HomeMy WebLinkAbout22-13208 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 22-13208 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
0
RESERVATION 1
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# 0 $
cawsloN 12 - 14 - 2022 0710 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW SUNSET BLVD BLOCK NO. e✓ 0010
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e RAINIER AVE S
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO F,/ D:2064076589 30
6� LAST NAME WOO FIRSTNAME JONG MIDDLE C 1 1 2 31
INITIAL
STREET ❑, 20641 98TH PL S CITY KENT ST WA 2jp, 980311449 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R No�/
❑ DRIVER'S' STATE WA SEXI M MELO B 06 - 20 - 1971 32
8 LICENSE#
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE C300958 sTArI WAvIN# 1N6AD07W39C417706
10 F91 PI ATE i4
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12❑ VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ 34
13❑2 2009 NISS FRONTI DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO UONG WOO 711 S 15TH ST RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO STATEFARM 139 2642-F29.47C 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE 5 36
LEGALLv res❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 OWNER ❑ YES 1/ NO D:2066310293
a
LAST NAME BELCHER FIRST NAME TIMOTHY MIDDLE L
INITIAL
17❑ STREET ❑', 4219 S OTHELLO ST#432 CITY SEATTLE ST' WA ZIP 98118 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.Q.B. 07 22 _ 1983 El 39
LICENSE# MMDDYY
20 ON DUTY STATUS 3 1 AIRBAG I RESTR EJECT I HU EET 2 INJURYCLASS 6 RARMANO NATURE OF INJU IES LPAIN ❑ 40
❑21❑ LICENSE TArE vIN1i 41
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 0 6 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1GQ
VEHICLE ❑ C[:] CITATION# CHARGE
LEGALLY YES N`LJ
25 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. ED19077
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13208
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JONES VENUS L
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
4219 S OTHELLO ST#432 SEATTLE WA 98118 2066310293 SEXi F MMDDYyry 07 - 22 - 1983
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ �; POS. USE CLASS
NAME
'(LASTr FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX' MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was traveling eastbound on SW Sunset BLVD approaching Rainier AVE S in the far right lane.
Pedestrian was illegally crossing over SW Sunset BLVD from north to south, outside of any
crosswalk, approximately 100 ft west of Rainier AVE S. Pedestrian was attempting to cross 7 lanes
of traffic and was wearing dark clothing with an alcohol bottle in hand. Driver 1 stated that he did not
see the pedestrian until the last moment and immediately applied heavy braking. Pedestrian kept
walking into the path of Unit 1 and the front end of Unit 1 struck the right side of the Pedestrian.
Pedestrian fell to the ground and appeared unresponsive but was also heavily intoxicated. Renton
AID arrived on scene and advised of no major injuries. Pedestrian was transported to Valley Medical
Center for evaluation.
Unit 1 sustained minor front-end damage and it does not appear the collision was at high speed.
This report is to document 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 12-15-22 12:47 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 1212712022 12:37:46 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 7:92 AM TIME POLICE ARRIVED 7:15 AM
PART I PAGE 2�OF❑
REPORT NO.! ED19077 CASE# 22-13208 DATE AND TIME 12/14/22 07:10
OF COLLISION
BS STOP
SW SUNSET BLVD
""NOT TO SCALE-
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