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HomeMy WebLinkAbout24-5481 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-5481 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 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# ❑ cawsloN 05 - 1-- 2024 1706 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ 439 RAINIER AVE S BLOCK ST e✓ MILEPOST 400 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 0 1 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2064224676 0 11 30 6❑ LAST NAME VO FIRSTNAME HIEP MIDDLE T 1 1 2 31 INITIAL STREET ❑ 11742 87TH AVE S CITY SEATTLE ST WA 2jp, 98178 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'M MID LOB 05 1— 16 — 1975 2 32 9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 9 EJECT 1 H U SE 9 CLASS 0 NONE OF INJURIES z❑ 3 10 9❑ P1 AT 14 C39342K STATE WA VIN# 5TFAY5F15HX633994 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR. 5 1 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR 2017 MAKE TOYT MODEL TUNDR STYLE PK VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34 13❑ DAMAGE YES YES[:] NO✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ LIABILITY INSURANCE Z INSURANCE CO STATE FARM 443.4338-E29.47 3 IN EFFECT &POLICY# 9TOP VE— CHARGE 36 LEGALLY YES❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 8 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ D:2533370456 16 a LAST NAME NELSON FIRST NAME RICHARD MIDDLE Ij INITIAL 17❑ NEW STREETREs7' 1902 E 67TH ST CITY TACOMA ST' WA ZIP 98404 37 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19 DRIVER # INJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CMH6926 TATe WA VIN# 1FALP6246RH142336 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. TOWED BY Gov HI 44 VEH YEAR 1994 MAKE FORD MODEL THUNDE STYLE $D DAMAGE TOWED NOO✓ BLIN YES NO 1/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP 5 vLFFcnLLYwcLE YES Nc❑ CITATION# 4AO246130 CHARGE OP MOT VEH W/OUT INSURANCE ,o BOTTOM 25 s � a =TAMAIVENA AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 12812 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE80521 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5481 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 was stopped in lane 3 traveling northbound on the 400 block of Rainier Ave S. Unit 1 vehicle was struck by Unit 2. Unit 2 stated he was not paying attention to the road and did not realize that Unit 1 had stopped. Unit 2 then struck Unit 1's rear vehicle. Unit 2 stated he was at fault. I observed minimum damage on Unit 1 and Unit 2. 1 certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. This report was electronically signed by Officer Si. Tamaivena #12812, May 23, 2024, at 1902 Renton, WA. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. S/TIVENI TAMAIVENA 05-23-24 07:39 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT DESIRES SCOTT 10272 5/26/2024 9:46:24 AM BADGE OR ID# 12812 OR]# WA0171300 TIME POLICE DISPATCHED 5:08 PM TIME POLICE ARRIVED 5:14 PM PART Ei PAGE IT]OF REPORT NO. EE80521 CASE# ' 24-5481 DATE AND TIME 05/23/24 17:06 OF COLLISION r 3 wr ^ r } t a Y y i PAGE 3 OF 3