HomeMy WebLinkAbout26-4846 TFFiNouCERA II I III 1 III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
SASE 26-4846 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION'. 06 - 21 - 2026 0803 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
TALBOT RD S BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e S GRADYWAY
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2538024673 0 11
30
6� LAST NAME RAISI FIRSTNAME MOHAMMAD MIDDLE M 1 2 31
INITIAL
STREET ❑ 3900 VETERANS DR APT F405 CITY KENT ST WA Zjp, 980323937 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� CNJ9371 sTArI WAurN# 2T18URHEOHC894083
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 5 1 33
12 3 5 VIN#' VIN#
ROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 7 $ 34
13 2 2017 TOYT COROL DAMAGE YES NO MEYER YES[:] NO✓
REGISTERED OWNER INFO ...D RAISI 3900 VETERANS DR APT F405 KENT WA 98032 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE INSURANCE CO ALLSTATE 869454011
IN EFFECT &POLICY# 9TOP
VE"'CLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2539815942
16 a
LAST NAME CHAVEZ-TREJO FIRST NAME JUAN MIDDLE
INITIAL
17❑ STREET ❑', 34243 36TH PL SW CITY' FEDERAL WAY ST WA ZIP 980232941 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 08 _ 29 _ 1969 39
LICENSE# MMDDYY
—NATURE OF INJURIES
H USE CLASS
NJAURSY COMPLAINT OF CHEST PAIN ❑ 40
20❑ ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 2 7
21❑ LICENSE I CTA8832 TAre I WA VIN# 1N4AL3AP7EC277023
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2014 MAKE NIS6 MODEL ALTIMA STYLE VEHICLETOWED TO BLIN TOWEDII GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO JUAN CHAVEZ-TREJO 3424336TH PL SW FEDERAL WAY WA 98023 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 942685189IN STOP 5
VEHICLE ,.I—I CITATION# CHARGE
25 to BOTTOM
LEGALLY YES❑ N
' a
7KLANE
S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
10008 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH16968
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4846
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ROJAS-CAZARES JONATHAN
(LAST FIRST,
ADDRESS&PHONE# D O.B.
12505 SE 203RD PL KENT WA 98031 2534224951 SEX M MMDDYyry 01 - 21 - 1990
PASSENGER WITNESS R✓ POS. USE CLASS UNIT# : SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
+
NAME
'(LAST FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was traveling northbound on Talbot RD S approaching a controlled intersection at S Grady
Way. Unit 2 was traveling eastbound on S Grady Way approaching the controlled intersection at
Talbot RD S. Driver 1 states that he had a green light and proceeded into the intersection. Driver 2
states he had a green light and proceeded into the intersection. Witness on westbound S Grady Way
at Talbot RD S advised that east/west traffic had a green light and Unit 2 would have had the green
light.
Both units entered the intersection, presumably with Unit 1 failing to obey the red light, and Unit 1
drove into the path of Unit 2. The front end of Unit 2 impacted the rear driver's side of Unit 1 causing
heavy and disabling damage. Both vehicles towed by Gene Meyers.
I attempted to locate footage of the collision but could not locate any. Unable to verify which unit had
the green light and right of way, witness statement only available information to provide
determination.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 06-22-26 03:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 7/1/2026 6:39:24 AM
BADGE OR ID# 10008 ORI#' WA0171300 TIME POLICE DISPATCHED; 8:04 AM TIME POLICE ARRIVED',8:05 AM
PART I PAGE IT]OF 3�
REPORT NO.! EH 16968 CASE# 26-4846 DATE AND TIME 06/21/26 08:03
OF COLLISION
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