Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
1/17/2011		 Time of Accident
07:45 AM 		County
Floyd - 34		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011003568
Literal Description
KIRKWOOD and SB/WB US 0018 / US 18 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
513834.2
Y-Coordinate
4774894.
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1 		Driver's Name - Last
CALAVENZO		 First
GUY		 Middle
MICHAEL		 Suffix
City
PANAMA CITY BEAC		 State
FL - Florida, US		 Zip
324178393
Driver's Age
50		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
FL - Florida, US		 Class
 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
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
Year
2003		 Make
 Model
LIBERTY		 Style
SUV		 Approximate Cost to Repair or Replace
3000
Initial Travel Direction
4 - West		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
65		 Point of Initial Impact
05 - Rear		 Most Damaged Area
06 - Left Rear		 Extent of Damage
3 - Functional damage		 Underride/Override
1 - None
Total Occupants
01		 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
04 - Crossed centerline/median		 Second Event
03 - Ran off road, left		 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
12 - Jackknife
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?
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Y

D
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E
If Property other than vehicles damaged explain Object Damaged
TRAILER		 Estimate of Damage
500
Owner's Name - Last
 First
 Middle
 Suffix
Owner Company Name
GUSTAFSON TRAILERS
City
BECKER		 State
MN - Minnesota, US		 Zip
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)
08 - Snow		 Environment
2 - Weather condition		 Location
 First Harmful Event of Crash (use codes 11-42 only)
12 - Jackknife
Manner of Crash/Collision
1 - Non-collision		 Roadway
02 - Road surface condition		 Type
Light Conditions
1 - Daylight		 Surface Conditions
3		 Type of Roadway Junction/Feature
07 - Crossover in median		 Workers Present?
D
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0
NARRATIVE

TRAILER VIN 5WKBE1623B1011011 2011 FREEDOM TRAILER VEHICLE 1 WAS WESTBOUND ON HIGHWAY 18 WHEN THE DRIVER LOST CONTROL OF HIS VEHICLE ON BLACK ICE. THE VEHICLE SPUN AROUND AND JACKKNIFED GOING INTO THE SOUTH MEDIAN AND CAME TO REST FACING EAST.
Officer
DOMINO 		Badge No.
364		 Time Officer Notified of Accident
07:50		 Time Officer Arrived At Scene
07:51
Name of Agency
P08		 Date of Report
1/17/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 08 Office
4425 Washington Avenue
Mason City,IA 50401-7002
Phone: (641) 424-3625
Fax: (641) 423-8381