Crash Information

L O C A T I O N	Date of Accident 3/9/2011	Time of Accident 09:40 PM	County Warren - 91	Accident occurred within corporate limits of (city)	Law Enforcement Case Number: 2011016324
	Literal Description HWY 65/69, .25 MILES S OF GENEVA ST				Legal Intervention? No	Private Property? No
					X-Coordinate: 453295.1
					Y-Coordinate 4584286.

U N I T 1	Driver's Name - Last TILLE			First JENNIFER			Middle LOUISE		Suffix
	City CHARITON			State IA - Iowa, US				Zip 500490000
	Driver's Age 30					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 5 - Uninjured	Occupant Protection 2 - Shoulder and lap belt used		Airbag Deployment 5 - Not deployed	Airbag Switch Status 3 - No ON/OFF switch present		Ejection 1 - Not ejected	Ejection Path	Trapped 1 - Not trapped
	Transported to: CHECKED OUT AT SCENE					Transported by: CHECKED OUT AT SCENE
	Insurance Co. Name
	Year 2006		Make Chevrolet - CHEV		Model TRAILBLAZER		Style SW		Approximate Cost to Repair or Replace 8000
	Initial Travel Direction 3 - South	Vehicle Action 01 - Movement essentially straight	Speed Limit 65	Point of Initial Impact 01 - Front	Most Damaged Area 01 - Front	Extent of Damage 4 - Disabling damage	Underride/Override 1 - None
	Total Occupants 1	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 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 I T 2	Driver's Name - Last TODD			First NOAH			Middle MICHAEL WILLIAM		Suffix
	City INDIANOLA			State IA - Iowa, US				Zip 501250000
	Driver's Age 27					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 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 3 - No ON/OFF switch present		Ejection 1 - Not ejected	Ejection Path	Trapped 1 - Not trapped
	Transported to: CHECKED OUT AT SCENE					Transported by: CHECKED OUT AT SCENE
	Insurance Co. Name
	Year 1991		Make Ford - FORD		Model ESC		Style 2D		Approximate Cost to Repair or Replace 9000
	Initial Travel Direction 3 - South	Vehicle Action 01 - Movement essentially straight	Speed Limit 65	Point of Initial Impact 05 - Rear	Most Damaged Area 05 - Rear	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 88 - Other (explain in narrative)	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 01 - Ran off road, right	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?

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) 03 - Cloudy	Environment 1 - None apparent	Location	First Harmful Event of Crash (use codes 11-42 only) 21 - Vehicle in traffic
Manner of Crash/Collision 3 - Rear-end	Weather Conditions (up to two) 03 - Cloudy	Roadway 01 - None apparent	Type
Light Conditions 5 - Dark, roadway not lighted	Surface Conditions 1	Type of Roadway Junction/Feature 01 - No special feature	Workers Present?

P
E
R
S
O
N

I
N
J
U
R
E
D

Name- Last
HUMBLE

First
TYLER

Middle
LANCE

Suffix

City

State

Zip Code

Age
21

Sex
Male

Unit No.
2

Seating Position
03 - Front: Right Side

Injury Status
3 - Non-incapacitating

Occupant Protection
2 - Shoulder and lap belt used

Airbag Deployment
5 - Not deployed

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:
MERCY HOSPITAL

Transported by:
AMBULANCE

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 2 WAS SOUTHBOUND HWY 65/69 FROM GENEVA ST. UNIT 1 WAS ALSO SOUTHBOUND HWY 65/69 FROM GENEVA ST. UNIT 1 STRUCK UNIT 2 IN THE REAR-END. UNIT 2'S TAILLIGHTS WERE POSSIBLY NOT WORKING. DUE TO BOTH TAILLIGHTS BEING SMASHED, AN EXAMINATION COULD NOT BE PERFORMED.

Officer SCHMIDT	Badge No. 336	Time Officer Notified of Accident 21:43	Time Officer Arrived At Scene 21:52
Name of Agency P02	Date of Report 3/9/2011	Investigation made at scene? Yes	T.I. #

Any questions about this report may be directed to the following address:
Iowa State Patrol District 02 Office
1619 Truro Pavement
Osceola,IA 50213-8383
Phone: (641) 342-2108
Fax: (641) 342-4653