Crash Information

L O C A T I O N	Date of Accident 10/9/2010	Time of Accident 07:37 PM	County Van Buren - 89	Accident occurred within corporate limits of (city)	Law Enforcement Case Number: 2010058390
	Literal Description J040 / RTE J40 and J040 / 160 ST and W046 / 100 AVE				Legal Intervention? No	Private Property? No
					X-Coordinate: 608224.6
					Y-Coordinate 4509130.

U N I T 1	Driver's Name - Last			First			Middle		Suffix
	City			State				Zip
	Driver's Age					Citation Charge Code 1		Citation Charge 1
	Gender	State	Class	Endorsements None	Restrictions None	Citation Charge Code 2		Citation Charge 2
	Alcohol Test Given?			Drug Test Given?		Citation Charge Code 3		Citation Charge 3
						Citation Charge Code 4		Citation Charge 4
	Seating Position	Injury Status	Occupant Protection		Airbag Deployment	Airbag Switch Status		Ejection	Ejection Path	Trapped
	Transported to:					Transported by:
	Insurance Co. Name
	Year 1996		Make Toyota - TOYT		Model T100		Style XTRACAB		Approximate Cost to Repair or Replace 1500
	Initial Travel Direction 1 - North	Vehicle Action 13 - Illegally Parked/unattended	Speed Limit 55	Point of Initial Impact 03 - Right Side	Most Damaged Area 03 - Right Side	Extent of Damage 3 - Functional damage	Underride/Override 1 - None
	Total Occupants 1	Traffic Controls 04 - Stop signs	Vehicle Config. 02 - Four-tire light truck (pick-up, panel)	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 12 - Jackknife	Second Event 08 - Cargo/equipment loss or shift	Third Event	Fourth Event 21 - Vehicle in traffic	Most Harmful Event (by vehicle) 23 - Parked motor vehicle
	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 CAMERON			First THOMAS			Middle KEITH		Suffix
	City BURLINGTON			State IA - Iowa, US				Zip 52601
	Driver's Age 75					Citation Charge Code 1 321.98		Citation Charge 1 OPERATION W/O REGISTRATION
	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 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 4 - Possible	Occupant Protection 2 - Shoulder and lap belt used		Airbag Deployment 1 - Deployed front of person	Airbag Switch Status 9 - Unknown		Ejection 1 - Not ejected	Ejection Path	Trapped 1 - Not trapped
	Transported to: FORT MADISON					Transported by: FARMINGTON EMS
	Insurance Co. Name
	Year 2007		Make Honda - HOND		Model CR-V		Style EX-L		Approximate Cost to Repair or Replace 5000
	Initial Travel Direction 2 - East	Vehicle Action 01 - Movement essentially straight	Speed Limit 55	Point of Initial Impact 01 - Front	Most Damaged Area 01 - Front	Extent of Damage 4 - Disabling damage	Underride/Override 1 - None
	Total Occupants 2	Traffic Controls 01 - No controls present	Vehicle Config. 04 - Sport utility vehicle	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 21 - Vehicle in traffic	Second Event	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			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	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
CAMERON

First
LINDA

Middle
GLADYS

Suffix

City

State

Zip Code

Age
71

Sex
Female

Unit No.
2

Seating Position
03 - Front: Right Side

Injury Status
4 - Possible

Occupant Protection
2 - Shoulder and lap belt used

Airbag Deployment
1 - Deployed front of person

Airbag Switch Status
9 - Unknown

Ejection
1 - Not ejected

Ejection Path
1 - Not ejected/not applicable

Trapped
1 - Not trapped

Transported to:
FORT MADISON HOSPITAL

Transported by:
FARMINGTON EMS

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 NORTH ON HIGHWAY W46 PULLING A BOAT TRAILER, WHEN IT FAILED TO STOP IN TIME FOR THE STOP SIGN. UNIT #1 JACKKNIFED CAUSING THE BOAT TO COME OFF THE TRAILER. UNIT #1 ATTEMPTED TO LOAD THE BOAT ONTO THE TRAILER WHEN UNIT #2 BROADSIDED UNIT #1 ON HIGHWAY J40. UNIT #1 WAS CITED FOR PARKING ON THE TRAVEL PORTION OF THE ROAD.

Officer BUCKALEW	Badge No. 090	Time Officer Notified of Accident 19:37	Time Officer Arrived At Scene 20:04
Name of Agency P13	Date of Report 10/10/2010	Investigation made at scene? Yes	T.I. #

Any questions about this report may be directed to the following address:
Iowa State Patrol District 13 Office
1300 S Grand Ave
Mt Pleasant,IA 52641-1862
Phone: (319) 385-8715
Fax: (319) 385-2743