HomeMy WebLinkAbout26-301 j ITFC II IIIII III IIIII II IIII IIIII I . 27I
OOLCERAF EG68623
COLLISION REPRT 1591971
❑ 0✓ FIRERES ED ❑ CASE# 26-301 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENCY 4200 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
COLLISION'. 01 - 11 - 2026 1402 17 =.= S 8 W E OF IN M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
DUVALL AVE NE BLOCK NO. e 2400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET S 8 W e NE 24TH ST
0 3 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:7025131182 0 1 30
6 LAST NAME CHA FIRST NAME JENNA MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 31301 120TH PL SE CITY AUBURN ST WA ZIP 98092 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO W/ INTERLOCKYES NO�/ YEs No�/
8 DRIVECEN STATE WA SEX F MMOCSYY' 11 — 13 — 1990 1 2 32
9 ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H EET ASS 1 NAruRE of INJURIES 2
LICENSE, CGU8774 STATE WA VN# 2T2BZMCA0KC170731 3
10[9� PI ATP tt
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM To
TRLR rRLR, 7 5 33
12 3 5 VIN# vI.
'.....: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 Y GOVT VEHICLE 1 $ 34
13 2 2019 LEXS RX 350 UT DAMAGE YES O No �MEYER Yes❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO SAFECO H2503634 3 4
IN EFFECT &POLICY# 4TOP _
srg NOLNG Yes❑NO❑ CITATION# 6AO059422 CHARGE FAIL TO YIELD MOTOR VEHICLE s o ooTrob 36
15
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 Q ❑ PEDESTRIAN ❑ D:9496323585
VEHICLE CYCLE OWNER YES NO
16�
LAST NAME ADAMS FIRST NAME JENIFER MIDDLE L
INITIAL
17 F1 STREET ❑
'❑ 2950 NE 11TH ST APT 629 CITY I RENTON ST, Wq ZIP 98056 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED fGNfTION PRESENT MEDIGALTRANSPORTED, 38
INTERLOCKYrs No INTERLOCK YES No vEs NC
19 DRIVER'S STATE WA SEX F I D.O.B. 10 19 1972 ❑ 39
LICENSE# MMDDYY -
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSLATE E CGL8342 TATE WA VIN# 5NMS5DAL7PH487153 � 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2023 MAKE HYUN MODEL SANTA STYLE UTVEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY INSURANCE INSURANCE CO GEIC04570-65.13.90
IN EFFECT &POLICY# 9TOP
vew1— ❑ ,.I—I CITATION# CHARGE t080TTOM
LecnLLr YES No
25 a a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
R.ONISHI 5738 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG68623
COLLISION REPORT III III III III III 111
1591972 CASE# 26-301
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME HAHN BRANDON C
(LAST,FIRST MIDDLE INITIAL}
ADDRESS&PHONE# DOB
31301 120TH PL SE AUBURN WA 98092 4252138301 SEX' M MMDDYYYY 12 — 03 — 1990
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z �' 1 POS. 3 2 4 1 USE CLASS '1 ---�
'NAME
LAsr F RST,MIDDLE INITIAL) OCKWELL RICH
ADDRESS&PHONE#
UNK 4254451912 SEX M D.O.B. _F _
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ �✓ POS. USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M _T L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NAT URE OF INJURIES❑ Q' POS. USE CLASS r— ----�
NARRATIVE
Unit 2 southbound on Duvall Ave NE, in number 1 lane. Unit 1 turning right at stop sign, from
eastbound NE 24th St to southbound Duvall Ave NE. Unit 1 pulled into intersection into path of unit 2,
striking unit 2 on the right side with front and front right bumper. Driver 1 Cha issued notice of
infraction for failing to yield right of way to vehicle.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 01-11-26 03:07 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 111412026 3:50:35 AM
BADGE OR ID# 5738 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 2:12 Pry/ TIME POLICE ARRIVED 2:48 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EG68623 CASE# 26-301 DATE AND TIME 01/11/26 14:02
OF COLLISION
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