20171107 Mandli OsmundsonSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W3 Wisconsin Motor Vehicle
Crash Report
Secondary
CrashAmendedCrash Type
DT4000 (Standard Crash)Reportable
TagsSchool Bus Related
NoActive School ZoneGovernment
Property
Trailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
02
Time Notified
12:11 PM
Date Notified
11/09/2017
Time Arrived
12:24 PM
Date Arrived
11/09/2017
Crash Time
12:11 PM
Crash Date
11/09/2017
Investigating Officer/Deputy
DEPUTY JEFF CAIN
Agency Crash Number
17110907
Primary Crash Document #Document Number Override
6V
L
1
3
M
V
8
W
3
Additional InformationPhotos, Other Documents
Photos ByDEPUTY JEFF CAIN
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
THE DRIVER OF UNIT 1 WAS WESTBOUND ON SNOWFLAKE LANE, A PRIVATE RD, AND UPON APPROACHING THE INTERSECTION WITH MOSQUITO BROOK RD, COULD NOT STOP DUE TO THE ROAD CONDITION. UNIT 1 SLID INTO THE RIGHT FRONT SIDE OF UNIT 2 AS IT WAS PASSING BY
NORTHBOUND ON MOSQUITO BROOK RD
Crash Time 12:11 PM
Crash Date 11/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W3 Wisconsin Motor Vehicle
Crash Report
Structure Type
Y Coordinate
5109508.5
X Coordinate
159237.390625
Longitude
-91.405238789
Latitude
46.054179755
ON MOSQUITO BROOK RD
0.56 MI S
OF PHIPP'S FIRE LANE RD
IN THE TOWN OF LENROOT
IN SAWYER COUNTY
Location
Special StudyAccess Control
No Control
Tribal Land
Crash Classification - Jurisdiction
No Special Jurisdiction
Crash Classification - Location
Public Property
Relation To Trafficway
Trafficway - On Road
Animal Type
Weather Condition(s)
Cloudy
Environment Factor(s)
None
Roadway Factor(s)
Road Surface Condition (Wet, Icy, Snow, Slush, Etc)
Road Surface Condition(s)
Ice
Light Condition
Daylight
Manner of Collision
08--Front To Side
First Harmful Event Location
On Roadway
First Harmful Event
Motor Veh In Transport
Crash Scene
Intersection Type
T-Intersection
Junction Location
Intersection
Within Interchange Area
NO
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Level
Road Curvature
Straight
Surface Type
Dirt
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Two-Way, Not Divided
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
1
Speed Limit
N/APre CrashTire
Mark
Direction Of Travel
Westbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
Passenger Car
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
01
Unit Summary
Extent Of Damage
Functional Damage
Vehicle Damage
12--Front
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
UT - SPORT UTILITY VEHICLE
Color
WHI - White
Model
Q5
Year
2015
Make
AUDI
Vehicle Identification Number
8007
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
609ZLT
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 12:11 PM
Crash Date 11/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W3 Wisconsin Motor Vehicle
Crash Report
Driver DistractionsUnknown If Distracted
Driver Actions
Speed Too Fast/Cond
Driver Prior Action Other
Vehicle Factors
Tires
What Driver Was Doing
Slow/Stopping
Vehicle Removed By
A-1 TOWING
Towed Due To Damage
Towed Due To Disabling Damage
VE
H
I
C
L
E
UN
I
T
01
Address
HAYWARD, WI 54843 , US
IndividualMICHAEL JOHN MANDLI01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
EventMotor Veh Tran Other Rdwy02
Event
03
Event
04
Individual
MICHAEL MANDLI
Insurance Company
AMERICAN-FAMILY-INS-CO
Policy Holder
UN
I
T
Crash Time 12:11 PM
Crash Date 11/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W3 Wisconsin Motor Vehicle
Crash Report
Individual Condition
Appeared Normal
Drug Type
Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
Test Not Given
Suspected Drug UseSuspected Alcohol Use
Action Other
IN
D
I
V
I
D
U
A
L
UN
I
T
Action
To/From SchoolLocationPrior ActionStriking Unit #
00
1
01
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
Not Transported
Trapped/Extricated
Not Trapped
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Ejected
Airbag
Non Deployed
Injury Severity
No Apparent Injury
IN
D
I
V
I
D
U
A
L
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--Front Seat-Left Side (Driver/Motorcycle/Bicycl
00
1
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
ber
State: Wisconsin Country: UNITED STATES
Address
RaceWHITEDate of Birth
12/27/1
Sex
Male
Citations Issued
0
DriverMICHAEL JOHN MANDLI
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:11 PM
Crash Date 11/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W3 Wisconsin Motor Vehicle
Crash Report
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Level
Road Curvature
Straight
Surface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Two-Way, Not Divided
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
2
Speed Limit
45Pre CrashTire
Mark
Direction Of Travel
Northbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
Utility Truck/Pickup Truck
Unit Type
Truck
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
02
Unit Summary
Driver DistractionsUnknown If Distracted
Driver ActionsNo Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
Vehicle Removed By
OWNER
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
02
Extent Of Damage
Minor Damage
Vehicle Damage
1--Right Front Corner
Initial Contact Point
1--Right Front Corner
Bus UseNot A BusBody Style
PK - PICKUP
Color
WHI - White
Model
SIERRA K15
Year
2006
Make
GENERAL MOTORS COR
Vehicle Identification Number
8572
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
LC1721
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
HAYWARD, WI 54843 , US
IndividualROGER CLARE OSMUNDSON02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Crash Time 12:11 PM
Crash Date 11/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W3 Wisconsin Motor Vehicle
Crash Report
EventMotor Veh Tran Other Rdwy02
Event
03
Event
04
Individual
ROGER OSMUNDSON
Insurance Company
PROGRESSIVE-CASUALTY-INS-CO
Policy Holder
UN
I
T
Crash Time 12:11 PM
Crash Date 11/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 6 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8W3 Wisconsin Motor Vehicle
Crash Report
Individual Condition
Appeared Normal
Drug Type
Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
Test Not Given
Suspected Drug UseSuspected Alcohol Use
Action Other
IN
D
I
V
I
D
U
A
L
UN
I
T
Action
To/From SchoolLocationPrior ActionStriking Unit #
00
2
02
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
Not Transported
Trapped/Extricated
Not Trapped
Ejection Path
Not Ejected/Not Applicable
Ejected
Not Ejected
Airbag
Non Deployed
Injury Severity
No Apparent Injury
IN
D
I
V
I
D
U
A
L
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--Front Seat-Left Side (Driver/Motorcycle/Bicycl
00
2
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
02
ber
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceWHITEDate of Birth
05/19/
Sex
Male
Citations Issued
0
DriverROGER
(715) 634-8771
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:11 PM
Crash Date 11/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 7 of 7
This report does not include any CJIS data.