HomeMy WebLinkAbout20150123 Wagner BuncakAgency Accident Number
AC
C
I
D
E
N
T
#
PO
L
I
C
E
#
Police Number
GE
N
E
R
A
L
I
N
F
O
R
M
A
T
I
O
N
Reportable Accident On Emergency Amended GZDVPJ3
DOT Document Number Document Override Number
15012300978
15
0
1
2
3
0
0
9
7
8
15012307
15
0
1
2
3
0
7
01/23/2015
4 - Accident Date
1517
5 - Time of Accident (Military Time)
02
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County ROUND LAKE - 13, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
B
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
27 FT15 - Est. Distance WEST15 - Hwy. Dir
16 - Fr/At Hwy No.CALLAHAN LAKE RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.983875
12 - Latitude -91.23942513 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event REAR-END93 - Manner of Collision
NO CONTROL
112 - Access Control
CURVE
113 - Road Curvature
LEVEL/FLAT
113 - Road Terrain
BLACKTOP, BITUMINOUS, OR ASPHALT - 2
Surface Type
NOT-PHYSICALLY-DIVIDED-(2-WAY TRAFFIC)115 - Traffic Way
ON-ROADWAY
117 - Relation To Roadway
DAYLIGHT114 - Light Condition WET116 - 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
OP
E
R
A
T
O
R
/
P
E
D
E
S
T
R
I
A
N
Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
EAST
23 - Dir Of Travel
4524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2022
31 - Expiration Year 34 - On Duty Accident
WAGNER
25 - Operator/Pedestrian Last Name
MICHAEL
25 - First Name
DEAN
25 - Middle Initial 25 - Suffix
05/11
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
WINTER
27 - City
WI
27 - State
54896
27 - Zip Code 28 - Telephone Number
FRONT-SEAT-LEFT-SIDE-(MC/BIKE DRIVER, TRAIN CONDUCTOR)
39 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
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
346.14(1)
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
FOLLOWING-TOO-CLOSE
122 - Driver Factors
APPEARED NORMAL88 - Driver or Pedestrian Cond UNKNOWN
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
01
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDVPJ3 1 5
VE
H
I
C
L
E
VE
H
O
W
N
E
R
Vehicle
Vehicle Owner
Insurance
School Bus
IN
S
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
XCSKR
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
4278
55 - Vehicle Identification Number
1997
50 - Year
HOND
51 - Make
CIVIC
52 - Model
2D - 2DR
53 - Body Style
GRN
54 - Color
0100 - Skidmarks to Impact (Ft)
FRONT
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OPERATOR
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
WAGNER
46 - Vehicle Owner Last Name
MICHAEL
46 - First Name
DEAN
46 - Middle Initial 46 - Suffix
05/11
Date Of Birth
46 - Company Name
47 - PO Box
WINTER48 - City WI48 - State 5489648 - Zip Code 49 - Telephone Number
STATE-FARM-GENERAL-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
WAGNER
61 - Policy Holder Last Name
MICHAEL
61 - Policy Holder First Name
61 - Policy Holder Company
01
01
01
01
BU
S
FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Operator/Pedestrian
Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
EAST
23 - Dir Of Travel
4524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2022
31 - Expiration Year 34 - On Duty Accident
BUNCAK
25 - Operator/Pedestrian Last Name
THOMAS
25 - First Name
L
25 - Middle Initial
SR
25 - Suffix
02/19/
32 - Date Of Birth
MALE
33 - Sex
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDVPJ3 2 525
VE
H
I
C
L
E
VE
H
O
W
N
E
R
Vehicle
Vehicle Owner
Insurance
OP
E
R
A
T
O
R
/
P
E
D
E
S
T
R
I
A
N
IN
S
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
SHOULDER-BELT-AND-LAP-BELT-USED
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
MAKING-LEFT-TURN
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 162 - No. of Citations Issued
