Iowa State Patrol: Department of Public Safety

Crash Information

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N 		Date of Accident
11/20/2012		 Time of Accident
03:25 PM 		County
Jefferson - 51		 Accident occurred within corporate limits of (city)
 Law Enforcement Case Number:
2012061723
Literal Description
NB/EB US 0034 / US 34 measuring 153 Meters East from US 0034 / US 34 and CEDAR AVE 		Legal Intervention?
No		 Private Property?
No
X-Coordinate:
572497.6
Y-Coordinate
4539422.
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1 		Driver's Name - Last
CLUBB		 First
FRED		 Middle
ARLO		 Suffix
City
BATAVIA		 State
IA - Iowa, US		 Zip
525330000
Driver's Age
52		 Citation Charge Code 1
N/A		 Citation Charge 1
N/A
Gender
Male		 State
IA - Iowa, US		 Class
A - Veh w/26001 GVWR or more Towed unit is 10001 GVWR or more		 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
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:
N/A		 Transported by:
N/A
Insurance Co. Name
Year
2006		 Make
Ford - FORD		 Model
F-150		 Style
TK		 Approximate Cost to Repair or Replace
8500
Initial Travel Direction
2 - East		 Vehicle Action
01 - Movement essentially straight		 Speed Limit
65		 Point of Initial Impact
05 - Rear		 Most Damaged Area
05 - Rear		 Extent of Damage
4 - Disabling damage		 Underride/Override
1 - None
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
21 - Vehicle in traffic		 Second Event
06 - Evasive action (swerve, panic braking, etc.)		 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
WIGGINS		 First
NEVILLE		 Middle
LEROY		 Suffix
City
FAIRFIELD		 State
IA - Iowa, US		 Zip
52556
Driver's Age
40		 Citation Charge Code 1
 Citation Charge 1
Gender
Male		 State
IL - Illinois, US		 Class
 Endorsements
None		 Restrictions

None		 Citation Charge Code 2
 Citation Charge 2
Alcohol Test Given?
2 - Blood		 Drug Test Given?
2 - Blood		 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
9 - Unknown		 Ejection
3 - Totally ejected		 Ejection Path
 Trapped
1 - Not trapped
Transported to:
JCHC		 Transported by:
AMBULANCE
Insurance Co. Name
Year
2003		 Make
Chevrolet - CHEV		 Model
SUBURBAN		 Style
SUV		 Approximate Cost to Repair or Replace
8000
Initial Travel Direction
2 - East		 Vehicle Action
05 - Overtaking/passing		 Speed Limit
65		 Point of Initial Impact
01 - Front		 Most Damaged Area
09 - Top		 Extent of Damage
5 - Severe, vehicle totaled		 Underride/Override
9 - Unknown
Total Occupants
1		 Traffic Controls
01 - No controls present		 Vehicle Config.
04 - Sport utility vehicle		 Cargo Body Type
01 - Not applicable		 Vehicle Defect
99 - Unknown		 Driver Condition
9 - Unknown		 Vision Obscured
01 - Not obscured		 Contributing Circumstances, Driver (up to 2)
SEQUENCE OF EVENTS First Event
21 - Vehicle in traffic		 Second Event
11 - Overturn/rollover		 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?
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
3 - Rear-end		 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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NARRATIVE

VEHICLE #1 WAS EASTBOUND ON HIGHWAY 34 IN THE RIGHT LANE WHEN IT WAS STRUCK FROM BEHIND BY EASTBOUND VEHICLE #2. VEHICLE #1 CAME TO REST IN THE MEDIAN AND VEHICLE #2 ROLLED AND CAME TO REST IN THE SOUTH DITCH OF HIGHWAY 34. THE DRIVER OF VEHICLE #1 WAS UNINJURED. THE DRIVER OF VEHICLE #2 WAS EJECTED AND WAS A FATALITY.
Officer
ANDERSON 		Badge No.
031		 Time Officer Notified of Accident
15:27		 Time Officer Arrived At Scene
15:39
Name of Agency
P13		 Date of Report
11/20/2012		 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