Loading...
HomeMy WebLinkAboutCC 5 CLAIM #92-28 08-17-92r CONSENT CALENDAR NO. 5 u F t 8-17-92 E N 0; �'T. Y O Inter -Com ���T.� L . E: AUGUST 41 1992 TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL FROM: CITY ATTORNEY CLAIMANT: JERRY SHAVER; CLAIM NO.: 92-28; CW FILE NO.: S 66794 SUBJECT: CLB; D/L: 11-24-91; DATE ORIGINAL CLAIM FILED W/ CITY 05-29- 92; DATE AMENDMENT OF CLAIM FILED W/ CITY 07-09-92; APPLICA- TTON FOR PFRMTSSTQN TO PRESENT LATE CLAIM FTT-Rn 07-28-92- Although 7-7A-97_ Although the Application for Permission to Present Late Claim, received in the City Clerk's office July 28, 1992, stated that the original claim and amendment were attached, they were, in fact, not included. The City Attorney's office has therefore attached the original claim and amendment to this memorandum. After investigation and review, it is recommended that the City Council reject the above -referenced Application for Permission to Present Late Claim and that upon such rejection the City Clerk advise the Claimant and the Claimant's attorney of such rejection. J S OURKE, City Attorney JGR: jab: R 1:080592(CL-x228. jab) Enclosure cc: Carl Warren & Company Finance Director City Manager 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17' 18 19 20 21 22 23 24 25 26 27 28 KENNETH G. CAMPION A Professional Corporation 15141 E. Whittier Blvd., Suite 500 Whittier, CA 90603-2135 (213) 945-7509 State Bar #: 65380 Attorney for Plaintiff IN THE MATTER OF THE, CLAIM OF JERRY SHAVER, Plaintiff, ds. CITY OF TUSTIN, Defendants. CASE NO.: APPLICATION FOR PERMISSION TO PRESENT LATE CLAIM TO: CITY OF TUSTIN Application is hereby made for permission to present the attached claim after expiration of the time limit provided in Government Code Section 911.2. (1) As stated in the attached claim and amendment claimant's cause of action arose out of an incident that occurred on 11/24/91, but did not cause injury until 1/23/92. (2) The six month period in which the City alleges that the claim should have been filed expired 5/24/92. (3) Claimant attempted to file the claim on 5/29/92 and an amended claim on 7/9/92, after the original claim was rejected. (4) The reason for claimant's delay in presenting the claim was because (1) Claimant was unaware of his injury until 1/23/92; 1 2 3 4 5 6 7 8 9 10 11 12! 