HomeMy WebLinkAbout23-1285 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-1285 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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#
GawsloN 01 - 30 - 2023 1834 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 2ND STREET BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SHATTUCKAVES
0 4 29
UNIT
MOTOR Z PEDAL- ❑ DAMAGETHRESHOLD MET PHONE
CYCLEYES NO =30
6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑ CITY ST ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
:NTERLOCKYEs NO INTERLOCK YES NO YES No
8 DRIVER'S. STATE SEX.U D.Q.B. 1 32
❑ :LICENSE# MMDDYY -❑
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10 1❑ P1 ALICENSETE 14 sTAT WA VIN#
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
rRLR. TRLR. 3 5 33
12❑ VIN# VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 1 NISS ALTIMA SD DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE CHARGE 5 36
LECALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN ✓ PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067955009
16 a
LAST NAME MIKESELL FIRST NAME MELANIE MIDDLE M
INITIAL
17❑ ST EETRE--- 419 S 2ND ST#368 CITY' RENTON ST WA ZIP 98057 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I No� YES t l NO❑
19 LICENSE# STATE WA ]SEX IF M .C.B. 10 _ 21 1971 39
NJURIES
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT H EET 2 NJAURSY 6 [NATURE.1SCRPAESI TO LEFT ELBOW,RIGHT LEG PAIN ❑ 40
❑21❑ LICENSE TATE vIN# 41
`1
PLATE#
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24 1 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
=ORAJEWSKI
(PRINT) OFFICER PHONE BADGE OR ID# 771�NCY
26 12399 0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED31201
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1285
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRS MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R 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.
RAYMOND GORAJEWSK/ 01-30-23 07:21 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 2/4/2023 4:17.12 PM
BADGE OR ID# ! 1Y399 OR]# WA0171300 TIME POLICE DISPATCHED; 6:35 PM TIME POLICE ARRIVED',6:38 PM
PART I PAGE IT]OF 4�
REPORT NO. ED31201 CASE# 23-1285 OF COLLISION
01/30/23 18:34
OF CbLLI510N
NARRATIVE
ASSIGNMENT/ARRIVAL
On 01/30/2023 at approximately 1835 hours, I was dispatched to a vehicle versus pedestrian collision
at the intersection of S 2nd Street and Shattuck Avenue S in the city of Renton, King County,
Washington.
I responded from 757 Rainier Avenue S and arrived at approximately 1838 hours.
PEDESTRIAN: MIKESELL, MELANIE M.
Upon arrival I observed the pedestrian, Melanie M. Mikesell (DOB: 10/21/1971, verified by
Washington Driver License), sitting on the southwest curb of Shattuck Avenue S and S 2nd Street.
Mikesell was wrapped in a blanket.
I checked Mikesell for injuries and she had pain to her right thigh and scrapes to her right elbow.
The Renton Fire Authority responded and evaluated Mikesell at the scene. She was not transported
to the hospital.
PEDESTRIAN INTERVIEW: MIKESELL, MELANIE M.
I spoke with Mikesell about the incident. The following is a summary of our conversation:
Mikesell walked west along the south sidewalk of S 2nd Street toward Shattuck Avenue S. Another
unidentified pedestrian was walking about 8 feet in front of her. Mikesell crossed Shattuck Avenue S
with the pedestrian signal in the marked crosswalk.
Mikesell observed the suspect vehicle drive west on S 2nd Street and stop at Shattuck Avenue S to
allow the unidentified pedestrian in front of her cross the street. As Mikesell was in about the middle
of the cross walk, the suspect vehicle accelerated from a stop and turned left into the crosswalk. The
front of the suspect vehicle collided with Mikesell and she fell to the floor.
The suspect vehicle stopped, reversed, then drove west on S 2nd Street and out of sight. The driver
did not check Mikesell for injuries or exchange information with her. Mikesell did not see the driver of
the suspect vehicle.
This concluded my conversation with Mikesell.
SUSPECT VEHICLE DESCRIPTION
Mikesell described the suspect vehicle as a red sedan, possibly a Nissan Altima, no more than 10
years old. Mikesell did not remember any distinguishing marks or characteristics of the vehicle, but
said the license plate had the characters "C 2 3" in it.
DISPOSITION
This concluded my involvement in this case.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Officer R. Gorajewski, #12399, on 01/30/2023 at 1918 hours in Renton,
Washington.
PAGE 3 OF 4
REPORT NO. ED31201 CASE# ' 23-1285 DATE AND TIME 01/30/23 18:34
OF COLLISION
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• ° ,"'°�•`" ••••-". i. YY�YYYYYY° EYYY�yti EYYYYYY° 'i vv9'��t 4 q.......iu,
S 2�sd S#
Shattuck Ave S'
PAGE 4 OF 4