Officer # Agency Code. Police Dispatched. On Private Property. Name of Cross Street or # of Ref. Mile Post Marker MP 101. Vehicle Owner.
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1 Idaho Collision Report ITD M Revised /29/96 Date of Collision Day of Collision /2/29 If Collision location is in: Intersection of 2 streets Intersection of Street and: Parking Lot / Driveway / Alley n-intersection UNIT Street City Zip Code 's License. Complete Box #, 2, 2, 3, 3 Canoga Park Name of Street In the Intersection with: Outside an Intersection Name of Cross Street or # of Ref. Mile Post Marker Miles N S E W Feet OF MP Agency Code Officer # On Private Property As Year Color Identification. Report District Posted Speed Posted Speed Dev. Injury Ejection Trapped Insurance Carrier Name 2//955 Y 0 O 05 Farm ( only, additional Same as Seating Passenger Names and es 2 3 ON Time Police Dispatched Thompson CDL M Monday 0.3 CA CA Pedestrian 3:25 98 Mark 9-3 3:30 Police Arrived 3:5 EMS Dispatched EMS Arrived # of Lanes Owner 999 Navy 099 Location 65 Miles. N E IN City or Town S W OF County R. R. Crossing # Collision Loc Mile Point Interchange # Make (Dodge-Chev.) Model (Dart-va) Style (2 Dr.) Truck Tractor License Plate. Dev. Latitude (GPS) Longitude (GPS) Thompson Ada Canoga Park, CA 98 BIGHAUL 92 Meridian Mark Peterbilt Long Haul PLH MT Injury Ejection Trapped Page 2 Attach UNIT 2 Street City Zip Code Meridian 's License. JB2356S M Bourne Pedestrian Year Identification. Dev. Injury Ejection Trapped Insurance Carrier Name /2/968 0 O 05 ( 2 only, additional Same as Seating Passenger Names and es Jason Owner As 99 Color Maroon Bourne Meridian, 8366 Make (Dodge-Chev.) Model (Dart-va) Style (2 Dr.) U.S. Govt Insurance Jason 5 SPY268 Dev. Injury Ejection Trapped 0 Ford Explorer SUV \ ORV License Plate. AW99 GAC Attach Injured To: Medical Care Provider Needed Seating Motorcycle Trailing 8 Equestrian 6 Pedestrian 9 Pedalcycle U Unknown Passenger Codes - n Trailing Sleeper Sect.(Truck Cab) 2 Other enclosed Passngr./Cargo area 3 Unenclosed Passngr./Cargo area 5 Riding on Exterior ective Devices 0 ne Shoulder Belt Only 2 Lap Belt Only 3 Shoulder & Lap t Ejected 2 Totally Ejected 3 Partially Ejected T Thrown from cycle etc. Child Safety Seat 5 Helmet Used 6 nmotorist Air Bag Equipped n-activated Air Bag, Belts in Use 8 n-activated Air Bag, Belts in Use 0 Air Bag Activated, Belts in Use Air Bag Activated, Belts in Use Ejection Trapped t Trapped 2 Trapped / Extrication unit used 3 Trapped / other extrication method By: Injury K Dead A Incapacitating B n-incapacitating C Possible 0 ne Evident U Unknown For Medical Care By Ambulance 2 Police Car 3 Helicopter Private 5 t EMS Provider Dispatched Pedestrian 2 Pedalcycle 3 Motorcycle Moped 6 Car 5 Bus 2 Single Truck - 2 axle/6 Tires 22 Single Truck - 3 axle 23 Truck with Trailer Police 2 Ambulance 3 Trng. Government 8 Pickup with Camper Pickup / Van / Panel / Sport Utility 2 Equestrian 30 Farm Equipment (List) 0 Construction Equip. (List) 5 Taxi 6 Fire Wrecker 8 School Bus Commercial 0 Motorhome Snowmobile 5 ATV 28 Train 9 n- Motor Veh. 2 Bobtail 25 Tractor w/semi Trailer 26 Tractor w/double Trailer 2 Tractor w/triple Trailer Boat Trailer 2 Utility Trailer 3 Travel Trailer Towed tjones v3530 Attachments 5 Mobile Home 2988
