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HomeMy WebLinkAbout24-8688 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF08335 170 27 COLLISION REP FIT 1591971 SASE 24-8688 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS OZ STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑ COLLISION.. O8 — 18 — 2024 0653 17 ❑.❑ N E IN S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ S CARR RD BLOCK NO. e✓ 10600 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 300 00 FEET MILES e S ❑ W e 106THAVESE 2 0 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YES NO F,/ D:2065197496 0 11 30 6� LAST NAME BRAR FIRSTNAME RAJWINDER MIDDLE K 1 1 2 31 INITIAL STREET ❑ 16128 SE 180TH PL CITY RENTON ST WA ZIP 98058 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/ 8❑ DRIVERS # STATE WA SEX'F MIDI Y' 01 — 24 — 1959 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 ATE 14 CLT1872 STATE WA VIN# 4T3RWRFV6RU132203 11[-j- TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# IR.. ro TRLR. TRLR 3 7 33 12 3 5 VIN#j VIN# :: FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34 13 8 2024 TOYT RAV4 UT DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILITY INSURANCE INSURANCE CO SAFECO H2495184 3 4 IN EFFECT &POLICY# 9TOP vECALLv Hla.e 5 36 res❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ LE STANDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA. YES NO ,/ D:2064275667 16 a LAST NAME ANDERSEN FIRST NAME ROLAND MIDDLE C INITIAL 17❑ STREET ❑', 17618 161ST AVE SE CITY' RENTON ST WA ZIP 98058 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[—] LICENSE# STATE WA SEX M MMDDW 10 _ 24 1967 39 WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 1 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I D58563E TATe WA vIN# S110P122183 ❑ 41 pLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. GI VEH YEAR 1997 MAKE pgly MODEL yl.,/E7' STYLE PK DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO 44 24❑ ES REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POINSURGY#E CO CONNECT AI04126380IN 1 9TOP 5 'E""LE ❑ N`L J ,J� CITATION# CHARGE LEG 25 i o BOTTOM ALLY YES $ ' OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 R.ON/SHl 5738 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF08335 COLLISION REPORT III III III III III 111 1591972 CASE# 24-8688 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME (LAST FIRST,MIDDLE INITIAL)_ ADDRESS&PHONE# SEX D.O.B. - - MMDDYYYY. PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# D D B SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS R PHONE# SEX D.O.B. MMDDYYYY. - PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Unit 2 westbound in curb lane of S Carr Rd, unit 1 westbound in 2nd lane. Unit 1 changed lanes before clearing unit 2; vehicles did not impact, but unit 2 driver Andersen said that he had to swerve into the curb to avoid collision. Unit 2 struck curb with right front tire, then rotated clockwise until left rear tire struck curb. Unit 2 suffered damage to left rear wheel. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 08-18-24 03:38 PM NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE QUINT TIBEAU 07691 1 8/25/2024 2:06:19 PM BADGE OR ID# ( 5738 OR]# WA0171300 TIME POLICE DISPATCHED 7:16 AM TIME POLICE ARRIVED 7:19 AM FART I PAGE IT]OF 3� REPORT NCV EF08335 CASE# ' 240688 DATE AND TIME 08/18/24 06:53 OF COLLISION 4 z TM tY s 5 t V 7- k E.4 1 �hk yeti, x w, PAGE 3 OF 3