Crash Information

L O C A T I O N	Date of Accident 8/30/2010	Time of Accident 03:30 AM	County Harrison - 43	Accident occurred within corporate limits of (city)	Law Enforcement Case Number: 2010050982
	Literal Description I-29 92.7MM NB				Legal Intervention? No	Private Property? No
					X-Coordinate: 246797.5
					Y-Coordinate 4627764.

U N I T 1	Driver's Name - Last PALOMARES PARAMO			First LUIS			Middle MIGUEL		Suffix
	City OMAHA			State NE - Nebraska, US				Zip 68108
	Driver's Age 21					Citation Charge Code 1 321.174		Citation Charge 1 NO LICENSE
	Gender Male	State NO - None, US	Class	Endorsements None	Restrictions None	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 3 - Non-incapacitating	Occupant Protection 2 - Shoulder and lap belt used		Airbag Deployment 5 - Not deployed	Airbag Switch Status 3 - No ON/OFF switch present		Ejection 1 - Not ejected	Ejection Path	Trapped 1 - Not trapped
	Transported to: N/A					Transported by: N/A
	Insurance Co. Name
	Year 1999		Make Ford - FORD		Model WINDSTAR		Style VAN		Approximate Cost to Repair or Replace 4500
	Initial Travel Direction 1 - North	Vehicle Action 01 - Movement essentially straight	Speed Limit 70	Point of Initial Impact 01 - Front	Most Damaged Area 01 - Front	Extent of Damage 5 - Severe, vehicle totaled	Underride/Override 1 - None
	Total Occupants 2	Traffic Controls 01 - No controls present	Vehicle Config. 03 - Van or mini-van	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 11 - Overturn/rollover	Most Harmful Event (by vehicle) 11 - Overturn/rollover
	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?

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) 02 - Partly cloudy	Environment 6 - Animal in roadway	Location	First Harmful Event of Crash (use codes 11-42 only) 11 - Overturn/rollover
Manner of Crash/Collision 1 - Non-collision	Weather Conditions (up to two) 02 - Partly cloudy	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
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Name- Last
CANO

First
MAURO

Middle
RIVAS

Suffix

City

State

Zip Code

Age
26

Sex
Male

Unit No.
1

Seating Position
03 - Front: Right Side

Injury Status
3 - Non-incapacitating

Occupant Protection
2 - Shoulder and lap belt used

Airbag Deployment
5 - Not deployed

Airbag Switch Status
3 - No ON/OFF switch present

Ejection
1 - Not ejected

Ejection Path
1 - Not ejected/not applicable

Trapped
1 - Not trapped

Transported to:
N/A

Transported by:
N/A

NON-MOTORIST

Type

Location

Action

Condition

Safety Equipment

Contributing Circumstances

Unit No. of Vehicle Striking

D
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A
G
R
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M

0

NARRATIVE

VEHICLE 1 WAS NORTHBOUND ON I-29 WHEN AN ANIMAL ENTERED THE ROAD. VEHICLE 1 SWERVED TO AVOID THE ANIMAL, LOST CONTROL OF THE VEHICLE AND ROLLED IT INTO THE MEDIAN. BOTH DRIVER AND PASSENGER SUFFERED VERY MINOR INJURIES AND REFUSED MEDICAL TREATMENT. THE DRIVER WAS CITED FOR NO LICENSE.

Officer BULLINGTON	Badge No. 253	Time Officer Notified of Accident 03:33	Time Officer Arrived At Scene 03:45
Name of Agency P03	Date of Report 8/30/2010	Investigation made at scene? Yes	T.I. #

Any questions about this report may be directed to the following address:
Iowa State Patrol District 03 Office
2025 Hunt Ave
Council Bluffs,IA 51503-4254
Phone: (712) 328-8001
Fax: (712) 328-1504