Loading...
HomeMy WebLinkAbout20180814 ortegel-shaffer-mcdonald.pdf18081405 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13J55KH WISCONSIN MOTOR VEHICLE CRASH REPORT Secondary CrashAmendedCrash Type DT4000 (STANDARD CRASH)Reportable TagsSchool Bus Related NOActive School ZoneGovernment Property Reporting ThresholdTrailer or TowedWork ZoneLane ClosureHit and RunOn Emergency Total Killed 00 Total Injured 04 Total Units 03 Time Notified 12:56 PM Date Notified 08/14/2018 Time Arrived 01:00 PM Date Arrived 08/14/2018 Crash Time 12:55 PM Crash Date 08/14/2018 Investigating Officer/Deputy DEPUTY AMANDA REED Agency Crash NumberPrimary Crash Document #Document Number Override 6V L 1 3 J 5 5 K H Additional InformationPHOTOS Photos ByDEPUTY AMANDA REED Reconstruction ByDiagram Description I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. SEE CASE # 18081405 Crash Time 12:55 PM Crash Date 08/14/2018Wisconsin Motor Vehicle Crash Form DT4000 1 of 11 This report does not include any CJIS data. 18081405 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13J55KH WISCONSIN MOTOR VEHICLE CRASH REPORT Structure Type NO STRUCTURE Y Coordinate 5087964.5 X Coordinate 152156.203125 Longitude -91.4808604 Latitude 45.857310907 INTERSECTION ON STH27 NB AT CTHE NB IN THE TOWN OF SAND LAKE 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) CLEAR Environment Factor(s) NONE Roadway Factor(s) NONE Road Surface Condition(s) DRY Light Condition DAYLIGHT Manner of Collision 08--FRONT TO SIDE First Harmful Event Location ON ROADWAY First Harmful Event MOTOR VEH IN TRANSPORT Crash Scene Intersection Type FOUR-WAY INTERSECTION Junction Location INTERSECTION Within Interchange Area UNKNOWN Truck Bus or HazMat NO Road Grade LEVEL Road Curvature STRAIGHT Surface Type BLACKTOP (BITUMINOUS) Traffic Control Inoperative/Missing NO Traffic Control STOP SIGN Traffic Way TWO-WAY, NOT DIVIDED Emergency Motor Vehicle Use NOT APPLICABLE Special Function NO SPECIAL FUNCTIONMost Harmful Event: Collision With MOTOR VEH IN TRANSPORT Total Lanes 2 Speed Limit 55Pre CrashTire Mark Direction Of Travel NORTHBOUND Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 1 Train/Bus # InjuredTotal Occs 4 Operating As EndorsementsVehicle Type PASSENGER CAR01 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UN IT Extent Of Damage DISABLING DAMAGE Vehicle Damage 4--RIGHT SIDE REAR, 5--RIGHT REAR CORNER, 6--REAR Initial Contact Point 5--RIGHT REAR CORNER Bus UseNOT A BUSBody Style 4D - 4DR Color BLU - BLUE Model MALIBU Year 2014 Make CHEVROLET Vehicle Identification Number 06270101 Country of Issuance UNITED STATES St IL Plate Type AUT - AUTOMOBILE License Plate Number VE H I C L E UN I T Vehicle Crash Time 12:55 PM Crash Date 08/14/2018Wisconsin Motor Vehicle Crash Form DT4000 2 of 11 This report does not include any CJIS data. 18081405 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13J55KH WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address SUGARGROVE, IL 60554 , US Owner Name 01 Driver DistractionsNOT DISTRACTED 01 Driver Actions FAILED TO YIELD RIGHT-OF-WAY Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing GOING STRAIGHT Vehicle Removed ByTowed Due To Damage TOWED DUE TO DISABLING DAMAGE UN I T VE H I C L E Sequence Of Events EventMOTOR VEH IN TRANSPORT01 EventMOTOR VEH IN TRANSPORT02 EventMOTOR VEH IN TRANSPORT03 Event 04 IndividualInsurance Company ALLSTATE-INS-CO Policy Holder UN I T Injury Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABL Ejected NOT EJECTED