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 and (2) was mistaken in his belief that there were no facts that would give rise to a cause of action against the City until April of 1992 when he was made aware of potential defects in the City's roadway that could create liability for his injuries. (5) In any event, there is no prejudice to City of Tustin by the filing or presentation of this claim 5 days after the time expired. I declare under penalty of perjury that the foregoing is true and correct. DATED: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2C 21 2'4 21 21 2 2 2 2 KENNETH G. CA, -1 e I ON A Professional Corporation 15141 E. Whittier Blvd., Suite 500 Whittier, CA 90603-2135 (213) 945-7509 State Bar J: 65380 Attorney for Plaintiff IN THE MATTER OF THE ) CLAIM OF JERRY SHAVER j Plaintiff ) VS. ) ) CITY OF TUSTIN, ) Defendants. ) 311 CASE NO.: 68 43 60 AMENDMENT OF CLAIM TO: CITY OF TUSTIN The attached claim is amended as follows: 1. As stated in the claim, the damage or injury is alleged to have occurred on 11/24/91, in which the time for presentation of this claim would have expired on or about -6/24/92. 2.. However, the cause of action did not accrue until January 23, 1992 when claimant's symptoms of emotional injury became manifest and he sought medical treatment for same. Therefore true date of injury is January 23, 1992, and the time for presentation of this claim does not expire until July 23, 1992. This amended claim will be filed before that date. 1 `' 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 2� 2E 2' 2� 3. In conclusion, while the dam. _ of the accident is correctly stated as 11/24/91 on the original claim form, the true date of the occurrence of injury or damages �anuary 23, 1992. IN 311 DATED : `Z KENNE`Di G.(-CAMPION Attorney fvo-� Claimant 0 :'NESS:S TO DAMAGE or INJU)•'': List all persons and ae---esatD of persona known <� have information: Not "`" rtained at this time. - .�_�Y -lie Address Phone , re Address Phone- # re' Address Phone % - I e • amoun't..c a.ime Rs ..ot- t e ate o re.s.entation...o. ...t a_.c t m .. 's :cont ute4 - T follows;` .:.. P' P , . S -nag,es':1h&1ried' to'.. (exact) Damages':. to property... .............................$ _x easefor,medical and hospital care..... - P. ..s •:•. p - 5 .000.00 ` f approximal Loss-;_of::.earnings::"::'.:'.:.. 0 0 0 0 ..... .. 0 0 0 0. 0 .'- 000 ... • .. ... 3 000.00a roxi.mat; Special* damages for General:.:ciarnages...........::.......................':....$_ 50.000•.00• . To•tar Damages "to Date.... 58,000.00 Cal_ amount claimed as of. presentation of -.,.this claim.'* $ 58,000:04 timated•prospective damages as far as known: Unknown p 1 and hospital care.....