HomeMy WebLinkAbout24-12560 IT �i " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF46245OLCERA
COLLISION REPORT 1591971
CASE# 24-12560 2
INTERSTATE ❑ CITY STREET FIRE I
RESULTED
STOLENSTATE ROUTE OTHER VEHICLE LOC'AI-AGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TRIBAL i UNITS TRUCK
#OF 02 SO"" TRAFFIC SIGNAL POLE 1 1 8 28
i RESERVATION : 2❑3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s o v' 12 - 06 - 2024 2159 17 =.= S 8 W❑ IN OF 8 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE SUNSET BLVD BLOCK POST
e
4a MILE POST 4100 .�
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------ 1.1 FEET e S 8 W e UNION AV NE
0 3 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2063109983 0 1 30
5 LAST NAME DIAZ MARTIN FIRST NAME ANGELICA MIDDLE N 1 1 2 31
INITIAL
STREET ❑✓ 4410 SE 2ND PL CITY; RENTON ST WA ZIP 98057 2
NEW ADDRESS
7� +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3
INTERLOCKYEs No✓ INTERLOCKVES NO✓ YEs NOF✓
8 DRIVER # STATE WA SEXI F MMDDYY' 02 - 10 - 1994 1 2 32
9 ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 N UET SE �JAU SY 1 [NATURE of INJURIES 2❑
LICENSE, CLE9700 STATE WA VIN# 2HGFC2F83MH559331 3
10 Fl I as ATP tt
11❑ TRAILER STATE TRAILER STATE
3 5 PLATE# PLATE# ROM To
TRLR TRLR 5 3 33
12 3 5 VIN# vIN#
FROM TO
13 4 VEH.YEAR 2021 MAKE HOND MODEL CIVIC STYLE SD VEHICLE TO YED NO fj'4 N TgAWIZLRS YES❑E ND 7 3 34
DAMAGE IIII._IIII HHttVVii((tt
REGISTERED OWNER INFO gNGEL/CADIAZ MARTIN 25030 43RD AVE S KENT WA 98032 VEHICLE RI4. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ NSURANCE CO GEICO 4579217516 B 4
IN EFFECT &POLICY# 9TOP _
srnNoiNc ❑ ❑ 4AO887018 CHARGE FA►L TO OBEY TRAFFIC CONTROL t a eorrob z 36
Ves NO CITATION#
15❑
MOTGR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR D:2532832625
16�
LAST NAME SHOOPMAN FIRST NAME BRANDON MIDDLE $
INITIAL
17F1 ❑STREET ❑10633 11THAVENUE CT S CITY' TACOMA ST, WA ZIP 984442705 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED fGNITION PRESENT MEDICAL TRANSPORTED: ❑ 38
INTERLOCKYES NO✓ JNTERLOCK YES NO✓ YES NO✓
19 DRIVER'S STATE WA SEX M D.o.e. 07 03 1986 39
GCENSE# MMDDYY -
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY� STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICEN PLATE� D18543C rarE WA vIN# 2FTRX18L63CA32312 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
TOWED BY GOV HI 44
VEH.YEAR 2003 MAKE FORD MODEL F150 STYLE DAMIAGE TOWED✓ No BLIN BANKERS ves No✓
24❑ REGISTERED OWNER INFO BRANDON SHOOPMAN 10633117H AVENUE CT S TACOMA WA 98444 VEHICLE NO.2
SHADFY DAGED AREA
4
LIABILITY INSURANCE INSURANCE CO STATE FARM 4310164CO747B
IN EFFECT &POLICY#
vEEeGwnaEEEY JL—JICITATION CHARGEYES❑ N COQl
25 a a
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. EF46245
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12560
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 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 traveling north on Union Av NE at intersection of NE Sunset Blvd/SR 900. Unit 1 fails to yield
right of way right turn. Unit 2 traveling east on NE Sunset Blvd approaching intersection at Union Av
NE. Unit 2 collides with Unit 1 causing major disabling front end damage to both vehicles, causing
Unit 1 to rotate and come to rest against the traffic signal light pole in the SE corner of the
intersection. The proximate cause of the collision was Unit 1 driver, who also admitted on scene that
she did not yield right of way. Unit 1 driver cited accordingly. No injuries reported. No evidence of
impairment.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 12-06-24 10:59 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 12/15/2024 7:50:10 PM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 10:00 PM TIME POLICE ARRIVED 10:02 PM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EF46245 CASE# 24-12560 DATE AND TIME 12/06/24 21:59
OF COLLISION
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