HomeMy WebLinkAbout24-8966 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
SASE 24-8966 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 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'.. O8 - 1-— 2024 0744 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 43RD ST BLOCK NO. e✓ 400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e TALBOT RD S
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2062713256 0 11
30
6� LAST NAME OWENS FIRSTNAME JONATHAN MIDDLE J 1 2 31
INITIAL
STREET ❑, 1457 S KENT DES MOINES RD CITy DES MOINES ST WA 2jp, 98198 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 3 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CLR6702 sTArI WAVIN# 1C4NJCBA2GD553777
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 T /g[ GOVT.VEHICLE 3 ] 34
13 8 2016 JEEP COMPA UT DAMAGE YES NOBS YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
4
14 LIABILITY INSURANCE Z INSURANCE CO GEICO 6159-21.79.64 3
IN EFFECT &POLICY# 9TOP
vE—LE CHAR 5 36
LEGALLY, YES❑NO CITATION# gg0672827 GE FAIL TO OBEY TRAFFIC CONTROL o Borrom
15❑ STANDIN 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068025142
16 a
LAST NAME CHACONCHAVEZ FIRST NAME MILTON MIDDLE Ij
INITIAL
17❑ STREET �', 17650 134TH AVE SE G-102 CITY RENTON ST WA Zip 98058 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 #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I C96470Y TAre WA VIN# 5TEWN72N62Z042866
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
TOWED BY Gov HI 44
VEH YEAR 2002 MAKE 7'Oy7- MODEL TACOMA STYLE PK DAMAGE TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP 5
vewcLe 25 YES N`LJ� CITATION# 4A0672828 CHARGE OP MOT VEH W/OUT INSURANCE to BOTTOM
LecnLLY ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
R.ON/SHl 5738 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF09773
COLLISION REPORT III III III III III 111
1591972 CASE# 24-8966
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MADRID ARNOLD D
(I.P.ST FIRST,
ADDRESS&PHONE#
17650 134TH AVE SE G-102 RENTON WA 98058 3464631492 SEX M MMDDYyry 10 - 13 - 2005
PASSENGER WITNESS UNIT# 2 Pas 3 AIRBAG 3 RESTR. q EJECT ? HELMET INJURY NATURE OF INJURIES
USE CLASS '1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT I 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 2 westbound S Carr Rd in lane 1, first vehicle stopped for red light at Talbot Rd S. When light
turned green, unit 2 driver Chacon Chavez entered intersection. Unit 1 driver Owens turned left from
eastbound turn lane, striking unit 2 front end. Witness Lindeman was in westbound lane 2 next to unit
2, and told me that the westbound light had turned green when unit 1 entered the intersection against
a red turn light. Witness Wood was behind unit 2, and told me the same. Witness Douglass was
facing northbound at the intersection, and provided dashcam footage (uploaded to Evidence.com).
Driver 1 Owens told me that he had been following other traffic, and was unable to see the red turn
light because of the sun backlighting it. Unit 2 driver Chacon Chavez told me that his vehicle was
uninsured.
Lindemann, Christian J 12/30/1985
253-970-2844
Wood, Susan R 11/01/1978
281-881-1564
Douglass, Benjamin J 10/03/1981
407-580-6242
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 08-26-24 09:22 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 8/29/2024 1:08:02 PM
BADGE OR ID# ( 5738 OR]# WA0171300 TIME POLICE DISPATCHED 7:45 AM TIME POLICE ARRIVED',7:57 AM
FART I PAGE IT]OF 3�
REPORT NO. EF09773 CASE# ' 24-8966 DATE AND TIME 08/26/24 07:44
OF COLLISION
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