HomeMy WebLinkAbout22-13739 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED24995 170
27
COLLISION REP FIT 1591971
CASE 22-13739 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION.. 12 - 1-- 2022 1924 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
2ND AV S BLOCK e✓ 900 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ V\e WELLS AV S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066976140 0 11
30
6� LAST NAME ENG FIRSTNAME JOSEPH MIDDLE W 1 1 2 31
INITIAL
STREET ❑ 6707 VISTA AVE S CITY SEATTLE ST WA 2jP, 981083661 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ PI ATFBit B067249 sTArI WA urN#' 1FA6P8CF5J5109441
-- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 7 33
12 2 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 1 2018 FORD MUSTAN SD DAMAGE YES NO ves❑ No
REGISTERED OWNER INFO JOSEPH ENG 6707 VISTA AVE S SEATTLE WA 98108 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO ALL STATES17849336 3 4
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
LEGALLY
Yes❑NO❑ CITATION# 10 BOTTOM
15❑ TANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067470321
16 a
LAST NAME ANZAI FIRST NAME CURTIS MIDDLE B
INITIAL
17❑ STREET ❑', 11516 85TH AVE S CITY SEATTLE ST WA ZIP 981783902 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE I WA SEX M I D.O.B. 10 _ 03 _ 1987 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I C83313U TAre WA VIN# 3TMLU42N89M026437
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2009 MAKE TOYT MODEL TACOMA STYLE TR VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CURTIS ANZAI 1151685TH AVE S SEATTLE WA 981783902 D:2067470321 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE INSU&POLICY#E CO GEICO 6046615693IN 1❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N`L J
s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
HANSEN HSU 12651 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED24995
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13739
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Units 1 and 2 both traveling west along 2nd Av S approaching Wells Av S. 2 Av S is a one way street,
East to West. Unit 1 traveling in right lane makes illegal lane change/left turn into Unit 2, traveling in
left lane, causing reportable disabling damage to the front driver side of Unit 1 and reportable
disabling damage to the front passenger side of Unit 2. No injuries.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 12-26-22 08:13 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1/15/2023 1:12:21 AM
BADGE OR ID# 12651 OR]#' WA0171300 TIME POLICE DISPATCHED! 7:30 PM TIME POLICE ARRIVED 7:36 PM
PART I PAGE IT]OF 3�
REPORT NO. ED24995 CASE# ' 22-13739 DATE AND TIME 12/26/22 19:24
OF COLLISION
I
i
I
i
One Way St
i
i
i
PAGE 3 OF 3