2 Business/Commercial 2 Industrial/Manufacturing Day 2 Dawn/Dusk Clear 2 Cloudy Dry 2 Wet 3 Rain Snow 0 ne Ruts/Bumps/Holes 2 Slick Asphalt (Bleeding) 3 Washboard 5 Sleet/Hail 6 Fog 3 Slush Ice 0 ne Exceeded Posted Speed 2 Speed Too Fast for Conditions 3 Too Slow for Traffic Improper Overtaking 0 ne Curve in Road 2 Hill Crest 3 School/Playground Recreational Area 3 Dark - Street Lights On Dark - Street Lights Off Auto / Motorcycle / Tractor with Semi Trailer 3 Top & Windows Undercarriage Blowing Dust/Sand 8 Severe Cross Winds 5 Snow 6 Mud High/Low Shoulder 5 Loose Gravel/Seal Coat 6 Under Construction Lane Closed 5 Improper Lane Change 6 Following Too Close Drove Left of Center 8 Off Roadway / Over Corrected 0 Improper Backing 3 Roadway Slope/Snowbank Trees/Crop/Brush 5 Reflection from Surface 6 Bright Sunlight 5 Agricultural 6 Undeveloped 5 Dark - Street Lights - Two Selections Possible Residential A Smoke/Smog Water 8 Flooded A Poor Pavement Markings Improper Turn 2 Failed to Signal 3 Failed to Yield Passed Stop Sign 5 Disregarded Signal 6 Tire Defect 33 Top 3 Undercarriage 2-Way & Raised/Depressed Divider 2 2-Way & 2-Way Left Turn Lane Divider 3 One-Way 2-Way & Divider A 2-Way & 2 Double Yellow Painted Divider 5 Ramp 6 Alley Rest Area 8 Port of Entry Concrete 2 Paved (Asphalt/Brick) 3 Gravel/Stone Dirt 0 ne Stop Sign 2 Yield 3 Traffic Signal Wheel Defect 8 Light Defect Defect 2 Alcohol Impaired 3 Drug Impaired Flashing Beacon 5 Traffic Signal-Ped. Only 6 R. R. Gates/Signal R. R. Flashing Beacon Trailing # 32 Trailing #2 8 Officer/Flagger A B C School Bus Signal -Pass Barrier Line Construction Signing Functioning 2 t Functioning 3 Removed 22 Inattention 23 Vision Obstruction 2 Asleep/Drowsy 25 Sick 26 Fatigued 2 Physical Impairment 53 Top 5 Undercarriage 28 Improperly Parked 3 Previous Accident 32 Distraction in/on (List) 35 Improper use of Turn Lane 9 0 ne Very Minor 2 Minor 3 Minor/Moderate Moderate 5 Moderate/Severe 6 Severe Very Severe Officer # Bright Headlights 8 Weather Conditions 0 Rain/Snow/Ice on Windows Cracked/Dirty Windows. Straight 2 Curve Upgrade/Downgrade 3 Hillcrest 5 Level UNIT # UNIT # 2 CONTRIBUTING CIRCUMSTANCES - 3 Possible Weather Conditions Locality Light Conditions Road Surface Conditions Other Road Conditions Roadway Geometrics SPECIFY VISION OBSTRUCTION POINT OF IMPACT ETENT OF DEFORMITY Splash/Spray from Other 8 Stopped on Roadway 3 Moving Parked Road Road Surface Traffic Control Traffic Sign 6 Billboard/Fence Building Page t Towed t Towed 05 Neither Alcohol or Drugs Detected 2 - Alcohol 3 - Drugs - Both ne Given 2 Test Refused 3 Blood Test Urine Test 5 Breath Test 6 Field Test BAC Test Results: Drug Used (if known): Results # Axles (If Carrier different from Owner) Bus 2 Van/Enclosed Box 3 Cargo Tank Flatbed 5 Dump 6 Concrete Mixer Auto Transporter 8 Garbage/Refuse of UNIT # UNIT # GVWR-Power Carrier Name GVWR-All Trailers 