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20190212 WHITE.pdf19021204 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL133SSFK 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 03:17 PM Date Notified 02/12/2019 Time Arrived 03:34 PM Date Arrived 02/12/2019 Crash Time 03:17 PM Crash Date 02/12/2019 Investigating Officer/Deputy DEPUTY SEAN ANDERSON Agency Crash Number 19021204 Primary Crash Document #Document Number Override 6V L 1 3 3 S S F K Additional InformationNONE Photos By Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. UNIT1 WAS SNOWPLOWING DRIVEWAY TO 8530N COUNTY RD K. UNIT 1 WAS BACKING UP AND DID NOT SEE UNIT2. UNIT 2 WAS TRAVELING NORTH ON COUNTY RD K. UNIT 1 BACKED INTO ROADWAY AND STRUCK UNIT 2 IN THE FRONT RIGHT CORNER. UNIT 2 WAS UNABLE TO STOP BECAUSE OF SNOWY AND ICY ROADS. DRIVER OF UNIT 1 SAID HE LOOKED BUT DID NOT SEE UNIT 2. Crash Time 03:17 PM Crash Date 02/12/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 6 This report does not include any CJIS data. 19021204 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL133SSFK WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type HOUSE/BUILDING Y Coordinate 5096967.5 X Coordinate 160696.359375 Longitude -91.377532871 Latitude 45.942363702 ON 8530N CTHK NB 71 FT N OF CTHE NB (HOUSE/BUILDING 8530N) IN THE TOWN OF BASS LAKE IN SAWYER COUNTY Location Special StudyAccess Control NO 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) SNOW Environment Factor(s) WEATHER CONDITIONS Roadway Factor(s) ROAD SURFACE CONDITION (WET, ICY, SNOW, SLUSH, ETC) Road Surface Condition(s) SNOW Light Condition DAYLIGHT Manner of Collision 02--FRONT TO REAR First Harmful Event Location ON ROADWAY First Harmful Event MOTOR VEH IN TRANSPORT 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 PARKING LOT OR PRIVATE PROPERTY Emergency Motor Vehicle Use NOT APPLICABLE Special Function NO SPECIAL FUNCTIONMost Harmful Event: Collision With MOTOR VEH IN TRANSPORT Total Lanes 1 Speed Limit N/APre CrashTire Mark Direction Of Travel WESTBOUND 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 MINOR DAMAGE Vehicle Damage 6--REAR Initial Contact Point 6--REAR Bus UseNOT A BUSBody Style PK - PICKUP Color MAR - MAROON (BURGUNDY) Model RAM Year 2014 Make DODGE Vehicle Identification Number 24110101 Country of Issuance UNITED STATES St WI Plate Type MUN - MUNICIPAL License Plate Number VE H I C L E UN I T Vehicle Crash Time 03:17 PM Crash Date 02/12/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 6 This report does not include any CJIS data. 19021204 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL133SSFK WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address HAYWARD, WI 54843 , US Owner Name 01 Driver DistractionsLOOKED BUT DID NOT SEE 01 Driver Actions UNSAFE BACKING Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing BACKING Vehicle Removed By OPERATOR Towed Due To Damage NOT TOWED UN I T VE H I C L E Sequence Of Events EventMOTOR VEH IN TRANSPORT01 Event 02 Event 03 Event 04 Government LAC COURTE OREILLES TRIBE Insurance Company HUDSON-INS-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 STONE LAKE, WI 54876 , US Race INDIAN Date of Birth 09/27/ Sex MALE Citations Issued 0 Driver IT Equipment Individual UN IN D I V ID U A L Crash Time 03:17 PM Crash Date 02/12/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 6 This report does not include any CJIS data. 19021204 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL133SSFK 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 BLACKTOP (BITUMINOUS) 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 MOTOR VEH IN TRANSPORT Total Lanes 2 Speed Limit 35Pre CrashTire Mark Direction Of Travel NORTHBOUND Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # InjuredTotal Occs 1 Operating As EndorsementsVehicle Type (SPORT) UTILITY VEHICLE02 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UN IT Extent Of Damage FUNCTIONAL DAMAGE Vehicle Damage 12--FRONT Initial Contact Point 12--FRONT Bus UseNOT A BUSBody Style UT - SPORT UTILITY VEHICLE Color SIL - SILVER (ALUMINUM) Model LIBERTY Year 2003 Make JEEP Vehicle Identification Number 91790202 Country of Issuance UNITED STATES St WI Plate Type LCO - LAC COURTE OREI License Plate Number VE H I C L E UN I T Vehicle Crash Time 03:17 PM Crash Date 02/12/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 6 This report does not include any CJIS data. 19021204 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL133SSFK WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address HAYWARD, WI 54843 , US Owner Name 02 Driver DistractionsNOT DISTRACTED 02 Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing GOING STRAIGHT Vehicle Removed By OPERATOR Towed Due To Damage NOT TOWED UN I T VE H I C L E Sequence Of Events EventMOTOR VEH IN TRANSPORT01 Event 02 Event 03 Event 04 IndividualInsurance Company AIG-ASURANCE-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 2 02 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 Race INDIAN Date of Birth Sex FEMALE Citations Issued 0 Driver IT Equipment Individual UN IN D I V ID U A L Crash Time 03:17 PM Crash Date 02/12/2019Wisconsin Motor Vehicle Crash Form DT4000 5 of 6 This report does not include any CJIS data. 19021204 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL133SSFK WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL 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 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 03:17 PM Crash Date 02/12/2019Wisconsin Motor Vehicle Crash Form DT4000 6 of 6 This report does not include any CJIS data.