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HomeMy WebLinkAbout07-4748Mark W. Allshouse, Esquire Attorney ID # 78014 4833 Spring Road. Shermans Dale, PA 17090 (717) 582-4006 Attorney for Plaintiffs PatriciaAnn Gantz and Kevin Gantz Plaintiffs v. Jason Brubacker, Defendant In the Court of Common Pleas Cumberland County, Pennsylvania Civil Action -Law Jury Trial Demanded NOTICE TO PLEAD TO: Mr. Jason Brubacker, Defendant 10 Brown Road Shippensburg, PA 17257 YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 Date: $//Q/~ rk W. Allshouse, E uire Aorney ID # 78014 4833 Spring Road Shermans Dale, PA 17090 (717) 582-4006 Attorney for Plaintiffs Mark W. Allshouse, Esquire Attorney ID # 78014 4833 Spring Road Shermans Dale, PA 17090 (717) 582-4006 Attorney for Plaintiffs PatriciaAnn Gantz and Kevin Gantz Plaintiffs v. In the Court of Common Pleas Cumberland County, Pennsylvania No. ~ 7 ~~ y 9 ~;l ~~ Jason Brubacker, :Civil Action -Law Defendant :Jury Trial Demanded COMPLAINT AND NOW, come Plaintiffs, PatriciaAnn Gantz and Kevin Gantz, her husband, by and through their attorney, Mark W. Allshouse, Esquire and respectfully aver as follows: 1. Plaintiffs are PatriciaAnn Gantz and Kevin Gantz, husband and wife, adult individuals, who reside at 442 West Main Street, Walnut Bottom, Cumberland County, Pennsylvania 17266. 2. Defendant is Jason Brubacker, an adult individual, with a last known address of 10 Brown Road, Shippensburg, Cumberland County, Pennsylvania 17257. 3. On or about August 13, 2005, Defendant Brubacker was driving and in possession and control of a 1998 Chevrolet 3500 pick up truck and was driving North on State Route 0174, also known as West Main Street, Walnut Bottom, Pennsylvania. 4. Defendant Brubacker was driving in a reckless and negligent manner by following the vehicle of Plaintiff more closely than is reasonable and prudent given the speed of the vehicles and condition of the highway and as a result, failed to control his vehicle causing it to collide with the Gantz vehicle in a powerful rear end collision. A true and correct copy of the Pennsylvania State Police Investigation Report done on the day of the accident is attached hereto and made a part hereof for reference marked as Exhibit "A". 1 5. Defendant Brubacker was cited for Pennsylvania Vehicle Code Violation 75 Pa. C.S.A. § 3310 for following too closely. 6. Plaintiffs are in no way and in no degree responsible for the rear end collision herein at issue and; therefore, are in no way comparatively negligent. 7. As a result of negligence and recklessness in the crash between the two vehicles, the Plaintiff, PatriciaAnn Gantz, sustained various injuries to her body including, but not limited to her head, cervical spine, upper extremities, lumbar spine, lower extremities, spinal cord and legs, as well as causing other pre-existing, but otherwise asymptomatic conditions to become problematic. 8. At the time of the accident, Mrs. Gantz was four (4) months pregnant. 9. At the time of the accident, passengers in the Plaintiff's vehicle included, Plaintiff, her son Tyler Gantz, age 9 her son Aaron Gantz, age 8, her son Zachary Gantz, age 6, and her unborn child born the 26th day of January 2006, named Megan Lauren Gantz. 10. As a result of the aforesaid injuries, Plaintiff was forced to seek and receive medical intervention including, but not limited to: a. Emergency transport and intervention at Carlisle Hospital; b. Multiple diagnostic tests; c. Several weeks of physical therapy, unsuccessfully attempting to alleviate her pain; d. Numerous visits to healthcare providers attempting to diagnose and treat the Plaintiff s injuries. 