Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
4/17/2012		 Time of Accident
06:20 AM 		County
Des Moines - 29		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2012021907
Literal Description
NB/EB US US 61 MILE #34.85 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
653986.4
Y-Coordinate
4510782.
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1 		Driver's Name - Last
GRAY		 First
PATRICK		 Middle
CHARLES		 Suffix
JR
City
BURLINGTON		 State
IA - Iowa, US		 Zip
52601
Driver's Age
22		 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?
2 - Blood		 Drug Test Given?
2 - Blood		 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
1 - Deployed front of person		 Airbag Switch Status
3 - No ON/OFF switch present		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
3 - Extricated by mechanical means
Transported to:
KING-LYNK FUNERAL HOME		 Transported by:
KING-LYNK FUNERAL HOME
Insurance Co. Name
Year
2000		 Make
Ford - FORD		 Model
FOCUS		 Style
4D		 Approximate Cost to Repair or Replace
5000
Initial Travel Direction
3 - South		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
65		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
5 - Severe, vehicle totaled		 Underride/Override
1 - None
Total Occupants
1		 Traffic Controls
01 - No controls present		 Vehicle Config.
01 - Passenger car		 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
21 - Vehicle in traffic		 Second Event
01 - Ran off road, right		 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?
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2 		Driver's Name - Last
DELANEY		 First
MICHAEL		 Middle
GERALD		 Suffix
City
WEST POINT		 State
IA - Iowa, US		 Zip
52656
Driver's Age
46		 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
2 - Incapacitating		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
1 - Deployed front of person		 Airbag Switch Status
3 - No ON/OFF switch present		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
3 - Extricated by mechanical means
Transported to:
UIHC		 Transported by:
MED FORCE
Insurance Co. Name
Year
2010		 Make
Chrysler - CHRY		 Model
TOWN & COUNTRY		 Style
MV		 Approximate Cost to Repair or Replace
20000
Initial Travel Direction
1 - North		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
65		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
5 - Severe, vehicle totaled		 Underride/Override
1 - None
Total Occupants
1		 Traffic Controls
01 - No controls present		 Vehicle Config.
03 - Van or mini-van		 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
01 - Ran off road, right		 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)
01 - Clear		 Environment
1 - None apparent		 Location
 First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic
Manner of Crash/Collision
2 - Head-on		 Roadway
01 - None apparent		 Type
Light Conditions
3 - Dawn		 Surface Conditions
1		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
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NARRATIVE

Officer
ANDREASEN 		Badge No.
161		 Time Officer Notified of Accident
06:32		 Time Officer Arrived At Scene
07:22
Name of Agency
P13		 Date of Report
4/17/2012		 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