Local Report Number * Crash Severity Hit/Skip. Road Types or Milepost AL - Alley AV - Avenue BL - Boulevard. CR - Circle CT- Court DR - Drive

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1 Photos Taken OH- OH- County * OH-P Other Traffic Crash Report Local Information þ City * Village * Township * Degrees / Minutes / Seconds Latitude o Roadway Division þ Divided Undivided Location Route Type Distance From Reference Miles Feet Yards Reference Point Used - Intersection - Mile Post - House Number Road Contour - Straight Level - Straight Grade - Curve Level Manner Crash Collision/Impact Road Surface 8 Narrative - Not Collision Between Two Motor Vehicles In Transport - Concrete - Blacktop, Bituminous, Asphalt - Brick/Block Work Zone Related PDO Under State Reportable Dollar Amount Private Property O F Reporting Agency NCIC * Local Report Number * Crash Severity Hit/Skip Reporting Agency Name * O R - Fatal - Injury - PDO Number Units Unit in error - Solved - Unsolved 98 - Animal City, Village, Township * Crash Date * Time Crash Day Week Longitude / // o / // -.. Divided Lane Direction Travel N - Northbound S - Southbound Location Route Number Dir From Ref Crash Location - Curve Grade N,S, E,W - Rear-End - Head-On - Rear-to-Rear - Slag, Gravel, Stone - Dirt 6 - Other Workers Present Law Enforcement Present (Officer/Vehicle) Law Enforcement Present (Vehicle Only) GARFIELD HTS 0 SEE LONG REPORT FORM. E - Eastbound W - Westbound Loc. Prefix N,S, E,W Number Thru Lanes Location Road name Reference Route Type 0 - Not an intersection 0 - Four-way Intersection 0 - T-Intersection 0 - Y-Intersection 0 - Traffic Circle/Roundabout Road Conditions Primary - Backing 6 - Angle 7 - Sideswipe, Same Direction Light conditions Reference Route Number 06 - Five-point, or more 07 - On Ramp 08 - Off Ramp 09 - Crossover 0 - Driveway/Alley Access Secondary Road Types or Milepost AL - Alley AV - Avenue BL - Boulevard 0 - Dry 0 - Wet 0 - Snow 0 - Ice 8 - Sideswipe, Opposite Direction Ref Prefix Primary Secondary - Daylight 7 - Dawn - Dusk - Dark - Lighted Roadway Type Work Zone GARFIELD HEIGHTS 0 0 ROCKSIDE - Lane Closure - Lane Shift/Crossover - Work on Shoulder or Median 0 7 CR - Circle CT- Court DR - Drive N,S, E,W - Railway Grade Crossing - Shared-Use Paths or Trails Decimal Degrees Latitude Longitude HE - Heights HW - Highway LA - Lane Location Road Type MP - Milepost PK - Parkway PI - Pike Route Types IR - Interstate Route (inc. turnpike) US - US Route SR - State Route Reference Name (Road, Milepost, House #) Intersection Related 0 - Sand, Mud, Dirt, Oil, gravel 06 - Water (Standing, Moving) 07 - Slush 08 - Debris* Weather - Intermittent or Moving Work - Other R D Clear - Cloudy - Fog, Smog, Smoke - Location First Harmful - On Roadway - On Shoulder - In Median - On Roadside ST - Street TE - Terrace TL - Trail WA - Way CR - Numbered County Route TR - Numbered Township Route Reference Road Type - On Gore 6 - Outside Trafficway 09 - Rut, Holes, Bumps, Uneven Pavement* 0 - Other * Secondary Condition Only - Rain - Sleet, Hail 6 - Snow - Dark - Roadway Not Lighted 6 - Dark - Unknown Roadway Lighting 7 - Glare* 8 - Other * Secondary Condition Only Location Crash in Work Zone Before the first Work Zone Warning Sign - Advance Warning Area - Transition Area PL - Place RD - Road SQ - Square 7 - Severe Crosswinds 8 - Blowing Sand, Soil, Dirt, Snow 9 - Other/Unknown School Zone Related 9 9 School Bus Related Yes, School Bus Directly Involved Yes, School Bus Indirectly Involved - Activity Area - Termination Area M O N Report Taken By þ Police Agency Date Crash Reported HSY700 (Rev 0/) Time Crash Reported Supplement (Correction or Addition to an Existing Report Sent to ODPS) Dispatch Time Arrival Time Time Cleared Officer's Name * Officer's Badge Number Checked By P. Hace 0 Other Investigation Time Total Minutes L T. Vargo

2 Unit Local Report Number * Unit Number Owner LP State Owner Name: Last, First, Middle License Plate Number ( ü Same As Driver) ( ü Same As Driver) Vehicle Identification Number Owner Phone Number - inc. area code Vehicle Year Vehicle Make Vehicle Model Vehicle Color þ 0 O H Pro Insurance Shown WILLIAMSON AJA M GYT98 Insurance Company Policy Number Towed By Carrier Name, HOND Honda ACC Accord BLK Black FIRST ACCEPTANCE NSOH H G C P A 7 7 ( ü Same As Driver) NORTHWOOD AVE MAPLE HEIGHTS OH 7 # s 0 Damage Scale - None - Minor - Functional - Disabling Carrier Phone - include area code US DOT HM Placard ID No. HM Class Number Vehicle Weight GVWR/GCWR Location Prior to Impact Special Function Intersection - Marked Crosswalk 0 - Intersection - No Crosswalk 0 - Intersection - Other 0 - Midblock - Marked Crosswalk 0 - Travel Lane - Other Location 06 - Bicycle Lane 07 - Shoulder/Roadside 08 - Sidewalk 09 - Median/Crossing Island 0 - Driveway Access - Shared-Use Path or Trail - Non-Trafficway Area - Less Than or Equal to 0k Lbs. - 0,00 to 6,000 Lbs - More Than 6,000 Lbs. Hazardous Material Released 0 - None 0 - Taxi 0 - Rental Truck (Over 0K Lbs) 0 - Bus - School (Public or Private) 0 - Bus - Transit 06 - Bus - Charter 07 - Bus - Shuttle 08 - Bus - Other Type Use - Personal - Commercial - Government In Emergency Response Cargo Body Type 0 Unit Type 0 - No Cargo Body Type/Not Applicable 0 - Bus/Van(9- Seats, Inc.Driver) 0 - Bus(6+ Seats, Inc Driver) 0 - Vehicle Towing Another Vehicle 0 - Logging 06 - Intermodal Container Chassis 07 - Cargo Van/Enclosed Box 08 - Grain, Chips, Gravel or Hit/Skip 09 - Ambulance 0 - Fire - Highway/Maintenance - Military - Police - Public Utility - Other Government 6 - Construction Equip. Passenger Vehicle (less than 9 passengers) 0 - Sub-Compact 0 - Compact 0 - Mid Size 0 - Full Size 0 - Minivan 06 - Sports Utility Vehicle 07 - Pickup 08 - Van Motorized Bicycle - Snowmobile/ATV - Other Passenger Vehicle 7 - Farm Vehicle 8 - Farm Equipment 9 - Motorhome 0 - Golf Cart - Train - Other (Explain in Narrative) 09 - Pole 0 - Cargo Tank - Flat Bed - Dump - Concrete Mixer - Auto Transporter - Garbage/Refuse Most Damaged Area Impact Area Trafficway Description - Two-Way, Not Divided - Two-Way, Not Divided, Continuous Left Turn Lane - Two-Way, Divided, Unprotected (Painted or Grass> Ft.) Median - Two-Way, Divided, Positive Median Barrier - One-Way Trafficway Hit / Skip Unit Med/Heavy Trucks or Combo Units>0k lbs - Single Unit Truck or Van axle,6 tires - Single Unit Truck + axles - Single Unit Truck/Trailer 6 - Truck/Tractor(Bobtail) 7 - Tractor/Semi-Trailer 8 - Tractor/Double 9 - Tractor/Triples 0 - Other Med/Heavy Vehicle Has HM Placard 0 - None 0 - Center Front 0 - Right Front 0 - Right Side 0 - Right Rear 