HomeMy WebLinkAbout25-723 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF67109OLCERA
COLLISION REPORT 1591971
❑ 0✓ RESULTED I
CASE 25-723 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LQCAI-A`NG 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 2
3n M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s o v' 01 - 23 - 2025 0840 17 =.[� S 8 W e IN
OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION �✓
GRANT AVE S BLOCK NO. e 1800 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 3001.1 00 FEET e✓ S 8✓ E e S 18TH ST
0 1 29
MOTOR ✓ PEDAL- F DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YES ✓NO 1 4 30
6 LAST NAME GAUGER FIRST NAME ANN MIDDLE K 1 1 2 31
INITIAL
STREET Q 7997 SAWGRASS WAY CITY; BLAINE ST WA ZIP; 982306813 2
NEW ADDRESS
7 +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYES ND INTERLOCKVEs NO YES NO
8 DRIVERS# STATE WA SEX I F MMD4YY' 02 - 16 - 1953 t 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET 2 CLASSY 1 NATURE of INJURIES 2
LICENSE, CBG4700 STATE WA VIN# JNIBJIAW4MW661759 3
10 F1 PI ATP tt
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM To
TRLR zRLR 5 1 33
12 0 0 VIN#' VIN#
FROM TO
13 4 VEH.YEAR2021 MAKE NISS MODEL ROGUE STYLE UT VEHICLE TOYED NO�iS46LIN T�VyED.6LRS �ESEENp m 34
DAMAGE IIII._IIII HHttVVii((tt I_I
REGISTERED OWNER INFO pq TRICK ACHEY 1411 GRANTAVESAPT D203 RENTON WA 98055 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE[,/] INSURANCE CO USAA 1698508
IN EFFECT &POLICY# 9TOP
vEn ' CHARGE t 5 36
IALLr yes❑NO❑ CITATION# 70 80TTOM
15❑ STMDwc s 7 6
UN# MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
1 T 02 VEHT,O,E CYCLE nWNFR
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE'
INITIAL
17❑ STREET I-I 37
'iJ CITY' /SSAQUAH ST ZIP
NEW ADDRESS
18❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED'. 38
CDL INTERLOCKYEs ND INTERLOCK YEs Nd YES NO
19 LICENS# STATE SEX U MMD[SYY I � E 39
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 USE 9 CLASS 0 ❑
21 LICENSE I PLATE# CMT2372 rare WA vIN# USE
41
42
22❑ TRAILER NO LICENSE STATE WA TRAILER STATE
PLATE# PLATE#
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 199$ MAKE pJJ55 MODEL pATHFIN STYLE UT VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24� DAMAGE YES NO� VES NO
REGISTERED OWNER INFO JOSEPH HUNTER 24435 SE MIRRORMONT BLVD ISSAQUAH WA 98027 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO UNKNOWN
IN EFFECT &POLICY# 9TOP
vemaE ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGnEEY YES N
25 a s
7OFFIS NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
OBS 1953 WA0171300
PART A PAGE 01 OF
3000-348-189(R 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF67109
COLLISION REPORT III III III III III 111
1591972 CASE# 25-723
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES
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
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 02-19-25 09:38 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE-
C.JACOBS 1953 211912025 9:44:03 AM
BADGE OR ID# j 1953 ORI# WA0171300 TIME POLICE DISPATCHED 8:46 AM TIME POLICE ARRIVED i 8:55 AM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4F
REPORT NO. EF67109 CASE# 25-723 O OF COLLI 510N TIME 01/23/25 08:40
COLLISION
NARRATIVE
On 1-23-25 at about 0856 1 arrived in the 1600 block Of Grant Ave S for a 2-vehicle collision. I
contacted the RP, identified via WADL as Ann Gauger in her vehicle on the side of the road. Gauger
had told the call receiver that she had hit a parked vehicle, and her vehicle was not drivable. There
was not other vehicle at the location where we made contact. I asked Gauger where the other
vehicle was? She told me; it was about 2 blocks south of our location. She was not sure what type of
vehicle she collided with. I asked Gauger what had happened to cause the collision. She believed
she was lost in thought and wasn't paying attention at the time of the collision.
I recalled passing a vehicle with a trailer that was not sitting right so, I drove back to find the vehicle.
I located the other vehicle in the 1800 block of Grant Ave S. I contacted a Nissan Pathfinder, WA
plate CMT2372 with an unlicensed flatbed trailer attached. The trailer had damage to the left side
wheel well and there was debris next to the vehicle that was consistent with unit 1. There was a utility
box that seem to have been knocked from the trailer due to the impact of the collision. The pathfinder
returned to Joseph Hnter out of Issaquah. I left an exchange of information on the windshield of unit
2 and provided driver 1 with a copy prior to releasing her.
Gauger suffers from heart problems and mental illness. She agreed that she probably should not be
driving. I am putting her in for a drivers re-evaluation.
This incident occurred in the city of Renton, County of King.
I declare under penalty of perjury under Washington state law that the foregoing is true and correct.
C. Jacobs/1953
PAGE 3 OF 4
REPORT NO. E F67109 CASE# 25-723 DATE AND TIME 01/23/25 08:40
OF COLLISION
Am
a ..
PAGE 4 OF 4