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HomeMy WebLinkAbout24-7977 )STATE TFcN 0 5 27i t Oc� RA EF02468 COLLISION REPRT 1591971 CASE# 24-7977 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCCO AGENCY. 4200 3 COUNTY RD NVOLVED CODING 2❑ TOTAL 1 PRIVATE WAY TRIBAL UNITS#OF 02 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 GDLLISION' 07 - 29 - 2024 1736 17 =.= S 8 W E IN OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION [Z NON INTERSECTION ❑ NE SUNSET BLVD BLOCK NO. ❑ MILE POST e 4a ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 �. FEET H S 8 W e KIRKLAND AV NE 0 1 29 MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE' ❑ YES Vl NO D:2063277801 0 1 30 5 LAST NAME JOHNSON-HERRING FIRST NAME JAILEN MIDDLE K 1 2 31 INITIAL STREET ❑ 3101 NE 18TH ST APT 3 CITY RENTON ST I WA I Zip 9805632 66 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs NOR] INTERLOCKYEs No�/ YES NoF,/ 8 LICIENS# STATE WA SEX M MMOCSYY' 07 1 2 32 9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY CLASS 1 NAruRE of INJURIES 2 10 LI ENSE BXG8804 STATE WA VN# 2C3CDXCT8JH143991 3 11[—j— TRAILER STATE TRAILER ..STATE ROM TO 11 3 0 PLATE# PLATE# TRLR TRLR 1 5 33 12 3 5 VIN#' vI. FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN GOVT VEHICLE 7 $ 34 13 4 201$ DODG CHARG SD DAMAGE YES ✓ NOIMW{� RS Yes❑ No REGISTERED OWNER INFO JAILENJOHNSON-HERRING 3101 NE 18TH STAPT 3 RENTON WA 98056 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 4 LIABILITY INSURANCE INSURANCE CO 4 14 GEICO 4130025762 IN EFFECT &POLICY# 9TOP vEH ' CHARGE t 5 36 IALL� yes❑NO❑ CITATION# 70 80TTOM 15❑ sTnNowc s 7 e MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHIC6E CYCLE' ❑ ❑ nWNFR YES,/ No D:4259225055 16� LAST NAME AYOUB FIRST NAME RICHARD MIDDLE I E 17 F1 INITIAL I STREET ❑ 37 'NEW ADDRESS❑ 3907 NE 11TH CT CITY I RENTON ST, WA ZIP 980563558 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 38 INTERLOCKYEs No�/ INTERLOCKYEs 0N-S/ll vEs No 19 DRIVER' # STATE WA SEX M MMDDYv 07 13 1978 ❑ 39 HELMET INJURY' NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICENSEBKE7450 TATE WA VIN# 1HGCR2F39FA126068 41 22❑ [TILER AILER PLATE# STATE PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR 2015 MAKE HOND MODEL ACCORD STYLE SD VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YE s�/ NO GENE MEYER YES No REGISTERED OWNER INFO RICHARD AYOUB 3907 NE 11TH CT RENTONWA98056 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSURANCE CO WA INS 4883404DO147B IN EFFECT &POLICY# 4TOP vemae ❑ CITATION11 CHARGE t080TTOM LecnLLy YES N J 25 e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HANSEN HSU 12651 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EF02468 COLLISION REPORT III III III III III 111 1591972 CASE# 24-7977 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 Unit 1 traveling south on Kirkland Av NE at the intersection of NE Sunset Blvd. Unit 2 traveling east on NE Sunset Blvd at intersection of Kirkland Av NE. Unit 1 failed to yield right of way through heavy traffic. Unit 1 driver proximate cause of collision. Unit 1 sustains disabling reportable front passenger damage. Unit 2 sustains reportable disabling front end damage. No injuries. Both vehicles privately impounded. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 07-29-24 08:08 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 8/5/2024 2:22:13 PM BADGE OR ID# 12651 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 5:37 PM TIME POLICE ARRIVED 5:37 PM PART IS 3 Da-3m5-,aa(R11ras) PAGE 27 OF 37 REPORT NO. EF02468 CASE# 24-7977 DATE AND TIME 07/29/24 17:36 OF COLLISION xm• a v s gdg a, s�u.✓,,,a,. ......a- ,. ,c Mr 4 rn pp 91 f I' 4 m 4 �Pz\ t t� y r "i,xi e PAGE 3 OF 3