MISSOURI UNIFORM CRASH REPORT paaeL op 61 -GENERAL CRASH INFORMATION i, ORj.NQY.NWE:4!t>.oRl ;

NEOSHO POLICE DEPARTMENT

MOO7303oo n!!MfavmaiamLEFTTHESCENE DRIVERNO. CLEARED

€ Yes fflNo INAI I l l € Yes € N0cRAsH .psc(ies'g.omoae o;,byJ NO. ix.iuneo NO. KILLEDcb*ssipicoriox ffii'-' I O I 0

... - .;@ .-. .%l M m-nM .a kl jJ a Ld. M Au J mffl1 mla_l-aLIK I / 11i gdM 1111I!;l aN* Ill u WQ!a a" - ' - ' : :, ;. ,-,.,.,,7, " W I

19 BAl-" II aiIs

R>i

P was '%MffA

NO. VEH. INV.

2

CRASH DATE _

04-15-2019CRAS.H.T1ME3M1L:)

16:20NOTljiEp pAT'E:'

04-15-2019TIME NOI:IFJED (MIL.)

16:22

IhQ/ESTlpATION DAT:

04-15-2019'jlME A.RR,IVED.(M.1.3.)

16:28

INVEST. AT SCENE.

ffiYO8 € NO

ROADWAY NON-COLLISION COLLISION INVOLVED l DIRECTIONAL ANALYSIS FOR IMPACT WITH MOTOR VEHICLE

,RA'sH".; ffl oRonadway as oF;eerr,um:ng [:l F;rollm/Jwuvmped [] Animal ' [] RailwayVehicle [] FronttoFront [] Angle [] Other[] Pedalcycle [] Animal Drawn Veh / Animal Ridden Trans I N Front to Rear € 8ideswipe (Same Dir.) (Ex/'laln)

"pea,, a 0, z ::;:; CI LOsca':/sho'E;%"P O ":Bdr'o:iiae: a :,'a:oe':i':':.':'e:'r.:";' 1 O :eeaa::oo:'ai;er 8 :a'::.;p;;Ig;npg. Hairr.giO € €';';:#',a ' Roadway o Ja"k"'fa '1 oNo'hn'-'Collision [] Pedestrian [:l Working MolorVehicle j (!W in motion bV MV)

COMME_R.CIAU MOTOR.VEHICLj'iNVOLVEMENT.pRl %ERl/k 7:;sweiithe'followingitq.dete.(:Ine-if the,'!6ommerclal Ve51i2e'i:fiffiids iri8egtlon' 7Qmust be completed:.1. Does this crash involve any of the following? 2. Examine each vehicle to determine iT If Is a commencial vehicle based upon the following:

,, ab: AA ppee:ssoonn rtraaran's'ypotnrt;u;def"o'rom"ed'tcal allenrlO, OR i No _ ::,::m::r::::; 2a. e(: 5Van With GVWR / GCWR Of mtxe lean i NO _ ::;o;i,,;:::7hiCle field81c.Avehiclelowedduetodiiabllngdamage. []Yes-Golonumber2. 2zbc:aAv"eoh':oc'ie'awh:i'h"'aha'z'alhr;oaua:'m'gaifeot':a9iso'p:"aoca'arti."o"'d"'gdn'a"'oRzYaa-capop":'opp'ar':aaiesavoelh'o:c"ie,7Gfo'

EVIDENTIARY PHOTOS TAKEN

fflYti8 € NO

BY WHOM

OFFICER PRUITT

AVAILABLE FROM § Invesligating Agency

NEOSHO POLICE DEPTRECONSTRUCTION

€ Yes aNO

BY WHOM

NAavqrusu_ FROM [] Investigaling Agency

NA2 - LOCATION

COUNTf;:

NEWTONMuNICllF:Aj__,!TY"

NEOSHO

syqTgOqE

NShrqp,ip44'r(g,g'B.

NA

.GPS CQQF!Q!NA,TE8 (DD'MM SS.SEORMAT) ,6r:'iN NA t,ipwa;: W NA

.0,N.,I

CRD KODIAK ROAD

R[;)IV'):.IDIR,

Sqis'rh;qe;;qog %

§ NA Feet

Miles

pqg47;os'.<€ After CI NA[] BeTore

ffl Al

JNTERj3E(JING, .iMO HWY 60

Ei,PEE_D LiM,l'l:

25

Rj)AD 41NT61QED 371., [] Unknown[] State € County ffl MuniThpal [] Private Property [] Other

SPEED LIMIT '

50 'ON%,orti,'

wGECI- CODE.

