HomeMy WebLinkAbout24-3527 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE65476 170
27
COLLISION REP FIT 1591971
CASE 24-3527 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ H F ❑ LOCAL AOENC 3
HIT IT&RUN � CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 2$
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: 04 - 01 - 2024 1437 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S CARR RD BLOCK NO. e✓ 10600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 260 00 FEET MILES e S ❑ W e 106TH PL SE
0 3 29
MOTU '�01 VEHtOR Z CLE CYCCLE. El �ESAGE NHORE✓LD MET PHONE 0 1 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY MAPLE VALLEY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES No YES No
8❑ LICIENSE#
STATE I
SEX'M MMDDYY _ - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEET 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10[9 PI ATE#
C7
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. TRLR 5 3 33
12 3 5 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE KIA MODEL UNKNO STYLE 4D VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE R 3 34
13 4 DAMAGE YES NO OVS NO
REGISTERED OWNER INFO VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
vewcLe
CHARGE 1 5 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2537364258
16 a
LAST NAME BATES FIRST NAME SARAH MIDDLE E
INITIAL
17❑ STREET ❑', 19406 SE 248TH ST CITY MAPLE VALLEY ST WA ZIP 98038 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YES
❑NOF,/
19[ DRIVER #
INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I B6322C TATE WA VIN1i 5N1DR2MM8HC691056
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2017 MAKE NISs MODEL PATHFIN STYLE SV I VEHICLE TOWED TO BLIN TOWEDBY YOB
HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO AUBURN SO 61515THSTSW AUBURN WA 98001 D:2539314938 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU8 PORGY#E CO INA SCHOOLS RISK MGMT POOL AUBURN SCHOOLS NUMBER 408 1GQ
IN EFFECTvEwCLE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 s � a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
R.ON/SHl 5738 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE65476
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3527
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) NEC/TA GREGORYP
(IAST FIRST,
ADDRESS&PHONE# D O.B.
10930 SE 172ND ST C-205 RENTON WA 98055 4258301633 SEX M MMDDYyry 09 - 22 - 1974
PASSENGER WITNESS UNIT# SEAT ' AIR BAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
✓ POS. USE CLASS
NAME
'(LASTr FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# Id DOB
E MMDDYYYV
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'
Unit 2 eastbound on S Carr Rd in lane 1 of 2, just east of 105th PI SE. Unit 1 turned right from
northbound 105th PI SE onto S Carr Rd at what witness Necita said was a high rate of speed, and
unit 1 failed to negotiate the turn. Unit 1 struck the right front corner of unit 2, then sped through red
light at 106th PI SE and south on 108th Ave SE. Unit 1 was not located; only description of occupants
was 2 juvenile Black males. Unit 2 was Auburn School District transport, driven by Auburn School
driver Bates.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 04-01-24 04:30 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 41512024 3:50:18 AM
BADGE OR ID# 5738 OR]# ! WA0171300 TIME POLICE DISPATCHED 2:54 PM TIME POLICE ARRIVED 2:54 PM
PART I PAGE IT]OF 3�
REPORT NO. EE65476 CASE# 24-3527 DATE AND TIME 04/01/2414:37
OF COLLISION
CA
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