Airbag DEPLOYED-COMBINATION Injury Severity NO APPARENT INJURY00 1 01 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY Safety Equipment SHOULDER & LAP BELT On Duty Crash Driver License Number STATE: ILLINOIS COUNTRY: UNITED STATES Address SUGARGROVE, IL 60554 , US Race WHITE Date of Birth 04/08 Sex MALE Citations Issued 1 Driver IT Equipment Individual UN IN D I V ID U A L Crash Time 12:55 PM Crash Date 08/14/2018Wisconsin Motor Vehicle Crash Form DT4000 3 of 11 This report does not include any CJIS data. 18081405 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13J55KH WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL Drug Type 00 1 01 Drug Test ResultsDrug Test TypeDrug Test GivenTEST NOT GIVEN Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given TEST NOT GIVEN Suspected Drug Use NO Suspected Alcohol Use NO Action Other Action To/From SchoolLocationPrior ActionStriking Unit # Time of DeathDate of DeathHospital EMS Run #EMS Agency IdentifierMedical Transport NOT TRANSPORTED UN I T Non Motorist IN D I V I D U A L Injury To/From SchoolLocationPrior ActionStriking Unit # Time of DeathDate of DeathHospital EMS Run #EMS Agency IdentifierMedical Transport NOT TRANSPORTED Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABL Ejected NOT EJECTED Airbag DEPLOYED-COMBINATION Injury Severity NO APPARENT INJURY00 2 01 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 3--FRONT SEAT-RIGHT SIDE (TRAIN ENGINEER Safety Equipment SHOULDER & LAP BELT On Duty Crash Driver License NumberAddress SUGARGROVE, IL 60554 , US Race WHITEDate of Birth 10/24 Sex FEMALE Citations Issued 0 Passenger IT Equipment Non Motorist Individual UN IN D I V ID U A L Crash Time 12:55 PM Crash Date 08/14/2018Wisconsin Motor Vehicle Crash Form DT4000 4 of 11 This report does not include any CJIS data. 18081405 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13J55KH WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL Drug Type 00 2 01 Drug Test ResultsDrug Test TypeDrug Test Given TEST NOT GIVEN Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given TEST NOT GIVEN Suspected Drug Use NO Suspected Alcohol Use NO Action Other Action UN I T IN D I V I D U A L Injury To/From SchoolLocationPrior ActionStriking Unit # Time of DeathDate of DeathHospital HAYWARD AREA MEM HOSP EMS Run #EMS Agency Identifier 5 Medical Transport EMS GROUND Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABL Ejected NOT EJECTED Airbag DEPLOYED-COMBINATION Injury Severity SUSPECTED MINOR INJURY00 3 01 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 4--SECOND SEAT-LEFT SIDE(MOTORCYCLE/BI Safety Equipment SHOULDER & LAP BELT On Duty Crash Driver License NumberAddress SUGARGROVE, IL 60554 , US Race WHITEDate of Birth 02/04 Sex MALE Citations Issued 0 Passenger IT Equipment Non Motorist Individual UN IN D I V ID U A L Crash Time 12:55 PM Crash Date 08/14/2018Wisconsin Motor Vehicle Crash Form DT4000 5 of 11 This report does not include any CJIS data. 18081405 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13J55KH WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL Drug Type 00 3 01 Drug Test ResultsDrug Test TypeDrug Test Given TEST NOT GIVEN Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given TEST NOT GIVEN Suspected Drug Use NO Suspected Alcohol Use NO Action Other Action UN I T IN D I V I D U A L Injury To/From SchoolLocationPrior ActionStriking Unit # Time of DeathDate of DeathHospital HAYWARD AREA MEM HOSP EMS Run #EMS Agency Identifier 5 Medical Transport EMS