NATRAFFICWAY

[] One-Way § Two-Way, Not Divided [] Two-Way, Divided, Unprotected Median [] Other

[] Two-Way, Not Divided, Continuous CenterTurn Lane[] Two-Way, Divided, Positive Vedian Barrier [:l Unknown

ROAD ALIGNMENT

ffl Slralght [] Curve[:l Unknown (Explain)

ROAD PRI)FILE

N Level € Downhill € Dlp[] Uphill 0 Hillcrest [] Unknown (Explain)

INTERSECTION TYPE [] NA

ffl 4-way Intersection [] Y-Intersection [] 5-way/More [] Unknown (Explain)0 T-Intersection [] Roundabout [] Other (Explain)

"=o".E)oryco. N[]D-'T5';ooNw':':' [:l Slush [] Standing Water [] Sand / Gravel [] Unknown (Explain)0 Wet [] Ice/Frost [3 Mud/Dirt [] MovingWaler [] Other(Explain)

ROAD SURF ACE

[] Concrete [] Brick [] Dlrf / Sand [] Cobblestoneg Asphalt [] Gravel [] Multi-SurTace [] Unknown (Explain)

WEATHER CONDITION

@ Clear [] Rain [] Sleet/Hail [] Fog/Mist [] Other(Explain)€ Cloud/ CI Snow O Freezing (Temp) CI Severe Crosswind [] Unknown (Explain)

-!!9!.T.,-p&Pa!rt9t'i'.%. ,=: 2j§ Day!ight [] Dark-Lightsd [:l Dark-Unlighted [] Dark-Unknown Lighting [] Other (Explain) 0 Unknown (Explain)

3='pAMAGE'TOPROPERTY,OTHERTHAN.VEHCILE81!i ffl None

LIST OWNER'S NAME & ADDRESS, DESCRIPTION OF PROPERTY, AND DAMAGE 0 MoDOT [] County [] Municipality

4 -WITNESS @ None tdsntifled [] Additional Witnesses in NarrativeNAME ADDRESS (Street, City, State, Zip) PHONE NUMBER

5-PE)E8TR1AN 8 NA 10 LawEnTorcement0ffioer [] OtherEmergencyServicesPeisonnel [] MoDOTWorker [] 01herTiafflouayWotker [] OtierPedealrianNO. NAME (Last, First, Ml) & ADDRESS (Street, City, State, Zip) PHONE NUMBER

DATE OF BIRTH SEX STRUCK BY VEH # INJ TRANS-PORT

SAFETYDEVICES

I

LOCATION

[] On Roadway [:l In Driveway Access [] On Median/Crossing Island[] On Sidewalk [] Off Roadway [] Unknown

CROSSING ROAD [] N,1

[] wiih Signal j[:l NOI At Crosswalk

[]O ANgoasinlgstnaSllgnal I [la linn Munamrkae,dkeCdrocsrsOwsasWlkalk[] unknown 10 unknown

OTHER/CTIONS ffl NA/None[] Getting On/Off Vehicle [:l Working in Tra&way [] unknown

[] Standing/Lying / Sitting in Traf&way [3 Playing In Traf&way [] Other (Explain)

[] Pushing / Working on Vehicle [3 Walking / Running in Trafflcway[] Behind{InFrontofParked{StoppedVeh [] lVilhTiafflt. [] AgainslTraffit.

SCHOOL INFO. [:l NA[] Going To/From School

[] Getting On/Off School Bus

CI Both oT the move

[3 Unknown (Explain)

PROBABLE CONTRIBUTING CIRCUMSTANCES i§ None

0 Failed to Yield [] Alcohol [] Vision Obstructed (Explain) CI Other (Explain)[] oisiractsd/Inausntive [] Drugs [:l Physical Impaimient (Explain) [] unknown (Explain)

DISTRACTION I INATTENTION CODE(S) [] NA

IllALCOHOL USE

€ Ye8 ffi NO € Unknown

DISTRIBUTION: COPY-AGENCYFILEi ORIGINAL-MISSOURISTATEHIGHWAYPATROL-TRAFFICRECORDSDIVISION-P.0.BOX568-JEFFERSON:ITY,MO65102 SHP-2RO1/19

REPORT# 1904-152 paae OF 68. .COLLISION

DIA3RAMComl

Before' (C

assDirectiony I

Crash.Even;(s) V1 N EC)W U V2 N E[U)W u V3 N E S W U V4 N E S W u V5 N E S W U V6 N E S W UIrcle One1 a

