Mail to: Office of Accident Records, 118 W. Capitol STATE OF SOUTH DAKOTA INVESTIGATOR'S MOTOR VEHICLE TRAFFIC ACCIDENT REPORT Form DPS - AR1 12/12/2014 Ave., Pierre, SD 57501 TraCS ID: 122521-195 TraCS Sequence: 2009300041 Agency Use FATAL Report Type FATAL Time of Accident 22:21 Hrs. Is this only a Wild Animal Hit Report? Agency Name SD HIGHWAY PATROL Date of Accident 09/12/2020 Reporting Officer Last Name BERNDT Reporting Officer First Name JOHN Reporting Officer Middle Name Reporting Officer # 195-122521 Location Description ON US HWY 14 AT (MRM 277.00 + .600) Latitude 44.527463 Longitude -99.450472 County 35 City or Rural 0000 Rural County Name 35 - HYDE L O On Road, Street, or Highway US HWY 14 C A At Intersection with T I Units Miles/ Direction Distance 0.5996 O Tenths of East N Direction Distance Units Junction or Intersecting Street and Roadway Surface Condition 01 - Dry Roadway Surface Type 02 - Asphalt (Blacktop) Roadway Align/Grade 01 - Straight and level MRM Relation to Junction 00 - Non(milepost) 277.00 junction Distance Units Direction of Name of Junction, Road, Street, or Highway Interchange AREA Location 00 - Not applicable & not interchange (default) Unit Type 01 - Motor vehicle in transport with driver Hit and Run 02 - No Driver's Name a Last First JASON Middle RICHARD Address -- Address (Line 2) City PIERRE State SD Zi Date of 5:501Eirth - Sex 1 - Male Non Motorist Location 96 - Not Applicable Non Motorist Action 96 - Not Applicable Non Motorist Contributing Phone 6056616186 DL State SI) DL Class 1 Circumstances (Up to Two] 96 - Not DL Status 01 - Normal within restrictions Driver Contributing Circumstances (Up to Two) 15 - allure to keep in proper lane, 23 - Distracted (list Applicable Drug Test Drug use 05 - Test given, but straction in narrative) 99k; nohtainahie at time Vision Contributing Circumstance oo - None port filed Alcohol Alcohol Test 00 - .00 NONE None used Injury Status 05 - No Injury Saltey Equipment 03 . Lap belt and shoulder harness sed Seating Position 01 - Operator 001 Air Bag Deployed oo - Not deployed Transported To Source olTransport 00 - Not "nansported EMS Trip it Is Driver the Owner Yes Ejection oo - Not ejected Citation Charge? 99 - Unknown Citation #1 Citation #2 Citation #3 Citation #4 Owner's NamerLast RAVNSBORG First JASON Middle RICHARD Addressmem City PIERRE 55:16 25'5501 Red Tag A510399 Model Year 2011 Make TAURUS VIN LIMITED Stale Year Estimated SpeedrHow License Plate it G00027 SD 2020 Travel Estimated? 02 - Speed 55 Driver Statement Damage Extent . Speed Limit 65 Total Occupants 1 03 - Disabling Towed 01 Damage Damage Amount (Vehicle and Contents) 4500 Insurance Co Name 25453 - NATIONWIDE INSURANCE OF AMERICA mew" Expiration Date 10/ Emergency Vehicle Use? insurance Policy Date 10/ 11/2019 11/2020 Vehicle Configuration 01 - Passenger car Trailer Type 00 - No trailer/attachment Cargo Body Type 00 - Na carga hndy Trailer LP Direction ofTravel Before Crash 04 - WesthaundAttached to State Year Power Unit . . . Trailer 2 Initial Point of Impact Most Damaged Area 01 License Plate State Year 01 - Position 1 - Position 1 'l 3 Underride/Override 00 - Na nnderride nr tr" er License Plate State Year override Traffic Control Device Type 00 - No cantrals Vehicle Contributing Circumstance 00 - None Vehicle Maneuver 01 - Straight ahead Road Contributing Circumstance 08 - Pedestrian, bicyclists, other non- occnpants in mad First Event 20 - Pedestrian Second Event Third Event Fourth Event Most Harmful Event for this Vehicle 20 - Pedestrian _Does the accident involve one or more of the following: a truck having a GCWR of 10,001 or more pounds; OR . a vehicle displaying a hazardous material placard; OR . a vehicle designed transport 9 or more people, including driver [Did the accident result in one or more i the following: . a fatality; OR . an injury requiring transponation for immediate medical attention; OR . a vehicle was disabled requiring a towaway from the scene Accident Involved Vehicle Purpose CarTier Name Street Address Street Address (Line 2) us City State Zip DOT GVWR GCWR 90 Hazardous Material Hazardous Material Hazardous Materials aterlal Class . . Released? Content Code Description Code I Unit Type 05 - Pedestrian Hi! and Run 96 - Not Applicable Driver's Name a Last BOEVER Firs! JOSEPH Middle PAUL Address PO BOX 535 Address (Line 2) State Zip Date or City SD 57345 Birth Sex 1 - Male Non Motorist Location on - shoulder Non Motorist Action 02 - Walking, running. #1991119, Playing. Cycling kaung