6TL9B7D7 17-193 6TL9B7D7 Document Number Override Crash Date 2/9/217 Date tified 2/9/217 On Emergency Government Property Reportable Description Diagram Hit and Run Primary Crash Document # Crash Time 7:4 AM Time tified 7:43 AM Active School Zone Lane Closure Crash Type Private Property/Parking Lot Agency Crash Number 17-193 Date Arrived 2/9/217 Total Units 2 School Bus Related Work Zone 13 LANGE COURT (68) 356-4895 Investigating Officer/Deputy DEPUTY K. SORENSON Time Arrived 7:46 AM Total Injured Tags Trailer or Towed Amended Total Killed Reconstruction By Secondary Crash Photos By Additional Information ne Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report. ON 2-9-17 AT APPROXIMATELY 7:43AM SAUK COUNTY DISPATCH ADVISED ME OF A TWO ACCIDENT IN THE KWIK TRIP PARKING LOT IN WEST BARABOO. I IDENTIFIED BOTH OPERATORS VIA WISCONSIN DRIVER'S LICENSE. 1 OPERATOR STATED "I RAN INTO HER, ITS ALL MY FAULT." 1 OPERATOR ADVISED SHE WAS DISTRACTED LOOKING AT THE CAR SHE JUST PASSED, WAS TRAVELING WESTBOUND ON LINN ST AND MADE A RIGHT TURN INTO THE KWIP TRIP PARKING LOT STRIKING 2 HEAD ON. 2 ADVISED SHE WAS SITTING IN THE PARKING LOT WAITING FOR TRAFFIC TO MOVE SO SHE COULD PULL OUT. SHE STATED 1 WAS PULLING INTO THE PARKING LOT AND SHE COULDN'T BACK UP FAST ENOUGH. 2 ALSO STATED SHE TRIED HONKING TO STOP 1 FROM HITTING HER. BOTH S ADVISED THE COLLISION HAPPEN IN THE PARKING LOT. Crash Form DT4 1 of 7 Crash Date 2/9/217 Crash Time 7:4 AM
6TL9B7D7 17-193 Location PARKING LOT STH33 WB LOT 62 (HOUSE/BUILDING 62) IN THE VILLAGE OF WEST BARABOO IN SAUK COUNTY Crash Scene First Harmful Manner of Collision 3--Front To Front Road Surface Condition(s) Dry Environment Factor(s) ne Latitude 43.475258421 X Coordinate 276123.59375 Structure Type House/Building First Harmful Location Shoulder Right Light Condition Daylight Roadway Factor(s) ne 13 LANGE COURT (68) 356-4895 Longitude -89.7683941 Y Coordinate 4817316 Weather Condition(s) Clear 1 1 Animal Type Crash Classification - Location Public Property Tribal Land Within Interchange Area NO Unit Summary Unit Status In Transit Vehicle Type Passenger Car Total Occs 1 Insurance? YES Most Harmful : Collision With Traffic Way Parking Lot or Private Property Surface Type Blacktop (Bituminous) Truck Bus or HazMat Vehicle License Plate Number 914VJH Vehicle Identification Number 1G2ZF57B984297398 Color RED - Red Initial Contact Point 12--Front Extent Of Damage Functional Damage Junction Location n-junction Train/Bus # Injured Direction Of Travel rthbound Total # Citations Issued Traffic Control Control Road Curvature Straight Relation To Trafficway n Trafficway - Parking Lot Crash Classification - Jurisdiction Special Jurisdiction Access Control Control Intersection Type t an Intersection Vehicle Operating As Classification D CLASS Pre CrashTire Mark Special Function Special Function Plate Type AUT - Automobile Make PONTIAC Body Style 4D - 4DR Vehicle Damage 1--Left Side Front Reporting Threshold Total Trailers Speed Limit 25 St WI Year 28 Unit Type Automobile Operating As Endorsements Road Grade Level Total Lanes Special Study Total HazMat Types Emergency Motor Vehicle Use n-emergency, n-transport Traffic Control Inoperative/Missing NO Country of Issuance ED STATES Model G6/VALUE L Bus Use t A Bus Crash Form DT4 2 of 7 Crash Date 2/9/217 Crash Time 7:4 AM
6TL9B7D7 17-193 1 Towed Due To Damage t Towed What Driver Was Doing Right Turn Driver Prior Action Other Vehicle Removed By ARNESON SERVICE Vehicle Factors t Applicable 13 LANGE COURT (68) 356-4895 Driver Actions Failure To Control, Failed To Keep In Designated Lane, Operated Motor Vehicle In Inattentive, Careless or Erratic Manner Driver Distractions Distraction/Inattention 1 OWNER Vehicle Owner TERESA M DIXON (68) 42-5139 214 CHESTNUT ST, US 1 Sequence Of s 2 3 4 Policy Holder Insurance Company SAFECO-INS-CO-OF-AMERICA STEVEN FILLHOUER Crash Form DT4 3 of 7 Crash Date 2/9/217 Crash Time 7:4 AM