1N%1:;4E y

ORIJ4,=

0a Indicate North

tQ7t; '0 '0:J> e%l?i;: f0:)E-0'

+- 0

- 4,.,,Iffliiiiml

aaaaay -Q -----------aax------------------ '

- 4

M O HY 60 M O H%fVY 60

t()A-4/00

C:2) jl

:>0

+1,

Drawing NotTo Scale_

I

INDICATE ROAD NAMES DIAGRAM NOT TO SCALE

REPORT# 1904-152 paael OF JL

7 - DR1VER8, VEHICLES, OWNER8 & OCCUPANT8

NO.'i

17A.DR1VER -NAME(Last;Fl7st,Ml),&pDDRE8S(3Qeet,_C.i§y,;@;4je,7ip)HUBBARD, JESSIE E 507 0RCHARD, , MO 64830

PHONE NUMBER

(417)439-2213DRIVERLICENSE/IDNUMBER STATE

U202077014 MDI

cS'TcATuS @Val'id € Exp'ired[] Susp/Rev/Denied [] Disqual CDL

€ 4A [:l Canceled/Othlivalid [] unknown

,PEL'o @ Operator Class !_ [] Permit [] Urknown[] CDL Class __ 0 MC Only (Exma:n)

zNA [1"""""G'ad W%%ssqayp

MC ENDORSEMENT

€ YeS € NO € NA

[] Unknown (Explain)

DATE OE BIRTH '

03-13-1993

SEX

F

SE%:TiFL

INJ

5

TRANS-PORT

1

EJEC-TION

2

' AIRBAG

3

SAFETY DEVICES

-1 g==,=-=.. :53;5-E=a.,:':, H!!!@tA5p'a"',P,800F OF. INSURAN.CE '

§ Yes [] No [] Not Required

.INSUQNC,E qQMP6rl,Y}:'.q[:1.. Expiied.

SAFECO INSURANCE

PHONE NO. (Optional) POLICY NUMBER ' [] NA

Z458140i

[].Driver

' @ Ve'hk.!e, :

7B..VEHIC1E - OWNER NAMg:_15aqt,' First, 41) 8yADDRp:ji.(p.trei.et,,City,,State,Zip) ffl SAD PHONE tyuvses @ SAD

YEAR

o;jobsMAKE

FORD

MODEL

EXPLORER

COLOR

BLK IVEH TYPE

I

TOT AL NO. OF OCC.

1

!p!c:.a!'!'h!'=s:,!""Tg.="!"'a': 1l4%MAJoF,3, YE2AOR20vlNJ1 i FiMi Ei U t 7i 5 i 8i I i 8i Ui Bi 3 i 3 i8i 6i 7

TOWED FROM E CENE :

El"9es '@ ;110 " '

JOWED DUE TO DIS! DAMAGE

0 Yes ffl NoVEj-IICLEQAMAGE,{qarJilidamaged.are,as)'. '.,'[]'(N63ie'/%lgDamsge.ri- . _ ..l.. ., ... , 141 .. . ; ..l_ .,{( . ,. . .. .. . - .. - ._ . ._.. i . .. _ ._.- . . -. - _' ....N'T'AL"MPAc.T.NoJ ? I 3 I 41 5 I ' I v *s - Underzrriage 22 - Cargo

TO2AtEQ.BY'. [] qry3nown._',€ ,',NA'..

[1 'NA -"I '-- - 'f4: ',-16 I 17

j,/ Ip 20-Burned - 24-Other19-Windshield 23-Unknown

ii 21 - Towed Unit (Explain)113 112- 111-l io l

.VEHICLE BODY TYPES -,'Aalamob/lss /,SpeclallyQehiffiie@ '.[' Vefiii!e:kl,sia % Publk Conveyance

8[]vPp:a"sa's:e"ng:eryVoac:no('t'+ La:::'B;,::-,'=:';=:- OAM=* 8a :.c:ioli':m=,l,eEn,s H M h E _:::::-:'::-:::::-:::_:;',a;':-:.:sg(P,l.u(NpsOl%G',I,a5nWs',,:,,'llhT,N'ick,.,..,.,,E4 [] Veh. Pulling Another Unit(s) TruckTractors, Or Haz Mat

:i[fliW:-==- N;&E<:;-=-]ffiuSi=;;J.';;;a'- p:qrtipi'iiNqJ't'i:iilfi=.=.',ttx'f,:)bsEMERGENCY VEHICLE INVOLVEMENT ffl NA

