Accident

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Authority: 1949 PA 300, Sec.257.

622 Compliance: Required MSP UD-10E Penalty: $100 and/or 90 days (Rev 11/2006)

External #

Crash ID

Page 01 of 01 Incident # 536-12 Incident Disposition File Class 93001

0129906

8306856

STATE OF MICHIGAN TRAFFIC CRASH REPORT


ORI: Department Name

Closed
Reviewer

MI 2336700
Crash Date Crash Time No. of Units

Eaton Rapids Police Dept


Crash Type Special Circumstances School Bus Special Study

PAUL MALEWSKI
None Hit and Run Weather Deer Fleeing Police Special Checks Fatal Area Non-Traffic Area ORV/Snowmobile

03/23/2012
County

15:15 None

02

Rear End
Relation to Roadway

Traffic Control

23 - Eaton
City/Twsp

On Road
Light Lane Closed Activity

Rain
Road Condition

09 - Intersection related-othr
Total Lanes Speed Limit Posted

46 - Eaton Rapids LOCATION


Prefix

Construction Zone (if applicable) Type

Daylight

Wet
Suffix

02

25
Divided Roadway

No

Road Name

Road Type

E
Distance

KNIGHT
Traffic Way

ST
Access Control

15 Feet E
Prefix Intersecting Road

01 - Not physically divided


Road Type Suffix

01 - No access control
Divided Roadway

MILL
Unit Number Unit Known State Driver License Number

ST
Date of Birth (Age)

01
Unit Type

Yes

MI C640135564901

11/25/1974 (37)

License Type Operator Chauffer Moped Injury Position

Endorsements Cycle Farm Recreation Restraint Hospital

Sex

Total Occupants Hazardous Action

02

12 - Unable to stop

Driver Information

U N I T / D R I V E R

MV

DANA LYNN CARL 4813 TOLES RD MASON, MI 48854


4 5 6 7 8

O (517) 628-2169
Interlock 9 99 Ejected Trapped

01

04

NONE
Ambulance

Driver Condition 1 2 3

Airbag Deployed

No
Test Results Urine Drugs Yes Test Type Towed To/By

Yes
No Blood Urine

NONE
Test Results Citation Issued Hazardous Other

Alcohol Yes No Refused Not offered Test Type Field PBT Breath Blood Vehicle Registration State Insurance / Policy #

Special Vehicles Private Trailer Type Vehicle Defect

CE32744
VIN

MI

STATE FARM MUTUAL INS


Vehicle Description Make Model

HOLT MASON TOWING


Color

0
Year Vehicle Type

3GCEK13328G281575
Location of Greatest Damage

CHEVROLET
Driveable

SILVERADO
Vehicle Direction Vehicle Use

GRY 01 - Private
Third

2008
Action Prior

Pickup truck

First Impact

02

02

Extent of Damage

No
Second

01 - Going Straight Ahead


Fourth

First Sequence of Events 17 ( indicates MOST harmful event) Passenger Information

Motor veh in transport


Date of Birth (Age) Sex Position Restraint Hospital

SHAWN WILLIAM CARL 4813 TOLES RD MASON, MI 48854 (517) 628-2169


Passenger Information

10/28/1972 (39)
Injury Airbag Deployed

03
Ejected

04
Trapped

NONE
Ambulance

Yes
Sex Position Restraint

NONE
Hospital

Date of Birth (Age)

Injury

Airbag Deployed

Ejected

Trapped

Ambulance

PASSENGERS

Passenger Information

Date of Birth (Age)

Sex

Position Restraint

Hospital

Injury

Airbag Deployed

Ejected

Trapped

Ambulance

Passenger Information

Date of Birth (Age)

Sex

Position Restraint

Hospital

Injury

Airbag Deployed

Ejected

Trapped

Ambulance

Passenger Information

Date of Birth (Age)

Sex

Position Restraint

Hospital

Injury

Airbag Deployed

Ejected

Trapped

Ambulance

Passenger Information

Date of Birth (Age)

Sex

Position Restraint

Hospital

Injury

Airbag Deployed

Ejected

Trapped

Ambulance

TRUCK/BUS

Carrier Information

Carrier Source

GVWR

ICCMC

USDOT

MPSC

Driver's CDL Type

Endorsements H N P S T X

CDL Exempt Farm Other Placard

CDL Restrictions 28 29 30 ID # 35 36

Interstate/Intrastate

Vehicle Type

Type & Axle Per Unit First Second

Cargo Body Type Third Fourth

Medical Card

Hazardous Material Cargo Spill

Class #

OWNERS

Owner Information

Owner Information

Person Advised of Damaged Traffic Control Contact Name: Contact Date: Contact Time:

