20161217 KobackGZHQM9J 41Wisconsin Motor Vehicle
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79 - E M S Number103
Measurements Taken
102
Witness Statements
101
Supplemental Reports
9
Names Exchanged
9
Construction Zone
9
Load Spillage
9
Truck, Bus, or Hazardous Materials
9
Trailer or Towed
9
Photos Taken
9
Fire
9
Government Property
9
Hit and Run
118 - Weather
Cloudy
116 - Road Surface Condition
Snow/Slush
114 - Light Condition
Dark-Not-Lighted
117 - Relation To Roadway
Outside-Shoulder-Left
115 - Traffic Way
Not-Physically-Divided-(2-Way Traffic)
Surface Type
Blacktop, Bituminous, or Asphalt - 2
113 - Road Terrain
Hill
113 - Road Curvature
Curve
112 - Access Control
No Control
93 - Manner of Collision
No Collision with Motor Vehicle in Transport
80 - First Harmful Event
Utility Pole
13 - Longitude-90.9609681379712 - Latitude
45.945868357443
17 - Structure Number17 - Structure Type
16 - Business/Frontage/Ramp16 - From/At Street Name
BARKER LAKE RD
16 - Fr/At Hwy No.
15 - Hwy. DirEAST15 - Est. Distance243 Ft
14 - Bus/Frnt/Rmp14 - On Street Name
LOG LODGE RD
14 - On Hwy No.
11 - Accident LocationNon-Intersection3 - Municipality
WINTER - 17, Town
2 - County
SAWYER - 57
8 - Total Killed
00
7 - Total Injured
00
6 - Total Units
01
5 - Time of Accident (Military Time)
2120
4 - Accident Date
12/17/2016
Document Override NumberDOT Document Number
GZHQM9JAmendedOn EmergencyReportable Accident
GE
N
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Police Number
PO
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AC
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Agency Accident Number
01
91 - Drugs Reported
91 - Drug Test
Test Not Given
90 - Alcohol Content90 - Alcohol TestTest Not Given
89 - Substance Presence
Unknown88 - Driver or Pedestrian CondNot Observed
122 - Driver Factors
Not-Applicable
64 - 5th Statute No.64 - 4th Statute No.64 - 3rd Statute No.64 - 2nd Statute No.64 - 1st Statute No.
62 - No. of Citations Issued0120 - Traffic Control
No-Control
119 - What Driver Was Doing
NEGOTIATING CURV
92 - Pedestrian Action92 - Pedestrian Location43 - Trapped/ExtricatedNot-Trapped
Medical Transport
4442 - Ejected
Not-Ejected
41 - Airbag
Non-Deployed
38 - Injury Severity
N - No Apparent Injury
40 - Safety EquipmentShoulder-Belt-And-Lap-Belt-Used39 - Seat PositionFront-Seat-Left-Side-(MC/Bike Driver, Train Conductor)
28 - Telephone Number
.
27 - Zip Code
54896
27 - State
WI
27 - City
WINTER
26 - PO Box26 - Address Street & Number
33 - Sex
Male
32 - Date Of Birth
06/17/
25 - Suffix25 - Middle InitialJ25 - First NameTIMOTHY25 - Operator/Pedestrian Last NameKOBACK
34 - On Duty Accident31 - Expiration Year
2024
30 - State
WI
29 - Driver's License Number
Operating Commercial Motor Vehicle3537 - Endorsements36 - Operating as ClassifiedD CLASS
24 - Speed Limit45
23 - Dir Of Travel
WEST
81 - Most Harmful Event: Collision With
Utility Pole
Unit Status
OP
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P
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N
Operator/Pedestrian
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School District Contracted With
Seating CapacityBody MakeSchool NameBus Travelling to/from
To From
BU
S
01
01
01
01
61 - Policy Holder Company
61 - Policy Holder First Name
TIMOTHY
61 - Policy Holder Last Name
KOBACK
60
Policy Holder Same As Owner
63 - Liability Insurance Company
UNKNOWN
49 - Telephone Number48 - Zip Code
5489648 - StateWI
48 - City
WINTER
47 - PO Box47- Address Street & Number
46 - Company Name
Date Of Birth
06/17/
46 - Suffix46 - Middle Initial
J
46 - First Name
TIMOTHY
46 - Vehicle Owner Last Name
KOBACK
Vehicle Owner Same As Operator
45
123 - Vehicle Factors
Not-Applicable
97 - Vehicle Removed By96
Vehicle Towed Due To Damage
95 - Extent Of Damage
Moderate
94 - Vehicle Damage
Front Driver Side, Front, Front Passenger Side
100 - Skidmarks to Impact (Ft)0
54 - Color
TAN
53 - Body Style
4D - 4DR
52 - Model
IMPALA
51 - Make
CHEV
50 - Year
2002
55 - Vehicle Identification Number428059 - Exp Year201758 - StateWI57 - Plate TypeAUT56 - License Plate Number992YEN
22 - Total Occupants
1
Vehicle Type
Passenger-Car
21 - Unit Type
Automobile
124 - Highway Factors
Snow,-Ice,-or-Wet
IN
S
School Bus
Insurance
Vehicle Owner
Vehicle
VE
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N
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Vehicle Identification NumberUnit TypeTrailer Make
Expiration YearStatePlate TypeLicense Plate Number106 - Power Unit Number
TR
L
01
Trailer
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82 - Object Struck82 - Striking Unit82 - Object Struck82 - Striking Unit
82 - Object Struck82 - Striking Unit82 - Object Struck82 - Striking Unit
82 - Object Struck82 - Striking Unit82 - Object Struck
Utility-Pole
82 - Striking Unit
01
83 - Government Damage Tag Number
87 - Telephone Number
.
