HomeMy WebLinkAbout20150616 Miesbauer RobinsonAgency 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 GZDSGV4
DOT Document Number Document Override Number
15061605
15
0
6
1
6
0
5
380
38
0
06/16/2015
4 - Accident Date
1608
5 - Time of Accident (Military Time)
02
6 - Total Units
00
7 - Total Injured
00
8 - Total Killed
SAWYER - 572 - County WINTER - 55, VILLAGE3 - Municipality NON-INTERSECTION11 - Accident Location
070
14 - On Hwy No.
WB
14 - On Street Name 14 - Bus/Frnt/Rmp
9 FT15 - Est. Distance EAST15 - Hwy. Dir
16 - Fr/At Hwy No.CRAWFORD ST16 - From/At Street Name 16 - Business/Frontage/Ramp
17 - Structure Type 17 - Structure Number
45.824858
12 - Latitude -91.00774513 - 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
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
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
WEST
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
2019
31 - Expiration Year 34 - On Duty Accident
MIESBAUER
25 - Operator/Pedestrian Last Name
CHRISTINE
25 - First Name
J
25 - Middle Initial 25 - Suffix
04/19/1
32 - Date Of Birth
FEMALE
33 - Sex
26 - Address Street & Nu r 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
MAKING-LEFT-TURN
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 0062 - 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 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 GZDSGV4 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
01
22 - Total Occupants
867PZV
56 - License Plate Number
AUT57 - Plate Type WI
58 - State
2016
59 - Exp Year
0619
55 - Vehicle Identification Number
2004
50 - Year
HOND
51 - Make
SEDAN
52 - Model
4D - 4DR
53 - Body Style
WHI
54 - Color 100 - Skidmarks to Impact (Ft)
FRONT DRIVER SIDE, FRONT
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
MIESBAUER
46 - Vehicle Owner Last Name
CHRISTINE
46 - First Name
J
46 - Middle Initial 46 - Suffix
04/19/
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
WINTER48 - City WI48 - State 5489648 - Zip Code 49 - Telephone Number
B AND B INSURANCE AGENCY INC63 - Liability Insurance Company Policy Holder Same As Owner60
MIESBAUER
61 - Policy Holder Last Name
CHRISTINE
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
4524 - Speed Limit
D CLASS
36 - Operating as Classified 37 - Endorsements 35
Operating Commercial Motor Vehicle
29 - Driver's License Number
MN
30 - State
2017
31 - Expiration Year 34 - On Duty Accident
ROBINSON
25 - Operator/Pedestrian Last Name
MICHAEL
25 - First Name
ROBERT
25 - Middle Initial 25 - Suffix
10/14/
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 GZDSGV4 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
MAPLE GROVE
27 - City
MN
27 - State
55311
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
OVERTAKING-ON-LEFT
119 - What Driver Was Doing
NO-CONTROL
120 - Traffic Control 0162 - No. of Citations Issued
346.32
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, IMPROPER-OVERTAKING
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
91 - Drugs Reported
NOT-APPLICABLE
124 - Highway Factors
AUTOMOBILE
21 - Unit Type
PASSENGER-CAR
Vehicle Type
01
22 - Total Occupants
198PCZ
56 - License Plate Number
AUT57 - Plate Type MN
58 - State
2015
59 - Exp Year
0142
55 - Vehicle Identification Number
2011
50 - Year
BMW
51 - Make
4D28X
52 - Model
4D - 4DR
53 - Body Style
BLK
54 - Color 100 - Skidmarks to Impact (Ft)
REAR PASSENGER SIDE, MIDDLE 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
ROBINSON
46 - Vehicle Owner Last Name
MICHAEL
46 - First Name
ROBERT
46 - Middle Initial 46 - Suffix
10/14/1
Date Of Birth
46 - Company Name
47- Address Street & Number 47 - PO Box
MAPLE GROVE48 - City MN48 - State 5531148 - Zip Code 49 - Telephone Number
FARMERS-INS-CO-INC63 - Liability Insurance Company Policy Holder Same As Owner60
ROBINSON
61 - Policy Holder Last Name
MICHAEL
61 - Policy Holder First Name
61 - Policy Holder Company
02
02
02
02
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDSGV4 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
ON JUNE 16TH, 2015 AT APPROXIMATELY 1610 PM I, DEPUTY MALCOLM HAAG, WAS CONTACTED BY SAWYER COUNTY DISPATCH TO RESPOND TO THE INTERSECTION OF STATE HWY 70 AND CRAWFORD ST. THERE WERE NO REPORTED INJURIES. I ARRIVED
ON SCENE AT APPROXIMATELY 1629 PM. THE VEHICLES HAD MOVED OFF THE SIDE OF THE ROADWAY AND THE DRIVERS HAD
EXCHANGED INFORMATION. I MADE CONTACT WITH THE DRIVER OF UNIT 01. SHE HANDED ME A WI DL THAT CONFIRMED HER
IDENTITY TO BE CHRISTINE MIESBAUER. CHRISTINE STATED THAT SHE WAS TRAVELING WESTBOUND ON STATE HWY 70 AND
HAD SLOWED TO TURN LEFT ONTO CRAWFORD ST IN WINTER. SHE STATED THAT SHE HAD ACTIVATED HER LEFT TURN SIGNAL.
