Iowa State Patrol: Department of Public Safety

Crash Information

L
O
C
A
T
I
O
N 		Date of Accident
12/27/2010		 Time of Accident
02:25 PM 		County
Dallas - 25		 Accident occurred within corporate limits of (city)
De Soto - 1850		 Law Enforcement Case Number:
2010073520
Literal Description
US 0169 /1203 GUTHRIE ST-KUM AND GO GAS STATION (PARKING LOT) 		Legal Intervention?
No		 Private Property?
Yes
X-Coordinate:
415531.0
Y-Coordinate
4599001.
U
N
I
T

1 		Driver's Name - Last
LOTT		 First
CHARLES		 Middle
M		 Suffix
JR
City
WEST ALLIS		 State
WI - Wisconsin, US		 Zip
532270000
Driver's Age
26		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
WI - Wisconsin, US		 Class
D - Chauffeur		 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
5 - Uninjured		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
5 - Not deployed		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
 Transported by:
Insurance Co. Name
Year
2009		 Make
 Model
 Style
4D		 Approximate Cost to Repair or Replace
1500
Initial Travel Direction
9 - Unknown		 Vehicle Action
88 - Other (explain in narrative)		 Speed Limit
0		 Point of Initial Impact
07 - Left Side		 Most Damaged Area
07 - Left Side		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
Total Occupants
1		 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
13 - Other non-collision		 Second Event
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
13 - Other non-collision
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
HENDERSON		 First
AMY		 Middle
JOANNA		 Suffix
City
HOLSTEIN		 State
IA - Iowa, US		 Zip
510250000
Driver's Age
35		 Citation Charge Code 1
 Citation Charge 1
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

B - Cor Lenses		 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
5 - Uninjured		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
5 - Not deployed		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
 Transported by:
Insurance Co. Name
Year
2003		 Make
Chrysler - CHRY		 Model
VOY		 Style
VN		 Approximate Cost to Repair or Replace
800
Initial Travel Direction
9 - Unknown		 Vehicle Action
09 - Backing		 Speed Limit
0		 Point of Initial Impact
05 - Rear		 Most Damaged Area
05 - Rear		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
Total Occupants
3		 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
13 - Other non-collision		 Second Event
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
13 - Other non-collision
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
6 - Outside Trafficway		 Weather Conditions (up to two)
02 - Partly cloudy		 Environment
1 - None apparent		 Location
 First Harmful Event of Crash (use codes 11-42 only)
13 - Other non-collision
Manner of Crash/Collision
1 - Non-collision		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
2		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
D
I
A
G
R
A
M

0
NARRATIVE

**** EXPLAIN THE VEHICLE ACTION FOR UNIT 001 UNIT 1 IS TURNING RIGHT TO PULL INTO A PARKING SPACE ON THE WEST SIDE OF THE KUM AND GO GAS STATION AT 1203 GUTHRIE IN DESOTO. WHILE TURNING TO PULL INTO A PARKING SPACE UNIT 2 STARTS TO BACK OUT OF THE ADJACENT PARKING SPACE. UNIT 2 THEN STRIKES THE REAR LEFT PASSENGER DOOR OF UNIT 1 WITH THE REAR RIGHT CORNER OF UNIT 2.
Officer
EVERETT 		Badge No.
455		 Time Officer Notified of Accident
14:25		 Time Officer Arrived At Scene
14:26
Name of Agency
P01		 Date of Report
12/28/2010		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 01 Office
260 NW 48th Place
Des Moines,IA 50313-2299
Phone: (515) 725-0010
Fax: (515) 725-0011