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HomeMy WebLinkAbout23-4846 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 23-4846 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 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# cowsloN 04 - 1-- 2023 2345 17 ❑-= S 8 IN e 1070 3 4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ RAINIER AVE S BLOCK NO. e✓ 700 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e S 7TH ST 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El No ,/ I D:4252286133 0 11 30 6❑ LAST NAME MCCORKLE FIRSTNAME ROBERT MIDDLE L 1 2 31 INITIAL STREET ❑ 14040 154TH AVE SE CITY RENTON ST WA 21p 98059 z 'NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES NO,/ I INTERLOCK YES NO YES R NO 8❑ LDRIVER # STATE WA SEX'M MID LOB 08 1— 31 — 1945 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 2 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑ 3 10❑ P1 aT�S� BHX9827 sTArI WAurN# 1FM5K8GTXHGB23284 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR $ 7 33 12 0 0 VIN#' VIN#' >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34 13 3 2017 FORD EXPLOR TR DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# 912P VEHICLE CHARGE 5 36 LEGALLY YEs❑NO❑ CITATION# 1 o BOTTOM 15❑ NDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES, No D:4252286133 16 a LAST NAME KEOSOMBATH FIRST NAME CRYSTAL MIDDLE INITIAL 17❑ STREET ❑', 19515 124TH AVE SE CITY KENT ST WA ZIP 98031 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NO❑ 19 LICENSED LIICENS # STATE SEX F MMDDYY —❑_ 39 WELMET {NJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT '1 USE 2 CLASS 1 ❑ 21❑ LICENSE I COIL 1149 TAre WA VIN# 4T3LWRFV6NU066056 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN It IN#. TOWED BV Gov HI 44 VEH YEAR 2022 MAKE 7'Oy7' MODEL RAV4 STYLE TR —TEHICLE TOWED✓ NOO BLIN GENE MEYERS YES No,/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I STOP 5 VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM LEGALLY YES N J 6 25 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. EE13161 COLLISION REPORT III III III III III 111 1591972 CASE# 23-4846 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) KEOSOMBATH MONICA (IAST FIRST, ADDRESS&PHONE# 19515 124TH AVE SE KENT SEXi F MMDDYyry - PASSENGER z WITNESS� UNIT# ! 2 POS 3 AIRBAG 6 RESTR. 2 EJECT ? 1 HELMET NATURE OF INJURIES USE 2 CLASS '1 NAME '(LP,STr FIRS' MIDDLE INITIAL) ADDRESS&PHONE# D O E4 SEX MMDDYVYV PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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' The Following was rewritten based on my body worn camera footage, as the original report was misplaced. On 4/29/23 at 2349 hours I on-viewed a blocking accident at 700 Rainier Ave S, City of Renton, County of King, Washington. Unit 1 (U1) was identified as Robert L. McCorkle (8/31/45), who was driving WA-BHX9827. Unit 2 (U2) was identified as Crystal Keosombath, with Monica Keosombath as the front passenger, they were in WA-CDL1149. Unit 2 stated they were traveling southbound on Rainier Ave S in the middle lane going through the S 7th St intersection when U1 struck them on the driver side. Unit 1 stated he was facing north at the Rainier Ave S and S 7th St attempting to make a left turn onto westbound s 7th St when he struck U2 with his front end. Both Units claimed to have had a green light, however is should be noted that there is no blinking yellow light for U1's turn lane. I observed minor damage to U1's front end and moderate damage to U2's driver side. Unit 2 was towed by Gene Meyers. I did not observe the accident. No reported or observed injuries. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MICAH BATTLE 10-23-23 08:09 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.EDWARDS 9070 1 10/26/2023 5:54:17 AM BADGE OR ID# 12049 ORI# WA0171300 TIME POLICE DISPATCHED 11:49 PM TIME POLICE ARRIVED]11:49 PM PART I PAGE IT]OF 3� REPORT NO.! EE13161 CASE# 23-4846 DATE AND TIME 04/29/23 23:45 OF COLLISION ai as 'c S 7th St` N *Not drawn to scale PAGE 3 OF 3