HomeMy WebLinkAbout23-10832 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-10832 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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# ❑
dowsloN 09 - 1-- 2023 1544 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
TALBOT RD S BLOCK NO. e✓ 800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:4252608268 0 11
30
LAST NAME FERNANDEZ POMO FIRST NAME CLAUDIA MIDDLE A
5 INITIAL 1 2 31
STREET ❑, 10601 ADDISON ST SW CITY TACOMA ST WA 2jp, 984993740 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 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� A6668732 sTArI WAVIN# 5XXGT4L36JG195685
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO 1 $ 34
13 2 2018 KIA OPTIMA YES❑ NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO PEOPLES INS CO 5551436 3 4
IN EFFECT &POLICY# 9TOP
15❑ VEHLE 5 36
LEGALLICY YES�No D CITATION# 3A0668510 CHARGE FAIL YIELD PRIVATE RD MOTOR I o aorrom
STANDING 8 7 6
MOTOR PEDAL- 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:4253456946
16 a
LAST NAME AL RUBAYE FIRST NAME NIDHAL MIDDLE S
INITIAL
17❑ STREET �' 9265 57TH AVE S#B2 CITY SEATTLE ST' WA ZIP 98118 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NoF,—/]
11
19 DRIVER'S STATE WA SEX M D.Q.B. 03 _ 26 _ 1977 0 39
LICENSE# MMDDYY
WELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21❑ LICENSE I LEM916M TAre WA vIN1t 4T4BF3EK78R146766
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2011 MAKE TOYT MODEL CAMRY STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO NIDHALALRUBAYE672715THAVENWAPT4 SEATTLEWA98117 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY
INSURANCE INSU&PORGY#E CO GENERAL INS CO 53-WA-9838634IN I 5VEHICLELLY ❑ CITATION# CHARGE
25 GQ
LEGA YES N`E]
s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE02935
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10832
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'
Unit 1 was exiting out of a parking lot in the west side of the 800 blk of Talbot RD S facing east
intending to turn left onto northbound Talbot RD S. Unit 2 was traveling southbound on Talbot RD S
approaching this driveway. The driveway Unit 1 was exiting out of has a concrete median indicating
that a right turn only (southbound) is the correct exit from the parking lot. Unit 1 drove around this
median to turn left onto northbound Talbot RD S. Driver 1 states she did not see Unit 2 approaching
and exited the private driveway onto Talbot RD S just as Unit 2 was passing traveling with the right of
way. The front end of Unit 1 struck the passenger side of Unit 2 causing moderate damage to both
vehicles.
Driver 1 was cited for failure to yield the right of way to a motor vehicle while entering roadway from a
private drive by exiting a parking lot onto Talbot RD S and not yielding to Unit 2, traveling with the
right of way, which was the proximate cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 09-20-23 04:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 912712023 10:19:36 AM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED 3:47 PM TIME POLICE ARRIVED',3:50 PM
PART I PAGE IT]OF 3�
REPORT NO. EE02935 CASE# 23-10832 DATE AND TIME 09/20/23 15:44
OF COLLISION
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