I CITY OF 706 Third Avenue Montgomery, West Virginia 25136 Email: cityofmontgomeryQverizon.net Phone: 304-442-5181 Fax: 304-442-5395 JAMES F. HIGGINS, JR. Mayor GARLAND UNDERWOOD Recorder COUNCIL Darrell Fixx Whitey Harlan John Jones Teri Lewis Rodney Terrell July 22,2008 Sandra Squire Public Service Commission P 0 Box 812 Charleston, WV 25323 Re: 08-1 149-MC-FC John Selbe vs Thomas dba Gauley Auto Dear Ms Squire: Per my conversation with Dave Rupel, enclosed you will find a copy of the requested accident report. Mr. Selbe's vehicle had a temporary hold on it, but has been released by authorization of Chief Pete Lopez, however, it is our understanding that the vehicle has not been picked up because Mr. Selbe refuses to pay the tow bill. Further questions pertaining to this matter may be addressed to Chief Lopez at the number listed above. Sincerely, Terri Kees Clerk DOH Form: 17-c Revised: 03Jt007 State of West Virginia Uniform Traffic Crash Report Reporting Agency's Record Number: ?rush Record Number 2 # of Vehicles Involved lw21m ~te/TimeofCrash: COUOty: # of Non-Motorists Involved: 1 KANAWHA I/ 0518 7 0 Intersection-Related #: [? Median Crossover-Related 0 0Intersection as Part of Interchange 0Traffic Circle I Roundabout 05-Point or More None OR $< 0Weather Conditions 0Physical Obstruction(s) 8 Angle - Direction 0Angle (Front to Si Clare 0Animal(s) in Roadway Not Specifled OR 0Other: Lighting: Weather (Select Up to 2): Clear Cloudy Fog, Smug, Smoke I1 0523 0e w a y Intersection 0T Intersection 0Y Intersection Thrn Roadway MergdDiverge Area 0Interseetion 0Intersection-Related Entrance / Exit Ramp OR Time of Arrival: GPS Cwrchinates: 0Junction, Interchange Area 0 Interstate to Interstate 0Single Vehicle Crash 0Rear End 0Head-On 0Sideswipe, Same Direction 0Sideswipe, Opposite Direction 0Rcar-b+Side 0Rear-to-Rear 1 / 05-21 16/21/2008 IO 0Not Applicable 0Spur 0Nurth 0East 0Truck Ruute 0Other 0 Alternate 0 Ramp 0South 0West 0Toll 3 Junction, Non-Interchange Area 0Intersection 0 Railroad Grade Crossing # of A B or C Injuries: , MONTGOMERY Municipality or Place of Crash: 0 # of Fatal Injuries: Date /Time Crash Repurted: 0ConntyrnARP City Street 0 State Park /Forest Road 0 M a t e Road 0hlvate PropertyIW-Roadway 0Other Non-Junction 1 0 P a g e p T of 308251 0Rain Sleet., Hail, ur Freezing Rain Snow 0 0BlowingSnuw [? Other 0Severe Crosswinds 0Blowing Sand, Soil, Dirt Roadway Surface Condition: 0Slush 0Mud, Dirt,Gravel, Sand 0Wet 0Ice/Frost 0Snow 0Water (Standing I Moving) Roadway Surface Type: Asphalt 0Concrete 0 Overtorn / ROUOVW 0Fire I Explosion 0Immersion 0Jackknife 0C q o I Equipment Loss or Shift 0Feu I Jumped from Mutor Veh 0Thrown or Falling Object 0Other Non-Collision 0 Other I Location of First Harmful Event: Q) Dry M Harmful Event: 0Daylight 0Dark - Lighted 0Dark - Not Lighted 0On Roadway 8 Roadside 0In Parking Lane o r Zone 0Outside of 0 Shoulder 0Gore 0OtTRoadway, Right-of-way 0Median 0Separator Locotion Unknown 0Unknu,,,n 0Gravel COLLISION WITH: 0Pedestrian 0Pedalcycle 0Railway Vehicle 0Animal 0Motor Vehicle in