Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
1/21/2011		 Time of Accident
06:20 AM 		County
Buena Vista - 11		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011004801
Literal Description
US HWY 71, 1 MILE SOUTH OF HWY 3 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
323898.6
Y-Coordinate
4733633.
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1 		Driver's Name - Last
ARETT		 First
CHARLES		 Middle
ARTHUR		 Suffix
City
STORM LAKE		 State
IA - Iowa, US		 Zip
505880000
Driver's Age
42		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
IA - Iowa, US		 Class
A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more		 Endorsements
T - Dbl/Trpl Trlr		 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
6 - Not applicable		 Airbag Switch Status
3 - No ON/OFF switch present		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
 Transported by:
Insurance Co. Name
MERIDIAN MANUFACTURING GROUP INC
Year
2005		 Make
 Model
CONV		 Style
TK		 Approximate Cost to Repair or Replace
1000
Initial Travel Direction
3 - South		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
55		 Point of Initial Impact
99 - Unknown		 Most Damaged Area
99 - Unknown		 Extent of Damage
3 - Functional damage		 Underride/Override
1 - None
Total Occupants
1		 Traffic Controls
01 - No controls present		 Vehicle Config.
09 - Tractor/semi-trailer		 Cargo Body Type
05 - Flatbed		 Vehicle Defect
05 - Other tire defect (explain in narrative)		 Driver Condition
1 - Apparently normal		 Vision Obscured
01 - Not obscured		 Contributing Circumstances, Driver (up to 2)
SEQUENCE OF EVENTS First Event
26 - Other non-fixed object (explain in narrative)		 Second Event
 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
26 - Other non-fixed object (explain in narrative)
Emergency Vehicle Type
1 - Not applicable		 Emergency Status
3 - Not Applicable
Carrier Name
MERIDIAN MANUFACTURING GROUP INC		 City
STORM LAKE		 State
IA - Iowa, US		 Zip
505887328
Number of Axles
3		 Gross Vehicle Weight Rating
52000		 Placard #
0000		 Hazardous Materials Released?
2 - No
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2 		Driver's Name - Last
VANLOON		 First
LAVERN		 Middle
GAYLEN		 Suffix
City
HARTLEY		 State
IA - Iowa, US		 Zip
513460000
Driver's Age
40		 Citation Charge Code 1
LOG BOOK VIOLATION		 Citation Charge 1
321.449 RE FED CODE 395.8F1
Gender
Male		 State
IA - Iowa, US		 Class
A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more		 Endorsements
N - Tank		 Restrictions

1 - MC Inst Permit		 Citation Charge Code 2
WHEEL FASTENERS		 Citation Charge 2
321.449 RE FED CODE 393.205C
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:
 Transported by:
Insurance Co. Name
Year
2003		 Make
Ford - FORD		 Model
F25		 Style
PK		 Approximate Cost to Repair or Replace
8000
Initial Travel Direction
1 - North		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
55		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
4 - Disabling damage		 Underride/Override
9 - Unknown
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
05 - Animal or object in roadway		 Second Event
52 - Hit and run		 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
05 - Animal or object in roadway
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)
03 - Cloudy		 Environment
8 - Other (explain in narrative)		 Location
 First Harmful Event of Crash (use codes 11-42 only)
26 - Other non-fixed object (explain in narrative)
Manner of Crash/Collision
2 - Head-on		 Roadway
01 - None apparent		 Type
Light Conditions
5 - Dark, roadway not lighted		 Surface Conditions
1		 Type of Roadway Junction/Feature
11 - Four-way intersection		 Workers Present?
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NARRATIVE

UNIT 1 WAS NORTH BOUND HWY 71. UNIT 2 SOUTH BOUND HWY 71. REAR DRIVER SIDE TRAILER WHEEL CAME OFF OF UNIT 1 AND STRUCK UNIT 2 IN THE FRONT CENTER OF HIS PICKUP. THIS IMPACT WAS DISABLING TO UNIT 2. UNIT 1 CONTINUED ON HWY 71 TO THE 3&71 TRUCK STOP WHERE IT WAS LOCATED BY LAW ENFORCEMENT.
Officer
BECKMAN 		Badge No.
104		 Time Officer Notified of Accident
07:00		 Time Officer Arrived At Scene
07:20
Name of Agency
P06		 Date of Report
1/21/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 06 Office
503 W 44th St
Spencer,IA 51301-2089
Phone: (712) 262-1424
Fax: (712) 262-3222