20161205 RiceAgency Accident Number
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Reportable Accident On Emergency Amended GZJ2865
DOT Document Number Document Override Number
16120516173
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16120503
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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
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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
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZJ2865 1 5
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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
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MV4000e 01/2005
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PK2012
Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZJ2865 2 525
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Vehicle
Vehicle Owner
Insurance
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IN
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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
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Wisconsin Motor Vehicle GZJ2865 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
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
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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
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZJ2865 4 5
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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
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZJ2865 5 5