HomeMy WebLinkAbout25-9546 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG45058OLCERA
COLLISION REPORT 1591971
CASE# 25-9546 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCCODIGENC'Y 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
TRIBAL UNITS 01 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 11 - 03 - 2025 1550 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE SUNSET BLVD BLOCK ST e 2000 .=
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FEET e✓ S 8 W e✓ `�BERDEEN AV NE
OF11
29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:9165493512 30
5 LAST NAME PHIPPS FIRST NAME ASHLINN MIDDLE M 1 2 31
INITIAL
STREET ❑ 18002108THAVESE CITY; RENTON ST WA ZIP; 98055 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3
INTERLOCK YES NO�/ INTERLOCKYEs NO�/ YES F NOF,/
8 DRIVER # STATE WA SEXI F MMDDYY' O6 - 27 - 2000 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR
CLASS Y',1 NATURE of INJURIES 2
LICENSE, C6770C STATE WA VIN#; NMOGE9F25L1448968 3
10 F1 PI ATP tt
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR TRLR 3 7 33
12 VIN#' VIN#
FROM TO
VEH.YEAR 2020 MAKE FORD MODEL TRANSI STYLE VN VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE m 34
13 DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO RENTON REGIONAL FIRE AUTH 18002108TH AVE SE RENTON WA 98055 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
INSURANCE 2 3 4
14 ABILITY INSURANCE CO SELF INS RENTON REGIONAL FIRE AUTHORITY
IN EFFECT &POLICY# G��
CHARGE t36
Lemur yes❑NO❑ CITATION#
15❑ STMDING I s 7 e
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT 02 PEDESTRIAN
VEHICLE CYCLE OWNER YES NO
16❑
LAST NAME FIRST NAME MIDDLE'
INITIAL
17❑ STREET ❑ CITY ST ZIP ❑ 37
NEW ADDRESS
1a❑ CDL IGNITION REQUIRED IGNITION PRESENT MED[CALTRANSPORTED: 38
INTERLOCKYEs NO INTERLOCK YES R No vEs NQ
19 LICENS# STATE SEX MMO[SYY 39
HELMET INJURY NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG RESTR EJECT USE CLASS ❑
21 PLATE# TATE VIN# 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
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
vemae ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGnEEY YES NC
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. EG45058
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9546
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) HEITMAN DYLAN S
ADDRESS&PHONE# D�
18002 108THAVE SE RENTON WA 98055 2537406377 SEXi M MMDDYYYY 02 — 17 — 2000
PASSENGER Z WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
1 POS. 3 '2 4 1 USE +CLASS
:NAME
(LAST EIFS7 MIDDLE INITIAL}
ADDRESS R PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE OF INJURIES
POS. USE CLASS ----�
:NAME
(L4ST FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. I USE CLASS
NARRATIVE
Unit 1 traveling westbound along 2000 block NE Sunset Blvd. Unit 1 struck by unknown projectile into
rear windshield causing reportable non disabling damage, partial shatter of said rear windshield. Unit
1 passenger reported hearing "thud" type noise prior to observing broken window, not a crack or
snap. Inconclusive as to what was the proximate cause of impact to Unit 1. No injuries reported.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 11-03-25 08:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.BRAUN 2194 111412025 10:56:41 PM
BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:56 PM TIME POLICE ARRIVED i 4:21 PM
PAST B 3 Da-3mx—arras(t 1Mff) PAGE 2�OF F3
REPORT NO. EG45058 CASE# 25-9546 DATE AND TIME 11/03/25 15:50
OF COLLISION
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