HomeMy WebLinkAbout25-2778 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 25-2778 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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# ❑
cawsloN 03 - 1-- 2025 2034 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 43RD ST BLOCK NO. e✓ 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET MILES e S ❑ W e DAMS AVE S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2065780496 0 7 30
6� LAST NAME ULSHAFER FIRSTNAME HUNTER MIDDLE D 1 1 2 31
INITIAL
STREET ❑, 19651 105TH AVE SE CITY RENTON ST WA 2jp, 980557363 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� CLU9025 sTArI WAvIN# 3KPF24AD7PE539083
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 3 2023 KIA FORTE SD DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO LISA ULSHAFER 19651105THAVE SE RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 531.8226-A13.47B 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY
Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:2066601749
LAST NAME CHATRATH FIRST NAME HERMAN MIDDLE N
INITIAL
17❑ STREET ❑', 18432 135TH PL SE CITY' RENTON ST WA ZIP 980588033 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYEs❑No� INTERLOCK ves No� YEs NDF
19 LDICENSEIVERI # STATE WA SEX M I D.MMDDW O6 _ 07 2002 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CPA3269 TAre WA vIN# JHMFA362X8S004105
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2008 MAKE HOND MODEL CIVIC STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ANMOLCHATRATH18432135THPLSERENTONWA98058 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY INSURANCE INSU&PORGY#E CO NATIONAL GENERAL 2023854857 1GQ,
IN EFFECTVEHICLE CITATION# CHARGE25❑
LEGALLY YES[Z N(�
J
s a
7Q"u,'
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
TIBEAU 07691 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF78296
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2778
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'
Narrative
The following occurred in the City of Renton, County of King, State of Washington.
On 03/27/2025 at about 2042 hours I was dispatched to a non-injury collision near S 43rd St and
Talbot RD S.
Upon arrival I contacted the driver and sole occupant of V-1, who identified himself as Hunter
Ulshafer with his WADL. Ulshafer stated that he was east bound in the #2 lane of S 43rd St and tried
changing lanes into lane #1. As he was doing this the vehicle behind him also changed lanes into
lane 1. Ulshafer was concerned about not striking that vehicle and ran into the back of V-2. The
driver and sole occupant of V-2 identified himself as Herman Chatrath with his WADL. He stated that
he was stopped on east bound S 43rd St in lane #2 for traffic, when his vehicle was struck from the
rear by V-1.
This incident was captured on my Axon body worn video camera. This report is a summary of events
that occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
Nothing further at this time.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Sgt. Q. Tibeau #07691 03/27/25 2144 hours, Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
QUINT TIBEAU 03-27-25 10:01 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
QUINT TIBEAU 07691 313012025 11:57:58 PM
BADGE OR ID# ( 07691 OR]# WA0171300 TIME POLICE DISPATCHED! 8:42 Pry] TIME POLICE ARRIVED;9:06 PM
FART I PAGE IT]OF 3�
REPORT NO. EF78296 CASE# 25-2778 DATE AND TIME 03/27/25 20:34
OF COLLISION
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