HomeMy WebLinkAbout26-2513 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG9278OLCERA
COLLISION REPORT 1591971
CASE# 26-2513 2
INTERSTATE CITY STREET❑ FIRE I
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LQCAI-A`NG 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY ❑ INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCLson' 04 - 01 - 2026 0450 17 =.= S 8 W e IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK NO.
SR 167 MILE POST e 15 00
4a❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 11. 00 FEET e✓ S 8 N e 1405
OF1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2538861581 0 1 30
5 LAST NAME CHASE FIRST NAME JUSTIN MIDDLE I L 1 1 2 31
INITIAL
STREET ❑ 25705 SE 456TH ST CITY; ENUMCLAW ST WA ZIP; 98022 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES No�/ INTERLOCKYES NO�/ YES No
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 10 - 08 - 1989 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USE ET CLASSY 1 [NATURE of INJURIES 2
LICENSE, CTY4030 STATE WA VIN# JTHKD5BHOC2094546 3
10 Fq I as ATP rt
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR zRLR 5 1 33
12 3 5 VIN# vIN#
FROM TO
13 3 VEH.YEAR2012 MAKE LEXS MODEL CT200H STYLE HB VEHICLE TOWED TO�iS46LIN T�VyED.6LRS GOVT VEHICLE
$ 1 34
DAMAGE IIII._IIII HHttVVii((tt I�_I
REGISTERED OWNER INFO JUST/N CHASE 25705 SE 456TH ST ENUMCLAW WA 98022 D:2538861581 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE NSURANCE CO PROGRESSIVE 991201726 2 3 4
IN EFFECT &POLICY# CDQG ❑ ❑ 6A0237679 CHARGEFOLLOW VEHICLE TOO CLOSELY 36
VEHICLE YES NO CITATION#
15
MOTOR PEDAL- PEDESTRIAN PROPERTY PHONE
DAM THR OLD MET N
UNIT VEHICLE ❑ CYCLE ❑ ❑ nWNRR vEs�/ No D:2537205497
16�
LAST NAME COLVILLE FIRST NAME BRADLEY MIDDLE'
INITIAL
17 F1 STREET ❑
❑ 7216 200TH ST CT E CITY SPANAWAY ST, WA ZIP 98387 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES No INTERLOCK YES No vEs NO
19 DRIVERS
MmDDYYj I -
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSE ASP1551 TATe WA VIN# 2B3CL5CT8BH595316 41
22❑ PLAILER TE# STATE PLATE# STATE 42
23 TRLR r RLR 43
UIN#. 'IN#
VEH.YEAR 2011 MAKE DDDG MODEL CHARGE STYLE SD VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO BRADLEY COLVILLE 7216200TH ST CT E SPANAWAY WA 98387 D:2537205497 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCECO STATE FARM 458.9626-AO6.47
IN EFFECT &POLICY# t STOP
HICL
L'EIL YES❑ NCO CITATION# CHARGE to BOTTOM
VEE
25 s s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
R.ONISHI 5738 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG92758
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2513
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 2 in right lane, stopped in line of traffic on cloverleaf from N/B SR-167 to S/B 1-405. Unit 1 N/B
SR-167 in turn lane. Driver 2 Colville told me that he saw Unit 1 approaching from behind in his
rearview mirror, but had no way to move out of the way. Driver 1 Chase told me that traffic ahead of
him stopped suddenly, causing him to strike Unit 2. Chase cited via complaint for Following Too
Closely.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 04-01-26 06:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 4/8/2026 4:07:26 AM
BADGE OR ID# 5738 ORI# WA0171300 TIME POLICE DISPATCHED 4:53 AM TIME POLICE ARRIVED i 4:58 AM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EG92758 CASE# 26-2513 DATE AND TIME 04/01/26 04:50
OF COLLISION
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