5 50 Los Angeles ICC # For Load DOT # For Load Shipping Papers 2 Side 3 Log Book City Zip ALCOHOL / DRUG INVOLVEMENT NA Alcohol / COMMERCIAL VEHICLE Refer to Instruction Sheet before completing Cargo Body BAC Test Results: Drug Used (if known): Results # Axles (If Carrier different from Owner) GVWR-Power Carrier Name GVWR-All Trailers Carrier Name & ICC# or DOT# for Load obtained from... Pirate Radio Van Line CA 963 of UNIT # 2 ICC # For Load UNIT # 2 City Zip NA 0 Pickup Bed DOT # For Load
3 # of s EventInvolved / Ped Action Sketch the scene Event Location njunction In Intersection EVENTS - Overturn 2 Separation of s 3 Cargo Loss/Shift Jack-Knifed 5 Ran off Road 6 Down Hill away Fire/Explosion 8 Gas/Inhalation ncollision 0 Loss of Control Fell/Pushed/Jumped 2 n-collision Injury 3 Immersion Came Back on Road 2 Drove L/R of Center 2 Intersection Related 3 At Driveway/Alley South / rth / One Veh. Collision With Pedestrian 5 Pedalcycle 6 Railroad Train Domestic Animal 8 Wild Animal Object t Fixed 20 Parked on Private Property 2 Attenuator 22 Bridge/Pier/Abutment 23 Bridge Parapet End On Roadway 2 Left Shoulder 3 Right Shoulder Driveway/Alley Related 5 On Ramp Direc tion rth South 2 Bridge Rail 25 Overpass 26 Guardrail Face 2 Guardrail End 28 Median Barrier 30 Highway Traffic Sign Post 3 Overhead Sign support 32 Street Light Support 33 Utility Pole 3 Pole 0 Delineator Post Roadside (Includes Sidewalk) 5 Outside Right of Way 6 Off Roadway - Loc Unknown 6 Ramp Related At Railroad Crossing South / rth / Culvert 2 Curb 3 Ditch Embankment 5 Fence 6 Mailbox Tree 8 Building Wall Fixed Object Median 8 Gore (If turning, select direction before turning) Same 52 Opposite 53 Turning Events Head-On Angle 5 59 A In Parking Lot B Parking Lot Access Road P Private Property Direc tion rth South. 8 Railroad Crossing Related Rear-End 56 Going Straight 2 Turning Right 3 Right Turn on Red Turning Left 5 Left Turn on Red 6 U-Turn Merging 8 Changing Lanes 0 Passing Negotiating Curve 2 Stopped in Traffic 3 Slowing in Traffic Same Dir 62 / Ped Action Angle Head-On 5 Rear-End 60 Backed Into 6 Parked Veh. 9 UNIT # UNIT # 2 FIRST EVENT RELATIONSHIP TO JUNCTION 5 5 THE EVENT LOCATION GENERAL DIRECTION OF TRAVEL List events for ALL units in the order they occurred N Actions Page Starting in Traffic 5 Parking 6 Entering Drivwy./Alley Leaving Drivwy./Alley 8 Backing 20 Avoiding Obstacle 2 Avoiding Veh./Ped. 22 Pursuing 23 Fleeing Pursuit 2 Racing 25 Parked 26 less in Motion t to Scale Pedestrian/Pedalcycle Actions 30 Crossing at Painted Intersection 3 Crossing at Unpainted Intersection 35 Crossing at n-intersection -walk 36 Crossing t at Intersection 0 Walk/Ride with Traffic in Bike Lane Walk/Ride with Traffic Bike Lane 2 Walk/Ride Facing Traffic in Bike Lane 3 Walk/Ride Facing Traffic Bike Lane 50 Standing on Roadway 5 Playing on Roadway 52 Working on Roadway 60 Enter/Leave School Bus 0 t on Roadway 9 Property Damage ne (Name of Object Struck - Owner Name and ) Narrative / Additional Information / Additional Passengers (indicate unit # and all information for additional passengers) $ Estimated Damage NOTE: See addendum page for crash narrative. WITNESSES Name Investigating Officer's Name and # kbeckett Send ORIGINAL to: Office of Highway Safety, P. O. Box 29, Boise, Idaho Date of Report Photos Approved By /5/29 Y N Date rmontgo E 3.53
