HomeMy WebLinkAbout23-4554 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-4554 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT ❑2$
TRIBAL UNITS 01 STRUCK' RETAINING WALL
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
GawsloN 04 - 1-- 2023 0230 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
GRANTAVES BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e S PUGET DR
0 1 29
MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElDESA✓NHORESHOLDMET PHONE 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY RENTON ST ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs No�/
DRIVERS
STATE SEX D '❑— 328 LICENSE MDYY❑ M
9 ON DUTY❑ STATUS I
AIRBAG 3 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10❑ P1 ATNES# CDU6217 sTAT WAv N# KNDJN2A29E7097327
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. ro
TRLR. A'RLA2 1 5 33
12❑ VIN#j VIN#'
Rom 34
13❑ VEH.YEAR 2014 MAKE K�A MODEL SOUL STYLE VEHICLE TOWED 0 TOO
ffBLIN TQ yEq.BLRs yOS❑ENO
DAMAGE ILJI tSA1Vi�6
REGISTERED OWNER INFO KATRINA SCACCIANOCE 1411 GRANTAVE S I-101 RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ ABILIT INSURANCE❑ INSURANCE CO IN EFFECT &POLICY#VEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <14,
15❑ STAIN.F-
UNIT 02 VE IOCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER
❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' Sr ZIP 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PRES
ENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NoR INTERLOCK YES I I NOF YES t l NO❑
19 LLIICENS RIVERIS# STATE SEX MMDDYY —❑_ 39
-----WELMET NATURE OF INJURIES 4O
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
LICENSE VIN# `1
PLATE#
42
22 [TRAILER T
❑ PLATE# STATE pLATE#ILER STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO IGQ
VEHICLE ❑ C[:] CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED55402
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4554
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'
Unit 1 had just recently been stolen from 1411 Grant AVE S and was traveling southbound on Grant
AVE S approaching S Puget DR. For unknown reasons but most likely a high rate of speed, Unit 1
failed to stop at the stop sign at S Puget DR. Unit 1 traveled over the east/west lanes of travel on S
Puget DR and the front end of Unit 1 struck a rock retaining wall. Unit 1 sustained heavy front end
damage. Unit 1 was abandoned at the scene and there is no driver description available. The
registered owner was contacted and confirmed vehicle was stolen (Case #23-4555). Unit 1 towed by
Bankers tow.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 04-23-23 03:34 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 4/28/2023 3:02:23 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 2i38 AM TIME POLICE ARRIVED';2:39 AM
PART I PAGE IT]OF
REPORT NO. ED55402 CASE# 23-4554 DATE AND TIME 04/23/23 02:30
OF COLLISION
GRANT AVE
C>=
k-
w
C�3
*ie*NOT TO SCALE*** cl-
�n
PAGE 3 OF 3