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20190817 larson - hamblin19081724 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0DT5JN1 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 03:13 PM Date Notified 08/17/2019 Time Arrived 03:18 PM Date Arrived 08/17/2019 Crash Time 03:13 PM Crash Date 08/17/2019 Investigating Officer/Deputy DEPUTY IAN HALL Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0DT5JN1Additional InformationPHOTOS, RECONSTRUCTION Photos ByDEPUTY HALL Reconstruction BySAWYER COUNTY SHERIFFDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. ON AUGUST 17, 2019, AT APPROXIMATELY 13:15 I DEPUTY HALL RESPONDED TO A TWO VEHICLE CRASH AT THE INTERSECTION OF CO HWY K AND PENINSULA ROAD IN THE HAYWARD TOWNSHIP. I ARRIVED ON SCENE AND OBSERVED A SILVER FORD TAURUS (UNIT 1) HAD STRUCK A WHITE FORD FARM TRUCK. IT APPEARED UNIT 1 WAS TRAVELING SOUTH ON CO HWY K AND THE WHITE TRUCK PULLED OUT IN FRONT OF UNIT 1. I IDENTIFIED THE DRIVER IF UNIT 1 AS AND THE DRIVER OF THE TRUCK AS 5. BOTH PARTIES WERE EXCHANGING INFORMATION. I ASKED JEFFREY WHAT HAPPENED AND HE SAID THE TRUCK PULLED OUT IN FRONT OF HIM AS HE WAS TRAVELING SOUTH ON CO HWY K. I ASKED WHAT HAPPENED AND HE SAID HE STOPPED AT THE STOP SIGN AT THE INTERSECTION OF CO HWY K AND PENINSULA RD. ROBERT SAID HE WAS TRAVELING WEST AND HE LOOKED BUT DIDN'T SEE UNIT 1 AND PULLED OUT FROM THE STOP SIGN AND SAW UNIT 1 AT THE LAST SECOND BEFORE THE IMPACT. UNIT 1 STRUCK THE RIGHT FRONT OF TRUCK. WAS ABLE TO REMOVE HIS TRUCK AFTER I TOOK PHOTOGRAPHS. UNIT 1 WAS REMOVED BY A-1 TOWING. WHILE TAKING SCENE PHOTOGRAPHS I DID OBSERVE TALL VEGETATION WHICH COULD HAVE BEEN A CONTRIBUTING FACTOR TO ROBERT NOT SEEING UNIT 1. THE VEGETATION WAS ON THE NORTH EAST SIDE OF THE INTERSECTION. NO CITATIONS WERE ISSUED TO EITHER DRIVER. Crash Time 03:13 PM Crash Date 08/17/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 8 This report does not include any CJIS data. 19081724 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0DT5JN1 WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type NO STRUCTURE Y Coordinate 5104680.5 X Coordinate 160633.546875 Longitude -91.383809914 Latitude 46.011548322 ON CTHK SB 31 FT S OF PENINSULA RD IN THE TOWN OF HAYWARD IN SAWYER COUNTY Location Special StudyAccess Control PARTIAL CONTROL Tribal Land Crash Classification - Jurisdiction NO SPECIAL JURISDICTION Crash Classification - Location PUBLIC PROPERTY Relation To Trafficway TRAFFICWAY - ON ROAD Animal Type Weather Condition(s) CLEAR Environment Factor(s) VISUAL OBSTRUCTION (S) Roadway Factor(s) NONE Road Surface Condition(s) DRY Light Condition DAYLIGHT Manner of Collision 08--FRONT TO SIDE First Harmful Event Location ON ROADWAY First Harmful Event MOTOR VEH IN TRANSPORT Crash Scene Intersection Type FOUR-WAY INTERSECTION Junction Location INTERSECTION Within Interchange Area NO Truck Bus or HazMat NO Road Grade LEVEL 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 MOTOR VEH IN TRANSPORT Total Lanes 2 Speed Limit 55 Pre CrashTire Mark Direction Of Travel SOUTHBOUND Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # RecordedTotal Occs 3 Operating As EndorsementsVehicle Type PASSENGER CAR01 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UNITExtent Of Damage DISABLING DAMAGE Vehicle Damage 12--FRONT Initial Contact Point 12--FRONT Bus Use NOT A BUS Body Style 4D - 4DR Color SIL - SILVER (ALUMINUM) Model TAURUS Year 2006 Make FORD Vehicle Identification Number 43040101 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number Vehicle UNITVEHICLECrash Time 03:13 PM Crash Date 08/17/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 8 This report does not include any CJIS data. 19081724 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0DT5JN1 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 GOING STRAIGHT Vehicle Removed ByTowed Due To Damage TOWED DUE TO DISABLING DAMAGE VEHICLEUNIT Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event RUN OFF ROADWAY RIGHT02 Event 03Event 04UnknownInsurance Company PROGRESSIVE-ADVANCED-INSURANCE-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 DEPLOYED-FRONT 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 02/09/ Sex MALE Citations Issued 0 Driver UN Individual Safety