HomeMy WebLinkAbout23-07063 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-07063 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 2$
6 0
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 06 - 21 - 2023 1910 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e✓ 5100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e HOQU/AM AV NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:9728058410 0 11
30
6� LAST NAME STRIEN FIRSTNAME MARK MIDDLE A 1 2 31
INITIAL
STREET ❑, 1221LWACO PL SE CITY RENTON ST WA ZIP 980594934 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
# STATE WA SEX'M I ELMIDI Y' 05 — 18 — 1975 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMETU SE CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 ATNES# BYH7232 sTAr WAv N# 5TDHZRBH8MS531479
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM To
TRLR. A'RLA2 1 3 33
12 3 0 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 3 7 34
13 4 2021 TOYT HIGHLA SV DAMAGE YES NO �MEYERS YES❑ No✓
REGISTERED OWNER INFO MARKSTRIEN 1221LWACO PL SE RENTONWA 980594934 D:9728058410 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 LIABILITY INSURANCE GEICO 4288513510
IN EFFECT &POLICY# � 9TOP
VEH" CHARGE 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2064652715
16 a
LAST NAME GUNDERSEN FIRST NAME EMIL MIDDLE A
INITIAL
17❑ STREET ❑', 13419 SE 95TH WAY CITY' RENTON ST WA ZIP 980593519 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 07 13 _ 1964 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BU65281 TAre WA VIN# 1GNGK26R1XJ460693
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TIN# IN RLR
#.UIN#. '
VEH YEAR 1999 MAKE CHEV MODEL SUBURB STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO EMIL GUNDERSEN 13419 SE 95TH WAY RENTON WA 98059 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO STATE FARM 082751382847KIN STOP
"F" LE Yes Nc❑ CITATION# 3A0350466 CHARGE FAIL TO OBEY TRAFFIC CONTROL o BOTTOM
LEGALLY
25 a
OFFICER'S NAME(PRINT)
26 OFFICER PHONE BADGE OR ID# AGENCY
HANSEN HSU 12651 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED76222
COLLISION REPORT III III III III III 111
1591972 CASE# 23-07063
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) STRIEN KARA D
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
122ILWACO PL SE RENTON WA 980594934 9728058410 SEXi F MMDDYyry 04 - 22 - 2012
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET LASS NATURE OF INJURIES
❑✓ 1 POS. 9 6 4 1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) STRIEN KAITLYN
ADDRESS&PHONE# DOB
122 ILWACO PL SE RENTON WA 980594934 9728058410 SEX F MMDDYVYY 07 _ 31 _ 2010
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 1 PCS 7 AIRBAG 6 RESTR. 4 EJECT 1 USE CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) OBERMILLER KYLE
AppREss R PHONE# 3609203550 M I. 12 01 _ 1983
SEX. D.O.B. _
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 traveling south on Hoquiam Av NE at NE 4th St. Unit 2 traveling westbound on NE 4th at
Hoquiam Av NE. Unit 2 driver ran the red light causing the collision. Unit 2 strikes Unit 1, causing
reportable disabling front end damage to Unit 2 and reportable disabling rear driver side damage to
Unit 1. Witness corroborates that Unit 2 driver ran the red light. No injuries reported. Unit 2 driver
cited for running the red light.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 06-21-23 09:34 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.TOLLIVER 10540 7/3/2023 6:31:27 PM
BADGE OR ID# 12651 OR]#' WA0171300 TIME POLICE DISPATCHED', 7:14 PM TIME POLICE ARRIVED',7:16 PM
PART I PAGE IT]OF 3�
REPORT NO. ED76222 CASE# ' 23-07063 DATE AND TIME 06/21/23 19:10
OF COLLISION
NOT TO SCALE
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