4 Idaho Collision Report Additional s Street ITD-90A City Zip Code 's License. Meridian JB M Bond As Year Color Time Identification. Agency License Plate. Dev. Injury Ejection Trapped Insurance Carrier Name //95 0 O 05 (This unit only, additional Same as Seating Passenger Names and es Pedestrian 8366 James t Date of Collision Officer # Dev.. /2/29 3: Owner 28 Black Bond Meridian, 8366 Make (Dodge-Chev.) Model (Dart-va) Style (2 Dr.) BOND FARMERS INSURANCE James Bugatti Veyron 6. 2 Door BVE IHMSS Injury Ejection Trapped Page Attach Street Pedestrian Owner As Year Make (Dodge-Chev.) Model (Dart-va) Style (2 Dr.) City Zip Code Color License Plate. Attach 's License. Identification. Dev. Injury Ejection Trapped Passenger Names and es (This unit only, Insurance Carrier Name additional Same as Seating Dev. Injury Ejection Trapped 0 ne Exceeded Posted Speed 2 Speed Too Fast for Conditions 3 Too Slow for Traffic Improper Overtaking 0 ne Curve in Road 2 Hill Crest 5 Improper Lane Change 6 Following Too Close Drove Left of Center 8 Off Roadway / Over Corrected 0 Improper Backing 3 Roadway Slope/Snowbank Trees/Crop/Brush 5 Reflection from Surface 6 Bright Sunlight CONTRIBUTING CIRCUMSTANCES - 3 Possible Improper Turn 2 Failed to Signal 3 Failed to Yield Passed Stop Sign 5 Disregarded Signal 6 Tire Defect Bright Headlights 8 Weather Conditions 0 Rain/Snow/Ice on Windows Cracked/Dirty Windows Wheel Defect 8 Light Defect Defect 2 Alcohol Impaired 3 Drug Impaired VISION OBSTRUCTION 22 Inattention 23 Vision Obstruction 2 Asleep/Drowsy 25 Sick 26 Fatigued 2 Physical Impairment 2 Splash/Spray from Other 8 Stopped on Roadway 3 Moving Parked 28 Improperly Parked 3 Previous Accident 32 Distraction in/on (List) 35 Improper use of Turn Lane 9 5 Traffic Sign 6 Billboard/Fence Building Seating Motorcycle Trailing 8 Equestrian 6 Pedestrian 9 Pedalcycle U Unknown Passenger Codes - n Trailing Sleeper Sect.(Truck Cab) 2 Other enclosed Passngr./Cargo area 3 Unenclosed Passngr./Cargo area 5 Riding on Exterior ective Devices 0 ne Shoulder Belt Only 2 Lap Belt Only 3 Shoulder & Lap t Ejected 2 Totally Ejected 3 Partially Ejected T Thrown from cycle etc. Child Safety Seat 5 Helmet Used 6 nmotorist Air Bag Equipped n-activated Air Bag, Belts in Use 8 n-activated Air Bag, Belts in Use 0 Air Bag Activated, Belts in Use Air Bag Activated, Belts in Use Ejection Trapped t Trapped 2 Trapped / Extrication unit used 3 Trapped / other extrication method Injury K Dead A Incapacitating B n-incapacitating C Possible 0 ne Evident U Unknown For Medical Care By Ambulance 2 Police Car 3 Helicopter Private 5 t Pedestrian 2 Pedalcycle 3 Motorcycle Moped 6 Car 5 Bus 2 Single Truck - 2 axle/6 Tires 22 Single Truck - 3 axle 23 Truck with Trailer Police 2 Ambulance 3 Trng. Government 8 Pickup with Camper Pickup / Van / Panel / Sport Utility 2 Equestrian 30 Farm Equipment (List) 0 Construction Equip. (List) 5 Taxi 6 Fire Wrecker 8 School Bus Commercial 0 Motorhome Snowmobile 5 ATV 28 Train 9 n- Motor Veh. 2 Bobtail 25 Tractor w/semi Trailer 26 Tractor w/double Trailer 2 Tractor w/triple Trailer Attachments Boat Trailer 2 Utility Trailer 3 Travel Trailer Towed 5 Mobile Home
