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HomeMy WebLinkAbout24-11662 IT �i " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF35259OLCERA COLLISION REPORT 1591971 CASE# 24-11662 2 INTERSTATE CITY STREET El STATE ROUTE OTHER LdCAI-AGENCY 4250 3 C©DING COUNTY RD PRIVATE WAY 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 02 STRUCK RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eaCL s o v' 11 - 09 - 2024 2053 17 =.= S 8 W e IN OF e 1070 s 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ NE e 2100 MILEBLO PO .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 F--1 MILES 1.1 FEET e S 8 W e ABERDEEN AV NE 0 1 29 MOTOR PEDAL- DAM AG TSHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES NHREO O 3 30 6 LAST NAME UNK FIRST NAME MIDDLE t 1 2 31 INITIAL STREET ❑) CITY', ST ZIP 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYES NOW] INTERLOCKVEs No�/ YES NOW 8❑ LCEENSE# SRVERSTTATE SEX U MMDDYY' —=— 1 2 32 9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 9 HELM USEET 9 CLASSY 0 NATURE OF INJURIES 2 LICENSE, UNK 3 10 F PI ATP# STATE V(N TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# ROM To TRLR zRLR 1 5 33 12 2 5 VIN#' VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BUN 7 5 TOWEBBY GOVT VEHICLE 13� UNKN UNK DAMAGE YES�No ✓� vEs❑ No� 34 REGISTERED OWNER INFO UNK VEHICLE NO. 1 SHADE IN DAMAGED AREA 11 35 14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP CHARGE t S 11 36 Lemur yes❑NO❑ CITATION# t a 80TTOM 15❑ STM ING s 7 e MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE CYCLE nWNFR YES'/ NO D:2066399347 16� LAST NAME ALI FIRST NAME SAHRA MIDDLE I A INITIAL 17 F1 STREET ❑❑ 11465 SE 195TH PL CITY KENT ST, yyq ZIP 9803100 37 73 NEW ADDRESS 1$❑ IGNITION REQUIREfl IGNITION PRESENT MEDICALTRANSPORTED 38 CDL INTERLOCKYEs No INTERLOCK YES No YES NO 19[ DRIVER'S STATE WA SEX F I D.o.e. 1 06 27 2001 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 LATEICAG6559 rare WA vIN# 5XXGU4L37HG136510 41 22❑ PLATE# STATE[TILER I PLATE# STATE 42 23= TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2017 MAKE KJq MODEL OPTIMA STYLE $D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24� DAMAGE YES NO� VES NO REGISTERED OWNER INFO SAHRAAL198379TH AVESWUNIT102 SEAT WA 98106 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO GEIC04600564605 IN EFFECT &POLICY# 9TOP vewae ❑ ,.I—I CITATION CHARGE OUR EEGnEEY YES N 25 s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HANSEN HSU 12651 WA0171300 PAGE 01 OF PART A 3000-348-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF35259 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11662 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) HASSAN JAHANDA ADDRESS&PHONE# D O B 13445 MLK JR WAY S APT Q303 SEA TTLE WA 981785201 6148045900 SEXi F MM DDYVYY 08 IT 30 - 2002 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES 2 POS. 9 1 4 1 USE CLASS 11 � ----� :NAME Lnsr EIRST,MIDDLE INITIAL) DORSEY EMANI ADDRESS&PHONE# SEATTLE 2066706248 SEX F MMDDYYYY D•O�e• 02 _ 08 _ 1997 SEAT RY PASSENGER a WITNESS� UNIT# EAT' 2 POS. 3 AIRBAG 2 RESTR. 4 'EJECT 1 HELMET USE C INLASS 1 NATURE OF INJURIES �-_- ----� NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# MMDDYY SEX/ D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I USE CLASS NARRATIVE Hit and run collision. Reported incident location at intersection of NE 9th St and Aberdeen Av NE. Unit 2 driver reports making right turn at intersection and was struck by unknown Unit 1, an older red truck, possibly a Ford F150. Unit 2 sustained reportable non disabling front driver side damage. No injuries reported. No actionable information for Unit 1. Unit 2 driver would not be able to identify driver of Unit 1 if she saw him again. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 11-09-24 09:33 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 1111312024 4:21:57 PM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1 8:56 PM TIME POLICE ARRIVED i 9:02 PM PAST B 3 Da-3mx-attar gt 1Mffp PAGE 2�OF F3 REPORT NO. E F35259 CASE# 24-11662 DATE AND TIME 11/09/24 20:53 OF COLLISION .a l� re ti c; t "s S �I S PAGE 3 OF 3