20141110 BrightonAgency Accident Number
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Reportable Accident On Emergency Amended GZFD863
DOT Document Number Document Override Number
14111008
14
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14111008
14
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11/10/2014
4 - Accident Date
1200
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County DRAPER - 03, TOWN3 - Municipality INTERSECTION11 - Accident Location
070
14 - On Hwy No.
WB
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.2ND ST16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.885536
12 - Latitude -90.85048513 - Longitude
DITCH80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control
STRAIGHT
113 - Road Curvature
LEVEL/FLAT
113 - Road Terrain
BLACKTOP, BITUMINOUS, OR ASPHALT - 2
Surface Type
NOT-PHYSICALLY-DIVIDED-(2-WAY TRAFFIC)115 - Traffic Way
OUTSIDE-SHOULDER-RIGHT
117 - Relation To Roadway
DAYLIGHT114 - Light Condition SNOW/SLUSH116 - Road Surface Condition BLOWING-SAND-SOIL-DIRT-SNOW118 - Weather
Hit and Run
9
Government Property
9
Fire
9
Photos Taken
9
Trailer or Towed
9
Truck, Bus, or Hazardous Materials
9
Load Spillage
9
Construction Zone
9
Names Exchanged
9
Supplemental Reports
101
Witness Statements
102
Measurements Taken
103 79 - E M S Number
Operator/Pedestrian
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Unit Status
CULVERT
81 - Most Harmful Event: Collision With
WEST
23 - Dir Of Travel
5524 - Speed Limit
A CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
IA
30 - State
2019
31 - Expiration Year 34 - On Duty Accident
BRIGHTON
25 - Operator/Pedestrian Last Name
RICHARD
25 - First Name
PAUL
25 - Middle Initial 25 - Suffix
05/23
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
FOREST CITY
27 - City
IA
27 - State
50436
27 - Zip Code
.
28 - Telephone Number
FRONT-SEAT-LEFT-SIDE-(MC/BIKE DRIVER, TRAIN CONDUCTOR)
39 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
40 - Safety Equipment
N - NO APPARENT INJURY
38 - Injury Severity
NON-DEPLOYED
41 - Airbag
NOT-EJECTED
42 - Ejected 44
Medical Transport
NOT-TRAPPED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
GOING-STRAIGHT
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 062 - No. of Citations Issued
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
NOT-APPLICABLE
122 - Driver Factors
APPEARED NORMAL88 - Driver or Pedestrian Cond NEITHER-ALCOHOL-NOR-DRUGS-PRESENT
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZFD863 1 4
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
TRUCK
21 - Unit Type
TRUCK-TRACTOR- (SEMI-ATTACHED)
Vehicle Type
1
22 - Total Occupants
SD2442
56 - License Plate Number
APO57 - Plate Type IA
58 - State
2015
59 - Exp Year
72902
55 - Vehicle Identification Number
2014
50 - Year
VOLV
51 - Make
TR
52 - Model
SE - SEMI-TRAILER
53 - Body Style
BLK
54 - Color
0100 - Skidmarks to Impact (Ft)
UNDERCARRIAGE
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96 97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
46 - Vehicle Owner Last Name 46 - First Name 46 - Middle Initial 46 - Suffix Date Of Birth
HUENEMAN FARMS LC46 - Company Name
& Number 47 - PO Box
GARNER48 - City IA48 - State 5043848 - Zip Code 49 - Telephone Number
GREAT-WEST-CASUALTY-CO63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 61 - Policy Holder First Name
HUENEMAN FARMS LC61 - Policy Holder Company
01
01
01
01
BU
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FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Trailer
01
TR
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1
106 - Power Unit Number
TF4544
License Plate Number
APO
Plate Type
IA
State
2015
Expiration Year
VOLVO
Trailer Make
TRLR
Unit Type
00363
Vehicle Identification Number
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
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PK2012
Wisconsin Motor Vehicle GZFD863 2 424
Fixed Objects Struck
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Property
ORGANIZATION
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
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HUEMEMAN FARMS LC
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
GARNER
86 - City
IA
86 - State
50438
86 - Zip Code
87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
DITCH
82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
105 - Photos By
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Diagram and Narrative
UNIT 1 WAS WESTBOUND ON STH 70, WHILE TRAVELING WB, VEHICLE LOST TRACTION ON SNOW COVERED ROADS, SLID INTO
THE EMBANKMENT OF THE WESTBOUND LANE OF STH 70, COLLIDING WITH A CULVERT AND DITCH COMING TO REST INTO THE
DITCHLINE AREA OF STH 70, WESTBOUND.
UNIT 1 WAS WESTBOUND ON STH 70, WHILE TRAVELING WB, VEHICLE LOST TRACTION ON SNOW COVERED ROADS, SLID INTO
THE EMBANKMENT OF THE WESTBOUND LANE OF STH 70, COLLIDING WITH A CULVERT AND DITCH COMING TO REST INTO THE
DITCHLINE AREA OF STH 70, WESTBOUND.
Officer Information
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZFD863 3 4
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125 - First Name 125 - Middle Initial
RIPCZINSKI
125 - Officer Last Name
GREG 326
131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET
126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
(715) 634-4858 EXT.
128 - Telephone Number
11/10/2014
132 - Date Notified 1225133 - Time Notified (Military Time)1249134 - Time Arrived (Military Time)
11/10/2014
135 - Date Of Report
14111008 14111008 19 - Special Study
18 - Agency Space
136
136
136 136
136
Truck and Bus
A truck or truck combination > 10,000 lbs
GVWR/GCWR
Any vehicle displaying a hazardous materials
placard
01
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A vehicle designed to carry 9 or more people, including the driver
136
Fatal Injury Medical Transport
One or more vehicles towed from the scene due to disabling damage
01Unit Number
137 - Hazardous Materials Class Numbers
137 - Hazardous Materials "UN" Nos.HazMat Placard Displayed Hazardous Cargo Was Released
137 - Name Of Hazardous Materials in this Load 137 - Name Of Hazardous Materials Released
Interstate Carrier138 569812140 - US DOT No.140 - ICC MC No.332128LC No.IC No.VEHICLE-SIDE141 - Source
HUENEMAN FARMS LC
139 - Carrier Name
142 - Carrier Address
GARNERCity IAState 50438Zip Code
80,000
143 - GVWR (Lbs)
2
144 - Total No. of Axles
TRACTOR/SEMI-TRAILER
145 - Vehicle Configuration
VAN-ENCLOSED-BOX
147 - Cargo Body Type
RAN-OFF-ROAD146 - First Event BLANK146 - Second Event
BLANK
146 - Third Event
BLANK
146 - Fourth Event
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZFD863 4 4