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HomeMy WebLinkAbout23-12944 ITFF' " ll� . 571 27POLCERA c III II COLLISION REP FIT 1591971 CASE 23-12944 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 2$ i TRIBAL ': UNITS 01 STRUCK TREE OR STUMP RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cowsloN 11 - 10 - 2023 0553 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ KIRKLAND AVE NE BLOCK NO. e✓ 500 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e OF, 1 29 MOTOR ✓ PEDAL- DAMAGETHRESHOLD MET PHONE UNITS VEHICLE ❑ CYCLE ❑ vEs �/No D:4254965795 30 g LAST NAME RASMUSSEN FIRSTNAME STEVEN MIDDLE L 1 1 2 31 INITIAL STREET ❑, 759 KIRKLAND AVE NE CITY RENTON ST WA ZIP' 980563812 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NOWINTERLOCKYEs NO�/ YES 1/ NO 8❑ LRIIVER # -, [NATURE OF INJURIES 9 ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 H U SE CLASS 7 I COMPLAINT OF BACK PAIN z❑ 3 10❑ P1 ATNFS# CEV8681 sTAr WAv N# JNICV6El76M262729 IT STATE TRAILER STATE 11 0 0 PLATE# PLATE# Rom ro TRLR. YRLR. 1 5 33 12❑ vIN#' UIN# FROM 34 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 13FAl 2011 INFI G37 DAMAGE YES No �LII� RS vEs❑ No✓ REGISTEREDOWNER WFO STEVEN RASMUSSEN 759 KIRKLAND AVE NE RENTON WA 98056 D:4254965795 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14❑ LIABILI INSURANCE NSURANCE CO NATIONAL GENERAL 2019018677 4 IN EFFECT &POLICY# TOPVEHICLE CHARGE36 LECALLv YES❑NO CITATION# <1�3 OTTOM 15❑ STANDING 7 6 UNIT 02 VEHICLE El CYCLE ❑ PEDESTRIAN ❑ PROPERTY ❑ D YES NO ❑ OLD MET PHONE 16 LAST NAME FIRST NAME ' MIDDLE INITIAL STREET CITY' ST ZIP 37 17❑ NEW ADDRESS❑' 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF vES t l NO❑ 19 LLIICENS # STATE SEX MMDDYY -�_ 39 HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ ❑21❑ TArE 41 IN#LICENSE V 1 PLATE# 42 22❑ PLATE# 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❑ &POINSULICY#E CO IN EFFECT 9TOP 5 VE"LE ❑ Nu J ,J� CITATION# CHARGE 25 i o BOTTOM LEGALLY YES s � e OFFICER'S NAME(PRINT) T.1FICER PHONE BADGE OR ID# AGENCY J 26 RYAN KARLO RIVERA 12649 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE20401 COLLISION REPORT III III III III III 111 1591972 CASE# 23-12944 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,FIRS 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' 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 11-10-23 06:51 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT D.MOYNIHAN 1128E 1111612023 5:06:53 PM BADGE OR ID# 112649 ORI#' WA0171300 TIME POLICE DISPATCHED 5:53 AM TIME POLICE ARRIVED',5:56 AM PART B PAGE IT]OF 4� REPORT NO. EE20401 CASE# 23-12944 DATEAND aE dF coyL� 11/10/23 05:53 LISIO isi©�u NARRATIVE On 11/10/2023, 1 was working uniformed patrol in a marked police car as 1 R23. At approximately 0553 hours, I was dispatched to an unknown injury accident at 505 Kirkland Ave NE, which is within the city limits of Renton, county of King, Washington. Dispatch advised that someone had seen a car crash into a tree across the street from their home. When I arrived at the dispatch location, I noticed that Unit 1 had collided head-on with a tree on the east side of the road along Kirkland Ave NE. I also noticed that there was a single occupant inside the involved vehicle in the driver's seat. I was able to speak to the driver of Unit 1. My conversation with him is summarized as follows: Unit 1 stated he was headed southbound on Kirkland Ave NE and headed to work. He then said that an unknown vehicle was headed northbound on Kirkland Ave NE. Unit 1 described that the unknown vehicle headed northbound had then begun to drift into the southbound lanes. Unit 1 then said he attempted to swerve out of the way so that he did not get hit. Unit 1 then lost control of his vehicle and collided with the tree. Other officers on the scene informed me that they had observed the roadway in the direction in which Unit 1 stated he drove. The roadway was slick and the area had minimal lighting from the nearby school. They had also informed me that they did not see any swerve marks in the southbound lanes of Kirkland Ave NE. Unit 1's vehicle sustained damage to the entire front side of the vehicle. Unit 1 stated that he may be injured and complained of lower back pain. The fire department eventually arrived and transported him to the hospital. I completed a SECTOR tow form for Unit 1 as he had left the scene before the Banker's Tow arrived. Bankers Tow eventually arrived and took Unit 1. A copy of the tow form was provided to Unit 1's driver before his departure. This report is for informational purposes to document the incident. 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: 11/10/2023 @ Renton, WA PAGE 3 OF 4 REPORT NO. EE20401 CASE# 23-12944 DATE AND TIME 11/10/2305:53 OF COLLISION Fence Raman PQ 23 12944 "NOT DRAWN TO S^LE`" r i RanCon T chn�cal Galleys P+nf of Impaci m 4 PAGE 4 OF 4