20160330 Conger SchreiberAgency Accident Number
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Police Number
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Reportable Accident On Emergency Amended GZDSGVC
DOT Document Number Document Override Number
03/30/2016
4 - Accident Date
1849
5 - Time of Accident (Military Time)
02
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality PARKING LOT11 - Accident Location
14 - On Hwy No.
PARKING LOT
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
K16 - Fr/At Hwy No.WB16 - From/At Street Name BUSINESS16 - Business/Frontage/Ramp
FIRE #
17 - Structure Type
13394W
17 - Structure Number 12 - Latitude 13 - Longitude
PARKED MOTOR VEHICLE80 - First Harmful Event HEAD ON93 - Manner of Collision
NO CONTROL
112 - Access Control 113 - Road Curvature 113 - Road Terrain
BLACKTOP, BITUMINOUS, OR ASPHALT - 2
Surface Type
PARKING-LOT-OR-PRIVATE-PROPERTY115 - Traffic Way
PARKING-LOT-OR-PRIVATE-PROPERTY
117 - Relation To Roadway
DAYLIGHT114 - Light Condition WET116 - Road Surface Condition CLOUDY118 - 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
OP
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P
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L - LEGALLY PARKED
Unit Status
OTHER NON-COLLISION
81 - Most Harmful Event: Collision With 23 - Dir Of Travel
N/A24 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number 30 - State 31 - Expiration Year 34 - On Duty Accident
25 - Operator/Pedestrian Last Name 25 - First Name 25 - Middle Initial 25 - Suffix
32 - Date Of Birth 33 - Sex
26 - Address Street & Number 26 - PO Box
27 - City 27 - State 27 - Zip Code 28 - Telephone Number
39 - Seat Position
NOT-APPLICABLE-NONMOTORIST
40 - Safety Equipment
38 - Injury Severity
NOT APPLICABLE
41 - Airbag
NOT-APPLICABLE
42 - Ejected 44
Medical Transport
NOT-APPLICABLE
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
LEGALLY-PARKED
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 62 - 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
88 - Driver or Pedestrian Cond 89 - Substance Presence
90 - Alcohol Test 90 - Alcohol Content 91 - Drug Test
01
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H
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N
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
56 - License Plate Number
LCO57 - Plate Type WI
58 - State 59 - Exp Year
2629
55 - Vehicle Identification Number
2008
50 - Year
CHEV
51 - Make
IMPALA
52 - Model
4D - 4DR
53 - Body Style
BLK
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT, FRONT PASSENGER SIDE, FRONT DRIVER SIDE
94 - Vehicle Damage
MINOR
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OWNER
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
CONGER
46 - Vehicle Owner Last Name
BONITA
46 - First Name
F
46 - Middle Initial 46 - Suffix
01/03/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
STONE LAKE48 - City WI48 - State 5487648 - Zip Code 49 - Telephone Number
NOT-REQUIRED63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
BU
S
FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Operator/Pedestrian
Unit Status
PARKED MOTOR VEHICLE
81 - Most Harmful Event: Collision With
SOUTH
23 - Dir Of Travel
N/A24 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2023
31 - Expiration Year 34 - On Duty Accident
SCHREIBER
25 - Operator/Pedestrian Last Name
JAMES
25 - First Name
B
25 - Middle Initial 25 - Suffix
10/27/MALE
33 - Sex
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Wisconsin Motor Vehicle
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Wisconsin Motor Vehicle GZDSGVC 2 525
VE
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N
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Vehicle
Vehicle Owner
Insurance
OP
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A
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O
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/
P
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IN
S
26 - Address Street & Number 26 - PO Box
HAYWARD
27 - City
WI
27 - State
54843
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
BACKING-MANEUVER
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.
