20160623 Green GonfiantiniAgency Accident Number
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Reportable Accident On Emergency Amended GZH0DMD
DOT Document Number Document Override Number
16062304
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16062304
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06/23/2016
4 - Accident Date
1544
5 - Time of Accident (Military Time)
02
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HAYWARD - 53, CITY3 - 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
16 - Fr/At Hwy No.STH 7716 - From/At Street Name BUSINESS16 - Business/Frontage/Ramp
FIRE #
17 - Structure Type
15594
17 - Structure Number 12 - Latitude 13 - Longitude
PARKED MOTOR VEHICLE80 - First Harmful Event UNKNOWN93 - Manner of Collision
NO CONTROL
112 - Access Control
STRAIGHT
113 - Road Curvature
LEVEL/FLAT
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 DRY116 - Road Surface Condition CLEAR118 - 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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L - LEGALLY PARKED
Unit Status
MOTOR VEHICLE IN TRANSPORT
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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Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
0
22 - Total Occupants
743VUH
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
538
55 - Vehicle Identification Number
2004
50 - Year
PONT
51 - Make
MONTANA
52 - Model
VN - VAN
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
REAR PASSENGER 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
GREEN
46 - Vehicle Owner Last Name
JESSICA
46 - First Name
DANIELLE
46 - Middle Initial 46 - Suffix
08/2 0
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - 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
WI
30 - State
2024
31 - Expiration Year 34 - On Duty Accident
GONFIANTINI
25 - Operator/Pedestrian Last Name
CURTIS
25 - First Name
RICHARD
25 - Middle Initial 25 - Suffix
04/10
32 - Date Of Birth
MALE
33 - Sex
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Wisconsin Motor Vehicle GZH0DMD 2 525
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Vehicle
Vehicle Owner
Insurance
OP
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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
RESTRAINT-USE-UNKNOWN
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
OTHER
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.
DRIVER-CONDITION
122 - Driver Factors
REDUCED ALERTNESS88 - 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
TRUCK
21 - Unit Type
PICKUP/UTILITY-TRUCK
Vehicle Type
1
22 - Total Occupants
HV5379
56 - License Plate Number
LTK57 - Plate Type WI
58 - State
2016
59 - Exp Year
31
55 - Vehicle Identification Number
2000
50 - Year
CHEV
51 - Make
SILVERADO
52 - Model
TK - TRUCK
53 - Body Style
MAR
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE
94 - Vehicle Damage
MINOR
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
GONFIANTINI
46 - Vehicle Owner Last Name
CURTIS
46 - First Name
RICHARD
46 - Middle Initial 46 - Suffix
04/10
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
STATE-FARM63 - Liability Insurance Company Policy Holder Same As Owner60
GONFIANTINI
61 - Policy Holder Last Name
CURTIS
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
Trailer
01
TR
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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
SGT NICK ALMOGHRABI
I, SGT. NICK AL-MOGHRABI, CHECKED ON DUTY FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT ON 06/23/16 AND HEARD TOWN OF HAYWARD OFFICER CIATTI OUT WITH A VEHICLE THAT WAS INVOLVED IN A PROPERTY DAMAGE CRASH AT THE
HAYWARD WALMART. THE STOP LOCATION WAS ON CHIPPEWA TRAIL NEAR WHEELER ROAD. UPON MY ARRIVAL, OFFICER CIATTI
INFORMED ME THAT THE OPERATOR WAS VERY DISORIENTED BUT DID NOT APPEAR TO BE UNDER THE INFLUENCE OF ALCOHOL
OR OTHER DRUGS. THE OPERATOR OF WHAT IS UNIT 2, CURTIS GONFIANTINI, TOLD OFFICER CIATTI THAT HE WAS GOING HOME
HOWEVER WAS TRAVELING THE WRONG WAY. GONFIANTINI DIDN'T KNOW WHAT HAD HAPPENED OR WHERE HE WAS. I WAS
FURTHER ADVISED THAT THE OPERATOR DIDN'T KNOW WHAT HAD HAPPENED OR HOW HE WOULD HAVE HIT A VEHICLE. UPON THE ARRIVAL OF EMS, I WAS DISPATCHED TO WALMART TO MEET WITH THE OWNER OF UNIT 1, JESSICA GREEN. GREEN TOLD ME
SHE HAD BEEN IN WALMART WHEN SHE WAS PAGED ABOUT HER VEHICLE. GREEN'S VEHICLE WAS PARKED ON THE WEST SIDE OF
LANE TWO APPROXIMATELY TEN PARKING SPACES FROM THE FRONT UNOCCUPIED. HER VEHICLE HAD BEEN STRUCK IN THE
REAR PASSENGER SIDE CAUSING DAMAGE TO THE TAILLIGHT AND BUMPER. I EXPLAINED TO GREEN THAT OFFICERS WERE OUT
WITH THE OPERATOR AND IT HAD NOT YET BEEN DETERMINED HOW THE INCIDENT HAD HAPPENED. I PROVIDED HER WITH THE
CASE NUMBER AND ADVISED A CRASH REPORT WOULD BE COMPLETED. PHOTOS OF THE DAMAGE WERE TAKEN BEFORE SHE
WAS RELEASED. I RETURNED TO THE SCENE AND WAS ADVISED BY THE PARAMEDIC AND OFFICER CIATTI THAT THERE WAS A CLEAR MEDICAL PROBLEM OCCURRING WITH MEDICAL TRANSPORT NEEDED. OFFICER CIATTI STATED HE SPOKE TO
GONFIANTINI'S WIFE WHO STATED THAT HER HUSBAND IS ALWAYS AWARE OF HIS SURROUNDINGS AND THAT SOMETHING MUST
BE WRONG. I PHOTOGRAPHED THE DAMAGE TO THE FRONT DRIVER'S SIDE. NO CITATIONS WERE ISSUED IN THIS MATTER.
