HomeMy WebLinkAbout22-13742 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 22-13742 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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# ❑
COLLISION 12 — 1—— 2022 2138 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
UNION AVE NE BLOCK NO. e✓ 1300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e NE SUNSET BLVD
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2063716151 0 4 30
6� LAST NAME LANDRESS FIRSTNAME DARYL MIDDLE W 1 2 31
INITIAL
STREET ❑, 201 UNION AVE SE UNIT 17 CITY RENTON ST WA 2jp, 98059 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs No✓ INTERLOCKYEs NO✓ YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI aT�Stt C36946N sTArI WAVIN#' 2GTEC1922P1511888
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 1 5 33
12 1VIN#j VIN#
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 ] 34
13 2 1997 GMC SIERRA PK DAMAGE vEs 0NO f �LAWkkRS vEs❑ No✓
REGISTERED OWNER INFO RUTH DANOWSKI 12535 ROOSEVELT WAY NE APT 202 SEATTLE WA 98125 D:2067510535 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE❑ INSURANCE CO NONE 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN.D'ING 7 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO PEDAL RTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME DAMIRCHELI FIRST NAME SAHAR MIDDLE
INITIAL
17❑ STREET NEW ADOREss❑' 2576 152ND AVE NE APT B303 CITY REDMOND ST WA ZIP 98052 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YES
❑NOF,/
19[—] LICENSE# STATE WA SEX U M D.C.B. 10 _ 12 _ 1987 39
20 ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 H EET 2 NJAURSY 6 BRUISE ON CHEST,HYSTERIA F—NATURE OF INJURIES 40
❑ 41
21❑ ILICENSE PLA E# BQF9849 TArE WA VIN1 SUXXWSC55GON92473 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2016 MAKE BMW MODEL X4 STYLE C4 VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO REZA JAMALZADEH 17135131ST AVE NE APT N307 WOODINVILLE WA 98072 D:4403192956 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 923553537IN I STOP 5
"""LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 s � e
7jo
R'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
THAN SELBERT 12641 [V7�ENCY
A0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED22016
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13742
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SPRUGER EVER
(LAST FIRST,
ADDRESS&PHONE# D O.B.
NOT GIVEN NOT GIVEN 2062916683 SEX U MMDDYyYv - -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) : WARNER DONNELL
ADDRESS&PHONE#
NOTGIVEN NOT GIVEN 9104966492 SEX' U MMoovvvv
PASSENGER []WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.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.
JONATHAN SELBERT 12-27-22 12:17 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 11512023 2:27.-02 AM
BADGE OR ID# 12641 OR]#' WA0171300 TIME POLICE DISPATCHED 9:39 PM TIME POLICE ARRIVED',9:40 PM
PART I PAGE IT]OF 4�
REPORT NO. ED22016 CASE# 22-13742 OF COLLISION
12/26/22 21:38
OF CbLLI510N
NARRATIVE
On 12/26/2022, at 2139, 1 responded for an Accident with Unknown Injuries at the intersection of
Union Ave NE and NE Sunset Boulevard in the City of Renton, King County, Washington State.
I arrived and observed a GMC Sierra Pickup (Vehicle 1) with heavy front-end damage in the
intersection facing south. I also observed a BMW X4 (Vehicle 2) westbound on Sunset Boulevard
just west of the intersection with its flashers on.
Two other uninvolved vehicles driven by witnesses Ever Sprunger and Donnell Warner were also
stopped in the roadway.
The driver of vehicle 1 stated that he had the right of way while driving sorthbound through the
intersection and that vehicle 2 had suddenly pulled in front of him.
The driver of vehicle 2 was in an extremely excitable state and could not manage to answer my
questions. She showed me a red mark on her chest that appeared to have been left by her seatbelt.
I requested the Fire Department respond to evaluate her injuries. As they arrived, she fell to the
ground. Whether this was due to her injuries, her excitement or some other factor was unclear. She
was transported to Valley Medical Center without providing a statement.
I was approached by two witnesses on scene, Ever and Donnell. Their statements are as follows:
According to Ever, both vehicles were passing through the intersection with a green light. Vehicle 2
attempted to make a left turn onto westbound NE Sunset Boulevard and her vehicle was struck by
vehicle 1. Ever saw the driver of vehicle 2 grip her chest and stopped to see if she required help.
According to Donnell, vehicle 2 was travelling northbound on Union Avenue NE and was making a
left turn onto NE Sunset Boulevard with the green light. As it did so, vehicle 1 appeared driving at a
high rate of speed and struck vehicle 1.
I observed heavy damage to the right side of vehicle 1.
Banker's Tow responded and removed both vehicles from the roadway.
The driver of vehicle 1 possessed a driver's license that was Suspended/Revoked in the Third
Degree and stated they did not have insurance. A Tow/Impound form and two citations (2A0674975
and 2A0674976) were prepared for driver 1.
The owner of vehicle 2 responded and provided proof of insurance for that vehicle.
Both vehicles were towed to Banker's Tow Yard.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer J. Selbert (12641) in the City of Renton, King County, Washington
State on 12/27/2022 at 0005.
PAGE 3 OF 4
REPORT NO. ED22016 CASE# 22-13742 DATE AND TIME 12/26/22 21:38
OF COLLISION
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