HomeMy WebLinkAbout23-985 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED32894 170
27
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z3-sss 2
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 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# ❑
cowsloN 01 - 1-- 2023 2151 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 3RD ST BLOCK e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4049525257 0 11
30
6� LAST NAME MOSELEY FIRSTNAME NADIR MIDDLE D 1 2 31
INITIAL
STREET ❑✓ 3625 ALBION PL N CITY SEATTLE ST WA 7jp, 98103 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELM
USEET 2 CLASS 1 NATURE OF INJURIES 2❑
3
LICENSE CFF3431 STATE WA VIN# 3C4NJDBBOMT596650
10 9❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 $ 34
13 1 2021 JEEP COMPA SV DAMAGE YES NO ves❑ No
REGISTERED OWNER INFO EAN HOLDINGS LLC 507 E SUMMA ST CENTRALIA WA 98531 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
1 INSURANCE CO 3 4
14 LIABILITY INSURANCE[ PROGRESSIVE 953327206
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 10 BOTTOM 5 36
LEGALLY
res❑NO❑ CITATION# 5
15❑ ......G 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064746558
16 a
LAST NAME KATAYAMA FIRST NAME STEVAN MIDDLE R
INITIAL
17❑ STREET Is❑' 538 MILL AVE S APT 301 CITY' RENTON ST WA ZIP 98057 37
NEW ADDREs
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK vEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE I WA SEX M I D.O.B. 07 18 _ 1962 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# AYV3558 TATE WA VIN# 41
WMWRE33453TD73336 1
42
22❑ PLATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
TOWED By Gov H 44
VEH YEAR 2003 MAKE MNNI MODEL COOPER STYLE $D —TEHICLE
TOWED✓ NOO BLIN BANKERS YES N.7
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO GEIC04094687474IN 1GQI
vE""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED32894
COLLISION REPORT III III III III III 111
1591972 CASE# 23-985
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'
On 01/23/2023 at 2154 hours I was dispatched to a 2 vehicle non injury collision at the 200 block of S
3rd St in the City of Renton, King County, Washington. I spoke with the driver of Vehicle 1 who stated
that she was unaware that S 3rd St was a one was street and was traveling East in the number 1
lane, preparing to turn left into the Safeway parking lot. While doing so, Driver 1 stated that she
crossed in front of Vehicle 2 and made contact with Vehicle 2's front passenger side with the front
drivers side of Vehicle 1. Driver 2 stated that he was traveling Eastbound on S 3rd St at the 200 block
in the number 2 lane when he observed Vehicle 1 attempt to turn left from the number 1 lane. Driver 2
stated that Vehicle 1 made contact with Vehicle 2 by colliding into the front passenger side of Vehicle
2 with the front driver side of Vehicle 1.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 01-23-23 10:56 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 211112023 1:47:57 AM
BADGE OR ID# 12509 OR]# WA0171300 TIME POLICE DISPATCHED 9:54 PM TIME POLICE ARRIVED:9:56 PM
PART I PAGE IT]OF 3�
REPORT NO. ED32894 CASE# ' 23-985 DATE AND TIME 01/23/23 21:51
OF COLLISION
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