Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
12/9/2010		 Time of Accident
05:00 PM 		County
Clinton - 23		 Accident occurred within corporate limits of (city)
De Witt - 1855		 Law Enforcement Case Number:
2010069461
Literal Description
312MM HWY 30 EB 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
702019.2
Y-Coordinate
4632039.
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1 		Driver's Name - Last
LOPEZ		 First
RAFAEL		 Middle
G		 Suffix
City
ROCK ISLAND		 State
IL - Illinois, US		 Zip
61201
Driver's Age
36		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
IL - Illinois, US		 Class
D - Chauffeur		 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
9 - Unknown		 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:
N/A		 Transported by:
N/A
Insurance Co. Name
Year
1996		 Make
Ford - FORD		 Model
E250		 Style
VAN		 Approximate Cost to Repair or Replace
1500
Initial Travel Direction
3 - South		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
65		 Point of Initial Impact
08 - Left Front		 Most Damaged Area
08 - Left Front		 Extent of Damage
3 - Functional damage		 Underride/Override
1 - None
Total Occupants
02		 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
99 - Unknown		 Contributing Circumstances, Driver (up to 2)
SEQUENCE OF EVENTS First Event
30 - Bridge/bridge rail/overpass		 Second Event
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
30 - Bridge/bridge rail/overpass
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)
07 - Sleet, hail, freezing rain		 Environment
2 - Weather condition		 Location
 First Harmful Event of Crash (use codes 11-42 only)
30 - Bridge/bridge rail/overpass
Manner of Crash/Collision
1 - Non-collision		 Roadway
02 - Road surface condition		 Type
Light Conditions
4 - Dark, roadway lighted		 Surface Conditions
3		 Type of Roadway Junction/Feature
02 - Bridge/overpass/underpass		 Workers Present?
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NARRATIVE

UNIT 1 WAS SOUTHBOUND ON HWY 61. UNIT 1 LOST CONTROL ON THE ICE, HIT THE BRIDGE, AND CAME TO REST IN THE MEDIAN.
Officer
GRIEM 		Badge No.
311		 Time Officer Notified of Accident
17:00		 Time Officer Arrived At Scene
17:01
Name of Agency
P12		 Date of Report
12/9/2010		 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