Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
1/11/2011		 Time of Accident
12:45 PM 		County
Webster - 94		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
20110002242
Literal Description
SB/WB US 0020 / 235TH ST 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
416355.3
Y-Coordinate
4700140.
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1 		Driver's Name - Last
LEIVA		 First
MARCIAL		 Middle
 Suffix
City
DES MOINES		 State
IA - Iowa, US		 Zip
503150000
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

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
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:
NA
Insurance Co. Name
Year
2003		 Make
General Motors - GMC		 Model
YUK		 Style
SW		 Approximate Cost to Repair or Replace
3000
Initial Travel Direction
4 - West		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
65		 Point of Initial Impact
07 - Left Side		 Most Damaged Area
07 - Left Side		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
Total Occupants
2		 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
04 - Crossed centerline/median		 Second Event
03 - Ran off road, left		 Third Event
 Fourth Event
33 - Ditch/embankment		 Most Harmful Event (by vehicle)
33 - Ditch/embankment
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
4 - Roadside		 Weather Conditions (up to two)
02 - Partly cloudy		 Environment
1 - None apparent		 Location
 First Harmful Event of Crash (use codes 11-42 only)
33 - Ditch/embankment
Manner of Crash/Collision
1 - Non-collision		 Roadway
02 - Road surface condition		 Type
Light Conditions
1 - Daylight		 Surface Conditions
4		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
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NARRATIVE

VEHICLE #1 WAS WESTBOUND ON HWY 20 WHEN IT LOST CONTROL, EVENTUALLY ENTERING THE NORTH DICH, ROLLING OVER AND COMING TO REST ON IT'S WHEELS.
Officer
RINARD 		Badge No.
095		 Time Officer Notified of Accident
12:45		 Time Officer Arrived At Scene
12:55
Name of Agency
P07		 Date of Report
1/11/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 07 Office
2437 235th St
Ft Dodge,IA 50501-8465
Phone: (515) 972-4213
Fax: (515) 972-4218