Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-1039
05/01/17
13:45 Hrs.
URBANDALE POLICE
DEPARTMENT
PETERSON RANDALL
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1109
05/01/2017
13:46 Hrs.
13:53 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00441278
04608869
DOUGLAS AVE WB AND 64TH
ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
BETHARDS
JERAMY
LEE
URBANDALE
IA
50322-0000
Male
33
NO
IA
C
NONE
B
30
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2012
CHEVROLET - CHEV
MALIBU
4 DR
BLACK - BLK
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
02 - TURNING LEFT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
08 - MOVING VEHICLE(S)
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
08 - REAR DRIVER SIDE
Emergency Status:
01 - NOT APPLICABLE
08 - REAR DRIVER SIDE
Cont. Circum., Drvr:
09 - IMPROPER OR ERRATIC
LANE CHANGING, 11 - MADE
IMPROPER TURN
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:54 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-1039
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
COLE
DANYELLE
ROSE
DES MOINES
IA
50317
Female
31
NO
IA
C
NONE
NONE
30
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
01 - FRONT PASSENGER SIDE
CORNER
01 - FRONT PASSENGER SIDE
CORNER
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,500.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
3
2008
MAZDA - MAZD
3I
4 DR
GRAY - GRY
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
98 - OTHER (EXPLAIN IN NARRATIVE)
1 - DAYLIGHT
02 - CLOUDY
Surface Conditions:
02 - WET
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 1 driver stated the following:
He was west bound on Douglas and was coming up to turn onto 64th Street. As he approached the intersection he saw a street sweeper coming the opposite direction and
felt it was in his lane so he changed lanes into the curb lane and then turned on 64th Street but was hit mid turn by Unit 2.
Unit 2 driver stated the following:
She stated she was behind Unit 1 by about a car and a half length when he turned on his signal to go into the curb lane. As she was about to pass Unit 1 it turned in front of
her and she struck him.
I checked with the street sweeper and he did not witness the crash.
Officer findings:
After reviewing the damage it was consistent with what Unit 2 driver stated. Unit 1 turned in front of Unit 2 and damage to the vehicles are consistent to a broadside crash.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:54 PM
2
3
17-1039
URBANDALE POLICE DEPARTMENT
5/30/2017 1:54 PM
3
3
17-1039
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-1045
05/02/17
17:30 Hrs.
URBANDALE POLICE
DEPARTMENT
PETERSON RANDALL
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1109
05/02/2017
17:31 Hrs.
18:27 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00433842
04609760
128TH ST SB AND AURORA AVE
001
Driver Name - Last:
First:
Middle:
YAMSANI
SANKALP
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
WEST DES MOINES
IA
50266-0000
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Male
17
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE,
08 - OPERATING VEHICLE IN A
RECKLESS, ERRATIC,
CARELESS, NEGLIGENT
MANNER
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$8,000.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2014
VOLKSWAGON - VOLK
JET
4D
SILVER - SIL
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:56 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-1045
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
JOHNSON
AMANDA
LEE
CLIVE
IA
50325-0000
Female
34
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2012
NISSAN - NISS
MUR
SW
BLACK - BLK
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
10 - SLOWING/STOPPING
(DECELERATING)
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$5,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
13 - T-INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 2 was slowing for a red light and about to make a complete stop when Unit 1 smashed into the rear of Unit 2.
Both drivers agreed to the above statement.
Unit 1 driver is at fault for the crash.
Both driver refused medical treatment.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:56 PM
2
3
17-1045
URBANDALE POLICE DEPARTMENT
5/30/2017 1:56 PM
3
3
17-1045
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01052
05/03/17
15:56 Hrs.
URBANDALE POLICE
DEPARTMENT
DOMEIER BEN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1130
05/03/2017
16:00 Hrs.
16:14 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00438640
04607612
2600 86TH STREET
001
Driver Name - Last:
First:
Middle:
DUBINOVIC
BENJAMIN
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
WEST DES MOINES
IA
50266
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Male
17
YES
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
40 - FTYROW: FROM STOP
SIGN
Traffic Controls:
04 - STOP SIGNS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$5,000.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02
2016
VOLKSWAGON - VOLK
JETTA
4D
SILVER - SIL
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:56 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
321.321
Citation Charge 1:
FAIL TO YIELD UPON
ENTERING THROUGH
HIGHWAY
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01052
002
Driver Name - Last:
First:
Middle:
ATENCO ATLAGCO
EDWIN
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
WEST DES MOINES
IA
50265
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Male
19
NO
NO
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
03 - MIDDLE PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
03 - MIDDLE PASSENGER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$5,000.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
03
2005
DODGE - DODG
NEON
4D
COPPER - CPR
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
Object Damaged:
Estimate of Damage:
Owner's Name - Last:
First:
Middle:
Suffix:
TRAFFIC MEDIAN SIGN
$100.00
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
05 - BROADSIDE (FRONT TO SIDE)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Company Owner Name:
City:
State:
Zip Code:
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
321.174(1)
Citation Charge 1:
NO VALID DRIVERS LICENSE
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
321.20B
FAILURE TO PROVIDE PROOF
OF FINANCIAL LIABILITY ACCID
Cit Chrg Code 4:
Citation Charge 4:
URBANDALE PUBLIC WORKS
URBANDALE
IA
50322
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 1 was stopped facing EB at the entrance to the Carole Circle Apts.
Unit 2 was SB in the 2600 block of 86th Street.
Unit 1 proceeded into the intersection and struck Unit 2.
Officer's Notes :
Driver of Unit 1 (Dubinovic) stated, "I was waiting to go straight across 86th Street to grab something to eat with my friend. I saw them (Unit 2) and it looked like they were
far enough back, so I went. I think they (Unit 2) may have switched lanes at he last minute and I hit them."
Driver of Unit 2 (Atlagco) stated, "He (Unit 1) was in the middle of the road and I couldn't stop in time. He just came out of that driveway right in front of me."
The passenger in Unit 1 fled the scene prior to my arrival.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:56 PM
2
3
17-01052
After Unit 2 was struck by Unit 1, Unit 2 spun and struck the center median, and corresponding median traffic sign, with it's rear, driver's side quarter-panel. Urbandale
Public Works was advised that the traffic sign was sheared off at it's base and would need to be replaced.
Unit 1 sustained disabling damage to the front-end of the vehicle and was towed away from the scene by Rick's Towing.
Unit 2 sustained disabling damage to the passenger-side and rear, driver's side quarter-panel of the vehicle, to include the rear, driver's side wheel being separated from the
vehicle. Unit 2 was towed away from the scene by Rick's Towing.
Dubinovic was issued a citation for Failure to Yield Upon Entering Through Highway. Atlagco was issued citations for Failure to Provide Proof of Financial Responsibility
(Accident) and No Valid Driver's License.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:56 PM
3
3
17-01052
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01048
05/03/17
10:24 Hrs.
URBANDALE POLICE
DEPARTMENT
PICKETT HOLLY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1122
05/03/2017
12:03 Hrs.
12:07 Hrs.
NO
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00435284
04607849
3600BLK INTERSTATE 80/35
NB/EB MM 126
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
MCDERMOTT
CLARK
GENE
CLIVE
IA
50325
Male
51
NO
IA
C
NONE
B
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2011
TOYOTA - TOYT
CAM
4D
TAN - TAN
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
04 - REAR PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
04 - REAR PASSENGER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$250.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:56 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01048
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
FAUST
ALEXIS
VICTORIA
CLIVE
IA
50325
Female
20
NO
IA
C
NONE
NONE
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02
2013
KIA - KIA
OPTIMA
SX
WHITE - WHI
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
07 - ENTERING TRAFFIC LANE
(MERGING)
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
10 - FRONT DRIVER SIDE
Emergency Status:
01 - NOT APPLICABLE
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
10 - FRONT DRIVER SIDE
Cont. Circum., Drvr:
09 - IMPROPER OR ERRATIC
LANE CHANGING
Second Event:
72 - HIT AND RUN
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
1 - NONE
$500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
06 - SIDESWIPE, SAME DIRECTION
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
321.263
Citation Charge 1:
LEAVING SCENE OF ACCIDENT
- FAIL TO PROVIDE AID OR
INFO
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
20 - ON-RAMP, MERGE AREA
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Driver of unit 1 made contact with the Urbandale Police Department reporting his vehicle had been struck by a hit and run driver at approximately 1030hrs on the interstate
near Douglas Ave, traveling north/east bound.
Driver of unit 1 provided this officer with the description of a white Kia, driven by a young (approximately 20 year old white female with long brown hair). Driver of unit 1
additionally provided this officer with a Iowa license plate of JAH980 but advised he was uncertain on the middle letter of the plate.
Driver of unit 1 described to this officer that he was traveling in the center lane of the interstate and observed unit 2 enter from the on ramp and rather than staying in the
"slow lane" or lane 3, it continued across said lane into his lane of travel, striking his vehicle.
This officer observed white paint transfer on the rear quarter panel of unit 1's passenger side, consistent with his account of the accident.
Driver of unit 1 advised unit 2 then pulled ahead of him and the two merged to the "fast lane" or lane 1 at which time he believed unit 2 was going to stop in the median.
Driver of unit 1 advised instead, unit 2 took off at a high rate of speed at which time he took the pictures of unit 2 provided to this officer as he had now realized the vehicle
was leaving without making contact with him.
This officer utilized search resources and located an Iowa registered Kia Optima, white in color bearing license plate JH980. Officers requested WDMPD make contact with
the registered owner, at an address in West Des Moines and were advised that this was his daughters vehicle and were provided the name of his daughter, Alexis Victoria
Faust, dob/1/09/1997 along with her cell phone number. This officer located the photograph of Faust via her Iowa Drivers License and noted the matching description of
driver given by unit 1.
This officer was contacted later that day by the grandmother of Faust indicating that they had been at that location at the time of the accident but noted
URBANDALE POLICE DEPARTMENT
5/30/2017 1:56 PM
2
3
17-01048
that she was in the car with her grand daughter and did not believe they had struck another vehicle. This officer asked that Faust and her vehicle be brought to the station
for further investigation.
At approximately 1600hrs this officer was advised that Faust, her vehicle and her grandparents were in the front lobby of the station at which time this officer made contact
with them.
This officer noted visible damage to Faust's front quarter panel, tire rub marks to the front driver side tire and rim as well as rub marks to the rear driver side tire and rim.
Faust advised this officer she believed the damage to her front quarter panel was old but gave no explanation as to when the damage had occurred. Faust admitted to
being in the area at the time of the accident and advised she observed some one very obviously following her at that location but noted she did not feel like she had hit any
one. Faust later stated that maybe the car was vibrating so much she did not recognize the contact between the two vehicles.
Faust was issued a citation for leaving the scene of the accident - fail to provide aid or info on a property damage only accident and was issued a written warning for
improper use of lanes.
Damage to both units 1 and 2 were documented on body camera.
This officer did make contact with driver of unit 1 and advised him he could pick up a copy of his drivers exchange at his convenience.
The case investigative status is CLOSED at this time.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:56 PM
3
3
17-01048
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-1057
05/04/17
07:45 Hrs.
URBANDALE POLICE
DEPARTMENT
BOEHM BRYCE
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1125
05/04/2017
07:55 Hrs.
07:58 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00440577
04608873
7000 DOUGLAS AVE
001
Driver Name - Last:
First:
Middle:
GARDNER
MICHAEL
JOE
City:
DES MOINES
State:
IA
Zip:
50310-0000
Suffix:
JR
Gender:
Male
Age:
36
NO
CDL:
License State:
IA
License Class:
D
License Endorsmnt: 2L
License Restrictions: NONE
Speed Limit:
30
Seating Position:
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
Driver Condition:
01 - APPARENTLY NORMAL
Alcohol Test Given: NO
1 - NONE
Drug Test Given:
Total Occupants:
01
2010
Vehicle Year:
Vehicle Make:
VCTY
Vehicle Model:
HSC
MC
Vehicle Style:
BLACK - BLK
Vehicle Color:
Vehicle Config:
17 - MOTORCYCLE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
03 - MIDDLE PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
12 - FRONT MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Second Event:
33 - VEHICLE IN TRAFFIC
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
1 - NONE
$1,500.00
4 - DISABLING DAMAGE
24 - FELL/JUMPED FROM VEHICLE
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
01 - NOT APPLICABLE
Injury Status:
3 - SUSPECTED MINOR/NONINCAPACITATING
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:56 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-1057
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
TIANO
CODY
VINCENT
DES MOINES
IA
50313-0000
Male
24
YES
IA
B
NONE
K
30
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
01
2014
PETERBILT - PTRB
Vehicle Defect:
UN
WHITE - WHI
16 - OTHER HEAVY TRUCK
(>10,000 LBS) (CANNOT
CLASSIFY)
01
- NONE
Vehicle Action:
03 - TURNING RIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
04 - REAR PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
04 - REAR PASSENGER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$200.00
1 - NONE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
06 - SIDESWIPE, SAME DIRECTION
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
05 - DRIVEWAY ACCESS (RELATED, NOT IN)
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Garbage Truck was turning out of Urban Ice Cream Shop and turning into the Bank Parking Lot. It needs a wide turn to make the turn.
Motorcycle was headed in the inside lane on Douglas when he saw the Garbage Truck turn into the inside lane. He attempted to change lanes into the outside lane.
He realized the Garbage Truck was turning into the bank he could not stop in time and laid the bike down and slid into the garbage truck.
Medics came and treated the driver of the motorcycle for some road rash on his leg.
Motorcycle had damage and scrapes to the right side.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:56 PM
2
3
17-1057
URBANDALE POLICE DEPARTMENT
5/30/2017 1:56 PM
3
3
17-1057
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01062
05/04/17
17:34 Hrs.
URBANDALE POLICE
DEPARTMENT
WILCUTT ERIC
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1103
05/04/2017
17:34 Hrs.
