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Home My WebLink About24-2702 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-2702 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 2$ TRIBAL UNITS 01 STRUCK' TREE OR STUMP RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cawsloN 03 - 12 - 2024 1352 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SW SUNSET BLVD BLOCK NO. e✓ 900 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 0 1 29 MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE 30 6 LAST NAME POWELL FIRST NAME CHRISTOPHER D MIDDLE 1 2 31 INITIAL STREET 01 17906 110TH STREET CT E CITY BONNEY LAKE ST WA ZIP' 98391 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 1 I [NATURE OF INJURIES H U EET 2 1 INJURY CLASS 5 INJURY TO HIPS AND LEGS z❑ 3 LICENSE C12348N sTArI WAvrN# 54DC4W160GS801638 10❑ PI ATE# 0 ----� TRAILER STATE TRAILER STATE 11 0 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12❑ vIN#' VIN# 2016 ISUT BOXTR DPYES[:] ❑ FROM 34 ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 13 2 DAMAGE YES NO YES NO✓ REGISTERED OWNER INFO JESSE BARSHAY 11018115TH STCTE BONNEYLAKE WA 98391 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE INSURANCE CO SELF INSURED 4 IN EFFECT &POLICY# veHICLe CHARGE 5 ❑ 36 LECALLv res❑NO❑ CITATION# BOTTOM 15❑ STAMOTOINDIING 6 UNIT U2 VEHICCLE ❑ CYCLE ❑ PEDESTRIAN ❑ oWNFRPROPERTY ❑ DYES NO OLD MET PHONE 16❑ LAST NAME FIRST NAME MIDDLE INITIAL STREET 17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38 INTERLOCK YEs❑NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 LLIRIVERSTICENS # STATE SEX MMDDYY —�_ 39 HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ ❑21❑ LICENSE TArE VIN# 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY Gov HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ &POINSULICY#E CO IN EFFECT 9TOP 5 vE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM LEGALLY YES N J 25 s e 7CA NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26LAN 12007 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE60148 COLLISION REPORT III III III III III 111 1591972 CASE# 24-2702 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) JOKUMSEN KEVIN D (LAST FIRST, ADDRESS&PHONE# D O.B. ' 44823 228TH AVE SE ENUMCLAW WA 98022 SEX M MMDDYyry 09 - 16 - 1963 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑✓ �; 1 POS, 3 2 4 1 USE 2 CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# DOB SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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 March 12, 2024, at 1352 hours dispatch requested that I respond to a collision that occurred at 904 SW sunset Blvd, in the city of Renton, county of king, and state of Washington. Upon my arrival I spoke with the passenger of unit 1, and he explained that his coworker and him were driving eastbound on SW Sunset Blvd when the collision occurred. The passenger explained that the driver was in the number one lane approaching the turn when he sneezed. When that occurred, the driver of unit 1 jerked the steering wheel to the right and dug his front right tire into the mud along the roadway. The passenger explained that the vehicle lost control and went up a muddy embankment striking a tree. After they collided with the tree, it caused the vehicle to turn on its side. The driver of unit one was trapped inside the vehicle and Renton Fire responded to the location to extract the driver. After several minutes, the driver was extracted from the vehicle. Medics told me that the driver sustained serious injuries to his legs and hips would be transported to Harborview Medical Center for further treatment. Gene Meyers towing arrived later and removed the box truck from the roadway. I provided the passenger with my contact information and case number. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.CATALAN 03-12-24 03:28 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 311812024 12:01:14 PM BADGE OR ID# 12007 ORI# WA0171300 TIME POLICE DISPATCHED 1:53 PM TIME POLICE ARRIVED;1:58 PM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. EE60148 r` POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 24-2702 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE ✓ G UNIT# 1 USDOT ICC# VEHICLE TYPE 4 CARGO BODY 8 TYPE 2 ❑ CARRIER 1 28 NW TRASH OUT NAME....... 3 CARRIER ADDRESS 18018 115TH ST CT E CITY BONNEY LAKE ST WA ZIP 98391 4 ❑ NAME # PLACARD: :❑ AME N IF NO NUMBER SOURCE 3 AXLES 02 GI12000 + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO i MIDDLE'... 29 LAST NAME FIRST NAME INITIAL STREET 30 NEW AnnRFrtP. CITY ST ZIP 6 g CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No zERLOCK YES E]NO� vES N LLIICIENSE STATE I SEX M��DYRYY' 2 7 F-1 ON DUTYl STATUS AIRBAG' RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE CLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIG P FROM TO DAMAGE Y EES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREETIAL ❑ 16 NEn+AnnRFs.�' CITY'. ST SIP CDL IGNITION REQUIRED IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.CATALAN 03-12-24 03:28 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 OR ID# 12007 O#I,WA0171300 JACOBS 3/18/2024 PAGE�OF 4 3000-345-013(R 11118) REPORT NO. EE60148 CASE# ' 24-2702 DATE AND TIME 03/12/24 13:52 OF COLLISION Tree t ''gyp 4 N TS PAGE 4 OF 4