86 - Zip Code
54867
86 - State
WI
86 - City
RADISSON
85 - PO Box85 - Address Street & Number
Government Property Type84 - Company Name
NORTH CENTRAL POWER CO
01
84 - Suffix84 - Middle Initial84 - First Name84 - Property Owner Last NameOrganization Type
Organization/Compa
Property
PR
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Fixed Objects Struck
Diagram and Narrative
DI
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105 - Photos By
ON DECEMBER 17, 2016, I, DEPUTY RYAN SCHICK WITH THE SAWYER COUNTY SHERIFF'S DEPT WAS ASKED BY DISPATCH TO
RESPOND NEAR THE ADDRESS W5579 LOG LODGE RD FOR A VEHICLE THAT HIT A POWER POLE AT 2120. DISPATCH ADVISED
THERE WAS NO ONE AROUND THE VEHICLE AND THAT AN EMPLOYEE OF NORTH CENTRAL POWER CO CALLED IT IN. THE COMPLAINANT SAID THERE WAS STILL POWER TO THE POLE AND THAT IT DIDN'T APPEAR TI BE BROKEN. I ARRIVED ON SCENE AT
2217. I RAN WI REGISTRATION 992YEN THROUGH DISPATCH. IT CAME BACK CURRENT AND CLEAR ON A 2002 CHEVROLET IMPALA
TAN TO A TIMOTHY J. KOBACK. I CONFIRMED NO ONE WAS NEAR OR AROUND THE VEHICLE. A TOW, ROADRUNNER, WAS EN
ROUTE TO TEH SCENE. I WITNESSED MODERATE DAMAGE TO THE FRONT AND FENDERS OF THE VEHICLE. I ASKED DISPATCH
FOR A PHONE NUMBER FOR KOBACK. DISPATCH GAVE ME ONE THAT WAS HIS DAUGHTERS. I CALLED HIS DAUGHTER AND SHE
STATED HE WAS AT HIS HOUSE AT 6988 CIRCLE B RD AND HE WAS OKAY. ONCE THE TOW REMOVED THE VEHICLE I RESPONDED TO HIS ADDRESS ON CIRCLE B. KOBACK SAID THE ROAD WAS SLIPPERY AND HE SLID OFF AND HIT THE POLE. KOBACK SAID HE
WAS GOING TO REMOVE THE CAR TOMORROW BUT I SAID IT HAS BEEN ALREADY TOWED. HE SAID OKAY. I CONFIRMED KOBACK
WAS OKAY AND UN-INJURED. I WAS CLEAR FROM THE CALL AT APPROXIMATELY 2328. PLEASE SEE SWSO CASE #: 16121705 FOR
MORE DETAILS.
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18 - Agency Space
19 - Special Study
135 - Date Of Report
12/18/2016
134 - Time Arrived (Military Time)2217133 - Time Notified (Military Time)2132132 - Date Notified
12/18/2016
128 - Telephone Number(715) 634-4858 Ext.127 - Zip Code54843127 - StateWI127 - CityHAYWARD
126 - Law Enforcement Agency Address Street & Number
15880 EAST FIFTH STREET
130 - Law Enforcement Agency NameSAWYER COUNTY SHERIFFS DEPT129 - Law Enforcement Agency No.
131 - Officer ID
351RYAN
125 - Officer Last Name
SCHICK
Officer Information
125 - Middle Initial125 - First Name
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