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Home My WebLink About09-7103 aD KOPE & ASSOCIATES, LLC BY: SHANE B. KOPE, ESQUIRE ATTORNEY I.D. 92207 395 ST. JOHNS CHURCH ROAD CAMP HILL, PA 17011 (717) 761-7573 sbkopeO-kopelaw.com Attorney for Plaintiff FERN KIPE Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 'el, 7111y / V. RODNEY D. BENDER CIVIL ACTION - LAW Defendant. PRAECIPE FOR WRIT OF SUMMONS To: Prothonotary Please issue a writ of summons in the above-captioned civil action. This Writ of Summons shall be issued and forwarded to Shane B. Kope, Plaintiff's Attorney. Respectfully Submitted, 6'/ Date: /r o1 i 10 KOPE & ASSOCIATES, LLC BY: SHANE B. KOPE, ESQUIRE ATTORNEY I.D. 92207 395 ST. JOHNS CHURCH ROAD CAMP HILL, PA 17011 (717) 761-7573 sbkope _kopelaw.com FEM KEPE Plaintiff V. RODNEY D. BENDER Defendant. AttOrneybrP tilfi B4THEaJC URr,,AF',OO A"C-PL.E ?- CUMBERLAND COUNTY, PA No. CIVIL ACTION - LAW WRIT OF SUMMONS TO RODNEY D. BENDER: YOU ARE HEREBY NOTIFIED THAT FERN KIPE'HASH COMMENCED AN, ACTION AGAINST YOU. lfl lrilf 1, Zia Prothonotary. By: - Deputy Dated: /00/67 p FILLL 20G9 OCT 16 Fib 1: 23 lel7f, 0 N4 mf? /11 pw ?, ? 0132 Al-7 RLE 0 i CE Sheriffs Office of Cumber10Md#M , 0N0TARY R Thomas Kline Sheriff 2009 OCT 28 AM 9= 41 Ronny R Anderson , Chief Deputy 11L) .?Ul.?i? i Y PENNSYUMA Jody S Smith Civil Process Sergeant OFF C -,?F T, ?-ERIFF Edward L Schorpp Solicitor Fern Kipe vs. Rodney D Bender Case Number 2009-7103 SHERIFF'S RETURN OF SERVICE 10/23/2009 04:25 PM - Valerie Weary, Deputy Sheriff, who being duly sworn according to law, states that on October 23, 2009 at 1625 hours, she served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Rodney D. Bender, by making known unto Mari Bender, wife of defendant at 1070 Country Club Road Camp Hill, Cumberland County, Pennsylvania 17011 its contents and at the same time handing to her personally the said true and correct copy of the same. SHERIFF COST: $41.94 SO ANSWERS, ipopuc??? -"f &4 October 27, 2009 R THOMAS KLINE, SHERIFF Deputy Sheriff 0 KOPE & ASSOCIATES, LLC BY: HILARY P. VESELL, ESQUIRE ATTORNEY I.D. 308358 395 ST. JOHNS CHURCH ROAD CAMP HILL, PA 17011 (717) 761-7573 hvesell@kopelaw.com FERN KIPE, Plaintiff, Attorney for Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA V. RODNEY D. BENDER, Defendant. No. 09-7103 (Civil Term) : JURY TRIAL DEMANDED N O T I C E TO DEFEND AND CLAIM RIGHTS 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 further notice for any money claimed in the 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 a- c: 3 C71 rnw --4 C:) y, C= G.J t r 1 -1 tJ7 x'' ^C J"o AVISO USTED HA SIDO DEMANDADO/A EN CORTE. Si usted desea defenderse de las demandas que se presentan mas adelante en las siguientes paginas, debe tomar accion dentro de los proximos veinte (20) dias despues de la notificacion de esta Demanda y Aviso radicando personalmente o por medio de un abogado una comparecencia escrita y radicando en la Corte por escrito sus defensas de, y objecciones a, las demandas presentadas aqui en contra suya. Se la advierte de que si usted falla de tomar accion como se describe anteriormente, el caso puede proceder sin usted y un fallo por cualquier suma de dinero reclamada en la demanda o cualquier otra reclamacion o remedio solicitado por el demandante puede ser dictado en contra suya por la Corte sin mas aviso adicional. Usted puede perder dinero o propiedad u otros derechos importantes para usted. LISTED DEBE LLEVAR ESTE DOCUMENTO A SU ABOGADO INMEDIATAMENTE. SI USTED NO TIENE UN ABOGADO O NO PUEDE PAGARLE A UNO, LLAME O VAYA A LA SIGUIENTE OFICINA PARA AVERIGUAR DONDE PUEDE ENCONTRAR ASISTENCIA LEGAL. SERVICIO DE REFERIDO A ABOGADO COLEGIO DE ABOGADOS DEL CONDADO DE YORK ABOGACIA DEL CONADADO DE YORK CALLE MRKET #137 ESTE YORK, PA 17401 TELEFONO: (717) 854-8755 AMERICAN WITH DISABILITIES ACT OF 1990 The Court of Common Pleas of Cumberland County is required by law to comply with the American with Disabilities Act of 1990. For more information about accessible facilities and reasonable accommodations available for disabled individuals having business before the Court, please contact the Court of Common Pleas of Cumberland County. All arrangements must be made at least 72 hours prior to any hearing or business before the Court. You must attend the scheduled conference of hearing. KOPE & ASSOCIATES, LLC BY: HILARY P. VESELL, ESQUIRE ATTORNEY I.D. 308358 395 ST. JOHNS CHURCH ROAD CAMP HILL, PA 17011 (717) 761-7573 hvesell@kopelaw.com Attorney for Plaintiff FERN KIPE, Plaintiff, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA V. RODNEY D. BENDER, Defendant. : No. 09-7103 (Civil Term) JURY TRIAL DEMANDED COMPLAINT AND NOW, comes the Plaintiff, Fern Kipe, by and through her Attorney Hilary P. Vesell, Esq. files this foregoing Complaint and avers the following: 1. Plaintiff, Fern Kipe, is an adult individual that currently resides at 5 Stone Spring Lane, Camp Hill, Cumberland County, Pennsylvania 17011. 2. Defendant, Rodney D. Bender is an adult individual that currently resides at 1070 Country Club Road, Camp Hill, Cumberland County, Pennsylvania. 3. On October 19, 2007, Plaintiff, Fern Kipe, was the passenger in a car driven by her husband. 4. At the time of the accident, Fern Kipe's husband was attempting to make a legal left turn from the Carlisle Pike onto Orrs Bridge Road. 5. On October 19, 2007, at the same time, Mr. Bender was attempting to make an illegal left turn onto the Carlisle Pike from a Hess gas station near Conodoguinet Avenue. See the Commonwealth of Pennsylvania Police Cash Reporting Form attached as Exhibit "A." 6. The force of the collision pushed Mr. Kipe's car into the car beside them. 7. As a result of the accident, Mr. Kipe's car was totaled. 8. Mrs. Kipe was then transported to the hospital from the scene of the accident. 9. This collision occurred as a direct result of the negligence of the Defendant. 10. Defendant, Rodney Bender was cited for violating 75 Pa. C.S.A. § 3324 and 75 Pa. C.S.A. § 3111(a) governing vehicles failing to yield. 11. The negligence of Defendant Rodney Bender consisted but is not limited to the following: (a) Failing to properly operate and control his vehicle; (b) Operating said motor vehicle in a careless manner, without regard for the rights and safety of those lawfully upon the highway; (c) Failing to keep alert and maintain lookout for the presence of other motor vehicles on the roads and highways; (d) Failing to exercise due care under the circumstances; (e) Failure to keep alert and maintain a proper lookout for oncoming traffic; (f) Failing to yield the right of way to any vehicle at an intersection or making an illegal turn; (g) Failing to stop said motor vehicle before striking the Plaintiffs vehicle; (h) Driving a vehicle in willful or wanton disregard for the safety of person or property; (i) Any and all other acts of negligence and carelessness which may otherwise be proven at the time of trial. 