HomeMy WebLinkAbout23-2636 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-2636 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFH1C;l F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 03 - 1-- 2023 1543 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD N BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 3RD ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067726140 0 11
30
6❑ LAST NAME SCOTT FIRSTNAME CLARA MIDDLE S 1 2 31
INITIAL
STREET ❑ 12410 79TH AVE S CITY SEATTLE ST WA Zjp, 98178 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 07 1— 20 — 1953 2 32
9 ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 H USEET ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aTES� AGT7176 sTAT� WA vIN# 2HGFG12896H503272
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 0 0 VIN#' VIN#'
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 1 $ 34
13 A 2006 HOND CIVIC CP DAMAGE YES NO YES[:] No✓
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
A NSURANCE CO 4
14 LIABILITY INSURANCE� SAFECO 6199291
IN EFFECT &POLICY# <,IQ
LEGA LE YES❑NO❑ CITATION# CHARGE $ 36
L—C' 3AO185876 VEH ENTER INTERSEC STEADY RED
15 1 STANDING 7 6
,l 1,1 VEHICLE MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
16
UNIT 02 Z CYCLE ❑ �/PEDESTRIAN ❑ OWNER ❑ YES NO D:2066029712
a
LAST NAME RIVERA FIRST NAME AUSTIN MIDDLE I D
INITIAL
17❑ STREET NEW ADDREss❑' 419 S 2ND ST CITY RENTON ST WA ZIP 980572229 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YES❑NO INTERLOCK yEs❑NOF YES❑NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 01 27 1999 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H U EET NJAU EY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CCT1852 TATE 41
WA vIN# JF1SG63655H704880 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2005 MAKE S(JB�Q MODEL FORESTE STYLE UT DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POLICY#E CO GEICO 6119504071IN 9TOP 5
VE"LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
RYAN KARLO RIVERA 1
12649 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED39646
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2636
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) WOOD SARA L
(LAST FIRST,
ADDRESS&PHONE#
10304 RAINIER AVE S SEATTlE WA 981782614 SEXi F MMDovyry 09 - 17 - 1973
PASSENGER Z WITNESS❑'UNIT# I 3 POS USE CLASS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES
: 1
NAME
'(LAST,FIRST,MIDDLE INITIAL) BATH ERIC R
ADDRESS&PHONE# D O B
17815 105TH PL SE APT L204 RENTON WA 98055 2066888811 SEX I M MMopvvvv23 _ 1970
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
[]WITNESS POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.MMDD -❑
YYYY.
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.
RYAN KARLO R/VERA 03-05-23 07:04 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 31512023 5:40:33 PM
BADGE OR ID# 12649 ORI# WA0171300 TIME POLICE DISPATCHED 3:47 PM TIME POLICE ARRIVED',3:51 PM
PART I PAGE IT]OF
REPORT NO. ED39646 CASE# 23-2636 OF COLLISION
03/04/23 15:43
OF CbLLI510N
NARRATIVE
On 03/04/2023 1 was working uniformed patrol in a marked police car as 1 R22. At approximately
1547 hours, I was dispatched to an unknown injury accident at the intersection of N 3rd St and
Sunset Blvd N. Dispatch advised that there was a two motor vehicle accident, with unknown injuries,
and was blocking the crosswalk.
When I was driving to the call dispatch updated me stating that it was a 3-car accident. Additionally,
an off-duty police officer had on-viewed the collision, stating that there were injuries to the involved
parties.
When I arrived, other officers and I identified the following involved parties:
Unit 1
Vehicle: Blue 2006 Honda Civic (WA/AGT7176, VIN/2HGFG12896H503272)
Driver: Clara S. Scott (DOB: 07/20/1953, verified via WADL)
Unit 2
Vehicle: Gray 2005 Subaru Forester (WA/CCT1852, VIN/JF1SG63655H704880)
Driver: Austin D. Rivera (DOB: 01/27/1999, VIN/verified via WADL)
Unit 3
Vehicle: Gray 2014 Ford Mustang (WA/AVC5575, VIN/1ZVBP8EM9E5227077)
Driver: Mark L. Wood (DOB: 06/29/1964, verified via WADL)
Front Passenger: Sara L. Wood (DOB: 09/17/1973, verified via WADL)
Unit 1 stated something along the lines that she was traveling northbound on Sunset Blvd N headed
to turn westbound onto N 3rd St. Unit 1 continued, stating she had the solid green arrow and
proceeded into the intersection to turn onto N 3rd St. Unit 1 then saw Unit 2 speeding down Sunset
Blvd N from the north heading south to continue on Sunset Blvd N. Unit 1 then said Unit 2 impacted
her in the middle of the intersection. Unit 1 then slid into Unit 3 which was stopped at a red light and
headed eastbound on N 3rd St.
