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Agency Case Number Agency NCIC Number GEORGIA County Date Rec. by DOT
202211230048 GA1040000 MOTOR VEHICLE CRASH REPORT MORGAN
Estimated Crash Dispatch Arrival Total Number of Inside City Of
Date Time Date Time Date Time Vehicles Injuries Fatalities
11/23/2022 07:22 PM 11/23/2022 07:24 PM 11/23/2022 07:30 PM 2 1 0
Road of At Its
Occurence GEORGIA 24 (ATHENS HIGHWAY) Intersection With
Corrected Report

Miles North East

Not At Its Sup To Original
Intersection But 300.00 Of LOWER APALACHEE ROAD
Feet South West

Latitude (Y) 33.692771900825 Longitude (X) -83.4409689903259 Hit and Run

(Format) 00.00000 (Format) -00.00000
Unit # Driver LAST NAME FIRST NAME MIDDLE NAME Unit # Driver LAST NAME FIRST NAME MIDDLE NAME
1 Ped
WILLIAMS LLOYD MATTHEW 2 Ped
CLARK JUSTIN WAYNE
Bike Bike
Address Address
Susp At Fault PUBLIC COPY REDACTED Susp At Fault PUBLIC COPY REDACTED
City State Zip DOB City State Zip DOB
ATHENS GA 30606-072 1951 WINDER GA 30680-746 1979
Driver's License No. Class State Country Driver's License No. Class State Country
PUBLIC COPY REDACTED C GA US PUBLIC COPY REDACTED C GA US
Insurance Co. Policy No. Telephone No. Insurance Co. Policy No. Telephone No.
GEICO 6040344381 PUBLIC COPY HARTFORD ACCIDENT 22UENNA2842 PUBLIC COPY
Year Make Model Year Make Model
2000 DODGE DAKOTA TK 2014 CHEVROLET EXPRESS
VIN Vehicle Color VIN Vehicle Color
1B7GL2AX2YS672350 WHITE 1GCZGUCG9E1132209 WHITE
Tag # State County Year Tag # State County Year
TDN3563 GA CLARKE 2023 P545825 SC SPARTANBURG 2022
Trailer Tag # State County Year Trailer Tag # State County Year

Owner Last Name First Middle Owner Last Name First Middle
Same as Driver Same as Driver
WILLIAMS LLOYD MATTHEW ENGINEERED INC SYSTEMS
Address Address
305 OLD MONROE RD 1121 DUNCAN-REIDVILLE ROAD
City State Zip City State Zip
ATHENS GA 30606-072 DUNCAN SC 29334
Removed By: Request Removed By: Request

CHANCEYS WRECKER SERVICE List INSURANCE TOW COMPANY List

Alcohol Test: Type: Results: Drug Test: Type: Results: Alcohol Test: Type: Results: Drug Test: Type: Results:
3 1 3 1 2 2
First Harmful Event: 11 Most Harmful Event: 11 Operator/Ped Cond: 6 First Harmful Event: 11 Most Harmful Event: 11 Operator/Ped Cond: 1
Operator Contributing Factors: 2 4 13 20 Operator Contributing Factors: 1
Vehicle Contributing Factors: 1 Roadway Contributing Factors:
1 Vehicle Contributing Factors: 1 Roadway Contributing Factors:
1
Direction of Travel: 2 Vehicle Maneuver: 1 Non-Motor Maneuver: Direction of Travel: 1 Vehicle Maneuver: 5 Non-Motor Maneuver:

Vehicle Class: 1 Vehicle Type: 2 Vision Obscured: 1 Vehicle Class: 1 Vehicle Type: 10 Vision Obscured: 1
Number of Occupants: 1 Area of Initial Contact: 12 Damage to Veh: 4 Number of Occupants: 2 Area of Initial Contact: 11 Damage to Veh: 4
Traffic-Way Flow: 2 Road Comp: 2 Road Character: 5 Traffic-Way Flow: 2 Road Comp: 2 Road Character: 5
Number of Lanes: 2 Posted Speed: 55 Work Zone: 0 Number of Lanes: 2 Posted Speed: 55 Work Zone: 0
Traffic Control: 7 Device Inoperative Yes No Traffic Control: 7 Device Inoperative Yes No

Citation Information: Citation Information:

Citation # 830000817 O.C.G.A. 40-6-391

Citation # 830000819 O.C.G.A. 40-6-120A2

Citation # 830000818 O.C.G.A. 50-10

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

Released? Yes No Released? Yes No

If YES, Name of 4 Digit Number from Diamond or Box: If YES, Name of 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
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COLLISION FIELDS

Manner of Collision: 2 Location at Area of Impact: 1 Weather: 1 Surface Condition: 1 Light Condition: 4

