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20170724 Nelson Moe17072403 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL12XVN04 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 11:28 AM Date Notified 07/24/2017 Time Arrived 11:43 AM Date Arrived 07/24/2017 Crash Time 11:25 AM Crash Date 07/24/2017 Investigating Officer/Deputy DEPUTY KEVIN GILLIS Agency Crash NumberPrimary Crash Document #Document Number Override 6V L 1 2 X V N 0 4 Additional InformationNone Photos By Reconstruction ByDiagram Description Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. WASHBURN COUNTY HIGHWAY DEPARTMENT WAS PAINTING LINES ON STATE HWY 27 AT THE INTERSECTION OF COUNTY HWY K. ONE OF THE HIGHWAY DEPARTMENT TRUCK, OPERATED BY TURNER MOE, NEEDED TO BACK UP, BUT DID NOT SEE THE MINI COOPER, DRIVEN BY JANET NELSON, THAT WAS BEHIND HIM. MR. MOE BACKED INTO MS. NELSON'S VEHICLE CAUSING VERY MINOR DAMAGES TO BOTH VEHICLES. Crash Time 11:25 AM Crash Date 07/24/2017Wisconsin Motor Vehicle Crash Form DT4000 1 of 9 This report does not include any CJIS data. 17072403 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL12XVN04 Wisconsin Motor Vehicle Crash Report Structure Type No Structure Y Coordinate 5094363.5 X Coordinate 151230.484375 Longitude -91.497388702 Latitude 45.91425954 ON STH27 NB 57 FT S OF CTHK IN THE TOWN OF BASS LAKE IN SAWYER COUNTY Location 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) Clear Environment Factor(s) None Roadway Factor(s) None Road Surface Condition(s) Dry Light Condition Daylight Manner of Collision 02--Front To Rear First Harmful Event Location On Roadway First Harmful Event Motor Veh In Transport Crash Scene Intersection Type T-Intersection Junction Location Intersection-Related Within Interchange Area NO Normal Posted Speed Limit 55 Advisory/Regulatory Speed Limit Regulatory Work Zone Speed Limit 55 Law Enforcement Present No Workers Present YES Work Zone Crash Type Work on Shoulder or Median Work Zone Crash Location Transition Area 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 Northbound Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # InjuredTotal Occs 2 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 Model COOPER Year 2013 Make MINI Vehicle Identification Number 517 Country of Issuance UNITED STATES St WI Plate Type TMP - Temporary Plate License Plate Number N8990J01 Vehicle Crash Time 11:25 AM Crash Date 07/24/2017Wisconsin Motor Vehicle Crash Form DT4000 2 of 9 This report does not include any CJIS data. 17072403 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL12XVN04 Wisconsin Motor Vehicle Crash Report Driver DistractionsNot Distracted Driver ActionsFollowing Too Close Driver Prior Action Other Vehicle Factors Not Applicable What Driver Was Doing Going Straight Vehicle Removed ByTowed Due To Damage Not Towed VE H I C L E UN I T 01 Extent Of Damage Minor Damage Vehicle Damage 12--Front Initial Contact Point 12--Front Bus UseNot A BusBody Style SW - STATIONWAGON Color BRO - Brown VE H I C L E UN I T Address ELK MOUND, WI 54739 , US IndividualJANET E NELSON01 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 JANET NELSON Insurance Company STATE-FARM-GENERAL-INS-CO Policy Holder UN I T Crash Time 11:25 AM Crash Date 07/24/2017Wisconsin Motor Vehicle Crash Form DT4000 3 of 9 This report does not include any CJIS data. 17072403 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL12XVN04 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 ELK MOUND, WI 54739 , US RaceWHITEDate of Birth 01/01 Sex Female Citations Issued 0 DriverJANET E NELSON IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment Crash Time 11:25 AM Crash Date 07/24/2017Wisconsin Motor Vehicle Crash Form DT4000 4 of 9 This report does not include any CJIS data. 17072403 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL12XVN04 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 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 3--Front Seat-Right Side (Train Engineers/Right 00 2 Safety Equipment Shoulder & Lap Belt On Duty Crash 01 ber State: Wisconsin Country: UNITED STATES Address ELK MOUND, WI 54739 , US RaceWHITEDate of Birth 08/15/1 Sex Female Citations Issued 0 PassengerDEBRA K OBERMEYER IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment Crash Time 11:25 AM Crash Date 07/24/2017Wisconsin Motor Vehicle Crash Form DT4000 5 of 9 This report does not include any CJIS data. 17072403 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL12XVN04 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 UseNon-Emergency, Non-TransportSpecial FunctionNo Special FunctionMost Harmful Event: Collision With Motor Veh In Transport Total Lanes 2 Speed Limit 55Pre 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 Straight Truck (Insert Truck) Unit Type Truck Vehicle Operating As Classification A CLASS Unit Status In Transit UN I T 02 Unit Summary Driver DistractionsLooked But Did Not See Driver ActionsNo Contributing Action Driver Prior Action Other Vehicle Factors Not Applicable What Driver Was Doing Backing Vehicle Removed ByTowed Due To Damage Not Towed VE H I C L E UN I T 02 Extent Of Damage Minor Damage Vehicle Damage 6--Rear Initial Contact Point 6--Rear Bus UseNot A BusBody Style OT - OTHER Color RED - Red Model NO DATA Year 2007 Make STERLING Vehicle Identification Number 1021 Country of Issuance UNITED STATES St WI Plate Type MUN - Municipal License Plate Number 70870 VE H I C L E UN I T 02 Vehicle Address SPOONER, WI 54801 , US GovernmentWASHBURN COUNTY HIGHWAY DEPT02 VE H I C L E OW N E R Vehicle Owner Sequence Of Events EventMotor Veh In Transport01 Crash Time 11:25 AM Crash Date 07/24/2017Wisconsin Motor Vehicle Crash Form DT4000 6 of 9 This report does not include any CJIS data. 17072403 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL12XVN04 Wisconsin Motor Vehicle Crash Report Event 02 Event 03 Event 04 Government WASHBURN COUNTY HIGHWAY DEPT Insurance Company COUNTRY-MUTUAL-INSURANCE-CO Policy Holder UN I T Crash Time 11:25 AM Crash Date 07/24/2017Wisconsin Motor Vehicle Crash Form DT4000 7 of 9 This report does not include any CJIS data. 17072403 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL12XVN04 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 3 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 3 Safety Equipment Shoulder & Lap Belt On Duty Crash 02 ber State: Wisconsin Country: UNITED STATES Address SHELL LAKE, WI 54871 , US RaceWHITEDate of Birth 03/04 Sex Male Citations Issued 0 DriverTURNER J MOE IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment US GovernmentWASHBURN COUNTY HIGHWAY DEPARTMENT PR O P OW N E R 01 Property Owner Fixed Objects Struck Crash Time 11:25 AM Crash Date 07/24/2017Wisconsin Motor Vehicle Crash Form DT4000 8 of 9 This report does not include any CJIS data. 17072403 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL12XVN04 Wisconsin Motor Vehicle Crash Report Damage Tag NumberStruck Object Other Object - Not Fixed Striking Unit 0201 Crash Time 11:25 AM Crash Date 07/24/2017Wisconsin Motor Vehicle Crash Form DT4000 9 of 9 This report does not include any CJIS data.