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20053017 henehan-meneely20053017 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5K2 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 02:26 PM Date Notified 05/30/2020 Time Arrived 02:34 PM Date Arrived 05/30/2020 Crash Time 02:25 PM Crash Date 05/30/2020 Investigating Officer/Deputy DEPUTY AMANDA REED Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0GMH5K2Additional InformationNONE, PHOTOS 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. ON MAY 30TH, 2020, I, DEPUTY REED RESPONDED TO A TWO VEHICLE ACCIDENT IN WHICH THE OPERATOR OF ONE VEHICLE, REAR ENDED ANOTHER VEHICLE. THE OPERATOR OF THE FIRST VEHICLE WAS FOUND TO BE HAVING A MEDICAL PROBLEM (SEIZURES.) THERE WAS MINOR DAMAGE TO BOTH VEHICLES. Crash Time 02:25 PM Crash Date 05/30/2020Wisconsin Motor Vehicle Crash Form DT4000 1 of 6 This report does not include any CJIS data. 20053017 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5K2 WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type NO STRUCTURE Y Coordinate 5102216.5 X Coordinate 151557.953125 Longitude -91.498888072 Latitude 45.984887639 ON STH27 SB 463 FT S OF FAIRWAY RD IN THE TOWN OF HAYWARD 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) CLEAR 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 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 BLACKTOP (BITUMINOUS) 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 45 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 MINOR DAMAGE Vehicle Damage 06 - REAR Initial Contact Point 06 - REAR Bus UseBody Style 2D - 2DR Color BLK - BLACK Model F150 Year 2016 Make FORD Vehicle Identification Number 15710101 Country of Issuance UNITED STATES St MN Plate Type LTK - LIGHT TRUCK License Plate Number VEHICLEUNIT Vehicle Crash Time 02:25 PM Crash Date 05/30/2020Wisconsin Motor Vehicle Crash Form DT4000 2 of 6 This report does not include any CJIS data. 20053017 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5K2 WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address 1570 IVORY AVE N LAKE ELMO, MN 55042 , US Owner Name THOMAS A HENEHAN (651) 747-75130101Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing GOING STRAIGHT Vehicle Removed By OPERATOR Towed Due To Damage NOT TOWED UNITVEHICLE Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event MOTOR VEH IN TRANSPORT02 Event 03Event 04IndividualInsurance Company STATE-FARM-GENERAL-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 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: MINNESOTA COUNTRY: UNITED STATES Address LAKE ELMO, MN 55042 , US Race WHITE Date of Birth 03/01/ Sex MALE Citations Issued 0 Driver ITSafety Equipment Individual UNINDIVIDUALCrash Time 02:25 PM Crash Date 05/30/2020Wisconsin Motor Vehicle Crash Form DT4000 3 of 6 This report does not include any CJIS data. 20053017 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5K2 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 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 45 Pre CrashTire Mark Direction Of Travel SOUTHBOUND Insurance? UNKNOWN Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # RecordedTotal Occs 1 Operating As EndorsementsVehicle Type UTILITY TRUCK/PICKUP TRUCK02 Unit Type TRUCK Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UNITVehicle Removed ByTowed Due To Damage NOT TOWED Extent Of Damage MINOR DAMAGE Vehicle Damage 12 - FRONT Initial Contact Point 12 - FRONT Bus UseBody Style 2D - 2DR Color WHI - WHITE Model F150 Year 2012 Make FORD Vehicle Identification Number 55160202 Country of Issuance UNITED STATES St WI Plate Type LTK - LIGHT TRUCK License Plate Number VEHICLEUNIT Vehicle Crash Time 02:25 PM Crash Date 05/30/2020Wisconsin Motor Vehicle Crash Form DT4000 4 of 6 This report does not include any CJIS data. 20053017 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5K2 WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address MINNEAPOLIS, MN 55419 , US Owner Name 0202Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing GOING STRAIGHT UNITVEHICLE Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event MOTOR VEH IN TRANSPORT02 Event 03Event 04Distracted By Injury Prior Action LocationStriking Unit # Distracted By Action NOT DISTRACTED Distracted By Source NOT APPLICABLE (NOT DISTRACTED) Time of DeathDate of DeathHospital HAYWARD AREA MEM HOSP EMS Run # 1 EMS Agency Identifier 1 Medical Transport EMS GROUND 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: MINNESOTA COUNTRY: UNITED STATES Address MINNEAPOLIS, MN 55419 , US Race WHITE Date of Birth 08/27/ Sex MALE Citations Issued 0 Driver ITSafety Equipment Non Motorist Individual UNINDIVIDUALCrash Time 02:25 PM Crash Date 05/30/2020Wisconsin Motor Vehicle Crash Form DT4000 5 of 6 This report does not include any CJIS data. 20053017 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0GMH5K2 WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition OTHER 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 UNITINDIVIDUALCrash Time 02:25 PM Crash Date 05/30/2020Wisconsin Motor Vehicle Crash Form DT4000 6 of 6 This report does not include any CJIS data.