HomeMy WebLinkAbout20150408 ParrAgency Accident Number
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Reportable Accident On Emergency Amended GZDT72S
DOT Document Number Document Override Number
15040804320
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15040802
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04/08/2015
4 - Accident Date
1635
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
077
14 - On Hwy No.
EB
14 - On Street Name 14 - Bus/Frnt/Rmp
351 FT15 - Est. Distance SOUTH15 - Hwy. Dir
16 - Fr/At Hwy No.TWIN LAKE RD 616 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
46.041159
12 - Latitude -91.32824413 - Longitude
MOTOR VEHICLE IN TRANSPORT80 - First Harmful Event SIDESWIPE. SAME DIRECTION93 - 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
OUTSIDE-SHOULDER-RIGHT
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
OP
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H - HIT AND RUN
Unit Status
MOTOR VEHICLE IN TRANSPORT
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
29 - Driver's License Number
WI
30 - State
2021
31 - Expiration Year 34 - On Duty Accident
PARR
25 - Operator/Pedestrian Last Name
JENNIFER
25 - First Name
C
25 - Middle Initial 25 - Suffix
06/08 4
32 - Date Of Birth
FEMALE
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
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
STOPPED-IN-TRAFFIC
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 62 - 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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Wisconsin Motor Vehicle GZDT72S 1 5
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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
964VTM
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2015
59 - Exp Year
9625
55 - Vehicle Identification Number
2008
50 - Year
TOYT
51 - Make
RAV4 LTD
52 - Model
UT - SPORT UTILITY
53 - Body Style
GLD
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT PASSENGER 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
PARR
46 - Vehicle Owner Last Name
JENNIFER
46 - First Name
C
46 - Middle Initial 46 - Suffix
06/08/
Date Of Birth
46 - Company Name
47 - PO Box
HAYWARD48 - City WI48 - State 5484348 - Zip Code . 49 - Telephone Number
STATE-FARM63 - Liability Insurance Company Policy Holder Same As Owner60
PARR
61 - Policy Holder Last Name
RONALD
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
H - HIT AND RUN
Unit Status
MOTOR VEHICLE IN TRANSPORT
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
29 - Driver's License Number 30 - State 31 - Expiration Year 34 - On Duty Accident
25 - Operator/Pedestrian Last Name 25 - First Name 25 - Middle Initial 25 - Suffix
32 - Date Of Birth 33 - Sex
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MV4000e 01/2005
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Wisconsin Motor Vehicle
Accident Report
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MV4000e 01/2005
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Wisconsin Motor Vehicle GZDT72S 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
27 - City 27 - State 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
UNKNOWN
41 - Airbag
UNKNOWN
42 - Ejected 44
Medical Transport
UNKNOWN
43 - Trapped/Extricated 92 - Pedestrian Location 92 - Pedestrian Action
BACKING-MANEUVER
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 62 - No. of Citations Issued
64 - 1st Statute No.64 - 2nd Statute No.64 - 3rd Statute No.64 - 4th Statute No.64 - 5th Statute No.
UNSAFE-BACKING
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
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
1
22 - Total Occupants
56 - License Plate Number 57 - Plate Type WI
58 - State 59 - Exp Year 55 - Vehicle Identification Number
50 - Year 51 - Make 52 - Model 53 - Body Style 54 - Color 100 - Skidmarks to Impact (Ft)
UNKNOWN
94 - Vehicle Damage
UNKNOWN
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
46 - Vehicle Owner Last Name 46 - First Name 46 - Middle Initial 46 - Suffix Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
48 - City 48 - State 48 - Zip Code 49 - Telephone Number
UNKNOWN63 - Liability Insurance Company Policy Holder Same As Owner60
61 - Policy Holder Last Name 61 - Policy Holder First Name
61 - Policy Holder Company
02
02
