SANITIZED SANITIZED SANITIZED SANITIZED Authority: 1949 PA 300, Sec.257.

622
Compliance: Required MSP UD-10E
External # Crash ID Page 01 of 01

Penalty: $100 and/or 90 days (Rev 01/2016)

1051607 1261577 File Class

Incident #
STATE OF MICHIGAN TRAFFIC CRASH REPORT 1051607
ORI Department Name Reviewer
MI 8234903 Detroit Police Department 3 RUSSELL MCINTOSH
Crash Date Crash Time No. of Units Crash Type Special Circumstances Special Checks
None Hit and Run School Bus Fatal Non-Traffic Area ORV/Snowmobile
01/09/2018 14:15 02 Single Motor Vehicle Fleeing Police Unknown Animal
County Traffic Control Relation to Roadway Weather Area
82 - Wayne None On the Road Clear NON-FRWY Straight Roadway
City/Twsp Contributing Circumstances Light Road Surface Condition Total Lanes Speed Limit Posted
1st 2nd
99 - Detroit Daylight Slush 07 30 Yes
None
Work Zone (if applicable)
Type Workers Present Activity Location
LOCATION

Prefix Primary Road Name Road Type Suffix Divided Roadway

WOODWARD AVE
Distance / Direction Trafficway
100 Feet N Not Physically Divided
Prefix Intersecting Road Name Road Type Suffix Divided Roadway
FARNSWORTH ST
Unit Number Unit Known State Driver License Number Date of Birth (Age) License Type Endorsements Sex Total Occupants Hazardous Action
01 Yes ############# ##/##/#### (54) Operator Cycle F 01 None
Chauffeur Farm
Moped Recreation
Unit Type Driver Information Driver is Owner Injury Position Restraint
E ############################## No O Engineer No Belts Available
##############################
BELLEVILLE, MI 48111 (###) ###-####
Driver Condition at Time of Crash Driver Distracted By Ejected Trapped Airbag Deployed
1st 2nd
Not Distracted Not Equipped
Appeared Normal
Hospital Ambulance
U N I T / D R I V E R

NONE NONE
Alcohol Suspected Contributing FactorAlcohol Test Type Alcohol Test Results Interlock Device
No No Breath Blood Urine Pending Test Results: No
Field PBT Refused Not Offered
Drug Suspected Contributing Factor Drug Test Type Drug Test Results Citation Issued
No No Blood Urine Pending Test Results: Hazardous
Field Refused Not Offered Other
Vehicle Registration State Vehicle Year Make Model Color
NONE Description

VIN Vehicle Type Special Vehicles Private Trailer Type Vehicle Defect
Other Not Applicable
Automation System(s) in Vehicle Automation System Level in Vehicle Automation System Level Engaged at Time of Crash

Insurance Company Insurance Policy # Towed By Towed To

############################## ##############################
Location of First Impact Extent of Damage (Power Unit and/or Trailers) Vehicle Direction Vehicle Use Action Prior
Greatest Damage 03 03 Minor Damage N Other Going Straight Ahead
Sequence of First Second Third Fourth
Events 17 - Motor Veh in Transport
( indicates MOST harmful event)

Passenger Information Date of Birth (Age) Sex Position Restraint

Injury Ejected Trapped Airbag Deployed

PASSENGERS

Hospital Ambulance

Passenger Information Date of Birth (Age) Sex Position Restraint

Injury Ejected Trapped Airbag Deployed

Hospital Ambulance

Carrier Information USDOT MC MPSC

TRUCK/BUS

Driver's CDL Type Endorsements CDL Exempt

H P T Farm
N S X Other
GVWR/GCWR Vehicle Configuration Cargo Body Type Medical Card Hazardous Material ID # Class #
10,000 lbs. or Less 10,001 - 26,000 lbs. Greater than 26,000 lbs. Placard Cargo Spill

Owner Information Owner Information

OWNERS

##############################
##############################
###################################, ## #####-#### (###) ###-####

Damaged Property Public Owner & Phone

SANITIZED SANITIZED SANITIZED SANITIZED Unit Number Unit Known State Driver License Number Date of Birth (Age) License Type Endorsements Sex Total Occupants Hazardous Action
02 No ############# ##/##/#### Operator Cycle 00 None
Chauffeur Farm
Moped Recreation
Unit Type Driver Information Driver is Owner Injury Position Restraint
MV ############################## No Restraint Use Unknown
##############################
(###) ###-####
Driver Condition at Time of Crash Driver Distracted By Ejected Trapped Airbag Deployed
1st 2nd
Unknown Unknown

Hospital Ambulance
U N I T / D R I V E R

NONE NONE
Alcohol Suspected Contributing FactorAlcohol Test Type Alcohol Test Results Interlock Device
No No Breath Blood Urine Pending Test Results: No
Field PBT Refused Not Offered
Drug Suspected Contributing Factor Drug Test Type Drug Test Results Citation Issued
No No Blood Urine Pending Test Results: Hazardous
Field Refused Not Offered Other
Vehicle Registration State Vehicle Year Make Model Color
DSD1620 MI Description 2015 FORD MUSTANG WHI
VIN Vehicle Type Special Vehicles Private Trailer Type Vehicle Defect
1FA6P8CF9F5412617 Passenger Car, SUV, Van Not Applicable
Automation System(s) in Vehicle Automation System Level in Vehicle Automation System Level Engaged at Time of Crash

Insurance Company Insurance Policy # Towed By Towed To

############################## ##############################
Location of First Impact Extent of Damage (Power Unit and/or Trailers) Vehicle Direction Vehicle Use Action Prior
Greatest Damage 07 07 Minor Damage N Commercial (Business) Stopped on Roadway
Sequence of First Second Third Fourth
Events 17 - Motor Veh in Transport
( indicates MOST harmful event)

Passenger Information Date of Birth (Age) Sex Position Restraint

Injury Ejected Trapped Airbag Deployed

PASSENGERS

Hospital Ambulance

Passenger Information Date of Birth (Age) Sex Position Restraint

Injury Ejected Trapped Airbag Deployed

Hospital Ambulance

Carrier Information USDOT MC MPSC

TRUCK/BUS

Driver's CDL Type Endorsements CDL Exempt

H P T Farm
N S X Other
GVWR/GCWR Vehicle Configuration Cargo Body Type Medical Card Hazardous Material ID # Class #
10,000 lbs. or Less 10,001 - 26,000 lbs. Greater than 26,000 lbs. Placard Cargo Spill

Owner Information Owner Information

WITNESS OWNERS

##############################
##############################
###################################, ## #####-#### (###) ###-####

Witness Information Witness Information

Investigated Reported Date (Time) 1st Investigator Name (Badge) 2nd Investigator Name (Badge) Photos
at Scene Yes 01/09/2018 (14:48) RONALD LACH (3603) No
Narrative Diagram
Arrived at loc. Met with TQ-1 who advised Q-Line #287 was involved in crash
with parked unoccupied vehicle. Per TQ-1 engineer conveyed to clinic prior to
DPD arrival and Q-Line #287 no longer at location. Per TQ-1 Vehicle #2 was
parked past white warning line on roadway and was struck while unoccupied as
Q-Line #287 past the location and sideswiped Vehicle #2. I observed a large
Ice/Slush pile between Vehicle #2 and curb. Notified Lt. Williams N&C.