17:50 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00435334
04608927
DOUGLAS AVE
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
MEADOWCROFT
MARISSA
LOUISE
ADEL
IA
50003-0000
Female
18
NO
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 16 - LOOKED BUT DID NOT SEE
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$5,000.00
5 - SEVERE, VEHICLE TOTALED
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2007
CHRYSLER - CHRY
CRU
VN
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:56 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
UR/71.030
Citation Charge 1:
FAILURE TO STOP IN
ASSURED CLEAR DISTANCE
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01062
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
REED
STEVEN
GLENN
URBANDALE
IA
50323-0000
Male
50
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2005
LEXUS - LEXS
L43
4D
BLACK - BLK
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
11 - STOPPED IN TRAFFIC
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
01 - NOT APPLICABLE
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
003
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
WEISER
MALLORY
ELIZABETH
URBANDALE
IA
50323-0000
Female
26
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2005
CHEVROLET - CHEV
TBZ
SW
WHITE - WHI
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
11 - STOPPED IN TRAFFIC
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
01 - NOT APPLICABLE
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:56 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
2
3
17-01062
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
Environment:
Roadway:
01 - NONE APPARENT
12 - TRAFFIC BACKUP, REGULAR CONGESTION
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Vehicle # 2 and vehicle #3 were stopped on the Douglas Ave over pass for regular congestion for roadwork at the intersection of 128th and Douglas Ave.
Vehicle #1 was in motion and could not stop and stuck vehicle #2 which then pushed vehicle #2 into vehicle #3.
The operator of the at fault vehicle stated that the car in front of her stopped fast and she was unable to get stopped in time before striking them.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:56 PM
3
3
17-01062
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01061
05/04/17
17:00 Hrs.
URBANDALE POLICE
DEPARTMENT
BOEHM BRYCE
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1125
05/04/2017
17:05 Hrs.
17:12 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00441898
04610709
STATE 28/MERLE HAY RD
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
LOHNER
SHARI
ELIZABETH
HIGH RIDGE
MO
63049-0000
Female
43
NO
MO
F
NONE
NONE
40
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02
2008
HONDA - HOND
SEDAN
4DR
BLUE - BLU
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
10 - SLOWING/STOPPING
(DECELERATING)
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
4 - POSSIBLE (COMPLAINT OF
PAIN/INJURY)
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:57 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01061
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
ARTHOFER
ANDREA
JEAN
ZWINGLE
IA
52079-0000
Female
22
NO
IA
C
NONE
NONE
40
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2008
CHEVROLET - CHEV
IMP
4D
BROWN - BRO
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
10 - SLOWING/STOPPING
(DECELERATING)
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
MERCY DOWNTOWN
URBANDALE EMS
Special Veh Func:
01 - NO SPECIAL FUNCTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Second Event:
33 - VEHICLE IN TRAFFIC
1 - NONE
$1,500.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
3 - SUSPECTED MINOR/NONINCAPACITATING
Source of Trans: 03 - EMS GROUND
Died at Scene:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
003
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
LOWREY
JAMES
EDWARD
WEST DES MOINES
IA
50266-0000
Male
67
NO
IA
C
NONE
NONE
40
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
01
2014
FORD - FORD
TRANSIT
VN
WHITE - WHI
04 - PASSENGER VAN (SEATS
<9)
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:57 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
UR/71.030
Citation Charge 1:
FAILURE TO STOP IN
ASSURED CLEAR DISTANCE
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
2
3
17-01061
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Vehicles 1 and 2 were in stop and go traffic on Merle Hay Rd heading South.
Driver 3 stated that the cars in front of him started moving and then slammed on their brakes and he did not have enough time to stop and ran into the back of Vehicle 2
which caused Vehicle 2 to strike Vehicle 1.
Driver 2 said she was in stop and go traffic not moving very much when Vehicle 3 ran into the back of her causing her to hit the vehicle in front of her.
Driver 2 had neck pain and was transported to Mercy Hospital by Urbandale EMS.
Driver in vehicle 1 had some neck pain. She was checked out by medics on scene but was not transported.
All cars were able to drive away from the scene.
Driver 3 was cited for failure to stop in assure clear distance.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
3
3
17-01061
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01069
05/05/17
16:37 Hrs.
URBANDALE POLICE
DEPARTMENT
BROOKS ANTHONY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1134
05/05/2017
17:01 Hrs.
17:23 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
DALLAS - 25
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00430338
04608949
DOUGLAS PKWY AND 158TH ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
FRIEDMAN
ROBERT
JOSEPH
JOHNSTON
IA
50131-0000
Male
61
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2010
TOYOTA - TOYT
CAM
4D
WHITE - WHI
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
02 - TURNING LEFT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 98 - DISTRACTION OUTSIDE
VEHICLE (EXPLAIN IN NARRATIVE)
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
04 - REAR PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
04 - REAR PASSENGER SIDE
Cont. Circum., Drvr:
42 - FTYROW: MAKING LEFT
TURN
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,500.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:57 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01069
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
BREITEN
SHARI
JOANN
CLIVE
IA
50325-0000
Female
52
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2004
ACURA - ACUR
MDX
SW
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
01 - FRONT PASSENGER SIDE
CORNER
01 - FRONT PASSENGER SIDE
CORNER
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
04 - ANGLE, ONCOMING LEFT TURN
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
UNIT 1 WAS TRAVELING WB APPROACHING THE INTERSECTION OF 158TH AND DOUGLAS PKWY.
UNIT 2 WAS TRAVELING EB APPROACHING THE INTERSECTION OF 158TH AND DOUGLAS PKWY.
UNIT 1 PROCEEDED TO MAKE A LEFT HAND TURN TO GO SB DOWN 158TH ST. IN DOING SO UNIT 1 TURNED DIRECTLY IN FRONT OF UNIT 2 AND UNIT 2
COULD NOT STOP IN TIME. THE VEHICLES COLLIDED.
DRIVER OF UNIT 1 STATED THERE WAS A VEHICLE TAIL GATING HIM AND WEAVING IN AND OUT OF TRAFFIC. HE STATED HE WAS LOOKING BEHIND HIM IN
HIS MIRROR WHEN HE TURNED LEFT TO GO DOWN 158TH. HE STATED HE WAS LOOKING AT THE OTHER VEHICLE SO MUCH THAT HE DID NOT SEE UNIT 2
COMING.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
2
3
17-01069
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
3
3
17-01069
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01070
05/05/17
17:40 Hrs.
URBANDALE POLICE
DEPARTMENT
GRIFFITH GEORGE
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1075
05/05/2017
17:33 Hrs.
17:41 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00438542
04608876
8700 BLK DOUGLAS AVE
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
PARMERLEE
RYAN
DANIEL
URBANDALE
IA
50322-0000
Male
38
NO
IA
C
L
B
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2006
HUMMER - HUMM
HU2
SW
WHITE - WHI
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Second Event:
33 - VEHICLE IN TRAFFIC
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
1 - NONE
$2,500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:57 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01070
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
MILSTEAD
BRENDA
SUE
URBANDALE
IA
50322-0000
Female
39
NO
IA
C
NONE
NONE
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
03
2000
JEEP - JEEP
GCH
SW
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
96 - OTHER NON-INTERSECTION (EXPLAIN IN
NARRATIVE)
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
On May 5, 2017 at 1733 hours I was dispatched to a two car property damage crash with no injuries at the intersection of Douglas Ave and 86th street.
Arrived at 1741 hours and noticed there were two crashes going east on Douglas Ave approaching the 86th street intersection.
Both drivers were out of their respective vehicles and said they were uninjured,
Both vehicles were east bound stopped for the traffic light at the intersection. Traffic started to move forward but came to a stop.
Vehicle One driver said he was distracted by something else and did not pay attention that the traffic had stopped striking vehicle two.
Minor damage was sustained by both vehicles and a warning was given for Failure to Stop in a Clear Assured Distance was given to vehicle one driver.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
2
3
17-01070
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
3
3
17-01070
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01071
05/05/17
18:09 Hrs.
URBANDALE POLICE
DEPARTMENT
BROOKS ANTHONY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1134
05/05/2017
18:09 Hrs.
18:10 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00438448
04608878
8700 BLOCK DOUGLAS AVE (PD
AND HYVEE INTERSECTION)
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
LEAHY
JAMES
JOSEPH
URBANDALE
IA
50322-0000
Male
71
NO
IA
C
L
B
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02
2013
FORD - FORD
TAU
4D
GRAY - GRY
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
02 - TURNING LEFT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 99 - UNKNOWN
Transported by:
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
01 - FRONT PASSENGER SIDE
CORNER
01 - FRONT PASSENGER SIDE
CORNER
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:57 PM
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
01 - RAN TRAFFIC SIGNAL
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01071
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
JOHNSON
KASHMERE
MARSEAN
URBANDALE
IA
50322-0000
Male
22
NO
IA
C
NONE
G
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02
2009
TOYOTA - TOYT
CAMRY
4D
GOLD - GLD
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
3 - DISABLED - OFFICER
ARRANGED
17-01071
04 - WEST
01 - NOT OBSCURED
Tow #:
Initial Trvl Dir:
Vision Obscured:
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
10 - FRONT DRIVER SIDE
Emergency Status:
01 - NOT APPLICABLE
10 - FRONT DRIVER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,000.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
05 - BROADSIDE (FRONT TO SIDE)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
Name - Last:
First:
Middle:
Suffix:
City:
State:
Zip Code:
Age:
Sex:
Unit No.:
Seating Position:
Occupant Protection:
GALAVN
ELYSIA
01 - NOT APPLICABLE
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
URBANDALE
IA
50322
21
FEMALE
2
03 - 1ST ROW: RIGHT SIDE
03 - SHOULDER AND LAP BELT USED
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
Airbag Deployment:
Airbag Switch Status:
Trapped:
Injury Status:
Ejection:
Ejection Path:
Alcohol Test Given:
Drug Test Given:
Source of Transport:
Died at Scene/Enroute:
Transported to:
Transported by:
33 - VEHICLE IN TRAFFIC
03 - NOT DEPLOYED
1 - NOT TRAPPED/APPLICABLE
4 - POSSIBLE (COMPLAINT OF PAIN/INJURY)
2 - NOT EJECTED
01 - NOT EJECTED/NOT APPLICABLE
03 - EMS GROUND
01 - NOT APPLICABLE
MEHODIST WEST
URBANDALE EMS
UNIT 1 WAS TRAVELING EB APPROACHING THE INTERSECTION OF DOUGLAS AND HY-VEE DRIVE.
UNIT 2 WAS TRAVELING WB APPROACHING THE INTERSECTION OF DOUGLAS AND HY-VEE DRIVE.
UNIT 1 ENTERED THE INTERSECTION TO MAKE A LEFT HAND TURN TO GO NB. UNIT 1 COMPLETED THE TURN INTO THE INTERSECTION FAILING TO YIELD
FOR THE LIGHT AND COLLIDED WITH UNIT 2 WHOM WAS CONTINUING WB THROUGH THE INTERSECTION.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
2
3
17-01071
DRIVER OF UNIT 1 WAS CITED FOR FAILURE TO OBEY A TRAFFIC CONTROL DEVICE.
OFFICER GRIFFITH WAS WORKING A DIFFERENT ACCIDENT IN THE 8600 BLOCK OF DOUGLAS AVE AND WITNESS THE VEHICLE COLLISION.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
3
3
17-01071
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01067
05/05/17
02:00 Hrs.
URBANDALE POLICE
DEPARTMENT
GRIFFITH GEORGE
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1075
05/11/2017
15:45 Hrs.
15:53 Hrs.
YES
Report to All Drivers: NO
Legal Intervention: NO
Private Property:
YES
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00439191
04607270
WESTPOINTE APARTMENTS
2510 CANTERBURY RD
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt: NONE
License Restrictions: NONE
Speed Limit:
Seating Position:
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Bus Use:
Transported to:
Drvr Distractions:
Transported by:
Special Veh Func:
Traffic Controls:
Point of Init
Impact:
Emergency Status:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
Cont. Circum., Drvr:
60 - TREE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
Second Event:
Third Event:
Fourth Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Most Harmful
Event:
60 - TREE
Abg Switch Stat:
99 - UNKNOWN
Abg Deploy:
Vehicle Defect:
Vehicle Action:
Trapped:
Ejection:
Ejection Path:
9 - UNKNOWN
9 - UNKNOWN
99 - UNKNOWN
Occpnt Protect:
99 - UNKNOWN
Tow:
Tow #:
Initial Trvl Dir:
Vision Obscured:
Injury Status:
9 - UNKNOWN
Source of Trans: 99 - UNKNOWN
Died at Scene:
Object Damaged:
Estimate of Damage:
Owner's Name - Last:
First:
Middle:
Suffix:
TREES
$800.00
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
06 - OUTSIDE TRAFFICWAY
01 - NON-COLLISION (SINGLE VEHICLE)
9 - UNKNOWN
99 - UNKNOWN
Surface Conditions:
99 - UNKNOWN
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
URBANDALE POLICE DEPARTMENT
99 - UNKNOWN
01 - NOT APPLICABLE
Company Owner Name:
City:
State:
Zip Code:
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
WEST POINTE APARTMENTS
URBANDALE
IA
50322
Environment:
Roadway:
99 - UNKNOWN
99 - UNKNOWN
Type of Road Junc/Feat:
04 - DRIVEWAY ACCESS (WITHIN)
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
5/30/2017 1:57 PM
60 - TREE
1
2
17-01067
I was dispatched on May 5th, 2017 to West pointe Apartments on a hit and run report.
Arrived and noticed that several trees leading to the main entrance of the apartment complex off Hickman Road had been hit by unknown vehicle.
Reporting party is the rental manager at West pointe. Alex Schwichtenberg-- Office 515-276-4993 Cell 641-231-1257
He said damage was not noticed when he left work at 1830 hours on 04 May 17 but did notice the trees at 0930 hrs on 05 May 17.
In this Officer's opinion the unknown driver was turning into the K-Mart parking lot from the private drive and for unknown reason possibly due to size of vehicle swung wide
and hit the trees as it was going NB to turn right into the lot.
The driver did not clear the rocks located on K-Mart's entrance and backed up over more trees.
Pictures were taken at the scene of damage and tire marks.
Possible suspect vehicles may have been Hawkeye Paving trucks that I noticed parked in K-Mart. No vehicles with the type of damage possibly sustained were noticed on
the two times that I checked the lot.
Other possible vehicle could be a delivery semi or similar over size vehicle making a delivery to K-Mart.
Case is suspended with out leads.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
2
2
17-01067
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01080
05/06/17
14:39 Hrs.
URBANDALE POLICE
DEPARTMENT
BROOKS ANTHONY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1134
05/06/2017
14:41 Hrs.
