HomeMy WebLinkAboutAGENDA REPORT 1996 0918 CC REG ITEM 10EAGENDA REPORT -
C = TY O F MOORPARK
TO: The Honorable City Council l
FROM: Kenneth C. Gilbert, Director of Public Works
DATE: September 12, 1996 (Council Meeting 9- 18 -96)
SUBJECT: Consider Left Turn Phasing for the Traffic Signal
at the Intersection of Moorpark Road and Tierra
Rejada Road
The City recently installed a traffic signal at the subject
intersection. The design for that traffic signal provides
for a permissive /restrictive left turn phase for west -to-
south left turners. As you may know, such a design provides
for a restricted left turn phase ( left green arrow) , followed
by permissive left turns on a GREEN light as gaps in the
traffic allow.
As a part of the City Council action to accept these
improvements and record the Notice of Completion, the City
Council requested that the function of this traffic signal
and the movement of traffic through this intersection be
brought back before the City Council for reevaluation in a
few months. This report is in response to that request.
Attached for your information is a copy of a Memo from the
Police Department summarizing traffic accidents which have
occurred in or near the subject intersection within the past
few months.
In the event it is the view of the City Council that the
design of the subject intersection may require modification,
it is recommended that, prior to directing any such change,
that the City Council direct the City Traffic Engineer to
perform a traffic study to evaluate the function of both the
present design as well as any proposed change.
Direct staff as deemed appropriate.
npktr2
0013127
City of Moorpark
Police Department
MEMORANDUM
TO: Capt. M. Rouse
FROM: Sr. Deputy J. Hill
DATE: 9 -10 -96
KECEIVET)
SEP 1 1 1996
CITY OF A400RPA%
799 AA00RPARI AVENUE
tv ±CiOF l ASS. =C, CA 83321
g
SUBJECT: Accidents at Tierra Rejada and Moorpark Rd.
As per your request, I researched the area of Tierra Rejada road and Moorpark road, for all
accidents that have occurred in that area since April of this year. My findings are as follows:
Month Number of Accidents Primary Collision Factor
App 1 21801a VC
May 0
June 0
July 0
August 3 22350, 22100a,21801a VC
Two of the collisions involved minor injuries, one had moderate injuries (motorcyclist), and one
was a non -injury collision. Two of the collisions were due to drivers making an unsafe left turn, in
front of other traffic, a violation of 21801a VC. If you need any further information regarding
these collisions, fell free to contact me.
cc: Ken Gilbert (Mint+
OFFICE OF THE CITY CLERK
TO: The Honorable City Council
FROM: Lillian E. Hare, City Clerk;
CC: Steven Kueny, City Manager
DATE: September 13, 1996
SUBJECT: Transmittal of Traffic Collision Report
Attached is the Traffic Collision Report for the motorcycle accident that occurred on August
18, 1996 at the intersection of Tierra Rejada Road and Moorpark Road. This item is being
provided relative to Item 10.E. of the September 18, 1996 City Council meeting agenda.
PARTY
DRIVER'S LICENSE NUMBER
STATE
CLASS
SAFETY
SI'A -I F OF CALIFORNIA
MAKFJMODEUCOLOR
LICENSE NUMBER STATE
1
)`
TRAFFIC COLLISION REPORT
M
W
84
...
n PACE OF 9
SPECIAL CONDITIONS
NO [NJ
H &R FEL
CITY
JOHN DAVID N. MACDONALD JR
JUDICIAL DISTRICT
NUMBER
PEDES-
1
[J
MOORPARK
3289 AMARILLO AVENUE
VENTURA
PARKED
CIIYlSTATE2IP
OWNER'S ADDRESS SAME AS DRIVER
NO KILL
H &R MISD
COUNTY
DIST
BEAT
96-68112
HEIGHT
0
BIRTHDATE•
VENTURA
5110
2A01
M
C *StaarB: 012G68I1
BR
COLLISION OCCURRED ON:
06101162
MO DAY
YEAR
TIME(2400)
NCIC N
OFFICER LD.
L
TIERRA REJADA ROAD
CHP USE ONLY
VEJIICLE TYPE
DESCRIBE VEHICLE DAMAGE SHADE W DAMAGED AREA
081181
96
1100
5600
001384
C
DIR TRV
ON STREET OR HIGHWAY
SPD I.MT
PCF
-
A
MILEPOST INFORMATION:
TIERRA REJADA ROAD
45
DAY OF WEEK
TOW AWAY
PHOTOGRAPHS BY:
i
DRIVER'S LICENSE NUMBER
STATE
CLASS
SUNDAY
VEH YR
[XJ YES [ J No
DEPUTY
N
pQ AT INTERSECTION WITH:
CA
I C
G
STATE HWY REL
R I VERA
310RKJ CA
...........
[I OR: MOORPARK ROAD
NAM F(FIRST,MIDDLE,LAST)
KJ
DONACIANO MIRA MONTEZ
[ 1 YES PQ NO
f 1 Name
PARTY
DRIVER'S LICENSE NUMBER
STATE
CLASS
SAFETY
VEH YR
MAKFJMODEUCOLOR
LICENSE NUMBER STATE
1
N8532750
ICA
M
W
84
...
HONDA MC 1000 BL \WTE
..................I.
7Y2638 CA
...........
DRIVER
NAME(FIRST,MIDDLE,LAST)
KI
JOHN DAVID N. MACDONALD JR
PEDES-
STREET ADDRESS
OWNER'S NAME f'1 SAME AS DRIVER
"ff
3289 AMARILLO AVENUE
PARKED
CIIYlSTATE2IP
OWNER'S ADDRESS SAME AS DRIVER
VTTL
SIMI VALLEY CA 93065
BICY-
SEX
HAIR
EYES
HEIGHT
WEIGHT
BIRTHDATE•
RACE
DISPO OF VEHICLE ON ORDERS OF: jq OFFICER [ J DRIVER [ ]OTHER
CL
M
BR
BR
15-111220
06101162
W
DAVES TOW (805) 526 -4221
OTHER
HOME PHONE BUSINESS PHONE
PRIOR MECHANICAL DEFECTS: NONE APPARENT REFER TO NARRATIVE [ J
[ J
(8 0 5) 583-2432 ( 310) 394-9650
CHP USE ONLY
VEJIICLE TYPE
DESCRIBE VEHICLE DAMAGE SHADE W DAMAGED AREA
INS URANCE CARRIER POLICY NUMBER
FARMER 7
I
[ J MOD.[ J MAJOR [q TOTAL
DIR TRV
ON STREET OR HIGHWAY
SPD I.MT
PCF
-
W
TIERRA REJADA ROAD
45
21801 a
PARTY
DRIVER'S LICENSE NUMBER
STATE
CLASS
SAFETY
VEH YR
MAKE/MODELICOLOR
LICENSE NUMBER STATE
2
N0277500
CA
I C
G
75
...
CHEVY VAN BLUE
....................
310RKJ CA
...........
