20091936 serini-lueloff20091936
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN4 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
06:56 PM
Date Notified
09/19/2020
Time Arrived
06:59 PM
Date Arrived
09/19/2020
Crash Time
06:56 PM
Crash Date
09/19/2020
Investigating Officer/Deputy
DEPUTY IAN HALL
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0DT5JN4Additional InformationPHOTOS, RECONSTRUCTION
Photos BySGT HALL
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 WEST ON COUNTY HWY B LOOKING FOR A LOCATION THEY PASSED TO BUY FIREWOOD. UNIT 2 WAS WEST BOUND ON COUNTY HWY
B AND APPROACHING UNIT 1. UNIT 1 WAS DRIVING SLOWER THATN THE SPEED LIMIT TO FIND THE DRIVEWAY. UNIT 2 BEGAN TO PASS UNIT 1 AND AS UNIT 2
PULLED INTO THE LEFT LANE TO PASS UNIT 1 BEGAN TO TURN AND ACTIVATED ITS TURN SIGNAL AND DID NOT SEE UNIT 2 PASSING. UNIT 2 STRUCK UNIT 1.
Crash Time 06:56 PM
Crash Date 09/19/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 7
This report does not include any CJIS data.
20091936
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN4 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
Y Coordinate
5102986.5
X Coordinate
162382.125
Longitude
-91.360091977
Latitude
45.997207897
ON CTHB WB
737 FT E
OF ROUND LAKE SCHOOL 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
DUSK
Manner of Collision
01 - ANGLE
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
55
Pre CrashTire
Mark
Direction Of Travel
WESTBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
2
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
09 - LEFT SIDE MIDDLE
Initial Contact Point
09 - LEFT SIDE MIDDLE
Bus UseBody Style
UT - SPORT UTILITY VEHICLE
Color
MAR - MAROON (BURGUNDY)
Model
TERRAIN
Year
2010
Make
GM
Vehicle Identification Number
18460101 Country of Issuance
UNITED STATES
St
IL
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 06:56 PM
Crash Date 09/19/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 7
This report does not include any CJIS data.
20091936
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN4 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
STREAMWOOD, IL 60107 , US
Owner Name
0101Driver Actions
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
LEFT TURN
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
LEFT TURN02
Event
03Event
04Individual
Insurance Company
ALLSTATE-INDEMNITY-CO
Policy Holder
UNITDistracted By
Injury
Distracted By Action
UNKNOWN
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
DEPLOYED-SIDE
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: ILLINOIS COUNTRY: UNITED STATES
Address
STREAMWOOD, IL 60107 , US
Race
WHITE
Date of Birth
04/25/
Sex
MALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 06:56 PM
Crash Date 09/19/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 7
This report does not include any CJIS data.
20091936
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN4 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
INDIVIDUALDistracted 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
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
DEPLOYED-CURTAIN
Injury Severity
NO APPARENT INJURY00201 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
09 - RIGHT
Row
01 - FRONT ROW
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License NumberAddress
BUFFALO GROVE, IL , US
Race
WHITE
Date of Birth
08/23/
Sex
FEMALE
Citations Issued
0
Passenger
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 06:56 PM
Crash Date 09/19/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 7
This report does not include any CJIS data.
20091936
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN4 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00201Drug 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
UNITINDIVIDUALTruck 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
55
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
UTILITY TRUCK/PICKUP TRUCK02 Unit Type
TRUCK
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITWhat Driver Was Doing
OVERTAKE LEFT
Vehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
MINOR DAMAGE
Vehicle Damage
03 - RIGHT SIDE MIDDLE
Initial Contact Point
02 - RIGHT SIDE FRONT
Bus UseBody Style
TK - TRUCK
Color
SIL - SILVER (ALUMINUM)
Model
SILVERADO
Year
2004
Make
CHEVROLET
Vehicle Identification Number
50620202 Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - LIGHT TRUCK
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 06:56 PM
Crash Date 09/19/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 7
This report does not include any CJIS data.
20091936
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN4 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
WAUSAU, WI 54401 , US
Owner Name
0202Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04Individual
Insurance Company
USAA-CASUALTY-INS-CO
Policy Holder
UNITDistracted By
Injury
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 INJURY00302 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
WAUSAU, WI 54401 , US
Race
WHITE
Date of Birth
12/16/
Sex
MALE
Citations Issued
0
Driver
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 06:56 PM
Crash Date 09/19/2020Wisconsin Motor Vehicle Crash
Form DT4000 6 of 7
This report does not include any CJIS data.
20091936
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0DT5JN4 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00302Drug 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 06:56 PM
Crash Date 09/19/2020Wisconsin Motor Vehicle Crash
Form DT4000 7 of 7
This report does not include any CJIS data.