14:46 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00441897
04610521
4600 BLOCK MERLE HAY RD
001
Driver Name - Last:
First:
Middle:
ARGUETA AVELAR
EMILIO
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
SIOUX FALLS
SD
57103-0844
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Male
37
NO
SD
1
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
04
2012
TOYOTA - TOYT
SEQUOI
UT
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
06 - CHANGING LANES
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 16 - LOOKED BUT DID NOT SEE
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
09 - MIDDLE DRIVER SIDE
Emergency Status:
01 - NOT APPLICABLE
09 - MIDDLE DRIVER SIDE
Cont. Circum., Drvr:
16 - FAILED TO KEEP IN
PROPER LANE
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$700.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:57 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01080
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
NORING
ASHLEY
MARIE
DES MOINES
IA
50317-0000
Female
29
NO
IA
D
3 - PASS VEH LESS THAN 16
PASS DESIGN
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02
2009
DODGE - DODG
JNY
SW
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
01 - FRONT PASSENGER SIDE
CORNER
01 - FRONT PASSENGER SIDE
CORNER
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
06 - SIDESWIPE, SAME DIRECTION
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
UNIT 1 WAS TRAVELING SB IN THE MIDDLE LANE AT THE 4600 BLOCK OF MERLE HAY RD.
UNIT 2 WAS TRAVELING SB SLIGHTLY BEHIND UNIT 1 IN THE INSIDE TURN LANE TO GO EB AT THE 4600 BLOCK OF MERLE HAY RD.
UNIT 1 MADE A SUDDEN LANE CHANGE TO THE LEFT, ENTERING UNIT 2'S LANE AND COLLIDING.
DRIVER OF UNIT 1 STATED HE NEEDED TO TURN AND WAS NOT FROM AROUND HERE. HE STATED HIS PASSENGER TOLD HIM TO TURN LEFT AT THAT
INTERSECTION. HE STATED HE LOOKED QUICKLY BUT DID NOT SEE UNIT 2 IN HIS BLIND SPOT. HE ADVISED HE WENT TO TAKE THE LANE AND COLLIDED
WITH THE OTHER VEHICLE.
WITNESS, ASHLEY DAVIS (515-783-8735) SAW THE COLLISION FROM A COUPLE VEHICLES BACK. SHE STATED THE SAME EVENTS AS THE UNIT 1 DRIVER.
DRIVER OF UNIT 1 WAS CITED FOR IMPROPER USE OF LANES.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
2
3
17-01080
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
3
3
17-01080
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01082
05/06/17
19:04 Hrs.
URBANDALE POLICE
DEPARTMENT
CLARK ANDREW
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1146
05/06/2017
19:05 Hrs.
19:40 Hrs.
YES
Report to All Drivers: NO
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00438679
04611564
5000 BLK NW 86TH ST
001
Driver Name - Last:
First:
Middle:
ROBINSON
EDWARD
RENE
City:
ANKENY
State:
IA
Zip:
50023-0000
Suffix:
II
Gender:
Male
Age:
22
NO
CDL:
License State:
IA
License Class:
D
License Endorsmnt: 3 - PASS VEH LESS THAN 16
PASS DESIGN
License Restrictions: B
Speed Limit:
35
Seating Position:
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
Driver Condition:
01 - APPARENTLY NORMAL
Alcohol Test Given: NO
1 - NONE
Drug Test Given:
Total Occupants:
1
2016
Vehicle Year:
Vehicle Make:
FORD - FORD
Vehicle Model:
TCN
VN
Vehicle Style:
WHITE - WHI
Vehicle Color:
Vehicle Config:
04 - PASSENGER VAN (SEATS
<9)
01 - NONE
Vehicle Defect:
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
02 - FRONT PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
02 - FRONT PASSENGER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$100.00
1 - NONE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:57 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01082
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
MONTGOMERY
CHARLES
DEWEY
URBANDALE
IA
50322
Male
87
NO
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2015
HONDA - HOND
CIVIC
4D
RED - RED
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
06 - CHANGING LANES
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
08 - REAR DRIVER SIDE
Emergency Status:
01 - NOT APPLICABLE
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
08 - REAR DRIVER SIDE
Cont. Circum., Drvr:
09 - IMPROPER OR ERRATIC
LANE CHANGING, 16 - FAILED
TO KEEP IN PROPER LANE
Second Event:
72 - HIT AND RUN
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
1 - NONE
$1,500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
06 - SIDESWIPE, SAME DIRECTION
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
98 - OTHER INTERCHANGE (EXPLAIN IN
NARRATIVE)
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
On the above date and time I, Officer Clark was dispatched to 4984 86th St. on a hit and run. Upon my arrival I was met by Unit 1. Unit 1 stated that he got off of the I80
Westbound Interstate at the 86th St. exit. After making a left hand turn coming South onto 86th St. in the left hand lane, a red Honda Civic (Unit 2) ran a red light and cut him
off. During that time Unit 1 continued to proceed South on 86th. St. Unit 1 stated that a witness pulled up next to Unit 2 to advise him that he crashed into Unit 1. The
witness stated that Unit 2 kept shaking his head no and proceeded without stopping to exchange information South on 86th St.
Unit 1 then pulled into 4984 86th St. to talk with the witness and call dispatch to report the motor vehicle crash.
There is body camera footage of this incident, and has been logged properly. Unit 1 also took pictures of Unit 2's vehicle and license plate. **** ReExam Reason:
DIMINISHED MENTAL CAPACITY
****Follow up completed by Advanced Accident Investigator H. Pickett 1122****
On Friday, May 12, 2017 this officer made contact with the owner of the suspect vehicle, Charles Montgomery at his residence. This officer asked Charles about the
accident he had been involved in on May 6, 2017 in the 5000blk of 86th Street. Charles advised this officer someone pulled up to him and said that he had been hit by a
vehicle and asked if he wanted the Police called. Charles advised this officer he did not feel any accident so he didn't think anything of it and did not notice the damage to
his vehicle at that time.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
2
3
17-01082
This officer noted significant damage to include a large dent, scrapes consistent with a sideswipe on the rear driver side quarter panel as well as damage to the wheel of the
driver side rear tire. This officer asked Charles if he was aware what the damage was from at the rear of his vehicle to which he stated, "I guess not". Charles was not
issued a citation for failing to provide Aid and Information as this officer believes his diminished mental capacity, the facts to include he ran a stop light, struck a vehicle and
then left the scene all while being unaware of his actions are more prevalent and should be addressed by the Department Of Transportation.
Charles provided this officer with his insurance information at that time and was advised a copy of the driver information exchange would be completed and mailed to him
upon completion.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:57 PM
3
3
17-01082
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01096
05/08/17
16:16 Hrs.
URBANDALE POLICE
DEPARTMENT
DOMEIER BEN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1130
05/08/2017
16:18 Hrs.
16:25 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00433638
04608716
129TH ST AND DOUGLAS PKWY
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
RAFFERTY
MARLYS
MAE
URBANDALE
IA
50323
Female
67
NO
FL
E
NONE
A
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
02 - FRONT PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
02 - FRONT PASSENGER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
04 - STOP SIGNS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$7,500.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2015
SUBARU - SUBA
OUTBACK
UT
RED - RED
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:58 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01096
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
SWALES
AARON
CHRISTOPHER
ALTOONA
IA
50009
Male
36
NO
IA
D
2 - VEH W/16001 GVWR OR
MORE NOT VID FOR TRK-TRC
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
1998
DODGE - DODG
DURANGO
LL
BLUE - BLU
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
11 - FRONT DRIVER SIDE CORNER
Emergency Status:
01 - NOT APPLICABLE
11 - FRONT DRIVER SIDE CORNER
Cont. Circum., Drvr:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Traffic Controls:
04 - STOP SIGNS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
05 - BROADSIDE (FRONT TO SIDE)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 1 was stopped facing NB at the intersection of 129th Street and Douglas Parkway.
Unit 2 was stopped facing WB at the same intersection.
Unit 2 struck Unit 1.
Officer's Notes :
Driver of Unit 1 (Rafferty) stated, "We all waited for our turn to go, I think he (Unit 2) just got impatient and went out of turn."
Driver of Unit 2 (Swales) stated, "I went through. I'm not gonna put that on her (Unit 1). It's my mom's birthday, I don't know what happened."
Unit 1 sustained disabling damage to the front, passenger side wheel area of the vehicle. Unit 1 was legally parked at Des Moines Christian to make arrangements.
Unit 2 sustained minor damage to the front, driver's side bumper area of the vehicle and was driven away from the scene by Swales.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
2
3
17-01096
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
3
3
17-01096
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01092
05/08/17
07:35 Hrs.
URBANDALE POLICE
DEPARTMENT
DOMEIER BEN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1130
05/08/2017
07:40 Hrs.
07:55 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
DALLAS - 25
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00431686
04612167
14300 BLK OF WATERFORD
ROAD
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
WILSON
CHARLES
VAL
DES MOINES
IA
50317
Male
36
NO
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
01
2009
CHEVROLET - CHEV
3500 CREW
PK
RED - RED
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:58 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01092
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
BREKKE
NICHOLAS
TODD
WAUKEE
IA
50263-0000
Male
17
NO
IA
C
NONE
Y
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2004
CHEVROLET - CHEV
TAHOE
LL
BLACK - BLK
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
02 - CLOUDY, 05 - RAIN
Surface Conditions:
02 - WET
Workzone Related:
Activity:
Location:
Type:
Workers Present:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 1 was stopped for traffic facing WB in the 14300 block of Waterford Road.
Unit 2 was directly behind Unit 1.
Unit 2 struck Unit 1.
Officer's Notes :
Unit 1 was stopped for traffic in as there was construction being completed in the area. The WB lane of traffic did have construction cones set up. However, no road
construction signage was present in the area.
Driver of Unit 1 (Wilson) stated, "I was stopped just waiting for traffic to clear and he (Unit 2) ran into the back of me."
Driver of Unit 2 (Brekke) stated, "We were stopped for traffic and he (Unit 1) started to inch forward like he was going to go. But he (Unit 1) stopped again and I ran into
him."
Unit 1 sustained minor damage to the rear-end of the vehicle and was driven away from the scene by Wilson.
Unit 2 sustained minor damage to the front-end of the vehicle and was driven away from the scene by Brekke.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
2
3
17-01092
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
3
3
17-01092
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-1102
05/09/17
12:00 Hrs.
URBANDALE POLICE
DEPARTMENT
LANG SGT GARY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1076
05/09/2017
12:05 Hrs.
12:11 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
YES
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00438668
04610538
4660 86TH STREET
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
SHIVERS
STEPHEN
ROBERT
URBANDALE
IA
50322-0000
Male
62
NO
IA
C
L
NONE
10
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2013
FORD - FORD
TAURUS
SD
BRONZE - BRZ
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
09 - BACKING
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 01 - NOT APPLICABLE/NO DRIVER
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$400.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:58 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-1102
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
SECORY
TIMOTHY
JON
WEST DES MOINES
IA
50265-0000
Male
36
NO
IA
C
NONE
B
10
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2005
VOLVO - VOLV
XC9
SW
GREEN - GRN
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 01 - NOT APPLICABLE/NO DRIVER
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$400.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
07 - IN PARKING LANE/ZONE
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
96 - OTHER NON-INTERSECTION (EXPLAIN IN
NARRATIVE)
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit one was backing out of the first parking spot in front of 4660 86th Street.
Unit two had entered the parking lot and was "waiting to drive down the isle" that unit one was backing from.
Unit one backed into unit two.
Neither driver complained of pain and both said they were ok. Both vehicles driven from scene. Very minor damage to both vehicles.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
2
3
17-1102
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
3
3
17-1102
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01105
05/09/17
17:08 Hrs.
URBANDALE POLICE
DEPARTMENT
PICKETT HOLLY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1122
05/09/2017
17:08 Hrs.
17:12 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00440278
04609664
AURORA AVE AND 72ND ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
MONROE
MICHAELA
KAY
DES MOINES
IA
50320-0000
Female
28
NO
IA
C
NONE
B
25
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2012
CHEVROLET - CHEV
EQX
SW
BLACK - BLK
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
02 - TURNING LEFT
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
11 - FRONT DRIVER SIDE CORNER
Emergency Status:
01 - NOT APPLICABLE
11 - FRONT DRIVER SIDE CORNER
Cont. Circum., Drvr:
11 - MADE IMPROPER TURN
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,500.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:58 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
UR/71.045
Citation Charge 1:
IMPROPER TURN AT
INTERSECTION
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01105
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
LINK
GREGORY
LEO
ANKENY
IA
50021-0000
Male
49
NO
IA
C
L
NONE
25
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2003
LEXUS - LEXS
G43
4D
CREAM, IVORY - CRM
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
11 - STOPPED IN TRAFFIC
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
11 - FRONT DRIVER SIDE CORNER
Emergency Status:
01 - NOT APPLICABLE
11 - FRONT DRIVER SIDE CORNER
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,500.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
04 - ANGLE, ONCOMING LEFT TURN
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 1 was traveling west on Aurora Ave anticipating a left turn to travel south bound on 72nd Street.
Unit 2 was stopped for a red light on 72nd Street facing north bound.
Driver of unit 1 made a left turn and traveled into the lane of unit 2, striking unit 2 at its front bumper.
Both parties reported no injuries at the time of the accident.
Unit 1 sustained damage along the entire driver side including the front bumper, quarter, both doors, driver front tire and rear quarter.
Unit 2 sustained damage to the front bumper/drivers quarter panel.
Both units were towed due to tires being blocked by damage and flattened.
Information was exchanged at the scene and a citation was issued to the driver of unit 1.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
2
3
17-01105
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
3
3
17-01105
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01111
05/09/17
21:23 Hrs.
URBANDALE POLICE
DEPARTMENT
DAWSON WESLEY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1145
05/09/2017
21:34 Hrs.
21:35 Hrs.
