Entity Number & Street - 126d - Left at Scene 126b 75. Expires 76. Vehicle Removed to: - 121b - - 67. City 42. Plate No. 121a 122 State 01 120b Zip - - - - - - Same as Driver 66. Number & Street 37. City - 120a 61. State 63. DOB mm dd 65. Owner's First Name EKLAVYA SARAF 119b Endorsements - - - - 62. Driver's License Number 0 1 2 0 -- 1 2 0 6 8 1 DL Class - - NJ - - 07302 - - 02 - EB WB - - . - - - - - - 54. Policy No. - 5 NB SB 22. Longitude Zip 36. Number & Street - 119a State 33. DOB mm dd Driven 01 13. Milepost 18. Speed Limit NJ - - - - 32. Driver's License Number Same as Driver 118b - JERSEY CITY S0533 12. Route No. To: 17. Cross Road Name/Route No. From: 20 Route Name/Route No. 21. Latitude 19. Ramp - F SARAF - - Hit & Run 29. Sex - - - . - - - - - - - 5 118a 57. Number & Street 35. Owner's First Name 04 Resp. to Emergency 119 COLES STREET - Pedalcylist Last Name - 01 15 Initial PRICILLA 0 2 105 Ped 2 Change Report Non-Reportable MOUNTAIN WAY of: 9. Total Injured 148 4212-09-39-28 01 E W 8. Total Code Killed - - - - (use 2400 hrs.) 01 0 7 1 2 1 9 -Th O 12 1 6 0 7 22 - F -Sa yy Reportable 11. Speed Limit 130 12 131 - - 132 Oper. 136. Charge - 137. Summons No. - Oper. - 141. Summons No. 84 85 86 A 01 01 01 B 01 05 C 01 D 01 Oper. - - 83 138. Charge - - 140. Charge Oper. - - 142. Charge 143. Summons No. - 94 95 Names & Addresses of Occupants If Deceased, Date & Time of Death 87 88 89 90 91 92 - 37 F - - - 11 04 - - PRICILLA SARAF 119 COLES STREET JERSEY CITY NJ 07302 01 - 37 M - - - 04 04 - - EKLAVYA SARAF 119 COLES STREET JERSEY CITY NJ 07302 06 01 - 01 F - - - 06 06 - - AMALIA SARAF 119 COLES STREET JERSEY CITY NJ 07302 04 01 - 03 M - - - 06 06 - - OSCAR SARAF 119 COLES STREET JERSEY CITY NJ 07302 NJTR-1 (Rev. 01/17) 93 139. Summons No. 133 03 134 -