5 3 Auto / Motorcycle / Tractor with Semi Trailer 3 Top & Windows Undercarriage Trailing # 32 Trailing #2 33 Top 3 Undercarriage Officer # POINT OF IMPACT ETENT OF DEFORMITY. 53 Top 5 Undercarriage 0 ne Very Minor 2 Minor 3 Minor/Moderate Moderate 5 Moderate/Severe 6 Severe Very Severe Page t Towed 3 Neither Alcohol or Drugs Detected 2 - Alcohol 3 - Drugs - Both ne Given 2 Test Refused 3 Blood Test Urine Test 5 Breath Test 6 Field Test BAC Test Results: Drug Used (if known): Results 3 ALCOHOL / DRUG INVOLVEMENT COMMERCIAL VEHICLE Cargo Body GVWR-All Trailers BAC Test Results: Drug Used (if known): Results Bus 2 Van/Enclosed Box 3 Cargo Tank Flatbed 5 Dump 6 Concrete Mixer Auto Transporter 8 Garbage/Refuse 0 Pickup Bed # Axles GVWR-Power GVWR-All Trailers ICC # For Load DOT # For Load # Axles NA Alcohol / Refer to Instruction Sheet before completing GVWR-Power ICC # For Load DOT # For Load Carrier Name & ICC# or DOT# for Load obtained from... Shipping Papers 2 Side 3 Log Book If Carrier name is different from vehicle owner, record the name and address in the narrative on page 3. # of s EventInvolved Going Straight 2 Turning Right 3 Right Turn on Red Turning Left 5 Left Turn on Red 6 U-Turn Event Location 0 njunction In Intersection / Ped Action EVENTS - Overturn 2 Separation of s 3 Cargo Loss/Shift Jack-Knifed 5 Ran off Road 6 Down Hill away Fire/Explosion 8 Gas/Inhalation ncollision 0 Loss of Control Fell/Pushed/Jumped 2 n-collision Injury 3 Immersion Came Back on Road 2 Drove L/R of Center THE EVENT LOCATION Merging 8 Changing Lanes 0 Passing Negotiating Curve 2 Stopped in Traffic 3 Slowing in Traffic 2 Intersection Related 3 At Driveway/Alley South / rth / Actions List events for ALL units on page 3. One Veh. Collision With Pedestrian 5 Pedalcycle 6 Railroad Train Domestic Animal 8 Wild Animal Object t Fixed 20 Parked on Private Property 2 Attenuator 22 Bridge/Pier/Abutment 23 Bridge Parapet End On Roadway 2 Left Shoulder 3 Right Shoulder Starting in Traffic 5 Parking 6 Entering Drivwy./Alley Leaving Drivwy./Alley 8 Backing 20 Avoiding Obstacle Driveway/Alley Related 5 On Ramp Direction rth South 2 Bridge Rail 25 Overpass 26 Guardrail Face 2 Guardrail End 28 Median Barrier 30 Highway Traffic Sign Post 3 Overhead Sign support 32 Street Light Support 33 Utility Pole 3 Pole 0 Delineator Post Roadside (Includes Sidewalk) 5 Outside Right of Way 6 Off Roadway - Loc Unknown FIRST EVENT RELATIONSHIP TO JUNCTION GENERAL DIRECTION OF TRAVEL South / rth / 2 Avoiding Veh./Ped. 22 Pursuing 23 Fleeing Pursuit 2 Racing 25 Parked 26 less in Motion Use this area only for events which do not fit on page 3. 