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HomeMy WebLinkAbout24-5361 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-5361 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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 2130 17 ❑. S 8 W Li OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ NE 4TH ST BLOCK NO. e✓ 4600 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ W e DUVAL!AVE NE 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLDHONE UNIT 01 VEHICLE ❑ CYCLE El MET P YES ✓NO D:9193689166 0 11 30 6� LAST NAME MEEK FIRSTNAME BISA MIDDLE A 1 1 2 31 INITIAL STREET ❑, 13551 SE 83RD ST CITY NEWCASTLE ST WA 2jp, 980593308 z 'NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10[1P1 ATNES# CGN3585 sTAr WAv N# WBA5R7COOLFH49821 5 TRAILER STATE TRAILER STATE 11 3-LATE# PLATE# FROM ro TRLR. TRLR 7 1 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34 13 2 2020 BMW 330XI 2D DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO ETHAN MERRILL 13551 SE 83RD ST NEWCASTLE WA 98059 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE INSURANCE 918856036 3 4 IN EFFECT &POLICY# 9TOP VE—LE 5 36 LEGALLY Yes❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062889167 16 a LAST NAME TRAN FIRST NAME VIET MIDDLE H INITIAL 17❑ STREET ❑', 4220 NE 2ND ST CITY' RENTON ST WA ZIP 980595014 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38 INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YEs❑NOF,/ 19 DRIVER'S STATE WA SEX M D.O.B. 04 28 _ 1983 39 LICENSE# MMDDYY WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS ❑ 21❑ LICENSE I BKF1139 TAre WA vIN# 19XFA1F58AE018092 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' VEH YEAR 2010 MAKE HOND MODEL CIVIC STYLE qD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO VIET TRAN 4220 NE 2ND ST RENTON WA 98059 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO SAFECO INSURANCE H2540535IN 1 9TOP 5 VEHICLE ❑ C—I CITATION# CHARGE io BOTTOM 25 Q LEGALLY YES NLJ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 JESSE VANDERHOEK 11631 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE79256 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5361 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' Vehicle #2 was driving westbound on NE 4th St, through the intersection of Duvall Ave NE. Vehicle #1 was driving eastbound on NE 4th St, and then turned north onto Duvall Ave NE. As vehicle #1 turned north onto Duvall Ave NE, the front left corner of vehicle #1 collided with the back left side of vehicle #2. The driver of vehicle #1 advised me she had a flashing yellow left turn arrow when she turned left onto Duvall Ave NE, though she did not know if vehicle #2's headlights were turned on. The driver of vehicle #1 advised me he had a green light to proceed westbound through the intersection of Duvall Ave NE, and told me his headlights were turned on. Based on the totality of the circumstances, it appeared vehicle #1 was the proximate cause of the collision. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. JESSE VANDERHOEK 05-21-24 01:22 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE D.SKELTON 9139 1 512212024 4:03:02 AM BADGE OR ID# 11631 OR]#' WA0171300 TIME POLICE DISPATCHED; 9:32 Pry TIME POLICE ARRIVED:9:37 PM PART I PAGE IT]OF 3� REPORT NO. EE79256 CASE# 24-5361 DATE AND TIME 05/20/24 21:30 OF COLLISION m4 .. . iE 1. Vehicle#1 ,.t i PAGE 3 OF 3