6TL9B7D7 17-193 Driver TERESA M DIXON (68) 42-5139 214 CHESTNUT ST, US Citations Issued Date of Birth ber 13 LANGE COURT (68) 356-4895 Sex Female Race WHITE State: Wisconsin Country: ED STATES 1 1 Equipment Helmet Use On Duty Crash Seat Position 1--Front Seat-Left Side (Driver/Motorcycle/Bicycl Safety Equipment ne Used - Vehicle Occupant Helmet Compliance Eye Protection Tint Compliance Ejected t Ejected Medical Transport t Transported Hospital Injury Severity Apparent Injury Airbag n Deployed Ejection Path t Ejected/t Applicable EMS Agency Identifier Date of Death Trapped/Extricated t Trapped EMS Run # Time of Death Striking Unit # Prior Action Location To/From School Action 1 1 Injury n Motorist Action Other Drug & Alcohol Alcohol Test Given Test t Given Drug Test Given Test t Given Suspected Alcohol Use Suspected Drug Use Alcohol Test Type Drug Test Type Alcohol Test Results Drug Test Results Drug Type Condition Appeared rmal Crash Form DT4 4 of 7 Crash Date 2/9/217 Crash Time 7:4 AM
6TL9B7D7 17-193 2 2 2 Unit Summary Unit Status In Transit Vehicle Type Passenger Car Total Occs 1 Insurance? YES Most Harmful : Collision With Traffic Way Parking Lot or Private Property Surface Type Blacktop (Bituminous) Truck Bus or HazMat Vehicle License Plate Number 889TYF Vehicle Identification Number 3FA6PH72DR11753 Color PLE - Purple Initial Contact Point 12--Front Extent Of Damage Functional Damage Towed Due To Damage t Towed What Driver Was Doing Stop In Traffic Driver Prior Action Other Driver Actions Contributing Action Train/Bus # Injured Direction Of Travel Southbound Vehicle Operating As Classification D CLASS Total # Citations Issued Special Function Special Function Traffic Control Control Pre CrashTire Mark Road Curvature Straight Plate Type AUT - Automobile Make FORD Body Style 4D - 4DR Vehicle Damage 12--Front Vehicle Removed By Vehicle Factors t Applicable Reporting Threshold Total Trailers Speed Limit 25 St WI Year 213 13 LANGE COURT (68) 356-4895 Unit Type Automobile Operating As Endorsements Emergency Motor Vehicle Use n-emergency, n-transport Traffic Control Inoperative/Missing NO Road Grade Level Model FUSION SE Bus Use t A Bus Total HazMat Types Total Lanes Country of Issuance ED STATES Driver Distractions t Distracted 2 OWNER Vehicle Owner TRACY RAE AHERN (68) 393-73 S4495 BELTER DR NORTH FREEDOM, WI 53951, US 1 Sequence Of s Crash Form DT4 5 of 7 Crash Date 2/9/217 Crash Time 7:4 AM
6TL9B7D7 17-193 2 13 LANGE COURT (68) 356-4895 3 4 Policy Holder Insurance Company STATE-FARM TRACY AHERN Crash Form DT4 6 of 7 Crash Date 2/9/217 Crash Time 7:4 AM
6TL9B7D7 17-193 Driver TRACY RAE AHERN S4495 BELTER DR NORTH FREEDOM, WI 53951, US Citations Issued Date of Birth ber 13 LANGE COURT (68) 356-4895 Sex Female Race WHITE State: Wisconsin Country: ED STATES 2 2 Equipment Helmet Use On Duty Crash Seat Position 1--Front Seat-Left Side (Driver/Motorcycle/Bicycl Safety Equipment Shoulder & Lap Belt Helmet Compliance Eye Protection Tint Compliance Ejected t Ejected Medical Transport t Transported Hospital Injury Severity Apparent Injury Airbag n Deployed Ejection Path t Ejected/t Applicable EMS Agency Identifier Date of Death Trapped/Extricated t Trapped EMS Run # Time of Death Striking Unit # Prior Action Location To/From School Action 2 2 Injury n Motorist Action Other Drug & Alcohol Alcohol Test Given Test t Given Drug Test Given Test t Given Suspected Alcohol Use Suspected Drug Use Alcohol Test Type Drug Test Type Alcohol Test Results Drug Test Results Drug Type Condition Appeared rmal Crash Form DT4 7 of 7 Crash Date 2/9/217 Crash Time 7:4 AM