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20190110 SIMON-STEVENS.pdf19011006 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL151TJNF WISCONSIN MOTOR VEHICLE CRASH REPORT Secondary CrashAmendedCrash Type DT4000 (STANDARD CRASH)Reportable TagsSchool Bus Related NOActive School ZoneGovernment Property Reporting ThresholdTrailer or TowedWork ZoneLane ClosureHit and RunOn Emergency Total Killed 00 Total Injured 00 Total Units 02 Time Notified 07:02 PM Date Notified 01/10/2019 Time Arrived 07:08 PM Date Arrived 01/10/2019 Crash Time 07:00 PM Crash Date 01/10/2019 Investigating Officer/Deputy DEPUTY MATTHEW JEFSON Agency Crash NumberPrimary Crash Document #Document Number Override 6V L 1 5 1 T J N F Additional InformationPHOTOS Photos ByDEPUTY MATTHEW JEFSON Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. I DEPUTY MATTHEW JEFSON WAS DISPATCHED TO A HIT AND RUN VEHICLE ACCIDENT ON CTH K NEAR GARY AVE. I ARRIVED ON SCENE AND MET WITH THE DRIVER OF UNIT 1. I GATHERED HER INFORMATION AND TOOK PHOTOS OF THE DAMAGE. I ALSO GATHERED UP PARTS FROM UNIT 2 THAT WERE LEFT ON SCENE. I ASKED WHAT HAD TAKEN PLACE AND THE DRIVER OF UNIT 1 SAID THAT SHE WAS TRAVELING EASTBOUND ON CTH K WHEN SHE NOTICED A VEHICLE TRAVELING NORTHBOUND ON ADKINS ROAD. SHE SAID THAT IT LOOKED LIKE THE VEHICLE WASNT GOING TO STOP SO SHE SWERVED INTO THE OPPOSITE LANE TO AVOID A COLLISION BUT UNIT 2 STRUCK HER IN THE REAR PASSENGER SIDE OF HER TRUCK. SHE SAID THE VEHICLE THEN JUST KEPT ON DRIVING. A SHORT TIME LATER THE DRIVER OF UNIT 2 CALLED DISPATCH AND ADVISED WHERE HE WAS. I WENT TO HIS LOCATION AND TOOK PHOTOS OF THE DAMAGE TO HIS VEHICLE. I ASKED WHAT HAD HAPPENED AND HE SAID HE TRIED TO STOP AT THE SIGN BUT DUE TO ICE ON THE ROADS WAS UNABLE TO STOP. HE THEN SAID HE GOT NERVOUS AND DIDNT HAVE A PHONE TO CALL LAW ENFORCEMENT SO HE CAME HOME AND CALLED. Crash Time 07:00 PM Crash Date 01/10/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 6 This report does not include any CJIS data. 19011006 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL151TJNF WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type Y Coordinate 5093931.5 X Coordinate 158428.25 Longitude -91.404546517 Latitude 45.913994942 INTERSECTION ON CTHK EB AT ATKINS AVE IN THE TOWN OF BASS LAKE IN SAWYER COUNTY Location Special StudyAccess Control FULL CONTROL Tribal Land LAC COURTE OREILLES BAND Crash Classification - Jurisdiction INDIAN RESERVATION/TRUST Crash Classification - Location TRIBAL LAND Relation To Trafficway TRAFFICWAY - ON ROAD Animal Type Weather Condition(s) CLEAR Environment Factor(s) NONE Roadway Factor(s) NONE Road Surface Condition(s) ICE Light Condition DARK/LIGHTED Manner of Collision 08--FRONT TO SIDE First Harmful Event Location ON ROADWAY First Harmful Event MOTOR VEH IN TRANSPORT Crash Scene Intersection Type T-INTERSECTION Junction Location INTERSECTION Within Interchange Area NO Truck Bus or HazMat NO Road Grade LEVEL Road Curvature STRAIGHT Surface Type BLACKTOP (BITUMINOUS) Traffic Control Inoperative/Missing NO Traffic Control NO CONTROL Traffic Way DIVIDED HWY W/O TRAFFIC BARRIER Emergency Motor Vehicle Use NOT APPLICABLE Special Function NO SPECIAL FUNCTIONMost Harmful Event: Collision With MOTOR VEH TRAN OTHER RDWY Total Lanes 2 Speed Limit 35Pre CrashTire Mark Direction Of Travel EASTBOUND Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # InjuredTotal Occs 1 Operating As EndorsementsVehicle Type UTILITY TRUCK/PICKUP TRUCK01 Unit Type TRUCK Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UN IT Extent Of Damage FUNCTIONAL DAMAGE Vehicle Damage 4--RIGHT SIDE REAR, 5--RIGHT REAR CORNER, 6--REAR Initial Contact Point 5--RIGHT REAR CORNER Bus UseNOT A BUSBody Style PK - PICKUP Color SIL - SILVER (ALUMINUM) Model SILVERADO Year 2012 Make CHEVROLET Vehicle Identification Number 24860101 Country of Issuance UNITED STATES St WI Plate Type FFO - FIRE FIGHTER RED License Plate Number VE H I C L E UN I T Vehicle Crash Time 07:00 PM Crash Date 01/10/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 6 This report does not include any CJIS data. 19011006 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL151TJNF WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address HAYWARD, WI 54843 , US Owner Name 01 Driver DistractionsNOT DISTRACTED 01 Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing GOING STRAIGHT Vehicle Removed By OWNER Towed Due To Damage NOT TOWED UN I T VE H I C L E Sequence Of Events EventMOTOR VEH IN TRANSPORT01 