Iowa State Patrol: Department of Public Safety

Crash Information

L
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C
A
T
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N 		Date of Accident
6/21/2011		 Time of Accident
09:56 AM 		County
Pottawattamie - 78		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011036046
Literal Description
INTERSTATE 80 WESTBOUND EXIT 46 OFF RAMP AND ANTIQUE CITY DRIVE WALNUT 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
314543.9
Y-Coordinate
4596508.
U
N
I
T

1 		Driver's Name - Last
EBERT		 First
KEITH		 Middle
J		 Suffix
City
SILVER CREEK		 State
NE - Nebraska, US		 Zip
68663
Driver's Age
41		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
NE - Nebraska, 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
6 - Not applicable		 Airbag Switch Status
3 - No ON/OFF switch present		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
NA		 Transported by:
Insurance Co. Name
Year
2011		 Make
 Model
 Style
TT		 Approximate Cost to Repair or Replace
100
Initial Travel Direction
4 - West		 Vehicle Action
03 - Turning right		 Speed Limit
70		 Point of Initial Impact
03 - Right Side		 Most Damaged Area
03 - Right Side		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
Total Occupants
01		 Traffic Controls
04 - Stop signs		 Vehicle Config.
09 - Tractor/semi-trailer		 Cargo Body Type
05 - Flatbed		 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
MCGINN		 First
MARY		 Middle
LOUISE		 Suffix
City
COUNCIL BLUFFS		 State
IA - Iowa, US		 Zip
515030000
Driver's Age
76		 Citation Charge Code 1
 Citation Charge 1
Gender
Female		 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
3 - No ON/OFF switch present		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
NA		 Transported by:
Insurance Co. Name
Year
2004		 Make
Chrysler - CHRY		 Model
CRU		 Style
VN		 Approximate Cost to Repair or Replace
6000
Initial Travel Direction
4 - West		 Vehicle Action
11 - Stopped for stop sign/signal		 Speed Limit
70		 Point of Initial Impact
03 - Right Side		 Most Damaged Area
03 - Right Side		 Extent of Damage
3 - Functional damage		 Underride/Override
1 - None
Total Occupants
01		 Traffic Controls
04 - Stop signs		 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?
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)
03 - Cloudy		 Environment
1 - None apparent		 Location
 First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic
Manner of Crash/Collision
6 - Sideswipe, same direction		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
1		 Type of Roadway Junction/Feature
20 - Off-ramp		 Workers Present?
NARRATIVE

Vehicle #1 and Vehicle #2 are travelling westbound on the Interstate 80 westbound exit 46 off ramp. There are conflicting statements on the events of the collision between vehicle#1 and vehicle #2 and very little roadway evidence to show what happened. Vehicle #1 did make contact with vehicle #2 in the left front and rear passenger doors with the right rear trailer tires. Both vehicles moved to the McDonalds parking lot after the collision. There is no diagram do to both vehicles being removed from the collision scene.
Officer
NORDYKE 		Badge No.
055		 Time Officer Notified of Accident
09:56		 Time Officer Arrived At Scene
10:21
Name of Agency
P03		 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 03 Office
2025 Hunt Ave
Council Bluffs,IA 51503-4254
Phone: (712) 328-8001
Fax: (712) 328-1504