HomeMy WebLinkAbout24-5783 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-5783 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# ❑
COLLISION 06 - 01 - 2024 0740 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 43RD ST BLOCK NO. e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FMILES EET e S ❑ E e EAST VALLEYRD
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES
�/No D:2532520440 0 81
30
6� LAST NAME THOEN FIRSTNAME STEVEN MIDDLE K 1 1 2 31
INITIAL
STREET ❑✓ 1741 22ND ST NE CITY AUBURN ST WA 2jp, 98002 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� AE10171 sTAr� AZ urN# 1FDXE4FS2BDA18863
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE J 9 34
13 3 2011 FORD ECONO CG DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO ARIZONA UHAUL 217 CENTRAL AVE N 3 PHOENIXAZ 85036 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO UHAUL LINK 3 4
IN EFFECT &POLICY# STOP
vErIICLE CHARGE 5 36
LEGALLv Ye6❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:7194657832
16 a
LAST NAME JELLINGS FIRST NAME ALEXANDER MIDDLE M
INITIAL
17❑ STREET ❑', 22431 SE 280TH PL CITY' MAPLE VALLEY ST WA ZIP 98038 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDIIVEW # STATE WA SEX U MMDDW 11 15 _ 1974 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BYR5319 TAre WA vIN# 5N1AT36B9MC673039
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GoI
VEH YEAR 2021 MAKE jyI$$ MODEL ROGUE STYLE $W —FEHICLE
TOWED NOO✓ BLIN TOWED BY v HyES NO 1/ 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 820383445IN 1 GD
vE""LE CITATION# CHARGE
LEGAL
25
LY YES N�
❑ s a
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. EE82745
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5783
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CRANSTON LEZLIE D
(LAST FIRST,
ADDRESS&PHONE# D O.B.
2049 MST NE AUBURN WA 98002 SEX F MMDDYyry 03 - 02 - 1994
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 1 PC& 3 2 4 1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D Q E4
SEX MMDDVYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 2 westbound on S 43rd St, stopped for red light at East Valley Rd. Unit 1 also westbound on S
43rd St, approaching intersection. Unit 1 driver Thoen told me that he attempted to stop his U-Haul
rental box van by applying the brakes as hard as possible, but still impacted the back end of unit 2.
The impact damaged unit 1 to the point where I could not check brake function. Driver 2 Jellings
noted that shortly after the collision, his check engine light came on, and a phone app advised that
there was a problem with his emission control system, unknown if related.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 06-01-24 10:57 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 6/2/2024 3:15:14 PM
BADGE OR ID# ( 5738 OR]#' WA0171300 TIME POLICE DISPATCHED 7:44 AM TIME POLICE ARRIVED 7:49 AM
FART I PAGE IT]OF 3�
REPORT NO. EE82745 CASE# 24-5783 DATE AND TIME 06/01/24 07:40
OF COLLISION
Unit 1
SW 43rd St
td da,fie a ;
....
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