Authority: 1949 PA 300, Sec.257.

622 External # Crash ID Page 101 of 01

1
Compliance: Required MSP UD-10E
Penalty: $100 and/or 90 days (Rev 11/2006)
0001974
00051871 6735576
51871 100013776 File Class 93001
Incident # 0001974 93001
Incident Disposition
STATE OF MICHIGAN TRAFFIC CRASH REPORT Closed
CLOSED
ORI: Department Name Reviewer
MI6378400
MI 2339999 ABC Police
TROY PD Dept Sgt. Mack
LIVINGSTON (00307)
Crash Date Crash Time No. of Units Crash Type Special Circumstances None Deer Special Checks
None Deer
10/05/2007
05/13/2010 16:00
17:52 202 Head On
5-REAR END School Bus Hit and Run Fleeing Police
Fatal Non-Traffic Area ORV/Snowmobile

County Traffic Control Relation to Roadway Special Study Weather Area

63
23--OAKLAND
Eaton NONE
SignalOF THESE On
ON Road
ROAD State CLOUDY
Clear 10-NON-FRWY STRAIGHT
07 - NON-FRWY ROADWAY
in Intersection
City/Twsp Construction Zone (if applicable) Light Road Condition Total Lanes Speed Limit Posted
Type Lane Closed Activity
60--TROY
84 Charlotte Daylight
DAYLIGHT Dry
DRY 502 50
40 Yes
YES
Construction/Maintenance Yes On Road
LOCATION

Prefix Road Name Road Type Suffix Divided Roadway

W
W FIRST
MAPLE RD
RD SW E
Distance Traffic Way Access Control
15
100Feet
FT WE 01 - NotPHYSICALLY
1-NOT physically divided
DIVIDED 01 - NoACCESS
1-NO access control
CONTROL
Prefix Intersecting Road Road Type Suffix Divided Roadway
N SECOND
MAPLELAWN RD
DR NE N
Unit Number Unit Known State Driver License Number Date of Birth (Age) License Type Endorsements Sex Total Occupants Hazardous Action
101 YYes MI M635429465681
MI G111222333444 09/01/1989
06/09/1957 (20)
(50) Operator Cycle M
M 102 12-UNABLE TO STOP
14 - Unknown
Chauffer Farm
Moped Recreation
Unit Type Driver Information Injury Position Restraint Hospital
M
MV JOHN KENNETH MARTIN
KNU GUY O
A 01
01 404 NONE
HAYES GREEN BEACH MEMORIAL HOSPITAL
U N I T / D R I V E R

1245
80 MAIN ST
WILSON AVE
LANSING, MI
CLAWSON MI 48111 (517) 999-7777
48017-1733 (248) 835-5872
Driver Condition Interlock Ejected Trapped Airbag Deployed Ambulance
1 2 3 4 5 6 7 8 9 99 NO
No NO
Yes NO
Yes Not Equipped
NO NONE
DELTA TWP FIRE DEPT
Alcohol Drugs Citation Issued
Yes No Refused Not offered Test Results Yes No Test Results Hazardous Other
Test Type Field PBT Breath Blood Urine Test Type Blood Urine Citation#: 10TR04453
Vehicle Registration State Insurance / Policy # Towed To/By Special Vehicles Private Trailer Type Vehicle Defect
DDX444
CCB5957 MI
MI GROUP INSURANCE
HOMEOWNERS 4409890000 BIG T'S TOWING 01 2 6
VIN Vehicle Make Model Color Year Vehicle Type
EZAS123EZASABC
1B4HS38N92F213847 Description DODGE
CHEVROLET DURANGO
SILVERADO SILVER
WHITE 2002
2006 01-PASSENGER
Truck/Bus CAR
Location of First Impact Extent of Driveable Vehicle Direction Vehicle Use Action Prior
Greatest Damage 1 07 107 Damage 1 YES W 01-PRIVATE 01-GOING STRAIGHT AHEAD
7 No N 10 - Road Construction 08 - Slowing/stop on roadway
Sequence of First Second Third Fourth
Events 17 - Motor
* 17-MOTOR VEHvehINinTRANSPORT
transport 01 - Loss of control 30 - Luminaire/light support
( indicates MOST harmful event)
*
Passenger Information Date of Birth (Age) Sex Position Restraint Hospital
FOREST Z STUMP 07/18/1963 (44) M 03 04 HAYES GREEN BEACH MEMORIAL HOSPITAL
123 CHERRY ST Injury Airbag Deployed Ejected Trapped Ambulance
LANSING, MI 48111 (517) 888-7777 K Not Equipped Yes Yes DELTA TWP FIRE DEPT
Passenger Information Date of Birth (Age) Sex Position Restraint Hospital

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

Carrier Information Carrier Source GVWR ICCMC USDOT MPSC

TRUCK/BUS

Driver's CDL Type Endorsements CDL Exempt CDL Restrictions

H P T Farm 28 29 30 35 36
N S X Other
Interstate/Intrastate Vehicle Type Type & Axle Per Unit Cargo Body Type Medical Card Hazardous Material ID # Class #
First Second Third Fourth
Placard Cargo Spill

