HomeMy WebLinkAbout24-11489 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF33167oc� RA COLLISION REPORT 1591971 CASE# 24-11489 2 INTERSTATE CITY STREET FIRE I RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 02 STRUCK CULVERT i RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eaCL s on' 11 - 06 - 2024 0130 17 =.[� S 8 W e OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ HARR/NGTON AV NE BLOCK NO. e 1000 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 30 1.1 00 FEET e✓ S 8 W e NE 10TH ST 1 5 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2063757278 1 4 30 6 LAST NAME SCOTT FIRST NAME CARViN MIDDLE D 1 1 2 31 INITIAL STREET ❑ 2650 NE 10TH ST B207 CITY; RENTON ST I WA ZIP; 98057 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDIQAL TRANSPORTED' 3 INTERLOCKYEs No./ INTERLOCKVEs N©✓ vEs NO✓ 8 DCIENSE# STATE WA SEXI M MMDDYY' 11 - 26 - 1969 32 9 ON DUTY STATUS' AIRBAG 2 RE 4 EJECT 1 N USE CLASSY',1 [NATURE of INJURIES 2 LICENSE, CHN5707 STATE WA VIN# KNDPC3A22C7348529 3 10 F1 PI ATP tt TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# 11ROM To TRLR zRLR 0 0 33 12 0 Q VIN#' VIN# FROM TO HICLE 13 4 VEH.YEAR 2012 MAKE K1A MODEL SPORTA STYLE SV VEHICLE TO YED NO fiS46LIN diW9YMEYER GESr`-IVT ENp✓ m 34 DAMAGE IIII._IIII I_I REGISTERED OWNER INFO CARVIN SCOT72650 NE LOTH ST 8207 RENTON WA 98057 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ NSURANCE CO NONE 3 IN EFFECT &POLICY# 9TOP VEnicLE CHARGE t 5 36 LEc LT YES❑NO❑ CITATION# t a 80TTOM 15❑ sTnNowc 7 e UNIT MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE 1 VEHICLE CYCLE nWNFR YES NO ✓ 16❑ LAST NAME NONE FIRST NAME MIDDLE' INITIAL 17❑ STREET ❑ CITY, SEATTLE ST ZIP ❑ 37 NEW ADDRESS 18❑ CDL IGNITION REQUIRED fGNfTION PRESENT MED[CALTRANSPORTED: 38 INTERLOCK YEs NO✓ INTERLOCK YES No✓ vEs NO✓ 19 LICENS# STATE SEX U MMDUYY 39 HELMET INJURY: NATURE OF INJURIES 4Q 20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS 1 ❑ 21 LICENSLATE E C444346 rare WA vIN# 2LMHJ5ATOABJ22816 41 22❑ PLATE# STATE[TILER I PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2010 MAKE L/NC MODEL MKT AWD STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO VES NO✓ REGISTERED OWNER INFO DANIEL MEKONNEN 11020 AUBURN AVE S SEATTLEWA98178 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO NONE IN EFFECT &POLICY# t STOP ­1— ❑ ,J—I CITATION# CHARGE to BOTTOM ,—LY YES N 25 s 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. EF33167 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11489 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 GLASS 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 CIASS ----� :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 loses control from parked position and reverses into another parked car and ends up in the culvert along the west side of the 1000 block of Harrington Av NE, adjacent to the property at Sunset Oaks at 2650 NE 10th St. Unit 1 driver no signs of impairment. Unit 1 gets stuck, partially high centered along curb and stuck in the dirt within the culvert. Unit 1 also makes contact with Unit 2 causing reportable disabling underside damage to Unit 1 and non reportable non disabling damage to the rear passenger side of Unit 2. No injuries. Unit 1 driver with no proof of vehicle 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 11-06-24 02:28 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY ATE P.SUMMERS 8887 11/7/2024 6:50:40 PM D BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1:34 AM TIME POLICE ARRIVED i 1:39 AM PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3 REPORT NO. EF33167 CASE# 24-11489 DATE AND TIME 11/06/2401:30 OF COLLISION t t r i i s4 ,t k fig t 1 { ~ t a PAGE 3 OF 3