HomeMy WebLinkAbout25-4763 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF96741oc� RA
COLLISION REPORT 1591971
CASE# 25-4763 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCAL A`OENC'Y 4250 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TOTAL 1
TRIBAL 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 E IN
COLLISION'. 06 - 01 - 2025 1334 17 =.�� S W OF ?070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
BENSON DR S BLOCK NO. e 3400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 00 FEET e✓ S 8 W e S 172ND ST
0 1 29
MOTtlR ✓ PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES NO O 1 30
6 LAST NAME UNKNOWN FIRST NAME MIDDLE 1 1 2 31
INITIAL
STREET F-1 CITY ST ZIP' 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCKYEs Nb YEs NO
8 LCEENSE# STATE SEX U MMDDYY+ -=-VER'S MOS. 1 1 2 32
9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT ? HELM
USEET 9 CLASS 0 NATURE OF INJURIES 2
LICENSE, 3
10� PI ATF# STATE V(N
TRAILER STATE TRAILER ,STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR TRLR 1 5 33
12 4 0 VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED fn TO BUN TOWED By GOVT VEHICLE
13 2 VOLK PASSAT SD DAMAGE YES NO ✓ YES NO✓ 1 5 34
REGISTERED OWNER INFO (NEW] VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO 4
IN EFFECT &POLICY# 9TOP
ic CHARGE t 5 36
Lemur yes[:]NO[:] CITATION# HARE 7 0¢OTTOM
15❑ sTnNowc B 7 e
III MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES�/ NO D:4257616921
16�
LAST NAME PREWETT FIRST NAME SHELBY MIDDLE I A
INITIAL
STREET ❑
17 ' 12526 SE 217TH ST CITY KENT ST, WA ZIP 98031 g 37
NEW ADDRESS
18� CDL IGNITION REQUIRED IGNTION PRESENT MEDIGALTRANSPORTED' 38
INTERLOCKYEs No✓ INTERLOCK YES No✓ YEs NC ✓
19[ DRIVER'S STATE WA SEX F I D.O.B. 06 02 1986 ❑ 39
LICENSE# MMDDYY -
HELMET INJURY' NATURE OF INJURIES 4p
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ? ❑
21 LICEN� BTR8469 TATE WA VIN# 5J6RE4H48BL091005 41
PLATE 22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2011 MAKE HOND MODEL CR-V EX STYLE UT VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO USAA 0183741 34R
IN EFFECT &POLICY# t
vLe 1— YES❑ N,—J CITATION11 CHARGE
25 9,Q
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
R.ONISHI 5738 WA0171300
PART A PAGE 01 OF 11 3000-345-159(R 11/181
POLIICFETRAFFICN CORRECTION REPORT NO. EF96741
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4763
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE IN PREWETT AMBER M
(LAST,FIRST, ITIAL}
ADDRESS&PHONE# D
12526 SE 217TH ST KENT WA 98031 2068185972 SEX' F MMDDvvvv O6 - 03 - 1987
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
�' 2 POS. 3 2 4 1 USE CLASS 1 ---�
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
S ' D.O
EX .B.MMDD -F L----------�
YYYY
PASSENGER F]WITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M -T L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY rNATURE OF INJURIES
❑ Q' POS. GLASS — ----�
NARRATIVE
Unit 2 southbound in the curb lane of Benson Dr S, with another vehicle also southbound in the
second lane. Unit 1 overtook both cars at a high rate of speed, passing between them and impacting
the left front corner of unit 2 with unknown portion of the passenger side body work. Unit 1 then
turned right on SE 174th St, then into the parking lot of 10700 SE 174th St. When unit 2 followed unit
1 into the parking lot, unit 1 fled around the east side of the building and out of sight. Passenger
Amber Prewett described unit 1 as a black 2000-2010 Volkswagen Passat.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 06-01-25 03:45 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 6/1/2025 4:26:27 PM
BADGE OR ID# 5738 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 2:49 PM TIME POLICE ARRIVED 2:45 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. E F96741 CASE# 25-4763 DATE AND TIME 06/01/25 13:34
OF COLLISION
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