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HomeMy WebLinkAbout24-5891 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EE87697oc� RA COLLISION REPORT 1591971 CASE# 24-5891 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE LOL`CO A`GENC'Y 4200 3[--� COUNTY RD NVOLVED CODING 2❑ TOTAL 1 PRIVATE WAY TRIBAL UNITS#OF 03 SO BJECT TRUCK 1 8 28 RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF'. N E COLLISION'. 06 - 03 - 2024 1818 17 =.= S 8 W E IN OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION 103RD AVE SE BLOCK NO. e 17400 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 C------�.� FEET e S B W 1 9 29 MOTtlR PEDAL- DAMAG THRESHOLD MET PHONE UNIT 01 VEHICLE CYCLE' YES NO ✓ 1 4 30 5❑ LAST NAME PATTERSON FIRST NAME LINDA MIDDLE F 1 1 2 31 INITIAL STREET E:1 3424 S 182ND PL NEW ADDRESS CITY SEATAC ST WA ZIP' 98188 2 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3 INTERLOCKYES NOW] INTERLOCK YES NO�/ YES D NOW 8 LCEVERSENSE# STATE WA SEX F MMorYY' 01 — 02 — 1950 32 9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY CLASS 1 NAruRE of INJURIES 2 LICENSE, CFF9057 STATE WA VN# JHMCD566XRC040087 3 10 PI ATF# TRAILER STATE TRAILER ,STATE 11 0 0 PLATE# PLATE# FROM TO TRLR TRLR 7 3 33 12 0 Q VIN# VIN# ( FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 13 0 1994 HOND ACCOR SD DAMAGE YES�No ✓� Yes No� m 34 REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE� INSURANCE CO PEMCO CA1469785 4 IN EFFECT &POLICY# 9TOP LEnAL�e CHARGE t S 36 Lemur yes❑NO❑ CITATION# 7 o BOTTOM 15❑ STM ING B UN# MOTOR PEDAL ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE 1 VEHICLE CYCLE. nWNFR YES NO 16❑ LAST NAME UNKNOWN FIRST NAME MIDDLE' INITIAL 17❑ STREET D CITY ST ZIP 4❑ 37 NEW ADDRESS 1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCKYEs No INTERLOCK YES0-001 Es NO' 19 F1 LICEENSE# STATE SEY U MMDDYY' -� 39 HELMET INJURY' NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG g RESTR g EJECT 1 USE 9 CLASS 0 ❑ 21 LICENSLATE E BPW9113 TATE WA VIN# 1GNFK13097R152443 41 22❑ PLTL ATE# STATE TILER PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR 2007 MAKE CHEV MODEL TAHOE STYLE UTVEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO KEENAN CLARK 12664 61ST PL S SEATTLEWA 98178 D:2063499125 VEHICLE NO.2 SHADE IN DAGE$AREA z �44 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 923923669 IN EFFECT &POLICY# I 9TOP VEHICLE LECAtLr ❑ N`,.ILJ —I CITATION CHARGE tO BOTTOM 25 YES a 6 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 TYLER EDIGER 12807 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EE87697 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5891 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) 'NAME (LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B. — [----------� MMDDYYYY PASSENGER F-1 WITNESS El UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--� POS. USE CLASS 'NAME (LAST FIRS,MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B. — L----------� MMDDYYYY PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. : USE CLASS ----� '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — L----------� MMDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ Q POS. USE CLASS �____ ----j NARRATIVE Both Unit 2 and 3 were legally parked and unoccupied at the time of this collision. Unit 1 was attempting to nose into a parking stall facing eastbound when her foot slipped off of the brake pedal and onto the gas pedal. Unit 1 was stated that she was unable to react in time and her vehicle went over the curb causing damage to both Unit 2 and 3. No injuries resulted from this collision and all units were able to leave under their own power. Unit 1 had damage to the rear drivers side and front passenger side. Unit 2 had damage to the rear passenger side. Unit 3 had damage to the front passenger side. The proximate cause of this collision was Unit 1 mistakenly pressing the accelerator rather than the brake pedal. This collision occurred within in the parking lot. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. TYLER EDIGER 06-04-24 12:55 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE 6/18/2024 2:50:22 AM J.THIELMAN 11462 BADGE OR ID# 12807 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 7:18 PM TIME POLICE ARRIVED 7:Y8 PM PART IS 3aaa-345-,aa(R11Y1s) PAGE 27OF 47 SUPPLEMENTAL REPORT No. EE87697 POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE#+ 24-5891 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS CITY NAME IF ST ZIP 4 ❑ NAME # PLACARD. GWUR NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS ,µ MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE UNIT# ' 3 PEDESTRIAN ❑', YES NO 5 VEHICLE CYCLE OWNER F,/ 1 4 29 LAST NAME UNKNOWN FIRST NAME MIDDLE'. INITIAL STREET 30 ❑ NEW ADDRFG CITY KENT ST ZIP 6 CDL GM710N REQUIRED GNi710N PRESENT MEDICALTANSPORTED. 1 31 I i INTERLOCK YES NO :INTERLOCK YES[]NO[] YES[]N_ DRIVER'S STATE SEX,U MD.0 B v LICENSE; 7 ON DUTY STATUS: AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES USE CLASS 8 ❑ I ,. 1 32 LICENSE CKG0690 TAT WA VIN# 4T1BK36B46U151756 PLATE# 9 2 TRAILER TRAILER PLATE#; STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.# VIN.R4 11 0 0 VEH.YEAR2006 I MAKE TOYT MODELA VALON STYLE SD VEHICLE TOWE E T ABLIN TOWED BY GOVT.VFHICI F FROM TO DAMAGE YES NO ✓ YES NO DANIELLE WESTWOOD 22564 116TH PL SE KENT WA 98031 D:2069201991 m 33 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 12 4 FROM TO LIABILITY INSURANCE❑ INSURANCE CO r TOP' IN EFFECT &POLICY# i S m 34 13 vewcEe YES NO CITATION# CHARGE 10 t3t)i TC)M ecauv sTANoINc 3 7 Pi MOTOR PEDAL_ ' PROPERTY DAMAGE THRESHOLD MET PHONE ❑ 35 14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO 15 LAST NAME FIRST NAME ❑INITMIDDL ALE 36 16 ❑ STREET �.. CITY ST.. ZIP NEW EETAODRr a COL IGNITION REQUIRED 1GNITION PRESENT MEDICALTANSPORTED. INTERLOCK YES NO INTERLOCK YEs N(1 'YES NO E17 37 LLIICENSE# STATE SEX MDDODyY —= L 18 ❑ ❑ HELMET INJURY NATURE OF INJURIES 38 ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS 19 ❑ ❑ 39 LICENSE viN PLATE# TAT # 20 ❑ TRAILER TRAILER ❑ 40 PLATE#. STATE PLATE# STATE 21 ❑ ❑ 41 TRLR TRLR VIN#7 VIN#i 42 22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43 2 3 4 LIABILITY INSURANCE INSURANCE CO IN EFFECT I &POLICY# tK-99 5 44 vewcEe ❑ ❑ CITATION# CHARGE 24 IEGALLY VES NO3 3 6 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. TYLER EDIGER 06-04-24 12:55 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 ORID# 12807 O#RI WA0171300 APPROVED BY 61118/2024 PAGE F OF 3000-345-013(R 11/18) REPORT NO. EE87697 CASE# 24-5891 DATE AND TIME 06/03/24 19:18 OF COLLISION „ax W s. 1 k1 v 3 t � PAGE 4 OF 4