HomeMy WebLinkAbout23-3322 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-3322 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;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
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 03 - 1-- 2023 0520 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
140TH WAY SE BLOCK NO. e✓ 15100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2534338602 0 11
30
6� LAST NAME LEE FIRSTNAME FALISHA MIDDLE S 1 2 31
INITIAL
STREET ❑, 14815 SE 179TH ST,#17C CITY RENTON ST WA Zlp' 98057 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES �/ �/NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� BZM2542 sTATI WA urN# 5XXGT4L38HG133778
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 5 1 33
12 3 5 VIN#' VIN#'
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 5 1 34
13 4 2017 KIA OPTIMA SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3
IN EFFECT &POLICY# 9TOP
VEwcLe CHARGE 1 5 36
LEGALLY Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4437181074
16 2
LAST NAME SCOTT FIRSTNAME MARTEZ MIDDLE W
INITIAL
17❑ NEW STREETREs7 17645 SE 188TH PL CITY' RENTON ST WA ZIP 98058 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCK YES❑NOR INTERLOCK YEs It I NOF YES t l NO❑
19 DRIVER'S STATE I WA SEX M I D.C.B. 02 _ 08 _ 1978 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
LICENSE I ❑21❑ PLA E# BJW6281 TATe 41
WA VIN# JN8AZ2NC789303319 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
GoI
VEH YEAR 2011 MAKE INF► MODEL QX56 STYLE UT DAMAGE TOWED NOO✓ BLIN TOWED BY v HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO ALLSTATE 817821801IN IUQI
'E""LE ❑ ,J� CITATION# CHARGELEGALLYYES N`L J25
=Kl
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12598 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED44889
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3322
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 Thursday, March 23, 2023 at 0524 hours, I was dispatched to a two-vehicle collision in the area of
the 15100 block of 140th Way SE.
The following occurred within the City of Renton, King County; Unit 1 - WA/ BZM2542 was being
driven by Falisha Lee and was driving northbound on 140th Way SE. Unit 2 - WA/ BJW6281 was
driven by Martez Scott and was also travelling northbound on 140th Way SE. Falisha stated she was
operating her vehicle in the lane 1 left turn lane when she thought she was clear of traffic to change
lanes into lane 2 left turn lane. Unit 2 was operating in lane 2 of the left turn lane. Martez stated he
had to brake quickly when Unit 1 came into lane 2. Falisha stated she was unable to avoid colliding
with Unit 2. The rear passenger side quarter panel and bumper collided with the front driver side
bumper of Unit 2. Unit 1 failed to yield while changing lanes, which ultimately resulted in a collision.
Both vehicles sustained damage, however no vehicle needed to be towed.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.WISN/EWSKI 03-23-23 07:00 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 3/23/2023 11:42:49 AM
BADGE OR ID# 12598 ORI# WA0171300 TIME POLICE DISPATCHED 5:24 AM TIME POLICE ARRIVED 5:31 AM
PART I PAGE IT]OF 3�
REPORT NO. ED4 8 9 CASE# 2y3 2 A m°M\ 0±2/230:2
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