HomeMy WebLinkAbout23-12675 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-12675 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT 8 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 11 - 1-- 2023 1245 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
108TH AVE SE BLOCK NO. e✓ 17900
4a❑ 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 ,/ I D:2064033607 0 11
30
6� LAST NAME RA FIRSTNAME RETH MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 20425 105TH AVE SE CITY KENT ST WA 21p 980315502 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CAR8223 sTArI WAurN# 5TDDBRCH6MS065102
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 7 4 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR N MAKE TOYT MODEL HIC�HLA STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
DAMAGE YES NO YES[:] NO✓
13❑ REGISTERED OWNER INFO KAOSAEPHAN20421105THAVESEKENTWA98031 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
LIABILITY INSURANCE INSURANCE CO
14❑ NS LIBERTY MUTUAL A02 268 2477 20 4032 3
IN EFFECT &POLICY# 9TOP
vewcLe CHARGE 1 5 36
LEIALLv YEs No CITATION# 3A0387759 FAIL TO YIELD MOTOR VEHICLE o eorrom
15❑ STANDING 8 7 6
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�U-NIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES, No D:4252284124
16 a
LAST NAME REED FIRST NAME JANICE MIDDLE M
INITIAL
17❑ STREET ❑', 18100 107TH PL SE UNIT 45 CITY RENTON ST WA ZIP 980556490 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l No❑
19 DRIVER'S STATE WA SEX F D.C.B. 07 27 1938 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE AMU9671 TAre WA VIN1t 1N4AL2AP7CN545421
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2012 MAKE NIS8 MODEL ALTIMA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO JANICE REED 18100107TH PL SE UNIT 45 RENTON WA 98055 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE I PORGY#E CO STATE FARM INS 412 1637 D0147IN STOP 5
VE""LE ❑ Nu,J CITATION# CHARGE
LEGAL io BOTTOM
LY YES
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE18554
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12675
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 110323 1 responded to a 2-vehicle non-injury/blocking collision near the 17900 block of 108th Ave
Se.
I contacted the driver of unit 2 who told me they were traveling southbound of 108th Ave Se in the #1
lane and became involved in a collision with unit 1 after unit 1 entered the roadway from a private lot.
The driver did not complain of injury. The vehicle sustained heavy front-end damage and was towed
by Gene Meyers.
I contacted the driver of unit 1, identified as Reth Ra (dob 10-15-85) via her WA DL. Ra confirms she
was entering the roadway from a private lot to southbound 108th Ave Se. Ra believes she had
enough time to enter the roadway safely but thinks the driver of unit 2 was driving too fast. Ra did not
complain of injury. Ra's vehicle sustained rear bumper damage.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I cited Ra via SECTOR under RCW 46.61.180.1 -FAILURE TO YIELD
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 11-07-23 09:05 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 1111112023 7:09:05 AM
BADGE OR ID# 10377 ORI#', WA0171300 TIME POLICE DISPATCHED; 12:50 PM TIME POLICE ARRIVED',12:55 PM
PART I PAGE IT]OF 3�
REPORT NO.! EE18554 CASE# ' 23-12675 DATE AND TIME 11/03/23 12:45
OF COLLISION
i
i
108th Ave SE
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