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HomeMy WebLinkAbout24-9980 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 SASE 24-9980 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 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 N E IN CITY# ❑ COLLISION'. O9 - 1-- 2024 1422 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE 4TH ST BLOCK NO. e✓ 4800 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 450 00 FMILES NEET e S ❑ E e DUVALL AVE NE 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4257388461 0 11 30 6� LAST NAME CAMPBELL FIRSTNAME ELI MIDDLE H 1 2 31 INITIAL STREET ❑ 5625 NE 2ND CT CITY RENTON ST WA ZIP 98059 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE ICNLJAUSSY 1 NATURE OF INJURIES z❑ 3 10 9❑ PI aT�S1t BQF9169 sTArI WAurN#' WBA4A9C57GGL88255 TRAILER STATE TRAILER STATE 11 0 5 PLATE# PLATE# FROM TO TRLR. A'RLR. 1 3 33 12 3 5 VIN#' VIN# >; FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO 3 ] 34 13 8 2016 BMW 428 4D YES[:] NO✓ REGISTERED OWNER INFO ..&I CAMPBELL 5625 NE 2ND CT RENTON WA 98059 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO NATIONWIDE 7246.1051862 3 4 IN EFFECT &POLICY# 9TOP VEHICLe CHARGE 1 5 36 LEGALLv YEs No CITATION# 4A0672833 FAIL YIELD PRIVATE RD MOTOR o aorrom 15❑ NDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE 16 UNIT 02 VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES 1/ NO D:9208438154 a LAST NAME YANG FIRST NAME KONG MIDDLE INITIAL 17❑ STREET ❑' 728 E COOLIDGE AVE CITY APPLETON ST WI ZIP 54915 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/ 19 DIVE STATE WI SEX M MMr C.B. 09 _ 23 _ 1988 39 WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CWW6587 TAre AZ vIN# 3KPF24AD2RE732986 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' VEH YEAR 2024 MAKE KIA MODEL FORTE STYLE 4D VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24 DAMAGE YES NO GENE MEYER YES NO REGISTERED OWNER INFO EAN HOLDINGS 4100 W GALVESTON ST#1 CHANDLERAZ85226 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE INSU&PORGY#E CO STATE FARM 0521177SFP49IN IGQ'E""LE ❑ ,J� CITATION# CHARGE LEGALLY YES N`L J 25 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. EF19928 COLLISION REPORT III III III III III 111 1591972 CASE# 24-9980 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) CAMPBELL PONGA K (I.P.ST FIRST, ADDRESS&PHONE# 5625 NE 2ND CT RENTON WA 98059 5038602834 SEXi F MMDDYyry 09 - 23 - 1984 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑✓ [ 1 POS. 3 2 4 1 USE CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) YANG MAI L ADDRESS&PHONE# DOB 728 E COOLIDGE AVE APPLETON WI 54915 SEX F MMDDYVYY 09 _ 21 _ 1993 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1 NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.E.MMDD -F YYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Unit 2 westbound in the inside (#2) lane of NE 4th St, 4800 block. Unit 1 pulling out of driveway on north side of NE 4th St, turning left onto eastbound NE 4th St. Unit 1 collided with unit 2, left front corner to right rear wheel and quarter panel. Driver 1 Eli Campbell told me that it was his fault, as he hadn't checked far enough down the street for oncoming traffic. Eli cited for Failure to Yield Right of Way - Vehicle Entering Highway From Private Road or Driveway. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 09-23-24 03:48 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 888 1 9/30/2024 11:55:29 AM BADGE OR ID# ! 5738 OR]# WA0171300 TIME POLICE DISPATCHED 2:28 PM TIME POLICE ARRIVED 2:38 PM PART I PAGE IT]OF 3� REPORT NO.! EF19928 CASE# ' 24-9980 DATE AND TIME 09/23/24 14:22 OF COLLISION i z PAGE 3 OF 3