[] Police [] Ambulance [] A. Emergency Vehicle on Emergency Run

[] Flre [] Oiher (Must check "A" / "B") -> [] B. Stationary With Emergency Equip. Activated

(,q;T.ROBUTINq'TRAFFl.CCQNDITIONS §.H4[J Congestion Ahead [] Other Incident Ahead[J Crash Ahead 0 unknown (Explain)

7C. VEHICLE ACTION/SEQUENCE OF EVENTS CODE8 [] Additional Codes Listed in Narrative (See C odes in Section 8)

-JOE35Qlgh73C4E7pl.E'.EgENl-J)Q.9pl71' []=U7nkno-wn l T . l T T l aa- 7@NIM5L:. :c9.=i(!);'. =l",. : T.'F:71;.EDlO,BJEpTpl. Q67E (;7. 7ALCOHOL USE

aYeS € Unkffl NO [:l NA

70. yR.QQJkgE, 9QNJRIBjj T.IN9 Q!!!QL!!AjTA!'lCi.Es.Y.:. [J None[:l Vehicle Defects (Explain) [] Vision Obstructed [] Failed To Dlm Headlights [] ImproperTowing/Pushing 0 0bject/Obstruction In Roadway[] Speed - Exceeded Limit [] Driver Fatigue r Asleep [] Failed To Use Lights [] tmpropeity Slopped On Roadway [] Distracted i Inattentive (Designate Type)

[] TOO Fast For Conditions [] Impnoper Signal § Following Too Close [] Improper Lane usage i Change [] Unknown (Explain)

[]Violation Slgnal I Sign [3 Improper Backing [] Wrong Side (Not Passing) [] Overcorrected J Other (Explain)IJ Failed to Yieio IJ Impnoper Turn IJ Wrong Side (One-Way) IJ Improper Riding / Clinging To Veh. Exterior[:lAlcohol [] Improper Passing [] Physical Impairment (Explain) [] Failed To Secure Load/Improper Loading[] Drugs ':] Improperly Parked [] Improper Stark From Park [] Anima(s) In Roadway

DISTRACTED / INATTENTIVE CODE(S) i NA(See Codes In Sedlon 8)

Ill7E..QORKZONE

[] Yes a NO [] Unknown

Workers Present

[] Yes [] No [] Unknown

;r.Bap;;q.poHBo3 [] None [] UnknownElectric: @ GteerffellowlRed [] Flashing Red [] Flashing Yellow [] Ramp Meter [] Other (Explain)

-Other []StopSign []NoPassing 7one0TumRestiicted []0fflcer/Flag7man []Signal0nSchaol Bus Controls: [] WarningSign/Device [] RailwayCtossingSign/Device 0 SchcolZore [] Yielc Sign 0 0ther(Expaln)

{CONTROL MALEUNCTIONING /,I!N9PEQ'QVE:/MISjalNG,, l

[] Yes (Explain) ffl NO€ Unknown [1 NA

,, OCCUPANTS - NAME (Last, First, Ml) DATE OF BIRTH SEX SEAT INJ TRANS- EJEC- AIR SAt'ETY PHONE NUMBER

ADDRESS (Street, City, Slate, Zip) MM-DD-YYYY LOC PORT TION BAG DEV'CES

7G. COMMERCIAL MOTOR VEHICLE ffl NA IIRequlted on vehicle if "Yes" was answered to questions in parts 1 anc 2in CMV inr'olvwent criteria and vehicle nests c ne :if the )hree ttiieria in part 2MOTOR CARRIER IDENTIFICATION (Leasee, etc.) - NAME & ADDRESS (Street, City, State, Zip) [] SAO PHONE wuvst_n [] SAO

COMMERCIAL/ [] InterslateCarrier [] NotinCammerce-GovernmentVehicle [] NolinCommerce-01herVehicle

NON-COMMERC'AL [] Intiastate Carrier [] No! in Commerce - Rental Vehicle

MC / MX / ICC NO. USDOT NO.

