U
N
I
T
1
|
Driver's Name - Last PUDENZ |
First MARVIN |
Middle EDWARD |
Suffix
|
City BREDA |
State IA - Iowa, US |
Zip 514360000 |
Driver's Age 52 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State IA - Iowa, US |
Class A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more |
Endorsements None |
Restrictions
B - Cor Lenses |
Citation Charge Code 2
|
Citation Charge 2
|
Alcohol Test Given? 4 - Breath |
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 6 - Not applicable |
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 JUERGENS PRODUCE & FEED COMPANY |
Year 2000 |
Make
|
Model
|
Style TRUCK TRACTOR |
Approximate Cost to Repair or Replace 35000 |
Initial Travel Direction 4 - West |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 55 |
Point of Initial Impact 01 - Front |
Most Damaged Area 01 - Front |
Extent of Damage 5 - Severe, vehicle totaled |
Underride/Override 1 - None |
Total Occupants 1 |
Traffic Controls 01 - No controls present |
Vehicle Config. 09 - Tractor/semi-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 21 - Vehicle in traffic |
Second Event 03 - Ran off road, left |
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 JUERGENS PRODUCE & FEED COMPANY |
City CARROLL |
State IA - Iowa, US |
Zip 514012157 |
Number of Axles 5 |
Gross Vehicle Weight Rating 90000 |
Placard #
|
Hazardous Materials Released? 2 - No |
U
N
I
T
2
|
Driver's Name - Last BRINKER |
First KENNETH |
Middle NORBERT |
Suffix
|
City HARLAN |
State IA - Iowa, US |
Zip 51537 |
Driver's Age 64 |
Citation Charge Code 1
|
Citation Charge 1
|
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
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 1 - Fatal |
Occupant Protection 9 - Unknown |
Airbag Deployment 9 - Unknown |
Airbag Switch Status 9 - Unknown |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 3 - Extricated by mechanical means |
Transported to:
|
Transported by:
|
Insurance Co. Name
|
Year 2006 |
Make Chevrolet - CHEV |
Model SILVERADO |
Style 4D |
Approximate Cost to Repair or Replace 20000 |
Initial Travel Direction 3 - South |
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 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 9 - Unknown |
Vision Obscured 01 - Not obscured |
Contributing Circumstances, Driver (up to 2)
|
| SEQUENCE OF EVENTS |
First Event 21 - Vehicle in traffic |
Second Event 01 - Ran off road, right |
Third Event
|
Fourth Event 50 - Fire/explosion |
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 |
Roadway 01 - None apparent |
Type
|
Light Conditions 1 - Daylight |
Surface Conditions 1 |
Type of Roadway Junction/Feature 11 - Four-way intersection |
Workers Present?
|
D I A G R A M
0 |
|
| NARRATIVE |
UNIT TWO WAS SOUTHBOUND ON COUNTY ROAD M66 AND WHEN IT REACHED THE STOP SIGN AT COUNTY ROAD F24 IT FAILED TO STOP AT THE STOP SIGN. UNIT ONE WAS WESTBOUND AND COLLIDED WITH UNIT TWO AT THE INTERSECTION. UNIT ONE CAME TO REST IN THE SOUTHWEST DITCH AND UNIT TWO CAME TO REST IN THE NORTHWEST DITCH. SHORTLY AFTER UNIT TWO CAME TO REST IT CAUGHT ON FIRE AND ATTEMPTS TO PULL THE DRIVER OUT WERE UNSUCCESSFUL. THE DRIVER OF UNIT TWO WAS PRONOUNCED DEAD AT THE SCENE. THE DRIVER OF UNIT ONE DIDN'T REPORT ANY INJURIES. RESPONDING TO THE CALL WERE THE IRWIN FIRE DEPT, IRWIN AMBULANCE, DEFIANCE AMBULANCE, AUDUBON COUNTY SHERIFF'S DEPT, IOWA STATE PATROL, AND IOWA DOT ENFORCEMENT. |
|
Officer
CUNNINGHAM |
Badge No. 036 |
Time Officer Notified of Accident 10:00 |
Time Officer Arrived At Scene 10:13 |
Name of Agency P04 |
Date of Report 11/2/2010 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 04 Office
3710 Highway 30 E
Denison,IA 51442-7560
Phone: (712) 263-4621
Fax: (712) 263-2325