DRIVER
NAM F(FIRST,MIDDLE,LAST)
KJ
DONACIANO MIRA MONTEZ
PGDES-
STREET ADDRESS
OWNER'S NAME J'1 SAME AS DRIVER
'r
11198 SOUTH J STREET
PARKED
CITYISTATEJZIP
OWNER'S ADDRESS SAME AS DRIVER
"'TT L
OXNARD CA 93033
BICY-
SIX
HAIR
EYES
HEIGHT
WEIGHT
BIRTHDATE
RACE
DISPO OF VEHICLE ON ORDERS OF: [ OFFICER KI DRIVER [ J OTHER
olfl
M
BR
BR
I 5 -06
175
091181,13
H
DAVES TOW (805) 526 -4221
OTHER
HOME PHONE BUSINESS PHONE
PRIOR MECHANICAL DEFECTS: NONE APPARENT tq REFER TO NARRATIVE [ J
[ ]
(8 0 5) 487-4179 (8 0 5) 487-7111
CHP USE ONLY
VEHICLE TYPE
DESCRIBE VEHICLE DAMAGE SHADE W DAMAGED AREA
[JUNK [ ]NONE [ ]MINOR
INSURANCE CARRIER POLICY NUMBER
ALLSTATE 699623726
I
[XJ MOD. [ J MAJOR [ J TOTAL
DIR TRV
I ON STREET OR HIGHWAY
SPD LMT
145
PCF
.
E
TIERRA REJADA ROAD
PARTY
DRIVER'S LICENSE NUMBER
STATE
CLASS
SAFETY
VEH YR
MAKFJMODELJCOLOR
LICENSE NUMBER STATE
3
I
DRIVER
I
NAM E(FIRST,MEDDLE,LAST)
PEDESS-
TRIAL
STREET ADDRESS
OWNER'S NAME [ J SAME AS DRIVER
PARKED
CITY /STATEILIP
OWNER'S ADDRESS [ J SAME AS DRIVER
VL I
gi(C
B ICIY-
SIX
HAIR
EYES
HEIGHT
WEIGHT
BIRTIEDATE
RACE
DISPO OF VEHICLE ON ORDERS OF: [ J OFFICER [ J DRIVER [ J OTHER
CL�S
OTHER
HOME PHONE BUSINESS PHONE
PRIOR MECHANICAL DEFECTS: NONE APPARENT [ J REFER TO NARRATIVE [ J
CHP USE ONLY
VE]IICLE TYPE:
DESCRIBE VEHICLE DAMAGE SHADE W DAMAGED AREA
MINOR
( J
INSURANCE CARRIER POLICY NUMBER
I
[ J MOD.[ J MANOR [ J
UIR 1'RV
ON STREET OR HIGHWAY
SPD LMT
PCP
PREPARER'S NAME:
DISPATCH NOTIFIED
RE'V1gWFR'S , AME)
DATE RL-'VIL7VED
THERRIEN W 001384
Y. NO N/A
./ / - �',/
li l
SI A I'F 01: CALIFORNIA
TRAFFIC COLLISION CODING
^wl':1\'lkI INCIDENT
TIME(2400)
NCIC NUMBER
OFFICER LD-
ur
NUMBER
y - 18 - 96
1100
5600
001384
96 -68112
OWNERS NAME/ADDRESS
i Pt •N P IY
NOTIFIED
DESCRIPTION OF DAMAGE
DAMAGE
SEATING POSITION
OCCUPANTS SAFETY EQUIPMENT
EJECTED FROM VEH
I - DRIVER
2 to 6 - PASSENGERS
A -NONE IN VEHICLE L - AIR BAG DEPLOYED
-
M/C BICYCLE HELMET
0 NOT EJECTED
7- STA. WGN. REAR
B - UNKNOWN M - AIR BAG NOT DEPLOYED DRIVER
C - LAP BELT USED N - OTHER
I - FULLY EJECTED
1 2 3 8 - R.R. OCC. IRK. OR VAN
V - NO
D - LAP BELT NOT USED P - NOT REQUIRED W - YES
2 - PARTIALLY EJECTED
3 - UNKNOWN
9 - POSITION UNKNOWN
E - SHOULDER HARNESS USED
4 5 6 0 - OTHER
F - SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER
7
G - LAP /SHOULDER HARNESS USED Q - IN VEHICLE USED X - NO
H - LAP /SHOULDER HARNESS NOT LJSm R - IN VEHICLE NOT USED Y - YES
J - PASSIVE RESTRAINT USED S - IN VEHICLE USE UNKNOWN
-
K - PASSIVE RESTRAINT NOT USED T - IN VEHICLE IMPROPER USE
U - NONE IN VEHICLE
ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK ( -) SHOULD BE EXPLAINED IN THE NARRATIVE
PRIMARY COLLISION FACTOR
LIST NUMBER (b) OF PARTY AT FAULT
TRAFFIC CONTROL DEVICES
TYPE OF VEHICLE
1113
MOVEMENT PRECEDING
1
2
COLLISION
A VC SECTION VIOLATED: CITED
X
A CONTROLS FUNCTIONING
X
A PASSENGER CAR/STN. WGN.
A STOPPED
1
21801 1 a ! NO
B
CONTROLS NOT FUNCTIONING'
B PASSENGER CAR W / TRAILER
X
B PROCEEDING STTtA1GHT
B OTHHER IMPROPER DRIVING-
C CONTROLS OBSCURED
X
C MOTORCYCLE / SCOOTER
C RAN OFF ROAD
C O'HHER TI{AN DRIVER'
D NO CONTROLS PRESENT/FACTOR
D PICKUP OR PANEL TRUCK
E PICKUP/PANEL IRK. W/ 71R.
F TRUCK OR TRUCK TRACTOR
X
D MAKING RIGHT TURN
E MAKING LEFT TURN
F MAKING U TURN
D LJNKNOWN`
TYPE OF COLLISION
E F=ELL ASLEEP-
A HEAD -ON
WEATHER (MARK 1 TO 2ITEMS)
B SIDESWIPE
G TRK. /PRK. TRACTOR W /CLR.
G BACKING
X
A CLEAR
C REAR END
H SCHOOL BUS
H SLOWING / STOPPING
B CLOUDY
D BROADSIDE
I OTHER BUS
C RAINING
I PASSING OTHER VEHICLE
E HITOBJECT
1 EMERGENCY VEHICLE
HWY. CONST. EQUIPMENT
J CHANGING LANES
K PARKING MANEUVER
D SNOWING
E FOG / VISIBILITY-
F OVERTURNED
G VEHICLE / PEDEST -BEAN
L BICYCLE
P �:
V
X
L ENTERING TRAFFIC
H OTHER': APPROACH TURN
M OTHER VEHICLE
M OTHER UNSAFE TURNING
WIND
G WIND
MOTOR
MOTOR VEF[[CLE INVOLVED W[TH
N PEDESTRIAN
N XING INTO OPPOSING LANE
LIGHTING
NON-
X
COLLISION
0 MOPED
0 PARKED
A DAYLIGHT
B PEDESTRIAN
B DUSK- DAWN
X C OTHER MOTOR VEHICLE 1 2
OTHER ASSOCIATED FACTOR
3
P MERGING
C DARK - STREET LIGHT'S
MARK 1 TO 2 ITEMS
Q TRAVELING WRONG WAY
D MOTOR VEH ON OTHER ROADWAY
A VC SECTION VIOLATION: CITE
D DARK - NO STREET LIGHTS
E PARKED MOTOR VEHICLE
R OTE {ER ^.