-,-,* Future• ex eases for medics a...... ' `• `� ""� - - - s; Future loss:-bf,­earnings • : ... _ $ _ ri• .. .• •. • : . . . . • • • • • • • •. • • .. . . . . . . . _ • f._. . Otherl:grospec.tive:=special- damages - Prospective general .damages ....... ................'..:...$ Total'estimated prospective damages ..........:....: k: READ UEFULLY ...' N :.. •:":. .. -• ' •INDICATE OW:'tile%;location and po ition•of vehicle (s) at point of impact. "` NORTH 0-71• your vehicle as the other vehicle as(�2 U�G1 the name -of -the street(s�, location of stop"signps•s gnats. • - � 0000: �. , .. :. . '- - • .. : - :�•- _� ..: ' . � - .. .. • .. - . - .. .' 0000 •. •. -;.1 ',r � .. • . _ . _«_««..« _. __0000. _ .. 000_0... .._ 0000.. •:.. �....:.:. ..._ . , . 0000.. - ' : .. - --- - •--- �_•-... , • •._• _• , .• •'t +� _0000 00_00. _ .. .. ........«... ... .. .. .. .•_. -'_ - �- .. «_._. .r. ._ . _. ... -_._ ., « �� . � _ 00_00 _ . ._.. ... 0000 ._. •.- _..� . ... ... . .... ........ _...--... __ 0000 ......_..�.... ._ _ .. .. _.. _-,:'.__ . w`':t. `/_ j•f•. i�.:. .,, •:i. rr:1•.. 0000. 000,0 ...=.:I,i' gna ture •.o- - C ai.mant or person fMng Type or print name: 1 to h is •'beha 1 f g relationship to aimant•.•• KENNETH G. CAMPION Attorney at Law' r reselit atio o a a se c a m s a felony(Penal-Code ec.12. ...CLAIM FOR DAMAGES - - - TO PERSON OR PROPERTY Inme of CIa manC _ _...... ...._..._...... ___ _...._ _..._.. ate o rt ti" o . nrJERRYr Az.'%.F2N- SliAfiEi2'=^-T•�;p��Ci�' orI:a,TCit?-; :cctirri� _ '11�j6g- _._....__.. _....___ ...� ome Address ot ClaimantState s � . _�-- � : _�•: �: �,�_.:i ...!:.; :�:..._. __....:'i_ .s+'i-:'.i'i� 1• .. ,,.:. �,� . �•+._: ��;:;,_ is �� �;,1 �:._`• 1 epil er ' . ..�._ e� i=... _. _ .• i � ► -- -.... _ ` - -• ------ --•• •--.( - lusinessLAddres,s o Ma. 11 t'. -City, tate ,. Business Telep one Hitm _ None..,. :.•. �.:.,i•,.. �n<:�.rs:: :t..•i-,. None j ve"a ress h -te •ep lone:=no: oto tw i -c•,jyou•(;1►•:11. -Claimant's ccupat on l'esire -iiot�es.:or? 6ominuniififtioiig;=t61be ad6t_.___... _._ ..._._. regarding -this c.lai.m_:, KENNETII. G....CAMPION (310) 945-7509 Truck driver Attorney at Law ••' �..: �;;, .'• Claimant oc a . ecus 15141 E. Whittier Blvd., Suite 50 No.— _. _.... _..._ . Whittier' t �A '` 90603 ien,did ,;;prc J UKY occur -' '' ,; ,Names - of any em� ogyees nvo vec ty7_ )lite:. 11/-24/91 in INJITRY"; or-DAMAGE:(c - rime: .. 5:30; p.m. : t ... 