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HomeMy WebLinkAbout25-00075 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG65742OLCERA COLLISION REPORT 1591971 INTERSTATE CITY STREET❑ FIRE ❑ CASE# 25-00075 2 RESULTED 1 ❑STATE ROUTE OTHER SVEHICLE TOLEN❑ HIT&RU ❑ LOCAL ING 3 HIT&RUN ✓ C©DING COUNTY RD �✓ PRIVATE WAY INVOLVED 2❑ TRIBAL i UNITS#OF 02 SO""TRUCK EARTH BANK OR LEDGE 1 8 28 i RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF N E IN eDL�ISION' 01 - 03 - 2026 1815 17 =.= S 8 W E OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. MAPLE VALLEY HIGHWAY 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 F--1 MILES. FEET e S 8 W e MAPLEWOOD PL SE 2 0 29 MOTOR PEDAL- DAMAG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:4252265041 0 1 30 6❑ LAST NAME FITZGERALD FIRST NAME STEVEN MIDDLE A 1 2 31 INITIAL STREET ❑ 16110 SE 156TH ST CITY; RENTON ST WA ZIP, 98058 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs ✓No INTERLOCKYEs Na✓ YES NO✓ 8 DCIEVERS NSE# STATE WA SEXI M MMDDYY' 04 - 12 - 1982 1 2 32 9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 9 N USEET ELM19 CLASSY 0 [NATURE of INJURIES 2 LICENSE, CBX6931 STATE WA y 1D4HB48N86F181524 3 10� as ATP tt IN# TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM To TRLR TRLR. 7 3 33 12 0 0 VIN#' vIN# FROM TO 13 2 VEH.YEAR2008 MAKE DODG MODEL DURAN STYLE UT VEHICLE TOYED NO�iS46LIN T�VyED.6LRS GES❑END 3 34 DAMAGE IIII._IIII AAttVVii((tt REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE RED 1 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE ElNSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP vEnic�E 5 36 Lemur YES❑NO❑ CITATION# CHARGE t a 80TTOM 15❑ STM ING 8 7 e MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE CYCLE nWNFR YES✓ NO D:2069498303 16� LAST NAME FRASER FIRST NAME REESA MIDDLE L INITIAL 17 F1 STREET ❑ ❑ 19108 130TH AVE SE CITY RENTON ST, yyq ZIP 98058 g 37 NEW ADDRESS 18❑ CDL IGNITION REQUIRED (GNITION PRESENT MEDICALTRANSPORTED'1 38 INTERLOCKYES NO✓ INTERLOCK YES NO✓ YES NO✓ 19 DRIVER'S STATE WA SEXI F I D.O.B. 04 23 1957 39 LICENSE# MMDDYY — 20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 R USEET 2 CLASSY 1 NATURE OF INJURIES 40 21 LICENSE I PLATE# BMW3625 TATE WA VIN# 2HKRW2H94JH676881 � 41 22❑ PLATE# STATE PLATE# STATE 42 23 TRLR r RLR 43 UIN#. 'IN# VEH.YEAR 2Q1$ MAKE HOND MODEL CR-V EX STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES �/ No GENE MEYERS E No✓ REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2 SHADFY DAMAGED AREA 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &.POLICY#YES vem1-1— ❑ N,J—I CITATION# CHARGEUR 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY WA0171300 26 E.EDMUNDS 12576 PART A PAGE 01 OF 1 3000-345-189(R 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG65742 COLLISION REPORT III III III III III 111 1591972 CASE# 25-00075 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) FITZGERALD STEVEN ADDRESS&PHONE# D� 16110 SE 156TH ST RENTON WA 98058 2068837719 SEXi M MMDDYYYY B. 01 - 14 - 1959 PASSENGER Z WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES �; 1 POS. 3 9 9 9 USE 9 CLASS 0 ----� :NAME <nsr EIRST,MIDDLE INITIAL) TONEY TAYLAR M ADDRESS R PHONE# 393 PARTLON ST BUCKLEY WA 98321 SEX' F D•O.B. 12 _ 14 _ 2005 MMDDYYYY SEAT HELMET INJURY NATURE OF INJURIES PASSENGER a WITNESS UNIT# 2 POS. ' 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1 ----� NAME MIDDLE INITIAL) SISKO SHERANA E (LAST,FIRST, AQQREss a PHONE# 25125 SE MIRRORMONT PL ISSAQUAH WA 98027 4256235640 SEX} F D,O.B. 11 _ 08 _ 1966 MMDDYYYY PASSENGER 0 WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE CFINJURIES POS. USE CLASS NARRATIVE Please see attached police report#26-00075 , which is hereby incorporated by reference as if fully set forth herein. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. E.EDMUNDS 01-04-26 01:56 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE M.BRAUN 2194 1/5/2026 1:04:54 AM BADGE OR ID# 12576 ORI# WA0171300 TIME POLICE DISPATCHED; 7:15 Pry/ TIME POLICE ARRIVED i 7:15 PM PAST B 3 Da-3mx-attar gt 1Mffp PAGE 2�OF 37 REPORT NO. EG65742 CASE# 25-00075 DATE AND TIME 01/03/26 19:15 OF COLLISION yr, n 4 4f. 1 J JF �3Fo � 4 a � y. 4;. PAGE 3 OF 3