E DARK • STREET LIGHTS NOT FUNCTION
F TRAIN
B VC SECTION VIOLATION: CITE
ROADWAY SURFACE
G BICYCLE
X A DRY
SOBRIETY -DRUG
H ANIMAL:
C VC SECTION VIOLATION: CITE
1 2 3 PHYSICAL
B WE{
(MARK 1 TO 2 ITEMS)
C SNOWY -ICY
X X A HAD NOT BEEN DRINKING
I FIXED OBJECT:
E VIS. OBSCURED;
D SLIPPERY (MUDDY,OQ,Y,EF'C.)
B HBD - UNDER INFLUENCE
F INATTENTION-
C HBD - NOT UNDER INFLUENCE
ROADWAY CONDITIONS
I OTHER OBJECT.
G STOP & GO TRAFFIC
D HBD -IMPAIRMENT UNK.•
MARK 1 TO 2ITEMS
PEDESTRIAN'S ACTIONS
A HOLES, DEEP RUTS*
X
H ENTERING / LEAVING RAMP
E UNDER DRUG INFLUENCE-
A NO PEDESTRIAN INVOLVED
1 PREVIOUS COLLISION
B LOOSE MATERIAL ON RDWY'
B CROSSING IN XWAIX/[NTEVLSECTION
F IMPAIRMENT - PHYSICAL•
C OBSTRUCTION ON ROADWAY-
J UNFAMILIAR WITH ROAD
G IMPAIRMENT NOT KNOWN
C CROSSING IN X (AI.X NOT AT
INTERSECTION
K DEF=ECTIVE VEH. EQUIP.; CITE
H NOT APPLICABLE
D CONSTRUCTION • REPAIR ZONE
E REDUCED ROADWAY WIDTH
ROSSING NOT IN CROSSWALK
I SLEEPY / FATIGUED
F FLOODED-
L UNINVOLVED VEHICLE
SPECIAL INFORMATION
ROAD - INCLUDES SHOULDER
M OTf{ER•:
G OlI1ER +:
ID
A HAZARDOUS MATERIAL
X
OT IN ROAD X X
N NONE APPARENT
B SEATRF.LT FAILURE
II ,N'O UNUSUAL CONDITIONS
PPROACHING /LEAVING SCHOOL BUS
SK El'CI I
O RUNAWAY VEHICLE
MISCELLANEOUS
STATE OF CALIFORNIA
m ----,- ♦ -VC l wTncnc
PAGE OF
NJ U"L)/ YV I I lr GJJGJJ t HJJL'
1 wLi�.�
OFFICER
I.D. NUMBER
DATE OF COIL ISION' T1MG?A00)
NCIC NUMBER
5600
001384 96 -68112
08 - i6 - 9d
1100
EXTENT OF INJURY ('X' ONE)
INJURED WAS ('X' ONE)
PARTY SEAT SAFETY EJECTED
WITNESS PASSG\GER AGE: SIX
ONLY ONE Y
FATAL SEVERE OTHER VISIBLE COMPLAINT'
INJURY OF PAIN
DRIVfit OTHER
NUMBER POS. EQUIP.
INJURY INJURY
X
1 1 W 1
34 M X
TELEPHONE
NAME/D.O.B. /ADDRESS
JOHN DAVID N. MACDONALD JR 06 -01 -62
(805) 583 --2432
H -3289 AMARILLO AVENUE, SIMI VALLEY, CA, 93065
(310) 394 -9650
TAKEN TO:
(INJURED ONLY) TRANSPORTED BY: SIMI VALLEY ADVENTIST
MED TRANS 405
DESCRIBE INJURIES:
LACERATION RIGHT KNEE, BROKEN LEG, SCRAPES TO STOMACH
VICTIM
OF VIOLENT CRIME NOTIFIED
1
20
M
TELEPHONE
N AM E/D.O. B. /ADDRESS
LYNN COSTA 09 -30 -75
(805) 526 -1731
H -1602 BARNES, SIMI VALLEY, CA, 93065
(818) 222 -2311
TAKEN TO:
(INIURED ONLY) TRANSPORTED BY:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
2
20
M
TELEPHONE
N AM EID.O. B.IADDRESS
CARL SHIDO 09 -30 -75
(805) 520 -4954
H -2522 E. WOODROW, SIMI VALLEY, CA, 93065
TAKEN TO:
(INJURED ONLY) TRANSPORTED BY:
DESCRIBE INJURIES:
--------------- ---- -T
VICTIM OF VIOLENT CRIME NOTIFIED
3 41 F 7
TELEPHONE
NAMEID.O.B. /ADDRESS
PATRICIA MAY 06 -24 -55
(805) 491 -0379
H -11038 HIDRETH, CAMARILLO, CA, 93012
TAKEN TO:
(INJURED ONLY) TRANSPORTED BY:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
4 33 F
TELEPHONE
NAME/D.O.B. /ADDRESS
LINDA MORAN 04 -19 -63
(805) 531 -0286
H -4445 SUMMERGLEN, MOORPARK, CA, 93021
TAKEN TO:
(INJURED ONLY) TRANSPORTED BY:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
LD NUMBER M0. DAY YR. Rf= VIE'WER'S NAME- .�
PREPARER'S NAME
08 -18 -96
MO. DAY YR.
THERRIEN W 001384
S"FA'17: OF CALIFORNIA
INJURED / WITNESSES /PASSENGERS
4
DATE OF COLLISION
TIME(?A00) NCIC NUMBER
FACE 1 OF Q
0 8 - 1 o
o - 96
OFFICER I.D.
1100 5600
NUMBER
001384
96 -68112
WITNESM EXTENT OF INJURY ('X' ONE) INJURED WAS ('X' ONE)
ONLY
FATAL SEVERE OTHER VISIBLE COMPLAINT PARTY SEAT SAFETY FJEC7ID INJURY INJURY INJURY OF PAIN
NUMBER POS. EQUIP
DRIVER PASS. PED.
