Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
1/21/2011		 Time of Accident
12:11 PM 		County
Van Buren - 89		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2011004925
Literal Description
WATER ST and CHESHIRE ST 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
588706.7
Y-Coordinate
4525956.
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1 		Driver's Name - Last
HARLAN		 First
MAX		 Middle
WAYNE		 Suffix
City
STOCKPORT		 State
IA - Iowa, US		 Zip
526510000
Driver's Age
36		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
IA - Iowa, US		 Class
B - Veh w/26001 GVWR or more Towed unit is less than 10001 GVWR		 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
3 - Non-incapacitating		 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:
N/A		 Transported by:
N/A
Insurance Co. Name
Year
2000		 Make
Dodge - DODG		 Model
DUR		 Style
SW		 Approximate Cost to Repair or Replace
2500
Initial Travel Direction
2 - East		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
25		 Point of Initial Impact
04 - Right Rear		 Most Damaged Area
04 - Right Rear		 Extent of Damage
4 - Disabling damage		 Underride/Override
1 - None
Total Occupants
2		 Traffic Controls
04 - Stop signs		 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
21 - Vehicle in traffic		 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?
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2 		Driver's Name - Last
HENDRICKS		 First
ROGER		 Middle
WILLIAM		 Suffix
City
BIRMINGHAM		 State
IA - Iowa, US		 Zip
525350000
Driver's Age
43		 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
 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:
N/A		 Transported by:
N/A
Insurance Co. Name
Year
1991		 Make
International - INTL		 Model
4900		 Style
6X6		 Approximate Cost to Repair or Replace
1000
Initial Travel Direction
1 - North		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
25		 Point of Initial Impact
01 - Front		 Most Damaged Area
01 - Front		 Extent of Damage
3 - Functional damage		 Underride/Override
1 - None
Total Occupants
2		 Traffic Controls
01 - No controls present		 Vehicle Config.
06 - Single-unit truck (>=3 axles)		 Cargo Body Type
04 - Cargo tank		 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
3 - Fire		 Emergency Status
1 - Yes, in emergency
Carrier Name
 City
 State
 Zip
Number of Axles
 Gross Vehicle Weight Rating
 Placard #
 Hazardous Materials Released?
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Y

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If Property other than vehicles damaged explain Object Damaged
STOP SIGN		 Estimate of Damage
150
Owner's Name - Last
 First
 Middle
 Suffix
Owner Company Name
CITY OF BIRMINGHAM
City
BIRMINGHAM		 State
IA - Iowa, US		 Zip
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
2 - Weather condition		 Location
 First Harmful Event of Crash (use codes 11-42 only)
21 - Vehicle in traffic
Manner of Crash/Collision
5 - Broadside		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
4		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
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NARRATIVE

UNIT #1 WAS TRAVELING EAST ON CHESHIRE STREET, WHEN IT FAILED TO STOP AT A STOP SIGN. UNIT #2 WAS TRAVELING NORTH ON WATER STREET, WHEN IT WAS UNABLE TO AVOID STRIKING UNIT #1. BOTH VEHICLES WERE RESPONDING TO A STRUCTURE FIRE IN THE CITY LIMITS OF BIRMINGHAM.
Officer
BUCKALEW 		Badge No.
090		 Time Officer Notified of Accident
12:11		 Time Officer Arrived At Scene
12:25
Name of Agency
P13		 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 13 Office
1300 S Grand Ave
Mt Pleasant,IA 52641-1862
Phone: (319) 385-8715
Fax: (319) 385-2743