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Agency Case Number Agency NCIC No. GEORGIA County Date Rec. by DOT
22-019713 0440200 MOTOR VEHICLE CRASH REPORT DEKALB 3/10/2022
Estimated Crash Dispatch Arrival Total Number of Inside City Of
Date Time Date Time Date Time Vehicles Injuries Fatalities
Unincorporated
3/10/2022 15:49 3/10/2022 15:52 3/10/2022 16:05 2 0 0

Road of At Its Intersection I 285 South ON FROM CHAMBLEE TUCKER RD

I 285 IR Suppl. To Original?
Occurence With
Miles North East
Not At Its
Feet South West Of Private Property?
Intersection But

Latitude (Y) 33.884251 Longitude (X) -84.250980 Hit And Run?

(Format) 00.00000 (Format) -00.00000

Unit # Driver LAST NAME FIRST MIDDLE Unit # Driver LAST NAME FIRST MIDDLE
Ped MENZIES OLIVER A Ped CORDOVA PEREZ MARIA A
1 Bike
Address 155 BLUE HERON WAY
2 Bike
Address 4111 SUMMER PL
Susp At Fault Susp At Fault

City State Zip DOB City State Zip DOB

COVINGTON (NEWTON) GA 30016 3/14/1995 SNELLVILLE (GWINNETT) GA 30039 6/4/1967
Driver's License No Class State Country Driver's License No Class State Country
057138562 CLASS C GA USA 059222033 CLASS C GA USA
Insurance Co. Policy No. Telephone No. Insurance Co. Policy No. Telephone No.
PROGRESSIVE 949722259 4702429034 ALLSTATE 000000815196162 6788517219
Year Make Model Year Make Model
2021 DODGE RAM 2005 HONDA ODYSSEY- ODY
VIN Vehicle Color VIN Vehicle Color
3C63RRGL9MG589050 Red 5FNRL38745B052547 Silver
Tag # State County Year Tag # State County Year
P363CH GA NEWTON 2022 PVY4199 GA DEKALB 2022
Trailer Tag # State County Year Trailer Tag # State County Year
NA YY 2022

Same as Driver Owner's Last Name First Middle Same as Driver Owner's Last Name First Middle
MENZIES OLIVER A CORDOVA PEREZ MARIA A
Address Address
155 BLUE HERON WAY 4111 SUMMER PL
City State Zip City State Zip
COVINGTON (NEWTON) GA 30016 SNELLVILLE (GWINNETT) GA 30039
Removed By: DRIVER Request List Removed By: DRIVER Request List
Alcohol Test: Type: Results: Drug Test: Type: Results: Alcohol Test: Type: Results: Drug Test: Type: Results:
No No No No

First Harmful Event: Most Harmful Event: Operator/Ped Cond: First Harmful Event: Most Harmful Event: Operator/Ped Cond:
Motor Vehicle In Motion Motor Vehicle In Motion Not Drinking Motor Vehicle In Motion Motor Vehicle In Motion Not Drinking

Operator Factors: Other Operator Factors: Other

Vehicle Factors: No Contributing Factors Roadway Factors: No Contributing Factors Vehicle Factors: No Contributing Factors Roadway Factors: No Contributing Factors

Direction of Travel: Vehicle Maneuver: Non-Motor Maneuver: Direction of Travel: Vehicle Maneuver: Non-Motor Maneuver:
South Straight South Straight

Vehicle Class: Vehicle Type: Vision Obscured: Vehicle Class: Vehicle Type: Vision Obscured:
Privately Owned Pickup Truck Not Obscured Privately Owned Van Not Obscured

Number of Occupants: Area of Initial Contact: Damage to Vehicle: Number of Occupants: Area of Initial Contact: Damage to Vehicle:
1 Other No Damage 1 Right Side-Far Front Minor Damage

Traffic Way Flow: Road Composition: Road Character: Traffic Way Flow: Road Composition: Road Character:
Two-Way Trafficway with a physical Black Top Straight and Level Two-Way Trafficway with a physical Black Top Straight and Level
barrier barrier
Number of Lanes: 4 Posted Speed: 65 Work Zone: None Number of Lanes: 4 Posted Speed: 65 Work Zone: None

Traffic Control: Lanes Device Inoperative: Yes No Traffic Control: Lanes Device Inoperative: Yes No
Citation Information: Citation Information:
Citation # O.C.G.A. § Citation # O.C.G.A. §
Citation # O.C.G.A. § Citation # O.C.G.A. §
Citation # O.C.G.A. § Citation # O.C.G.A. §
COMMERCIAL MOTOR VEHICLES ONLY COMMERCIAL MOTOR VEHICLES ONLY
Carrier Name Carrier Name
Address City State Zip Address City State Zip

U.S. D.O.T. # No. of Axles G.V.W.R U.S. D.O.T. # No. of Axles G.V.W.R

Cargo Body Type Vehicle Config. Interstate Fed. Reportable Cargo Body Type Vehicle Config. Interstate Fed. Reportable
Intrastate Yes No Intrastate Yes No

