20190911 donnellan19091120
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GNQ6N3 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
01
Time Notified
04:39 PM
Date Notified
09/11/2019
Time Arrived
04:50 PM
Date Arrived
09/11/2019
Crash Time
04:39 PM
Crash Date
09/11/2019
Investigating Officer/Deputy
DEPUTY MICHAEL SIMPSON
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0GNQ6N3Additional InformationNONE, PHOTOS
Photos ByNO PHOTOS
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 DRIVER SAID THAT SHE WAS TRAVELING NORTHBOUND ON HWY 27 WHEN THE VEHICLE SHE WAS DRIVING BEGAN TO VIOLENTLY SHAKE,
SHE FELT A THUD, AND THE VEHICLE MADE A LOT OF NOISE. THE DRIVER SAID THAT WHEN SHE LOOKED IN HER DRIVER'S SIDE MIRROR TO PULL
OVER SHE OBSERVED HER DRIVER'S SIDE FRONT TIRE OFF OF THE VEHICLE AND TRAVELING INTO AND ACROSS THE SOUTHBOUND LANE WHERE
IT STRUCK A NO PASSING ZONE SIGN. THE DEPUTY OBSERVED THAT THE SIGN POST WAS BROKEN OF AT THE BASE AND THE SIGN ITSELF WAS
NOT DAMAGED. THE VEHICLE DID NOT APPEAR TO HAVE ANY DAMAGE AND THE TIRE WAS RECOVERED.
Crash Time 04:39 PM
Crash Date 09/11/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
19091120
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GNQ6N3 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5100115
X Coordinate
151629.203125
Longitude
-91.496441592
Latitude
45.966070944
ON STH27 NB
0.38 MI N
OF RAINBOW RD
IN THE TOWN OF BASS LAKE
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 - NOT ON ROAD
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
SHOULDER LEFT
First Harmful Event
TRAFFIC SIGN POST
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
SAG(BOTTOM)
Road Curvature
STRAIGHT
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
TRAFFIC SIGN POST
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal 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
MINOR DAMAGE
Vehicle Damage
11--LEFT FRONT CORNER
Initial Contact Point
NON-COLLISION
Bus Use
NOT A BUS
Body Style
VN - VAN
Color
WHI - WHITE
Model
GRAND CARA
Year
2011
Make
DODGE
Vehicle Identification Number
99670101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 04:39 PM
Crash Date 09/11/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
19091120
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GNQ6N3 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HURLEY, WI 54534 , US
Owner Name
HOME MEDICAL PRODUCTS AND SERVICES
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
TIRES, WHEELS
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
OPERATOR
Towed Due To Damage
TOWED BUT NOT DUE TO DISABLING DAMAG
VEHICLEUNIT Sequence Of Events
Event
EQUIPMENT FAILURE (BLOWN TIRE, BRAKE FAILURE, ETC)01Event
TRAFFIC SIGN POST02
Event
03Event
04Injury
Distracted By
LocationStriking Unit #
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 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
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
06/19/
Sex
FEMALE
Citations Issued
0
Driver
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 04:39 PM
Crash Date 09/11/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
19091120
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GNQ6N3 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
UNITINDIVIDUALAddress1701 N 4TH ST
SUPERIOR, WI 54880 , US
GovernmentWISCONSIN DEPT OF TRANSPORTATION
(715) 392-7925
PROPOWNER01Fixed Objects Struck
Property Owner
Damage Tag Number
314586
Structure NumberStruck Object
TRAFFIC SIGN POST
Striking Unit
0101
Crash Time 04:39 PM
Crash Date 09/11/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.