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HomeMy WebLinkAbout25-6889 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG25414oc� RA COLLISION REPORT 1591971 INTERSTATE CITY STREET FIRE I CASE# 25-6889 2 RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 s 28 TRIBAL UNITS 02 STRUCK RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eaCL s o v' 08 - 07 - 2025 2204 17 =.= S 8 W e OF IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SUNSET BLVD N BLOCK NO. e 100 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 1.� FEET e S 8 W e BRONSONWAYN 0 4 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2066962951 0 4 30 5 LAST NAME MEZGEBO FIRST NAME GENET MIDDLE G 1 1 2 31 INITIAL STREET ] 450 BREMERTON AV NE UNIT G CITY; RENTON ST I WA ZIP; 98059 2 NEW ADDRESS 7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSP©RTED 3 INTERLOCKYEs No✓ INTERLOCKYEe N©✓ YEs No✓ 8 DRIVER' # STATE WA SEXI F MMDDYY' 01 — 01 — 1992 1 2 32 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR CLASSY 14 NATURE of INJURIES 2 LICENSE, CTB9718 STATE WA VIN#; JMIBL1UG2B1490595 3 10 Fl I as ATP rt TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# FROM To TRLR TRLR 7 1 1 33 12 3 0 VIN#' vIN# FROM TO VERYEAR 2011 MAKE MAID MODEL 3 STYLE V Y EHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 1 13� DAMAGE YES II_II NO ✓ YESII_] N 34O REGISTERED OWNER INFO GENET MEZG..4WEIREMERTON AVE NE UNIT G RENTON WA 98059 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE El NSURANCE CO NONE 3 4 IN EFFECT &POLICY# Q�Q ICE ❑ ❑ 5A0663861 CHARGE OP MOT VEH W/OUT INSURANCE 36 YES NO CITATION# 15 MOTCSR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE CYCLE nWNFR D:4253628073 16� LAST NAME KATZ FIRST NAME SOPHIA MIDDLE' L INITIAL 17 F1 STREET ❑❑ 13838 SE 86TH ST CITY NEWCASTLE ST, WA ZIP 980593432 37 NEW ADDRESS 18 —1CDL IGNITION REf�UIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCKYEs NO✓ INTERLOCK YES NO✓ YES NO✓ 19 DRIVERS ' MMDDYY — HELMET INJURY: NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICENSE CGG4455 TATE WA VIN# 7SAYGDEE2PF662333 41 22❑ PLAILER TE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2023 MAKE TESL MODEL MODEL Y STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO✓ VES NO✓ REGISTERED OWNER INFO SARA KATZ 13838 SE 86TH ST NEWCASTLE WA 98059 VEHICLE NO.2 SHADFY DAGEAREA LIABILITY INSURANCE[Z INSURANCE CO PEMCO CA0613821 IN EFFECT &POLICY# 9TOP veHICLE ❑ ,o CITATION11 CHARGE t080TTOM LEGALLY YES N 25 a e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HANSEN HSU 12651 WA0171300 PAGE 01 OF PART A 3000-348-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG25414 COLLISION REPORT III III III III III 111 1591972 CASE# 25-6889 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) MOSA MARITA ADDRESS&PHONE# 450 BREMERTON AVE NE UNIT G RENTON WA 98059 SEXi F MMDooYBYYY 01 IT 28 - 2012 PASSENGER Z WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES Q 1 PAS. 3 2 4 1 USE CLASS 1 ----� :NAME (LAST EIRST,MIDDLE INITIAL) { KATZ BARRY N ADDRESS&PHONE# D�B 13838 SE 86TH ST NEWCASTLE WA 980593432 SEX'' M MMDavvvr 04 _ 06 _ 1978 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER a WITNESS UNIT# 2 POS. 3 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1 ----� NAME MIDDLE INITIAL) KATZ SARA M (LAST,FIRST, ADDRESS&PHONE# 13838 SE 86TH ST NEWCASTLE WA 980593432 SEX' F D.O.R 08 _ 05 _ 1978 MMDDYYYY PASSENGER WITNESS UNIT# 2 SEAT 7 AIRBAG 2 RESTR. 4 EJECT 1 HELM NATUR ET INJURY 1 E OF INJURIES a POS. USE CLASS NARRATIVE Scene not observed. Per involved parties, collision occurred somewhere near the 100 block of Sunset Blvd N, near Bronson Way N, as both Unit 1 and Unit 2 were turning left in their respective left turn lanes. Unit 1 reportedly turned into Unit 2 causing reportable non disabling front driver side damage to Unit 1 and reportable non disabling passenger side damage, sideswipe damage, to Unit 2. No injuries reported. Unit 1 driver with no proof of insurance. Unit 1 driver cited for no insurance. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 08-08-25 12:20 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 91412025 2:40:07 PM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 10:08 PM TIME POLICE ARRIVED 10:11 PM PART B 3 Da-3mx-attar gt 1Mffp PAGE F2 --]OF F3 REPORT NO. EG25414 CASE# 25-6889 DATE AND TIME 08/07/25 22:04 OF COLLISION �f t wn. t { pH w� 4 x C gi UA �gm 1 S a u � 3 3 { ` w. i h e tt v PAGE 3 OF 3