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Home My WebLink About24-0863 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c COLLISION REP FIT 1591971 CASE 24-0863 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 7 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# COLLISION.. 01 - 24 - 2024 1613 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BENSON RD S BLOCK NO. e✓ 1600 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e S 16TH ST 0 6 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4255030709 0 9 30 6� LAST NAME SAMS FIRSTNAME LEON MIDDLE O 1 1 2 31 INITIAL STREET ❑, 12631 NE 9TH PL#C203 CITY BELLEVUE ST WA ZIP 98005 z 'NEW ADDRESS ]❑ 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 USE 2 1 CLASS NATURE OF INJURIES z❑ 3 10❑ Pi ATE 14 BV60645 STATE WA VIN# JNKCP11A32T506833 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# ROM ro TRLR. TRLR 5 1 33 12 3 5 VIN#j VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 9 9 34 13 2 2002 lNFI G20 SD DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO IVYSAMS 11111 NE 9THPL#C203 BELLEVUE WA 98005 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE z INSURANCE CO NATIONAL GENERAL 2020909616 4 LI EFFECT &POLICY# TOPVEHICLE CHARGE 36 LEGALLv res❑NO❑ CITATION# <1�3 OTTOM 15❑ ITAIN.D— 7 6 UNIT a2 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES ❑ DYES NO �OLDMET PHONE 16 a LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL STREET CITY BELLEVUE ST ZIP 17❑ NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 LLIICENS # STATE SEX U MMDDYY —❑_ 39 WELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑ 21❑ LICENSE D01933A TATE WA VIN# 1GCCS199578221751 ❑ 41 pLATE# 42 22❑ PILER LATE# STATE pLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. 24❑ DVEH YEAR 2007 MAKE CHEV MODEL COLORA STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV!TN- REGISTERED 44 AMAGE YES NO YES OWNER INFO LARRY LANGELL 1425 S PUGET DR#211 RENTON WA 98055 VEHICLE NO.2 SHADEDAMAGEbAREA s Cd INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 9TOP VE""LE CITATION# CHARGE to BOTTOM LEGALLY YES N� 25❑ 7 7CA NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY26LAN 12007 0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT No. EE44312 COLLISION REPORT III III III III III 111 1591972 CASE# 24-0863 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) WYLER WILLIAM C (LAST FIRST, ADDRESS&PHONE# D O.B. ' 2204 E GRAND AVE EVERETT WA 98201 SEX M MMDDYyry 08 - 08 - 1988 ------------------------- PASSENGER Z WITNESS❑ UNIT# 3 PEA $ AIRBAG 2 RESTR. q EJECT ? 1 HELMET INJURY NATURE OF INJURIES USE 2 CLASS !1 NAME (LAST,FIRST,MIDDLE INITIAL) : WYLER DIZZY ADDRESS&PHONE# D O B EVERETT SEX: M MMDD o v 03 _ O6 _ 2023 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# 3 POS 7 AIRBAG 2 RESTR. 11 EJECT 1 USE 1 2 CLASS 1 NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B. MMDDYYYY. - PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' On January 24, 2024 at 1613 hours dispatch requested that I respond to a collision that occurred at Talbot Rd S and S Puget Dr. Dispatch advised that a driver complained of leg pain. Upon my arrival I spoke with the driver of unit 1. He explained that he was going northbound on Benson Dr S and approaching S Puget Dr when the collision occurred. He stated he was following the flow of traffic but failed to notice that traffic was coming to a stop. He was unable to bring his vehicle to stop, locked his brakes, and slid into unit 2. This impact caused a chain reaction that pushed unit 2 into unit 3. Unit 2 fled the scene after the collision and was last seen going eastbound on S Puget Dr. I then spoke with the driver of unit 3 and he explained he was stopped at the light when the collision occurred. Unit 2 struck his rear bumper, causing moderate damage. Unit 2 pulled around him and fled the scene. I was unable to contact unit 2, but I provided the two other drivers with a copy of the exchange of information. Unit 1 was removed by Bankers Towing. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.CATALAN 01-25-24 09:56 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 1/25/2024 1:37:00 PM BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED; 4:20 Pry] TIME POLICE ARRIVED',4:26 PM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT No. EE44312 r`I POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-0863 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USL70r !CC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST' ZIP' 4 ❑ NAME # PLACARD: :❑ GI NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO D:2067693097 0 9 29 LAST NAME : WILCOX FIRST NAME ALYSSA MIDDLE M INITIAL STREET 30 NEW AnDRFSIP 2204E GRAND AVE CITY EVERETT ST WA ZIP 98201 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs No zERLOCK YES[:]NO[:] YES N DRIVER'S LICENSE STATE I WA SEX F MMDDYYv 04 - 10 - 1990 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE CAX3139 TAr WA VIN# 3CZRU6H16NM704004 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR2022 MAKE HOND MODELHRV STYLE UT I VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1Ci P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFOALYSSA WILCOX 2204 E GRAND AVE EVERETT WA 98201 D:2067693097 J 9 33 12 � SHADE IN DAMAGED AREA 7 j FROM TO LIABILITY INSURANCE INSURANCE CO STATEFARM 428 6434 B0148B q"i"Olx IN EFFECT &POLICY# 1 EHICLE 34 13 2 LEGALLY YESZ NO❑ CITATION# CHARGE 0 BOTTUM STANDING } 8 7 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ STREET"[-] 16 NEW nnR CITY ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK 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 ICLASS 19 ❑ 39 LICENSE rnr VIN# PLATE# 20 ❑ TRAILER' TRAILER El40 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 AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LECALLv 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 01-25-24 09:56 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 12007 O#IL WA0171300 JACOBS 1/25/2024 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. EE44312 CASE# 24-0863 DATE AND TIME 01/24/2416:13 OF COLLISION 5 TS AN ! i S Puget i r tn y x i t PAGE 4 OF 4