4:Y1.:. .Unknown w sere . r GE or NJ MY occur Describe fully an .. ocate on diagram on,.,., cever�se~ side- of -th•is•'sheet:---Where---appropriate, -give street .names and addressee': indmensurements or;.lnnJlna See ,,'diagram on CHP report :'••i i tot Address r'ht, `tet- .... n �, r._ +,_ rt._. /c: :,'=�?P4_•iaS+� . )escr eta — -ow- L or - mant`dzov�a,o�auhJYtl`;-sck, a pedestrian on the ftty' s .premises 1 y o you claim e s respons ei : ,.: • L. la M,* wa! F �� ; ;.Ftt• ;:.r .?.��+. r:=:_ Premises were inadequately illuminated: , 2. Motorists were -inadequately warned of NEdIrsection. 3. The premises lacked traffic control signals. 3escribe Ln detail each or NMGM - Psychiatric injury to claimant resulting from'collision with third party. as damav and/or injury investigated by police orshe-ror California Highwal 'atrol?Yes Name of agency that investigated: California Highway Patrol Not for. claimant Jere paramedics or ambulance called? If so, name County,or City imliul ance If injured, 'state date, • time inme and address of doctor -of your first visit? lospital Address Phone )octor Goldman Address 2690 Pacific Ave., Phone(800)289-298 Santa Ana, CA )octor ' Address Phone This Claim must be signed on Reverse Side. _ PEDES. STREET ADDRESS "� TUSTIN POLICE DEPARTMENT riG1 1 °p REPORT lOw»tw'f RAC[ afpaRTOM Or VL/OC" O•. owot,s Or: I T S$ r.(+GKT w oc+R �D+ n ♦ W TRAFFiC COLLISION YIriCLE ,,,...,a •WT f aw" ...,.,.a0 r,.0»T TUSTIN .. , CEiN � l :..L f(t >•AJA 0 0 ,"T 91-0889 FATAL ""`° I �� ORANGE G5 1 u"'C 1 W, Dat � 4 " Tut 1>60" ..�� . O•�CtA r ° �— O«�-"tD ON i� of 17 23 3022 Y p1�.ii.:—.IJ—..--_ _---------- ----------------------••---- OAT Ol wlta TOW AWAY P••OTOGAAP" fT: —1S :.�[►o�T,».O"..•n0•. TV T F STn ❑►� OFC. DEr1NEY sTAn "W -V RtL 35MI.1 ►f�Ni OJ AT IWTtAslCTIOM WIT S AMAGANSET WY "'—T ♦vs ®►+O sT•n ©OR: 111' 6" nR ►.L[f Or TA ' Nut[, MOD(Lr COLO" LICENSE"V..f[R PARTY O"�ERfLIc`"f`""""" STATS CLAsf fArCTYVlK 3 88 F ORD F350 TOW TRUCK 3L03619 , . CA j ... ..... .CA . .... .. ; oRnER AtAA� (Ill LAST)oDLL. LAST) 2DR WH M T E - JERRY ALLEN SHAVER Owl.l,fMAmt &&MEAsO"v[R ,Lass ITRCET ADDRESS JOHN ExxON TOP NG T" API [3Ow«ur [R's AGOR(st f( AS °wrv(R rA,K[D CITY ISTAY [,DO I ❑ RAC[ dfPOf,T10". Or vc»Clt OM CROERs Lr. ❑ OrnC[R � Owv(R u f�CT. "� f[t nuR t•[3 ntK.'r•T M BRO HAZ 5-9 wtrc.R �,T►.OATt „n DAT vlM 170 O1. 09 68 1�L OWNER - AUTO CLUB R[nR TO w,tRanvE ►1YOR y[ptAMCAL DLrtCTs: Mo"t A"AftEw OTHER rout ►►+a•ESAA04IN ( st+sa+css ►Montt ( DAMAGED ARLA O"PLrs&OMLT D[so..(Vtr•CLLO,�•�aGE vtr,CL.t TYrt ❑,P-r. E] ,.a E] ..OR PffURAMCt CARItI[R rouCT Numalm � �NOa QN/►�OR QTOTAL GOLDEN EAGLE CCP132113 dR GI ON STREET OR -OMwAT SPEED PCr L"T cc Q ►NC ❑ TRAVEL S YORBA ST. Q C"P ❑ WA,cE,W009LICOLOR UC[Mf(NVfAL(R :TAR oRrvER•s uc(Nss MufsscR sTATL CLASS `Af�M vclL I&PARTY . . . . . . . . 