20170807 Kann BackmanSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VW 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
12:20 PM
Date Notified
08/07/2017
Time Arrived
12:34 PM
Date Arrived
08/07/2017
Crash Time
12:20 PM
Crash Date
08/07/2017
Investigating Officer/Deputy
DEPUTY JEFF CAIN
Agency Crash Number
17080703
Primary Crash Document #Document Number Override
6V
L
1
3
M
V
8
V
W
Additional InformationPhotos
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.
UNIT 1 WAS STOPPED IN THE EASTBOUND LANE OF HWY B WAITING A WESTBOUND CAR TO PASS SO IT COULD TURN NORTH ONTO HWY S WHEN UNIT 2, ALSO EASTBOUND, COLLIDED WITH UNIT 1. UNIT 2 HAD 105 FT OF SKID MARK PRIOR TO COLLISION. UNIT 1 LEFT TURN SIGNAL WAS STILL
OPERATING AFTER COLLISION.
Crash Time 12:20 PM
Crash Date 08/07/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 11
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VW Wisconsin Motor Vehicle
Crash Report
Structure Type
Y Coordinate
5098761
X Coordinate
180208.375
Longitude
-91.127676318
Latitude
45.967821326
INTERSECTION
ON CTHB
AT CTHS
IN THE TOWN OF HUNTER
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)
Clear
Environment Factor(s)
None
Roadway Factor(s)
None
Road Surface Condition(s)
Dry
Light Condition
Daylight
Manner of Collision
04--Rear 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
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
55Pre CrashTire
Mark
Direction Of Travel
Eastbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
4
Operating As EndorsementsVehicle Type
(Sport) Utility Vehicle
Unit Type
Automobile
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
UT - SPORT UTILITY VEHICLE
Color
GRY - Gray
Model
SUBURBAN
Year
2007
Make
CHEVROLET
Vehicle Identification Number
1GNFK16307J288836
Country of Issuance
UNITED STATES
St
IL
Plate Type
AUT - Automobile
License Plate Number
G877398
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 12:20 PM
Crash Date 08/07/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 11
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VW Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
Driver Actions
No Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Stop In Traffic
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
01
Address16 BLUEHILL CT
MARCO ISLAND, FL 34145 , US
IndividualKARL F KANN
(847) 529-675401
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
KARL KANN
Insurance Company
INS-CO-OF-THE-STATE-OF-PENNSYLVANIA-(C/O
Policy Holder
UN
I
T
Crash Time 12:20 PM
Crash Date 08/07/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 11
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VW 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
Driver License NumberK5005066706508
State: Florida Country: UNITED STATES
Address858 E JANICE CT
LA CROSSE, WI 54601 , US
RaceWHITEDate of Birth
02/25/1967
Sex
Male
Citations Issued
0
DriverKARL F KANN
(847) 529-6754
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:20 PM
Crash Date 08/07/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 11
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VW 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
4--Second Seat-Left Side(Motorcycle/Bicycle Pa
00
2
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
Driver License NumberAddress
MARCO ISLAND, FL 34145 , US
RaceWHITEDate of Birth
03/24/1
Sex
Female
Citations Issued
0
PassengerSTEPHANIE J KANN
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:20 PM
Crash Date 08/07/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 11
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VW 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
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
3
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
Driver License NumberAddress
ONALASKA, WI 54650 , US
RaceWHITEDate of Birth
07/15/
Sex
Male
Citations Issued
0
PassengerBJORN BACKMAN
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:20 PM
Crash Date 08/07/2017Wisconsin Motor Vehicle Crash
Form DT4000 6 of 11
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VW 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
4
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
6--Second Seat-Right Side
00
4
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
Driver License NumberAddress
ONALASKA, WI 54650 , US
RaceWHITEDate of Birth
03/24
Sex
Female
Citations Issued
0
PassengerMICHELLE J BACKMAN
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:20 PM
Crash Date 08/07/2017Wisconsin Motor Vehicle Crash
Form DT4000 7 of 11
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VW 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
55Pre CrashTire
Mark
Direction Of Travel
Eastbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
1
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
02
Unit Summary
Driver DistractionsDistraction/Inattention
Driver ActionsOperated Motor Vehicle In Inattentive, Careless or Erratic Manner
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
Minor Damage
Vehicle Damage
5--Right Rear Corner
Initial Contact Point
5--Right Rear Corner
Bus UseNot A BusBody Style
4D - 4DR
Color
RED - Red
Model
GRAND AM
Year
2003
Make
PONTIAC
Vehicle Identification Number
5706
Country of Issuance
UNITED STATES
St
MN
Plate Type
AUT - Automobile
License Plate Number
772VTN
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
RED WING
REDWING, MN 55066 , US
IndividualLANE MICHAEL JABLONSKE02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Crash Time 12:20 PM
Crash Date 08/07/2017Wisconsin Motor Vehicle Crash
Form DT4000 8 of 11
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VW Wisconsin Motor Vehicle
Crash Report
EventMotor Veh In Transport02
Event
03
Event
04
Individual
ELENA PIENTKA
Insurance Company
AMERICAN-FAMILY-INS-CO
Policy Holder
UN
I
T
Crash Time 12:20 PM
Crash Date 08/07/2017Wisconsin Motor Vehicle Crash
Form DT4000 9 of 11
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VW 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
5
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
5
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
02
mber
State: Minnesota Country: UNITED STATES
Address
GOODHUE, MN 55027 , US
RaceHISPANICDate of Birth
09/26/
Sex
Female
Citations Issued
1
DriverELENA MARIA PIENTKA
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 12:20 PM
Crash Date 08/07/2017Wisconsin Motor Vehicle Crash
Form DT4000 10 of 11
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL13MV8VW 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
6
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
4--Second Seat-Left Side(Motorcycle/Bicycle Pa
00
6
Safety Equipment
Booster Seat
On Duty Crash
02
Driver License NumberAddress
RED WING, MN 55066 , US
RaceHISPANICDate of Birth
05/13
Sex
Female
Citations Issued
0
PassengerKATARINA ROSE PELEHOS
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Violations
DescriptionINATTENTIVE DRIVINGSeq Num001Statute Number346.89(1)Issue To?
005
UTC Number
AE01461701
Crash Time 12:20 PM
Crash Date 08/07/2017Wisconsin Motor Vehicle Crash
Form DT4000 11 of 11
This report does not include any CJIS data.