HomeMy WebLinkAbout24-728 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
❑ ✓❑ RESULTED ❑ CASE# z4az8 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 01 - 1-— 2024 1655 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SHATTUCK AVE S BLOCK NO. e✓ 600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2063712111 1 4 30
6❑ LAST NAME MCADORY FIRSTNAME FRANCES MIDDLE J 1 1 2 31
INITIAL
STREET ❑, 334 WELLS AVE S APT 203 CITY RENTON ST WA 7jp, 98059 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
✓ I iNTERLOCKYEs NO NTERLOCKYEs NO✓ YES R No
8[-] LDRIVER # STATE WA SEX'F MID
.O B 03 — 07 — 1965 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 2 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10❑ P1 ATE 14 BMA6253 STATE WA v N# JTHBN3OF430110567
C....� TRAILER STATE TRAILED STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 5 1 33
12 0 VIN#' VIN#.
2003 LEXS LS 400 SD pL ❑ FROM 34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO u BLIN TOWED BY GOVT.VEHICLE
13 4 DAMAGE YES NO ✓ YES NO✓
REGISTERED OWNER INFO FRANCES MCADOR1334 WELLS AVES APT 203 RENTON WA 98059 D:2 0 6 3 71 2111 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO eq�T3 4
IN EFFECT &POLICY# 9TOP
VEI" CHARGE 5 36
LEGALLY YEs❑NO❑ CITATION# 10 BOTTOM
15❑ 1NDIING 8 7 6
UNIT U2 VEHIMOTCCLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES✓ NO OLD MET PHONE
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 LLIICENS RIVER# SEX U MMDDYY 39
WELMET 1NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
❑ILICENSE 21❑ PLA E# D40621A TATe 41
WA VIN# 1GTFG15X231200071 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN It 'IN#.
VEH YEAR 2008 MAKE GMC MODEL SAVANA STYLE VN VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO ADRIAN RAMIRAZ-LOZANO 2061624TH AVE S SEATAC WA 98198 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES N
$ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MICAH BATTLE 12049 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE47396
COLLISION REPORT III III III III III 111
1591972 CASE# 24-728
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MCADORY LOUIS
(LAST FIRST,
ADDRESS&PHONE#
334 WELLS AVE S APT 203 RENTON WA 98059 SEX M MMDDYyry 12 - 25 - 1955
PASSENGER I�I WITNESS UNIT# j 1 POS 3 AIRBAG 2 RESTR. 4 EJECT ? I HELMET LASS NATURE of INJURIES
L`!1 USE 2 CLASS '1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
24-728
On 1/21/24 at 1657 hours, I was dispatched to a blocking accident at 600 Shattuck Ave S within the
City of Renton, County of King, Washington.
Unit 1 (U1) was identified as Frances J. McAdory (3/7/65, verified by WADL) who was driving WA-
BMA6253. Louis McAdory (12/25/55) was the front passenger.
Unit 2 (U2) was unoccupied and legally parked on the east side of Shattuck Ave S. The vehicle is
registered to Adrian Ramirez-Lozano (11/1/98).
U1 stated she fell asleep and ran into the backend of U2, she further stated that she is diabetic and
that may be why she fell asleep.
Renton Fire responded to the scene and determined the U1 vitals were a little out of the normal. No
complaints of pain or obvious injuries reported.
I observed substantial damaged to U1's front passenger side, and moderate damage to the rear
driver side of U2. U1 was partially blocking the road and was towed.
The registered owner of U2 was not on scene, however the case information was left with the owners
son.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically Signed, M. Battle 12049, 1/21/24, 1758
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MICAH BATTLE 01-21-24 06:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 21512024 6:53:24 AM
BADGE OR ID# 12049 OR]# WA0171300 TIME POLICE DISPATCHED 4:87 PM TIME POLICE ARRIVED',5:05 PM
PART I PAGE IT]OF
REPORT NO. EE47396 CASE# 24-728 DATE AND TIME 01/21/24 16:55
OF COLLISION
i
AN
'Not drawn to scale
U1
cc
2
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