HomeMy WebLinkAbout23-843 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE RESULTED ❑ CASE 23-843 z
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DArE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
cowsloN 01 - 19 - 2023 2223 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LOGAN AVE N BLOCK NO. e✓ 600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 6TH ST
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2067346173 0 3 30
6� LAST NAME SAEPHANH FIRSTNAME NAOMI MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 15606 SE 254TH PL CITY COVINGTON ST WA ZIP 98042 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 1❑ PI ATFBit CBF1665 sTATI WA urN# JFIZNAA11D2727816
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 5 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 7 $ 34
13 3 2013 TOYT SCION CP DAMAGE YES NOBS YES : No✓
REGISTERED OWNER INFO LOUSAEP .22110102ND PL SE KENT WA 98031 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 INSURANCE CO 3 4
14 ABILI V INSURANCE AMERICAN FAMILY CONNECT PROPERTYA10 3 7 7 784 4
IN EFFECT &POLICY# 9TOP
VEH" CHARGE to BOTTOM 5 36
LEGALLY YES❑NO❑ CITATION# 5
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UN�T 02 VEHICLE ❑ CYCLE ❑ ❑ : OWNER [:]EA.
YEs NO 1/ D:2533261053
16 a
LAST NAME HANNAMAN FIRST NAME PATRICIA MIDDLE I E
INITIAL
17 STREET❑ NEW ADDREss❑' 29909 164TH AVE SE CITY KENT ST WA ZIP 98042 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19[-] DCENS STATE WA ]SEX IF M D.C.B. 12 _ 08 _ 1948 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# BUE5798 TATE 41
WA VIN# SFNYF6H55L6049429 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
TOWED BY GOV HI 44
VEH YEAR 2020 MAKE HOND MODEL PILOT EX STYLE $V DAMAGE TOWED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO GEIC04208319741IN 1 9TOP
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED32892
COLLISION REPORT III III III III III 111
1591972 CASE# 23-843
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'
On 01/19/2023 1 was dispatched to a blocking accident at the intersection of Logan Ave N and N 6th
St. When I arrived, I met with the drivers of Vehicle 1 and Vehicle 2 and observed that the vehicles
had collided in the #1 lane. The driver of Vehicle 1 stated that she was making a right turn from N 6th
St onto Logan Ave N to head from West to South. Driver 1 said that she looked for oncoming traffic
heading South on Logan Ave N and while looking for oncoming traffic, she did not see Vehicle 2
slowed in front of her. Driver 1 stated that she collided with Vehicle 2 by hitting the front drivers side
of Vehicle 1 into the rear driver side of Vehicle 2. Driver 2 stated that she was observing oncoming
traffic just as Driver 1 was and observed a vehicle traveling South on Logan Ave N. Driver 2 stated
that she slowed due to the yield sign that is posted at the intersection and felt Vehicle 1 make contact
with Vehicle 2 by hitting the front driver side of Vehicle 1 into the rear drivers side of Vehicle 2.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 01-19-23 11:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 211112023 1:52:02 AM
BADGE OR ID# 12509 OR]# WA0171300 TIME POLICE DISPATCHED 10:26 PM TIME POLICE ARRIVED'10:27 PM
PART I PAGE IT]OF 3�
REPORT NO. ED32892 CASE# ' 23-843 DATE AND TIME 01/19/23 22:23
OF COLLISION
,•'NOT TO SCALE:'.°,.
V 6th St.
Logan Ave. N
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