20170522 Gougar Bowser17052202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN02 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
01:39 PM
Date Notified
05/22/2017
Time Arrived
02:04 PM
Date Arrived
05/22/2017
Crash Time
01:37 PM
Crash Date
05/22/2017
Investigating Officer/Deputy
DEPUTY KEVIN GILLIS
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
2
X
V
N
0
2
Additional InformationPhotos
Photos ByDEPUTY KEVIN GILLIS
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS TRAVELING WEST ON HOSPITAL RD CROSSING US HWY 63 WHEN HE STRUCK UNIT 2 WHO WAS TRAVELING SOUTH ON US HWY 63. UNIT 1 DID STOP AT THE STOP SIGN, BUT DID NOT SEE UNIT 2 WHEN HE PROCEEDED INTO THE INTERSECTION.
Structure Type
Y Coordinate
5106716
X Coordinate
154652.578125
Longitude
-91.462306736
Latitude
46.026826425
INTERSECTION
ON USH63 SB
AT HOSPITAL RD
IN THE TOWN OF HAYWARD
IN SAWYER COUNTY
Location
Crash Time 01:37 PM
Crash Date 05/22/2017This report does not include any CJIS data.
7of1
Wisconsin Motor Vehicle Crash
Form DT4000
17052202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN02 Wisconsin Motor Vehicle
Crash Report
Special StudyAccess Control
Partial 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)
None
Road Surface Condition(s)
Dry
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
Four-Way Intersection
Junction Location
Intersection
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
Stop Sign
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
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
Driver Actions
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed01
Extent Of Damage
Functional Damage
Vehicle Damage
1--Right Front Corner, 12--Front
Initial Contact Point
1--Right Front Corner
Bus UseNot A BusBody Style
4D - 4DR
Color
SIL - Silver (Aluminum)
Model
GRAND PRIX
Year
2005
Make
PONTIAC
Vehicle Identification Number
21464
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
454ZNG
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 01:37 PM
Crash Date 05/22/2017This report does not include any CJIS data.
7of2
Wisconsin Motor Vehicle Crash
Form DT4000
17052202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN02 Wisconsin Motor Vehicle
Crash Report
Driver DistractionsUnknown If Distracted
No Contributing Action
VE
H
I
C
L
E
UN
I
T
Address15470 PINEWOOD DR #66
HAYWARD, WI 54843 , US
IndividualBRANDON W GOUGAR01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Event
02
Event
03
Event
04
Individual
BRANDON GOUGAR
Insurance Company
DAIRYLAND-INS-CO
Policy Holder
UN
I
T
Crash Time 01:37 PM
Crash Date 05/22/2017This report does not include any CJIS data.
7of3
Wisconsin Motor Vehicle Crash
Form DT4000
17052202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN02 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
RaceWHITEDate of Birth
05/24
Sex
Male
Citations Issued
0
DriverBRANDON W GOUGAR
IN
D
I
V
I
D
U
A
L
UN
I
T
Drug &
Alcohol
Injury
Equipment
Non Motorist
Individual
Crash Time 01:37 PM
Crash Date 05/22/2017This report does not include any CJIS data.
7of4
Wisconsin Motor Vehicle Crash
Form DT4000
17052202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN02 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
Divided Hwy W/O Traffic Barrier
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
Southbound
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
02
Unit Summary
Driver DistractionsNot Distracted
Driver ActionsNo Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
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
6--Rear, 7--Left Rear Corner
Initial Contact Point
7--Left Rear Corner
Bus UseNot A BusBody Style
TK - TRUCK
Color
BLK - Black
Model
F-150
Year
2014
Make
FORD
Vehicle Identification Number
7123
Country of Issuance
UNITED STATES
St
PA
Plate Type
AUT - Automobile
License Plate Number
ZJY2002
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
CARLISLE, PA 17013 , US
IndividualTHOMAS L BOWSER02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Crash Time 01:37 PM
Crash Date 05/22/2017This report does not include any CJIS data.
7of5
Wisconsin Motor Vehicle Crash
Form DT4000
17052202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN02 Wisconsin Motor Vehicle
Crash Report
Event
02
Event
03
Event
04
Individual
THOMAS BOWSER
Insurance Company
STATE-FARM-GENERAL-INS-CO
Policy Holder
UN
I
T
Crash Time 01:37 PM
Crash Date 05/22/2017This report does not include any CJIS data.
7of6
Wisconsin Motor Vehicle Crash
Form DT4000
17052202
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL12XVN02 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
nse Number
State: Pennsylvania Country: UNITED STATES
Address
CARLISLE, PA 17013 , US
RaceWHITEDate of Birth
10/26/
Sex
Male
Citations Issued
0
DriverTHOMAS L BOWSER
IN
D
I
V
I
D
U
A
L
UN
I
T
Drug &
Alcohol
Injury
Equipment
Non Motorist
Individual
Crash Time 01:37 PM
Crash Date 05/22/2017This report does not include any CJIS data.
7of7
Wisconsin Motor Vehicle Crash
Form DT4000