HomeMy WebLinkAbout23-5599 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 23-$$99 2 6 0
INTERSTATE CITY STREET RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 05 - 18 - 2023 0436 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
EASTVALLEYRD M18000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW 43RD ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2533327880 0 11
30
6 LAST NAME MC MORRIS FIRST NAME BART MIDDLE E 1 1 2 31
INITIAL
STREET 01 5305 S JUNETT ST CITY TACOMA ST WA ZIP 98409 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
# STATE WA SEXI M I D-MIDI Y' 02 — 10 — 1970 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 1❑ P1 ATNES# CE66536 sTAr WAu N# KM8R7DGEXPU502444
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2023 HYUN PALISA UT MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES No �LII� RS YES[:] No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO USAA 005619421C <��34
IN EFFECT &POLICY#VEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION#
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068169621
16 a
LAST NAME TOLD FIRST NAME AMOS MIDDLE B
INITIAL
17 STREET❑ NEW ADDREss❑' 35328 25TH AVE SW APT 13 CITY FEDERAL WAY ST WA ZIP 98023 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YES
❑NOF,/
19 LDI IVER # STATE WA SEX M M D.C.B. 04 05 _ 1986 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# BUW3533 TArE 41
WA vIN# 1G1JC5SG3D4208190 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
TOWED BY Gov HI 44
VEH YEAR 2013 MAKE CHEV MODEL SONIC LS STYLE $D —VEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE &POINSURGY#E CO GEIC04626013264IN--E ❑ ,J� CITATION# CHARGE25 C�Q
LEGALLY YES N`L J
s � e
7JACOB
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26WEBER 12532 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED61933
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5599
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 05/18/2023, at approximately 0438 hours I was dispatched to East Valley Rd and SW 43rd St for
a report of an injury collision. I arrived on scene and observed Vehicle 2 in the intersection just south
of the two southbound left hand turn lanes. I observed Vehicle 1 had been able to move off the road
into a parking lot. I spoke with Driver 1 who advised he had been traveling westbound on SW 43rd St
just east of East Valley Rd when his light changed to red. Driver 1 advised he dd not register the red
light and he continued into the intersection where he struck Vehicle 2, who he advised had the green
light. I spoke with Driver 2 who advised he was traveling northbound on East Valley RD when he
entered the intersection under a green light. Upon entering the intersection, Driver 2 advised he was
struck by Vehicle 1. Both vehicles were towed by Bankers under owner request. Aside from the
impact of the airbags, there were no injuries. There was no uninvolved property damage.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JACOB WEBER 05-18-23 05:43 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 512012023 11:31:56 AM
BADGE OR ID# 12532 OR]# WA0171300 TIME POLICE DISPATCHED 4:38 AM TIME POLICE ARRIVED',4:42 AM
PART I PAGE IT]OF
REPORT NO. ED61933 CASE# 23-5599 DATE AND TIME 05/18/23 04:36
OF COLLISION
SW 43 ST
East Valley Rosa
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