HomeMy WebLinkAbout23-5568 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-5568 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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#
cawsloN 05 - 1-- 2023 1133 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
HARDIE AVE SW BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a SW SUNSET BLVD
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2062297012 0 11
30
6� LAST NAME WELLINGS FIRSTNAME MEGAN MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 7911 S 115TH PL CITY SEATTLE ST WA ZIP 981783835 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 H USEET 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi ATNES# BPW8543 sTAr WAv N# JM3TCBEY9J0231440
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 1 3 33
12 3 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13❑2 ZO18 MAID CX-9 DAMAGE YES NO YES[:] ✓NO
REGISTERED OWNER INFO DAVID WELLINGS 7911 S 115TH PL SEATTLE WA 98178 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO USAA 007971796C 4
IN EFFECT &POLICY# 9TOP
EwoLe 1 5 36
EIF" YES❑NO❑ CITATION# 3AO402345 CHARGE FAIL YIELD LEFT TURN MOTOR
L o aorroM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067726140
16 a
LAST NAME SCOTT FIRST NAME CLARA MIDDLE S
INITIAL
17❑ STREET ❑', 12410 79TH AVE S CITY' SEATTLE ST WA ZIP 981784826 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NOF,/
19 RRS LDIIVE STATE WA ]SEX IF M .C.B. 07 20 _ 1953 39
HELMET {NJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 USE 2 CLASS RIGHT ARM ABRASION
21❑ LICENSE I CHD5838 TAre I WA vIN# 3CZRU6H5XNM725442
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE HOND MODEL HR-V STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES'/ NO GENE MEYER YES NO
REGISTERED OWNER INFO CLARA SCOTT PO BOX 504 RENTON WA 98057 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POLICY#E CO SAFECO UNKNOWNIN CQVEHICLE
❑ C—I CITATION# CHARGE io
LEGALLY YES N`LJ
25
7KLANE
NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED65534
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5568
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST 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 INJURY 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'
Unit 1 was traveling southbound on Hardie AVE SW intending to turn left onto eastbound SW Sunset
BLVD. Unit 2 was traveling northbound on Hardie AVE SW traveling straight through the intersection
with the right of way. Unit 1 did not have the right of way for the left turn and needed to yield the right
of way to Unit 2. Unit 1 failed to yield the right of way to Unit 2 and initiated the left turn pulling into
the path of Unit 2. The front end of Unit 2 impacted the passenger side of Unit 1 causing moderate/
heavy damage to both vehicles. Unit 2's damage was disabling and was towed by Gene Meyer.
Driver 2 sustained minor abrasions to the right arm and was treated on scene by Renton AID.
Driver 1 cited for failure to yield the right of way to a motor vehicle when making a left turn by, failing
to yield to Unit 2, which was traveling with the right of way, and initiated a left turn into Unit 2's path
which was the proximate cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 05-17-23 12:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 5/31/2023 7:53:55 AM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED 11:34 AM TIME POLICE ARRIVED 11:38 AM
PART I PAGE IT]OF 3�
REPORT NO. ED65534 CASE# ' 23-5568 DATE AND TIME 05/17/23 11:33
OF COLLISION
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