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Home My WebLink About20150407 Mott WeissAgency 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 GZDPHZG DOT Document Number Document Override Number 15040701 15 0 4 0 7 0 1 04/07/2015 4 - Accident Date 0134 5 - Time of Accident (Military Time) 02 6 - Total Units 04 7 - Total Injured 00 8 - Total Killed SAWYER - 572 - County SAND LAKE - 14, TOWN3 - Municipality INTERSECTION11 - Accident Location 070 14 - On Hwy No. WB 14 - On Street Name 14 - Bus/Frnt/Rmp 15 - Est. Distance 15 - Hwy. Dir AA16 - Fr/At Hwy No.16 - From/At Street Name 16 - Business/Frontage/Ramp 17 - Structure Type 17 - Structure Number 45.854307 12 - Latitude -91.53908413 - Longitude MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event ANGLE93 - Manner of Collision NO CONTROL 112 - Access Control CURVE 113 - Road Curvature LEVEL/FLAT 113 - Road Terrain BLACKTOP, BITUMINOUS, OR ASPHALT - 2 Surface Type DIVIDED-HIGHWAY-MEDIAN-STRIP-WITHOUT-TRAFFIC-BARRIER115 - Traffic Way ON-ROADWAY 117 - Relation To Roadway DARK-NOT-LIGHTED114 - Light Condition WET116 - 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 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 SOUTH 23 - Dir Of Travel 4524 - Speed Limit D CLASS 36 - Operating as Classified 37 - Endorsements 35 Operating Commercial Motor Vehicle 0803 29 - Driver's License Number WI 30 - State 2021 31 - Expiration Year 34 - On Duty Accident MOTT 25 - Operator/Pedestrian Last Name VICTORIA 25 - First Name JANE 25 - Middle Initial 25 - Suffix 06/08 32 - Date Of Birth FEMALE 33 - Sex 26 - Address Street & Number 26 - PO Box SPOONER 27 - City WI 27 - State 54801 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 C - POSSIBLE 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 GOING-STRAIGHT 119 - What Driver Was Doing STOP-SIGN 120 - Traffic Control 162 - No. of Citations Issued 346.46(1) 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 01 Accident Report of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZDPHZG 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 4 22 - Total Occupants 508UMR 56 - License Plate Number AUT57 - Plate Type WI 58 - State 2016 59 - Exp Year 6520 55 - Vehicle Identification Number 2010 50 - Year CHEV 51 - Make EQUINOX 52 - Model 4H - HATCHBACK 4 53 - Body Style RED 54 - Color 100 - Skidmarks to Impact (Ft) FRONT 94 - Vehicle Damage SEVERE 95 - Extent Of Damage Vehicle Towed Due To Damage 96 A-1 TOWING 97 - Vehicle Removed By NOT-APPLICABLE 123 - Vehicle Factors 45 Vehicle Owner Same As Operator MOTT 46 - Vehicle Owner Last Name VICTORIA 46 - First Name JANE 46 - Middle Initial 46 - Suffix 06/08/ Date Of Birth 46 - Company Name 47- Address Street & Number 47 - PO Box SPOONER48 - City WI48 - State 5480148 - Zip Code 49 - Telephone Number PROGRESSIVE-CLASSIC-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60 MOTT 61 - Policy Holder Last Name VICTORIA 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 WEST 23 - Dir Of Travel 5524 - Speed Limit A CLASS 36 - Operating as Classified 37 - Endorsements 35 Operating Commercial Motor Vehicle 29 - Driver's License Number WI 30 - State 2020 31 - Expiration Year 34 - On Duty Accident WEISS 25 - Operator/Pedestrian Last Name LESHA 25 - First Name E 25 - Middle Initial 25 - Suffix 09/16 32 - Date Of Birth 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 GZDPHZG 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 RICE LAKE 27 - City WI 27 - State 54868 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 C - POSSIBLE 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 91 - Drugs Reported NOT-APPLICABLE 124 - Highway Factors TRUCK 21 - Unit Type STRAIGHT-TRUCK-(INSERT TRUCK) Vehicle Type 1 22 - Total Occupants