Do Read Make A
Resume:
Authority: **** PA ***, Sec.***.***
Compliance: Required MSP UD-10E
Penalty: $100 and/or 90 days (Rev 11/2020)
External # Crash ID
070****-******* File Class 93001
Incident #
STATE OF MICHIGAN TRAFFIC CRASH REPORT 21831824
ORI
MI 6302100
Department Name
MSP Metro North
Reviewer
MICHAEL MCCUAIG
Crash Date
09/09/2024
Crash Time
15:45
No. of Units
05
Crash Type
Unknown
Special Circumstances
None Hit and Run School Bus
Fleeing Police Unknown Animal
Special Checks
Fatal Non-Traffic Area ORV/Snowmobile
County
50 - Macomb
Traffic Control
None
Relation to Roadway
On the Road
Weather
Clear
Area
FRWY Other Freeway Areas
City/Twsp
89 - Roseville
Contributing Circumstances
1st
None
2nd
Light
Daylight
Road Surface Condition
Dry
Total Lanes
04
Speed Limit
70
Posted
Yes
Work Zone (if applicable)
Type
Workers Present
Activity
Location
Prefix
Primary Road Name
I 696
Road Type
HWY
Suffix
Divided Roadway
W
Distance / Direction
132 Feet E
Trafficway
Divided Hwy with Barrier
Prefix
Intersecting Road Name
GROESBECK
Road Type
HWY
Suffix
Divided Roadway
S
L O C A T I O N
Unit Number
01
Unit Known
Yes
State Driver License Number
MI K640036210027
Date of Birth (Age)
01/09/1965 (59)
License Type Endorsements
Operator Cycle
Chauffeur Farm
Moped Recreation
Sex
F
Race
W
Total Occupants
01
Hazardous Action
Unknown
Unit Type
MV
Driver Information
AIMEE ELIZABETH KRUL
29701 MAPLEGROVE ST
SAINT CLAIR SHORES, MI 48082 248-***-****
Driver is Owner
Yes
Injury
O
Position
Front - Left
Restraint
Shoulder and Lap Belt
Driver Condition at Time of Crash
1st
Appeared Normal
2nd
Driver Distracted By
Not Distracted
Ejected
Trapped
Airbag Deployed
Not Deployed
Hospital
NONE
Ambulance
NONE
Alcohol Suspected
No
Contributing Factor
No
Alcohol Test Type
Breath Blood Urine
Field PBT Refused Not Offered
Alcohol Test Results
Pending Test Results:
Interlock Device
No
Drug Suspected
No
Contributing Factor
No
Drug Test Type
Blood Urine
Field Refused Not Offered
Drug Test Results
Pending Test Results:
Citation Issued
Hazardous
Other
Vehicle Registration
AIMEEEE
State
MI
Vehicle
Description
Year
1998
Make
HONDA
Model
ACCORD
Color
BLK
VIN
1HGCG5644WA171161
Vehicle Type
Passenger Car, SUV, Van
Special Vehicles
Not Applicable
Private Trailer Type
Vehicle Defect
Automation System(s) in Vehicle
No
Automation System Level in Vehicle
No Automation
Automation System Level Engaged at Time of Crash
No Automation
Insurance Company
STATEFARM
Insurance Policy #
4794482C1622M
Towed By
ABLE
Towed To
ABLE
Location of
Greatest Damage 02
First Impact
02
Extent of Damage (Power Unit and/or Trailers)
Disabling Damage
Vehicle Direction
W
Vehicle Use
Private
Action Prior
Changing Lanes
Sequence of
Events
( indicates MOST harmful event)
First
17 - Motor Veh in Transport
Second
17 - Motor Veh in Transport
Third
Fourth
U N I T / D R I V E R
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
P A S S E N G E R S
Carrier Information
USDOT
MC
MPSC
Driver's CDL Type Endorsements
H
N
P
S
T
X
CDL Exempt
Farm
Other
GVWR/GCWR
10,000 lbs. or Less 10,001 - 26,000 lbs. Greater than 26,000 lbs. Vehicle Configuration
Cargo Body Type
Medical Card
Hazardous Material
Placard Cargo Spill
ID #
Class #
T R U C K / B U S
Owner Information
Owner Information
OWNERS
Damaged Property
Public
Owner & Phone
Page 01 of 03
Unit Number
02
Unit Known
Yes
State Driver License Number
MI D120067122050