Transport Parked Motor Vehicle 0Work Zone / Maintenance Equip 0 Other Non-Fixed Object 0Impact Attenuator / Crash Cushion 0 Dirt 0 Brick 0Other: 0 Bridge Overhead Structure 0Bridge Pier or Support 0 BridgeRaO 0 Culvert 0Curb 0Ditch 0Embankment 0Guardrail Face 0GaardraiIEnd 0Cable Median Barrier 0 Concrete Traffic Barrier :rash Record Number Reporting Agency's Record Number: - R o d C o n t d b u e g Circumstances: (Select Up to 3) a None 0 (7 Roadsurface Condition ICY, dc.) [? Shoulders Ruts, Holes, Bumps Worn, Travd Polished Surface Obsmction Rad>vny 0Pavement Marking Not Visible Debris School Zone Related: 'No 0yes 0 yes 0No 0Unknown S P d urnit: lof IO 0 uaiw 0Construction 0Maintenance WorkZone 0None 0Low 0 Soft 0High Problem wl Traffic Control Device Non-Higbway Work 0Inoperative 0Missing 0Obscured 0 0Other lLpe of School Zone S i p : 0When Present 0None 0Whenmashing 0 Lkts specmc n m a 0Yes,School Bus Directly Involved 0Yes,School Bas Indirectly Involved page12 308251 0Before 1stWarning S i p 0Advance Warning Area 0Transition (Merge) Area School Zone Flashers: 0Present, Not Active 0Present,Active 0 Nothesent School Zone speed Limit: 0 0 Moving Work 0Work on Shoulder ur h Median Date of Submission: ~/22/2008 State of West Virginia Uniform Traffic Crash Report 'eportingAgenq's Record Number: 308251 1 DOH Form: 17-dgm Revised: 02l2007 Mate 01 West Virginia UnxPorrn "VU 1 ".am. 1 I- Revised 02/21 Vehicle Duta Crash Record Number: Type: Address: 1 VehicleNumber: 01 0 Motor Veh in Transport Reporting Agency's Record Number: 0Parked Motor Veh / Trailer 0Working Veh /Equipment P o BOX 232 Run: 0No, Did Nut Leave Scene Driver Presence at Time of Crash: 0Driver Operated Vehicle 0Yea, Car and Driver Left Scene 0 Driverless Vehicle s-l0 0 None 0 Used as School Bus 0 Used an Other Bus 1992 0 Poiice 0Courtesy Patrol 0Ambulance @ Taxi 0 Fire Truck 0Military PICKUP Used as an Emergency @ yes 0Public School Bus 0Private School Bus 0Scheduled Service Bus Crash Avoidance Maneuver: a Essentially Straight Ahcad 0Backing 0 CbangingLPnes 0 overtaking I ~arning No 0 Yes 0MakingU-Turn 0 Slowing 0Stopped inTraffic 0Leaving Traffic Lane 0Entering Traffic Lane 0Negotiating a Curve 0Other Occurrence of Ftre: @ No Fire 3 Yes, Vehicle CnughtFire Moditled Vehicle: a No 0Y n None Evident or Reported 0Braking - Skidmarks Evident 0Braking -Driver Stated 0 Braking - Other Evidence 0 Steering - Evidence or Stated 0 Steering and Braking 0 Other 0 Commuter Bus 0 Tour Bus 0 ShuttleBus 0Church Bus 0Modtfied for PersunalPrivate Use :ontributing Clrcumstances, Motor Vehicle (Select up to 2): None 0Brakes 0 Wiper8 Steering Power Train Mirrors Suspenston Vehlcle 1s Primarily Used tu Transport Gouda, Property, or People for Commerce: *Nu Insurance: 0Yet Vehicle Impact Role: 0Undertide, Compartment Iutrusioa Unhown 0Override, Motor Vehicle in Transport 0Override, Other Motor Vehicle - - Other Phone Ins. AgeM Name ur Phone TRACY-MASSEY INc 0Other 7 0 No Underride or Override TrPftic Control Functioning Properly: 0yes 0N~ 0Underride, Compartment Intrusion 1 