20160727 Porter NelsonAgency Accident Number
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Reportable Accident On Emergency Amended GZDXX6K
DOT Document Number Document Override Number
16072707
16
0
7
2
7
0
7
07/27/2016
4 - Accident Date
1532
5 - Time of Accident (Military Time)
02
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County BASS LAKE - 01, TOWN3 - Municipality INTERSECTION11 - Accident Location
027
14 - On Hwy No.
SB
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.WILLIAMS RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.954282
12 - Latitude -91.49466813 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event REAR-END93 - Manner of Collision
FULL 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
ON-ROADWAY
117 - Relation To Roadway
DAYLIGHT114 - Light Condition WET116 - Road Surface Condition RAIN118 - 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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Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
SOUTH
23 - Dir Of Travel
5524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2024
31 - Expiration Year 34 - On Duty Accident
PORTER
25 - Operator/Pedestrian Last Name
MEGAN
25 - First Name
E
25 - Middle Initial 25 - Suffix
05/04/
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
WAUNAKEE
27 - City
WI
27 - State
53597
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
SLOWING-OR-STOPPING
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
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PICKUP/UTILITY-TRUCK
Vehicle Type
2
22 - Total Occupants
479WUY
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
1GNSKJKC9GR1
55 - Vehicle Identification Number
2016
50 - Year
CHEV
51 - Make
SUBURBAN
52 - Model
4D - 4DR
53 - Body Style
GRY
54 - Color 100 - Skidmarks to Impact (Ft)
REAR
94 - Vehicle Damage
VERY-MINOR
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OPERATOR
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
PORTER
46 - Vehicle Owner Last Name
MEGAN
46 - First Name
E
46 - Middle Initial 46 - Suffix
05/04/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
WAUNAKEE48 - City WI48 - State 5359748 - Zip Code 49 - Telephone Number
AMERICAN-FAMILY63 - Liability Insurance Company Policy Holder Same As Owner60
PORTER
61 - Policy Holder Last Name
MEGAN
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
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
SOUTH
23 - Dir Of Travel
5524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
Number
WI
30 - State
2022
31 - Expiration Year 34 - On Duty Accident
NELSON
25 - Operator/Pedestrian Last Name
RILEY
25 - First Name
N
25 - Middle Initial 25 - Suffix
10/14/
32 - Date Of Birth
FEMALE
33 - Sex
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Wisconsin Motor Vehicle GZDXX6K 2 525
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Vehicle
Vehicle Owner
Insurance
OP
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IN
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26 - Address Street & Number 26 - PO Box
STONE LAKE
27 - City
WI
27 - State
54876
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
SLOWING-OR-STOPPING
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.
SPEED-TOO-FAST-FOR-CONDITIONS
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
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
691DYZ
56 - License Plate Number
AUT57 - Plate Type MN
58 - State
2017
59 - Exp Year
2003
50 - Year
DODG
51 - Make
STRATUS
52 - Model
4D - 4DR
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
A-1 TOWING AND RECOVERY
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
KAUFMAN-NELSON
46 - Vehicle Owner Last Name
NICOLE
46 - First Name
M
46 - Middle Initial 46 - Suffix
05/26/1
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
STONE LAKE48 - City WI48 - State 5487648 - Zip Code 49 - Telephone Number
GEICO-GENERAL-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
KAUFMAN-NELSON
61 - Policy Holder Last Name
NICOLE
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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01
65 - Unit No
PORTER
66 - Occupant Last Name
RYAN
66 - First Name
F
66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
WAUNAKEE
68 - City
WI
68 - State
53597
68 - Zip Code
11/08/1
67 - Date of Birth
M
69 - Sex
FRONT-SEAT-RIGHT-SIDE-(TRAIN ENGINEER)
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-APPLICABLE
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
DI
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Diagram and Narrative
FREY, NATHAN #397
UNIT 1 WAS DRIVING SOUTH ON 27/ 70, SLOWING FOR A VEHICLE TURNING ONTO WILLIAMS ROAD. UNIT 2 WAS BEHIND UNIT 1.
UNIT 2 APPLIED BRAKES, BUT DUE TO HEAVY RAIN, WENT INTO A SKID. UNIT 2 STRUCK THE REAR OF UNIT 1 CAUSING MODERATE
TO SEVERE DAMAGE TO THE FRONT END. UNIT 1 SUSTAINED VERY MINOR DAMAGE. THE
UNIT 1 WAS DRIVING SOUTH ON 27/ 70, SLOWING FOR A VEHICLE TURNING ONTO WILLIAMS ROAD. UNIT 2 WAS BEHIND UNIT 1.
UNIT 2 APPLIED BRAKES, BUT DUE TO HEAVY RAIN, WENT INTO A SKID. UNIT 2 STRUCK THE REAR OF UNIT 1 CAUSING MODERATE
TO SEVERE DAMAGE TO THE FRONT END. UNIT 1 SUSTAINED VERY MINOR DAMAGE. THE
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OPERATOR OF THE VEHICLE THAT TURNED OFF ON WILLIAMS ROAD WAS UNIDENTIFIED AND DID NOT STOP FOR THE CRASH. UNIT 2 WAS REMOVED BY A-1 TOWING AND RECOVERY. BOTH DRIVERS EXCHANGED INSURANCE INFORMATION, NAMES, AND
PHONE NUMBERS.
OPERATOR OF THE VEHICLE THAT TURNED OFF ON WILLIAMS ROAD WAS UNIDENTIFIED AND DID NOT STOP FOR THE CRASH. UNIT 2 WAS REMOVED BY A-1 TOWING AND RECOVERY. BOTH DRIVERS EXCHANGED INSURANCE INFORMATION, NAMES, AND
PHONE NUMBERS.
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125 - First Name 125 - Middle Initial
Officer Information
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
07/27/2016
132 - Date Notified 1532133 - Time Notified (Military Time)1543134 - Time Arrived (Military Time)
07/27/2016
135 - Date Of Report
16072707 19 - Special Study
18 - Agency Space
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