Crash Information

L O C A T I O N	Date of Accident 12/29/2010	Time of Accident 11:36 AM	County Jasper - 50	Accident occurred within corporate limits of (city)	Law Enforcement Case Number: 2010073894
	Literal Description SB/WB Interstate 0080 measuring 325 Meters West from Interstate 0080 (Milepost 156)				Legal Intervention? No	Private Property? No
					X-Coordinate: 480294.2
					Y-Coordinate 4615848.

U N I T 1	Driver's Name - Last DAVIS			First WILLIAM			Middle JACOB		Suffix
	City BEAVERTON			State OR - Oregon, US				Zip 97006
	Driver's Age 45					Citation Charge Code 1		Citation Charge 1
	Gender Male	State OR - Oregon, US	Class A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more	Endorsements N - Tank	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 GREATWIDE DEDICATED TRANSPORT
	Year 2006		Make		Model HERITAGE		Style TR		Approximate Cost to Repair or Replace 0
	Initial Travel Direction 4 - West	Vehicle Action 01 - Movement essentially straight	Speed Limit 70	Point of Initial Impact 99 - Unknown	Most Damaged Area 99 - Unknown	Extent of Damage 1 - None	Underride/Override 1 - None
	Total Occupants 2	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 26 - Other non-fixed object (explain in narrative)	Third Event	Fourth Event	Most Harmful Event (by vehicle) 26 - Other non-fixed object (explain in narrative)
	Emergency Vehicle Type 1 - Not applicable					Emergency Status 3 - Not Applicable
	Carrier Name GREATWIDE DEDICATED TRANSPORT			City DALLAS		State TX - Texas, US			Zip 75251
	Number of Axles 5			Gross Vehicle Weight Rating 80000		Placard # N			Hazardous Materials Released? 2 - No

U N I T 2	Driver's Name - Last MICKLEY			First RALPH			Middle E		Suffix JR
	City PEKIN			State IL - Illinois, US				Zip 61554
	Driver's Age 64					Citation Charge Code 1		Citation Charge 1
	Gender Male	State IL - Illinois, US	Class D - Chauffeur	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 9 - Unknown		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 1997		Make Oldsmobile - OLDS		Model CUTLASS		Style 4D		Approximate Cost to Repair or Replace 500
	Initial Travel Direction 4 - West	Vehicle Action 01 - Movement essentially straight	Speed Limit 70	Point of Initial Impact 01 - Front	Most Damaged Area 01 - Front	Extent of Damage 3 - Functional damage	Underride/Override 1 - None
	Total Occupants 2	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 21 - Vehicle in traffic	Second Event 26 - Other non-fixed object (explain in narrative)	Third Event	Fourth Event	Most Harmful Event (by vehicle) 26 - Other non-fixed object (explain in narrative)
	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) 04 - Fog, smoke	Environment 1 - None apparent	Location	First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic
Manner of Crash/Collision 1 - Non-collision	Weather Conditions (up to two) 04 - Fog, smoke	Roadway 01 - None apparent	Type
Light Conditions 1 - Daylight	Surface Conditions 2	Type of Roadway Junction/Feature 01 - No special feature	Workers Present?

P
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J
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Name- Last
MICKLEY

First
LINDA

Middle

Suffix

City

State

Zip Code

Age
59

Sex
Female

Unit No.
02

Seating Position
03 - Front: Right Side

Injury Status
4 - Possible

Occupant Protection
9 - Unknown

Airbag Deployment
5 - Not deployed

Airbag Switch Status
9 - Unknown

Ejection
1 - Not ejected

Ejection Path
1 - Not ejected/not applicable

Trapped
1 - Not trapped

Transported to:
METHODIST

Transported by:
COLFAX FIRE

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 WEST ON INTERSTATE 80 IN THE OUTSIDE LANE. UNIT 2 WAS TRAVELING WEST ON INTERSTATE 80 IN THE INSIDE LANE. UNIT 2 ATTEMPTED TO PASS UNIT 1. A LARGE PIECE OF ICE CAME OFF OF THE TRAILER OF UNIT 1, BECAME AIRBORNE, AND STRUCK UNIT 2 IN THE WINDSHIELD. THE ICE THEN PIERCED THE WINDSHIELD AND STRUCK THE PASSENGER IN THE FRONT SEAT OF UNIT 2. UNIT 2 CAME TO REST ON THE INSIDE SHOULDER OF INTERSTATE 80 FACING WEST. UNIT 1 EXITED THE INTERSTATE AT THE 155 MILE MARKER AND WAITED FOR LAW ENFORCEMENT IN A PARKING LOT OF AN ABANDONED BUSINESS NORTH OF THE INTERSTATE.

Officer VANZEE	Badge No. 044	Time Officer Notified of Accident 11:36	Time Officer Arrived At Scene 11:44
Name of Agency P01	Date of Report 12/29/2010	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