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20191124 ciresi-hellerSAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F1BQ6V 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 11:12 AM Date Notified 11/24/2019 Time Arrived 11:20 AM Date Arrived 11/24/2019 Crash Time 11:12 AM Crash Date 11/24/2019 Investigating Officer/Deputy DEPUTY DEREK BECKSTRAND Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0F1BQ6VAdditional InformationNONE, PHOTOS, RECONSTRUCTION Photos ByD. BECKSTRAND Reconstruction BySAWYER COUNTY SHERIFFDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. I ARRIVED ON SCENE AND SAW TWO INDIVIDUALS WHO IDENTIFIED THEMSELVES VIA MINNESOTA DL. TOLD ME THAT HE SAW STOPPED AT THE STOP SIGN TURNING RIGHT ONTO HWY 27/70. THEN TOLD ME HE THOUGHT HAD ALREADY TURNED AS HE APPROACHED THE SIGN. TOLD ME THAT HE REAR ENDED AND THAT IT WAS FAULT. TOLD ME THAT HE WAS SITTING AT THE STOP SIGN AND WAS TURNING RIGHT WHEN HE WAS HIT BY BOTH INDIVIDUALS WROTE A STATEMENT. HAD MINOR DAMAGE TO THE PASSENGER SIDE OF FRONT BUMPER OF THE TRUCK. HAD MINOR DAMAGE TO THE REAR DRIVER SIDE TIAL LIGHT AND BUMPER. Crash Time 11:12 AM Crash Date 11/24/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 6 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F1BQ6V WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type NO STRUCTURE Y Coordinate 5087995.5 X Coordinate 152158.546875 Longitude -91.480852689 Latitude 45.857590254 ON CTHE SB 102 FT N OF STH27 SB IN THE TOWN OF SAND 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 - ON ROAD Animal Type Weather Condition(s) CLOUDY Environment Factor(s) NONE Roadway Factor(s) NONE Road Surface Condition(s) WET Light Condition DAYLIGHT Manner of Collision 02--FRONT TO REAR First Harmful Event Location ON ROADWAY 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 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 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 1 Operating As EndorsementsVehicle Type PASSENGER CAR01 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UNITExtent Of Damage MINOR DAMAGE Vehicle Damage 6--REAR, 7--LEFT REAR CORNER Initial Contact Point 7--LEFT REAR CORNER Bus Use NOT A BUS Body Style 4D - 4DR Color BLU - BLUE Model ACCORD Year 2013 Make HONDA Vehicle Identification Number 83720101 Country of Issuance UNITED STATES St MN Plate Type AUT - AUTOMOBILE License Plate Number Vehicle UNITVEHICLECrash Time 11:12 AM Crash Date 11/24/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 6 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F1BQ6V WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address ARDEN HILLS, LA 55112 , US Owner Name 0101Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing SLOW/STOPPING Vehicle Removed By OPERATOR Towed Due To Damage NOT TOWED VEHICLEUNIT Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event 02Event 03Event 04Individual Insurance Company STATE-FARM-MUTUAL-AUTOMOBILE-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: MINNESOTA COUNTRY: UNITED STATES Address ARDEN HILLS, MN 55112 , US Race WHITE Date of Birth 08/05/ Sex MALE Citations Issued 0 Driver UN Individual Safety EquipmentITIDUALINDIV Crash Time 11:12 AM Crash Date 11/24/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 6 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F1BQ6V 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 UNITINDIVIDUALTruck 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 1 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 OPERATOR Towed Due To Damage NOT TOWED Extent Of Damage MINOR DAMAGE Vehicle Damage 12--FRONT Initial Contact Point 12--FRONT Bus Use NOT A BUS Body Style 4D - 4DR Color BLK - BLACK Model RAM TRUCK Year 2013 Make RAM Vehicle Identification Number 10210202 Country of Issuance UNITED STATES St MN Plate Type LTK - LIGHT TRUCK License Plate Number Vehicle UNITVEHICLECrash Time 11:12 AM Crash Date 11/24/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 6 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F1BQ6V WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address EDEN PRARIE, MN 55347 , US Owner Name 0202Driver Actions LOOKED BUT DID NOT SEE 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 04Individual Insurance Company CHUBB-INDEMNITY-INS-CO 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 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: MINNESOTA COUNTRY: UNITED STATES Address EDEN PRARIE, MN 55347 , US Race WHITE Date of Birth 11/23/ Sex MALE Citations Issued 0 Driver UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 11:12 AM Crash Date 11/24/2019Wisconsin Motor Vehicle Crash Form DT4000 5 of 6 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F1BQ6V 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 11:12 AM Crash Date 11/24/2019Wisconsin Motor Vehicle Crash Form DT4000 6 of 6 This report does not include any CJIS data.