200513 hamblin-fogal20051408
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRS WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
PRIVATE PROPERTY/PARKING LOTReportable
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
02:03 PM
Date Notified
05/14/2020
Time Arrived
02:03 PM
Date Arrived
05/14/2020
Crash Time
06:23 AM
Crash Date
05/13/2020
Investigating Officer/Deputy
DEPUTY AMBER ALMOGHRABI
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0FZQKRSAdditional InformationPHOTOS
Photos ByDEPUTY AMBER AL-MOGHRABI
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON MAY 15, 2020, I, DEPUTY AMBER AL-MOGHRABI, WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT. AT APPROXIMATELY 14:03, I
WAS ADVISED BY DISPATCH TO CALL AT THE TOWN OF SPIDER LAKE GARAGE REFERENCE A 2 VEHICLE ACCIDENT THAT HAD HAPPENED THE
DAY BEFORE. UPON CALLING HE STATED THAT ON MAY 14, 2020 AT APPROXIMATELY 6:23 AM, WHILE AT THE TOWN OF SPIDER LAKE GARAGE, HE
BACKED ONE OF THE WORK TRUCKS INTO A CO-WORKER'S PERSONAL TRUCK. HE STATED THAT HE WAS BACKING OUT OF THE GARAGE AND CUT THE
WHEEL SHARP TO BACK INTO A PARKING SPOT AND DIDN'T SEE THE OTHER TRUCK PARKED THERE. HE STATED THE TAILGATE OF HIS WORK TRUCK WAS
DOWN AND HIT THE FRONT OF THE OTHER TRUCK. I ASKED IF THERE WAS DAMAGE TO THE WORK TRUCK AND HE STATED THERE WAS NOT. I ASKED
IF THERE WAS DAMAGE TO THE OTHER TRUCK AND HE STATED THERE WAS QUITE A BIT OF DAMAGE TO THE HOOD OF THE OTHER TRUCK, BUT THAT THE
OWNER HAD ALREADY TAKEN IT TO ERNIE'S AUTOBODY TO GET AN ESTIMATE ON IT. I GOT ALL OF PERSONAL INFORMATION AND THE INFORMATION
FOR THE TOWN OF SPIDER LAKE TRUCK. STATED THAT HE WAS NOT WEARING HIS SEATBELT AT THE TIME AS HE WAS LITERALLY JUST BACKING THE
TRUCK OUT OF THE GARAGE TO MOVE IT OUT OF THE WAY AND PARK IT IN A DIFFERENT PARKING SPOT IN THE LOT AND THAT HE WAS GOING MAYBE 3
MILES PER HOUR, IF THAT. HE STATED THE INSURANCE FOR THE TRUCK WAS THROUGH GLATFELTER-AMERICAN ALTERNATIVE AND THAT THEY WILL BE
CALLING THE INSURANCE COMPANY. I ASKED WHY HE DIDN'T REPORT THIS THE DAY BEFORE, AND HE STATED THAT HE DIDN'T KNOW BY LAW HE HAD
Crash Time 06:23 AM
Crash Date 05/13/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 5
This report does not include any CJIS data.
20051408
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRS WISCONSIN MOTOR VEHICLE
CRASH REPORT
TO AND THEY WERE ALREADY TAKING CARE OF THE INSURANCE PART. HE STATED HE WAS JUST TOLD BY ANOTHER CO-WORKER THAT HE HAD TO
REPORT IT AND THAT IT WILL BE PUT IN A NEW POLICY AT THE STATION. I ASKED HIM IF I COULD SPEAK WITH THE OWNER OF THE OTHER VEHICLE. UPON
SPEAKING WITH THE OWNER OF THE OTHER TRUCK INVOLVED, HE STATED HIS NAME WAS SEE REPORT FOR MORE DETAILS.
Structure Type
NO STRUCTURE
Y Coordinate
5110520.5
X Coordinate
172648.609375
Longitude
-91.233048677
Latitude
46.069809441
ON TOWN HALL RD
397 FT W
OF ACCESS RD #87
IN THE TOWN OF SPIDER LAKE
IN SAWYER COUNTY
Location
Special StudyAccess Control
NO CONTROL
Tribal Land
Crash Classification - Jurisdiction
PRIVATE PROPERTY
Crash Classification - Location
PRIVATE PROPERTY
Relation To Trafficway
NON TRAFFICWAY - PARKING LOT
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
03 - FRONT TO REAR
First Harmful Event Location
OFF ROADWAY, LOCATION UNKNOWN
First Harmful Event
PARKED MOTOR VEHICLE
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
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 Limit
05
Pre 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
UTILITY TRUCK/PICKUP TRUCK01 Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITInitial Contact Point
06 - REAR
Bus UseBody Style
CB - CAB CHASSIS
Color
RED - RED
Model
F450 SUPER
Year
2011
Make
FORD
Vehicle Identification Number
19030101 Country of Issuance
UNITED STATES
St
WI
Plate Type
GOV - U S GOVERNMENT
License Plate Number
Vehicle
Crash Time 06:23 AM
Crash Date 05/13/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 5
This report does not include any CJIS data.
20051408
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRS WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
10896 TOWN HALL ROAD
HAYWARD, WI 54843 , US
Owner Name
TOWN OF SPIDER LAKE
(715) 462-45140101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
BACKING
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
NO DAMAGE
Vehicle Damage
00 - NO DAMAGE
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
PARKED MOTOR VEHICLE01
Event
02Event
03Event
04Government
TOWN OF SPIDER LAKE
Insurance Company
AMERICAN-ALTERNATIVE-INS-CORP
Policy Holder
UNITInjury
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
07 - LEFT
Row
01 - FRONT ROW
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
06/23/
Sex
MALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 06:23 AM
Crash Date 05/13/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 5
This report does not include any CJIS data.
20051408
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRS WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
Drug & Alcohol
Individual Condition
NOT OBSERVED
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 #
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)UNITNon Motorist
INDIVIDUALTruck 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
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 Limit
05
Pre 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
UTILITY TRUCK/PICKUP TRUCK02 Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
LEGALLY PARKED
Unit Summary
UNITInitial Contact Point
01 - RIGHT FRONT CORNER
Bus UseBody Style
PK - PICKUP
Color
GRY - GRAY
Model
F250 SUPER
Year
2015
Make
FORD
Vehicle Identification Number
17390202 Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - LIGHT TRUCK
License Plate Number
Vehicle
Crash Time 06:23 AM
Crash Date 05/13/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 5
This report does not include any CJIS data.
20051408
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0FZQKRS WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
0202Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
LEGALLY PARKED
Vehicle Removed By
OWNER
Towed Due To Damage
NOT TOWED
Extent Of Damage
FUNCTIONAL DAMAGE
Vehicle Damage
01 - RIGHT FRONT CORNER, 11 - LEFT FRONT CORNER, 12 - FRONT
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
PARKED MOTOR VEHICLE01
Event
02Event
03Event
04IndividualInsurance Company
RURAL-MUTUAL-INS-CO-(ATTN:-CLAIMS-DEPT)
Policy Holder
UNITCrash Time 06:23 AM
Crash Date 05/13/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 5
This report does not include any CJIS data.