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 20027636 2. Police Dept. of 10. Crash Occurred On: MANCHESTER RD E Dir 100 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 04 101 102 103 104 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 02 30. Eyes 109 110 111 112 113 114 115 116 117 Restrictions OP Same as Driver 72571 04494 2 To: 17. Cross Road Name/Route No. From: 20 Route Name/Route No. 21. Latitude 19. Ramp - - - . - - - - - - - - 55. NJ Ins. Code 4032283493 Parked 56. Driver's First Name 148 Ped Initial - Pedalcylist Last Name - Resp. to Emergency Hit & Run 59. Sex - State - - Endorsements 31. State 60. Eyes Initial 34. Expires mm yy yy Restrictions - - Last Name -- -- 61. State - - - 63. DOB mm dd WEST ORANGE 39. Model 40. Color 41. Year Initial Last Name VAN WT NJ 07052 11 125 11 1981 XN945R 44. VIN WEST ORANGE 43. State NJ 45. Expires 09/21 1 G T G P 3 2 M4 B 3 5 0 2 7 9 6 46. Vehicle Removed to: 68. Make 69. Model 70. Color 71. Year JEEP WRANGLER BK 126a State Zip NJ 07052 72. Plate No. 73. State 2013 C39MRJ 74. VIN NJ 75. Expires 08/21 1 C 4 A J WA G 9 D L 5 2 5 1 2 6 76. Vehicle Removed to: Towed Disabled Towed Impounded - 47. Authority 03 48. Alcohol Drug Test No Given: Type: Breath Driver Yes Police Driven Towed Disabled Left at Scene Towed Impounded Towed Disabled & Impounded Refused Urine Blood 0. - - % Pending 50. Carrier No. - - - - - - - - - - - - - USDOT MC/MX None Spill - - - - Hazard Class 51. GVWR / GCWR 10,000 lbs. 78. Alcohol Drug Test No Given: Type: Breath 0. Results: Placard No. (trucks & buses only) 28 Yes % Refused Urine Blood Pending - - - - - - - - - - - - - 10,001 - 26,000 lbs. MC/MX 26,001 lbs. 52. Motor Carrier or Government Entity 26 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. 28 129 07 - 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. 28 129 07 - 135. Damage to Other Property State Zip City State Zip - - - - - No Yes (If Yes, describe) 128 Number & Street City - 127d 26 26,001 lbs. - - 127c 127e 82. Motor Carrier or Government Entity Number & Street - 126d 127a Driver Owner 49. Hazardous Material None On Board 126c 126e 77. Authority Owner Results: Towed Disabled & Impounded 28 126b - Left at Scene 10 124 67. City 42. Plate No. 01 121b - - - - 28 WESTMINSTER TER Zip 121a 13 TESHA R GARY State 01 120b 123 Same as Driver 66. Number & Street 6 ORANGE PL - 120a 122 64. Expires mm yy yy - - - - - - 65. Owner's First Name 37. City 119b Zip Endorsements - - - - 62. Driver's License Number 0 4 2 2 -- 0 4 2 5 4 9 DL Class - - NJ - - 58. City - - 02 25 EB WB - - . - - - - - - 54. Policy No. 02 5 NB SB 22. Longitude 08736 36. Number & Street 02 119a Zip SJ BURY PLUMBING LLC Driven 02 13. Milepost 18. Speed Limit State 33. DOB mm dd - - 12. Route No. NJ - - - - 32. Driver's License Number B9419 118b - DL Class 04 GMC 01 M BURY MANASQUAN 38. Make 02 Hit & Run 29. Sex - - - . - - - - - - - 5 118a 57. Number & Street 35. Owner's First Name 03 Resp. to Emergency 395 FIRST AVE - Pedalcylist Last Name J 01 08 Initial STUART 0 4 105 Ped 2 Change Report Non-Reportable WESTMINSTER TER of: 9. Total Injured 148 07541587-6 01 E W 8. Total Code Killed - - - - (use 2400 hrs.) 01 1 0 0 8 2 0 O 15 1 9 0 7 22 - Th -F -Sa yy Reportable 11. Speed Limit 130 07 131 10 - 132 10 Oper. 136. Charge - - Oper. 141. Summons No. 83 84 85 86 87 88 89 90 91 92 01 01 01 05 71 M - - - 11 04 C D NJTR-1 (Rev. 01/17) 138. Charge Oper. - - B Oper. - - 140. Charge A 137. Summons No. 93 - - 142. Charge 143. Summons No. - 94 - 139. Summons No. 95 - Names & Addresses of Occupants If Deceased, Date & Time of Death STUART J BURY 395 FIRST AVE MANASQUAN NJ 08736 133 02 134 02