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20190926 cave19092644 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0FB0005 WISCONSIN MOTOR VEHICLE CRASH REPORT Secondary CrashAmendedCrash Type PRIVATE PROPERTY/PARKING LOTReportable 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 11:12 PM Date Notified 09/26/2019 Time Arrived 11:45 PM Date Arrived 09/26/2019 Crash Time 11:12 PM Crash Date 09/26/2019 Investigating Officer/Deputy DEPUTY MATTHEW JEFSON Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0FB0005Additional 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 RESPONDED TO A TWO VEHICLE CRASH AT THE PARKING LOT AT 9107N RIVER RD. I ARRIVED AND WAS MET BY THE OWNER OF UNIT 1. HE ADVISED THAT UNIT 2 LEFT DUE TO THE TIME IT TOOK TO ARRIVE. UNIT 1 ADVISED THAT UNIT 2 LEFT ALL HIS INFORMATION. I GATHERED THAT INFORMATION AND ALSO UNIT 1'S INFORMATION. UNIT 1 ADVISED THAT UNIT 2 WAS LEAVING AND BACKED INTO HIS VEHICLE WITH HIS HITCH. I TOOK PHOTOGRAPHS AND CLEARED. Crash Time 11:12 PM Crash Date 09/26/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 5 This report does not include any CJIS data. 19092644 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0FB0005 WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type HOUSE/BUILDING Y CoordinateX Coordinate LongitudeLatitudeINTERSECTION ON 9107 RIVER RD AT PARKING LOT (HOUSE/BUILDING 9107) IN THE TOWN OF HUNTER 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 DARK/UNLIT Manner of Collision 04--REAR TO REAR 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 CurvatureSurface Type BRICK OR BLOCK 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 LanesSpeed 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 (SPORT) UTILITY VEHICLE01 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status LEGALLY PARKED Unit Summary UNITExtent Of Damage FUNCTIONAL DAMAGE Vehicle Damage 6--REAR Initial Contact Point 6--REAR Bus Use NOT A BUS Body Style UT - SPORT UTILITY VEHICLE Color WHI - WHITE Model EXPLORER Year 2017 Make FORD Vehicle Identification Number 95040101 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number Vehicle UNITVEHICLECrash Time 11:12 PM Crash Date 09/26/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 5 This report does not include any CJIS data. 19092644 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0FB0005 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 WISCONSIN-MUTUAL-INS-CO Policy Holder UNITTruck 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 LanesSpeed 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 UNITExtent Of Damage NO DAMAGE Vehicle Damage NO DAMAGE Initial Contact Point 6--REAR Bus Use NOT A BUS Body Style PK - PICKUP Color GRY - GRAY Model F350 Year 2013 Make FORD Vehicle Identification Number 875310202 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number Vehicle UNITVEHICLECrash Time 11:12 PM Crash Date 09/26/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 5 This report does not include any CJIS data. 19092644 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0FB0005 WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address ROBERTS, WI 54023 , US Owner Name 0202Driver Actions NO CONTRIBUTING ACTION 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 PARKED MOTOR VEHICLE01 Event 02Event 03Event 04IndividualInsurance Company STATE-FARM-GENERAL-INS-CO Policy Holder UNITInjury Distracted By Distracted By Action NOT DISTRACTED Distracted By Source NOT APPLICABLE (NOT DISTRACTED) 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 INJURY00102 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 ROBERTS, WI 54023 , US Race WHITE Date of Birth 06/18/ Sex MALE Citations Issued 0 Driver E UN Individual Safety EquipmentITIDUALINDIV Crash Time 11:12 PM Crash Date 09/26/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 5 This report does not include any CJIS data. 19092644 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0FB0005 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 Use NO Suspected Alcohol Use NO To/From SchoolAction Other Action Prior Action LocationStriking Unit #Non Motorist UNITINDIVIDUALCrash Time 11:12 PM Crash Date 09/26/2019Wisconsin Motor Vehicle Crash Form DT4000 5 of 5 This report does not include any CJIS data.