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20190518 sova19051822 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0FB0002 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 07:11 PM Date Notified 05/18/2019 Time Arrived 07:42 PM Date Arrived 05/18/2019 Crash Time 99:99 Crash Date 05/18/2019 Investigating Officer/Deputy DEPUTY MATTHEW JEFSON Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0FB0002Additional InformationPHOTOS Photos ByM. JEFSON Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. I, DEPUTY MATTHEW JEFSON OF THE SAWYER COUNTY SHERIFF'S DEPARTMENT WAS DISPATCHED TO THE WANNIGANS BAR IN THE OJIBWA TOWNSHIP FOR A HIT AND RUN ACCIDENT IN THE PARKING LOT. I ARRIVED ON SCENE AND WAS MET BY MS. WHO ADVISED THAT SHE CAME OUT TO GET SOMETHING FROM HER VEHICLE AND NOTICED THAT SOMEONE HAD SIDE SWIPED IT. THERE WAS DAMAGE TO THE DRIVER DOOR AND FRONT DRIVERS SIDE QUARTER PANEL. MS. SOVA GAVE ME HER INSURANCE CARD. I THEN TOOK PHOTOS OF THE DAMAGE. I ASKED AROUND AND NOBODY SEEN ANYTHING AND MS. WAS UNSURE WHAT TIME IT HAD ACTUALLY OCCURED. Crash Time 99:99 Crash Date 05/18/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 5 This report does not include any CJIS data. 19051822 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0FB0002 WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type HOUSE/BUILDING Y CoordinateX Coordinate LongitudeLatitudePARKING LOT CTHG NB LOT N5909 (HOUSE/BUILDING N5909) IN THE TOWN OF OJIBWA 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 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 06--SIDESWIPE/OPPOSITE DIRECTION First Harmful Event Location IN PARKING LANE OR ZONE First Harmful Event PARKED MOTOR VEHICLE 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 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 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 # RecordedTotal Occs 0 Operating As EndorsementsVehicle Type PASSENGER VAN01 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status LEGALLY PARKED Unit Summary UNITExtent Of Damage FUNCTIONAL DAMAGE Vehicle Damage 9--LEFT SIDE MIDDLE, 10--LEFT SIDE FRONT, 11--LEFT FRONT CORNER Initial Contact Point 9--LEFT SIDE MIDDLE Bus Use NOT A BUS Body Style VN - VAN Color BLK - BLACK Model GRAND CARA Year 2015 Make DODGE Vehicle Identification Number 83850101 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number Vehicle UNITVEHICLECrash Time 99:99 Crash Date 05/18/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 5 This report does not include any CJIS data. 19051822 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0FB0002 WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address HAYWARD, WI 54843 , US Owner Name 0101Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing LEGALLY PARKED Vehicle Removed By OPERATOR Towed Due To Damage NOT TOWED VEHICLEUNIT Sequence Of Events Event PARKED MOTOR VEHICLE01 Event 02Event 03Event 04IndividualInsurance Company STATE-FARM-MUTUAL-AUTOMOBILE-INS-CO Policy Holder UNITTruck Bus or HazMat NO Road Grade UNKNOWN Road Curvature UNKNOWN Surface Type UNKNOWN Traffic Control Inoperative/Missing UNKNOWN Traffic Control UNKNOWN Traffic Way UNKNOWN Emergency Motor Vehicle Use UNKNOWN Special Function UNKNOWN Most Harmful Event: Collision With PARKED MOTOR VEHICLE Total Lanes 0 Speed LimitPre CrashTire Mark Direction Of Travel UNKNOWN Insurance? UNKNOWN Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # RecordedTotal Occs 1 Operating As EndorsementsVehicle Type PASSENGER CAR02 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status HIT AND RUN Unit Summary UNITExtent Of Damage VEHICLE NOT AT SCENE Vehicle Damage VEHICLE NOT AT SCENE Initial Contact Point VEHICLE NOT AT SCENE Bus Use NOT A BUS Body StyleColor ModelYearMakeVehicle Identification Number 0202Country of IssuanceStPlate TypeLicense Plate Number Vehicle UNITVEHICLECrash Time 99:99 Crash Date 05/18/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 5 This report does not include any CJIS data. 19051822 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0FB0002 WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address , , Owner Name 0202Driver Actions UNKNOWN Driver Prior Action Other Vehicle Factors UNKNOWN What Driver Was Doing UNKNOWN Vehicle Removed By OPERATOR Towed Due To Damage NOT TOWED VEHICLEUNIT Sequence Of Events Event PARKED MOTOR VEHICLE01 Event 02Event 03Event 04Injury Distracted By LocationStriking Unit # Distracted By Action Distracted By Source Time of DeathDate of DeathHospital EMS Run #EMS Agency IdentifierMedical Transport NOT TRANSPORTED Trapped/Extricated NOT APPLICABLE Ejection Path NOT EJECTED/NOT APPLICABLE Ejected NOT APPLICABLE Airbag NOT APPLICABLE Injury Severity NO APPARENT INJURY00102 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY Safety Equipment NONE USED - VEHICLE OCCUPANT On Duty Crash Driver License NumberAddress , , RaceDate of Birth SexCitations Issued 0 Driver UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 99:99 Crash Date 05/18/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 5 This report does not include any CJIS data. 19051822 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0FB0002 WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition NOT OBSERVED Drug Type 00102Drug Test ResultsDrug Test TypeDrug Test Given TEST NOT GIVEN Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given TEST NOT GIVEN Suspected Drug UseSuspected Alcohol Use To/From SchoolAction Other Action Prior Action UNITINDIVIDUALCrash Time 99:99 Crash Date 05/18/2019Wisconsin Motor Vehicle Crash Form DT4000 5 of 5 This report does not include any CJIS data.