Date of Birth (Age)
01/18/1983 (41)
License Type Endorsements
Operator Cycle
Chauffeur Farm
Moped Recreation
Sex
M
Race
B
Total Occupants
01
Hazardous Action
Unknown
Unit Type
MV
Driver Information
ANTHONY CORTEZ DAVIS
22986 BEACONSONFIELD
EASTPOINTE, MI 48021 313-***-****
Driver is Owner
Yes
Injury
O
Position
Front - Left
Restraint
Shoulder and Lap Belt
Driver Condition at Time of Crash
1st
Appeared Normal
2nd
Driver Distracted By
Not Distracted
Ejected
Trapped
Airbag Deployed
Not Deployed
Hospital
NONE
Ambulance
NONE
Alcohol Suspected
No
Contributing Factor
No
Alcohol Test Type
Breath Blood Urine
Field PBT Refused Not Offered
Alcohol Test Results
Pending Test Results:
Interlock Device
No
Drug Suspected
No
Contributing Factor
No
Drug Test Type
Blood Urine
Field Refused Not Offered
Drug Test Results
Pending Test Results:
Citation Issued
Hazardous
Other
Vehicle Registration
5QJE64
State
MI
Vehicle
Description
Year
2023
Make
FORD
Model
F150
Color
BLU
VIN
1FTEW1EPXPKE61883
Vehicle Type
Pickup Truck
Special Vehicles
Not Applicable
Private Trailer Type
Vehicle Defect
Automation System(s) in Vehicle
No
Automation System Level in Vehicle
No Automation
Automation System Level Engaged at Time of Crash
No Automation
Insurance Company
STATEFARM
Insurance Policy #
425439180222G
Towed By
NONE
Towed To
NONE
Location of
Greatest Damage 07
First Impact
07
Extent of Damage (Power Unit and/or Trailers)
Minor Damage
Vehicle Direction
W
Vehicle Use
Private
Action Prior
Going Straight Ahead
Sequence of
Events
( indicates MOST harmful event)
First
17 - Motor Veh in Transport
Second
Third
Fourth
U N I T / D R I V E R
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
P A S S E N G E R S
Carrier Information
USDOT
MC
MPSC
Driver's CDL Type Endorsements
H
N
P
S
T
X
CDL Exempt
Farm
Other
GVWR/GCWR
10,000 lbs. or Less 10,001 - 26,000 lbs. Greater than 26,000 lbs. Vehicle Configuration
Cargo Body Type
Medical Card
Hazardous Material
Placard Cargo Spill
ID #
Class #
T R U C K / B U S
Owner Information
Owner Information
OWNERS
Witness Information
Witness Information
WITNESS
Investigated
at Scene Yes
Reported Date (Time)
09/09/2024 (16:31)
1st Investigator Name (Badge)
AIDAN MILLS (1020)
2nd Investigator Name (Badge)
Photos
No
Narrative
All 5 unit drivers stated they did not know what happened to cause the crash. Driver of Unit 1 stated she remembered hitting a truck, Unit 2, which may have been the first collision. Driver of Unit 3 was transported to Ascension Hospital with minor injuries. No citations, as fault could not be determined. Diagram is drawn as Troopers arrived on scene. No other injuries reported. Diagram
Authority: 1949 PA 300, Sec.257.622
Compliance: Required MSP UD-10E
Penalty: $100 and/or 90 days (Rev 11/2020)
External # Crash ID
070****-******* File Class 93001
Incident #
STATE OF MICHIGAN TRAFFIC CRASH REPORT 21831824
ORI
MI 6302100
Department Name
MSP Metro North
Reviewer
MICHAEL MCCUAIG
Crash Date
09/09/2024
Crash Time
15:45
No. of Units
05
Crash Type
Unknown
Special Circumstances
None Hit and Run School Bus
Fleeing Police Unknown Animal
Special Checks
Fatal Non-Traffic Area ORV/Snowmobile
County
50 - Macomb
Traffic Control
None
Relation to Roadway
On the Road
Weather
Clear
Area
FRWY Other Freeway Areas
City/Twsp
89 - Roseville
Contributing Circumstances
1st
None
2nd
Light
Daylight
Road Surface Condition
Dry
