HomeMy WebLinkAbout23-6223 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-6223 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4150 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#
cawsloN 06 - 01 - 2023 1500 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 8TH ST BLOCK NO. e ❑
MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e LOGAN AVE N
0 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2062358129 0 11
30
6� LAST NAME KUPPER FIRSTNAME PETER MIDDLE S 1 2 31
INITIAL
STREET ❑ 14610 SE 278TH PL CITY KENT ST WA 2jp, 980424375 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� D52717B sTArI WAvIN# 1 NPCXPEX4HD445460
TRAILER STATE TRAILED STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 7 33
12 0 0 VIN#' VIN#'
>; FROM TO
VEH.YEAR 2017 MAKE PTRB MODEL 567 STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
DAMAGE YES NO ✓ YES[:] NO✓
13❑ REGISTERED OWNER INFO WESTERNDBAWESTERNPACIFPOBOX24065 SEATTLEWA98124 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
3 4
14 LIABILITY INSURANCE INSURANCE CO COMMERCIAL INSURANCE ASSOCIATES 1337531796
EFFECT
&POLICY#
IN EF 9TOP
ve FE CHARGE 5 36
LEH'C Yes❑NO❑ CITATION# 10 BOTTOM
15 MOTR❑ STANDING 8 7 6
�U-NIT 02 VEHICCLE CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME CRAWFORD FIRST NAME AKEI MIDDLE N
INITIAL
17❑ STREET ❑ 220 W MAIN ST APT 1 CITY CHEHALIS ST WA ZIP 98532 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19 DRIVER'S STATE WA SEX M D.C.B. 01 13 _ 1997 39
LICENSE# MMDDYY
HELMET {NJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS HE
❑
21❑ LICENSE I CDV0872 TAre I WA VIN# WVWMP7AN5BE727205
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2011 MAKE VOLK MODEL CC STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO AKEI CRAWFORD 220WMAIN STAPT 1 CHEHALIS WA 98532 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO PROGRESSIVE 962625169IN I STOP 5
VE""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED67207
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6223
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
POS. 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'
On 060123 at approximately 1530 hours I responded to a 2-vehicle injury/non-blocking collision at
Logan Ave N and N 8th St.
I contacted the driver of unit 2 who told me they were traveling westbound in the #1 lane of N 8th,
(just west of Logan Ave N when their driver side rear quarter panel and tire were struck by unit 1.
Driver complained of a headache and was observed by Renton Fire. His vehicle sustained enough
damage that a tow was called.
I contacted the driver of unit 1 who told me they were traveling westbound in the #2 lane of N 8th.
Driver says after crossing Logan Ave N, he merged into lane #1 and struck unit 2. Driver said, "I
didn't see him." Unit 1 did not sustain heavy damage. No injuries were reported by this driver.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 06-02-23 10:10 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 6/5/2023 2:25:50 PM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 3:00 PM TIME POLICE ARRIVED 3:00 PM
PART I PAGE IT]OF 3�
REPORT NO. ED67207 CASE# ' 23-6223 DATE AND TIME 06/01/23 15:00
OF COLLISION
N 8TH ST
Logan Ave. N
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