02
02
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Wisconsin Motor Vehicle GZDT72S 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
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01
65 - Unit No
NONE
66 - Occupant Last Name 66 - First Name 66 - Middle Initial 66 - Suffix
01
68 - Address Street & Number 68 - PO Box
68 - City 68 - State 68 - Zip Code
67 - Date of Birth 69 - Sex
71 - Seat Position
NOT-APPLICABLE-NONMOTORIST
72 - Safety Equipment
N - NO APPARENT INJURY
70 - Injury Severity
NOT APPLICABLE
73 - Airbag
NOT-APPLICABLE
75 - Ejected
Medical Transport
77
NOT-APPLICABLE
76 - Trapped/Extricated 78 - Agency Space
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
105 - Photos By
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Diagram and Narrative
AMBER AL-MOGHRABI
ON APRIL 8, 2015, I WAS ADVISED BY DISPATCH OF A HIT AND RUN ACCIDENT THAT HAPPENED ON STATE HWY 77 BY TWIN LAKE
ROAD. DISPATCH STATED THE CALLER WAS AT HOME NOW ON 12489 N LARSON ROAD. UPON ARRIVAL AT 18:05, I MET WITH
JENNIFER AND RONALD PARR. JENNIFER STATED SHE WAS DRIVING EASTBOUND ON STATE
ON APRIL 8, 2015, I WAS ADVISED BY DISPATCH OF A HIT AND RUN ACCIDENT THAT HAPPENED ON STATE HWY 77 BY TWIN LAKE
ROAD. DISPATCH STATED THE CALLER WAS AT HOME NOW ON 12489 N LARSON ROAD. UPON ARRIVAL AT 18:05, I MET WITH
JENNIFER AND RONALD PARR. JENNIFER STATED SHE WAS DRIVING EASTBOUND ON STATE
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Wisconsin Motor Vehicle GZDT72S 4 5
HIGHWAY 77 WHEN SHE MET A VEHICLE IN FRONT OF TWIN LAKES TAP, THAT WAS PARKED ON THE RIGHT SIDE OF THE ROAD. JENNIFER STATED THE TRUCK WAS STILL PARTIALLY ON THE ROADWAY. SHE STATED SHE DID NOT HAVE TIME TO PASS THE
TRUCK, SO SHE STOPPED BEHIND IT TO WAIT FOR IT TO MOVE. SHE STATED THE TRUCK WAS NOT IN PARK, BUT THE BREAK
LIGHTS WERE STILL ON SO SHE FIGURED IT WOULD BE DRIVING FORWARD. JENNIFER THEN STATED ALL OF A SUDDEN THE
TRUCK STARTED TO BACK UP AND TURNED HIS WHEEL SO HE ENDED UP HITTING HER VEHICLE. JENNIFER THEN SAID THE
TRUCK DROVE FORWARD, DID A U-TURN, AND DROVE OFF. SHE STATED SHE DID MAKE EYE CONTACT WITH THE MALE DRIVER,
BUT DID NOT GET A LICENSE PLATE. THE FRONT OF THE PASSENGER SIDE OF HER VEHICLE WAS SCRATCHED AND DENTED. THE ANTENNA ON HER VEHICLE WAS TORN OFF AND THE SIDE MIRROR WAS PUSHED IN AND THE BACK OF IT WAS TORN OFF. I
INFORMED JENNIFER TO GET AN ESTIMATE ON HER VEHICLE AND INFORM ME WHAT IT WAS, I WILL ALSO BE PLACING PHOTOS OF
JENNIFER'S VEHICLE INTO EVIDENCE. I CLEARED THE CALL AT 18:21.
HIGHWAY 77 WHEN SHE MET A VEHICLE IN FRONT OF TWIN LAKES TAP, THAT WAS PARKED ON THE RIGHT SIDE OF THE ROAD. JENNIFER STATED THE TRUCK WAS STILL PARTIALLY ON THE ROADWAY. SHE STATED SHE DID NOT HAVE TIME TO PASS THE
TRUCK, SO SHE STOPPED BEHIND IT TO WAIT FOR IT TO MOVE. SHE STATED THE TRUCK WAS NOT IN PARK, BUT THE BREAK
LIGHTS WERE STILL ON SO SHE FIGURED IT WOULD BE DRIVING FORWARD. JENNIFER THEN STATED ALL OF A SUDDEN THE
TRUCK STARTED TO BACK UP AND TURNED HIS WHEEL SO HE ENDED UP HITTING HER VEHICLE. JENNIFER THEN SAID THE
TRUCK DROVE FORWARD, DID A U-TURN, AND DROVE OFF. SHE STATED SHE DID MAKE EYE CONTACT WITH THE MALE DRIVER,
BUT DID NOT GET A LICENSE PLATE. THE FRONT OF THE PASSENGER SIDE OF HER VEHICLE WAS SCRATCHED AND DENTED. THE ANTENNA ON HER VEHICLE WAS TORN OFF AND THE SIDE MIRROR WAS PUSHED IN AND THE BACK OF IT WAS TORN OFF. I
INFORMED JENNIFER TO GET AN ESTIMATE ON HER VEHICLE AND INFORM ME WHAT IT WAS, I WILL ALSO BE PLACING PHOTOS OF
JENNIFER'S VEHICLE INTO EVIDENCE. I CLEARED THE CALL AT 18:21.
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125 - First Name 125 - Middle Initial
Officer Information
ALMOGHRABI
125 - Officer Last Name
AMBER 340
131 - Officer ID
129 - Law Enforcement Agency No.SAWYER COUNTY SHERIFFS DEPT130 - Law Enforcement Agency Name
15880 EAST FIFTH STREET
126 - Law Enforcement Agency Address Street & Number
HAYWARD127 - City WI127 - State 54843127 - Zip Code (715) 634-4858 EXT. 128 - Telephone Number
04/08/2015
132 - Date Notified 1729133 - Time Notified (Military Time)1805134 - Time Arrived (Military Time)
04/09/2015
135 - Date Of Report
15040804320 15040802 19 - Special Study
18 - Agency Space
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Wisconsin Motor Vehicle GZDT72S 5 5