20161010 Briggs KraftAgency Accident Number
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Reportable Accident On Emergency Amended GZDXX6L
DOT Document Number Document Override Number
16101003
16
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0
1
0
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3
10/10/2016
4 - Accident Date
1650
5 - Time of Accident (Military Time)
02
6 - Total Units 7 - Total Injured 8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality INTERSECTION11 - Accident Location
063
14 - On Hwy No.
SB
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.GREENWOOD LN16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.000548
12 - Latitude -91.50337313 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event ANGLE93 - 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
EAST
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 34 - On Duty Accident
BRIGGS
25 - Operator/Pedestrian Last Name
STACY
25 - First Name
A
25 - Middle Initial 25 - Suffix
10/22/
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
SPOONER
27 - City
WI
27 - State
54801
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-LEFT-TURN
119 - What Driver Was Doing
STOP-SIGN
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.
FAIL-TO-YIELD-RIGHT-OF-WAY
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
Accident Report
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Wisconsin Motor Vehicle GZDXX6L 1 5
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
VISIBILITY-OBSCURED
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
2
22 - Total Occupants
583TKY
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
9
55 - Vehicle Identification Number
2007
50 - Year
TOYT
51 - Make
PRIUS
52 - Model
4H - HATCHBACK 4
53 - Body Style
TAN
54 - Color
0100 - Skidmarks to Impact (Ft)
REAR DRIVER SIDE
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
ROADRUNNER TOWING HAYWARD
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
BRIGGS
46 - Vehicle Owner Last Name
STACY
46 - First Name
A
46 - Middle Initial 46 - Suffix
10/22/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
SPOONER48 - City WI48 - State 5480148 - Zip Code .49 - Telephone Number
GEICO-GENERAL-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
BRIGGS
61 - Policy Holder Last Name
STACY
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
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
WI
30 - State
2020
31 - Expiration Year 34 - On Duty Accident
KRAFT
25 - Operator/Pedestrian Last Name
SAMANTHA
25 - First Name
R
25 - Middle Initial 25 - Suffix
11/12/
32 - Date Of Birth
FEMALE
33 - Sex
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
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PK2012
Wisconsin Motor Vehicle GZDXX6L 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
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
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
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
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
MK7704
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
172
55 - Vehicle Identification Number
2011
50 - Year
JEEP
51 - Make
GRAND CHER
52 - Model
4D - 4DR
53 - Body Style
WHI
54 - Color
0100 - Skidmarks to Impact (Ft)
FRONT
94 - Vehicle Damage
VERY-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
KRAFT
46 - Vehicle Owner Last Name
SAMANTHA
46 - First Name
R
46 - Middle Initial 46 - Suffix
11/12
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code (.49 - Telephone Number
HOLDEN INSURANCE63 - Liability Insurance Company Policy Holder Same As Owner60
KRAFT
61 - Policy Holder Last Name
SAMANTHA
61 - Policy Holder First Name
61 - Policy Holder Company
02
02
02
02
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Wisconsin Motor Vehicle GZDXX6L 3 5
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
BRIGGS
66 - Occupant Last Name
CHYNA
66 - First Name
M
66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
SPOONER
68 - City
WI
68 - State
54801
68 - Zip Code
10/16
67 - Date of Birth
F
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-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
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
DI
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Diagram and Narrative
UNIT 1 WAS OPERATING ON GREENWOOD LANE AND LEFT INTERSECTION. THE OPERATOR OF UNIT 1 BELIEVED THERE WAS NO
TRAFFIC, BUT ADMITS HER VIEW WAS OBSTRUCTED BY OTHER VEHICLES SLOWING TO TURN WEST ON GREENWOOD LANE. THE
OPERATOR OF UNIT 2 WAS TRAVELING SOUTH AND HIT THE REAR DRIVERS SIDE OF UNIT 1.
UNIT 1 WAS OPERATING ON GREENWOOD LANE AND LEFT INTERSECTION. THE OPERATOR OF UNIT 1 BELIEVED THERE WAS NO
TRAFFIC, BUT ADMITS HER VIEW WAS OBSTRUCTED BY OTHER VEHICLES SLOWING TO TURN WEST ON GREENWOOD LANE. THE
OPERATOR OF UNIT 2 WAS TRAVELING SOUTH AND HIT THE REAR DRIVERS SIDE OF UNIT 1.
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Wisconsin Motor Vehicle GZDXX6L 4 5
NO CITATIONS WERE ISSUED. THERE WAS MODERATE DAMAGE TO UNIT ONE THAT REQUIRED TOWING. OPERATORS EXCHANGED NAMES AND PHONE NUMBERS AS WELL AS INSURANCE COMPANIES. DUE TO HEAVY TRAFFIC, THE SCENE WAS
CLEARED AND PICTURES WERE NOT TAKEN.
NO CITATIONS WERE ISSUED. THERE WAS MODERATE DAMAGE TO UNIT ONE THAT REQUIRED TOWING. OPERATORS EXCHANGED NAMES AND PHONE NUMBERS AS WELL AS INSURANCE COMPANIES. DUE TO HEAVY TRAFFIC, THE SCENE WAS
CLEARED AND PICTURES WERE NOT TAKEN.
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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
10/10/2016
132 - Date Notified 1650133 - Time Notified (Military Time)1653134 - Time Arrived (Military Time)
10/20/2016
135 - Date Of Report
16101003 19 - Special Study
18 - Agency Space
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDXX6L 5 5