0Underride, No Compartment lnhuslon Vehicle Maneuver /Action: Home Phone ZtpCodr Vehicle Used as a Bus: vehicle: 0No Slnte 1 0 Properly Registered RED 0 stopsign Displaylng Hazardous Materials Placard: 10 LONDON Special Function of Motor Vehicle: 0Parked 0 TurningRight 0 Turning Left of _ _ - e Yes, Driver Left Scene ctty C HEVROLET Page _4 308251 a Tires 0Singlevehicle 0Both 0No Damage 0MinorDamage 0 Functional Damage Disabling Damage GVWR or GCWR: Less Than or Equal To 0Wheels 0Lights (Head,Signal, Tail, etc.) @ Striking 0Struck Windows Truck CoupIinglTrailer Hitch/Safety Chains 10,0001bs 010,001 - 26,000 Ibs 0More Than 26,UUOlbs Number of Axles: Total / Max Occupants of Veh: Other 02 0 1 1 0 Manner, in which Vehicle was Removed from Scene: 0Driven @ TOWHI Due to Damage ~ o w e d t o : GAULEY BRIDE, WV 0TOWHI Due to Driver ~ondition (3Left at Scene Towed by: GAULEY AUTO SALES Crash Record Number: VehicZeNumbm; 01 Crash Events: 01 Overturn / Rollover 02 Fire / Explosion 03 immersion 84 Jackknife 05 Cargo/Equipment Loss or Shltl 06 Equipment Failure 07 Scparatlon of Unite 08 Ran Off Road Right 09 Ran Off Road Left 1 10 Crou Median / Centerline 19 Motor Vehicle in Transport 11 Downhill Runaway 12 Fell I Jumped from Motor Vehlcle 20 Parked Motor Vehicle 21 Struck by Falllng I Shiftlng Cargo or Anything Set in Motion by Veh 22 Work Zone /Maintenance Eqnip 23 Other Non-Fised Object 24 Impact Attenuator I Crash Cushion 25 BridgeIOverhead Structure 26 Bridge Pier or Support 27 BndgeRail 28 Culvert 13 Thrown or Falling ObJect 14 Other Non-CoUsion COLLISION WITH: 1s PedcsMsn 16 Pedalcycle 17 Railroad Veblele 18 Animal 29 Curb 30 Ditch 31 Embankment 32 Guardrail Face 33 Guardrail End 34 Cable Median Barrier 35 Concrete Barrier 36 Other TraMc Barrier 37 Tree (Standing) 38 Utility Pole / Light Support 0 Motorcycle T r m c Sigm Support Trattlc Signal Support Other Post, Pule, or Suppurt Fence Mailbox 44 Other Fixed Object Sequence of Events: 09 0 ATV 1 42 I20 Most Harmful Event: 120 Property Damaged Other Than Vehicles: 0 Pass.Veh,TowingtJnit 0 0 Bus Tractor Trailer None c]Work Zone /Maintenance Equipment t2 12 of 10 - 39 40 4I 42 43 Select the ONE Wagram that best matches the involved vehicle and identify damaged areas: Slngle Unit Vehicle Page 5 Reporting Agency's Record Number: 308251 0Impact Attenuator / Crash Cushion 1 1 1 D 3 3 Bridge I Tunnel 1 s 3 0Culvert 0Guardrail 0Concrete Barrier Cable Median Barrler c]Other TraMc Barrier 6 6 0 0 13 Top 14 Undercarriage 13 Top 0 14 Undercarriage 1 Area of InltiOl Impact: #: Light Support 13 Top 0 14 Undercarriage 1 0Trafec Sign Support n T r a m Signal Support i_l Other Post, Pole or Support Fence Most Damaged Area: nmmOx 0 atY m 0 13 Top 14 Undercarriage 14 Uaderatriage Using the Numbers from the Diagram Above, Idenflfy the Following: Number of Traillug Units: c] 13 Top 0UbUityPoleI 6 Plate Clans Ltcense Plate Number State - sntc Year - ~- vpcode Make Model Mode1 Year I Body Type C]WVDOH city MPrIvate 0utliity Company i----i 'roslr Record Number: 'eportingAgency's Recurd Number: b o w n or