NO
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00438648
04608495
COLBY PKWY AND 86TH ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
DORNBURG
STEPHEN
CHARLES
URBANDALE
IA
50322-0000
Male
61
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2004
BUICK - BUIC
PRK
4D
GRAY - GRY
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
02 - TURNING LEFT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
01 - FRONT PASSENGER SIDE
CORNER
01 - FRONT PASSENGER SIDE
CORNER
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$100.00
2 - MINOR DAMAGE
32 - NON-MOTORIST (SEE NONMOTORIST SECTION - NOT A UNIT)
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
32 - NON-MOTORIST (SEE NONMOTORIST SECTION - NOT A UNIT)
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
01 - NON-COLLISION (SINGLE VEHICLE)
4 - DARK, ROADWAY LIGHTED
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
46 - FTYROW: TO NONMOTORIST
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
321.327
Citation Charge 1:
FAIL TO YEILD TO
PEDESTRIANS RIGHT OF WAY
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
32 - NON-MOTORIST (SEE NON-MOTORIST
SECTION - NOT A UNIT)
Location:
01 - INTERSECTION: WITHIN MARKED
CROSSWALK
001
Type:
01 - PEDESTRIAN
Name - Last:
First:
Middle:
Suffix:
Address:
City:
State:
Zip Code:
Age:
HALFERTY
MONTE
3225 86TH STREET #412
URBANDALE
IA
50322
URBANDALE POLICE DEPARTMENT
Action:
01 - ENTERING OR CROSSING ROADWAY
Condition:
01 - APPARENTLY NORMAL
Safety Equipment:
01 - NOT APPLICABLE
Contributing Circumstances:
01 - NO IMPROPER ACTION
Alcohol Test Given:
Drug Test Given:
Source of Transport:
5/30/2017 1:58 PM
NO
1 - NONE
01 - NOT TRANSPORTED
1
2
17-01111
Sex:
Unit No. of Vehicle Striking:
Injury Status
MALE
001
3 - SUSPECTED MINOR/NON-INCAPACITATING
Died at Scene/Enroute:
Transported to:
Transported by:
01 - NOT APPLICABLE
Accident was Vehicle striking pedestrian
Intersection of Colby Parkway and 86th Street
Unit 1 was in the left turn lane on Colby PKWY facing WB to turn SB on 86th Street.
Driver of Unit 1 said that he saw a pedestrian in a wheel chair near the entrance to the Urbandale Library driveway. Driver stated that he thought the pedestrian was waiting
for traffic.
Driver of Unit 1 stated the traffic signal was a green arrow however when he was in the intersection the traffic signal changed to a solid green light. As Driver of Unit 1
proceeded to go through the intersection to head SB he slammed on his brakes and struck the pedestrian in a wheel chair.
The pedestrian stated that he proceeded to cross the cross walk heading EB because he observed a white illuminated walk signal. Pedestrian stated that he thought the
driver was yielding. Pedestrian stated that the driver of Unit 1 slammed on his brakes and struck his wheel chair. Pedestrian was knocked over out of his wheel chair onto
the roadway.
Pedestrian complained of minor pain in his arm. Medics checked the pedestrian for his minor injuries. Pedestrian had a minor scratch on his left elbow area of his arm as
well as a bump from the fall. Pedestrian was not transported or taken to the hospital. Both parties were given a drivers exchange with the needed information.
Unit 1 had a minor scratch to vehicle located on the front passengers side bumper unknown if it was from this accident.
Unit 1 was cited for failure to yield to a pedestrian.
No damage was observed on the wheel chair of the pedestrian.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
2
2
17-01111
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01107
05/09/17
17:52 Hrs.
URBANDALE POLICE
DEPARTMENT
PETERSON RANDALL
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1109
05/09/2017
17:52 Hrs.
17:54 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00435285
04608481
I-80/35 MM 125.8 SB
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
STEVENS
NATALIE
ANN
BOONE
IA
50036-0000
Female
55
NO
IA
C
NONE
B
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$4,500.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2008
DODGE - DODG
AVN
4D
SILVER - SIL
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Abg Switch Stat:
04 - DEPLOYED FRONT OF
Abg Deploy:
PERSON
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
3 - DISABLED - OFFICER
ARRANGED
17-01107
03 - SOUTH
01 - NOT OBSCURED
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
Fourth Event:
Injury Status:
33 - VEHICLE IN TRAFFIC
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
CLIVE FD
Special Veh Func:
Traffic Controls:
Most Harmful
Event:
MERCY WEST
01 - NOT APPLICABLE
5/30/2017 1:58 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01107
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
FASTENAU
MITCHELL
ANDREW
WEST DES MOINES
IA
50266-0000
Male
32
NO
IA
C
NONE
B
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2005
TOYOTA - TOYT
HGH
SW
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 2 was driving southbound when suddenly he was hit by Unit 1. Unit 2 said he didnt think he was slowing down he was just driving with traffic.
I Officer Peterson was sitting on the opposite side of the interstate when I heard the crash and looked over. I could see the driver of Unit 1 head back and could tell she was
injuried. I advised my dispatch of the crash and to start medics. I made my way around and made the scene . Unit 1 driver was alert and complaining of chest pain due to
the air bag deployment. Driver of Unit 2 said he was fine and did not need medical attention.
Driver of Unit 1 was at fault for the vehicle crash.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
2
3
17-01107
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
3
3
17-01107
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01124
05/11/17
10:47 Hrs.
URBANDALE POLICE
DEPARTMENT
BUTCHER BRIAN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1124
05/11/2017
10:47 Hrs.
10:53 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00436226
04610531
NW URBANDALE DR AND
MEREDITH DR
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
VAWTER
CHRISTOPHER
RAY
ELKHART
IA
50073-0000
Male
26
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
01 - RAN TRAFFIC SIGNAL
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$10,000.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2007
CHEVROLET - CHEV
IMP
4D
WHITE - WHI
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Abg Switch Stat:
04 - DEPLOYED FRONT OF
Abg Deploy:
PERSON
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
4 - POSSIBLE (COMPLAINT OF
PAIN/INJURY)
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Fourth Event:
33 - VEHICLE IN TRAFFIC
Source of Trans: 03 - EMS GROUND
Died at Scene:
URBANDALE POLICE DEPARTMENT
URB EMS
Special Veh Func:
Traffic Controls:
Most Harmful
Event:
MERCY
01 - NOT APPLICABLE
5/30/2017 1:58 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01124
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
BRIDGES
CHELSEY
MARIE
ANKENY
IA
50021
Female
23
NO
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Point of Init
Impact:
03 - MIDDLE PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
03 - MIDDLE PASSENGER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
1 - NONE
$20,000.00
5 - SEVERE, VEHICLE TOTALED
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Defect:
01 - NONE
Abg Switch Stat:
04 - DEPLOYED FRONT OF
Abg Deploy:
PERSON
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
3 - EXTRICATED BY MECHANICAL
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
3 - SUSPECTED MINOR/NONINCAPACITATING
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Source of Trans: 03 - EMS GROUND
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
05 - BROADSIDE (FRONT TO SIDE)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
01 - NO SPECIAL FUNCTION
02 - TRAFFIC SIGNALS
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02 - EAST
01 - NOT OBSCURED
URB EMS
Special Veh Func:
Traffic Controls:
01
2015
KIA - KIA
OPTIMA
4D
RED - RED
01 - PASSENGER CAR
Tow #:
Initial Trvl Dir:
Vision Obscured:
MERCY
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
UNIT 1 WAS NORTH BOUND ON NW URBANDALE APPROACHING MEREDITH DR IN THE LEFT LANE.
UNIT 2 WAS EAST BOUND ON MEREDITH APPROACHING NW URBANDALE IN THE RIGHT LANE.
UNIT 1 HAD A RED LIGHT AND UNIT 2 HAD A GREEN LIGHT.
UNIT 1 RAN THE RED LIGHT AND BROADSIDE UNIT 2 IN THE PASSENGER SIDE. UNIT 2 WAS SPUN AROUND AND FLIPPED ON THE DRIVERS SIDE.
DRIVER OF UNIT 1 STATED HE WAS RUNNING LATE BACK TO WORK AND KNEW THE LIGHT WAS RED WHEN HE WENT THROUGH IT.
DRIVER OF UNIT 2 HAD TO BE EXTRACTED BY MECHANICAL MEANS AND THEN TRANSPORTED TO MERCY.
DRIVER OF UNIT 1 HAD A COMPLAINT OF PAIN ON HIS LEFT ARM FROM AIRBAG IMPACT.
WITNESS STATED HE WAS RIGHT BEHIND UNIT 1 AND OBSERVED THE WHOLE ACCIDENT. STATED THAT UNIT 2 DID NOT HIT THE BRAKES AT ALL UNTIL
THE LAST SECOND. STATED THAT THE DRIVER APPEARED TO NOT BE PAYING ATTENTION AT ALL AND KNEW THE COLLISION WAS GOING TO HAPPEN.
DRIVER OF UNIT 1 CITED FOR FAILURE TO OBEY A TRAFFIC CONTROL DEVICE.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
2
3
17-01124
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
3
3
17-01124
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-011256
05/11/17
13:19 Hrs.
URBANDALE POLICE
DEPARTMENT
BROOKS ANTHONY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1134
05/11/2017
13:19 Hrs.
13:26 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00437038
04607737
100TH ST AND 99TH ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
HATFIELD
MARY
ANN
DES MOINES
IA
50315-0000
Female
37
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02
2013
NISSAN - NISS
SBL
4D
SILVER - SIL
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 16 - LOOKED BUT DID NOT SEE
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
40 - FTYROW: FROM STOP
SIGN
Traffic Controls:
04 - STOP SIGNS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:58 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-011256
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
SHAFER
RICHARD
EARL
ANKENY
IA
50021-0000
Male
73
NO
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2016
NISSAN - NISS
VRS
4D
BLACK - BLK
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
11 - FRONT DRIVER SIDE CORNER
Emergency Status:
01 - NOT APPLICABLE
11 - FRONT DRIVER SIDE CORNER
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,500.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
05 - BROADSIDE (FRONT TO SIDE)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
UNIT 1 WAS ENTERING THE ROADWAY AT 99TH AND 100TH ST FROM A STOP SIGN WB.
UNIT 2 WAS SB, APPROACHING THE INTERSECTION OF 99TH AND 100TH IN THE TURN LANE TO GO EB ON 99TH.
UNIT 1 PROCEEDED OUT INTO THE INTERSECTION AT THE SAME TIME UNIT 2 ENTERED THE INTERSECTION. IN DOING SO UNIT 1 COLLIDED WITH UNIT 2.
DRIVER OF UNIT 1 STATED SHE LOOKED BUT DID NOT SEE UNIT 2 COMING FROM THE NORTH WHEN SHE ENTERED THE ROADWAY FROM THE STOP SIGN.
DRIVER OF UNIT 1 WAS CITED FOR FAILURE TO YIELD WHEN MAKING A LEFT TURN.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
2
3
17-011256
URBANDALE POLICE DEPARTMENT
5/30/2017 1:58 PM
3
3
17-011256
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01126
05/11/17
17:53 Hrs.
URBANDALE POLICE
DEPARTMENT
BROOKS ANTHONY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1134
05/11/2017
17:54 Hrs.
17:59 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00434413
04607325
12200 BLOCK HICKMAN RD
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
CLARK
RICHARD
LEE
WAUKEE
IA
50263-0000
Male
72
NO
IA
C
NONE
NONE
50
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02
2013
TOYOTA - TOYT
PRI
4D
RED - RED
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
02 - TURNING LEFT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
04 - REAR PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
04 - REAR PASSENGER SIDE
Cont. Circum., Drvr:
42 - FTYROW: MAKING LEFT
TURN, 98 - OTHER (EXPLAIN IN
NARRATIVE)
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:59 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01126
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
SCHURMAN
TIMOTHY
MILES
CLIVE
IA
50325-0000
Male
55
NO
IA
C
L
B
50
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2017
TRIUMPH - TRIU
MOTORCYCLE
BKE
GRAY - GRY
17 - MOTORCYCLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,500.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
10 - HELMET (DOT COMPLIANT)
Injury Status:
4 - POSSIBLE (COMPLAINT OF
PAIN/INJURY)
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
05 - BROADSIDE (FRONT TO SIDE)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
05 - DRIVEWAY ACCESS (RELATED, NOT IN)
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
UNIT 1 WAS TRAVELING EB IN THE 12200 BLOCK OF HICKMAN RD APPROACHING THE INTERSECTION.
UNIT 2 WAS WB IN THE 12200 BLOCK OF HICKMAN RD APPROACHING THE INTERSECTION.
UNIT 1 GOT INTO THE TURN LANE TO MAKE A LEFT HAND TURN TO GO NB IN THE STEW HANSENS DODGE LOT.
UNIT 2 GOT INTO THE TURN LANE TO MAKE A RIGHT HAND TURN TO GO NB IN THE STEW HANSEN'S DODGE LOT.
UNIT 1 WAS ALMOST THROUGH THE INTERSECTION WHEN UNIT 2 WAS APPROACHING TO MAKE ITS TURN. UNIT 2 COLLIDED WITH UNIT 1.
DRIVER OF UNIT 1 STATED HE DID NOT SEE THE BIKE COMING.
DRIVER OF UNIT 2 STATED THERE WAS A LOT OF TRAFFIC AND HE WAS TRYING TO GET OFF THE ROAD AND POSSIBLY FIND A DIFFERENT ROUTE HOME.
WITNESS, JESSICA MENKEN WAS BEHIND UNIT 2 DURING THE ACCIDENT. (712-249-0022)
URBANDALE POLICE DEPARTMENT
5/30/2017 1:59 PM
2
3
17-01126
URBANDALE POLICE DEPARTMENT
5/30/2017 1:59 PM
3
3
17-01126
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01133
05/13/17
10:30 Hrs.
URBANDALE POLICE
DEPARTMENT
ROSE NATHAN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1132
05/13/2017
10:45 Hrs.
10:50 Hrs.
NO
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
DES MOINES - 1945
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00441878
04608867
US 6/DOUGLAS AVE AND STATE
28/MERLE HAY RD
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
IBRAHIM
MANAHIL
MAHMOUD MOHAMED
DES MOINES
IA
50316-0000
Female
19
IA
0
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
07 - UNDER THE INFLUENCE
OF DRUGS/MEDS
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
2
2001
FORD - FORD
TAURUS
4DR
GREEN - GRN
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 97 - OTHER DISTRACTION INSIDE
VEHICLE (EXPLAIN IN NARRATIVE)
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$100.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:59 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
321.263
Citation Charge 1:
LEAVE THE SCENCE OF AN
ACCIDENT
Cit Chrg Code 2:
321.20B
FAILURE TO PROVIDE PROOF
Citation Charge 2:
OF FINANCIAL LIABILITY
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
UR/71.001.007
FAILURE TO HAVE A VALID
LICENSE FOR OPERATING A
MOTOR V
17-01133
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
BURG
THAD
RYAN
DES MOINES
IA
50309-0000
Male
40
IA
C
NONE
HJ
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02
1999
SATURN - SATR
SL1
4DR
GREEN - GRN
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$100.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
The driver of Unit 1 rear ended Unit 2 and left the scene. The driver of Unit 2 followed Unit 1 until officers pulled Unit 1 over.
