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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.