06 - Rear Center 07 - Left Rear Pre-Crash Actions Left Side 09 - Left Front 0 - Top and Windows - Undercarriage - Load/Trailer - Total (All Areas) - Other Bus/Van/Limo (9 or More Including Driver) - Bus/Van (9- Seats, Inc Driver) - Bus(6+ Seats, Inc Driver) - Animal with Rider - Animal with Buggy, Wagon, Surrey - Bicycle/Pedacyclist 6 - Pedestrian/Skater 7 - Other Action - Non-Contact - Non-Collision - Striking - Struck - Striking/Struck 0 Contributing Circumstances Primary 0 Secondary 0 - Straight Ahead 0 - Backing 0 - Changing Lanes 0 - Overtaking/Passing 0 - Making Right Turn 06 - Making Left Turn 0 - None 0 - Failure to Yield 0 - Ran Red Light 0 - Ran Stop Sign 0 - Exceeded Speed Limit 06 - Unsafe Speed 07 - Improper Turn 08 - Left Center 09 - Followed Too Closely/ACDA 0 - Improper Lane Change /Passing/Off Road 07 - Making U-Turn 08 - Entering Traffic Lane 09 - Leaving Traffic Lane 0 - Parked - Slowing or Stopped in Traffic - Driverless - Negotiating a Curve - Other Action - Improper Backing - Improper Start From Parked Position - Stopped or Parked Illegally - Operating Vehicle in Negligent Manner - Swerving to Avoid (Due to External Conditions) 6 - Wrong Side/Wrong Way 7 - Failure to Control 8 - Vision Obstruction 9 - Operating Defective Equipment 0 - Load Shifing/Falling/Spilling - Other Improper Action - Entering or Crossing Specified Location 6 - Walking, Running, Jogging, Playing, Cycling 7 - Working 8 - Pushing Vehicle 9 - Approaching or Leaving Vehicle 0 - Standing - None - Improper Crossing - Darting - Lying and/or Illegally in Roadway 6 - Failure to Yield Right Way 7 - Not Visible (Dark Clothing) 8 - Inattentive 9 - Failure to Obey Traffic Signs /Signals/Officer 0 - Wrong Side the Road - Other Action Vehicle Defects - Other Action 0 - Turn Signals 0 - Head Lamps 0 - Tail Lamps 0 - Brakes 0 - Steering 06 - Tire Blowout 07 - Worn or Slick tires 08 - Trailer Equipment Defective 09 - Motor Trouble 0 - Disabled From Prior Accident - Other Defects Sequence s First Most Harmful Harmful Collision with Person, Vehicle or Object Not Fixed - Pedestrian - Parked Motor Vehicle - Pedalcycle - Work Zone Maintenance Equipment 6 - Railway Vehicle (Train,Engine) - Struck by Falling, Shifting Cargo 7 - Animal - Farm or Anything Set in Motion by a 8 - Animal - Deer Motor Vehicle 9 - Animal - Other - Other Movable Object 0 - Motor Vehicle in Transport Unit Speed þ Stated Estimated HSY80 OHU (Rev 0/) Posted Speed Traffic Control No Controls 0 - Stop Sign 0 - Yield Sign 0 - Traffic Signal 0 - Traffic Flashers 06 - School Zone 6 Non-Collision s 0 - Overturn/Rollover 0 - Fire/Explosion 0 - Immersion 0 - Jackknife 0- Cargo/Equipment Loss or Shift Collision With Fixed Object - Impact Attenuator/Crash Cushion 6 - Bridge Overhead Structure 7 - Bridge Pier or Abutment 8 - Bridge Parapet 9 - Bridge Rail 0 - Guardrail Face - Guardrail End - Portable Barrier 07 - Railroad Crossbucks 08 - Railroad Flashers 09 - Railroad Gates 0 - Construction Barricade - Person (Flagger, Officer) - Pavement Markings 06 - Equipment Failure (Blown Tire, Brake Failure, etc) 07 - Separation Units 08 - Ran Off Road Right 09 - Ran Off Road Left - Median Cable Barrier - Median Guardrail Barrier - Median Concrete Barrier 6 - Median Other Barrier 7 - Traffic Sign Post 8 - Overhead Sign Post 9 - Light/Luminaries Support 0 - Utility Pole - Crosswalk Lines - Walk/Don't Walk - Other 6 - Not Reported Unit Direction From 0 - Cross Median - Cross Center Line Opposite Direction Travel - Downhill Runaway - Other Non-Collision - Other Post, Pole or Support - Culvert - Curb - Ditch - Enbankment 6 - Fence 7 Mailbox To - North - South - East - West 8 - Tree 9 - Fire Hydrant 0 - Work Zone Maintenance Equipment - Wall, Building, Tunnel - Other Fixed Object - Northeast 6 - Northwest 7 - Southeast 8 - Southwest

3 Unit Local Report Number * Unit Number Owner Name: Last, First, Middle ( Same As Driver) 0 Owner ( Same As Driver) Owner Phone Number - inc. area code ( Same As Driver) Damage Scale - None LP State License Plate Number Vehicle Identification Number Vehicle Year Vehicle Make Vehicle Model Vehicle Color Pro Insurance Shown Insurance Company Policy Number Towed By Carrier Name, # s 0 - Minor - Functional - Disabling Carrier Phone - include area code US DOT HM Placard ID No. HM Class Number Vehicle Weight GVWR/GCWR Location Prior to Impact - Less Than or Equal to 0k Lbs. - 0,00 to 6,000 Lbs - More Than 6,000 Lbs. Hazardous Material Released 0 - Intersection - Marked Crosswalk 0 - Intersection - No Crosswalk 0 - Intersection - Other 0 - Midblock - Marked Crosswalk 0 - Travel Lane - Other Location 06 - Bicycle Lane 07 - Shoulder/Roadside 08 - Sidewalk 09 - Median/Crossing Island 0 - Driveway Access - Shared-Use Path or Trail - Non-Trafficway Area 0 - None 0 - Taxi 0 - Rental Truck (Over 0K Lbs) 0 - Bus - School (Public or Private) 0 - Bus - Transit 06 - Bus - Charter 07 - Bus - Shuttle 08 - Bus - Other Type Use - Personal - Commercial - Government In Emergency Response Cargo Body Type Unit Type 0 Special Function No Cargo Body Type/Not Applicable 0 - Bus/Van(9- Seats, Inc.Driver) 0 - Bus(6+ Seats, Inc Driver) 0 - Vehicle Towing Another Vehicle 0 - Logging 06 - Intermodal Container Chassis 07 - Cargo Van/Enclosed Box 08 - Grain, Chips, Gravel or Hit/Skip 09 - Ambulance 0 - Fire - Highway/Maintenance - Military - Police - Public Utility - Other Government 6 - Construction Equip. Passenger Vehicle (less than 9 passengers) 0 - Sub-Compact 0 - Compact 0 - Mid Size 0 - Full Size 0 - Minivan 06 - Sports Utility Vehicle 07 - Pickup 08 - Van Motorized Bicycle - Snowmobile/ATV - Other Passenger Vehicle 7 - Farm Vehicle 8 - Farm Equipment 9 - Motorhome 0 - Golf Cart - Train - Other (Explain in Narrative) 09 - Pole 0 - Cargo Tank - Flat Bed - Dump - Concrete Mixer - Auto Transporter - Garbage/Refuse Most Damaged Area Impact Area Trafficway Description - Two-Way, Not Divided - Two-Way, Not Divided, Continuous Left Turn Lane - Two-Way, Divided, Unprotected (Painted or Grass> Ft.) Median - Two-Way, Divided, Positive Median Barrier - One-Way Trafficway Hit / Skip Unit Med/Heavy Trucks or Combo Units>0k lbs - Single Unit Truck or Van axle,6 tires - Single Unit Truck + axles - Single Unit Truck/Trailer 6 - Truck/Tractor(Bobtail) 7 - Tractor/Semi-Trailer 8 - Tractor/Double 9 - Tractor/Triples 0 - Other Med/Heavy Vehicle Has HM Placard 0 - None 0 - Center Front 0 - Right Front 0 - Right Side 0 - Right Rear 06 - Rear Center 07 - Left Rear Pre-Crash Actions 08 - Left Side 09 - Left Front 0 - Top and Windows - Undercarriage - Load/Trailer - Total (All Areas) - Other Bus/Van/Limo (9 or