No preview available
HomeMy WebLinkAbout24-04737 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-04737 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENC 4100 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'. 05 - 1-- 2024 1430 17 ❑-= S 8 IN e 1070 3 4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NE SUNSET BLVD M4100 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ e S ❑❑ FEET VV a UNION AV NE 0 1 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:4254290781 0 7 30 6� LAST NAME CRUEGER FIRSTNAME MOLLY MIDDLE A 1 1 2 31 INITIAL STREET ❑1 1809 FIELD PL NE CITY RENTON ST WA ZIP' 980594256 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/ 8❑ DRIVERS # STATE WA SEXI F MIDI Y' 09 — O6 — 2007 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10[1PI ATE 14 355YE1 STATE WA v N#' 1J4FJ68S5PL642037 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# Rom ro TRLR. TRLR 3 7 33 12 3 5 VIN#' VIN# >; FROM TO ❑ VEH.YEAR 1993 JEEP CHERO MAKE M DAMAGE YES NO YES[:] NO✓ ODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34 13 4 REGISTERED OWNER INFO ANNEKJALLIN 1801 FIELD PL NE RENTONWA 98059 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO FIRST NATIONAL P5790826 4 LI EFFECT I SUR N# TOPVEHICLE CHARGE 36 LEGALLY YES❑NO❑ CITATION# <1�3 OTTOM 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ cvcLE ❑ ❑ OWNER [:]EA. YEs No ,/ D:4255034425 16 a LAST NAME FARRELL FIRST NAME MUY MIDDLE K INITIAL 17❑ STREET ❑', 1321 S PUGET DR APT E34 CITY RENTON ST WA ZIP 980554332 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38 INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19 DRIVEW # INJURY6 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS HEAD/NECK PAIN 21❑ LICENSE AZH0014 TATe WA vIN# 5J6RM4H73GL053931 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' VEH YEAR 2016 MAKE HOND MODEL CRV STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO MUYFARRELL 1321 S PUGETDRAPTE34 RENTON WA 980554332 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE INSU PORGY#ECO STATE FARM 4512261 E1847IN 1 9TOP "'LE CITATION# CHARGE 25 i o BOTTOM LEGALLY YES[Z NEI ❑ s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 HANSEN HSU 12651 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE75206 COLLISION REPORT III III III III III 111 1591972 CASE# 24-04737 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' Units 1 and 2 both traveling westbound on NE Sunset Blvd at the intersection of Union Av NE. Unit 1 rear ends Unit 2 causing non reportable non disabling front end damage to Unit 1 and non reportable non disabling rear end damage to Unit 2. No reported injuries though Unit 2 driver appeared to display discomfort and pain to her head and neck. Aid declined. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 05-02-24 05:30 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT DESIRES SCOTT 10272 51812024 10:47:42 AM BADGE OR ID# 12651 OR]# WA0171300 TIME POLICE DISPATCHED! 3:41 PM TIME POLICE ARRIVED;3:53 PM PART Ei PAGE IT]OF REPORT NO. EE75206 CASE# ' 24-04737 DATE AND TIME 05/02/24 14:30 OF COLLISION 1 1 t a i a PAGE 3 OF 3