11. As a result of the Defendant's recklessness and negligence, the Plaintiff was caused to experience and suffer the following harm: 2 a. Pain in her neck, upper extremities, cervical and lumbar spine, knees, pelvis and left foot. b. Pain and stiffness in the morning and again as the day progresses; c. Pain when bending or any prolonged sitting; d. Pain in holding any heavy amounts, including her newborn child; e. The inability to engage in any of life's regular activities in which she had been accustomed to prior to the accident; f. Fear and anxiety arising from indications that her symptoms from the possibility of injury to her unborn child; g. Fear and anxiety arising from indications that her symptoms and problems may not be successfully treated and resolved. 12. The Plaintiff has been advised and, therefore, avers that her injuries are serious and the pain currently experienced by Plaintiff may be permanent. 13. As a result of Defendant's recklessness, Plaintiff Gantz has sustained a severe shock to her nerves and nervous system, has caused her to undergo great anguish and physical pain, which she still suffers and will continue to suffer for an indefinite time in the future. 14. As a further result of Defendant's recklessness, Plaintiffs have been compelled to expend various sums of money for travel to and from doctors' appointments, medicine and medical attention. 15. Plaintiffs have been advised and, therefore, aver that they will continue to expend such sums of money for medicine and medical attention for an unlimited time in the future. 16. As a result of the crash and injuries sustained by Plaintiff, PatriciaAnn Gantz, Plaintiffs have been unable to follow their usual occupations and routines and have been 3 deprived of the ability to enjoy simple pleasures in life and will be unable to do so for indefinite time in the future. 17. Plaintiffs have satisfied all conditions precedent in the filing and in proceeding of this lawsuit. WHEREFORE, Plaintiff PatriciaAnn Gantz demands judgment against Defendant Jason Brubacker demands judgment in an amount in excess of the amount requiring compulsory amount in excess of the amount requiring compulsory arbitration. COUNTI PatriciaAnn Gantz and Kevin Gantz v. Jason Brubaker 18. The averments contained in paragraphs 1 through 17 of this Complaint are hereby incorporated by reference as if set forth at length. 19. The aforesaid injuries and harm sustained by Plaintiffs was a direct and proximate result of the recklessness and gross negligence of Defendant Brubacker. 20. The recklessness and gross negligence of Defendant Brubacker is both general and in the following particular respects: a. Driving and otherwise operating a vehicle under his control in a reckless, careless, negligent and unsafe manner; b. Driving and otherwise operating a vehicle under his control in violation of the Pennsylvania Motor Vehicle Code. c. Driving and otherwise operating a vehicle under his control such that it struck the vehicle occupied and being operated by Plaintiff, PatriciaAnn Gantz. d. Driving and otherwise operating a vehicle without due regard to the right, safety and position of Plaintiff's vehicle; 4 e. Driving and otherwise operating a vehicle under his control without due regard for other traffic on the road; f. Failing to pay attention to other vehicles located on the roadway and to maintain control of his own vehicle at all times; 21. As a result of the recklessness herein set forth, and the negligence set forth in Count II hereof, the Plaintiffs sustained harm as previously hereinbefore set forth. 22. It is believed and, therefore, averred that Plaintiff will in the future require continued medical care and treatment. 23. As a result of the negligence as set forth herein, Plaintiff has incurred substantial costs for co-pays, medical treatment, prescription drugs, fees for medical records, filing fees, mileage for medical appointments and the like, which amounts will continue in the future. 