20160708 WedinAgency Accident Number
AC
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Police Number
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Reportable Accident On Emergency Amended GZDXX6H
DOT Document Number Document Override Number
07/08/2016
4 - Accident Date
1708
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County BASS LAKE - 01, TOWN3 - Municipality INTERSECTION11 - Accident Location
14 - On Hwy No.
SCIPIO AVE
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.L C O DR16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.905514
12 - Latitude -91.41065113 - 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
SHOULDER-(OTHER THAN SHOULDER WITHIN MEDIAN OR GORE)
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
OP
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P
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Unit Status
DITCH
81 - Most Harmful Event: Collision With
EAST
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
MN
30 - State
2017
31 - Expiration Year 34 - On Duty Accident
WEDIN
25 - Operator/Pedestrian Last Name
KYLE
25 - First Name
DEVAN
25 - Middle Initial 25 - Suffix
09/30/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
MINNEAPOLIS
27 - City
MN
27 - State
55408
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
MAKING-RIGHT-TURN
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 362 - No. of Citations Issued
346.63(1)(A)
64 - 1st Statute No.
346.63(1)(B)
64 - 2nd Statute No.
346.62(2)
64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
EXCEEDING-SPEED-LIMIT, FAILURE-TO-HAVE-CONTROL
122 - Driver Factors
ABILITY IMPAIRED88 - Driver or Pedestrian Cond ALCOHOL-PRESENT
89 - Substance Presence
TEST GIVEN90 - Alcohol Test 1290 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDXX6H 1 4
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
ROUGH-PAVEMENT
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
2
22 - Total Occupants
402UBN
56 - License Plate Number
AUT57 - Plate Type MN
58 - State
2017
59 - Exp Year
7308
55 - Vehicle Identification Number
2007
50 - Year
BMW
51 - Make
CP28X
52 - Model
2D - 2DR
53 - Body Style
SIL
54 - Color
251100 - Skidmarks to Impact (Ft)
TOP OF VEHICLE, REAR, FRONT PASSENGER SIDE, FRONT, REAR DRIVER SIDE, UNDERCARRIAGE
94 - Vehicle Damage
SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
A-1 TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
WEDIN
46 - Vehicle Owner Last Name
KYLE
46 - First Name
DEVAN
46 - Middle Initial 46 - Suffix
09/30/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
MINNEAPOLIS48 - City MN48 - State 5540848 - Zip Code 49 - Telephone Number
UNKNOWN63 - Liability Insurance Company Policy Holder Same As Owner60
WEDIN
61 - Policy Holder Last Name
KYLE
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
Occupant
Address Same As Operator
OC
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01
65 - Unit No
WEDIN
66 - Occupant Last Name
RAINER
66 - First Name
BJORK
66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
MINNEAPOLIS
68 - City
MN
68 - State
55408
68 - Zip Code
08/27/67 - Date of Birth F69 - Sex
FRONT-SEAT-RIGHT-SIDE-(TRAIN ENGINEER)
71 - Seat Position
RESTRAINT-USE-UNKNOWN
72 - Safety Equipment
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDXX6H 2 424
N - NO APPARENT INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
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
Fixed Objects Struck
PR
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N
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Property
UNKNOWN
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
86 - City 86 - State 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
DI
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Diagram and Narrative
DEPUTY FREY #397
SEE SUPPLEMENTAL REPORTSEE SUPPLEMENTAL REPORT
Officer Information
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDXX6H 3 4
OF
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125 - First Name 125 - Middle Initial
FREY
125 - Officer Last Name
NATHAN 397
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
07/08/2016
132 - Date Notified 1708133 - Time Notified (Military Time)1728134 - Time Arrived (Military Time)
07/08/2016
135 - Date Of Report
19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDXX6H 4 4