Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
9/3/2010		 Time of Accident
06:45 PM 		County
Hamilton - 40		 Accident occurred within corporate limits of (city)
Ellsworth - 2355		 Law Enforcement Case Number:
2010052013
Literal Description
I-35 131.45 MM NB 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
452973.2
Y-Coordinate
4681733.
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1 		Driver's Name - Last
ELLIOTT		 First
MATTHEW		 Middle
MICHAEL		 Suffix
City
JESUP		 State
IA - Iowa, US		 Zip
500140000
Driver's Age
22		 Citation Charge Code 1
321.20B-B		 Citation Charge 1
VIOLATION - FINANCIAL LIABILITY - ACCIDENT
Gender
Male		 State
IA - Iowa, US		 Class
C - Non-commercial vehicle or commercial Veh w/26000 GVWR or less & either 16 Pass Design or Hazmat		 Endorsements
 Restrictions

B - Cor Lenses		 Citation Charge Code 2
321.285		 Citation Charge 2
FAILURE TO STOP WITHIN THE ASSURED CLEAR DISTANCE
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
4 - Possible		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
1 - Deployed front of person		 Airbag Switch Status
1 - Switch in ON position		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
 Transported by:
Insurance Co. Name
Year
1996		 Make
Pontiac - PONT		 Model
SNF		 Style
2D		 Approximate Cost to Repair or Replace
15000
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
4 - Disabling damage		 Underride/Override
4 - Underride, compartment intrusion unknown
Total Occupants
02		 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
06 - Evasive action (swerve, panic braking, etc.)		 Second Event
21 - Vehicle in traffic		 Third Event
 Fourth Event
10 - Separation of units		 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?
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2 		Driver's Name - Last
SEED		 First
JEFFREY		 Middle
JOHN		 Suffix
City
LAKEVILLE		 State
MN - Minnesota, US		 Zip
55044
Driver's Age
44		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
MN - Minnesota, US		 Class
B - Veh w/26001 GVWR or more Towed unit is less than 10001 GVWR		 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:
 Transported by:
Insurance Co. Name
Year
2002		 Make
General Motors - GMC		 Model
SAVANNA		 Style
SLT-VAN		 Approximate Cost to Repair or Replace
15000
Initial Travel Direction
1 - North		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
70		 Point of Initial Impact
05 - Rear		 Most Damaged Area
05 - Rear		 Extent of Damage
3 - Functional damage		 Underride/Override
9 - Unknown
Total Occupants
03		 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
06 - Evasive action (swerve, panic braking, etc.)		 Second Event
01 - Ran off road, right		 Third Event
 Fourth Event
10 - Separation of units		 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?
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
1 - None apparent		 Location
1 - Before work zone warning sign		 First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic
Manner of Crash/Collision
3 - Rear-end		 Roadway
01 - None apparent		 Type
2 - Lane shift/crossover (head-to-head traffic)
Light Conditions
1 - Daylight		 Surface Conditions
1		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
No
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D 		Name- Last
KENNEY		 First
ANDREA		 Middle
LEIGH		 Suffix
City
 State
 Zip Code
Age
20		 Sex
Female		 Unit No.
01		 Seating Position
03 - Front: Right Side		 Injury Status
3 - Non-incapacitating		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
1 - Deployed front of person		 Airbag Switch Status
1 - Switch in ON position		 Ejection
1 - Not ejected		 Ejection Path
1 - Not ejected/not applicable		 Trapped
1 - Not trapped
Transported to:
 Transported by:
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
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D 		Name- Last
SEED		 First
SHARON		 Middle
LOUISE		 Suffix
City
 State
 Zip Code
Age
46		 Sex
Female		 Unit No.
02		 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:
 Transported by:
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
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D 		Name- Last
SEED		 First
BLAKE		 Middle
WESTON		 Suffix
City
 State
 Zip Code
Age
8		 Sex
Male		 Unit No.
02		 Seating Position
09 - Rear: 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:
 Transported by:
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
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NARRATIVE

VEHICLE #2 WAS SLOWING FOR TRAFFIC IN ROADWAY . VEHICLE #1 ATTEMPTED TO AVOID A VEHICLE SLOWING IN THE LEFT LANE THAT HAD VEERED TO THE RIGHT. VEHICLE #1 STRUCK VEHICLE #2 ON THE LEFT SHOULDER OF THE ROAD. ALL SUBJECTS AND PASSENGERS IN BOTH VEHICLES COMPLAINED OF INJURIES BUT REFUSED AN AMBULANCE. DRIVER OF VEHICLE #1 DID NOT HAVE INSURANCE. HE WAS ISSUED A CITATION FOR NO INSURANCE AND FAILURE TO STOP IN A SAFE AND SURE DISTANCE.
Officer
EIMERS 		Badge No.
273		 Time Officer Notified of Accident
18:05		 Time Officer Arrived At Scene
18:15
Name of Agency
P07		 Date of Report
9/3/2010		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 07 Office
2437 235th St
Ft Dodge,IA 50501-8465
Phone: (515) 972-4213
Fax: (515) 972-4218