Iowa State Patrol: Department of Public Safety

Crash Information

L
O
C
A
T
I
O
N 		Date of Accident
09/18/2012		 Time of Accident
09:43 AM 		County
Buchanan - 10		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2012051677
Literal Description
V065 / BENSON-SHADY GROVE AVE and 270TH ST 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
577761.2
Y-Coordinate
4694525.
U
N
I
T

1 		Driver's Name - Last
JOHNSTONE		 First
CLAYTON		 Middle
WILLIAM-MICHAEL		 Suffix
City
GILBERTVILLE		 State
IA - Iowa, US		 Zip
50634
Driver's Age
16		 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

Y - Intermediate License		 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
1 - Fatal		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
1 - Deployed front of person		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
3 - Extricated by mechanical means
Transported to:
COVENANT		 Transported by:
JESUP AMBULANCE
Insurance Co. Name
Year
2004		 Make
Chevrolet - CHEV		 Model
IMPALA		 Style
4D		 Approximate Cost to Repair or Replace
10000
Initial Travel Direction
4 - West		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
50		 Point of Initial Impact
07 - Left Side		 Most Damaged Area
07 - Left Side		 Extent of Damage
5 - Severe, vehicle totaled		 Underride/Override
1 - None
Total Occupants
1		 Traffic Controls
04 - Stop signs		 Vehicle Config.
01 - Passenger car		 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
01 - Ran off road, right		 Third Event
 Fourth Event
11 - Overturn/rollover		 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
N
I
T

2 		Driver's Name - Last
PHILLIPS		 First
STEVEN		 Middle
CLETUS		 Suffix
City
JESUP		 State
IA - Iowa, US		 Zip
50648
Driver's Age
57		 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

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
3 - Non-incapacitating		 Occupant Protection
2 - Shoulder and lap belt used		 Airbag Deployment
1 - Deployed front of person		 Airbag Switch Status
9 - Unknown		 Ejection
1 - Not ejected		 Ejection Path
 Trapped
3 - Extricated by mechanical means
Transported to:
COVENANT		 Transported by:
JESUP AMBULANCE
Insurance Co. Name
Year
1999		 Make
Mercury - MERC		 Model
MOUNTAINEER		 Style
LL		 Approximate Cost to Repair or Replace
10000
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
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
21 - Vehicle in traffic		 Second Event
03 - Ran off road, left		 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)
02 - Partly cloudy		 Environment
1 - None apparent		 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
5 - Dark, roadway not lighted		 Surface Conditions
1		 Type of Roadway Junction/Feature
11 - Four-way intersection		 Workers Present?
D
I
A
G
R
A
M

0
NARRATIVE

Vehicle 1 was traveling West on 270th Street when it was struck by Vehicle 2 who was traveling North on Benson-Shady Grove Ave. Both vehicles entered the ditch in the NW corner of the intersection. Assisted by Jesup Fire&Rescue, Jesup Police Department, Buchanan County Sheriff's Department. ****On 11/14/2013 this report was edited to change the driver #1 contributing circumstances from other to Failure to yield right of way from a stop sign. Sgt. Douglas E. Rupe #211
Officer
JANSSEN 		Badge No.
326		 Time Officer Notified of Accident
22:05		 Time Officer Arrived At Scene
22:34
Name of Agency
P10		 Date of Report
09/19/2012		 Investigation made at scene?
Yes		 T.I. #


Any questions about this report may be directed to the following address:
Iowa State Patrol District 10 Office
15239 35th St
Oelwein,IA 50662-9446
Phone: (319) 283-5521
Fax: (319) 283-2046