HomeMy WebLinkAbout23-6084 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED65021 170
27
COLLISION REP FIT 1591971
CASE 23-6084 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 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#
cowsloN 05 - 1-- 2023 2018 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 2ND ST BLOCK NO. e ❑
MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e W/L!IAMS AVE S
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2532172705 0 11
30
6� LAST NAME WDL FIRSTNAME RHILMINA MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 27009 194TH PL SE CITY COVINGTON ST WA ZIP 98042 z
'NEWADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO NTERLOCKYES ND YEs No
8 LICIENSE# STATE Wq SEX'U MM DAY' 04 - 01 - 2000 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATE 14 CJA9915 sTATe WAV N#' 2HKRS4H28PH422691
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM TO
TRLR 3 5. TRLR 33
12 2 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 4 2023 HOND CRV UT DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO RHIL.SAGAPOLUTELE 27009194TH PL SE COVINGTON WA 98042 D:2532172705 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 958907674 3 4
IN EFFECT &POLICY# 9TOP
ve'CLe CHARGE 1 5 36
LEGALLv Ye8❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069660224
16 a
LAST NAME CROCKETT FIRST NAME DAKARI MIDDLE ID
INITIAL
17❑ NEW STREETREs7 12058 70TH AVE S CITY' SEATTLE ST' WA ZIP 98175 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER #
❑ ON DUTY STATUS I
AIRBAG 1 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# D827566 TATE 41
WA VIN 1B7GL23YXPS145810 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
YEAR 1993 MAKE DODG MODEL DAKOTA STYLE TR VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
VEH
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DAKARI CROCKETT 1205870TH AVE S SEATTLE WA 98175 D:2069660224 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N J
25 e
7TRADER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 4553 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED65021
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6084
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/(OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SAGAPOLUTELE LOS/LOSIVALE L
(LAST FIRST,
ADDRESS&PHONE# D O.B.
91725 IHIPEHU ST OHAU HI 96706 8089407584 SEX F MMDDvyvv 10 - 24 - 2002
PASSENGER WITNESS❑ UNIT# SEA 3 AIRBAG 6 RESTR. q EJECT ? HELMET INJURY NATURE OF INJURIES
pos. USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) CROCKETT KIMBERLY M
ADDRESS&PHONE# D O E4
200 SW 5TH PL RENTON WA 98057 2063972848 SEX F MMDDvvvv 09 _ 17 _ 1975
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
[]WITNESS POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 05/29/2023 at approximately 2018 hours, I was sitting at the intersection of S 2nd ST and Wells
AVE S, in the City of Renton, County of King. I heard tires squeal but I couldn't see any thing in the
immediate area that would have done it. As I turned WB on S 2nd ST, I saw a two vehicle collision in
the intersection of S 2nd ST and Williams AVE S.
As I pulled up I check for injuries and there were none. I spoke with the driver of Unit 1 who was
identified with a WA state license and she confirmed she was driving WB on S 2nd ST and made a
left turn from the middle lane onto Williams AVE S causing the collision with Unit 2.
The driver of Unit 2 who was also identified with a WA State license confirmed the account of the
collision as well as the Witness Kimberly Crockett.
I did not issue a citation to the driver of Unit 1 for Making an Unsafe Lane Change or Turn. Unit 1
was not drivable and was towed from the scene at owners request. The driver of Unit 2 asked if we
could push his vehicle to a parking stall so he didn't have to pay for a tow.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.TRADER 05-29-23 09:14 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 512912023 10:58:50 PM
BADGE OR ID# 4553 OR]#' WA0171300 TIME POLICE DISPATCHED; 8:98 Pry/ TIME POLICE ARRIVED',8:18 PM
PART I PAGE IT]OF 3�
REPORT NO. ED65021 CASE# 23-6084 DATE AND TIME 05/29/23 20:18
OF COLLISION
S 2nd ST
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d
c
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