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HomeMy WebLinkAbout24-10341 �oLcRaiTFFiN 0 3 27c REPORT NO. EF21542 "i ,one COLLISION REP F 1591971 CASE 24-10341 2 INTERSTATE CITY STREET FIRE ❑ RESULTED STOLEN 1 1 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4200 3[� HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TRIBAL UN 75 TOTAL#OF STRUCK OBJECT 11 8 2$ RESERVATION 2 3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY# coATL s ory 10 - 03 - 2024 0609 17 a. S e W 8 OF 8 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. NE4THST MILEPOST T ❑ MILEPOST 8 4300 4a .� DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 1,= FEET e S e W 8 WHITMAN CT NE OF11 29 MOTOR PEDAL- DAM ETHRESHOLD MET PHONE UNIT 01 VEHICLE CYCLE YES ,/No D:6025459988 0 4 30 6 LAST NAME SMITH FIRST NAME ROBIN MIDDLE' M [; 2 31 INITIAL STREET I`�I' 1713 S 282ND PL#15 CITY FEDERAL WAY WA NEW ADDRESS S7 ZIP 98003 z 7❑ COL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES LINOZINTERLOCK YES No YES NOW DRIVE STATE WA SEX'F MM flYY 08 - 21 - 1995 1 2 32 8❑ L 9 ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H U5 E7 CLASRS 1 NATURE OF INJURIES 2 10 1❑ L1,CENSte CHT2897 STATE WA WIN# JHMCG56792CO32570.Tr 3 11 3 5 PLATE# STATE TRAIPLATE# STATE ROMRA To TRLR TRLR. 7 3 33 12 3 5 vIN#' VIN# FROM TO 13 $ VEH.YEAR2002 MAKE HOND MODEL ACCOR STYLE 4D VEHICLETOWEED2NOn fBLIN Tv4 LBYMEYER GGvv�ENOLI 3 5 34 ❑ DAMAGE II1I._IIII -IIJJ REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 INSURANCE CO 4 LIABILITY INSURANCE IN EFFECT &POLICY# STOP CHARGE OP MOT VEH W/OUT INSURANCE, 10 ftOTTOM 5 ❑ 36 15 YES❑NO CITATION# 4A0793354,4A0793354❑ sranomc 7 6 MOTOR PEDAL PROPERTY THR OLD MET PHONE UNIT 02 ❑ PEDESTRIAN ❑ [:]FA D:4253014491 VEHICLE CYCLE OWNER � NO 16� LAST NAME HENDERSON FIRST NAME JAMES MIDDLE E INITIAL 17❑ STREET El 14566 167TH PL SE CITY RENTON ST', WA ZIP 98059 37 NEW ADDRESS I I ❑ 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDI.CALTRANSPORTED ❑ 38 WTERLOCKvEs No INTERLOCK Es Tao YES No,� 19 DRIVER'# ON DUTY STATUS AIRBAG 4 RESTR 4 EJECT 1 HELM ET INJ S 1 NAruRE of INJURIES 40 21❑ LICENSE,INDEEGO TATf WA vIN# 1N6ED1EK4NN684441 ❑ 41 PLATE# TRAILER TRAILER ❑22 PLATE# STATE PLATE STATE 42 23� 43 TRLR RLR VIN#. '[N#, Y VEH.YEAR 2022 MAKE /I//SS MODEL FRONT/E STYLE PK DAMIAGETOWED✓ NO GENE MEYER YESO BLIN TOWED B GO N HI O� 44 / 24 REGISTERED OWNER INFO OWNED BYDRIVER VEHICLE NQ.2 SHADE IN DAGED AREA LIABILITY INSURANCE[2] INSURANCE CO PROGRESSIVE 928739621 2 4 IN EFFECT &POLICY# t 4TOP 5 venue YES❑ N J .1-1 CITATION# CHARGE tOBOTTOM �ecns�v 25 s e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 R.ONISHI 5738 WA0171300 PART A . PAGE 01 OF 9000-345-159(R 11(181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF21542 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10341 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. - MMDDYYYY PASSENGER❑WITNESS❑;UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURECFINJURIES 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 CLASS ----� :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 2 turning left, from westbound NE 4th St on southbound Whitman Ct NE. Unit 1 eastbound on NE 4th St, approaching Whitman Ct NE. Driver 1 Smith told me that she was driving in lane 1, and approaching a slowly moving car in her lane. Smith said that she swung right and accelerated to what she believed was about 45 mph to pass, and as she moved back into lane 1, she saw unit 2 starting to turn into her path. Smith said that she honked, saw unit 2 slow, then saw unit 2 continue into turn. Unit 1 then struck unit 2, front end into unit 2 right side. Driver 2 Henderson said that he saw that approaching traffic was far enough from intersection to allow turn, then as he turned, he saw unit 1 swing out into lane 2 at high speed and strike his truck. Smith had no insurance coverage. Smith cited for exceeding stated speed limit by 10 mph in an area where speed limit was under 40 mph, and operating motor vehicle without insurance. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ON/SH/ 10-03-24 07:33 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE D.SKELTON 9139 1 101512024 3:49:03 AM BADGE OR ID# 5738 ORI# WA0171300 TIME POLICE DISPATCHED 6:11 AM TIME POLICE ARRIVED i 6:13 AM PART B 3000-345.160(R1Vt8) PAGE F2 --]OF F3 REPORT NO. EF21542 CASE# 24-10341 DATE AND TIME 10/03/2406:09 OF COLLISION i d e� , r I i 3 d r IfM i in v5 \ 5� KU` 7' t tl PAGE 3 OF 3