Crash Information

L O C A T I O N	Date of Accident 6/6/2009	Time of Accident 02:00 AM	County Scott - 82	Accident occurred within corporate limits of (city)	Law Enforcement Case Number: 2009034402
	Literal Description MM278.6 EB 80				Legal Intervention? No	Private Property? No
					X-Coordinate: 675422.4
					Y-Coordinate 4611170.

U N I T 1	Driver's Name - Last GUERRA			First FABIAN			Middle E		Suffix
	City CHICAGO			State IL - Illinois, US				Zip 60659
	Driver's Age 41					Citation Charge Code 1		Citation Charge 1
	Gender Male	State IL - Illinois, US	Class D - Chauffeur	Endorsements None	Restrictions None	Citation Charge Code 2		Citation Charge 2
	Alcohol Test Given? 2 - Blood			Drug Test Given? 2 - Blood		Citation Charge Code 3		Citation Charge 3
						Citation Charge Code 4		Citation Charge 4
	Seating Position 01 - Front: Left Side / Motorcycle Driver	Injury Status 1 - Fatal	Occupant Protection 2 - Shoulder and lap belt used		Airbag Deployment 9 - Unknown	Airbag Switch Status 9 - Unknown		Ejection 1 - Not ejected	Ejection Path	Trapped 1 - Not trapped
	Transported to: GENISIS WEST					Transported by: UNKNOWN
	Insurance Co. Name
	Year 1997		Make Toyota - TOYT		Model AVALON		Style 4DR		Approximate Cost to Repair or Replace 35000
	Initial Travel Direction 4 - West	Vehicle Action 01 - Movement essentially straight	Speed Limit 70	Point of Initial Impact 08 - Left Front	Most Damaged Area 07 - Left Side	Extent of Damage 5 - Severe, vehicle totaled	Underride/Override 2 - Underride, compartment intrusion
	Total Occupants 2	Traffic Controls 01 - No controls present	Vehicle Config. 01 - Passenger car	Cargo Body Type 01 - Not applicable	Vehicle Defect 01 - None	Driver Condition 1 - Apparently normal	Vision Obscured 01 - Not obscured	Contributing Circumstances, Driver (up to 2)
	SEQUENCE OF EVENTS			First Event 05 - Animal or object in roadway	Second Event 06 - Evasive action (swerve, panic braking, etc.)	Third Event	Fourth Event 21 - Vehicle in traffic	Most Harmful Event (by vehicle) 21 - Vehicle in traffic
	Emergency Vehicle Type 1 - Not applicable					Emergency Status 3 - Not Applicable
	Carrier Name			City		State			Zip
	Number of Axles			Gross Vehicle Weight Rating		Placard #			Hazardous Materials Released?

U N I T 2	Driver's Name - Last EDELMAN			First DENNIS			Middle WAYNE		Suffix II
	City SUNSET			State TX - Texas, US				Zip 76270
	Driver's Age 38					Citation Charge Code 1		Citation Charge 1
	Gender Male	State TX - Texas, US	Class A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more	Endorsements T - Dbl/Trpl Trlr	Restrictions	Citation Charge Code 2		Citation Charge 2
	Alcohol Test Given? 1 - None			Drug Test Given? 1 - None		Citation Charge Code 3		Citation Charge 3
						Citation Charge Code 4		Citation Charge 4
	Seating Position 01 - Front: Left Side / Motorcycle Driver	Injury Status 5 - Uninjured	Occupant Protection 2 - Shoulder and lap belt used		Airbag Deployment 5 - Not deployed	Airbag Switch Status 9 - Unknown		Ejection 1 - Not ejected	Ejection Path	Trapped 1 - Not trapped
	Transported to:					Transported by:
	Insurance Co. Name CORE CARRIER CORP
	Year 2006		Make International - INTL		Model 9400I		Style CONVENTION		Approximate Cost to Repair or Replace 15000
	Initial Travel Direction 2 - East	Vehicle Action 01 - Movement essentially straight	Speed Limit 70	Point of Initial Impact 07 - Left Side	Most Damaged Area 10 - Under Carriage	Extent of Damage 4 - Disabling damage	Underride/Override 5 - Override, moving vehicle
	Total Occupants 1	Traffic Controls 01 - No controls present	Vehicle Config. 07 - Truck/trailer	Cargo Body Type 02 - Van/enclosed box	Vehicle Defect 01 - None	Driver Condition 1 - Apparently normal	Vision Obscured 01 - Not obscured	Contributing Circumstances, Driver (up to 2)
	SEQUENCE OF EVENTS			First Event 22 - Vehicle in/from other roadway	Second Event 21 - Vehicle in traffic	Third Event	Fourth Event	Most Harmful Event (by vehicle) 21 - Vehicle in traffic
	Emergency Vehicle Type 1 - Not applicable					Emergency Status 3 - Not Applicable
	Carrier Name CORE CARRIER CORP			City KANSAS CITY		State KS - Kansas, US			Zip 66106
	Number of Axles 5			Gross Vehicle Weight Rating 54000		Placard #			Hazardous Materials Released?

ACCIDENT ENVIRONMENT		ROADWAY CHARACTERISTICS Major Contributing Circumstances:	WORKZONE RELATED?	SEQUENCE OF EVENTS
Location of First Harmful Event 1 - On Roadway	Weather Conditions (up to two) 01 - Clear	Environment 6 - Animal in roadway	Location	First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic
Manner of Crash/Collision 5 - Broadside	Weather Conditions (up to two) 01 - Clear	Roadway 01 - None apparent	Type
Light Conditions 5 - Dark, roadway not lighted	Surface Conditions 1	Type of Roadway Junction/Feature 01 - No special feature	Workers Present?

P
E
R
S
O
N

I
N
J
U
R
E
D

Name- Last
HOLMAN

First
JASON

Middle
D

Suffix

City

State

Zip Code

Age
28

Sex
Male

Unit No.
1

Seating Position
01 - Front: Left Side / Motorcycle Driver

Injury Status
2 - Incapacitating

Occupant Protection
1 - None used

Airbag Deployment
9 - Unknown

Airbag Switch Status
9 - Unknown

Ejection
1 - Not ejected

Ejection Path
1 - Not ejected/not applicable

Trapped
1 - Not trapped

Transported to:
GENISIS EAST

Transported by:
UNKNOWN

NON-MOTORIST

Type

Location

Action

Condition

Safety Equipment

Contributing Circumstances

Unit No. of Vehicle Striking

D
I
A
G
R
A
M

0

NARRATIVE

UNIT 1 WAS TRAVELING WEST ON INTERSTATE 80 WHEN A DEER CAME OUT OF THE NORTH DITCH. UNIT 1 SWERVED TO MISS THE DEER AND WENT ACROSS THE MEDIAN AND STRUCK UNIT 2. UNIT 1 CAME TO REST IN THE SOUTH DITCH. UNIT 2 CAME TO REST IN THE RIGHT LANE.

Officer STREETS	Badge No. 271	Time Officer Notified of Accident 02:25	Time Officer Arrived At Scene 02:30
Name of Agency P12	Date of Report 6/6/2009	Investigation made at scene? Yes	T.I. #

Any questions about this report may be directed to the following address:
Iowa State Patrol District 12 Office
22365 20th Ave
Stockton,IA 52769-9612
Phone: (563) 284-9501
Fax: (563) 284-9504