Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
5/23/2011		 Time of Accident
11:15 PM 		County
Decatur - 27		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011029946
Literal Description
LAMONI REST AREA 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
427477.7
Y-Coordinate
4500905.
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1 		Driver's Name - Last
BENDTSEN		 First
PHILIP		 Middle
BERNARD		 Suffix
City
SARTELL		 State
MN - Minnesota, US		 Zip
56377
Driver's Age
74		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
MN - Minnesota, 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:
N/A		 Transported by:
N/A
Insurance Co. Name
Year
2004		 Make
 Model
SEMI		 Style
TT		 Approximate Cost to Repair or Replace
0
Initial Travel Direction
2 - East		 Vehicle Action
09 - Backing		 Speed Limit
10		 Point of Initial Impact
02 - Right Front		 Most Damaged Area
02 - Right Front		 Extent of Damage
1 - None		 Underride/Override
1 - None
Total Occupants
1		 Traffic Controls
01 - No controls present		 Vehicle Config.
09 - Tractor/semi-trailer		 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
23 - Parked motor vehicle		 Second Event
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
23 - Parked motor vehicle
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
 First
 Middle
 Suffix
City
 State
 Zip
Driver's Age
 Citation Charge Code 1
 Citation Charge 1
Gender
 State
 Class
 Endorsements
None		 Restrictions

None		 Citation Charge Code 2
 Citation Charge 2
Alcohol Test Given?
 Drug Test Given?
 Citation Charge Code 3
 Citation Charge 3
Citation Charge Code 4
 Citation Charge 4
Seating Position
 Injury Status
 Occupant Protection
 Airbag Deployment
 Airbag Switch Status
 Ejection
 Ejection Path
 Trapped
Transported to:
 Transported by:
Insurance Co. Name
Year
2006		 Make
 Model
SEMI		 Style
TT		 Approximate Cost to Repair or Replace
0
Initial Travel Direction
9 - Unknown		 Vehicle Action
12 - Legally Parked		 Speed Limit
10		 Point of Initial Impact
05 - Rear		 Most Damaged Area
05 - Rear		 Extent of Damage
1 - None		 Underride/Override
1 - None
Total Occupants
1		 Traffic Controls
01 - No controls present		 Vehicle Config.
09 - Tractor/semi-trailer		 Cargo Body Type
01 - Not applicable		 Vehicle Defect
01 - None		 Driver Condition
8 - Other (explain in narrative)		 Vision Obscured
88 - Other (explain in narrative)		 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?
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Y

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If Property other than vehicles damaged explain Object Damaged
2011 VOLKSWAGEN JETTA SE		 Estimate of Damage
5000
Owner's Name - Last
 First
 Middle
 Suffix
Owner Company Name
City
 State
 Zip
ACCIDENT ENVIRONMENT ROADWAY CHARACTERISTICS
Major Contributing Circumstances:		 WORKZONE RELATED? SEQUENCE OF EVENTS
Location of First Harmful Event
6 - Outside Trafficway		 Weather Conditions (up to two)
01 - Clear		 Environment
8 - Other (explain in narrative)		 Location
 First Harmful Event of Crash (use codes 11-42 only)
23 - Parked motor vehicle
Manner of Crash/Collision
7 - Sideswipe, opposite direction		 Roadway
01 - None apparent		 Type
Light Conditions
4 - Dark, roadway lighted		 Surface Conditions
1		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
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0
NARRATIVE

VEHICLE #1 WAS BACKING UP WHEN IT STRUCK VEHICLE #2 WITH ITS RIGHT FRONT TIRE. VEHICLE #1 STRUCK A 2011 JETTA SE WHICH VEHICLE #2 WAS HAULING. OCCUPANT OF VEHICLE#2: GILBERT CORBIN, AGE 31, OF HOUSTON, TX.
Officer
KNEDLER 		Badge No.
443		 Time Officer Notified of Accident
23:15		 Time Officer Arrived At Scene
23:20
Name of Agency
P02		 Date of Report
5/23/2011		 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