EventMOTOR VEH TRAN OTHER RDWY02 Event 03 Event 04 IndividualInsurance Company ESURANCE-INSURANCE-COMPANY Policy Holder UN I T Injury Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABL Ejected NOT EJECTED Airbag NON DEPLOYED Injury Severity NO APPARENT INJURY00 1 01 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY Safety Equipment SHOULDER & LAP BELT On Duty Crash Driver License Number STATE: WISCONSIN COUNTRY: UNITED STATES Address HAYWARD, WI 54843 , US RaceDate of Birth 10/12/ Sex FEMALE Citations Issued 0 Driver IT Equipment Individual UN IN D I V ID U A L Crash Time 07:00 PM Crash Date 01/10/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 6 This report does not include any CJIS data. 19011006 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL151TJNF WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL Drug Type 00 1 01 Drug Test ResultsDrug Test TypeDrug Test GivenTEST NOT GIVEN Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given TEST NOT GIVEN Suspected Drug Use NO Suspected Alcohol Use NO Action Other Action To/From SchoolLocationPrior ActionStriking Unit # Time of DeathDate of DeathHospital EMS Run #EMS Agency IdentifierMedical Transport NOT TRANSPORTED UN I T Non Motorist IN D I V I D U A L Truck Bus or HazMat NO Road Grade LEVEL Road Curvature STRAIGHT Surface Type DIRT Traffic Control Inoperative/Missing NO Traffic Control STOP SIGN Traffic Way TWO-WAY, NOT DIVIDED Emergency Motor Vehicle Use NOT APPLICABLE Special Function NO SPECIAL FUNCTIONMost Harmful Event: Collision With MOTOR VEH TRAN OTHER RDWY Total Lanes 2 Speed Limit 25Pre CrashTire Mark Direction Of Travel NORTHBOUND Insurance? NO Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 3 Train/Bus # InjuredTotal Occs 1 Operating As EndorsementsVehicle Type (SPORT) UTILITY VEHICLE02 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status HIT AND RUN Unit Summary UN IT Extent Of Damage FUNCTIONAL DAMAGE Vehicle Damage 11--LEFT FRONT CORNER, 12--FRONT Initial Contact Point 1--RIGHT FRONT CORNER Bus UseNOT A BUSBody Style UT - SPORT UTILITY VEHICLE Color SIL - SILVER (ALUMINUM) Model DURANGO Year 2004 Make DODGE Vehicle Identification Number 47740202 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number VE H I C L E UN I T Vehicle Crash Time 07:00 PM Crash Date 01/10/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 6 This report does not include any CJIS data. 19011006 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL151TJNF WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address HAYWARD, WI 54843 , US Owner Name 02 Driver DistractionsNOT DISTRACTED 02 Driver Actions SPEED TOO FAST/COND, UNKNOWN Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing SLOW/STOPPING Vehicle Removed By OPERATOR Towed Due To Damage NOT TOWED UN I T VE H I C L E Sequence Of Events EventMOTOR VEH TRAN OTHER RDWY01 Event 02 Event 03 Event 04 Injury EMS Run #EMS Agency IdentifierMedical Transport NOT TRANSPORTED Trapped/Extricated NOT APPLICABLE Ejection Path NOT EJECTED/NOT APPLICABL Ejected NOT APPLICABLE Airbag NOT APPLICABLE Injury Severity NO APPARENT INJURY00 2 02 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY Safety Equipment RESTRAINT USE UNKNOWN On Duty Crash Driver License Number STATE: WISCONSIN COUNTRY: UNITED STATES Address HAYWARD, WI 54843 , US Race INDIANDate of Birth 02/20/ Sex MALE Citations Issued 3 Driver IT Equipment Individual UN IN D I V ID U A L Crash Time 07:00 PM Crash Date 01/10/2019Wisconsin Motor Vehicle Crash Form DT4000 5 of 6 This report does not include any CJIS data. 19011006 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL151TJNF WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition NOT OBSERVED Drug Type 00 2 02 Drug Test ResultsDrug Test TypeDrug Test GivenTEST NOT GIVEN Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given TEST NOT GIVEN Suspected Drug UseSuspected Alcohol Use Action Other Action To/From SchoolLocationPrior ActionStriking Unit # Time of DeathDate of DeathHospital UN I T Non Motorist IN D I V I D U A L Violations DescriptionOPERATE MOTOR VEHICLE W/O INSURANCESeq Num001Statute Number344.62(1)Issue To? 002 UTC Number BB32931601 DescriptionDRIVING TOO FAST FOR CONDITIONSSeq Num001Statute Number346.57(3)Issue To? 002 UTC Number BB32931702 DescriptionHIT AND RUNSeq Num004Statute Number346.67(1)Issue To? 002 UTC Number BB32931803 Crash Time 07:00 PM Crash Date 01/10/2019Wisconsin Motor Vehicle Crash Form DT4000 6 of 6 This report does not include any CJIS data.