NARRATIVE

Vehicle two was traveling north on Georgia 24 (Athens Highway) when vehicle one made an improper left hand
turn while failing to yield to oncoming traffic. Driver of vehicle one was traveling south on Athens Highway when
the driver attempted to turn into the gas station. The gas station is called the Rainbow Food Store. Rainbow has
two entrances and has a ditch separating both entrances. Upon further investigation, vehicle one was attempting
to make the left hand turn into the ditch, mistaking it for the entrance. Vehicle one was in the center turning lane.
Due to vehicle one failing to yield, vehicle two made contact with vehicle one, damaging both vehicle's front ends.
Both vehicles received disabling damage. The passenger of vehicle two stated no injury and the driver
complained of right foot/ankle injury. National E.M.S. was requested to the scene. The driver of vehicle one was
under the influence of drugs/alcohol. The driver of vehicle one was placed under arrest. National E.M.S. arrived
on scene and medically cleared driver of vehicle two. Vehicle one was removed from scene by next list tow
company, Chancey’s Wrecker Service, and vehicle two was removed by its insurance companies tow truck. Driver
one was issued four citations. Driving under NARRATIVE CONTINUED
influence drugs/alcohol, open ON SUPPLEMENT
container, PAGE...
failing to yield to vehicle,
DIAGRAM

PROPERTY DAMAGE INFORMATION

Damage Other Than Vehicle: Owner:

WITNESS INFORMATION

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

OCCUPANT INFORMATION
Name (Last, First): WILLIAMS, LLOYD Address PUBLIC COPY REDACTED
Age: Sex: Unit #: Position: Safety Eq: Ejected: Extricated: Air Bag: Injury: Taken for
1 71 M 1 1 3 1 2 2 0 Treatment: 2

Injured Taken To: By: EMS Notified Time (Fatality Only): EMS Arrival Time (Fatality Only): Hospital Arrival Time (Fatality Only):

Name (Last, First): CLARK, JUSTIN Address PUBLIC COPY REDACTED

Age: Sex: Unit #: Position: Safety Eq: Ejected: Extricated: Air Bag: Injury: Taken for
43 M 2 1 3 1 2 2 4 Treatment: 2
2
Injured Taken To: By: EMS Notified Time (Fatality Only): EMS Arrival Time (Fatality Only): Hospital Arrival Time (Fatality Only):

Name (Last, First): SAMS, JASON Address PUBLIC COPY REDACTED

Age: Sex: Unit #: Position: Safety Eq: Ejected: Extricated: Air Bag: Injury: Taken for
43 M 2 3 3 1 2 2 0 Treatment: 2
3
Injured Taken To: By: EMS Notified Time (Fatality Only): EMS Arrival Time (Fatality Only): Hospital Arrival Time (Fatality Only):

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 (Fatality Only): EMS Arrival Time (Fatality Only): Hospital Arrival Time (Fatality Only):

ADMINISTRATIVE
Photos Taken: Yes By: Officer Note: If collision resulted in a fatality, please send prompt notification to the GDOT Crash
No Reporting Unit via either email at GeorgiaFARS@dot.ga.gov or Fax at (404) 635-2963.

Report By: Agency: Report Date: Checked By: Date Checked:

OCON, MIGUEL MORGAN COUNTY 11/23/2022 SAYE, TIMOTHY RYAN 11/25/2022

GEORGIA MOTOR VEHICLE CRASH REPORT

 GEORGIA MOTOR VEHICLE CRASH REPORT Page 3 of 4

Agency Case Number: Estimated Crash Date: OCON, MIGUEL

202211230048 11/23/2022 OCON, MIGUEL
NARRATIVE

Vehicle two was traveling north on Georgia 24 (Athens Highway) when vehicle one made an improper left hand
turn while failing to yield to oncoming traffic. Driver of vehicle one was traveling south on Athens Highway when
the driver attempted to turn into the gas station. The gas station is called the Rainbow Food Store. Rainbow has
two entrances and has a ditch separating both entrances. Upon further investigation, vehicle one was attempting
to make the left hand turn into the ditch, mistaking it for the entrance. Vehicle one was in the center turning lane.
Due to vehicle one failing to yield, vehicle two made contact with vehicle one, damaging both vehicle's front ends.
Both vehicles received disabling damage. The passenger of vehicle two stated no injury and the driver
complained of right foot/ankle injury. National E.M.S. was requested to the scene. The driver of vehicle one was
under the influence of drugs/alcohol. The driver of vehicle one was placed under arrest. National E.M.S. arrived
on scene and medically cleared driver of vehicle two. Vehicle one was removed from scene by next list tow
company, Chancey’s Wrecker Service, and vehicle two was removed by its insurance companies tow truck. Driver
one was issued four citations. Driving under influence drugs/alcohol, open container, failing to yield to vehicle,
and improper left hand turn.

ADDITIONAL CITATION INFORMATION

Unit #:

Citation # 830000817 O.C.G.A. 40-6-391

Citation # 830000819 O.C.G.A. 40-6-120A2

Citation # 830000818 O.C.G.A. 50-10

Citation # 830000820 O.C.G.A. 40-6-71

ADDITIONAL OCCUPANT INFORMATION

ADDITIONAL WITNESS INFORMATION
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ADITTIONAL or FULL PAGE DIAGRAM