HomeMy WebLinkAbout20150201 Brutger LovelandAgency Accident Number
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Reportable Accident On Emergency Amended GZDNRQP
DOT Document Number Document Override Number
02/01/2015
4 - Accident Date
0215
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 INTERSECTION11 - Accident Location
077
14 - On Hwy No.
WB
14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir
16 - Fr/At Hwy No.UPPER A RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.065205
12 - Latitude -91.19661413 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event ANGLE93 - Manner of Collision
NO CONTROL
112 - Access Control
STRAIGHT
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 DRY116 - 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
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With 23 - Dir Of Travel
5524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
MN
30 - State
2016
31 - Expiration Year 34 - On Duty Accident
BRUTGER
25 - Operator/Pedestrian Last Name
JEFFREY
25 - First Name
W
25 - Middle Initial 25 - Suffix
10/06/
32 - Date Of Birth
MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
WOODBURY
27 - City
MN
27 - State
55129
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 062 - No. of Citations Issued
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 NEITHER-ALCOHOL-NOR-DRUGS-PRESENT
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
Page
PK2012
Wisconsin Motor Vehicle GZDNRQP 1 5
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Vehicle
Vehicle Owner
Insurance
School Bus
IN
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91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
2
22 - Total Occupants
794KGU
56 - License Plate Number
AUT57 - Plate Type MN
58 - State
2015
59 - Exp Year
8301
55 - Vehicle Identification Number
2011
50 - Year
CHEV
51 - Make
SILVERADO
52 - Model
4D - 4DR
53 - Body Style
BLK
54 - Color
50100 - Skidmarks to Impact (Ft)
FRONT PASSENGER SIDE, REAR DRIVER SIDE, MIDDLE DRIVER SIDE, REAR PASSENGER SIDE
94 - Vehicle Damage
SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96 97 - Vehicle Removed By
TIRES, TURN-SIGNALS, STOP-LAMPS, SUSPENSION-SYSTEM
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
46 - Vehicle Owner Last Name 46 - First Name 46 - Middle Initial 46 - Suffix Date Of Birth
PAR 10 COMPANIES46 - Company Name
47- Address Street & Number 47 - PO Box
MINNETONKA48 - City MN48 - State 5534348 - Zip Code 49 - Telephone Number
OWNERS-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 61 - Policy Holder First Name
PAR 10 COMPANIES61 - 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
NORTH
23 - Dir Of Travel
0524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
Number
WI
30 - State
2018
31 - Expiration Year 34 - On Duty Accident
LOVELAND
25 - Operator/Pedestrian Last Name
SHANE
25 - First Name
A
25 - Middle Initial 25 - Suffix
07/13/
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 GZDNRQP 2 525
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Vehicle
Vehicle Owner
Insurance
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IN
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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
GOING-STRAIGHT
119 - What Driver Was Doing
STOP-SIGN
120 - Traffic Control 162 - No. of Citations Issued
346.18(3)
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
FAIL-TO-YIELD-RIGHT-OF-WAY
122 - Driver Factors
APPEARED NORMAL88 - Driver or Pedestrian Cond NEITHER-ALCOHOL-NOR-DRUGS-PRESENT
89 - Substance Presence
TEST NOT GIVEN90 - Alcohol Test 90 - Alcohol Content TEST NOT GIVEN91 - Drug Test
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PICKUP/UTILITY-TRUCK
Vehicle Type
1
22 - Total Occupants
GT3687
56 - License Plate Number
LTK57 - Plate Type WI
58 - State
2014
59 - Exp Year
9495
55 - Vehicle Identification Number
2001
50 - Year
GMC
51 - Make
SIERRA
52 - Model
4D - 4DR
53 - Body Style
MAR
54 - Color
0100 - Skidmarks to Impact (Ft)
