08728 PERRYSBURG TOWNSHIP POLICE 01

Transcription

1 LOCAL INFORMATION * CRASH SEVERITY HIT/SKIP FATAL - SVED 2 - INJURY 2 - UNSVED - PDO REPORTING AGENCY NCIC * REPORTING AGENCY NAME * PHOS TAKEN PDO UNDER UNIT IN ERROR PRIVATE OF STATE PROPERTY UNITS 98- ANIMAL OH-2 OH-P REPORTABLE 99-UNKNOWN OH- OTHER DLAR AMOUNT VILLAGE * WNSHIP * PERRYSBURG TWP CITY, VILLAGE, WNSHIP * COUNTY * 87 CITY * CRASH DATE * TIME OF CRASH DAY OF WEEK Tue DEGREES / MINUTES / SECONDS DECIMAL DEGREES O LATITUDE LONGITUDE LATITUDE O / // O / // R ROADWAY DIVISION DIVIDED LANE DIRECTION OF TRAVEL OF THRU LANES ROAD TYPES OR MILEPOST 2 DIVIDED N - NORTHBOUND E - EASTBOUND AL - ALLEY CR - CIRCLE UNDIVIDED S - SOUTHBOUND W - WESTBOUND AV - AVENUE CT - COURT BL - BOULEVARD DR - DRIVE US LOCATION ROUTE LOC PREFI LOCATION ROAD NAME LOCATION ROUTE N,S, TYPE E,W, DISTANCE REFERENCE REFERENCE POINT - INTERSECTION 2 - MILE POST - HOUSE ROAD CONUR - STRAIGHT LEVEL 2 - STRAIGHT GRADE - CURVE LEVEL MILES FEET YARDS MANNER 2OF CRASH CLISION/ - NOT CLISION BETWEEN TWO S IN TRANSPORT ROAD SURFACE OHIO - CONCRETE 2 - BLACKP, BITUMINOUS, ASPHALT - BRICK/ BLOCK TRAFFIC CRASH REPORT 728 PERRYSBURG WNSHIP PICE 0 25 DIR REF N,S, E,W, CRASH LOCATION 4 - CURVE GRADE O F 0 - NOT AN INTERSECTION REFERENCE ROUTE TYPE - FOUR-WAY INTERSECTION - T-INTERSECTION - Y-INTERSECTION - TRAFFIC CIRCLE/ROUNDABOUT 2 - END - HEAD ON SLAG, GRAVEL SNE 5 - DIRT 6 - OTHER ROAD CONDITIONS 5 - BACKING 6 - ANGLE REFERENCE ROUTE LONGITUDE FIVE POINT, OR MORE - ON RAMP - OFF RAMP 7 - SIDESWIPE, SAME DIRECTION LIGHT CONDITIONS - CROSSOVER 0 - DRIVEWAY/ ALLEY ACCESS REF PREFI 8 - SIDESWIPE, OPPOSITE DIRECTION N,S, E,W, - DAYLIGHT 2 - DAWN - DUSK - RAILWAY GRADE CROSSING 2 - SHARED-USE PATHS OR TRAILS 0 - DRY - WET - SNOW - ICE WEATHER 4 - DARK - LIGHTED ROADWAY HE - HEIGHTS HW- HIGHWAY LA - LANE LOCATION ROAD TYPE 2 MP - MILEPOST PK - PARKWAY PI - PIKE ROUTE TYPES PL - PLACE RD - ROAD SQ - SQUARE IR - INTERSTATE ROUTE ( INC. TURNPIKE ) US - US ROUTE SR - STATE ROUTE REFERENCE NAME ( ROAD, MILEPOST, HOUSE ) - SAND, MUD, DIRT, OIL, GRAVEL - WATER ( STANDING, MOVING ) - SLUSH - DEBRIS * - CLEAR 2 - CLOUDY - FOG, SMOG, SMOKE INTERSECTION RELATED 4 - RAIN 6 - SNOW 5 - DARK - ROADWAY NOT LIGHTED ST - STREET TE - TERRACE TL- TRAIL LOCATION OF - ON ROADWAY 2 - ON SHOULDER - IN MEDIAN 4 - ON ROADSIDE - RUT, HES, BUMPS, UNEVEN PAVEMANT * 0 - OTHER 5 - SLEET, HAIL 6 - DARK - UNKNOWN ROADWAY LIGHTING 7 - GLARE * 8 - OTHER LIME CITY SEVERE CROSSWINDS 8 - BLOWING SAND, SOIL, DIRT, SNOW 9 - OTHER/ UNKNOWN * CONDITION ONLY SCHO ZONE RELATED WA - WAY CR - ED COUNTY ROUTE TR - ED WNSHIP ROUTE RD REFERENCE ROAD TYPE ON GORE 6 - OUTSIDE TRAFFICWAY * CONDITION ONLY SCHO BUS RELATED YES, SCHO BUS DIRECTLY INVVED YES, SCHO BUS INDIRECTLY INVVED WORK ZONE RELATED WORKERS PRESENT LAW ENFORCEMENT PRESENT ( OFFICER/ VEHICLE ) LAW ENFORCEMENT PRESENT TYPE OF WORK ZONE - LANE CLOSURE 2 - LANE SHIFT/ CROSSOVER - WORK ON SHOULDER OR MEDIAN 4 - INTERMITTENT OR MOVING WORK 5 - OTHER LOCATION OF CRASH IN WORK ZONE - BEFORE THE WORK ZONE WARNING SIGN 2 - ADVANCE WARNING - TRANSITION 4 - ACTIVITY 5 - TERMINATION ( VEHICLE ONLY ) NARRATIVE Units, 2,, 4, and 5 were traveling Eastbound on US. Units 2,, 4, and 5 stopped at a red light at the intersection of US and Lime City Road. Unit failed to stop and rear-ended Unit 2, causing Unit 2 to rear-end Unit, causing Unit to rearend Unit 4 and causing Unit 4 to rear-end Unit 5. DIAGRAM WRITE AN ''N'' ON THE COMPASS DIAGRAM INDICATE THE DIRECTION OF NORTH REPORT TAKEN BY SUPPLEMENT ( CORRECTION OR ADDITION PICE AGENCY AN EISTING REPORT SENT ODPS ) OTHER INVESTIGATION TIME DATE CRASH REPORTED TIME CRASH REPORTED DISPATCH TIME ARRIVAL TIME TIME CLEARED TAL MINUTES 00 OFFICER'S NAME * OFFICER'S BADGE CHECKED BY WIDMER, DONNY HSY700 OH ( REV 0/2 ) GOTTFRIED, MONICA L Page: of 9

2 UNIT OWNER NAME: LAST,, MIDDLE OWNER PHONE - INC. CODE OWNER ADDRESS: CITY, STATE, ZIP LP STATE LICENSE PLATE VEHICLE IDENTIFICATION OH PIJ4788 FDWEFLEDA862 0 VEHICLE YEAR VEHICLE MAKE VEHICLE MODEL VEHICLE COR 2 FORD EC WHI PROOF OF INSURANCE COMPANY PICY WED BY INSURANCE SHOWN EMC INSURANCE Maddison Moters CARRIER NAME, US LOCATION PRIOR 0 PRE - CRASH S 0 OHIO 0 BECK SUPPLIES N ST FREMONT Ohio 44 VEHICLE WEIGHT GVWR / GCWR 2 - LESS THAN OR EQUAL 0K LBS. 2-0,00 26,000 LBS - MORE THAN 26,000 LBS. 0 - INTERSECTION - MARKED CROSSWALK - INTERSECTION - NO CROSSWALK - INTERSECTION - OTHER - MIDBLOCK - MARKED CROSSWALK - TRAVEL LANE - OTHER LOCATION - BICYCLE LANE - SHOULDER / ROADSIDE - SIDEWALK - MEDIAN / CROSSING ISLAND 0 - DRIVEWAY ACCESS - SHARED - USE PATH OR TRAIL 2 - NON - TRAFFICWAY 0 - NONE - TAI - RENTAL TRUCK ( OVER 0K LBS ) - BUS - SCHO ( PUBLIC OR PRIVATE ) - BUS - TRANSIT - BUS - CHARTER - BUS - SHUTTLE - BUS - OTHER 0 - STRAIGHT AHEAD - BACKING - CHANGING LANES - OVERTAKING / PASSING - MAKING RIGHT TURN - MAKING LEFT TURN - PERSONAL - GOVERNMENT - AMBULANCE 0 - FIRE - HIGHWAY / MAINTENANCE 2 - MILITARY - PICE 4 - PUBLIC UTILITY 5 - OTHER GOVERNMENT 6 - CONSTRUCTION EQUIP. - MAKING U - TURN - ENTERING TRAFFIC LANE - LEAVING TRAFFIC LANE 0 - PARKED - SLOWING OR SPPED IN TRAFFIC 2 - DRIVERLESS 0 - NO / NOT APPLICABLE - BUS / VAN ( 9-5 SEATS, INC DRIVER ) - BUS ( 6 + SEATS, INC DRIVER ) - VEHICLE WING ANOTHER VEHICLE - LOGGING - INTERMODAL CONTAINER CHASSIS - VAN / ENCLOSED BO - GRAIN, CHIPS, GRAVEL 0 - SUB - COMPACT - COMPACT - MID SIZE - FULL SIZE - MINIVAN - SPORT UTILITY VEHICLE - PICKUP - VAN MORIZED BICYCLE - SNOWMOBILE / ATV 2 - OTHER PASSENGER VEHICLE 7 - FARM VEHICLE 8 - FARM 9 - MORHOME - GF CART 2 - TRAIN 22 - OTHER ( EPLAIN IN NARRATIVE ) - NEGOTIATING A CURVE - PE 0 - TANK - FLAT BED 2 - DUMP DAMAGED - CONCRETE MIER 4 - AU TRANSPORTER 5 - GARBAGE / REFUSE - NONE - FUNCTIONAL DAMAGED 0 CARRIER PHONE - INCLUDE CODE - TWO - WAY, NOT DIVIDED - TWO - WAY, DIVIDED, UNPROTECTED ( PAINTED OR GRASS > 4 FT. ) MEDIAN MED / HEAVY TRUCKS OR COMBO UNITS > 0K LBS 0 - NONE - SINGLE UNIT TRUCK OR VAN 2ALE, 6 TIRES 4 - SINGLE UNIT TRUCK; + ALES 5 - SINGLE UNIT TRUCK / TRAILER 6 - TRUCK / TRACR ( BOBTAIL ) 7 - TRACR / SEMI - TRAILER 8 - TRACR / DOUBLE 9 - TRACR / TRIPLES - OTHER MED / HEAVY VEHICLE - CENTER - RIGHT - RIGHT SIDE - RIGHT - CENTER - LEFT - LEFT SIDE - LEFT 0 - P AND WINDOWS - UNDERCARRIAGE 2 - LOAD / TRAILER - TAL ( ALL S ) 5 - ENTERING OR CROSSING SPECIFIED LOCATION 6 - WALKING, RUNNING, JOGGING, PLAYING, CYCLING 7 - WORKING 8 - PUSHING VEHICLE 9 - APPROACHING OR LEAVING VEHICLE - STANDING 59 BECK SUPPLIES 000 N ST FREMONT Ohio BUS / VAN ( 9-5 SEATS, INC DRIVER ) 22 - BUS ( 6 + SEATS, INC DRIVER ) 2 - ANIMAL WITH RIDER 27 - OTHER - NON - CONTACT 2 - NON - CLISION - STRIKING 2 - OTHER 0 - NONE - FAILURE YIELD - RAN RED LIGHT - RAN SP SIGN - ECEEDED SPEED LIMIT - UNSAFE SPEED - IMPROPER TURN - LEFT OF CENTER - FLOWED CLOSELY / ACDA 0 - IMPROPER LANE CHANGE - IMPROPER BACKING 2 - IMPROPER START PARKED POSITION - SPPED OR PARKED ILLEGALLY 4 - OPERATING VEHICLE IN NEGLIGENT MANNER 5 - SWERVING AVOID ( DUE ETERNAL CONDITIONS ) 6 - WRONG SIDE / WRONG WAY 7 - FAILURE CONTR 8 - VISION OBSTRUCTION 9 - OPERATING DEFECTIVE - LOAD SHIFTING / FALLING / SPILLING 2 - OTHER IMPROPER 2 - IMPROPER CROSSING 26 - FAILURE YIELD RIGHT OF WAY 29 - FAILURE OBEY TRAFFIC SIGNS 0 - WRONG SIDE OF THE ROAD - OTHER 0 - TURN SIGNALS - HEAD LAMPS - TAIL LAMPS - BRAKES - STEERING - TIRE BLOWOUT - WORN OR SLICK TIRES - TRAILER DEFECTIVE - MOR TROUBLE 0 - DISABLED PRIOR ACCIDENT - OTHER DEFECTS SEQUENCE OF S NON - CLISION S 0 - OVERTURN / RLOVER - FIRE / EPLOSION - IMMERSION - JACKNIFE - / LOSS OR SHIFT - FAILURE - SEPERATION OF UNITS - RAN OFF ROAD RIGHT - RAN OFF ROAD LEFT 0 - CROSS MEDIAN - CROSS CENTER LINE 2 - DOWNHILL RUNAWAY - OTHER NON - CLISION CLISION WITH PERSON, VEHICLE OR OBJECT NOT FIED 4 - PEDESTRIAN 2 - PARKED 5 - PEDALCYCLE 22 - WORK ZONE MAINTENANCE 6 - RAILWAY VEHICLE ( TRAIN, ENGINE ) 2 - STRUCK BY FALLING, SHIFTING 7 - ANIMAL - FARM 8 - ANIMAL - DEER 2 MOVABLE OBJECT 9 - ANIMAL - OTHER - IN TRANSPORT CLISION WITH FIED OBJECT 25 - ATTENUAR / CRASH CUSHION 0 - GUARDRAIL FACE - GUARDRAIL END 2 - PORTABLE BARRIER - MEDIAN CABLE BARRIER 4 - MEDIAN GUARDRAIL BARRIER 5 - MEDIAN CONCRETE BARRIER 6 - MEDIAN OTHER BARRIER 7 - TRAFFIC SIGN POST 8 - OVERHEAD SIGN POST 9 - LIGHT / LUMINARIES SUPPORT 40 - UTILITY PE POST, PE 4 - CURB 47 - MAILBO 5 - WALL, BUILDING, TUNNEL 52 - OTHER FIED OBJECT TRAFFIC CONTR NORTH 5 - NORTHEAST 0 - NO CONTRS - RAILROAD CROSSBUCKS - CROSSWALK LINES - SP SIGN - RAILROAD FLASHERS 4 - WALK / DON'T WALK - YIELD SIGN - RAILROAD GATES 5 - OTHER - EAST 7 - SOUTHEAST - TRAFFIC SIGNAL 6 - NOT REPORTED 0 - CONSTRUCTION BARRICADE 4 - WEST 8 - SOUTHWEST - TRAFFIC FLASHERS - PERSON ( FLAGGER, OFFICER ) - SCHO ZONE 2 - PAVEMENT MARKINGS Page: 2 of 9 HSY8 OHU ( REV 0/2 ) 4

