HomeMy WebLinkAbout24-1400 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-1400 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&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# ❑
COLLISION: 02 - 08 - 2024 0319 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 4TH ST BLOCK NO. e✓ 1300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e GARDEN AVE N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2068543138 0 11
30
6❑ LAST NAME POTTER FIRSTNAME RICHARD MIDDLE W 1 2 31
INITIAL
STREET ❑ 14244 161 ST AVE SE CITY RENTON ST WA 2jp, 98059 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 08 1— 28 — 1958 1 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� BGH4254 sTArr WAurN# 2G1WU581769275803
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 3 ] 34
13 1 2006 CHEV IMPALA SD DAMAGE YES NO �LIkRS ves❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
1 LIABILITY INSURANCE INSURANCE CO <�3
4
14 ❑ COAST NATIONAL G00347473025
IN EFFECT &POLICY#VEHICL CHARGE36
LEGALLv Yes❑NO CITATION# TTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2063485044
16 a
LAST NAME MASON FIRST NAME CHAD MIDDLE A
INITIAL
17 NEW STREETR 7' 733 S 207TH ST CITY DES MOINES ST WA ZIP 98198 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK vEs❑NOF YEs❑NOF,/
19 DRIVER'S STATE I WA SEX M I D.C.B. 05 _ 18 _ 1971 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG g RESTR g EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# D49747C TArE 41
WA VIN# 1B7GG22YSXS198141 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED By Gov HI 44
VEH YEAR 1999 MAKE DODG MODEL DAKOTA STYLE TR —TEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE❑ &POINSULICY#E CO NONE NONEIN IUVEHICLE
STOP
❑ ,.II CITATION# CHARGELEGALLY YES N`LJ25 '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
TYLER EDIGER 12807 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE50849
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1400
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 2 ran out of gas while traveling westbound on N 4th St, approaching Garden Ave N. Unit 2 exited
his vehicle and was pushing the vehicle westbound attempting to get it out of the roadway. Unit 2
stated that his hazard lights were on. Unit 1 was also traveling westbound on N 4th St, approaching
Garden Ave N. Unit 1 did not notice Unit 2 in the roadway, stating that he did not see any lights. Unit
1 rear ended Unit 2, causing very significant damage to both vehicles. The driver of Unit 2 was able to
jump out of the way and both parties were uninjured in this collision. Both vehicles were in the second
lane from right at the time of the collision. Neither vehicle was able to leave under their own power
and both were towed by bankers towing. I was unable to determine if Unit 2 had the hazard lights on
at the time of the collision, but due to this intersection being fairly well lit I believe that Unit 1 should
have noticed Unit 2 in the roadway. Both drivers were evaluated and cleared by fire. 1 uploaded
images of the vehicles to Axon.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
TYLER EDIGER 02-08-24 04:36 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 2/15/2024 8:44:08 PM
BADGE OR ID# 1Y807 OR]#' ' WA0171300 TIME POLICE DISPATCHED 3:21 AM TIME POLICE ARRIVED';3:26 AM
PART I PAGE IT]OF
REPORT NO. EE50849 CASE# 24-1400 DATE AND TIME 02/08/24 03:19
OF COLLISION
Not drawn to, scale
it 2
ZI
CD
PAGE 3 OF 3