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20071508 white-thayer20071508 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F03P3P 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 09:41 AM Date Notified 07/15/2020 Time Arrived 10:00 AM Date Arrived 07/15/2020 Crash Time 09:41 AM Crash Date 07/15/2020 Investigating Officer/Deputy DEPUTY LUCAS SHEPARD Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0F03P3PAdditional InformationPHOTOS Photos ByL. SHEPARD Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. ON JULY 15TH, 2020, AT APPROXIMATELY 9:41AM, DEPUTY SHEPARD RESPONDED TO 13380 TREPANIA RD, HAYWARD, WI 54843, ON THE LCO RESERVATION, AT THE LCO CLINIC BUILDING, TO TAKE A REPORT OF A MINOR TWO VEHICLE CRASH THAT OCCURRED IN THE PARKING LOT. THE TWO DRIVERS INVOLVED WERE AND . WAS PARKED ALONG THE CURB IN THE FRONT OF THE BUILDING LEGALLY. WHITE WAS PARKED IN THE HANDICAP PARKING SPACE NEAR THE FRONT OF THE BUILDING AS WELL. BACKED OUT OF HER SPACE AND INTO THE SIDE OF VEHICLE. THE REAR DRIVERS SIDE CORNER OF VEHICLE STRUCK THE PASSENGER SIDE OF . BOTH VEHICLES SUSTAINED MINOR DAMAGE CONSISTING OF DENTING AND SCRATCHING, BUT COULD BOTH STILL BE DRIVEN. THEY BOTH HAD VALID INSURANCE AND EXCHANGED INFORMATION BEFORE ALL PARTIES CLEARED FROM THE SCENE. Crash Time 09:41 AM Crash Date 07/15/2020Wisconsin Motor Vehicle Crash Form DT4000 1 of 6 This report does not include any CJIS data. 20071508 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F03P3P WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type Y Coordinate 5096849 X Coordinate 161723.109375 Longitude -91.364241495 Latitude 45.941805398 ON TREPANIA RD 0.60 MI E OF CTHE NB IN THE TOWN OF BASS LAKE IN SAWYER COUNTY Location Special StudyAccess Control NO CONTROL Tribal Land LAC COURTE OREILLES BAND Crash Classification - Jurisdiction INDIAN RESERVATION/TRUST Crash Classification - Location TRIBAL LAND 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 05 - REAR TO SIDE First Harmful Event Location IN PARKING LANE OR ZONE First Harmful Event PARKED MOTOR VEHICLE Crash Scene Intersection Type NOT AN INTERSECTION Junction Location NON-JUNCTION Within Interchange Area UNKNOWN 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 N/A 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 PASSENGER CAR01 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UNITExtent Of Damage FUNCTIONAL DAMAGE Vehicle Damage 07 - LEFT REAR CORNER Initial Contact Point 07 - LEFT REAR CORNER Bus UseBody Style 4D - 4DR Color SIL - SILVER (ALUMINUM) Model FUSION Year 2007 Make FORD Vehicle Identification Number 34190101 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number VEHICLEUNIT Vehicle Crash Time 09:41 AM Crash Date 07/15/2020Wisconsin Motor Vehicle Crash Form DT4000 2 of 6 This report does not include any CJIS data. 20071508 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F03P3P WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address STONE LAKE, WI 54876 , US Owner Name 0101Driver Actions UNSAFE BACKING Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing BACKING Vehicle Removed By OPERATOR Towed Due To Damage NOT TOWED UNITVEHICLE Sequence Of Events Event PARKED MOTOR VEHICLE01 Event 02Event 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: WISCONSIN COUNTRY: UNITED STATES Address STONE LAKE, WI 54876 , US Race INDIAN Date of Birth 08/23/ Sex FEMALE Citations Issued 0 Driver ITSafety Equipment Individual UNINDIVIDUALCrash Time 09:41 AM Crash Date 07/15/2020Wisconsin Motor Vehicle Crash Form DT4000 3 of 6 This report does not include any CJIS data. 20071508 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F03P3P 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 PARKING LOT OR PRIVATE PROPERTY Emergency Motor Vehicle Use NOT APPLICABLE Special Function NO SPECIAL FUNCTION Most Harmful Event: Collision With MOTOR VEH IN TRANSPORT Total Lanes 0 Speed Limit N/A 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 (SPORT) UTILITY VEHICLE02 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status LEGALLY PARKED Unit Summary UNITVehicle Removed By OPERATOR Towed Due To Damage NOT TOWED Extent Of Damage FUNCTIONAL DAMAGE Vehicle Damage 03 - RIGHT SIDE MIDDLE Initial Contact Point 03 - RIGHT SIDE MIDDLE Bus UseBody Style 4H - HATCHBACK 4 DOOR Color GRY - GRAY Model GRAND CHER Year 2015 Make JEEP Vehicle Identification Number 10250202 Country of Issuance UNITED STATES St WI Plate Type AUT - AUTOMOBILE License Plate Number VEHICLEUNIT Vehicle Crash Time 09:41 AM Crash Date 07/15/2020Wisconsin Motor Vehicle Crash Form DT4000 4 of 6 This report does not include any CJIS data. 20071508 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F03P3P WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address COUDERAY, WI 54828 , 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 MOTOR VEH IN TRANSPORT01 Event 02Event 03Event 04IndividualInsurance Company ERIE-INSURANCE-EXCHANGE Policy Holder UNITDistracted By Injury LocationStriking Unit # Distracted By Action Distracted By Source Time of DeathDate of DeathHospital EMS Run #EMS Agency IdentifierMedical Transport NOT TRANSPORTED Trapped/Extricated UNKNOWN Ejection Path UNKNOWN Ejected UNKNOWN Airbag UNKNOWN Injury Severity NO APPARENT INJURY00202 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 COUDERAY, WI 54828 , US Race INDIAN Date of Birth 06/26/ Sex FEMALE Citations Issued 0 Occupant Of Motor Vehicle Not In Transport ITSafety Equipment Non Motorist Individual UNINDIVIDUALCrash Time 09:41 AM Crash Date 07/15/2020Wisconsin Motor Vehicle Crash Form DT4000 5 of 6 This report does not include any CJIS data. 20071508 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0F03P3P 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 09:41 AM Crash Date 07/15/2020Wisconsin Motor Vehicle Crash Form DT4000 6 of 6 This report does not include any CJIS data.