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HomeMy WebLinkAbout26-333 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG68601OLCERA COLLISION REPORT 1591971 ❑ 0✓ FIRERES ED I CASE# 26-333 2 INTERSTATE CITY STREET FIRE STOLENSTATE ROUTE OTHER VEHICLE LOL`CODICENC'Y 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# DATE OF N E eDLLIs[oN' 01 - 12 - 2026 1655 17 =.= S 8 W E INOF 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE 4TH ST BLOCK NO. e 3800 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 10001.1 FEET e✓ S 8 W e QUEEN AV NE 0 4 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2069404319 0 1 30 5 LAST NAME DUNHAM FIRST NAME WILLIAM MIDDLE A 1 1 2 31 INITIAL STREET ❑ 860 FIELD AVE NE CITY; RENTON ST I WA ZIp; 980594594 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES NO✓ INTERLOCKVES N©✓ YES NO✓ 8 DRIVER # STATE WA SEXI M MMDDYY' 08 - 11 - 1931 1 2 32 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR CLASS ELMJY',1 NATURE of INJURIES 2 LICENSE, CKT8852 STATE WA VIN# 2V8HW54X59R580388 3 10 Fq I PI ATE# TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# ROM To TRLR TRLR 3 1 5 33 12 3 0 VIN#' vIN# FROM TO VEH.YEAR 2009 MAKE VOLK MODEL ROUTAN STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 $ 34 13� DAMAGE YES II_II NO ✓ YESII_] NO REGISTERED OWNER INFO LYNNAE DUNHAM 860 FIELD AVE NE RENTON WA 98059 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 4 LIABILITY INSURANCE INSURANCE CO 4 14 ALLSTATE 007968029 IN EFFECT &POLICY# 9TOP vEn ' CHARGE t 5 36 IALLr yes❑NO❑ CITATION# t a 80TTOM 15❑ STM ING s 7 e UN# MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE 1 VEHiC1.E CYCLE nWNFR YES�/ NO 16� LAST NAME PARRISH FIRST NAME MATTHEW MIDDLE R INITIAL STREET ❑ 17 ❑ 12827 239TH AVE SE CITY ISSAQUAH ST, WA ZIP 98027 37 NEW ADDRE SS 18❑ CDL IGNITION REYUIRED IGNITION PRESENT MEDICAL TRANSPORTED: ❑ 38 INTERLOCKYEs NO✓ INTERLOCK YES No✓ vEs NO✓ 19 DRIVER'S STATE WA SEX M D.O,e. 01 13 1982 39 LICENSE# MMDDYY - : 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY NATURE OF INJURIES 40 USE CLASS 1 ❑ 21 LICENSE D53623E TATE WA VIN# 3FTTW8E3XPRA08310 41 22❑ PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN It VEH.YEAR 2023 MAKE FORD MODEL MAVERIC STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO✓ VES NO✓ REGISTERED OWNER INFO MIDDLE FORK ROASTERS 420 S 96TH ST STE 6 SEATTLE WA 98108 VEHICLE NO.2 SHADE DAMAGED AREA 3 4 LIABILITY INSURANCE INSURANCE CO SENTRY 2532004003 IN EFFECT &POLICY# 9TOP vewae ❑ ,J—I CITATION# CHARGE t080TTOM ,—LY YES N 25 e 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. EG68601 COLLISION REPORT III III III III III 111 1591972 CASE# 26-333 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES POS. ' USE CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CLASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I USE CLASS NARRATIVE Unit 1 westbound along 3800 block of NE 4th St. Unit 1 making left turn into private driveway in center turn lane. Unit 2 traveling eastbound along 3800 block of NE 4th St. Unit 1 failed to yield right of way left turn and was proximate cause of collision. Unit 1 sustained reportable non disabling front passenger side damage. Unit 2 sustained reportable non disabling front end damage. 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 01-12-26 05:35 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE CASEYPROCTER 12123 1H4/2026 12:42:01 AM BADGE OR ID# 12651 ORI# WA0171300 TIME POLICE DISPATCHED 4:56 PM TIME POLICE ARRIVED i 4:58 PM PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3 REPORT NO. EG68601 CASE# 26-333 DATE AND TIME 01/12/26 16:55 OF COLLISION u„ �1 All W t y. „ U , ZVI 4� s, I PAGE 3 OF 3