Loading...
20191202 nugent- pedersonSAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0JB3P3K 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 02 Total Units 02 Time Notified 04:14 PM Date Notified 12/02/2019 Time Arrived 04:15 PM Date Arrived 12/02/2019 Crash Time 04:13 PM Crash Date 12/02/2019 Investigating Officer/Deputy DEPUTY NATHAN FREY Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0JB3P3KAdditional InformationNONE, PHOTOS Photos By397 Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. UNIT 1 WAS EXITING THE MARATHON GAS STATION. WHILE EXITING, UNIT 1 WAS HAVING DIFFICULTY GETTING TRACTION. UNIT 3 WAS NORTHBOUND ON HIGHWAY 63 AFTER TURNING RIGHT OFF OF SOUTH KANSAS AVE. THE OPERATOR OF UNIT 3 NOTICED A PASSENGER CAR TRAVELING NORTH IN THE INSIDE NORTH-BOUND LANE OF HIGHWAY 63. UNIT 3 ALSO OBSERVED UNIT 1 EXITING THE MARATHON GAS STATION AND BEGAN TO SLOW. UNIT 2 OVERTOOK UNIT 3 AND STRUCK THE REAR DRIVER'S SIDE OF UNIT 1. BOTH UNIT 1 AND 2 ENDED UP IN THE SOUTHBOUND OUTSIDE LANE. THE OPERATOR OF UNIT ONE APPEARED UNINJURED AND NO AIRBAGS WERE DEPLOYED. THE OPERATOR AND PASSENGER OF UNIT 2 WERE SEEN AND TRANSPORTED BY SAWYER COUNTY EMT. UNIT 2 HAD A COMBINATION OF ALL FRONT AIRBAGS DEPLOY. BOTH UNIT 1 AND 2 WERE REMOVED BY ROADRUNNER TOWING. Crash Time 04:13 PM Crash Date 12/02/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 7 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0JB3P3K WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type Y Coordinate 5105459 X Coordinate 153061.953125 Longitude -91.481882914 Latitude 46.014746791 ON USH63 NB 179 FT W OF CALIFORNIA AVE IN THE CITY OF HAYWARD 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) NOT APPLICABLE Road Surface Condition(s) SNOW Light Condition DUSK Manner of Collision 08--FRONT TO SIDE 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 NO CONTROL Traffic Way DIVIDED HWY W/O TRAFFIC BARRIER Emergency Motor Vehicle Use NOT APPLICABLE Special Function NO SPECIAL FUNCTION Most Harmful Event: Collision With MOTOR VEH IN TRANSPORT Total Lanes 4 Speed Limit 25 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 (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 8--LEFT SIDE REAR Initial Contact Point 8--LEFT SIDE REAR Bus Use NOT A BUS Body Style UT - SPORT UTILITY VEHICLE Color GRY - GRAY Model CHEROKEE Year 2016 Make JEEP Vehicle Identification Number 54750101 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number Vehicle UNITVEHICLECrash Time 04:13 PM Crash Date 12/02/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 7 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0JB3P3K WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address N6628 METCALF RD STONE LAKE, WI 54876 , US Owner Name TERI LYNN NUGENT 0101Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing ENTERING TRAFFIC LANE Vehicle Removed ByTowed Due To Damage TOWED DUE TO DISABLING DAMAGE VEHICLEUNIT Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event 02Event 03Event 04Individual Insurance Company USAA-CASUALTY-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 STONE LAKE, WI 54876 , US Race WHITE Date of Birth 06/12/ Sex FEMALE Citations Issued 0 Driver UN Individual Safety EquipmentITIDUALINDIV Crash Time 04:13 PM Crash Date 12/02/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 7 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0JB3P3K 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 DIVIDED HWY W/O TRAFFIC BARRIER Emergency Motor Vehicle Use NOT APPLICABLE Special Function NO SPECIAL FUNCTION Most Harmful Event: Collision With MOTOR VEH IN TRANSPORT Total Lanes 4 Speed Limit 25 Pre CrashTire Mark Direction Of Travel NORTHBOUND Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # RecordedTotal Occs 2 Operating As EndorsementsVehicle Type PASSENGER CAR02 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UNITVehicle Removed ByTowed Due To Damage TOWED DUE TO DISABLING DAMAGE Extent Of Damage DISABLING DAMAGE Vehicle Damage 1--RIGHT FRONT CORNER, 12--FRONT Initial Contact Point 12--FRONT Bus Use NOT A BUS Body Style SD - SEDAN Color BLK - BLACK Model FUSION Year 2014 Make FORD Vehicle Identification Number 30270202 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number Vehicle UNITVEHICLECrash Time 04:13 PM Crash Date 12/02/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 7 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0JB3P3K WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address 12118 N UPPER A RD HAYWARD, WI 54843 , US Owner Name MICHELLE KATE PEDERSON 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 04Individual Insurance Company STATE-FARM-GENERAL-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 HAYWARD AREA MEM HOSP EMS Run # 1913795 EMS Agency Identifier 6000954 Medical Transport EMS GROUND Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABLE Ejected NOT EJECTED Airbag DEPLOYED-COMBINATION Injury Severity SUSPECTED MINOR 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 HAYWARD, WI 54843 , US Race WHITE Date of Birth 01/22/ Sex FEMALE Citations Issued 0 Driver UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 04:13 PM Crash Date 12/02/2019Wisconsin Motor Vehicle Crash Form DT4000 5 of 7 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0JB3P3K 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 UNITINDIVIDUALInjury Distracted By LocationStriking Unit # Distracted By Action Distracted By Source Time of DeathDate of DeathHospital HAYWARD AREA MEM HOSP EMS Run # 1913795 EMS Agency Identifier 6000954 Medical Transport EMS GROUND Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABLE Ejected NOT EJECTED Airbag DEPLOYED-COMBINATION Injury Severity POSSIBLE 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 NumberAddress HAYWARD, WI 54843 , US RaceDate of Birth 06/21/ SexCitations Issued 0 Passenger UN Individual Non Motorist Safety EquipmentITIDUALINDIV Crash Time 04:13 PM Crash Date 12/02/2019Wisconsin Motor Vehicle Crash Form DT4000 6 of 7 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0JB3P3K 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 UNITINDIVIDUALDate of Birth 04/21/ Address HAYWARD, WI 54843 , US Individual (01Witness WITNESSCrash Time 04:13 PM Crash Date 12/02/2019Wisconsin Motor Vehicle Crash Form DT4000 7 of 7 This report does not include any CJIS data.