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20161205 RiceAgency Accident Number AC C I D E N T # PO L I C E # Police Number GE N E R A L I N F O R M A T I O N Reportable Accident On Emergency Amended GZJ2865 DOT Document Number Document Override Number 16120516173 16 1 2 0 5 1 6 1 7 3 16120503 16 1 2 0 5 0 3 12/05/2016 4 - Accident Date 1130 5 - Time of Accident (Military Time) 02 6 - Total Units 00 7 - Total Injured 00 8 - Total Killed SAWYER - 572 - County BASS LAKE - 01, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location 027 14 - On Hwy No. NB 14 - On Street Name 14 - Bus/Frnt/Rmp 535 FT15 - Est. Distance NORTH15 - Hwy. Dir 16 - Fr/At Hwy No.SAVITSKI RD16 - From/At Street Name 16 - Business/Frontage/Ramp 17 - Structure Type 17 - Structure Number 45.939436 12 - Latitude -91.49245213 - Longitude MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event SIDESWIPE. OPPOSITE DIRECTION93 - Manner of Collision NO CONTROL 112 - Access Control STRAIGHT 113 - Road Curvature HILL 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 WET116 - 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 OP E R A T O R / P E D E S T R I A N Unit Status MOTOR VEHICLE IN TRANSPORT 81 - Most Harmful Event: Collision With NORTH 23 - Dir Of Travel 5524 - Speed Limit D CLASS 36 - Operating as Classified 37 - Endorsements 35 Operating Commercial Motor Vehicle 29 - Driver's License Number WI 30 - State 2024 31 - Expiration Year 34 - On Duty Accident RICE 25 - Operator/Pedestrian Last Name VICTORIA 25 - First Name A 25 - Middle Initial 25 - Suffix 02/23/ 32 - Date Of Birth FEMALE 33 - Sex 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 OTHER 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 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 of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZJ2865 1 5 VE H I C L E VE H O W N E R Vehicle Vehicle Owner Insurance School Bus IN S 91 - Drugs Reported NOT-APPLICABLE 124 - Highway Factors AUTOMOBILE 21 - Unit Type PASSENGER-CAR Vehicle Type 1 22 - Total Occupants 850WRS 56 - License Plate Number AUT57 - Plate Type WI 58 - State 2017 59 - Exp Year 5552 55 - Vehicle Identification Number 2012 50 - Year FORD 51 - Make EXPLORER 52 - Model UT - SPORT UTILITY 53 - Body Style GRN 54 - Color 100 - Skidmarks to Impact (Ft) FRONT DRIVER SIDE 94 - Vehicle Damage 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 RICE 46 - Vehicle Owner Last Name VICTORIA 46 - First Name A 46 - Middle Initial 46 - Suffix 02/23 Date Of Birth 46 - Company Name 47- Address Street & Number 47 - PO Box HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number PROGRESSIVE-CLASSIC-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60 HOUGH 61 - Policy Holder Last Name ELIZABETH 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 SOUTH 23 - Dir Of Travel 5524 - 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 UNKNOWN 25 - Operator/Pedestrian Last Name UNKNOWN 25 - First Name UNKNOWN 25 - Middle Initial 25 - Suffix 0 32 - Date Of Birth 33 - Sex Accident Report of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle Accident Report of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZJ2865 2 525 VE H I C L E VE H O W N E R Vehicle Vehicle Owner Insurance OP E R A T O R / P E D E S T R I A N IN S UNKNOWN 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 UNKNOWN 41 - Airbag UNKNOWN 42 - Ejected 44 Medical Transport UNKNOWN 43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action GOING-STRAIGHT 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. IMPROPER-OVERTAKING 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 91 - Drugs Reported NOT-APPLICABLE 124 - Highway Factors AUTOMOBILE 21 - Unit Type PASSENGER-CAR Vehicle Type 1 22 - Total Occupants UNKNOWN 56 - License Plate Number AUT57 - Plate Type WI 58 - State 59 - Exp Year UNKNOWN 55 - Vehicle Identification Number 50 - Year 51 - Make 52 - Model 53 - Body Style 54 - Color 100 - Skidmarks to Impact (Ft) UNKNOWN 94 - Vehicle Damage UNKNOWN 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 UNKNOWN 