OH-1(Rev.10/99)

TRAFFIC C RASH R EPORT Private Photos OH-2 OH-3 OH-1P OTHER Hit / Skip Local Report # * Crash Severity Property Taken 1 Not Hit / Skip 'X' 1 Fatal 3 PDO 'X' 2 Solved If Yes If Yes 12-027 3 2 Injury 4 Unknown 1 3 Unsolved N.C.I.C. # * Reporting Agency * # Units Unit Error Date of Crash * 98 = Animal 08301 Franklin Police Department 02 01 99 = Unknown 01272012 Time of Crash Day of Week City * Village * TWP * Name ( Of City, Village or Township) * County # * Latitude Longitude 0804 FRI X Franklin 83 CRASH OCCURRED ON Type Location Point Used LOCAL INFORMATION Prefix Crash Location Type Loc 1 Named Street 3 Numbered Route N St.Rt.123 3 2 Numbered Street 6810.00 N ST.RT.123 AT / REFERENCE Reference Point Used 04 House Number 08 Place Name W/O Reference Dist Reference DR Prefix Reference Ref Point 01 State Line 05 Township Boundary 09 Driveway 02 Intersection 2 Streets 06 Mile Post 10 Street or Route W/O Reference 6810 04 03 County Line 07 Corporation Limit Unit # # of Occ. Name (Last, First, Middle) A 01 01 HARRIS BRANDY L Address (Street, City, State, Zip Code) 20 CLEARVIEW LN Franklin OH 45005-0000 Social Security Number Date of Birth Age Sex Home Phone # Work Phone # 12211974 37 F (937) 479-4852 InjuredTaken To DL State DL # LP State LP # Injured 1 None 4 Other Transported By 2 EMS 5 Unknown OH SC837748 OH FLV1843 Taken By 1 3 Police Owner Name (if same, write "SAME") Address( Street, City, State, Zip Code) HARRIS BRANDY L 20 CLEARVIEW LN Franklin OH 45005-0000

Year Make Model Color Insurance Company Towing Service Owner Phone # 2010 DODG CHA BLK American Commerce Ins. (937) 479-4852 Offense Charged Offense Description Citation # Local Code? 'X' If Yes

Unit # # of Occ. Name (Last, First, Middle) B 02 01 THOMAS LANCE Address (Street, City, State, Zip Code

Motorist / Non-Motorist 802 S MAIN ST Franklin OH 45005-0000 Social Security Number Date of Birth Age Sex Home Phone # Work Phone # 01141994 18 M (937) 718-8891 DL State DL # LP State LP # Injured 1 None 4 Other Transported By InjuredTaken To Taken By 2 EMS 5 Unknown OH TR841066 OH FAB9658 1 3 Police Owner Name (if same, write "SAME") Address( Street, City, State, Zip Code) WOOD CHRISTA L 802 S MAIN ST FRANKLIN OH 45005

Year Make Model Color Insurance Company Towing Service Owner Phone # 1995 DODG RAM RED/SIL The General Auto Ins. (937) 746-2087 Offense Charged Offense Description Citation # Local Code? 'X' If Yes

Unit # Date of Birth Age Sex Name (Last, First, Middle) Home Phone # C Address (Street, City, State, Zip Code) Injured Taken By Transported By Injured Taken To 1 None 4 Other 2 EMS 5 Unknown 3 Police Unit # Date of Birth Age Sex Name (Last, First, Middle) Home Phone # Occupant D Address (Street, City, State, Zip Code) Injured Taken By Transported By Injured Taken To 1 None 4 Other 2 EMS 5 Unknown 3 Police

Seating Position Safety Equipment Air Bag Air Bag Switch Ejection Trapped Injuries 01 Front - Left ( MC Driver) Motorist 1 Not Present 1 Not Ejected 1 No Injury 1 Not Deployed 1 Not Trapped A 02 Front - Middle AA01 None Used AA2 In On Position 2 Totally Ejected AA 01 04 12 Deployed-Front 41 1 1 2 Extricated By 2 Possible 03 Front - Right 02 Shoulder Belt Only 3 Deployed-Side 3 In Off Position 3 Partially Ejected Mechanical Means 3 Non- 04 Second - Left ( MC Pass) Incapacitating 03 Lap Belt Only 4 Deployed Both 4 Unknown 4 Not Applicable 3 Freed BY Non- Mechanical Means 05 Second - Middle 04 Shoulder /Lap Belt Front/Side 5 Unknown 4 Incapacitating 01B 06 Second - Right 04B B 5 Not Applicable B B B 4 Unknown B 5 Fatal Injury 05 Child Safety Seat 141 11 07 Third - Left 06 MC Helmet Used 6 Unknown 6 Unknown 08 Third - Middle 07 Use Unknown 09 Third - Right C C Non-Motorist C C C C C 10 Sleeper Section Of Cab 08 Non Used 11 Enclosed Cargo Area 09 Helmet Used 12 Unenclosed Cargo Area 10 Protective Pads D 13 Trailing Unit D 11 Reflective Clothing D D D D D 14 Exterior 12 Lighting 15 Other 13 Other Supplement * 16 Non-Motorist 14 Unknown 17 Unknown 'X' if Yes HSY7001 Top Copy - ODPS Bottom Copy - Agency Unit Numbers Damage Area Pre-Crash Actions Sequence Of Events Posted Speed Drug Test Status A B

