20161009 Cooper StanleyAgency Accident Number
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Reportable Accident On Emergency Amended GZGXX66
DOT Document Number Document Override Number
16100913715
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16100904
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10/09/2016
4 - Accident Date
1135
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 INTERSECTION11 - Accident Location
14 - On Hwy No.
CTH B/ MINNESOTA AVE
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
02716 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.007235
12 - Latitude -91.48135313 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event SIDESWIPE. SAME DIRECTION93 - 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 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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Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
WEST
23 - Dir Of Travel
2524 - 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
COOPER
25 - Operator/Pedestrian Last Name
WILLIAM
25 - First Name
JAMES
25 - Middle Initial 25 - Suffix
10/03
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
INVER GROVE HEIG
27 - City
MN
27 - State
55076
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
TURNING-ON-RED
119 - What Driver Was Doing
TRAFFIC-SIGNAL-OPERATING
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 UNKNOWN
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
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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
289NTD
56 - License Plate Number
AUT57 - Plate Type MN
58 - State
2016
59 - Exp Year
0123
55 - Vehicle Identification Number
1996
50 - Year
MAZD
51 - Make 52 - Model
4D - 4DR
53 - Body Style
GLD
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE
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
COOPER
46 - Vehicle Owner Last Name
WILLIAM
46 - First Name
JAMES
46 - Middle Initial 46 - Suffix
10/03/1
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
INVER GROVE HEIG48 - City MN48 - State 5507648 - Zip Code .49 - Telephone Number
PROGRESSIVE-CASUALTY-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
COOPER
61 - Policy Holder Last Name
WILLIAM
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
Operator/Pedestrian
Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
WEST
23 - Dir Of Travel
2524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2020
31 - Expiration Year
POLICE
34 - On Duty Accident
STANLEY
25 - Operator/Pedestrian Last Name
SAVANNAH
25 - First Name
W
25 - Middle Initial 25 - Suffix
10/11/
32 - Date Of Birth
FEMALE
33 - Sex
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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
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
MAKING-RIGHT-TURN
119 - What Driver Was Doing
TRAFFIC-SIGNAL-OPERATING
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.
OTHER
122 - Driver Factors
APPEARED NORMAL88 - Driver or Pedestrian Cond UNKNOWN
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - 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
93283
56 - License Plate Number
MUN57 - Plate Type WI
58 - State 59 - Exp Year
6398
55 - Vehicle Identification Number
2016
50 - Year
FORD
51 - Make
TAURUS
52 - Model
4D - 4DR
53 - Body Style
WHI
54 - Color 100 - Skidmarks to Impact (Ft)
REAR PASSENGER SIDE
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
46 - Vehicle Owner Last Name 46 - First Name 46 - Middle Initial 46 - Suffix Date Of Birth
CITY OF HAYWARD46 - Company Name
15889 3RD ST
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
LEAGUE-OF-WISCONSIN-MUNICIPALITIES-MUTUAL-INS63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 61 - Policy Holder First Name
CITY OF HAYWARD61 - 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
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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
POPLIN
ON OCTOBER 9TH, 2016 I DEPUTY POPLIN WAS WORKING FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT. OFFICER STANLEY WAS WORKING FOR THE CITY OF HAYWARD POLICE DEPARTMENT. OFFCIER STANLEY ADVISED SHE WAS IN A CRASH AND
NEEDED THE COUNTY TO HANDLE THE CRASH REPORT. THE DRIVER OF UNIT 1 ADVISED THAT HE WAS STATIONARY AT THE RED
LIGHT ON COUNTY HWY B WAITING TO TURN LEFT ONTO STATE HWY 27. THE DRIVER OF UNIT 1 SAID THE TRAFFIC LIGHT WAS
TAKING A REALLY LONG TIME AND HE MUST NOT HAVE PULLED FAR ENOUGH UP TO TRIP THE SENSOR TO MAKE THE LIGHTS
SWITCH. OFFICER STANLEY SAID SHE SAW THIS VEHICLE NOT TRIPPING THE SENSOR FOR THE TRAFFIC LIGHT AND ADVISED SHE
WAS GOING TO USE HER CAR TO TRIP THE SENSOR AND ASSIST THE CITIZEN. OFFICER STANLEY ADVISED THAT WHEN SHE DID THIS SHE GOT TO CLOSE TO UNIT 1 AND CAUSED VERY MINOR DAMAGE TO BOTH UNIT 1 AND UNIT 2.
ON OCTOBER 9TH, 2016 I DEPUTY POPLIN WAS WORKING FOR THE SAWYER COUNTY SHERIFF'S DEPARTMENT. OFFICER STANLEY WAS WORKING FOR THE CITY OF HAYWARD POLICE DEPARTMENT. OFFCIER STANLEY ADVISED SHE WAS IN A CRASH AND
NEEDED THE COUNTY TO HANDLE THE CRASH REPORT. THE DRIVER OF UNIT 1 ADVISED THAT HE WAS STATIONARY AT THE RED
LIGHT ON COUNTY HWY B WAITING TO TURN LEFT ONTO STATE HWY 27. THE DRIVER OF UNIT 1 SAID THE TRAFFIC LIGHT WAS
TAKING A REALLY LONG TIME AND HE MUST NOT HAVE PULLED FAR ENOUGH UP TO TRIP THE SENSOR TO MAKE THE LIGHTS
SWITCH. OFFICER STANLEY SAID SHE SAW THIS VEHICLE NOT TRIPPING THE SENSOR FOR THE TRAFFIC LIGHT AND ADVISED SHE
WAS GOING TO USE HER CAR TO TRIP THE SENSOR AND ASSIST THE CITIZEN. OFFICER STANLEY ADVISED THAT WHEN SHE DID THIS SHE GOT TO CLOSE TO UNIT 1 AND CAUSED VERY MINOR DAMAGE TO BOTH UNIT 1 AND UNIT 2.
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125 - First Name 125 - Middle Initial
Officer Information
POPLIN125 - Officer Last Name JAY 352131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
(715) 634-4858 EXT.
128 - Telephone Number
10/09/2016132 - Date Notified 1135133 - Time Notified (Military Time)1136134 - Time Arrived (Military Time)10/09/2016135 - Date Of Report
16100913715 16100904 19 - Special Study
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18 - Agency Space
Accident Report
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MV4000e 01/2005
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