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HomeMy WebLinkAbout24-12004 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-12004 z 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 03 STRUCK RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION.. 11 - 1-- 2024 0525 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ N 3RD ST BLOCK NO. e✓ 2000 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 200 00 FMILES EET ❑ S ❑ W e BLA/NEAVENE 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:2539938409 0 9 30 6� LAST NAME NDOUR FIRSTNAME MARIAMA MIDDLE 1 2 31 INITIAL STREET ❑✓ 439 TACOMA AVE NE CITY RENTON ST WA ZIP 98056 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/ 8 LRIIVER # ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 H USE CLASS ICNLJAURY 1 NATURE OF INJURIES z❑ 3❑LICENSE CFE1605 STATE WA uN# KL8CB6SAXHC791639 10 8❑ Pr ATF� 11[-j- TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# IR.. ro TRLR. TRLR 2 6 33 12 3 5 VIN#j VIN# :: FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE J 9 34 13 2 2017 CHEV SPARK 2H DAMAGE vEs 0NO agW�MEYER vEs❑ No REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO DIRECT AUTO INS 2024097219 4 IN EFFECT &POLICY# TOPVEHCLE CHARGE 36 LEGALLYYES NO CITATION# 4A0793361 FOLLOW VEHICLE TOO CLOSELY <1�3 orrow 15❑ STANDING 7 6 VEHICLE MOTOR PEDAL-: PROPERTY DAM THR OLD MET PHONE UNIT 02 CYCLE OWNER YES NO❑✓ ❑ PEDESTRIAN ❑ ❑ �/ D:3168412161 16 a LAST NAME NGUYEN FIRST NAME CHANH MIDDLE V INITIAL 17❑ STREET ❑', 7244 NOBLE CITY' GRAND PRAIRIE ST TX ZIP 75054 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38 INTERLOCK YES❑NO� INTERLOCK vEs❑NOF YES ❑NOF,/ 19 DRIVER'S STATE I TX SEX M I D.Q.B. 08 _ 10 _ 1957 39 LICENSE# MMDDYY WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE PTS1363 TATE TX vIN1t 2T2BK16A4AC059036 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. GoI VEH D YEAR 2010 MAKE LEXS MODEL RX 350 STYLE UT AMAGE TOWED NOO✓ BLIN TOWED By v HyES NO 1/ 44 24❑ fj REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO ALLSTATE 429337342IN I GD LEGAL 25 LY YES N� ❑ 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. EF38801 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12004 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' Due to storm damage, westbound N 3rd St was reduced from 2 lanes to 1 lane, with cones deployed blocking the left lane at the point where the lanes reduced. Road conditions were full darkness, street lights lit, wet pavement. Unit 3 was stopped in the left lane at the reduction point, waiting for right lane traffic to clear. Unit 2 was stopped in the left lane behind unit 3. Unit 1 was traveling in the left lane, but was unable to brake before striking the back of unit 2, which was pushed into the back of unit 3. Unit 1 suffered heavy front end damage, unit 2 suffered minor damage to rear bumper, unit 3 suffered no noticeable damage. Driver 1 Ndour told me that units 3 and 2 stopped in the lane in front of her unexpectedly. Ndour cited for following too closely for conditions. **** AUTO-POPULATED SECTION **** THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER": Motor Vehicle Unit 1 Traffic Control: CONES (LANE RESTRICTION) Motor Vehicle Unit 2 Traffic Control: CONES (LANE RESTRICTION) Motor Vehicle Unit 3 Traffic Control: CONES (LANE RESTRICTION) **** END OF AUTO-POPULATED SECTION **** I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 11-20-24 07:30 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 1112312024 9:52:43 AM BADGE OR ID# 5738 ORI#' WA0171300 TIME POLICE DISPATCHED 5:27 AM TIME POLICE ARRIVED 5:30 AM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. EF38801 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-12004 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO D:4259199822 rF0 9 29 LAST NAME LINDQUIST FIRST NAME DOUGLAS MIDDLE'.. J INITIAL STREET 30 NEW AnnRF.g 251 VASHON AVE SE CITY RENTON ST WA ZIP 98059 5 [2 1 1 2 31 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED INTERLOCK YEs NO zERLOCK YES❑N0� YES N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 03 - 31 - 2000 7 ON DUTY� STATUS AIRBAG' 2 RESTR. 4 EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE C113662 TAr WA VIN# 3C6LRVAG5ME584170 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR2021 MAKE DODG MODELRAM VAN STYLE CG VEHICLE TOWE E T SABLIN TOWED BY anvi vFH1C P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFOFIRE PROT COSCO4308 S 131ST PL TUKWILAWA 98168 J 9 33 SHADE IN DAMAGED AREA 12 z 3 4 FROM TO LIABILITY INSURANCE INSURANCE CO ACE AMERICAN INS ISAH10816142 grOp IN EFFECT &POLICY# 1 VEHICLE 34 13 2 ecnuv YES NO❑ CITATION# CHARGE 0 BOTTOM STANDING S 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME IDDL ❑ 35 AL STREET 16 ST An [_% CITY ST ZIP CDL IGNITION REdUiREE7 IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YES NO YES NO El 17 37 LICENSE# STATE SEX MMDDDYBYY -� II 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of 1NJURIEs 38 USE (CLASS 19 ❑ 39 LICENSE rnr VIN# PLATE# 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LEGALLv STANDING S 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 11-20-24 07:30 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 25 ORID# 5738 O#I',WA0171300 SCOTT 11123/202 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. EF38801 CASE# ' 24-12004 DATE AND TIME 11/20/24 05:25 OF COLLISION i Via.. "1 Yy h t 1} t� t } 4 i rl l PAGE 4 OF 4