3 UNIT MOBUS SHEILA M OWNER NAME: LAST,, MIDDLE OWNER PHONE - INC. CODE OWNER ADDRESS: CITY, STATE, ZIP 97 FOSRIA RD PEMBERVILLE Ohio LP STATE LICENSE PLATE VEHICLE IDENTIFICATION OH GQU8574 B7HL822S VEHICLE YEAR VEHICLE MAKE VEHICLE MODEL VEHICLE COR DODG DAK GRY PROOF OF INSURANCE COMPANY PICY WED BY INSURANCE SHOWN PROGRESSIVE VJ'S WING 59 - NONE - FUNCTIONAL DAMAGED 0 CARRIER NAME, CARRIER PHONE - INCLUDE CODE 4 US VEHICLE WEIGHT LOCATION PRIOR 0 PRE - CRASH S GVWR / GCWR - LESS THAN OR EQUAL 0K LBS. 2-0,00 26,000 LBS - MORE THAN 26,000 LBS. 0 - INTERSECTION - MARKED CROSSWALK - INTERSECTION - NO CROSSWALK - INTERSECTION - OTHER - MIDBLOCK - MARKED CROSSWALK - TRAVEL LANE - OTHER LOCATION - BICYCLE LANE - SHOULDER / ROADSIDE - SIDEWALK - MEDIAN / CROSSING ISLAND 0 - DRIVEWAY ACCESS - SHARED - USE PATH OR TRAIL 2 - NON - TRAFFICWAY 0 - NONE - TAI - RENTAL TRUCK ( OVER 0K LBS ) - BUS - SCHO ( PUBLIC OR PRIVATE ) - BUS - TRANSIT - BUS - CHARTER - BUS - SHUTTLE - BUS - OTHER 0 - STRAIGHT AHEAD - BACKING - CHANGING LANES - OVERTAKING / PASSING - MAKING RIGHT TURN - MAKING LEFT TURN - PERSONAL - GOVERNMENT - AMBULANCE 0 - FIRE - HIGHWAY / MAINTENANCE 2 - MILITARY - PICE 4 - PUBLIC UTILITY 5 - OTHER GOVERNMENT 6 - CONSTRUCTION EQUIP. - MAKING U - TURN - ENTERING TRAFFIC LANE - LEAVING TRAFFIC LANE 0 - PARKED - SLOWING OR SPPED IN TRAFFIC 2 - DRIVERLESS NO / NOT APPLICABLE - BUS / VAN ( 9-5 SEATS, INC DRIVER ) - BUS ( 6 + SEATS, INC DRIVER ) - VEHICLE WING ANOTHER VEHICLE - LOGGING - INTERMODAL CONTAINER CHASSIS - VAN / ENCLOSED BO - GRAIN, CHIPS, GRAVEL 0 - SUB - COMPACT - COMPACT - MID SIZE - FULL SIZE - MINIVAN - SPORT UTILITY VEHICLE - PICKUP - VAN MORIZED BICYCLE - SNOWMOBILE / ATV 2 - OTHER PASSENGER VEHICLE 7 - FARM VEHICLE 8 - FARM 9 - MORHOME - GF CART 2 - TRAIN 22 - OTHER ( EPLAIN IN NARRATIVE ) - NEGOTIATING A CURVE - PE 0 - TANK - FLAT BED 2 - DUMP DAMAGED - CONCRETE MIER 4 - AU TRANSPORTER 5 - GARBAGE / REFUSE - TWO - WAY, NOT DIVIDED - TWO - WAY, DIVIDED, UNPROTECTED ( PAINTED OR GRASS > 4 FT. ) MEDIAN MED / HEAVY TRUCKS OR COMBO UNITS > 0K LBS 0 - NONE - SINGLE UNIT TRUCK OR VAN 2ALE, 6 TIRES 4 - SINGLE UNIT TRUCK; + ALES 5 - SINGLE UNIT TRUCK / TRAILER 6 - TRUCK / TRACR ( BOBTAIL ) 7 - TRACR / SEMI - TRAILER 8 - TRACR / DOUBLE 9 - TRACR / TRIPLES - OTHER MED / HEAVY VEHICLE - CENTER - RIGHT - RIGHT SIDE - RIGHT - CENTER - LEFT - LEFT SIDE - LEFT 0 - P AND WINDOWS - UNDERCARRIAGE 2 - LOAD / TRAILER - TAL ( ALL S ) 5 - ENTERING OR CROSSING SPECIFIED LOCATION 6 - WALKING, RUNNING, JOGGING, PLAYING, CYCLING 7 - WORKING 8 - PUSHING VEHICLE 9 - APPROACHING OR LEAVING VEHICLE - STANDING 2 - BUS / VAN ( 9-5 SEATS, INC DRIVER ) 22 - BUS ( 6 + SEATS, INC DRIVER ) 2 - ANIMAL WITH RIDER 27 - OTHER 5 - NON - CONTACT 2 - NON - CLISION - STRIKING 2 - OTHER NONE - FAILURE YIELD - RAN RED LIGHT - RAN SP SIGN - ECEEDED SPEED LIMIT - UNSAFE SPEED - IMPROPER TURN - LEFT OF CENTER - FLOWED CLOSELY / ACDA 0 - IMPROPER LANE CHANGE - IMPROPER BACKING 2 - IMPROPER START PARKED POSITION - SPPED OR PARKED ILLEGALLY 4 - OPERATING VEHICLE IN NEGLIGENT MANNER 5 - SWERVING AVOID ( DUE ETERNAL CONDITIONS ) 6 - WRONG SIDE / WRONG WAY 7 - FAILURE CONTR 8 - VISION OBSTRUCTION 9 - OPERATING DEFECTIVE - LOAD SHIFTING / FALLING / SPILLING 2 - OTHER IMPROPER 2 - IMPROPER CROSSING 26 - FAILURE YIELD RIGHT OF WAY 29 - FAILURE OBEY TRAFFIC SIGNS 0 - WRONG SIDE OF THE ROAD - OTHER 0 - TURN SIGNALS - HEAD LAMPS - TAIL LAMPS - BRAKES - STEERING - TIRE BLOWOUT - WORN OR SLICK TIRES - TRAILER DEFECTIVE - MOR TROUBLE 0 - DISABLED PRIOR ACCIDENT - OTHER DEFECTS SEQUENCE OF S NON - CLISION S 0 - OVERTURN / RLOVER - FIRE / EPLOSION - IMMERSION - JACKNIFE - / LOSS OR SHIFT - FAILURE - SEPERATION OF UNITS - RAN OFF ROAD RIGHT - RAN OFF ROAD LEFT 0 - CROSS MEDIAN - CROSS CENTER LINE 2 - DOWNHILL RUNAWAY - OTHER NON - CLISION CLISION WITH PERSON, VEHICLE OR OBJECT NOT FIED 4 - PEDESTRIAN 2 - PARKED 5 - PEDALCYCLE 22 - WORK ZONE MAINTENANCE 6 - RAILWAY VEHICLE ( TRAIN, ENGINE ) 2 - STRUCK BY FALLING, SHIFTING 7 - ANIMAL - FARM 8 - ANIMAL - DEER 2 MOVABLE OBJECT 9 - ANIMAL - OTHER - IN TRANSPORT CLISION WITH FIED OBJECT 25 - ATTENUAR / CRASH CUSHION 0 - GUARDRAIL FACE - GUARDRAIL END 2 - PORTABLE BARRIER - MEDIAN CABLE BARRIER 4 - MEDIAN GUARDRAIL BARRIER 5 - MEDIAN CONCRETE BARRIER 6 - MEDIAN OTHER BARRIER 7 - TRAFFIC SIGN POST 8 - OVERHEAD SIGN POST 9 - LIGHT / LUMINARIES SUPPORT 40 - UTILITY PE POST, PE 4 - CURB 47 - MAILBO 5 - WALL, BUILDING, TUNNEL 52 - OTHER FIED OBJECT 5 55 TRAFFIC CONTR 0 - NO CONTRS - RAILROAD CROSSBUCKS - SP SIGN - RAILROAD FLASHERS - YIELD SIGN - RAILROAD GATES - TRAFFIC SIGNAL 0 - CONSTRUCTION BARRICADE - TRAFFIC FLASHERS - PERSON ( FLAGGER, OFFICER ) - SCHO ZONE 2 - PAVEMENT MARKINGS - CROSSWALK LINES 4 - WALK / DON'T WALK 5 - OTHER 6 - NOT REPORTED 4 - NORTH - EAST 4 - WEST 5 - NORTHEAST 7 - SOUTHEAST 8 - SOUTHWEST Page: of 9 HSY8 OHU ( REV 0/2 )