12. As a direct and proximate result of the negligence, carelessness and/or recklessness of the Defendant Rodney Bender, the Plaintiff, Fern Kipe, suffered serious and permanent injuries including but not limited to: (a) Cervical sprain/strain (b) Lumbar sprain/strain (c) Impaired joint mobility, muscle performance, and range of motion (d) Daily headaches/pain 13. As a direct and proximate result of the negligence, carelessness and/or recklessness of the Defendant Rodney Bender, the Plaintiff, Fern Kipe, was forced to incur medical bills and expenses for the injuries she has suffered and she may continue to incur medical expenses in the future. 14. As a direct and proximate result of the negligence, carelessness and/or recklessness of the Defendant, Rodney Bender, the Plaintiff, Fern Kipe, has suffered great physical pain, discomfort and mental anguish and she will continue to endure the same for an indefinite period of time in the future, to her great physical and emotional detriment and loss. 15. As a direct and proximate result of the negligence, carelessness and/or recklessness of the Defendant, Rodney Bender, the Plaintiff, Fern Kipe, has suffered a loss of life's pleasures, and she will continue to suffer the same in the future, to her great detriment and loss. 16. As a direct and proximate result of the negligence, carelessness and/or recklessness of the Defendant Rodney Bender, the Plaintiff, Fern Kipe, has been and probably will in the future be hindered from attending to her daily duties to her great detriment, loss, humiliation and embarrassment. WHEREFORE, Plaintiff, Fern Kipe, seeks damages from Defendant, Rodney Bender, in an excess of the compulsory arbitration limits of Cumberland County exclusive of interest and costs. Respectfully Submitted, KOPE & ASSOCIATES, LLC By: hb a 11'rA I ? ? Hilary P. esell, Esquire Date: ? l ? I VERIFICATION I, Fern Kipe, the Plaintiff in this matter, have read the foregoing Complaint. I verify that my averments in this Complaint are true and correct and based upon my personal knowledge. I understand that any false statements herein are made subject to the penalties of 18 Pa. C.S. 4904 relating to unsworn falsifications to authorities. Dated: t_/? Q,? ?? Fern Kipe / 11, CERTIFICATE OF SERVICE I, Hilary P. Vesell, Esquire of Kope & Associates, LLC, hereby certify that a true copy of the foregoing Complaint was served this date upon the below- referenced individual at the below listed addresses by way of first class mail, postage pre-paid: Rodney Bender 1070 Country Club Road Camp Hill, PA 17011 KOPE & ASSOCIATES, LLC By: Hilary P. Vekell, Esq. I. D. 30835 395 St. Johns Church Road Camp Hill, PA 17011 (717) 761-7573 Date: Z/?-/f / 71,.: ---S yvC°C65 /95 I COMMONWEALTH OF PENNSYLVANIA _...J POLICE CRASH REPORTING FORM Case Closed Reportable Crash Page AA 500 1 0 Yes Q No a Yes Q No 0 a. s s 2 8 e 4 M s g ber ?'?? Police A enc 71000614 g y Pa4rol Zone 21103 Precinct I i Township nvest gation Da4e (MM- DD-YYYY) 2007 e (mil) Arrival Time (mil) L Investigator Badge N umber 1217 PTLM JASON JULSETH . 1922 Bade Number A l A SNYDER 19-11 rova PP 12 Date (MM-DD-YYYY) 27 2007 County County Name 21 Cumberland Municipality Municipality Name 103 am d T DAY of !Meek p en own ship O Sun Q Thu Crash Date (MM-DD-YYYY) 10 19 2007 Crash Time (mil) No of Units People 1200 Injured Killed 2 complete O Mon Fri O Tue O sat Workzone (If Yes, complete form M, Section 29 O Yes No School Bus Q Yes No Related Form F Q Wed Q Unk School Zone O Yes N Notify PENNDOT Related O Maintenance O Yes No Intersection Twine Q q Way Intersection Q "Y" Intersection O Multi-Leg O Midblock 'T' Intersection O Traffic Circle/ Intersection Round About O On Ramp Route Number Segment (Optional) Travel Lanes Speed Limit 0011 03 40 Street Name CARLISLE Sigg in° Q Interstate Turnpike Turnpike State (Not Turnpike) O (East/West) O Spur Highway h Route Number Segment (Optional) Travel Lanes Speed Limit 02 25 0 ? Street Name CONODOGUINET &via S 9aiinn° O Interstate Q Turnpike Turnpike State (Not Turnpike) (East/West) O Spur O Highwal Page 1 of 8 O Off Ramp Q Railroad Crossing °S&eflaL 00 O Crossover Q Other Location ---- r North °- O South Street Ending O East PK O West O O Unknown Q County O Local Road Road or Street House Number (if applicable) For Mid-block crashes only. Use postal House Number and make sure Principal Roadway Street Name is filled in if using this option O Private Other/ Road O Unknown 0 North C ° O South Street Ending O East AV °- O West - O Unknown O County s Local Road Private Other/ Road or Str t O O ee Road Unknown E i Intersecting Rt Num Or Mile Post Y = Or Segment Marker ? p O North eet L' Intersecting eet Name Please v . 41 O South St Ending s ® m Enter Information for BOTH L O East E O West Or Miles ? r3 b p g andmarks Intersecting Rt Num Or Mile Post if Using r This Option Q ::] r Segment Marker c O O North istance From Crash a Intersecting Stree ame O South Scene to Landmark 1 J St Endin O East (for Crash between Landmark 7 and Degrees Minutes Seconds Latitude: 40 14 16 .1000- 000 E O West ? Landmark 2) Degrees Minutes Seconds Longitude: - 76 57 14 000 ° . Traffic Control D vrce O Yield Sign ® W Not Applicable Q Traffic Signal Active RR Crossing e ? O Flashing Traffic Controls Signal O Stop Sign O Passive RR Crossing Controls O Police Officer or I ICD functioning Flagman O Other Type TCD No Controls Device Functioning Emergency O Improperly CD Preemptive Si nl O Unknown Lane Closed (If "Not Applicable ", skip rest of the Cane Closure section) 0 Not Applicable Q Partially Q Fully Q Unknown m Traffic Yes O No M Detoured O d Unknown Q FORM M AA-500 (14102) Q Device Not Device Functioning Functioning O 9 a Properly O Unknown Lane clos O North O East Q North and South O All Arrncnon O South Q West O East and West (N,S,E,W) JEW, nme O< 30 Min. Q 30-60 Min. Q 1-3 hrs Q 3-6 hrs Q 6-9 hrs Q> 9 hours O Unknown PENNDOT COCKY http://www.dot6.state.pa.us/crsapp/Printlmages/XmiFiles/20071 03790200910141149124... 10/14/2009 Drint CRS W0065795 Ct;®M(r` OMUdEA 4b ®(f PEHMSSY0.&9ANYA POLICE CRASH REPORTING FORM Page 2 of 8 Page: Il??llllllllu? C,,,, Number 7 AA -500 z 1 route use omy ? r i I I - W0065795 Motor Vehicle in c - O Hit & Run Vehicle O Illegally Parked O Legally Parked O Non - Motorized +o (? Unit O Pedestrian O Pedestrian on Skates, Disabled From in Wheelchair, etc O Previous Crash O Train O Phantom Vehicle Commercial Vehicle O Yes 0 No (If 'Pedestrian' or "Pedestrian on Skates, in Wheelchair, etc", Complete Form m, section 18) (If Yes, Complete Form C) Unit No First Name MI Date of Birth (MM-DD-YYYY) O1 RODNEY D? ll 22 1968 Delete? Last Name Tele hone Number O BENDER 7179752363 Address / City / State a zip 1070 COUNTRY CLUB RD CAMP HILL PA a 17011 Driver License Number g State Class s 21696207 PA ?M C t Alcohol/Drugs Suspected Driver or Pedestrian PhvsicaJ Condition a No O Illegal Drugs O Medication - Apparently Illegal Drug Normal O Use O Fatigue O Medication O Alcohol O Alcohol and Drugs O Unknown r--) Had Been d O Sick Asleep Drinking O O Unknown N Alcohol Test Type ® 0 Test Not Given O Breath O Other Primary Vehicle Code violation Charged? V O Blood O Urine Unknown if O VEHICLES FAILING TO YIELD • Yes O No s Test Given Alcohol Test Results O Test Refused O Result wn Driver Presence 1=Driver Operated 3=Driver Fled Scene ?. O Test Given, Contaminated Results Vehicle 4=Hit and Run 2=No Driver 9=Unknown Owner/Driver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh