Vehicle Modification for a Person with Disabilities in Mystic , CT

2026-11-03

EHICLE EVALUATION REPORT Date of Evaluation : 9 / 19 / 25 and 3 / 16 / 26 ☑ Intent to modify a NEW vehicle Туре of Vehicle to be Purchased : MNIVAN CHRYSLER PACIFICA XT BRAUN CONVERSION PASSENGER ONLY Disability : Quadriplegia , unspecified History of Muscle Spasms : Minimal in Lower extremities Height : 51 . 5 " seated in wheelchair Weight : 250lbs Vehicle Used For Evaluation : ESMC ' s 2019 Dodge Grand Caravan Wheelchair Used During Evaluation : Permobil F5 Wheelchair to be used for vehicle modification : Yes Town Where Consumer Lives : Mystic ENTRY / WHEELCHAIR SECUREMENT / INTERIOR 1 . Outside Ramp Operation Remote 2 . wheelchair Access Ramp for lowered floor vehicle with kneeling feature Side - Entry Power Fold Out 3 . Automatic Door Opener Slide 4 . Lowered Floor 5 6 . Doог Орening height must accommodate : 51 . 5 " Minivan with Kneeling Feature Wheelchair Tiedown ☑ Power Securement ( release to be mounted for independent use by client ) Passenger Position Manual Retractable Tie Downs for use to ride as passenger in the midsection Seatbelt Tyре 2А Rigid Female Receptacle N ADDITION TO THE ITEMS INCLUDED IN THIS REPORT , IT IS RECOMMENDED THAT CLIENT ' S CONSIDER THE БAСTORY DPTIONS BELOW . NOTE THAT BHS IS NOT FACTORY OFLLONS BELOW NOTEHAT BRSIS NOTION NOT RESPONSIBLE FOR FUNDING THESE EXTRA OPTIONS . AAA Plus ( extended distance towing package ) Air conditioning Alternator ( heavy dut Alternator ( heavy duty ) Automatic load leveling system Automatic Transmission ( with overdrive if available ) Abtoma Systeally an Backing Object Detection System ( typically available on high end packages ) Battery ( heavy duty , maintenance - free )

Connecticut

2026-05-05