Unit 2 stated something along the lines that he was traveling southbound on Sunset Blvd N headed
straight across the intersection. Unit 2 stated he had the solid green light and began to proceed past
the intersection. Unit 2 mentioned the light was green for sometime. Unit 2 described seeing Unit 1
enter the intersection, in the direction in which he was driving, before impacting Unit 1.
Unit 3 stated something along the lines of that he and his passenger were stopped at the red light,
preparing to continue eastbound on N 3rd St. Unit 3 only remembers then being hit by Unit 1. Unit 3
did not observe the collision between Units 1 and 2. Unit 3 also did not know which one of them had a
solid green light.
Other officers on scene identified a witness on the scene as Eric R. Bath (DOB:05/23/1970, verified
via DOL photo).
Eric stated that he was at Burger King outside on a smoke break. The Burger King Eric was at is to
the northwest of the intersection. Eric then said he saw that Unit 2 had the green light to continue
going southbound on Sunset Blvd N. Eric then saw Unit 1 in the middle of the intersection, turning to
get onto N 3rd St then impacting Unit 2.
Unit 1 sustained damage to the entire front of her vehicle as well as the passenger side. Unit 1 had
side airbag deployment on the passenger side where she was struck.
Unit 2 sustained damage to the entire front of his vehicle. Unit 2 had full front airbag deployment.
PAGE 3 OF 6
REPORT NO. ED39646 CASE# 23-2636 OF COLLISION
03/04/23 15:43
OF CbLLI510N
NARRATIVE
Unit 3 sustained damage to the front driver's side wheel area from Unit 1.
Based on the information the witness provided and statements made by all parties, I found that Unit 1
was the cause of the accident. I subsequently issued a traffic infraction for RCW 46.61.055.3C to Unit
1 to be sent to her through the mail.
This concludes my report.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Signature: Ryan Rivera (#12649) Date and Place: 03/04/2023 @ Renton, WA
PAGE 4 OF 6
SUPPLEMENTAL REPORT No. ED39646
r`I POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-2636
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USL70r !CC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST' ZIP'
4 ❑ NAME # PLACARD: :❑
GI NAME IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN � OWNER � YES NO
D:2063000976
0 8 29
LAST NAME : WOOD FIRST NAME MARK MIDDLE L
INITIAL
STREET 30
❑ NEW AnnRFSP 10304 RAINIER AVE S CITY SEATTLE ST WA ZIP 981782614
6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31
INTERLOCK YEs NO zERLOCK YES❑N0� vES N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv', 06 - 29 - 1964
7
ON DUTYl STATUS AIRBAG' 2 RESTR. 2 EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE AVC5575 TAr WA VIN# 1ZVBP8EM9E5227077
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN It VIN.#.
11 0 0 VEH.YEAR2014 MAKE FORD MODELMUSTAN STYLE CV VEHICLE TOWE ET SABLIN TOWED BY anvi vFH1CP FROM TO
DAMAGE YES NO YES NO
33
REGISTERED OWNER INFO OWNED BY DRIVER J 9
12 SHADE IN DAMAGED AREA
7GQ
j4 FROM TO
LIABILITY INSURANCE INSURANCE CO USAA 012621005C71013 IN EFFECT &POLICY# 1EwcLE 34
13LEGALLY YES NO❑ CITATION# CHARGE
STANDING S} 7 6
14 ❑ UNIT Tr Vd 1RE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE 35
PEDESTRIAN
15 LAST NAME FIRST NAME INITIAL
AL
❑ 36
STREET
16 NEW AnntxFs� CITY ST ZIP
CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK YEs NO YEs NO ❑
17 4 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE CLASS
19 ❑ LICENSE TAT VIN# 39
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ ❑ 41
TRLR TRLR
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43
3 4 71
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LERicLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LEGALLv
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
RYAN KARLO RIVERA 03-05-23 07:04 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 OR ID# 12649 O#I',WA0171300 CHRISTIANSEN 3/5/2023 PAGE�OF 6
3000-345-013(R 11118)
REPORT NO. ED39646 CASE# ' 23-2636 DATE AND TIME 03/04/23 15:43
OF COLLISION
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