HomeMy WebLinkAbout24-3128 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-3128 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 1 ❑28
TRIBAL UNITS 01 STRUCK META!SIGN POST
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
GawsloN 03 - 1-- 2024 0025 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
SE 128TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e 158THAVE SE
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES ✓NO D:4252416899 30
6� LAST NAME MATHUR FIRSTNAME SOMIT MIDDLE S 1 1 2 31
INITIAL
STREET ❑ 8923 138TH AVE SE CITY NEWCASTLE ST WA 2jp, 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� SH18640 sTArI WAvIN# 5TDDGRFH8JSO48309
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 5 33
12❑ VIN#j VIN#
FROM
34
13 4 VEH.YEAR20,18 MAKE TOYT MODEL HIGHLA STYLE UT VEHICLE TOWED�NOOpLSABLIN TSIYY.Ep9vMEYER VEHICLE
❑ DAMAGE IILLJJII (�ciV6
REGISTERED OWNER INFO 130.151 MATHUR.13138TH AVE SE NEWCASTLE WA 98059 D:4257492231 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ ABILI V INSURANCE INSURANCE CO ALLSTATE 820203001 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN.D'ING 7 6
UNIT VE IA.
MOTOCLE El CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWN ARTY ❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t l NO❑
19 LLIICENS # STATE SEX MMDDYY -❑_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. 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❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
=BROWN
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12765 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE61843
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3128
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TRAN TIFFANYM
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
328 YAKIMA PL SE RENTON WA 98059 4259199918 SEXi F MMDDYyYv 11 - 18 - 2005
PASSENGER WITNESS UNIT# 1 SEA 7 AIRBAG 6 RESTR. q EJECT ? 1 HELMET INJURY NATURE OF INJURIES
USE 2 CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL) NGUYEN STELLA V
ADDRESS&PHONE# DOB
13908 SE 88TH PL NEWCASTLE WA 98059 2068760557 SEX IF ..;D O vv 03 _ 29 _ 2006
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 1 POS 9 AIRBAG 6 RESTR. 4 EJECT 1 USE 2 CLASS 1
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 1 was traveling eastbound on SE 128th St in lane #1. The weather was raining substantially, the
roads were very wet, and there was standing water. When approaching 158th Ave SE, unit 1
attempted to make a right turn at speeds above the speed limit and that were too fast for the
conidition. Unit 1 lost traction during the turn and instead drove head-on into a tree at the southeast
corner of SE 128th St and 158th Ave SE. This caused substantial damage to the front end of unit 1.
Unit 1 also took out the stop sign/road sign on that corner (sign # D2761). The city roads department
was notified. Unit 1 traveling at speeds too fast for the road conditions and attemping to make a turn
while doing so was the proximate cause of this collision. The vehicle was towed from the scene as it
was unable to move on its own power. All airbags were deployed. No one was injured.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
NATHANIEL BROWN 03-23-24 01:38 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 3/23/2024 4:11:32 PM
BADGE OR ID# 12765 ORI# WA0171300 TIME POLICE DISPATCHED 12:27 AM TIME POLICE ARRIVED';12:31 AM
PART I PAGE IT]OF
REPORT NO. EE61843 CASE# 24-3128 DATE AND TIME 03/23/24 00:25
OF COLLISION
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