CARGO [] Enclosed Box [] Flalbed [3 Concrete Mixer [] Garbage/Refuse [1 Pole Trailer [] Vehk.le Towing [] Inlermodal [1 NA(No 0 0ther

,PEBooY € CargoTank € Dump 0 ArtoTransporfer CI Grain/Chlp/Gravel 0 Log Ano)herVeh. Container Cargo € UnknownChassis Body)

PLACARD DISPLAYED

HAZARDOUS 0 Yes [] NoMATERIALS z Unknown

4-DIGIT NO. CLASS HM CARGO PRESENT

€ Yes € NO

[] Unknown

HM CARGO RELEASED

[1 Yes € NO

[] unknown

HAZARDOUS MATERIAL NAME

[] Page Not Used REPORT# 1904-152 PAGEL OF JL

7 - DRIVERS, VEHICLES, OWNERS & OCCuPANTS

NO.

274,DRIVER 7;NAMj(5a.;t,,FlyslQ4) 4..A9DRE9.S (S%re.el Cijy, Sitate, 4!:P)JOHNSON, ERICAo D 2214 WISCONSIN AVE, JOPLIN, MO 64804 4,

PHONE NUMBER

,(417) 592-1583DRIVERLICENSE/IDNUMBER STATE

L202183014 M:)I

LsTATus'c § Valid [] Expired[] Susp/Rev/Denied [] Disqual CDL

€ 4A [] Canceled i oih livalid [] Unknown:.-=-=-'- -----= I€ CDL Class € MC Onlv Q

[ ThfflmIA b Thmffi ill Illli(l)! it.A AI:I 4T

i;ffl! ;HNa(JK WI:mr!a RI'tJn NA '-ri i-i-.- i iai-' ri i i_ii___:_a ""' " I !f ffilI [ t n !! W l: 3I_I }000 IJ IIIIUIIII I l_tltlO LI LlllllCtln38Cl - laP An 154!! r"@ !!:4

DATE 017 BiRTH .

06-11-1 977

SEX

F

SEATLOC

FL

INJ

5

TRANS-PORT

1

EJEC-TION

2

AIR!3!IG

3

SAFETY;QEVICE8

-IV's'oN ffl NOI Obstructed [] Trees r Bush [] Sign [] Moving Veh [] Other (Explain)

oBsTRucTEo 0 Windshield [] Building € Hillcresl [] Stopped Veh 0 unknown€ NA 0 Loaj on Veh [] Embankment [] Parked Veh [] Glare (Explain)

PROOE OF INSURANCE ..

8 Yes [] No []' Not Required'INSURA%ICE t;OMPQIYo, [] Eylred,iPROGRESSIVE INSURANCE

PHONE NO. (Optional) POLICY xuvstin [] NA

911760"l205'Drive; '

@Vehicle .

7B...gEHilCLE- QWNER I:lAA!IE p.,ast, Fi+5t.!Ml)'§,AppQESSJSlreet, Ci.ty; Sta,14,,41p) ffl SAD PHONE NtJMBER i SAD

YEAR

(?0\8MAKE

HYUN

MODEL

ACCENT

COLOR

BLK IVEH TYPE

I

TOT AL NO. OF OCC.

3

5i9El9; , PLA,TE N(,. I !ST ATE .i YEARKE9V5D l"'-i6 I 2019

VI§. -

3i Ki P i C r 3 i 4i.A i 3 i 9 i J i Ei 0 i 3 i I i 6 i 8 i ITOWED.EROM ECENE'l

'€ 9es=i'N0 -'- 'T9b!ED D!E T,O DIS. DA)4GE5;;s a-'ffio "

:lNEIHTllCA:,:E1M.D;MAAcTGNEo::Mla,rklal31.q.la,m4a4gle5d,14<:as.i.ly= a.' (;p,,ltlU:rldee,/,,:o,pla:m%2e2;.,argO"'rqwe:o..sy(..'[] unknow7'.'4QQ;'-

[] NA 8 I 214/

15'% €E

r%xI 17l,/

- 19 - Windshield 23 - Unknown%x 20 - Bumed 24 - Other

l i:i lii liii 10 1 J JI - IOwea uni} IcxplklQvehic31slopy,'npes.-.huioffi6b:iis 4oSpeciilt9;'9ehlciffiffi':',0.'uffihfcle.Useo,hs'pu&ni: Conveyanoe

Qvp:a:::ioc:-) Ls::eB"B:::9,-,'+WID5W/D;,::,-8AM=q 8:':;rH;=enis B-:::::-:=_:=:::,a:",a:,::'.:s I (NolLG'/,:nsedWsc""T,,'hDNG[]PassengerVan(9+W/Driver)E4 .,,..,,..,,,........,,,... ,,,.......,,....,-...,..,,.......:....,...,:.....,.,[] Sporl LltilityVehicle [] School Bus O€ 23 wwhh €z Ocathre;oVveahnicle (Code) __(Doe s not app Ly to T__ruckTra clor,2_J Placard Veh. Only)[] Limousine (7-8 W/oriver) 0 Intercity [] Less than Or

€ Limousine (9-15 W/Driver) € Transit / Commuter z 4 yyH 0 Pi6up a Truck Tractor w:th NO units 1 equallol0,0001bs.