O1 01=Private Vehicle Owned/ Owned/Leased by Driver 05=PENNDOT Vehicle 08=Other Municipal 98=Other Leased by Driver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown Same as Owner First Name Owner Last Name or Business Name (If Pedestrian, skip this Section) Driver O RODNEY BENDER A ddress / City / State / Zip Vehicle Make *Make Code 1 1070 COUNTRY CLUB RD CAMP HILL PA 170117011 Toyota 49 VIN Model Year Vehicle Model (see overlay) JT3HN86R510327167 2001 RUN License Plate Reg. State Est. Speed Vehicle Towed Towed By ERD7761 PA 015 0 Yes O No ROADSIDE RESCUE Insurance Insurance Company Policy No a Yes O No O known ERIE INSURANCE EXCHANG Q051708445H E $ Trailing 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No e Unit No. 09? Type ? Tag Year Tag St unit 2=Towing Truck 5=Camper 8=Other _ ili T '- ? n ra I( Q/ Units: 3=Towing Utility Trailer 6=Full Trailer 9=Unknown L Direction of e Travel Vehicle Position *Movement * 02 12 "See Special Usage Overlay Vehicle Color Veh;cle 05=Large Truck 20=Unicycle Bicycle 12=Commer cial , , 06=Yellow utomobile 06=5UV Tricycle 07=Silver 07=V l t Passenger 00=Not Ap licable C i r cyc or e an 21=Other Pedalcycle 08=Gold o arr er p 01 Fi us 10=Snowmobile 22=Horse & Buggy 01=Blue 09=Brown mall Truck 11=Farm Equip 23=Horse & Rider 02=R d = re Veh 13=Taxi 02=Ambulance 21=Tractor Trailer e 10=Orange e Form 12=Construction Equip 24=Train 03=White 11=Purple 13=ATV 25=Trolley 0 03=Police 22=Twin Trailer 08=Other Emergency 23=Triple Trailer 4=Green 12=Other (If "20" or "2I ", Complete 18=Other Type Spec Veh 98=Other 05=Black 99=Unknown Form M, Section 17) 19=Unk. Type Spec Veh 99=Unknown Vehicle 31 =Modified Veh 11 =Pupil Transport 99=Unknown Initial Impact Point 00=Non-Collision 14=Undercarriage 11 Damage Indicator O=None 2=Funct ional Gradient 3=Downhill 4 B Road Alignment 01-12=Clock Points 15=Towed Unit 1=Minor 3=Disabling ? = ottom of Hill 1 1=Level S= Top of Hill 1=Straight IT 2=Curved 13=Top 99 =Unknown 9=Unknown 2=Uphill 9=Unknown 9=Unknown ro (1002) PENNDOT COPY http://www. dot6.state.pa. us/crsapp/Printlmages/XmIFiles/2007103 790200910141149124... 10/14/2009 Print CRS W0065795 Page 3 of 8 COHMOMRIFALTH GO: J P®d E CRASH REPORTING FORM R9BCg1 IIII?nIMIIIIIIIN?IINI?II Page: Crash Number AA 500 2 Police Use Only W0065795 J-tr otor Vehicle in ansport O Hit & Run Vehicle O Illegally Parked O Legally Parked O Non • Motorized to Commercial Vehicle destrian O Pedestrian on Skat es, Disabled From O Yes No in Wheelchair, etc O Previous Crash O Train O Phantom Vehicle edestrian" or "Pedestrian on Skates, in Wheelchair, etc", Complete Form M, Section 28) (If Yes, Complete form C) First Name MI Date of Birth (MM-DD-YYYY) 02 ELMER TT 08 12 1934 Delete? Last Name Tele hone Number odd s / C? IPE C r 0 g S C 6 y9 d T it d b d 's e a Ity tote 5 STONE SPRING LANE CAMP HILL PA )river License Number Alcohol/Drugs Suspected 0 No 0 Illegal Drugs O Medication O Alcohol O Alcohol and Drugs O Unknown Alcohol Test Type a Test Not Given O Blood Alcohol Test Results a" Zi 17011 State Class PA ?? - Apparently Illegal Drug Normal O Use O Fatigue O Medication O Had Been O Sick Asleep O Unknown O Breath O Other Primary Vehicle Code Violation Charged? O Urine O Test G vi enlf NONE -? O Yes No O Test Refused Unknown Driver Presence O Results 1=Driver Operated 3=Driver Fled Scene O Test Given, Vehicle 4=Hit and Run Contaminated Results 2=No Driver 9=Unknown Owner/Driver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh 01 01=Private Vehicle Owned/ Owned/Leased by Driver 05=PENNDOT Vehicle 08=Other Municipal 98=Other Leased by Driver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown Same as Owner First Name Driver O ELMER T Owner Last Name or Business Name (If Pedestrian, skip this KIPE A ddress / City / state / Zip 1 5 STONE SPRING LN CAMP HILL PA 170117011 Vehicle Make *Make Cod( Buick/Opel 18 VIN Model Year Vehicle Model (see overlay) 2G4WS52J921280124 - 2002 1 CCU 1 License Plate Reg. State Est. Speed Vehicle Towed Towed By EGB9755 PA 025 a Yes O No ROADSIDE RESCUE I nsurance Insurance Company Policy No o w Yes O No O known ERIE INSURANCE EXCHANG Q062000286 H E Trailin 1z o S g T e 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Unit No. Of Tag Year - Trailing Unit a 2=Towing Truck 5=Camper 8=Other Tag St V Units: 3=Towing Utility Trailer 6=Full Trailer 9=Unknown L a Direction of "Vehicle Position 04 rave Vehicle Color 06=Yellow 12 07=Silver 08=Gold 01=Blue 09=13rown 02=Red 10=Orange 03=White 1 i=Purple 04=Green 12=Other 05=Black 99=Unknown Vehicle Tvpe 0I 01=Automobile 02=Motorcycle 03=Bus 04=Small Truck (If "02", Complete Form M, Section 26) (If "20" or "21 , Complete Form M, Section 27) 'Movement 01 *See overlay 05=Large Truck 20=Unicycle, Bicycle, 06=SUV Tricycle 07=Van Z1=Other Pedalcycie 10=Snowmobile 22=Horse & Buggy 11=Farm Equip 23=Horse & Rider 12=Construction Equip 24=Train 13=ATV 25=Trolley 18=Other Type Spec Veh 98=Other 19=Unk. Type Spec Veh 99=Unknown Special Usage 00 12=Commercial Passenger 00=Not Applicable Carrier 01=Fire Veh 13=Taxi 02=Ambulance 21 =Tractor Trailer 03=Police 22=Twin Trailer 08=Other Emergency 23=Triple Trailer Vehicle 31 =Modified Veh 11=Pupil Transport 99=Unknown Initial Impact Point MO=NOne Gradient 3=Downhill Road Alignment j j 00=Non-Collision 14=Undercarria a nctional 01-12=Clock Points 15=Towed Un itg sablin 1=Level 4=Bottom of Hill a 1=Straight 13=Top 99=Unknown g 2=Uphill 5=lop of Hill 2=Curved 9=Unknown 9=Unknown FORM N AA-500 (12/02) PENNDOT COPY http://www.dot6. state.pa.us/ersapp/Printjmages/Xm]Files/2007103 790200910141149124... 10/14/2009 Print CRS W0065795 Page 4 of 8 COMMONWEALYN OF d IE CRASH IEPOR1(8 G FORM R99lxl III II?I?IIIIIII??INIIII Page: Crash Number J PO AA 5500 2 Police Use Only 1 Li--j W0065795 C - Motor Vehicle in Hit & Run Vehicle e Type Transport O O Illegally Parked O Legally Parked QNon -Motorized Commercial Vehicle top Unit O Pedestrian O Pedestrian on Skates, Disabled From Q Yes 0 No in Wheelchair, etc O Previous Crash O Train Q Phantom Vehicle (if "Pedestrian" or "Pedestrian on Skates, in Wheelchair, etc", Complete Form M, Section 28) (If Yes, Complete Form Q Unit No First Name 103 JOHN MI Date of Birth (MM-DD-YYYY) H? 11 29 1951 Delete? Last Name Tele hone Number Q WIMBROUGH 7038011467 Address / City / State Zi 0 a 1 725 FIELDSTONE DRIVE LEESBURG VA 20176 u Driver License Number State Class c T65-94-9127 VA s = ? Alcohol/Drugs Suspected Driver or Pedestrian PhvsiwI Condition t1 No Q Illegal Drugs Q Medication a Apparently Illegal Drug Normal O Use O Fatigue Q Medication O Alcohol O Alcohol and Drugs O Unknown Had Been O i k O b S c Q Asleep Q Unknown Drinkin y Alcohol Test Type ® Test Not Given Q Breath O Other Primary Vehicle Code Violation Charged? v Q Blood Q Urine O G nlf DIRECTING TRAFFIC O Yes No s Test e Alcohol Test Results Q Test Refused O Resulu n Driver Presence 1=Driver Operated 3=Driver Fled Scene [(fl. O Test Given, Contaminated Results Vehicle 4=Hit and Run I 1 - 2=No Driver 9=Unknown •?.. Owner/Driver 00=Not Applicable 02=Private Vehicle Not 04=State Police Vehicle 07=Municipal Police Veh 09=Federal Gov Veh OZ 01=Private Vehicle Owned/ Owned/Leased by Driver 05=PENNDOT Vehicle 08=Other Municipal 98=Other KLeased by Driver 03=Rented Vehicle 06=Other State Gov Veh Government Vehicle 99=Unknown Same aO s Owner First Name Owner Last Name or Business Name (If Pedestrian, skip this Section) Driver C/O SHARED FLIGHT AVIATION LLC Address / City / State / Zip Vehicle Make "Make Code 1001 SYCOLIN RD, ST#6 LEESBURG VA 201750175 Cadillac 19 VIN Model Year Vehicle Model (see overlay) 1 GYFK63817R387263 2007 ESC License Plate Reg. State Est. Speed Vehicle Towed Towed By KGY9233 VA 000 O Yes 0 No Insurance Insurance Company Policy No p a Yes O No O k own USAA 002616858-7102 VA 0 S Trailing Type 1=Towing Pass. Veh 4=Mobile/Modular Home 7=Semi-Trailer Tag No Tag Year Tag St C Unrt No. 09? Unit ? 