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20191104 walsh-olson19110411 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5JR 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 11:28 AM Date Notified 11/04/2019 Time Arrived 11:45 AM Date Arrived 11/04/2019 Crash Time 11:27 AM Crash Date 11/04/2019 Investigating Officer/Deputy DEPUTY AMANDA REED Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0GMH5JRAdditional 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 NOVEMBER 4TH, 2019, I, DEPUTY REED RESPONDED TO A TWO VEHICLE PROPERTY DAMAGE ACCIDENT IN THE HOSPITAL PARKING LOT. I FOUND THE DRIVER OF THE TRUCK INVOLVED, KEVIN WALSH, TO BE AT FAULT. HE ALSO DID NOT HAVE INSURANCE. HE BACKED INTO A CAR DRIVEN BY CAUSING DAMAGE TO THE CAR. Crash Time 11:27 AM Crash Date 11/04/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 6 This report does not include any CJIS data. 19110411 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5JR WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type HOUSE/BUILDING Y Coordinate 5107492.5 X Coordinate 152741.921875 Longitude -91.48748319 Latitude 46.032827276 PARKING LOT STH27 NB LOT 11040 (HOUSE/BUILDING 11040) IN THE TOWN OF HAYWARD 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) SNOW Environment Factor(s) NONE Roadway Factor(s) NONE Road Surface Condition(s) WET Light Condition DAYLIGHT Manner of Collision 02--FRONT TO REAR First Harmful Event Location IN PARKING LANE OR ZONE 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 CURVE RIGHT 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 02 Speed LimitPre CrashTire Mark Direction Of Travel NOT ON ROADWAY Insurance? NO Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 2 Train/Bus # RecordedTotal 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 UNITExtent Of Damage NO DAMAGE Vehicle Damage NO DAMAGE Initial Contact Point 6--REAR Bus Use NOT A BUS Body Style 4D - 4DR Color BLK - BLACK Model AVALANCHE Year 2002 Make CHEVROLET Vehicle Identification Number 44190101 Country of Issuance UNITED STATES St WI Plate Type LTK - LIGHT TRUCK License Plate Number Vehicle UNITVEHICLECrash Time 11:27 AM Crash Date 11/04/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 6 This report does not include any CJIS data. 19110411 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5JR WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address WINTER, WI 54896 , US Owner Name 0101Driver 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 VEHICLEUNIT Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event PARKED MOTOR VEHICLE02 Event 03Event 04Injury Distracted By LocationStriking Unit # Distracted By Action UNKNOWN Distracted By Source UNKNOWN Time of DeathDate of DeathHospital EMS Run #EMS Agency IdentifierMedical Transport NOT TRANSPORTED Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABLE 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 Number STATE: WISCONSIN COUNTRY: UNITED STATES Address WINTER, WI 54896 , US Race WHITE Date of Birth 07/02/ Sex MALE Citations Issued 2 Driver UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 11:27 AM Crash Date 11/04/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 6 This report does not include any CJIS data. 19110411 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5JR 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 To/From SchoolAction Other Action Prior Action UNITINDIVIDUAL Violations DescriptionOPERATE MOTOR VEHICLE W/O INSURANCEStatute Number344.62(1)Issue To? 001 UTC Number BE64942701 DescriptionUNSAFE BACKING OF VEHICLEStatute Number346.87Issue To? 001 UTC Number BE64942602 Truck Bus or HazMat NO Road Grade LEVEL Road Curvature CURVE RIGHT 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 2 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 1 Operating As EndorsementsVehicle Type PASSENGER CAR02 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UNITInitial Contact Point 12--FRONT Bus Use NOT A BUS Body Style 4D - 4DR Color SIL - SILVER (ALUMINUM) Model GRAND PRIX Year 2004 Make PONTIAC Vehicle Identification Number 35160202 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number Vehicle Crash Time 11:27 AM Crash Date 11/04/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 6 This report does not include any CJIS data. 19110411 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5JR WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address HAYWARD, WI 54843 , US Owner Name ULTIMATE AUTO BODY (715) 699-16010202Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing SLOW/STOPPING Vehicle Removed By OPERATOR Towed Due To Damage NOT TOWED Extent Of Damage MINOR DAMAGE Vehicle Damage 12--FRONT VEHICLEUNITUNITVEHICLE Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event MOTOR VEH IN TRANSPORT02 Event 03Event 04Organization/Company ULTIMATE AUTO BODY Insurance Company NATIONAL-INDEMNITY-CO Policy Holder UNITInjury Time of DeathDate of DeathHospital EMS Run #EMS Agency IdentifierMedical Transport NOT TRANSPORTED Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABLE 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 RESTRAINT USE UNKNOWN On Duty Crash Driver License Number STATE: WISCONSIN COUNTRY: UNITED STATES Address HAYWARD, WI 54843 , US Race WHITE Date of Birth 08/20/ Sex MALE Citations Issued 0 Driver UN Individual Safety EquipmentITIDUALINDIV Crash Time 11:27 AM Crash Date 11/04/2019Wisconsin Motor Vehicle Crash Form DT4000 5 of 6 This report does not include any CJIS data. 19110411 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5JR WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Distracted By 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 To/From SchoolAction Other Action Prior Action LocationStriking Unit # Distracted By Action NOT DISTRACTED Distracted By Source NOT APPLICABLE (NOT DISTRACTED) Non Motorist UNITINDIVIDUALCrash Time 11:27 AM Crash Date 11/04/2019Wisconsin Motor Vehicle Crash Form DT4000 6 of 6 This report does not include any CJIS data.