€ Motorized Bicycle z Charter/ Tou, z 5 Wh, More [] Other Heavy Truck € T"ok 'acfor W"h One Unit

a zTO,FrPada'oy""'ThomSchool [] Other [] Unknown a Unknown(Expla:n) 8 T7"ruco:T,ac,0,WnhT'ao'o'W'hT7:,eeUn,sou"'a : z[:lz UG'OnrekOanOioelWrni2h6an0zosO,oboaolbs.EMERGENCY VEHICLE INVOLVEMENT § NA

[] Police [] Ambulance [] A. Emergency Vehlcle on Emergency Run

0 Fire [:l Other (Must check "A"/"B") -> [I B. Stationary With Emergency Equip. Activated

C, OhlTRIBUTING;mAyFFIC CONDITIONS' _ @ H4.

[] CongestionAhead [] OtherlncidentAhead

[] Crash Ahead [] unknown (Explain)

7C. VEHICLE ACTION i st:ouesce OF EVENT8 CODE8 [] Additional Codes Listed in Narrative (See Codes In seci:on a)

%;-!!\:.',':;Tffl['!E:8:.1, € u7+tnown, , , , , , , , 7Axiv:7;qpo:Tsi7_,7' T,ta=p-,i=TeTo?5=7:i;ALCOHOL USE€ Yes [:] Unk

ffl NO € NA

7o:_":"9!'!'Q'c9NT'!'!'L!:'!N9P!!9!"376!!t!9.!;sS;% § None[] Vehicle Defects (Explain) [] Vision Obstructed a Failed To Dim Headlights [:l Impnoper Towing i Pushing CI Object i Obstruction In Roadway[] Speed - Exceeded Limi( [] Driver Fatigue/Asleep [] Failed To Use Lights [] Improperly Slopped On Roadway € Distracted/Inattentive (Designate Type)[] TOO Fast For Conditions [] Improper Signal [] Following Too Close [] Improper Lane Usage / Change [] Unknown (Explain)

[] Violation Slgnal/Sign [1 Improper Backing [] Wrong Side (Not Passing) 0 0veico+rected J Other (Explain)IJ Failed to Yield IJ Improper Tum IJ Witing Side (One-Way) IJ Improper Riding / Clinging To Veh. Exterior[] Alcohol [] Improper Passing [] Physical Impairment (Explain) [] Failed TO Secure Load/Improper Loading

[] Drugs J Improperly Parked [] Improper Start From Park [] Animal(s) In Roadway

DISTRACTED r INATTENTIVE CODE(S) ffl NA(See Codes In Sedlan 8)

lil7E..W9RKZONEjJyes @ No [] Unknown

Workers Present

[] Yes 0 No [] Unknown

Nt'qt;t:.lt-.9osT!o!:!i [1 None [] UnknownElectric:8 Green/Yellow/Red [] Flashing Red [1 Flashing Yellow [] Ramp Meter [] Other (Explain)

aOlher []StopSign []NoPa7sing 7ane[]Tu7nRestricled 00fflcer/Flagman []Signal0nSchool Bus Controls: [1 Warnlng Sign/Device [] Railway Crossing Sign / Device [] Schcol Zore [] Yield Sign [] Other (Exp ain)

CONTROI MALFUNCTIONING /:lNOPEpTQ/j:,/;ISSIN,G " ,

€ Yes (Explain) N No[] Unknown [] NA

,, OCC;uPANT8 - NAME (Last, First, Ml) DATE OF BIRTH SEX SEAT INJ TRANS- EJEC- AIR SAFETY PHONE NUMBER

ADDRESS (Street, Clty, Slate, Zip) MM-DO-YYYY LOC PORT TION BAG DEV'CES

__MA_RTIN, LUCY D02-12-2003 F FR 5 1 2 3 5 (417) 592-1583-2214 WISCONSIN AVE, JOPLIN, MO 64804

MARTIN, LYDIA N05-13-2005 F SR 5 1 2 1 5 (417) 592-1583

2214 WISCONSIN AVE, JOPLIN, MO 64804

7G, COMMERCIAL MOTOR VEHICLE § NA Required on vehicle if "Yes" was answered to questions in parts 4 anc 2 In C:MV inr'olveirent criteria and ve hicle r'ieets c no xf the three criteria in part 2

MOTOR CARRIER IDENTIFICATION (Leasee, etc.) - NAME a ADDRESS (Street, City, Siate, Zip) [] SAO PHONE NUMBER [] SAO

COMMERCIAL/ [] InterstateCarrier [] NatinCommerce-Gove+nmentVehicle [] NotinCommerce-OtherVehicle

NON-COMMERCIAL [] Intrastate Carrier [] Not in Commerce - Rental Vehicle

MC / MX / ICC NO. uSDOT NO.

