20161009 AlamillaAgency Accident Number
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Reportable Accident On Emergency Amended GZHH72P
DOT Document Number Document Override Number
16100901
16
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9
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10/09/2016
4 - Accident Date 5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
14 - On Hwy No.
ROUND LAKE SCHOOL RD
14 - On Street Name 14 - Bus/Frnt/Rmp
0.39 MI15 - Est. Distance SOUTH15 - Hwy. Dir
07716 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.023833
12 - Latitude -91.36316113 - 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
UNKNOWN
117 - Relation To Roadway
DARK-NOT-LIGHTED114 - 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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U - UNKNOWN
Unit Status
MAILBOX
81 - Most Harmful Event: Collision With
NORTH
23 - Dir Of Travel
4524 - 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
UNKNOWN
39 - Seat Position
RESTRAINT-USE-UNKNOWN
40 - Safety Equipment
38 - Injury Severity
NON-DEPLOYED
41 - Airbag
UNKNOWN
42 - Ejected 44
Medical Transport
NOT-TRAPPED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
GOING-STRAIGHT
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
NOT OBSERVED88 - Driver or Pedestrian Cond UNKNOWN
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
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Accident Report
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Wisconsin Motor Vehicle GZHH72P 1 4
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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
1
22 - Total Occupants
192ZEG
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
886
55 - Vehicle Identification Number
50 - Year
TOYT
51 - Make
CAMRY
52 - Model
SD - SEDAN
53 - Body Style
RED
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, FRONT, OTHER, MIDDLE DRIVER SIDE
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
ROADRUNNER TOWING
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
ALAMILLA
46 - Vehicle Owner Last Name
SAMANTHA
46 - First Name
R
46 - Middle Initial 46 - Suffix
07/30
Date Of Birth
46 - Company Name
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
01
01
01
01
BU
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FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Trailer
01
TR
L
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
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Wisconsin Motor Vehicle
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Wisconsin Motor Vehicle GZHH72P 2 424
Fixed Objects Struck
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Property
INDIVIDUAL
Organization Type
HUBBELL
84 - Property Owner Last Name
CHRIS
84 - First Name
L
84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
EAU CLAIRE
86 - City
WI
86 - State
54701
86 - Zip Code 87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
MAILBOX
82 - Object Struck
01
82 - Striking Unit
DITCH
82 - Object Struck
01
82 - Striking Unit
TREE
82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
105 - Photos By
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Diagram and Narrative
DEPUTY KEVIN GILLIS
THE VEHICLE APPEARED TO BE TRAVELING NORTH ON ROUND LAKE SCHOOL RD. THE VEHICLE WENT OFF THE ROAD INTO THE
DITCH ON THE WEST SIDE, STRIKING A MAILBOX. THE VEHICLE THEN STRUCK A TREE ON THE DRIVER SIDE AND CAME TO A STOP.
NO OCCUPANTS WERE AROUND THE VEHICLE.
THE VEHICLE APPEARED TO BE TRAVELING NORTH ON ROUND LAKE SCHOOL RD. THE VEHICLE WENT OFF THE ROAD INTO THE
DITCH ON THE WEST SIDE, STRIKING A MAILBOX. THE VEHICLE THEN STRUCK A TREE ON THE DRIVER SIDE AND CAME TO A STOP.
NO OCCUPANTS WERE AROUND THE VEHICLE.
Officer Information
Accident Report
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Wisconsin Motor Vehicle GZHH72P 3 4
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125 - First Name 125 - Middle Initial
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
10/09/2016
132 - Date Notified 0034133 - Time Notified (Military Time)0039134 - Time Arrived (Military Time)
10/17/2016
135 - Date Of Report
16100901 19 - Special Study
18 - Agency Space
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZHH72P 4 4