Owner Information Owner Information

OWNERS

Person Advised of Damaged Traffic Control Damaged Property Public

Contact Name: OFR. FRIENDLY LUMINAIRE/LIGHT SUPPORT Yes
Contact Date: 10/05/2007 Owner & Phone
Contact Time: 16:20 HALLMARK TOWNSHIP
(517) 111-2345
 Unit Number Unit Known State Driver License Number Date of Birth (Age) License Type Endorsements Sex Total Occupants Hazardous Action
202 YYes MI G630098115318
MI W999888777666 04/25/1977
01/01/1951 (33)
(56) Operator Cycle M
M 302 00-NONE
04 - Disregard traffic control
Chauffer Farm
Moped Recreation
Unit Type Driver Information Injury Position Restraint Hospital
M
MV BRENT
FALLIN CHARLES
WINTER GROTH O
C 01
01 404 NONE
NONE
U N I T / D R I V E R

111NLEAF
898 DRIVE
ADAMS RD UNIT 6
LANSING,
BIRMINGHAMMI 48111 (517) 123-4567
MI 48009-5664 (248) 444-0811
Driver Condition Interlock Ejected Trapped Airbag Deployed Ambulance
1 2 3 4 5 6 7 8 9 99 NO
Yes NO NO Yes
NO NONE
NONE
Alcohol Drugs Citation Issued
Yes No Refused Not offered Test Results Yes No Test Results Hazardous Other
Test Type Field PBT Breath Blood Urine .15 Test Type Blood Urine 128 Citation#:
Vehicle Registration State Insurance / Policy # Towed To/By Special Vehicles Private Trailer Type Vehicle Defect
XXX000
BXX3065 MI
MI TRUCKER'S
STATE FARM1122334455
2680930F1122 NONE 00 1
VIN Vehicle Make Model Color Year Vehicle Type
1A2B3C4D5E6F7G89
1HGFA16548L097859 Description HONDA
INTERNATIONAL TITANCIVIC RED
WHITE 2008
2004 01-PASSENGER
Truck/Bus CAR
Location of First Impact Extent of Driveable Vehicle Direction Vehicle Use Action Prior
Greatest Damage 5 01 501 Damage 2 YES W 01-PRIVATE 04-STOPPED ON ROADWAY
2 Yes W 02 - Commercial(business) 01 - Going Straight Ahead
Sequence of First Second Third Fourth
Events * 17-MOTOR VEH veh
17 - Motor IN TRANSPORT
in transport
*
( indicates MOST harmful event)

Passenger Information Date of Birth (Age) Sex Position Restraint Hospital

RENATA
TAD POHL STOJCEVSKI 08/19/1974 (44)
01/01/1963 (35) FM 03
03 405 NONE
HAYES GREEN BEACH MEMORIAL HOSPITAL
4578 LILLY
17878 VACRIDR
LN Injury Airbag Deployed Ejected Trapped Ambulance
LANSING, MI 48111 (517) 222-3345 O
A NO
Not Equipped NO NO
Yes NONE
DELTA TWP FIRE DEPT
LIVONIA MI 48152-3124
Passenger Information Date of Birth (Age) Sex Position Restraint Hospital
JEANETTE STOJCEVSKI 11/10/1978 (31) F 06 4 REFUSED
1725 N. EDGEMONT #303 Injury Airbag Deployed Ejected Trapped Ambulance
LOS ANGELES CA 90027 C NO NO NO REFUSD-REFUSED
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

Carrier Information Carrier Source GVWR ICCMC USDOT MPSC

TRUCK/BUS

DUCKIE'S CONTAINER Log Book 80,000 147707 000000202062 000000198627

1122 PENNY LANE Driver's CDL Type Endorsements CDL Exempt CDL Restrictions
LANSING, MI 48111 Group A H P T Farm 28 29 30 35 36
N S X Other
Interstate/Intrastate Vehicle Type Type & Axle Per Unit Cargo Body Type Medical Card Hazardous Material ID # Class #
First Second Third Fourth
Interstate AY 2 Yes Placard Cargo Spill 1993 1.3
T3 S3 2 2
Owner Information Owner Information
WITNESS OWNERS

D. DUCK ENTERPRISES
1245 SCROOGE DR
QUACKER, MI 48877 (111) 456-4567

Witness Information Witness Information

DAISY DUCK LUKE DUKE
4545 POND DR 1245 GETTYSBURG
LANSING, MI 48111 (517) 999-6666 Age:
LANSING, MI 48111 (517) 258-3697
Age:

Investigated Reported Date (Time) 1st Investigator Name (Badge) 2nd Investigator Name (Badge) Photos By
at Scene Yes 05/13/2010
10/05/2007 (17:52)
(16:02) N.
M.GOBLER (68)
FISHER (00156) B. SINE (56666) SLT
YES
Narrative Diagram
VEHICLE
Unit #1 n/b#1onFAILED TO
First Rd, STOPsay
witness BEFORE
Unit #1STRIKING #2.light plus his lights and
had a green
siren engaged, Unit #2 w/b on Second Road and ran the red light striking Unit #1.
Unit #1 came to rest in NW corner of intersection where it collided with light pole.
The driver was ejected through the driver side window and was trapped between
the pole and vehicle. Unit #2 driver said that he did not hear the siren or see the
police vehicle, stated he was driving into the sun and it obstructed his vision.