Damaged Property

Public

Owner & Phone

Unit Number Unit Known

State Driver License Number

Date of Birth (Age)

02
Unit Type

Yes

MI V525101429592

07/28/1971 (40)

License Type Operator Chauffer Moped Injury Position

Endorsements Cycle Farm Recreation Restraint Hospital

Sex

Total Occupants Hazardous Action

02

00 - None

Driver Information

U N I T / D R I V E R

MV

BURT JOHN VINCENT 3573 S WAVERLY RD EATON RAPIDS, MI 48827


4 5 6 7 8 9 99

C (517) 392-2836
Interlock Ejected Trapped

01

04

NONE
Ambulance

Driver Condition 1 2 3

Airbag Deployed

No
Test Results Urine Drugs Yes Test Type Towed To/By

No
No Blood Urine

NONE
Test Results Citation Issued Hazardous Other

Alcohol Yes No Refused Not offered Test Type Field PBT Breath Blood Vehicle Registration State Insurance / Policy #

Special Vehicles Private Trailer Type Vehicle Defect

CAG6070
VIN

MI

BRISTOL WEST PREFERRED INS


Vehicle Description Make Model

PARKED
Color

0
Year Vehicle Type

1GCEC14W1YE143927
Location of Greatest Damage

CHEVROLET
Driveable

TRUCK
Vehicle Direction Vehicle Use

SIL 01 - Private
Third

2003
Action Prior

Pickup truck

First Impact

06

06

Extent of Damage

Yes
Second

08 - Slowing/stop on roadway
Fourth

First Sequence of Events 17 ( indicates MOST harmful event) Passenger Information

Motor veh in transport


Date of Birth (Age) Sex Position Restraint Hospital

CALEB AUSTIN VINCENT 3573 S WAVERLY RD EATON RAPIDS, MI 48827


Passenger Information

11/12/1997 (14) (517) 392-2836


Injury Airbag Deployed

03
Ejected

04
Trapped

NONE
Ambulance

No
Sex Position Restraint

NONE
Hospital

Date of Birth (Age)

Injury

Airbag Deployed

Ejected

Trapped

Ambulance

PASSENGERS

Passenger Information

Date of Birth (Age)

Sex

Position Restraint

Hospital

Injury

Airbag Deployed

Ejected

Trapped

Ambulance

Passenger Information

Date of Birth (Age)

Sex

Position Restraint

Hospital

Injury

Airbag Deployed

Ejected

Trapped

Ambulance

Passenger Information

Date of Birth (Age)

Sex

Position Restraint

Hospital

Injury

Airbag Deployed

Ejected

Trapped

Ambulance

Passenger Information

Date of Birth (Age)

Sex

Position Restraint

Hospital

Injury

Airbag Deployed

Ejected

Trapped

Ambulance

TRUCK/BUS

Carrier Information

Carrier Source

GVWR

ICCMC

USDOT

MPSC

Driver's CDL Type

Endorsements H N P S T X

CDL Exempt Farm Other Placard

CDL Restrictions 28 29 30 ID # 35 36

Interstate/Intrastate

Vehicle Type

Type & Axle Per Unit First Second

Cargo Body Type Third Fourth

Medical Card

Hazardous Material Cargo Spill

Class #

WITNESS OWNERS

Owner Information

Owner Information

Witness Information

Witness Information

Investigated Reported Date (Time) 1st Investigator Name (Badge) at Scene Yes 03/23/2012 (15:18) MICHAEL SEELEY (4637) Narrative

2nd Investigator Name (Badge)

Photos By

SEELEY
Diagram

#1 & #2 are both EB on E. Knight St. #2 was slowing/stopping to make a right turn into City Lot #6. #2 slowed due to vehicle A exiting Lot 6. #1 was momentarily distracted and did not realize #2 had slowed, stopped to allow A to exit. #1 drive into rear of #2. Driver #2's head bounced off back window and was causing pain, was transported to ERMC for treatment. #1 at fault, cited for Failing to Stop in an Assured Clear Distance.

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