BIKE OTHER
5
NAM E/D.O. B. /ADDRESS
DAVID MONTANTE
02-27-65
TELEPHONE
H -21033 LANARK
STREET, CANOGA PARK, CA, 91303
(818) 341 -8875
(INJURED ONLY) TRANSPORTED BY:
(818) 994 -5656
TAKEN T0:
DESCRIBE INJURIES:
VICTIM OF V10f ENT CRIME NOTIFIED
6 31 M
NAM E/D. O. B. /ADDRESS
DONALD BROWN
TELEPHONE
H -2918 GARDNER
STREET, SIMI VALLEY, CA, 93065
(805) 527 -9064
(INJURB) ONLY) TRANSPORTED BY:
(80-5) 583-8911
TAKEN 40:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
7 55 M
NAME/D.O.B./ADDRESS
RONALD ARSLAN
TELEPHONE
H -12470 CHERRYGROVE, MOORPARK, CA, 93020
(805) 529 -7293
(INJURED ONLY) TRANSPORTID BY:
(805) 391 -1784
TAKEN TO
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
NAME/D.O.B. /ADDRESS
TELEPHONE
(INJURED ONLY) TRANSPORTED BY:
TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
NAM E/D.O.6. /AI)D RE.SS
TELEPHONE
(INJURED ONLY) TRANSPORTID BY:
TAKEN TO:
DESCRIBE INJURIES:
PREPARER'S NAME
VICRM 01' VIOLENT CRIME NOTIFIED
THERRIEN W
:1.1) NUMBER M0. DAY YR. REVIF�N AMG
DAY }'It.
,R'S
001384 08- 18 -96,
��/T,'/W_
TRAFFIC COLLISION REPORT
NARRATIVE /SUPPLEMENTAL CONT. VENTURA COUNTY SHERIFF'S DEPARTMENT CA 05600 PAGE —OF
DATE OF ORIGINAL INCIDENT TIME (2400) NCIC NUMBER OFFICER I.D. NUMBER
Mo. Day Yr. QI 17i
a$ irt3 9 (o i 1 DO 5600
NOTIFICATION
I received a call of an injury traffic accident at the intersection of Tierra Rejada Road and Moorpark
Road in the City of Moorpark. Senior Deputy Gruen also responded to the scene and arrived prior to
my arrival. Upon my arrival at the scene I was briefed by Senior Deputy Gruen on the progress of the
investigation.
All times, speeds and measurements in this report are approximates. All measurements were taken with
a Rolatape and were rounded off to the nearest half foot unless otherwise noted. Deputy Rivera
photographed the entire scene.
SCENE
This traffic accident occurred in the intersection of Tierra Rejada Road and Moorpark Road. This
intersection is a "T" type. This area of Moorpark City is rural in nature. In this area, Tierra Rejada
Road is an east and west four lane asphalt roadway, two lanes in each direction. The roadway is
separated by a raised center median. The intersection is controlled by a traffic signal device in all
directions. Vehicles traveling westbound on Tierra Rejada Road as Party One was traveling, there is a
protective / permissive left turn lane for Moorpark Road, southbound. There was no foreign debris at
the scene. All roadway markings and signs were in good working order. There was no vision
obscurement noted which would be a factor in this traffic accident. The posted speed limit for this
area of Tierra Rejada Road is 45 miles per hour.
This area of Moorpark Road intersects Tierra Rejada Road from the south. There are two lanes for
vehicles to travel onto Tierra Rejada Road, east and westbound only, from Moorpark Road. Vehicular
traffic is controlled by a traffic signal device.
REPARE R'S NAME
N ERrz.l
I.D. NUMBER MO. DAY YR. REVIEWER'S N E
MO D:'�Y ) R
9 - 9d"
TRAFFIC COLLISION REPORT
NARRATIVE /SUPPLEMENTAL CONT. VENTURA COUNTY SHERIFF'S DEPARTMENT CA 05600
DATE OF ORIGINAL INCIDENT TIME (2400) NCIC NUMBER OF
Mo. Day y� OFFICER I.O. NUMBER —'
e ; 143 �t(v II00 5600 i:3 a�•WS►IZ
AREA OF IMPACT
The area of impact was determined by the debris and physical evidence located on the roadway to be
17 feet north of the south roadway edge of Tierra Rejada Road and 28 feet west of the east roadway
edge, prolongation, of Moorpark Road.
PHYSICAL EVIDENCE
I Located at the scene was 48 feet of locked wheel skid from Vehicle Two's left front tire. Using a
coefficient of friction ranging from .7 to .8 percent the speed Vehicle Two was traveling was calculated
I
as 30 to 35 miles per hour to produce that length of a skid.
STATEMENTS
Party One John MacDonald was interviewed at Simi Valley Adventist Hospital. MacDonald said he
was traveling westbound on Tierra Rejada Road and was intending to make a left turn, southbound,
onto Moorpark Road. MacDonald said the traffic signal was green for his direction and he started his
left turn. MacDonald said he never saw the van (V2) that hit him. I asked MacDonald where he was
going. MacDonald said he was intending to drive out to the Rock Store taking Las Posas Road to
Mulholland Highway. I asked MacDonald how familiar he was with the motorcycle. MacDonald said
he has been riding awhile and was very familiar with his bike.
Party Two Donaciano Mira Montez was interviewed at the scene. Mira Montez said he was traveling
eastbound on Tierra Rejada Road in the number two lane approaching the intersection. Mira Montez
said the traffic signal was green and he was traveling the speed limit, 45 miles per hour. Mira Montez
said there was a green van in the number one lane also traveling eastbound on Tierra Rejada Road just
BE C: AV R . REVIEW/J E�R'S N�A� M
FMC. DAY YR
i4vi' .
TRAFFIC COLLISION REPORT
NARRATIVE /SUPPLEMENTAL CONT. VENTURA COUNT, .;T,,1ENT cAaSSOo
DATE OF ORIGINAL INCIDENT TIME (2400! NCIC NUS' ° -, D. NUMBER
Mo. Dav Yr.
08 1 gi (n l 100 5600 i �1' Q (o • (v13 I t7
PAGE ? OF
slightly ahead of his vehicle. Mira Montez said he saw the motorcycle make his left turn in front of the
green van and his vehicle. Mira Montez said he tried to avoid hitting the motorcyclist by applying the
vehicle's brakes. Mira Montez said the green van almost collided into the side of the motorcycle. Mira
Montez said he could not avoid the collision.
Witness One Lynn Costa and Witness Two Carl Shido were interviewed at the scene. Costa and Shido
were in the same vehicle and were stopped on Moorpark Road waiting to make a right turn, eastbound,
onto Tierra Rejada Road. Costa and Sliido said the traffic signal for their direction was red and the
traffic signal for the east and westbound traffic was green. Costa and Shido saw the motorcycle
traveling westbound on Tierra Rejada Road in the left turn lane. The motorcycle driver slowed his
vehicle and then made his a left tum into the path of both vehicles traveling eastbound on Tierra Rejada
Road. Costa and Shido said the motorcycle almost made it through the intersection before the blue van
(V2) collided into the side of the motorcycle. I asked both Costa and Shido how fast was the van
traveling. Both said the speed limit, 45 miles per hour.
