HomeMy WebLinkAbout25-6398 j TFCII IIIII III IIIII II IIII IIIII I . 27I 5
OOLICERAF EG144
COLLISION REPRT 1591971
CASE# 25-6398 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL A`NG 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TRIBAL UNITS#OF 04 TRUCK EARTH BANK OR LEDGE 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coLLISION' 07 - 25 - 2025 1523 17 =.= S 8 W e IN OF 8 1070 a
4� ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
BRONSONPLNE BLOCK ST e 500 .�
4a 3❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET e S B W
1 9 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHON
UNIT 01 E
VEHICLE ❑ CYCLE ❑ YES An No D:3478283505 1 4 30
g LAST NAME KUMAR FIRST NAME JATINDER MIDDLE t 0 1 31
INITIAL
STREET ❑ 9748 201 ST STREET CT E CITY GRAHAM ST WA ZIP 983386589 2
NEW ADDRESS
7 CDL : IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCK YES No�/ INTERLOCKYE! Nd�/ YES NoF,/
8 LICIENSE#RVER' STATE WA SEX M MMDO DrYY' 08 32
9 ON DUTY STATUS AIRBAG 1 RESTR 4 EJECT 1 HELMET USE CLASS 2 INJURY 7 NAruRE of INJURIES 2
COMPLAINT ARM PAIN
10 LI ENSE! D95866G STATE WA VrN# 516M1D9B6CH214128 3
TRAILER STATE TRAILER ,STATE
11 2 5 PLATE# PLATE# ROM To
rRLR TRLR 1 5 33
12 0 Q VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 v GOVT VEHICLE m 34
13 2 2012 AUTO SWEEP SS DAMAGE YES ONO � �MEYER YEs No
REGISTERED OWNER INFO LLC OLSON BROTHERS PRO-VAC 10314TH AVE N KENT WA 98032 D:8885655665 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE� INSURANCE CO ZURICH BAP9702723-02
IN EFFECT &POLICY# �__TO_P_
VEHICLE CHARGE ❑ 36
ecnur YES❑NO❑ CITATION# BOTTOM
15❑ owc
UNIT OZ MOTOR PEDAL ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
VEHICLE CYCLE. nWNFR YES NO
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE'
INITIAL
17❑ STREET ❑ CITY KENT ST ZIP ❑ 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT NEDICALTRANSPORTED: 38
INTERLOCKYEs No INTERLOCK YES 0-001 XEs No
19 LICIENSE# STATE SEX U MMDDYY -� ❑ 39
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG g RESTR g EJECT 1 USE 9 CLASS 0 ❑
21 LICENSLATE E BYM4575 TATE WA VIN# 1GNSKBKCOFR616699 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2015 MAKE CHEV MODEL TAHOE STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO BILLY GALLOWAY 561 BRONSON PL NE RENTON WA 98056 D:2064277748 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO ALLSTATE 807308501
IN EFFECT &POLICY# t 9TOP
V IAI e ❑ ,J—I CITATION# CHARGE tO BOTTOM
LecALLY YES N`[_
25 s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
K.LANE 10008 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG14453
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6398
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. — [----------�
MMDDYYYY
PASSENGER WITNESS 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, a commercial street sweeper, was traveling northbound in the 500 blk of Bronson PL NE. This
area is a large hill with a steep grade and Unit 1 was traveling up-hill. Driver 1 states that he came to
a stop with the engine running, but that the vehicle began to roll downhill uncontrollably as the brakes
were seemingly ineffective. Unit 1 backed uncontrolled across the roadway (east to west) and struck
Unit 2 which was parked unoccupied in the driveway of 561 Bronson PL NE which is on the west side
of the roadway. Unit 2 sustained damage to the rear driver's side corner of the vehicle. Unit 1
continued backwards striking Unit 3 which was a "lending library" small mailbox style structure as well
as the fence line between 561 and 557 Bronson PL NE. As Unit 1 continued back, it went into the
yard of 561 Bronson PL NE (Unit 4) which had a large earth ledge, rockery and was at a lower
elevation than the roadway. Unit 1 rolled backwards and now down this further steep drop into the
yard of 561 Bronson PL NE striking a unbuilt box with contents for a shed inside. Unit 1 came to rest
on a large tree with heavy damage to the cab and sweeper container of the vehicle.