Suspected Violation(s) by Driver: - Vehicle Number (fromVehicle Data Page) /308251 Rules ofthe Road - Turninc, Yieliiine, Signaling 0Failure to Stop for Red Signal Reckless/Careless/Hit and Run TVUC Offenses 0Turn in Violation of Traffic Control 0Improper Method and Position of Turn [7 Failure to Stop for Flashing Red Signal 0Negligent Humieidc 0Vidation of Turn on Red 0Failure to Obcy Flashing Signal Reckless Driving; Driving tu Endanger; Negligent Driving Cyellow or Red) Failure to Obey Signal, Generally Violation of RR Grade Crossing Device ur Regulatiuns Failure to Obey Stop Sign Failure to Obcy Yield Sign Failure to Obcy T d c Cuntrol Device 0Inattentive, Careless, Improper Driving 8 Fleeing or Eluding Law Enforcement Authorized Person Directing Traffic Hit and Run, Failure to Stup After Aeeidcnt sviuos Violation Resulting in Death 0 8 0 Yon-Moving License and Registration Vicilatiitns 0Driiing While License Suspended or Revoked Other Driver License Restrietiuns Cummercial Driver Viulatiuns Vehicle Registration Viulatiuns Failure to Carry Insurance Card Driving Uninsured Vehicle Non-Moving Violations, Generally 0 Impairment Offenses 0 0 0 tutcs o f the Rudd - Lane r s a w 0Driving \Yhik Intoxirntcd (Alcohd Unsafe or ProhibiQd h e Change Improper usc of Lane Certain T r d c to Use Right Lane 0Lane Vidatiuns, Generally or Drugs) or BAC Abmc Limit 0 0 Driving While Impaired Driving Under Influence uf Controlled Substance Driving Under Influence of Non-Controlled Substance Drinking While Operating nlcgal Pussessiun uf .Qlcuhul ur Drugs Driving with Detectable Alcuhol (CDL w Under 21 Yews &Age) Refusal to Submit to Chemical Tcst 0 Lules uf the Road - Wrong Side, Pdaring and Following 0 0 'quipnirnt Lamp Vidatiuns 0Driving Wrong Way on One-way Road Driving on Left, Wrong Side of Road, Generally Improper, Unsafe Passing Passing on Right (Drive Omof Pavement to Pass) c]Passed Stopped School Bus Failure tu Give Way When Overtaken Fdlowing Tuu Closely Wrung Side, Passing, Folluwing Viulatiuns, Generally 0 0 0Brake Violations 0Failure to Require Restraint Use Mutureycle Equipment Viulatiuns 0Viulatiun of Hazardous Cargu Regulatiuns 0Size,Weight, Luad Viulatiuns 0Equipment Viulatiuns, Generally 0 Seeed Relatcd Offenses 0 u 0 0 0 Failure to Signal for Turn or Stop 0Failure to Yield to Emergency Vehicle 0Failure to Yield, Generally 0Enter Intersection when Space Insufficient 0 0Failure to Obey Law Enforcement, Fireman, Failure to Maintain Control of Vehicle Racing Speeding (Above Speed Limit) Speed Greater than Reasonable and Prudent firceding Spccia~Limit Driving tw Sluwly of I Rnles of the Road - Traffic Signs and Signals No Violations Page 0 I Mher Violation5 0Parking 0Theft, Unauthutiztd Use uf Mutur Vehicle 0Driving Where Prohibited 0Other Muving Viulatiun :ihtion(s) Ismed tu Driver: Charge State Code /Municipal Ordinance Citation Numbcr Warning 0 0 - STATEMENT OF DRIVER: n DOH Form: I7-drv Revised: OB2007 State of West Virginia Uniform Traffic Crash Report 1 'rashRecord Number: 'eportingAgency's Recard Number: Driver Data