2 CA ••• ••""'""••' Qn.•-r E (mAST. woOLE. LAST) PAQUITA AIDA SAID OwM[J1: M.fIE QSAA.(AsDwwtR ►a,.♦ STRL(T ADDRESS TWArl ® o+M+cR•s A.DoRcu �,...EA'°"�`" PARKED CMsSTATE IZIP v[r�CLt ❑ rluR IL ETES ncw_' t w1DC staT„OATt ° T T ." �°3 RACE W . ❑ BRO BRO 5-5 110 CKnC's: MOM[ AM ♦RO1T Q RCiiR TO I.ARRATVt C ►ORE ►ROME fVfi+ESS r"OR t MOR NECI•AT'•CAL oEsC".EVE_CLL DAA�AG S,^DE w OA►+AGLD AREA Or"ER C3 ( ( } IA C»• ts[ ONLY Y»OR IL_r1 r.CL CARM[R roucT P*Uh&a 'woo. � NAJOR ' TOT"r4SLAA N/A ,O: ❑ mm. Of oM sTRt cT oR r■cr«+A f.[[D PCP L*AT rt,c ❑ Cpv sTA� ❑ TRAVEL W YORBA � T ,� _ yC[Ml"N..•IR vLm. TR, rut(r rOOILr COLOR s'T ATE C W f SAi ETv (ouv. 1PARTY1 OMVER"s UCLN" Hu"REA . . . . . . . . . . . . . . . . . . . . . . 3 oPsvu wttu iRRsr. bNOOLE. LASTI PEDES. STREET ADDRESS Tta AN lOw»tw'f RAC[ afpaRTOM Or VL/OC" O•. owot,s Or: I T S$ r.(+GKT w oc+R �D+ n ♦ W p^SLR Q VAAKEO CITY, STAT [r LIP YIriCLE YC"T, f(t >•AJA Curr aCAAMIR u"'C Ow"[R s MAwE ❑ SA.Mf As O,.v[R u. .A nwwcR Aoowlss 1.� f t lOw»tw'f RAC[ afpaRTOM Or VL/OC" O•. owot,s Or: I T S$ r.(+GKT w oc+R �D+ n ♦ W p^SLR Q Dwv[lt � OT1QR yR. OP �OM ftR[[T O" r. GrM AT TRAVEL r,E►AR/R s K&ANE �l RLLEV I E�� I `'661 "y t AiPaROlT C AOR NtiCMAJXAL OtPlCT1: ( } c"v Val O»LT GtLCnal vt..CLL P --A" v f►K LA TT P'S ^ 140"t ku U IPS PouCT PeLaostR Q • MO4L Na.rOA TOTAL $Palo PCP K:c ❑ 1c,- ►VC ❑ ❑ y� A,rtR To "AAw►TTVt TRAFr=IC COLLISION! CQQINl _ -0• 1 '�.. 24 .,.. Q 1 � •w2 w •.� ,� •Cf PSO,*E;IrY I 92-03)38 SEATING POSITION I - PAVER �'r=UDANTc SAr"STY - NONE IN VEHICLE EQUIPMENT Y C g��r• F . ►. 1 FROM '. '0&'kA TO I . PASSENGERS B - UNKNOWN L • Air BAG DEPLOYED 7-STA. WGN. REAR I - RR OCC. TRK_ OR VAN C UP BELT USED 0 • LAP BELT NOT USED M • AIR BAG NOT DEPLOYED DAVER N.OTHER V' NO TEJECTED 0 . NOT EJECTED t - FULLY EJECTED I 2 J I • POSITION UNKNOWN E • SHOULDER HARNESS USED . NOT REOUIREO W - YES 2 • PARTIALLY EJECTS_ 0 - OTHER �• F • SHWLDER HARNESS NOT USED �1I� ^ pCS7plT S . UNKNOWN S 6 G - LAP I SHOULDER HARNESS USED i�1GP PASSENER HICLE USED 7 H . LAP -'SHOULDER HARNESS NOT USED J • PASSIVE RESTRAINT USED Ho R - IN VEHICLE NOT USED Y - YES K •PASSIVE RESTRAINT NOT USED 3 -IN VEHICLE USE UNKNOWN T - IN VEHICLE II..PROPEA USE ITEM$ MARKED BELOW WHICH AREu • NONE IN VEHICLE F OLLOwEC Br AN ASTERISK ') PRIMARY COLLISION FACTOR I SHOULD BE EXPLAINED IN THE NARRATIVE UST NUMBER riI OF PARTY AT FAULT