HomeMy WebLinkAbout24-00138 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-00138 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 EARTH BANK OR LEDGE
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 01 - 1-- 2024 2330 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N 8TH ST BLOCK NO. e✓ 600
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FMILES N EET e S ❑ E e LOGAN AV N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:4806290300 30
5� LAST NAME WONG FIRST NAME WILLIAM MIDDLE P 1 2 31
INITIAL
STREET ❑, 12230 SE 60TH ST APT 33 CITy BELLEVUE ST WA 2jp, 980063824 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� BNY0969 sTArI WAvIN# 2T18URHE9KC165653
TRAILER STATE TRAILER STATE
11 1 5 PLATE# PLATE# FR.. ro
TRLR. TRLR 3 7
2❑ 33
1 VIN#' VIN#i
Rom 34
13❑ VEH.YEAR2019 MAKE TOYT MODEL COROL STYLE SD VEHICLE TOWED NOOpLSABLIN TSIYYEp9vMEYER VEHICLE
DAMAGE IILLJJII (5�IV6
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
4
14❑ LIABILITY INSURANCE INSURANCE CO AMERICAN COMMERCIAL INSURANCE 00056356 3
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLv YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN."' 6
UNIT 02 VE ICCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 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 MMDDYY -�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE LICENSE vIN# 41
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 IGQ"'LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
=HSU
AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12651 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE48280
COLLISION REPORT III III III III III 111
1591972 CASE# 24-00138
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 1 traveling west on N 8th St passing Logan Av N. Unit 1 driver reported difficulty seeing roadway
and continued west, straight past a stop sign onto Boeing property. Unit 1 high centered onto curb on
private property, causing reportable disabling front end damage. No injuries reported. No evidence of
impairment. Unit 1 privately impounded.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 01-05-24 12:40 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
P.SUMMERS 8887 2/7/2024 7:17.45 PM
BADGE OR ID# ! 12651 ORI#' WA0171300 TIME POLICE DISPATCHED; 11:38 PM TIME POLICE ARRIVED 11:43 PM
PART I PAGE IT]OF 3�
REPORT NO. EE48280 CASE# ' 24-00138 DATE AND TIME 01/04/24 23:30
OF COLLISION
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