More Including Driver) - Bus/Van (9- Seats, Inc Driver) - Bus(6+ Seats, Inc Driver) - Animal with Rider - Animal with Buggy, Wagon, Surrey - Bicycle/Pedacyclist 6 - Pedestrian/Skater 7 - Other Action - Non-Contact - Non-Collision - Striking - Struck - Striking/Struck Contributing Circumstances Primary 0 Secondary 0 - Straight Ahead 0 - Backing 0 - Changing Lanes 0 - Overtaking/Passing 0 - Making Right Turn 06 - Making Left Turn 0 - None 0 - Failure to Yield 0 - Ran Red Light 0 - Ran Stop Sign 0 - Exceeded Speed Limit 06 - Unsafe Speed 07 - Improper Turn 08 - Left Center 09 - Followed Too Closely/ACDA 0 - Improper Lane Change /Passing/Off Road 07 - Making U-Turn 08 - Entering Traffic Lane 09 - Leaving Traffic Lane 0 - Parked - Slowing or Stopped in Traffic - Driverless - Negotiating a Curve - Other Action - Improper Backing - Improper Start From Parked Position - Stopped or Parked Illegally - Operating Vehicle in Negligent Manner - Swerving to Avoid (Due to External Conditions) 6 - Wrong Side/Wrong Way 7 - Failure to Control 8 - Vision Obstruction 9 - Operating Defective Equipment 0 - Load Shifing/Falling/Spilling - Other Improper Action - Entering or Crossing Specified Location 6 - Walking, Running, Jogging, Playing, Cycling 7 - Working 8 - Pushing Vehicle 9 - Approaching or Leaving Vehicle 0 - Standing - None - Improper Crossing - Darting - Lying and/or Illegally in Roadway 6 - Failure to Yield Right Way 7 - Not Visible (Dark Clothing) 8 - Inattentive 9 - Failure to Obey Traffic Signs /Signals/Officer 0 - Wrong Side the Road - Other Action Vehicle Defects - Other Action 0 - Turn Signals 0 - Head Lamps 0 - Tail Lamps 0 - Brakes 0 - Steering 06 - Tire Blowout 07 - Worn or Slick tires 08 - Trailer Equipment Defective 09 - Motor Trouble 0 - Disabled From Prior Accident - Other Defects Sequence s First Most Harmful Harmful Collision with Person, Vehicle or Object Not Fixed - Pedestrian - Parked Motor Vehicle - Pedalcycle - Work Zone Maintenance Equipment 6 - Railway Vehicle (Train,Engine) - Struck by Falling, Shifting Cargo 7 - Animal - Farm or Anything Set in Motion by a 8 - Animal - Deer Motor Vehicle 9 - Animal - Other - Other Movable Object 0 - Motor Vehicle in Transport Unit Speed 0 Stated Estimated HSY80 OHU (Rev 0/) Posted Speed Traffic Control 0 - No Controls 0 - Stop Sign 0 - Yield Sign 0 - Traffic Signal 0 - Traffic Flashers 06 - School Zone 6 Non-Collision s 0 - Overturn/Rollover 0 - Fire/Explosion 0 - Immersion 0 - Jackknife 0- Cargo/Equipment Loss or Shift Collision With Fixed Object - Impact Attenuator/Crash Cushion 6 - Bridge Overhead Structure 7 - Bridge Pier or Abutment 8 - Bridge Parapet 9 - Bridge Rail 0 - Guardrail Face - Guardrail End - Portable Barrier 07 - Railroad Crossbucks 08 - Railroad Flashers 09 - Railroad Gates 0 - Construction Barricade - Person (Flagger, Officer) - Pavement Markings 06 - Equipment Failure (Blown Tire, Brake Failure, etc) 07 - Separation Units 08 - Ran Off Road Right 09 - Ran Off Road Left - Median Cable Barrier - Median Guardrail Barrier - Median Concrete Barrier 6 - Median Other Barrier 7 - Traffic Sign Post 8 - Overhead Sign Post 9 - Light/Luminaries Support 0 - Utility Pole - Crosswalk Lines - Walk/Don't Walk - Other 6 - Not Reported Unit Direction From 0 - Cross Median - Cross Center Line Opposite Direction Travel - Downhill Runaway - Other Non-Collision - Other Post, Pole or Support - Culvert - Curb - Ditch - Enbankment 6 - Fence 7 Mailbox To - North - South - East - West 8 - Tree 9 - Fire Hydrant 0 - Work Zone Maintenance Equipment - Wall, Building, Tunnel - Other Fixed Object - Northeast 6 - Northwest 7 - Southeast 8 - Southwest