6 Ramp Related At Railroad Crossing Culvert 2 Curb 3 Ditch Embankment 5 Fence 6 Mailbox Tree 8 Building Wall Fixed Object Median 8 Gore (If turning, select direction before turning) Direction rth South Same Crossing at Painted Intersection 3 Crossing at Unpainted Intersection 35 Crossing at n-intersection -walk 36 Crossing t at Intersection 0 Walk/Ride with Traffic in Bike Lane Walk/Ride with Traffic Bike Lane 2 Walk/Ride Facing Traffic in Bike Lane 3 Walk/Ride Facing Traffic Bike Lane Opposite 53 Turning Events Head-On Angle 5 59 Rear-End 56 Same Dir 62 A In Parking Lot B Parking Lot Access Road P Private Property 8 Railroad Crossing Related / Ped Action Pedestrian/Pedalcycle Actions Angle Head-On 5 Rear-End 60 Backed Into 6 Parked Veh Standing on Roadway 5 Playing on Roadway 52 Working on Roadway 60 Enter/Leave School Bus 0 t on Roadway 9
6 Idaho Collision Report Page 6 Narrative / Additional Information / Additional Passengers: I spoke with Mr. Thompson and he showed signs of extreme fatigue. He had been driving for 36 2 hours straight with no sleep and his reaction time was impaired by drowsiness. So when the 3 traffic in front of him slowed down suddenly, he failed to notice in time and rear-ended Mr. Bourne's Explorer with his truck. Also, his windshield was extremely dirty and hard to see 5 through. 6 Mr. Bourne had been following Mr. Bond too closely in an attempt to get a closer look at Bond's way cool Bugatti. I suspect this was also inspired by professional rivalry between the two 8 spies. When he was struck from behind by the Mr. Thompson's Peterbilt he was catapulted forward 9 and struck the back of Mr. Bond's Bugatti with enough force to damage the retractable spoiler. 0 Mr. Bond claims to have been minding his own business and not taunting Mr. Bourne with his superior vehicle. CHANGES TO CRASH REPORT SINCE FIRST TRANSMIT: FIELD: PolicefldCreateUser CHANGED ON: /8/29 :23:52 PM FROM: tjones TO: KBECKETT FIELD: fldcarriercode CHANGED ON: /8/29 :26: PM FROM: California TO: British Columbia FIELD: fldcarriercode CHANGED ON: /8/29 :26:9 PM FROM: British Columbia TO: California FIELD: fldcarriercode CHANGED ON: /8/29 :2:0 PM FROM: California TO: Ottowa FIELD: fldcarriercode CHANGED ON: /8/29 :2:5 PM FROM: Ottowa TO: California FIELD: AccdfldTrafficControl CHANGED ON: /8/29 2:36:8 PM FROM: ne TO: Traffic Signal FIELD: AccdfldTrafficControl CHANGED ON: /8/29 2:3:05 PM FROM: Traffic Signal TO: ne FIELD: AccdfldTrafficControl CHANGED ON: /8/29 2:3:05 PM FROM: Traffic Signal TO: ne FIELD: EventfldEventCode CHANGED ON: /8/29 2:3:0 PM FROM: TO: Rear End FIELD: WitfldWitness CHANGED ON: /8/29 2:5:3 PM FROM: TO: Tes FIELD: WitfldWitnessName CHANGED ON: /8/29 2:5:39 PM FROM: TO: Tes FIELD: PolicefldCreateUser CHANGED ON: /8/29 2:53:6 PM FROM: KBECKETT TO: kbeckett FIELD: AccdMeasuredFromMilepost CHANGED ON: 3/2/20 :2:0 PM FROM: TO: FIELD: AccdfldIntersectionDistance CHANGED ON: 3/2/20 :2: PM FROM: TO: 0.3 FIELD: AccdfldIntersectionDistances CHANGED ON: 3/2/20 :2: PM FROM: TO: Miles FIELD: AccdfldDirFromIntersection CHANGED ON: 3/2/20 :2:56 PM FROM: TO: FIELD: AccdfldRefPrimaryName CHANGED ON: 3/2/20 :3:0 PM FROM: MP TO: MP
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