20190527 thyssen-brueggeman19051809
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL133SSFL 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
06:37 AM
Date Notified
05/27/2019
Time Arrived
06:37 AM
Date Arrived
05/27/2019
Crash Time
06:37 AM
Crash Date
05/27/2019
Investigating Officer/Deputy
DEPUTY DEREK BECKSTRAND
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL133SSFLAdditional InformationPHOTOS
Photos ByDEPUTY SIMPSON
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON MAY 15TH 2019 DISPATCH ADVISED ME OF A TRAFFIC CRASH ON C HWY B AT THE ROUND LAKE MARINA. WHEN I ARRIVED THERE WERE TWO
PARTIES OUTSIDE THEIR VEHICLES IN THE MARINA PARKING LOT. I ASKED THEM WHAT HAPPENED AND TOLD ME THAT SHE WAS TRYING TO
TURN LEFT OUT OF THE PARKING LOT AND DID NOT SEE FROM THE LEFT. I COLLECTED EACH OF THEIR INFORMATION, DID NOT
HAVE HER INSURANCE CARD ON HER BUT VERBALLY TOLD ME SHE HAS PROGRESSIVE INSURANCE. NEITHER PARTY SAID THEY HAD ANY
INJURIES. I GAVE EACH PARTY THE CASE NUMBER AND ADVISED THEM TO GIVE THEIR INSURANCE COMPANIES THE NUMBER. I CLEARED FROM
THE SCENE AND APPROXIMATELY AN HOUR LATER I SAW DODGE CARAVAN STOPPED AT A STOP SIGN IN HAYWARD, OFF OF HWY 77.
VAN HAD SHUT OFF AT THE STOP SIGN AND SHE WAS UNABLE TO GET IT STARTED. EVENTUALLY WE GOT THE VAN STARTED AND
DROVE AWAY FROM THE SCENE.
Crash Time 06:37 AM
Crash Date 05/27/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 6
This report does not include any CJIS data.
19051809
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL133SSFL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5101947
X Coordinate
165872.828125
Longitude
-91.31441615
Latitude
45.98959081
ON CTHB WB
673 FT W
OF RICHARDSON BAY RD
IN THE TOWN OF HAYWARD
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)
CLOUDY
Environment Factor(s)
NONE
Roadway Factor(s)
NONE
Road Surface Condition(s)
DRY
Light Condition
DAYLIGHT
Manner of Collision
08--FRONT TO SIDE
First Harmful Event Location
ON ROADWAY
First Harmful Event
MOTOR VEH IN TRANSPORT
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
OTHER LOCATION NOT LISTED AB
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
LEVEL
Road Curvature
CURVE - UNKNOWN DIRECTION
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
35
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 VAN01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
FUNCTIONAL DAMAGE
Vehicle Damage
2--RIGHT SIDE FRONT, 3--RIGHT SIDE MIDDLE, 4--RIGHT SIDE REAR
Initial Contact Point
3--RIGHT SIDE MIDDLE
Bus Use
NOT A BUS
Body Style
VN - VAN
Color
SIL - SILVER (ALUMINUM)
Model
CARVAN
Year
2000
Make
DODGE
Vehicle Identification Number
01680101 Country of Issuance
UNITED STATES
St
WI
Plate Type
LCO - LAC COURTE OREI
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 06:37 AM
Crash Date 05/27/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 6
This report does not include any CJIS data.
19051809
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL133SSFL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
COUDERAY, WI 54828 , US
Owner Name01Driver Distractions
NOT 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
NOT TOWED
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04IndividualInsurance Company
PROGRESSIVE-DIRECT-INSURANCE-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
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
COUDERAY, WI 54828 , US
Race
INDIAN
Date of Birth
11/16/
Sex
FEMALE
Citations Issued
0
Driver
ITEquipment
Individual
UNINDIVIDUALCrash Time 06:37 AM
Crash Date 05/27/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 6
This report does not include any CJIS data.
19051809
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL133SSFL WISCONSIN MOTOR VEHICLE
CRASH REPORT
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
UNIT Non Motorist
INDIVIDUALTruck 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
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 Limit
N/A
Pre 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 CAR02 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
MINOR DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER, 12--FRONT
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
4H - HATCHBACK 4 DOOR
Color
WHI - WHITE
Model
EXPLORER
Year
2013
Make
FORD
Vehicle Identification Number
28400202 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 06:37 AM
Crash Date 05/27/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 6
This report does not include any CJIS data.
19051809
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL133SSFL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner AddressOwner Name02Driver Distractions
NOT DISTRACTED
02Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
LEFT TURN
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04IndividualInsurance Company
PROGRESSIVE-DIRECT-INSURANCE-CO
Policy Holder
UNITInjury
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00202 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 NumberAddress
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
05/15/1
Sex
FEMALE
Citations Issued
0
Driver
ITEquipment
Individual
UNINDIVIDUALCrash Time 06:37 AM
Crash Date 05/27/2019Wisconsin Motor Vehicle Crash
Form DT4000 5 of 6
This report does not include any CJIS data.
19051809
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL133SSFL WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00202Drug 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 06:37 AM
Crash Date 05/27/2019Wisconsin Motor Vehicle Crash
Form DT4000 6 of 6
This report does not include any CJIS data.