4 / / Local Report Number * / 0 WILLIAMSON AJA M OL State Operator License Number OL Class No Valid O H OL M/C End NORTHWOOD AVE MAPLE HEIGHTS OH Condition Alcohol/Drug Suspected Alcohol Test Status Alcohol Test Type Alcohol Test Value Drug Test Status Drug Test Type RZ7 Offense Charged Offense Description Citation Number ( Local Code ) Hands-Free Device Used Driver Distracted By F / 0 PHILLIPS MICHAEL M OL State Operator License Number OL Class No Valid X X OL M/C End ROCKSIDE RD GARFIELD HTS OH GARFIELD HTS FIRE DE Condition Alcohol/Drug Suspected Alcohol Test Status Alcohol Test Type Alcohol Test Value Drug Test Status Drug Test Type Offense Charged ( Local Code ) Offense Description Citation Number Hands-Free Device Used 0 9. Driver Distracted By Injuries - No Injury/None Reported - Possible - Non-Incapacitating - Incapacitating - Fatal Seating Position Injured Taken By 0 - Front - Left Side ( Driver) 0 - Front - Middle 0 - Front - Right Side 0 - Second - Left Side ( Passenger) 0 - Second - Middle 06 - Second - Right Side - Not Transported / Treated at Scene - EMS - Police - Other Safety Equipment Used 0 - None Used - Vehicle 0 - Shoulder Belt Only Used 0 - Lap Belt Only Used 0 - Shoulder Belt and Lap Belt Used 07 - Third - Left Side ( Side Car) 08 - Third - Middle 09 - Third - Right Side 0 - Sleeper Section Cab (Truck) - Passenger in Other Enclosed Cargo Area (Non-Trailing Unit Such as a Bus, Pick-up with Cab) Safety Equipment 0 - Child Restraint System-Forward Facing 06 - Child Restraint System-Rear Facing 07 - Booster Seat 08 - Used - Passenger in Unenclosed Cargo Area - Trailing Unit - Riding on Vehicle Exterior (Non-Trailing Unit) Other 09 - None Used 0 - Used - Protective Pads Used (Elbows, Knees, Etc) Air Bag Usage - Reflective Clothing - Lighting - Other - Not Deployed - Deployed Front - Deployed Side - Deployed Both Front/Side - Not Applicable 9 - Deployment Unknown Ejection Trapped Operator License Class Condition Alcohol/Drug Suspected - Not Ejected - Totally Ejected - Partially Ejected - Not Applicable - Not Trapped - Extricated by Mechanical Means - Extricated by Non-Mechanical Means - Class A - Class B - Class C - Regular Class (Ohio is "D") - MC/Moped Only - Apparently Normal - Physical Impairment - Emotional (Depressed, Angry, Disturbed) - Illness - Fell Asleep, Fainted, Fatigued 6 - Under The Influence Medications, Drugs, Alcohol 7 - Other - None - Yes - Alcohol Suspected - Yes - HBD Not Impaired - Yes - Drugs Suspected - Yes - Alcohol and Drugs Suspected Alcohol Test Status - None Given - Test Refused - Test Given, Contaminated Sample/Unusable - Test Given, Results Known - Test Given, Results Unknown Alcohol Test Type - None - Blood - Urine - Breath - Other Drug Test Status - None Given - Test Refused - Test Given, Contaminated Sample/Unusable - Test Given, Results Known - Test Given, Results Unknown Drug Test Type - None - Blood - Urine - Other Driver Distracted By - No Distraction Reported - Phone - Texting/ ing - Electronic Communication Device - Other Electronic Device (Navigation Device, Radio, DVD) 6 - Other Inside the Vehicle 7 - External Distraction 0 WILLIAMSON JAIDA NORTHWOOD AVE MAPLE HTS OH F 0 Unit Number 0 WILLIAMSON CHASE NORTHWOOD AVE MAPLE HTS OH 7 Injuries Name: Last, First, Middle Injured Taken By EMS Agency Medical Facility Injured Taken To Safety Equipment Used 0 7 Date Birth Seating Position 0 6 Age 6 M Air Bag Usage Gender Ejection Trapped HSY806 (Rev 0/)