24. The actions of Defendant Brubacker were in violation of the Pennsylvania Vehicle Code for which he was charged, and believed to have been convicted, constitute negligence, per se. WHEREFORE, Plaintiff PatriciaAnn Gantz demands judgment against Defendant Jason Brubacker demands judgment in an amount in excess of the amount requiring compulsory amount in excess of the amount requiring compulsory arbitration. COUNT II Kevin Gantz, in his own right v. Jason Brubaker 25. The averments contained in paragraphs 1 through 24 of this Complaint are hereby incorporated by reference thereto as set forth at length herein; 26. At all times hereto, Plaintiff Kevin Gantz was the husband and spouse of Plaintiff PatriciaAnn Gantz. 5 27. As a result of the negligence of the Defendant, Plaintiff Kevin Gantz was forced to attend to the physical injuries sustained by his wife, PatriciaAnn Gantz. 28. As a result of the negligence of the Defendant, Plaintiff Kevin Gantz was denied the companionship, consortium, love, affection, tenderness of his wife and spouse, PatriciaAnn Gantz. WHEREFORE, Plaintiff Kevin Gantz demands judgment against Defendant Brubacker in an amount in excess of the amount requiring compulsory arbitration. Respectfully Submitted Date: $ (~Ol ~1 y Mar W. Allshouse, Esq ire Attorney I.D. # 78014 4833 Spring Road Shermans Dale, PA 17090 (717) 582-4006 Attorney for Plaintiffs 6 Exhibit "A" r z 3 COMMONWEALTH OF PENNSYLVANIA P~IICE [RASH REPORTING FORi~II i~mwiiiubiiiuin ~~..~. ~ ~~ el°sea Reportable Crash 4/ P 0 8 514 4 3 JOD 1 ~ Yes Q No ®Yes Q No Police envy Patin) Zone Incident Number ~ o dz f • 6 ~ c~~ _ 1 ,-~33 ~z Invest} orlon Date (MM-Dn-YYYY) Prec~nti .. G Ager~ Name d Q ~' ~ C~!$L~ ~ a .~ ' ~ ~ Z " ~4G~Gls ~ ~T~ Tom b er ~ Badge Num I Q Dis arch Time (mil) Arrival lime (mil) Investigator ~S a a 3 ~ S oc~ s 1 re ~:~t~ ~ Bad a Number Approval Date (MM-DD-YYYY) Reviewer t g t D ~S - ~- ~ C1C 4-• C - ee County County Name Munid liity Munia li Name Dr'Lv of UI elk ~ ~ Qee7'I{ /~~l~TD~ ~st, O Sun Q Thu 2 ~ ~/lf~~/~/!f~ ~ Q Mon Q Fri 00 * *If ll O > ed Crash Date (MM-DD-YYYY} Crash Time (mip No of Units Peo Ie Inured Ki ~ Tue ~ Sat complete s ~ ~ " j 3 - O D ,S ~ d ~ ~ ~- a ~ ~ Z d d Form F Q Wed Q Unk ~ Workzone pf Yes, Complete O Yes ®No School Bus O Yes ®No ~~ °ne O Yes ~ No Ma•,r finance O ~O Yes (~ No l d t R e a e Form M, Section 29) ¢ lprpC~ection Tvt~e Mufti-Leg 0 Off Ram Railroad Crossin *S~oat Q 4 Way Intersection Q 'Y' Intersection O Intersection P O g L~ tts?II ~ ~ S . ~ Midblock Traffic Circle/ On Ram Q 'T" Intersection O Round About ~ P O Crossover O Other ~ See Overla Route Number Segmerrt (Optional) Travel Lanes Speed Limit ~ North House Number (if applicable) o south oa . a ~ -~ 7 cy Z a o 1 Street Name Street Ending c O East For Mid-blxk crashes only. Use a (~ WeSt postal House Number and make sure "~ ~. C ~ Prinapal Roadway Street Name is /1 ~ I S f f't' / 't/ fl Unknown tiped m if using this option -~ ~ Interstate Turnpike Turnpike ~ State O County O Local Road Q Private 0 Other! ~S ~ (Not Turnpike) ~ (East/V-lest) O Spur Highway Road or Street Road Unknown ~ Route Number Segment (Optional) Travel Lanes Speed Limit o (~ North O South m m ° ;, `~ ~ ~ Street Name Street Ending w O East y O West ~ ~ m O O Unknown ~" ;; ,~ 8sZt1~ interstate 0 Tumpike O Turnpike ~ State O County ~ Local Road O Private O Other! O d k ~ ~ nown Un (Not Turnpike) (East/INest) Spur Highway Road or Street Roa ~ h Itrtersectin Rt Num Or Mile Post Or Segment Marker h o N Feet [ ~ ^ ~~ ~ ort q N . o south E m E Or Intersecting Street Name St Ending ~ O East ~ u Please Enter ~ ~ ~ ~ O West Or Miles g information BOTH °p f L t ~ ~ ' ~ ° '- ' o: ~ " d or ti Landmarks ~ if using tion Thi O N Intersedin Rt Num Or Mile Post Or Segment Marker ~ ~ O x ~ ~ O North f~istance Frain Crash Scene to Landmark 1 p s . ~ ~ Q South h b _ c Or Intersecting Street Name St Ending ~ O East {for Cras etween Landmark ~ and ~ ~ ~ ~ a West Landmark 2} ~ Degrees Minutes Seconds Degrees Minutes Seconds ~-~-~ Q ~ Longiwde: - ~ ~ ,~ 17I ~ ( Latitude: ~ Q ~:© . . ~•-_--~-~ Traffic [ontrol Device Police Officer or ~ Yield Sign ~ Flagman ~? Not Applicable Q Traffic Signal Active RR Crossing O Other Type TCD O i~ FurKOonina Device Functioning Emergency ~ No Controls O Im r CJ Preemptive P oPedY ~ +'~ Controls Flashing Traffic nal 0 Stop Sign ~ Passive RR ~ Unknown ~ Si Signal Device Not Device FunRionin ~ Functionin ~ Pro ri g ~ Unknown g pe Y g Crossing Controls ~~ (/f "Not,4pplicable', skip rest of tfie Lane Closure section) ,~ O North O East O North and South Q All c Not Applicable ~ Partially !