FRONT, FRONT DRIVER SIDE, FRONT PASSENGER SIDE
94 - Vehicle Damage
SEVERE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96
OWNER
97 - Vehicle Removed By
TURN-SIGNALS, STEERING-SYSTEM, HEAD-LAMPS, OTHER
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
LOVELAND
46 - Vehicle Owner Last Name
SHANE
46 - First Name
A
46 - Middle Initial 46 - Suffix
07/13
Date Of Birth
46 - Company Name
47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
ERIE-INSURANCE-EXCHANGE63 - Liability Insurance Company Policy Holder Same As Owner60
LOVELAND
61 - Policy Holder Last Name
SHANE
61 - Policy Holder First Name
61 - Policy Holder Company
02
02
02
02
Accident Report
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MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDNRQP 3 5
School Bus
02
BU
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FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Occupant
Address Same As Operator
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01
65 - Unit No
B
66 - Occupant Last Name
R
66 - First Name
W
66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
WOODBURY
68 - City
MN
68 - State
55129
68 - Zip Code
67 - Date of Birth
F
69 - Sex
FRONT-SEAT-RIGHT-SIDE-(TRAIN ENGINEER)
71 - Seat Position
SHOULDER-BELT-AND-LAP-BELT-USED
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NON-DEPLOYED
73 - Airbag
NOT-EJECTED
75 - Ejected
Medical Transport
77
NOT-TRAPPED
76 - Trapped/Extricated 78 - Agency Space
Trailer
01
TR
L
1
106 - Power Unit Number License Plate Number Plate Type State Expiration Year
Trailer Make Unit Type Vehicle Identification Number
105 - Photos By
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Diagram and Narrative
ON 02012015 AT APPROXIMATELY 14:15 I, DEPUTY CHRIS LEVERTON WAS WORKING THE 7:00-15:00 PATROL SHIFT FOR THE
SAWYER COUNTY SHERIFF'S DEPARTMENT WHEN I WAS DISPATCHED TO STH 77 AND CTH A FOR A TWO VEHICLE ACCIDENT
WITHOUT INJURIES. AT THE TIME OF DISPATCH I WAS ON CTH F AND STH 48. I INFORMED DISPATCH THAT IT
ON 02012015 AT APPROXIMATELY 14:15 I, DEPUTY CHRIS LEVERTON WAS WORKING THE 7:00-15:00 PATROL SHIFT FOR THE
SAWYER COUNTY SHERIFF'S DEPARTMENT WHEN I WAS DISPATCHED TO STH 77 AND CTH A FOR A TWO VEHICLE ACCIDENT
WITHOUT INJURIES. AT THE TIME OF DISPATCH I WAS ON CTH F AND STH 48. I INFORMED DISPATCH THAT IT
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDNRQP 4 5
WOULD BE APPROXIMATELY 45 MINUTES BEFORE I WOULD ARRIVE. LCO OFFICERS 502 AND 530 ASSISTED WITH THE CALL SINCE THEY WERE CLOSER. LCO OFFICERS ARRIVED ON SCENE AT 14:30 AND CONTACTED DISPATCH WITH WI REG GT3687 AND MN REG
794-KGU. LCO OFFICER 502 REQUESTED TWO TOW TRUCKS ONE FOR A PICKUP THAT WAS OPERATED BY JEFFERY WAYNE
BRUTGER DOB: 10-06-1962. JEFFERYS VEHICLE WAS HAULING A SNOWMOBILE AND TRAILER. UNIT 2 WITH WI REG GT3687 WAS
OPERATED BY SHANE A. LOVELAND DOB: 07131967. I ARRIVED ON SCENE AT APPROXIMATELY 14:55. I OBSERVED THE PICKUP
AND TRAILER FACING SOUTHBOUND ON STH 77 IN THE NORTH-WEST BOUND LANE, WITH ITS TRAILER IN THE DITCH LINE ALONG
WITH AN OVERTURNED SNOWMOBILE SITTING IN THE DITCH LINE AS WELL. I OBSERVED UNIT TWO TO BE PARKED IN THE PARKING LOT OF A BUSINESS WITH SIGNIFICANT FRONT END DAMAGE TO THE VEHICLE. SHANE INFORMED ME THAT HE WAS
TRAVELING NORTH ON CTH A WHERE HE STOPPED AT THE INTERSECTION OF CTH A AND STH 77, SHANE STATED THAT HE
LOOKED BOTH WAYS TWICE AND PROCEEDED ACROSS THE ROADWAY WHERE HE STRUCK JEFFERY'S VEHICLE DUE TO NOT
SEEING IT. JEFFERY STATED HE TRIED TO SWERVE AROUND THE VEHICLE BUT IT WAS TOO LATE. SKID MARKS SHOW THIS
ACTION. JEFFERY EXPLAINED THAT SHANE DID STOP AT THE STOP SIGN, THEN PROCEEDED TO ENTER THE INTERSECTION IN AN
ATTEMPT TO ACCESS UPPER A RD. I ESTIMATE THE DAMAGE TO BOTH VEHICLES TO BE TOTALED ALONG WITH THE DAMAGE
DONE TO THE SNOWMOBILE REGISTRATION : 7226AM. SHANE STATED HE WAS AT FAULT AND SIMPLY DID NOT SEE THE OTHER VEHICLE. I INFORMED SHANE THAT I WOULD BE ISSUING HIM A CITATION FOR WI STAT: 346.18(3) FYR FROM A STOP SIGN. SHANE
STATED OKAY.
