Crash Information

L O C A T I O N	Date of Accident 11/1/2010	Time of Accident 08:00 AM	County Buena Vista - 11	Accident occurred within corporate limits of (city)	Law Enforcement Case Number: 2010062410
	Literal Description 630TH ST				Legal Intervention? No	Private Property? No
					X-Coordinate: 340358.7
					Y-Coordinate 4718675.

U N I T 1	Driver's Name - Last LOPEZ			First KATELYNN			Middle ALICE		Suffix
	City ALBERT CITY			State IA - Iowa, US				Zip 505100000
	Driver's Age 15					Citation Charge Code 1 321.288		Citation Charge 1 FAIL TO MAINTAIN CONTROL
	Gender Female	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 7 - Minor Sch License	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 6 - Not applicable	Airbag Switch Status 3 - No ON/OFF switch present		Ejection 1 - Not ejected	Ejection Path	Trapped 1 - Not trapped
	Transported to: BUENA VISTA CO. HOSPITAL					Transported by: FATHER
	Insurance Co. Name
	Year 1995		Make		Model GCH		Style SW		Approximate Cost to Repair or Replace 4000
	Initial Travel Direction 4 - West	Vehicle Action 01 - Movement essentially straight	Speed Limit 55	Point of Initial Impact 07 - Left Side	Most Damaged Area 07 - Left Side	Extent of Damage 5 - Severe, vehicle totaled	Underride/Override 1 - None
	Total Occupants 02	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 03 - Ran off road, left	Second Event 33 - Ditch/embankment	Third Event	Fourth Event	Most Harmful Event (by vehicle) 03 - Ran off road, left
	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) 33 - Ditch/embankment
Manner of Crash/Collision 1 - Non-collision	Weather Conditions (up to two) 01 - Clear	Roadway 01 - None apparent	Type
Light Conditions 1 - Daylight	Surface Conditions 1	Type of Roadway Junction/Feature 01 - No special feature	Workers Present?

P
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Name- Last
SOUZA

First
DUSTIN

Middle

Suffix

City

State

Zip Code

Age
13

Sex
Male

Unit No.
01

Seating Position
03 - Front: Right Side

Injury Status
5 - Uninjured

Occupant Protection
2 - Shoulder and lap belt used

Airbag Deployment
6 - Not applicable

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:
BUENA VISTA CO. HOSPITAL

Transported by:
FATHER

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 WESTBOUND ON 630TH STREET. WHEN THE DRIVER LOST CONTROL WITH THE VEHICLE GOING INTO THE SOUTH DITCH FLIPPING ONTO IT'S TOP COMING TO REST IN THE MIDDLE OF 630TH STREET.

Officer MAIER	Badge No. 215	Time Officer Notified of Accident 08:16	Time Officer Arrived At Scene 08:37
Name of Agency P06	Date of Report 11/1/2010	Investigation made at scene? Yes	T.I. #

Any questions about this report may be directed to the following address:
Iowa State Patrol District 06 Office
503 W 44th St
Spencer,IA 51301-2089
Phone: (712) 262-1424
Fax: (712) 262-3222