4 UNIT KATAKIS VICRIA L OWNER NAME: LAST,, MIDDLE OWNER PHONE - INC. CODE OWNER ADDRESS: CITY, STATE, ZIP 2440 LEMOYNE RD PERRYSBURG Ohio LP STATE LICENSE PLATE VEHICLE IDENTIFICATION OH DIB80 HGCR2F8FA796 0 VEHICLE YEAR VEHICLE MAKE VEHICLE MODEL VEHICLE COR 5 HOND CLS WHI PROOF OF INSURANCE COMPANY PICY WED BY INSURANCE SHOWN FARMERS INS PAT & SONS 59 - NONE - FUNCTIONAL DAMAGED 0 CARRIER NAME, CARRIER PHONE - INCLUDE CODE 4 US VEHICLE WEIGHT LOCATION PRIOR 0 PRE - CRASH S GVWR / GCWR - LESS THAN OR EQUAL 0K LBS. 2-0,00 26,000 LBS - MORE THAN 26,000 LBS. 0 - INTERSECTION - MARKED CROSSWALK - INTERSECTION - NO CROSSWALK - INTERSECTION - OTHER - MIDBLOCK - MARKED CROSSWALK - TRAVEL LANE - OTHER LOCATION - BICYCLE LANE - SHOULDER / ROADSIDE - SIDEWALK - MEDIAN / CROSSING ISLAND 0 - DRIVEWAY ACCESS - SHARED - USE PATH OR TRAIL 2 - NON - TRAFFICWAY 0 - NONE - TAI - RENTAL TRUCK ( OVER 0K LBS ) - BUS - SCHO ( PUBLIC OR PRIVATE ) - BUS - TRANSIT - BUS - CHARTER - BUS - SHUTTLE - BUS - OTHER 0 - STRAIGHT AHEAD - BACKING - CHANGING LANES - OVERTAKING / PASSING - MAKING RIGHT TURN - MAKING LEFT TURN - PERSONAL - GOVERNMENT - AMBULANCE 0 - FIRE - HIGHWAY / MAINTENANCE 2 - MILITARY - PICE 4 - PUBLIC UTILITY 5 - OTHER GOVERNMENT 6 - CONSTRUCTION EQUIP. - MAKING U - TURN - ENTERING TRAFFIC LANE - LEAVING TRAFFIC LANE 0 - PARKED - SLOWING OR SPPED IN TRAFFIC 2 - DRIVERLESS NO / NOT APPLICABLE - BUS / VAN ( 9-5 SEATS, INC DRIVER ) - BUS ( 6 + SEATS, INC DRIVER ) - VEHICLE WING ANOTHER VEHICLE - LOGGING - INTERMODAL CONTAINER CHASSIS - VAN / ENCLOSED BO - GRAIN, CHIPS, GRAVEL 0 - SUB - COMPACT - COMPACT - MID SIZE - FULL SIZE - MINIVAN - SPORT UTILITY VEHICLE - PICKUP - VAN MORIZED BICYCLE - SNOWMOBILE / ATV 2 - OTHER PASSENGER VEHICLE 7 - FARM VEHICLE 8 - FARM 9 - MORHOME - GF CART 2 - TRAIN 22 - OTHER ( EPLAIN IN NARRATIVE ) - NEGOTIATING A CURVE - PE 0 - TANK - FLAT BED 2 - DUMP DAMAGED - CONCRETE MIER 4 - AU TRANSPORTER 5 - GARBAGE / REFUSE - TWO - WAY, NOT DIVIDED - TWO - WAY, DIVIDED, UNPROTECTED ( PAINTED OR GRASS > 4 FT. ) MEDIAN MED / HEAVY TRUCKS OR COMBO UNITS > 0K LBS 0 - NONE - SINGLE UNIT TRUCK OR VAN 2ALE, 6 TIRES 4 - SINGLE UNIT TRUCK; + ALES 5 - SINGLE UNIT TRUCK / TRAILER 6 - TRUCK / TRACR ( BOBTAIL ) 7 - TRACR / SEMI - TRAILER 8 - TRACR / DOUBLE 9 - TRACR / TRIPLES - OTHER MED / HEAVY VEHICLE - CENTER - RIGHT - RIGHT SIDE - RIGHT - CENTER - LEFT - LEFT SIDE - LEFT 0 - P AND WINDOWS - UNDERCARRIAGE 2 - LOAD / TRAILER - TAL ( ALL S ) 5 - ENTERING OR CROSSING SPECIFIED LOCATION 6 - WALKING, RUNNING, JOGGING, PLAYING, CYCLING 7 - WORKING 8 - PUSHING VEHICLE 9 - APPROACHING OR LEAVING VEHICLE - STANDING 2 - BUS / VAN ( 9-5 SEATS, INC DRIVER ) 22 - BUS ( 6 + SEATS, INC DRIVER ) 2 - ANIMAL WITH RIDER 27 - OTHER 5 - NON - CONTACT 2 - NON - CLISION - STRIKING 2 - OTHER NONE - FAILURE YIELD - RAN RED LIGHT - RAN SP SIGN - ECEEDED SPEED LIMIT - UNSAFE SPEED - IMPROPER TURN - LEFT OF CENTER - FLOWED CLOSELY / ACDA 0 - IMPROPER LANE CHANGE - IMPROPER BACKING 2 - IMPROPER START PARKED POSITION - SPPED OR PARKED ILLEGALLY 4 - OPERATING VEHICLE IN NEGLIGENT MANNER 5 - SWERVING AVOID ( DUE ETERNAL CONDITIONS ) 6 - WRONG SIDE / WRONG WAY 7 - FAILURE CONTR 8 - VISION OBSTRUCTION 9 - OPERATING DEFECTIVE - LOAD SHIFTING / FALLING / SPILLING 2 - OTHER IMPROPER 2 - IMPROPER CROSSING 26 - FAILURE YIELD RIGHT OF WAY 29 - FAILURE OBEY TRAFFIC SIGNS 0 - WRONG SIDE OF THE ROAD - OTHER 0 - TURN SIGNALS - HEAD LAMPS - TAIL LAMPS - BRAKES - STEERING - TIRE BLOWOUT - WORN OR SLICK TIRES - TRAILER DEFECTIVE - MOR TROUBLE 0 - DISABLED PRIOR ACCIDENT - OTHER DEFECTS SEQUENCE OF S NON - CLISION S 0 - OVERTURN / RLOVER - FIRE / EPLOSION - IMMERSION - JACKNIFE - / LOSS OR SHIFT - FAILURE - SEPERATION OF UNITS - RAN OFF ROAD RIGHT - RAN OFF ROAD LEFT 0 - CROSS MEDIAN - CROSS CENTER LINE 2 - DOWNHILL RUNAWAY - OTHER NON - CLISION CLISION WITH PERSON, VEHICLE OR OBJECT NOT FIED 4 - PEDESTRIAN 2 - PARKED 5 - PEDALCYCLE 22 - WORK ZONE MAINTENANCE 6 - RAILWAY VEHICLE ( TRAIN, ENGINE ) 2 - STRUCK BY FALLING, SHIFTING 7 - ANIMAL - FARM 8 - ANIMAL - DEER 2 MOVABLE OBJECT 9 - ANIMAL - OTHER - IN TRANSPORT CLISION WITH FIED OBJECT 25 - ATTENUAR / CRASH CUSHION 0 - GUARDRAIL FACE - GUARDRAIL END 2 - PORTABLE BARRIER - MEDIAN CABLE BARRIER 4 - MEDIAN GUARDRAIL BARRIER 5 - MEDIAN CONCRETE BARRIER 6 - MEDIAN OTHER BARRIER 7 - TRAFFIC SIGN POST 8 - OVERHEAD SIGN POST 9 - LIGHT / LUMINARIES SUPPORT 40 - UTILITY PE POST, PE 4 - CURB 47 - MAILBO 5 - WALL, BUILDING, TUNNEL 52 - OTHER FIED OBJECT 0 55 TRAFFIC CONTR 0 - NO CONTRS - RAILROAD CROSSBUCKS - SP SIGN - RAILROAD FLASHERS - YIELD SIGN - RAILROAD GATES - TRAFFIC SIGNAL 0 - CONSTRUCTION BARRICADE - TRAFFIC FLASHERS - PERSON ( FLAGGER, OFFICER ) - SCHO ZONE 2 - PAVEMENT MARKINGS - CROSSWALK LINES 4 - WALK / DON'T WALK 5 - OTHER 6 - NOT REPORTED 4 - NORTH - EAST 4 - WEST 5 - NORTHEAST 7 - SOUTHEAST 8 - SOUTHWEST Page: 4 of 9 HSY8 OHU ( REV 0/2 )

