Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
1/10/2011		 Time of Accident
10:02 AM 		County
Polk - 77		 Accident occurred within corporate limits of (city)
Urbandale - 7875		 Law Enforcement Case Number:
2011001683
Literal Description
NB/EB Interstate 0035 measuring 1289 Feet West from Interstate 0035 (Milepost 131) 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
440723.5
Y-Coordinate
4611466.
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1 		Driver's Name - Last
SIEVE		 First
JOHN		 Middle
JOSEPH		 Suffix
City
BOONE		 State
IA - Iowa, US		 Zip
500360000
Driver's Age
62		 Citation Charge Code 1
321.20B-B		 Citation Charge 1
VIOLATION - FINANCIAL LIABILITY - ACCIDENT
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
 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
5 - Uninjured		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
5 - Not deployed		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
N/A		 Transported by:
N/A
Insurance Co. Name
Year
1999		 Make
Dodge - DODG		 Model
R15		 Style
PK		 Approximate Cost to Repair or Replace
1500
Initial Travel Direction
2 - East		 Vehicle Action
88 - Other (explain in narrative)		 Speed Limit
65		 Point of Initial Impact
04 - Right Rear		 Most Damaged Area
04 - Right Rear		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
Total Occupants
1		 Traffic Controls
01 - No controls present		 Vehicle Config.
02 - Four-tire light truck (pick-up, panel)		 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
13 - Other non-collision		 Second Event
06 - Evasive action (swerve, panic braking, etc.)		 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?
U
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2 		Driver's Name - Last
POLLOCK		 First
SCOTT		 Middle
WILLIAM		 Suffix
City
ANITA		 State
IA - Iowa, US		 Zip
500200000
Driver's Age
44		 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
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
N/A		 Transported by:
N/A
Insurance Co. Name
Year
2005		 Make
Ford - FORD		 Model
F25		 Style
PK		 Approximate Cost to Repair or Replace
2000
Initial Travel Direction
2 - East		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
65		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
2 - Minor damage		 Underride/Override
1 - None
Total Occupants
2		 Traffic Controls
01 - No controls present		 Vehicle Config.
07 - Truck/trailer		 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
 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)
08 - Snow		 Environment
2 - Weather condition		 Location
 First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic
Manner of Crash/Collision
6 - Sideswipe, same direction		 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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D 		Name- Last
WAHLERT		 First
DAVID		 Middle
ALLEN		 Suffix
City
 State
 Zip Code
Age
54		 Sex
Male		 Unit No.
2		 Seating Position
03 - Front: Right Side		 Injury Status
5 - Uninjured		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
5 - Not deployed		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
1 - Not ejected/not applicable		 Trapped
1 - Not trapped
Transported to:
N/A		 Transported by:
N/A
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
D
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0
NARRATIVE

VEHICLE 1 WAS EASTBOUND ON INTERSTATE 80 AT THE 130 MILE MARKER. A NON CONTACT VEHICLE LOST CONTROL IN FRONT OF VEHICLE 1. VEHICLE 1 HIT THE BRAKES AND TURNED TO THE RIGHT TO MISS THE NON CONTACT VEHICLE. VEHICLE 2 WAS TRAVELING EASTBOUND ON INTERSTATE 80 AT THE 130 MILE MARKER. VEHICLE 1 THEN CROSSED INTO THE OUTSIDE LANE IN FRONT OF VEHICLE 2. VEHICLE 1 THEN HIT VEHICLE 2.
Officer
PEARSTON 		Badge No.
168		 Time Officer Notified of Accident
10:02		 Time Officer Arrived At Scene
10:02
Name of Agency
P01		 Date of Report
1/10/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 01 Office
260 NW 48th Place
Des Moines,IA 50313-2299
Phone: (515) 725-0010
Fax: (515) 725-0011