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20170810 Leair Prock17081002 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13KD6N2 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 04:57 PM Date Notified 08/10/2017 Time Arrived 05:03 PM Date Arrived 08/10/2017 Crash Time 04:55 PM Crash Date 08/10/2017 Investigating Officer/Deputy DEPUTY DARIN JENSEN Agency Crash NumberPrimary Crash Document #Document Number Override 6V L 1 3 K D 6 N 2 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. UNIT 1 AND UNIT 2 WERE BOTH TRAVELING NORTH. THE OPERATOR OF UNIT 2 STATED WHEN THEY LOOKED IN THEIR REAR VIEW MIRROR THEY SAW UNIT 1 TRAVELING VERY CLOSE TO THEM. UNIT 1 OPERATOR STATED THE FELT A "JAR" AND REALIZED UNIT 2 HAD REAR ENDED THEM. UNIT 1 HAD MODERATE TO SEVERE DAMAGE AND UNIT 1 HAD VERY MINOR DAMAGE TO ITS BACK BUMPER. Crash Time 04:55 PM Crash Date 08/10/2017Wisconsin Motor Vehicle Crash Form DT4000 1 of 10 This report does not include any CJIS data. 17081002 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13KD6N2 Wisconsin Motor Vehicle Crash Report Structure Type Y CoordinateX Coordinate LongitudeLatitudeON STH63 NB 200 FT S OF STRESS ROAD IN THE TOWN OF HAYWARD 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 02--Front To Rear First Harmful Event Location On Roadway First Harmful Event Motor Veh In Transport 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 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 Northbound Insurance? NO Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 1 Train/Bus # InjuredTotal Occs 3 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 Extent Of Damage Disabling Damage Vehicle Damage 12--Front Initial Contact Point 12--Front Bus UseNot A BusBody Style 4D - 4DR Color BRO - Brown Model MALIBU Year 2000 Make CHEVROLET Vehicle Identification Number 738 Country of Issuance UNITED STATES St WI Plate Type AUT - Automobile License Plate Number 766VNS VE H I C L E UN I T 01 Vehicle Crash Time 04:55 PM Crash Date 08/10/2017Wisconsin Motor Vehicle Crash Form DT4000 2 of 10 This report does not include any CJIS data. 17081002 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13KD6N2 Wisconsin Motor Vehicle Crash Report Driver DistractionsDistraction/Inattention Driver Actions Following Too Close Driver Prior Action Other Vehicle Factors Not Applicable What Driver Was Doing Going Straight Vehicle Removed By OPERATOR Towed Due To Damage Towed Due To Disabling Damage VE H I C L E UN I T 01 Address , , Unknown 01 VE H I C L E OW N E R Vehicle Owner Sequence Of Events EventMotor Veh In Transport01 EventMotor Veh In Transport02 Event 03 Event 04 Crash Time 04:55 PM Crash Date 08/10/2017Wisconsin Motor Vehicle Crash Form DT4000 3 of 10 This report does not include any CJIS data. 17081002 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13KD6N2 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 SPOONER, WI 54801 , US RaceWHITEDate of Birth 03/09 Sex Male Citations Issued 1 DriverKEVIN L LEAIR IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment Crash Time 04:55 PM Crash Date 08/10/2017Wisconsin Motor Vehicle Crash Form DT4000 4 of 10 This report does not include any CJIS data. 17081002 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13KD6N2 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 Child Restraint System - Rear Facing On Duty Crash 01 Driver License NumberAddress SPOONER, WI 54801 , US RaceDate of Birth 04/13/ Sex Male Citations Issued 0 PassengerVINCENT L LEAIR-BARRETT IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment Crash Time 04:55 PM Crash Date 08/10/2017Wisconsin Motor Vehicle Crash Form DT4000 5 of 10 This report does not include any CJIS data. 17081002 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13KD6N2 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 6--Second Seat-Right Side 00 3 Safety Equipment Booster Seat On Duty Crash 01 Driver License NumberAddress SPOONER, WI 54801 , US RaceDate of Birth 11/11 Sex Male Citations Issued 0 PassengerLUCAS J LEAIR IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment Violations DescriptionOPERATE MOTOR VEHICLE W/O INSURANCESeq Num001Statute Number344.62(1)Issue To? 001 UTC Number AE01454001 Crash Time 04:55 PM Crash Date 08/10/2017Wisconsin Motor Vehicle Crash Form DT4000 6 of 10 This report does not include any CJIS data. 17081002 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13KD6N2 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 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 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 Minor Damage Vehicle Damage 6--Rear Initial Contact Point 6--Rear Bus UseNot A BusBody Style TK - TRUCK Color SIL - Silver (Aluminum) Model SIERRA Year 2012 Make GENERAL MOTORS COR Vehicle Identification Number 6809 Country of Issuance UNITED STATES St WI Plate Type LTK - Light Truck License Plate Number LF4317 VE H I C L E UN I T 02 Vehicle Address FALL CREEK, WI 54742 , US IndividualDAVID A PROCK ( Vehicle Owner Sequence Of Events EventMotor Veh In Transport01 Crash Time 04:55 PM Crash Date 08/10/2017Wisconsin Motor Vehicle Crash Form DT4000 7 of 10 This report does not include any CJIS data. 17081002 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13KD6N2 Wisconsin Motor Vehicle Crash Report EventMotor Veh In Transport02 Event 03 Event 04 Individual DAVID PROCK Insurance Company FARMERS-INS-CO-INC Policy Holder UN I T Crash Time 04:55 PM Crash Date 08/10/2017Wisconsin Motor Vehicle Crash Form DT4000 8 of 10 This report does not include any CJIS data. 17081002 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13KD6N2 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 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 4 Safety Equipment Shoulder & Lap Belt On Duty Crash 02 ber State: Wisconsin Country: UNITED STATES Address FALL CREEK, WI 54742 , US RaceWHITEDate of Birth 02/04/1 Sex Male Citations Issued 0 DriverDAVID A PROCK IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment Crash Time 04:55 PM Crash Date 08/10/2017Wisconsin Motor Vehicle Crash Form DT4000 9 of 10 This report does not include any CJIS data. 17081002 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13KD6N2 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 3--Front Seat-Right Side (Train Engineers/Right 00 5 Safety Equipment Shoulder & Lap Belt On Duty Crash 02 Driver License NumberP6205326280207 State: Wisconsin Country: UNITED STATES Address FALL CREEK, WI 54742 , US RaceWHITEDate of Birth 08/22/ Sex Female Citations Issued 0 PassengerLINDA L PROCK IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment Crash Time 04:55 PM Crash Date 08/10/2017Wisconsin Motor Vehicle Crash Form DT4000 10 of 10 This report does not include any CJIS data.