Crash Information

L O C A T I O N	Date of Accident 4/30/2011	Time of Accident 09:48 PM	County Hamilton - 40	Accident occurred within corporate limits of (city)	Law Enforcement Case Number: 2011025703
	Literal Description INTERSTATE 35 - MEASURING 1388 FEET SOUTH OF (MILEPOST 128)				Legal Intervention? No	Private Property? No
					X-Coordinate: 452873.1
					Y-Coordinate 4675913.

U N I T 1	Driver's Name - Last TERLOUW			First DANIEL			Middle GIACOMO		Suffix
	City CLIVE			State IA - Iowa, US				Zip 503250000
	Driver's Age 40					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 02 - Front: Center	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: N/A					Transported by: N/A
	Insurance Co. Name
	Year 1999		Make Volkswagon - VOLK		Model PAS		Style 4D		Approximate Cost to Repair or Replace 1500
	Initial Travel Direction 3 - South	Vehicle Action 01 - Movement essentially straight	Speed Limit 70	Point of Initial Impact 05 - Rear	Most Damaged Area 05 - Rear	Extent of Damage 2 - Minor 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	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 LETT			First BRIEN			Middle LAKEITH		Suffix
	City HOPKINS			State MN - Minnesota, US				Zip 55343
	Driver's Age 31					Citation Charge Code 1 321J.2		Citation Charge 1 OWI 3RD
	Gender Male	State MN - Minnesota, US	Class D - Chauffeur	Endorsements None	Restrictions None	Citation Charge Code 2 321.445		Citation Charge 2 FAILURE TO WEAR SEATBELT
	Alcohol Test Given? 4 - Breath			Drug Test Given? 1 - None		Citation Charge Code 3 321.288		Citation Charge 3 FAILURE TO MAINTAIN CONTROL
						Citation Charge Code 4 321.174		Citation Charge 4
	Seating Position 01 - Front: Left Side / Motorcycle Driver	Injury Status 5 - Uninjured	Occupant Protection 1 - None used		Airbag Deployment 1 - Deployed front of person	Airbag Switch Status 1 - Switch in ON position		Ejection 1 - Not ejected	Ejection Path	Trapped 1 - Not trapped
	Transported to: N/A					Transported by: N/A
	Insurance Co. Name
	Year 2011		Make Dodge - DODG		Model AVENGER		Style 4D		Approximate Cost to Repair or Replace 3000
	Initial Travel Direction 3 - South	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 4	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 03 - Ran off road, left	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) 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 1 - Non-collision	Weather Conditions (up to two) 01 - Clear	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
MELVILLE

First
BONNIE

Middle
JEAN

Suffix

City

State

Zip Code

Age
40

Sex
Female

Unit No.
1

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:
N/A

Transported by:
N/A

NON-MOTORIST

Type

Location

Action

Condition

Safety Equipment

Contributing Circumstances

Unit No. of Vehicle Striking

D
I
A
G
R
A
M

0

NARRATIVE

VEHICLE 1 WAS SOUTHBOUND ON INTERSTATE 35 AT THE 128MM IN THE INSIDE LANE. VEHICLE 2 WAS ALSO SOUTHBOUND INTERSTATE 35 AT THE 128. VEHICLE 2 THEN RAN INTO THE REAR OF VEHICLE 1. VEHICLE 2 THEN WENT OF THE ROAD TO LEFT.

Officer PEARSTON	Badge No. 168	Time Officer Notified of Accident 21:48	Time Officer Arrived At Scene 21:57
Name of Agency P01	Date of Report 4/30/2011	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