HomeMy WebLinkAbout25-4891 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF98967OLCERA
COLLISION REPORT 1591971
CASE# 25-4891 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ VEHICLE ❑ LOCALANG 3
HIT&RUN CQDIN6
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3I M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s o v' 06 - 05 - 2025 1010 17 =.= S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO.
❑
MILE POST e
4a
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ C------ 1.1 FEET e S 8 W e LIND AVE SW
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4254454089 0 1 30
5 LAST NAME LE FIRST NAME JERRELL MIDDLE L 1 1 2 31
INITIAL
STREET ] 818 NORTH ST SE
'NEW ADDRESS CITY I OLYMP/A ST WA ZIP, 98$013$27 2
7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO�/ INTERLOCKY Nb,/ YES F NO F✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 12 - 19 - 1996 1 2 32
9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 1 N USEET INJUR
CLASSY',1 NATURE of INJURES 2
LICENSE, CFF6586 STATE WA VIN#; 1HGCM665X7A102323 3
10 Fl I PI ATP rt
TRAILER STATE TRAILER STATE ROM To 11 3 5 PLATE# PLATE#
TRLR zRLR 1 3 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2007 MAKE yOND MODEL ACCOR STYLE 4D VEHICLE TOWED[n TO ZBLIN TOWED BY GOVT VEHICLE g 1 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO TRUNG LE 318 NORTH STSE TUMWATERWA98501 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 3 4
2 LIABILITY INSURANCE INSURANCE CO
14 Z PROGRESSIVE 994641406
IN EFFECT &POLICY#
VEHICLE OUR,
CHARGE 5
Lemur yes[:]NO[:] CITATION# 36
7 0
15❑ sTnNowc 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNRR vEs�/ No D:2069310710 N:4259811037
16�
LAST NAME NIETO-CARRILLO FIRST NAME VICTOR MIDDLE I N
INITIAL
17
STREET ❑ 37
NEW ADORE SS❑ 27902 PACIFIC HWY S APT 226 CITY FEDERAL WAY ST, WA ZIP 980032902 4
18❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 38
CDL INTERLOCKYEs No INTERLOCKvEs No ves No
FcDL
19 DRIVERS
MMDDYY -
HELMET INJURY: URE OF INJURIES 40
20❑ ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 1 USE CLASS 1 NAT ❑
LICENSE FT-1-1
vIN# 1 GTBUWEY3SF308562 41
21 PATE#
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR r RLR 43
UIN#. 'IN#
VEH.YEAR 2Q25 MAKE GMC MODEL SIERRA STYLE pi( VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES �/ No GENE MEYERS TOWING
REGISTERED OWNER INFO CADILLAC BROTHERTON 205 SW 12TH ST RENTONWA 98057 D:4259811000 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO FEDERATED MUTUAL INSURANCE COMPANY 9185688
IN EFFECT &POLICY# t 9TOP
VeEHIC
ILe ,J—I CITATION# CHARGE 7060TTOM
LEn��Y YES❑ N`[
25 s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
JESSE VANDERHOEK 11631 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF98967
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4891
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 GLASS 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
Vehicel #1 was traveling southbound on Lind Ave SW, approaching SW Grady Way. Vehicle #2 was
in the outside lane traveling northbound on Lind Ave SW, approaching SW Grady Way. The driver of
vehicle #1 advised me he used the left turn lane to turn left onto SW Grady Way. The driver of
vehicle #1 told me that the left turn arrow was flashing yellow when he attempted to turn left. The
front left corner of vehicle #1 collided with the back left side of vehicle #2. The driver of vehicle #2
provided me with the same story, and added that the signal for northbound traffic was green when he
proceeded through the interesction. Based on the totalitiy of the circumstances, it appeared the
actions of vehicle #2 were the proximate cause of this collision.
RTF
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JESSE VANDERHOEK 06-05-25 01:26 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 6/9/2025 7:54:58 AM
BADGE OR ID# j 11631 ORI# WA0171300 TIME POLICE DISPATCHED 10:11 AM TIME POLICE ARRIVED i 10:11 AM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. E F98967 CASE# 25-4891 DATE AND TIME 06/05/25 10:10
OF COLLISION
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