20161123 Binder BodenschatzAgency Accident Number
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Reportable Accident On Emergency Amended GZJ3QMF
DOT Document Number Document Override Number
11/23/2016
4 - Accident Date
1630
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HUNTER - 07, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
14 - On Hwy No.
RIVER RD
14 - On Street Name 14 - Bus/Frnt/Rmp
372 FT15 - Est. Distance NORTH15 - Hwy. Dir
16 - Fr/At Hwy No.TN RD 5316 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.957294
12 - Latitude -91.14615813 - Longitude
UNKNOWN80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control
CURVE
113 - Road Curvature
HILL
113 - Road Terrain
BLACKTOP, BITUMINOUS, OR ASPHALT - 2
Surface Type
NOT-PHYSICALLY-DIVIDED-(2-WAY TRAFFIC)115 - Traffic Way
OUTSIDE-SHOULDER-RIGHT
117 - Relation To Roadway
DUSK114 - Light Condition SNOW/SLUSH116 - Road Surface Condition CLOUDY118 - 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
DITCH
81 - Most Harmful Event: Collision With
SOUTH
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
FL
30 - State
2017
31 - Expiration Year 34 - On Duty Accident
BINDER
25 - Operator/Pedestrian Last Name
STEPHANI
25 - First Name
ANN
25 - Middle Initial 25 - Suffix
12/29/
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Number 26 - PO Box
HALLANDALE
27 - City
FL
27 - State
33009
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
NEGOTIATING-CURVE
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
01
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZJ3QMF 1 4
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
105MSF
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2017
59 - Exp Year
153
55 - Vehicle Identification Number
2004
50 - Year
AUDI
51 - Make
A8 QUATTRO
52 - Model
4D - 4DR
53 - Body Style
BLU
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, FRONT, FRONT PASSENGER SIDE, MIDDLE PASSENGER SIDE
94 - Vehicle Damage
SEVERE
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
BODENSCHATZ
46 - Vehicle Owner Last Name
STEPHEN
46 - First Name
J
46 - Middle Initial 46 - Suffix Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code .49 - Telephone Number
HAYWARD INS BY BONCLER REALTY63 - Liability Insurance Company Policy Holder Same As Owner60
BODENSCHATZ
61 - Policy Holder Last Name
STEPHEN
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 GZJ3QMF 2 424
Fixed Objects Struck
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Property
ORGANIZATION
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
JUMP RIVER ELECTRIC
84 - Company Name Government Property Type
COUNTY ROAD B
85 - Address Street & Number 85 - PO Box
HAYWARD
86 - City
WI
86 - State
54843
86 - Zip Code 87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
UTILITY-POLE
82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 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
VEHICLE TRAVELING SOUTH ENCOUNTERED ICE COVERED ROAD. DRIVER LOST CONTROL CRESTING HILL AND SLID INTO DITCH
ON RIGHT SIDE SHOULDER. DRIVER STRUCK AN ELECTRICAL POLE WITH DRIVERS SIDE FRONT PANEL AND A GUIDE WIRE WITH
FRONT LEFT PANEL. VEHICLE HAD SEVERE DAMAGE. OPERATOR DID NOT REPORT UNTIL 4-5 HOURS AFTER EVENT.
VEHICLE TRAVELING SOUTH ENCOUNTERED ICE COVERED ROAD. DRIVER LOST CONTROL CRESTING HILL AND SLID INTO DITCH
ON RIGHT SIDE SHOULDER. DRIVER STRUCK AN ELECTRICAL POLE WITH DRIVERS SIDE FRONT PANEL AND A GUIDE WIRE WITH
FRONT LEFT PANEL. VEHICLE HAD SEVERE DAMAGE. OPERATOR DID NOT REPORT UNTIL 4-5 HOURS AFTER EVENT.
Officer Information
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Wisconsin Motor Vehicle GZJ3QMF 3 4
OF
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125 - First Name 125 - Middle Initial
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
11/23/2016
132 - Date Notified 2116133 - Time Notified (Military Time)2145134 - Time Arrived (Military Time)
11/23/2016
135 - Date Of Report
19 - Special Study
18 - Agency Space
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