UNSAFE-BACKING
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
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PICKUP/UTILITY-TRUCK
Vehicle Type
1
22 - Total Occupants
FV2926
56 - License Plate Number
LTK57 - Plate Type WI
58 - State
2016
59 - Exp Year
439
55 - Vehicle Identification Number
2014
50 - Year
DODG
51 - Make
RAM
52 - Model
4D - 4DR
53 - Body Style 54 - Color
0100 - Skidmarks to Impact (Ft)
REAR
94 - Vehicle Damage
MINOR
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OWNER
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
SCHREIBER
46 - Vehicle Owner Last Name
JAMES
46 - First Name
B
46 - Middle Initial 46 - Suffix
10/27/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
SECURA-INS-A-MUTUAL-CO63 - Liability Insurance Company Policy Holder Same As Owner60
SCHREIBER
61 - Policy Holder Last Name
JAMES
61 - Policy Holder First Name
61 - Policy Holder Company
02
02
02
02
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School Bus
02
BU
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FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Occupant
Address Same As Operator
OC
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P
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T
01
65 - Unit No
CONGER
66 - Occupant Last Name 66 - First Name 66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
68 - City 68 - State 68 - Zip Code
67 - Date of Birth 69 - Sex
71 - Seat Position
NOT-APPLICABLE-NONMOTORIST
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-APPLICABLE
76 - Trapped/Extricated 78 - Agency Space
Trailer
01
TR
L
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
105 - Photos By
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Diagram and Narrative
ON MARCH 30, 2016 AT APPROXIMATELY 6:49PM, I, DEPUTY RYAN SCHICK WAS ASKED BY DISPATCH TO RESPOND TO THE LCO
LITTLE CASINO FOR A MINOR TWO VEHICLE ACCIDENT WITH NO INJURIES OR LANE BLOCKAGE. I ARRIVED ON SCENE AT
APPROXIMATELY 7:20PM AND SPOKE TO THE OPERATOR OF THE BLACK CHEVROLET IMPALA THAT GOT HIT,
ON MARCH 30, 2016 AT APPROXIMATELY 6:49PM, I, DEPUTY RYAN SCHICK WAS ASKED BY DISPATCH TO RESPOND TO THE LCO
LITTLE CASINO FOR A MINOR TWO VEHICLE ACCIDENT WITH NO INJURIES OR LANE BLOCKAGE. I ARRIVED ON SCENE AT
APPROXIMATELY 7:20PM AND SPOKE TO THE OPERATOR OF THE BLACK CHEVROLET IMPALA THAT GOT HIT,
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Wisconsin Motor Vehicle GZDSGVC 4 5
BONITA F. CONGER. I ALSO MET IN THE PARKING LOT WHERE THE CRASH OCCURED WITH THE PICKUP TRUCK DRIVER THAT HAD BACKED INTO CONGER, JAMES B. SCHREIBER. SCHREIBER TOLD ME HE WAS BACKING UP AND DID NOT SEE CONGER'S VEHICLE
AND BACKED INTO THE FRONT OF IT. I WITNESSED BOTH VEHICLES WITH MINOR DAMAGE. I ASKED BOTH PARTIES IF THEY WERE
INJURED AND BOTH SAID NO. I TOLD BONITA AND SCHREIBER A CRASH REPORT WOULD BE FILLED OUT FOR BOTH OF THEIR
INSURANCE COMPANIES. I ASKED IF THEIR VEHICLES WERE DRIVEABLE AND BOTH STATED YES. I TOLD BONITA AND SCHREIBER
THEIR INSURANCE COMPANY WOULD GET AHOLD OF SAWYER COUNTY FOR A COPY OF THE CRASH REPORT. I WAS CLEAR FROM
THE CALL AT APPROXIMATELY 7:37PM.
BONITA F. CONGER. I ALSO MET IN THE PARKING LOT WHERE THE CRASH OCCURED WITH THE PICKUP TRUCK DRIVER THAT HAD BACKED INTO CONGER, JAMES B. SCHREIBER. SCHREIBER TOLD ME HE WAS BACKING UP AND DID NOT SEE CONGER'S VEHICLE
AND BACKED INTO THE FRONT OF IT. I WITNESSED BOTH VEHICLES WITH MINOR DAMAGE. I ASKED BOTH PARTIES IF THEY WERE
INJURED AND BOTH SAID NO. I TOLD BONITA AND SCHREIBER A CRASH REPORT WOULD BE FILLED OUT FOR BOTH OF THEIR
INSURANCE COMPANIES. I ASKED IF THEIR VEHICLES WERE DRIVEABLE AND BOTH STATED YES. I TOLD BONITA AND SCHREIBER
THEIR INSURANCE COMPANY WOULD GET AHOLD OF SAWYER COUNTY FOR A COPY OF THE CRASH REPORT. I WAS CLEAR FROM
THE CALL AT APPROXIMATELY 7:37PM.
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125 - First Name 125 - Middle Initial
Officer Information
SCHICK
125 - Officer Last Name
RYAN 351
131 - Officer ID
129 - Law Enforcement Agency No.SAWYER COUNTY SHERIFFS DEPT130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET
126 - Law Enforcement Agency Address Street & Number
HAYWARD127 - City WI127 - State 54843127 - Zip Code (715) 634-4858 EXT.128 - Telephone Number
03/30/2016
132 - Date Notified 1849133 - Time Notified (Military Time)1920134 - Time Arrived (Military Time)
04/06/2016
135 - Date Of Report
19 - Special Study
18 - Agency Space
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