201712102 Hertrlein Lazar.pdf17120206
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6W 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
06:04 PM
Date Notified
12/02/2017
Time Arrived
06:38 PM
Date Arrived
12/02/2017
Crash Time
06:04 PM
Crash Date
12/02/2017
Investigating Officer/Deputy
DEPUTY NICOLE RIPCZINSKI
Agency Crash NumberPrimary Crash Document #Document Number Override
6V
L
1
3
1
B
Q
6
W
Additional InformationPhotos
Photos ByN. RIPCZINSKI
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON DECEMBER 2, 2017 I, DEPUTY RIPCZINSKI WAS DISPATCHED TO REDS BIG BEAR INN AT N1614 COUNTY HWY W FOR A 2 VEHICLE PROPERTY DAMAGE ACCIDENT. I ARRIVED ON-SCENE AT APPROXIMATELY 6:38 PM. WHEN I ARRIVED ON-SCENE I MET WITH BOTH PARTIES. OPERATOR OF
UNIT 1 ADVISED UNIT 1 WAS MAKING RIGHT HAND TURN INTO BIG BEAR PARKING LOT WHEN UNIT 2 REAR-ENDED UNIT 1. OPERATOR OF UNIT 2
ADVISED THAT UNIT 1 HAD COME TO A COMPLETE STOP AND OPERATOR OF UNIT 2 ADVISED THAT OPERATOR "COULD HAVE BEEN A LITTLE
FURTHER BACK." OPERATOR UNIT 2 STATED UNIT 1 WAS NOT UTILIZING DIRECTIONAL AND CAME TO A COMPLETE STOP BEFORE TURNING.
OPERATOR UNIT 2 ADVISED OPERATOR WAS SLOWING DOWN AND OPERATOR SAW BREAK LIGHTS, HAD JUST RECENTLY HAD BRAKES FIXED,
HOWEVER WAS NOT ABLE TO STOP IN TIME. PASSENGER IN UNIT 1 IS 36 WEEKS PREGNANT HOWEVER, UNINJURED BUT WAS GOING TO SEE DR JUST IN CASE. BOTH PARTIES HAD INSURANCE, HOWEVER UNIT 2 OWNER DID NOT HAVE CURRENT PAPERWORK NOR DID UNIT 1 HAVE PROOF.
UNIT 1 ADVISED INSURANCE WAS THROUGH PRECOUR INSURANCE OUT OF PHILLIPS AND UNIT 2 ADVISED OPERATOR HAD SEPERATE INSURANCE
BUT OWNER OF UNIT HAD SECURA SUPREME INSURANCE. MINOR DAMAGE TO REAR END OF UNIT 1. MODERATE DAMAGE TO UNIT 2, FLUIDS AND
FRONT END PUSHED INTO PASSENGER TIRE. UNIT 2 WAS LEFT ON-SCENE UNTIL INSURANCE COMPANY COULD TOW. NAMES WERE EXCHANGED
AS WELL AS CASE NUMBER GIVEN TO BOTH PARTIES.
Crash Time 06:04 PM
Crash Date 12/02/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 10
This report does not include any CJIS data.
17120206
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6W Wisconsin Motor Vehicle
Crash Report
Structure Type
Y Coordinate
5075234
X Coordinate
207587.890625
Longitude
-90.76079047
Latitude
45.768734401
ON CTHW
433 FT S
OF WEST LN
IN THE TOWN OF WINTER
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
Dark/Unlit
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?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
4
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
Functional Damage
Vehicle Damage
5--Right Rear Corner, 6--Rear, 7--Left Rear Corner
Initial Contact Point
6--Rear
Bus UseNot A BusBody Style
UT - SPORT UTILITY VEHICLE
Color
RED - Red
Model
EXPEDITION
Year
2017
Make
FORD
Vehicle Identification Number
13241
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
HERTLN
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 06:04 PM
Crash Date 12/02/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 10
This report does not include any CJIS data.
17120206
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6W Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
Driver Actions
Other Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Right Turn
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
01
Address
PHILLIPS, WI 54555 , US
IndividualJAMES W HERTLEIN01
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
JAMES HERTLEIN
Insurance Company
PRECOUR
Policy Holder
UN
I
T
Crash Time 06:04 PM
Crash Date 12/02/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 10
This report does not include any CJIS data.
17120206
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6W 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
PHILLIPS, WI 54555 , US
RaceWHITEDate of Birth
02/17/
Sex
Male
Citations Issued
0
DriverJAMES W HERTLEIN
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 06:04 PM
Crash Date 12/02/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 10
This report does not include any CJIS data.
17120206
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6W 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
PHILLIPS, WI 54555 , US
RaceWHITEDate of Birth
09/06/
Sex
Female
Citations Issued
0
PassengerNICHOLE A HERTLEIN
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 06:04 PM
Crash Date 12/02/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 10
This report does not include any CJIS data.
17120206
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6W 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
4--Second Seat-Left Side(Motorcycle/Bicycle Pa
00
3
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
Driver License NumberAddress
PHILLIPS, WI 54555 , US
RaceWHITEDate of Birth
08/24/
Sex
Female
Citations Issued
0
PassengerMACY A HERTLEIN
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 06:04 PM
Crash Date 12/02/2017Wisconsin Motor Vehicle Crash
Form DT4000 6 of 10
This report does not include any CJIS data.
17120206
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6W 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
PHILLIPS, WI 54555 , US
RaceWHITEDate of Birth
07/23
Sex
Female
Citations Issued
0
PassengerMYA C HERTLEIN
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 06:04 PM
Crash Date 12/02/2017Wisconsin Motor Vehicle Crash
Form DT4000 7 of 10
This report does not include any CJIS data.
17120206
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6W 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
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 ActionsFollowing Too Close
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
Vehicle Removed By
OWNER
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
02
Extent Of Damage
Disabling Damage
Vehicle Damage
1--Right Front Corner, 11--Left Front Corner, 12--Front
Initial Contact Point
12--Front
Bus UseNot A BusBody Style
UT - SPORT UTILITY VEHICLE
Color
TAN - Tan
Model
TAHOE
Year
2002
Make
CHEVROLET
Vehicle Identification Number
0533
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
262ZTD
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
HAYWARD, WI 54843 , US
IndividualSCOTT J BURTON02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Crash Time 06:04 PM
Crash Date 12/02/2017Wisconsin Motor Vehicle Crash
Form DT4000 8 of 10
This report does not include any CJIS data.
17120206
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6W Wisconsin Motor Vehicle
Crash Report
Event
02
Event
03
Event
04
Individual
SCOTT BURTON
Insurance Company
SECURA-SUPREME-INS-CO
Policy Holder
UN
I
T
Crash Time 06:04 PM
Crash Date 12/02/2017Wisconsin Motor Vehicle Crash
Form DT4000 9 of 10
This report does not include any CJIS data.
17120206
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6W 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
ber
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceWHITEDate of Birth
11/14/
Sex
Female
Citations Issued
0
DriverSHEILA I LAZAR
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 06:04 PM
Crash Date 12/02/2017Wisconsin Motor Vehicle Crash
Form DT4000 10 of 10
This report does not include any CJIS data.