HomeMy WebLinkAbout23-741 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE# 23-741 z
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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# ❑
cowsloN 01 - 1-- 2023 2008 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 43RD ST BLOCK NO. e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4102515846 0 81
30
6� LAST NAME OXFORD FIRSTNAME LEE MIDDLE T 1 1 2 31
INITIAL
STREET ❑, 28432 33RD LN S CITY AUBURN ST WA ZIP 98001 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8 LRIIVERCENS # STATE SEX'M MDMDD 08 - 09 - 1959 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNIJAU RY 1 NATURE OF INJURIES 2❑
3
10 9❑ Pi aTES� CFG8422 sTArI WAurN# 4T18E32K24U901536
TRAILER STATE 7RAILEk STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>;. FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE J 9 34
13 3 2004 TOYT CAMRY 4D DAMAGE vEs 0NO agW�MEYER ves❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 963473037 4
IN EFFECT &POLICY# TOPVEHCLE CHARGE 36
LEGALLYYES NO CITATION# 3AO123650 INATTENTIVE DRIVING <1�3
orrow
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD M PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ DD 20
ET69925722
16 a
LAST NAME PUTNAM FIRST NAME JOHN MIDDLE IS
INITIAL
17 STREET❑ NEW ADDREss❑' 9505 NE 16TH ST CITY' CLYDE HILL ST' WA ZIP 98004 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK vEs It I NOF YES
t l NOF,/
19 LICENs# STATE WA SEX M MMDDYY 02 _ 10 _ 1981 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# 41
D88835A TArE WA VIN 1FTER4FH5NLD27502 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED By Gov HI 44
VEH YEAR 2022 MAKE FORD MODEL RANGER STYLE PK DAMAGE TOWED No✓ BLIN yES!TN-
REGISTERED 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POLICY#E CO ALL STATEIN 1 9TOP
VE""LE CITATION# CHARGE
LEGAL
25 i o BOTTOM
LY YES Nu
❑ s
7TH
NAME(PRINT) OFFICER PHONE BADGE OR ID# FVA0171300
NCY26MAN 11462
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED31407
COLLISION REPORT III III III III III 111
1591972 CASE# 23-741
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,FIRST 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'
Case Number 23-741
On 01/17/2023 at approximately 2011 hours, I was dispatched to an unknown injury collision near the
intersection of SW 43rd ST and East Valley RD within the City of Renton, King County, Washington.
While en route, dispatch relayed there was two vehicle collision and one involved driver was acting
strange. The collision site was later located in the 100 block of S 43rd ST.
Unit one WA/CFG8422 was driven by Lee Oxford. Unit two WA/Lic D88835A was driven by John
Putnam.
Putnam stated he was stopped for a red traffic light in the westbound left hand turn lane which turns
south onto East Valley RD. While he was waiting for the light, he was struck in the rear by unit one.
There was minor damage to his vehicle.
Oxford informed Officers he rear ended Putnam as he was stopped for traffic. There was significant
damage to his vehicle and was towed from the scene.
Based on the above statements and damage to both vehicles, I determined unit one to be the
proximate cause of the collision. Oxford was issued a traffic infraction for inattention.
I certify (declare) under the penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed J.Thielman/11462
01/18/2023 0408 Hours Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.THIELMAN 01-18-23 04:20 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 1 2/5/2023 6:35:12 PM
BADGE OR ID# 11462 OR]# WA0171300 TIME POLICE DISPATCHED; 8:10 PM TIME POLICE ARRIVED 8:13 PM
PART I PAGE IT]OF
REPORT NO. ED31407 CASE# ' 23-741 DATE AND TIME 01/17/23 20:08
OF COLLISION
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