HomeMy WebLinkAbout24-7042 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-7042 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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#
cowsloN 07 - 1-- 2024 1925 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 3RD ST BLOCK e✓ 200 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e HOUSER WAYS
2 3 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:2063709375 2 3 30
6F] LAST NAME MAINGI FIRSTNAME JACKSON MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 1804 164TH ST E CITY TACOMA ST WA ZIP, 984453361 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 10 1— 27 — 1963 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 1❑ PI ATE 14 CAY8342 sTAr WA u N#' JTDEBRBE9LJ008948
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM To
TRLR. TRLR 3 1 33
12 2 5 VIN#' VIN#
ROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 1 34
13 1 2020 TOYT COROL SD DAMAGE YES NO ves❑ No
REGISTERED OWNER INFO JACKSON MAINGI 1804164TH ST E TACOMA WA 98445 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE U INSURANCE CO AMERICAN FAM 410082882261 3 4
IN EFFECT &POLICY# 9TOP
CHARGE
VE—L'
15❑ 1 5 36
LEGALLY YEs❑NO❑ CITATION# 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a �UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2063100765
LAST NAME PRICHARD FIRST NAME JILL MIDDLE C
INITIAL
17❑ STREET ❑', 6900 E GREEN LAKE WAY N APT 2 CITY SEATTLE ST WA ZIP 981155499 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALt—TRANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YES N0F YEst lNOF,/]
19 D IVERI # STATE WA SEX F M D.O.B. 03 �_ 03 _ 1964 39
HELMET I INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CBK8270 TAre WA vIN1i WAUFAAF42NA006839
❑ 41
PLATE#
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2022 MAKE AUDI MODEL A4 STYLE SD VEHICLE TOWED TO BLIN TOWEDev GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO JILL PRICHARD 4545 SANDPOINT WAYNE APT 60 SEATTLEWA98105 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO PROGRESSIVE 917190094IN 1 9TOP 5
VEHICLE ❑ N`LJ
,.I—I CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
HANSEN HSU 12651 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE93032
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7042
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'
Units 1 and 2 both traveling eastbound from S 3rd St and Main Av S onto Houser Way S. Unit 1
veered into Unit 2 causing non reportable non disabling damage to the front passenger side of Unit 1
and to the rear driver side of Unit 2. No injuries. It appears proximate cause of collision was confusion
from lane of travel by Unit 1 driver.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 07-05-24 10:30 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 7/5/2024 11:20:22 PM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 7:30 PM TIME POLICE ARRIVED',7:36 PM
PART I PAGE IT]OF
REPORT NO. EE93032 CASE# ' 24-7042 DATE AND TIME 07/055/24 19:25
OF COLLISION
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