HomeMy WebLinkAbout20150118 KernerAgency Accident Number
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Reportable Accident On Emergency Amended GZDVPJ2
DOT Document Number Document Override Number
15011800762
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15011803
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01/18/2015
4 - Accident Date
0400
5 - Time of Accident (Military Time)
01
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County HAYWARD - 06, TOWN3 - Municipality PRIVATE PROPERTY11 - Accident Location
14 - On Hwy No.
PRIVATE PROPERTY
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.PHELAN RD16 - From/At Street Name 16 - Business/Frontage/Ramp
FIRE #
17 - Structure Type
13382W
17 - Structure Number
46.002837
12 - Latitude -91.36204113 - Longitude
TREE80 - First Harmful Event NO COLLISION WITH MOTOR VEHICLE IN TRANSPORT93 - Manner of Collision
NO CONTROL
112 - Access Control
STRAIGHT
113 - Road Curvature
LEVEL/FLAT
113 - Road Terrain
DIRT -5
Surface Type
PARKING-LOT-OR-PRIVATE-PROPERTY115 - Traffic Way
PARKING-LOT-OR-PRIVATE-PROPERTY
117 - Relation To Roadway
DARK-NOT-LIGHTED114 - Light Condition SNOW/SLUSH116 - Road Surface Condition CLEAR118 - Weather
Hit and Run
9
Government Property
9
Fire
9
Photos Taken
9
Trailer or Towed
9
Truck, Bus, or Hazardous Materials
9
Load Spillage
9
Construction Zone
9
Names Exchanged
9
Supplemental Reports
101
Witness Statements
102
Measurements Taken
103 79 - E M S Number
Operator/Pedestrian
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Unit Status
TREE
81 - Most Harmful Event: Collision With
EAST
23 - Dir Of Travel
5524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
WI
30 - State
2019
31 - Expiration Year 34 - On Duty Accident
KERNER
25 - Operator/Pedestrian Last Name
MARCUS
25 - First Name
M
25 - Middle Initial 25 - Suffix
08/10/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
HAYWARD
27 - City
WI
27 - State
54843
27 - Zip Code
28 - Telephone Number
FRONT-SEAT-LEFT-SIDE-(MC/BIKE DRIVER, TRAIN CONDUCTOR)
39 - Seat Position
RESTRAINT-USE-UNKNOWN
40 - Safety Equipment
N - NO APPARENT INJURY
38 - Injury Severity
NON-DEPLOYED
41 - Airbag
NOT-EJECTED
42 - Ejected 44
Medical Transport
NOT-TRAPPED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
GOING-STRAIGHT
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 162 - No. of Citations Issued
346.70(1)
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
SPEED-TOO-FAST-FOR-CONDITIONS, FAILURE-TO-HAVE-CONTROL
122 - Driver Factors
NOT OBSERVED88 - Driver or Pedestrian Cond UNKNOWN
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDVPJ2 1 4
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
TRUCK
21 - Unit Type
PICKUP/UTILITY-TRUCK
Vehicle Type
1
22 - Total Occupants
JS6647
56 - License Plate Number
LTK57 - Plate Type WI
58 - State
2015
59 - Exp Year
72151
55 - Vehicle Identification Number
1997
50 - Year
DODG
51 - Make 52 - Model
TK - TRUCK
53 - Body Style
MAR
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT, FRONT PASSENGER SIDE, FRONT DRIVER SIDE
94 - Vehicle Damage
SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OWNER
97 - Vehicle Removed By
OTHER
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
KERNER
46 - Vehicle Owner Last Name
MARK
46 - First Name
W
46 - Middle Initial 46 - Suffix
11/05/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
ENCOMPASS-INSURANCE-CO-OF-AMERICA63 - Liability Insurance Company Policy Holder Same As Owner60
KERNER
61 - Policy Holder Last Name
MARK
61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
BU
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FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Trailer
01
TR
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106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
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Fixed Objects Struck
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Property
UNKNOWN
Organization Type 84 - Property Owner Last Name 84 - First Name 84 - Middle Initial 84 - Suffix
01
84 - Company Name Government Property Type
85 - Address Street & Number 85 - PO Box
86 - City 86 - State 86 - Zip Code 87 - Telephone Number
83 - Government Damage Tag Number
01
82 - Striking Unit
TREE
82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
82 - Striking Unit 82 - Object Struck 82 - Striking Unit 82 - Object Struck
105 - Photos By
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Diagram and Narrative
POPLIN
ON JANUARY 18TH, 2015 AT APPROXIMATEY 04:00 UNIT 1 WAS GOING EAST ON THE PRIVATE ROAD SECTION OF PHELAN RD WENT
IT LEFT ROADWAY STRIKING A TREE ON THE SOUTH SIDE OF THE ROAD. THE DRIVER LEFT THE SCENE AND FAILED TO NOTIFY
LAW ENFORCEMENT. AT ABOUT 09:22 A NEIGHBOR CALLED REFERENCE THIS VEHICLE AGAINST A TREE.
ON JANUARY 18TH, 2015 AT APPROXIMATEY 04:00 UNIT 1 WAS GOING EAST ON THE PRIVATE ROAD SECTION OF PHELAN RD WENT
IT LEFT ROADWAY STRIKING A TREE ON THE SOUTH SIDE OF THE ROAD. THE DRIVER LEFT THE SCENE AND FAILED TO NOTIFY
LAW ENFORCEMENT. AT ABOUT 09:22 A NEIGHBOR CALLED REFERENCE THIS VEHICLE AGAINST A TREE.
Officer Information
Accident Report
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Wisconsin Motor Vehicle GZDVPJ2 3 4
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125 - First Name 125 - Middle Initial
POPLIN
125 - Officer Last Name
JAY 352
131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET
126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
(715) 634-4858 EXT.
128 - Telephone Number
01/18/2015
132 - Date Notified 0922133 - Time Notified (Military Time)0932134 - Time Arrived (Military Time)
01/18/2015
135 - Date Of Report
15011800762 15011803 19 - Special Study
18 - Agency Space
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Wisconsin Motor Vehicle GZDVPJ2 4 4