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20190924 marquardt-peterson19092415 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB2 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 02:17 PM Date Notified 09/24/2019 Time Arrived 02:27 PM Date Arrived 09/24/2019 Crash Time 99:99 Crash Date 09/24/2019 Investigating Officer/Deputy DEPUTY KEVIN GILLIS Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0G5WRB2Additional InformationPHOTOS Photos ByDEPUTY KEVIN GILLIS Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. UNIT 01 WAS BACKING OUT OF PARKING SPOT WHEN UNIT 02 WAS DRIVING THROUGH THE PARKING LOT. UNIT 01 BACKED INTO UNIT 02 DRIVER'S SIDE DOOR. Crash Time 99:99 Crash Date 09/24/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 6 This report does not include any CJIS data. 19092415 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB2 WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type Y Coordinate 5107584.5 X Coordinate 152967.5625 Longitude -91.484643371 Latitude 46.033768505 INTERSECTION ON HOSPITAL DR AT PARKING LOT/ STH27 EB 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) CLEAR Environment Factor(s) NONE Roadway Factor(s) NONE Road Surface Condition(s) DRY Light Condition DAYLIGHT Manner of Collision 07--REAR TO SIDE 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 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 NON-EMERGENCY, NON-TRANSPORT Special Function NO SPECIAL FUNCTION Most Harmful Event: Collision With MOTOR VEH IN TRANSPORT 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 UTILITY TRUCK/PICKUP TRUCK01 Unit Type TRUCK Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UNITExtent Of Damage MINOR DAMAGE Vehicle Damage 7--LEFT REAR CORNER Initial Contact Point 7--LEFT REAR CORNER Bus Use NOT A BUS Body Style TK - TRUCK Color GRY - GRAY Model DAKOTA Year 2005 Make DODGE Vehicle Identification Number 98620101 Country of Issuance UNITED STATES St WI Plate Type LTK - LIGHT TRUCK License Plate Number Vehicle UNITVEHICLECrash Time 99:99 Crash Date 09/24/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 6 This report does not include any CJIS data. 19092415 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB2 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 BACKING Vehicle Removed By OPERATOR Towed Due To Damage NOT TOWED VEHICLEUNIT Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event 02Event 03Event 04IndividualInsurance Company HARTFORD-ACCIDENT-&-INDEMNITY-CO Policy Holder UNITInjury Distracted By 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 NOT APPLICABLE On Duty Crash Driver License Number STATE: WISCONSIN COUNTRY: UNITED STATES Address HAYWARD, WI 54843 , US Race WHITE Date of Birth 11/11/ Sex MALE Citations Issued 0 Driver UN Individual Safety EquipmentITIDUALINDIV Crash Time 99:99 Crash Date 09/24/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 6 This report does not include any CJIS data. 19092415 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB2 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 UseSuspected Alcohol Use NO To/From SchoolAction Other Action Prior Action LocationStriking Unit #Non Motorist UNITINDIVIDUALTruck 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 NON-EMERGENCY, NON-TRANSPORT Special Function NO SPECIAL FUNCTION Most Harmful Event: Collision With MOTOR VEH IN TRANSPORT 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 UNITVehicle Removed By OPERATOR Towed Due To Damage NOT TOWED Extent Of Damage MINOR DAMAGE Vehicle Damage 9--LEFT SIDE MIDDLE Initial Contact Point 9--LEFT SIDE MIDDLE Bus Use NOT A BUS Body Style 4D - 4DR Color BLU - BLUE Model AVENGER Year 2013 Make DODGE Vehicle Identification Number 77520202 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number Vehicle UNITVEHICLECrash Time 99:99 Crash Date 09/24/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 6 This report does not include any CJIS data. 19092415 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB2 WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address HAYWARD, WI 54843 , US Owner Name 0202Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing GOING STRAIGHT VEHICLEUNIT Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event 02Event 03Event 04IndividualInsurance Company AMERICAN-FAMILY-INS-CO Policy Holder UNITInjury 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 INJURY00202 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY Safety Equipment NOT APPLICABLE On Duty Crash Driver License Number STATE: WISCONSIN COUNTRY: UNITED STATES Address HAYWARD, WI 54843 , US Race WHITE Date of Birth 08/06/ Sex FEMALE Citations Issued 0 Driver UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 99:99 Crash Date 09/24/2019Wisconsin Motor Vehicle Crash Form DT4000 5 of 6 This report does not include any CJIS data. 19092415 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB2 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 To/From SchoolAction Other Action Prior Action UNITINDIVIDUALCrash Time 99:99 Crash Date 09/24/2019Wisconsin Motor Vehicle Crash Form DT4000 6 of 6 This report does not include any CJIS data.