HomeMy WebLinkAbout23-5782 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-5782 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 05 - 1-- 2023 2138 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 5418
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254447128 0 11
30
6� LAST NAME JAYNE FIRSTNAME RICHARD MIDDLE J 1 2 31
INITIAL
STREET ❑ 975 ABERDEEN AVE NE#E102 CITY RENTON ST WA Zjp, 98056 NEW ADDRESS ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEXI M MM D Y' 12 1- 04 - 1986 2 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� CDY0142 sTArI WAurN# 1GKFK66U63J281287
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2003 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 GMC YUKON UT DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO RICHARD JAYNE 3804 SE SUNRISE DR CAMAS WA 98607 D:4254447128 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICV# 9TOP
VEHICLE CHARGE 5 36
LEGALLY Yes❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2069547430
16 a
LAST NAME VOLZ FIRST NAME WILLIAM MIDDLE R
INITIAL
17 STREET ILAKE KATHLEEN DR SE CITY RENTON ST WA ZIP 98059 37
NEW ADDREs�' 13404E
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 03 _ 30 _ 1967 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑ 41
21❑ ILICENSE PLA E# BUH6631 TArE WA VIN# 1GKEK13T81R150211 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2001 MAKE GMC MODEL YUKON STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO WILLIAM VOLZ 13404 E LAKE KATHLEEN DR BE RENTON WA 98059 D:2069547430 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' 6
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26LAN 12007 0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED64108
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5782
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'
On 05/22/23 at 2138 hours dispatch requested that I respond to a collision that occurred at 5418 NE
Sunset Blvd. Upon my arrival I spoke with the driver of unit 1, a 2003 GMC Yukon XL bearing
Washington plates CDY1042. The driver, Richard J. Jayne, explained he was going westbound on
NE Sunset Blvd. when the collision occurred. Richard said he saw someone step into the roadway, so
he swerved left and accidentally drove into the eastbound lane. He struck unit 2 head on, causing
savere damage to both vehicles.
I then spoke with the driver of unit 2, a 2001 GMC Yukon bearing Washington plates BUH6631. The
driver, William R. Volz, said he was driving eastbound when he saw unit 1 driving the wrong way.
They struck head on, disabling both vehicles.
Both drivers refused medical assistance, but both vehicles were disabled and towed away by
Bankers Towing.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 05-23-23 02:19 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
P.SUMMERS 8887 512612023 2:29:31 PM
BADGE OR ID# ! 12007 OR]# WA0171300 TIME POLICE DISPATCHED 9:42 Pry TIME POLICE ARRIVED 9:46 PM
PART I PAGE IT]OF 3�
REPORT NO. ED64108 CASE# 23-5782 DATE AND TIME 05/22/23 21:38
OF COLLISION
ICE SUNSET BLVD
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