Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
5/30/2011		 Time of Accident
06:40 PM 		County
Keokuk - 54		 Accident occurred within corporate limits of (city)
Keota - 3952		 Law Enforcement Case Number:
2011031371
Literal Description
W BROADWAY AVE and W015 / 330TH AVE 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
586477.8
Y-Coordinate
4579669.
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1 		Driver's Name - Last
ULIN		 First
BRIAN		 Middle
KEITH		 Suffix
City
RICHLAND		 State
IA - Iowa, US		 Zip
525850000
Driver's Age
51		 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

B - Cor Lenses		 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
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
 Transported by:
Insurance Co. Name
Year
2008		 Make
Ford - FORD		 Model
F250		 Style
TK		 Approximate Cost to Repair or Replace
1500
Initial Travel Direction
3 - South		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
45		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
Total Occupants
1		 Traffic Controls
01 - No controls present		 Vehicle Config.
02 - Four-tire light truck (pick-up, panel)		 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
03 - Ran off road, left		 Second Event
33 - Ditch/embankment		 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
33 - Ditch/embankment
Emergency Vehicle Type
2 - Police		 Emergency Status
1 - Yes, in emergency
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)
33 - Ditch/embankment
Manner of Crash/Collision
1 - Non-collision		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
1		 Type of Roadway Junction/Feature
12 - T - intersection		 Workers Present?
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NARRATIVE

V WAS SOUTHBOUND ON W-15 PREPARING TO TURN EAST ON WEST BROADWAY (KEOTA) V1 WAS SOUTHBOUND ON W-15 RESPONDING TO ASSIST ANOTHER OFFICER ON A DOMESTIC CALL. V1 WENT TO PASS V WHILE V WAS TURNING. V SAW V1 AND AVOIDED AN ACCIDEENT. V1 WENT OFF THE ROAD EAST (LEFT) AND HIT A DITCH CAUSING DAMAGE TO FRONT BUMPER AND REAR WINDOW. V SUSTAINED NO DAMAGE. V-467BNA LIC 984ZZ1989
Officer
GENT 		Badge No.
077		 Time Officer Notified of Accident
19:08		 Time Officer Arrived At Scene
19:42
Name of Agency
P13		 Date of Report
5/30/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 13 Office
1300 S Grand Ave
Mt Pleasant,IA 52641-1862
Phone: (319) 385-8715
Fax: (319) 385-2743