5 Local Report Number * / Witness Addendum Unit Number Name: Last, First, Middle Date Birth GRANT ORLANDO TARKINGTON CLEVELAND OH M Injuries - No Injury/None Reported - Possible - Non-Incapacitating - Incapacitating - Fatal Injured Taken By - Not Transported / Treated at Scene - EMS - Police - Other Safety Equipment Used 0 - None Used - Vehicle 0 - Shoulder Belt Only Used 0 - Lap Belt Only Used 0 - Shoulder Belt and Lap Belt Used Safety Equipment 0 - Child Restraint System-Forward Facing 06 - Child Restraint System-Rear Facing 07 - Booster Seat 08 - Used 09 - None Used 0 - Used - Protective Pads Used (Elbows, Knees, Etc) - Reflective Clothing - Lighting - Other Seating Position Air Bag Usage Ejection Trapped 0 - Front - Left Side ( Driver) 0 - Front - Middle 0 - Front - Right Side 0 - Second - Left Side ( Passenger) 0 - Second - Middle 06 - Second - Right Side 07 - Third - Left Side ( Side Car) 08 - Third - Middle 09 - Third - Right Side 0 - Sleeper Section Cab (Truck) - Passenger in Other Enclosed Cargo Area (Non-Trailing Unit Such as a Bus, Pick-up with Cab) - Passenger in Unenclosed Cargo Area - Trailing Unit - Riding on Vehicle Exterior (Non-Trailing Unit) Other - Not Deployed - Deployed Front - Deployed Side - Deployed Both Front/Side - Not Applicable 9 - Deployment Unknown - Not Ejected - Totally Ejected - Partially Ejected - Not Applicable - Not Trapped - Extricated by Mechanical Means - Extricated by Non-Mechanical Means HSY8 OHP (Rev 0/)

6 LOCAL REPORT NUMBER 077 IN COUNTY OF 8 REPORTING AGENCY GARFIELD HEIGHTS CRASH LOCATION ROCKSIDE RD OHIO TRAFFIC CRASH REPORT DIAGRAM / NARRATIVE CONTINUATION DATE OF CRASH M 0 D 0 Unit one states she was traveling west on Rockside Rd. She stated that there was a very strong sun glare. She stated that as she approached a traffic light in front 6 and was having a hard time seeing the light due to the glare but the last she saw was green. She stated that as she was passing under the light a person on a bike pulled out in front her and she struck the front his bike causing the rider to fall to the ground. Y OH- 07 A witness stated he was behind unit one and that she had a green light as she approached the light but was unsure if the light changed or not. He stated the glare was very bad and there was no speeding or reckless driving at the time the crash. Unit stated that he hit the crossing button at the crosswalk and the cross symbol appeared. He stated that he entered the crosswalk and as he entered the second lane traffic unit one did not stop and hit his bike causing him to fall and scrape his knee. Unit was treated on scene and released to his father who was on scene. Officers tested the cross don't cross button. Upon hitting the button the light and walk symbol cycle almost immediately. OFFICER'S SIGNATURE X BADGE NUMBER 0 HSY 700 /07