Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
2/19/2011		 Time of Accident
09:49 AM 		County
Franklin - 35		 Accident occurred within corporate limits of (city)
Alexander - 0082		 Law Enforcement Case Number:
2011012477
Literal Description
VILLA AVE and STATE ST 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
460906.6
Y-Coordinate
4739129.
U
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1 		Driver's Name - Last
JENSEN		 First
KAYLA		 Middle
ANN		 Suffix
City
ALEXANDER		 State
IA - Iowa, US		 Zip
504200000
Driver's Age
18		 Citation Charge Code 1
321.322		 Citation Charge 1
FAIL TO OBEY STOP SIGN AND YIELD RIGHT OF WAY
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

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
2001		 Make
Chevrolet - CHEV		 Model
CAV		 Style
4D		 Approximate Cost to Repair or Replace
2500
Initial Travel Direction
4 - West		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
30		 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
04 - Stop signs		 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
 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
 City
 State
 Zip
Number of Axles
 Gross Vehicle Weight Rating
 Placard #
 Hazardous Materials Released?
U
N
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2 		Driver's Name - Last
HANSON		 First
KELLY		 Middle
ANN		 Suffix
City
MESERVEY		 State
IA - Iowa, US		 Zip
504570000
Driver's Age
52		 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

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
4 - Possible		 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
1993		 Make
Chevrolet - CHEV		 Model
CAV		 Style
SW		 Approximate Cost to Repair or Replace
1000
Initial Travel Direction
3 - South		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
35		 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
4		 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
22 - Vehicle in/from other roadway		 Second Event
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
22 - Vehicle in/from other roadway
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)
22 - Vehicle in/from other roadway
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?
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D 		Name- Last
SCHULTZ		 First
SHELLY		 Middle
KAY		 Suffix
City
 State
 Zip Code
Age
49		 Sex
Female		 Unit No.
02		 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:
 Transported by:
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
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N 		I
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D 		Name- Last
SCHULTZ		 First
SOPHIA		 Middle
 Suffix
City
 State
 Zip Code
Age
12		 Sex
Female		 Unit No.
02		 Seating Position
04 - Center: Left Side / Motorcycle Passenger		 Injury Status
4 - Possible		 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:
 Transported by:
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
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D 		Name- Last
SCHULTZ		 First
CONNOR		 Middle
 Suffix
City
 State
 Zip Code
Age
15		 Sex
Male		 Unit No.
02		 Seating Position
06 - Center: Right Side		 Injury Status
4 - Possible		 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:
 Transported by:
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
P
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N 		I
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D 		Name- Last
HAMILTON		 First
LAURISSA		 Middle
JANE		 Suffix
City
 State
 Zip Code
Age
17		 Sex
Female		 Unit No.
01		 Seating Position
03 - Front: Right Side		 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
1 - Not ejected/not applicable		 Trapped
1 - Not trapped
Transported to:
 Transported by:
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
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NARRATIVE

VEHICLE ONE TRAVELING WEST BOUND FAILED TO YIELD THE RIGHT AWAY STRIKING VEHICLE 2 WHICH WAS TRAVELING SOUTH BOUND
Officer
SALDIVAR 		Badge No.
281		 Time Officer Notified of Accident
10:02		 Time Officer Arrived At Scene
10:15
Name of Agency
P07		 Date of Report
2/19/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 07 Office
2437 235th St
Ft Dodge,IA 50501-8465
Phone: (515) 972-4213
Fax: (515) 972-4218