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HomeMy WebLinkAbout24-11448 IT �i " II IIIII III IIIII II IIII IIIII I . 7 27c REPORT NO EF33165OLCERA COLLISION REPORT 1591971 CASE# 24-11448 2 INTERSTATE ❑ CITY STREET FIRE I RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LdCAI-A`NG 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 s 28 TRIBAL UNITS 02 STRUCK ❑ RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eaCL s o v' 11 - 04 - 2024 1600 17 =.= S 8 W❑ OF IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SUNSET BLVD NE BLOCK POST e 4a MILE POST 2700 .� ❑ ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 MILES 1.1 FEET e S 8 W e NE 10TH ST 0 1 29 MOTOR PEDAL- DAMAG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:3602923225 0 7 30 6 LAST NAME BOWMAN FIRST NAME KATIE MIDDLE R 1 1 2 31 INITIAL STREET ❑✓ 955 EDMONDS AV NE B CITY; RENTON ST WA ZIP; 98056 2 NEW ADDRESS 7� +COL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3 INTERLOCKYEs NO✓ INTERLOCKVEs NO✓ YES F NOF,/ 8 DRIVER # STATE WA SEXI X MMDDYY' 02 — 23 — 1985 1 2 32 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR CLASSY 14 NATURE of INJURIES 2❑ LICENSE, CHRO103 STATE WA VIN# WVWCA0158GK021553 3 10 Fl I as ATP rt 11❑ TRAILER STATE TRAILER STATE 3 5 PLATE# PLATE# ROM To TRLR zRLR. 1 5 33 12 3 5 VIN# vIN# FROM TO VEH.YEAR 1986 MAKE VOLK MODEL CABR/O STYLE VEHICLE TOWED TO BLIN TOWED By G VEHICLE 9 9 34 13 DAMAGE YES NO ✓ YES ES❑ NO✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ NSURANCE CO NONE 4 IN EFFECT &POLICY# 9TOP _ srnNowc ❑ ❑ 4AO452432 CHARGE OP MOT VEH W/OUT INSURANCE, t a oorrob z 36 Yes NO CITATION# 15❑ MOTGR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT O2 VEHICLE CYCLE nWNFR YES�/ NO D:2062296294 16� LAST NAME KAUR FIRST NAME RANDHIR MIDDLE' INITIAL 17 F1 STREET ❑❑ 10542 SE 229TH PL CITY KENT 5T, WA ZIP 980312604 37 NEW ADDRESS 1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38 CDL INTERLOCKYES NO✓ INTERLOCK YESEl NO✓ YES NO✓ 19 DRIVER'S ' STATE WA SEX F D.O.B. 05 12 1973 � 39 LICENSE# MMDDYY - HELMET INJURY: NATURE OF INJURIES 4Q 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICEN E LATEIBSH0631 rare WA vIN# WBXHT3C3XG5E56706 41 22❑ PLATE# STATE[TILER I PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2016 MAKE BMW MODEL X1 STYLE $V VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24❑ DAMAGE YES NO✓ VES NO✓ REGISTERED OWNER INFO RANDHIR KAUR 10542 SE 229TH PL KENT WA 98031 VEHICLE NO.2 SHADE IN DAMAGEAREA 2 3 LIABILITY INSURANCE❑ INSURANCE CO SAFECO H2426536 IN EFFECT &POLICY# t STOP HICL L'—L YES N CL] CITATION# CHARGE to BOTTOM VEE 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HANSEN HSU 12651 WA0171300 ❑ PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF33165 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11448 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES POS. ' USE CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CLASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I USE CLASS NARRATIVE Unit 1 and 2 both traveling southbound along the 2700 block of Sunset Blvd NE at the intersection of NE 10th St. Unit 2 stopped for traffic at intersection. Unit 1 rear ends Unit 2 causing non reportable non disabling front end damage to Unit 1 and reportable non disabling damage to the rear end of Unit 2. No injuries. Unit 1 driver cited for following too closely to avoid collision and operating motor vehicle without valid insurance. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 11-04-24 04:47 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 11/7/2024 6:51:00 PM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1 4:03 PM TIME POLICE ARRIVED i 4:09 PM PAST B 3 Da-3m5—attar(txIMR) PAGE 2�OF F3 REPORT NO. EF33165 CASE# 24-11448 DATE AND TIME 11/04/2416:00 OF COLLISION MR t y, t t A, u fu �;. z` R �k :x PAGE 3 OF 3