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HomeMy WebLinkAbout24-5501 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c COLLISION REP FIT 1591971 CASE 24-5501 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 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# cowsloN 05 - 1-- 2024 1152 17 ❑-= S 8 IN e 1070 3 4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ LAKE AVE S/S TOBIN S BLOCK T e✓ MILEPOST 200 ❑ 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e LAKE AVE S/S TOBIN S 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2067694794 0 11 30 6❑ LAST NAME RICHARDS FIRSTNAME RAYMOND MIDDLE V 1 2 31 INITIAL STREET ❑ 7844 SOUTH SUNNYCREST RD,SEA CITY SEATTLE ST WA 2jp, 98178 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'U MID LOB 11 1— 13 — 2007 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U SE ICNLJAUSSY 1 NATURE OF INJURIES z❑ 3 LICENSE CK$8201 sTArI WAVIN#' 2G1 WU583189288695 10 F91 PI ATE# 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 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TNQ ��yp Y GOVT.VEHICLE 3 ] 34 13 A 2008 CHEV IMPALA P4 DAMAGE YES NO �" YES❑ No✓ REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILITY INSURANCE U INSURANCE CO PEMCO INSURANCE CA 0817352 IN EFFECT &POLICY# 9TOP ve EFFECT CHARGE 1 5 36 LEGAL IF" Yes❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE �UNITU2 VEHICLE ❑ CYCLE ❑ ❑ PROPOWNER ❑ YES1/ No D:3238103227 16 a LAST NAME RICHARD FIRST NAME RICHARD MIDDLE G INITIAL 17❑ STREET ❑' 5125 S BA ST,SEATTLE CITY' SEATTLE ST' WA ZIP 98178 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NO INTERLOCK vEs I I NOF YEs t l NOF,/ 19 DRIVER'S STATE WA SEX M D.C.B. 03 _ 23 _ 1950 0 39 LICENSE# MMDDYY WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CLE8659 TAre WA VIN1t WDDGF81X29R058004 ❑ 41 PLATE# 42 22❑ PILER LATE# STATE pLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. TOWED BY Gov HI 44 VEH YEAR 2009 MAKE MERZ MODEL C CLA$$ STYLE $D —TEHICLE TOWED✓ NOO BLIN PERSONAL TOW YES No�/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSU8 PORGY#E CO STATE FARM 532-8224-A30-47IN 9TOP 5 VEHICLE YES[:] N C[:] CITATION# CHARGE to BOTTOM LEGALLY 25 e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 SULIASI TAMAIVENA 12788 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE80525 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5501 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 advised he was on Lake Ave S, stopped at the stop sign traveling north. He stated that he cleared the intersection before entering. He said before he crossed a pedestrian, walked across, waited, and then attempted to pass the intersection when he was hit by Unit#2. He stated that he was not injured, and his vehicle was still drivable. He had damages on both right-side passenger doors. He believes that Unit#2 was speeding when his car was hit. Also, his front passenger was unable to open. Unit#2 advised that he was on S Tobin ST traveling West. He advised while attempting to pass Lake Ave S, Unit#2, who did not stop at the stop sign and tried to cross over but was hit by his vehicle. He advised that Unit#1 did not attempt to stop at a stop sign. His car was still drivable, but he wanted his vehicle to be towed through his personal towing. No injuries. His vehicle received heavy damage in the front area of his car. It should be noted that it's a one-lane road in both directions on Lake Ave S and S Tobin St. Photos were taken and uploaded to evidence. Information was exchanged with both parties. **** AUTO-POPULATED SECTION **** THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER": Light Condition: LITTLE DARK **** END OF AUTO-POPULATED SECTION **** I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. SULIASI TAMA/VENA 05-24-24 01:00 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 5/26/2024 9:46:15 AM BADGE OR ID# 1Y788 ORI#` WA0171300 TIME POLICE DISPATCHED 11:55 AM TIME POLICE ARRIVED 11:58 AM APART B PAGE IT]OF REPORT NO. EE80525 CASE# ' 24-5501 DATE AND TIME 05/24/24 11:52 OF COLLISION `3 W� t 0 PAGE 3 OF 3