Witness Three Patricia Ma v was interviewed at the scene. May said she was traveling westbound on
Tierra Rejada Road approaching the intersection of Moorpark Road. May said she saw the motorcycle
in the left turn lane of Tierra Rejada Road intending to make a left turn onto Moorpark Road. May said
there were vehicles traveling eastbound on Tierra Rejada Road. May said the traffic signal was green
for their direction but she could not see the eastbound traffic signal but assumed it was green because
of the traffic flow. May said there were two vans, one in the number one lane and the other in the
number two lane. Both vans were traveling eastbound on Tierra Rejada Road. May said the van in the
number one lane just missed colliding into the motorcycle, but the van in the number two lane could
not avoid colliding into the side of the motorcycle. May said the vans were traveling the speed limit,
40 to 45 miles per hour.
Witness Four Linda Moran was interviewed at the scene. Moran said she was traveling eastbound on
RCPARE R'S NA�1E
I.D. NUMBER MO- DAY Yt;
3 L7 la
REVIF WFR'S NA41F
MC) DAY V h.
TRAFFIC COLLISION REPORT
NARRATIVE /SUPPLEh1ENTAL CONT. VENTURACOUNTYSHERIFF 'SDEPARTMENT CA 05600 PAGE 8 OF
DATE OF ORIGINAL "• TIME (2400) NCIC NUMBER OFFICER I.D. NUMBER
y �Y r. 1 nU 5600
Ctd
Tierra Rejada Road in the number one lane approaching the intersection of Moorpark Road. Moran
said the traffic signal was green for the eastbound traffic. Moran said she saw the motorcycle in the
left turn lane, westbound, of Tierra Rejada Road. Moran said she thought the motorcycle was going to
stop but it continued into the intersection directly in front of her vehicle. Moran said she applied the
vehicle's brakes and just barely missed the motorcycle. Moran said there was a van in the number two
lane who collided into the side of the motorcycle. Moran said the driver of the blue van (V2) could not
avoid the traffic accident.
Witness Five David Montante was interviewed at the scene. Montante said he was traveling eastbound
on Tierra Rejada Road in the number one lane approximately one hundred feet behind both vans.
Montante said he saw the motorcycle (V 1) traveling westbound on Tierra Rejada Road in the left turn
lane. Montante said the motorcycle was intending to make a left turn onto Moorpark Road. Both vans
attempted to avoid colliding into the side of the motorcycle. The van in the number one lane missed the
motorcycle but the van (V2) in the number two lane collided into the side of the motorcycle. Montante
said the drive of the van (V2) could not avoid the traffic accident.
SUMMARY
Parry One was traveling westbound on Tierra Rejada Road in the left turn lane intending to make a left
turn onto Moorpark Road. Party Two was traveling eastbound on Tierra Rejada Road in the number
two traffic lane approaching the intersection of Moorpark Road. Party Two's vehicle collided into the
side of Party One's vehicle.
CAUSE
Party One MacDonald caused the traffic in that he violated California Vehicle Code section 21801 (a)
which states:
;;E.PARE. R'S NAM -
'r1 -.::� n 0 1 G�
I.D. NUMBER I MO. F)AV "I REVIEWFR S NA Mt
%1O_ D,',Y V�
TRAFFIC COLLISION REPORT
COUNTY SHERIFF'S DEPARTMENT CA 05600 PAGE 41 OF
NARRATIVE /SUPPLEMENTAL CONT. VENTU,,
DATE OF ORIGINAL INCIDENT TIME (2400) NCIC NUMBER OFFICER I.D. NUMBER
Mo. Day Yr. l l i�0 5600 133' q( ` c,-251 17, 08 g q W
"The driver of a vehicle intending to turn to the left or to complete a U -turn upon a
highway, or to turn left into public or private property, or an alley, shall yield the
right -of -way to all vehicles approaching form the opposite direction which are
close enough to constitute a hazard at any time during the turning movement and
shall continue to yield the right -of -way to the approaching vehicles until the left or
U -turn can be made with reasonable safety."
RECOMMENDATIONS
No action to be taken.
_ :iEPARER'S NAME
I.D. NUMBER MO. DAY YR, REV EWFR', Np,MF MO. DAY V R
Sl.�ATE• OF CALIFO RN [A
PAGE
TRAFFIC COLLISION REPORT
OF
SPECIAL CONDITIONS
NO INI
11 &R FEL
CITY
MO DAY YEAR
0
[]
MOORPARK
NO KILL
H &R MISD
COUNTY
001971
DAY OF WEEK
0
PHOTOGRAPHS BY:
VENTURA
[XJ YES [ ] No
COLLISION OCCURRED ON:
L
TIERRA REJADA ROAD
OWNER'S NAME J'C] SAME AS DRIVER
C
A
MILEPOST INFORMATION:
T
CCTY /STATE/ZIP
OWNER'S ADDRESS [�] SAME AS DRIVER
1
MOORPARK CA 93021
0
SIX
HAIR
N
DQ AT INTERSECTION WITH:
WEIGHT
IUDICIAL DISTRICT
PAGE
STATE
OF
f
f:
5110 2A
C *Staare: G1IR6491
MO DAY YEAR
TIME(24W)
IUDICIAL DISTRICT
NUMBER
STATE
VENTURA
96 -28951
DIST BEAT
5110 2A
C *Staare: G1IR6491
MO DAY YEAR
TIME(24W)
NCIC N
OFFICER I.D.
4109196
0630
5600
001971
DAY OF WEEK
TOW AWAY
PHOTOGRAPHS BY:
TUESDAY
[XJ YES [ ] No
NONE
STATE H WY REL
NONE
PART Y
DRIVER'S LICENSE NUMBER
STATE
C
i
VEH YR
MAKE/MODELICOLOR
LICENSE NUMBER STATE
1
N5623880
CA
C
G
90
TOYOTA COROLLA BLU
2TAC740 CA
DRIVER
NAM E(FIRST,MIDDLE,LAST)
jq
PATRICIA ANNE KAMINSKI
PEDES-
STREET ADDRESS
OWNER'S NAME J'C] SAME AS DRIVER
' j'
6668A JULLIARD AVE
PARKED
CCTY /STATE/ZIP
OWNER'S ADDRESS [�] SAME AS DRIVER
VT
MOORPARK CA 93021
BICY.
SIX
HAIR
EYES
HEIGHT
WEIGHT
BIRTHDATE
RACE
DISPO OF VEHICLE ON ORDERS OF: [ OFFICER ['] DRIVER [ ] OTHER
CI ]
F
BLN
BRN
5 -04
150
07 27 50
W
SWINK'S TOWING (805) 522 -2262
OTHER
HOME PHONE BUSINESS PHONE
PRIOR MECHANICAL. DEFECTS: NONE APPARENT n REFER TO NARRATIVE [ )
[)
(8 0 5) 529-6885 (8 0 5) 389-6404
HPPt �o�E
DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE cE CARRIER
G 5 4 6 6 2 4 7
[X] oM D. [ ] MAJOR [I TOTAL
DIR TRV
ON STR EET OR HIGHWAY
SPD LMT
145
PCT=
=_
S
TIERRA REJADA
.21801A
PARTY
DRIVER'S LICENSE NUMBER
STATE
CLASS
SAFETY
VEH YR
MAKFJMODEL/COLOR
LICENSE NUMBER STATE
2
N6061692
CA
C
G
89
...
