HomeMy WebLinkAbout20150214 Manthey StraponAgency Accident Number
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Reportable Accident On Emergency Amended GZDTZ9F
DOT Document Number Document Override Number
15021405
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15021405
15
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02/14/2015
4 - Accident Date
0911
5 - Time of Accident (Military Time)
02
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County SPIDER LAKE - 15, TOWN3 - Municipality NON-INTERSECTION11 - Accident Location
OO
14 - On Hwy No.14 - On Street Name 14 - Bus/Frnt/Rmp
0.35 MI15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.JANET RD16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.109030
12 - Latitude -91.30077613 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event SIDESWIPE. OPPOSITE DIRECTION93 - Manner of Collision
NO CONTROL
112 - Access Control
CURVE
113 - Road Curvature
HILL
113 - Road Terrain Surface Type
NOT-PHYSICALLY-DIVIDED-(2-WAY TRAFFIC)115 - Traffic Way
ON-ROADWAY
117 - Relation To Roadway
DAYLIGHT114 - Light Condition SNOW/SLUSH116 - Road Surface Condition SNOW118 - 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
SOUTH
23 - Dir Of Travel
3524 - 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
MANTHEY
25 - Operator/Pedestrian Last Name
DOUGLAS
25 - First Name
E
25 - Middle Initial 25 - Suffix
03/28/MALE
33 - Sex
26 - Address Street & Number 26 - PO Box
DRUMMOND
27 - City
WI
27 - State
54832
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
NEGOTIATING-CURVE
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
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDTZ9F 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
AUTOMOBILE
21 - Unit Type
PICKUP/UTILITY-TRUCK
Vehicle Type
1
22 - Total Occupants
FN9413
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
03055
55 - Vehicle Identification Number
50 - Year
TOYT
51 - Make
TACOMA
52 - Model
2D - 2DR
53 - Body Style
BGE
54 - Color 100 - Skidmarks to Impact (Ft)
MIDDLE DRIVER SIDE, REAR DRIVER SIDE
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
MANTHEY
46 - Vehicle Owner Last Name
DOUGLAS
46 - First Name
E
46 - Middle Initial 46 - Suffix
03/28/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
DRUMMOND48 - City WI48 - State 5483248 - Zip Code 49 - Telephone Number
USAA-CASUALTY-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60
MANTHEY
61 - Policy Holder Last Name
DOUGLAS
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
Operator/Pedestrian
Unit Status
MOTOR VEHICLE IN TRANSPORT
81 - Most Harmful Event: Collision With
NORTH
23 - Dir Of Travel
3524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
WI
30 - State
2016
31 - Expiration Year 34 - On Duty Accident
STRAPON
25 - Operator/Pedestrian Last Name 25 - First Name 25 - Middle Initial 25 - Suffix
10/FEMALE
33 - Sex
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDTZ9F 2 424
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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
DEPLOYED
41 - Airbag
NOT-EJECTED
42 - Ejected 44
Medical Transport
NOT-TRAPPED
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
NEGOTIATING-CURVE
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
91 - Drugs Reported
SNOW,-ICE,-OR-WET
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
925BMH
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
8409
55 - Vehicle Identification Number
2011
50 - Year
HOND
51 - Make
PILOT X
52 - Model
4D - 4DR
53 - Body Style
BLK
54 - Color 100 - Skidmarks to Impact (Ft)
REAR DRIVER SIDE
94 - Vehicle Damage
MODERATE
95 - Extent Of Damage
Vehicle Towed Due To Damage
96 97 - Vehicle Removed By
NOT-APPLICABLE
123 - Vehicle Factors
45
Vehicle Owner Same As Operator
STRAPON
46 - Vehicle Owner Last Name
MARC
46 - First Name
B
46 - Middle Initial 46 - Suffix
07/15/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code 49 - Telephone Number
HOLDEN INSURANCE63 - Liability Insurance Company Policy Holder Same As Owner60
STRAPON
61 - Policy Holder Last Name
MARC
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 GZDTZ9F 3 4
School Bus
02
BU
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FromTo
Bus Travelling to/from School Name Body Make Seating Capacity
School District Contracted With
Trailer
01
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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
ROB HOUSE
UNIT 1 WAS TRAVELING SOUTH ON HIGHWAY OO. UNIT 2 WAS TRAVELING NORTH ON HIGHWAY OO. AFTER PASSING BIRKIE TRAIL, UNIT 2 WAS NEGOTIATING A CURVE WHILE GOING DOWN HILL. UNIT 2 VEHICLE SLID SIDEWAYS DUE TO ICE AND SNOW
CONDITIONS AND STRUCK UNIT 1 ON THE DRIVERS SIDE. BOTH VEHICLES SUSTAINED MODERATE DAMAGE. NO INJURIES
REPORTED
UNIT 1 WAS TRAVELING SOUTH ON HIGHWAY OO. UNIT 2 WAS TRAVELING NORTH ON HIGHWAY OO. AFTER PASSING BIRKIE TRAIL, UNIT 2 WAS NEGOTIATING A CURVE WHILE GOING DOWN HILL. UNIT 2 VEHICLE SLID SIDEWAYS DUE TO ICE AND SNOW
CONDITIONS AND STRUCK UNIT 1 ON THE DRIVERS SIDE. BOTH VEHICLES SUSTAINED MODERATE DAMAGE. NO INJURIES
REPORTED
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125 - First Name 125 - Middle Initial
Officer Information
HOUSE125 - Officer Last Name ROB 317131 - 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
02/14/2015132 - Date Notified 0911133 - Time Notified (Military Time)0940134 - Time Arrived (Military Time)02/20/2015135 - Date Of Report
15021405 15021405 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDTZ9F 4 4