HomeMy WebLinkAbout26-290 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG68749OLCERA
COLLISION REPORT 1591971
❑ 0 RESULTED I
CASE# 26-290 2
INTERSTATE CITY STREET FIRE STOLENSTATE ROUTE OTHER VEHICLE LdCAI-AGENCY 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 IN eDLLISION' 01 - 11 - 2026 0811 17 =.= S 8 W E OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOMAPLE VALLEY HWY MILE POST
e 14000 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 50 00 FEET e✓ S 8 W e 140TH WAY SE
2 0 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2067014121 0 1 30
6 LAST NAME ODOH FIRST NAME ROSEMARY MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 10013 SE 219TH PL CITY; KENT ST WA ZIP; 980312512 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs ND✓ INTERLOCICvEs NO✓ YES N ✓
8❑ DRIVER # STATE WA SEXI F MMDDYY' 01 - 20 - 1963 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASSY 1 [NATURE of INJURIES 2
LICENSE, CLV8224 STATE WA VIN# 5TDKBRCHXRS610815 3
10 Fq I PI ATP rt
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM To
TRLR rRLR 7 1 3 33
12 4 0 VIN#' vIN#
FROM TO
13 2 VEH.YEAR2024 MAKE 1.0y- MODEL HIGHLA STYLE VEHICLE TOYED NO�iS46LIN T�VyED.6LR$ �ESEENo 7 3 34
DAMAGE IIII._IIII AAttVVii((tt
REGISTERED OWNER INFO ROSEMARY ODOH 10013 SE 219TH PL KEN7 WA 98031 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14� LIABILITY INSURANCE� NSURANCECO STATE FARM 4566576-B22-478 4
IN EFFECT &POLICY#VEHICLE
9TOP _
srgNOLNG ❑ ❑ CITATION# 6AO107332 CHARGE INATTENTIVE DRIVING s Io¢orrofi 36
Yes NO
15
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:2064898896
16�
LAST NAME YERABEK FIRST NAME MARY MIDDLE' L
INITIAL
17 STREET ❑ 37
4925 S 107TH ST CITY TUKWILA ST, WA ZIP 981782023
NEW ADDRESS I I I I I I [I
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDfCALTRANSPORTED 38
INTERLOCKYES NO✓ (NTERLC3G(£YES No✓ YES NO,✓
19 DRIVER'S STATE WA SEX F I D.O-B, 12 24 1971 39
LICENSE# MMDOYY -
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21 ILICENSEPLATE# 723WFU rare WA vIN# USE
41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2007 MAKE FORD MODEL F(J$IOJ1/ STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO MARY YERABEK 4925 S 107TH ST TUKWILA WA 98178 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE[Z INSURANCE CO ALLSTATE 964 276 838
IN EFFECT &POLICY# t STOP
HICL
L'EIL YES❑ N C[] CITATION# CHARGE to BOTTOM
VEE 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
K.LANE 10008 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG68749
COLLISION REPORT III III III III III 111
1591972 CASE# 26-290
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 INJURY NATURE OF INJURIES
POS. ' USE GLASS 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 was traveling eastbound on Maple Valley HWY approaching 140th WAY SE, in the left#2 lane
of two eastbound lanes of travel. Unit 2 was also traveling eastbound on Maple Valley HWY
approaching 140th WAY SE, in the right#1 lane of eastbound lanes of travel -slightly behind Unit 1 in
a position commonly referred to as the "blind spot". Unit 1 did not see Unit 2, and initiated a lane
change to the right from the #2 lane to the #1 lane occupied by Unit 2. The passenger side of Unit 1
impacted the front driver's side of Unit 2. This collision spun Unit 2 out into the intersection, while
Unit 1 continued eastbound off the roadway and into a grass lowered embankment.
Unit 2 sustained moderate but non-disabling damage and was able to be driven from the scene. Unit
1 sustained moderate/heavy damage and was towed by Gene Meyer Tow.
Driver 1 was cited for Inattentive Driving by not driving with due care and regard to other vehicles,
and initiating a lane change into a lane occupied by another vehicle which was the proximate cause
of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 01-11-26 11:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 111412026 11:43:22 AM
BADGE OR ID# j 10008 ORI# WA0171300 TIME POLICE DISPATCHED 8:12 AM TIME POLICE ARRIVED 8:17 AM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EG68749 CASE# 26-290 DATE AND TIME 01/11/26 08:11
OF COLLISION
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