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HomeMy WebLinkAbout24-12014 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c COLLISION REP FIT 1591971 CASE 24-12014 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 OZ 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 0856 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ LIND AVE SW BLOCK NO. e✓ 2700 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e SW 27TH ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:5035765613 0 11 30 6� LAST NAME SIMMERMAKER FIRSTNAME AUSTIN MIDDLE A 1 1 2 31 INITIAL STREET ❑✓ 17731 SE RIVER RD CITY PORTLAND ST OR 2jp, 97269 z NEW ADDRESS ]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/ ❑ DRIVER'S' STATE OR SEX'M MOB 08 - 16 1- 1994 1 2 32 8 LICENSE# 9 ON DUTY D. ❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM USEET I ICNLJAURY 1 NATURE OF INJURIES 2❑ 3 10 1❑ PI ATE 14 6746YY sTAT OR V N#' 1 FAHP34N55W310211 5 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR 2005 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34 13 4 FORD FOCUS 4D DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO JOHN CARSON 3460 NW FOREST LN PORTLAND OR 97229 VEHICLE NO. 1 ❑ ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO STATE FARM 126 5393-D21.37C 3 4 IN EFFECT &POLICY# Q Pve'CLe CHARGE 36 LEGALLY re8 No clTAnoN# 4A0793362 FAIL TO OBEY TRAFFIC CONTROLrom15❑ G 6 MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES 1/ NO D:2069154850 16 a LAST NAME ROBASSE FIRST NAME ADRIENNE MIDDLE D INITIAL 17❑ STREET ❑', 2043 SE 8TH PL CITY' RENTON ST WA ZIP 98055 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38 INTERLOCK YES❑NO INTERLOCK yEEsI I I NOF YEs t l NO� 19� DRIVER # STATE INA ]SEX IF M.C... O6 _ 11 1951 El 39 WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE ARP1502 TATe WA vIN# 4S4BP61C677306732 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' TOWED BY GOV HI 44 VEH YEAR 2007 MAKE $UBA MODEL LEGACY STYLE $W DAMAGE TOWED TOO✓ BLIN YES NO 1/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE &POINSURGY#E CO AARP 55PHJ934245IN STOP 5 'E""LE ❑ ,J� CITATION# CHARGE io BOTTOM LEGALLY YES N`L J 25 ' e 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. EF38802 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12014 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) STEVENS DELANEYG (LAST FIRST, ADDRESS&PHONE# 14061 SE AL TA VISTA DR HAPPY VALLEY OR 97086 3105629776 SEXi F MMDDYyry 01 - 25 - 1991 PASSENGER I�I WITNESS UNIT# ! 1 SQL 3 AIRBAG 2 RESTR. 4 EJECT ? HELIVIET INJURY NATURE of INJURIES L�!1 USE CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# DOB SEX MMDDYVYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B. MMDDYYYY. - PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Unit 2 s/b Lind Ave SW in curb lane. Unit 1 e/b SW 27th St in second lane, approaching Lind Ave SW. At intersection, unit 2 entered intersection on a green light. Unit 1 entered intersection on a fresh red, and unit 2 struck unit 1 at rear passenger door. Driver 1 Simmermaker told me that he was following a large semitruck, and was unable to see the traffic signal until he entered the intersection. Cited Simmermaker for failing to obey traffic signal. 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 04:16 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 1112312024 9:52:40 AM BADGE OR ID# 5738 ORI#' WA0171300 TIME POLICE DISPATCHED 9:00 AM TIME POLICE ARRIVED',9:11 AM PART I PAGE IT]OF REPORT NO. EF38802 CASE# ' 24-12014 DATE AND TIME 11/20/24 08:56 OF COLLISION 3 s s } Y r t S i d t n t v } �t 1 yy � t { PAGE 3 OF 3