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20092106 doyle200921006 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRBH 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 01 Total Units 01 Time Notified 07:06 AM Date Notified 09/21/2020 Time Arrived 07:37 AM Date Arrived 09/21/2020 Crash Time 07:06 AM Crash Date 09/21/2020 Investigating Officer/Deputy DEPUTY KEVIN GILLIS Agency Crash NumberPrimary Crash Document #Document Number Override 6VL0G5WRBHAdditional InformationPHOTOS Photos BySAVITSKI #346 Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. UNIT ONE WAS EASTBOUND ON STATE ROAD 27/70 1/4 MILE WEST OF THE VILLAGE OF COUDERAY WHEN HE SAW A DEER NEXT TO THE ROAD. THE ATTACHED DRIVER, STATED HE THEN "BLACKED OUT" AND DOESN'T KNOW WHAT HAPPENED. I OBSERVED HIS TIRE MARKS TO CROSS THE CENTER LINE, CROSS THE DITCH ON THE NORTH SIDE OF 27/70 AND DRIVE APPROXIMATELY 105 YARDS INTO THE WOODS ON THE NORTH SIDE OF 27/70 BEFORE HE CAME TO A HALT AT THE BASE OF THE TREE HE STRUCK. Crash Time 07:06 AM Crash Date 09/21/2020Wisconsin Motor Vehicle Crash Form DT4000 1 of 4 This report does not include any CJIS data. 200921006 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRBH WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type NO STRUCTURE Y Coordinate 5080282 X Coordinate 164930.34375 Longitude -91.311450611 Latitude 45.794689871 ON STH27 SB 72 FT E OF MAPES RD IN THE TOWN OF COUDERAY 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 ROADSIDE First Harmful Event TREE Crash Scene Intersection Type NOT AN INTERSECTION Junction Location NON-JUNCTION Within Interchange Area NO Time Scene Cleared 09:00 AM Date Scene Cleared 09/21/2020 Time All Lanes Open 09:00 AM Date All Lanes Open 09/21/2020 Time Initial Lane/Rd Closed 08:38 AM Date Initial Lane/Rd Closed 09/21/2020 Reasons for Closure TOW TRUCK Closure Type CLOSURE-ONE DIRECTION 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 TREE Total Lanes 2 Speed Limit 55 Pre CrashTire Mark Direction Of Travel EASTBOUND 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 UNITModel SILVERADO Year 2018 Make CHEVROLET Vehicle Identification Number 11480101 Country of Issuance UNITED STATES St WI Plate Type LTK - LIGHT TRUCK License Plate Number Vehicle Crash Time 07:06 AM Crash Date 09/21/2020Wisconsin Motor Vehicle Crash Form DT4000 2 of 4 This report does not include any CJIS data. 200921006 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRBH WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address WATERLOO, WI 53594 , US Owner Name 0101Driver Actions RAN OFF ROADWAY 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 FUNCTIONAL DAMAGE Vehicle Damage 01 - RIGHT FRONT CORNER, 02 - RIGHT SIDE FRONT, 10 - LEFT SIDE FRONT, 11 - LEFT FRONT CORNER, 12 - FRONT Initial Contact Point 12 - FRONT Bus UseBody Style PK - PICKUP Color BLK - BLACK VEHICLEUNITUNITVEHICLE Sequence Of Events Event MOTOR VEH IN TRANSPORT01 Event RUN OFF ROADWAY LEFT02 Event 03Event 04Individual Insurance Company STATE-FARM-GENERAL-INS-CO Policy Holder UNITInjury EMS Run #EMS Agency IdentifierMedical Transport NOT TRANSPORTED Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABLE Ejected NOT EJECTED Airbag DEPLOYED-FRONT Injury Severity SUSPECTED MINOR 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 WATERLOO, WI 53594 , US Race WHITE Date of Birth 01/07/ Sex MALE Citations Issued 0 Driver ITSafety Equipment Individual UNINDIVIDUALCrash Time 07:06 AM Crash Date 09/21/2020Wisconsin Motor Vehicle Crash Form DT4000 3 of 4 This report does not include any CJIS data. 200921006 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL0G5WRBH 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 UNITNon Motorist INDIVIDUALCrash Time 07:06 AM Crash Date 09/21/2020Wisconsin Motor Vehicle Crash Form DT4000 4 of 4 This report does not include any CJIS data.