5 UNIT PZIN DAVID A OWNER NAME: LAST,, MIDDLE OWNER PHONE - INC. CODE OWNER ADDRESS: CITY, STATE, ZIP 2674 THOMPSON RD PERRYSBURG Ohio 455 LP STATE LICENSE PLATE VEHICLE IDENTIFICATION OH EF90 JTDKNDU5A VEHICLE YEAR VEHICLE MAKE VEHICLE MODEL VEHICLE COR 0 YT PRI DBU PROOF OF INSURANCE COMPANY PICY WED BY INSURANCE SHOWN GRANGE MUTUAL INSURANCE PA254 PAT & SONS 59 - NONE - FUNCTIONAL DAMAGED 0 CARRIER NAME, CARRIER PHONE - INCLUDE CODE 4 US VEHICLE WEIGHT LOCATION PRIOR 0 PRE - CRASH S GVWR / GCWR - LESS THAN OR EQUAL 0K LBS. 2-0,00 26,000 LBS - MORE THAN 26,000 LBS. 0 - INTERSECTION - MARKED CROSSWALK - INTERSECTION - NO CROSSWALK - INTERSECTION - OTHER - MIDBLOCK - MARKED CROSSWALK - TRAVEL LANE - OTHER LOCATION - BICYCLE LANE - SHOULDER / ROADSIDE - SIDEWALK - MEDIAN / CROSSING ISLAND 0 - DRIVEWAY ACCESS - SHARED - USE PATH OR TRAIL 2 - NON - TRAFFICWAY 0 - NONE - TAI - RENTAL TRUCK ( OVER 0K LBS ) - BUS - SCHO ( PUBLIC OR PRIVATE ) - BUS - TRANSIT - BUS - CHARTER - BUS - SHUTTLE - BUS - OTHER 0 - STRAIGHT AHEAD - BACKING - CHANGING LANES - OVERTAKING / PASSING - MAKING RIGHT TURN - MAKING LEFT TURN - PERSONAL - GOVERNMENT - AMBULANCE 0 - FIRE - HIGHWAY / MAINTENANCE 2 - MILITARY - PICE 4 - PUBLIC UTILITY 5 - OTHER GOVERNMENT 6 - CONSTRUCTION EQUIP. - MAKING U - TURN - ENTERING TRAFFIC LANE - LEAVING TRAFFIC LANE 0 - PARKED - SLOWING OR SPPED IN TRAFFIC 2 - DRIVERLESS NO / NOT APPLICABLE - BUS / VAN ( 9-5 SEATS, INC DRIVER ) - BUS ( 6 + SEATS, INC DRIVER ) - VEHICLE WING ANOTHER VEHICLE - LOGGING - INTERMODAL CONTAINER CHASSIS - VAN / ENCLOSED BO - GRAIN, CHIPS, GRAVEL 0 - SUB - COMPACT - COMPACT - MID SIZE - FULL SIZE - MINIVAN - SPORT UTILITY VEHICLE - PICKUP - VAN MORIZED BICYCLE - SNOWMOBILE / ATV 2 - OTHER PASSENGER VEHICLE 7 - FARM VEHICLE 8 - FARM 9 - MORHOME - GF CART 2 - TRAIN 22 - OTHER ( EPLAIN IN NARRATIVE ) - NEGOTIATING A CURVE - PE 0 - TANK - FLAT BED 2 - DUMP DAMAGED - CONCRETE MIER 4 - AU TRANSPORTER 5 - GARBAGE / REFUSE - TWO - WAY, NOT DIVIDED - TWO - WAY, DIVIDED, UNPROTECTED ( PAINTED OR GRASS > 4 FT. ) MEDIAN MED / HEAVY TRUCKS OR COMBO UNITS > 0K LBS 0 - NONE - SINGLE UNIT TRUCK OR VAN 2ALE, 6 TIRES 4 - SINGLE UNIT TRUCK; + ALES 5 - SINGLE UNIT TRUCK / TRAILER 6 - TRUCK / TRACR ( BOBTAIL ) 7 - TRACR / SEMI - TRAILER 8 - TRACR / DOUBLE 9 - TRACR / TRIPLES - OTHER MED / HEAVY VEHICLE - CENTER - RIGHT - RIGHT SIDE - RIGHT - CENTER - LEFT - LEFT SIDE - LEFT 0 - P AND WINDOWS - UNDERCARRIAGE 2 - LOAD / TRAILER - TAL ( ALL S ) 5 - ENTERING OR CROSSING SPECIFIED LOCATION 6 - WALKING, RUNNING, JOGGING, PLAYING, CYCLING 7 - WORKING 8 - PUSHING VEHICLE 9 - APPROACHING OR LEAVING VEHICLE - STANDING 2 - BUS / VAN ( 9-5 SEATS, INC DRIVER ) 22 - BUS ( 6 + SEATS, INC DRIVER ) 2 - ANIMAL WITH RIDER 27 - OTHER 5 - NON - CONTACT 2 - NON - CLISION - STRIKING 2 - OTHER NONE - FAILURE YIELD - RAN RED LIGHT - RAN SP SIGN - ECEEDED SPEED LIMIT - UNSAFE SPEED - IMPROPER TURN - LEFT OF CENTER - FLOWED CLOSELY / ACDA 0 - IMPROPER LANE CHANGE - IMPROPER BACKING 2 - IMPROPER START PARKED POSITION - SPPED OR PARKED ILLEGALLY 4 - OPERATING VEHICLE IN NEGLIGENT MANNER 5 - SWERVING AVOID ( DUE ETERNAL CONDITIONS ) 6 - WRONG SIDE / WRONG WAY 7 - FAILURE CONTR 8 - VISION OBSTRUCTION 9 - OPERATING DEFECTIVE - LOAD SHIFTING / FALLING / SPILLING 2 - OTHER IMPROPER 2 - IMPROPER CROSSING 26 - FAILURE YIELD RIGHT OF WAY 29 - FAILURE OBEY TRAFFIC SIGNS 0 - WRONG SIDE OF THE ROAD - OTHER 0 - TURN SIGNALS - HEAD LAMPS - TAIL LAMPS - BRAKES - STEERING - TIRE BLOWOUT - WORN OR SLICK TIRES - TRAILER DEFECTIVE - MOR TROUBLE 0 - DISABLED PRIOR ACCIDENT - OTHER DEFECTS SEQUENCE OF S NON - CLISION S 0 - OVERTURN / RLOVER - FIRE / EPLOSION - IMMERSION - JACKNIFE - / LOSS OR SHIFT - FAILURE - SEPERATION OF UNITS - RAN OFF ROAD RIGHT - RAN OFF ROAD LEFT 0 - CROSS MEDIAN - CROSS CENTER LINE 2 - DOWNHILL RUNAWAY - OTHER NON - CLISION CLISION WITH PERSON, VEHICLE OR OBJECT NOT FIED 4 - PEDESTRIAN 2 - PARKED 5 - PEDALCYCLE 22 - WORK ZONE MAINTENANCE 6 - RAILWAY VEHICLE ( TRAIN, ENGINE ) 2 - STRUCK BY FALLING, SHIFTING 7 - ANIMAL - FARM 8 - ANIMAL - DEER 2 MOVABLE OBJECT 9 - ANIMAL - OTHER - IN TRANSPORT CLISION WITH FIED OBJECT 25 - ATTENUAR / CRASH CUSHION 0 - GUARDRAIL FACE - GUARDRAIL END 2 - PORTABLE BARRIER - MEDIAN CABLE BARRIER 4 - MEDIAN GUARDRAIL BARRIER 5 - MEDIAN CONCRETE BARRIER 6 - MEDIAN OTHER BARRIER 7 - TRAFFIC SIGN POST 8 - OVERHEAD SIGN POST 9 - LIGHT / LUMINARIES SUPPORT 40 - UTILITY PE POST, PE 4 - CURB 47 - MAILBO 5 - WALL, BUILDING, TUNNEL 52 - OTHER FIED OBJECT 0 55 TRAFFIC CONTR 0 - NO CONTRS - RAILROAD CROSSBUCKS - SP SIGN - RAILROAD FLASHERS - YIELD SIGN - RAILROAD GATES - TRAFFIC SIGNAL 0 - CONSTRUCTION BARRICADE - TRAFFIC FLASHERS - PERSON ( FLAGGER, OFFICER ) - SCHO ZONE 2 - PAVEMENT MARKINGS - CROSSWALK LINES 4 - WALK / DON'T WALK 5 - OTHER 6 - NOT REPORTED 4 - NORTH - EAST 4 - WEST 5 - NORTHEAST 7 - SOUTHEAST 8 - SOUTHWEST Page: 5 of 9 HSY8 OHU ( REV 0/2 )

6 UNIT DAMSCHRODER JAMES L OWNER NAME: LAST,, MIDDLE OWNER PHONE - INC. CODE OWNER ADDRESS: CITY, STATE, ZIP PINE RD WOODVILLE Ohio 4469 LP STATE LICENSE PLATE VEHICLE IDENTIFICATION OH BDY5 GCCS VEHICLE YEAR VEHICLE MAKE VEHICLE MODEL VEHICLE COR CHEV SIL SIL PROOF OF INSURANCE COMPANY PICY WED BY INSURANCE SHOWN AU OWNERS INSURANCE NONE - FUNCTIONAL DAMAGED 0 CARRIER NAME, CARRIER PHONE - INCLUDE CODE US VEHICLE WEIGHT LOCATION PRIOR 0 PRE - CRASH S GVWR / GCWR - LESS THAN OR EQUAL 0K LBS. 2-0,00 26,000 LBS - MORE THAN 26,000 LBS. 0 - INTERSECTION - MARKED CROSSWALK - INTERSECTION - NO CROSSWALK - INTERSECTION - OTHER - MIDBLOCK - MARKED CROSSWALK - TRAVEL LANE - OTHER LOCATION - BICYCLE LANE - SHOULDER / ROADSIDE - SIDEWALK - MEDIAN / CROSSING ISLAND 0 - DRIVEWAY ACCESS - SHARED - USE PATH OR TRAIL 2 - NON - TRAFFICWAY 0 - NONE - TAI - RENTAL TRUCK ( OVER 0K LBS ) - BUS - SCHO ( PUBLIC OR PRIVATE ) - BUS - TRANSIT - BUS - CHARTER - BUS - SHUTTLE - BUS - OTHER 0 - STRAIGHT AHEAD - BACKING - CHANGING LANES - OVERTAKING / PASSING - MAKING RIGHT TURN - MAKING LEFT TURN - PERSONAL - GOVERNMENT - AMBULANCE 0 - FIRE - HIGHWAY / MAINTENANCE 2 - MILITARY - PICE 4 - PUBLIC UTILITY 5 - OTHER GOVERNMENT 6 - CONSTRUCTION EQUIP. - MAKING U - TURN - ENTERING TRAFFIC LANE - LEAVING TRAFFIC LANE 0 - PARKED - SLOWING OR SPPED IN TRAFFIC 2 - DRIVERLESS NO / NOT APPLICABLE - BUS / VAN ( 9-5 SEATS, INC DRIVER ) - BUS ( 6 + SEATS, INC DRIVER ) - VEHICLE WING ANOTHER VEHICLE - LOGGING - INTERMODAL CONTAINER CHASSIS - VAN / ENCLOSED BO - GRAIN, CHIPS, GRAVEL 0 - SUB - COMPACT - COMPACT - MID SIZE - FULL SIZE - MINIVAN - SPORT UTILITY VEHICLE - PICKUP - VAN MORIZED BICYCLE - SNOWMOBILE / ATV 2 - OTHER PASSENGER VEHICLE 7 - FARM VEHICLE 8 - FARM 9 - MORHOME - GF CART 2 - TRAIN 22 - OTHER ( EPLAIN IN NARRATIVE ) - NEGOTIATING A CURVE - PE 0 - TANK - FLAT BED 2 - DUMP DAMAGED - CONCRETE MIER 4 - AU TRANSPORTER 5 - GARBAGE / REFUSE - TWO - WAY, NOT DIVIDED - TWO - WAY, DIVIDED, UNPROTECTED ( PAINTED OR GRASS > 4 FT. ) MEDIAN MED / HEAVY TRUCKS OR COMBO UNITS > 0K LBS 0 - NONE - SINGLE UNIT TRUCK OR VAN 2ALE, 6 TIRES 4 - SINGLE UNIT TRUCK; + ALES 5 - SINGLE UNIT TRUCK / TRAILER 6 - TRUCK / TRACR ( BOBTAIL ) 7 - TRACR / SEMI - TRAILER 8 - TRACR / DOUBLE 9 - TRACR / TRIPLES - OTHER MED / HEAVY VEHICLE - CENTER - RIGHT - RIGHT SIDE - RIGHT - CENTER - LEFT - LEFT SIDE - LEFT 0 - P AND WINDOWS - UNDERCARRIAGE 2 - LOAD / TRAILER - TAL ( ALL S ) 5 - ENTERING OR CROSSING SPECIFIED LOCATION 6 - WALKING, RUNNING, JOGGING, PLAYING, CYCLING 7 - WORKING 8 - PUSHING VEHICLE 9 - APPROACHING OR LEAVING VEHICLE - STANDING 2 - BUS / VAN ( 9-5 SEATS, INC DRIVER ) 22 - BUS ( 6 + SEATS, INC DRIVER ) 2 - ANIMAL WITH RIDER 27 - OTHER 4 - NON - CONTACT 2 - NON - CLISION - STRIKING 2 - OTHER NONE - FAILURE YIELD - RAN RED LIGHT - RAN SP SIGN - ECEEDED SPEED LIMIT - UNSAFE SPEED - IMPROPER TURN - LEFT OF CENTER - FLOWED CLOSELY / ACDA 0 - IMPROPER LANE CHANGE - IMPROPER BACKING 2 - IMPROPER START PARKED POSITION - SPPED OR PARKED ILLEGALLY 4 - OPERATING VEHICLE IN NEGLIGENT MANNER 5 - SWERVING AVOID ( DUE ETERNAL CONDITIONS ) 6 - WRONG SIDE / WRONG WAY 7 - FAILURE CONTR 8 - VISION OBSTRUCTION 9 - OPERATING DEFECTIVE - LOAD SHIFTING / FALLING / SPILLING 2 - OTHER IMPROPER 2 - IMPROPER CROSSING 26 - FAILURE YIELD RIGHT OF WAY 29 - FAILURE OBEY TRAFFIC SIGNS 0 - WRONG SIDE OF THE ROAD - OTHER 0 - TURN SIGNALS - HEAD LAMPS - TAIL LAMPS - BRAKES - STEERING - TIRE BLOWOUT - WORN OR SLICK TIRES - TRAILER DEFECTIVE - MOR TROUBLE 0 - DISABLED PRIOR ACCIDENT - OTHER DEFECTS SEQUENCE OF S NON - CLISION S 0 - OVERTURN / RLOVER - FIRE / EPLOSION - IMMERSION - JACKNIFE - / LOSS OR SHIFT - FAILURE - SEPERATION OF UNITS - RAN OFF ROAD RIGHT - RAN OFF ROAD LEFT 0 - CROSS MEDIAN - CROSS CENTER LINE 2 - DOWNHILL RUNAWAY - OTHER NON - CLISION