CARGO [] EndosedBox [] Flalbed [] ConcreteMixer [] Garbage/Refuse [] PoleTtailer [] Vehide rowing [] Intemiodal € N%(No [] 01hsr

,PEBooY [] CargoTank [:l Dutnp [] AcloTrans4orter [:l Grain/Chlp/Gravel [] Log Mo'ha"ah' co"atner cargo [] UnknownChassis Body)PLACARD DISPLAYED

HAZARDOUS [] Yes CI No

MATERIALS a Unkno,

4-DIGIT NO. CLASS HM CARGO PRESENT

€ YeS 0 NO[] Unknown

HM CARGO RELEASED

€ Ye8 € NO

0 unknown

HAZARDOUS MATERIAL NAME

REPORT# 1904-152 paae5 op JL

8-CODE8

SEAT LOCATION

XX - Not Known B - Pedalcycle M - Motorcycle CP - Commencial PassengerOE - Occupant - Enclosed Load AreaOU - Occupant - unenclosed Load AreaRC - Rail CrewSV - Other (Explain in Narrative)NA - Not Applicable

INJURY1. Fatal2. Suspected

Serious Injury3. Evldent -

Not Disabling4. Probable -

Not Apparent5. None Apparentu. UnknownN. NA

TRANSPORTED(For Medical

Treatment)

1. No2. EMS3. 01herU. UnknownN. NA

EJECTION

1. NA2. No3. Partially4. TotallyU. Unknown

AIR BAG

j. None/NA 9. Deployed -3. Not Oeiployed Combination4. Removed 10. Deployment5. Deployed - Front Unknown6. Deployed - Side U. Air Bag Presence7. Deployed - Curtain Unknown8. Deployed - Other

(Knee, Air Bell, etc.)

iE:.a!!""o"aaa ......,.,.........,.,,.....!Jk"7. DOT Compliant 15. Other

MC Helmet Ll. Use Unknown8. NCI Helmet N. Nof Applicable

VEHICLE ACTION/SEQUENCE OF EVENTS (Items with double-asterisk ['] require additional coding)

j. Going Straight 10. Slait Fnom Parked 19. Airbome 28. Separation of Units 37. Collision Inv. Other Ob%ct (Explain) 44. Thrown / Falling Obiect2. Overlaking IT , Backing 20. Ran Off ROadWa/ - Right 29. Returned 10 ROadWa/ 38. 01Her Non-Collision 45. Struck sy Falling, Shming Cargo,3. Making Right Tum 12. Slopped in Traffic 21. Ran Off Roadway - Lefi 30. Collision Inv. Pedestrian 39. Collision Inv. Bicycle{Pedalcycle Object Sei in Motion By Own MV4. Right Tum on Red 13. Parked 22. Overturn/Rollover 3t Collision Inv. Bicycle/Pedalcycle in Bicycle Lane 48. Ran Off Roadway - Other (Explain)5. Making LeftTum 14. Changing Lanes 23. Fire/Explosion 32. Collision Inv. RailwayVeh. 40. Collision Inv. Animal DiawnVehicle{ 47. Cross Separator6. Making U-Tum 15. Avoiding 24. Immersion 33. Collision Inv. Animal (') Animal Ridden ForTransportation7. Skidding/Sliding 16. CrossMedian 25. Jackknife 34. Collisionlnv.MVinTransport 41. Collisionlnv.WorkingMV8. Slowing / Stopping 17. Cross Center Of Road 26. Cargo Loss/ Shiffl 35. Collision Inv. Parked MV 42. Downhill Runaway9. Start in Traflm: 18. Cross Road 27. Equipment Failune 38. Collision Inv. Fixed Object (') 43. Fell/Jumped From MV

ANIMAL CODE8 FOR VEHICLE ACTION / SEQUENCE OF EVENT860. Deer 81. FarmAnimal 62. Dog 83. OtherAnimal U. 11nknown

