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HomeMy WebLinkAbout25-5425 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG04042OLCERA COLLISION REPORT 1591971 CASE# 25-5425 2 INTERSTATE CITY STREET El STATE ROUTE OTHER LOCALAGENCY 4250 3 C©DING COUNTY RD PRIVATE WAY 2 TOTAL#OF OBJECT 1 2 4 28 TRIBAL UNITS 02 STRUCK RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eDCL s o v' 06 - 22 - 2025 0135 17 =.= S 8 W e OF IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SUNSET BLVD NE BLOCK ST e 1055 .= 4a❑ MILE POST DISTANCE OF(REFERENCE OR CROSS STREET) 5 1❑ 30 00 FEET e✓ S 8 W e NE 10TH PL 1 4 29 MOTOR PEDAL- DAM AG TSHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES NHREO ✓ 1 5 30 g LAST NAME NONE FIRST NAME MIDDLE 31 INITIAL STREET NEW ADDRESS CITY I NEWCASTLE ST ZIP 2 7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3 INTERLOCKYEs NO✓ INTERLOCKY NO✓ YES[:]NOW 8❑ LCEENSE# SRVERISTTATE SEX U MMDDYY' —�— 1 2 32 ON DUTY STATUS' AIRBAG 2 RESTR 9 EJECT 1 HELM USEET 9 CLASSY 1 NATURE OF INJURIES 2 9❑ LICENSE, CRJ5298 STATE WA V(N# 4JGFB4FB3RA997843 3 10 Fq I as ATE rt TRAILER STATE TRAILER STATE ROM To 11 0 0 PLATE# PLATE# TRLR TRLR 33 12 0 0 VIN#' vIN# FROM TO VEH.YEAR ZO24 MAKE MERZ MODEL GLE STYLE VEHICLE TOWED TO BUN TOWEDBY GOVT VEHICLE 0 0 34 DAMAGE YES NO ✓ YESE] NO✓ 13� REGISTERED OWNER INFO DEEPAKSATRA11714SE80THST NEWCASTLE WA980569191 D:5103742922 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 3 14❑ LIABILITY INSURANCE[%/] INSURANCE CO PROGRESS/VE 9955164232 4 IN EFFECT &POLICY# 9TOP v""' CHARGE t 5 36 LEGALLY yes❑NO❑ CITATION# t a 80TTOM 15❑ STANDING s 7 e UN# MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLDMET PHONE 1 VEHICLE CYCLE nWNFR YES NO ✓ 16F] LAST NAME UNKNOWN I FIRST NAME MIDDLE' INITIAL 17 F1 STREET ❑ CITY, NEWCASTLE ST ZIP 37 NEW ADDRESS I I I I I 1 ❑ 1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38 INTERLOCKvES No✓ (1TERLGCKYES ✓No vEs NO I✓ 19 LICENS# STATE SEX U MMDDYY I � E 39 HELMET INJURY: NATURE OF INJURIES 4Q 20❑ ON DUTY STATUS AIRBAG g RESTR g EJECT 1 USE 9 CLASS 0 ❑ 21 PLATE# UNK TATE VIN# UNK 41 LICENSE I22❑ [TILER TRAILER PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# 44 VEH.YEAR MAKE FORD MODEL UNK STYLE TR VEHICLE TOWED TO BLIN TOWED BY GOV HI 24 DAMAGE YES NO✓ VES NO✓ REGISTERED OWNER INFO UNKNOWN NEWCASTLE VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# GQ VEHICLE ❑ .I—I CITATION# CHARGE LEGALLY YES N`L] 25 a ' s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HANSEN HSU 12651 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG04042 COLLISION REPORT III III III III III 111 1591972 CASE# 25-5425 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 NJURY 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 Unit 2 backing sideswipes Unit 1 while Unit 1 was parked next to Unit 2 within the parking lot of Christy's Bar and Grill at 1055 Sunset Blvd NE. Unit 1 sustains non reportable non disabling minor scratches along the front passenger side quarter panel above the front right tire. Unknown damages to Unit 2. Unit 2 minimal information, possible a black Ford truck, unknown model or plate. Unknown driver of Unit 2. Unit 1 was legally parked unoccupied during the incident. No reported injuries or further suspect information 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. HANSEN HSU 06-23-25 12:53 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 6/25/2025 5:50:04 PM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1:39 AM TIME POLICE ARRIVED i 1:46 AM PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3 REPORT NO. EG04042 CASE# 25-5425 DATE AND TIME 06/22/2501:35 OF COLLISION �x} �Y z� nt I +r 1 t9 q t 2�r � c uli�� Yr Its-, 4 4 � „ 1x,rti r@ s ~s t PAGE 3 OF 3