The URL can be used to link to this page

Home My WebLink About23-13495 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 23-13495 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4250 3 HIT&RUN ✓ CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS 04 STRUCK' FENCE RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cawsloN 11 - 1-- 2023 2255 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE 4TH ST BLOCK NO. e✓ 2464 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 1 9 29 UNIT 01 VEHICLE MOTPI PEDAL-ORCYCLE ElDESA✓NHORESHOLDMET PHONE 1 4 30 6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31 INITIAL STREET ❑ CITY ST ZIP 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCK YES NO YES No 8❑ LIRCIENSRE# STATE SEX u MMDOBYY - 32 9 ON DUTY❑ STATUS I AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑ 3 10❑ P1 ATE 14 CAE3517 sTAT WAu N# 1 FAFP40473F443916 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# IR.. ro TRLR. TRLR 3 7 33 12 0 0 VIN#' VIN# 2003 FORD MUSTAN SD ❑ RO�34 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 13 2 DAMAGE YES ✓ NO YES NO✓ REGISTERED OWNER INFO YAIRA NEGRON VAZQUEZ 231298TH STREET CT S APT S258 TACOMA WA 98444 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP VEHICLE CHARGE 5 36 LECALLv YES❑NO❑ CITATION# 1 o BOTTOM 15❑ STAIND'ING 6 UNIT 02 VE IOOR CYCLE ❑ PEDESTRIAN ❑ PROPE OWNFRRTY ❑ DYES✓ NO OLD MET PHONE 16❑ LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL STREET CITY AUBURN ST ZIP $ 17❑ NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED 38 INTERLOCK YEs❑No� INTERLOCK YES It1 I NoF t l YES NO 19 LLIICENS # STATE SEX U MMDDYY —=_ 39 WELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT '1 USE 9 CLASS 0 ❑ ❑21❑ PLATE# BFJ3866 TATe WA VIN# 3C4PDD6(dXDT648409 41 4 42 22 [TRAILER TILER ❑ PLATE# STATE pLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR 2013 MAKE DODG MODEL JOURNEY STYLE $I/ VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 L4❑ DAMAGE YES NO✓ YES NO✓ REGISTERED OWNER INFO DARSHEEN SARGENT 8372 WABASH AVE S UNITB SEATTLE WA 98118 D:4255722177 N:4255722177 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE❑ &POINSURGY#E CO pROGRESSIVE 949516096IN 1 9TOP 5 'E""LE ❑ Nu,J CITATION# CHARGE LEG 25 i o BOTTOM ALLY YES $ ' OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 C.ARNOLD 12509 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE27729 COLLISION REPORT III III III III III 111 1591972 CASE# 23-13495 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 11/23/2023 at 2258 hours I was dispatched to a 3 vehicle collision at 2464 blk of NE 4th St. When I arrived, there were 2 parked vehicles that were struck (Vehicles 2 and 3) by Vehicle 1 that was still on scene with no driver. I asked witnesses what had happened and they said that a male was driving but refused to give his name and said that the male had been drinking. It appears that Vehicle 1 was traveling West on NE 4th St from Edmonds Ave NE when it went over the North curb and into a fence belonging to the property owner of 401 Edmonds Ave NE, totalling about $4,000 in damage to his fence. It then appears that the driver attempted to correct Vehicle 1's path and over-corrected striking Vehicle 3 causing minor damage by striking the rear drivers side bumper of Vehicle 3 with the front passenger side bumper of Vehicle 1. Vehicle 3 was parked on the North side of the street facing West. Vehicle 1 then appears to have over-corrected and failed to reduce it speed and struck Vehicle 2 that was also parked. Vehicle 2 was parked on the South side of the street facing East. It appears that Vehicle 1 struck the rear driver side bumper of Vehicle 2 with the front drivers side bumper of Vehicle 1. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.ARNOLD 11-24-23 12:28 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.TOLLIVER 10540 1 121712023 2:12:47 AM BADGE OR ID# 12509 OR]# WA0171300 TIME POLICE DISPATCHED 10:58 PM TIME POLICE ARRIVED 11:00 PM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. EE27729 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-13495 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE t_"J � PEDESTRIAN YES IN 1 4 29 LAST NAME : UNKNOWN FIRST NAME MIDDLE INITIAL STREET 30 FS�' CITY AUBURN ST ZIP 6 NEW AnnR CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES NO zERLOCK YES❑N0� YES N DRIVER'S STATE I SEX U M��DYSYv' —� 2 LICENSE 7 ON DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES F� USE CLASS 8 ❑ 1 32 LICENSE I CEF3876 [TAT WA VIN# 1HGFA16527LO55463 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR2007 MAKE HOND MODEL CIVIC STYLE SD I VEHICLE TOWS ET SABLIN TOWED BY anvi vEH1GP FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO GRADY SENN 20310 SE 384TH ST AUBURNWA98092 m 33 12 � SHADE IN DAMAGED AREA 3 4 FROM TO LIABILITY INSURANCE[] INSURANCE CO IN EFFECT &POLICY# t 9 1"01? VEHICLE 1 o BOrroM 34 13 ❑ LEGALLY YES❑ NO❑ CITATION# CHARGE STANDING 8 7 14 ❑ UNIT# 4 MOTOR PEDAL � PROPERTY DAMAGE THRESHOLD MET PHONE ❑ 35 VEHICLE CYCLE PEDESTRIAN OWNER YES NO D:4259198008 N:4259198008 36 15 ❑ LAST NAME LE FIRST NAME HUN G MIDDLE A INITIAL ' 16 ❑ STREET"[] 401 EDMONDS AVE NE CITY! RENTON ST WA Z!P 98056 NEW AnnRFSR CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED 17 ❑ INTERLOCK YES NO INTERLOCK YES NO rES NO ❑ DRIVER'S STATE SEX M D.O.B 5 37 18 ❑ LICENSE# MMDDYYY O6 - 22 - 1975 ON DUTY STATUS AIRBAG RESTR, EJECT HELMET INJURY NATURE OF INJURIES ❑ 38 USE (CLASS 19 ❑ 39 LICENSE VIN# PLATE# rnr 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 21 ❑ [441 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LecALLv STANDING S 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.ARNOLD 11-24-23 12:28 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 ORID# 12509 O#II,WA0171300 APTOLLIVER 12n/2023 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. EE27729 CASE# 23-13495 DATE AND TIME 11/23/23 22:55 OF COLLISION Text � 41-3 y '" M yr Y. J v i I PAGE 4 OF 4