WOULD BE APPROXIMATELY 45 MINUTES BEFORE I WOULD ARRIVE. LCO OFFICERS 502 AND 530 ASSISTED WITH THE CALL SINCE THEY WERE CLOSER. LCO OFFICERS ARRIVED ON SCENE AT 14:30 AND CONTACTED DISPATCH WITH WI REG GT3687 AND MN REG
794-KGU. LCO OFFICER 502 REQUESTED TWO TOW TRUCKS ONE FOR A PICKUP THAT WAS OPERATED BY JEFFERY WAYNE
BRUTGER DOB: 10-06-1962. JEFFERYS VEHICLE WAS HAULING A SNOWMOBILE AND TRAILER. UNIT 2 WITH WI REG GT3687 WAS
OPERATED BY SHANE A. LOVELAND DOB: 07131967. I ARRIVED ON SCENE AT APPROXIMATELY 14:55. I OBSERVED THE PICKUP
AND TRAILER FACING SOUTHBOUND ON STH 77 IN THE NORTH-WEST BOUND LANE, WITH ITS TRAILER IN THE DITCH LINE ALONG
WITH AN OVERTURNED SNOWMOBILE SITTING IN THE DITCH LINE AS WELL. I OBSERVED UNIT TWO TO BE PARKED IN THE PARKING LOT OF A BUSINESS WITH SIGNIFICANT FRONT END DAMAGE TO THE VEHICLE. SHANE INFORMED ME THAT HE WAS
TRAVELING NORTH ON CTH A WHERE HE STOPPED AT THE INTERSECTION OF CTH A AND STH 77, SHANE STATED THAT HE
LOOKED BOTH WAYS TWICE AND PROCEEDED ACROSS THE ROADWAY WHERE HE STRUCK JEFFERY'S VEHICLE DUE TO NOT
SEEING IT. JEFFERY STATED HE TRIED TO SWERVE AROUND THE VEHICLE BUT IT WAS TOO LATE. SKID MARKS SHOW THIS
ACTION. JEFFERY EXPLAINED THAT SHANE DID STOP AT THE STOP SIGN, THEN PROCEEDED TO ENTER THE INTERSECTION IN AN
ATTEMPT TO ACCESS UPPER A RD. I ESTIMATE THE DAMAGE TO BOTH VEHICLES TO BE TOTALED ALONG WITH THE DAMAGE
DONE TO THE SNOWMOBILE REGISTRATION : 7226AM. SHANE STATED HE WAS AT FAULT AND SIMPLY DID NOT SEE THE OTHER VEHICLE. I INFORMED SHANE THAT I WOULD BE ISSUING HIM A CITATION FOR WI STAT: 346.18(3) FYR FROM A STOP SIGN. SHANE
STATED OKAY.
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125 - First Name 125 - Middle Initial
Officer Information
LEVERTON
125 - Officer Last Name
CHRIS 318
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
02/01/2015
132 - Date Notified 1415133 - Time Notified (Military Time)1455134 - Time Arrived (Military Time)
02/01/2015
135 - Date Of Report
19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDNRQP 5 5