Phone DL State DL Class Non Motorist Contributing Circumstances DL Status 96 - Not Applicable Up to Two) 00 - None Driver Contrihuting Circumstances (Up to Two) 96 - Drug Test at Applicable as - Test given, but 99 - Vision Contributing Circumstance 96 - Not nobtalnable at time report pplicable led Alcohol Alcohol Test Use 93 - Test given, but 99 - nobtalnable at time report Injury Status 01 - Fatal Saltey Equipment 11 - Lighting (Non-motorist nly) Seating Position 96 - Not Applicable nowmobile, pedestrian, etc.) 002 Air Bag Deployed 96 - Not Applicable Transported To LUCE LUZE RECK FUNERAL HO led Ejection 96 - Not Applicable snowmobile, pedestrian, elce) Citation Charge? 96 - Not Applicable Citation Citation Citation Source olTransport 97 - Other Citation #4 EMS Trip it is Driver the Owner Owner's Name Last First Middle Address Address (Line 2) City State Zip Red Tag Year Make Model VIN Estimated Speed How License Plate it State Year Travel Estimated? 96 - Not Speed Applicable Speed Limit 65 Total Occupants 3:212:33}; 96 Damage Amount (Vehicle and Contents) insurance Cor Name Insurance Policy fifteen" Expiration Date Vehicle Configuration 96 - Not Emergency Vehicle Use? 96 - Not Applicable Appucame Trailer Type 96 - Not Applicable Cargo Body Type 96 - Not Applicable Direction of Travel Before Crash 96 - Not applicable (immobile from previous accident, stuck, etc.) Trailer LP # Attached to Power Unit State Year Initial Point of Impact Trailer 2 State License Plate # Year Trailer 3 State License Plate # Year Most Damaged Area Underride/Override 96 - Not Applicable Traffic Control Device Type 96 - Not Applicable Vehicle Contributing Circumstance 96 Not Applicable Vehicle Maneuver 96 - Not Applicable Road Contributing Circumstance 96 - Not Applicable First Event 96 - Not Applicable Second Event 96 - Not Applicable Third Event 96 - Not Applicable Fourth Event 96 - Not Applicable Most Harmful Event for this Vehicle Does the accident involve one or more of the following: Did the accident result in one or more of the following: • a truck having a GCWR of 10,001 or more pounds; OR • a vehicle displaying a hazardous material placard; OR • a vehicle designed to transport 9 or more people, including driver • a fatality; OR • an injury requiring transportation for immediate medical attention; OR • a vehicle was disabled requiring a towaway from the scene Accident Involved Vehicle - Purpose 96 - Not Applicable Carrier Name Street Address Street Address (Line 2) US DOT GVWR # 98 City State Zip Hazardous Material Released? Hazardous Material Content Code Hazardious Material Class Code GCWR Hazardous Materials Description Work Zone Related? 02 - No First Harmful Event? 20 - Pedestrian Workers Present? 96 - Not Applicable Location of First Harmful Event 02 Shoulder Work Zone 96 - Not Applicable Work Zone Location 96 - Not Applicable Trafficway Description 01 - Two-way, not divided Manner of Collision 00 - No collision between 2 MV in transport Light Condition 02 - Dark - roadway not lighted School Bus Related? 00 - No Weather Conditions (up to two) 02 Cloudy D A M A G E D O Damaged Object (Property Other Than Vehicles) B Owner's Full Name - Last First Name J Address Address (Line 2) E C City State T Estimate of Damage Middle Name Zip I N J U R E D Last Name P Unit # Address E State R City S Injury Status O Seating Position N Air Bag Deployed Transported to First Name Middle Name Address (Line 2) Zip Date of Birth Sex Ejection Safety Equipment Source of Transport EMS Trip # D I A G R A M NARRATIVE UNIT #1 WAS TRAVELING WESTBOUND ON US HWY 14. UNIT #1 DRIVER WAS DISTRACTED. UNIT #1 ENTERED THE NORTH SHOULDER WHILE TRAVELING WESTBOUND. UNIT #2 (PEDESTRIAN) WAS WALKING ON THE NORTH SHOULDER. UNIT #2 WAS STRUCK BY UNIT #1. UNIT #2 WAS CARRYING A LIGHT. THE EXACT TIME OF CRASH IS STILL UNDER INVESTIGATION. THE TIME OF LAW ENFORCEMENT ARRIVAL IS ESTIMATED AS THE RESPONDING SHERIFF DID NOT ADVISE DISPATCH WHEN HE ARRIVED. THE PEDESTRIAN WAS TRANSPORTED FROM THE SCENE BY THE CORONER. INFORMATION FOUND DURING THE INVESTIGATION INDICATES A DRIVER DISTRACTION. THE SPECIFIC DISTRACTION IS STILL UNDER INVESTIGATION. W I T N E S S Last Name First Name Middle Name Address Address (Line 2) City Date Notified 09/12/2020 State Zip Time Notified 22:24 Hrs. Agency Type 01 - Highway Investigation Made at Scene? patrol 01 - Yes Approval Officer Last Name NORMAN Phone # Date Arrived 09/12/ Time Arrived 2020 22:45 Hrs. Photos Taken? Y Date Approved 10/ 30/2020 First Name MYRON Middle Name