Iowa State Patrol: Department of Public Safety

Crash Information

L
O
C
A
T
I
O
N 		Date of Accident
6/21/2011		 Time of Accident
06:06 PM 		County
Webster - 94		 Accident occurred within corporate limits of (city)
Fort Dodge - 2690		 Law Enforcement Case Number:
2011036151
Literal Description
NB/EB 3RD AVE NW and NB/EB US 0169 / US 169 and NB/EB Iowa 0007 / 190TH ST 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
399474.6
Y-Coordinate
4707734.
U
N
I
T

1 		Driver's Name - Last
SCHULZ		 First
MYRON		 Middle
VERNON		 Suffix
2ND
City
BURLINGTON		 State
IA - Iowa, US		 Zip
52601
Driver's Age
81		 Citation Charge Code 1
321.322(1)		 Citation Charge 1
FAIL TO OBEY STOP SIGN
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
4 - Possible		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
9 - Unknown		 Airbag Switch Status
9 - Unknown		 Ejection
2 - Partially ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
TRINITY REGIONAL		 Transported by:
TRINITY REGIONAL AMBULANCE
Insurance Co. Name
Year
1997		 Make
 Model
MOTORHOME		 Style
MH		 Approximate Cost to Repair or Replace
70000
Initial Travel Direction
1 - North		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
55		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
5 - Severe, vehicle totaled		 Underride/Override
1 - None
Total Occupants
2		 Traffic Controls
04 - Stop signs		 Vehicle Config.
13 - Motor home/recreational vehicle		 Cargo Body Type
14 - Large mobile home		 Vehicle Defect
99 - Unknown		 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
SCHMIEDER		 First
CRYSTAL		 Middle
LYNN		 Suffix
City
FORT DODGE		 State
IA - Iowa, US		 Zip
50501
Driver's Age
29		 Citation Charge Code 1
 Citation Charge 1
Gender
Female		 State
IA - Iowa, US		 Class
D - Chauffeur		 Endorsements
3 - Pass Veh less than 16 Pass Design		 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
4 - Possible		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
9 - Unknown		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
3 - Extricated by mechanical means
Transported to:
TRINITY REGIONAL		 Transported by:
TRINITY REGIONAL AMBULANCE
Insurance Co. Name
Year
2005		 Make
Dodge - DODG		 Model
GRAND CARAVAN		 Style
SV		 Approximate Cost to Repair or Replace
15000
Initial Travel Direction
2 - East		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
35		 Point of Initial Impact
02 - Right Front		 Most Damaged Area
03 - Right Side		 Extent of Damage
5 - Severe, vehicle totaled		 Underride/Override
1 - None
Total Occupants
6		 Traffic Controls
01 - No controls present		 Vehicle Config.
03 - Van or mini-van		 Cargo Body Type
01 - Not applicable		 Vehicle Defect
99 - Unknown		 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?
P
R
O
P
E
R
T
Y

