20170512 Hammerel17051205895
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJZ Wisconsin Motor Vehicle
Crash Report
Secondary
CrashAmendedCrash Type
Private Property/Parking LotReportable
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
09:52 AM
Date Notified
05/12/2017
Time Arrived
10:00 AM
Date Arrived
05/12/2017
Crash Time
09:45 AM
Crash Date
05/12/2017
Investigating Officer/Deputy
DEPUTY AMBER ALMOGHRABI
Agency Crash Number
17051201
Primary Crash Document #Document Number Override
6V
L
1
3
W
8
H
J
Z
Additional InformationPhotos
Photos ByDEPUTY AMBER AL-MOGHRABI
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON MAY 12, 2017, I, DEPUTY AMBER AL-MOGHRABI WAS WORKING PATROL FOR THE SAWYER COUNTY SHERIFF'S DEPT. AT APPROXIMATELY 9:52 I WAS DISPATCHED TO THE HAYWARD AREA MEMORIAL HOSPITAL PARKING LOT TO MEET WITH MITCH RICE REFERENCE ANOTHER VEHICLE
HITTING HIS PARKED MOTORCYCLE. UPON ARRIVAL AT 10:00 I MET WITH MITCH WHO STATED THAT HE WAS IN THE HOSPITAL AND WHEN HE CAME
OUT HE NOTICED THAT HIS SON'S MOTORCYCLE THAT HE WAS DRIVING HAD BEEN MOVED. MITCH STATED THAT HE NOTICED A WHITE PIECE OF
PAPER STICKING OUT OF THE MOTORCYCLE THAT HAD AN INSURANCE CARD ATTACHED TO IT. HE STATED THAT THE PAPER GAVE A NAME OF
JAY HAMMEREL AND A PHONE NUMBER AND ALL HIS INSURANCE INFORMATION. I TOOK PICTURES OF THE MOTORCYCLE WHICH HAD MINOR
DAMAGE TO THE WHOLE LEFT SIDE. I WILL PLACE THOSE PHOTOGRAPHS INTO EVIDENCE. AT THIS TIME LORETTA HAMMEREL CAME OUT TO SPEAK WITH US. SHE STATED THAT SHE WORKED IN THE HOSPITAL AND THAT HER HUSBAND CALLED HER TO TELL HER WHAT HAPPENED. SHE
STATED THAT HE HAD LEFT NOT KNOWING HOW TO GET A HOLD OF THE OWNER OF THE MOTORCYCLE SO LEFT HIS INFORMATION FOR HIM.
LORETTA SAID THAT HER HUSBAND, JAY, WAS BACKING OUT OF HIS PARKING SPOT AND HIS THE MOTORCYCLE. I INFORMED BOTH PARTIES TO
CONTACT THEIR INSURANCE COMPANIES TO LET THEM KNOW WHAT WAS GOING ON AND THAT I WOULD BE DOING AN MV4000 AND A REPORT IF
THEIR INSURANCE NEEDED IT. NEITHER PARTIES HAD ANY FURTHER QUESTIONS. I CLEARED THE CALL AT 10:14.
Crash Time 09:45 AM
Crash Date 05/12/2017This report does not include any CJIS data.
6of1
Wisconsin Motor Vehicle Crash
Form DT4000
17051205895
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJZ Wisconsin Motor Vehicle
Crash Report
Structure Type
House/Building
Y Coordinate
5107552
X Coordinate
152921.125
Longitude
-91.485218043
Latitude
46.033454786
ON 11040 HOSPITAL DR
941 FT E
OF STH27 NB
(HOUSE/BUILDING 11040)
IN THE TOWN OF HAYWARD
IN 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)
Clear
Environment Factor(s)
None
Roadway Factor(s)
None
Road Surface Condition(s)
Dry
Light Condition
Daylight
Manner of Collision
07--Rear To Side
First Harmful Event Location
In Parking Lane or Zone
First Harmful Event
Parked Motor Vehicle
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
Level
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
Parked Motor Vehicle
Total Lanes
0
Speed Limit
10Pre 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
01
Unit Summary
Extent Of Damage
No Damage
Vehicle Damage
No Damage
Initial Contact Point
6--Rear
Bus UseNot A BusBody Style
PK - PICKUP
Color
TAN - Tan
Model
RAM 2500
Year
2005
Make
DODGE
Vehicle Identification Number
2944
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
JD1965
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 09:45 AM
Crash Date 05/12/2017This report does not include any CJIS data.
6of2
Wisconsin Motor Vehicle Crash
Form DT4000
17051205895
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJZ Wisconsin Motor Vehicle
Crash Report
Driver DistractionsUnknown If Distracted
Driver Actions
No Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Backing
Vehicle Removed By
OWNER
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
01
Address
HAYWARD, WI 54843 , US
IndividualJAY A HAMMEREL01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventParked Motor Vehicle01
Event
02
Event
03
Event
04
Individual
LORETTA HAMMEREL
Insurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UN
I
T
Crash Time 09:45 AM
Crash Date 05/12/2017This report does not include any CJIS data.
6of3
Wisconsin Motor Vehicle Crash
Form DT4000
17051205895
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJZ Wisconsin Motor Vehicle
Crash Report
Individual Condition
Not Observed
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
RaceWHITEDate of Birth
06/20/
Sex
Male
Citations Issued
0
DriverJAY A HAMMEREL
IN
D
I
V
I
D
U
A
L
UN
I
T
Drug &
Alcohol
Injury
Equipment
Non Motorist
Individual
Crash Time 09:45 AM
Crash Date 05/12/2017This report does not include any CJIS data.
6of4
Wisconsin Motor Vehicle Crash
Form DT4000
17051205895
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJZ 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
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 Limit
10Pre 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
0
Operating As EndorsementsVehicle Type
Motorcycle
Unit Type
Motorcycle
Vehicle Operating As Classification
M CLASS
Unit Status
Legally Parked
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
7--Left Rear Corner, 8--Left Side Rear, 9--Left Side Middle, 10--Left Side Front,
11--Left Front Corner
Initial Contact Point
9--Left Side Middle
Bus UseNot A BusBody Style
RC - RACER
Color
RED - Red
Model
CBR650F
Year
2014
Make
HONDA
Vehicle Identification Number
01325
Country of Issuance
UNITED STATES
St
WI
Plate Type
CYC - Cycle
License Plate Number
632BL
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
CHIPPEWA FALLS, WI 54729 , US
IndividualDAKOTA M LEWIT02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Crash Time 09:45 AM
Crash Date 05/12/2017This report does not include any CJIS data.
6of5
Wisconsin Motor Vehicle Crash
Form DT4000
17051205895
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13W8HJZ Wisconsin Motor Vehicle
Crash Report
Event
02
Event
03
Event
04
Individual
MITCHELL RICE
Insurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UN
I
T
Crash Time 09:45 AM
Crash Date 05/12/2017This report does not include any CJIS data.
6of6
Wisconsin Motor Vehicle Crash
Form DT4000