200111 lund-tungseth20011110
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JW 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
10:26 AM
Date Notified
01/11/2020
Time Arrived
10:45 AM
Date Arrived
01/11/2020
Crash Time
10:25 AM
Crash Date
01/11/2020
Investigating Officer/Deputy
DEPUTY AMANDA REED
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0GMH5JWAdditional InformationPHOTOS
Photos ByDEPUTY AMANDA REED
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNABLE TO DO AN ACCURATE DIAGRAM AS THE VEHICLES WERE ALREADY MOVED PRIOR TO MY ARRIVAL ON SCENE. I RESPONDED TO A REPORT
OF A MINOR TWO VEHICLE ACCIDENT AT THE TOWN OF ROUND LAKE DUMP. UPON MY ARRIVAL, I MET WITH WHO HAD BEEN
DRIVING AND TRYING TO MANEUVER AROUND A PARKED VEHICLE OWNED BY WHEN SHE ACCIDENTALLY SIDE SWIPED HIM.
THE QUARTERS WERE MARKED OFF BY ORANGE TRAFFIC CONES TO KEEP TRAFFIC MOVING IN ONE DIRECTION, THERE WERE TWO EMPLOYEES
ON SITE ATTEMPTING TO DIRECT TRAFFIC, BUT IT APPEARED TO BE VERY DISORGANIZED AND CLUTTERED TO ME. DUE TO THAT REASON, I
CHOSE NOT TO ISSUE A CITATION TO
Crash Time 10:25 AM
Crash Date 01/11/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 5
This report does not include any CJIS data.
20011110
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JW WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5106831.5
X Coordinate
175273.625
Longitude
-91.19668344
Latitude
46.037949603
PRIVATE PROPERTY
CTHA EB
IN THE TOWN OF ROUND LAKE
IN SAWYER COUNTY
Location
Special StudyAccess Control
NO CONTROL
Tribal Land
Crash Classification - Jurisdiction
OTHER
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
NON TRAFFICWAY - PARKING LOT
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
05--SIDESWIPE/SAME DIRECTION
First Harmful Event Location
OFF ROADWAY, LOCATION UNKNOWN
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
UNKNOWN
Surface Type
SLAG, GRAVEL, OR STONE
Traffic Control Inoperative/Missing
NO
Traffic Control
TRAFFIC CONTROL PERSON
Traffic Way
PARKING LOT OR PRIVATE PROPERTY
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
PARKED MOTOR VEHICLE
Total Lanes
0
Speed LimitPre CrashTire
Mark
Direction Of Travel
NOT ON ROADWAY
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
11--LEFT FRONT CORNER
Initial Contact Point
10--LEFT SIDE FRONT
Bus Use
NOT A BUS
Body Style
4D - 4DR
Color
BLK - BLACK
Model
IMPALA
Year
2008
Make
CHEVROLET
Vehicle Identification Number
00620101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 10:25 AM
Crash Date 01/11/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 5
This report does not include any CJIS data.
20011110
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JW 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
PARK MANEUVER
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
PARKED MOTOR VEHICLE02
Event
03Event
04Individual
Insurance Company
WADENA-INSURANCE-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
RESTRAINT USE UNKNOWN
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
HAYWARD, WI 54843 , US
Race
WHITE
Date of Birth
12/12/
Sex
FEMALE
Citations Issued
0
Driver
UN Individual
Safety EquipmentITIDUALINDIV
Crash Time 10:25 AM
Crash Date 01/11/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 5
This report does not include any CJIS data.
20011110
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JW 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
UNKNOWN
Surface Type
SLAG, GRAVEL, OR STONE
Traffic Control Inoperative/Missing
NO
Traffic Control
TRAFFIC CONTROL PERSON
Traffic Way
PARKING LOT OR PRIVATE PROPERTY
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
Total Lanes
0
Speed LimitPre CrashTire
Mark
Direction Of Travel
NOT ON ROADWAY
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
0
Operating As EndorsementsVehicle Type
PASSENGER CAR02 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
LEGALLY PARKED
Unit Summary
UNITVehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
MINOR DAMAGE
Vehicle Damage
1--RIGHT FRONT CORNER, 2--RIGHT SIDE FRONT
Initial Contact Point
2--RIGHT SIDE FRONT
Bus Use
NOT A BUS
Body Style
4D - 4DR
Color
TAN - TAN
Model
LE SABRE
Year
1997
Make
BUICK
Vehicle Identification Number
20180202 Country of Issuance
UNITED STATES
St
MN
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 10:25 AM
Crash Date 01/11/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 5
This report does not include any CJIS data.
20011110
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GMH5JW WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
ELY, MN 55731 , US
Owner Name
0202Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
LEGALLY PARKED
VEHICLEUNIT Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
PARKED MOTOR VEHICLE02
Event
03Event
04IndividualInsurance Company
COUNTRY-MUTUAL-INSURANCE-CO
Policy Holder
UNITCrash Time 10:25 AM
Crash Date 01/11/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 5
This report does not include any CJIS data.