HomeMy WebLinkAbout26-4531 TFFiNouCERA II I III 1 III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 26-4531 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER HIT F ❑ LOCAL AOENC 4'100 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 - 11 - 2026 0936 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 7TH ST BLOCK NO. e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO F,/ D:2064747631 30
6 LAST NAME LY FIRSTNAME JORDAN MIDDLE N 1 2 31
INITIAL
STREET ❑, 5128 S RUGGLES ST CITY SEATTLE ST WA 2jp, 981780000 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10� P1 aT�S� CW1951 sTAT1 WAvIN# 5J8YE1H05TL003415
TRAILER STATE TRAILER STATE
11 0 5 PLATE# PLATE# FROM To
rRLR. TPILR. 1 5 33
12❑ VIN#' VIN#
FROM TO
VEH.YEAR MAKE MDX MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 A 2026 ACUR DAMAGE YES NO YES[:] No
REGISTEREDOWNER WFO CHAE INC 301 BAKER BLVD TUKWILAWA98188 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 UABILI INSURANCE IN EFFECT &U NS POLICY#URANCE CO ZURICH AMERICAN INS CO ADM0823921 3 4
9TOP
CHARGE
VE—LE
15 5 35
LEGALLvSTANDING YEs❑NO❑ CITATION# 1 o BOTTOM
❑ 8 7 6
MOTOR PEDAL ❑ PEDESTRIAN PROPERTY DAM THR MET PHONE
16
UNIT a2 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES NO ,/OLD D:2062474943
a
LAST NAME TEETER FIRST NAME CHARLES MIDDLE I E
INITIAL
17❑ STREET ❑', 13405 43RD AVE S CITY' TUKWILA ST WA ZIP 981683257 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK yEEsIII I I NOF YES
t l NO❑
19 DRIVER # STATE SEX M MMODYY 10 _ 31 1941 39
20 ON DUTY STATUS 1 AIRBAG RESTR EJECT 3 HELMET 6 INJURY 6 NATURE of INJURIES 40
USE CLASS RIBS/CHEST PAIN
❑21❑ TATE 41
LICENSE 'l
PLATE#
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQ
VEHICLE ❑ ,.I—I CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26 4 9 K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH18720
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4531
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ERISEN BRITTANY
(LAST FIRST,
ADDRESS&PHONE# D.O.B.
2066774958 SEX' F MMDDYYYY -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
�✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX' MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was in a driveway to a car dealership located on the north side of the 200 blk of SW 7th ST,
facing south, and intending to enter traffic on SW 7th ST. Unit 2, a bicyclist, was traveling eastbound
on the north sidewalk in the 200 bk of SW 7th ST approaching Unit 1.
Driver 1 stated that he looked to the right (west) and saw the bicyclist but stated he was far back.
Driver 1 advised he had pulled forward and the front of his vehicle had crossed over the sidewalk and
was near the roadway. Rider 2 advised that he initially stopped to allow Unit 1 to make his turn, but
that there was a delay due to traffic. Rider 2 said he saw more traffic coming so he thought it was
safe to pass and began to ride in front of Unit 1. Driver 1 said that he was looking to the left (east)
and saw a break in traffic so he began to enter the roadway and did not see Unit 2 in front of him.
Unit 1 began to accelerate and the front end of Unit 1 struck Unit 2. The impact was very low speed,
but it did cause Unit 2 to tip over and Rider 2 hit the ground.
Unit 1 sustained very minor, if any, damage. Unit 2 did not appear to be damaged. Rider 2 sustained
abrasions to his chest area and complained of pain. Rider 2 transported to the hospital as a
precaution due to his age and potential for unknown injury.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Pedalcyclist TEETER
Roadway Type: SIDEWALK
**** END OF AUTO-POPULATED SECTION ****
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 06-11-26 12:47 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 7/7/2026 4:10:04 PM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED 9:36 AM TIME POLICE ARRIVED 9:37 AM
PART I PAGE IT]OF 3�
REPORT NO.! EH 18720 CASE# 26-4531 DATE AND TIME 06/11/26 09:36
OF COLLISION
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