~ Fully Q Unknown ~~ a South O West Q East and West (N,S,E,W) r m Traffic Yes (~ No ~~~ Unknown [~ S1lb~ O ~ 30 Min. O 30-60 Min. 0 1-3 hrs Q 3-6 hrs Q 6-9 hrs Q > 9 hours Q Unknown Foam s an-sao (~uozl PENNDOT COPY fV /r ~~-+ P~LMIC~ CQtl~S REIPORTfR! ~ RM 11lI,d~ ~II ~~~~~ I~ ~~~~I~ ~ Crash Number Police Use only Page p 0 8 514 4 3 AA 500 2 ~ -~S"o3~ ~~ 4 ~ p _ Motor Vehicle in ~ ®Transport o Hit & Run Vehicle o Illegally Parked o Legally Parked oNon -Motorized Commenaial Vehicle ~ ;, Unit ~ pedestrian (~ Pedestrian on Skates, o Disabled From Q Train o Phantom Vehicle ~ Yes ~ No in 4Yheelchair, etc PreNOUS Crash {-t Yes, Complete Form C) (K `Pedestrian" or 'Pedestrian on Skated in Wheelchair, etc", Complete Form M, Section 28) Unit No First Name MI Date of Birth (MM-DD-YYYY) s a ~~ 3 1 1 `~ Delete? Last Name Tel hone Number o ,Q u ~ G X E~ '~f'7 y77 - 0'7~ 7 Address ! !state Zi c Q /~,/ ~f j fCJ L7Kad/V ~,a ~%~~/"/ G~iVSI~Gf~~ /~ ! 7 Z S 7 R ~ - Driver License Number State Class z~a~os~6 ~',~0 C . ~ Alcohol/ rUrugs Suspected ~ Driver or Pedestrian Ptsysica( Condition ~ ~ No Q Illegal Drugs o Meditation ~ Nppa~relntly O Legal Drug o Fatigue o Medication om. ~ Q Alcohol o Alcohol and Drugs o Unknown Had Been 0 Sick o Asleep o Unknown ~ - Drinking G` Alcohol rest rvve ~ Test Nat Given o Breath o Other ~mary Vehicle Code Violation Charged? m v ~ Unknown if o Blood o Urine 33~a ®Yes o No _ s Test Given >° Alcohol Test Results ~] Test Refused o Resul ~ Driver Presence 1=Driver Operated 3=Driver Fled Scene O ~ Test Given, minated Re ults ~• ~ Co t ~) Vehicle 4-Hit 8nd Run ( n a s 2=No Driver 9=Unknown OwneNDriver 00=Not Applicable 02~rivate Vehicle Not 04=State Police'Jehicle 07=Municipal Police Veh 09=Federal Gov Veh 01=Private Vehicle Owned/ OvvnedlLeased by Driver 05=PENNDOT Vehicle 08-0ther Municipal 98=Other (,~ ~ Leased by Driver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown m Same as Ovvrter First Name Owner. Last Name or Business Name (If Pedestrian, skip this Section) Driver Q'AJ ~~ Address !City /State /Zip Vehicle Make *Make Code Cl~~u2~c~ eZ C~ VIM Model Year Vehicle Model (see overlay) f G C~ .~3 /~3 - oso6 a 1~ ~ s~ ~~ao State Es License Plate Reg t. Speed Vehicle Towed Towed B ~ / ~, Z ~. I f ' Uy ~ v ,~ o Yes (Q Wo ___.__. 1»svrance Insurance Company Policy No Yes o No o known fit~~~i9vr2G~Qiv p -~fLs` ~ ~ ! f~ ~. ~a-Z 5 s 3 R ... . . „ E ~ Trailing r 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No lag Year Tag St Unit No; of © U~ ^ 2=Towing Truck S=Camper 8=Other m ~~~ g 3=Towing Utility Trailer 6=Full Trailer 9=Unknown u D~ ® xVehicle Position ~ *Movement © *Se~e Via/ Usage overlay Vehicle Color Vehicle Tyne 05=Large Truck ZO=Unicycle, Bicycle, © Q 12=Commercial 06=Ye11~++ 07=Sihrer 01=Automobile fl6=5lSV Sri~le Q ~ 02=Motorcycle 07=Van 21=Other Pedalcyde Passenger 00=Not Applicable Carrier 01 F V h 08=Gold 01=Blue 09=Brown 03=Bus 10=Snowmobile 22=Horse & Buggy 04=Small Truck 11=Farm Equip 23=Horse & Rider = ire e 13=Taxi 02=Ambulance 21=Tractor Trailer 02=Red 10=Orange 03=White 11=Purple (-f "02", Complete form 12=Construction Equip 24=Train M, Section 26) 13=ATV 25=Trolley 03=Police 22=Twin Trailer 08=Other Emergency 23-Triple Trailer 04=Green 12=0~ther 05=Black 99=Unknown (!f "20" or "2t", Complete ~B=Other Type Spec Veh 98=Other Form M, Section 27) 19=Unk. Type Spec Veh 99=Unknown t t= ~pilcTransport 99=U~nfoe~Veh Initial Impact Polrrt Damage /ndicator Gradient 3=Downhill Road Alianmeni 00=Non-Collision 14=Undercarriage 01-12=Clock Paints 15=Towed Unit a O=None 2=Functional ~ 1=Minor 3=Disabling ©1=Level 4=Bottom of Hilt 5=Top of Hili ~ i=Straight rv 2=C d 13=Top 99=Unknown 9=Unknown 2=Uphill 9=Unknown u e 9=Unknown FORM • rn-soo (vtia2) PENNDOT COPY N~ ,~ co~~a~rE cYH a~ ~Er~~sv~.v~~w /n~ /A~ n/~ APaLICE CRASH REPQR4'IONG ~ORRA Page: . I"1f'1 500 2 PO{1C4 Use ~ ~ ! ~0 ~~ ~~ Q P0851443 r~ ®TrMansporthide in Hit & Run Vehicle Q III all Parked O Le al Parked O eg y g ly Q Non -Motorized Commercial Vehide 10 ~. c Unit ~ PedesViBn ~ Pedestrian on Skates, ~ Disabled From ~ Train h O Phantom Vehicie Wh l i i h P C O Yes ®No ~ n ee a r, etc c revious ras (tf "pedestrian" or 'Pedestrian en Skates, in Wheelchair, ett", Com fete Form M, Section ,281 (~ Yes, Complete Form CJ Unit No First Name Ml Date of Birdt(MM-DD-YYYY) Delete? Last Name Tele hone Number O G ~ ~ ~ 7r7~~S.?2 - 33.x1 Ad d ress / / Sta e t Zi m ~j ~ l ~ ~ f ~ ,~ d TTG ` ~' ~ r r ~ o c Driver iictnse Number State U--ass -- ~ ~ ~ t Z~ S 3 ~' '4 .~ R ~~ ~.` 1 Atmhol/Drtras Susvected Driver w Pedem inn Ph~sfcaf Condition m ~ (~ No Q illegal Drugs Q Medication ®Apparently Illegal Drug Fati ue Medication Norrnal O Use 0 g O a O Alcohol O Alcohol and Drugs O Unknown Had Been O O Side O Asl e k (~ U ~ p e n nown Drinkin a Alcoho! Test Tune D Q Test Not Given Q Breath O Other Primary Vehide [ode Violation Charged? -01 v Unknown if O Blood O Urine 0 ~~ r/~ /t/Q~~ O Yes ~ No :c Test Given > Akohoi Test Results O Test Refused d Renskunlu n Qri`ver Presence 1=Drives Operated 3=4river Fied Scene a. ~ O Test Given, Contaminated Results ~ Vehicle 4=Hit and Run 2=N0 Driver 9=Unknown OwneNDriver 00=Not Applicable 02=Private Vehide Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh O1=Private Vehicle Owned/ Owned/Leased by Drner 05=PENNDOT Vehicle 08=Other Munidpal 98=Other < d 1 teased by Driver 03.Rented Vehicie 06=Other State Gov Veh Government Vehicle 99=Unknown Same as Owner First Name Owner last Name or Business Name {!f Pedestrian, skip this Section) Driver ~ Address 1 I State /Zip Vehic l e Make *Make Code ~ j ~FrG~/,~oGes T a C7 V1N Model Year Vehicle Model (see overlay) 1 ~ ~ I> o ~' O ~ .v 3 ~ ~ o ~ o o .a ~1 ~~ . ~.~ License Plate lteg. State Est Speed i/ehide Towed Towed 8Y 7 ,S P ~ Q Yes ~ No Insurance insurance Company Policy No r (~ Yes Q No O known Ni¢-T! oNt/ipt .~"~vS . .5,~ ,~7 ,~ ~y'6 ~~a ' '~ Trani ~ 1 Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Tag Year tag St Unit No, of ~ Unk ~ 2 Towing Truck 5=Camper 8=0ther ili T m ~ ra ng 3=Towing utility Trailer 6=Full Trailer 9=Unknown Units: Direction of rav~~ ~ 'Vehide Position r['T ~ 'A9ovement ( j r~~ * See I C•/j r J I c (1-± O l ~ l U~~ ver ay Vehide Color Vehide Type OS=Large Truck 20=Unicycle, Bicycle, ,t, /7 d !! 12=Commercial 06=Yellow D a 07=Silver 01=Automobile 06=SUV Tricycle cle 07=Van 21 O h ®02=Motor Passenger 00=Not Applicable Carrier , cy - t er Pedalcycie O Of3--Gold 03=Bus iO=Snowmobile 22=Horse & Buggy t=Fire Veh 13=Taxi 01=Blue 09=Brown 04=Small Truck 1 t=farm Equip 23=horse & Rider 02°Arnbulance 21=TraROr Trailer 02=Red 16=Orange {lf "02", Complete farm 12=Construction Equip 24....Train 03=Police 22=Twin Trailer 03=Wi1ite 11=Purple M, Section 26) 13=AN 25=Trolley ~=her Emergency 23=Triple Trailer 04=Green 12=Other 05=Black 99=Unknown A A 16=Other T 5 Veh 98=Other {lf 20 or 21 ;Complete 1g=Unk. T ye S p Veh 99=Unknown form M, Section 27) YP l~ Vehide 31~Modified Veh 11=Pupil Transport 9g~Unknawn initial impact Point Damage indicator Gradleni 3=Downhill Road Alignment 00=Non-Collision 14=Undercarriage f~ ~ 01-12=Clock Points 15=Taxed Unit O=None 2=Functional ~ t=Minor 3=Disabling 1_L~l 4=Bottom of Hiil D 5=Top of Hilt ~f 1=Straight ! 2 C d 13=Top 99=Unknown 9=Unknown 2=Uphill g=Unknown = urve 9=Unknown FORM ,r av-5oo {12!02) PENNDOT COPY ~~~ COMMONWEALTH OF PEiNNSYLVANIA POLICE CRASH REPORTING i'ORflA ~9e AA 500 3 Por~ae ~~ o y ~! r,SU33 9 ~ iiuimsia~~i n,~._~, -~ P0851443 p- 1=Driver 2=Passen er S~3LI~rsitioo: [} 00=Not A Passenggeer/Occupant 01 D i All V ~id ,Saferv Eouinmenr One: ~~ E 00=None Used !Not Applicable (jd Not Applicable g 7=Pedestrian 8=Other r = ver - e es 02-Front Seat Middle Position 03~ront Seat Right Side 01=Shoulder Belt Used 1=Not Elected 02=Lap Belt Used 2=Totally E!