I, SGT. NICK AL-MOGHRABI, CHECKED ON DUTY FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT ON 06/23/16 AND HEARD TOWN OF HAYWARD OFFICER CIATTI OUT WITH A VEHICLE THAT WAS INVOLVED IN A PROPERTY DAMAGE CRASH AT THE
HAYWARD WALMART. THE STOP LOCATION WAS ON CHIPPEWA TRAIL NEAR WHEELER ROAD. UPON MY ARRIVAL, OFFICER CIATTI
INFORMED ME THAT THE OPERATOR WAS VERY DISORIENTED BUT DID NOT APPEAR TO BE UNDER THE INFLUENCE OF ALCOHOL
OR OTHER DRUGS. THE OPERATOR OF WHAT IS UNIT 2, CURTIS GONFIANTINI, TOLD OFFICER CIATTI THAT HE WAS GOING HOME
HOWEVER WAS TRAVELING THE WRONG WAY. GONFIANTINI DIDN'T KNOW WHAT HAD HAPPENED OR WHERE HE WAS. I WAS
FURTHER ADVISED THAT THE OPERATOR DIDN'T KNOW WHAT HAD HAPPENED OR HOW HE WOULD HAVE HIT A VEHICLE. UPON THE ARRIVAL OF EMS, I WAS DISPATCHED TO WALMART TO MEET WITH THE OWNER OF UNIT 1, JESSICA GREEN. GREEN TOLD ME
SHE HAD BEEN IN WALMART WHEN SHE WAS PAGED ABOUT HER VEHICLE. GREEN'S VEHICLE WAS PARKED ON THE WEST SIDE OF
LANE TWO APPROXIMATELY TEN PARKING SPACES FROM THE FRONT UNOCCUPIED. HER VEHICLE HAD BEEN STRUCK IN THE
REAR PASSENGER SIDE CAUSING DAMAGE TO THE TAILLIGHT AND BUMPER. I EXPLAINED TO GREEN THAT OFFICERS WERE OUT
WITH THE OPERATOR AND IT HAD NOT YET BEEN DETERMINED HOW THE INCIDENT HAD HAPPENED. I PROVIDED HER WITH THE
CASE NUMBER AND ADVISED A CRASH REPORT WOULD BE COMPLETED. PHOTOS OF THE DAMAGE WERE TAKEN BEFORE SHE
WAS RELEASED. I RETURNED TO THE SCENE AND WAS ADVISED BY THE PARAMEDIC AND OFFICER CIATTI THAT THERE WAS A CLEAR MEDICAL PROBLEM OCCURRING WITH MEDICAL TRANSPORT NEEDED. OFFICER CIATTI STATED HE SPOKE TO
GONFIANTINI'S WIFE WHO STATED THAT HER HUSBAND IS ALWAYS AWARE OF HIS SURROUNDINGS AND THAT SOMETHING MUST
BE WRONG. I PHOTOGRAPHED THE DAMAGE TO THE FRONT DRIVER'S SIDE. NO CITATIONS WERE ISSUED IN THIS MATTER.
Officer Information
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125 - First Name 125 - Middle Initial
ALMOGHRABI
125 - Officer Last Name
NICK 392
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
06/23/2016
132 - Date Notified 1545133 - Time Notified (Military Time)1601134 - Time Arrived (Military Time)
06/23/2016
135 - Date Of Report
16062304 16062304 19 - Special Study
18 - Agency Space
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