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20190716 miller-marucha19071613 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB1 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 01 Total Units 02 Time Notified 12:24 PM Date Notified 07/16/2019 Time Arrived 12:27 PM Date Arrived 07/16/2019 Crash Time 12:22 PM Crash Date 07/16/2019 Investigating Officer/Deputy DEPUTY KEVIN GILLIS Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0G5WRB1Additional 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 TRAVELING WEST ON CTH B WHEN UNIT 02 WAS TURNING NORTH ONTO ROUND LAKE SCHOOL RD OFF OF CTH B. UNIT 02 DID NOT SEE UNIT 01 AND STUCK UNIT 01 CAUSING DISABLING DAMAGES TO BOTH VEHICLES. Crash Time 12:22 PM Crash Date 07/16/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 9 This report does not include any CJIS data. 19071613 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB1 WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type Y Coordinate 5103005.5 X Coordinate 162157.296875 Longitude -91.36300049 Latitude 45.997267606 ON ROUND LAKE SCHOOL RD 16 FT N OF CTHB WB 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) CLOUDY Environment Factor(s) NONE Roadway Factor(s) NONE Road Surface Condition(s) DRY Light Condition DAYLIGHT Manner of Collision 06--SIDESWIPE/OPPOSITE DIRECTION 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 STOP SIGN Traffic Way DIVIDED HWY W/O TRAFFIC BARRIER Emergency Motor Vehicle Use EMERGENCY OPERATION, EMERGEN 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 # RecordedTotal Occs 2 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 DISABLING DAMAGE Vehicle Damage 11--LEFT FRONT CORNER, 12--FRONT Initial Contact Point 12--FRONT Bus Use NOT A BUS Body Style PK - PICKUP Color MAR - MAROON (BURGUNDY) Model SIERRA K15 Year 2009 Make GENERAL MOTORS COR Vehicle Identification Number 01190101 Country of Issuance UNITED STATES St WI Plate Type LTK - LIGHT TRUCK License Plate Number Vehicle UNITVEHICLECrash Time 12:22 PM Crash Date 07/16/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 9 This report does not include any CJIS data. 19071613 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB1 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 By ROADRUNNER TOWING Towed Due To Damage TOWED DUE TO DISABLING DAMAGE VEHICLEUNIT Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event 02Event 03Event 04IndividualInsurance Company SECURA-SUPREME-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 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 08/27/ Sex MALE Citations Issued 0 Driver UN Individual Safety EquipmentITIDUALINDIV Crash Time 12:22 PM Crash Date 07/16/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 9 This report does not include any CJIS data. 19071613 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB1 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 HAYWARD AREA MEM HOSP EMS Run #EMS Agency Identifier 6000954 Medical Transport EMS GROUND Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABLE Ejected NOT EJECTED Airbag NON DEPLOYED Injury Severity SUSPECTED MINOR INJURY00201 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 HAYWARD, WI 54843 , US Race WHITE Date of Birth 08/30/ Sex FEMALE Citations Issued 0 Passenger UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 12:22 PM Crash Date 07/16/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 9 This report does not include any CJIS data. 19071613 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB1 WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition PHYSICALLY IMPAIRED 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 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 DIVIDED HWY W/O TRAFFIC BARRIER Emergency Motor Vehicle Use EMERGENCY OPERATION, EMERGEN 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 EASTBOUND Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # RecordedTotal Occs 3 Operating As EndorsementsVehicle Type UTILITY TRUCK/PICKUP TRUCK02 Unit Type TRUCK Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UNITVehicle Removed By A-1 TOWING Towed Due To Damage TOWED DUE TO DISABLING DAMAGE Extent Of Damage DISABLING DAMAGE Vehicle Damage 12--FRONT Initial Contact Point 12--FRONT Bus Use NOT A BUS Body Style PK - PICKUP Color SIL - SILVER (ALUMINUM) Model RAM 1500 Year 2005 Make DODGE Vehicle Identification Number 87410202 Country of Issuance UNITED STATES St WI Plate Type LTK - LIGHT TRUCK License Plate Number Vehicle UNITVEHICLECrash Time 12:22 PM Crash Date 07/16/2019Wisconsin Motor Vehicle Crash Form DT4000 5 of 9 This report does not include any CJIS data. 19071613 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB1 WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address HAYWARD, WI 54843 , US Owner Name 0202Driver Actions LOOKED BUT DID NOT SEE Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing LEFT TURN VEHICLEUNIT Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event LEFT TURN02 Event 03Event 04IndividualInsurance Company GEICO-GENERAL-INS-CO Policy Holder UNITInjury Distracted By LocationStriking Unit # Distracted By Action UNKNOWN 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 UNKNOWN Injury Severity NO APPARENT INJURY00302 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 09/26/ Sex MALE Citations Issued 0 Driver UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 12:22 PM Crash Date 07/16/2019Wisconsin Motor Vehicle Crash Form DT4000 6 of 9 This report does not include any CJIS data. 19071613 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB1 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 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 UNKNOWN Injury Severity NO APPARENT INJURY00402 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 HAYWARD, WI 54843 , US Race WHITE Date of Birth 03/12 Sex MALE Citations Issued 0 Passenger UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 12:22 PM Crash Date 07/16/2019Wisconsin Motor Vehicle Crash Form DT4000 7 of 9 This report does not include any CJIS data. 19071613 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB1 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 UNITINDIVIDUALInjury Distracted By Prior Action 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 INJURY00502 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position UNKNOWN Safety Equipment SHOULDER & LAP BELT On Duty Crash Driver License Number STATE: WISCONSIN COUNTRY: UNITED STATES Address HAYWARD, WI 54843 , US Race INDIAN Date of Birth 12/19 Sex MALE Citations Issued 0 Passenger UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 12:22 PM Crash Date 07/16/2019Wisconsin Motor Vehicle Crash Form DT4000 8 of 9 This report does not include any CJIS data. 19071613 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRB1 WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL Drug Type 00502Drug 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 UNITINDIVIDUALCrash Time 12:22 PM Crash Date 07/16/2019Wisconsin Motor Vehicle Crash Form DT4000 9 of 9 This report does not include any CJIS data.