2834-24 Mitchell-Valley-All-Way-Stop-Report.pdf

96 118a 05 Page 1 of 2 Fatal New Jersey Police Crash Investigation Report Reportable Non-Reportable Change Report 04 97 1. Case Number 11. Speed Limit 118b 10. Crash 01 2022-004921 Occurred On: VALLEY ROAD S 25 -- -- -- 02 98 2. Police Dept. of Code Road Name Dir 12. Route No. Suffix 13. Milepost 119a 01 WEST ORANGE 01 At Intersection with 18. Speed Limit 25 3. Station/Precinct Feet N E Of : MITCHELL STREET -- 99

-- 99 119b -- Miles 17. Cross Road Name/Route No. 07 -- S W 19. -- To: -- NB EB 14. 15. 16. Ramp 100a From: 20. Route Name/Route No. SB WB 120a 4. Date of Crash 5. Day of Week 6. Time 7. Municipality 8. Total 9. Total 01 01 mm dd yy (use 2400 hrs.) Code

01 01 mm dd yy (use 2400 hrs.) Code Killed Injured 21. Latitude 22. Longitude MON 100b 03/14/22 1648 0722 -- -- -- -- 120b 04 23. Veh. # 24. Policy No. 25. NJ Ins. Code 53 Veh. # 54. Policy No. 55. NJ Ins. Code -- 101 01 6091-69-16-07 148 02 6082-98-31-61 148 121a 02 Parked Ped Pedalcyclist Resp. to Emergency Hit & Run Parked Ped Pedalcyclist Resp. to Emergency Hit & Run 01 26. Driver's First Name Initial Last Name 29. Sex 56. Driver's First Name Initial Last Name 59. Sex 102 121b HENOK -- MENGSTAB M WELLINGTON

121b HENOK -- MENGSTAB M WELLINGTON O CUMMINGS M 01 -- 103 27. Number & Street 57. Number & Street 01 7725 BRISTOL SQUARE CT 261 CAMDEN STREET 104 122 2 28. City State Zip 58 City State Zip 03 SPRINGFIELD VA 22153 NEWARK NJ 07103-2472 123 30. Eyes DL Class Restrictions Endorsements 31. State 60. Eyes DL Class

DL Class Restrictions Endorsements 31. State 60. Eyes DL Class Restrictions Endorsements 61. State 01 02 D -- -- VA 02 D -- -- NJ 105 32. Driver’s License Number 33. DOB 34. Expires 62. Driver’s License Number 63. DOB 64. Expires 04 B61409086 mm dd yy mm yy C92477807607692 mm dd yy mm yy 03/06/93 03/28 07/10/69 07/23 124 35. Owner's First Name Initial Last Name 65. Owner's First Name Initial Last Name 11 Same As Same As 125 106 Driver

Same As 125 106 Driver AWET T SEGID Driver WELLINGTON O CUMMINGS -- 11 36. Number & Street 66. Number & Street 107 1 SHERIDAN AVE 261 CAMDEN STREET 126a -- 26 37. City State Zip 67. City State Zip WEST ORANGE NJ 07052-2628 NEWARK NJ 07103-2472 126b 108 04

126b 108 04 -- 38. Make 39. Model 40. Color 41. Year 42. Plate No. 43. State 68. Make 69. Model 70. Color 71. Year 72. Plate No. 73. State NIS ROG GY 2009 J87NHD NJ TOY HIG BK 2019 W67PET NJ 126c 109 04 -- 44. VIN 45. Expires 74. VIN 75. Expires 110 JN8AS58V69W184970 01/23 5TDZZRFH5KS299502 10/22 126d 01 46. Vehicle Removed to: 76. Vehicle Removed to: -- 111 -- --

-- 126e Driven Towed Disabled Towed Disabled & Impounded Driven Towed Disabled Towed Disabled & Impounded 26 01 Left at Scene Towed Impounded Left at Scene Towed Impounded 127a 112 26 -- 47. Authority 77. Authority Owner Driver Police Owner Driver Police 127b 113 -- -- 48. Alcohol Drug Test 49. Hazardous Material 78 Alcohol Drug Test 79. Hazardous Material Given : No Yes Refused None On Board Spill Given

79. Hazardous Material Given : No Yes Refused None On Board Spill Given : No Yes Refused None On Board Spill 127c 114 -- -- Type : Breath Blood Urine -- -- Type : Breath Blood Urine -- -- Hazard Class Placard No. 127d 115 Results: 0. -- % Pending Results: 0. -- % Pending Hazard Class Placard No. -- -- 50. Carrier No. 51. GVWR / GCWR (trucks & buses only) 80. Carrier No. 81. GVWR / GCWR (trucks & buses only)

127e 116 USDOT -- None < 10,000 lbs. USDOT -- None < 10,000 lbs. 26 04 10,001 - 26,000 lbs. 10,001 - 26,000 lbs. MC/MX -- MC/MX -- 128 117 > 26,001 lbs. > 26,001 lbs. 26 03 52. Motor Carrier or Government Entity 82. Motor Carrier or Government Entity -- -- 129