2=Towing Truck S=CamPer 8=Other e Trailin 0 Units: 3=Towing Utility Trailer 6=full Trailer 9=Unknown 2 o Direction of Vehicle Position `Movement s ravg?e --- N O1 03 See Special Usage Overlay Vehicle Color Vehicle Type 05=Large Truck 20=Unicycle Bicycle 00 12=Commercial OS 06=Yellow D7=Silver 01=Automobile 06 02=M t l 06=SUV 07=V n , , Tricycle 00=Not Applicable Passenger i C 08=Gold o orcyc e a 2 1 =Other ycle 01 Fi arr er 01=Blue 09=Brown 03=Bus D4=Small Truck 10=Snowmobile 11=farm Equip 22=Horse & & Buggy 23=Horse & Rider = re Veh 02=Ambulance 13=Taxi 21=Tractor Trailer 02=Red 03=Whit 10=Orange (If "02', Complete Form 12=Construction Equip 24=Train 03=Police 22=Twin Trailer e 04=Green I I=Purple 12=Other M, Section 26) 13=ATV 25=Trolley 08=Other Emergency 23=Triple Trailer 05=Black 99=Unknow (If "20" or "21" Complete 18=Other Type Spec Veh 98=Other Vehicle 31 =Modified Veh n Form M, Section 27) 19=Unk. Type Spec Veh 99=Unknown 11=Pupil Transport 49=Unknown Initial Impact Point Damage Indicator Gradient 3=Downhill Road Alignment unct - ional DO=Non-Collision 14=Undercarriage a O=None 2=F 4=Bottom of Hill 1=Straight 11 01-12=Clock Points 15=Towed Unit 1=Minor 3=Disabling 1 1=Level 5=Top of Hill 1 2=Curved 13=Top 99=Unknown 9=Unknown 2=Uphill ? 9=Unknown 9=Unknown FORM # AA-500 (12102) PENNDOT COPY - http://www.dot6. state.pa.us/crsapp/Printlmages/XmIFiles/2007103 790200910141149124... 10/14/2009 Print CRS W0065795 Page 5 of 8 ® J AR9VA III I?II?I?IIII?I?? LI I PO CE III CRASH REPORTING FORM d Page Crash Number AA 500 3 Police Use Only W0065795 Person TVOe: A 1=Driver Seat Position: Safes Epyipment One: Ejection: D 00=Not A Passenger/Occupant E 00=None used / Not Applicable G O=Not Applicable 2=Passenger 7=Pedestrian 01=Driver - All Vehicles 01=Shoulder Belt Used 1=Not Ejected 02=front Seat Middle Position 02=Lap Belt Used 2=Totally Ejected B=Other 9=Unknown 03=Front Seat Right Side 03=lap And Shoulder Belt Used 3=Partially Ejected 04=Second Row - Left Side Or 04=Child Safety Seat Used 9=Unknown Motorcycle Passenger 05=Motorcycle Helmet Used 05=Second Row - Middle Position 06=Bic cle Helmet Used H Ejection Path: 06 S d R Ri h Sid o 59-X: B F =Female M=Male = econ ow - g t e 10=Safety Belt Used Improperly O=Not Ejected /Not Applicable 07=Third Row Or Greater - 11 =Child Safety Seat Used Improperly 1=Through Side Door Opening Left Side 12=Helmet Used Improperly U =Unknown 08=Third Row Or Greater - 90=Restraint Used, Type Unknown 2=Through Side Window Middle Position 99=Unknown 3=Through Windshield o fnjury Severity: O N I d 09=Third Row Or Greater - 4=Through Back Door Right Side Safety Eguipment Two: 5=Through Back Door Tailgate Opening 10=Sleeper Section of Truckcab 00=None Used / Not Applicable 6=Through Roof Opening (Sunroof/ Convertible To 11 Down ) 1 Oth l E d e ? = ot njure 1=Killed p = n er nc ose 01=Front Air Bag Deployed (For This Seat) Roof Opening (Convertible Passenger Or Cargo Area 02=Side Air Bag Deployed (For This Seat) hrou 7-T 0 2=Major Injury 3=Moderate op Up) 12=ln Open Area 03=Other Type Air Bag Deployed (Back Of Pickup, Etc.) 04=Multiple Air Bags Deployed 9=Unknown Injury 4=Minor Injury 8=Injury, Unk 13=Trailing Unit 05=Motorcycle Eye Protection 14=Riding On Vehicle Exterior 06=Bicyclist Wearing Elbow/Knee/Pads Extrication: 15=Bus Passenger 10=Air Bag Not Deployed, Switch On Severity 9=Unknown if O=Not Applicable 98=Other 11 =Air Bag Not Deployed, Switch Off 1=Not Extricated 99=Unknown 12=Air Bag Not Deployed In Injury , 2=Extricated By Mechanical Means Unk Switch Setting 3=Freed By Non - Mechanical Means 13=Air Bag Removed (Prior To Crash) 8=Other LJ 19=Unknown If Air Bag Deployed 9=Unknown 99=Unknown EMS Agency: HAMPDEN TOWNSHIP EMS Medical Facility: HOLY SPIRIT HOSPITAL Unit No Person No O1 74 OF, Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I p 10 - 03 - 1947 1? M? 0? O1 03 10 1? 0? l? Name / Address / Phone o Same as RODNEY BENDER 1070 COUNTRY CLUB RD CAMP HILL PA 17011 71 EMS Transport Operator 0 Yes 0 No Unit No Person No 02 02 Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I p 08 - 12 - 1934 1? M? 4? O 1 03 12 1F EI F Name / Address / Phone R Same as ELMER T. KIPE 5 STONE SPRING LANE CAMP HILL PA 17011 EMS Transport Operator Yes O No Unit No Person No 02 03 Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H 1 0 10 - 21 - 1950 4? 03 03 12 1? 0? 1? Name / Address / Phone o same as FERN KIPE 5 STONE SPRING LANE CAMP HILL PA 17011 EMS Transport Operator 0 Yes 0 No Unit No Person No 03 04 Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I 11 - 29 - 1951 1 M 0 01 03 10 1 0 1 DE' ?????????? Name / Address / Phone Lo ame as EMS Transport perator JOHN H. WIMBROUGH 725 FIELDSTONE DRIVE LEESBURG VA 20176 p Yes No Unit No Person No Date of Birth (MM-DD-YYYY) A B C D E F G H I DeDe7--????????H Name / Address / Phone ? Same as Operator EMS Transport 0 Yes 0 No Unit No Person No Delete? Date of Birth (MM-DD-YYYY) A B C D E F G H I D--?????????? Name / Address / Phone Ej Same as Operator EMS Transport 0 Yes C:)No FORM M AA-500 (I V02) PENNDOT COPY http: //www. dot6. state.pa. uslcrsappIPrintImageslXmIFiles/2007103 790200910141149124... 10/14/2009 Print CRS W0065795 Page 6 of 8 J COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTIN G FGR41Ili CrashNumber Page AA 500 4 Polite Use Only W0 065795 Crash Description O=Non-Collision 2=Head On 4=Angle 6=Sideswipe 8=Hit Pedestrian c o 1=Rear End 3=Rear to Rear 5=Sideswi a (Backin ) S K (Opposite Direction) g ( ame fection) 7=Hit Fixed Object 9=Other/Unknown E E Relation to Roadway 1 1=On Travel Lanes 3=Median 2=Shoulder 4 R d i 5=Outside Trafficway 7=Gore (Ramp Intersection) o „ = oa s de 6=1n Parking Lane 9=Unknown 15 N 1=Daylight 3=Dark -Street 5=Dawn Illumination B=Other j ` ? 1 2=Dark - No Lights Street Lights 4=Dusk 6=Dark - Unknown Roadway Lighting c E ather Conditions ? 1=No Adverse 1 Conditions 3=Sleet (Hail) 5=Fog - - ------- 7=Sleet & Fog 9=Unknown E _ 2=Rain _ 4=Snow 6=Rain & Fog _? 8=Other V _ Road Surface Conditions O=Dry 2=Sand, Mud, oil 1 W t _ Dirt, 4=Slush 6=Ice Patches B=Other 7=W t r - St di W = e 3=Snow Cove red 5=Ice ? e an ng Moving Harm Event L/R Most? Utility ole Number t 02 ? Harmful Events (harm Event) 01 =Hit Unit 1 - 30=Hit Fence Or Wall 31=Hit Building Unit No 02=Hit Unit 2 32=Hit Culvert 01 2 ? 