FLORIDA TRAFFIC CRASH REPORT HIGHWAY SAFETY & MOTOR VEHICLES,

LONG FORM X SHORT FORM 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
11/Feb/2023 03:28 PM 11/Feb/2023 03:28 PM 11/Feb/2023 12:00 AM 2023004140 24841257

CRASH IDENTIFIERS
County Code City Code County of Crash Place or City of Crash Within City Limits Time Reported Time Dispatched
01 54 MIAMI-DADE HIALEAH Yes 11/Feb/2023 11/Feb/2023
03:28 PM 03:31 PM
Time on Scene Time Cleared Scene Completed Reason (if Investigation NOT Completed) Notified By
11/Feb/2023 11/Feb/2023 04:00 Yes Law Enforcement
03:43 PM PM

ROADWAY INFORMATION
Crash Occured On Street, Road, Highway At Street Address# At Lattitude and Longitude
W 12TH AVE 25.866604 -80.306842

At Feet Or Miles Direction From Intersection With Street, Road, Highway Or From Milepost #
W 49TH ST
Road System Identifier Type Of Shoulder Type Of Intersection
5 Local 1 Paved 2 Four-Way 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 1 Front to Rear
First Harmful Event Type First Harmful Event First Harmful Event Location Within Interchange First Harmful Event Relation to Junction
14 1 On Roadway No 2 Intersection
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 QUWN95 FL 04/Apr/2023 2T3W1RFV5MW124409
Year Make Model Style Color Extent of Damage Est. Damage Towed Due To Damage Vehicle Removed By Rotation
2021 TOYT RAV4 UT RED Functional 600 No DRIVER Driver
Insurance Company Insurance Policy Number
INFINITY AUTO INSURANCE 109901214243001
Name of Vehicle Owner (Check Box If Business) Current Address (Number and Street) City and State Zip Code
OSVALDO OSABA HERNANDEZ 1315 W 29TH ST APT 312 HIALEAH FL 33012
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: West W 49 ST 10 30 6
CMV Configuration Cargo Body Type Area of Initial Impact Most Damaged Area

Comm GVWR/GCWR Trailer Type (trailer one) Trailer Type (trailer two)
4 Not Applicable
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
16 (Sport) Utility Vehicle 1 None 1 No 1 No Special Function
Vehicle Maneuver Action Trafficway Roadway Grade Roadway Alignment Most Harmful Event Most Harmful Event Detail
3 Turning Left 1 Two-Way, Not Divided 1 Level 1 Straight 2 Collision with Non-Fixed 14 Motor Vehicle in Transport
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 CRTM38 FL 22/Oct/2023 1D4GP25B36B731974
Year Make Model Style Color Extent of Damage Est. Damage Towed Due To Damage Vehicle Removed By Rotation
2006 DODG CARAVAN VN RED Functional 600 No DRIVER Driver
Insurance Company Insurance Policy Number
INFINITY AUTO INSURANCE 109901161008001

HSMV 90010 S Page 1 of 4

Date of Crash Date of Report Invest. Agency Report Number HSMV Crash Report Number
11/Feb/2023 03:28 PM 11/Feb/2023 03:28 PM 2023004140 24841257

Name of Vehicle Owner (Check Box If Business) Current Address (Number and Street) City and State Zip Code
HENRY LICOR LLERENA 1115 W 51 PL HIALEAH FL 33012
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 W 12 AVE 15 30 4
CMV Configuration Cargo Body Type Area of Initial Impact Most Damaged Area

Comm GVWR/GCWR Trailer Type (trailer one) Trailer Type (trailer two)
4 Not Applicable
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
2 Passenger Van 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 1 Two-Way, Not Divided 1 Level 1 Straight 2 Collision with Non-Fixed 14 Motor Vehicle in Transport
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
5 Traffic Control Signal 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 ROSELY MARIA LICOR VILLANUEVA 27/Jan/1999 2 Female No
Address City State Zip Code
1115 W 51 PL HIALEAH FL 33012
Driver License Number State Expires DL Type Req. End. Injury Severity Ejection
L261733995270 FL 27/Jan/2032 5 E/Operator 2 No 1 None 1 Not Ejected
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 1 Left 1 Front 1 Not Applicable
Used
Drivers Actions at Time of Crash (first) Drivers Actions at Time of Crash (second) Driver Distracted By Vision Obstruction
11 Ran Red Light 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 No
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
2 1 Driver 2 OSVALDO OSABA HERNANDEZ 04/Apr/1980 1 Male No
Address City State Zip Code
1315 W 29TH ST APT 312 HIALEAH FL 33012
Driver License Number State Expires DL Type Req. End. Injury Severity Ejection
O216640801240 FL 04/Apr/2028 5 E/Operator 2 No 1 None 1 Not Ejected
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 1 Left 1 Front 1 Not Applicable
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
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 No
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
3 3 Passenger 2 DAILY CRUZ GONZALEZ 12/Nov/1982 2 Female 1 None 1 Not
Ejected
Address City State Zip Code
1315 W 29 ST APT 312 HIALEAH FL 33012

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Date of Crash Date of Report Invest. Agency Report Number HSMV Crash Report Number
11/Feb/2023 03:28 PM 11/Feb/2023 03:28 PM 2023004140 24841257

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 1 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 Injury Severity Ejection
4 3 Passenger 2 OSDIEL OSABA 10/Nov/2007 1 Male 1 None 1 Not
Ejected
Address City State Zip Code
1315 W 29 ST APT 312 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 2 1
Used
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 ROSELY MARIA LICOR VILLANUEVA 316.074(1) FAIL TO OBEY TRAFFIC CONTROL SIGNAL (FAILED TO AGFO2SE
STOP AT TRAFF
NARRATIVE
Vehicle #1 was traveling Southbound on West 12th Avenue, approaching West 49th Street.
Vehicle #2 was traveling Westbound on West 49th Street, approaching West 12th Avenue, attempting to make a left turn with a green light.
Driver of Vehicle #1 failed to stop at a red light and collided with Vehicle #2.
Based on physical evidence and statements provided, driver of vehicle #1 was found at fault and cited for the accident.
No other passengers and no injuries observed or reported on scene.
Drivers exchange issued.

REPORTING OFFICER
ID/Badge # Rank and Name Department Type of Department
2395 MPSA Y.LORENZO HIALEAH POLICE DEPARTMENT PD

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Date of Crash Date of Report Invest. Agency Report Number HSMV Crash Report Number
11/Feb/2023 03:28 PM 11/Feb/2023 03:28 PM 2023004140 24841257

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