Total Lanes
04
Speed Limit
70
Posted
Yes
Work Zone (if applicable)
Type
Workers Present
Activity
Location
Prefix
Primary Road Name
I 696
Road Type
HWY
Suffix
Divided Roadway
W
Distance / Direction
132 Feet E
Trafficway
Divided Hwy with Barrier
Prefix
Intersecting Road Name
GROESBECK
Road Type
HWY
Suffix
Divided Roadway
S
L O C A T I O N
Unit Number
03
Unit Known
Yes
State Driver License Number
MI H400067887334
Date of Birth (Age)
05/01/2000 (24)
License Type Endorsements
Operator Cycle
Chauffeur Farm
Moped Recreation
Sex
M
Race
W
Total Occupants
01
Hazardous Action
Unknown
Unit Type
MV
Driver Information
ANDREW WILLIAM HILL
7568 PACKARD AVE
WARREN, MI 48091 586-***-****
Driver is Owner
Yes
Injury
O
Position
Front - Left
Restraint
Shoulder and Lap Belt
Driver Condition at Time of Crash
1st
Appeared Normal
2nd
Driver Distracted By
Not Distracted
Ejected
Trapped
Airbag Deployed
Deployed - Combination
Hospital
OTHER
Ambulance
ROSEVILLE FIRE DEPT
Alcohol Suspected
No
Contributing Factor
No
Alcohol Test Type
Breath Blood Urine
Field PBT Refused Not Offered
Alcohol Test Results
Pending Test Results:
Interlock Device
No
Drug Suspected
No
Contributing Factor
No
Drug Test Type
Blood Urine
Field Refused Not Offered
Drug Test Results
Pending Test Results:
Citation Issued
Hazardous
Other
Vehicle Registration
ETC4640
State
MI
Vehicle
Description
Year
2011
Make
DODGE
Model
AVENGER
Color
BLK
VIN
1B3BD1FB5BN565248
Vehicle Type
Passenger Car, SUV, Van
Special Vehicles
Not Applicable
Private Trailer Type
Vehicle Defect
Automation System(s) in Vehicle
No
Automation System Level in Vehicle
No Automation
Automation System Level Engaged at Time of Crash
No Automation
Insurance Company
NONE
Insurance Policy #
NONE
Towed By
SERVICE
Towed To
SERVICE
Location of
Greatest Damage 08
First Impact
08
Extent of Damage (Power Unit and/or Trailers)
Disabling Damage
Vehicle Direction
W
Vehicle Use
Private
Action Prior
Going Straight Ahead
Sequence of
Events
( indicates MOST harmful event)
First
17 - Motor Veh in Transport
Second
Third
Fourth
U N I T / D R I V E R
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
P A S S E N G E R S
Carrier Information
USDOT
MC
MPSC
Driver's CDL Type Endorsements
H
N
P
S
T
X
CDL Exempt
Farm
Other
GVWR/GCWR
10,000 lbs. or Less 10,001 - 26,000 lbs. Greater than 26,000 lbs. Vehicle Configuration
Cargo Body Type
Medical Card
Hazardous Material
Placard Cargo Spill
ID #
Class #
T R U C K / B U S
Owner Information
Owner Information
OWNERS
Damaged Property
Public
Owner & Phone
Page 02 of 03
Unit Number
04
Unit Known
Yes
State Driver License Number
GA 050945870
Date of Birth (Age)
08/29/1982 (42)
License Type Endorsements
Operator Cycle
Chauffeur Farm
Moped Recreation
Sex
F
Race
W
Total Occupants
01
Hazardous Action
Unknown
Unit Type
MV
Driver Information
STEPHANIE MARIE MARN
1218 VESPER DR
COLOMBUS, GA 31904 706-***-****
Driver is Owner
Yes
Injury
O
Position
Front - Left
Restraint
Shoulder and Lap Belt
Driver Condition at Time of Crash
1st
Appeared Normal
2nd
Driver Distracted By
Not Distracted
Ejected
Trapped
Airbag Deployed
Deployed - Combination
Hospital
NONE
Ambulance
NONE
Alcohol Suspected
No
Contributing Factor
No
Alcohol Test Type
Breath Blood Urine
Field PBT Refused Not Offered
Alcohol Test Results
Pending Test Results:
Interlock Device
No
Drug Suspected
No
Contributing Factor
No
Drug Test Type
Blood Urine
