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HomeMy WebLinkAbout25-7031 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG19658oc� RA COLLISION REPORT 1591971 CASE# 25-7031 2 INTERSTATE CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL CO A`NG 4250 3 COUNTY RD NVOLVED CODING PRIVATE WAY 2❑ TRIBAL UNITS#OF TOTAL TRUCK BJECT 1 28 02 UTILITY POLE RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF'. N E COLL.IsfoN'. 08 - 13 - 2025 0104 17 =.= S 8 W H IN OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑ 156TH AVE SE BLOCK NO, e 14200 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 C------�. FEET H S 8 W e SE 142ND PL 0 4 29 MOTtlR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO 30 5 LAST NAME UNKNOWN FIRST NAME MIDDLE 1 1 2 31 INITIAL STREET ❑ CITY ST ZIP' 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3 INTERLOCKYES ✓NO INTERLOCKYEs No✓ YEs NoF,/ LICIENSE# STATE SEX U MMDDYY'. —=— t 32 8❑ VERS 9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 HELM USEET 9 CLASS 0 NATURE OF INJURIES 2 10❑ LI ENSE' A8605591 STATE WA VIN# 1C4RJFBG6MC671212 3 TRAILER STATE TRAILER ,STATE 11 3 5 PLATE# PLATE# FROM TO TRLR TRLR 7 1 33 12 VIN# VIN PP:... FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 13 2 2021 JEEP GRAND P4 DAMAGE YES NO ✓ YEs❑ No✓ m 34 REGISTERED OWNER INFO JOSHUAWALlER 16945 SE 138TH ST RENTON WA 93059 D:4253628805 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4 IN EFFECT &POLICY# 9�2t LEwcLE CHARGE S ❑ 36 Ecnur YES❑NO❑ CITATION# 10 BOTTOM 15❑ STM ING 7 0 PEDAL-. ✓ R PHONE UNIT©2VME©HTIOCRLE PEDESTRIAN PROPERTY O CYCLE nWNFR 16❑ LAST NAME PSE FIRST NAME MIDDLE' INITIAL STREET ❑ 17 ' 3❑ 55 110TH AVE NE CITY BELLEVUE ST, WA ZIP 98004 g 37 NEW ADDRESS 1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38 INTERLOCKYES No jNTERLOCKYES NO YEs No 19[ DRIVER' # STATE SEY X MMD YY' 01 01 198 0 39 I INJURY' NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ 21 PLATE# TATE VIN#LICENSE 4� 41 22❑ [TILER AILER PLATE# STATE PATE# STATE ❑ 42 43 23 TRLR UIN#. ''NIN#. VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24= DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP VEHICLE ❑ ,.I—I CITATION# CHARGE tO BOTTOM ALLY YES N`LJ 25 a a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 MARIA FERNANDES 12848 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EG19658 COLLISION REPORT III III III III III 111 1591972 CASE# 25-7031 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 Vehicle 1 struck a PSE utility pole on the eastside of the intersection at 156TH AVE SE and SE 142ND PL in Renton, WA. The pole snapped at the base and landed on top of Vehicle 1. The collision caused power lines connected to the pole to drape across the intersection. The unknown driver of Vehicle 1 fled the scene and it was unknown if there were any injuries. The registered owner and PSE were notified. Vehicle 1 had damage to the front end and roof. I took photographs of the damage. 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MAR►A FERNANDES 08-13-25 02:52 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 8/16/2025 4:17:29 PM BADGE OR ID# 9Y848 ORI#' f WA0171300 TIME POLICE DISPATCHED'; 1:08 AM TIME POLICE ARRIVED 1:13 AM PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37 REPORT NO. EG19658 CASE# 25-7031 DATE AND TIME 08/13/25 01:04 OF COLLISION C, ' ql v, +i st` s til(4��lr I ` r Y. t i i I I ti V;ll i y d , II I. t } i � t�t ' t I PAGE 3 OF 3