Driver 1 stated he was relatively uninjured with only arm pain.
Unit 1 sustained a large level of damage with the cab crushed inward on the passenger side and the
rear sweeper apparatus damaged.
Unit 1 towed by Bankers tow.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: UNCONTROLLED BACKING
**** END OF AUTO-POPULATED SECTION ****
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 07-26-25 02:45 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 7/30/2025 12:07:18 PM
BADGE OR ID# 10008 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 3:25 PM TIME POLICE ARRIVED 3:30 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 47
SUPPLEMENTAL REPORT No. EG14453POLICE TRAFFIC
1 27
... °`f COLLISION REPORT CASE# 25-6398
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE ✓
UNIT# 1 USDOT 1 1011468 ICC# VEHICLE TYPE 2 1 CARGO BODY 9
TYPE
2 ❑ 1 28
CARRIER NAME. OLSON BROTHERS PRO-VAC ILL
3 CARRIER L
ADDRESS 1031 4TH AVE N
CITY KENT ST WA ZIP 98032
4 NAME # PLACARD -�
NAME IF NO NUMBER
SOURCE' 3 AXLES 02 lWVR 1000 +
4a F] ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
}j� PEDESTRIAN ✓ D:2064277748
5 UNIT vT 3 VEHICLE CI CYCLE '. C) C� OWNER '�✓ YES NO
MIDDLE 29
LAST NAME RIVISTO FIRST NAME GINA INITIAL
STREET 30
NFW ADDRF. 561 BRONSON PL NE CITY PI I RENTON ST WA ZIP 980563666
6 [2 E]I PRESENT MEDICALT#NSPORTED: 1 31
CDL IGM710N REQUIRED IGNi710N
INTERLOCK YES. NO INTERLOCK YES NO YES N
G
DRIVER'S STATE I SEX F MDDDYB1 01 - O6 - 1981
❑ LICENSE 1
7
ON DUTY STATUS: AIRBAG RESTR. EJECT HELMET I INJURY NATUREOFINJURIES
USE CLASS
8 ❑ #LICENSE vtN 1 32
PLATE# rAr
9 TRAILER TRAILER 2
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWE E T ABLIN TOWED BY GOVT.VFHICI F FROM TO
DAMAGE YES NO YES NO
m 33
REGISTERED OWNER INFO.� SHADE IN DAMAGED AREA
12
LIABILITY INSURANCE❑ INSURANCE CO 4 FROM TO
TO
IN EFFECT &POLICY# 34
13 YES NO CITATION# CHARGE
10 8C)1`l OM
ecauv
sTANoiNc 4 MOTOR ❑ PEDAL- ❑ PROPERTY T.. L ..
DAMAGE THRESHOLD MET PHONE ❑ 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES✓ NO D:4086370122
36
L
15 ❑ SEREESATHIEN SIRIWAN MIDDLE ❑AST NAME FIRST NAME INITIAL
16 ❑ STREET ❑ 557 BRONSON PL NE CITY RENTON ST WA ZIP 98056
NFW ADDRESS"
GDL IGNITION REQUIRED 10NI71ON PRESENT MEDICAL TANSPORTED
17 INTERLOCK YES NO INTERLOCK YES NO 1YES NO
DRIVER'S STATE SEX F D.O.B 37
18 LICENSE MMDDY 12 - 24 - 1997
HELMET INJURY NATURE OF INJURIES ❑ 38
ON DUTY❑ STATUS AIRBAG RESTR. EJECT USE CLASS
19 ❑ LICENSE rAT vIN ❑ 39
PLATE# #
20 ❑ TRAILER TRAILER ❑ 40
PLATE#< STATE PLATE# STATE
21 ❑ TRLR TRLR 41
UIN# VIN#
42
22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43
2 3 4
LIABILITY INSURANCE[—] INSURANCE CO
IN EFFECT &POLICY# t.K-99
5 44
vFHic�F ❑ ❑ CITATION# CHARGE 24 IEGALLY VES NOSTIWDING3 3 6
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 07-26-25 02:45 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 OR ID# 10008 O#RI WA0171300 APJACOBS 7133012025
PAGE�OF
3000-345-013(R 11l18)
REPORT NO. EG 14453 CASE# 25-6398 DATE AND TIME 07/25/25 15:23
OF COLLISION
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