EquipmentITIDUALINDIV Crash Time 03:13 PM Crash Date 08/17/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 8 This report does not include any CJIS data. 19081724 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0DT5JN1 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 LocationStriking Unit #Non Motorist UNITINDIVIDUALInjury 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 TRAPPED Ejection Path NOT EJECTED/NOT APPLICABLE Ejected NOT EJECTED Airbag NON DEPLOYED Injury Severity NO APPARENT INJURY00201 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 6--SECOND SEAT-RIGHT SIDE Safety Equipment CHILD RESTRAINT SYSTEM - FORWARD FACING On Duty Crash Driver License NumberAddress HAYWARD, WI 54843 , US Race WHITE Date of Birth 10/27 Sex FEMALE Citations Issued 0 Passenger UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 03:13 PM Crash Date 08/17/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 8 This report does not include any CJIS data. 19081724 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0DT5JN1 WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL Drug Type 00201Drug 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 UNITINDIVIDUALInjury 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 TRAPPED Ejection Path NOT EJECTED/NOT APPLICABLE Ejected NOT EJECTED Airbag NON DEPLOYED Injury Severity NO APPARENT INJURY00301 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 5--SECOND SEAT-MIDDLE Safety Equipment CHILD RESTRAINT SYSTEM - FORWARD FACING On Duty Crash Driver License NumberAddress HAYWARD, WI 54843 , US Race WHITE Date of Birth 08/04/ Sex MALE Citations Issued 0 Passenger UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 03:13 PM Crash Date 08/17/2019Wisconsin Motor Vehicle Crash Form DT4000 5 of 8 This report does not include any CJIS data. 19081724 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0DT5JN1 WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL Drug Type 00301Drug 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 UNITINDIVIDUALTruck Bus or HazMat NO Road Grade LEVEL Road Curvature STRAIGHT Surface Type BLACKTOP (BITUMINOUS) Traffic Control Inoperative/Missing NO Traffic Control STOP SIGN Traffic Way TWO-WAY, NOT DIVIDED Emergency Motor Vehicle Use NOT APPLICABLE Special Function NO SPECIAL FUNCTION Most Harmful Event: Collision With MOTOR VEH IN TRANSPORT Total Lanes 2 Speed Limit 45 Pre CrashTire Mark Direction Of Travel WESTBOUND 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 TRUCK02 Unit Type TRUCK Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UNITWhat Driver Was Doing GOING STRAIGHT Vehicle Removed By OPERATOR Towed Due To Damage NOT TOWED Extent Of Damage FUNCTIONAL DAMAGE Vehicle Damage 1--RIGHT FRONT CORNER Initial Contact Point 1--RIGHT FRONT CORNER Bus Use NOT A BUS Body Style TK - TRUCK Color WHI - WHITE Model F450 Year 2000 Make FORD Vehicle Identification Number 12490202 Country of Issuance UNITED STATES St WI Plate Type FRM - FARM License Plate Number Vehicle UNITVEHICLECrash Time 03:13 PM Crash Date 08/17/2019Wisconsin Motor Vehicle Crash Form DT4000 6 of 8 This report does not include any CJIS data. 19081724 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0DT5JN1 WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address HAYWARD, WI 54843 , US Owner Name 0202Driver Actions FAILED TO YIELD RIGHT-OF-WAY Driver Prior Action Other Vehicle Factors NOT APPLICABLE VEHICLEUNIT Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event 02Event 03Event 04IndividualInsurance Company RURAL-MUTUAL-INS-CO-(ATTN:-CLAIMS-DEPT) Policy Holder UNITInjury 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 INJURY00402 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 03/27/ Sex MALE Citations Issued 0 Driver UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 03:13 PM Crash Date 08/17/2019Wisconsin Motor Vehicle Crash Form DT4000 7 of 8 This report does not include any CJIS data. 19081724 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0DT5JN1 WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL Drug Type 00402Drug 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 03:13 PM Crash Date 08/17/2019Wisconsin Motor Vehicle Crash Form DT4000 8 of 8 This report does not include any CJIS data.