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200522 benjaminson20052221 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F7HWRG 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 06:02 PM Date Notified 05/22/2020 Time Arrived 06:10 PM Date Arrived 05/22/2020 Crash Time 05:50 PM Crash Date 05/22/2020 Investigating Officer/Deputy DEPUTY AMBER OSHEA DORN Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0F7HWRGAdditional InformationPHOTOS Photos ByA.OSHEADORN 322 Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. ON 05/22/2020 AT APPROXIMATELY 1802 UNIT 1 WAS ATTEMPTING TO PARK INTO A CAMPSITE AT THE KOA CAMPGROUND IN HAYWARD, WI. UNIT 1 TOOK THE CORNER SHARP AND SIDE SWIPED UNIT 2 ON THE FRONT PASSENGER SIDE FENDER. Crash Time 05:50 PM Crash Date 05/22/2020Wisconsin Motor Vehicle Crash Form DT4000 1 of 5 This report does not include any CJIS data. 20052221 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F7HWRG WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type NO STRUCTURE Y Coordinate 5109379.5 X Coordinate 156498.546875 Longitude -91.440445434 Latitude 46.051655698 ON PHIPPS RD 172 FT E OF USH63 NB IN THE TOWN OF LENROOT IN SAWYER COUNTY Location Special StudyAccess Control FULL 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) CLEAR Environment Factor(s) NONE Roadway Factor(s) NONE Road Surface Condition(s) DRY Light Condition DAYLIGHT Manner of Collision 07 - SIDESWIPE/SAME DIRECTION 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 DIRT 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 PARKED MOTOR VEHICLE Total Lanes 0 Speed Limit 10 Pre CrashTire Mark Direction Of Travel EASTBOUND 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 NO DAMAGE Vehicle Damage 00 - NO DAMAGE Initial Contact Point 07 - LEFT REAR CORNER Bus UseBody Style 4D - 4DR Color BLK - BLACK Model RAM Year 2018 Make DODGE Vehicle Identification Number 87480101 Country of Issuance UNITED STATES St MN Plate Type LTK - LIGHT TRUCK License Plate Number VEHICLEUNIT Vehicle Crash Time 05:50 PM Crash Date 05/22/2020Wisconsin Motor Vehicle Crash Form DT4000 2 of 5 This report does not include any CJIS data. 20052221 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F7HWRG WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address 6113 259TH STREET WYOMING, MN 55092 , US Owner Name RYAN S BENJAMINSON 0101Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing PARK MANEUVER Vehicle Removed By OWNER Towed Due To Damage NOT TOWED UNITVEHICLE Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event PARKED MOTOR VEHICLE02 Event 03Event 04Individual Insurance Company AMERICAN-FAMILY-INS-CO Policy Holder UNITDistracted By Injury 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 APPLICABLE Ejection Path NOT EJECTED/NOT APPLICABLE Ejected NOT APPLICABLE Airbag NON DEPLOYED Injury Severity NO APPARENT INJURY00101 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 07 - LEFT Row 01 - FRONT ROW Safety Equipment RESTRAINT USE UNKNOWN On Duty Crash Driver License Number STATE: MINNESOTA COUNTRY: UNITED STATES Address WYOMING, MN 55092 , US Race WHITE Date of Birth 07/27/ Sex MALE Citations Issued 0 Driver ITSafety Equipment Individual UNINDIVIDUALCrash Time 05:50 PM Crash Date 05/22/2020Wisconsin Motor Vehicle Crash Form DT4000 3 of 5 This report does not include any CJIS data. 20052221 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F7HWRG 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 #UNITNon Motorist INDIVIDUALTruck Bus or HazMat NO Road Grade LEVEL Road Curvature STRAIGHT Surface Type DIRT 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 10 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 UNITVehicle Removed By OWNER Towed Due To Damage NOT TOWED Extent Of Damage FUNCTIONAL DAMAGE Vehicle Damage 02 - RIGHT SIDE FRONT Initial Contact Point 02 - RIGHT SIDE FRONT Bus UseBody Style 4D - 4DR Color WHI - WHITE Model SILVERADO Year 2014 Make CHEVROLET Vehicle Identification Number 49390202 Country of Issuance UNITED STATES St ME Plate Type LTK - LIGHT TRUCK License Plate Number VEHICLEUNIT Vehicle Crash Time 05:50 PM Crash Date 05/22/2020Wisconsin Motor Vehicle Crash Form DT4000 4 of 5 This report does not include any CJIS data. 20052221 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F7HWRG WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address DULUTH, MN 55807 , US Owner Name 0202Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing LEGALLY PARKED UNITVEHICLE Sequence Of Events Event PARKED MOTOR VEHICLE01 Event MOTOR VEH IN TRANSPORT02 Event 03Event 04IndividualInsurance Company STATE-FARM-GENERAL-INS-CO Policy Holder UNITCrash Time 05:50 PM Crash Date 05/22/2020Wisconsin Motor Vehicle Crash Form DT4000 5 of 5 This report does not include any CJIS data.