20110729 pelzel-harris20110729
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW9 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
02:05 PM
Date Notified
11/07/2020
Time Arrived
02:10 PM
Date Arrived
11/07/2020
Crash Time
01:30 PM
Crash Date
11/07/2020
Investigating Officer/Deputy
DEPUTY CHARLES LOGAN
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0GD2XW9Additional 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.
BOTH UNIT 1 AND UNIT 2 WERE PARKED IN THE MARKETPLACE FOODS PARKING LOT. BOTH VEHICLES WERE PREPARING TO LEAVE THE PARKING LOT AND
WERE BACKING UP. UNIT 1 STATED SHE LOOKED BEFORE SHE BEGAN TO BACK UP AND DID NOT SEE ANYONE OR ANY VEHICLE IN THE TAVEL PATH
HOWEVER WHEN SHE WAS BACKING UP SHE STRUCK UNIT 2. UNIT 2 STATED SHE HAD ALREADY BACKED OUT OF THE PARKING SPACE AND UNIT 1 BACKED
INTO HER VEHICLE. UNIT 1 STATED THERE WAS NO DAMAGE TO THE VEHICLE. UNIT 2 HAD MINOR DAMAGE TO THE LEFT REAR TAIL LIGHT AND LEFT REAR
FENDER. DEPUTY LOGAN TOOK PHOTOS OF THE DAMAGE.
Crash Time 01:30 PM
Crash Date 11/07/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 6
This report does not include any CJIS data.
20110729
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW9 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
HOUSE/BUILDING
Y Coordinate
5105165
X Coordinate
152976.71875
Longitude
-91.482766967
Latitude
46.012063711
PARKING LOT
STH27 NB LOT 10514
(HOUSE/BUILDING 10514)
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
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
04 - REAR TO REAR
First Harmful Event Location
IN PARKING LANE OR ZONE
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
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
1
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 VEHICLE01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
NO DAMAGE
Vehicle Damage
00 - NO DAMAGE
Initial Contact Point
06 - REAR
Bus UseBody Style
UT - SPORT UTILITY VEHICLE
Color
SIL - SILVER (ALUMINUM)
Model
GLADIATOR
Year
2020
Make
JEEP
Vehicle Identification Number
91370201 Country of Issuance
UNITED STATES
St
MN
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 01:30 PM
Crash Date 11/07/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 6
This report does not include any CJIS data.
20110729
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW9 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
LINO LAKES, MN 55014 , US
Owner Name
0201Driver Actions
UNKNOWN
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
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04Individual
Insurance Company
USAA-CASUALTY-INS-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
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00201 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
LINO LAKES, MN 55014 , US
RaceDate of Birth
09/25/
Sex
FEMALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 01:30 PM
Crash Date 11/07/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 6
This report does not include any CJIS data.
20110729
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW9 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
NOT OBSERVED
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
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
1
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
IN TRANSIT
Unit Summary
UNITVehicle Removed By
OPERATOR
Towed Due To Damage
NOT TOWED
Extent Of Damage
MINOR DAMAGE
Vehicle Damage
07 - LEFT REAR CORNER
Initial Contact Point
07 - LEFT REAR CORNER
Bus UseBody Style
LL - CARRYALL
Color
RED - RED
Model
SUV
Year
2010
Make
CHEVROLET
Vehicle Identification Number
65130102 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
VEHICLEUNIT Vehicle
Crash Time 01:30 PM
Crash Date 11/07/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 6
This report does not include any CJIS data.
20110729
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW9 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
HAYWARD, WI 54843 , US
Owner Name
0102Driver Actions
UNKNOWN
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
BACKING
UNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
02Event
03Event
04Individual
Insurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UNITDistracted By
Injury
LocationStriking Unit #
Distracted By Action
UNKNOWN
Distracted By Source
UNKNOWN
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 INJURY00102 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
RaceDate of Birth
11/12/
Sex
FEMALE
Citations Issued
0
Driver
ITSafety Equipment
Non Motorist
Individual
UNINDIVIDUALCrash Time 01:30 PM
Crash Date 11/07/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 6
This report does not include any CJIS data.
20110729
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0GD2XW9 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00102Drug 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 01:30 PM
Crash Date 11/07/2020Wisconsin Motor Vehicle Crash
Form DT4000 6 of 6
This report does not include any CJIS data.