VOLVO 740 TAN
....................
2NVU548 CA
...........
DRIVER
NAME(FIRST.MEDDLE,LAST)
P
TRINH THI HUYEN TRAN
PEDES-
STREET ADDRESS
OWNER'S NAME KI SAME AS DRIVER
13305 WINTERGREEN
PARKED
CIIY/STATEJW
OWNER'S ADDRESS KI SAME AS DRIVER
`T
MOORPARK CA 93021
C CY-
SIX
HAIR
EYES
HEIGHT
WEIGHT
BIRTHDATE
RACE
DLSPO OF VEHICLE ON ORDERS OF: [ J OFFICER [�] DRIVER [ ]OTHER
'In
F
IBLKIBRN15-03
110
05130156
DRIVEN
OTHER
HOME PHONE BUSINESS PHONE
PRIOR MECHANICAL DEFECTS: NONE APPARENT IQ REFER TO NARRATIVE [ ]
[]
I (8 0 5) 529-8566 ( 818) 226-2664
CHP USE ONLY
VEHICLE TYPE
DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
UNK
[ ] [ J NONE [�] MINOR
INSURANCE CARRIER POLICY NUMBER
ALLSTATE 0 67 572059
I
(]MOD.[ ]MAJOR [ ]TOTAL
►
1 J
DIR TPVJ
ON STRFEf OR HIGHWAY
SPD LMT
PCF
E
TIERRA REJADA
145
PARTY
DRIVER'S ICENSE NUMBER
STATE
CLASS
SAFETY
VEH YR
MAKE/MODELJCOLOR
LICENSE NUMBER STATE
3
...
....................
...........
DRIVER
I
NAME(FIRST,MIDDLE.LAST)
PEDES-
STREET ADDRESS
OWNER'S NAME [ J SAME AS DRIVER
T
11
PARKED
CITYISTATFJZIP
OWNER'S ADDRESS [ SAME AS DRIVER
Vt�il�
BICY-
SIX
HAIR
EYES
HEIGHT
WEIGHT
BIRTHDATE
RACE
DISPO OF VEHICLE ON ORDERS OF: [) OFFICER [ DRIVER [ ] OTHER
CL�S S
OTHER
HOME PHONE BUSINESS PHONE
PRIOR MECHANICAL DEFECTS: NONE APPARENT [ ] REFER TO NARRATIVE [ ]
CUP USE ONLY
V011C E TYPE
DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
UNK
[ � [ � NONE [ ] MINOR
[ ]
INSURANCE CARRIER POLICY NUMBER
I
[ MOD. ( MAJOR [ ]TOTAL
D I R TRV
ON STREET OR HIGHWAY
SPD LMT
PCF
►
PREPARER'S NAME
DISPATCH NOTIFIED
Rr,7
HILL J 0 019 71
Ya Nv NIA
STATE OF CM -IFORN IA
TRAFFIC COLLISION CODING PAGE iq OP
DATE OF ORIGINAL INCIDENT
TIME(2400)
NCIC NUMBER
FFIC ER I.D.
NUMBER
04 - 09 - 96
0630
5600 :::T
001971
96 -28951
OWNERS NAMFIADDRESS
NOTIFEm
PROPERTY
DESCRIPTION OF DAMAGE
DAMAGE
SEATING POSITION
SAFETY EQUIPMENT
EJECTED FROM VEH
OCCUPANTS M1C BICYCLE - HELMET
I - DRIVER
,to 6 - PASSENGERS
A - NONE IN VElHICLE L - AIR BAG DEPLOYED
B - UNKNOWN M - AIR BAG NOT DEPLOYED DRIVER
0 - NOT EJECTED
: - FULLY EJECTED
7. STA. WGN. REAR
C - LAP BELT USED N - OTHER V - NO
2 - PARTIALLY EJECTED
1 2 3 8 - RR OCC. TRK. OR VAN
D - LAP BELT NOT USED P - NOT REQUIRED W - YES
3 UNKNOWN
9 - POSITION UNKNOWN
E - SHOULDER HARNESS USED
4 5 6 0 - OTHER
F - SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER
G - LAP /SHOULDER HARNESS USED Q - IN VEHICLE USED X - NO
7
H - LAP /SHOULDER HARNESS NOT USED R - IN VEHICLE NOT USED Y - YES
I - PASSIVE RESTRAINT USED S - IN VEHICLE USE UNKNOWN
K - PASSIVE RESTRAINT NOT USED T - IN VEHICLE IMPROPER USE
U - NONE IN VEHICLE
ITEMS MARKED BELOW WHICH ARE WLLOWED BY AN ASTERISK (•) SHOULD BE EXPLAINED IN THE NARRATIVE
�TI
PRIMARY COLLISION FACTOR MOVEMENT PRECEDING
LIST NUMBER (A) OF PARTY AT FAULT TRAFFIC CONTROL DEVICES 12 TYPE OF VEILICLE IF1 2 COLLISION
A VC SECTION VIOLATED: Crrm
X
A CONTROLS FUNCTIONING
X
X
A PASSENGER CAR/STN. WGN.
I
I
_==�
A STOPPED
1
2 1 8 0 1A NO
B CONTROLS NOT FUNCTIONING-
B PASSENGER CAR W / TRAILER
X
B PROCEEDING STRAIGHT .
B OTHER IMPROPER DRIVING-
C CONTROLS OBSCURED
C MOTORCYCLE / SCOOTER
C RAN OFF ROAD
C OTHER THAN DRIVER-
D NO CONTROLS PRESENT/FACTOR
D PICKUP OR PANEL TRUCK
E PICKUP/PANEL TRK. Wl TLR.
F TRUCK OR TRUCK TRACTOR
X
D MAKING RIGHT TURN
E MAKING LEFT TURN
F MAKING UTURN
D UNKNOWN •
TYPE OF COLLISION
E FELI-ASIF.EP•
A HEAD -ON
WEATHER (MARK 1 TO 2ITEMS)
B SIDESWIPE
G ITKr RK. TRACTOR W /II-R.