D
A
M
A
G
E
If Property other than vehicles damaged explain Object Damaged
LAWN & GRASS		 Estimate of Damage
500
Owner's Name - Last
 First
 Middle
 Suffix
Owner Company Name
STARLITE BEST WESTERN VILLAGE
City
FORT DODGE		 State
IA - Iowa, US		 Zip
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)
06 - Rain		 Environment
1 - None apparent		 Location
3 - Within transition area for lane shift		 First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic
Manner of Crash/Collision
5 - Broadside		 Roadway
05 - Work Zone (construction, maintenance, utility)		 Type
2 - Lane shift/crossover (head-to-head traffic)
Light Conditions
1 - Daylight		 Surface Conditions
2		 Type of Roadway Junction/Feature
11 - Four-way intersection		 Workers Present?
No
P
E
R
S
O
N 		I
N
J
U
R
E
D 		Name- Last
RHONE		 First
XAIVER		 Middle
J		 Suffix
City
 State
 Zip Code
Age
15		 Sex
Male		 Unit No.
2		 Seating Position
09 - Rear: Right Side		 Injury Status
4 - Possible		 Occupant Protection
9 - Unknown		 Airbag Deployment
9 - Unknown		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
1 - Not ejected/not applicable		 Trapped
1 - Not trapped
Transported to:
TRINITY REGIONAL		 Transported by:
TRH AMBULANCE
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
P
E
R
S
O
N 		I
N
J
U
R
E
D 		Name- Last
BRYSON		 First
JERIQUE		 Middle
J		 Suffix
City
 State
 Zip Code
Age
14		 Sex
Male		 Unit No.
2		 Seating Position
04 - Center: Left Side / Motorcycle Passenger		 Injury Status
4 - Possible		 Occupant Protection
9 - Unknown		 Airbag Deployment
9 - Unknown		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
1 - Not ejected/not applicable		 Trapped
1 - Not trapped
Transported to:
TRH		 Transported by:
TRH AMBULANCE
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
P
E
R
S
O
N 		I
N
J
U
R
E
D 		Name- Last
WHEAT		 First
NICHOLAS		 Middle
J		 Suffix
City
 State
 Zip Code
Age
13		 Sex
Male		 Unit No.
2		 Seating Position
03 - Front: Right Side		 Injury Status
4 - Possible		 Occupant Protection
9 - Unknown		 Airbag Deployment
9 - Unknown		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
1 - Not ejected/not applicable		 Trapped
1 - Not trapped
Transported to:
TRH		 Transported by:
TRH AMBULANCE
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
P
E
R
S
O
N 		I
N
J
U
R
E
D 		Name- Last
VARGASON		 First
NOAH		 Middle
J		 Suffix
City
 State
 Zip Code
Age
12		 Sex
Male		 Unit No.
2		 Seating Position
06 - Center: Right Side		 Injury Status
4 - Possible		 Occupant Protection
9 - Unknown		 Airbag Deployment
9 - Unknown		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
1 - Not ejected/not applicable		 Trapped
1 - Not trapped
Transported to:
TRH		 Transported by:
TRH AMBULANCE
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
P
E
R
S
O
N 		I
N
J
U
R
E
D 		Name- Last
HALBUR		 First
SHANE		 Middle
J		 Suffix
City
 State
 Zip Code
Age
12		 Sex
Male		 Unit No.
2		 Seating Position
07 - Rear: Left Side		 Injury Status
4 - Possible		 Occupant Protection
9 - Unknown		 Airbag Deployment
9 - Unknown		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
1 - Not ejected/not applicable		 Trapped
1 - Not trapped
Transported to:
TRH		 Transported by:
TRH AMBULANCE
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
P
E
R
S
O
N 		I
N
J
U
R
E
D 		Name- Last
SCHULZ		 First
DOROTHY		 Middle
LOUISE		 Suffix
City
 State
 Zip Code
Age
80		 Sex
Female		 Unit No.
1		 Seating Position
03 - Front: Right Side		 Injury Status
4 - Possible		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
9 - Unknown		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
1 - Not ejected/not applicable		 Trapped
3 - Extricated by mechanical means
Transported to:
TRH		 Transported by:
TRH AMBULANCE
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 A NORTHBOUND MOTORHOME. VEHICLE #2 WAS AN EASTBOUND MINIVAN. THE MINIVAN HAD ENTERED THE INTERSECTION WHEN IT WAS STRUCK IN THE RIGHT SIDE BY THE MOTORHOME WHICH HAD FAILED TO STOP FOR THE STOP SIGN. THE MOTORHOME WENT INTO THE NORTHEAST CORNER OF THE DITCH AND ROLLED ONTO ITS DRIVER SIDE. THE MINIVAN WAS SPUN AROUND AND REMAINED IN THE INTERSECTION.
Officer
MILLS 		Badge No.
263		 Time Officer Notified of Accident
18:06		 Time Officer Arrived At Scene
18:18
Name of Agency
P07		 Date of Report
6/21/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 07 Office
2437 235th St
Ft Dodge,IA 50501-8465
Phone: (515) 972-4213
Fax: (515) 972-4218