01A 02B 08A 01B 35A 35B 1AB1 201 201 Non-Motorist Location O Motorist 1 None 01 Movements Essentially Traffic Control 2 Test Refused Straight Ahead 3 Test Given, Contaminated 02 Backing 2022 20 Sample/Unusable A A B 03 Changing Lanes 4 Test Given, Results Known A B 01 Marked Crosswalk At 01 01 04 Overtaking/Passing 5 Test Given, Results Unknown Intersection 05 Turning Right 01 No controls 6 Unknown 3 3 02 Intersection/ No Crosswalk 06 Turning Left 02 Drug Test Type 03 Non-Intersection Crosswalk 07 Making U-Turn 03 04 Driveway Access Crosswalk 08 Entering Traffic Lane 04 Traffic Signal 05 In Roadway 09 Leaving Traffic Lane 05 Traffic Flashers 44 11AB 06 Not In Roadway 10 Parked 06 School Zone Non-Collision 07 Median (But Not Shoulder) 11 Slowing/Stopped In Traffic 07 Railroad 1 None 01 Overturn/Rollover 08 Island 12 Driverless 02 Fire/Explosion 08 Railroad Flashers 2 Blood B 09 Shoulder 13 Other 03 Immersion 09 Railroad Gates 3 Urine 10 Sidewalk O 14 Unknown 04 Jackknife 10 Construction Barricade 4 Other 11 Within 10 Feet Of Roadway Non-Motorist 05 Cargo/Equipment Loss/Shift 11 Police Officer ( Not Shoulder, Median, 15 Entering/Crossing In Specified 06 Equipment Failure 12 Pavement Markings Drug Test 1&2 Result Sidewalk, Island) Location 07 Separation Of Units 13 Crosswalk Lines A B 12 Beyond 10 Feet Of Roadway 16 Walking, Running, Jogging, 08 Ran Off Road Right 14 Walk/Don't Walk Signal (Within Trafficway) Playing, Cycling 09 Ran Off Road Left 15 Traffic Control Device 13 Outside Trafficway 17 Working 10 Cross Median/Centerline Inoperative, Missing, Obscured 111122 14 Shared Use Paths Or Trails Most Damaged Area 18 Pushing Vehicle 11 Downhill Runaway 16 Other 15 Unknown 19 Approaching/Leaving Vehicle 12 Other Non-Collision 1 None 20 Playing/Working On Vehicle 13 Unknown Non-Collision Direction 2 Marijuana Type Of Unit 21 Standing Collision w/ Person, Vehicle, From To From To 3 Cocaine 22 Other Or Object Not Fixed 4 Opiates 23 Unknown 14 Pedestrian A 04B 5 Amphetamines 09 B 15 Pedalcycle 31A 21 03A 07B 6 PCP 01 None 16 Railway Vehicle 1 North Motorist Contributing Circumstances 7 Other 02 Center Front 17 Animal - Farm 2 South 8 Unknown at Time Of Reporting 01 Sub-Compact 03 Right Front 18 Animal - Deer 3 East 02 Compact 04 Right Side 19 Animal - Other 4 West Type of Intersection 03 Mid Size 05 Right Rear 02AB 01 20 Motor Vehicle In 5 Northeast 04 Full Size 06 Rear Center Motorist 21 Parked Motor Vehicle 6 Northwest 05 Minivan 07 Left Rear 01 None 22 Work Zone Maintenance Equipment 7 Southeast 01 06 Sport Utility Vehicle 08 Left Side 02 Failure To Yield 23 Other Movable Object 8 Southwest 01 Not An Intersection 07 Pickup 09 Left Front 03 Ran Red Light, Or Stop Sign 24 Unknown Movable Object 9 Unknown 02 Four-Way Intersection 08 Panel/Van 10 Top And Windows 04 Exceeded Collision with Fixed Object 03 T-Intersection 09 Single Unit Truck; 11 Undercarriage 05 Unsafe Speed 25 Impact Attenuator/Crash Cushion 04 Y-Intersection 2 Axles, 6 Tires 12 Load / Trailer 06 Improper Turn 26 Bridge Overhead Structure Condition 05 Traffic Circle/Roundabout 10 Single Unit Truck; 3+ Axles 13 Total (All Areas) 07 Left of Center 27 Bridge Pier Or Abutment 06 Five-Point, Or More 11 Truck/Trailer 14 Other 08 Followed Too Closely/ACDA 28 Bridge Parapet 07 On Ramp 12 Truck Tractor (Bobtail) 15 Unknown 09 Improper Lane Change/ 29 Bridge Rail 11A B 08 Off Ramp 13 Tractor/Semi-Trailer Drove Off Road/ 30 Guardrail Face 1 Apparently Normal 09 Crossover 14 Tractor/Double Short Point Of Impact Improper Passing 31 Guardrail End 2 Physical Impairment 10 Driveway/Access 15 Tractor/Double Long 10 Improper Backing 32 Median Barrier 3 Emotional 11 Railway Grade Crossing 16 Fifth Wheel Or Converter Dolly 11 Improper Start From Parked Position 33 Highway Post 4 Illness 12 Shared-Use Paths Or Trails 17 Tractor/Triples 12 Stopped or Parked Illegally 34 Overhead Sign Post 5 Fell Asleep, Fainted, Fatigued, Etc. 09A 04B 13 Unknown 18 Motorcycle 13 Operating Vehicle In Erratic, 35 Light/Luminaries Support 6 Under The Influence Of 19 Motorized Bicycle 01 None Reckless, Careless, Negligent or 36 Utility Pole Medications/Drugs/Alcohol Occurrence 20 School Bus 02 Center Front Aggressive Manner 37 Other Post, Pole Or Support 7 Other 21 Church Bus 03 Right Front 14 Swerving to Avoid (Due to Wind, 38 Culvert 8 Unknown 22 Public Bus 04 Right Side Slippery Surface, Vehicle, Object, 39 Curb 23 Other Bus 05 Right Rear 1 Non-Motorist In Roadway, Etc) 40 Ditch Alcohol/Drug Suspected 24 Police Vehicle 06 Rear Center 15 Failure To Control 41 Embankment 1 On Roadway 25 Fire Truck 07 Left Rear 16 Vision Obstruction 42 Fence 2 On Shoulder 26 Ambulance/Rescue 08 Left Side 17 Driver Inattention 43 Mailbox 1AB1 3 In Median 27 Taxi 09 Left Front 18 Fatigue/Asleep 44 Tree 1 None 4 On Roadside 28 Motor Home 10 Top And Windows 19 Operating Defective Equipment 45 Other Fixed Object 2 Yes-Alcohol Suspected 5 On Gore 29 Train 11 Undercarriage 20 Load Shifting/Falling/Spilling 46 Work Zone Maintenance Equipment 3 Yes-HBD Not Impaired 6 Outside Trafficway 30 Farm Vehicle 12 Load/Trailer 21 Other Improper Action 47 Unknown Fixed Object 4 Yes-Drugs Suspected 7 Unknown 31 Farm Equipment 13 Total (All Areas) 22 Unknown 48 Other 5 Yes-Alcohol / Drugs Suspected 32 Snowmobile 49 Unknown 14 Other Non-Motorist 6 Unknown Road Contour 33 Construction Equipment 15 Unknown 23 None First Harmful Event 34 All Others 24 Improper Crossing Alcohol Test Status Action Non-Motorist 25 Darting 35 Animal W/Rider 1 26 Lying And/Or Illegally In Roadway 11A B 36 Animal W/Buggy 27 Failure To Yield Right Of Way 11A B 1 Straight Level 37 Bicycle 4A 4B 28 Not Visible (Dark Clothing) Of the Sequence of Events - Which 2 Straight Grade 38 Pedestrian 29 Inattentive one is the First Harmful Event (1-4) 1 None 3 Curve Level 39 Pedalcyclist 1 Non-Contact 30 Failure to Obey Traffic Signs, 2 Test Refused 4 Curve Grade 40 Skater 2 Non-Collision Signals, Or Officer Most Harmful Event 3 Test Given, Contaminated 41 Other-Non Motorist 3 Striking 31 Wrong Side Of The Road Sample/Unusable Road Conditions 42 Unknown 4 Struck 32 Other 4 Test Given, Results Known Primary Secondary In Emergency Response 5 Both Striking And Struck 33 Unknown 1A 1B 5 Test Given, Results Unknown 6 Unknown 6 Unknown 01 Of the Sequence of Events - Which Vehicle Defect One is the Most Harmful event (1-4) Alcohol Test Type 01 Dry Code Only If '19' 11A B 02 Wet Striking Vehicle: Selected Above 03 Snow 1 No Override/ Underride Speed Detected 11A B 04 Ice 05 Sand, Mud, Dirt, Oil, Gravel 2 Yes 1 None 4 Breath A B 06 Water (Standing, Moving) 3 Unknown 2 Blood 5 Other 01 Turn Signals 07 Slush 22A B 3 Urine 1A B Damage Scale 02 Head Lamps 08 Debris** 03 Tail Lamps 1 Stated Alcohol Test Result 09 Rut, Holes, Bumps, Uneven 1 No Underride Or Override 2 Underride, Compartment 04 Brakes 2 Estimated Speed Pavement ** Intrusion 05 Steering 10 Other 2A 3B A 3 Underride, No Compartment 06 Tire Blowout Speed . 11 Unknown 1 None 07 Worn Or Slick Tires Intrusion ** Secondary Road Conditions ONLY 08 Trailer Equipment Defective 2 Non-Functional Damage 4 Underride, Compartment 3 Functional Damage 09 Motor Trouble Intrusion Unknown 10 A B 4 Disabling Damage 10 Disabled From Prior Crash . 5 Override, Motor Vehicle In 5 Severe 11 Other Defects Local Report # * Transport Supplement * 6 Unknown 6 Override , Other Vehicle 35 B 'X' if Yes 7 Unknown 12-027 Top Copy - ODPS Bottom Copy - Agency Narrative Unit #1 was attempting to pull out of the McDonalds parking lot located at 6810 N. St. Rt. 123 and pulled into the path of Unit #2 who was traveling Northbound on N. St. RT. 123 Causing damage to both vehicles.