GROUND Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABL Ejected NOT EJECTED Airbag DEPLOYED-COMBINATION Injury Severity SUSPECTED MINOR INJURY00 4 01 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 6--SECOND SEAT-RIGHT SIDE Safety Equipment SHOULDER & LAP BELT On Duty Crash Driver License NumberAddress SUGARGROVE, IL 60554 , US Race WHITEDate of Birth 02/04 Sex MALE Citations Issued 0 Passenger IT Equipment Non Motorist Individual UN IN D I V ID U A L Crash Time 12:55 PM Crash Date 08/14/2018Wisconsin Motor Vehicle Crash Form DT4000 6 of 11 This report does not include any CJIS data. 18081405 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13J55KH WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL Drug Type 00 4 01 Drug Test ResultsDrug Test TypeDrug Test Given TEST NOT GIVEN Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given TEST NOT GIVEN Suspected Drug Use NO Suspected Alcohol Use NO Action Other Action UN I T IN D I V I D U A L Violations DescriptionFAIL/YIELD RIGHT/WAY FROM STOP SIGNSeq Num001Statute Number346.18(3)Issue To? 001 UTC Number AE53885901 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 Use NOT APPLICABLE Special Function NO SPECIAL FUNCTIONMost Harmful Event: Collision With MOTOR VEH IN TRANSPORT Total Lanes 2 Speed Limit 55Pre CrashTire Mark Direction Of Travel WESTBOUND Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # InjuredTotal Occs 01 Operating As EndorsementsVehicle Type UTILITY TRUCK/PICKUP TRUCK02 Unit Type TRUCK Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UN IT Vehicle Removed ByTowed Due To Damage TOWED DUE TO DISABLING DAMAGE Extent Of Damage DISABLING DAMAGE Vehicle Damage 12--FRONT Initial Contact Point 12--FRONT Bus UseNOT A BUSBody Style 4D - 4DR Color BRZ - BRONZE Model SIERRA Year 2001 Make GENERAL MOTORS COR Vehicle Identification Number 08260202 Country of Issuance UNITED STATES St WI Plate Type LTK - LIGHT TRUCK License Plate Number VE H I C L E UN I T Vehicle Crash Time 12:55 PM Crash Date 08/14/2018Wisconsin Motor Vehicle Crash Form DT4000 7 of 11 This report does not include any CJIS data. 18081405 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13J55KH WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address SPRINGBROOK, WI 54875 , US Owner Name 02 Driver DistractionsNOT DISTRACTED 02 Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other Vehicle Factors NOT APPLICABLE What Driver Was Doing GOING STRAIGHT UN I T VE H I C L E Sequence Of Events EventMOTOR VEH IN TRANSPORT01 EventMOTOR VEH IN TRANSPORT02 EventMOTOR VEH IN TRANSPORT03 Event 04 IndividualInsurance Company STATE-FARM-GENERAL-INS-CO Policy Holder UN I T Injury EMS Run #EMS Agency IdentifierMedical Transport NOT TRANSPORTED Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABL Ejected NOT EJECTED Airbag NON DEPLOYED Injury Severity SUSPECTED MINOR INJURY00 5 02 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY Safety Equipment SHOULDER & LAP BELT On Duty Crash Driver License Number STATE: WISCONSIN COUNTRY: UNITED STATES Address SPRINGBROOK, WI 54875 , US Race WHITEDate of Birth 07/26 Sex MALE Citations Issued 0 Driver IT Equipment Individual UN IN D I V ID U A L Crash Time 12:55 PM Crash Date 08/14/2018Wisconsin Motor Vehicle Crash Form DT4000 8 of 11 This report does not include any CJIS data. 18081405 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13J55KH WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL Drug Type 00 5 02 Drug Test ResultsDrug Test TypeDrug Test GivenTEST