20190123 RICE.pdf19012302
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14ZCGFD 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
01
Time Notified
04:11 PM
Date Notified
01/23/2019
Time Arrived
04:29 PM
Date Arrived
01/23/2019
Crash Time
04:11 PM
Crash Date
01/23/2019
Investigating Officer/Deputy
DEPUTY JEFF HOEHNE
Agency Crash Number
19012302
Primary Crash Document #Document Number Override
6V
L
1
4
Z
C
G
F
D
Additional InformationNONE, RECONSTRUCTION
Photos By
Reconstruction BySAWYER COUNTY SHERIFFDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
WAS DRIVING HIS SATURN VUE SOUTHEAST DOWN BEAVER BROOKE ROAD WHICH WAS SNOW AND ICE COVERED. STATED THAT
HE HIT SOME RUTS IN THE ROAD AND LOST CONTROL OF HIS VEHICLE AND SLID INTO THE DITCH WHERE IT OVERTURNED AND ENDED UP ON THE
ROOF. DURING THE ROLL OVER THE VEHICLE ALSO HIT A TREE AND DAMAGED THE FRONT OF THE VEHICLE. ZI ASKED IF HE NEEDED MEDICAL ATTENTION AND HE STATED HE WAS OK. KOZAK ENTERPRISE TOWING AND RECOVERY REMOVED THE VEHICLE FROM THE DITCH AND
TOWED IT AWAY.
Crash Time 04:11 PM
Crash Date 01/23/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
19012302
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14ZCGFD WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5079722
X Coordinate
167116.265625
Longitude
-91.283017388
Latitude
45.790720307
ON BEAVER BROOK RD
0.25 MI E
OF STH27 NB
IN THE TOWN OF COUDERAY
IN SAWYER COUNTY
Location
Special StudyAccess Control
NO CONTROL
Tribal Land
Crash Classification - Jurisdiction
NO SPECIAL JURISDICTION
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
TRAFFICWAY - NOT ON ROAD
Animal Type
Weather Condition(s)
CLEAR
Environment Factor(s)
NONE
Roadway Factor(s)
ROAD SURFACE CONDITION (WET, ICY, SNOW, SLUSH,
ETC)
Road Surface Condition(s)
SNOW
Light Condition
DAYLIGHT
Manner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
SHOULDER RIGHT
First Harmful Event
OVERTURN/ROLLOVER
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
LEVEL
Road Curvature
STRAIGHT
Surface Type
SLAG, GRAVEL, OR STONE
Traffic Control Inoperative/Missing
NO
Traffic Control
NO CONTROL
Traffic Way
TWO-WAY, NOT DIVIDED
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTIONMost Harmful Event: Collision With
OVERTURN/ROLLOVER
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
SOUTHBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER CAR01
Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UN
IT
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER, 2--RIGHT SIDE FRONT, 3--RIGHT SIDE MIDDLE
Initial Contact Point
11--LEFT FRONT CORNER
Bus UseNOT A BUSBody Style
UT - SPORT UTILITY VEHICLE
Color
RED - RED
Model
VUE
Year
2006
Make
SATURN
Vehicle Identification Number
74900101
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 04:11 PM
Crash Date 01/23/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
19012302
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14ZCGFD WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
WINTER, WI 54896 , 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 ByTowed Due To Damage
NOT TOWED
UN
I
T
VE
H
I
C
L
E
Sequence Of Events
EventOVERTURN/ROLLOVER01
Event
02
Event
03
Event
04
IndividualInsurance Company
GEICO-ADVANTAGE-INSURANCE-CO
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
RADISSON, WI 54867 , US
Race
WHITE
Date of Birth
09/12/
Sex
MALE
Citations Issued
0
Driver
IT
Equipment
Individual
UN
IN
D
I
V
ID
U
A
L
Crash Time 04:11 PM
Crash Date 01/23/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
19012302
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14ZCGFD 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
Crash Time 04:11 PM
Crash Date 01/23/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.