HomeMy WebLinkAbout25-2660 )STATE
TFcN 0 5 27i 1
Oc� RA EF79342
COLLISION REPRT 1591971
INTERSTATE CITY STREET FIRE ❑
CASE# 25-2660 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOL`CO A`DENC'Y 4200 3
COUNTY RD INVOLVED
CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 03 - 24 - 2025 1525 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
MAPLE VALLEY HIGHWAY MILE POST
e 2400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 500 00-1 MILES N E
FEET e✓ S 8 W e SE 5TH ST
2 0 29
MOTtlR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES NO ✓ O 1 30
5 LAST NAME BAKOLES FIRST NAME JAMES MIDDLE A 1 1 2 31
INITIAL
STREET 19401 63RD AVE NE CITY ARLINGTON ST WA ZIP 982237843 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 3
INTERLOCKYEs No�/ INTERLOCKYEs NO�/ YES NoF,/
8 DRIVER'S
STATE WA SEX M MMDO OCSYY' 08 — 21 — 1981 ' 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET CLASS 1 NATURE of INJURIES 2
10 LI ENSE ti� BJY9978 STATE WA VN# 5NPE34AF9JH640364 3
TRAILER STATE TRAILER ,STATE
11 4 0 PLATE# PLATE# ROM TO
TRLR TRLR 3 7 33
12 4 Q VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE
13 4 201$ HYUN SONATA DAMAGE YES DNO ✓ YEs_ No 3 7 34
REGISTERED OWNER INFO JAMES BAKOLES 1940163RD AVE NE ARLINGTON WA 98223 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2 3 4
14 STATE FARM 575321 tA1747
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE 5 36
Lemur YES❑NO❑ CITATION# 7 0 80TTOM
15❑ sTnNowc s 7
�II1 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:2063903761
16�
LAST NAME MCKINNEY FIRST NAME TANYA MIDDLEI C
INITIAL
STREET ❑
17 22563 SE 261 ST ST CITY MAPLE VALLEY ST, WA ZIP 98038 37
NEW AbORESS
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED. 38
INTERLOCKYES No INTERLOCK YES Na vEs No
19 DRIVER'S STATE WA SEX F I D.Os. 10 08 1970 ❑ 39
LICENSE# MMDL7YY -
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENS D68337F rarE W/a VIN# 1FTEW1E45LFB22554 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2020 MAKE FORD MODEL F150 STYLE TR VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO PATRICK MCKINNEY 22563 SE 261ST ST MAPLE VALLEY WA 98038 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO GEICO 0542186606
IN EFFECT &POLICY# 9TOP
vewae ❑ CITATION11 CHARGE 1060TTOM
A r YES N J
25 s 7 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HANSEN HSU 12651 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF79342
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2660
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS El UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
NARRATIVE
Unit 1 and Unit 2 drivers both reported collision near the 2400 block of Maple Valley Hwy. Unit 1
traveling westbound in the right lane of travel. Unit 2 traveling westbound in the left lane of travel. Unit
1 reported making lane change in front of Unit 2. Unit 1 driver reported that Unit 2 sped up causing
non reportable non disabling rear driver side damage to Unit 1 and non reportable non disabling front
passenger side damage to Unit 2. No injuries. Unit 2 driver did not initially remain on scene as she
reported that she felt unsafe as Unit 1 driver was road raging. Unit 2 driver later reports collision via
911 phone call as well. No PC for hit and run. Based on accounts from both Unit drivers. It appears
that proximate cause of collision was Unit 1's lane change.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 03-24-25 06:57 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
DAT
BRYAN GROZAV 12489 41212025 9:13:01 PM
BADGE OR ID# 12651 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 3:49 PM TIME POLICE ARRIVED 3:54 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EF79342 CASE# 25-2660 DATE AND TIME 03/24/25 15:25
OF COLLISION
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