HomeMy WebLinkAbout23-3815 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED84495 170
27
COLLISION REP FIT 1591971
CASE 23-3815 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 04 - 1-- 2023 1940 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD M4000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTU '�01 VEHtOR Z CLE CYCCLE. El �ESAGE NHORE✓LD MET PHONE 0 1 30
6� LAST NAME UNK FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑, UNK CITY BELLEVUE
NEW ADDRESS ST ZIP'. 2
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs No�/ YES R No�/
8❑ DRIVERS
STATE SEX u MMDDYY - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 9 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10 9� P1 ATE 14 AB2551 STATE WA VIN#
11[-j- TRAILER STAE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 2 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE ACUR MODEL RLX STYLE SD VEHICLE TOWED TO BLIN 7 3 TOWED By GOVT.VEHICLE 34
13 4 DAMAGE YES NO yES❑ NO
REGISTERED OWNER INFO UNK UNK BELLEVUE VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 1060TTOM 5 36
LEGALLY YES❑NO❑ CITATION# 5
15❑ STAIN.D'ING 7 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO PEDAL RTY ❑ DYES NO SOLD MET PHONE
16 a
LAST NAME GOLDERBERG FIRST NAME ROBERT MIDDLE E
INITIAL
17❑ NEW STREETRE57 15502 SE 55TH PL CITY BELLEVUE ST' WA ZIP 98006 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK yEs It I NOF YES
t l NOF,/
19 D IVEW #
❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CEP9002 TATE 41
WA VIN# JF2SJAEC1EH501309 1
42
22❑ PLATE# STATE TILER PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
TOWED ey Gov HI 44
VEH YEAR 2014 MAKE SUBA MODEL FORESTS STYLE SV EHICLETOWED TOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 5255204C2947IN 1GQ'E""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. ED84495
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3815
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 04/03/2023 at 1943 hours I was dispatched to a hit and run collision at the 4000 blk of NE Sunset
Blvd. I met with Driver 2 who told me that he was traveling Eastbound on NE Sunset Blvd in the
lefthand lane. Driver 2 said that Vehicle 1 was behind him in the righthand lane and attempted to
merge left into the lefthand lane. Driver 2 stated that Vehicle 1 miscalculated the merge and the front
driver side bumper of Vehicle 1 made contact with the rear passenger bumper of Vehicle 2. Driver 2
stated that Vehicle 1 then proceeded to correct itself into the righthand lane and proceed Eastbound
on NE Sunset Blvd at a high rate of speed, crossing through a red light at the intersection of NE
Sunset Blvd and Union Ave NE. Driver 2 stated that he would not be able to identify the driver of
Vehicle 1 if he saw them again. The license plate provided for Vehicle 1 also had no return and after
analyzing a photo taken of Vehicle 1 1 was unable to discern a plate due to the photo being blurry. I
uploaded photos of the damage to Vehicle 2 to evidence.com under this case and a photo of the
suspect vehicle was also uploaded to evidence.com.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 07-19-23 08:36 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 713112023 12:22:11 AM
BADGE OR ID# 12509 OR]# WA0171300 TIME POLICE DISPATCHED 7:43 PM TIME POLICE ARRIVED 7:49 PM
PART I PAGE IT]OF 3�
REPORT NO. ED84495 CASE# ' 23-3815 DATE AND TIME 04/03/23 19:40
OF COLLISION
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