0 03=Hit Unit 3 04=Hit Unit 4 05 Hi 33=Hit Bridge Pier Or Abutment 34=Hit d = t Unit 5 35=Hit Bridge Rail Please Put 3 ? Events in 0 06=Hit Other Traffic Unit 07=Hit Deer 08=Hit Other Anim l 36=Hit Boulder Or Obstacle On Roadway 37 Hit I Sequential a 09=Collision With Other Non = mpact Attenuator 38=Hit Fire Hydrant 0 Order 0 Fixed Object 11=Struck By Unit 1 39=Hit Roadway Equipment 40=Hit Mail Box 1e 0 E 12=Struck By Unit 2 41 =Hit Traffic Island 13=Struck By Unit 3 42=Hit Snow Bank Harm Event L/R Most? Utility Pole Number 14=Struck By Unit 4 43=Hit Temporary Construction c 9 1 1 E 15=Struck By Unit 5 16=Struck By Other Traffic Unit Barrier 48=Hit Other Fixed Object 21=H it Tree Or Shrubbery 49=Hit Unknown FixeOb t W 2 0 22=Hit Embankment 23=Hit Utility Pole 24 Hi ff jec 50=Overturn/Roll Over 51=Struck By Thrown Or Falling = t Tra ic Sign Object 3 0 L7EE 25=Hit Guard Rail 26=Hit Guard Rail End 27=Hit C b 52=Pot Holes Or Other Pavement Irregularities 53 k ur 28=Hit Concrete Or =Jac nife 54=Fire In Vehicle 0 Longitudinal Barrier 29=Hit Ditch 58=Other Non-Collision 99=Unknown Harmful Event 17 Unit No Harm Event Most Unit No Harm Event O1 ? Driver Action (D) 00=No Contributinr Action 7=Careless Or Illegal Backing On Roadwa th 01=Driver Was Distacted 18=Driving On The Wrong Do not repeat this information on multiple pages 02=Driving using Hand Held Phone Side Of Road 03=Driving Using Hands Free Phone 19=Making Improper Environmental /Roadway Potential Factors (EIR) t 00 2 3 04=Making Illegal U-Turn 05=Improper/Careless Turning 06=Turnin From Wron L Entrance To Highway 20=Making Improper Exit F 00=None I1 =Slippery Road Conditions (Ice/Snow) g g ane 07=Proceeding W/O rom Highway 21 =Careless Parking/Unparking 01=Windy Conditions 12=Substance On Roadway 02=Sudden Weather Conditions 13=Potholes 03=Other Weather Conditions 14 B k Clearance After Stop 08=Running Stop Sign 09=Running Red Light 22=Over/Under Compensation At Curve 23 S d = ro en Or Cracked Pavement 04=Deer In Roadway 15=TCD Obstructed 10=Failure To Respond To r r affic Control De i = pee ing 24=Driving Too Fast For Conditions 05=Obstacle On Roadway 16=Soft Shoulder Or Shoulder Drop Off 06=Other Animal In Roadway 28=Other Roadway Factor t n v ce 11 Tail g 12=Sudden Slowi /St 25=Failure To Maintain Proper Speed 26=Driver Fleeing Police (Pot Chase) 1s 07=Glare 29=Other Environmental Factor 08=Work Zone R l t d n o ppin 13=Illegally Stopped OnpRoag 27=Driver inexperienced e a e 99=Unknown c 14=Careless Passing Or Lane 28=Failure To Use Specialized Equip Possible Vehicle Failures (V) 12=Wipers 0 00=None 06=Exhaust 13=Driver Seating/Control Change 15=PassinIn No Passing Zone 16=Driving The Wrong Way On 92=Affected By Physical Condition 98=Other Improper Driving Actions 99=Unknown 0 01=Tires 07=Headlights 14=Body, Doors, Hood, Etc 1-Way Street 02=Brake System 08=Signal Lights 15=Trailer Hitch 01 03=Steering System 09=Other Lights 16=Wheels 04=Suspension 10=Horn 17=Airbags wait Q 1 1 05 2 3 4 a 05=Power Train 11 =Mirrors 18=Trailer Overloaded 19=U Shifted 0 Unit Trailer ailer Load v No 01 1 00 2 Unit 02 9 00 No 2 3 4 20=Improper Towing 21 Ob d Unit 02 = structe Windshield 1 QQ 2 99=Unknown Pedestrian Action (P) 00=None 03=Working 04=Pushing Vehicle 01=Entering Or Crossing At 05=Approaching Or Leaving Vehicle Indicated Prime Factor Unit No Factor Code Specified Location 02=Walking, Running, Jogging 06=Working On Vehicle 07=Standing m not repeat this information on 9 multiple pages. O 1 05 , Or Playing 98=Other 99=Unknown E/R V D P 0 00 0 If EIR is the Prime Factor Unit No O 1 00 Unit No QZ QQ Type, leave Unit No blank FORM Y AA-5D0 (12(02) PEUNDOT COPY http://www.dot6. state.pa.uslcrsappIPrintlmageslXmIFiles/2007103 790200910141149124... 10/14/2009 Print CRS W0065795 Page 7 of 8 COMMONWEALTH OF PENNSYLVANIA III (I?II?IINIII?I?I? POLICE CRA SH REPORTING FORM Crash Number Page AA 500 4 Police Use Only W0065795 Crash Description O=Non-Collision 2=Head On 4=Angle 6=Sideswipe B=Hit Pedestrian co a _ o 1=Rear End 3=Rear to Rear 5=Sideswi a (Opposite Direction) (Backing) (Same rirection) 7=Hit Fixed Object 9=Other/Unknown E Relation to Roadway 1 1=0n Travel Lanes 3=Median 5=Outside Trafficway 7=Gore (Ramp Intersection) ? 2 Sh ld o V = ou er 4=Roadside 6=1n Parking Lane 9=Unknown 1s t - 1=Daylight 3=Dark t- Street 5=Dawn B=Other Illumination ] 2=Dark - No Lights ? 6=Dark - Unknown Street Lights 4=Dusk Roadway Lighting T t Sleet & Fog Weather Conditions j? 1 Cond?itionse 3=Sleet (Hail) 5=Fog 7 9=Unknown ? E = 6=Rain & Fog 8=Other 2=Rain _ 4=Snow L] - - - - Road Surface Conditions O=Dry 2=Sand, Mud, Dirt, 4=Slush 6=Ice Patches B=Other ? Oil 7=W ter - Standin 1 W W g = et 3=Snow Covered 5=Ice Moving Harm Event L/R Most? Utility Pole Number 1 12 ? - Harmful Events (Harm Event) 30=Hit Fence Or Wall 01=Hit Unit 1 31=Hit Building Unit No 02=Hit Unit 2 32=Hit Culvert 03 2 El ? 03=Hit Unit 3 33=Hit Bridge Pier Or Abutment 04=Hit Unit 4 34=Hit Parapet End 05 Hit U it 5 35 Hi B id = n = t r ge Rail 06=Hit Other Traffic Unit 36=Hit Boulder Or Obstacle Please Put 3 F-1 07= Hit Deer On Roadway Events in 08=Hit Other Animal 37=Hit Impact Attenuator Sequential 09=Collision With Other Non 38=Hit Fire Hydrant e Order 4 O Fixed Object 39=Hit Roadway Equipment 11 =Struck By Unit 1 40=Hit Mail Box 12=Struck By Unit 2 41 =Hit Traffic Island 16 13 S k B 42 i i E Harm Event L/R Most7 Utility Pole Number = truc y Un =H t 3 t Snow Bank 14=Struck By Unit 4 43=Hit Temporary Construction 1 O 15 =Struck By Unit 5 Barrier 16=Struck By Other Traffic Unit 48=Hit Other Fixed Object Unit No 21=Hit Tree Or Shrubbery 49=Hit Unknown Fixed Object W N 12 ? Q 22=Hit Embankment 50=OverturNRoll Over 23=Hit Utility Pole 51=Struck By Thrown Or Falling 24 Hit T ff Si b = ra ic gn O ject Please Put 3 Events in o 25=Hit Guard Rail 52=Pot Holes Or Other 26=Hit Guard Rail End Pavement Irregularities 27=Hit Curb 53=Jacknife Sequential 28=Hit Concrete Or 54=Fire in Vehicle Order 4 O Longitudinal Barrier 58=Other Non-Collision 29=Hit Ditch 99=Unknown Harmful Event t7 First Unit No Harm Event Most Unit No Harm Event na-rinful in fin ve!• nt in O1 02 vet 02 1 1 Driver Action (D) 17=Careless Or Illegal 00=No Contributing Action Backing On Roadway 18 i i 4 tt?h h =Dr v ng on The Wrong 01=Dr ver Was Distracted 111. 02=Dr1v1ng Using Hand Held Phone Side Of Road Do not repeat this information on multiple pages 03=Driving Using Hands Free Phone 19=Making Improper Environmental /Roadway 1 Poterttia! Factors MR) 2 3 04=Making Illegal U-Turn Entrance To Highway 05=Improper/Careless Turning 20=Making Improper Exi 06 T i F = um ng rom Wrong Lane From Highway 00=None 11=Slippery Road Conditions (Ice/Snow) 01 07=Proceeding W/O 21 =Careless Parking/Unparking Clearance After Sto 22 =Windy Conditions 12=Substance On Roadway 02=Sudden Weather Conditions 13=Potholes 03=Other W th C diti 1 k p =Comp n sat 08 =Running St op Sign Compensation At Curve 09=Running Red Light 23=S eedin ea er on ons 4=Bro en Or Cracked Pavement 04=Deer In Roadway 15=TCD Obstructed p g 10=Failure To Respond To 24=Drivin T g oo Fast For Conditions Other Traffic Control Device 05=Obstacle On Roadway 16=Soft Shoulder Or Shoulder Drop Off 06=Other Animal In Roadway 28=Other Roadway Factor p Y Y 25=failure Maintain Proper Speed 11=Tailgatingg 26=Driver Fleeing Police (POl Chase) 12=Sudden Slowin /Sto in is 07=Glare 29=01her Environmental Factor g p g 27=Driver inexperienced 13=I1legally