•ected b3=Lap A,rud Shoulder Belt Used 3=Partiall E d 4=Unknown y jecte 04=Second Row -Left Side Or 04=Child Safety Seat Used 9=Unknown Motorcycle Passen er 05=Motorcyce Helmet Used 05=Second Row - Midgdl P i i 05 ' ~.• e os t OC~Sewnd Row -Right Side on =6 a Helmet Used 10=Safety Belt Used Improperly ~ H F.iection Path• p B F =Female M=Male U =U k 07=Third Row Or Greater - 1-eft Side 08=Third Row Or Greater - 11=Child Safety Seat Used Improperly Not Ejected /Not Applicable i2=Helmet Used Improperly 1=Through Side Door Opening 2=mrough Side Window 90 R t i t U d T ~ n nown Middle Position = es ra n se , ype Unknown 99=Unknown 3=Through Windshield o ~ b in1UrV >;r~- O=Not Injur d U9=Third Row Or Greater - .Right Side 10=Sleeper Section of Truckcab 11=1n Oth r Endos d Through Back Door Safety~uinment Two: 5=Through Back Door Tail ate Opening F 00=None Used /Not Applicable 6=Through Roof Openin Sunroof/ Corn rtibl T D n ~ e 1=Killed 2=Major Injury e e Passenger Or Cargo Area t 2=1n Open Area e e op ow 01=Front Air Bag Deployed {For Tha Seat) OZ=Side Air Bag Deployed (For This Seat) ?=Through Roof Opening (Convertible To U ) 03 h O T Ai ~ 3=Moc~rate Injury (Back Of Pickup, Etc.) 13=Trailing Unit p p = er t ype r Bag Deployed 04=Multiple Air Bags Deployed 9=Unknown 05=Motorcyde Eye Protection 4=Minor Injury 8=Injury, Unk 14=Riding On Vehicle Exterior 15=Bus Passenger 0~-Bitydist Weanng Elbow/KneeJPads t 0=Air Bag Not Deployed Switch On ~ ~- Seventy 9~Unknown if 98~ther 99=Unknown , 11=Air Bag Not Deployed, Switch Off o=Not Applicable 12=Air Bag Not Deployed, 1=Not Extricated Injury Unk Switch Setting 2=Extricated By Mechanical Means 13=Air Bag Removed (prior To Crash) 3=Freed By Non -Mechanical Means 19=Unknown If Air Bag Deployed 8=Other 99=Unknown 9=.Unknown ` ` r EMS Agency: ~CGGor~ ~/~GC;rNG S Medical Facil' '~-~ ig,2 u S G ~ f~o5~ Unk No Person No ©~ o ~ Delete? Date of Birth (MM-DD-YYYY) q B C p E F G H I o m-cam- aa~c~ o ~ ~ ~ oQ ^ Name !Address /Phone Same as Operator EMS Transport o Yes ®No ~ Unit No Person No Delete? Date of Birth (MM-DD-YYYY) A B C ^ D E F G H I Name /Address /Phone Same as EMS Transport operator ®Yes o No Unk No Person No ~ a o~ Deletes Date of Birth {MM-DD-YYY17 A B C D E F G H I o m-~- ~~ I~~©®o s©®Ol~ ~ Name /Address /Phone t~ Same as --7"s/~~ 6~.~ T~ Operator ! l -.--.-- EMS Transport ~ Yes o N . o Unit No Person Na Dz D3 De[ete? Date of Birth (MM-DD-YYYY) A B C D E F G H j o Cis -4 zr'` - ! ~ 4 7 ~~~ ©~~ aQ0© ~ Name /Address !Phone Same as ~~~~ T~ operator .~-- ERAS Transport O Yes !~} No Unit Na Person No ~ ~ Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I ~ ~ i -a o - ~ ~ ~ 0~~~~ o o [~ o ~ ^ Name /Address /Phone Same as ..,d~GC1~G ~/T~- Operator EMS Transport o Yes ~ No Unit No Person No Deletes Date of Birth (MM-DD-YYY1~ nA B C D E F G H I ~ m-~ L J^^mmm^~ Name /Address /Phone ~ Same as EMS Transport Operator rnnu. ~~_re...~.envf~ O Yes o No --' - PENNDOT COPY ~~~ .J COMMONWEALTH QF PENNSYLVANIA POLICE CRASH REPORTING FORM Page AA 500 4 ~°''~ ~~ y Z `1~d 3 ~ ~~ OC~ t ~, v N~I~IIII~IIY ~,~... P0851443 Gash ~scrintion ~ O=Non-C~tlision 2=Head On 4=Angle 6-.Sideswipe B=Hit Pedestrian 1 pi ti it R O rec on} e ppos 1= ear End 3=Raar to Real s=Sideswi { ~ ~ (Sacking) (Same ~rection 7=Hit Fxad a o ) Object 9--OtherNnknown a Relation M Roadway ~ 1=0n Travel Lanes 3=1Nedian S--Outside Traflicrvay 7=Gore (Ramp Intersection) o ~ - 2Y.Shoutder 4=Roadside 6=1n Parking lane 9=Unknown s ' ~ tllumirra6on 1 r;1 / 1=Daylight 3=Dark - Stnaet xDawn 8=ether t V9~ 1 ` r t spark - No f~¢ark -Unknown Street Li hts 4-Dusk tio~ ' h " N v ia ~ Weather Conditions © 1=No~A i~b'onse 3=Sleet {Hain ~Fo9 7=Sleet 8 Fog 9=Unknown ~ 2=Rain 4=Snow f~Rain & Fog ti=0ttter c Road Surfare Conditions ~ 2=gand, Mud, Dirt, 4=Slush 6=Ice Patches B=Other O=DN Oil ~1t~ 7=W~ter Standing 3_=Snow Covered or Moving Harm Event ,tlR Most? Uti by Dole Num r - t n ® Han»fut Ev+ertt!t (Hann Everttl 30=Hit Fente Or Waq 01-Hii Unit 1 