CLISION WITH PERSON, VEHICLE OR OBJECT NOT FIED 4 - PEDESTRIAN 2 - PARKED 5 - PEDALCYCLE 22 - WORK ZONE MAINTENANCE 6 - RAILWAY VEHICLE ( TRAIN, ENGINE ) 2 - STRUCK BY FALLING, SHIFTING 7 - ANIMAL - FARM 8 - ANIMAL - DEER 2 MOVABLE OBJECT 9 - ANIMAL - OTHER - IN TRANSPORT CLISION WITH FIED OBJECT 25 - ATTENUAR / CRASH CUSHION 0 - GUARDRAIL FACE - GUARDRAIL END 2 - PORTABLE BARRIER - MEDIAN CABLE BARRIER 4 - MEDIAN GUARDRAIL BARRIER 5 - MEDIAN CONCRETE BARRIER 6 - MEDIAN OTHER BARRIER 7 - TRAFFIC SIGN POST 8 - OVERHEAD SIGN POST 9 - LIGHT / LUMINARIES SUPPORT 40 - UTILITY PE POST, PE 4 - CURB 47 - MAILBO 5 - WALL, BUILDING, TUNNEL 52 - OTHER FIED OBJECT 5 55 TRAFFIC CONTR 0 - NO CONTRS - RAILROAD CROSSBUCKS - SP SIGN - RAILROAD FLASHERS - YIELD SIGN - RAILROAD GATES - TRAFFIC SIGNAL 0 - CONSTRUCTION BARRICADE - TRAFFIC FLASHERS - PERSON ( FLAGGER, OFFICER ) - SCHO ZONE 2 - PAVEMENT MARKINGS - CROSSWALK LINES 4 - WALK / DON'T WALK 5 - OTHER 6 - NOT REPORTED 4 - NORTH - EAST 4 - WEST 5 - NORTHEAST 7 - SOUTHEAST 8 - SOUTHWEST Page: 6 of 9 HSY8 OHU ( REV 0/2 )

7 / / OCCUPANT 59 0 MITWER JONATHAN A TWP RD 2 FREMONT Ohio COMPLAINT 0 2 STATE OPERAR LICENSE CLASS CONDITION ALCOH/DRUG SUSPECTED ALCOH TEST STATUS ALCOH TEST TYPE ALCOH TEST VALUE DRUG TEST STATUS DRUG TEST TYPE NO M / C RV45886 OFFENSE CHARGED ( LOCAL CODE ) OFFENSE DESCRIPTION CITATION ACDA - Assured Clear Distance Ahead 45.2A 6 M MOBUS DAVID B 50 OH FOSRIA RD PEMBERVILLE Ohio 4450 INJURIES INJURED TAKEN BY EMS AGENCY MEDICAL FACILITY INJURED TAKEN COMPLAINT STATE OPERAR LICENSE CLASS CONDITION ALCOH/DRUG SUSPECTED ALCOH TEST STATUS ALCOH TEST TYPE ALCOH TEST VALUE DRUG TEST STATUS DRUG TEST TYPE NO M / C RR OFFENCE CHARGED ( LOCAL CODE ) OFFENSE DESCRIPTION CITATION INJURIES INJURED TAKEN BY - NO INJURY / NONE REPORTED - NOT TRANSPORTED / TREATED AT SCENE 2 - POSSIBLE 2 - EMS - NON - INCAPACITATING 0 - NONE - VEHICLE OCCUPANT - NONE 2 - REFLECTIVE CLOTHING - PICE - CHILD RESTRAINT SYSTEM - FOREWARD FACING 4 - INCAPACITATING - SHOULDER BELT ONLY LIGHTING - CHILD RESTRAINT SYSTEM - FACING 5 - FATAL - PROTECTIVE PADS - LAP BELT ONLY - BOOSTER SEAT ( ELBOWS, KNEES, ECT ) - SHOULDER AND LAP BELT - M OH SEATING POSITION LEFT SIDE ( DRIVER ) - - MIDDLE - - RIGHT SIDE - SECOND - LEFT SIDE ( PASSENGER ) - SECOND - MIDDLE - SECOND - RIGHT SIDE EJECTION TRAPPED - NOT EJECTED - NOT TRAPPED 2 - TALLY EJECTED 2 - ETRICATED BY MECHANICAL MEANS - PARTIALLY EJECTED - ETRICATED BY 4 - NOT APPLICABLE NON - MECHANICAL MEANS - THIRD - LEFT SIDE ( SIDE CAR ) 2 - PASSENGER IN UNENCLOSED - THIRD - MIDDLE - TRAILING UNIT 4 - RIDING ON VEHICLE ETERIOR ( NON - TRAILING UNIT ) - THIRD - RIGHT SIDE SLEEPER SECTION OF CAB ( TRUCK ) 6 - OTHER - PASSENGER IN OTHER ENCLOSED ( NON - TRAILING UNIT SUCH AS A BUS, PICK-UP WITH CAP ) OPERAR LICENSE CLASS CONDITION 5 - FELL ASLEEP, FAINTED, FATIGUED - CLASS A - APPARENTLY NORMAL 6 - UNDER THE INFLUENCE OF 2 - CLASS B 2 - PHYSICAL IMPAIRMENT MEDICATIONS, DRUGS, ALCOH - CLASS C - EMOTIONAL ( DEPRESSED, ANGRY, DISTURBED ) 7 - OTHER 4 - REGULAR CLASS ( OHIO IS "D" ) 4 - ILLNESS 5 - MC / MOPED ONLY AIR BAG USAGE - NOT DEPLOYED 2 - DEPLOYED - DEPLOYED SIDE 4 - DEPLOYED BOTH / SIDE 5 - NOT APPLICABLE 9 - DEPLOYMENT UNKNOWN ALCOH / DRUGS SUSPECTED - NONE 2 - YES - ALCOH SUSPECTED - YES - HBD NOT IMPAIRED 4 - YES - DRUGS SUSPECTED 5 - YES - ALCOH AND DRUGS SUSPECTED ALCOH TEST STATUS ALCOH TEST TYPE DRUG TEST STATUS DRUG TEST TYPE - NONE GIVEN - TEST GIVEN, CONTAMINATED SAMPLE / UNUSABLE - NONE - URINE 4 - BREATH 5 - OTHER - NONE GIVEN - TEST GIVEN, CONTAMINATED SAMPLE / UNUSABLE - NONE - URINE - NO DISTR REPORTED 2 - PHONE - TETING / ING 4 - ELECTRONIC COMMUNICATION 5 - OTHER ELECTRONIC ( NAVIGATION, RADIO, DVD ) 6 - OTHER INSIDE VEHICLE 7 - ETERNAL DISTR COMPLIANT COMPLIANT HSY8 OHM ( REV 0/2 ) Page: 7 of 9

8 / / OCCUPANT 59 KATAKIS VICRIA L LEMOYNE RD PERRYSBURG Ohio COMPLAINT 0 STATE OPERAR LICENSE CLASS CONDITION ALCOH/DRUG SUSPECTED ALCOH TEST STATUS ALCOH TEST TYPE ALCOH TEST VALUE DRUG TEST STATUS DRUG TEST TYPE NO M / C RG945 OFFENSE CHARGED ( LOCAL CODE ) OFFENSE DESCRIPTION CITATION M PZIN DAVID A 66 OH THOMPSON RD PERRYSBURG Ohio 455 INJURIES INJURED TAKEN BY EMS AGENCY MEDICAL FACILITY INJURED TAKEN COMPLAINT STATE OPERAR LICENSE CLASS CONDITION ALCOH/DRUG SUSPECTED ALCOH TEST STATUS ALCOH TEST TYPE ALCOH TEST VALUE DRUG TEST STATUS DRUG TEST TYPE NO M / C RK7899 OFFENCE CHARGED ( LOCAL CODE ) OFFENSE DESCRIPTION CITATION INJURIES INJURED TAKEN BY - NO INJURY / NONE REPORTED - NOT TRANSPORTED / TREATED AT SCENE 2 - POSSIBLE 2 - EMS - NON - INCAPACITATING 0 - NONE - VEHICLE OCCUPANT - NONE 2 - REFLECTIVE CLOTHING - PICE - CHILD RESTRAINT SYSTEM - FOREWARD FACING 4 - INCAPACITATING - SHOULDER BELT ONLY LIGHTING - CHILD RESTRAINT SYSTEM - FACING 5 - FATAL - PROTECTIVE PADS - LAP BELT ONLY - BOOSTER SEAT ( ELBOWS, KNEES, ECT ) - SHOULDER AND LAP BELT - F OH SEATING POSITION LEFT SIDE ( DRIVER ) - - MIDDLE - - RIGHT SIDE - SECOND - LEFT SIDE ( PASSENGER ) - SECOND - MIDDLE - SECOND - RIGHT SIDE EJECTION TRAPPED - NOT EJECTED - NOT TRAPPED 2 - TALLY EJECTED 2 - ETRICATED BY MECHANICAL MEANS - PARTIALLY EJECTED - ETRICATED BY 4 - NOT APPLICABLE NON - MECHANICAL MEANS - THIRD - LEFT SIDE ( SIDE CAR ) 2 - PASSENGER IN UNENCLOSED - THIRD - MIDDLE - TRAILING UNIT 4 - RIDING ON VEHICLE ETERIOR ( NON - TRAILING UNIT ) - THIRD - RIGHT SIDE SLEEPER SECTION OF CAB ( TRUCK ) 6 - OTHER - PASSENGER IN OTHER ENCLOSED ( NON - TRAILING UNIT SUCH AS A BUS, PICK-UP WITH CAP ) OPERAR LICENSE CLASS CONDITION 5 - FELL ASLEEP, FAINTED, FATIGUED - CLASS A - APPARENTLY NORMAL 6 - UNDER THE INFLUENCE OF 2 - CLASS B 2 - PHYSICAL IMPAIRMENT MEDICATIONS, DRUGS, ALCOH - CLASS C - EMOTIONAL ( DEPRESSED, ANGRY, DISTURBED ) 7 - OTHER 4 - REGULAR CLASS ( OHIO IS "D" ) 4 - ILLNESS 5 - MC / MOPED ONLY AIR BAG USAGE - NOT DEPLOYED 2 - DEPLOYED - DEPLOYED SIDE 4 - DEPLOYED BOTH / SIDE 5 - NOT APPLICABLE 9 - DEPLOYMENT UNKNOWN ALCOH / DRUGS SUSPECTED - NONE 2 - YES - ALCOH SUSPECTED - YES - HBD NOT IMPAIRED 4 - YES - DRUGS SUSPECTED 5 - YES - ALCOH AND DRUGS SUSPECTED ALCOH TEST STATUS ALCOH TEST TYPE DRUG TEST STATUS DRUG TEST TYPE - NONE GIVEN - TEST GIVEN, CONTAMINATED SAMPLE / UNUSABLE - NONE - URINE 4 - BREATH 5 - OTHER - NONE GIVEN - TEST GIVEN, CONTAMINATED SAMPLE / UNUSABLE - NONE - URINE - NO DISTR REPORTED 2 - PHONE - TETING / ING 4 - ELECTRONIC COMMUNICATION 5 - OTHER ELECTRONIC ( NAVIGATION, RADIO, DVD ) 6 - OTHER INSIDE VEHICLE 7 - ETERNAL DISTR COMPLIANT COMPLIANT HSY8 OHM ( REV 0/2 ) Page: 8 of 9

9 / / OCCUPANT 59 DAMSCHRODER JAMES L 955 PINE RD WOODVILLE Ohio COMPLAINT 0 STATE OPERAR LICENSE CLASS CONDITION ALCOH/DRUG SUSPECTED ALCOH TEST STATUS ALCOH TEST TYPE ALCOH TEST VALUE DRUG TEST STATUS DRUG TEST TYPE NO M / C RG89888 OFFENSE CHARGED ( LOCAL CODE ) OFFENSE DESCRIPTION CITATION OH 4 M COMPLAINT STATE OPERAR LICENSE CLASS NO M / C CONDITION ALCOH/DRUG SUSPECTED ALCOH TEST STATUS ALCOH TEST TYPE ALCOH TEST VALUE DRUG TEST STATUS DRUG TEST TYPE OFFENCE CHARGED ( LOCAL CODE ) OFFENSE DESCRIPTION CITATION INJURIES - NO INJURY / NONE REPORTED 2 - POSSIBLE - NON - INCAPACITATING 4 - INCAPACITATING 5 - FATAL INJURED TAKEN BY - NOT TRANSPORTED / TREATED AT SCENE 2 - EMS - PICE 0 - NONE - VEHICLE OCCUPANT - SHOULDER BELT ONLY - LAP BELT ONLY - SHOULDER AND LAP BELT - CHILD RESTRAINT SYSTEM - FOREWARD FACING - CHILD RESTRAINT SYSTEM - FACING - BOOSTER SEAT - - NONE PROTECTIVE PADS ( ELBOWS, KNEES, ECT ) 2 - REFLECTIVE CLOTHING - LIGHTING SEATING POSITION LEFT SIDE ( DRIVER ) - - MIDDLE - - RIGHT SIDE - SECOND - LEFT SIDE ( PASSENGER ) - SECOND - MIDDLE - SECOND - RIGHT SIDE EJECTION TRAPPED - NOT EJECTED - NOT TRAPPED 2 - TALLY EJECTED 2 - ETRICATED BY MECHANICAL MEANS - PARTIALLY EJECTED - ETRICATED BY 4 - NOT APPLICABLE NON - MECHANICAL MEANS - THIRD - LEFT SIDE ( SIDE CAR ) 2 - PASSENGER IN UNENCLOSED - THIRD - MIDDLE - TRAILING UNIT 4 - RIDING ON VEHICLE ETERIOR ( NON - TRAILING UNIT ) - THIRD - RIGHT SIDE SLEEPER SECTION OF CAB ( TRUCK ) 6 - OTHER - PASSENGER IN OTHER ENCLOSED ( NON - TRAILING UNIT SUCH AS A BUS, PICK-UP WITH CAP ) OPERAR LICENSE CLASS CONDITION 5 - FELL ASLEEP, FAINTED, FATIGUED - CLASS A - APPARENTLY NORMAL 6 - UNDER THE INFLUENCE OF 2 - CLASS B 2 - PHYSICAL IMPAIRMENT MEDICATIONS, DRUGS, ALCOH - CLASS C - EMOTIONAL ( DEPRESSED, ANGRY, DISTURBED ) 7 - OTHER 4 - REGULAR CLASS ( OHIO IS "D" ) 4 - ILLNESS 5 - MC / MOPED ONLY AIR BAG USAGE - NOT DEPLOYED 2 - DEPLOYED - DEPLOYED SIDE 4 - DEPLOYED BOTH / SIDE 5 - NOT APPLICABLE 9 - DEPLOYMENT UNKNOWN ALCOH / DRUGS SUSPECTED - NONE 2 - YES - ALCOH SUSPECTED - YES - HBD NOT IMPAIRED 4 - YES - DRUGS SUSPECTED 5 - YES - ALCOH AND DRUGS SUSPECTED ALCOH TEST STATUS ALCOH TEST TYPE DRUG TEST STATUS DRUG TEST TYPE - NONE GIVEN - TEST GIVEN, CONTAMINATED SAMPLE / UNUSABLE - NONE - URINE 4 - BREATH 5 - OTHER - NONE GIVEN - TEST GIVEN, CONTAMINATED SAMPLE / UNUSABLE - NONE - URINE - NO DISTR REPORTED 2 - PHONE - TETING / ING 4 - ELECTRONIC COMMUNICATION 5 - OTHER ELECTRONIC ( NAVIGATION, RADIO, DVD ) 6 - OTHER INSIDE VEHICLE 7 - ETERNAL DISTR COMPLIANT COMPLIANT HSY8 OHM ( REV 0/2 ) Page: 9 of 9