HomeMy WebLinkAbout23-5814 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-5814 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 1 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#
cowsloN 05 - 1-- 2023 1343 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LOGAN AVE N BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 3RD ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2064668789 0 11
30
6� LAST NAME HA FIRSTNAME CUONG MIDDLE P 1 1 2 31
INITIAL
STREET ❑ 7207121STPLSE CITY NEWCASTLE ST WA ZIP 980561222 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� C56534V sTArI WAvIN# 1FTEWIEPOLF667749
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 5 1 34
13 2 2020 FORD F150 DAMAGE vEs 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI VINSURANCE INSURANCE CO STATE FARM 2038181.1312.47F 3
IN EFFECT &POLICY# 9TOP
15❑ VEHICLE 1 5 36
LEGALLY YES�No D CITATION# 3A0402356 CHARGE FAIL YIELD LEFT TURN MOTOR 10 aorrom
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065108455
16 a
LAST NAME HUNT FIRST NAME JENNIFER MIDDLE ,/
INITIAL
17❑ STREET ❑', 1245 BIGELOW AVE N CITY AUBURN ST WA ZIP 98002 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C.B. 02 _ 23 _ 1977 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 5 CLASS ❑
21❑ LICENSE 665PBK TAre 41
OR VIN# KNDJ23AUXP7871393
❑
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE KIA MODEL SOUL STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES�/ NO GENE MEYER YES NO
REGISTERED OWNER INFO EAN HOLDINGS LLC 10950 NE HOLMAN ST PORTLAND OR 97220 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#ECO STATE FARM 5203395-1325-47AIN STOP 5
VEHICLE ❑ C[ CITATION# CHARGE io BOTTOM
LEGALLY YES N
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED65537
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5814
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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'
Unit 2 was traveling northbound on Logan AVE N proceeding through the intersection at N 3rd ST
with a green light and right of way. Unit 1 was traveling southbound on Logan AVE S in the left turn
lane to turn left onto eastbound N 3rd ST with a flashing yellow signal indicating he must yield to
oncoming northbound traffic. Unit 1 failed to yield this right of way and initiated the left-hand turn,
turning eastbound into the path of Unit 2. The front end of Unit 2 impacted the rear passenger side of
Unit 1 causing moderate/heavy disabling damage to both vehicles. Both vehicles towed by Gene
Meyer.
Driver 1 cited for failure to yield the right of way to a motor vehicle when making a left turn by, failing
to yield to Unit 2, traveling with the right of way, and turning left in front of Unit 2 which was the
proximate cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 05-23-23 02:53 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 512412023 10:06:06 PM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED 1:46 PM TIME POLICE ARRIVED',1:50 PM
PART I PAGE IT]OF 3�
REPORT NO. ED65537 CASE# ' 23-5814 DATE AND TIME 05/23/23 13:43
OF COLLISION
i 4
N Ord ST
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