Stopped On Road 0 08 =Work Zone Related 99=Unknown 28=Failure To Use Specialized Equip 14 s Passing Or Lane 92=Aff d B Ph t i l ec e y ys ca Condition Chan e Possible Vehicle Failures (V) 12=Wipers 00=None 06=Exhaust 13=Driver Seating/Control 15=Passin In No Passing Zone 98=01her Improper Driving Actions g 16=Driving The Wrong Way On 99=Unknown 01=Tires 07=Headlight5 14=Body, Doors, Hood, Etc 1-Way Street °i c 02=Brake System 08=Signal Lights 15=Trailer Hitch Steering System stem 09=Other Li hts 16=Wheels 9 Y 9 04=Sus 17=Airba ensi s 10 H Unit No 03 1 00 2 3 .4 p g on = orn a 05=Power Train 11 =Mirrors 18=Trailer Overloaded ° 19=Unsecure/Shifted it 03 1 00 2 Trailer Load N Unit No 9 2 3 4 v o 20=Improper Towing Unit No = 21=Obstructed Windshield 99=Unknown 1 = 2 Pedestrian Action P () 03=Working 00=None 04=Pushing Vehicle 01=Entering Or Crossing At 05=Approaching Or Leaving Vehicle 0 ctor Unit No Factor Code 6=Working On Vehicle Specified Location 02=Walking, Running, Jogging, 07=Standing 9 ? this mation on 01 OS n Or Playing 98=Other 99=Unknown J P Q If EIR is the Prime Factor Unit No 03 00 Unit No Type, leaveUnit No blank FORM / AA-500 (12N2) PENNDOT COPY http://Www.dot6. state.pa.uslcrsappIPrintImageslXmIFiles/2007103 790200910141149124... 10/14/2009 Print CRS W0065795 I COMMONWEALTH OF PENNSYLVANIA POLICE CRASH REPORTING FORM Page AA 500 5 Police Use Only Name I Address Phone 0 2 Narrative and additional witnesses: Accident Investigation Notification Issued? 0 Property Damage O 10/45 REPORTABLE. V1-BENDER, V2-KIPE, V3-WIMBROUGH. V1 ATTEMPTING TO TURN LEFT ONTO CARLISLE PIKE OUT OF HESS GAS STATION NEAR CONODOGUINET AVENUE. V3, WHILE STOPPED AT RED LIGHT, NORTHBOUND, AT CARLISLE PIKE AND ORRS BRIDGE ROAD, ALLOWED V1 INTO TRAFFIC. WHILE AT THE SAME TIME, V2 WAS ATTEMPTING A LEFT TURN NORTHBOUND ON CARLISLE PIKE ONTO ORRS BRIDGE ROAD. V1 CAME OUT IN FRONT OF V3 FOR THE LEFT TURN, V2 AND V1 SUBSEQUENTLY COLLIDED. BOTH DRIVER AND PASSENGER OF V1 TRANSPORTED TO HOLY SPIRIT FOR UNKNOWN MINOR INJURIES. V2 AND V1 VEHICLES TOWED BY ROADSIDE RESCUE. V1 ISSUED > CITATION. NOAI EXCHANGED TO V1 AND V3. V2 INFORMATION WILL BE DOWNSTAIRS ON WHITE BOARD WHEN THEY GET OUT OF HOSPITAL AND ASK FOR INFORMATION. FERN KIPE (WIFE OF V2) WAS PASSENGER. z V 6 9 N 2 m C FORM A AA-500 (IZW) PENNDOT COPY Page 8 of 8 1111111111111111111111 Crash Number http://www. dot6. state. pa. us/ersapp/PrintImages/XmIFiles/2007103 790200910141149124... 10/14/2009 Crash Reporting System Synopsis Quality Assurance Synopsis Report Crash Synopsis created 10/14/2009 for Crash Number W0065795 WebGroup: QA Police Agency Data: Page 1 of 2 Print C CloseWindow The crash report was recorded by police agency 21103-Hampden Township, patrol zone -100, under incident number HAM20071000614. The dispatch date was 10/19/2007, the dispatch time was 1215 hours, the investigation date was 10/19/2007, the arrival time was 1217 hours. The investigator was PTLM. JASON JULSETH, badge number 1922. The report was approved by JEFFREY A SNYDER, badge number 19-11 on 12/27/2007. Crash Data: This is an angle crash occurred in Cumberland in the municipality of Hampden Township, on Friday, 10/19/2007 at 1200 hours. The illumination at the time of the crash was daylight. The 3 -unit crash involved 4 people with 2 injuries. There were no fatalities. This is a reportable crash. Highway maintenance was not notified. The crash was not school bus related. The crash was not school zone related. The crash did not occur in a work zone. The roadway surface was dry. Weather conditions included No adverse conditions. A notification of an accident investigation was issued. The indicated prime factor for this crash was a driver's action (making an improper / careless turn) for unit 01. The first harmful event for this crash was that unit 1 Hit unit 02 and the most harmful event for this crash was that unit 2 was struck by unit 1. Type Location: This was a a "T" intersection crash, which occurred at no special location. Principal Roadway: Cumberland County, route 0011, the orientation of the roadway was North, there were 03 travel lane(s), the speed limit was 40 Mph, with a state highway route signing. Intersecting Road: Cumberland County, CONODOGUINET Avenue, the orientation of the roadway was North, there were 02 travel lane(s), the speed limit was 25 Mph, with a local road or street route signing. GPS: The police-entered Latitude was 40 14:16.000 and the police-entered Longitude was 76 57:14.000 TCD: Traffic Control Device: no traffic control device, No controls. Work zone: Type of Work Zone: not a work zone. Lane Closure: Not applicable. UNIT INFORMATION: 1 Unit Number 1 was a motor vehicle in transport. The unit was owned by BENDER, RODNEY. Address: 1070 COUNTRY CLUB RD CAMP HILL PA 170117011. This 2001 Toyota identified by VIN: JT3HN86R510327167 was registered in PA with License ERD7761. Travel speed: 015. Unit insured: vehicle has insurance, Insurance Company: ERIE INSURANCE EXCHANGE. The Unit was towed by ROADSIDE RESCUE. This was not a commercial vehicle. This Unit was an SUV, Vehicle color: Silver, Special Usage: Not applicable. The initial impact point was at 11 o'clock, Damage Indicator: Disabling (severe - not driveable), Vehicle role: Hit unit 02. Vehicle position: in the right turn lane. Direction of travel: North, Movement: Turning left, Gradient: on a level roadway, Alignment: Straight. http://www.dot6.state.pa.us/ersapp/generateSynopsis.do?method=executeGenerateSynopsis 10/14/2009 Crash Reporting System Page 2 of 2 Driver Information: The driver of this unit was RODNEY D BENDER. Address: 1070 COUNTRY CLUB RD CAMP HILL PA 17011. Telephone: 717-975-2363, Drivers License #: 21696207, State: PA. DOB: 10/03/1947. Age: 60. Sex: Male. Seat position: driver's seat. Primary safety equipment: lap and shoulder belt were used. Secondary safety equipment: Air bag not deployed, switch on. Injury severity: Not injured. Ejection: Not ejected. Alcohol/Drugs Suspected: none suspected, Alcohol Test Type: Test not given, Alcohol Test Results: Result = 0.00. Driver's action(s), 1 making an improper / careless turn. The individual's condition was apparently normal. Vehicle code VEHICLES FAILING TO YIELD was violated. Citation was written. UNIT INFORMATION: 2 Unit Number 2 was a motor vehicle in transport. The unit was owned by KIPE, ELMER T. Address: 5 STONE SPRING LN CAMP HILL PA 170117011. This 2002 Buick/Opel identified by VIN: 2G4WS52J921280124 was registered in PA with License EGB9755. Travel speed: 025. Unit insured: vehicle has insurance, Insurance Company: ERIE INSURANCE EXCHANGE. The Unit was towed by ROADSIDE RESCUE. This was not a commercial vehicle. This Unit was an automobile, Vehicle color: an other color, Special Usage: Not applicable. The initial impact point was at 11 o'clock, Damage Indicator: Disabling (severe - not driveable), Vehicle role: was struck by unit 1. Vehicle position: in the left lane. Direction of travel: North, Movement: Going straight, Gradient: on a level roadway, Alignment: Straight. Driver Information The driver of this unit was ELMER T KIPE. Address: 5 STONE SPRING LANE CAMP HILL PA 17011. Drivers License #: 08287168, State: PA. DOB: 08/12/1934. Age: 73. Sex: Male. Seat position: driver's seat. Primary safety equipment: lap and shoulder belt were used. Secondary safety equipment: Air bag not deployed, unknown switch setting. Injury severity: Minor injury. Ejection: Not ejected. Alcohol/Drugs Suspected: none suspected, Alcohol Test Type: Test not given, Alcohol Test Results: Result = 0.00. The individual's condition was apparently normal. Vehicle code NONE was violated. No citation was written. Passanger Information: a passenger 03: FERN KIPE, Address: 5 STONE SPRING LANE CAMP HILL PA 17011. DOB: 10/21/1950. Age: 56. Sex: Female. Seat position: Front seat right side. Primary safety equipment: lap and shoulder belt were used. Secondary safety equipment: Air bag not deployed, unknown switch setting. Injury severity: Minor injury. Ejection: Not ejected. UNIT INFORMATION: 3 Unit Number 3 was a motor vehicle in transport. The unit was owned by C/O SHARED FLIGHT AVIATION LLC. Address: 1001 SYCOLIN RD, ST#6 LEESBURG VA 201750175. This 2007 Cadillac identified by VIN: 1GYFK63817R387263 was registered in VA with License KGY9233. Travel speed: Stopped. Unit insured: vehicle has insurance, Insurance Company: USAA. The Unit was not towed. This was not a commercial vehicle. This Unit was an SUV, Vehicle color: Black, Special Usage: Not applicable. The initial impact point was at 11 o'clock, Damage Indicator: Minor (able to be driven), Vehicle role: was struck by unit 2. Vehicle position: in the curb lane right. Direction of travel: North, Movement: Stopped in traffic lane, Gradient: on a level roadway, Alignment: Straight. Driver Information: The driver of this unit was JOHN H WIMBROUGH. Address: 725 FIELDSTONE DRIVE LEESBURG VA 20176. Telephone: 703-801-1467, Drivers License* T65-94-9127, State: VA. DOB: 11/29/1951. Age: 55. Sex: Male. Seat position: driver's seat. Primary safety equipment: lap and shoulder belt were used. Secondary safety equipment: Air bag not deployed, switch on. Injury severity: Not injured. Ejection: Not ejected. Alcohol/Drugs Suspected: none suspected, Alcohol Test Type: Test not given, Alcohol Test Results: Result = 0.00. The individual's condition was apparently normal. Vehicle code DIRECTING TRAFFIC was violated. No citation was written. Print CloseWindow http://www.dot6.state.pa.us/crsapp/generateSynopsis.do?method=executeGenerateSynopsis 10/14/2009 V jTF?OjNOTAK 2;j 11 JI12" A,ii I I : i ;_ CUMBERLAND COUNTY PENNSYLVANIA Johnson, Duffie, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com FERN KIPE, Plaintiff, V. RODNEY D. BENDER, Defendant Attorneys for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-7103 CIVIL ACTION - LAW JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter the appearance of the undersigned on behalf of the Defendant in the above-captioned matter. Respectfully submitted, JO , SO , DUFFIE, STEWART & WEIDNER B' J erso J. Shipman, quire A torney I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Date: Attorneys for Defendant :451169 'IF CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Praecipe to Enter Appearance has been duly served upon the following counsel of record, by depositing the same in the United States Mail, postage prepaid, in Lemoyne, Pennsylvania, on July 22, 2011: Hilary P. Vesell, Esquire Kipe & Associates, LLC 395 St. Johns Church Road Camp Hill, PA 17011 JOH WN, DUFFIE, STEWART & WEIDNER &-a') Shipman , I , HE HOTHOI~!OTARy >U °18ERL;,.ND COU114TY F'E,tt4SYLVANIA Johnson, Duffie, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com FERN KIPE, V. Plaintiff RODNEY D. BENDER, Defendant NOTICE TO PLEAD TO: Fern Kipe c/o Hilary P. Vesell, Esquire Kipe & Associates, LLC 395 St. Johns Church Road Camp Hill, PA 17011 NO. 09-7103 CIVIL ACTION - LAW JURY TRIAL DEMANDED AND NOW, this day of August, 2011, you are hereby notified to plead responsively within twenty (20) days of the date of service hereof, or judgment may be entered against you. Attorneys for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JOHNSON, DUFFIE, STEWART & WEIDNER i (By: 4 Jeff n J. ipm n, Esquire Counsel for Defendant, Rodney Bender Johnson, Duffie, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com FERN KIPE, V. Plaintiff RODNEY D. BENDER, Defendant JURY TRIAL DEMANDED ANSWER AND NEW MATTER OF DEFENDANT RODNEY D. BENDER AND NOW, comes the Defendant, Rodney D. Bender, by and through his counsel, Jefferson J. Shipman and Johnson, Duffie, Stewart & Weidner, and files the following Answer and New Matter to Plaintiffs Complaint: 1. Admitted upon information and belief. 2. Admitted. 3. Admitted upon information and belief. 4. Denied. After reasonable investigation, the answering Defendant is without sufficient knowledge or information to form a belief as to the truth of the averments contained in paragraph 4 and the same are therefore denied and strict proof Attorneys for Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-7103 CIVIL ACTION - LAW is demanded at the time of trial. 5. Admitted in part, denied in part. It is admitted that Mr. Bender was attempting to make a left turn onto the Carlisle Pike from a Hess Gas Station. The remaining averments of paragraph 5 are conclusions of law and fact to which no response is required. if a response is deemed to be required, the averments contained therein are specifically denied. 6. Denied. After reasonable investigation, the answering Defendant is without sufficient knowledge or information to form a belief as to the truth of the averments contained in paragraph 6, and the same are therefore denied. 7. Denied. After reasonable investigation, the answering Defendant is without sufficient knowledge or information to form a belief as to the truth of the averments contained in paragraph 7, and the same are therefore denied. 8. Denied. After reasonable investigation, the answering Defendant is without sufficient knowledge or information to form a belief as to the truth of the averments contained in paragraph 8, and the same are therefore denied. 9. Denied. The averments contained in paragraph 9 are conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. 10. Admitted in part, denied in part. It is admitted that there was a citation issued. The remaining averments contained in paragraph 10 are conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. 11. Denied. The averments contained in paragraph 11 and subparagraphs (a) through (i) are conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. (a) Denied. It is specifically denied that Mr. Bender failed to properly operate and control his vehicle; (b) Denied. It is specifically denied that Mr. Bender was operating said vehicle in a careless manner without regard to the rights and safety of those on the highway; (c) Denied. It is specifically denied that Mr. Bender failed to keep alert and maintain lookout for the presence of other motor vehicles; (d) Denied. It is specifically denied that Mr. Bender failed to exercise due care under the circumstances; (e) Denied. It is specifically denied that Mr. Bender fail to keep alert and maintain a proper lookout; (f) Denied. It is specifically denied that Mr. Bender failed to yield the right-of-way to any vehicle at an intersection or made an illegal turn; (g) Denied. It is specifically denied that Mr. Bender failed to stop the motor vehicle before the collision; (h) Denied. It is specifically denied that Mr. Bender drove a vehicle in a willful or wanton disregard for the safety of person or property; (i) Denied. It is specifically denied that Mr. Bender committed any and all other acts of negligence and carelessness. 