20190315 nickence-gabbert19031601
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8WJ 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
11:44 PM
Date Notified
03/15/2019
Time Arrived
12:01 AM
Date Arrived
03/16/2019
Crash Time
11:42 PM
Crash Date
03/15/2019
Investigating Officer/Deputy
DEPUTY MICHAEL SIMPSON
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL13MV8WJAdditional InformationPHOTOS
Photos ByDEPUTY M. SIMPSON #357
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS TRAVELING EASTBOUND ON COUNTY ROAD B GOING UP A HILL WHEN UNIT 2 CAME OVER THE HILL IN THE OPPOSITE LANE. UNIT 1
TRIED TO GO TO THE SOUTH SIDE OF THE ROADWAY. UNIT 2 MADE CONTACT WITH UNIT 1 ON THE DRIVER'S SIDE. UNIT 1 ENDED UP ON THE
SOUTH SIDE OF COUNTY RD B FACING NORTHEAST AND UNIT 2 ENDED UP ON THE SOUTH SIDE OF COUNTY RD B FACING SOUTHWEST. THE
ROADWAY WAS SNOW COVERED AND NEITHER VEHICLE COULD SEE THE CENTERLINE.
Crash Time 11:42 PM
Crash Date 03/15/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 7
This report does not include any CJIS data.
19031601
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8WJ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5101685
X Coordinate
168727.75
Longitude
-91.277474722
Latitude
45.988622184
ON CTHB NB
620 FT S
OF HOPP RD
IN THE TOWN OF ROUND LAKE
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 - ON ROAD
Animal Type
Weather Condition(s)
SNOW
Environment Factor(s)
WEATHER CONDITIONS
Roadway Factor(s)
NONE
Road Surface Condition(s)
SNOW
Light Condition
DARK/UNLIT
Manner of Collision
06--SIDESWIPE/OPPOSITE DIRECTION
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
Time Scene Cleared
03:49 AM
Date Scene Cleared
03/16/2019
Time All Lanes Open
03:49 AM
Date All Lanes Open
03/16/2019
Time Initial Lane/Rd Closed
11:42 PM
Date Initial Lane/Rd Closed
03/15/2019
Reasons for Closure
TOW TRUCK
Closure Type
CLOSURE-ONE DIRECTION
Truck Bus or HazMat
NO
Road Grade
DOWNHILL
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 FUNCTION
Most Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
EASTBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
2
Operating As EndorsementsVehicle Type
PASSENGER VAN01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITModel
VAN
Year
2012
Make
CHRYSLER
Vehicle Identification Number
593550101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
Crash Time 11:42 PM
Crash Date 03/15/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 7
This report does not include any CJIS data.
19031601
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8WJ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
COUDERAY, WI 54828 , US
Owner Name01Driver DistractionsNOT DISTRACTED
01Driver 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
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
7--LEFT REAR CORNER, 8--LEFT SIDE REAR, 9--LEFT SIDE MIDDLE, 10--LEFT
SIDE FRONT
Initial Contact Point
4--RIGHT SIDE REAR
Bus Use
NOT A BUS
Body Style
4H - HATCHBACK 4 DOOR
Color
SIL - SILVER (ALUMINUM)VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04IndividualInsurance Company
GEICO-ADVANTAGE-INSURANCE-CO
Policy Holder
UNITHelmet 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
COUDERAY, WI 54828 , US
Race
INDIAN
Date of Birth
06/19/
Sex
FEMALE
Citations Issued
0
Driver
ITEquipment
Individual
UNINDIVIDUALCrash Time 11:42 PM
Crash Date 03/15/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 7
This report does not include any CJIS data.
19031601
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8WJ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Injury
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00101Drug Test ResultsDrug Test TypeDrug Test Given
TEST 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
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00101 Tint ComplianceEye Protection
UNIT Non Motorist
INDIVIDUALInjury
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00201 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
3--FRONT SEAT-RIGHT SIDE (TRAIN ENGINEER
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License NumberAddress
COUDERAY, WI 54828 , US
Race
INDIAN
Date of Birth
05/08/
Sex
FEMALE
Citations Issued
0
Passenger
ITEquipment
Individual
UNINDIVIDUALCrash Time 11:42 PM
Crash Date 03/15/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 7
This report does not include any CJIS data.
19031601
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8WJ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00201Drug Test ResultsDrug Test TypeDrug Test Given
TEST 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
UNIT Non Motorist
INDIVIDUALTruck Bus or HazMat
NO
Road Grade
DOWNHILL
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 FUNCTION
Most Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
Total Lanes
2
Speed Limit
55
Pre 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
PASSENGER CAR02 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
DISABLING DAMAGE
Vehicle Damage
9--LEFT SIDE MIDDLE, 10--LEFT SIDE FRONT, 11--LEFT FRONT CORNER
Initial Contact Point
11--LEFT FRONT CORNER
Bus Use
NOT A BUS
Body Style
2D - 2DR
Color
SIL - SILVER (ALUMINUM)
Model
CAVALIER
Year
2002
Make
CHEVROLET
Vehicle Identification Number
03200202 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 11:42 PM
Crash Date 03/15/2019Wisconsin Motor Vehicle Crash
Form DT4000 5 of 7
This report does not include any CJIS data.
19031601
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8WJ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
WINTER, WI 54896 , US
Owner Name02Driver Distractions
NOT DISTRACTED
02Driver 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
TOWED DUE TO DISABLING DAMAGE
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
CROSS CENTERLINE02
Event
03Event
04IndividualInsurance Company
USAA-CASUALTY-INS-CO
Policy Holder
UNITInjury
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00302 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
WINTER, WI 54896 , US
Race
WHITE
Date of Birth
09/08/
Sex
MALE
Citations Issued
0
Driver
ITEquipment
Individual
UNINDIVIDUALCrash Time 11:42 PM
Crash Date 03/15/2019Wisconsin Motor Vehicle Crash
Form DT4000 6 of 7
This report does not include any CJIS data.
19031601
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8WJ WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00302Drug Test ResultsDrug Test TypeDrug Test Given
TEST 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
UNIT Non Motorist
INDIVIDUALCrash Time 11:42 PM
Crash Date 03/15/2019Wisconsin Motor Vehicle Crash
Form DT4000 7 of 7
This report does not include any CJIS data.