HomeMy WebLinkAbout25-8942 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-8942 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 2$
6 0
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 10 - 1-- 2025 1917 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAPLE VALLEY HWY BLOCK NO. e✓ 1700 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a ON RAMP NB/405
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4255350280 30
6� LAST NAME JOHNSON FIRSTNAME JOSEPH MIDDLE 1 1 1 2 31
INITIAL
STREET ❑ 12805 W MACS LOOP RD CITY GRANITE FALLS ST WA ZIP 98252 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]No✓ INTERLOCKYEs NO✓ YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� C63216Y sTArI WAvrN# 1FDUF5GT8NED14805
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12❑ vIN#' UIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 2022 FORD F550 TR DAMAGE YES NO ✓ YES[:] No✓
REGISTERED OWNER INFO CLARKS CONCRETEPUM .11511477TH STNE LAKE STEVENS WA 98258 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO WESTERN NAT MUT INS CPP 1289328 03 3 4
IN EFFECT &POLICY# 9TOP
VEHlcl.e 5 36
LEGAL
Lv res❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDINGMOTOR 8 7 6
UNIT 02 VEHICLE ❑ CYCLE ❑ PEDESTRIAN PROPERTY❑✓ OWN A ❑ DYES✓ OL
NO D MET PHONE
16 a
LAST NAME SAUNDERS FIRST NAME NIKO MIDDLE R
INITIAL
17❑ STREET ❑' 2019 S 292ND ST CITY FEDERAL WAY ST WA ZIP 98003 37
NEW ADDRE I I I I I ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19 DR ENS STATE WA SEX M MMDDYY 10 _ 04 2002 39
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT HELMET INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS TORSO LEGS
❑21❑ LICENSE TArE VIN1 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 0 2 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
VE"LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES Nu
25 s � e
=HSU
AME(PRINT) OFFICER PHONE BADGE OR ID#
26 12851 [V7�ENCY
A0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG38080
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8942
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) RADFORD MALIA
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
4258305839 SEXi F MMDDYYYY 10 - 27 - 1959
----------------------------
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 making left turn from eastbound Maple Valley Hwy onto northbound on ramp of 1-405. 1700
block Maple Valley Hwy. Unit 2 pedestrian crossing marked cross walk on the north side of Maple
Valley Hwy, westbound, at the intersection of northbound on ramp to 1-405. Witness behind Unit 1
and Unit 1 both report that they had the green protected left turn arrow and thus the right of way. Unit
2 did not have right of way and darted into crosswalk and did not heed the do not cross sign. Unit 1
struck Unit 2 causing non reportable non disabling damage to Unit 1. No injuries reported save for
Unit 2 pedestrian who complained of minor leg and torso pain and was treated on scene by Renton
Fire. Unit 2 pedestrian was proximate cause of collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 10-15-25 10:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 10/16/2025 1:20:59 AM
BADGE OR ID# 12651 OR]#' ' WA0171300 TIME POLICE DISPATCHED 7:98 PM TIME POLICE ARRIVED 7:22 PM
PART I PAGE 2�OF❑
REPORT NO. EG38080 CASE# ' 25-8942 DATE AND TIME 10/15/25 19:17
OF COLLISION
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