Unit 1 stated she was scared because she had smoked some marijuana before driving and that's why she left.
Unit 1 was found to be at fault for the accident. The driver was charged with leaving the scene of an accident, failure to provide proof of financial liability, no driver's license
and possession of marijuana.
No injuries
Very minor damage
URBANDALE POLICE DEPARTMENT
5/30/2017 1:59 PM
2
3
17-01133
URBANDALE POLICE DEPARTMENT
5/30/2017 1:59 PM
3
3
17-01133
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01134
05/13/17
11:35 Hrs.
URBANDALE POLICE
DEPARTMENT
WILCUTT ERIC
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1103
05/13/2017
12:35 Hrs.
12:38 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00438668
04610490
MEREDITH DR AND 86TH ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
CHANA
LAL
RIN
DES MOINES
IA
50310-0000
Male
34
NO
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2014
TOYOTA - TOYT
CAMRY SE
4D
GRAY - GRY
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
02 - TURNING LEFT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 16 - LOOKED BUT DID NOT SEE
Transported by:
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
98 - OTHER (EXPLAIN IN
NARRATIVE)
98 - OTHER (EXPLAIN IN
NARRATIVE)
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$0.00
1 - NONE
98 - OTHER (EXPLAIN IN
NARRATIVE)
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 1:59 PM
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
42 - FTYROW: MAKING LEFT
TURN
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
UR/71.001.050
Citation Charge 1:
LEFT TURNS; YIELDING
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01134
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
KALWISHKY
LELAND
WARD
URBANDALE
IA
50322
Male
81
NO
IA
C,M
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2008
KAWASAKI - KAWK
EN500
MC
BLACK - BLK
17 - MOTORCYCLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
98 - OTHER (EXPLAIN IN
NARRATIVE)
98 - OTHER (EXPLAIN IN
NARRATIVE)
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$500.00
2 - MINOR DAMAGE
98 - OTHER (EXPLAIN IN
NARRATIVE)
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
10 - HELMET (DOT COMPLIANT)
Injury Status:
3 - SUSPECTED MINOR/NONINCAPACITATING
Source of Trans: 03 - EMS GROUND
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
98 - OTHER (EXPLAIN IN NARRATIVE)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
METHODIST MAIN
URBANDALE EMS
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
98 - OTHER (EXPLAIN IN NARRATIVE)
Vehicle #1 was eastbound on Meredith Dr in the left turn lane to head north on 86th St. Vehicle #1 failed to yield the right-of-way and made a left hand turn in front of
vehicle #2.
Vehicle #2 (Motorcycle) used an evasive move and laid his motorcycle down in the intersection avoiding contact with vehicle #1, Neither vehicle ever made contact with
each other.
Witness, Ron Spencer, stated he was stopped on 86th St with a red light and observed the motorcycle west on Meredith Dr with the green light. Ron stated that vehicle #1
failed to yield and turned in front of the motorcycle causing the accident.
Motorcycle suffered minor damage. Operator of the motorcycle was transported to Methodist Main for arm and leg injuries.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:59 PM
2
3
17-01134
URBANDALE POLICE DEPARTMENT
5/30/2017 1:59 PM
3
3
17-01134
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01148
05/14/17
23:00 Hrs.
URBANDALE POLICE
DEPARTMENT
PETERSON RANDALL
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1109
05/15/2017
07:25 Hrs.
07:45 Hrs.
YES
Report to All Drivers: NO
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00441139
04611004
4830 65TH ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt: NONE
License Restrictions: NONE
Speed Limit:
25
Seating Position:
Bus Use:
Transported to:
Drvr Distractions: 01 - NOT APPLICABLE/NO DRIVER
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
09 - MIDDLE DRIVER SIDE
Emergency Status:
01 - NOT APPLICABLE
08 - REAR DRIVER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$8,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
0
2011
FORD - FORD
ECP
SW
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
12 - LEGALLY PARKED
Tow:
1 - DRIVEN AWAY
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Occpnt Protect:
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Cit Chrg Code 3:
Citation Charge 3:
Injury Status:
Source of Trans:
Cit Chrg Code 4:
Citation Charge 4:
Died at Scene:
URBANDALE POLICE DEPARTMENT
5/30/2017 1:59 PM
1
3
17-01148
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
BOUGH
DEREK
LEANDER
DES MOINES
IA
50312
Male
43
NO
IA
C
NONE
NONE
25
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
06 - UNDER THE INFLUENCE
OF ALCOHOL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 12 - EATING OR DRINKING
RELATED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
10 - FRONT DRIVER SIDE
Emergency Status:
01 - NOT APPLICABLE
10 - FRONT DRIVER SIDE
Cont. Circum., Drvr:
08 - OPERATING VEHICLE IN A
RECKLESS, ERRATIC,
CARELESS, NEGLIGENT
MANNER, 09 - IMPROPER OR
ERRATIC LANE CHANGING
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$10,000.00
3 - FUNCTIONAL DAMAGE
35 - PARKED MOTOR VEHICLE
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2015
JEEP - JEEP
RENEGADE
4 DR
BLACK - BLK
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
4 - NOT DISABLED PRIVATELY ARRANGED
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Fourth Event:
Most Harmful
Event:
35 - PARKED MOTOR VEHICLE
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
07 - SIDESWIPE, OPPOSITE DIRECTION
4 - DARK, ROADWAY LIGHTED
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 1 was legally parked in front of 4830 65th Street from 1900 hours 5/14/17 until 0725 hours today 5/15/17. When Linda came out and saw Unit 1 had been damaged
from an unknown vehicle.
As I was working on the case. A male named Derek called in to report a crash that occurred last night on 65th Street. I made contact with Derek and he admitted to hitting
Unit 1. Derek stated that he drove home and had his SUV towed to Dewey Ford/Jeep in Ankeny. Derek admitted to drinking last night and not really remembering driving
home. Derek's vehicle had white paint transfer on his vehicle and Unit 1 has black paint transfer on it.
Derek in Unit 2 is at fault for the crash. Due to the time gap no OWI case could be made.
I Officer Peterson went out to Dewey Ford/Jeep and took photos of the damage to Unit 2.
URBANDALE POLICE DEPARTMENT
5/30/2017 1:59 PM
2
3
17-01148
URBANDALE POLICE DEPARTMENT
5/30/2017 1:59 PM
3
3
17-01148
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01149
05/15/17
07:40 Hrs.
URBANDALE POLICE
DEPARTMENT
BUTCHER BRIAN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1124
05/15/2017
07:55 Hrs.
08:06 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00436614
04607293
US 6/HICKMAN RD AND 104TH
ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
KURTH
SHANNON
LEA
DES MOINES
IA
50310-0000
Female
42
NO
IA
C
NONE
NONE
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2001
TOYOTA - TOYT
COA
4D
WHITE - WHI
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
03 - TURNING RIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:00 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01149
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
JOHNSON
SANDRA
JEAN
WINDSOR HEIGHTS
IA
50324-0000
Female
57
NO
IA
C
NONE
B
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2012
CHEVROLET - CHEV
TRV
SW
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
UNITS 1 AND 2 WERE WEST BOUND ON HICKMAN APPROACHING 104TH STREET IN THE RIGHT LANE.
UNIT 1 BEGAN TO SLOW AND MAKE A RIGHT TURN ON 104TH STREET.
UNIT 2 STRUCK UNIT 1 AND CAUSED IT TO SPIN OUT AND FACE EAST BOUND IN THE WEST BOUND LANES.
DRIVER OF UNIT 2 STATED SHE SAW UNIT 1 SLOW DOWN TO MAKE THE TURN. STATED SHE LOOKED IN HER REAR VIEW MIRROR AND WHEN SHE LOOKED
BACK FORWARD AGAIN SHE REALIZED SHE WAS NOT BRAKING HARD ENOUGH AND REAR ENDED UNIT 1.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
2
3
17-01149
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
3
3
17-01149
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01150
05/15/17
07:40 Hrs.
URBANDALE POLICE
DEPARTMENT
BUTCHER BRIAN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1124
05/15/2017
07:55 Hrs.
08:06 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00436614
04607293
US 6/HICKMAN RD AND 104TH
ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
KRAVA
ZACHARY
WILLIAM THOMAS
URBANDALE
IA
50322-0000
Male
29
NO
IA
A
L
NONE
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
01
2016
FORD - FORD
F15
PK
GRAY - GRY
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:00 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01150
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
JOHNSON
SANDRA
JEAN
WINDSOR HEIGHTS
IA
50324-0000
Female
57
NO
IA
C
NONE
B
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2012
CHEVROLET - CHEV
TRV
SW
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
UNIT 1 WAS WEST BOUND APPROACHING 104TH ST IN THE RIGHT LANE.
UNIT 2 WAS STOPPED AFTER JUST BEING INVOLVED IN A SEPARATE ACCIDENT. 17-01149.
UNIT 1 REAR ENDED UNIT 2.
DRIVER OF UNIT 1 STATED THAT HE OBSERVED THE VEHICLE THE UNIT 2 STRUCK MAKING A RIGHT TURN AND OBSERVED UNIT 2 BEGIN TO BRAKE.
STATED HE COULD NOT STOP IN TIME AFTER UNIT 2 CAME TO REST FROM ITS FIRST COLLISION.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
2
3
17-01150
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
3
3
17-01150
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01155
05/15/17
17:35 Hrs.
URBANDALE POLICE
DEPARTMENT
CLARK ANDREW
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1146
05/15/2017
17:37 Hrs.
18:00 Hrs.
YES
Report to All Drivers: NO
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00440385
04611471
INTERSTATE 35/I 35 (MM 130.5)
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
TRAVIS
PHILLIP
GRANGRUTH
WADENA
MN
56482
Male
30
NO
MN
D
NONE
NONE
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
1
1996
DODGE - DODG
RAM
PK
GREEN - GRN
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
08 - REAR DRIVER SIDE
Emergency Status:
01 - NOT APPLICABLE
08 - REAR DRIVER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
01 - NOT APPLICABLE
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:00 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01155
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
ROBERTSON
SARAH
NICOLE
HUXLEY
IA
50124-0000
Female
28
NO
IA
C
NONE
NONE
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2011
SUBARU - SUBA
OUT
SW
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
02 - FRONT PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
03 - MIDDLE PASSENGER SIDE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE,
15 - OVER-CORRECTING/OVER
-STEERING
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$5,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
06 - SIDESWIPE, SAME DIRECTION
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
On the above stated date and time, I, Officer Clark was dispatched to I-80 mile marker 130.5 on an initial hit and run. Upon my arrival I made contact with Unit 2. Unit 2 was
distraught and initially told me that she was in the center lane and noticed the vehicle ahead of her that she was coming behind started to brake, at that time Unit 2 used her
signal to get over and avoid Unit 1 ahead of her. After she got into the left lane, Unit 2 stepped on her brakes, slid, tried to correct her wheel and collided with Unit 1. Unit 1
continued east bound on the interstate and Unit 2 pulled over into the left side median to call authorities.
After follow up, dispatch informed me that Unit 1 called in and got off at the next exit to call in a motor vehicle crash he was just involved in. I then proceeded to have Unit 2
follow me to the next exit to check Unit 1 and assess damages. After examining both units and matching the description and confirmation from both units involved, I received
a statement from Unit 1.
Unit 1 stated that he was slowing down in traffic, Unit 1 then heard squealing tires. Unit 1 looked behind him and saw a car shoot out from behind his trailer that was
connected to his truck. Unit 1 stated that Unit 2 almost rear ended him, then swerved into him at a 45 degree angle while still squealing tires out of control. Unit 2 then
collided with Unit 1, bounced off of his truck and into the left hand shoulder. Unit 1 then pulled off of the road at the next exit to call authorities.
Both units filled out a detailed accident statement form of the crash.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
2
3
17-01155
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
3
3
17-01155
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01165
05/16/17
18:53 Hrs.
URBANDALE POLICE
DEPARTMENT
BROOKS ANTHONY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1134
05/16/2017
18:52 Hrs.
18:52 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00440794
04610480
MEREDITH DR AND 69TH ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
KAYLOR
STEVEN
ANDREW
URBANDALE
IA
50322-0000
Male
30
NO
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02
2006
JEEP - JEEP
LBY
SW
BLUE - BLU
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
02 - TURNING LEFT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Traffic Controls:
04 - STOP SIGNS
Point of Init
Impact:
01 - FRONT PASSENGER SIDE
CORNER
01 - FRONT PASSENGER SIDE
CORNER
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:00 PM
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01165
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
JENNINGS
PAUL
S
WINTHROP
WA
98862-0000
Male
53
NO
WA
NONE
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
02
2017
CADILLAC - CADI
CTS
4D
MAROON, BURGUNDY
(PURPLE) - MAR
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
10 - FRONT DRIVER SIDE
Emergency Status:
01 - NOT APPLICABLE
09 - MIDDLE DRIVER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,500.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
06 - SIDESWIPE, SAME DIRECTION
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
UNIT 1 WAS FACING NB STOPPED AT THE CORNER OF 69TH AND MEREDITH. UNIT I BEGAN ENTERING THE ROADWAY FROM THE INTERSECTION OF 69TH
AND MEREDITH DR.
UNIT 2 WAS TRAVELING WB IN THE 6800 BLOCK OF MEREDITH DRIVE APPROACHING THE INTERSECTION OF 69TH AND MEREDITH. UNIT 2 WAS IN THE FAR
RIGHT LANE.
UNIT 1 PULLED OUT ONTO MEREDITH MAKING A LEFT HAND TURN AND INTO THE FAR RIGHT LANE, TAKING PART OF UNIT 2'S LANE AND STRIKING THE
UNIT 2.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
2
3
17-01165
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
3
3
17-01165
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01167
05/16/17
23:20 Hrs.
URBANDALE POLICE
DEPARTMENT
SMITH KEVIN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1133
05/16/2017
23:27 Hrs.
23:44 Hrs.
