HomeMy WebLinkAbout23-9278 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-9278 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4100 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 08 - 1-- 2023 2220 17 ❑.= S 8 IN e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE N BLOCK NO. e✓ 175
4a 1❑ 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:2064326596 0 11
30
6❑ LAST NAME WELIYO FIRSTNAME LUL MIDDLE J 1 1 2 31
INITIAL
STREET ❑✓ 20050 14TH AVE NE#7 CITY SHORELINE ST WA ZIP 98155 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 06 1- 07 - 1999 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� W8336B sTAT� WA urN# 2HGFC1F72GH655165
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. A'RLR. 1 5 33
12 0 0 VIN#' VIN#'
FROM TO
❑ VEH.YEAR 2016 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 1 5 TOWED BY GOVT.VEHICLE 34
13 4 HOND CIVIC SD DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO LUL WELI102005014TH AVE NE#7 SHORELINE WA 98155 D:2064326596 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE z INSURANCE CO NATIONAL GENERAL 2013697191 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# 3AO500969 <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT ' ❑✓ ❑ .PEDESTRIAN ❑ ❑ YES NO 1/ PHONE
2062298207
VEHICLE CYCLE OWNER
16 a
LAST NAME MELESE FIRST NAME EYASSU MIDDLE JA
INITIAL
17 NEW STREETREs7' 3404 S 297TH ST CITY AUBURN ST' WA ZIP 98001 37
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.O.B. 03 _ 27 1984 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS NECK AND LEG
LICENSE I ❑21❑ PLA E# BFP0982 TATE WA VIN# 41
JHMCR6F35HC016002 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2017 MAKE yOND MODEL ACCORD STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY INSURANCE I PORGY#ECO AMERICAN FAMILY INSURANCE BX09739466 1U
9TOP
IN EFFECT
VE'LLe ❑ ,J� CITATION# CHARGE o BOTTOMLGALYYESN J25 '
=TURNER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12650 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED88775
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9278
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 2 was driving south bound on Rainier Ave S approaching a yellow light at the intersection of S
2nd and Rainier Ave S, he began to slow as he approached the light. Unit 1 was driving directly
behind Unit 2 when she observed the light turning yellow, beliving that Unit 1 was going to drive
through the light she did slow down and rear ended unit 1.
Unit 1 had minor damage to the front bumper of the vehicle, the front bumper had fallen off and
coolant was coming out of the vehicle. Unit 2 had minor damage to the rear bumper of their vehicle.
Unit stated they had no injuries, Unit 2 stated that their neck and leg hurt. Unit 2 was evaluated by fire
and cleared.
I assisted both parties in exchanging information.
Unit 1 was cited for Following Too Closely (RCW 46.61.145) as she failed to leave appropriate room
to stop, causing the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON TURNER 08-13-23 01:46 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 8/13/2023 12:45:00 PM
BADGE OR ID# 12650 OR]# WA0171300 TIME POLICE DISPATCHED 10:20 PM TIME POLICE ARRIVED',10:22 PM
PART Ei PAGE IT]OF
REPORT NO. ED88775 CASE# 23-9278 DATE AND TIME 08/12/23 22:20
OF COLLISION
V
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