Iowa State Patrol: Department of Public Safety

Crash Information

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A
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N 		Date of Accident
1/22/2011		 Time of Accident
05:00 PM 		County
Monroe - 68		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011005465
Literal Description
586TH AVE AND 162ND LANE 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
507514.7
Y-Coordinate
4546921.
U
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T

1 		Driver's Name - Last
WILLIAMS		 First
ADAM		 Middle
JOHN		 Suffix
City
LOVILIA		 State
IA - Iowa, US		 Zip
501500000
Driver's Age
17		 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

S - SR Required		 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:
 Transported by:
Insurance Co. Name
Year
1998		 Make
General Motors - GMC		 Model
JIMMY		 Style
SUV		 Approximate Cost to Repair or Replace
2400
Initial Travel Direction
1 - North		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
55		 Point of Initial Impact
09 - Top		 Most Damaged Area
09 - Top		 Extent of Damage
5 - Severe, vehicle totaled		 Underride/Override
1 - None
Total Occupants
1		 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
03 - Ran off road, left		 Second Event
11 - Overturn/rollover		 Third Event
 Fourth Event
 Most Harmful Event (by vehicle)
11 - Overturn/rollover
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?
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P
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R
T
Y

D
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E
If Property other than vehicles damaged explain Object Damaged
STREET SIGN		 Estimate of Damage
300
Owner's Name - Last
 First
 Middle
 Suffix
Owner Company Name
MONROE COUNTY
City
 State
 Zip
ACCIDENT ENVIRONMENT ROADWAY CHARACTERISTICS
Major Contributing Circumstances:		 WORKZONE RELATED? SEQUENCE OF EVENTS
Location of First Harmful Event
4 - Roadside		 Weather Conditions (up to two)
01 - Clear		 Environment
1 - None apparent		 Location
 First Harmful Event of Crash (use codes 11-42 only)
11 - Overturn/rollover
Manner of Crash/Collision
1 - Non-collision		 Roadway
02 - Road surface condition		 Type
Light Conditions
1 - Daylight		 Surface Conditions
3		 Type of Roadway Junction/Feature
12 - T - intersection		 Workers Present?
D
I
A
G
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M

0
NARRATIVE

THE VEHICLE WAS NORTHBOUND ON 586TH AVENUE. THE ROAD WAS ICE COVERED AND THE VEHICLE LOST CONTROL AND ROTATED COUNTERCLOCKWISE. THE VEHICLE ENTERED THE DITCH AND FLIPPED ONTO IT'S ROOF AT 162ND LANE. THE VEHICLE CAME TO REST ON ITS TOP FACING EAST IN THE SOUTH DITCH OF 162ND LANE.
Officer
DANIELS 		Badge No.
089		 Time Officer Notified of Accident
17:07		 Time Officer Arrived At Scene
17:18
Name of Agency
P02		 Date of Report
1/22/2011		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 02 Office
1619 Truro Pavement
Osceola,IA 50213-8383
Phone: (641) 342-2108
Fax: (641) 342-4653