U
N
I
T
1
|
Driver's Name - Last BERNER |
First BRANDON |
Middle MICHAEL |
Suffix
|
City DAVENPORT |
State IA - Iowa, US |
Zip 528060000 |
Driver's Age 28 |
Citation Charge Code 1 321.20B-A |
Citation Charge 1 VIOLATION - FINANCIAL LIABILITY COVERAGE |
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 321J.2(2)(a) |
Citation Charge 2 OPER VEH WH INT (OWI) / 1ST OFF |
Alcohol Test Given? 4 - Breath |
Drug Test Given? 9 - Refused |
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:
|
Transported by:
|
Insurance Co. Name
|
Year 2008 |
Make Ford - FORD |
Model FUSION |
Style 4D |
Approximate Cost to Repair or Replace 2500 |
Initial Travel Direction 4 - West |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 70 |
Point of Initial Impact 02 - Right Front |
Most Damaged Area 02 - Right Front |
Extent of Damage 4 - Disabling 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 6 - Under the influence of alcohol/drugs/medications |
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 PRINCE |
First JERRY |
Middle T |
Suffix
|
City MARYVILLE |
State TN - Tennessee, US |
Zip 37801 |
Driver's Age 48 |
Citation Charge Code 1
|
Citation Charge 1
|
Gender Male |
State TN - Tennessee, US |
Class A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more |
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:
|
Transported by:
|
Insurance Co. Name PASCHALL TRUCK LINES |
Year 2007 |
Make International - INTL |
Model TRACTOR |
Style TT |
Approximate Cost to Repair or Replace 250 |
Initial Travel Direction 4 - West |
Vehicle Action 01 - Movement essentially straight |
Speed Limit 70 |
Point of Initial Impact 06 - Left Rear |
Most Damaged Area 06 - Left Rear |
Extent of Damage 2 - Minor damage |
Underride/Override 1 - None |
Total Occupants 1 |
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
|
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 PASCHALL TRUCK LINES |
City MURRAY |
State KY - Kentucky, US |
Zip 420711889 |
Number of Axles 5 |
Gross Vehicle Weight Rating 54000 |
Placard #
|
Hazardous Materials Released? 3 - Not applicable |
| 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) 21 - Vehicle in traffic |
Manner of Crash/Collision 6 - Sideswipe, same direction |
Roadway 01 - None apparent |
Type
|
Light Conditions 1 - Daylight |
Surface Conditions 1 |
Type of Roadway Junction/Feature 01 - No special feature |
Workers Present?
|
D I A G R A M
0 |
|
| NARRATIVE |
UNIT 1 AND UNIT 2 WERE WESTBOUND ON INTERSTATE 80 AT MILE MARKER 274. UNIT 1 WAS APPROACHING UNIT 2 FROM BEHIND AS UNIT 2 WAS IN THE RIGHT LANE, WHEN THE RIGHT SIDE OF UNIT 1 COLLIDED WITH THE BACK OF UNIT 2 ON THE LEFT SIDE OF THE SEMI-TRAILER. UNIT 1 WENT INTO THE MEDIAN AFTER IMPACT. UNIT 1 CONTINUED WEST THROUGH THE MEDIAN AND CAME OUT OF THE MEDIAN HEADING WESTBOUND. UNIT 1 STOPPED ON THE RIGHT SHOULDER OF WESTBOUND INTERSTATE 80. UNIT 2 PULLED OVER BEHIND UNIT 1. |
|
Officer
PEDERSEN |
Badge No. 173 |
Time Officer Notified of Accident 17:32 |
Time Officer Arrived At Scene 17:32 |
Name of Agency P12 |
Date of Report 4/9/2011 |
Investigation made at scene? Yes |
T.I. #
|
Any questions about this report may be directed to the following address:
Iowa State Patrol District 12 Office
22365 20th Ave
Stockton,IA 52769-9612
Phone: (563) 284-9501
Fax: (563) 284-9504