46 - Vehicle Owner Last Name UNKNOWN 46 - First Name 46 - Middle Initial 46 - Suffix Date Of Birth 46 - Company Name 47- Address Street & Number 47 - PO Box 48 - City 48 - State 48 - 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 Accident Report of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZJ2865 3 5 School Bus 02 BU S 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 105 - Photos By DI A G R A M A N D N A R R A T I V E Diagram and Narrative DEPUTY AMBER AL-MOGHRABI ON DECEMBER 5, 2016, I WAS ADVISED TO CALL VICTORIA RICE REFERENCE A HIT AND RUN. UPON CALLING VICTORIA, SHE STATED AT APPROXIMATELY 11:30 AM SHE WAS TRAVELING NORTHBOUND ON STATE HIGHWAY 27. SHE STATED THERE WAS A FEDEX TRUCK PARKED ON THE SIDE OF THE ROAD AT A DRIVEWAY DELIVERING BOXES. SHE STATED SHE WAS UNSURE OF THE EXACT LOCATION, BUT THE TRUCK WAS TAKING UP A SMALL PORTION OF THAT LANE. VICTORIA INFORMED ME THAT ALL THE OTHER CARS WERE GOING AROUND THE TRUCK SO SHE DID TOO. SHE STATED AT THE TIME SHE DID, THERE WAS A TAN VAN THAT WAS TRAVELING SOUTHBOUND AND SIDE SWIPED THE DRIVER SIDE OF HER VEHICLE. SHE STATED THE OTHER VEHICLE DID NOT SLOW DOWN WHEN THEY SAW THE TRUCK AND EVERYONE PASSING. VICTORIA SAID SHE STOPPED TO LOOK AT THE DAMAGE ON HER VEHICLE, BUT THE OTHER CAR KEPT GOING. VICTORIA STATED SHE WAS WEARING HER SEATBELT AND WAS NOT INJURED. I INFORMED VICTORIA THAT I WOULD HAVE TO COME TO HER HOUSE AND TAKE PICTURES OF HER VEHICLE. I ARRIVED AT 7492N HIGHLAND ROAD AND TOOK PICTURES. I NOTICED THERE WAS MINOR DAMAGE TO THE DRIVER SIDE OF THE VEHICLE. THE SIDE VIEW MIRROR WAS SHATTERED AND THERE WAS A SMALL CRACK IN HER DRIVER SIDE FRONT WINDOW. I INFORMED VICTORIA TO GET AN ESTIMATE ON HER CAR AND TO CONTACT HER INSURANCE COMPANY. I ALSO INFORMED HER IF SHE SAW THE TAN VAN AROUND THE AREA WITH DAMAGE TO THE DRIVER SIDE TO GET THE LICENSE PLATE NUMBER AND CONTACT THE SAWYER COUNTY SHERIFF'S DEPARTMENT. I ENTERED THE PICTURES INTO EVIDENCE AND CLEARED THE CALL AT 14:23. ON DECEMBER 5, 2016, I WAS ADVISED TO CALL VICTORIA RICE REFERENCE A HIT AND RUN. UPON CALLING VICTORIA, SHE STATED AT APPROXIMATELY 11:30 AM SHE WAS TRAVELING NORTHBOUND ON STATE HIGHWAY 27. SHE STATED THERE WAS A FEDEX TRUCK PARKED ON THE SIDE OF THE ROAD AT A DRIVEWAY DELIVERING BOXES. SHE STATED SHE WAS UNSURE OF THE EXACT LOCATION, BUT THE TRUCK WAS TAKING UP A SMALL PORTION OF THAT LANE. VICTORIA INFORMED ME THAT ALL THE OTHER CARS WERE GOING AROUND THE TRUCK SO SHE DID TOO. SHE STATED AT THE TIME SHE DID, THERE WAS A TAN VAN THAT WAS TRAVELING SOUTHBOUND AND SIDE SWIPED THE DRIVER SIDE OF HER VEHICLE. SHE STATED THE OTHER VEHICLE DID NOT SLOW DOWN WHEN THEY SAW THE TRUCK AND EVERYONE PASSING. VICTORIA SAID SHE STOPPED TO LOOK AT THE DAMAGE ON HER VEHICLE, BUT THE OTHER CAR KEPT GOING. VICTORIA STATED SHE WAS WEARING HER SEATBELT AND WAS NOT INJURED. I INFORMED VICTORIA THAT I WOULD HAVE TO COME TO HER HOUSE AND TAKE PICTURES OF HER VEHICLE. I ARRIVED AT 7492N HIGHLAND ROAD AND TOOK PICTURES. I NOTICED THERE WAS MINOR DAMAGE TO THE DRIVER SIDE OF THE VEHICLE. THE SIDE VIEW MIRROR WAS SHATTERED AND THERE WAS A SMALL CRACK IN HER DRIVER SIDE FRONT WINDOW. I INFORMED VICTORIA TO GET AN ESTIMATE ON HER CAR AND TO CONTACT HER INSURANCE COMPANY. I ALSO INFORMED HER IF SHE SAW THE TAN VAN AROUND THE AREA WITH DAMAGE TO THE DRIVER SIDE TO GET THE LICENSE PLATE NUMBER AND CONTACT THE SAWYER COUNTY SHERIFF'S DEPARTMENT. I ENTERED THE PICTURES INTO EVIDENCE AND CLEARED THE CALL AT 14:23. Officer Information Accident Report of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZJ2865 4 5 OF F I C E R I N F O R M A T I O N 125 - First Name 125 - Middle Initial ALMOGHRABI 125 - Officer Last Name AMBER 340 131 - 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 12/05/2016 132 - Date Notified 1306133 - Time Notified (Military Time)1331134 - Time Arrived (Military Time) 12/06/2016 135 - Date Of Report 16120516173 16120503 19 - Special Study 18 - Agency Space Accident Report of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZJ2865 5 5