G BACKING
A CLEAR
C REAR END
H SCHOOL BUS
H SLOWING/ STOPPING
X
B CLOUDY
X
D BROADSIDE
I OTHER BUS
I PASSING OTHER VEHICLE
C RAINING
E HIT OBJECT
I EMERGENCY VEHICLE
I CHANGING LANES
D SNOWING
F OVERTURNED
K HWY. CONST. EQUIPMENT
K PARKING MANEUVER
E FOG / VISIBILITY:
G VEHICLE / PEDESTRIAN
L BICYCLE
L ENTERING TRAFFIC
F OTHER-:
H OTHER-:
M OTHER VEHICLE
M OTHER UNSAFE TURNING
G WIND
MOTOR VEHICLE INVOLVED WITH
N PEDESTRIAN
N XING INTO OPPOSING LANE
LIGHTING _
A NON - COLLISION
1
0 MOPED
O PARKED
P MERGING
X
A DAYLIGHT
B PEDESTRIAN
OTT ASSOCIATED FOR
X
B DUSK- DAWN
C OTHER MOTOR VEHICLE
1
2
3
MARK II TO 2 ITEMS
Q TRAVELING WRONG WAY
C DARK - STREET LIGHTS
D MOTOR VEH ON OTHER ROADWAY
A VC SECTION VIOLATION: CITE
R OTHER-:
D DARK - NO STREET LIGHTS
E PARKED MOTOR VEHICLE
E DARK - STREET' LIGHTS NOT FUNCTION
F TRAIN
B VC SECTION VIOLATION: CITE
C VC SECTION VIOLATION: CITE
ROADWAY SURFACE
G BICYCLE
H ANIMAL:
1
2
3
SOBRIETY -DRUG
PHYSICAL
(MARK 1 TO 2ITEMS)
X
A DRY
B WET
X
X
A HAD NOT BEEN DRINKING
C SNOWY -ICY
1 FIXED OBJECT:
E VIS. OBSCURED:
B HBD - UNDER INFLUENCE
D SLIPPERY (MUDDY,OILY,EIC.)
F INATTENTION-
C HBD - NOT UNDER INFLUENCE
1 OTHER OBJECT:
G STOP A GO TRAFFIC
D HBD - IMPAIRMENT UNK.•
ROADWAY COPIDI170NS
MARK I TO 21TEMS
PEDESTRIAN'S ACTIONS
H ENTERING / LEAVING RAMP
E UNDER DRUG INFLUENCE -
A HOLES, DEEP RUTS-
X
A NO PEDESTRIAN INVOLVED
1 PREVIOUS COLLISION
F IMPAIRMENT - PHYSICAL•
B LOOSE MATERIAL ON RDWY•
B CROSSING IN XWAIXANIERSEC ION
I UNFAMILIAR WITH ROAD
G IMPAIRMENT NOT KNOWN
C OBSTRUCTION ON ROADWAY-
C CROSSING IN XWALK NOT AT
INTERSECTION
K DEFECTIVE VEH. EQUIP.: CITE
H NOT APPLICABLE
D CONSTRUCTION - REPAIR ZONE
1 SLEEPY/ FATIGUED
E REDUCED ROADWAY WIDTH
D CROSSING NOT IN CROSSWALK
L UNINVOLVED VEHICLE
SPECIAL INFORMATION
F FLOODED-
E IN ROAD - INCLUDES SHOULDER
M OTHER-:
A HAZARDOUS MATERIAL
G OTHER*:
F NOT IN ROAD
X
X
N NONE APPARENT
B SEAT-BELT FAILURE
X
H NO UNUSUAL CONDITIONS
G APPROACHING/LEAVING SCHOOL BUS
O RUNAWAY VEHICLE
SKETCH
MISCELLANEOUS
�jU.o n c :A.)n ®
PYA-1,WJ�41W Ad
UA fG OF CALIFORNIA
INJURED /WIT
—1
IVYJDr.J/YAJJL'
iNky ✓KJ
YAOL or
DATE OF COLLISION
TIME(2400)
NCIC NUMBER
OFFICER I.D.
NUMBER
04 - 09 - 96
0630
5600
001971
96 -28951
EXTENT
OF INJURY ('X' ONE)
INJURED WAS ('X' ONE)
WITNESS
PASSENGER
AGE
SIX
PARTY
SCAT
SAFETY
FJECiFD
ONLY
ONLY
FATAL
SEVERE
OTHER VISIBLE
COMPLAINT
NUMBER
POS.
EQUIP.
INJURY
INJURY
INJURY
OF PAIN
DRI VER
PASS.
FD
P.
BIKE
OTHER
1
F
NAMFID.O. B. /ADDRESS TELEPHONE
NORA KASPAR
H -21211 NORDHOFF, CHATSWORTH, CA, (805) 484 -0851
(818) 709 -3418
(INJURED ONLY) TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
'
VICTIM OF VIOLENT CRIME NOTIFIED
NAME/D.O. B. /ADDRESS TELEPHONE
(INJURED ONLY) TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
VICI4M OF VIOLENT CRIME NOTE -gD
NAME/D.O.B./ADDRESS TELEPHONE
(INJURED ONLY) TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
NAME/D.O.B. /ADDRESS TELEPHONE
(INJURED ONLY) TRANSPORTED BY: TAKEN T0:
DESCRIBE IN] URIES:
VICTIM OF VIOLENT CRIME NOTIFIED
FT-
NAME/`D.O.B-/ADDRE-SS TELEPHONE
(INJURED ONLY) TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
PREPARER'S NAME l.D
NUMBER
MO. DAY YR. REVIBWM,
N M0.
DAY YR-
HILL J
001971
04 -09 -96
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL
DATE OF ORIGINAL INCIDENT TIME (2400) NCIC NUMBER OFFICER I.D. NUMBER
04/09/96 0630 5600 001971 96 -28951
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
29
30
31
32
33
34
35
36
37
38
SUMMARY
V -1 WAS W/B ON TIERRA REJADA ROAD, IN THE LEFT TURN LANE, AT THE
INTERSECTION OF MOORPARK ROAD. V -2 WAS E/B ON TIERRA REJADA ROAD, IN
THE #2 LANE, APPROACHING THE INTERSECTION OF MOORPARK ROAD. P -1
TURNED LEFT IN FRONT OF R -2, CAUSING THE R/F OF V -2 TO COLLIDE INTO THE
R/R OF V -1.
CAUSE
P -I (KAMINSKI) CAUSED THIS COLLISION BY FAILING TO YIELD TO ON -COMING
TRAFFIC THAT WAS CLOSE ENOUGH TO CONSTITUTE AN IMMEDIATE HAZARD,
PRIOR TO MAKING A LEFT TURN. THIS IS A VIOLATION OF 21801a CVC.
PREPARER'S NAME I.D. NUMBER DATE NAME DATE
J HILL 001971 04/09/96
CHP 556 C'STARS
,TATEOF CALIFORNIA fU
ro A Ccu n
- r-1 I ISION REPORT- Property Damage Only DSO+
c
Origin! to Oflbar copy(Ies) to hwMrd p Ypes)
SPECIAL CONDITIONS
HIT i RUN
CIP! /D M� /51
U YR
JUDICIAL DISTRICT NUMYER
1iY /!'� +/,�,r�(J�
REPORTING OISTAICT [EAT R POR[1!N OffSC[II -�
COUNY
!COLLKION OCCURRED ON E.
