Crash Information

L O C A T I O N	Date of Accident 6/20/2011	Time of Accident 09:35 PM	County Cedar - 16	Accident occurred within corporate limits of (city) Clarence - 1330	Law Enforcement Case Number: 2011035995
	Literal Description QUINCY AVE and 120TH				Legal Intervention? No	Private Property? No
					X-Coordinate: 661294.5
					Y-Coordinate 4642509.

U N I T 1	Driver's Name - Last DIERKS			First SCOTT			Middle ALLEN		Suffix
	City CLARENCE			State IA - Iowa, US				Zip 52216
	Driver's Age 30					Citation Charge Code 1		Citation Charge 1
	Gender Male	State IA - Iowa, US	Class A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more	Endorsements N - Tank	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 01 - Front: Left Side / Motorcycle Driver	Injury Status 1 - Fatal	Occupant Protection 2 - Shoulder and lap belt used		Airbag Deployment 6 - Not applicable	Airbag Switch Status 3 - No ON/OFF switch present		Ejection 3 - Totally ejected	Ejection Path	Trapped 1 - Not trapped
	Transported to: U OF IOWA					Transported by: LIFE GUARD
	Insurance Co. Name
	Year 2011		Make		Model 800 RANGER XP		Style ATV		Approximate Cost to Repair or Replace 500
	Initial Travel Direction 1 - North	Vehicle Action 01 - Movement essentially straight	Speed Limit 50	Point of Initial Impact 03 - Right Side	Most Damaged Area 02 - Right Front	Extent of Damage 2 - Minor damage	Underride/Override 1 - None
	Total Occupants 02	Traffic Controls 01 - No controls present	Vehicle Config. 15 - Moped/All-Terrain Vehicle	Cargo Body Type 01 - Not applicable	Vehicle Defect 01 - None	Driver Condition 6 - Under the influence of alcohol/drugs/medications	Vision Obscured 01 - Not obscured	Contributing Circumstances, Driver (up to 2)
	SEQUENCE OF EVENTS			First Event 06 - Evasive action (swerve, panic braking, etc.)	Second Event 11 - Overturn/rollover	Third Event	Fourth Event	Most Harmful Event (by vehicle) 11 - Overturn/rollover
	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) 01 - Clear	Environment 1 - None apparent	Location	First Harmful Event of Crash (use codes 11-42 only) 11 - Overturn/rollover
Manner of Crash/Collision 1 - Non-collision	Weather Conditions (up to two) 01 - Clear	Roadway 01 - None apparent	Type
Light Conditions 5 - Dark, roadway not lighted	Surface Conditions 1	Type of Roadway Junction/Feature 01 - No special feature	Workers Present?

P
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Name- Last
MOHR

First
DANIEL

Middle
JAMES

Suffix

City

State

Zip Code

Age
26

Sex
Male

Unit No.
01

Seating Position
04 - Center: Left Side / Motorcycle Passenger

Injury Status
4 - Possible

Occupant Protection
1 - None used

Airbag Deployment
6 - Not applicable

Airbag Switch Status
3 - No ON/OFF switch present

Ejection
1 - Not ejected

Ejection Path
1 - Not ejected/not applicable

Trapped
1 - Not trapped

Transported to:

Transported by:

NON-MOTORIST

Type

Location

Action

Condition

Safety Equipment

Contributing Circumstances

Unit No. of Vehicle Striking

D
I
A
G
R
A
M

0

NARRATIVE

UNIT 1 WAS GOING NORTH BOUND ON QUINCY AVENUE AT 120TH STREET. AT THE SPOT OF THE ACCIDENT QUINCY AVENUE IS A GRAVEL ROAD. AS UNIT 1 WAS GOING THROUGH A CURVE IN THE ROAD UNIT 1 DROVE THROUGH A SMALL RAIN WASH OUT. THE DRIVER LOST CONTROL OF UNIT 1 AND IT OVERTURNED ON TO THE PASSENGER SIDE. AS UNIT 1 OVER TURNED THE DRIVER WAS EJECTED. THE DRIVER WAS TRANSPORTED FROM THE SCENE FOR INJURIES SUSTAINED IN THE CRASH. THE PASSENGER DIDN'T SEEK MEDICAL TREATMENT.

Officer COSTELLO	Badge No. 322	Time Officer Notified of Accident 21:37	Time Officer Arrived At Scene 21:59
Name of Agency P12	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 12 Office
22365 20th Ave
Stockton,IA 52769-9612
Phone: (563) 284-9501
Fax: (563) 284-9504