Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
11/10/2012		 Time of Accident
02:30 PM 		County
Plymouth - 75		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2012060168
Literal Description
2/3 MILE SOUTH OF HWY 3 ON POLK AVE 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
253254.1
Y-Coordinate
4742774.
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1 		Driver's Name - Last
GERRIETTS		 First
MATTHEW		 Middle
CONRAD		 Suffix
City
REMSEN		 State
IA - Iowa, US		 Zip
51050
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

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
1 - None used		 Airbag Deployment
5 - Not deployed		 Airbag Switch Status
3 - No ON/OFF switch present		 Ejection
3 - Totally ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
FLOYD VALLEY HOSPITAL		 Transported by:
REMSEN AMBULANCE
Insurance Co. Name
Year
1998		 Make
Ford - FORD		 Model
EXPLORER		 Style
OTHER		 Approximate Cost to Repair or Replace
4000
Initial Travel Direction
3 - South		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
55		 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
3		 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?
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)
11 - Overturn/rollover
Manner of Crash/Collision
1 - Non-collision		 Roadway
01 - None apparent		 Type
Light Conditions
1 - Daylight		 Surface Conditions
1		 Type of Roadway Junction/Feature
01 - No special feature		 Workers Present?
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D 		Name- Last
GERRIETTS		 First
MINDY		 Middle
SUE		 Suffix
City
 State
 Zip Code
Age
16		 Sex
Female		 Unit No.
1		 Seating Position
07 - Rear: Left Side		 Injury Status
3 - Non-incapacitating		 Occupant Protection
1 - None used		 Airbag Deployment
6 - Not applicable		 Airbag Switch Status
3 - No ON/OFF switch present		 Ejection
1 - Not ejected		 Ejection Path
1 - Not ejected/not applicable		 Trapped
1 - Not trapped
Transported to:
FLOYD VALLEY HOSPITAL		 Transported by:
OYENS AMBULANCE
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
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D 		Name- Last
RENKEN		 First
PHILLIP		 Middle
ALOYSIUS		 Suffix
City
 State
 Zip Code
Age
15		 Sex
Male		 Unit No.
1		 Seating Position
03 - Front: Right Side		 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
1 - Not ejected/not applicable		 Trapped
1 - Not trapped
Transported to:
FLOYD VALLEY HOSPITAL		 Transported by:
PRIVATE VEHICLE
NON-MOTORIST Type
 Location
 Action
 Condition
 Safety Equipment
 Contributing Circumstances
 Unit No. of Vehicle Striking
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NARRATIVE

UNIT ONE WAS SOUTHBOUND ON POLK AVENUE AT A HIGH RATE OF SPEED AND LOST CONTROL. THE VEHICLE ROLLED SEVERAL TIMES AND THE DRIVER WAS EJECTED.
Officer
WILLIS 		Badge No.
316		 Time Officer Notified of Accident
14:45		 Time Officer Arrived At Scene
14:51
Name of Agency
P06		 Date of Report
11/13/2012		 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