Vehicle Number Cfrom VehicleData Page) LEE JOHN Last \ddrap: 0 First iof 10 JR suffi Middle Same as 800 4TH AVENUE APT. 22 Veh Owner wv MONTGOMERY State aty License Type: 25136 Zipcode Issuing State: 0GDL Level 1 0CDL Instruction Permit 0CDL class: 0GDL Level 2 0Motorcycle Instruction Permit OAOBOC 0GDL Level 3 0Motorcycle Only NotLicensed 0Driving License 0 Instruction Permtt 1 License Restrictions: (Select All that Apply) Lie. Number: Date of Birth: 06/21E008 status: Endorsements: (Select Up to 5) I 0Valid 0Expired 0None 0T - Double~ripleTrailers 0None 0Corrective Lenses 0Limited-Other Mechanical Devices Prosthetic Aid Automatic Transmission c] Outside Mirror c] Limit to Daylight Only Limit to Employment Most Be Accompanied by Adult 0 0 0 0 0 0S - School Bus 0N - Tank Vehicle 0H - Hazardous Materials 0 0 0 0F - Motorcycle (WV Only) 0Other - Non-WV Licenses Only 1 CDL Intrastate Motor Vehicles w/o Air Brakes Military Vehicles only Except Class A Bus Except Class A and Class B Bus Except Tractor - Trailer Farm Waiver Other )river Condition at Time of Crash: 0Suspended 0Revoked 0Probation 0Surrendered 0VaKdnnterluck 0Fraudulent P -Passenger Vehicle - X Combined Tank / Haz Materials I Action(s) of Driver that Contributed to the Crash: (Select Up to 4) c]None 0Apparently Normal 0Emotional Om 0Fell Asleep, Fainted, Fatigued Ran Off Road 0Failed to Yield Right of Way Disregarded Tramc Signs Ran Red Light c]Disregarded Other Road Markings Exceeded Posted Speed Limit c] Drove Too Fast For Conditions 0 Under the influence of M&cation/AlcohoVDrngs 0Other Page16 i 308251 SELBE )river's Name: 1 01 70 0Improper Turn 0Improper Backing 0Improper Passing 0Operated Veh in Aggresslve Manner Wrong Side or Wrong Way 0Swerved or Avoided 0Over Correcting / 0Followed Too Closely Over Steering 0Other Improper Acthn Failed to Keep in Proper Lane Operated Veh in Erratic, Reckless, or Careless Manner )river Use of Alcohol Suspected Alcohol Use Suspected: Alcohol Test Given: 0 TestGfven None Given 0 TestRefused nknown PBT Results: Type of Alcohol Test Given (Select Up to 2): blood Serum UBreatb UUrine [? Field 0Other: 0Pass 0Fail BAC Results: 0 0Pending 0Unknown )river Use of Drugs Suspected: ~e~ Drug Use Suspected: nknown )river Distracted By: Drug Test Given: Type of Drug Test Given: 0TestGken Q N one Given 0TestRefused 0Unknown if Tested 1) Not mstracted 0 Electronic Communication Device 0Serum 0Urine 0Other Drug Test Results (Check AI1 that Appfy): 0None 0Marijuana 0Cocaine Opiate 0 Other Electronic Device 0Other Inside Vehicle 0Amphetamine 0Pending 0PCP 0Other Controlled Substance Other Drug 0 Other Outside Vehicle . s . -..--VI .I- 1 v- a 9V.u.