HomeMy WebLinkAbout23-1743 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE$# 23-1743 2 576
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F E: LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
TRIBAL UNITS 02 STRUCK TREE,ROCK,FENCE
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GowsloN 02 - 11 - 2023 1206 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW SUNSET BLVD BLOCK NO. e✓ 2100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,12 FMILES EET e S ❑ E e NACHES AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2067911895 30
6� LAST NAME GALLOWAY FIRSTNAME ISAIAH MIDDLE J 1 1 2 31
INITIAL
STREET El 13445 MARTIN LUTHER KING JR W CITY SEATTLE ST WA ZIP 98178 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
$❑ LICIENSE# STATE WA SEX'M I ELMMDDYY' 06 — 20 — 1994 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 1 EJECT 1 H U EET CLASS 1 NATURE OF INJURIES 2❑
3
10� P1 aT�S� AGZ1166 sTAT� WAvIN# WDBJF65HXXA834400
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12❑ vIN#' VIN#
Rom M TO
34
13❑ VEH.YEAR 1999 MAKE MERZ MODEL E320 STYLE 4D VEHICLE TOWED No pLSSBLIN TQ yEq.BLRs YES❑ENO
DAMAGE ILJI tSA1Vi�6
REGISTERED OWNER INFO TIFFANEYJONES 13445 MARTIN LUTHER KING JR W SEATTLE WA 98178 D:4435722013 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICV# 9TOP
VEHicLE CHARGE 5 36
LEGALLY res No CITATION# 3AO095052 OP MOT VEH W/OUT INSURANCE o eorrom
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY 1/ DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2067341499 N:2536828910
16❑
LAST NAME BAUTISTA FUENTES FIRST NAME DAVID MIDDLE /
INITIAL
17 STREET I❑ S❑' 32019 42ND PLSW CITY' FEDERAL WAY ST WA ZIP 98023 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NO❑
19 DRIVE # STATE SEX M M .C.B. 08 _ 01 198 2 39
INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PIR I I TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ 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 I 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
ALEKSANDRIGNATOV 12619 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED34406
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1743
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) NOE JOSEPH W
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B.
22 JOHN ST APT 6 SEATTLE WA 98109 2067345863 SEX M MMDDYyry 06 - 22 - 1984
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ POS. USE CLASS
NAME
'(LAST,FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYV
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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'
Unit one was traveling westbound on SW Sunset BLVD just west of Naches AVE SW in lane 1 of 2.
Vehicles in front of unit one slowed down rapidly. Unit one attempted to avoid the vehicles, abruptly
changed lanes in to lane 2 of 2, lost control, went across the center line/on coming traffic, and struck
a fence on the south side of the roadway.
Photos uploaded into Axon evidence.
Unit one cited for no insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
ALEKSANDR IGNATOV 02-11-23 04:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 2/16/2023 4:31:36 AM
BADGE OR ID# 12619 ORI# WA0171300 TIME POLICE DISPATCHED 12:36 PM TIME POLICE ARRIVED'12:44 PM
PART I PAGE IT]OF 3�
REPORT NO. ED34406 CASE# ' 23-1743 DATE AND TIME 02/11/23 12:06
OF COLLISION
U
C i
LL
- K1'�t�'`R'18y
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