344.62(1)
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
NOT-APPLICABLE
122 - Driver Factors
APPEARED NORMAL88 - Driver or Pedestrian Cond ALCOHOL-PRESENT
89 - Substance Presence
TEST GIVEN, ALCOHOL UNKNOWN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
150VYW
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
5457
55 - Vehicle Identification Number
2002
50 - Year
MERC
51 - Make
SABLE
52 - Model
4D - 4DR
53 - Body Style
SIL
54 - Color
0100 - Skidmarks to Impact (Ft)
REAR
94 - Vehicle Damage
MINOR
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OPERATOR
97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
ELSNER
46 - Vehicle Owner Last Name
MARIE
46 - First Name
C
46 - Middle Initial 46 - Suffix
12/25/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
UNKNOWN63 - Liability Insurance Company Policy Holder Same As Owner60
ELSNER
61 - Policy Holder Last Name
MARIE
61 - Policy Holder First Name
61 - Policy Holder Company
02
02
02
02
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDVPJ3 3 5
School Bus
02
BU
S
FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Trailer
01
TR
L
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
105 - Photos By
DI
A
G
R
A
M
A
N
D
N
A
R
R
A
T
I
V
E
Diagram and Narrative
POPLIN
ON JANUARY 23RD, 2015 I DEPUTY POPLIN WAS DISPATCHED TO A CRASH AT COUNTY HWY B AT CALLAHAN LAKE RD. I SPOKE TO THE DRIVER OF UNIT2 FIRST AND HE SAID HE JUST PULLED OUT OF A RESIDENCE AND WAS GOING AT A LOW RATE OF SPEED ON
COUNTY HWY B PLANNING ON TURNING ONTO CALLAHAN LAKE RD. HE ALSO SAID HE HAD HIS SIGNAL ON. I SPOKE THE DRIVER
OF UNIT1 WHO ADVISED THAT UNIT2 PULLED OUT IN FRONT OF HIM AND WENT 15 MPH ON PURPOSE TO MAKE HIM MAD. THE
DRIVER OF UNIT 1 SAID HE GOT VERY CLOSE TO UNIT 2 TO MAKE A POINT THAT HE WAS DISPLEASED WITH UNIT 2'S ACTIONS. THE
DRIVER OF UNIT 1 THEN SAID THAT UNIT 2 PURPOSEFULLY SLAMMED ON ITS BRAKES TO CAUSE A CRASH. I ASKED THE DRIVER
OF UNIT 1 IF UNIT 2 HAD HIS SIGNAL ON TO INDICATE A TURN. THE DRIVER OF UNIT 1 SAID HE DID SEE THE SIGNAL ON HOWEVER HE DIDN'T KNOW IF IT WAS BEFORE OR AFTER IMPACT.
ON JANUARY 23RD, 2015 I DEPUTY POPLIN WAS DISPATCHED TO A CRASH AT COUNTY HWY B AT CALLAHAN LAKE RD. I SPOKE TO THE DRIVER OF UNIT2 FIRST AND HE SAID HE JUST PULLED OUT OF A RESIDENCE AND WAS GOING AT A LOW RATE OF SPEED ON
COUNTY HWY B PLANNING ON TURNING ONTO CALLAHAN LAKE RD. HE ALSO SAID HE HAD HIS SIGNAL ON. I SPOKE THE DRIVER
OF UNIT1 WHO ADVISED THAT UNIT2 PULLED OUT IN FRONT OF HIM AND WENT 15 MPH ON PURPOSE TO MAKE HIM MAD. THE
DRIVER OF UNIT 1 SAID HE GOT VERY CLOSE TO UNIT 2 TO MAKE A POINT THAT HE WAS DISPLEASED WITH UNIT 2'S ACTIONS. THE
DRIVER OF UNIT 1 THEN SAID THAT UNIT 2 PURPOSEFULLY SLAMMED ON ITS BRAKES TO CAUSE A CRASH. I ASKED THE DRIVER
OF UNIT 1 IF UNIT 2 HAD HIS SIGNAL ON TO INDICATE A TURN. THE DRIVER OF UNIT 1 SAID HE DID SEE THE SIGNAL ON HOWEVER HE DIDN'T KNOW IF IT WAS BEFORE OR AFTER IMPACT.
OF
F
I
C
E
R
I
N
F
O
R
M
A
T
I
O
N
125 - First Name 125 - Middle Initial
Officer Information
POPLIN125 - Officer Last Name JAY 352131 - Officer ID
129 - Law Enforcement Agency No.
SAWYER COUNTY SHERIFFS DEPT
130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET126 - Law Enforcement Agency Address Street & Number
HAYWARD
127 - City
WI
127 - State
54843
127 - Zip Code
(715) 634-4858 EXT.
128 - Telephone Number
01/23/2015132 - Date Notified 1517133 - Time Notified (Military Time)1526134 - Time Arrived (Military Time)01/24/2015135 - Date Of Report
15012300978 15012307 19 - Special Study
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDVPJ3 4 5
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDVPJ3 5 5