12. Denied. The averments contained in paragraph 12 are in part conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. After reasonable investigation, Mr. Bender is without sufficient knowledge or information to form a belief as to the truth of the remaining averments contained in paragraph 12, and the same are therefore denied and strict proof is demanded at the time of trial. 13. Denied. The averments contained in paragraph 13 are in part conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. After reasonable investigation, Mr. Bender is without sufficient knowledge or information to form a belief as to the truth of the remaining averments contained in paragraph 13, and the same are therefore denied and strict proof is demanded at the time of trial. 14. Denied. The averments contained in paragraph 14 are in part conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. After reasonable investigation, Mr. Bender is without sufficient knowledge or information to form a belief as to the truth of the remaining averments contained in paragraph 14, and the same are therefore denied and strict proof is demanded at the time of trial. 15. Denied. The averments contained in paragraph 15 are in part conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. After reasonable investigation, Mr. Bender is without sufficient knowledge or information to form a belief as to the truth of the remaining averments contained in paragraph 15, and the same are therefore denied and strict proof is demanded at the time of trial. 16. Denied. The averments contained in paragraph 16 are in part conclusions of law and fact to which no response is required. If a response is deemed to be required, the averments contained therein are specifically denied. After reasonable investigation, Mr. Bender is without sufficient knowledge or information to form a belief as to the truth of the remaining averments contained in paragraph 16, and the same are therefore denied and strict proof is demanded at the time of trial. WHEREFORE, the Defendant, Rodney Bender, respectfully requests that judgment be entered in his favor and that Plaintiff's Complaint be dismissed with prejudice. NEW MATTER 17. That Plaintiff's alleged cause of action may be barred in whole or in part by the Pennsylvania Motor Vehicle Financial Responsibility Law and the limited tort option. 18. That if it should be found that there was any negligence on the part of Mr. Bender, which is denied, then in that event, any such negligence was not a factual cause of the accident nor Plaintiff's alleged injuries. 19. That Plaintiffs alleged injuries may have been caused by third parties or entities not presently involved in this action. 20. That Plaintiff's alleged cause of action may be barred by the applicable statute of limitations. 21. That Plaintiffs alleged injuries may have been pre-existing. 22. That the Plaintiff may have failed to mitigate her alleged injuries. WHEREFORE, the Defendant, Rodney Bender, respectfully requests that judgment be entered in his favor and that Plaintiff's Complaint be dismissed with prejudice. Respectfully submitted, JOHNSON, DUFFIE, STEWART & WEIDNER Je 6rs&hld. Shipmarf, Esquire A orney I.D. No. 51785 301 Market Street Date: August -1-1 2011 :452090 P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Defendant VERIFICATION The undersigned verifies that the facts set forth in the foregoing document are true and correct to the best of his knowledge, information and belief. This verification is made subject to the penalties of 18 Pa. C.S.A. §4904, relating to unsworn falsifications to authorities. -&4 R Adneynder Dated: `712-& :452118 CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Answer and New Matter of Defendant has been duly served upon the following counsel of record, by depositing the same in the United States Mail, postage prepaid, in Lemoyne, Pennsylvania, on August _L, 2011: Hilary P. Vesell, Esquire Kipe & Associates, LLC 395 St. Johns Church Road Camp Hill, PA 17011 JOHNSON, DUFFIE, STEWART & WEIDNER J ff J. Ship n 1't_ED-Ci Eic ,'EE PROTHONOTAR". 2911 AUG -5 AM 11: 19 f-IU 98ERLAND COUNTY PENNSYLVANIA KOPE & ASSOCIATES, LLC BY: HILARY P. VESELL, ESQUIRE ATTORNEY I.D. 308358 395 ST. JOHNS CHURCH ROAD CAMP HILL, PA 17011 (717) 761-7573 hvesell@kopelaw.com FERN KIPE, Plaintiff, V. RODNEY D. BENDER, Defendant. Attorney for Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 09-7103 (Civil Term) JURY TRIAL DEMANDED ANSWER TO NEW MATTER 17. Denied. The averments of this paragraph are conclusions of law to which no response is required. To the extent that a response is deemed required said averments are denied. 18. Denied. The averments of this paragraph are conclusions of law to which no response is required. To the extent that a response is deemed required said averments are denied. 19. Denied. The averments of this paragraph are conclusions of law to which no response is required. To the extent that a response is deemed required said averments are denied. 20. Denied. The averments of this paragraph are conclusions of law to which no response is required. To the extent that a response is deemed required said averments are denied. 21. Denied. The averments of this paragraph are conclusions of law to which no response is required. To the extent that a response is deemed required said averments are denied. 22. Denied. The averments of this paragraph are conclusions of law to which no response is required. To the extent that a response is deemed required said averments are denied. Respectfully Submitted, KOPE & ASSOCIATES, LLC h " lk4j'u Date: 1 Hilary P. V II, Esq. Page 2 of 3 CERTIFICATE OF SERVICE I, Hilary P. Vesell, Esquire of Kope & Associates, LLC, hereby certify that a true copy of the foregoing Answer to New Matter was served this date upon the below- referenced individual at the below listed addresses by way of first class mail, postage pre- paid: Jefferson J. Shipman, Esquire Johnson, Duffle, Steward & Weidner 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 KOPE & ASSOCIATES, LLC By: kim &1))D HILARY P. V ELL, Esq. I.D. 308358 395 St. Johns Church Road Camp Hill, PA 17011 (717) 761-7573 Date: SO) I Page 3 of 3 Johnson, Duffie, Stewart & Weidner By: Jefferson J. Shipman I.D. No. 51785 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jjs@jdsw.com o r. f r?rt @?J -n - Cj)r s v C' rn 'Z cn Attorneys for Defendant FERN KIPE., Plaintiff, V, RODNEY D. BENDER, Defendant. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 09-7103 CIVIL ACTION - LAW JURY TRIAL DEMANDED PRAECIPE TO MARK THE DOCKET SETTLED SATISFIED AND DISCONTINUED TO THE PROTHONOTARY: Kindly mark the above docket settled, satisfied and discontinued. KOPE & ASSOCIATES By: Hilary P. Ve ell, Esquire Counsel for- laintiff DATE: i1c, I I a 480895 JOHNSON, DUFFIE, STEWART & WEIDNER Jeff Vbn J-Shi*an, Esquire Counsel for Defendant DATE: 4, ,