Field Refused Not Offered
Drug Test Results
Pending Test Results:
Citation Issued
Hazardous
Other
Vehicle Registration
EYS265
State
GA
Vehicle
Description
Year
2016
Make
JEEP
Model
COMPASS
Color
SIL
VIN
1C4NJCBAXGD612297
Vehicle Type
Passenger Car, SUV, Van
Special Vehicles
Not Applicable
Private Trailer Type
Vehicle Defect
Automation System(s) in Vehicle
No
Automation System Level in Vehicle
No Automation
Automation System Level Engaged at Time of Crash
No Automation
Insurance Company
PROGRESSIVE
Insurance Policy #
968727677
Towed By
SERVICE
Towed To
SERVICE
Location of
Greatest Damage 10
First Impact
06
Extent of Damage (Power Unit and/or Trailers)
Disabling Damage
Vehicle Direction
W
Vehicle Use
Private
Action Prior
Going Straight Ahead
Sequence of
Events
( indicates MOST harmful event)
First
17 - Motor Veh in Transport
Second
Third
Fourth
U N I T / D R I V E R
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
P A S S E N G E R S
Carrier Information
USDOT
MC
MPSC
Driver's CDL Type Endorsements
H
N
P
S
T
X
CDL Exempt
Farm
Other
GVWR/GCWR
10,000 lbs. or Less 10,001 - 26,000 lbs. Greater than 26,000 lbs. Vehicle Configuration
Cargo Body Type
Medical Card
Hazardous Material
Placard Cargo Spill
ID #
Class #
T R U C K / B U S
Owner Information
Owner Information
OWNERS
Witness Information
Witness Information
WITNESS
Investigated
at Scene
Reported Date (Time)
1st Investigator Name (Badge)
2nd Investigator Name (Badge)
Photos
Narrative
Diagram
Authority: 1949 PA 300, Sec.257.622
Compliance: Required MSP UD-10E
Penalty: $100 and/or 90 days (Rev 11/2020)
External # Crash ID
070****-******* File Class 93001
Incident #
STATE OF MICHIGAN TRAFFIC CRASH REPORT 21831824
ORI
MI 6302100
Department Name
MSP Metro North
Reviewer
MICHAEL MCCUAIG
Crash Date
09/09/2024
Crash Time
15:45
No. of Units
05
Crash Type
Unknown
Special Circumstances
None Hit and Run School Bus
Fleeing Police Unknown Animal
Special Checks
Fatal Non-Traffic Area ORV/Snowmobile
County
50 - Macomb
Traffic Control
None
Relation to Roadway
On the Road
Weather
Clear
Area
FRWY Other Freeway Areas
City/Twsp
89 - Roseville
Contributing Circumstances
1st
None
2nd
Light
Daylight
Road Surface Condition
Dry
Total Lanes
04
Speed Limit
70
Posted
Yes
Work Zone (if applicable)
Type
Workers Present
Activity
Location
Prefix
Primary Road Name
I 696
Road Type
HWY
Suffix
Divided Roadway
W
Distance / Direction
132 Feet E
Trafficway
Divided Hwy with Barrier
Prefix
Intersecting Road Name
GROESBECK
Road Type
HWY
Suffix
Divided Roadway
S
L O C A T I O N
Unit Number
05
Unit Known
Yes
State Driver License Number
MI A520772522445
Date of Birth (Age)
06/14/1976 (48)
License Type Endorsements
Operator Cycle
Chauffeur Farm
Moped Recreation
Sex
M
Race
A
Total Occupants
01
Hazardous Action
Unknown
Unit Type
MV
Driver Information
SOE LIN AUNG
16965 PENROD DR
CLINTON TOWNSHIP, MI 48035 586-***-****
Driver is Owner
No
Injury
O
Position
Front - Left
Restraint
Shoulder and Lap Belt
Driver Condition at Time of Crash
1st
Appeared Normal
2nd
Driver Distracted By
Not Distracted
Ejected
Trapped
Airbag Deployed
Not Deployed
Hospital
NONE
Ambulance
NONE
Alcohol Suspected
No
Contributing Factor
No
Alcohol Test Type
Breath Blood Urine
Field PBT Refused Not Offered
Alcohol Test Results
Pending Test Results:
Interlock Device
No
Drug Suspected
No
Contributing Factor
No
Drug Test Type
Blood Urine