YES
Report to All Drivers:
Legal Intervention: NO
Private Property:
NO
County:
DALLAS - 25
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00430575
04609591
4000 156TH ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
MATHEWS
LINDSEY
STEWART
URBANDALE
IA
50323-0000
Female
32
NO
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
06 - UNDER THE INFLUENCE
OF ALCOHOL
YES
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
01 - FRONT PASSENGER SIDE
CORNER
01 - FRONT PASSENGER SIDE
CORNER
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$10,000.00
5 - SEVERE, VEHICLE TOTALED
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2007
NISSAN - NISS
ALT
4D
WHITE - WHI
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Abg Switch Stat:
04 - DEPLOYED FRONT OF
Abg Deploy:
PERSON
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
3 - DISABLED - OFFICER
ARRANGED
N/A
01 - NORTH
98 - OTHER (EXPLAIN IN
NARRATIVE)
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
Fourth Event:
Most Harmful
Event:
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
33 - VEHICLE IN TRAFFIC
01 - NOT APPLICABLE
5/30/2017 2:00 PM
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01167
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt: NONE
License Restrictions: NONE
Speed Limit:
35
Seating Position:
Bus Use:
Transported to:
Drvr Distractions: 01 - NOT APPLICABLE/NO DRIVER
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
07 - REAR DRIVER SIDE CORNER
Emergency Status:
01 - NOT APPLICABLE
07 - REAR DRIVER SIDE CORNER
Cont. Circum., Drvr:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$5,000.00
4 - DISABLING DAMAGE
98 - OTHER (EXPLAIN IN
NARRATIVE)
Second Event:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
99 - UNKNOWN
Third Event:
0
Fourth Event:
TRAILER
BLACK - BLK
98 - OTHER (EXPLAIN IN
NARRATIVE)
10 - TRAILER HITCH/TRUCK
COUPLING, SAFETY CHAIN
Most Harmful
Event:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Trapped:
Ejection:
Ejection Path:
Tow:
6 - ABANDONED/LEFT AT
SCENE
Occpnt Protect:
99 - UNKNOWN
99 - UNKNOWN
98 - OTHER (EXPLAIN IN
NARRATIVE)
Abg Switch Stat:
Abg Deploy:
Vehicle Action:
Tow #:
Initial Trvl Dir:
Vision Obscured:
Cit Chrg Code 4:
Citation Charge 4:
Died at Scene:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
4 - DARK, ROADWAY LIGHTED
05 - RAIN
Surface Conditions:
02 - WET
NO
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 3:
Citation Charge 3:
Injury Status:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
14 - LARGE UTILITY TRAILER
(2+AXLES)
Cit Chrg Code 2:
Citation Charge 2:
Source of Trans:
Workzone Related:
Activity:
Location:
Type:
Workers Present:
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Vehicle Configuration for Unit 2 is a flat bed trailer.
Unit 1
Unit 1
Unit 2
Unit 1
Unit 1
Unit 2
was NB on 156th St. in the 4000 blk.
was in the right hand lane NB on 156th St.
was left unattended in the roadway and was stationary.
rear ended Unit 2.
continued fifty feet after collision.
was moved fifty feet after collision.
Unit 1
Unit 1
Unit 1
Unit 1
Unit 2
Unit 1
stated that she was NB in the right hand lane on 156th St.
stated that she was traveling the speed limit or slower.
stated that she could not see that well because of the rainfall.
stated that she did not see Unit 2 on the roadway.
appeared to be left unattended in the travel portion of the roadway.
did rear end Unit 2.
There appeared to be no sign of braking from Unit 1. Unit 1 was totaled and un driveable. Unit 2 had three flat tires. Unit 2 also appeared to have an issue with the trailer
hitch. There was wires wrapped around the hitch. There was no license plate or VIN for Unit 2.
Unit 2 appears to have been abandoned and left near the intersection of 156th St. and Ridgemont Dr.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
2
3
17-01167
After the incident, the driver of Unit 1 was picked up by a passerby and taken home. The passerby, Taylor Brown, did call for assistance and returned to the scene. Unit 1
would later return prior to UPD's arrival on scene.
While speaking with Uit 1 I was able to smell a moderate odor of an alcoholic beverage coming from there person. Unit 1 was given a PBT which indicated a BAC of .126%.
Unit 1 admitted to drinking prior to driving but unsure if any alcohol was consumed after the incident.
Ricks was called for a private tow of Unit 1. Unit 2 was left at the scene.
*** There was rainfall during the time of the accident. Unknown if this played a factor into the incident. Unit 2 did not appear to have been legally parked prior to incident.
Taylor Brown contact info: 515-443-1527
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
3
3
17-01167
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01178
05/17/17
18:21 Hrs.
URBANDALE POLICE
DEPARTMENT
DOMEIER BEN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1130
05/18/2017
18:27 Hrs.
18:35 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00435290
04609633
4000 BLK OF I-80/35 SB/WB
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
CAMP
COURTNEY
LEE
FAIRFAX
IA
52228
Female
23
NO
IA
C
NONE
NONE
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
01
2006
DODGE - DODG
CARAVAN
VN
GRAY - GRY
04 - PASSENGER VAN (SEATS
<9)
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
07 - REAR DRIVER SIDE CORNER
Emergency Status:
01 - NOT APPLICABLE
07 - REAR DRIVER SIDE CORNER
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:00 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01178
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
MEYER
KENDRA
RAE
WEST DES MOINES
IA
50266
Female
32
NO
IA
C
NONE
NONE
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2014
LINCOLN - LINC
MKX
LL
BLACK - BLK
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
01 - FRONT PASSENGER SIDE
CORNER
01 - FRONT PASSENGER SIDE
CORNER
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
05 - RAIN
Surface Conditions:
02 - WET
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 1 was SB in stop-and-go traffic in the 4000 block of I-80/35 SB/WB.
Unit 2 was directly behind Unit 1.
Unit 2 struck Unit 1.
Officer's Notes :
Neither of the involved parties had complaints of injuries at the scene.
Driver of Unit 1 (Camp) stated, "I was stopping for traffic because it was really backing up because of the storm."
Driver of Unit 2 (Meyer) stated, "I saw her (Unit 1) braking really hard and swerved to the left to try to avoid hitting her."
Unit 1 sustained minor damage to the rear, driver's side bumper area of the vehicle and was driven away from the scene by Camp.
Unit 2 sustained minor damage to the front, passenger side bumper area of the vehicle and was driven away from the scene by Meyer.
As a result of this accident, another "chain re-action" accident occurred directly to the north of this incident a short time later. All parties waited on scene until my arrival.
Separate case number (17-01180) was taken for the other collision (not directly involved with this case).
Due to the weather and amount of trips holding at the time of this call, involved driver information exchanges were mailed to each party on 05/18/2017.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
2
3
17-01178
URBANDALE POLICE DEPARTMENT
5/30/2017 2:00 PM
3
3
17-01178
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01180
05/17/17
18:21 Hrs.
URBANDALE POLICE
DEPARTMENT
DOMEIER BEN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1130
05/18/2017
18:27 Hrs.
18:35 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00435290
04609633
4000 BLK OF I-80/35 SB/WB
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
ESSY
MARK
ANTHONY
WEST DES MOINES
IA
50265
Male
63
NO
IA
C
NONE
NONE
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
01
2015
GENERAL MOTORS - GMC
SIERRA
PK
BLACK - BLK
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:01 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01180
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
WEBB
CHARLES
EARL
URBANDALE
IA
50322
Male
63
NO
IA
C
NONE
NONE
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
01
1994
DODGE - DODG
DAKOTA
PK
GRAY - GRY
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,000.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
05 - RAIN
Surface Conditions:
02 - WET
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 1 was stopping for another accident that had occurred just to the south of his location (4000 block of I-80/35 SB/WB).
Unit 2 was directly behind Unit 1.
Unit 2 struck Unit 1.
Officer's Notes :
Neither of the involved parties had complaints of injuries at the scene.
Driver of Unit 1 (Essy) stated, "I stopped for the other accident that had occurred just in front of me and he (Unit 2) must not have been able to stop in time."
Driver of Unit 2 (Webb) stated, "He (Unit 1) was stopping for another accident just ahead of him and I couldn't stop in time."
Unit 1 sustained minor damage to the rear-end of the vehicle and was driven away from the scene by Essy.
Unit 2 sustained minor damage to the front-end of the vehicle and was towed away (private tow) from the scene by G & S Towing (arranged by Webb).
The other accident that occurred just to the south of Unit 1 (was a separate incident) was filed under case number : 17-01178.
Due to the number of trips holding at the time of the incident, all involved parties were provided the case number for the incident at the scene. Driver information exchanges
were subsequently mailed to the involved parties on 05/18/2017.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:01 PM
2
3
17-01180
URBANDALE POLICE DEPARTMENT
5/30/2017 2:01 PM
3
3
17-01180
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-1172
05/17/17
13:01 Hrs.
URBANDALE POLICE
DEPARTMENT
PICKETT HOLLY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1122
05/17/2017
12:59 Hrs.
13:30 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00436231
04609969
11000 AURORA AVE
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
STANLEY
SCOTT
ROBERT
URBANDALE
IA
50322-0000
Male
51
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2006
KIA - KIA
SPT
SW
BROWN - BRO
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
10 - SLOWING/STOPPING
(DECELERATING)
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
09 - RAILWAY CROSSING DEVICE
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
02 - AIRBAG TURNED OFF
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:01 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-1172
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
KAUFFMAN
CRAIG
ALLAN
PLEASANTVILLE
IA
50225-0000
Male
46
NO
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
01
2013
FORD - FORD
F15
PK
BLUE - BLU
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
09 - RAILWAY CROSSING DEVICE
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
UR/71.030
Citation Charge 1:
FAILURE TO STOP IN
ASSURED CLEAR DISTANCE
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
03 - RAILROAD GRADE CROSSING
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Units 1 and 2 were west bound on Aurora Ave in approximately the 11000blk.
Unit 1 was ahead of unit 2 and began to slow for the railroad crossing at this location.
Unit 2 did not slow and failed to stop in assured clear distance, striking unit 1 from behind.
No injuries were reported at the time of the accident.
Unit 1 sustained damage to the rear bumper as well as gate, while unit 2 sustained damage to the front bumper.
Driver of unit 2 was cited for failure to stop in assured clear distance.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:01 PM
2
3
17-1172
URBANDALE POLICE DEPARTMENT
5/30/2017 2:01 PM
3
3
17-1172
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01176
05/17/17
05:08 Hrs.
URBANDALE POLICE
DEPARTMENT
WILCUTT ERIC
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1103
05/18/2017
05:08 Hrs.
05:15 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00436030
04608916
DOUGLAS AVE AND 109TH ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
SORENSEN
SUSAN
LYNN
WINTERSET
IA
50273-0000
Female
59
NO
IA
C
NONE
T
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2004
MITSUBISHI - MITS
OUT
SW
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
11 - STOPPED IN TRAFFIC
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:01 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01176
002
Driver Name - Last:
First:
Middle:
SARAWAN
YASMEEN
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
URBANDALE
IA
50323-0000
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Female
35
NO
IA
C
NONE
NONE
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
2
2010
HONDA - HOND
PILOT
SW
MAROON, BURGUNDY
(PURPLE) - MAR
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 16 - LOOKED BUT DID NOT SEE
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
UR/71.030
Citation Charge 1:
FAILURE TO STOP ASSURED
CLEAR DISTANCE
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
003
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
JOHNSON
JON
ROBERT
JOHNSTON
IA
50131-0000
Male
50
NO
IA
C
NONE
NONE
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Defect:
1
2005
FORD - FORD
F15
PK
RED - RED
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Vehicle Action:
11 - STOPPED IN TRAFFIC
Tow:
1 - DRIVEN AWAY
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:01 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
2
3
17-01176
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
05 - RAIN
Surface Conditions:
02 - WET
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
Environment:
Roadway:
02 - WEATHER CONDITION
12 - TRAFFIC BACKUP, REGULAR CONGESTION
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Vehicle #3 was stopped in the middle of the roadway due to regular congestion and heavy rain. Vehicle #1 was also stopped for congestion.
Vehicle #2 was unable to stop for the congestion and struck vehicle #1 which pushed that vehicle into vehicle #3.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:01 PM
3
3
17-01176
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01168
05/17/17
00:35 Hrs.
URBANDALE POLICE
DEPARTMENT
SMITH KEVIN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1133
05/17/2017
00:43 Hrs.
00:47 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00437054
04611374
INTERSTATE 35/I 35 AND 100TH
ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
KING
ANDREA
ELIZABETH
WAUKEE
IA
50263-0000
Female
28
NO
IA
D
3 - PASS VEH LESS THAN 16
PASS DESIGN
NONE
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2012
CHEVROLET - CHEV
MAL
4D
BLACK - BLK
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
03 - MIDDLE PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
03 - MIDDLE PASSENGER SIDE
Cont. Circum., Drvr:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$7,500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:01 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01168
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
CROWE
MILTON
LEE
ALTOONA
IA
50009-0000
Male
63
IA
C
NONE
NONE
65
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
1
1986
TOYOTA - TOYT
SHORT BED
PK
WHITE - WHI
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
3 - DISABLED - OFFICER
ARRANGED
NA
04 - WEST
01 - NOT OBSCURED
Tow #:
Initial Trvl Dir:
Vision Obscured:
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
07 - REAR DRIVER SIDE CORNER
Emergency Status:
01 - NOT APPLICABLE
07 - REAR DRIVER SIDE CORNER
Cont. Circum., Drvr:
04 - DRIVING LESS THAN THE
POSTED SPEED LIMIT
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,500.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
06 - SIDESWIPE, SAME DIRECTION
5 - DARK, ROADWAY NOT LIGHTED
05 - RAIN
Surface Conditions:
02 - WET
Workzone Related:
Activity:
Location:
Type:
Workers Present:
Unit 1
Unit 2
Unit 1
Unit 2
Unit 1
Unit 1
Unit 1
Unit 1
Unit 2
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
was WB in the 10100 blk of I80/35.
was WB in the 10100 blk of I80/35.
was behind Unit 2 traveling Wb.
slowed down to allow traffic to pass.
was attempting to either change lanes or merge.
thought Unit 2 was stationary.
did make contact with Unit 2 via sideswipe.
stopped ahead of Unit 2.
stopped near place of accident.
Unit 1 stated that they thought Unit 2 was parked on the side of the road. Unit 1 stated that they were trying to get over/merge. Unit 1 stated that they were a little fuzzy and
couldn't remember how the accident happened.
Unit 1 sustained functional damage and was able to drive away. Unit ones damage was to the passenger side of the vehicle. Damage was from back passenger door to the
front of the front passenger door.
Unit 2 stated that he was traveling at a slow speed to allow vehicles to pass. Unit 2 stated he was not stationary. Unit 2 did not know what happened to cause the accident.