- *'"r". Revleed 02/i . I Driver m d Vi? icle Passenger Data Reporting Agency's Record Numbw: Crash Record Number: 01 1 M c -qq-11'037----7i-I----l------I-. I ___- j JOHN SELBE Page 8 OQ 308251 LEE 01 /JR 01 05/19/1990 018 ------I-- I I I I Gender: M Male F Female ! ~ I 1 Lett 2 Middle 2 Other Enclosed Cargo Area 3 Right 3 Unenclosed Cargo Area 4 Fourth 5 Other Row 4 Other 5 Unknown 4 Trailing Unit 5 Riding on Motor Vehicle Exterior 6 Unknown 1 Sleeper Section of Cab 6 Unknown Indiv # from Above 01 Airbag 10 Trapped Extricated Ejected 01 O' Medical Transport BY Ejection Path - DOT Approved Helmet: Proper Use of Occupant Protection: 01 Used Properly 02 Used Improperly ID # EMS Resoonse Run Nukber Receiving Facility Name Notifled Time Scene Time Hospital Time 02 No 03 Unknown i 1 I Dateof Death Timeof Death PhC De: I I I i I I I i NOT DEPLOYED (This Seat): US Available, Didn't Deploy 06 Available, Turned off - 08 Previously Deployed Nut Replaced 09 Disabled er Removed 1U Unable to Determine Due tu Vehicle Damage 01 Yes 03 Unknown Responding EMS Agency Airbag Deployed Codes: U7 None Tnstalled -Due to Vehicle Damage 06 Child Restraint System Rear Facing I I I DEPLOYED (This Seat): 01 Front 02 Side 03 Other 04 Multiple Directions (Front and - - 1 Front 2 Second 3 Third Trapped I Extricated Codes: Ejection Codes: Ejection Path: U1 Not Ejected 02 Ejected, Partially 01 Thru Side Door Opening 01 Not Trapped 03 Unknown 03 Ejected, Totally 04 Unknown 03 Thru Wlndshield 04 Thru Back Wlndow ' 02 Thru Side Window Tailgate Opening 08 OtherPath w Unknown Pa 06 Thru Roof Opening 07 Thru Convertible (Top Up) Roof Place of Victim's Death: Medically Transported By: 01 Not Transported 02 EMS 05 Thru Back Door I 03 Law Enforcement 04 Refused 05 Other 06 Unknown 01 AtScene 02 EnRoute 03 At Medical Facility 04 Home 05 Other Crash Recurd Number: VehicleNurnber: 02 Crash Events: 01 Overturn I Rollover 02 Fire / Explosion 03 Immersion 04 Jackknife 05 CargolEqulpment Loss or Shift 06 Equipment Failure 07 Separation of Units 08 Ran Off Road Right 09 Ran Off Road Left 10 Cross Median / Centerline 11 Downhill Runaway 12 Fell / Jamped from Motor Vehlcle 13 Thrown or Falling Object 14 Other Non-Collision COLLISION WITH: 15 Pedestrian 16 Pedalcycle 17 Railroad Vehicle 18 Animal j Reporting Agency's Record Number: 19 Motor Vehicle in Transport 20 Parked Motor Vehicle 21 Struck by Falling / Shifting Cargo or Anything Set fo Motion by Veh 22 Work Zone / Maintenance Equip 23 Other Non-Fued Object 24 Impact Attenuator /Crash Cushion 25 Bridgeloverhead Structure 26 Bridge Pier or Support 27 BridgeRnil 28 Culvert 29 Curb 30 Dltck 31 Embankment 32 Guardrail Face 33 Guardrail End 34 Cable Median Barrier 35 Concrete Barrier 36 Other TrafRc Barrier 37 Tree (Standing) 38 Utility Pole /Light Support SingleUnitVehicle 10 Motorgele 0 ATV Trafllc Sfgn Support Trafllc Signal Sopport Other Port, Pole, or Support Fence 43 Mailbox 44 Other Fixed Object Sequence of Events: I 1 38 20 ~ 20 Property Damaged Other Than Vehicles: 0 Pass.Veb,TowlngUnit 0 Bus 0 - Tractor Trailer 0None 0Work Zone /Maintenance Equipment 0Impact Attenuator I Crash Cushion 0Bridge 1 Tunnel Culvert 0 Guardrail Concrete Barrier 0 13 Top 14 Undercarriage ' I 0Cable Median Barrier Other Traffc Barrier 6 a 13 Top 0 14 Undercarriage Using the Numbers from the Dlagram Above, Identify the Following: 0 13 Top 0 14 Undercarriage of 10 - 39 40 41 42 Most Harmful Event: Select the ONE Diagram that best matches