Manner Of Collision or Impact School Bus Related Diagram Write an "N" on the compass diagram to indicate 6 1 the direction of north. 1 Not Collision Between 1 No Two Vehicles In Transport 2 Yes, Directly Involved 2 Rear-end 3 Yes, Indirectly Involved 3 Head-on 4 Unknown 4 Rear-To-Rear Work Zone Related 5 Backing 6 Angle 7 Sideswipe, Same Direction 8 Sideswipe, Opposite Direction 1 9 Unknown 1 No 2 Yes Weather 3 Unknown 01 Type of Work Zone 01 Clear 1 Lane Closure 02 Cloudy 2 Lane Shift/Crossover 03 Fog, Smog, Smoke 3 Work On Shoulder Or Median 04 Rain 4 Intermittent/Moving Work 05 Sleet, Hail (Freezing Rain Drizzle) 5 Other 06 Snow 07 Severe Crosswinds Location Of Crash In 08 Blowing Sand, Soil, Dirt, Snow 09 Other 10 Unknown Light Conditions Primary Secondary 1 Before First Work Zone 11 2 Advance Warning Area 3 Transition Area 1 Daylight 4 Activity Area 2 Dawn 3 Dusk Workers Present 4 Dark - Lighted Roadway 5 Dark - Not Lighted 6 Dark - Unknown Lighting 1 7 Glare 1 No 8 Other 2 Yes 9 Unknown 3 Unknown