Unit 2 sustained non-functional damage. Back driver side tire was flat and the rear lights were taken out. Rick's Towing was contacted for a private tow.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:01 PM
2
3
17-01168
The lanes where the incident occurred were confusing based on the weather conditions and the poorly marked lane lines. There had been heavy rainfall during the night.
The road conditions were wet. Both vehicles appeared to be in proper working order.
Unit 1 is the at fault driver based on driving conditions and manner of collision. No citations issued. Driver exchange given to each Unit.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:01 PM
3
3
17-01168
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01174
05/17/17
16:45 Hrs.
URBANDALE POLICE
DEPARTMENT
ROSE NATHAN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1132
05/17/2017
16:45 Hrs.
16:50 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00438666
04610344
ILTIS DR AND 86TH ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
MAHAMAT
FATIME
HASSAN
JOHNSTON
IA
50131
Female
33
OT
N/A
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 15 - INATTENTIVE/LOST IN
THOUGHT
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
05 - DRIVING TOO FAST FOR
CONDITIONS, 07 - FOLLOWED
TOO CLOSE
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,000.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
04
2001
ACURA - ACUR
MDX
SW
BEIGE - BGE
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Abg Switch Stat:
04 - DEPLOYED FRONT OF
Abg Deploy:
PERSON
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Fourth Event:
Most Harmful
Event:
Injury Status:
33 - VEHICLE IN TRAFFIC
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:01 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
4
17-01174
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
HODGSON
DOUGLAS
BRIAN
URBANDALE
IA
50322-0000
Male
47
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,000.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2014
ACURA - ACUR
MDX
SW
BLACK - BLK
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
003
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
GREEN
SARAH
KRISTINE
JOHNSTON
IA
50131-0000
Female
40
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
05
2008
TOYOTA - TOYT
SNA
VN
SILVER - SIL
04 - PASSENGER VAN (SEATS
<9)
01 - NONE
Vehicle Action:
10 - SLOWING/STOPPING
(DECELERATING)
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
08 - REAR DRIVER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:01 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
2
4
17-01174
004
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
BURGETT
DUNG
HANH
URBANDALE
IA
50322-0000
Female
39
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2004
TOYOTA - TOYT
CAM
4D
GRAY - GRY
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
02 - TURNING LEFT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
09 - MIDDLE DRIVER SIDE
Emergency Status:
01 - NOT APPLICABLE
09 - MIDDLE DRIVER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
05 - RAIN
Surface Conditions:
02 - WET
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
02 - SURFACE CONDITION (E.G., WET, ICY)
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Conditions - Dark due to raining
Unit 3 was slowing down due to decelerating traffic (NB left lane).
Unit 2 was slowing down due to Unit 3 slowing down (NB left lane).
Unit 4 was waiting to turn left in the center turn lane (SB).
Unit 1(NB left lane) did not slow down in time and collided with the rear of Unit 2. This sent Unit 2 into the rear of Unit 3. Unit 3 then hit Unit 4 on the driver's side.
Unit 1 came to rest in the NB left lane. All other units came to rest in the center turning lane.
Multiple other people on site confirmed what had happened.
Medics examined all involved and no one was transported.
Unit 1 was at fault for not driving appropriately based on the conditions and failure to stop in a clear and assured distance.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:01 PM
3
4
17-01174
URBANDALE POLICE DEPARTMENT
5/30/2017 2:01 PM
4
4
17-01174
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01177
05/17/17
17:22 Hrs.
URBANDALE POLICE
DEPARTMENT
PICKETT HOLLY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1122
05/17/2017
17:22 Hrs.
17:30 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00437088
04608901
9900 DOUGLAS AVE
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
MOORE
PAIGE
CAROLINE
DES MOINES
IA
50312
Female
25
NO
CO
A
NONE
B
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2006
PONTIAC - PONT
G6
4D
BLUE - BLU
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:01 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01177
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
FERGUSON
VALERIE
MICHELE
URBANDALE
IA
50322
Female
27
NO
IA
0
NONE
NONE
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
02
1995
DODGE - DODG
DAKOTA
PK
RED - RED
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
01 - CLEAR
Surface Conditions:
02 - WET
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
321.174(1)
Citation Charge 1:
NO VALID DRIVERS LICENSE
Cit Chrg Code 2:
Citation Charge 2:
321.446
FAILURE TO USE CHILD
RESTRAINT DEVICE
Cit Chrg Code 3:
Citation Charge 3:
321.285
FAILURE TO STOP IN
ASSURED CLEAR DISTANCE
Cit Chrg Code 4:
Citation Charge 4:
321.17
OPERATING NON-REGISTERED
VEHICLE
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Units 1 and 2 were east bound on Douglas Ave in the 9900blk.
Driver of unit 1 stated a vehicle pulled abruptly in front of her causing her to brake quickly.
Driver of unit 2 failed to stop in assured clear distance and rear ended unit 1.
No injuries were reported at the time of the accident.
Unit 1 sustained damage to the rear bumper and trunk while unit 2 sustained damage to the front bumper.
Driver of unit 2 was cited for failure to stop in assured clear distance, operating an unregistered motor vehicle, failure to have a valid license and failure to use child restraint
device.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:01 PM
2
3
17-01177
URBANDALE POLICE DEPARTMENT
5/30/2017 2:01 PM
3
3
17-01177
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01187
05/18/17
20:30 Hrs.
URBANDALE POLICE
DEPARTMENT
ROSADO ALEX
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1141
05/18/2017
20:35 Hrs.
20:40 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00438676
04611229
INTERSTATE 35/SW RAMP AND
INTERSTATE 35/SE RAMP AND
86TH ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
RICE
SKYLER
MATTHEW
MANSON
IA
50563-0000
Male
24
NO
IA
C
NONE
NONE
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Defect:
01
1995
FORD - FORD
K1500
PC
GREEN - GRN
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Vehicle Action:
09 - BACKING
Tow:
1 - DRIVEN AWAY
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
19 - STARTING OR BACKING
IMPROPERLY
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$0.00
1 - NONE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
15 - BOAT
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
321.323
Citation Charge 1:
UNSAFE BACKING ON
HIGHWAY
Cit Chrg Code 2:
321.20B
FAILURE TO PROVIDE PROOF
Citation Charge 2:
OF FINANCIAL LIABILITYACCIDEN
Cit Chrg Code 3:
5 - UNINJURED
Citation Charge 3:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Injury Status:
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
5/30/2017 2:02 PM
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01187
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
BARTZ
SHEA
SUSANN
JOHNSTON
IA
50131-0000
Female
25
NO
IA
C
NONE
NONE
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2015
CHEVROLET - CHEV
IMP
4D
SILVER - SIL
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
11 - STOPPED IN TRAFFIC
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
01 - FRONT PASSENGER SIDE
CORNER
01 - FRONT PASSENGER SIDE
CORNER
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
3 - DAWN
01 - CLEAR
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Units 1 and 2 were legally stopped in traffic waiting for a light.
Unit 1 suddenly began rolling backward; driver of unit 1 stated the truck may have slipped out of gear.
Unit 1 had a boat attached via trailer, the boat/trailer rolled back, striking the hood of unit 2 and continued toward the passenger side fender, damaging the fender and
headlight area.
Driver of unit 1 stated he just bought the truck and boat/trailer today. He also stated that insurance is available, but was unable to provide proof on this day.
Driver of unit 1 put at fault for unsafe backing on highway.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:02 PM
2
3
17-01187
URBANDALE POLICE DEPARTMENT
5/30/2017 2:02 PM
3
3
17-01187
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-1190
05/19/17
16:25 Hrs.
URBANDALE POLICE
DEPARTMENT
BROOKS ANTHONY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1134
05/19/2017
16:45 Hrs.
16:45 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00440272
04608721
3600 BLOCK 72ND ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
RAMOS ZUNIGA
ITZEL
ESCARLETE
CLIVE
IA
50325-0000
Female
22
NO
IA
C
NONE
NONE
25
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2009
TOYOTA - TOYT
COA
4D
RED - RED
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 98 - DISTRACTION OUTSIDE
VEHICLE (EXPLAIN IN NARRATIVE)
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
11 - FRONT DRIVER SIDE CORNER
Emergency Status:
01 - NOT APPLICABLE
11 - FRONT DRIVER SIDE CORNER
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,500.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:02 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
321.20B
Citation Charge 1:
FAILURE TO PROVIDE PROFF
OF FINANCIAL LIABILITY
Cit Chrg Code 2:
321.307
FOLLOWING TO CLOSE
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-1190
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
SCHMITT
RYAN
PERRY
URBANDALE
IA
50322-0000
Male
28
NO
IA
C
NONE
B
25
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2006
FORD - FORD
FUSION
4D
BLACK - BLK
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
01 - NORTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
07 - REAR DRIVER SIDE CORNER
Emergency Status:
01 - NOT APPLICABLE
07 - REAR DRIVER SIDE CORNER
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
4 - POSSIBLE (COMPLAINT OF
PAIN/INJURY)
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
02 - CLOUDY, 05 - RAIN
Surface Conditions:
02 - WET
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 1 was traveling NB in the 3600 block of 72nd st behind Unit 2.
Unit 2 was traveling NB in the 3600 block of 72nd st just in front of Unit 1.
Unit 2 was slowing down because of other vehicles that were stopped and slowing in front of him.
Unit 1 was unable to stop in time and rear ended unit 2.
Driver of unit 1 stated she was looking at the fold down stop sign that was at the corner of the intersection. She stated when she looked up she saw unit 2 was stopped.
She stated she tried to stop before hitting the vehicle but could not stop in time.
Driver of unit 1 was cited for following to close and failure to provide security against liability.
Driver of unit 2 complained of chest pain. He refused medics several times but kept saying his chest and shoulder was bothering him. Appeared to possibly be a seat belt
injury.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:02 PM
2
3
17-1190
URBANDALE POLICE DEPARTMENT
5/30/2017 2:02 PM
3
3
17-1190
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01193
05/19/17
17:37 Hrs.
URBANDALE POLICE
DEPARTMENT
BROOKS ANTHONY
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1134
05/19/2017
17:37 Hrs.
17:39 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00440934
04610479
6700 BLOCK MEREDITH DR
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
MORRIS
MICHAEL
KENNETH
DES MOINES
IA
50310-0000
Male
55
NO
IA
C
NONE
NONE
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
01
2012
CHEVROLET - CHEV
SLV
PK
WHITE - WHI
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
11 - FRONT DRIVER SIDE CORNER
Emergency Status:
01 - NOT APPLICABLE
11 - FRONT DRIVER SIDE CORNER
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$2,500.00
1 - NONE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:02 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01193
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
Vehicle Defect:
HILTON
NATHAN
QUENTIN
CEDAR FALLS
IA
50613-0000
Male
35
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
02
1998
CHEVROLET - CHEV
C15
PK
WHITE - WHI
02 - FOUR-TIRE TRUCK (PICKUP)
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
02 - EAST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
05 - REAR PASSENGER SIDE
CORNER
05 - REAR PASSENGER SIDE
CORNER
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$0.00
1 - NONE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
02 - CLOUDY
Surface Conditions:
02 - WET
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
01 - NOT APPLICABLE
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 2 was traveling EB in the 6700 block of Meredith Dr.
Unit 1 was traveling EB behind unit 2 in the 6700 block of Meredith Dr.
Unit 2 slowed for traffic in front of him that was slowed or stopped.
Unit 1 was unable to stop in time and rear-ended unit 2.
Driver of Unit 1 stated he realized he would not be able to stop his vehicle in time. He stated he swerved to the left in an attempt to avoid a collision but his drivers side front
bumper did not clear the other vehicle.
Appeared to be very little to no damage done to unit 2. All damage appears to be on unit 1 only,
URBANDALE POLICE DEPARTMENT
5/30/2017 2:02 PM
2
3
17-01193
URBANDALE POLICE DEPARTMENT
5/30/2017 2:02 PM
3
3
17-01193
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01191
05/19/17
16:47 Hrs.
URBANDALE POLICE
DEPARTMENT
GRIFFITH GEORGE
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1075
05/19/2017
16:53 Hrs.
17:03 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00438677
04611422
OVER PASS INTERSTATE 35/I 35
AND 86TH ST
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
MITCHELL
KAYDIE
DANIELLE
WEST DES MOINES
IA
50266-0000
Female
25
NO
IA
C
NONE
B
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2015
CHEVROLET - CHEV
EQX
SW
SILVER - SIL
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:02 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01191
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
JENDRO
CARSON
DANE
JOHNSTON
IA
50131-0000
Male
17
NO
IA
C
NONE
BY
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2012
FORD - FORD
FUS
4D
SILVER - SIL
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$5,000.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
01 - NOT APPLICABLE
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
003
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
BARNUM BRUESCHKE
KYRA
CECELIA
URBANDALE
IA
50322-0000
Female
16
NO
IA
C
NONE
BY
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Bus Use:
Transported to:
Drvr Distractions: 04 - TALKING ON A HAND-HELD
DEVICE
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
3 - UNDERRIDE, NO COMPARTMEN
$2,500.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
1997
BUICK - BUIC
PRK
4D
RED - RED
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Trapped:
Ejection:
Ejection Path:
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Tow #:
Initial Trvl Dir:
Vision Obscured:
03 - SOUTH
01 - NOT OBSCURED
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:02 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
2
3
17-01191
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
1 - DAYLIGHT
02 - CLOUDY
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
98 - OTHER INTERCHANGE (EXPLAIN IN
NARRATIVE)
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
On May 18th 2017 I was dispatched to the 5000 block of 86th in the south bound lane on a property damage crash.
Arrived at 1703 hours and saw at least 6 cars in the turn lane but later was informed that only three vehicles were involved.
The other vehicles were parents of the drivers that were called before the Police and had arrived at the scene.
All drivers were out of the their respective vehicles and said they were unhurt.
Roadway is a slight crest of a hill caused by an over pass of Interstate 35/80. Vehicles were just past the crest on the downhill and SB lanes.
Vehicle one driver said she stopped for traffic backed up from the traffic light at the intersection of 86th and I-35/80 exit EB.
Vehicle two driver said he saw vehicle one come to in his words an abrupt stop and stopped just short before he made contact.
Vehicle three driver said she looked up from her cell phone and tried to stop but hit vehicle two causing that vehicle to hit vehicle one.
By the description given both drivers vehicle two and three could have received citations. Vehicle two for following too close and vehicle three for failure to stop in cleared
assured distance. Both drivers (2 & 3) were inexperienced that contributed to the crash.
