Iowa State Patrol: Department of Public Safety

Crash Information

L
O
C
A
T
I
O
N 		Date of Accident
5/22/2011		 Time of Accident
06:14 AM 		County
Harrison - 43		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011029656
Literal Description
SB/WB INTERSTATE 0029, (I-29 SB 91 MM) 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
246553.8
Y-Coordinate
4623979.
U
N
I
T

1 		Driver's Name - Last
BLOMBERG		 First
CHRISTOPHER		 Middle
MICHAEL		 Suffix
City
VISTA		 State
CA - California, US		 Zip
920830000
Driver's Age
24		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
CA - California, 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
 Injury Status
 Occupant Protection
 Airbag Deployment
 Airbag Switch Status
 Ejection
 Ejection Path
 Trapped
Transported to:
 Transported by:
Insurance Co. Name
Year
1999		 Make
 Model
SC		 Style
SD		 Approximate Cost to Repair or Replace
4500
Initial Travel Direction
 Vehicle Action
 Speed Limit
 Point of Initial Impact
 Most Damaged Area
 Extent of Damage
 Underride/Override
Total Occupants
 Traffic Controls
 Vehicle Config.
 Cargo Body Type
 Vehicle Defect
 Driver Condition
 Vision Obscured
 Contributing Circumstances, Driver (up to 2)
SEQUENCE OF EVENTS First Event
 Second Event
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
Emergency Vehicle Type
 Emergency Status
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
 Weather Conditions (up to two)
 Environment
 Location
 First Harmful Event of Crash (use codes 11-42 only)
25 - Animal
Manner of Crash/Collision
 Roadway
 Type
Light Conditions
 Surface Conditions
 Type of Roadway Junction/Feature
 Workers Present?
D
I
A
G
R
A
M

0
NARRATIVE

Unit 1 southbound Interstate 29 near the 91 mile marker. Deer ran into roadway striking Unit 1 in left front and side of vehicle. Vehicle was disabled due to damage.
Officer
PAULSEN 		Badge No.
148		 Time Officer Notified of Accident
06:14		 Time Officer Arrived At Scene
06:38
Name of Agency
P04		 Date of Report
5/22/2011		 Investigation made at scene?
No		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 04 Office
3710 Highway 30 E
Denison,IA 51442-7560
Phone: (712) 263-4621
Fax: (712) 263-2325