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HomeMy WebLinkAbout24-9163 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO ER 0491oc� RA COLLISION REPORT 1591971 ASE# 24-9163 2 INTERSTATE CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENCY 4250 3 COUNTY RD NVOLVED CODING PRIVATE WAY 2❑ TOTAL 1 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 GoulsloN' 08 - 31 - 2024 1815 17 =.= S 8 W E IN OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑ ABERDEEN AV NE BLOCK ST e 2400 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 �. FEET S 8 W e NE 24TH ST 0 1 29 PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLEMOTtlR ❑ CYCLE' ❑ YES NO O 1 30 6 LAST NAME UNKNOWN FIRST NAME MIDDLE 1 1 2 31 INITIAL STREET ❑ CITY ST ZIP' 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3 INTERLOCKYEs NOR] INTERLOCKYEs No�/ YEs NoF,/ 8 LCEENSE# STATE SEX U MMDDYY+ —=—VER'S MOS. 1 1 2 32 9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 HELM USEET 9 CLASS 0 NATURE OF INJURIES 2 LICENSE, CLN5936 STATE WA VIN# 3C3CFFBR9CT382714 3 10 PI ATP tt 11[—j— TRAILER STATE TRAILER ,STATE 11 2 $ PLATE# PLATE# FROM TO TRLR TRLR 3 7 33 12 2 5 VIN# VIN# ( FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE $ $ 34 13 4 2012 FIAT 500 HB DAMAGE YES NO YES❑ NO REGISTERED OWNER INFO FILEMON VASOUEZ 4908236TH STSW MOUNTLAKE TERRACE WA 98043 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4 IN EFFECT &POLICY# 4TOP ic CHARGE 5 36 Lemur yes❑NO❑ CITATION# HARE 7 o BOTTOM 15❑ sTnNowc B 7 e UNIT OZ MOTOR PEDAL ❑ PEDESTRIAN PROPERTY DAM T O OLD MET PHONE VEHICLE CYCLE. nWNFR YES NO 16� LAST NAME MAIER FIRST NAME BRAN MIDDLE' INITIAL 37 ❑ 17 STREET� '❑ 2009 ABERDEEN AV NE CITY I RENTON ST, WA ZIP 98056 $ NEW AbbRESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDIGALTRANSPORTED' 38 INTERLOCKYEs No jNTERLOCK YES No rEs NO 19[ LICEENSE# STATE SEX U MMO.B. � ❑ 39 ' 20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY NATURE OF INJURIES 40 USE CLASS 1 ❑ 21 LICEN� BVL1364 TATE WA vIN# 4T3DWRFV6L0006196 41 PLATE 22❑ [TILER TRAILER PLATE# STATE PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR 2020 MAKE TOYT MODEL RAV4 STYLE $D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO ALLEN MAIER 2009 ABERDEEN AV NE RENTON WA 98056 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCECO STATE FARM 4788954DIO47 IN EFFECT &POLICY# t 9TOP veeicLe ❑ ,J—I CITATION# CHARGE tO BOTTOM LecAllr YES N`.LJ 25 a ' OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 HANSEN HSU 12651 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EF10491 COLLISION REPORT III III III III III 111 1591972 CASE# 24-9163 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 Hit and run phone report. No injuries. Unit 2 driver reported that Unit 2 was traveling north on Aberdeen Av NE at intersection of NE 24th St. Unit 1 was traveling westbound on NE 24th St at intersection of Aberdeen Av NE. Unit 2 driver reports Unit 1 failed to stop at four way stop and drove into Unit 2 causing reportable rear bumper and rear driver side damage. Unit 2 driver only requested civil action to unidentified driver of Unit 1 who did not remain on scene. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 08-31-24 09:03 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 9/1/2024 12:36:21 AM BADGE OR ID# 12651 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 7:43 PM TIME POLICE ARRIVED 7:44 Pry] PART B 3 Da-3m5-,aa(R11ras) PAGE 27 OF 37 REPORT NO. EF10491 CASE# 24-9163 DATE AND TIME 08/31/24 19:15 OF COLLISION N mw , p :'... ,rya*a sq, , ..��`' u SCENE NOT c)E�SE7VEO F m a y'•.uf , : PAGE 3 OF 3