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HomeMy WebLinkAbout24-6908 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 SASE 24-6908 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3 HIT 8 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 07 - 01 - 2024 1837 17 ❑.❑ S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ S 3 ST BLOCK e✓ 200 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El NO D:2063005691 0 11 30 6❑ LAST NAME WEIMER FIRSTNAME RYAN MIDDLE W 1 2 31 INITIAL STREET ❑ 7807 211 AVE EAST CITY BONNEY LAKE ST WA ZIP 98391 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'M MID -O B 07 1- 30 - 1973 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 1 EJECT 1 HELMET USE 2 1 CLASS NATURE OF INJURIES z❑ 3 10 9� P1 AT 14 CBN9533 STATE WA VIN# 5UXFA53532LV70425 C.... TRAILER STATE PLATE LA E{ STATE 11 0 0 PLATE# PLATT E# FROM ro TRLR. TRLR 7 3 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34 13 1 ZOO2 BMW X5 UT DAMAGE YES NO YES❑ NO REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14� LIABILITY INSURANCE� INSURANCE CO STATE FARM 5093019.815.47 4 IN EFFECT &POLICY# TOPVEHICLE CHARGE36 LEGALLv Yes❑NO CITATION# <1�3 OTTOM 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2535818000 16 a LAST NAME DANO FIRST NAME ISRAEK MIDDLE JE INITIAL 17 STREET NEW ADORE57 11512 173RD ST E CITY PUYALLUP ST' WA ZIP 98374 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'S STATE WA SEX M D.O.B. 01 16 _ 1987 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40 ❑21❑ PLATE# D7575C TATE 41 GOV vIN1 15GGD3014C1180605 1 42 22❑ PIR ILER LATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2012 MAKE GILL MODEL G30D STYLE BU VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO REGIONAL TRANSITAUTHORIT CENTRAL PUGET SOUND 370196TH ST SW LAKEWOOD WA 98499 VEHICLE NO.2 SHADE DA GEbAREA LIABILITY INSURANCE I PORGY#ECO WASH TRANS INSURANCE POOL WSTIP 2003 IGQ 5 IN EFFECT —ILLE ❑ ,J� CITATION# CHARGE 25 LEGALLY YES N`L J s � e 7BRYAN NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26GROZAV 12489 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE92203 COLLISION REPORT III III III III III 111 1591972 CASE# 24-6908 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' On Monday July 01, 2024, 1 responded to a 911 call regarding a two vehicle collision regarding a metro bus. I arrived on scene and contacted the invooved parties. No injuries were reprots, there were no passengers on the bus, and the damage was mininal to the involved vehicels. Unit one driver- Ryan indicated he did not realize South 3rd St was a one way and didnt noticed the bus on his left as he attempted to turn into the Safeway parking lot casuing him to crash into the side of unit two.Unit two driver-Israel indicated he was driving straight on South 3rd St when unit one crashed into the side of the bus. King County Metro suspervisor responded to the scene. I provided the involved parties a copy of the exchange of information. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. BRYAN GROZAV 07-01-24 08:54 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 888 1 71212024 4:46:33 PM BADGE OR ID# ! 12489 ORI# WA0171300 TIME POLICE DISPATCHED; 6:42 PM TIME POLICE ARRIVED',6:57 PM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. EE92203 r` POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 24-6908 1 COMMERCIAL MOTOR CARRIER INTERSTATE ✓ INTRASTATE G UNIT'# 2 USDOT ICC# ' VEHICLE TYPE 1 CARGO 6ODY 1 ;TYPE 2 ❑ 1 28 CARRIER NAME. SOUND TRANSIT ..... 3 CARRIER ADDRESS 3701 96TH ST SW. CITY LAKEWOOD ST WA ZIP'', 98499 4 ❑ NAME # PLACARD: :❑ NAME IF NO NUMBER SOURCE 3 AXLES 02 GI 8000 + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO i MIDDLE'... 29 LAST NAME FIRST NAME INITIAL STREET 30 NFW AnnRFrtP. CITY ST ZIP 6 CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No zERLOCK YES❑N0� vES N LLIICIENSE STATE I SEX M��DYRYY' 2 7 F-1 ON DUTYl STATUS AIRBAG' RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE CLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIG P FROM TO DAMAGE Y EES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREETIAL ❑ 16 NFln+AnnRFs.� CITY'. ST 21P CDL IGNITION REDUIREE7 IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. BRYAN GROZAV 07-01-24 08:54 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED BADGE O#I' AP 126 ORID# 12489 WA0171300 SUMMERS 7212 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. EE92203 CASE# 24-6908 DATE AND TIME 07/01/2418:37 OF COLLISION r � l v 4 O �ti 2 tanF., Y a a. PAGE 4 OF 4