HomeMy WebLinkAbout23-12785 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12785 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 3 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 1022 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
TABLOT RD S BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W HF j GgApyWAy
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2066310882 0 81
30
6� LAST NAME YOUNG FIRSTNAME LEANNE MIDDLE E 1 1 2 31
INITIAL
STREET ❑✓ 614 SHATTUCK AVE S CITY RENTON ST WA ZIP 980580482 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❑ PI aT�S1t AJB0987 sTAr� WA #' 2HGF62F59CH554948
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE J 9 34
13 2 2012 HOND CIVIC DAMAGE YES NOBS YES : No✓
REGISTERED OWNER INFO LEANNE YOUNG 19229 SE 234TH PL RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO METROMILE42.0961Y9.01.01 3 4
IN EFFECT &POLICY# 9TOP
15❑ vEGAEHA"LE 5 36
LLLY YES�No D CITATION# 3A0087435 CHARGE INATTENTIVE DRIVING 1 o aorrom
STANDING 8 7 6
MOTOR PEDAL- 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ DD 2067904928
16 a
LAST NAME SIRAT FIRST NAME ALLAH MIDDLE M
INITIAL
17❑ STREET ❑', 20411 81 ST E BONNEY LAKE CITY BONNEY LAKE ST WA ZIP 983910000 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES
t l No�
19� D IVERI # STATE WA SEX M Mr D.C.B. 04 16 _ 1980 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I C21139U TAre I WA VIN1i 1GCHSBEA2L1170157
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE CHEV MODEL COLORA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO KLEINFELDER INC 14710 NE 87TH ST STE 100 REDMOND WA 98052 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO ACORD 570075822155IN 1 GD
25❑ VEHICLe CITATION# CHARGE
LEGALLY YES N�
JAGENCY
s e
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. EE20167
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12785
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 traveling behind Unit 2 southbound on Talbot RD S approaching a traffic signal at S Grady
Way. Driver 1 states the traffic signal was yellow and she believed Unit 2 was going to attempt to
make the traffic light so she did not brake so that she too could make the traffic signal. Unit 2 lawfully
slowed and stopped for the Yellow signal as it was soon turning red. Based upon Driver 1's
assumption that Unit 2 was going to proceed through the intersection, she was traveling too fast to
stop in time. The front end of Unit 1 struck the rear end of Unit 2. Unit 1 sustained moderate/heavy
disabling front damage. Unit 2 sustained minor/moderate rear end damage. Unit 1 towed by Bankers
tow.
Driver 1 was cited for Inattentive Driving by not driving with due care and caution to persons or
property by traveling in such a way that she could not avoid the collision when Unit 2 conducted a
lawful common driver action.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 11-06-23 01:32 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 11/16/2023 7:58:08 AM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED; 10:22 AM TIME POLICE ARRIVED',10:22 AM
PART I PAGE IT]OF
REPORT NO. EE20167 CASE# ' 23-12785 DATE AND TIME 11/06/23 10:22
OF COLLISION
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