31=Hit Building t - ' -'.1 tyre Ko {!,S 02=Hit Unit 2 32=Hit Cuhrert 2 m a ~ ~ ~/~ 03=Hit Unit 3 33=Hit Bridge Pier Or Abutment 04=kit Unit 4 34--Hit Parapet End 05=Hit U id it 5 35 Hit B R il ~rLL--, n r ge = a 06=Hit Other Traffic Unit 36=Hit Boulder Or Obstacle Please Poi 3 m a O ~ "'1~ Events in I ~ 07=Hit Deer On R Pdway 08=Hit Other Animal 37=Hit Im act Attenuator Sequential 09=CoIIKion With Other Non 38=Hit Fire Hydrant c Order 4 ~ ~ ~ ~ ~~ Fixed Object 39=Hit Roadway Equipment 11=Struck By Unit 1 40=Hit Mail Sox 12=Strode By Unit 2 41=Hit Traffic Island s 13 St k B U i 42 S Hi B k E = ruc y n = t now an t 3 ,Q Hann Event L/R Most? Unity bole Number 14=Strudk By Unit 4 43=Hit Temporary Construction c ~. d ~ ! / ~ ` 15=Strode By Unit 5 Barrier 15=Struck By Other Traffic Unit 48=Hit Other Faced Object 2 Unit No 1=Hit Tree Or Shrubbery 49=Hit Unknown Fixed Object '"' [rn 2 m ~ (~ ~^ ~~ i-L ~ 22=Hit Embankment 50=OverturNRoll Over 23=Hit Utility Pole St-Struck By Thrown Or Failing 24=Hit Tra#f ect Si Ob ~ .J .. .. ic gn j 25=Hit Guard Rail 52=Pot Holes Or Other Please Put ~ Events in 3 ~ ^ ~ 26=Hit Guard Rail End Pavement Irregularities 27=Hit Curb 53=Jackn'rfe -- Sequentla! 26=Hit Concrete Or 54=Fire In Vehicle Order ~ ^ 4 Q ~ ~~ Longitudinal Barrier 58=Other Non-Collis,on 29=Hit Ditch 99=Unknown Harm#ul Event first Unit No Harm Event Most Unit No Harm Event Harmful ~ ~ ~ ~~! ~ ® © ~ ~ d ~ Driver Action [OJ 17=Careless Or Illegal 00=No Contributing Action Backing On Roadway 18 D i i Th 0 O ~ , etT~h = r v ng n e Wrong 1=Driver Was Distracted 02~riving Using Hand Held Phone Side OF Road 0o not reprac the ~^tormsnon on mulopk Pa9a 03=Driving Using Hands Free Phone 19=Making lmproper Environmental/Roadwav r ti t F ct Pbi (E/R) t ©0 2 ~ 3 ~ 04=Makng Illegal U-Tom Entrance Ta Highway 05=Improper/Careless Taming 20=Making Improper Exit 06 T a a o s ~err = urning From Wrong Lane From Highway 00=None 1 I=Slippery Road Conditions (Ice/Snow) 07=Proceeding W/0 21=Careless Parkin n rkin Clearance After Stop 22=OverN ~ ~ g d 01=Windytonditicros 12=Substance On Roadway 02=Sudden Weather Conditions 13=Potholes n er 08=Runnin St n g °~ ~ Compensation At Curve 09=Runnin Re Li t 03--Other Weather Conditions 14=6roken Or Cracked Pavernent 04=Deer to Roadway 15=TCD Obstructed q g iO=Failure 7o Respond To 23=5pee~ng. Other Traffic Control Device Z'4=Driving Too Fast For tonditions 05=Otniade On Roadway 16=Soft Shoulder Or Shoulder Drop Off 06=Other Animal In Roadway 28=Other Roadway factor 11=Tailgatingy 25=Failure To Maintain Proper Speed 12=Sudden Sktwiny5to ping 26°Dnver ~~ Ponce (Po1 Chase) p 07=Glare 29=Other Environmental Factor Road Z7=Driver inexperienced 13=IIIegaNy Stopped On c o 08=Work Zone Related 99=Unknown 14=Careless Pass-ng Or Lane 28=Failure To Use Specialized Equip 92=Affected B Ph sical Condition Ch y y ange a P Possible Vehicle Faituns ({~ 12-Wipers 00=None 06=Exhaust 13-Driver Seating/Control 15=Passing In No Passing Zone gB=Other improper Driving Actions 16=Driving The Wrong Way On ~=Unknown 01=Tires 07=Headlights 14=8ody, Doors, Hood, Etc 1•Way Street O1 ~ 02=Brake System 08=Signal Lights 15=Trailer Hitch 03=Steerin S em t}9=Ot er Li hts 16=Wheels g 17 Airba s n tynit ® t !~ Z NO ! ~ v'Z 3 4 a = gs 10=Horn io 04=Suspen 05=Power Train 11=Mirrors 18=Trailer Overloaded '~ c 19=Unsecure/Shifted Unit ~ t~ Z m Trailer Load ~ © unit m 3 m 4 No © j D~ 2 v No t 20=Improper lowing ~+~' Mort a ~. 99=0bk ~ed Windshield 7 O~ 2 m Pedestrian Action fP9 03=Working 00=None 04=Pushing Vehicle 01=Entering Or Crossing At OS =Approaching Or leaving Vehicle 06=Workin O V S afi hi Indicated Prime Factor Unit No Factor Code g pe n ed tocation e cle 02=Walking, Running, Jogging, 07=Standing Do not repeat tltis information on muhiple pages. ~} ® Ot Playing 98=Other 99=Unknown E/R V D P ~ Q ® a ff E/R is tfie Prime Paccar Unit No m Unit No Type, leave Unit No blank LL.