20160903 Thompson BrunnerAgency Accident Number
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Reportable Accident On Emergency Amended GZDGTZH
DOT Document Number Document Override Number
16090310
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9
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09/03/2016
4 - Accident Date
2045
5 - Time of Accident (Military Time)
02
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County LENROOT - 08, TOWN3 - Municipality PRIVATE PROPERTY11 - Accident Location
14 - On Hwy No.
PRIVATE PROPERTY
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
06316 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp
FIRE #
17 - Structure Type
12006N
17 - Structure Number
46.068802
12 - Latitude -91.43220713 - Longitude
PARKED MOTOR VEHICLE80 - First Harmful Event REAR TO REAR93 - Manner of Collision
NO CONTROL
112 - Access Control
STRAIGHT
113 - Road Curvature
LEVEL/FLAT
113 - Road Terrain
SLAG, GRAVEL, OR STONE - 4
Surface Type
PARKING-LOT-OR-PRIVATE-PROPERTY115 - Traffic Way
PARKING-LOT-OR-PRIVATE-PROPERTY
117 - Relation To Roadway
DARK-NOT-LIGHTED114 - Light Condition SAND-MUD-DIRT-OR-OIL116 - 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
PARKED MOTOR VEHICLE
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
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
0
22 - Total Occupants
372TTN
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
2592
55 - Vehicle Identification Number
2011
50 - Year
BUIC
51 - Make
REGAL
52 - Model
4D - 4DR
53 - Body Style
WHI
54 - Color 100 - 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
THOMPSON
46 - Vehicle Owner Last Name
MARK
46 - First Name
S
46 - Middle Initial 46 - Suffix
10/04
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
H - HIT AND RUN
Unit Status
MOTOR VEHICLE IN TRANSPORT
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
WI
30 - State
2023
31 - Expiration Year 34 - On Duty Accident
BRUNNER
25 - Operator/Pedestrian Last Name
GRACE
25 - First Name
JAN
25 - Middle Initial 25 - Suffix
09/08/
32 - Date Of Birth
FEMALE
33 - Sex
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Wisconsin Motor Vehicle GZDGTZH 2 424
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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
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 362 - No. of Citations Issued
346.63(1)(A)
64 - 1st Statute No.
346.63(1)(B)
64 - 2nd Statute No.
346.67(1)
64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
UNSAFE-BACKING, OTHER
122 - Driver Factors
ABILITY IMPAIRED88 - Driver or Pedestrian Cond ALCOHOL-PRESENT
89 - Substance Presence
TEST GIVEN90 - Alcohol Test 2490 - Alcohol Content TEST NOT GIVEN91 - Drug Test
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
737YFP
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
9896
55 - Vehicle Identification Number
2016
50 - Year
CHEV
51 - Make
EQINOX
52 - Model
UT - SPORT UTILITY
53 - Body Style
GRY
54 - Color 100 - Skidmarks to Impact (Ft)
REAR PASSENGER 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
BRUNNER
46 - Vehicle Owner Last Name
GRACE
46 - First Name
JAN
46 - Middle Initial 46 - Suffix
09/08/1
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
UNKNOWN63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 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
DEPUTY KEVIN GILLIS
VEHICLE WAS PARKED IN FRONT OF IT'S RESIDENCE. SUSPECT'S VEHICLE PULLED INTO THE DRIVEWAY AND WHILE ATTEMPTING TO BACK UP IT STRUCK THE BACK BUMPER OF THE PARKED VEHICLE. THE SUSPECT'S VEHICLE THEN LEFT THE SCENE. VEHICLE WAS PARKED IN FRONT OF IT'S RESIDENCE. SUSPECT'S VEHICLE PULLED INTO THE DRIVEWAY AND WHILE ATTEMPTING TO BACK UP IT STRUCK THE BACK BUMPER OF THE PARKED VEHICLE. THE SUSPECT'S VEHICLE THEN LEFT THE SCENE.
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125 - First Name 125 - Middle Initial
Officer Information
GILLIS
125 - Officer Last Name
KEVIN 345
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
09/03/2016
132 - Date Notified 2053133 - Time Notified (Military Time)2101134 - Time Arrived (Military Time)
09/04/2016
135 - Date Of Report
16090310 19 - Special Study
18 - Agency Space
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