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200601 fillipp-neibert20060116 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRBB 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 03:38 PM Date Notified 06/01/2020 Time Arrived 03:40 PM Date Arrived 06/01/2020 Crash Time 03:35 PM Crash Date 06/01/2020 Investigating Officer/Deputy DEPUTY KEVIN GILLIS Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0G5WRBBAdditional InformationPHOTOS Photos ByDEPUTY KEVIN GILLIS Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. UNIT ONE WAS BACKING OUT OF THEIR DRIVEWAY ONTO CTH KK WHEN UNIT 2 STRUCK UNIT 1 IN THE REAR OF THE VEHICLE. UNIT 1 DIDN'T SEE UNIT 2 WHEN IT WAS BACKING OUT OF THE DRIVEWAY, AND UNIT 2 DIDN'T SEE UNIT 1 BACKING OUT OF THE DRIVEWAY. Crash Time 03:35 PM Crash Date 06/01/2020Wisconsin Motor Vehicle Crash Form DT4000 1 of 6 This report does not include any CJIS data. 20060116 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRBB WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type HOUSE/BUILDING Y Coordinate 5092651 X Coordinate 153940.296875 Longitude -91.461319488 Latitude 45.900261201 ON 15358W CTHKK WB 387 FT W OF CIRCLE RD (HOUSE/BUILDING 15358W) IN THE TOWN OF BASS 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) CLOUDY Environment Factor(s) NONE Roadway Factor(s) NOT APPLICABLE Road Surface Condition(s) DRY Light Condition DAYLIGHT Manner of Collision 03 - FRONT TO REAR First Harmful Event Location ON ROADWAY First Harmful Event MOTOR VEH IN TRANSPORT Crash Scene Intersection Type NOT AN INTERSECTION Junction Location DRIVEWAY ACCESS-RELATED 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 NON-EMERGENCY, NON-TRANSPORT Special Function NO SPECIAL FUNCTION Most Harmful Event: Collision With MOTOR VEH IN TRANSPORT Total Lanes 2 Speed Limit N/A 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 FUNCTIONAL DAMAGE Vehicle Damage 05 - RIGHT REAR CORNER, 06 - REAR Initial Contact Point 05 - RIGHT REAR CORNER Bus UseBody Style UT - SPORT UTILITY VEHICLE Color BLK - BLACK Model RAV4 Year 2017 Make TOYOTA Vehicle Identification Number 25880101 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number VEHICLEUNIT Vehicle Crash Time 03:35 PM Crash Date 06/01/2020Wisconsin Motor Vehicle Crash Form DT4000 2 of 6 This report does not include any CJIS data. 20060116 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRBB 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 BACKING Vehicle Removed By OWNER Towed Due To Damage NOT TOWED UNITVEHICLE Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event 02Event 03Event 04Individual Insurance Company STATE-FARM-MUTUAL-AUTOMOBILE-INS-CO Policy Holder UNITDistracted By Injury Distracted By Action UNKNOWN Distracted By Source UNKNOWN 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 SHOULDER & LAP BELT On Duty Crash Driver License Number STATE: WISCONSIN COUNTRY: UNITED STATES Address HAYWARD, WI 54843 , US Race HISPANIC Date of Birth 02/03/ Sex MALE Citations Issued 0 Driver ITSafety Equipment Individual UNINDIVIDUALCrash Time 03:35 PM Crash Date 06/01/2020Wisconsin Motor Vehicle Crash Form DT4000 3 of 6 This report does not include any CJIS data. 20060116 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRBB 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 BLACKTOP (BITUMINOUS) Traffic Control Inoperative/Missing NO Traffic Control NO CONTROL Traffic Way DIVIDED HWY W/O TRAFFIC BARRIER Emergency Motor Vehicle Use NON-EMERGENCY, NON-TRANSPORT Special Function NO SPECIAL FUNCTION Most Harmful Event: Collision With MOTOR VEH IN TRANSPORT Total Lanes 2 Speed Limit N/A 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 VEHICLE02 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UNITVehicle Removed By ROADRUNNER TOWING Towed Due To Damage TOWED DUE TO DISABLING DAMAGE Extent Of Damage DISABLING DAMAGE Vehicle Damage 01 - RIGHT FRONT CORNER, 11 - LEFT FRONT CORNER, 12 - FRONT Initial Contact Point 12 - FRONT Bus UseBody Style UT - SPORT UTILITY VEHICLE Color GRN - GREEN Model SOUL Year 2015 Make KIA MOTORS CORPORA Vehicle Identification Number 26030202 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number VEHICLEUNIT Vehicle Crash Time 03:35 PM Crash Date 06/01/2020Wisconsin Motor Vehicle Crash Form DT4000 4 of 6 This report does not include any CJIS data. 20060116 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRBB WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address HAYWARD, WI 54843 , US Owner Name 0202Driver Actions UNKNOWN Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing GOING STRAIGHT UNITVEHICLE Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event 02Event 03Event 04Individual Insurance Company PROGRESSIVE-CLASSIC-INS-CO Policy Holder UNITDistracted By Injury LocationStriking Unit # Distracted By Action UNKNOWN Distracted By Source UNKNOWN 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 INJURY00202 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 07 - LEFT Row 01 - FRONT ROW 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 04/27/ Sex FEMALE Citations Issued 0 Driver ITSafety Equipment Non Motorist Individual UNINDIVIDUALCrash Time 03:35 PM Crash Date 06/01/2020Wisconsin Motor Vehicle Crash Form DT4000 5 of 6 This report does not include any CJIS data. 20060116 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRBB 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 UNITINDIVIDUALCrash Time 03:35 PM Crash Date 06/01/2020Wisconsin Motor Vehicle Crash Form DT4000 6 of 6 This report does not include any CJIS data.