The Crash INVOLVED one or more of the following: A The crash RESULTED in one or more of the following: Truck/Bus A truck (motor vehicle) with a GVWR more than 10,000 pounds; or A fatality; or N A truck (motor vehicle) with a hazardous materials placard; or An injury requiring transportation for immediate medical treatment; or D Unit # A bus designed for at least 8 persons, including driver. At least one vehicle was towed due to disabling damage or required intervening assistance before proceeding under its own power. Company (From Shipping Papers) Company Phone

Address (Street, City, St, Zip Code)

Placard # # Dia. US DOT ICC MC PUCO Trailer LP St. Trailer LP Year Trailer LP #

Hazardous Hazardous Cargo Body Type Weight (GVWR) CDL Class 1 Class A 01 Not Applicable 05 Pole 09 Concrete Mixer Materials Placard Material Released 2 Class B 02 Bus (9-15) Including Driver) 06 Cargo Tan 10 Auto Transporter 1 Less/Equal 10,000 1 No 1 No 3 Class C 2 Yes 03 Van/Enclosed Box 07 Flatbed 11 Garbage/Refuse 2 10,001 - 26,000 2 Yes 4 Class M 3 Not Applicable 04 Grain/Chips/Gravel 08 Dump 12 Other 3 More Than 26,000 5 Class D 3 Unknown 4 Unknown 13 Unknown Police Action Date01272012 Crash Reported Time0804 Rec Call 0804Dispatch 0814Arrived Cleared0830 Other 45 71Total Minutes Officer's Name * Badge # * Checked By Date Report Filed * Back, Michael1F35 Diekman, Edward 01272012 Report Taken By Local Report # * 1 Police Agency Report Taken At 1 Scene Supplement * 2 Station 2 Motorist 'X' if Yes 113 Other 12-027 Top Copy - ODPS Bottom Copy - Agency