Authority: 1949 PA 300, Sec.257.

622 External # Crash ID Page 1

Compliance: Required MSP UD-10E
Penalty: $100 and/or 90 days (Rev 11/2006) 105590 Incident # 105590 File Class :
Incident Disposition
STATE OF MICHIGAN TRAFFIC CRASH REPORT Open
ORI: Department Name Reviewer
MI8234913 Detroit Police Department Lt. LANCE LABURDY (L213)
Crash Date Crash Time No. of Units Crash Type Special Circumstances Special Checks
l None m Deer m Fatal m Non-Traffic Area m ORV/Snowmobile
01/14/2010 02:30 02 Angle m School Bus m Hit and Run m Fleeing Police
County Traffic Control Relation to Roadway Special Study Weather Area
82 - Wayne Signal On Road None Clear 03 - FRWY Transition area
City/Twsp Construction Zone (if applicable) Light Road Condition Total Lanes Speed Limit Posted
Type Lane Closed Activity
99 - Detroit Dark-Lighted Other/Unknown 08 25 Yes
Prefix Road Name Road Type Suffix Divided Roadway
L O C A T I O N

EDSEL FORD SERV DR

Distance (ft.) Traffic Way Access Control
10.0 Feet S 01 - Not physically divided 01 - No access control
Prefix Intersecting Road Road Type Suffix Divided Roadway
W GRAND BLVD
Unit Number Unit Known State Driver License Number Date of Birth (Age) License Type Endorsements Sex Total Occupants Hazardous Action
m Operator m Cycle
m Chauffer m Farm
01 No m Moped m Recreation 02 04 - Disregard traffic control
Unit Type Driver Information Injury Position Restraint Hospital

MV O 01 04 None
U N I T / D R I V E R

Driver Condition Interlock Ejected Trapped Airbag Deployed Ambulance

l1 m2 m3 m4 m5 m6 m7 m8 m9 m 99 No No None

le
Alcohol Test Results Drugs Test Results Citation Issued
m Yes l No m Refused m Not Offered m Yes l No m Hazardous m Other
Test Type m Field m PBT m Breath m Blood m Urine Test Type m Blood m Urine

Sa
Vehicle Registration State Insurance/Policy # Towed To/By # Special Vehicles Private Trailer Type Vehicle Defect
0000000 MI UNK N/A
VIN Vehicle Make Model Color Year Vehicle Type
Description
00000000000000000 PONTIAC BONIVILLE GRN 1900 Passenger Car
Location of First Impact Extent of Damage Driveable Vehicle Direction Vehicle Use Action Prior
Greatest Damage
or
01 01 01 Yes N 01 - Private 01 - Going Straight Ahead
Sequence of Events First Second Third Fourth

( l indicates MOST harmful event) l 17 - Motor veh in transport

tf

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

Injury Airbag Deployed Ejected Trapped Ambulance

No

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

Injury Airbag Deployed Ejected Trapped Ambulance

P A S S E N G E R S

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

T R U C K/B U S

Driver's CDL Type Endorsements CDL Exempt CDL Restrictions

mH mP mT m Farm
mN mS mX m Other m 28 m 29 m 30 m 35 m 36

Interstate/Intrastate Vehicle Type Type and Axle Per Unit Cargo Body Type Medical Card Hazardous Material ID # Class #
First Second Third Fourth
m Placard m Cargo Spill
O W N E R

Owner Information Owner Information

Person Advised of Damaged Traffic Control Damaged Property Public

Contact Name :
Contact Date : Owner and Phone
Contact Time :
 Unit Number Unit Known State Driver License Number Date of Birth(Age) License Type Endorsements Sex Total Occupants Hazardous Action
l Operator m Cycle
m Chauffer m Farm
02 Yes MI D420799469903 11/26/1974 (35) m Moped m Recreation F 01 00 - None
Unit Type Driver Information Injury Position Restraint Hospital
TOMIKA KIMBERLY DIALS
21931 KENOSHA
MV OAK PARK MI 48237 (313)740-5106 O 01 04 None
U N I T / D R I V E R

Driver Condition Interlock Ejected Trapped Airbag Deployed Ambulance

l 1 m2 m3 m4 m5 m6 m7 m8 m9 m 99
No No None
Alcohol Test Results Drugs Test Results Citation Issued
m Yes l No m Refused m Not Offered m Yes l No m Hazardous m Other
Test Type m Field m PBT m Breath m Blood Urine Test Type m Blood m Urine
Vehicle Registration State Insurance/Policy # Towed To/By # Special Vehicles Private Trailer Type Vehicle Defect
BWM2067 MI STATE FARM/2818323-F15-22 N/A
VIN Vehicle Make Model Color Year Vehicle Type
Description
1GYFK63837R135062 CADILLAC ESCLADE SIL 2007 Passenger Car
Location of First Impact Extent of Damage Driveable Vehicle Direction Vehicle Use Action Prior
Greatest Damage
02 02 02 Yes W 01 - Private 01 - Going Straight Ahead
Sequence of Events First Second Third Fourth

( l indicates MOST harmful event) l 17 - Motor veh in transport

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

P A S S E N G E R S

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

Injury Airbag Deployed Ejected Trapped Ambulance

Passenger Information Date of Birth (Age)

Injury Airbag Deployed

Sa
Sex Position Restraint

Ejected Trapped
Hospital

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

Injury Airbag Deployed Ejected Trapped Ambulance

tf

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

No

Injury Airbag Deployed Ejected Trapped Ambulance

Carrier Information Carrier Source GVWR ICCMC USDOT MPSC

T R U C K/B U S

Driver's CDL Type Endorsements CDL Exempt CDL Restrictions

mH mP mT m Farm
mN mS mX m Other m 28 m 29 m 30 m 35 m 36

Interstate/Intrastate Vehicle Type Type and Axle Per Unit Cargo Body Type Medical Card Hazardous Material ID # Class #
First Second Third Fourth
m Placard m Cargo Spill
WITNESS O W N E R

Owner Information Owner Information

MAKINI PEARSON
19391 HILTON DR 35
SOUTHFIELD MI (248)556-1056
Witness Information Witness Information

Investigated Reported Date (Time) 1st Investigator Name (Badge) 2nd Investigator Name (Badge) Photo By
at Scene.
No 01/14/2010 (16:53) Off. MARLAN SMITH (895)
Narrative Diagram
#2 stated #1 disregarded the traffic signal and collided into her aunt's
vehicle (which she was dirving).

External #: 105590
Incident #: 105590