U
N
I
T
2
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Driver's Name - Last HENDERSON |
First RALPH |
Middle BENJIMAN |
Suffix
|
City CLERMONT |
State IA - Iowa, US |
Zip 52135 |
Driver's Age 41 |
Citation Charge Code 1 321.288 |
Citation Charge 1 FAIL TO MAINTAIN CONTROL |
Gender Male |
State CO - Colorado, US |
Class
|
Endorsements None |
Restrictions
None |
Citation Charge Code 2 321.20B-B |
Citation Charge 2 VIOLATION OF FINANCIAL LIABILITY COVERAGE-ACCIDENT |
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 5 - Not deployed |
Airbag Switch Status 3 - No ON/OFF switch present |
Ejection 1 - Not ejected |
Ejection Path
|
Trapped 1 - Not trapped |
Transported to: GUNDERSEN CLINIC-POSTVILLE |
Transported by: POSTVILLE AMBULANCE |
Insurance Co. Name
|
Year 2004 |
Make
|
Model DISCOVERY |
Style SUV |
Approximate Cost to Repair or Replace 15000 |
Initial Travel Direction 3 - South |
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 05 |
Traffic Controls 01 - No controls present |
Vehicle Config. 04 - Sport utility vehicle |
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 06 - Evasive action (swerve, panic braking, etc.) |
Second Event 04 - Crossed centerline/median |
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
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City
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State
|
Zip
|
Number of Axles
|
Gross Vehicle Weight Rating
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Placard #
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Hazardous Materials Released?
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