20190810 MIZER - KOENINGS19081017
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HWRB04 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
12:10 PM
Date Notified
08/10/2019
Time Arrived
12:27 PM
Date Arrived
08/10/2019
Crash Time
12:09 PM
Crash Date
08/10/2019
Investigating Officer/Deputy
DEPUTY DARIN JENSEN
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0HWRB04Additional InformationPHOTOS
Photos ByD JENSEN
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS TRAVELING NORTHBOUND ON HIGHWAY W AND THEN CAME TO STOP AT THE STOP SIGN AT THE INTERSECTION OF HIGHWAY W AND
HIGHWAY B. THE OPERATOR OF UNIT 1 STATED SHE LOOKED BOTH WAYS AND STATED SHE DID NOT SEE UNIT 2 TRAVELING WESTBOUND. THE
OPERATOR OF UNIT 1 PULLED OUT INTO THE INTERSECTION AND THEN NOTICED UNIT 2. THE OPERATOR OF UNIT 2 BEGAN MOVING OVER IN HIS
LANE HOWEVER UNIT 1 COLLIDED WITH UNIT 2 STRIKING THE VEHICLE TWICE, ONCE IN THE FRONT AND ONCE IN THE REAR. UNIT 2 WENT INTO
THE DITCH AND THEN CAME TO REST ON THE SHOULDER OF HIGHWAY B. UNIT 2 WAS PUSHED NORTHBOUND AND CAME TO REST ON BARKER
LAKE ROAD.
Crash Time 12:09 PM
Crash Date 08/10/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 7
This report does not include any CJIS data.
19081017
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HWRB04 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y CoordinateX Coordinate
LongitudeLatitudeON CTHB WB
0 FT N
OF CTHW
IN THE TOWN OF WINTER
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 - 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
08--FRONT TO SIDE
First Harmful Event Location
ON ROADWAY
First Harmful Event
MOTOR VEH IN TRANSPORT
Crash Scene
Intersection Type
OTHER
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
STOP SIGN
Traffic Way
TWO-WAY, NOT DIVIDED
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
STRUCK BY FALLING, SHIFTING CARGO OR ANYT
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
(SPORT) UTILITY VEHICLE01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
DISABLING DAMAGE
Vehicle Damage
5--RIGHT REAR CORNER, 12--FRONT
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
UT - SPORT UTILITY VEHICLE
Color
BLK - BLACK
Model
EQUINOX
Year
2015
Make
CHEVROLET
Vehicle Identification Number
62350101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 12:09 PM
Crash Date 08/10/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 7
This report does not include any CJIS data.
19081017
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HWRB04 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
BARRON, WI 54812 , US
Owner Name01Driver DistractionsUNKNOWN IF DISTRACTED
01Driver Actions
OTHER CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
LEFT TURN
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
LEFT TURN02
Event
03Event
04IndividualInsurance Company
WISCONSIN-MUTUAL-INS-CO
Policy Holder
UNITInjury
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
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
BARRON, WI 54812 , US
Race
WHITE
Date of Birth
10/06/
Sex
FEMALE
Citations Issued
0
Driver
ITEquipment
Individual
UNINDIVIDUALCrash Time 12:09 PM
Crash Date 08/10/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 7
This report does not include any CJIS data.
19081017
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HWRB04 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
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
UNIT Non Motorist
INDIVIDUALTruck Bus or HazMat
NO
Road Grade
DOWNHILL
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
WESTBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
2
Operating As EndorsementsVehicle Type
PASSENGER CAR02 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
DISABLING DAMAGE
Vehicle Damage
8--LEFT SIDE REAR, 11--LEFT FRONT CORNER
Initial Contact Point
11--LEFT FRONT CORNER
Bus Use
NOT A BUS
Body Style
TK - TRUCK
Color
BLU - BLUE
Model
F150
Year
2013
Make
FORD
Vehicle Identification Number
08070202 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 12:09 PM
Crash Date 08/10/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 7
This report does not include any CJIS data.
19081017
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HWRB04 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
WATERFORD, WI 53185 , US
Owner Name02Driver DistractionsNOT DISTRACTED
02Driver 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
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04Individual
DAVID KOENINGS
Insurance Company
ALLSTATE-INS-CO
Policy Holder
UNITInjury
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
DEPLOYED-FRONT
Injury Severity
NO APPARENT INJURY00202 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
WATERFORD, WI 53185 , US
Race
WHITE
Date of Birth
04/18/
Sex
MALE
Citations Issued
0
Driver
ITEquipment
Individual
UNINDIVIDUALCrash Time 12:09 PM
Crash Date 08/10/2019Wisconsin Motor Vehicle Crash
Form DT4000 5 of 7
This report does not include any CJIS data.
19081017
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HWRB04 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
Action Other
Action
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
UNIT Non Motorist
INDIVIDUALInjury
To/From SchoolLocationPrior ActionStriking Unit #
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABL
Ejected
NOT EJECTED
Airbag
DEPLOYED-FRONT
Injury Severity
NO APPARENT INJURY00302 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
3--FRONT SEAT-RIGHT SIDE (TRAIN ENGINEER
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
WATERFORD, WI 53185 , US
Race
WHITE
Date of Birth
03/12/
Sex
FEMALE
Citations Issued
0
Passenger
ITEquipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 12:09 PM
Crash Date 08/10/2019Wisconsin Motor Vehicle Crash
Form DT4000 6 of 7
This report does not include any CJIS data.
19081017
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0HWRB04 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00302Drug 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
Action Other
Action
UNITINDIVIDUALCrash Time 12:09 PM
Crash Date 08/10/2019Wisconsin Motor Vehicle Crash
Form DT4000 7 of 7
This report does not include any CJIS data.