HomeMy WebLinkAbout23-1601 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-1601 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
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❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
cowsloN 02 - 08 - 2023 0730 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HIGHWAY BLOCK NO. e✓ 2400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2535539418 0 6 30
6❑ LAST NAME GREEN FIRSTNAME JAMES MIDDLE C 1 1 2 31
INITIAL
STREET ❑✓ 26285 238TH LANE SE CITY MAPLE VALLEY ST WA 2jp, 98038 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
-O B 02 1- 07 - 1988 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� BQD4761 sTArI WAurN# JA4A23A38KZ037939
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2019 MITS OUTLAN MAKE MODEL STYLE VEHICLE TOWED fn TO VBLINJ TOWED BY GOVT.VEHICLE 3 7 34
13 4 DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14� INEFITYINSURANCE� INSURANCECOLIBERTYMUTUALA022680517724028 4
LI EFFECT I SUR N# TOPVEHCLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ cvcLE ❑ ❑ OWNER [:]EA.
YEs No ,/ D:2532491157
16 a
LAST NAME FAHRENKRUG FIRST NAME NATHAN MIDDLE R
INITIAL
17❑ STREET ❑', 23607 SE 284TH ST CITY' MAPLE VALLEY ST WA ZIP 980383338 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 10 _ 12 _ 1987 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BVH0049 TAre WA VIN# JA4AT3AA5LZ006956
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE MITS MODEL ECLIPSE STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ASHLIE FAHRENKRUG 23607 SE 284TH ST MAPLE VALLEY WA 98038 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE I PORGY#ECO STATE FARM 2317538 C1847CIN 1U�'E""LE
TOP
❑ ,J� CITATION# CHARGE TTOMLEGALLYYES N`L J25 '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
S.MORR/S 2613 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED34980
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1601
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 02/08/2023 at 0743 hours I arrived in the 2400 block of Maple Valley Highway for a two car non
injury accident in Renton Washington, King County.
Both drivers were identified by Washington Drivers licenses. Both vehicles were able to be driven
away from the scene. Both drivers agreed on the cause of the accident.
U2 was WB with U1 directly behind him. As U2 slowed for traffic U1 did not realize everyone was
slowing and drove directly into the rear of U2 causing damage to the rear of U2 and moderate
damage to the front of U1.
Although I did not issue a citation in this collision, U1 is the proximate cause of this collision for
inattention.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
S.MORRIS 02-08-23 09:21 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 211712023 4:25:47 PM
BADGE OR ID# 2613 OR]# i WA0171300 TIME POLICE DISPATCHED 7:40 AM TIME POLICE ARRIVED 7:43 AM
PART I PAGE IT]OF
REPORT NO. ED34980 CASE# 23-1601 DATE AND TIME 02/08/23 07:30
OF COLLISION
Aw"OhL ul
r.Na U2
IR-W 2400 MVH
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