TRAFFIC CONTROL DEVICES 12' • Q vC SECTION VIOLATED: c o I I A CONTROLS FUNC1)C+4"G 1 3 TYPE OF VEHICLE 1 12j 3 MOVEMENT PROCEDI: 1� Z Q50A V C 1c I B CONTROLS HOT FUNCTIONIN"• I I A PASSENGER CAR r STA. WGK COLUSION . I BOTHER IMPROPER pRrvING • I C CONTROLS _OBSCURED I I 18 PASSENGER CAR w r TRAILER STOPPED • I C OTHER THAN DRIVER- Y I D NO COId7ROL.S PRESENT / FACTOR. ( C MOTORCYCLE /SCOOTER I I D PICKUP OR PANEL TRUCK PROCEEDING SigAIG. I D UNKNOWN PE OF COLUS+O+r I E PICKUP r PANEL TRK. W /TLA RAN OFF ROAD I A HEAD-ON MAKING gGHT TURN JE FE11 ASLEEP• I B SIDESwIP£ I F TRUCK OR TRUCK TRACTORWAKING WHSLOVANG LEFT TURN C REAR ENO I I G TRK r TRK TRACTOR W/ TLR MAKING U TURN I KIRK 1 TO 2 ITEI.LS 1 D BROADSIDE I H SCHOOL Bus !SACKING IEHIT OBJECT I I OTHER 8U3 / STOPPING nIESCLOUDY IFOVERTURNED I J EMERGENCY VEHICLEI PA551NIG OTHER 1►EMC G VEHICLE / PEDESTRIAN I HWY. CONST. EOUtP►.tEPiT J CHANGING LANES G H OTHER•; fPEDESTRIAN K PARKING MANUEVEA I E FOG / VtSIBtUTY FT. MOTOR VEHICLE INVOLVED VATHL 1 MOTHERLvEHICLE ENTERING TRAFFIC F OTHER•: ANON-COLLISION I MOTHER UNSAFE TVI;- G B PEDESTRIAN I O MOPED I N XING INTO OPPOSIN• -_ LIGHTING I C OTHER MOTOR VEHICLE O PARKED I A OAYL)GHT t v. K - OAJVN D MOTOR VEK ON OTHER ROADWAY ( OTHER ASSOCIATED FACTOR P ME RGING K •STREET LIGHTS E PARKED MOTOR VEHICLE I (MARY( I TO 2 ITEMS) O TRAVELING WRONG WA K . NO STREET UGHTS jDARK F TtiAtN A Yc ucno./ vlou�no.. urEc R OTHER:' - • STREET UGHTS NOT I G BICYCLE 22350 VC ® ' iUNCT10NINC• H AMMAL B Yc steno« v1oLAnoa: alto ROADWAY SURFACE A DRY I FlXED OBJECT: Ores ONO SOBRIETY-0Rur, I3 WET C VC ucn0.. VIO ATIO,t CITED i I PHYSICAL C SNOWY . ICY ND J OTHER OBJECT: OQres [:)boo (WAgx T TO 2 ITEMS SuPPERY ( MUDDY. OILY. ETC.) D A HAD HOT BEEN DRINKIN ( E VISION OBSCUREMENT : B HBO - UNDER INFLUENCE ROADWAY CONDITION'S I ( I I F INATTEIMotc C HBO - NOT UNDER INFLU ( MARK I TO 2 ITEMS J PEOESTRANS ACTION I GST i GO TRAFFIC I D HBO . IMPAIRMENT UNK.' AHO PEDESTRIAN INVOLVED II H ENTERNG I LEAVING RAMP E UNOER DRUG IWL•U.' I A HOLES. DEEP RUTS- B LOOSE MATERIAL ON ROWY•• IRE V g CROSSING IN CROSSWALK I I I PREVIOUS COLUSON I F IMPAIRUENT - PHYSSCAL G IMPAMMENT AT INTERSECTION I J UNFAIsUAR vvITH ROAD NOT KNOWI C OBSTRUCTIQN ON ROADWAY• D CONST PUC TI OH - REPMR C SWALK .NOT K DEFECTIVE VEK EQUIP, cIYEo H NOT APPLICABLE ZONE REDUCED ROADWAY MOTH AT CONT ER�CT� Orts ..o I SLEEPY / FATIGUED F FLOODED D CROSSING ,NPT IN CROSSWALK I i (_ UNINVOLVED VEHICLE SPECIAL INFORMATION G OTHER•: E IN ROAD . INCLUOES SHOULDER- I I I M OTHER-: A HAZARDOUS MATERIAL XI H NO UNUSUAL CONpIIIONS 111 NOT IN ROAD G APPROACH I LEAVING SCHOOL 13US YI N NONE APPARENT s.rnc.l ( O RUNAWAY VEHICLE I I I I ` f I A/10ELLAM.OV. 1^ 0 1 C A T MOI.fM y I � D I B • .47 z �.