FIXED OBJECT CODE8 FOR VEHICLE ACTION / 8EQuENCE OF EVENT8

20. Tree/Stump(Standing) 28. Culverl 32. Building 38. BridgeRail 44. Wall21. Embankmenl / Driveway I Ground/ Rock Bluff 27. Highway Traffic Sign Post / Support 33. Traffic Slgnal Support 39. Guardrail End 45. Cable Banier22. Guardrail Face 28. Bridge Pier/Abutmenl/Support 34. Impact Attenuator I Crash CushiomO. Other Traffic Barrier 46. Bridge Overhead Structure23. Utility Pole 29. Curb 35. Fke Hydrant jH. Overhead Sign Support 47. Overhead Line/Cable24. Fence 30. MailBox 36. Other(Explain) 42. Dltch Ll. Unknown25. Street Light Support 31. Corcrete Traffic Barrier 37. Bridge Parapet End 43. Other Post/Pole / Support

DISTRACTED I INATTENTIVE CODE8L ExtemalDiskation 5. CommunicatianOevioe-Hand-held 9. Eating{Drinking 13. ComputerEquipmsnllElectronicGamesletc.

2. Passengers 6. Communication Device - Hands Free 10. Reading 14. Adjusting Vehicle Controls

3. Stereo/Audio/VideoEquipmenl 7. CommunicationDevice-Texting/E-mailing jj. Tobact.ouse 15. Other(Explain)

4. Navigaiion Device 8. Communication Device - Web Browsing 12. Groomin0

VEHICLE TYPE CODE81. Motor Vehicle in Transport 3. Working Motor Vehicle 5. Animal Drawn Vehicle / Animal Ridden For Transporiation Puiposeis2. ParkedMotorVehicle 4. Pedalcyt.le U. Unknown

OTHER VEHICLE CODE8

j. RidingMower/GardenTractor 3. Snowmobile 5. AnimalDiawnVehicle/AnimalRiddenForTransportation 6. LowSpeedVehicle

2.GolfCatt 4.Forklifi 7.Olher(Explain)

9. NARRATIVE/STATZMENT84. (If additional room Is necessary, use Section ll - Narrative / Statements Continuation)

On April 15, 2019, at approximately 16:20 hours, I responded to the intersection of Kodiak

Road and Highway 60 in reference to a 2 vehicle traffic crash.

Upon my arrival to the intersection I made contact with both drivers and they advised me

that no one was injured and did not need medical attention.

I spoke to the driver of vehicle 1 who was identified by her Missouri driver's license as

Jessie Hubbard. Ms. Hubbard was operating her 2008 Ford Explorer displaying Missouri

license PH8H8R. Ms. Hubbard advised me that she was traveling south on Kodiak Road and

needed to turn west bound on Highway 60. Ms. Hubbard said as she was getting ready to turn

vehicle 1 stopped in front of her and she hit the back of the vehicle. Ms. Hubbard said

she was looking over her left shoulder at traffic when the crash occurred. The damage to

Ms. Hubbard's vehicle consisted of minimal damage to the front bumper.

I spoke to the driver of vehicle 2 and she was identified by her Kissouri driver's license

as Erica Johnson. Ms. Johnson was operating her 2018 Hyundai Accent displaying Missouri

license KE9V5D. Ms. Johnson said she was traveling south on Kodiak Road when she was going

to turn west bound onto Highway 60. Ms. Johnson said there was traffic traveling west on

Highway 60 so she stopped to wait for traffic to clear. When Ms. Johnson stopped vehicle 1

hit the rear of her vehicle. rhe damage to Ms. Johnson's vehicle consisted of damage to

the rear bumper.

Both vehicles were released from the scene.

Nothing further.

10. REPORTING AND REVIEWING OFFICER INFORMATION

Fj,§PORT.lNG OEj,IC.ERQ/4q 'JOHN T. PRUITT

pSN/ B49QEi,NO.100JTP

QEA'l:/ZQNE .,,NS

TROOP/ plS.TRICT I P.RE.ClNCTCOUS

REVIEWING.OFFICER NAME DSN/,B6QGE NO., REVIEWING OF'lCER 2 NAME DSN IBADGE NO.

§ Page Not Used REPORT# 1904-152 PAGEjlOPJ

11. NARRATIVE/STATEMENT8CONTINllATION(lfaddltlonalroomlanecessaryuseNarrative/StatementsContinuatlonlSupplement)

ORIG44