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20191214 kellerSAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0JB3P3N 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 01 Time Notified 08:51 AM Date Notified 12/14/2019 Time Arrived 09:12 AM Date Arrived 12/14/2019 Crash Time 05:00 AM Crash Date 12/14/2019 Investigating Officer/Deputy DEPUTY NATHAN FREY Agency Crash Number 19121404 Primary Crash Document #Document Number Override 6VL0JB3P3NAdditional InformationPHOTOS 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 TRAVELING NORTH ON PEDERSON ROAD APPROACHING A LEFT TURN IN A ROADWAY SAG. THE OPERATOR OF UNIT 1 LOST CONTROL DUE TO THE HARD SNOW PACK/ ICE, AND ENTERED THE NORTHBOUND DITCH, STRIKING A LARGE TREE. UNIT 1 SUSTAINED DISABLING HEAVY DAMAGE TO THE FRONT END. THE OPERATOR WAS UNINJURED. Crash Time 05:00 AM Crash Date 12/14/2019Wisconsin Motor Vehicle Crash Form DT4000 1 of 4 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0JB3P3N WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type Y Coordinate 5111757 X Coordinate 168415.359375 Longitude -91.28849634 Latitude 46.078867768 ON PEDERSON RD 0.40 MI N OF STH77 EB IN THE TOWN OF SPIDER 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) SNOW Environment Factor(s) NONE Roadway Factor(s) NONE Road Surface Condition(s) SNOW, ICE Light Condition DARK/UNLIT Manner of Collision NO COLLISION W/VEHICLE IN TRANSPORT First Harmful Event Location SHOULDER RIGHT First Harmful Event DITCH Crash Scene Intersection Type NOT AN INTERSECTION Junction Location NON-JUNCTION Within Interchange Area NO Truck Bus or HazMat NO Road Grade SAG(BOTTOM) Road Curvature CURVE LEFT Surface Type OTHER 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 DITCH 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 TRUCK01 Unit Type TRUCK Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UNITExtent Of Damage DISABLING DAMAGE Vehicle Damage 1--RIGHT FRONT CORNER, 11--LEFT FRONT CORNER, 12--FRONT Initial Contact Point 12--FRONT Bus Use NOT A BUS Body Style PK - PICKUP Color GRY - GRAY Model SILVERADO Year 2015 Make CHEVROLET Vehicle Identification Number 62800101 Country of Issuance UNITED STATES St WI Plate Type LTK - LIGHT TRUCK License Plate Number Vehicle UNITVEHICLECrash Time 05:00 AM Crash Date 12/14/2019Wisconsin Motor Vehicle Crash Form DT4000 2 of 4 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0JB3P3N WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address 13626 W SJOSTROM CIR HAYWARD, WI 54843 , US Owner Name DAVID L KELLER 0101Driver Actions SPEED TOO FAST/COND Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing NEGOTIATING CURVE 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 TREE03 Event 04Individual Insurance Company WISCONSIN-MUTUAL-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 DEPLOYED-SIDE Injury Severity NO APPARENT INJURY00101 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY Safety Equipment NONE USED - VEHICLE OCCUPANT On Duty Crash Driver License Number STATE: WISCONSIN COUNTRY: UNITED STATES Address HAYWARD, WI 54843 , US Race WHITE Date of Birth 03/21/ Sex MALE Citations Issued 0 Driver UN Individual Safety EquipmentITIDUALINDIV Crash Time 05:00 AM Crash Date 12/14/2019Wisconsin Motor Vehicle Crash Form DT4000 3 of 4 This report does not include any CJIS data. SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0JB3P3N 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 UNITINDIVIDUALCrash Time 05:00 AM Crash Date 12/14/2019Wisconsin Motor Vehicle Crash Form DT4000 4 of 4 This report does not include any CJIS data.