HomeMy WebLinkAbout26-2281 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG90694OLCERA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE ❑
CASE# 26-2281 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCCODIOENC'Y 4100 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#
eaCL s on' 03 - 23 - 2026 1431 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAIN AVE S BLOCK NO. e 300 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET B S B W e
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2532090356 30
5 LAST NAME YANN FIRST NAME DEVON MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 5815 64TH AVE W
NEW ADDRESS CITY', UNIVERSITY PLACE ST, WA ZIp; 98467 2
7❑ +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO INTERLOCK YES NO YES F NO
8❑ DCIENSE# STATE WA SE XI M MMDDYY' 09 - 19 - 2004 32
9 ON DUTY STATUS' AIRBAG 1 RESTR 13 EJECT 3 HELMET 5 INJURY 6 NATURE of INJURIES 2
USE ,CLASS LEFT KNEE ROAD RASH/INJURY
10 PI ENSrtEI 7K8356 STATE WA VIN#, JH2SC57056M203896 3
TRAILER
11 2 5 STATE TRAILER STATE PLATE# PLATE# ROM To
TRLR rRLR 5 1 33
12 VIN#' VIN#
FROM TO
13 2 VEH.YEAR2006 MAKE yOND MODEL CBR100 STYLE MC DAMI GE TOWED NOfiS46LIN diW9YMEYER GOVT VFNpHICI m 34
DAMAGE IIII._IIII I_I
REGISTERED OWNER INFO RYAN RAUCH 2O,10337TH DR S BOTHELL WA 98021 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE ElNSURANCE CO
IN EFFECT &POLICY# 9TOP
vEnic�E CHARGE t 5 36
Lemur YES❑NO❑ CITATION# t a BOTTOM
15❑ STM ING s 7 e
MOTOR PEDESTRIAN PEDAL-:. PROPERTY DAM THR OLD ME PHONE
UNIT 0'
VEHICLE CYCLE' OWNER YES N T O
16❑
LAST NAME FIRST NAME MIDDLE'
INITIAL
17❑ STREET ❑ CITY ST ZIP ❑ 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MED[CALTRANSPORTED: 38
INTERLOCKYEs NO INTERLOCK YES R No vEs NQ
19 DRIVER'S
# STATE SEX MMDDYY 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG RESTR EJECT USE CLASS ❑
21 PLATE# T-1- VIN# 41
LICENSE
22❑ [TILER TRAILER
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
vewae ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGnEEY YES N`0
25 a s
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. EG90694
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2281
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 (motorcycle) was traveling northbound in the 300 blk of Main AVE S. Driver 1 states they
recently purchased the motorcycle and is inexperienced and non-endorsed. Unit 1 came upon
stopped traffic at an unknown speed. Poor braking technique resulted in the motorcycle losing
control and going on to its side as it slid down the pavement. No other vehicles struck. Driver 1
sustained injury to left knee and leg. Driver 1 transported to VMC with minor injuries as a precaution.
Unit 1 towed by Gene Meyer at Driver 1 request.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 03-24-26 09:22 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/1/2026 10:19:13 AM
BADGE OR ID# j 10008 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:37 Pry] TIME POLICE ARRIVED i 2:40 PM
PAST B 3 Da-345,tas(txIMR) PAGE 2�OF F3
REPORT NO. EG90694 CASE# 26-2281 DATE AND TIME 03/23/2614:31
OF COLLISION
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