��y.4��s r- TR .FFIC COLLIS10N CODCNt 1 2� .,.. 91 1 i ( 3022 661 P�O+[pry 0A►AGF o, A.W&,, 91-08�A9 1 C.C3 2— PNOT D . LAP BELT MCUSED ' SAFETY EQUIPMENT •- POSITION UNKNOWN EJECTED FROM VEH. EATING POSITION f+_L�rPAt�"1 �. r Me-vrl F . I -F, ►[f T rNl D grST_ 1 • DRIVER A . NOHE IN VENC:E L • AIR BAG DEPLOYED O • IN VEHICLE USED x - No Y YES 0 - HOT EJECTED (A 2 TO [ • PASSENGERS S . UNXMoww M - AIR LAG HOT OEPROYED DRIVER 7 I • FULLY EJECTED II 7 • STA, wGK R"A C • LAP BELT V!;? N • OTHER V • NO T • IN VEMCLE IMPROPER USF U • NONE IN VENCLE I • PARTIALLY EJECTED -- ITEMS MARKED BELOW wHKH ARE FOLLOWED BY AN ASTERISK I • 1 SHOULD BE E.xPIJUNED IN THE HARRAnvE. PRIMARY COLUSION FACIOR REQUIRED w • YES 1 2 3 TYPE OF VEHICLE 2 3 7 • UNKNOWN • AFL OCC. TRK_ OR VAN D . LAP BELT MCUSED ' C vc ucno" Y101.Ar=wc •- POSITION UNKNOWN E . SHOULDER--lNESs USED AINT DAS3EHGEA 1 23 0.OTHER F . SHOULOER P-A-'++ES3 HOT USED rNl D grST_ F INATTENnoN- S 6 A A ANE53 USED G • LMP r S-OU:-iH O • IN VEHICLE USED x - No Y YES H ENTERING I LEAVING RAMP 4 H - LAP • S"O%)L:cR HARNESS NOT USED R -IN VEHICLE NOT USED • 7 J • PASSIVE AES'=AtNT USED S IN vEHICLE USE UNKNOWN Dv[f K . PASSIVE RES'RAINT HOT USED T • IN VEMCLE IMPROPER USF U • NONE IN VENCLE M OTHER': ITEMS MARKED BELOW wHKH ARE FOLLOWED BY AN ASTERISK I • 1 SHOULD BE E.xPIJUNED IN THE HARRAnvE. PRIMARY COLUSION FACIOR TRAFF= CONTROL OEV►CES 1 2 3 TYPE OF VEHICLE 2 3 UST NUMBER 101 OF PART' AT FAULT A vCS TION VIOLATED: �a3 I A CO++tIrCtS FUHCTIONNG A PASSENGER CAR I STA. wGK OI 21950A V ►o I B CONTZXS NOT FUNCnCw&MG' I I B PASSENGER CAR W I TRAILER i B OTHER tMPROPER OAIVING • I C C_-,wTP0,_3 063CUREO C MOTORCYCLE I SCOOTEA I Y D 'o CO" oOL] PQESENT / FACTOR' I Q PICKUP OR PANEL TRUCK { C OTHER THAN OfVVER' OF COLUSION j E PICKUP I PANEL TRIC W-1 TLA I D UNKNOWN' I A rEADv+ RUCK Oft TRACTOR F TA TR E FEASLEEP* LL DES.P'E ► B Sw I G TRK _ I TRK. MACTOA w / TLA C PEAR EPI H SCHOOL Bus WEATHER ( "AK 1 TO 2 ITEMS 1 (Q BROACSOE I OTHER BUS J EMERGENCY VEHICLE X A CLEAR FEHIT 06. ECT K HwY. CONST. EOUIPMIENT IB CLOUDY i F OVERT;; --+EO C RAINING X I G vEHICLE / PEDESTRIAN L BKYCL E I D SNOWING H OTHER MOTHER VEHICLE E FOG !VISIBILITY FT. UOTOFI ti_►*CLE INVOLVED WITH { N PEDESTRIAN OTHER•: A H.oN.:.DLLIsIO" Q MOO -EDF G WINO A I B