HomeMy WebLinkAbout24-7658 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE97772 170
27
COLLISION REP FIT 1591971
SASE 24ass8 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 2$
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 07 - 20 - 2024 1140 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 3RD ST BLOCK NO. e✓ 1500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SUNSET BLVD N
0 4 29
UNIT MOTOR
Z PEDAL-
CYCLE ❑ YESAGE NHORE✓LD MET PHONE 0 4 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑ CITY' ISSAQUAH
NEW ADDRESS ST Zlp'. 2
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
:NTERLOCKYEs NO INTERLOCK YES NO YES No
8 DRIVER'S STATE SEX U D.O.B. 1 2 32
❑ :LICENSE# MMDDYY —❑
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10❑ P1 ATNES# CDL8043 sTAT WAu N# JN8AS58V58W122524
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 1 34
13 4 2008 NISS ROGUE SW DAMAGE YES NO YES
❑ NO✓
REGISTERED OWNER INFO ANNEROBERSON480INDIGO PL NW ISSAQUAH WA 98027 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLe CHARGE 1 5 36
LEGALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067787384
16 a
LAST NAME BASS FIRSTNAME EDWARD MIDDLE j
INITIAL
17❑ STREET ❑', 28102 153RD AVE SE CITY KENT ST WA ZIP 98042 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDIIVER # STATE WA SEX U M .C.B. 08 _ 15 _ 1951 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I C56005S TATe WA VIN1t 1FTFW1EF7DFD04280
❑ 41
PLATE# ❑
42
22❑ TRAILER 21O71AC STATE WA TRAILER STATE
PLATE# PLATE#
43
23❑ TRUR 42KA68S13S2900345 IN#
VEH YEAR 2013 MAKE FORD MODEL F150 STYLE pK VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO� YES NO
REGISTERED OWNER INFO EDWARD BASS 28102153RD AVE SE KENT WA 98042 D:2067787384 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO MUTUAL OFENUMCLAWAB70052466 IGQ
5
IN EFFECT
vE""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 s � a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ON/SHl 5738 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE97772
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7658
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) BASS LITA M
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
28102 153RD AVE SE KENT WA 98042 2067787385 SEXi F MMDDYyry 01 - 31 - 1959
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 3 2 4 1 USE CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O E4
SEX MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Units 1 and 2 both turning left from eastbound N 3rd St to northbound Sunset Blvd N. There are two
turn lanes at this intersection; unit 1 was in the outside lane, unit 2 in the inside lane. During the turn,
unit 1 drifted across lane markers and struck unit 2, left side of unit 1 vs. right front corner of unit 2.
Unit 1 failed to stop, accelerating and then turning onto northbound 1-405 at Sunset Blvd N. Driver 2
Edward Bass described driver 1 as a slim white or light complected female, and believes that he
might be able to ID driver 1 if seen again. Passenger 2 Lita Bass took photo showing unit 1 license as
WA CDL8023. I photographed damage to unit 2 (right front bumper area). All photos uploaded to
Evidence.com.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 07-20-24 05:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 7/21/2024 2:07:24 PM
BADGE OR ID# ( 5738 OR]#' > WA0171300 TIME POLICE DISPATCHED 12:41 PM TIME POLICE ARRIVED 1:38 PM
FART I PAGE IT]OF 3�
REPORT NO. EE97772 CASE# ' 24-7658 DATE AND TIME 07/20/24 11:40
OF COLLISION
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