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HomeMy WebLinkAbout24-5728 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-5728 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# ❑ cowsloN 05 - 1-- 2024 1644 17 ❑.❑ S 8 W Li OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BLOCK OAKESDALEAVESW ST e✓ MILEPOST 4200 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 200 00 FEET e S B W e SW 43RD ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:5037019992 0 11 30 6� LAST NAME HALL FIRSTNAME MICHAEL MIDDLE J 1 1 2 31 INITIAL STREET ❑, 7563 CAMDEN ST NE CITY KEIZER ST OR ZIP' 97303 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/ ❑ DRIVER'S'' STATE OR SEX I M MDMDD� 03 - 1 21 - 1978 1 2 32 8 LICENSE# 9 ON DUTY D. ❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM USEET I ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10 9� P1 ATE 14 429NVJ STATE OR VIN# 5TDBBRCHONS561750 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# ROM ro TRLR. TRLR 7 3 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34 13 9 2022 TOYT HIC�HLA SW DAMAGE YES NO YES[:] NO✓ REGISTERED OWNER INFO ALLIANCE PACKAGING 1000 SW43RD ST RENTON WA 98057 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE INSURANCE CO AMERICAN AUTOMOBILE SCV0108152301 3 4 IN EFFECT &POLICY# 9TOP VEHICLE CHARGE 5 36 LE�ALLv YES No CITATION# 4AO435200 FAIL YIELD PRIVATE RD MOTOR o eorrom 15❑ NDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4255520062 16 a LAST NAME SMITH FIRST NAME DORIAN MIDDLE S INITIAL 17❑ STREET ❑' 9400 RAINIER AVE S 243 CITY SEATTLE ST WA ZIP 98118 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38 INTERLOCK YES❑NO� INTERLOCK YEs❑NOF YES ❑NoF,/ 19 DRIVER # INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY[:I] STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE A7293333 TATe WA YIN# JF2(BTAMC3L8269178 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. TOWED BY GOV HI 44 VEH YEAR 2020 MAKE $(JB�Q MODEL�/ STYLE $W —FEHICLE TOWED✓ NOO BLIN BANKERS YES No�/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE DAGED AREA 4 LIABILITY INSURANCE INSU&PORGY#E CO FOREMOST G01466350900IN 1GQVE""LE ❑ ,J� CITATION# CHARGE LEGALLY YES N`L J 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 R.ON/SHl 5738 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE82596 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5728 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) TARRANCE MICHAEL D (LAST FIRST, ADDRESS&PHONE# D O.B. ' 31655 MILITARY RD S F303 AUBURN WA 98001 SEX M MMDDYyry 02 - 28 - 1990 PASSENGER I�I WITNESS UNIT# 2 pQ g AIRBAG 2 RESTR. 4 EJECT ? HELIVIET INJURY NAruRE of INJURIES L�!1 USE CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# Id I DOB E MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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 2 s/b in lane 1 (left turn lane) Oakesdale Ave SW. Unit 1 exiting driveway on west side of road onto Oakesdale Ave SW, attempting to cross Oakesdale to business driveway on the east side of the road. Driver 1 Hall said that he waited for a gap in traffic, but did not notice unit 2 still traveling at speed in lane 1. Unit 1 front end struck unit 2's right front wheel area, breaking right front axle. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 05-30-24 05:59 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE JESSE VANDERHOEK 11631 1 6/2/2024 8:28:45 AM BADGE OR ID# 5738 OR]# WA0171300 TIME POLICE DISPATCHED; 4:47 Pry] TIME POLICE ARRIVED 4:59 PM PART I PAGE IT]OF 3� REPORT NO. EE82596 CASE# ' 24-5728 DATE AND TIME 05/30/24 16:44 OF COLLISION .m�"• was L4 lo-y} �,.�. `y ''�`.�;: � 4 t- r, n y PAGE 3 OF 3