HomeMy WebLinkAbout23-1156 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-1156 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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.. 01 - 1-- 2023 0835 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 4000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 00 FEET e S ❑ E e UNION AVE NE❑
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4257668851 0 11
30
5❑ LAST NAME AKANA FIRSTNAME BRIAN MIDDLE H 1 1 2 31
INITIAL
STREET ❑, 5911 NELSON SIDING RD CITY CLE SLUM ST WA ZIP 98922 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 08 1- 30 - 1985 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10� P1 aTES� 53025D sTATI WA urN# 1 FT7X2667BEC96132
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. A'RLA2 1 3 33
12 3 5 VIN#' VIN#'
FROM TO
VEH.YEAR 2011 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 3 7 TOWED BY GOVT.VEHICLE 34
13 4 FORD F2PU 4C DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO CITYRENTON 3555 NE 2ND ST RENTON WA 98056 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14� LIABILITY INSURANCE INSURANCECO CITY OF RENTON SELF INSURED 3 4
IN EFFECT &POLICY# 9TOP
VEHICe CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES NO ,/ D:2069465881
16 a
LAST NAME BROOKINS FIRST NAME AUDREY MIDDLE R
INITIAL
17 STREET❑ NEW ADOREss❑' 2223 BENSON RD S APT M202 CITY RENTON ST WA ZIP 980558817 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 D IVE #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CBL8303 TATE 41
WA VIN# 1HGCR2F54GA230650 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2016 MAKE HOND MODEL ACCORD STYLE SO VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO AUDREY BROOKINS 2223 BENSON RD S APT M202 RENTON WA 98055 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 5273189C2247IN 1GQI
VEHICLE ❑ C[ CITATION# CHARGE
LEGALLY YES N
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
E.CHANG 10065 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED30627
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1156
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) STEWART TERON R
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
24216 197TH PL SE MAPLE VALLEY WA 980388763 2067758832 SEX M MMDDYyry 03 - 16 - 2003
PASSENGER Z WITNESS UNIT# 1 SEAPOS 3 AIRBAG 2 RESTR. q EJECT ? 1 H USE 2 CLASS 1 NATURE OF INJURIES
NAME
(LAST,FIRST,MIDDLE INITIAL) ALFORD TYRIN J
ADDRESS&PHONE# D O B
2223 BENSON RD S APT M202 RENTON WA 98055 SEX M MMDDYvvv 09 _ 07 _ 2017
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 PGS 7 AIRBAG 2 RESTR. 10 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) ALFORD TRAVONTE B
ADDREss&PHONE# 2223 BENSON RD S APT M202 RENTON WA 98055 SEX M D.O•B. 04 _ 27 _ 2021
MMDDYYYY
PASSENGER WITNESS UNIT# ! 2 SEAT AIRBAG 2 RESTR. 10 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES
❑ POS. USE CLASS
NARRATIVE'
On 01-27-2023 at about 0835 hours, I was sent to a collision located in the 4000 block of NE 4th St,
in the City of Renton, King County, Washington.
Unit 1 Plate: WA 53025D Driver: Akana, Brian H (08-30-1985)
Unit 2 Plate: WA CBL8380 Driver: Brookins, Audrey R (09-04-1985)
Both drivers were identified via a DOL photo.
Upon arrival, I learned nobody was hurt and both parties had the same account. Unit 1 pulled out of a
driveway on the north side of NE 4th St. Unit 2 was headed westbound on NE 4th St in lane 2. Unit 2
struck the front of unit 1 as unit 1 was trying to turn eastbound into the double left turn lane. Unit 2
had the right of way.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 01-29-23 05:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 2/2/2023 10:38:48 AM
BADGE OR ID# 10065 OR]# WA0171300 TIME POLICE DISPATCHED 8:41 AM TIME POLICE ARRIVED'8:47 AM
PART I PAGE IT]OF
REPORT NO. ED30627 CASE# ' 23-1156 DATE AND TIME 01/27/23 08:35
OF COLLISION
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