Vehicle three was towed by Rick's Towing as it was disabled.
Exchange was given to all drivers and there respective parents.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:02 PM
3
3
17-01191
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01196
05/19/17
22:11 Hrs.
URBANDALE POLICE
DEPARTMENT
TAYLOR REBECCA
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1097
05/19/2017
22:21 Hrs.
22:21 Hrs.
NO
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00439061
04608871
8300 BLK OF DOUGLAS
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
PETER
NYUMAH
KONDOKEH
ALTOONA
IA
50009-0000
Male
31
NO
IA
C
NONE
S
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
06 - UNDER THE INFLUENCE
OF ALCOHOL
REFUSED
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2002
LINCOLN - LINC
LS
4D
CREAM, IVORY - CRM
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
3 - DISABLED - OFFICER
ARRANGED
17-01197
04 - WEST
01 - NOT OBSCURED
Tow #:
Initial Trvl Dir:
Vision Obscured:
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
10 - FRONT DRIVER SIDE
Cont. Circum., Drvr:
03 - EXCEEDED AUTHORIZED
SPEED, 07 - FOLLOWED TOO
CLOSE
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$5,000.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:02 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
321.263
Citation Charge 1:
LEAVE SCENE OF ACCIDENTFATIL TO PROVIDE AID OR
INFO
Cit Chrg Code 2:
321.285
Citation Charge 2:
FAILURE TO STOP IN
ASSURED CLEAR DISTANCE
Cit Chrg Code 3:
Citation Charge 3:
321.285
SPEEDING 55 OR U NDER
ZONE (6 THRU 10 OVER)
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01196
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
GREEN
STEVEN
ROBERT
URBANDALE
IA
50322-0000
Male
61
NO
IA
D
2 - VEH W/16001 GVWR OR
MORE NOT VID FOR TRK-TRC
B
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2016
CHEVROLET - CHEV
TRX
SW
WHITE - WHI
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
01 - MOVEMENT ESSENTIALLY
STRAIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
06 - REAR MIDDLE
Emergency Status:
01 - NOT APPLICABLE
06 - REAR MIDDLE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$1,500.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
01 - NOT APPLICABLE
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
4 - DARK, ROADWAY LIGHTED
02 - CLOUDY, 04 - FREEZING RAIN/DRIZZLE
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
NO
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
12 - FOUR-WAY INTERSECTION
FRA No.:
Horizontal Alignment:
Vertical Alignment:
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Driver of Vehicle 2 was WB on Douglas when he noticed a vehicle coming up behind him extremely fast. Driver of Vehicle 2 stated that before he knew it, Vehicle 1 had
struck him while he was still moving in approximately the 8300 blk of Douglas. Driver of Vehicle 2 stated that the Driver of Vehicle 1 made no attempt to stop and kept
driving. Driver of Vehicle 2 followed Vehicle 1 NB on 86th St. Driver of Vehicle 2 stated that the driver of Vehicle 1 sped away and was definitely speeding over the posted
35 mph.
Driver of Vehicle 2 watched as the Driver of Vehicle 1 lose control in the 4500 blk of 86th, go up over the curb into the grass and struck a parked motor vehicle. See 1701197 for further details.
Vehicle 1 sustained functional damage to the front end and was impounded by Rick's Towing.
Vehicle 2 sustained damage to the rear bumper but was able to be driven away from the scene.
Driver of Vehicle 1 was arrested for OWI, see Officer K. Smith's report for further information.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:02 PM
2
3
17-01196
URBANDALE POLICE DEPARTMENT
5/30/2017 2:02 PM
3
3
17-01196
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01197
05/19/17
22:15 Hrs.
URBANDALE POLICE
DEPARTMENT
TAYLOR REBECCA
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1097
05/19/2017
22:11 Hrs.
22:21 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
YES
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00438704
04610381
PARKING LOT 4531 86TH ST.
001
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
PETER
NYUMAH
KONDOKEH
ALTOONA
IA
50009-0000
Male
31
NO
IA
C
NONE
S
35
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
06 - UNDER THE INFLUENCE
OF ALCOHOL
REFUSED
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
01
2002
LINCOLN - LINC
LS
4D
CREAM, IVORY - CRM
01 - PASSENGER CAR
Vehicle Defect:
01 - NONE
Vehicle Action:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Tow:
3 - DISABLED - OFFICER
ARRANGED
17-01197
01 - NORTH
01 - NOT OBSCURED
Tow #:
Initial Trvl Dir:
Vision Obscured:
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
11 - FRONT DRIVER SIDE CORNER
Emergency Status:
01 - NOT APPLICABLE
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
10 - FRONT DRIVER SIDE
Cont. Circum., Drvr:
03 - EXCEEDED AUTHORIZED
SPEED, 06 - LOST CONTROL
Second Event:
01 - RAN OFF ROAD, RIGHT
Third Event:
35 - PARKED MOTOR VEHICLE
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
1 - NONE
$5,000.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Fourth Event:
Most Harmful
Event:
35 - PARKED MOTOR VEHICLE
Abg Switch Stat:
03 - NOT DEPLOYED
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
03 - SHOULDER AND LAP BELT
USED
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
REFUSED
01 - NOT APPLICABLE
5/30/2017 2:02 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01197
002
Driver Name - Last:
First:
Middle:
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt: NONE
License Restrictions: NONE
Speed Limit:
20
Seating Position:
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
98 - OTHER (EXPLAIN IN
NARRATIVE)
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
03 - MIDDLE PASSENGER SIDE
Emergency Status:
01 - NOT APPLICABLE
02 - FRONT PASSENGER SIDE
Cont. Circum., Drvr:
88 - NO IMPROPER ACTION
Traffic Controls:
01 - NO CONTROLS PRESENT
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$3,000.00
4 - DISABLING DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
00
2006
NISSAN - NISS
PFI
SW
BLACK - BLK
03 - SPORT UTILITY VEHICLE
Vehicle Defect:
01 - NONE
Vehicle Action:
12 - LEGALLY PARKED
Tow:
2 - DISABLED - PRIVATELY
ARRANGED
Tow #:
Initial Trvl Dir:
Vision Obscured:
Bus Use:
02 - EAST
98 - OTHER (EXPLAIN IN
NARRATIVE)
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Occpnt Protect:
Cit Chrg Code 3:
Citation Charge 3:
Injury Status:
Source of Trans:
Cit Chrg Code 4:
Citation Charge 4:
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
02 - SHOULDER
05 - BROADSIDE (FRONT TO SIDE)
4 - DARK, ROADWAY LIGHTED
02 - CLOUDY, 04 - FREEZING RAIN/DRIZZLE
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
96 - OTHER NON-INTERSECTION (EXPLAIN IN
NARRATIVE)
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
35 - PARKED MOTOR VEHICLE
Driver of Vehicle 1 was leaving the scene of another accident, see 17-01196. Driver of Vehicle left the roadway in the 4500 blk of 86th St., and struck a parked motor
vehicle in the parking lot of 4531 86th St. Vehicle 2 was unoccupied as it was legally parked.
Vehicle 1 sustained disabling damage and was impounded by Rick's Towing.
Vehicle 2 sustained disabling damage as the rear passenger tire was flattened by the contact. Owner of Vehicle 2 was going to make his own arrangements for the vehicle.
Driver of Vehicle 1 was arrested for OWI, see Officer K. Smith's report for further information.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:02 PM
2
3
17-01197
URBANDALE POLICE DEPARTMENT
5/30/2017 2:02 PM
3
3
17-01197
Case Number:
Date of Acc:
Time of Acc:
Name of Agency:
Officer:
17-01195
05/19/17
21:15 Hrs.
URBANDALE POLICE
DEPARTMENT
SMITH KEVIN
Badge #:
Report Date:
Officer Notified:
Officer Arrived:
Scene Investigated:
1133
05/19/2017
21:17 Hrs.
21:22 Hrs.
YES
Report to All Drivers: YES
Legal Intervention: NO
Private Property:
NO
County:
POLK - 77
Acc Loc City:
URBANDALE - 7875
Acc Dir From City: "N/A"
Closest City:
"N/A"
Miles From City:
"N/A"
Road,Street,HWay: "N/A"
Definable Location: "N/A"
Milepost Number:
"N/A"
At Intersection with:
Div HWay Trvl Dir:
Distance 1:
Direction 1:
Distance 2:
Direction 2:
X-Coordinate:
Y-Coordinate:
Location Literal
Description:
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
"N/A"
00435370
04607311
INTERSTATE 35/SE RAMP AND
US 6/HICKMAN RD AND
INTERSTATE 35/NE RAMP
001
Driver Name - Last:
First:
Middle:
WELBAUM
TIMOTHYSCOTT
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
MILFORD
MI
48381-1767
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Male
60
MI
NONE
NONE
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2014
VICT
VICTORY
MOTORCYCLE
RED - RED
17 - MOTORCYCLE
Vehicle Defect:
01 - NONE
Vehicle Action:
03 - TURNING RIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Special Veh Func:
01 - NO SPECIAL FUNCTION
12 - FRONT MIDDLE
Emergency Status:
01 - NOT APPLICABLE
12 - FRONT MIDDLE
Cont. Circum., Drvr:
07 - FOLLOWED TOO CLOSE
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$750.00
2 - MINOR DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
2 - NOT EJECTED
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
11 - HELMET (OTHER)
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
URBANDALE POLICE DEPARTMENT
01 - NOT APPLICABLE
5/30/2017 2:03 PM
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
1
3
17-01195
002
Driver Name - Last:
First:
Middle:
SIMON
GERALDLINUS
City:
State:
Zip:
Suffix:
Gender:
Age:
CDL:
License State:
License Class:
License Endorsmnt:
License Restrictions:
Speed Limit:
Seating Position:
GRAND LEDGE
MI
48837-9279
Driver Condition:
Alcohol Test Given:
Drug Test Given:
Total Occupants:
Male
59
NO
MI
NONE
NONE
45
01 - 1ST ROW: LEFT
SIDE/MOTORCYCLE DRIVER
01 - APPARENTLY NORMAL
NO
1 - NONE
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Style:
Vehicle Color:
Vehicle Config:
1
2014
VICT
VICTORY
MOTORCYCLE
ORANGE - ONG
17 - MOTORCYCLE
Vehicle Defect:
01 - NONE
Vehicle Action:
03 - TURNING RIGHT
Tow:
1 - DRIVEN AWAY
Tow #:
Initial Trvl Dir:
Vision Obscured:
04 - WEST
01 - NOT OBSCURED
Bus Use:
Transported to:
Drvr Distractions: 02 - NOT DISTRACTED
Transported by:
Traffic Controls:
02 - TRAFFIC SIGNALS
Point of Init
Impact:
05 - REAR PASSENGER SIDE
CORNER
05 - REAR PASSENGER SIDE
CORNER
Most Damaged
Area:
Undrrid/Ovrid:
Rpr/Rplc Cost:
Ext of Damage:
First Event:
1 - NONE
$8,000.00
3 - FUNCTIONAL DAMAGE
33 - VEHICLE IN TRAFFIC
Second Event:
Third Event:
Fourth Event:
Most Harmful
Event:
33 - VEHICLE IN TRAFFIC
Abg Switch Stat:
01 - NOT APPLICABLE
Abg Deploy:
Trapped:
Ejection:
Ejection Path:
1 - NOT TRAPPED/APPLICABLE
1 - NOT APPLICABLE
01 - NOT EJECTED/NOT
APPLICABLE
Occpnt Protect:
11 - HELMET (OTHER)
Injury Status:
5 - UNINJURED
Source of Trans: 01 - NOT TRANSPORTED
Died at Scene:
First Harmful Event Loc:
Manner of Crash/Collision:
Light Conditions:
Weather Conditions:
01 - ON ROADWAY
03 - REAR END (FRONT TO REAR)
4 - DARK, ROADWAY LIGHTED
02 - CLOUDY
Surface Conditions:
01 - DRY
Workzone Related:
Activity:
Location:
Type:
Workers Present:
01 - NOT APPLICABLE
Special Veh Func:
01 - NO SPECIAL FUNCTION
Emergency Status:
01 - NOT APPLICABLE
Cont. Circum., Drvr:
33 - PASSING:
THROUGH/AROUND BARRIER
Carrier Name:
Carrier Address:
Carrier City:
Carrier State:
Carrier Zip:
Cargo Body Type:
01 - NOT APPLICABLE
Number of Axles:
HazMat Involvement:
HazMat Placard:
Placard #:
HazMat Released?:
Converter Dolly:
GVWR:
Cit Chrg Code 1:
Citation Charge 1:
Cit Chrg Code 2:
Citation Charge 2:
Cit Chrg Code 3:
Citation Charge 3:
Cit Chrg Code 4:
Citation Charge 4:
Environment:
Roadway:
01 - NONE APPARENT
01 - NONE APPARENT
Type of Road Junc/Feat:
01 - NON-JUNCTION/NO SPECIAL FEATURE
FRA No.:
Horizontal Alignment:
Vertical Alignment:
NO
First Harmful Evt of Crash:
33 - VEHICLE IN TRAFFIC
Unit 1 was WB in the turn lane to go NB at Hickman Rd. and I80/35 Intersection.
Unit 2 was WB in the turn lane to go NB at Hickman Rd. and I80/35 Intersection.
Unit 1 was making a right hand turn to the on ramp going NB.
Unit 2 was making a right hand turn to the on ramp going NB.
Unit 2 was ahead of Unit 1.
Both units were traveling together with other motorcycles.
Unit 2 was rear ended by Unit 1 while turning.
Unit 2 advised that while he was turning there was a patch of sand. Unit 2 advised this might have caused his tires to slide. Unit 2 attempted to avoid the sand on the
roadway.
Unit 1 advised that he noticed the sand in the roadway and attempted to avoid as well. Unit 1 stated that because of the sand, this might have caused the accident.
There was some sand/gravel in the roadway where both units were turning. Both units were traveling together in a pack of other motorcyclist. It appears that Unit 1 was
following to close to Unit 2. Unit 2 sustained functional damage. Unit 1 sustained minor damage. Both units were driven away.
Unit 1 is the at fault unit. Both units knew each other. Unit 1 did not have a phone number for his insurance company.
URBANDALE POLICE DEPARTMENT
5/30/2017 2:03 PM
2
3
17-01195
URBANDALE POLICE DEPARTMENT
5/30/2017 2:03 PM
3
3
17-01195