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HomeMy WebLinkAbout24-12165 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 CASE 24-12165 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4250 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 8 2$ 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# cowsloN 11 - 1-- 2024 1611 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BENSON DR S BLOCK NO. e✓ 17300 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e BENSON RD S 0 1 29 UNIT MOTOR Z PEDAL ElD DYESAMAGE NHORESHOLD MET PHONE 0 9 30 01 6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31 INITIAL STREET ❑ CITY ST ZIP 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYE3 NO INTERLOCK YES NO YES No 8❑ LIRCIENSRE# STATE I SEX u MMDDYY '❑- 1 1 2 32 9 ON DUTY❑ STATUS I AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑ 3 LICENSE sTATI vrN#' 10❑ PI ATE 14 TRAILER STATE TRAILER STATE 11 4 0 PLATE# PLATE# ROM ro TRLR. TRLR 4 8 33 12 4 0 vIN#' VIN# FROM TO ❑ VEH.YEAR MAKE MODEL STYLE 4D VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE J 9 34 13 3 DAMAGE YES NO YES❑ NO REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 ABILI INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICV# 9TOP VEHICLE CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM 15❑ STANDING 7 6 UNIT 02 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE VEHICLE ❑ ❑CYCLE ❑ : OWNER ❑ YES 1/ NO D:9097200676 16 a LAST NAME WALLING FIRST NAME ERIN MIDDLE E INITIAL 17 STREET I3❑' 1129 SW PENDLETON WAY CITY PORT ORCHARD ST WA ZIP 98367 37 NEW ADDREs 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED ❑ 38 INTERLOCK YES❑No� INTERLOCK YES It1 I NoF t l YES NO 19[—] D IVEW # I {NJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ ❑21❑ PLA E# 1A775GY TATe 41 ID vIN# 1C4RJFCG6FC692367 4 42 22 [TRAILER TILER ❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. TOWED BY Gov HI 44 VEH YEAR 2015 MAKE JEEP MODEL GRAND STYLE UT —FEHICLE TOWED NOO✓ BLIN yES NO 24❑ fj REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO GEIC04202290088IN I GD VE""LE CITATION# CHARGE LEGALLY YES Nu 25❑ s e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 R.ON/SHl 5738 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF39186 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12165 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 standing facing northwest on Benson Dr S in the number 1 lane, unit 1 driving northwest behind unit 2. Driver 2 Walling told me that she had stopped at the Benson Dr S/Benson Rd S intersection to make a U-Turn to face southbound. Unit 1 struck her car from behind, then fled northwest on Benson Dr S. Walling was only able to describe unit 1 as a white 4-door sedan, unknown further. Checked traffic camera at Talbot Rd S/S Puget Dr, without success. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 11-24-24 06:42 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE D.SKELTON 9139 1 1112512024 3:46:23 AM BADGE OR ID# 5738 OR]# ! WA0171300 TIME POLICE DISPATCHED; 5:21 PM TIME POLICE ARRIVED',5:35 PM PART I PAGE IT]OF 3� REPORT NO. EF39186 CASE# ' 24-12165 DATE AND TIME 11/24/24 16:11 OF COLLISION s Z 1 t T,f �r 4 l S � e � A { z �l v �w l PAGE 3 OF 3