CHRISTINE SAID THAT AS SHE WAS TURNING LEFT A VEHICLE WAS APPROACHING HER AND ATTEMPTING TO PASS HER ON THE LEFT ON STATE HWY 70. SHE SAID THAT THEY MADE CONTACT. CHRISTINE APPEARED TO BE VERY UNSETTLED AND AFFECTED
BY THE INCIDENT. SHE HAD CONTACTED HER DAUGHTER AND I REQUESTED THAT HER DUAGHTER DRIVE HER HOME. I MADE
CONTACT WITH A WITNESS THAT WAS DRIVING A MINIVAN IN BETWEEN UNIT 01 AND UNIT 02. SHE WAS CONFIRMED FROM HER
WI DL TO BE ELIZABETH HOVEL. SHE SAID THAT UNIT 01 WAS TURNING LEFT AND UNIT 02 WAS ATTEMPTING TO PASS HER AND
UNIT 01 ON THE LEFT. SHE SAID THAT UNIT 02 WAS STRUCK BY UNIT 01 AS IT ATTEMPTED TO PASS BEFORE ENSURING THAT THE
PASSING LOCATION WAS SAFE. I SPOKE WITH THE DRIVER OF UNIT 02, HE WAS CONFIRMED TO BE MICHAEL ROBINSON BY HIS
MN DL. HE STATED THAT UNIT 01 AND THE MINIVAN WERE DRIVING SLOWLY AND HE WANTED TO PASS THEM. HE SAID THAT HE BEGAN TO PASS THE TWO VEHICLES AND DID NOT OBSERVE UNIT 01 HAVE IT'S TURN SIGNAL ON UNTIL THEY MADE CONTACT. HE
STATED THAT IT WAS TOO LATE AND HE WAS STRUCK AS HE WAS PASSING. MICHAEL SAID THAT HE SHOULD NOT HAVE PASSED
AND WAITED UNTIL HE WAS SURE THE PASS OF THE VEHICLE WAS SAFE TO DO SO.
ON JUNE 16TH, 2015 AT APPROXIMATELY 1610 PM I, DEPUTY MALCOLM HAAG, WAS CONTACTED BY SAWYER COUNTY DISPATCH TO RESPOND TO THE INTERSECTION OF STATE HWY 70 AND CRAWFORD ST. THERE WERE NO REPORTED INJURIES. I ARRIVED
ON SCENE AT APPROXIMATELY 1629 PM. THE VEHICLES HAD MOVED OFF THE SIDE OF THE ROADWAY AND THE DRIVERS HAD
EXCHANGED INFORMATION. I MADE CONTACT WITH THE DRIVER OF UNIT 01. SHE HANDED ME A WI DL THAT CONFIRMED HER
IDENTITY TO BE CHRISTINE MIESBAUER. CHRISTINE STATED THAT SHE WAS TRAVELING WESTBOUND ON STATE HWY 70 AND
HAD SLOWED TO TURN LEFT ONTO CRAWFORD ST IN WINTER. SHE STATED THAT SHE HAD ACTIVATED HER LEFT TURN SIGNAL.
CHRISTINE SAID THAT AS SHE WAS TURNING LEFT A VEHICLE WAS APPROACHING HER AND ATTEMPTING TO PASS HER ON THE LEFT ON STATE HWY 70. SHE SAID THAT THEY MADE CONTACT. CHRISTINE APPEARED TO BE VERY UNSETTLED AND AFFECTED
BY THE INCIDENT. SHE HAD CONTACTED HER DAUGHTER AND I REQUESTED THAT HER DUAGHTER DRIVE HER HOME. I MADE
CONTACT WITH A WITNESS THAT WAS DRIVING A MINIVAN IN BETWEEN UNIT 01 AND UNIT 02. SHE WAS CONFIRMED FROM HER
WI DL TO BE ELIZABETH HOVEL. SHE SAID THAT UNIT 01 WAS TURNING LEFT AND UNIT 02 WAS ATTEMPTING TO PASS HER AND
UNIT 01 ON THE LEFT. SHE SAID THAT UNIT 02 WAS STRUCK BY UNIT 01 AS IT ATTEMPTED TO PASS BEFORE ENSURING THAT THE
PASSING LOCATION WAS SAFE. I SPOKE WITH THE DRIVER OF UNIT 02, HE WAS CONFIRMED TO BE MICHAEL ROBINSON BY HIS
MN DL. HE STATED THAT UNIT 01 AND THE MINIVAN WERE DRIVING SLOWLY AND HE WANTED TO PASS THEM. HE SAID THAT HE BEGAN TO PASS THE TWO VEHICLES AND DID NOT OBSERVE UNIT 01 HAVE IT'S TURN SIGNAL ON UNTIL THEY MADE CONTACT. HE
STATED THAT IT WAS TOO LATE AND HE WAS STRUCK AS HE WAS PASSING. MICHAEL SAID THAT HE SHOULD NOT HAVE PASSED
AND WAITED UNTIL HE WAS SURE THE PASS OF THE VEHICLE WAS SAFE TO DO SO.
Witness
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDSGV4 4 5
WI
T
N
E
S
S
HOVEL
107 - Witness Last Name
ELIZABETH
107 - First Name
M
107 - Middle Initial
01
& Number 108 - PO Box
1/27/1
109 - Date of Birth
SHELL LAKE
110 - City
WI
State
54871
110 - Zip Code 111 - Telephone Number
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
HAAG
125 - Officer Last Name
MALCOLM 380
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
06/16/2015
132 - Date Notified 1610133 - Time Notified (Military Time)1629134 - Time Arrived (Military Time)
07/07/2015
135 - Date Of Report
15061605 380 19 - Special Study
18 - Agency Space
Accident Report
of
MV4000e 01/2005
Page
PK2012
Wisconsin Motor Vehicle GZDSGV4 5 5