HomeMy WebLinkAbout23-8553 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-8553 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 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 07 - 1-- 2023 1208 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MILEPOST
S 2ND ST BLOCK
4a❑ e✓ p ❑
O.
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a MORRlS AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:3855528978 0 81
30
6� LAST NAME AHLGREEN FIRSTNAME JOSHUA MIDDLE J 1 2 31
INITIAL
STREET ❑, 8308 2ND ST NE CITY LAKE STEVENS ST WA ZIP' 982583335 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs No�/
8❑ DRIVERS
# STATE WA SEX'M I ELMIDI Y' 01 — 09 — 2001 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 ATNES# D23844B sTAr WAu N# 1 N6ED27Y64C403712
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 7 33
12 2 5 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T k GOVT.VEHICLE J 9 34
13 1 2004 NISS FRONTI PK DAMAGE YES NOBS YES❑ No✓
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 964873688 3 4
IN EFFECT &POLICY# 9TOP
vErIICLE CHARGE 5 36
LEGALLv res❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063346749
16 a
LAST NAME TEFERA FIRST NAME YONAS MIDDLE I Z
INITIAL
17❑ STREET ❑', 32326 48TH AVE S CITY AUBURN ST WA ZIP 980012633 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDI IVE STATE WA SEX M M D.C.B. 04 11 1985 39
HELMET {NJURy NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 USE 2 CLASS 7 POSSIBLE HEAD INJURY
21❑ LICENSE G611679Z TArE GOV vIN1 5NMSIDAJOPH517099
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE HYUN MODEL SANTA STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO LEASE GSA PUGET SOUND VAMC MS 138 SEATTLE WA 98108 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO US GOVERNMENT SELFIN I GQO`
25❑
VEHICLE CITATION# CHARGE
LEGALLY YES N�
JAGENCY
s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED85546
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8553
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'
Unit 1 was behind Unit 2 traveling westbound on S 2nd ST approaching a traffic light at Morris AVE S.
Either the light had just turned red or both units were unaware of the presence of the red signal, but
Driver 2 states that he made a quick stop to stop for the red light. Driver 1 states that he did not
anticipate this stop and was unable to stop in time which was the proximate cause of the collision.
The front end of Unit 1 struck the rear end of Unit 2. Unit 1 sustained heavy and disabling front end
damage. Unit 2 sustained moderate rear end damage. Driver 2 was transported for medical
treatment complaining of head pain and nausea. Both vehicles towed by Bankers tow.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 07-26-23 02:24 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 8/2/2023 1:24:53 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 4Y:09 PM TIME POLICE ARRIVED 12:11 PM
PART I PAGE IT]OF
REPORT NO. ED85546 CASE# ' 23-8553 DATE AND TIME 07/26/23 12:08
OF COLLISION
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MORRIS AVE S
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