C.D.L. ? Yes No C.D.L. Suspended? Yes No C.D.L. ? Yes No C.D.L. Suspended? Yes No
Vehicle Placarded? Yes No Hazardous Materials? Yes No Vehicle Placarded? Yes No Hazardous Materials? Yes No
Hazmat Released? Yes No Hazmat Released? Yes No
If YES: Name or 4 Digit Number from Diamond or Box: If YES: Name or 4 Digit Number from Diamond or Box:
One Digit Number from Bottom of Diamond: One Digit Number from Bottom of Diamond:
Ran Off Road Down Hill Runaway Cargo Loss or Shift Separation of Units Ran Off Road Down Hill Runaway Cargo Loss or Shift Separation of Units

GDOT-523 (07/17)
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COLLISION FIELDS

Manner of Collision: Sideswipe-Same Direction Location at Area of Impact: On Roadway - Non- Weather: Clear Surface Condition: Dry Light Condition: Daylight
Intersection

NARRATIVE

Based on the evidence at the scene and the statements provided, the following was determined.

Both vehicles entering I-285 east/south from I-85. Vehicle 1 and Vehicle 2 struck. Vehicle 1 was a pickup pulling a trailer (DOT#3359122). I observed no noticeable damage to the trailer. Vehicle 2
was a minivan with damage to the right side view mirror.

Driver 1 advised that he came onto the roadway from I-85. Driver 1 advised that Driver 2 was behind him. Driver 1 advised that the accident happened on I-285 south/east after the Chamblee Tucker
Rd overpass but before the gore area of the Chamblee Tucker Rd ramp entering onto I-285 south/east. Driver 1 advised he had just pushed his trailer. At first because of other items on his
windshield I did not notice the dash camera. Driver 1 advised dash camera footage would not be available to us on the scene. Driver 1 advised that he turned his turn signal on changed lanes and
after being in his lane for a few seconds Driver 2 was on the side of him.

Driver 2 advised that she was in the far right lane. Driver 2 advised that she was coming from I-85. Driver 2 advised that she was in her lane and Driver 1 came into her lane (this would mean Driver
1 came into her lane from the right shoulder). Driver 2 advised that she honked her horn. Driver 2 advised that Driver 1 came into her lane and struck her.
Both drivers blamed the other and advised that the other vehicle hit them while they were in their lane. There was no witness on the scene. There was no viewable video footage. The at-fault driver
was unable to be determined.

Both drivers were given a case card. Recording made via Body Worn.

DIAGRAM

GDOT-523 (07/17)
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PROPERTY DAMAGE INFORMATION

Damage Other Than Vehicle: Owner:

WITNESS INFORMATION

Name (Last, First) Address City State Zip Code Telephone Number

GDOT-523 (07/17)
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OCCUPANT INFORMATION

Name (Last, First): MENZIES, OLIVER Address: 155 BLUE HERON WAY COVINGTON (NEWTON), GA 30016

Age: Sex: Unit # Position: Safety Eq: Ejected: Extricated: Air Bag: Injury: Taken for Treatment:
1 26 Male 1 Front Seat-Left Side Unknown Not Applicable No Non-Deployed Air No Apparent Injury No
(O)
Injured Taken To: By: EMS Notified Time: EMS Arrival Time: Hospital Arrival Time:

Name (Last, First): CORDOVA PEREZ, MARIA Address: 4111 SUMMER PL SNELLVILLE (GWINNETT), GA 30039

Age: Sex: Unit # Position: Safety Eq: Ejected: Extricated: Air Bag: Injury: Taken for Treatment:
2 54 Female 2 Front Seat-Left Side Lap and Shoulder Belt Used Not Applicable No Non-Deployed Air No Apparent Injury No
(O)
Injured Taken To: By: EMS Notified Time: EMS Arrival Time: Hospital Arrival Time:

Name (Last, First): Address:

Age: Sex: Unit # Position: Safety Eq: Ejected: Extricated: Air Bag: Injury: Taken for Treatment:
3
Injured Taken To: By: EMS Notified Time: EMS Arrival Time: Hospital Arrival Time:

Name (Last, First): Address:

Age: Sex: Unit # Position: Safety Eq: Ejected: Extricated: Air Bag: Injury: Taken for Treatment:
4
Injured Taken To: By: EMS Notified Time: EMS Arrival Time: Hospital Arrival Time:

ADMINISTRATIVE

Photos Taken: Yes No By: Officer Note: If collision resulted in a fatality, please send prompt notification to the
GDOT Crash Reporting Unit via either email at GeorgiaFARS@dot.ga.gov or Fax at
BWC (404) 635-2963.
Report By: Agency: Report Date: Checked By: Date Checked:
Cummings, J (3351) Dekalb Co Police Department 03/10/2022 20:43 COLE, C 3/10/2022

GDOT-523 (07/17) [Printed: 3/10/2022 | 8454725] MAIL TO: Georgia Department of Transportation, CRASH REPORTING UNIT, 935 United Ave, SE, Atlanta, GA 30316-2590