HomeMy WebLinkAbout23-961 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z3-ss1 2
INTERSTATE CITY STREET FIRE
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 01 - 1-- 2023 1040 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MORRIS AVE S BLOCK NO. e✓ p
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e S 3RD ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:4252216217 0 11
30
6❑ LAST NAME MOELLER FIRSTNAME MICHAEL MIDDLE H 1 2 31
INITIAL
STREET ❑ 12714 174TH AVE SE CITY RENTON ST WA ZIP 98056 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO 1/ I INTERLOCK YES NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 08 1— 30 — 1948 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ P1 aT�S� BGE5038 sTAr� WAVIN# KNAlN4D74E5156322
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 1 5 33
12 0 0 VIN# VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[AWk GOVT.VEHICLE 34
13 4 2014 KIA CADENZ SD DAMAG 7 3 E YES NO YES[:] No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PEMCO CA 1454077 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY
res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:4253922655
16 2
LAST NAME JEPSKY FIRST NAME NORMAN MIDDLE E
INITIAL
17❑ NEW STREETR 24226 S
7 E TIGER MT RD CITY ISSAQUAH ST WA ZIP 98027 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YES
❑NOF,/
19 LICENSE# STATE WA SEX M M .C.B. 02 _ 11 1931 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ PLA E# BIT5710 TArE WA VIN# 2TIBURHEXHC919619 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2017 MAKE 7'Dy7' MODEL CORO!! STYLE $D —FEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 2791016FO647NIN STOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
PHILIP DAVIS 12018 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED30626
COLLISION REPORT III III III III III 111
1591972 CASE# 23-961
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MOELLER SUSAN N
(IAST FIRST,
ADDRESS&PHONE# D O.B.
RENTON 4252218643 SEX U MMDDYyYv 11 - 21 - 1954
PASSENGER Z WITNESS UNIT# 1 SEA 1 AIRBAG'2 RESTR. 4 EJECT ? 1 HELMET SE 12 INJURY1 NATURE OF INJURIES
POSCLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYVYV
PASSENGER ❑WITNESS UNIT# SEAT 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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
PHILIP DAVIS 01-23-23 12:37 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 2/2/2023 10:40:26 AM
BADGE OR ID# 12018 ORI# WA0171300 TIME POLICE DISPATCHED{ 10:43 AM TIME POLICE ARRIVED 10:43 AM
PART I PAGE IT]OF 4�
REPORT NO. ED30626 CASE# 23-961 OF COLLISION
01/23/23 10:40
OF CbLLI510N
NARRATIVE
23-961
On 1-23-23 around 1043 hours I observed two vehicles blocking an intersection. I soon observed the
incident to be a non-injury, blocking collision at the intersection of MORRIS AVE S/S 3RD ST,
Renton, King Co, WA.
I observed vehicle WA BIT5710, Unit 2, and WA BGE5083, Unit 1, in the middle of the intersection.
heavy front-end damage. Both vehicles had heavy front-end damage and side panel damage. Unit 2
sustained damage to the driver side and unit 1 sustained damage to the passenger side.
I contacted Michael Moeller, driver of Unit 1, who advised the following. Michael was driving south on
Morris Ave S approaching S 3rd St. As Michael approached the intersection, his wife Susan, seated
in the front passenger seat advised, "make the green light." Michael went through the intersection on
a green light and collided with unit 2, traveling east on S 3rd St, in the intersection.
I contacted Norman Lepsky, driver of Unit 2 who advised the following. Norman was driving west on S
3rd St toward Morria Ave S. Norman entered the intersection on a green light and collided with unit 1.
Both drivers were medically cleared by RFA and the only passenger, Susan, requested to leave on
foot to a funeral before RFA arrived.
A passing witness, Shelby Smith 425-336-8789, unprompted, advised the following. Smith was
walking north on Morris Ave S as unit 1 entered the intersection. Smith did not see the intersection,
but turn around just after hearing the collision and advised the signal on Morris Ave S was red.
Both vehicles were towed privately by Bankers Towing.
Nothing further.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by P Davis 12018 on January 23, 2023 at 11:33 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED30626 CASE# ' 23-961 DATE AND TIME 01/23/23 10:40
OF COLLISION
c
u7
4
S 3rd St
N
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