Field Refused Not Offered
Drug Test Results
Pending Test Results:
Citation Issued
Hazardous
Other
Vehicle Registration
EPV1797
State
MI
Vehicle
Description
Year
2022
Make
LEXUS
Model
RX
Color
BLK
VIN
2T2HZMDAXNC340588
Vehicle Type
Passenger Car, SUV, Van
Special Vehicles
Not Applicable
Private Trailer Type
Vehicle Defect
Automation System(s) in Vehicle
No
Automation System Level in Vehicle
No Automation
Automation System Level Engaged at Time of Crash
No Automation
Insurance Company
AAA
Insurance Policy #
AUT700458807
Towed By
NONE
Towed To
NONE
Location of
Greatest Damage 03
First Impact
03
Extent of Damage (Power Unit and/or Trailers)
Minor Damage
Vehicle Direction
W
Vehicle Use
Private
Action Prior
Going Straight Ahead
Sequence of
Events
( indicates MOST harmful event)
First
17 - Motor Veh in Transport
Second
Third
Fourth
U N I T / D R I V E R
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
P A S S E N G E R S
Carrier Information
USDOT
MC
MPSC
Driver's CDL Type Endorsements
H
N
P
S
T
X
CDL Exempt
Farm
Other
GVWR/GCWR
10,000 lbs. or Less 10,001 - 26,000 lbs. Greater than 26,000 lbs. Vehicle Configuration
Cargo Body Type
Medical Card
Hazardous Material
Placard Cargo Spill
ID #
Class #
T R U C K / B U S
Owner Information
DAMIAN OLIVERA BERGALLO
1710 ORCHARD LN
BLOOMFIELD HILLS, MI 48301
Owner Information
OWNERS
Damaged Property
Public
Owner & Phone
Page 03 of 03
Unit Number
Unit Known
State Driver License Number
Date of Birth (Age)
License Type Endorsements
Operator Cycle
Chauffeur Farm
Moped Recreation
Sex
Race
Total Occupants
Hazardous Action
Unit Type
Driver Information
Driver is Owner
Injury
Position
Restraint
Driver Condition at Time of Crash
1st
2nd
Driver Distracted By
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
Alcohol Suspected
Contributing Factor
Alcohol Test Type
Breath Blood Urine
Field PBT Refused Not Offered
Alcohol Test Results
Pending Test Results:
Interlock Device
Drug Suspected
Contributing Factor
Drug Test Type
Blood Urine
Field Refused Not Offered
Drug Test Results
Pending Test Results:
Citation Issued
Hazardous
Other
Vehicle Registration
State
Vehicle
Description
Year
Make
Model
Color
VIN
Vehicle Type
Special Vehicles
Private Trailer Type
Vehicle Defect
Automation System(s) in Vehicle
Automation System Level in Vehicle
Automation System Level Engaged at Time of Crash
Insurance Company
Insurance Policy #
Towed By
Towed To
Location of
Greatest Damage
First Impact
Extent of Damage (Power Unit and/or Trailers)
Vehicle Direction
Vehicle Use
Action Prior
Sequence of
Events
( indicates MOST harmful event)
First
Second
Third
Fourth
U N I T / D R I V E R
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
Passenger Information
Date of Birth (Age)
Sex
Race
Position
Restraint
Injury
Ejected
Trapped
Airbag Deployed
Hospital
Ambulance
P A S S E N G E R S
Carrier Information
USDOT
MC
MPSC
Driver's CDL Type Endorsements
H
N
P
S
T
X
CDL Exempt
Farm
Other
GVWR/GCWR
10,000 lbs. or Less 10,001 - 26,000 lbs. Greater than 26,000 lbs. Vehicle Configuration
Cargo Body Type
Medical Card
Hazardous Material
Placard Cargo Spill
ID #
Class #
T R U C K / B U S
Owner Information
Owner Information
OWNERS
Witness Information
Witness Information
WITNESS
Investigated
at Scene
Reported Date (Time)
1st Investigator Name (Badge)
2nd Investigator Name (Badge)
Photos
Narrative
Diagram
Contact this candidate