the involved vehicle and identify damaged areas: 0 Page 10 308251 13 Top 13 Top 0 14 Undercarriage Area of Inltial Impact: 1 14 Undercarriage Most Damaged Area: Utility Pole / #:I Light Support 9Traffic Sign Support c]Traffic Signal Support a Other Post, Pole or Support @ Fence 0Mailbox E Other Fixed Object Damaged Property Owner(s): WVDOH D city Rprivate 0utility Company ~ t a t eSI west vir inla Uniiorm I rattic Crash Keport Vehicle Data Crash Record Number: Type: 0Mutur Veh owner's ~ame(s): Address: 1 VehicleNumber: 02 @ Working Veh I Equipment Parked Motor Veh I Trailer in Transport 0Yes, Driver Left Scene 0Yes, Car and Driver Left Scene Po Box 175 1 WV MONTGOMERY C'ry Culor /FOCUSZX4 2005 VIN HARDTOP,&DOOR Plate Class 1FAFP34N35W106255 None 7U 9870 A @ Police @ Courtesy Patrol 0Ambulance 0Taxi @ FireTruck 0 Mllitary 0 Person (Flagger, etc.) 0 Traftlc Control Signal 0School Zune Signs 0Warning Signs Traffic Control Functioning Properly: ~ 0yes - SILVER Driverlease Vehicle 125136 State ZipCudr Horn Phone Proof of Liability Insurance: Registration Status: i 0Driver Operated Vehicle Properly Registered Other Phone Ins. Co: THE HARTFORD Llcense Plate Number Special Function of Motor Vehicle: 0UsedasSchoolBus 0UsedasOtherBus of.10 Driver Presence at Time of Crash:. Nu,Did Nut Leave Scene Hit and Run: I ISABELLE GODFREY FORD Page 9 Reporting Agency's Record Number: 308251 0No , , I Vehicle Used as a Bus: Used as an Emergency Vehicle: 0Private School Bus 0Yes 0Scheduled Service Bus 0No 0 Straight 0CurveLeft 0 Curve Right 0ShuttleBus 0Church Bus 0Modified for Persunallhlvate Uae 0 Level 0 ~ p h i 0Sag (Bottom) 0 Hillcrest 0Downhill 0 Striking 0Singlevehicle 0Both 0 Struck Veh Travel Speed (Mpm: 7 Extent of Damage 0Underride, Compartment Intrtlslon 0Underrlde, No Compartment Intrusion 0Override, Motor Vehicle in Transpurt 0Override, Other Motor Vehicle 0~ o ~ a m a g e 0 RfinorDamage 0 Functional Damage B)Disabling Damage GVWR or GCWR: @ Essentially Straight Ahead 0Backing 13 Changing Lanes 0 Overtaking / Passing 0 Parked 0TurningRight c? Turning Left Displaying Hazardous Materials Placard: 0 No Yes 0Making U-Turn 0Slowing 0Stopped in Traffic 0Leaving Traffic Lane 8 None Evident or Reported 0 Entering Traffic Lane @ Steering Evidence or Stated @ Steering and Braking 0Other 0Negotiating a Curve 0Other Occurrence of Fire: 0 No Fire @ Yes, Vehicle CauKhtFire Modifled Vehicle: 0 No 0 Yes - @ Braking Skidmarks Evident 3 Braking - Driver Stated 0Braking - Other Evidence - Vehicle is Prtmarily Used to Transport Good#, Property, or People for Commerce: oN. 0Yes None OBrakes Wipers Steering Power Train Mirrors 0T i e s 0 Less Than or Equal To wheels 10,0001bs 0 10,001 - 26,000 Ibs 0More Than 26,UWlbs 0Lights (Head, Sinal, Tail, etc.) 0 Windows i? Truck Coupiing/Trailer 0 Hitch/Safety Chains 0Suspension 0 Other Number of Axles: 02 Total I Max Orcupants of Veh: 0 0 1 0 Manner, in whfch Vehicle was Removed from Scene: 0Driven 0Towed Due to Damage Towed to: 0Towed Due to Driver Condition Towed by: Left at Scene
© Copyright 2024 Paperzz
