HomeMy WebLinkAbout23-8704 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-8704 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 0 5 2$
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 07 - 1-- 2023 2110 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SUNSET BLVD NE BLOCK T e✓
MILEPOST 500
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
UNIT 01 VEHICLE
MOTZ PEDAL-ORCYCLE ElDESA✓NHORESHOLDMET PHONE 0 4 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY Sr 21P 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES No YES No
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10[3 LICENS P1 ATE 14 CGU9622 STATE WA VIN# 1NXBR12E71Z549441
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# IR.. To
TRLR. A'RLR. 1 5 33
12 3 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 1 34
13 3 2001 TOYT COROL SD DAMAGE YES NO YES❑ NO
REGISTERED OWNER INFO SARA GILBERT 11025 SE 241ST PL APTK301 KENT WA 98030 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP
VE'C CHARGE to BOTTOM 5 36
15
LEGALLv Yes❑NO❑ CITATION# 5
❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ PROPSOWNE ❑ YES 1/ No D:4255185670
16 a
LAST NAME GILLESPIE FIRST NAME STERLING MIDDLE JA
INITIAL
17 STREET NEW ADDREs�' 438 STOW AVE S APT 7 CITY NORTH BEND ST WA ZIP 98045 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YYEEsI I I NOF YES
t l NO/
19 LICENSE# STATE WA SEX M MMDDYY 05 _ 04 1993 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ PLATE# BVM8422 TATE WA VIN# 4T1BF1FK000604751 4
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2016 MAKE 7'Oy7' MODEL CAMRY STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 4567975132347AIN 1GQVE""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. ED84498
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8704
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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 NJURY 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 07/30/2023 at 2114 hours I was dispatched to a hit and run collision at around the 500 blk of
Sunset Blvd NE near the i405 on-ramp. When I arrived, I spoke with Driver 2 who stated that he was
traveling West on Sunset Blvd NE and attempting to turn left to head North onto i405 NB. Driver 2
stated that he saw Vehicle 1 speeding South on NE Sunset Blvd and he did not have time to avoid a
collision. Driver 2 has a yield sign at this intersection. Driver 2 stated that Vehicle 1 made contact with
Vehicle 2 by colliding with the front passenger side with the front bumper of Vehicle 1. Driver 2 stated
that prior to Police arrival, Driver 1 fled the scene in an unknown direction. Driver 2 described Driver 1
as a black male of an unknown age wearing a purple and yellow jersey, standing at around 5'8" tall
with a thin build. Driver 2 also noted that Driver 1 was cross-eyed.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 07-30-23 10:16 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 713112023 12:24:58 AM
BADGE OR ID# 12509 OR]# WA0171300 TIME POLICE DISPATCHED; 9:14 PM TIME POLICE ARRIVED 9:17 PM
PART B PAGE IT]OF 3�
REPORT NO. ED84498 CASE# 23-8704 DATE AND TIME 07/30/23 21:10
OF COLLISION
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