- O Y YEAR THE (240j_-,; 44:)
Ofl1C
INTENSE TM —
WIT.:
_ .. -
OAY Of WEEK TOW AWAY STAT[ HIONWAV R TED
- S' -M .T_ W" S ❑YES QYES
-.' - �.
FEETIMILES Of
PARTY DRIVER'SUCENBE !7SER ✓n
7�� 3
STATE CLASS 5AF P. SHADE KETCH
�j DAMAGED .
/iJ(/
t /7 rY/
D ER NAME (FlRST, W O LE, LAST)
PHONE
AREA
INDICATE
NORTH
PE0. STREET�
-CITY i �TF!
PK VEH SEX SIRTHOATE INSUR -SCE CARRIER POLICY NUMSER zl�/ O
Ii• �T=;Z!_-�
SPEED \ /
J2
SICYCLE IX [L ON
_
v
OTHER E Y MAKEJMODELf COLOR LICENSE NUMSER VEK TYPE ARTY
67s3� r��Mzo 2 ,
.� ,s
ppR2 DRIVER'S LICENSE NU E ��
3
S
LASS SAFETYEQU►. SHADE
G DAMAGED
fir
0 VE NAME (Fl ,MIDDLE. LAST)
/Y/
► E NUMB AREA
_
PED. THE ORES
to
GTYI6TSTEfL
i�4 mfr M
J � _ _
[i //'!71
►KVEN SIRT TE INSURANCEC RIER POLICY SER 2 /
L'u
CYCLE DI V L ON STREET OR AY /J
SPEED U(T.
OTHER VESITR LICENSE NUMBER
11 7v .
STATE VEKTYPE PARTY
2
YYtT. G SEX NAME
AD ��, ' j � ,I PHONE NUMYER
(/
Q�u ►ARTY NO.
/y
�
DDRESS
PHONE NUMSER
PARTYNO.
SEX NA
o
ADDRESS
DAMAGED PROPERTY
PROP. A.AE
OWNER IN
PRIMARY COLLISION FACTOR
TRAFFIC CONTROL DEVICES
,
2
TYPE OF VEHICLE
�
2
MOVEMENT PRECEDING
COLLISION -
UST NUMBER (N) OF PARTY AT FAULT
N
A VC SECTION VIOLATED:
YACONTROLS
FUNCTIONING
WMAPASSENGER
CAR rsTX TOR'WAGON
1ASTOPPED
B CONTROLS NOT FUNCTIONING
PASSENGER CAR W /TRAILER
B PROCEEDING STRAIGHT.
✓G
CCONTROLS OBSCURED
C MOTORCYCLE I SCOOTER
C RAN OFF ROAD
N
B OTHER IMPROPER DRIVING '
D NO CONTROLS PRESENT / FACTOR'
IYPICKUP OR PANEL TRUCK
DMArjNG RIGHT TURN
COTHER THAN DRIVER •
TYPE OF COLLISION
PICKUP / PANEL TRUCK W / TRAILER
E MAKING LEFT TURN
DUNKNOWN
=AHEAD-ON
F TRUCK OR TRUCK TRACTOR
F MAKING U TURN
E FELL ASLEEP •
B SIDESWIPE
G TRUCK I TRUCK TRACTOR W / TRLA
G BACKING
REAR END
IH
SCHOOL BUS
HsLoYANG / STOPPING
7
D BROADSIDE -
OTHER BUS
I PASSING OTHER VEHICLE
WEATHER ( MARK 1 TO 21TEMS)
ACLEAR
EMT OBJECT
j EMERGENCY VEHICLE
j CHANGING LANES
BCLOUDY
F OVERTURNED
K IGHWAY CONST. EQUIPMENT
K PARKING MANEUVER
G VEHICLE I PEDESTBICYCLE
ENTERING TRAFFIC
1C RAINING
D
H OTHER' :
OTHER VEHICLE
OTHER UNSAFE TURNING
SNOWING
/ VISIBILITY �,
MOTOR VEHICLE
N PEDESTRIAN
N XING INTO OPPOSING LANE
FOG
IMAN
A NON - COLLISION
13 PEDESTRIAN
C OTHER MOTOR VEOTHER
MOPED
ASSOCIATED FACTOR(S)
1 TO 21TEMS)
O PARKED
P MERGING
D TRAVELING WRONG WAY
F OTHER:
GWIND
LIGHTING
R OTHER'
A DAYLIGHT
D MOTOR VEHICLE O(MARK
B DUSK - DAWN
E PARKED MOTOR VA
VCSECTION VIOLATION :
C DARK - STREET LIGHTS
F TRAIN
DARK - NO STREET LIGHTS
GBICYCLE
B VC SECTION VIOLATION
E STREET LIGHTS NOT
ANIMAL:
SOBRIETY -DRUG
DARK - FUNCTIONING
j
2
PHYSICAL
FIXED OBJECT:
( MARK 1 TO2ITEMS)
A HAD NOT BEEN DRINKING
ROADWAY SURFACE
A DRY
B WET
E VISION OBSCUREMENT :
B HBD -UNDER INFLUENCE
C HBO - NOT UNDER INFLUENCE
,J OTHER OBJECT :
C SNOWY -ICY
F INATTENTION'
HBD - IMPAIRMENT UNKNOWN'
D SLIPPERY ( MUDDY, OILY, ETC.)
ROADWAY CONDITIONS)
PEDESTRIAN'S ACTION
G STOP GO TRAFFIC
E UNDER DRUG INFLUENCE
H ENTERI NG /LEAVVININ G RAMP
F IMPAIRMENT -PHYSICAL'
( MARK 1 TO 21TEMS)
A NO PEDESTRIAN INVOLVED
PREVIOUS COLLISION
G IMPAIRMENT NOT KNOWN
A HOLES, DEEP RUTS •
B CROSSING IN CROSSWALK
j UNFAMILIAR WITH ROAD
H NOT APPLICABLE
AT INTERSECTION
$LOOSE MATERIAL ON ROADWAY'
K DEFECTIVE VEH EQUIP.:
( SLEEPY/ FATIGUED
C OBSTRUCTION ON ROADWAY'
C CROSSING IN CROSSWALK- NOT
SPECIAL INFORMATION
DCONSTRUCT10N - REPAIR ZONE
AT INTERSECTION
I JA HAZARDOUS MATERIAL
E REDUCED ROADWAY WIDTH
DCROSSING - NOT IN CROSSWALK
IL UNINVOLVED VEHICLE
F FLOODED •
E IN ROAD - INCLUDES SHOULDER
M OTHER' :
GOTHER' :
F NOT IN ROAD
NONE APPARENT
NO UNUSUAL CONDITIONS
G APPROACHING I LEAVING SCHOOL OUS
O RUNAWAY VEHICLE
CHP 55"3 (REV 11 A8) OPI W2 bl� ,w �o
OATS O/• C(O tQL1 ■ION
TI
NCIC NV MRRR,y/
OrrlCt///R����I.O.
NFU
►AO<
Q/
/M / /</ /��aGA�O /nom,
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