HomeMy WebLinkAbout24-1832 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-1832 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
COLLISION.. 02 - 19 - 2024 2158 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
140TH WAY SE
BLOCK NO. e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 40 00 FMILES EET e S ❑ E e SE156TH ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2536404935 0 11
30
6 LAST NAME SALAS GASCA FIRSTNAME ROBERTO MIDDLE 1 2 31
INITIAL
STREET ❑, 1735 178TH STREET CT E CITY SPANAWAY ST WA Zjp, 98387 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 3 RESTR 9 EJECT 1 H U EET 2 1 INJURY CLASS 6 [NATURE OF INJURIES
NECK AND BACK PAIN z❑
3
LICENSE CJt0364 sTArI WAurN# JFIVA1C64J9814423
10[ PI ATE#
0 TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# ROM ro
PLA YRLR. 6 1 33
12 4 0 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE $ 4 34
13 4 2018 SUBA WRX SD DAMAGE YES NO �L kkR'S TOWING veS❑ NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 INSURANCE CO <�3
4
14 IN EF E INSURANCE GEICO 4167.15.70.82
IN EFFECT &POLICV#VEHCLE CHARGE TTOM 5 36
LEGALLY YES❑NO❑ CITATION# 5
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:4257387002
16 a
LAST NAME CHRISTOPHER FIRST NAME JONES MIDDLE J
INITIAL
17 STREET❑ NEW ADOREss❑' 17206 146TH AVE SE CITY RENTON ST WA ZIP 98058 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YES❑NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER #
ON DUTY STATUS AIRBAG,2 RESTR 9 EJECT 1 HE 2 INJURY 6 NATURE of INJURIES 40
USE CLASS NECK PAIN
❑21❑ PLATE# CBH3151 TArE WA VIN# 41
5UXF633593LH47615 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
TOWED BY Gov HI 44
VEH YEAR 2003 MAKE BNliry MODEL X5 STYLE (/T —FEHICLE
TOWED✓ NOO BLIN BANKER'S TOWING YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ESURANCEPAWA9356181IN STOP 5
VE""LE ❑ Nu,J CITATION# CHARGE
LEGAL to BOTTOM
LY YES
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
NATHANIEL BROWN 12765 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE53203
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1832
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CRESS ACACIA M
(IAST FIRST,
ADDRESS&PHONE# D O.B.
13948 SE 156TH ST RENTON WA 98058 SEX F MMDDYyry 12 - 14 - 2004
PASSENGER L,WITNESS[] UNIT# 1 I SEAT POS. 3 AIRBAG 2 RESTR. 9 EJECT ? HELMET INJURY NATURE OF INJURIES
USE 2 CLASS 1
NAME
(LP,ST,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&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 on SE 156th ST about to make a left turn onto northbound 140th Way SE as Unit 2 was
traveling southbound on 140th Way SE in lane #3. Unit 1 stated they did not see any nearby car so
they attempted to make the left turn, however, once near lane #3, the driver of unit 1 looked to his left
and saw unit 2 driving toward them with no headlights on. Unit 2 then collided with unit 1 causing
severe damage to front of unit 2 and the side and front end of unit 1. Neither vehicle was able to
move under their own power. Both drivers complained of neck pain. The driver of unit 2 stated he was
traveling in lane #3 of 140th Way SE with his lights on when unit 1 pulled out in front him. He did not
have time to slow down or swerve out of the way, causing the two vehicles to collide. Upon further
inspection after turning unit 2 on, the headlights came on and the headlight switch was turned on.
Unit 1 failing to pay attention to oncoming traffic was the proximate cause of this collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
NATHANIEL BROWN 02-20-24 12:03 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 1 2/23/2024 6:27:14 PM
BADGE OR ID# 112765 ORI#' i WA0171300 TIME POLICE DISPATCHED 10:01 PM TIME POLICE ARRIVED';10:07 PM
PART I PAGE IT]OF 3�
REPORT NO. EE53203 CASE# 24-1832 DATE AND TIME 02/19/24 21:58
OF COLLISION
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