20170403 Coffman ShirriffSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14MH5JT 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
03:44 PM
Date Notified
04/03/2017
Time Arrived
03:59 PM
Date Arrived
04/03/2017
Crash Time
03:43 PM
Crash Date
04/03/2017
Investigating Officer/Deputy
DEPUTY AMANDA REED
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
4
M
H
5
J
T
Additional InformationPhotos
Photos ByDEPUTY AMANDA REED
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON APRIL 3RD, 2017, I, DEPUTY REED WAS WORKING A PATROL SHIFT FOR THE SAWYER COUNTY SHERIFFS OFFICE. AT APPROXIMATELY 1544, SAWYER DISPATCH REQUESTED I RESPOND TO THE LCO GRINDSTONE CASINO FOR A MINOR TWO VEHICLE ACCIDENT WHICH HAD OCCURRED IN
THEIR PARKING LOT. SAWYER DISPATCH ADVISED THERE WERE NO INJURIES. I ARRIVED ON SCENE AT APPROXIMATELY 1559. I OBSERVED TWO
DARK COLORED CHEVROLET TRUCKS IN THE PARKING LOT AND TWO MALES TALKING BY THE TRUCKS. I OBSERVED THAT ONE TRUCK, DRIVEN BY
MR. COFFMAN, HAD MINOR SCRATCHES JUST ABOVE THE BUMPER ON THE BACK LEFT SIDE. I OBSERVED THE OTHER TRUCK, DRIVEN BY MR.
SHIRRIFF, HAD A SMASHED IN RIGHT FRONT FENDER AND A CRACKED GRILL. BOTH SUBJECTS ADVISED THAT MR. COFFMAN HAD BACKED HIS
TRUCK INTO MR. SHIRRIFF'S TRUCK. I RELAYED THEIR DRIVERS LICENSE AND TRUCK REGISTRATIONS TO DISPATCH. BOTH VEHICLES WERE REGISTERED AND INSURED. BOTH MALES HAD VALID DRIVERS LICENSES. I BEGAN TAKING PHOTOS OF THE DAMAGE AND ADVISED MR. SHIRRIFF
TO CONTACT HIS INSURANCE COMPANY AS THE DAMAGE WAS REPORTABLE. I ADVISED MR. COFFMAN I WOULD BE MAILING HIM A CITATION FOR
INATTENTIVE DRIVING. MR. COFFMAN ADMITTED TO ME THAT HE WAS NOT LOOKING BEHIND HIM AS HE BACKED UP AND WAS INSTEAD WATCHING
A CAR PULLING INTO THE PARKING LOT.
Crash Time 03:43 PM
Crash Date 04/03/2017This report does not include any CJIS data.
7of1
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14MH5JT Wisconsin Motor Vehicle
Crash Report
Structure Type
House/Building
Y Coordinate
5097251
X Coordinate
160669.234375
Longitude
-91.378082275
Latitude
45.944892883
PARKING LOT
CTHK LOT 8575
(HOUSE/BUILDING 8575)
IN THE TOWN OF BASS LAKEIN SAWYER COUNTY
Location
Special StudyAccess Control
No Control
Tribal Land
Crash Classification - Jurisdiction
Private Property
Crash Classification - Location
Private Property
Relation To Trafficway
Non Trafficway - Parking Lot
Animal Type
Weather Condition(s)
Cloudy, Rain
Environment Factor(s)
None
Roadway Factor(s)
None
Road Surface Condition(s)
Wet
Light Condition
Daylight
Manner of Collision
No Collision W/Vehicle In Transport
First Harmful Event Location
Off Roadway, Location Unknown
First Harmful Event
Motor Veh Tran Other Rdwy
Crash Scene
Intersection Type
Not an Intersection
Junction Location
Non-Junction
Within Interchange Area
NO
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Unknown
Road Curvature
Straight
Surface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Parking Lot or Private Property
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh Tran Other Rdwy
Total Lanes
0
Speed LimitPre CrashTire
Mark
Direction Of Travel
Not On Roadway
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
1
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
01
Unit Summary
Extent Of Damage
Minor Damage
Vehicle Damage
6--Rear
Initial Contact Point
6--Rear
Bus UseNot A BusBody Style
2D - 2DR
Color
DGR - Green, Dark
Model
1500
Year
2004
Make
CHEVROLET
Vehicle Identification Number
9331
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
A806
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 03:43 PM
Crash Date 04/03/2017This report does not include any CJIS data.
7of2
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14MH5JT Wisconsin Motor Vehicle
Crash Report
Driver DistractionsDistraction/Inattention
Driver Actions
Operated Motor Vehicle In Inattentive, Careless or Erratic Manner
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Backing
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
01
Address
HAYWARD, WI 54843 , US
IndividualDOUGLAS W COFFMAN01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
EventParked Motor Vehicle02
Event
03
Event
04
Individual
DOUGLAS COFFMAN
Insurance Company
PROGRESSIVE-CLASSIC-INS-CO
Policy Holder
UN
I
T
Crash Time 03:43 PM
Crash Date 04/03/2017This report does not include any CJIS data.
7of3
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14MH5JT 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
HAYWARD, WI 54843 , US
RaceINDIANDate of Birth
11/07/
Sex
Male
Citations Issued
1
DriverDOUGLAS W COFFMAN
IN
D
I
V
I
D
U
A
L
UN
I
T
Drug &
Alcohol
Injury
Equipment
Non Motorist
Individual
Violations
DescriptionINATTENTIVE DRIVINGSeq Num001Statute Number346.89(1)Issue To?
001
UTC Number
V310574501
Crash Time 03:43 PM
Crash Date 04/03/2017This report does not include any CJIS data.
7of4
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14MH5JT Wisconsin Motor Vehicle
Crash Report
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Level
Road CurvatureSurface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Parking Lot or Private Property
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
0
Speed LimitPre CrashTire
Mark
Direction Of Travel
Not On Roadway
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 DistractionsNot Distracted
Driver ActionsNo Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Legally Parked
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
02
Extent Of Damage
Functional Damage
Vehicle Damage
1--Right Front Corner
Initial Contact Point
1--Right Front Corner
Bus UseNot A BusBody Style
PK - PICKUP
Color
BLK - Black
Model
K1500
Year
2015
Make
CHEVROLET
Vehicle Identification Number
8840
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
KS9790
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
HAYWARD, WI 54843 , US
IndividualJAMES W SHIRRIFF02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventParked Motor Vehicle01
Crash Time 03:43 PM
Crash Date 04/03/2017This report does not include any CJIS data.
7of5
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14MH5JT Wisconsin Motor Vehicle
Crash Report
EventMotor Veh Tran Other Rdwy02
Event
03
Event
04
Individual
JAMES SHIRRIFF
Insurance Company
PROGRESSIVE-CLASSIC-INS-CO
Policy Holder
UN
I
T
Crash Time 03:43 PM
Crash Date 04/03/2017This report does not include any CJIS data.
7of6
Wisconsin Motor Vehicle Crash
Form DT4000
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL14MH5JT 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
RaceINDIANDate of Birth
12/27/
Sex
Male
Citations Issued
0
DriverJAMES W SHIRRIFF
IN
D
I
V
I
D
U
A
L
UN
I
T
Drug &
Alcohol
Injury
Equipment
Non Motorist
Individual
Crash Time 03:43 PM
Crash Date 04/03/2017This report does not include any CJIS data.
7of7
Wisconsin Motor Vehicle Crash
Form DT4000