NOT GIVEN Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given TEST NOT GIVEN Suspected Drug Use NO Suspected Alcohol Use NO Action Other Action To/From SchoolLocationPrior ActionStriking Unit # Time of DeathDate of DeathHospital UN I T Non Motorist IN D I V I D U A L Truck Bus or HazMat NO Road Grade LEVEL Road Curvature STRAIGHT Surface Type BLACKTOP (BITUMINOUS) Traffic Control Inoperative/Missing NO Traffic Control STOP SIGN Traffic Way TWO-WAY, NOT DIVIDED Emergency Motor Vehicle Use NOT APPLICABLE Special Function NO SPECIAL FUNCTIONMost Harmful Event: Collision With MOTOR VEH IN TRANSPORT Total Lanes 2 Speed Limit 55Pre CrashTire Mark Direction Of Travel SOUTHBOUND Insurance? YES Total HazMat Types 0 Total Trailers 0 Total # Citations Issued 0 Train/Bus # InjuredTotal Occs 01 Operating As EndorsementsVehicle Type PASSENGER CAR03 Unit Type AUTOMOBILE Vehicle Operating As Classification D CLASS Unit Status IN TRANSIT Unit Summary UN IT Vehicle Removed ByTowed Due To Damage TOWED DUE TO DISABLING DAMAGE Extent Of Damage DISABLING DAMAGE Vehicle Damage 10--LEFT SIDE FRONT, 11--LEFT FRONT CORNER Initial Contact Point 11--LEFT FRONT CORNER Bus UseNOT A BUSBody Style 4D - 4DR Color BLK - BLACK Model WAGON Year 2011 Make SUBARU Vehicle Identification Number 58180303 Country of Issuance UNITED STATES St ID Plate Type AUT - AUTOMOBILE License Plate Number VE H I C L E UN I T Vehicle Crash Time 12:55 PM Crash Date 08/14/2018Wisconsin Motor Vehicle Crash Form DT4000 9 of 11 This report does not include any CJIS data. 18081405 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13J55KH WISCONSIN MOTOR VEHICLE CRASH REPORT Owner Address STONE LAKE, WI 54876 , US Owner Name 03 Driver DistractionsNOT DISTRACTED 03 Driver Actions NO CONTRIBUTING ACTION Driver Prior Action Other STOPPED AT STOP SIGN Vehicle Factors NOT APPLICABLE What Driver Was Doing OTHER UN I T VE H I C L E Sequence Of Events EventMOTOR VEH IN TRANSPORT01 EventMOTOR VEH IN TRANSPORT02 EventMOTOR VEH IN TRANSPORT03 Event 04 IndividualInsurance Company AMERICAN-FAMILY-INS-CO Policy Holder UN I T Injury EMS Run #EMS Agency IdentifierMedical Transport NOT TRANSPORTED Trapped/Extricated NOT TRAPPED Ejection Path NOT EJECTED/NOT APPLICABL Ejected NOT EJECTED Airbag NON DEPLOYED Injury Severity SUSPECTED MINOR INJURY00 6 03 Tint ComplianceEye Protection Helmet ComplianceHelmet Use Seat Position 1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY Safety Equipment SHOULDER & LAP BELT On Duty Crash Driver License Number STATE: WISCONSIN COUNTRY: UNITED STATES Address STONE LAKE, WI 54876 , US Race WHITEDate of Birth 03/27 Sex FEMALE Citations Issued 0 Driver IT Equipment Individual UN IN D I V ID U A L Crash Time 12:55 PM Crash Date 08/14/2018Wisconsin Motor Vehicle Crash Form DT4000 10 of 11 This report does not include any CJIS data. 18081405 SAWYER COUNTY SHERIFFS DEPT 15880 EAST FIFTH STREET HAYWARD, WI 54843 (715) 634-4858 6VL13J55KH WISCONSIN MOTOR VEHICLE CRASH REPORT Drug & Alcohol Individual Condition APPEARED NORMAL Drug Type 00 6 03 Drug Test ResultsDrug Test TypeDrug Test GivenTEST NOT GIVEN Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given TEST NOT GIVEN Suspected Drug Use NO Suspected Alcohol Use NO Action Other Action To/From SchoolLocationPrior ActionStriking Unit # Time of DeathDate of DeathHospital UN I T Non Motorist IN D I V I D U A L Crash Time 12:55 PM Crash Date 08/14/2018Wisconsin Motor Vehicle Crash Form DT4000 11 of 11 This report does not include any CJIS data.