~~JJ~~JJ '~'" "''``S0° t77J~`r PENNDOT COPY ~~,4 ~~ CONRMONWEALTH OF PENNSYLVANIA . POLICE CRASH REPORTING ifORNI Page AA 500 5 ~ a,y Z- /sue ~'~ ~'~ C3~ d 9~IIIIIII~MII1 ~._r, ~ P0851443 - - ~ _ _~._ _.y... _ j..w ~... _.-j... »». j j - - j F i j .....»_i..__._-i...........;.»..__..i......._..i....» .....:...........i- ... _......i...........i......_._j-._»-.._i...........i...._.».-i....... ..o ........i._...._..i.. ... ..._..i.»._.....i...._..... .... .. j :. i ..... ... _ .»_ ...._.....; : i ~ i : : - .... ... ...... _ . i~~~l~? r~?.4,yv . - .. € j ... .ry. .... ...j._ ...j... ...j_. ..j... . ~.r. ...~... w ~ Y•~.s... ...j... ~: : ' ^- .~ ...;... ...1... ...; 2 : ; - - . ."..-^^--~- ~ a ....~...........€......... i ..~ 1... :~ ...:._ ..........:...........i...... . _.. . .j... ...j... ..j... _.j._ ..1... : : /n' a - ...__. .. .. • ... ...:... . _.#. ...j... ,.. _..:... ..;..» j ..j_». ...1...........j...........j witness .Name . Ad Tess s ,Phone ~ r- n ~ 2 Narrative and additional witnesses: Accident Investigation Notification Issued? ® Property Darreage Q e one resen , o n se This collision occurred as UNIT#2 was traveling north an SR0174 and was s o 1 g urn In o er r~veway. a er urn slgna on an was m slowin down. UNtT#1 ahem ted to veer off to the left o avoid strikin UNIT#2 but was unsuccessful. UNiT#1 struck UNiT#2 in the rear~bumper area with his ran ng umper. mpac cause o spin c oc wlse an came ores In z ~a c M N Physical evidence at the scene included verbal statements from both Operators' 3 drivewa .She related that she had her turn signal on and was slowing down #o tum. She related that she looked into her rearview mirror and observed the other ~... ~ M~'`'~'"`' PENNDOT COPY COp~RAO~iil~dll.'9'a1 OF i~WR15Yi.VAit~1~ ~I ~ III~I I ~~ Il~lllll ~ Gash Number i'OU~k Cdt~SDi OifEPOR'1'IP'lts F06tRA P898 ® kew CIA 5~ N °""`~ "~ Z- ~ ~ O motion ~ ~ S ~ L_71 `71. ~ ~ Plarrative and additional witnesses: I interviewed Operator#2 on scene on 08/13/05 at approximately 1440 hours. He re a e a e was rave mg Wort on 4 an a looked over at a tractor unsuccessful. a .. L i Z C a w C i K z ~'- .-~ ~EN~DOTC4PY VERIFICATION I, Kevin Gantz, verify that the statements in the foregoing document are true and correct to the best of my knowledge, information and belief under penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. Date: g~~o~o~ ~ e 'n antz VERIFICATION I, PatriciaAnn Gantz, verify that the statements in the foregoing document are true and correct to the best of my knowledge, information and belief under penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. Date: ~'~~~~~ PatriciaAnn Gantz A,~ ~ 5. ~-.t V ~ 4' ~' ~ Z . (~\ ~ f r ~ ' t ~ ' _ ' Y ~ '+ .. i" `„ ~ ~ -~ 4._e_s f ~ .J -S ~ 1~ _.A.J 1A\ r r ! /f V SHERIFF'S RETURN - REGULAR CASE NO: 2007-04748 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND GANTZ PATRICIAANN ET AL VS BRUBACKER JASON RICHARD SMITH Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within COMPLAINT & NOTICE BRUBACKER JASON DEFENDANT the at 1216:00 HOURS, on the 16th day of August 2007 at 10 BROWN ROAD SHIPPENSBURG, PA 17257 IVAN BREBACKER, FATHER was served upon by handing to a true and attested copy of COMPLAINT & NOTICE together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing 18.00 Service 18.24 Postage .58 Surcharge 10.00 .00 S'~~.~'Ib~ ~ 46.82 Sworn and Subscibed to before me this day of So Answers: R. Thomas Kline 08/20/2007 CHRISTIAN LAWYER L IONS By: eputy Sheriff A.D. Mark W. Allshouse, Esquire Attorney ID # 78014 4833 Spring Road Shermans Dale, PA 17090 (717) 582-4006 Attorney for Plaintiffs PatriciaAnn Gantz and Kevin Gantz, Plaintiffs v. Jason Brubacker, Defendant In the Court of Common Pleas Cumberland County, Pennsylvania : No. 07-4748 Civil Civil Action -Law Jury Trial Demanded PRAECIPE TO DISCONTINUE TO THE PROTHONOTARY: Please mark the above caption matter as settled, discontinued and forever ended. Date: ~/l~//~g` 1VXark W. Allshouse, squire 'Atty. LD. # 78014 r 4833 Spring Road ` Shermans Dale, PA 17090 (717) 582-4006 Attorney for Plaintiffs ,~--~ r. ~:a - ~~ ~;_,`4 wl, ~.: ° <: