20070212 nelson20070212
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW6 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
03
Time Notified
09:53 AM
Date Notified
07/02/2020
Time Arrived
10:20 AM
Date Arrived
07/02/2020
Crash Time
09:53 AM
Crash Date
07/02/2020
Investigating Officer/Deputy
DEPUTY CHARLES LOGAN
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0GD2XW6Additional InformationPHOTOS
Photos ByC.LOGAN
Reconstruction BySAWYER COUNTY SHERIFFDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS TRAVELING NORTH ON HWY 63 WHEN TWO WHEELS AND BRAKE DRUMS FELL OFF THE TRAILER. THE DRIVER OF UNIT 1 SAID HE SAW THE
WHEELS COME OFF AND ONE OF THEM CONTINUED TO ROLL DOWN THE ROAD SO HE TRIED TO BLOCK IT WITH HIS TRUCK TO MAKE SURE NO ONE HIT IT,
THE OTHER ONE WAS STILL IN THE ROADWAY. TWO VEHICLES STRUCK THAT PIECE OF WHEEL/TIRE/BRAKE PARTS CAUSING DAMAGE TO BOTH. UNIT 3 WAS
TOWED DUE TO THE DAMAGE CAUSED. UNIT 3 DROVE TO THE MECHANIC BUT LEARNED THERE WAS SEVERE DAMAGE UNDERNEATH ALSO. THE DRIVER OF
UNIT 1 STATED THE TRUCK HAD BEEN INSPECTED A SHORT TIME BEFORE BY THE COMPANY MECHANIC AND FOUND NO ISSUES WITH THE WHEELS OR
TIRES. THE DRIVER OF UNIT 1 WAS NOT THE OWNER OF THE TRUCK, BOTH UNIT 2 AND UNIT 3 STRUCK AND RAN OVER A LARGE CHUNK OF METAL DEBRIS.
Crash Time 09:53 AM
Crash Date 07/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 8
This report does not include any CJIS data.
20070212
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW6 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5119988.5
X Coordinate
165589.6875
Longitude
-91.330730468
Latitude
46.151364361
ON USH63 NB
0.73 MI N
OF MOODY'S RD
IN THE TOWN OF LENROOT
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
00 - NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
ON ROADWAY
First Harmful Event
THROWN OR FALLING OBJECT
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
TRUCK OR TRUCK COMBINATION > 10,000LBS GVWR/GCWR
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
OTHER NON-COLLISION
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
1
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
TRUCK TRACTOR (SEMI ATTACHED)01Unit Type
TRUCK
Vehicle Operating As Classification
A CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
MINOR DAMAGE
Vehicle Damage
14 - UNDERCARRIAGE
Initial Contact Point
00 - NON-COLLISION
Bus UseBody Style
DS - TRACTOR-TRUCK DIESEL
Color
WHI - WHITE
Model
SEMI
Year
2005
Make
VOLVO
Vehicle Identification Number
15010101 Country of Issuance
UNITED STATES
St
WI
Plate Type
TOR - TRACTOR
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 09:53 AM
Crash Date 07/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 8
This report does not include any CJIS data.
20070212
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW6 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
CUSHING, WI 54006 , US
Owner Name
0101Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
OTHER
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
UNITVEHICLE Sequence Of Events
Event
EQUIPMENT FAILURE (BLOWN TIRE, BRAKE FAILURE, ETC)01Event
02Event
03Event
04Organization/Company
LAURITSEN FIREWOOD & RENTAL INC
Insurance Company
PROGRESSIVE-CLASSIC-INS-CO
Policy Holder
UNIT Trailer/Towed
Vehicle Identification Number
D15B
Address
2606 250TH AVE
CUSHING, WI 54006 , US
Organization/CompanyUnit Type
FULL TRAILER
TRAILER/Country of Issuance
UNITED STATES
State
WI
Make
SAVG
Plate Type
STL - SEMI
Trailer Plate #01UNITInjury
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
FREDERIC, WI 54837 , US
Race
WHITE
Date of Birth
12/11
Sex
MALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 09:53 AM
Crash Date 07/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 8
This report does not include any CJIS data.
20070212
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW6 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
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 #
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
UNITNon Motorist
INDIVIDUALMeasured WeightMeasured WidthMeasured LengthMeasured Height
Escort Vehicle PresentEscort Vehicle Required
By Permit
Permitted Vehicle On
Permitted Route
WI Permit NumberOS/OW Load
Permitted Load
NOT APPLICABLE
Carrier Type
INTRASTATE CARRIER
US DOT #
1004033
Cargo Body Type
LOG TRUCK
Vehicle Configuration
TRUCK TRACTOR/SEMI-TRAILER
GVWR
MORE THAN 26,000 LB01 Address
CUSHING, WI 54006 , US
Name
01Source
DRIVERUse Vehicle Owner Same as Carrier
Carrier
CKBUSUNITTRUTotal 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
Crash Time 09:53 AM
Crash Date 07/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 8
This report does not include any CJIS data.
20070212
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW6 WISCONSIN MOTOR VEHICLE
CRASH REPORT
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
STRUCK BY FALLING, SHIFTING CARGO OR ANYT
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
Insurance?
YES
UNITOwner Address
HAYWARD, WI 54843 , US
Owner Name
0202Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed By
OWNER
Towed Due To Damage
NOT TOWED
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
14 - UNDERCARRIAGE
Initial Contact Point
14 - UNDERCARRIAGE
Bus UseBody Style
UT - SPORT UTILITY VEHICLE
Color
BLK - BLACK
Model
X5
Year
2016
Make
BMW
Vehicle Identification Number
65690202 Country of Issuance
UNITED STATES
St
WI
Plate Type
TMP - TEMPORARY PLAT
License Plate Number
VEHICLEUNIT Vehicle
UNITVEHICLE Sequence Of Events
Event
STRUCK BY FALLING, SHIFTING CARGO OR ANYTHING SET IN MOTION BY MOTOR VEHICLE01
Event
02Event
03Event
04IndividualInsurance Company
PROGRESSIVE-CLASSIC-INS-CO
Policy Holder
UNITRaceDate of Birth
09/16/
Sex
FEMALE
Citations Issued
0
Driver
IT Individual
IDUALCrash Time 09:53 AM
Crash Date 07/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 8
This report does not include any CJIS data.
20070212
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW6 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
Injury
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
LocationStriking Unit #
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 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
UNITSafety Equipment
Non MotoristUN
INDIVIDUALINDIVTotal HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER CAR03 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
Crash Time 09:53 AM
Crash Date 07/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 6 of 8
This report does not include any CJIS data.
20070212
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW6 WISCONSIN MOTOR VEHICLE
CRASH REPORT
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
STRUCK BY FALLING, SHIFTING CARGO OR ANYT
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
Insurance?
YES
UNITOwner Address
STILLWATER, MN 55082 , US
Owner Name
0303Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
12 - FRONT, 14 - UNDERCARRIAGE
Initial Contact Point
12 - FRONT
Bus UseBody Style
UT - SPORT UTILITY VEHICLE
Color
WHI - WHITE
Model
ACADIA
Year
2013
Make
GENERAL MOTORS COR
Vehicle Identification Number
38330303 Country of Issuance
UNITED STATES
St
MN
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
UNITVEHICLE Sequence Of Events
Event
STRUCK BY FALLING, SHIFTING CARGO OR ANYTHING SET IN MOTION BY MOTOR VEHICLE01
Event
02Event
03Event
04IndividualInsurance Company
WEST-BEND-MUTUAL-INS-CO
Policy Holder
UNITRaceDate of Birth
12/17/
Sex
FEMALE
Citations Issued
0
Driver
(IT Individual
IDUALCrash Time 09:53 AM
Crash Date 07/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 7 of 8
This report does not include any CJIS data.
20070212
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW6 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
Injury
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00303Drug 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)
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 INJURY00303 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
STILLWATER, MN 55082 , US
UNITSafety Equipment
Non MotoristUN
INDIVIDUALINDIVCrash Time 09:53 AM
Crash Date 07/02/2020Wisconsin Motor Vehicle Crash
Form DT4000 8 of 8
This report does not include any CJIS data.