FB38348 56 - License Plate Number HTK57 - Plate Type WI 58 - State 2015 59 - Exp Year 2889 55 - Vehicle Identification Number 2015 50 - Year FORD 51 - Make SUPER DUTY 52 - Model CB - CAB CHASSIS 53 - Body Style WHI 54 - Color 100 - Skidmarks to Impact (Ft) REAR PASSENGER SIDE 94 - Vehicle Damage MODERATE 95 - Extent Of Damage Vehicle Towed Due To Damage 96 S&R TOWING 97 - Vehicle Removed By NOT-APPLICABLE 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 BIMBO BAKERIES USA INC46 - Company Name 255 BUSINESS CENTER DR 47- Address Street & Number 47 - PO Box HORSHAM48 - City PA48 - State 19044-342448 - Zip Code 49 - Telephone Number ACE-AMERICAN-INS-CO63 - Liability Insurance Company Policy Holder Same As Owner60 61 - Policy Holder Last Name 61 - Policy Holder First Name BIMBO BAKERIES USA INC61 - Policy Holder Company 02 02 02 02 Accident Report of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZDPHZG 3 5 School Bus 02 BU S FromTo Bus Travelling to/from School Name Body Make Seating Capacity School District Contracted With Occupant Address Same As Operator OC C U P A N T 01 65 - Unit No ULBRICH 66 - Occupant Last Name WAYNE 66 - First Name E 66 - Middle Initial JR 66 - Suffix 01 68 - Address Street & Number 68 - PO Box SPOONER 68 - City WI 68 - State 54801 68 - Zip Code 07/01 67 - Date of Birth M 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 DEPLOYED 73 - Airbag NOT-EJECTED 75 - Ejected Medical Transport 77 NOT-TRAPPED 76 - Trapped/Extricated 78 - Agency Space Occupant Address Same As Operator OC C U P A N T 01 65 - Unit No PARSONS 66 - Occupant Last Name ROBIN 66 - First Name L 66 - Middle Initial 66 - Suffix 02 68 - Address Street & Number 68 - PO Box WEBSTER 68 - City WI 68 - State 54893 68 - Zip Code 03/07/ 67 - Date of Birth F 69 - Sex SECOND-SEAT-RIGHT 71 - Seat Position RESTRAINT-USE-UNKNOWN 72 - Safety Equipment B - NON-INCAPACITATING INJURY 70 - Injury Severity DEPLOYED 73 - Airbag NOT-EJECTED 75 - Ejected Medical Transport 77 NOT-TRAPPED 76 - Trapped/Extricated 78 - Agency Space Occupant Address Same As Operator OC C U P A N T 01 65 - Unit No PFAFF 66 - Occupant Last Name JUSTIN 66 - First Name M 66 - Middle Initial 66 - Suffix 03 68 - Address Street & Number 68 - PO Box SPRINGBROOK 68 - City WI 68 - State 54875 68 - Zip Code 08/26/ 67 - Date of Birth M 69 - Sex SECOND-SEAT-LEFT-SIDE-(MC/BIKE PASSENGER, TRAIN BREAKMA 71 - Seat Position RESTRAINT-USE-UNKNOWN 72 - Safety Equipment B - NON-INCAPACITATING INJURY 70 - Injury Severity DEPLOYED 73 - Airbag NOT-EJECTED 75 - Ejected Medical Transport 77 NOT-TRAPPED 76 - Trapped/Extricated 78 - Agency Space Accident Report of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZDPHZG 4 5 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 DEPUTY KEVIN GILLIS VEHICLE WAS TRAVELING SOUTH ON COUNTY RD AA AND DID NOT STOP AT THE STOP SIGN. THAT VEHICLE STRUCK THE VEHICLE TRAVELING WEST ON HWY 70. THE VEHICLE THAT WAS TRAVELING SOUTH CAME TO A STOP IN THE MIDDLE OF HWY 70, WHILE THE VEHICLE THAT WAS STRUCK CAME TO A STOP IN THE DITCH. VEHICLE WAS TRAVELING SOUTH ON COUNTY RD AA AND DID NOT STOP AT THE STOP SIGN. THAT VEHICLE STRUCK THE VEHICLE TRAVELING WEST ON HWY 70. THE VEHICLE THAT WAS TRAVELING SOUTH CAME TO A STOP IN THE MIDDLE OF HWY 70, WHILE THE VEHICLE THAT WAS STRUCK CAME TO A STOP IN THE DITCH. 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 GILLIS125 - Officer Last Name KEVIN 345131 - 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 04/07/2015132 - Date Notified 0137133 - Time Notified (Military Time)0142134 - Time Arrived (Military Time)04/07/2015135 - Date Of Report 15040701 19 - Special Study 18 - Agency Space Accident Report of MV4000e 01/2005 Page PK2012 Wisconsin Motor Vehicle GZDPHZG 5 5