HomeMy WebLinkAbout23-4846 (2) 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
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as
'c
S 7th St`
N
*Not drawn to scale
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