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20190608 kellerSAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0Z6J8VP 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 10:59 AM Date Notified 06/08/2019 Time Arrived 11:30 AM Date Arrived 06/08/2019 Crash Time 10:57 AM Crash Date 06/08/2019 Investigating Officer/Deputy DEPUTY AMANDA REED Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0Z6J8VPAdditional InformationPHOTOS Photos ByDEPUTY AMANDA REED Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. ON JUNE 8TH, 2019, I, DEPUTY REED RESPONDED TO A TWO VEHICLE MINOR ACCIDENT IN THE PARKING LOT AT SPIDER LAKE TOWNHALL. DRIVER OF VEHICLE #1, ACCIDENTLY BACKED INTO VEHICLE #2, WHICH WAS LEGALLY PARKED AND OWNED BY Crash Time 10:57 AM Crash Date 06/08/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 5 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0Z6J8VP WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type NO STRUCTURE Y Coordinate 5110519.5 X Coordinate 172689 Longitude -91.232527055 Latitude 46.069818474 ON TOWN HALL RD 264 FT W OF ACCESS RD #87 IN THE TOWN OF SPIDER LAKE IN SAWYER COUNTY Location Special StudyAccess Control NO CONTROL Tribal Land Crash Classification - Jurisdiction PRIVATE PROPERTY Crash Classification - Location PRIVATE PROPERTY Relation To Trafficway NON TRAFFICWAY - PARKING LOT Animal Type Weather Condition(s) CLEAR Environment Factor(s) NONE Roadway Factor(s) NONE Road Surface Condition(s) DRY Light Condition DAYLIGHT Manner of Collision NO COLLISION W/VEHICLE IN TRANSPORT First Harmful Event Location OFF ROADWAY, LOCATION UNKNOWN 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 UNKNOWN Surface Type BLACKTOP (BITUMINOUS) 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 FUNCTION Most Harmful Event: Collision With PARKED MOTOR VEHICLE Total Lanes 0 Speed LimitPre CrashTire Mark Direction Of Travel NOT ON ROADWAY 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 UNITExtent Of Damage FUNCTIONAL DAMAGE Vehicle Damage 4--RIGHT SIDE REAR, 5--RIGHT REAR CORNER Initial Contact Point 5--RIGHT REAR CORNER Bus Use NOT A BUS Body Style 4D - 4DR Color GRY - GRAY Model OUTBACK Year 2013 Make SUBARU Vehicle Identification Number 15770101 Country of Issuance UNITED STATES St MN Plate Type AUT - AUTOMOBILE License Plate Number VEHICLEUNIT Vehicle Crash Time 10:57 AM Crash Date 06/08/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 5 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0Z6J8VP WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address STILLWATER, MN 55082 , US Owner Name01Driver DistractionsUNKNOWN IF DISTRACTED 01Driver Actions UNKNOWN Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing BACKING Vehicle Removed ByTowed Due To Damage NOT TOWED UNITVEHICLE Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event PARKED MOTOR VEHICLE02 Event 03Event 04Individual Insurance Company STATE-FARM-MUTUAL-AUTOMOBILE-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 INJURY00101 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 NumberAddress STILLWATER, MN 55082 , US Race WHITE Date of Birth 11/29/ Sex MALE Citations Issued 0 Driver ITEquipment Individual UNINDIVIDUALCrash Time 10:57 AM Crash Date 06/08/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 5 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0Z6J8VP WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition NOT OBSERVED 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 UNIT Non Motorist INDIVIDUALTruck Bus or HazMat NO Road Grade UNKNOWN Road Curvature UNKNOWN Surface Type BLACKTOP (BITUMINOUS) 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 FUNCTION Most Harmful Event: Collision With MOTOR VEH IN TRANSPORT Total Lanes 0 Speed LimitPre CrashTire Mark Direction Of Travel NOT ON ROADWAY Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # InjuredTotal Occs 0 Operating As EndorsementsVehicle Type PASSENGER CAR02 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status LEGALLY PARKED Unit Summary UNITExtent Of Damage FUNCTIONAL DAMAGE Vehicle Damage 11--LEFT FRONT CORNER Initial Contact Point 11--LEFT FRONT CORNER Bus Use NOT A BUS Body Style 4D - 4DR Color BLK - BLACK Model EDGE Year 2014 Make FORD Vehicle Identification Number 58230202 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number VEHICLEUNIT Vehicle Crash Time 10:57 AM Crash Date 06/08/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 5 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0Z6J8VP WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address CLAM LAKE, WI 54517 , US Owner Name02Driver DistractionsNOT DISTRACTED 02Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing LEGALLY PARKED Vehicle Removed By OWNER Towed Due To Damage NOT TOWED UNITVEHICLE Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event PARKED MOTOR VEHICLE02 Event 03Event 04Individual Insurance Company AMERICAN-FAMILY-INS-CO Policy Holder UNITCrash Time 10:57 AM Crash Date 06/08/2019Wisconsin Motor Vehicle Crash Form DT4000 5 of 5 This report does not include any CJIS data.