PEOES'ZAN LIGHTING C OTHER MOTOR VEHICLE I ASSOCI FACTOR I OTTER SS A DAYL)GHT Q MOTOR VEK ON OTHER ROADWAY 1IAT 2D 17 1 g DUSK • DAWN I E PARKS: MOTOR VEHICLE A vc ucnwrouT1,00c Ano DARK - STREET LIGHTS LI F TRAIN r[s 1 - 22350 VC ®"o D DARK - No STREET UGHTS G BICYCLI ono E DARK STREET LIGHTS NOT I Ham` B .c ucna+ r/Ov.nac (]r[s FU NC TION*NG• ROADWAY SURFACE •IADRY B WET I C SNOwf Icy I D SUPP£RY I MUDDY. OILY. ETC. I ROADWAY CONDIT10"S MARX 1 TO 2 ITEMS ) I A'+OLES DEEP RUTS - B LOOSE MATERIAL ON ROWY I C OBSTRUCnON ON ROADWAY'' I Q CONSTRUCTION - REPAIA ZONE I E REDUCED ROADWAY W10TH I F FLOODED- G OTHER•: XI H NO UNUSUAL CONDITIONS r Sa[Ttn I { I ( I y B S � T 1 I AXED rvEG7: J O 'HER C,&JECT. PE:STRLAKS ACT10N A NO PEYSrmAN INVOLVED AO5%wG IN CROSSWALK X I B AT INTERISECT)ON IC CAOSS.IG M CPO%SWALK • NOT A T tN - c.RSE C T1004 I D C:RcssNG • NOT IN CROSSWALX E IN ROAZ -INCLUDES SHOULDER 1 F NOT I1. aOAO 1 G APPQC;ACH I LEAVING SCHOOL BUS I I I r ' ?Z T ,r- MOvE1r+ENT PROCEDING COLLISION A STOPPED B PROCEEDING STRAIGHT C RAN OFF ROAD D MAKING RIGHT TURN E MAKING LEFT TURN F MAKING U TURN G BACKING H SLOWING / STOPPING I PASSING OTHER VEHICLE J CHANGING LANES �( PARKING MANUEVER L, ENTERING TRAFFIC • .....ten ..w • CC Tl10 YldC: N XING INTO 0PP09N0 LANE 10 PARKED I P ME RGI NG Q TRAVELING WRONG: WAY R OTHER:* SC18I TY-0RUG PHYSICAL MARKT TO 2 ITEMS) A HAD NOT BEEN DRINKING B HBO - UNDER INFLUENCE C HDD - NOT UNDER INFLU.' D HBO. IMPAIRMENT LINK' E UNDER DRUG IWL F IMPAIRMENT • P*IYSICAL' G IMPAlRUFMT NOT KMOWM H.NOT APPUCABLE I SLEEPY I FAnGUED SnEOAL INFQRMATION A MAZARDOus MATERIAL 0..0 C vc ucno" Y101.Ar=wc Un0 I]Y[s C)..o E VISION OBSCUREMENT : F INATTENnoN- G STOP A GO TRAFAC H ENTERING I LEAVING RAMP I PREVIOUS COLUSION J UNFAIIUAR WITH ROAD K DEFECTIVE VEK EOUIP.: Ano Dv[f 0.0 L UNNVOLVED VEHIC-E M OTHER': N NONE APPARENT O RUNAWAY VEHVCLE rsGLLLn++W�s T ,r- MOvE1r+ENT PROCEDING COLLISION A STOPPED B PROCEEDING STRAIGHT C RAN OFF ROAD D MAKING RIGHT TURN E MAKING LEFT TURN F MAKING U TURN G BACKING H SLOWING / STOPPING I PASSING OTHER VEHICLE J CHANGING LANES �( PARKING MANUEVER L, ENTERING TRAFFIC • .....ten ..w • CC Tl10 YldC: N XING INTO 0PP09N0 LANE 10 PARKED I P ME RGI NG Q TRAVELING WRONG: WAY R OTHER:* SC18I TY-0RUG PHYSICAL MARKT TO 2 ITEMS) A HAD NOT BEEN DRINKING B HBO - UNDER INFLUENCE C HDD - NOT UNDER INFLU.' D HBO. IMPAIRMENT LINK' E UNDER DRUG IWL F IMPAIRMENT • P*IYSICAL' G IMPAlRUFMT NOT KMOWM H.NOT APPUCABLE I SLEEPY I FAnGUED SnEOAL INFQRMATION A MAZARDOus MATERIAL