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Home My WebLink About20180728 BERGUM.pdf18072806 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13MV8WB Wisconsin Motor Vehicle Crash Report Secondary CrashAmendedCrash Type DT4000 (Standard Crash)Reportable TagsSchool Bus Related NoActive School ZoneGovernment Property Trailer or TowedWork ZoneLane ClosureHit and RunOn Emergency Total Killed 00 Total Injured 01 Total Units 01 Time Notified 03:28 PM Date Notified 07/28/2018 Time Arrived 03:32 PM Date Arrived 07/28/2018 Crash Time 03:28 PM Crash Date 07/28/2018 Investigating Officer/Deputy DEPUTY MICHAEL SIMPSON Agency Crash NumberPrimary Crash Document #Document Number Override 6V L 1 3 M V 8 W B Additional InformationPhotos Photos ByDEPUTY SIMPSON Reconstruction ByDiagram Description Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. DRIVER STATE THAT A HEAVY DOWN POUR OCCURRED AND DURING THAT DOWN POUR THE DRIVER BELIEVED THAT HE HYDROPLANED AND ENTERED THE EMBANKMENT DRIVER'S SIDE FIRST. A WITNESS THAT WAS DIRECTLY BEHIND THE DRIVER CONFIRMED THE SAME THING. THE VEHICLE HIT MULTIPLE SMALL TREES ON THE DRIVER'S SIDE. DRIVER HAD A SWOLLEN KNEE AND WAS SEEN BY EMS BUT DID NOT RIDE IN AMBULANCE TO HOSPITAL. PASSENGER HAD TO APPARNT INJURY AND NO COMPLAINTS OF INJURY. Crash Time 03:28 PM Crash Date 07/28/2018Wisconsin Motor Vehicle Crash Form DT4000 1 of 5 This report does not include any CJIS data. 18072806 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13MV8WB Wisconsin Motor Vehicle Crash Report Structure Type No Structure Y Coordinate 5106530 X Coordinate 162169.828125 Longitude -91.365332005 Latitude 46.02890583 ON STH77 EB 551 FT W OF ROUND LAKE SCHOOL RD IN THE TOWN OF HAYWARD IN SAWYER COUNTY Location Special StudyAccess Control No Control Tribal Land Crash Classification - Jurisdiction No Special Jurisdiction Crash Classification - Location Public Property Relation To Trafficway Trafficway - On Road Animal Type Weather Condition(s) Rain Environment Factor(s) Weather Conditions Roadway Factor(s) Road Surface Condition (Wet, Icy, Snow, Slush, Etc) Road Surface Condition(s) Wet Light Condition Daylight Manner of Collision No Collision W/Vehicle In Transport First Harmful Event Location On Roadway First Harmful Event Embankment Crash Scene Intersection Type Not an Intersection Junction Location Non-Junction Within Interchange Area NO Reporting Threshold No Truck Bus or HazMat No Road Grade Level Road Curvature Straight Surface Type Blacktop (Bituminous) Traffic Control Inoperative/Missing NO Traffic Control No Control Traffic Way Two-Way, Not Divided Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With Embankment Total Lanes 2 Speed Limit 55Pre CrashTire Mark Direction Of Travel Eastbound Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # InjuredTotal Occs 2 Operating As EndorsementsVehicle Type Passenger Car Unit Type Automobile Vehicle Operating As Classification D CLASS Unit Status In Transit UN I T 01 Unit Summary Extent Of Damage Disabling Damage Vehicle Damage 7--Left Rear Corner, 8--Left Side Rear, 9--Left Side Middle, 10--Left Side Front, 11--Left Front Corner Initial Contact Point 10--Left Side Front Bus UseNot A BusBody Style 4D - 4DR Color WHI - White Model G37 Year 2013 Make INFINITI Vehicle Identification Number JN1CV6AR4DM Country of Issuance UNITED STATES St WI Plate Type AUT - Automobile License Plate Number VE H I C L E UN I T 01 Vehicle Crash Time 03:28 PM Crash Date 07/28/2018Wisconsin Motor Vehicle Crash Form DT4000 2 of 5 This report does not include any CJIS data. 18072806 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13MV8WB Wisconsin Motor Vehicle Crash Report Driver DistractionsNot Distracted Driver Actions No Contributing Action Driver Prior Action Other Vehicle Factors Not Applicable What Driver Was Doing Going Straight Vehicle Removed By OPERATOR Towed Due To Damage Towed Due To Disabling Damage VE H I C L E UN I T 01 Address HAYWARD, WI 54843 , US Individual 01 VE H I C L E OW N E R Vehicle Owner Sequence Of Events EventMotor Veh In Transport01 EventEmbankment02 Event 03 Event 04 IndividualInsurance Company STATE-FARM-MUTUAL-AUTOMOBILE-INS-CO Policy Holder UN I T Crash Time 03:28 PM Crash Date 07/28/2018Wisconsin Motor Vehicle Crash Form DT4000 3 of 5 This report does not include any CJIS data. 18072806 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13MV8WB Wisconsin Motor Vehicle Crash Report Individual Condition Appeared Normal Drug Type Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given Test Not Given Suspected Drug UseSuspected Alcohol Use Action Other IN D I V I D U A L UN I T Action To/From SchoolLocationPrior ActionStriking Unit # 00 1 01 Time of DeathDate of DeathHospital EMS Run #EMS Agency IdentifierMedical Transport Not Transported Trapped/Extricated Not Trapped Ejection Path Not Ejected/Not Applicable Ejected Not Ejected Airbag Deployed-Curtain Injury Severity Suspected Minor Injury IN D I V I D U A L UN I T Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 1--Front Seat-Left Side (Driver/Motorcycle/Bicycl 00 1 Safety Equipment Shoulder & Lap Belt On Duty Crash 01 ber State: Wisconsin Country: UNITED STATES Address HAYWARD, WI 54843 , US RaceASIANDate of Birth 01/05/ Sex Male Citations Issued 0 Driver IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment Crash Time 03:28 PM Crash Date 07/28/2018Wisconsin Motor Vehicle Crash Form DT4000 4 of 5 This report does not include any CJIS data. 18072806 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13MV8WB Wisconsin Motor Vehicle Crash Report Individual Condition Appeared Normal Drug Type Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given Test Not Given Suspected Drug UseSuspected Alcohol Use Action Other IN D I V I D U A L UN I T Action To/From SchoolLocationPrior ActionStriking Unit # 00 2 01 Time of DeathDate of DeathHospital EMS Run #EMS Agency IdentifierMedical Transport Not Transported Trapped/Extricated Not Trapped Ejection Path Not Ejected/Not Applicable Ejected Not Ejected Airbag Non Deployed Injury Severity No Apparent Injury IN D I V I D U A L UN I T Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 3--Front Seat-Right Side (Train Engineers/Right 00 2 Safety Equipment Shoulder & Lap Belt On Duty Crash 01 ber State: Wisconsin Country: UNITED STATES Address STONE LAKE, WI 54876 , US RaceINDIANDate of Birth 08/07 Sex Female Citations Issued 0 Passenger IN D I V I D U A L UN I T Injury Drug & Alcohol Individual Non Motorist Equipment Crash Time 03:28 PM Crash Date 07/28/2018Wisconsin Motor Vehicle Crash Form DT4000 5 of 5 This report does not include any CJIS data.