HomeMy WebLinkAbout23-11568 TFFiNouCERA II I l�� I III � I III I �IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-11568 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HIT& F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 RESERVATION STRUCK
z
3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
cowsloN 10 - 09 - 2023 1729 17 ❑. N E IN S H W H OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 75 1. 00 FEET MILES e S B W e S 4TH PL
OF,1 29
MOTOR ✓ PEDAL- DAMAGE THRESHOLD MET PHONE
UNITS VEHICLE ❑ CYCLE ❑ YEs �/No D:4257382346 0 8 30
6 F] LAST NAME NGIGI FIRSTNAME ANTHONY MIDDLE K 1 1 2 31
INITIAL
STREET El 11101 SE 208TH ST#1231 CITY KENT ST WA 2jp, 98031 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 2 RESTR 4 EJECT 1 HELMETU E ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ PI ATF AWP7559 sTAT WAu N# 3GNAL3EKXES596748
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE g 9 34
13 3 2014 CHEV CAPTIV SW DAMAGE YES No YES[:] No
✓
REGISTERED OWNER INFO MARY KIRABA 11101 SE 208TH ST 1231 KENTWA98031 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
r1 3 4
LIABILITY INSURANCE INSURANCE CO TRAVELERS 9940561432031 14
IN EFFECT &POLICY# 9TOP
15❑ LE
vEGALLv HICLe 1 5 36
res�No D CITATION# 3A0629775 CHARGE FOLLOW VEHICLE TOO CLOSELY 10 aorrom
STANDING 8 7 6
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4254291704
16 a
LAST NAME MCBRIDE FIRST NAME CONOR MIDDLE I P
INITIAL
17❑ STREET ❑ 1706 KENNEWICK AVE NE CITY RENTON ST WA ZIP 98056 37
NEW ADDRESS I I I I I ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSFORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs❑No� YES
No�
19 LDI IVEW # STATE WA SEX M M D.C.B. 02 _ 18 _ 2001 39
HELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE BDY7306 TATe WA vIN# JMIGJ1T63E1144693
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2014 MAKE MAZp MODEL 6SE STYLE qp VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MICHELLE MCBRIDE 1706 KENNEWICK AVE NE RENTON WA 98056 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 4111427-B27-47AIN 1 9TOP 5
VE""LE CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES N�
❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ON/SHl 5738 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE10147
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11568
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
PM USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 2 northbound on Rainier, stopped in line of traffic at red stop signal. Unit 1 northbound, failed to
stop for stopped traffic and struck Unit 2, right front corner to left rear corner. Contributing factor was
Unit 1 following too closely on wet roadway.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 10-09-23 06:55 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.EDWARDS 9070 1 1011712023 1:36:04 PM
BADGE OR ID# 5738 OR]# WA0171300 TIME POLICE DISPATCHED 5:41 PM TIME POLICE ARRIVED',5:46 PM
PART B PAGE IT]OF 3�
REPORTNO. EE10147 CASE# 23-11568 DATE AND TIME 10/09/2317:29
OF COLLISION
I
t
Unit 1 Unit 2
i
N '' Rainier Ave S
PAGE 3 OF 3